International Journal of Psychiatry in Medicine最新文献

ObjectiveThis study examined the effect of sertraline combined with psychological hotline-based Naikan therapy (a structured form of self-reflection) in the treatment of adolescents with depressive disorder. Hotline-based Naikan therapy is where telephone operators who have been trained in this form of therapy help address psychological distress for callers through telephone counselling.MethodsA randomized controlled trial was conducted involving 93 adolescent outpatients with depressive disorder, with 47 participants assigned to the combined group and 46 to the sertraline alone group. Adolescents in the combined group received treatment using sertraline at the same dose as those in the sertraline alone group. Depression and anxiety levels in both groups were evaluated using the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) at baseline and after the 2nd, 4th and 12th week of treatment.ResultsThere were no significant differences between the groups at baseline in terms of demographic or clinical characteristics. Participants in both the combined and sertraline groups reported no serious adverse reactions. By the end of the 12th week of treatment, significant between-group differences were found on the SDS and the SAS scores, favoring the combined treatment group (χ² = 6.68, P = 0.010 and χ² = 5.68, P = 0.017, respectively).ConclusionSertraline combined with psychological hotline-based Naikan therapy is more effective in reducing depressive and anxiety symptoms in adolescents with depressive disorder than in those receiving sertraline alone.

ObjectiveTo examine the accuracy of general practitioners (GPs) in identifying children with probable mental health problems, and to determine factors associated with accuracy.MethodThis study is a secondary analysis of baseline data from a trial involving 1051 children aged 5-15 years and their parents, recruited from 40 GP practices participating in a collaborative care network in Tehran, Iran. 'Probable mental health problem' was defined by a positive result on the Strengths and Difficulties Questionnaire (SDQ). At the baseline visit, GPs, unaware of SDQ ratings, recorded if they noted any mental health problem in children and indicated the treatments or referrals they had provided. Multilevel regression analyses identified factors associated with GPs' correct detection of children with probable mental health problems.ResultsGPs labeled 311 children (29.7%) as having a mental health problem, and of those, referred 109 for psychiatric consultation. In contrast, the prevalence of 'probable mental health problems' was 35.3% (N = 369). Of children with probable mental health problems, GPs correctly identified 207 (56.1%), while failing to detect 162 (43.9%). In the adjusted regression analysis, correct identification was associated with higher SDQ total score, emotional problem and hyperactivity subscale scores. In addition, parents' poor mental health and a past history of mental health service use were also significantly and independently associated with correct identification of probable mental health problems by GPs.ConclusionsThese findings suggest the need for enhanced training of GPs in Iran, specifically in detecting less severe and less apparent mental health problems among children.

ObjectiveThe prevalence of post-stroke anxiety (PSA) is reported to be 20%-25%. There is insufficient evidence on the efficacy of antidepressants for treating anxiety in such patients. This Prospective Randomized Open Blinded Endpoint (PROBE) study was designed to assess the safety and efficacy of fluoxetine in PSA.MethodsIn this single-center pilot study conducted in India, post-stroke patients (1-6 months after stroke) were randomized to fluoxetine (intervention group: 20 mg/ day for 12 weeks) or standard medical care (control group). The primary outcome was improvement in the Hamilton Anxiety Rating Scale (HAM-A) at 12 weeks. The secondary outcomes were anxiety remission (>50% improvement in HAM-A), modified Rankin Scale (mRS), Barthel Index (BI), quality of life (SF-36), and Hamilton Depression Rating Scale (HAM-D). A linear regression analysis was done for determinants of HAM-A to account for baseline differences in the intervention and control groups.ResultsA total of 60 patients were randomized (30 to the intervention group, 30 to the control group). The overall prevalence of post-stroke anxiety among participants in the study was 50.8%, and 31.5% experienced both anxiety and depression. The average HAM-A score at baseline was 11, and average follow-up score at study conclusion was 4. There was similar improvement in the HAM-A score at 12 weeks post-randomization in the intervention and control groups [fluoxetine: -8.0 (95% CI = -11.0 to -4.0); control: -7.0 (95% CI = -9.5 to -4.0); p = 0.91]. Likewise, there was no significant difference between intervention and control groups at 12 weeks post-randomization on the mRS, BI, SF-36, or HAM-D. There were no serious adverse events in either group during the study.ConclusionFluoxetine and standard medical care had comparable improvement in HAM-A in post-stroke patients with mild anxiety at 12 weeks. Further study of the pharmacological treatment of post-stroke patients with more severe anxiety is needed.Clinical trial registrationCTRI/2018/12/016568.

