International Journal of Psychiatry in Medicine最新文献

ObjectiveTransgender individuals (TGs) experience discrimination, socio-cultural, and financial challenges, along with disparities in access to health care as well as gender affirming care, all of which are compounded by the presence of psychiatric morbidity. The objective of this study was to estimate the prevalence of psychiatric morbidity among TGs and assess the unmet needs of those with psychiatric morbidity.MethodsThis cross-sectional study was conducted from October 2023 to May 2024 in India. A convenience sample of 128 transgender women assigned male at birth, with gender dysphoria attending awareness camps about mental health issues were assessed using DSM-5-TR. They were administered a semi-structured interview, and the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS).ResultsThe prevalence of any DSM-5-TR mental disorder was 72% (n = 92). Major depressive disorder (n = 51, 40%) was the most common diagnosis. The mean number of needs on CANSAS was 6.1. Only 8.5% of these needs were met. The most commonly reported unmet needs among those with psychiatric disorder were money (79.3%), welfare benefits (69.5%), basic education (40.1%), psychological distress (44.5%), intimate relationships (37%), accommodation (34%), transportation (32%), and information on condition and treatment (29.3%).ConclusionThe prevalence of any DSM-5-TR mental disorder was high, with depression being the most common. Most of the needs expressed by the transgender individuals with psychiatric disorders were unmet, with the most reported needs being access to basic amenities, financial difficulties, and unaddressed psychological distress.

ObjectiveThis systematic review and meta-analysis evaluated the efficacy, acceptability, and tolerability of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in individuals with severe mental illness (SMI).MethodsPubMed, Embase, the Cochrane Library, Google Scholar, and ClinicalTrials.gov were searched on December 1, 2025, for randomized controlled trials (RCTs) of GLP-1RAs in participants with SMI. Primary outcomes were weight reduction, glycated hemoglobin (HbA1c) reduction, all-cause dropouts, and adverse-effect dropouts. Mean differences (MDs) and risk ratios (RRs) were estimated using a frequentist random-effects model.ResultsIncluded were 10 RCTs (N = 665) of exenatide, liraglutide, and semaglutide. Participants were those with schizophrenia, schizophrenia-spectrum disorders, or bipolar disorder with cardiometabolic risk. Compared with placebo/usual care, GLP-1RAs significantly reduced weight (MD = -6.17 kg, 95% CI: -9.10 to -3.25, I² = 91.8%, 9 trials) and HbA1c (MD = -0.31%, 95% CI: -0.40 to -0.22, I² = 51.3%, 8 trials). All-cause dropouts did not differ significantly between groups (RR = 0.98, 95% CI: 0.71 to 1.35, I² = 28.5%, 10 trials), nor did adverse-effect dropouts (RR = 0.99, 95% CI: 0.35 to 2.77, I² = 31.6%, 5 trials). Low-certainty evidence supports the tolerability and efficacy of GLP-1RAs for weight and HbA1c reduction. Moderate-certainty evidence also supports their acceptability.ConclusionLimited evidence suggests that GLP-1RAs may reduce body weight and slightly reduce HbA1c in individuals with SMI who have prediabetes or are overweight/obese. GLP-1RAs are likely acceptable and may be tolerated in this population.

ObjectiveTo evaluate the effects of a combined psychological and functional exercise intervention on emotion, quality of life, and brain-derived neurotrophic factor (BDNF) levels in patients with Parkinson's disease (PD).MethodsIn this randomized controlled trial, 172 patients with PD were randomly assigned into 2 groups with 86 patients in each group. The control group received routine care, while the intervention group received a 12-week intervention combining psychological support with functional exercise in addition to routine care. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Parkinson's Disease Questionnaire-39 (PDQ-39), Barthel Index, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and serum BDNF levels were assessed before and after the intervention. Adherence rates were also determined for each group. Spearman correlation analysis was used to examine associations between changes in BDNF (ΔBDNF) and changes in HAMA (ΔHAMA) and HAMD (ΔHAMD) scores.ResultsAt the end of the 12-week clinical trial, the intervention group demonstrated significantly lower HAMA, HAMD, PDQ-39, and MDS-UPDRS scores (P < 0.001), and higher Barthel Index scores and BDNF levels compared to the control group. The adherence rate in the intervention group was higher than in the control group (90.70% vs 76.74%, respectively, P = 0.01).ConclusionA combined psychological and functional exercise intervention significantly improved emotional well-being, quality of life, daily functioning, adherence, and BDNF levels (compared to the control group) in patients with PD. Based on these findings, this multi-component intervention may have value in treating PD patients.

