International Review of Psychiatry最新文献

Major depressive disorder (MDD) significantly impairs adolescents' development, with increasing rates of treatment resistance and suicide risk. Ketamine has emerged as a promising, rapid-acting antidepressant in adults, but its efficacy and safety in adolescents remain unclear. This systematic review and meta-analysis aimed to evaluate short-term outcomes of ketamine administration in youth with mood disorders. Following PRISMA guidelines and PROSPERO registration (CRD42024568658), four studies were included, comprising 272 adolescents aged 12-18 years. Three studies (n = 189) contributed data to the meta-analysis. At 24 hours post-administration, ketamine showed a small, non-significant effect on depressive symptoms compared to placebo (SMD = -0.19; 95% CI: -0.41 to 0.04). Clinical response and remission were not significantly different between groups, but ketamine was associated with a significantly higher rate of suicidal ideation remission (RR = 1.49; 95% CI: 1.06 to 2.08). Adverse events were generally mild, transient, and consistent with known pharmacological effects. While findings support ketamine's potential role in acute presentations, current evidence is preliminary. Larger randomized controlled trials with extended follow-up are needed to clarify the clinical utility, optimal protocols, and long-term safety of this approach in adolescent populations.

Research indicates that sociodemographic, clinical, and global functioning are associated with autism spectrum disorder (ASD). To measure and compare sociodemographic, clinical, and global functioning vulnerability profiles of a sample of Mexican children and adolescents with and without ASD. The study was done at two outpatient institutions in Mexico City. The assessment used semi-structured interviews with rating scales, and t-tests and chi-squared (χ²) tests were run to evaluate group comparisons. A latent class analysis was executed to generate probabilistic vulnerability profiles. A total of 103 participants were recruited, 22 with ASD (21.3%, mean age 12.8 ± 3.17, 77.27% male). Those without ASD showed a significantly special education placement (χ² = 3.91, p = 0.048), had oppositional and defiant symptoms (t = 3.32, p = 0.001), and lower global functioning as measured by the Children's Global Assessment Scale (t = 11.78; p = 0.001) and the World Health Organization Disability Assessment Schedule 2.0 (t = -4.10; p = 0.001). Vulnerability was identified in a subgroup of participants with ASD due to increased psychosocial and psychopathological symptoms and lower global functionality. Mexican children and adolescents with ASD experience special education placement and impaired global functioning.

Adolescence is a critical developmental period during which many mental and substance use disorders first emerge, yet global estimates remain limited. Using data from the Institute for Health Metrics and Evaluation for the Global Burden of Disease Study 2021, we examined prevalence among adolescents aged 10-19 years across 204 countries. In 2021, 15.2% had at least one mental disorder. Anxiety disorders were most prevalent (4.9%), followed by conduct disorder (2.7%), ADHD (2.6%), and depressive disorders (2.4%), with major depressive disorder affecting 2.0%. Autism spectrum disorders accounted for 0.9%, intellectual disability 1.7%, bipolar disorder 0.3%, and eating disorders 0.3% (anorexia 0.1%, bulimia 0.2%). Schizophrenia (0.04%) and other disorders (0.2%) contributed smaller fractions. Substance use disorders affected 0.8%, mainly drug use (0.5%) and alcohol (0.3%), with cannabis use disorders at 0.4%. Prevalence varied by sex, region, and socio-demographic development: females showed higher internalizing conditions, males higher externalizing disorders. High-SDI regions had highest prevalence (20.7%) versus low-SDI (13.4%); High-Income North America recorded 22.8%, South Asia 9.7%, and Sub-Saharan Africa 11.6%, likely reflecting under-recognition, stigma, and limited diagnostic capacity. These findings highlight the global significance of adolescent mental health, disparities across sexes and regions, and the need for context-specific prevention and treatment strategies.

Problematic smartphone use (PSU) among youths has emerged as a significant public health concern. PSU is defined as a pattern of smartphone use characterized by loss of control, preoccupation, and continued use despite negative consequences, often resembling behavioral addiction in its impact on daily functioning and well-being. A nationwide case-control study explored the prevalence and predictive role of boredom and loneliness in a cohort of Italian university students aged 18-24 years, as assessed by Smartphone Addiction Scale-short version (SAS-SV) for the presence/absence of PSU. Among enrolled 1,660 participants, PSU was identified in 31.7% of the sample. Multivariate regression model (sex weighted) revealed that SAS-SV levels were positively predicted by boredom inattention (p < 0.001) and disengagement (p = 0.007), emotional loneliness (p = 0.002) and general loneliness (p < 0.001). Logistic binomial regression analysis documented that PSU is significantly predicted only by higher levels of emotional loneliness and boredom state. Our findings underline the need for early preventive strategies and tailored therapeutic interventions targeting emotional regulation and coping strategies to manage boredom state, in order to reduce the risk of PSU in youths. Both boredom and emotional loneliness seem to be essential psychopathological targets for promoting youth psychological well-being in the digital era.