ObjectiveAlthough 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 role of psychiatric symptoms and motivating factors in seeking 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.MethodA total of 301 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.ResultsNearly 6 in 10 individuals seeking spiritual help in the religious center had significant psychiatric symptoms. Furthermore, 7 in 10 patients sought 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.ConclusionThese results highlight the need for greater integration of mental health services with the 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.

ObjectiveThe syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a potentially life-threatening electrolyte disturbance commonly encountered in older adults, particularly in association with serotonergic and dopaminergic medications. Both duloxetine and levodopa have been individually implicated in the development of SIADH, although the mechanism often remains unclear.MethodsSingle case presentation and review.ResultsA 73-year-old woman with newly diagnosed depression and parkinsonism was initiated on duloxetine (30 mg/day) and levodopa/benserazide (tradename Madopar) (100/25 mg, 3 times daily). Within 24 h, she developed fatigue, nausea, confusion, and dizziness. Laboratory evaluation revealed severe hyponatremia (serum sodium: 115 mmol/L), low serum osmolality (230 mOsm/kg), high urine osmolality (310 mOsm/kg), and urinary sodium of 43 mmol/L, with a clinically euvolemic status. Thyroid and adrenal function test were normal. Both medications were discontinued. Fluid restriction and hypertonic saline infusion led to normalization of sodium levels over 72 h, with complete clinical recovery.ConclusionThis case highlights an unusually rapid onset of SIADH after combined initiation of duloxetine and levodopa/benserazide. The temporal proximity of symptom onset suggests a possible synergistic interaction. Clinicians should maintain vigilance for acute hyponatremia in older adults shortly after introducing serotonergic and dopaminergic agents.

ObjectiveSuicide reattempts, reflecting ongoing vulnerability, are common among individuals with prior attempts, yet data from Iran is limited. This study explored reattempts among all suicide attempters who survived in the Fars province during the year 2023 to inform prevention strategies.MethodsThis prospective study analyzed all registered suicide attempts and death in the Fars during 2023, using a comprehensive database, the Integrated Suicide Data Monitoring and Registration System. Cases were determined and reviewed over 352 days to identify reattempts. Variables included demographic data, attempt history, and occasion-related factors. Statistical analyses involved descriptive statistics, chi-square, t-tests, and logistic regression to examine factors predicting suicide reattempts using SPSS, with significance set at P < .05. Ethical approval was secured from the relevant committee.ResultsAmong all cases, 577 individuals (6.1%) reattempted suicide out of a total of 9472 attempters (failed or succeeded). Gender distribution among re-attempters was similar. Single individuals had higher reattempt rates. Although re-attempters had a lower fatality rate than first-time attempters, the difference was not statistically significant. The average interval between attempts was 5.2 weeks, and 75% occurred within 15 weeks. Logistic regression revealed that being single significantly increased reattempt odds (OR = 1.57, 95% CI: 1.17-2.11, P = .003), while other factors such as age, gender, and day of the week were not significant.ConclusionOur findings indicated that single individuals were more vulnerable to suicide reattempts, underscoring the need for targeted and timely interventions. Being alert in the high-risk post-attempt period is crucial. Future studies should use longitudinal and qualitative methods to explore the complex interplay of personal, social, and systemic factors predicting suicide reattempt.