ObjectiveRepetitive transcranial magnetic stimulation (rTMS) is an established treatment for comorbid post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). However, there are no universal protocols regarding the type of rTMS recommended, including among military and first responders. This study aimed to describe high frequency rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) administered to inpatients with comorbid PTSD and MDD at Ward 17, Austin Health in Melbourne, Australia.MethodRetrospective review of patient files was undertaken for adult inpatients admitted between 01/01/2017 and 01/12/2024 with PTSD and MDD who received ten or more rTMS treatments during admission. Paired t-tests were used for statistical analysis.ResultsAmong 65 patients and 118 admissions, the majority received high frequency rTMS to the left DLPFC (n = 106, 89.8%), followed by rTMS applied to the right DLPFC (n = 8, 6.8%). The group who received left-sided rTMS had an average of 6 fewer treatments and admission length that was 10 days shorter, but almost half required readmission for further rTMS treatments. The most common side effects reported were pain, fatigue, light-headedness or dizziness, and increased anxiety. Left-sided rTMS was associated with significant improvements in MADRS (Cohen's D = 1.36, 95% CI = 1.06-1.65, P < .001), PCL-5 (D = 1.18, 95% CI = 0.72-1.63, P < .001), HoNOS (D = 1.20, 95% CI = 0.94-1.46, P < .001), and MoCA scores (D = -0.56, 95% CI = -0.81 to -0.31, P < .001).ConclusionsHigh frequency left-sided rTMS is generally well tolerated and may reduce both depressive and PTSD symptoms. Further research to assess rTMS subtypes and target specific symptomatology would support standardization of care and inform future protocol guidelines.

BackgroundThis research assessed the causal influence of atrial fibrillation (AF) on depression.MethodsA two-sample Mendelian randomization (MR) approach was utilized along with data from additional databases. A genome-wide association study (GWAS) involving 463,010 participants allowed for the exploration of genetic variations associated with AF. Another GWAS with 215,644 individuals offered insights into the relationship between gene variants and depression. Data on the correlation between gene variants and depression were obtained from another GWAS encompassing 449,414 individuals. Effect sizes were assessed utilizing the inverse-variance weighted technique. Sensitivity analysis was conducted by weighted median, outlier, MR pleiotropy residual sum, weighted mode, and MR-Egger. A meta-analysis of the inverse-variance weighted (IVW) results from the two datasets was conducted.ResultsA significant association was found between genetically predicted AF and increased incidence of depression using 15 single nucleotide polymorphisms (SNPs) as markers. No evidence of gene pleiotropy was detected, as indicated by MR-Egger. Sensitivity analyses employing alternative Mendelian randomization techniques consistently yielded robust results. The combined odds ratio for depression was estimated at 29.19 (95% CI = 4.43-192.13, P < 0.001).ConclusionThis study found a causal relationship between genetically predicted AF and a heightened risk of depression.

ObjectivePostoperative glioma patients often experience negative emotions, which affect their treatment adherence and prognosis. The PERMA intervention (focusing on Positive emotions, Engagement, Relationship, Meaning, and Accomplishment) seeks to enhance psychological well-being and quality of life (QoL). This study examines the effects of the PERMA intervention on negative emotions, treatment adherence, and prognosis in postoperative glioma patients.MethodsA total of 124 postoperative glioma patients recruited from January 2022 to February 2024 were randomly assigned to an intervention group (n = 62) or a control group (n = 62). The control group received routine postoperative care, while the intervention group received an additional PERMA psychological intervention for 1 month. Outcome assessments included anxiety symptoms (SAS), depressive symptoms (SDS), treatment adherence, complications, and QoL. Outcomes were analyzed using Kaplan-Meier (KM) survival curves.ResultsBaseline characteristics were comparable between groups (P > 0.05). After the intervention, both groups showed significant improvements in SAS and SDS scores (P < 0.05); furthermore, post-intervention SAS and SDS scores in the intervention group were significantly lower than those in the control group (P < 0.0001). Treatment adherence was significantly higher and complication rates significantly lower in the intervention group compared to control group (P < 0.05). QoL was improved in both groups (P < 0.05); however, the intervention group scored significantly higher than the control group across all QoL domains (P < 0.0001). KM analysis revealed a significant association between the PERMA-based intervention and better outcomes overall (P < 0.05).ConclusionA PERMA-based psychological intervention effectively reduced anxiety and depression, enhanced treatment adherence, lowered complication risks, and improved QoL compared to routine post-operative care in postoperative glioma patients.

