International Journal of Psychiatry in Medicine最新文献

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.

BackgroundPoststroke depression (PSD), with an approximately one third prevalence in stroke patients, is associated with increased morbidity and mortality. This study investigated the relationship between serum brain-derived neurotrophic factor (BDNF) levels and early-onset PSD, along with other clinical variables.MethodsClinical data and radiological images of 88 patients diagnosed with acute ischemic stroke were examined. Serum BDNF levels were measured within the first 72 hours following stroke diagnosis. On the 14th day following stroke diagnosis, Montreal Cognitive Assessment (MoCA), Hamilton Depression Rating Scale (HAMD17), and National Institutes of Health Stroke Scale (NIHSS) were administered to the patients.ResultsSerum BDNF levels (P = 0.022) and MoCA values (P = 0.004) of patients with early-onset PSD were significantly lower, and NIHSS values (P = 0.027) were significantly higher compared to patients without early-onset PSD. There was a significantly negative correlation between BDNF value and HAMD-17 score. Receiver operating characteristic (ROC) analysis was used to investigate the extent that BDNF level could predict early-onset PSD, and cut-off values were determined. For a BDNF cut-off value of 361.5, sensitivity and specificity values were 75% and 56%, respectively, indicating that serum BDNF levels could serve as a useful predictor of early-onset PSD.ConclusionLower serum BDNF levels are associated with early-onset PSD and may serve as a potential biomarker, although causal conclusions are limited due to the study's cross-sectional design.

ObjectiveTo systematically evaluate the efficacy of electroconvulsive therapy (ECT) combined with antidepressant medication in patients with treatment-resistant depression.MethodsA search of the CNKI, Wanfang, Vip, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science databases was conducted from their inception to January 1, 2025. Randomized controlled trials evaluating the efficacy of ECT combined with antidepressant medication in patients with treatment resistant depression were included. The experimental group received ECT combined with antidepressant drugs, while the control group received either ECT alone or ECT combined with a placebo. Data were analyzed using RevMan 5.2 software.ResultsA total of 11 randomized controlled trials involving 1254 patients were included in the analysis. Patients treated with ECT combined with antidepressants showed significantly greater improvement in depressive symptoms (SMD = 0.29, 95% CI = 0.47 to 0.12, P = 0.001) and higher remission rates (OR = 1.73, 95% CI = 1.24 to 2.40, P = 0. 001) compared to patients treated with ECT alone. There was no significant difference between the two groups in seizure duration (SMD = 0.17, 95% CI = 0.14 to 0.49, P = 0.28) or the incidence of adverse effects (OR = 1.15, 95% CI = 0.73 to 21.82, P = 0.54).ConclusionThe combination of ECT and antidepressant medication modestly improves depressive symptoms and increases remission rates in patients with treatment resistant depression. Additionally, there is no significant difference in seizure duration or the incidence of adverse reactions compared to ECT alone, suggesting a comparable safety profile.

ObjectiveTo explore the impact of comprehensive professional case management on the negative emotions of breast cancer patients undergoing postoperative radiotherapy.MethodsA total of 102 breast cancer patients who underwent their first radiation treatment between July 2021 and June 2022 at a hospital in Guangzhou, China, were randomly assigned to two groups: a control group of 51 patients who received routine nursing care, and an intervention group of 51 patients who received comprehensive professional case management in addition to routine nursing care, including personalized interventions such as extended care for breast cancer patients with indwelling infusion ports. The effects of the intervention were evaluated using the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Self-Efficacy Scale (positive attitude, self-relaxation, and self-decision making) before and after the intervention.ResultsThere were no significant differences in anxiety, depression, or self-efficacy scores between the two groups before radiation therapy (P > .05). However, the SAS and SDS scores of the intervention group after radiation therapy (43.32 ± 3.87 and 40.7 ± 2.89, respectively) were significantly lower than those of the control group (49.66 ± 3.49 and 49.2 ± 3.19, respectively; t = 8.672 and 14.130, P < .01). The self-efficacy scores of the intervention group after radiation therapy (positive attitude: 49.3 ± 1.31, self-relaxation: 9.04 ± .68, and self-decision making: 37.03 ± .98) were also significantly higher than those of the control group (positive attitude: 44.6 ± .95, self-relaxation: 7.32 ± .53, and self-decision making: 31.42 ± .89; t = 20.48, 17.15, and 30.330, respectively; P < .01).ConclusionComprehensive professional case management, in conjunction with specialized intravenous therapy, compared to usual standard care, significantly improved negative emotions and self-efficacy in breast cancer patients undergoing radiotherapy.

