Dialogues in Clinical Neuroscience最新文献

Introduction: Depression includes different phenotypes. Modern-type depression (MTD) is a gateway disorder to pathological social withdrawal, known as hikikomori. Adverse childhood experiences (ACEs) are also important aetiologies of depression. Recently, immune imbalance has been proposed as a biological basis of depression. We hypothesised that peripheral immunological characteristics may be involved in subtyping of depression.

Methods: 21 patients with major depressive disorder (MDD) and 24 healthy controls (HC) were recruited. Peripheral blood mononuclear cells (PBMCs) were examined for surface antigens by flow cytometry. Participants were administered psychological scales such as Patient Health Questionnaire (PHQ)-9, Modern-Type Depression Trait Scale (TACS-22), Hikikomori Questionnaire (HQ-25), Child Abuse and Trauma Scale (CATS).

Results: MDD group showed significantly higher percentage of B cells than HC group (p = 0.032). MDD group presented a negative correlation between: PHQ-9 and CD8 T effector memory cells (r= -0.639, p = 0.002), TACS-22 and monocytes (r= -0.459, p = 0.036), HQ-25 and NK T cells (r= -0.638, p = 0.004), CATS and Intermediate monocytes (r= -0.594, p = 0.009).

Conclusions: MTD traits, hikikomori tendencies, and ACEs were correlated with specific characteristics of peripheral immune cells. Our results suggest that immune imbalance influences the diverse presentations of depression. Further validation is warranted by large-scale prospective studies.

Background: Psychotropic medications are critical in managing severe mental illnesses (SMI) such as schizophrenia, major depressive disorder (MDD) and bipolar disorder. However, these treatments often lead to adverse side effects that can impair patients' quality of life (QoL) and affect treatment adherence.

Objective: This study aims to investigate the specific side effects of psychotropic treatments that contribute to a decline in QoL among patients with SMI, independently of treatment adherence.

Methods: We conducted a cross-sectional study with 1248 patients diagnosed with SMI, recruited from a university psychiatric unit in Marseille, France. QoL was assessed using the Schizophrenia Quality of Life Scale (SQoL-18), and side effects were measured using the UKU Side Effect Rating Scale. Treatment adherence was evaluated using the Medication Adherence Rating Scale (MARS). Statistical analyses included Pearson correlations and multiple linear regression models to identify predictors of QoL.

Results: The study found that side effects, as identified by the UKU scores, could significantly predict a reduction in QoL across multiple domains, including multiple dimensions of QoL and the overall QoL index, independent of treatment adherence. Patients on antipsychotics and benzodiazepines reported higher levels of adverse side effects, which correlated with lower QoL scores. An increase in the number of psychotropic treatment classes was also associated with a significant decline in QoL (p < 0.001).

Conclusion: Managing psychic side effects and minimising polypharmacy are critical to improving QoL in patients with SMI. Clinicians should consider these factors when developing personalised treatment strategies to enhance patient outcomes.

Soon after the introduction of second-generation antipsychotics, antipsychotic off-label use (OLU) progressively became a common prescribing practice. This evolving practice should be regularly monitored considering the growing number of persons exposed to the adverse effects of antipsychotics. The aim of the present review was to synthesise the literature published over the last 15 years on antipsychotic OLU for mental health symptoms. Observational studies confirm the persisting high rate of antipsychotic OLU prescription in two out of three youths and 30-60% of adults using antipsychotics. Increasing rates of low-dose quetiapine prescriptions for anxiety or sleep symptoms are paradigmatic of the current public health concern regarding antipsychotic OLU. Such prescriptions receive impetus from industry-funded marketing strategies and prescribers' feeling of innocuousness, with a resulting underestimation of the risk of adverse drug reactions (ADR). However, antipsychotic OLU should be neither trivialised nor demonised since it may be the only therapeutic option in persons with resistant psychiatric disorders or serious ADR with labelled drugs. To reduce the populational impact of antipsychotic OLU, it is necessary to better control the influence of the pharmaceutical industry regarding newly marketed drugs and to better inform prescribers and users about the risks associated with OLU prescribing.