ObjectiveIndia faces a critical shortage of mental health professionals, leaving primary care physicians (PCPs) as the primary point of contact for many individuals needing psychiatric care. The Diploma in Primary Care Psychiatry Program (DPCP), a one-year training initiative, aims to equip PCPs in India to manage psychiatric conditions in underserved areas. On-Consultation Training (OCT) is a module in the DPCP designed exclusively for practicing PCPs where a psychiatrist trains PCPs in live video streaming of their own real-time general consultations of primary health centres. This study identifies a training gap within the DPCP.MethodsPCPs (n = 62) from Uttarakhand, Bihar, and Karnataka states in India received training in the DPCP from 2019 to 2024. Assessed were their exposure to six psychiatric disorders (tobacco addiction, alcohol addiction, psychosis, somatization disorder, anxiety disorder, and depressive disorder) during On-Consultation Training (OCT) sessions. Adequate training per doctor was defined as encountering at least two patients with each disorder.ResultsA total of 650 psychiatric cases seen during OCT sessions were reviewed. Only tobacco addiction and depressive disorder met the training adequacy benchmark (exposure to two cases with the disorder). Alcohol addiction, psychosis, somatization disorder, and anxiety disorders fell below the threshold, highlighting a specific training gap.ConclusionsThis study identified a training gap in the DPCP. The restructuring of the Collaborative Video Consultation (CVC) module with case-specific quotas, expert case demonstrations, and enhanced real-time feedback during OCT could help close this and other training gaps. Addressing these issues will better prepare PCPs in India to manage a broader range of psychiatric conditions, enhancing mental health care delivery in primary care settings.

ObjectiveFew studies have simultaneously addressed self-management of cardiovascular and mental health in Black women at cardiovascular risk. This 24-week pilot prospective crossover randomized-controlled trial tested TEAM-Red, a 5-session, biweekly, nurse and peer-educator remotely delivered group self-management intervention for young Black women, vs Enhanced waitlist control (eWL).MethodsTEAM-Red intervention, adapted from an evidence-based program and culturally tailored based on stakeholder input, enrolled 50 depressed Black women ages 18-49 with at least one risk factor for hypertension. Participants were randomized to TEAM-Red (n = 25) or eWL (n = 24) and assessed at Screening, Baseline, 12 weeks, and 24 weeks. Those in eWL crossed over to receive TEAM-Red at 12 weeks and all participants were followed to 24 weeks. The primary goal was acceptability and feasibility. The primary outcome was change on depression severity from baseline to 12 weeks assessed via 9-item Patient Health Questionnaire (PHQ-9). Secondary outcomes were perceived stress, mental health quality of life, diet quality, energy expended, social support, hypertension knowledge, and alcohol use.ResultsAmong women depressed at baseline (N = 31), TEAM-Red participants had 17.1 times higher odds of depression remission at week 12 (OR = 17.14, 95% CI: 1.78, 164.97; P = .014). At 12 weeks, TEAM-Red participants showed significantly lower PHQ-9 scores (P = .042), improved diet quality (P = .025) and mental health quality of life (P = .032) and reduced perceived stress (P = .038) compared to eWL. Treatment satisfaction and engagement was high (89% found it useful), with 22% attrition.ConclusionsTEAM-Red demonstrated significant clinical benefits with a 17-fold higher odds of depression remission and meaningful improvements in mental health quality of life, diet quality, and perceived stress compared to controls. Despite limitations including small sample size and short follow-up period, this culturally tailored intervention shows promise for reducing cardiovascular risk and improving mental health outcomes in young Black women at risk for hypertension should results be replicated with a larger sample in a fully powered trial.

ObjectiveThis qualitative study examined the psychosocial support needs of small cell lung cancer (SCLC) patients within China's family-oriented cultural context. Guided by cultural adaptation theory, the study explored how cultural values shape patients' psychological experiences and treatment decision-making.MethodsUsing a phenomenological purposive sampling strategy, 32 SCLC patients from a tertiary oncology hospital in Tianjin, China (May 2024-March 2025) participated in semi-structured, in-depth interviews. Transcripts were managed with NVivo 12, and themes were identified using Colaizzi's phenomenological analysis.ResultsDistinct cultural factors influenced patient needs. Six major themes emerged: (1) dual psychological crises stemming from disease stigma and prognostic dread; (2) pervasive insecurity due to recurrence uncertainty; (3) heightened decision-making stress and information asymmetry; (4) Ethical and Familial Complexities in Treatment Choices-patients struggled to balance personal survival with family responsibilities and financial constraints; (5) an imbalance between the desire for professional psychological support and reliance on informal peer networks; and (6) deliberate suppression of negative emotions to maintain family stability.ConclusionsThe findings revealed a conflict between medical imperatives and entrenched family-oriented cultural values, underscoring the complexity of providing psychosocial support in SCLC care to Chinese patients.