The emergence of new psychopathological constructs, e.g. "modern-type depression" (MTD), arose concerns in diagnosis and treatment of youth depression. Our study explored the role of MTD within an Italian youth sample (n = 273; aged 14-25) with major depressive disorder (MDD), through MINI 7.0.0, BDI-II, TACS-22 and TEMPS-M. Around 49.8% of MTD depression was found, specifically among females (p < 0.001). Only depressive and cyclothymic temperaments together with TACS-22 "complaint" subscale were found positive predictors of depressive severity (F(4,170)=55.872, p < 0.001, R²=0.568). Binomial logistic regression analyses found sex differences in the explanatory effects of affective temperamental profiles on the likelihood of developing MTD depression. In males, both depressive and cyclothymic temperaments (both, p = 0.004) are risky factors, while hyperthymic temperament is a protective factor (p = 0.010). In females, only cyclothymic temperament was found to be a positive predictor (p = 0.018). According to our findings, MTD may have a clinical relevance in youth MDD. There is the need to routinely include MTD assessment in clinical practice for a better MDD characterization and for offering tailored therapeutic approaches to MTD depression, based on sex differences and affective temperamental profile.

Maladaptive daydreaming (MD) is defined as a psychological condition characterized by immersive, narrative-based fantasies that dominate waking consciousness and interfere with daily functioning. While daydreaming is an adaptive cognitive activity, above all in adolescents, MD represents an extreme and compulsive variant associated with significant emotional distress, social withdrawal, academic and occupational impairment. This narrative review offers a comprehensive synthesis of the current literature on MD, with particular emphasis on its clinical manifestations, neurobiological underpinnings, epidemiology, comorbidities, differential diagnosis, and therapeutic perspectives. The review highlights the role of dissociation, trauma history, attention dysregulation, and obsessive-compulsive traits in the pathogenesis of MD, while also distinguishing it from normative mind-wandering, fantasy-prone personality, and psychotic disorders. Despite increasing evidence, MD is not included in the diagnostic systems, and this leads to underdiagnosis and a lack of targeted treatments. Assessment tools such as the Maladaptive Daydreaming Scale (MDS) and the Structured Clinical Interview for Maladaptive Daydreaming (SCIMD) will be explored as useful tools for clinical identification. Finally, treatment options will be discussed even if still not validated. We aim to underscore the nosological significance of this clinical entity, advocating for its recognition in the future landscape of psychiatric classification.

This study explored the mental health and well-being of 267 adolescents in two vulnerable urban communities in Paraguay, using a mixed-methods convergent triangulation design. Quantitative measures included the Psychological Well-Being Scale for Youth (BIEPS-J), the Depression, Anxiety, and Stress Scale (DASS-21), and the Drug Abuse Screening Test (DAST-10). Qualitative data on mental health subjective experiences and community perspectives were collected through semi-structured focus groups. Results revealed that a significant portion of adolescents reported moderate-to-extremely severe levels of depression and anxiety, the majority reported no or only mild stress. Overall psychological well-being scores were favorable, scoring highest in self-acceptance and interpersonal relationships, and lowest in personal projects. Multiple regression analyses showed that stress and drug use were significant negative predictors of psychological well-being, while anxiety, stress, and age positively predicted depression. Qualitative findings highlighted risk factors such as emotional isolation, pressure, and stigma; as well as protective resources, including supportive friendships, community groups (e.g., parish, sports) and future aspirations. These findings underscore the importance of community-based psychosocial interventions that address distress while reinforcing protective factors already present in adolescents' environments.

Psychiatry has had a rocky past, the future is bright, but challenges lie ahead. Advancing technology offers the prospect of re-defining mental illness based on pathophysiology. The prospect of personalised medicine offers the hope of more effective, targeted treatments. Exploiting innovation however, depends on evolving social attitudes and government policy, factors beyond the direct control of psychiatry. We must also defend the boundaries of psychiatry against potential fragmentation or risk surrendering our professional role to other Healthcare professionals and loosing a holistic approach to care and the therapeutic relationship, which should always underpin everything we do. As well as embracing the advances offered by translational medicine and Artificial Intelligence, psychiatrists must continue to influence, inform and educate if our future patients are to see real benefit from the innovation that is unfolding before our eyes.

Against the background of strong social determinants and modulators on the incidence, prevalence, course and lived experience of the dominant western conceptualisation of 'mental illness', this text explores literature in the fields of subaltern/subaltern studies, precarity/precariousness, the relationship between precarity and mental health outcomes, as well as madness/Mad Studies. These fields of work offer key, under-explored insights into matters of importance for the practice of psychiatry at the clinical coalface and across society. In the discussion, the authors debate, from survivor/lived-experience and professional perspectives, whether a combination of autonomous, collaborating (and potentially competing and conflicting) (i) user-controlled organisations of mutual help, support, Mad Studies (as part of and in alliance with New Social Movements (NSMs)), and (ii) professionally-controlled systems of practice and research in the fields of psychiatry and mental health could work effectively together but also in some tension with each other. Engaging in dialogue and debate on these issues could help psychiatry and our broader understanding of madness and mental distress move forward.