Background: Emerging observational studies have indicated the association between autism spectrum disorder (ASD) and IBD, including Crohn's disease (CD) and ulcerative colitis (UC), whereas the causality remains unknown.

Methods: Summary-level data from large-scale genome-wide association (GWAS) studies of IBD and ASD were retrieved. Mendelian randomisation analyses were performed with a series of sensitivity tests.

Results: Genetic predisposition to ASD was not associated with the risk of IBD (odds ratio [OR] = 0.99, 95% confidence interval [CI = 0.91-1.06, p = 0.70; OR [95% CI]: 1.03 [0.93-1.13], p = 0.58 for CD; OR [95% CI]: 0.96 [0.87-1.05], p = 0.37 for UC) in the IIBDGC dataset. In the FinnGen dataset, their causal effects were unfounded (OR [95% CI]: 1.04 [0.94-1.15], p = 0.49 for IBD; OR [95% CI]: 1.08 [0.89-1.31], p = 0.42 for CD; OR [95% CI]: 1.00 [0.88-1.13], p = 0.95 for UC). In the meta-analysis of two datasets, the OR was 1.01 (95% CI 0.96-1.07, p = 0.45). For the risk of ASD under genetic liability to IBD, the OR from meta-analysis was 1.03 (95% CI 1.01-1.05, p = 0.01).

Conclusion: Our findings indicate genetic predisposition to ASD might not increase the risk of IBD, whereas genetic liability to IBD is associated with an increased risk of ASD. Further investigations using more powerful datasets are warranted.

We introduce here a general model of Functional Neurological Disorders based on the following hypothesis: a Functional Neurological Disorder could correspond to a consciously initiated voluntary top-down process causing involuntary lasting consequences that are consciously experienced and subjectively interpreted by the patient as involuntary. We develop this central hypothesis according to Global Neuronal Workspace theory of consciousness, that is particularly suited to describe interactions between conscious and non-conscious cognitive processes. We then present a list of predictions defining a research program aimed at empirically testing their validity. Finally, this general model leads us to reinterpret the long-debated links between hypnotic suggestion and functional neurological disorders. Driven by both scientific and therapeutic goals, this theoretical paper aims at bringing closer the psychiatric and neurological worlds of functional neurological disorders with the latest developments of cognitive neuroscience of consciousness.

Introduction: To investigate the neurophysiological aspects of addiction, the microstate characteristics of internet gaming disorder (IGD), alcohol use disorder (AUD), and healthy control (HC) groups were compared using resting-state electroencephalography (EEG).

Methods: In total, 199 young adults (75 patients with IGD, 57 patients with AUD, and 67 HCs) participated in this study. We conducted EEG microstate analysis among the groups and also compared the obtained parameters with the results of psychological assessments.

Results: The global explained variance, occurrence, and coverage of microstate C were significantly lower in the AUD group than in the IGD group. Additionally, rates of transition from microstates A, B, and D to C were significantly lower in the AUD group than in the IGD group, whereas rates of transition from microstate A to B were lower in the IGD group compared to HCs. Furthermore, the occurrence of microstate C and transition from microstate B to C were negatively correlated with the Alcohol Use Disorder Identification and Behavioural Inhibition Scale score.

Conclusion: There were significant differences in microstate characteristics among the groups, which correlated with the psychological scores. These findings suggest that microstate features can be used as neuromarkers in clinical settings to differentiate between addictive disorders and evaluate the pathophysiology of AUD and IGD.

