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Short-Term Psychodynamic Psychotherapy is the First-Line Option for Depression and Treatment Resistant Depression According to Available Evidence. 根据现有证据,短期心理动力学心理疗法是治疗抑郁症和难治性抑郁症的一线选择。
IF 3.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-18 DOI: 10.1177/07067437241299487
Allan Abbass, Patrick Luyten, Falk Leichsenring
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引用次数: 0
Clinical Correlates of Antipsychotic Plasma Levels with Long-Acting Paliperidone: Corrélats cliniques des concentrations plasmiques de palipéridone à libération prolongée. 长效帕潘立酮抗精神病药血浆水平的临床相关性。
IF 3.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-15 DOI: 10.1177/07067437241295648
Robert B Zipursky, Ofer Agid, Michael Kiang, Gary Remington

Objectives: The majority of patients with schizophrenia experience dramatic improvement in psychotic symptoms when treated with antipsychotic medication. Maintenance treatment can prevent relapses but problems with medication adherence limit effectiveness. Long-acting injectable antipsychotics (LAIs) provide an opportunity to establish adherence but challenges remain in ensuring that the dose selected is therapeutic. Therapeutic drug monitoring has not been established as valuable for LAIs in the maintenance treatment of schizophrenia. This exploratory study was undertaken to describe plasma paliperidone levels in outpatients treated with the LAI paliperidone palmitate and to determine whether paliperidone levels are associated with subjective experience on medication and side effects.

Methods: Twenty-one outpatients with schizophrenia receiving treatment with LAI paliperidone consented to participation in this study. Blood samples were obtained for measurement of paliperidone and prolactin levels at the first visit. A second paliperidone level was obtained at the time of the next injection for 18 of the participants. Clinical rating scales were administered at the first visit to assess illness severity, attitudes regarding medication, subjective well-being and side effects.

Results: Paliperidone levels were highly correlated at the two time points (ρ = .85; P < .001). Mean paliperidone level at the first visit was 34.9 ng/ml and ranged from 5.1 to 73.9 ng/ml. Higher paliperidone levels were correlated with higher prolactin levels (ρ = 0.59, P < .01) and lower sexual desire (ρ = -.58, P < .01).

Conclusions: We demonstrated that paliperidone levels can be measured reliably in patients receiving LAI paliperidone. Higher plasma levels were associated with higher prolactin levels and reduced sexual desire but not with measures of subjective experience on medications or other side effects. Measurement of paliperidone levels in patients treated with paliperidone palmitate may have the potential to minimize the dose of medication prescribed and, in turn, the severity of sexual side effects.

目标:大多数精神分裂症患者在接受抗精神病药物治疗后,精神症状会得到显著改善。维持治疗可以防止复发,但服药依从性问题限制了治疗效果。长效注射用抗精神病药物(LAIs)为坚持用药提供了机会,但在确保所选剂量具有治疗作用方面仍存在挑战。在精神分裂症的维持治疗中,治疗药物监测对 LAIs 的价值尚未得到证实。这项探索性研究旨在描述接受LAI帕利哌酮棕榈酸酯治疗的门诊患者的血浆帕利哌酮水平,并确定帕利哌酮水平是否与用药的主观感受和副作用有关:21名接受LAI帕利哌酮治疗的门诊精神分裂症患者同意参与本研究。在首次就诊时采集血液样本以测量帕利哌酮和催乳素水平。18名参与者在下一次注射时接受了第二次帕利哌酮水平测定。首次就诊时使用临床评分量表评估疾病严重程度、对药物治疗的态度、主观健康状况和副作用:结果:帕利哌酮水平在两个时间点高度相关(ρ = .85;P P P 结论:帕利哌酮水平在两个时间点高度相关:我们证明,可以可靠地测量接受 LAI 帕利哌酮治疗的患者的帕利哌酮水平。较高的血浆水平与较高的催乳素水平和性欲降低有关,但与药物或其他副作用的主观体验测量无关。测量帕利哌酮棕榈酸酯患者的帕利哌酮水平有可能最大限度地减少处方药物的剂量,进而减少性副作用的严重程度。
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引用次数: 0
Clinical Characteristics of Inpatients with Schizophrenia Spectrum Disorder Treated with Electroconvulsive Therapy: A Population-Level Cross-Sectional Study: Titre: Caractéristiques cliniques des patients hospitalisés présentant un trouble du spectre de la schizophrénie et traités par électrochocs : Une étude de population transversale. 电休克疗法治疗精神分裂症谱系障碍住院患者的临床特征:人群水平横断面研究: 标题: 电休克疗法治疗精神分裂症谱系障碍住院患者的临床特征:人群水平横断面研究。
IF 3.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-11 DOI: 10.1177/07067437241290181
Tyler S Kaster, Amreen Babujee, Isobel Sharpe, Taeho Greg Rhee, Tara Gomes, Paul Kurdyak, George Foussias, Duminda Wijeysundera, Daniel M Blumberger, Simone N Vigod