ObjectiveTo compare the antidepressant efficacy, cognitive impact, and safety profile of magnetic seizure therapy (MST) vs. modified electroconvulsive therapy (MECT) in Chinese adolescents with treatment-resistant major depressive disorder (MDD).MethodsThis single-center, evaluator-blinded, prospective randomized controlled trial enrolled 120 adolescents aged 13-18 years diagnosed with treatment-resistant MDD. Participants were randomly assigned to either the MST group or the MECT group (n = 60 per group). The primary outcome was improvement in depressive symptoms measured by the Beck Depression Inventory-II (BDI-II) score. Secondary outcomes included changes in cognitive function assessed by the Montreal Cognitive Assessment (MoCA), time to reorientation, and adverse event incidence per CTCAE 5.0 criteria.ResultsThe reduction of depressive symptoms on the BDI-II was significantly greater in the MECT group (51.8%) compared to the MST group (46.5%) (P < 0.001), although clinical response rates were similar (90.0% vs 91.1%). The MST group showed significant improvement in MoCA total score, whereas the MECT group demonstrated a slight decline (P < 0.001). MST was associated with greater cognitive preservation (+0.96 vs 0.36 MoCA score), fewer adverse events (28.9% vs 64.0%, P < 0.001), and faster reorientation (6.9 ± 1.8 min vs 18.7 ± 6.8 min, P < 0.001) compared to MECT.ConclusionMST exhibited comparable antidepressant efficacy to MECT while offering superior cognitive protection and safety in adolescents with treatment-resistant MDD. These findings suggest MST may be a preferred treatment option balancing symptom relief with neurodevelopmental preservation.

ObjectiveDifferentiated thyroid cancer (DTC) is the most common endocrine malignancy; despite excellent long-term survival, survivors often face an underrecognized psychosocial burden. This study examined how anxiety and depression relate to health-related quality of life (QoL) in DTC survivors, accounting for sociodemographic and clinical variables, to identify predictors of global health status and symptom burden.MethodIn this cross-sectional study, 518 biochemically stable DTC survivors (TSH 0.5-2.0 mIU/L) attending routine follow-up at a tertiary nuclear medicine clinic completed the Hospital Anxiety and Depression Scale (HADS) and the European Organisation for Research and Treatment of Cancer QoL Questionnaire-Core 30 (EORTC QLQ-C30).ResultsParticipants (mean age 46.6 ± 11.8 years; 86% female; mean time since diagnosis 6.8 ± 4.6 years) showed high rates of depression (51%) and anxiety (26%). Women had higher anxiety/depression and lower HRQoL than men. Those with depression had higher anxiety scores, lower global health/functioning, and higher overall symptoms (all P < .001). Anxiety showed broader, more consistent inverse associations with HRQoL than depression. In multivariable linear regression, anxiety and depression were the strongest independent predictors of lower global health status and higher fatigue, whereas demographic (age, sex) and disease/treatment variables (time since diagnosis, number of radioactive iodine treatments) were not significant.ConclusionsPsychological distress-particularly anxiety-was more strongly associated with poorer HRQoL than disease/treatment indicators in DTC survivors. Routine psychosocial screening (eg, HADS), referral to psycho-oncology, targeted fatigue management, and gender-sensitive support should be integrated into endocrine follow-up to address this hidden survivorship burden.

ObjectiveIt is not known whether relative fat mass (RFM)-a height- and waist-based estimator of total adiposity-predicts late-life depressive symptoms better than conventional anthropometrics.MethodsThis study analyzed harmonized data from two nationally representative aging cohorts: the English Longitudinal Study of Ageing (ELSA) and the US Health and Retirement Study (HRS). Adults ≥50 years without baseline depressive symptoms (CES-D-8 <3) and with valid anthropometrics and covariates were followed biennially for up to 14 years (ELSA n = 4176; HRS n = 5054). RFM was computed from measured height and waist circumference and examined continuously (each 1-standard deviation [SD] increase) and by tertiles. Incident depressive symptoms were defined as CES-D-8 ≥3 at follow-up. Cox models estimated hazard ratios (HR) with progressive adjustment. Dose-response was assessed using restricted cubic splines. Predictive performance was compared with body mass index (BMI) and waist circumference (WC) via time-dependent AUCs. Sensitivity analyses used multiple imputation and propensity-score matching.ResultsOver a mean 8.60 years (ELSA) and 8.57 years (HRS), 1467 and 1769 participants developed incident depressive symptoms. Higher baseline RFM predicted incident depressive symptoms in both cohorts (for each 1-SD, Model 3: ELSA HR = 1.15, 95% CI = 1.06-1.25; HRS HR = 1.10, 95% CI = 1.05-1.16). Compared with low RFM, high RFM remained associated with higher risk (ELSA HR = 1.37, 95% CI = 1.12-1.67; HRS HR = 1.29, 95% CI = 1.14-1.46). Restricted cubic splines suggested a J-shaped association. Time-dependent AUCs showed RFM consistently outperformed BMI and WC across follow-up. Findings were robust in multiple imputation and propensity-matched analyses.ConclusionsIn two national cohorts of older adults, higher RFM was prospectively associated with incident depressive symptoms and demonstrated superior time-varying discrimination compared with BMI and WC, supporting RFM as a pragmatic tool for late-life depressive symptoms risk stratification.