Sexual abuse within the Catholic Church is a distressing concern. As part of the investigation conducted by the French Independent Commission on Sexual Abuse in the Church, we analysed available files of convicted sexual abusers between 1950 and 2020. We analysed the socio-demographic and clinical characteristics of French clergymen sex offenders. Thirty-five clergymen were included. Sexual assaults were documented for 176 individuals in total, including 153 minors (79.7% male) and 23 adults (52.2% female). No sex offender assaulted both juvenile and adult victims. Homosexuality was declared in 50% of the perpetrators. A past history of child sexual abuse was observed in 30% (N = 9) of juvenile offenders. The mean number of victims per offender was around 5, with the highest mean number in male or both sex juvenile offenders. More than 90% of the victims were known to the perpetrator. Both hands-on and hands-off sexual offences occurred in over 80% of male juvenile offenders compared to less than 6% of female juvenile offenders and less than 17% of adult offenders. Sex offenders within the Catholic Church present some specificities in comparison to non religious sex offenders, such as a higher number of male juvenile victims somewhat older and more often known. Personal, interpersonal and systemic factors, some of which being specific, interact to foster sexual offence. Prevention of sexual abuse within the Catholic Church is crucial.

Introduction: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder with a multifaceted etiology. This case report explores the ischemic cryptogenic vascular dissection as a potential underlying cause of ASD.

Methods: A 9-year-old child presented with symptoms of ASD, including social interaction difficulties, repetitive behaviors, and cognitive challenges. Despite conventional ASD treatments, significant improvement was only observed after addressing an underlying ischemic cryptogenic vascular dissection identified through DCE-CT.

Results: Following a reconstructive treatment approach to the vascular dissection, the patient showed marked improvement in cognitive functions, social abilities, and a reduction in ASD-related symptoms whether during the perioperative period or during approximately 5-month follow-up.

Conclusion: This case suggests that ischemic cryptogenic vascular dissection may contribute to the symptoms of ASD. Identifying and treating underlying vascular anomalies may offer a new avenue for mitigating ASD symptoms, emphasizing the need for comprehensive diagnostic estimations in ASD management.

Introduction: Antidiabetic drugs, reduction of carbohydrates intake, maintaining normal weight and physical activity are the cornerstone of diabetes 2 treatment.

Methods: This opinion article is not intended to challenge hundreds of studies unequivocally demonstrating the benefits of a healthy lifestyle including appropriate diet in controlling the consequences of T2DM. The article questions whether the benefits of dietary restrictions for the management of T2D in older adults who are already demented, are worth the potential detrimental effects on quality of life for the patients and their caregivers, as well as the effects of dietary restrictions on frailty, sarcopenia.

Discussion: However, the benefit of dietary restrictions including carbohydrates restrictions, might not manifest in elderly Alzheimer and vascular dementia patients with type 2 diabetes. On the contrary, such restrictions might hinder the patients' and caregiver's quality of life and encumber attempts to maintain normal weight in a population which tends to be underweight. Therefore, the benefit/risk ratio of dietary restriction should be weighed in this population on an individual basis.

Introduction: This study evaluates the impact of a two-hour team-based learning (TBL) curriculum on medical students' knowledge, comprehension, ethical understanding, and attitudes towards psychedelic therapies.

Methods: Sixty-three pre-surveys and fifty post-surveys assessed students' perceived knowledge and attitudes using Likert scales. Forty-eight matched pre/post-knowledge tests with multiple-choice questions quantified changes in comprehension. The TBL approach featured independent learning, team readiness assessments, and application exercises.

Results: Post-curriculum, students demonstrated significantly improved test scores (mean 41.4% increase, p < 0.0001) and more positive attitudes across 16 of 18 items (p ≤ 0.0495). Overall attitude scores increased 23% (p < 0.0001). Qualitative feedback reflected enhanced comfort discussing psychedelics clinically. While some students expressed support for psychedelic-assisted therapy, others cited reservations.

Discussion: This innovative curriculum bridged an important education gap given the increasing relevance of psychedelic medicine. Findings suggest TBL enhances medical student preparedness in this emerging field. Continued curricular development is warranted to ensure proper psychedelic education aligns with patient needs and legislative policies. As psychedelic research progresses, maintaining instructional excellence is crucial for future healthcare professionals.