Objective: Electroconvulsive therapy (ECT) is an evidence-based treatment for schizophrenia when anti-psychotic medications do not sufficiently control symptoms of psychosis or rapid response is required. Little is known about how it is used in routine clinical practice. The aim of this study was to identify the association of demographic and clinical characteristics with administration of ECT for schizophrenia spectrum disorders (SSD).

Methods: Among psychiatric inpatients with a diagnosis of SSD in Ontario, Canada (2006-2023), patient-level socio-demographic and clinical characteristics were described in those who did and did not receive ECT. We used multi-variable logistic regression to assess the association between patient-level characteristics and administration of ECT during index hospitalization.

Results: From 164,632 admissions, 2,168 (1.3%) involved exposure to ≥1 inpatient ECT procedure. Compared to those not receiving ECT, those receiving ECT were older, had higher rates of pre-admission medication use, medical and psychiatric comorbidities, outpatient mental health service use, but lower rates of substance use disorders. In the multi-variable logistic regression model, patient-level characteristics most strongly associated with receiving inpatient ECT were the presence of catatonia (odds ratio [OR]: 5.83; 95% confidence interval [95% CI]: 4.01-8.46), comorbid depression (OR: 2.49; 95% CI: 2.07-2.98), obsessive-compulsive disorder (OR: 2.16; 95% CI: 1.55-3.00), while characteristics most strongly associated with not receiving inpatient ECT were myocardial infarction (OR: 0.44; 95% CI: 0.20-0.95) and family conflict towards patient (OR: 0.47; 95% CI: 0.31-0.71). Neither severity of psychotic symptoms, non-command auditory hallucinations nor delusions were associated with administration of ECT.

Conclusions: While characteristics associated with the use of ECT are generally consistent with the indications for ECT (e.g., catatonia, mood disorders), ECT is rarely used amongst individuals with SSD. Severity of psychotic symptoms was not associated with the use of inpatient ECT suggesting an opportunity to increase the use of ECT in this population.

目的:电休克疗法(ECT)是在抗精神病药物不能充分控制精神病症状或需要快速反应时治疗精神分裂症的一种循证疗法。人们对其在常规临床实践中的应用知之甚少。本研究旨在确定人口统计学和临床特征与精神分裂症谱系障碍(SSD)电痉挛疗法的相关性:方法:在加拿大安大略省(2006-2023 年)诊断为 SSD 的精神病住院患者中,对接受和未接受电痉挛疗法的患者的社会人口学和临床特征进行了描述。我们使用多变量逻辑回归法评估了患者水平特征与住院期间接受电痉挛疗法之间的关联:在164,632例住院患者中,有2,168例(1.3%)住院患者接受了≥1次ECT治疗。与未接受电痉挛疗法的患者相比,接受电痉挛疗法的患者年龄较大,入院前用药、医疗和精神疾病合并症、门诊精神健康服务使用率较高,但药物使用障碍的发生率较低。在多变量逻辑回归模型中,与接受住院电疗相关性最强的患者特征是存在紧张症(几率比 [OR]:5.83;95% 置信区间 [95%CI]:4.01-8.46)、合并抑郁症(OR:2.49;95% CI:2.心肌梗死(OR:0.44;95% CI:0.20-0.95)和家庭对患者的冲突(OR:0.47;95% CI:0.31-0.71)与不接受住院电疗相关性最强。精神病症状的严重程度、非指令性幻听或妄想均与电痉挛疗法的使用无关:尽管与使用电痉挛疗法相关的特征与电痉挛疗法的适应症(如紧张症、情绪障碍)基本一致,但电痉挛疗法很少在SSD患者中使用。精神病症状的严重程度与住院患者使用电痉挛疗法无关,这表明有机会在这一人群中增加电痉挛疗法的使用。
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引用次数: 0
Cognitive-Behavioural Social Skills Training: Mediation of Treatment Outcomes in a Randomized Controlled Trial for Youth at Risk of Psychosis: L'entraînement aux compétences sociales cognitivo-comportementales : variables médiatrices des résultats thérapeutiques dans le cadre d'un essai clinique randomisé pour les jeunes présentant un risque de psychose. 认知行为社交技能培训:针对有精神病风险的青少年的随机对照试验中治疗结果的中介作用》(Cognitive-Behavioural Social Skills Training: Mediation of Treatment Outcomes in a Randomized Controlled Trial for Youth at Risk of Psychosis)。
IF 3.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-11 DOI: 10.1177/07067437241295636
Daniel J Devoe, Lu Liu, Amy Braun, Kristin S Cadenhead, Barbara A Cornblatt, Eric Granholm, Jean Addington

