International Journal of Psychiatry in Medicine最新文献

Objectives: To assess the efficacy of escitalopram combined with quetiapine vs quetiapine alone in the treatment of depressive episodes of bipolar disorder (BPD).

Methods: 88 hospitalized patients with a BPD depressive episode were recruited into the study. All patients were randomized to a control group (n = 44) or the intervention group (n = 44). Members of the control group received quetiapine fumarate alone, with an initial dose 50 mg/time twice/day; the dose was increased by 50-100 mg daily until 300-600 mg/d was reached. The treatment group received quetiapine at the same doses plus escitalopram, with the initial dose of escitalopram 10 mg/d, adjusting the dose to 20 mg/d after 1 week. Both groups were treated for 8 weeks. The scores on the Hamilton Depression Scale (HAMD) and Young Mania Rating Scale (YMRS), along with levels of IL-6, IL-1β, MIF, SOD, CAT, MDA and GSH-Px, were compared between groups.

Results: Among those in the intervention group, 88.6% of participants experienced a 50% or greater reduction in HAMD score compared to 70.5% in the control group (P < .05). Participants in the intervention group also experienced a significantly greater reduction in IL-6, IL-1β, MIF and MDA levels (P < .05), and a significant increase in SOD, CAT and GSH-Px levels compared to the control group (P < .05).

Conclusion: Escitalopram oxalate combined with quetiapine is more effective than quetiapine alone in the treatment of patients with bipolar depressive episodes, which can effectively improve the symptoms of depression, inhibit the body's inflammatory response, regulate the state of oxidative stress, and does not increase the risk of mania.

Objective: Despite the well-established increased risk of cardiovascular mortality in individuals with bipolar disorder (BD), prevention and treatment of cardiovascular risk factors and diseases have been largely overlooked in this population. This manuscript reviews the pathophysiological basis of the connection between BD and cardiovascular diseases, highlighting their shared mechanisms, reciprocal interactions, and relevant prevention and treatment strategies.

Methods: For this narrative review, a search was carried out on PubMed using the keywords bipolar disorder, cardiovascular diseases, and cardiovascular risk factors.

Results: The increased frequency of cardiovascular morbidity in BD can be attributed to overlapping biological and psychosocial mechanisms. These mechanisms are complex and involve both direct effects of BD and indirect effects mediated by lifestyle and pharmacological factors. Cardiovascular diseases also significantly exacerbate the clinical course of BD and increase morbidity and healthcare costs; thus, their effective management can improve psychiatric outcomes and vice versa. However, patients with BD frequently encounter healthcare barriers.

Conclusion: Awareness initiatives and research on integrated care are needed to determine the best strategies for improving cardiovascular and psychiatric outcomes in individuals with BD.

Objective: Although religious leaders play an important role in providing informal mental health care to individuals struggling to seek religious and spiritual care, existing studies have not explored the magnitude of psychiatric symptoms and motivators to seek mental health services from religious leaders in religious listening centers and mental hospitals. This paper presents preliminary data from a survey aimed at assessing psychiatric symptoms and factors associated with access to spiritual services among 151 individuals at a religious listening center, as well as to determine the pathways of care among 150 patients attending a mental health clinic in conflict zones of the Eastern Democratic Republic of the Congo.

Method: Three hundred and one participants were screened for psychiatric symptoms and factors motivating access to religious leaders using a semi-structured questionnaire. Descriptive analyses were performed to determine information on psychiatric symptoms and factors affecting access to spiritual and mental health services.

Results: Nearly 6 in 10 individuals seeking spiritual help in the religious center had psychiatric symptoms. Furthermore, 7 in 10 patients seek help for mental health needs from religious leaders and healers before seeking conventional mental health services; among such individuals, there was a high prevalence of bipolar disorder and schizophrenia spectrum disorder, recurrent admissions, and poor adherence to psychotropic medication.

Conclusion: These results highlight the need for greater integration of mental health services with care provided by religious organizations within conflict zones such as the Congo. They also emphasize the need for greater promotion of person-centered care that considers and integrates patients' religious beliefs in their treatment.

Objective: Functional seizures (FS) are a highly debilitating symptom of functional neurological disorder (FND). FS requires a multi-disciplinary approach to treatment because the patient's initial presentation is to neurology, emergency medicine, or primary care and treatment consists of psychotherapy. People with FS commonly experience severe childhood trauma, particularly sexual trauma. The authors aimed to investigate associations between reported trauma and maladaptive coping mechanisms in the FS population.

Methods: This retrospective, observational study reports on 137 patients enrolled in the FS Clinic at the University of Colorado between March 2020 - March 2021. Multiple linear regression was used to reveal associations between self-reported childhood sexual and violent trauma and maladaptive coping mechanisms of self-blame and disengagement on the Brief COPE. A quantile regression was generated for each of these outcomes.

Results: Results showed that violent and sexual trauma were experienced by 47.5% and 61.6% of the population sample, respectively. Of those exposed to violent trauma, 27.2% perceived it as extremely severe while 43.4% of those exposed to sexual trauma perceived it as extremely severe. Quantile regressions for self-blame and disengagement showed significance for the 25^th percentile of those who experienced violent trauma. Self-blame was significantly associated with the 50^th and 75^th percentile of those exposed to sexual trauma.

Conclusions: This evidence supports the value of identifying trauma experienced by individuals with FS as it is associated with specific coping mechanisms that may affect treatment. Identifying prior trauma and resulting coping mechanisms can potentially assist in individualizing care for people with FS.