ObjectiveBody image disturbance may moderate childhood sexual abuse and self-injury in borderline personality disorder (BPD).MethodsThe study involved 60 female patients diagnosed with BPD and 60 healthy participants. The diagnosis of BPD (and identification of healthy participants) was conducted through standardized psychiatric interviews. Participants were assessed with the Multidimensional Body Self Relations Questionnaire (MBSRQ), Inventory of Statements About Self-injury (ISAS), and Childhood Trauma Questionnaire-Short Form (CTQ-SF).ResultsThe findings indicated significantly higher negative scores on both the CTQ-SF and MBSRQ among patients diagnosed with BPD. Appearance orientation moderated the relationship between sexual abuse experiences and self-harm behaviors in a non-linear way. Specifically, low appearance orientation amplified the effect of sexual abuse on self-injury risk, whereas high appearance orientation acted as a protective factor, buffering the impact of sexual abuse on self-harm.ConclusionsThe relationship between childhood sexual abuse and self-injury in BPD patients is non-linear, and appearance orientation conditionally moderates this link. Low appearance orientation amplifies the impact of sexual abuse whereas high appearance orientation attenuates it. Therefore, appearance orientation is a clinically meaningful individual-difference indicator in trauma-informed self injury risk assessment and case formulation in BPD.

ObjectiveBreast cancer patients undergoing radiotherapy frequently experience psychological distress that negatively impacts treatment outcomes and quality of life. Evidence for structured psychological interventions during radiotherapy remains limited. This study evaluated the longitudinal effects of a structured education plus entertainment therapy intervention on anxiety, depression, and quality of life in mainland China breast cancer patients during and after radiotherapy using linear mixed model analysis.MethodsThis single-center, parallel-group, assessor-blinded randomized controlled trial enrolled 280 female breast cancer patients (aged 18-75 years) receiving adjuvant radiotherapy. Participants were randomized 1:1 to intervention (structured education plus entertainment therapy) or control (standard care). Primary outcomes were Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) trajectories assessed at baseline (T0), mid-radiotherapy (T1), end of radiotherapy (T2), and 1, 3, and 6 months post-radiotherapy (T3-T5). Secondary outcomes included quality of life (EORTC QLQ-C30/BR23 domains), acute toxicity (CTCAE v5.0), and adherence. Linear mixed models with group × time interaction assessed intervention effects.ResultsOf 280 randomized patients, 252 (90%) completed the T5 assessment. The intervention group showed significantly improved SAS trajectory (group × time interaction β = -1.82, 95% CI: -3.14 to -0.50, P = 0.007) with estimated marginal mean difference of -3.45 points at T5. SDS trajectory improvement was marginally significant (β = -1.56, 95% CI: -3.12 to 0.01, P = 0.051). Minimal clinically important difference (MCID, ≥0.5 SD improvement) was achieved by 48.6% vs 31.4% for anxiety (P = 0.004) and 42.1% vs 29.3% for depression (P = 0.027) for intervention and control groups, respectively. Global health status improved significantly (β = 4.23, P < 0.001). Grade ≥2 radiation dermatitis occurred in 37.1% vs 48.6% (P = 0.055) in intervention and control groups, respectively. High adherence (≥70% sessions) in 72.1% of intervention patients was associated with greater benefits.ConclusionsThe structured education plus entertainment therapy intervention demonstrated small-to-moderate clinically meaningful improvements in anxiety, depression, and quality of life during radiotherapy, with effects persisting through 6-month follow-up. Implementation into routine radiotherapy care of breast cancer patients in China appears feasible and effective.