Objectives: Currently, there are no effective treatments for functional outcomes (i.e., role and social) and negative symptoms for youth at clinical high-risk (CHR) for psychosis. Investigations into possible mechanisms that may contribute to the improvement of functioning and negative symptoms are needed in CHR research to help inform psychosocial treatments. The present study examined whether functioning and negative symptoms were mediated by asocial beliefs, defeatist beliefs, self-efficacy, maladaptive schemas, anxiety, depression, social cognition, or attenuated psychotic symptoms (APS) in a large clinical trial.

Methods: CHR participants (n = 203; 104 females; 99 males) were recruited as part of a three-site randomized control trial comparing group cognitive-behavioural social skills training (CBSST) versus a supportive therapy group. Mediation analyses were conducted to test the relationships between treatment group, mediators (asocial beliefs, defeatist beliefs, self-efficacy, maladaptive schemas, anxiety, depression, social cognition, and APS), and outcome (social and role functioning, and negative symptoms). The mediation analyses employed conditional process path analysis via ordinary least squares regression.

Results: At the end of treatment, but not 12-month follow-up, more severe APS were found to mediate the impact of treatment on negative symptoms, and social and role functioning. The greater the severity of APS, the less likely that CBSST would result in improvement in negative symptoms and social and role functioning. Many of the other variables showed significant associations with social (less for role) functioning and negative symptoms but did not mediate the effect of treatment on these outcomes at the end of treatment or 12-month follow-up.

Conclusions: There were no significant mediators except for APS at the end of treatment. Since more severe APS may result in participants being unable to fully participate in therapy and thus limit their gains, clinical implications may include offering some individual therapy to prepare these young people to benefit from the group treatment.

目标:目前,对于处于精神病临床高风险(CHR)的青少年,还没有针对功能结果(即角色和社交)和不良症状的有效治疗方法。在临床高危青少年研究中,需要对可能有助于改善功能和消极症状的机制进行调查,以帮助为社会心理治疗提供依据。本研究考察了在一项大型临床试验中,功能和阴性症状是否受反社会信念、失败主义信念、自我效能感、适应不良图式、焦虑、抑郁、社会认知或减轻的精神病性症状(APS)的影响:作为三地随机对照试验的一部分,招募了CHR参与者(n = 203;104名女性;99名男性),对认知行为社交技能训练(CBSST)小组与支持性治疗小组进行比较。研究人员进行了中介分析,以检验治疗组、中介因素(非社会信念、失败主义信念、自我效能感、适应不良图式、焦虑、抑郁、社会认知和 APS)和结果(社会和角色功能以及负面症状)之间的关系。中介分析通过普通最小二乘法回归进行条件过程路径分析:结果:在治疗结束时,但不是在 12 个月的随访中,发现更严重的 APS 对治疗对消极症状、社会和角色功能的影响具有中介作用。APS的严重程度越高,CBSST越不可能改善负面症状以及社交和角色功能。许多其他变量与社会(角色)功能和负性症状有显著关联,但在治疗结束或12个月的随访中,这些变量并不介导治疗对这些结果的影响:结论:在治疗结束时,除 APS 外,没有其他重要的中介因素。由于较严重的APS可能导致参与者无法完全参与治疗,从而限制了他们的收益,因此临床意义可能包括提供一些个人治疗,为这些年轻人从小组治疗中获益做好准备。
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引用次数: 0
The Psychological Health of Iranian Citizens Protesting the Actions of Their Country's Morality Police: La santé psychologique des citoyens iraniens qui manifestent contre les actions de la police des mœurs de leur pays. 抗议本国道德警察行为的伊朗公民的心理健康》(The Psychological Health of Iranian Citizens Protesting the Actions of Their Country's Morality Police)。
IF 3.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-10 DOI: 10.1177/07067437241295638
Sophia Marchetti, Anthony Feinstein