ObjectiveDepression is the most common mental health complication after stroke, leading to poor post-stroke outcomes. Few observational studies have reported factors associated with antidepressant use in these patients. Therefore, this study assessed patient and clinical characteristics associated with receiving antidepressant prescriptions at discharge following hospital admission for acute stroke.MethodsIdentified were patients admitted with acute stroke or transient ischemic attack from an institutional stroke registry (October 1, 2019, through October 31, 2020). Electronic health record review was used to assess antidepressant prescription at discharge and predictors such as demographics, health behaviors, clinical comorbidities, and stroke prognostic characteristics.ResultsOut of 803 patients with stroke, 220 (27.4%) received an antidepressant prescription at discharge, including 82 (12.8%) patients who were started on antidepressants at discharge. A multivariable model indicated that sex (female vs. male OR = 1.53; 95% CI = 1.09-2.16), race (Black vs. White: OR = 0.67; 95% CI = 0.47-0.96), number of clinical comorbidities (OR = 1.16; 95% CI = 1.03-1.32), history of depression (OR = 4.91; 95% CI = 2.59-9.31), and discharge disposition (to inpatient rehabilitation facility vs. home: OR = 1.52; 95% CI = 1.01-2.30) were significantly associated with receipt of antidepressant prescriptions among all users. Discharge disposition (to an inpatient rehabilitation facility) was the only variable associated with initiating an antidepressant prescription at discharge (OR = 2.92; 95% CI = 1.62-5.28).ConclusionAntidepressant prescriptions for poststroke patients were more frequent among females, White adults, and those discharged to an inpatient rehabilitation facility. These findings describing antidepressant prescription patterns underscore the need for specific guidelines aiding antidepressant use after stroke.

ObjectiveThis study investigated the effects of Electroconvulsive Therapy (ECT) on intracranial pressure (ICP) by measuring the optic nerve sheath diameter (ONSD) using ultrasonography. While ECT is a common and effective treatment for various psychiatric disorders, its impact on cerebral hemodynamics, particularly ICP, remains unclear. Previous research suggests that ECT may increase cerebral blood flow and oxygen consumption, potentially elevating ICP. However, there is limited direct evidence linking ECT to measurable ICP changes.MethodsIn this study, ONSD was measured at 4 time points during ECT in 24 patients, including pre-ECT, post-induction, post-ictal, and in the post-anesthesia care unit (PACU).ResultsThe results showed no statistically significant changes in ONSD, indicating that ECT does not significantly alter ICP based on this non-invasive measurement.ConclusionThese findings suggest that, at least in the context of this study, ECT does not lead to clinically relevant changes in ICP.

ObjectivePost-stroke depression (PSD) is the most frequent psychiatric disorder after stroke, occurring in about 30% of stroke survivors. Little is known about the influence of dietary B-vitamin intake on PSD risk. This analysis examined the relationship between dietary B-vitamin intake and depression among post-stroke patients.MethodsA total of 1080 patients aged ≥20 years who had suffered a stroke participating in the 2007-2018 National Health and Nutritional Examination Surveys (NHANES) were included in this cross-sectional study. Depressive symptoms were evaluated using the 9-item Patient Health Questionnaire (PHQ-9). The association between dietary B vitamins intake and PSD was examined using logistic regression analysis.ResultsAfter controlling for potential confounders (sex, age, race, BMI, family PIR, education level, marital status, history of disease, hypertension, hypercholesterolemia, diabetes, smoking, alcohol use and energy), significant inverse associations were found between dietary vitamin B1 (P = 0.002) and B6 (P = 0.002) intake and PHQ-9 scores. These association were significantly modified by unhealthy lifestyle factors and inflammation-related markers.ConclusionsDietary vitamin B1 and B6 intake were inversely associated with PSD risk. The association between vitamin B1 or B6 and PSD was modified by unhealthy lifestyle factors and inflammation-related indicators. Future prospective studies are needed to determine the causal relationship between higher dietary vitamin B1 and B6 intake and lower risk of PSD.