Objectives: This study assessed the prevalence and correlates of post-traumatic stress disorder (PTSD) among internally displaced people (IDP) in the Qoloji Camp, Somali Regional State, Eastern Ethiopia.

Methods: A community-based cross-sectional study was conducted from October 20 to November 5, 2021. The study utilized systematic random sampling to identify 410 IDP participants from the Qoloji Camp. PTSD was measured using the PTSD Check-list for DSM-5 (PCL-5). Bivariate analysis was performed to determine the crude odds ratio, and multivariate analysis was used to calculate adjusted odds ratios for associations between PTSD and independent variables.

Results: A total of 404 participants were interviewed (98.5% response rate). The estimated prevalence of PTSD symptoms was 41.1%. In the multivariate logistic regression analysis, several factors were significantly associated with PTSD: being female (AOR = 2.5, 95% CI = 1.39-4.44), lack of food and water (AOR = 2.2, 95% CI = 1.17, 4.23), destruction of personal property (AOR = 3.1, 95% CI = 1.62-6.09), and experiencing torture or beatings (AOR = 1.8, 95% CI = 1.01-3.28).

Conclusion: This study found a high prevalence of PTSD symptoms among IDPs, with factors such as female sex, property destruction, deprivation of essential goods and services, and experiences of torture or beatings significantly associated with those symptoms. To address these findings, prioritizing the well-being of IDPs with a specific focus on women, on-site screening, and the establishment of a referral system to facilitate access to specialized care are essential to enhance the overall mental health of such persons.

Objective: Clinicians have noted that the ongoing war on Gaza has had a psychological impact on people with multiple sclerosis (PwMS) whose mental health is particularly vulnerable during stressful times such as these. The present study sought to examine the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among PwMS in Jordan during the Gaza war outbreak.

Methods: This was a cross-sectional study involving 171 patients (PwMS) out of 372 patients approached (46% response rate) who were being seen in the MS unit at Al Bashir Hospital, Ammann, Jordan. Inclusion criteria required that participants had been following daily news updates of the October 7 war in Gaza during a period of 4 months.

Results: Of participants, 125 (73.1%) were female, 98 (57.3%) were on therapy for less than five years, and 30 (17.5%) reported having a relapse during the past 6 months. Significant PTSD symptoms were identified in 58.5% (100 of 171 participants). Those at higher risk were the unemployed (OR = 2.14, 95% CI = 1.13-4.07, P = 0.02), whereas patients receiving dimethyl fumarate (19.9%) were at lower risk (OR = 0.43, 95% CI = 0.19-0.94, P = 0.02).

Conclusion: The high rate of significant PTSD symptoms among people with MS in this study underscores the need for attention by primary care providers and the implementation of a comprehensive multidisciplinary approach to optimize the mental well-being of this fragile population.

Objective: There are inconsistent reports regarding the relationship between cannabis use and male sexual function with almost no data about synthetic cannabinoids (SC) and their effect on male sexual functions. This study investigated psychological concerns related to male sexual functions among cannabis and SC users. The research assessed different sexual functions and aspects of sexual psychopathology in cannabis and SCs dependent men compared to controls.

Method: Thirty male patients with cannabis dependence, thirty male patients with SCs dependence, and thirty matched controls from the outpatient clinic at Kasr Al Ainy hospital, Egypt, were assessed using the Structured Clinical Interview for DSM-IV TR Axis I Disorders (SCID-I), International Index of Erectile Function (IIEF), and Sexuality scale.

Results: The means of IIEF questionnaire in the cannabis and SC group were significant lower (worse) than the means of the control group (P < .001) except the orgasmic function in cannabis group (P = .052). In the SCs group, sexual depression was higher and preoccupation lower than in the cannabis group (P < .020; P < .003, respectively) and control groups (P < .001; P < .001, respectively). The duration and dose of cannabis and SCs correlated significantly with sexual esteem, sexual preoccupation and all domains of IIEF.

Conclusion: Cannabis and SC dependence were associated with lower erectile function, sexual desire, intercourse satisfaction and overall satisfaction, and lower orgasmic functions in the SC group than controls. Both groups showed higher sexual depression, lower sexual esteem and sexual preoccupation than controls. SC has a higher negative impact on male sexual functions and psychopathology than does cannabis.

Objective: The COVID-19 pandemic has had a profound impact on individuals with mental health (MH) disorders and on the delivery of MH services. Few studies have examined treatment models not requiring substantial changes to the delivery of services during pandemic restrictions, such as collaborative care management (CoCM) programs. Therefore, a longitudinal retrospective cohort analysis was conducted to examine the impact of the COVID-19 pandemic on a psychopharmacological CoCM program.

Method: Data were collected on all U.S. Veterans enrolled in a CoCM program at a large VA during the first 10 months of the COVID-19 pandemic and compared to a matched control group one-year prior to that date. Treatment in the program pre-COVID vs. treatment during the pandemic was compared in relation to baseline symptomatology, improvements in MH symptoms, and program adherence.

Results: A total of 462 Veterans were referred during the control period, compared to 351 during the same time period during the pandemic. Veterans enrolled during the first four months of each study arm, to allow for a minimum of 6 months of follow up data, had no differences in baseline symptoms of depression or anxiety between groups. Veterans receiving care during the pandemic had higher rates of program completion than pre-pandemic controls. COVID-era Veterans also had higher rates of depression response compared to controls, but no differences were observed between groups on depression remission, anxiety response, or anxiety remission.

Conclusions: Psychopharmacological CoCM treatment models can successfully manage depression and anxiety with no observed decrease in the effectiveness of this intervention even during periods of unprecedented disruptions to MH services.