Objective: To determine the mental health of Iranian citizens protesting the actions of their country's Morality Police. Street protests across Iran were met with violent suppression that included security forces reportedly targeting protestors' eyes.

Method: A group of 63 Iranian protestors (58.7% female; mean age 32.0 [SD = 9.43] years, from all socio-economic classes) who had been part of street protests against the regime's morality police, was recruited by convenience sampling between May and August 2023 by journalists working underground in Iran. The study was conducted in Farsi by telephone (n = 60) and in-person (n = 3). Demographic and psychometric data were collected, the latter including symptoms of posttraumatic stress disorder (PTSD; Impact of Events Scale-Revised) and depression (Beck Depression Inventory-Revised), in Farsi-validated scales. Between-group comparisons were undertaken with one-way ANOVA and post-hoc Tukey comparisons. Significance was set at P < 0.05.

Results: The protestors comprised three groups: not wounded (n = 27: 59.26% female, mean age 34.44 [SD = 12.11] years), non-eye wound (n = 23; 60.87% female, mean age 32.61 [SD = 5.89] years) and eye-wound (n = 13; 53.85% female, mean age 27.54 [SD = 6.58] years). The eye wound group (blinded in one or both eyes) had less severe intrusion symptoms of PTSD (P = 0.048) and depression (P = 0.0001) than the non-eye wound group. The not wounded group had less severe symptoms of depression than the non-eye wound group (P = 0.003). Every protestor who had lost sight regarded their actions, notwithstanding their physical consequences, in a positive psychological light.

Conclusions: Contrary to our a-prior hypothesis, Iranian protestors blinded in one or both eyes were faring better psychologically than protestors with non-eye wounds. Possible reasons for this included higher rates of psychological treatment and social support in the eye-wound group compared to the other two groups post-injury and the nascent development of posttraumatic growth.

目的确定抗议伊朗道德警察行为的伊朗公民的心理健康状况。伊朗全国各地的街头抗议都遭到了暴力镇压,据报道,安全部队还将抗议者的眼睛作为目标:2023 年 5 月至 8 月期间,在伊朗从事地下工作的记者通过方便抽样的方式招募了 63 名伊朗抗议者(58.7% 为女性;平均年龄 32.0 [SD = 9.43]岁,来自各个社会经济阶层),他们曾参加过反对伊朗政权道德警察的街头抗议活动。研究通过电话(n = 60)和面谈(n = 3)以波斯语进行。研究收集了人口统计学和心理测量数据,后者包括经波斯语验证的创伤后应激障碍(PTSD;事件影响量表-修订版)和抑郁症(贝克抑郁量表-修订版)症状。组间比较采用单因素方差分析和事后 Tukey 比较。显著性设定为 P 结果:抗议者分为三组:未受伤组(n = 27:59.26% 为女性,平均年龄 34.44 [SD = 12.11]岁)、未眼部受伤组(n = 23;60.87% 为女性,平均年龄 32.61 [SD = 5.89]岁)和眼部受伤组(n = 13;53.85% 为女性,平均年龄 27.54 [SD = 6.58]岁)。眼部受伤组(单眼或双眼失明)的创伤后应激障碍(P = 0.048)和抑郁症(P = 0.0001)等侵入性症状的严重程度低于未眼部受伤组。未受伤组的抑郁症状比眼睛未受伤组轻(P = 0.003)。每一位失明的抗议者都从积极的心理角度看待他们的行为,尽管这些行为造成了身体上的后果:与我们之前的假设相反,单眼或双眼失明的伊朗抗议者的心理状况要好于双眼未受伤的抗议者。可能的原因包括:与其他两组相比,眼部受伤组在受伤后接受心理治疗和获得社会支持的比例更高,以及创伤后成长刚刚开始。
{"title":"The Psychological Health of Iranian Citizens Protesting the Actions of Their Country's Morality Police: La santé psychologique des citoyens iraniens qui manifestent contre les actions de la police des mœurs de leur pays.","authors":"Sophia Marchetti, Anthony Feinstein","doi":"10.1177/07067437241295638","DOIUrl":"10.1177/07067437241295638","url":null,"abstract":"<p><strong>Objective: </strong>To determine the mental health of Iranian citizens protesting the actions of their country's Morality Police. Street protests across Iran were met with violent suppression that included security forces reportedly targeting protestors' eyes.</p><p><strong>Method: </strong>A group of 63 Iranian protestors (58.7% female; mean age 32.0 [SD = 9.43] years, from all socio-economic classes) who had been part of street protests against the regime's morality police, was recruited by convenience sampling between May and August 2023 by journalists working underground in Iran. The study was conducted in Farsi by telephone (<i>n</i> = 60) and in-person (<i>n</i> = 3). Demographic and psychometric data were collected, the latter including symptoms of posttraumatic stress disorder (PTSD; Impact of Events Scale-Revised) and depression (Beck Depression Inventory-Revised), in Farsi-validated scales. Between-group comparisons were undertaken with one-way ANOVA and post-hoc Tukey comparisons. Significance was set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>The protestors comprised three groups: not wounded (<i>n</i> = 27: 59.26% female, mean age 34.44 [SD = 12.11] years), non-eye wound (<i>n</i> = 23; 60.87% female, mean age 32.61 [SD = 5.89] years) and eye-wound (<i>n</i> = 13; 53.85% female, mean age 27.54 [SD = 6.58] years). The eye wound group (blinded in one or both eyes) had less severe intrusion symptoms of PTSD (<i>P</i> = 0.048) and depression (<i>P</i> = 0.0001) than the non-eye wound group. The not wounded group had less severe symptoms of depression than the non-eye wound group (<i>P</i> = 0.003). Every protestor who had lost sight regarded their actions, notwithstanding their physical consequences, in a positive psychological light.</p><p><strong>Conclusions: </strong>Contrary to our a-prior hypothesis, Iranian protestors blinded in one or both eyes were faring better psychologically than protestors with non-eye wounds. Possible reasons for this included higher rates of psychological treatment and social support in the eye-wound group compared to the other two groups post-injury and the nascent development of posttraumatic growth.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437241295638"},"PeriodicalIF":3.3,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stratified Care in Cognitive Behavioural Therapy: A Comparative Evaluation of Predictive Modelling Approaches for Individualized Treatment: La stratification des soins pour l'orientation vers une thérapie cognitivo-comportementale: une évaluation comparative des approches de modélisation prédictive pour un traitement individualisé. 认知行为疗法中的分层护理:个性化治疗预测模型方法的比较评估。
IF 3.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-10 DOI: 10.1177/07067437241295635
Margaret Jamieson, Andrew Putman, Marsha Bryan, Bojay Hansen, Phillip E Klassen, Nicholas Li, Bethany McQuaid, David Rudoler

Objective: In response to high demand and prolonged wait times for cognitive behavioural therapy (CBT) in Ontario, Canada, we developed predictive models to stratify patients into high- or low-intensity treatment, aiming to optimize limited healthcare resources.

Method: Using client records (n = 953) from Ontario Shores Centre for Mental Health Sciences (January 2017-2021), we estimated four binary outcome models to assign patients into complex and standard cases based on the probability of reliable improvement in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. We evaluated two choices of cut-offs for patient complexity assignment: models at an ROC (receiver operating characteristic)-derived cut-off and a 0.5 probability cut-off. Final model effectiveness was assessed by assigning treatment intensity (high-intensity or low-intensity CBT) based on the combined performance of both GAD-7 and PHQ-9 models. We compared the treatment assignment recommendations provided by the models to those assigned by clinical assessors.

Results: The predictive models demonstrated higher accuracy in selecting treatment modality compared to provider-assigned treatment selection. The ROC cut-off achieved the highest prediction accuracy of case complexity (0.749). The predictive models exhibited large sensitivity and specificity trade-offs (which influence the rates of patient assignment to high-intensity CBT) despite having similar accuracy statistics (ROC cut-off = 0.749, 0.5 cut-off = 0.690), emphasizing the impact of cut-off choices when implementing predictive models.

Conclusions: Overall, our findings suggest that the predictive model has the potential to improve the allocation of CBT services by shifting incoming clients with milder symptoms of depression to low-intensity CBT, with those at highest risk of not improving beginning in high-intensity CBT. We have demonstrated that models can have significant sensitivity and specificity trade-offs depending on the chosen acceptable threshold for the model to make positive predictions of case complexity. Further research could assess the use of the predictive model in real-world clinical settings.

目的:针对加拿大安大略省认知行为疗法(CBT)的高需求量和漫长的等待时间,我们开发了预测模型,将患者分层为高强度或低强度治疗,旨在优化有限的医疗资源:利用安大略省海岸心理健康科学中心(Ontario Shores Centre for Mental Health Sciences)的客户记录(n = 953)(2017 年 1 月至 2021 年 1 月),我们估算了四个二元结果模型,根据患者健康问卷-9(PHQ-9)和广泛焦虑症-7(GAD-7)得分的可靠改善概率,将患者分为复杂病例和标准病例。我们评估了患者复杂性分配的两种临界值选择:ROC(接收者操作特征)得出的临界值模型和 0.5 概率临界值模型。根据 GAD-7 和 PHQ-9 模型的综合表现,通过分配治疗强度(高强度或低强度 CBT)来评估模型的最终有效性。我们将模型提供的治疗分配建议与临床评估人员的建议进行了比较:结果:与提供者指定的治疗选择相比,预测模型在选择治疗方式方面表现出更高的准确性。ROC 临界值对病例复杂性的预测准确率最高(0.749)。尽管预测模型具有相似的准确性统计(ROC 临界值 = 0.749,0.5 临界值 = 0.690),但却表现出较大的灵敏度和特异性权衡(影响患者被分配到高强度 CBT 的比率),这强调了在实施预测模型时选择临界值的影响:总之,我们的研究结果表明,预测模型具有改善 CBT 服务分配的潜力,它能将抑郁症状较轻的患者转移到低强度的 CBT,而那些抑郁症状没有改善的高风险患者则开始接受高强度的 CBT。我们已经证明,根据模型对病例复杂性做出积极预测时所选择的可接受阈值,模型可能会在灵敏度和特异性方面做出重大权衡。进一步的研究可以评估预测模型在实际临床环境中的应用。
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引用次数: 0
Brain Age Gap as a Predictor of Early Treatment Response and Functional Outcomes in First-Episode Schizophrenia: A Longitudinal Study: L'écart d'âge cérébral comme prédicteur de la réponse en début de traitement et des résultats fonctionnels dans un premier épisode de schizophrénie : une étude longitudinale. 预测首发精神分裂症患者早期治疗反应和功能结果的脑年龄差距:一项纵向研究。
IF 3.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-10 DOI: 10.1177/07067437241293981
Lejia Fan, Zhenmei Zhang, Xiaoqian Ma, Liangbing Liang, Liu Yuan, Lijun Ouyang, Yujue Wang, Zongchang Li, Xiaogang Chen, Ying He, Lena Palaniyappan

Objectives: Accelerated brain aging, i.e., the age-related structural changes in the brain appearing earlier than expected from one's chronological age, is a feature that is now well established in schizophrenia. Often interpreted as a feature of a progressive pathophysiological process that typifies schizophrenia, its prognostic relevance is still unclear. We investigate its role in response to antipsychotic treatment in first-episode schizophrenia.

Methods: We recruited 49 drug-naive patients with schizophrenia who were then treated with risperidone at a standard dose range of 2-6 mg/day. We followed them up for 3 months to categorize their response status. We acquired T1-weighted anatomical images and used the XGboost method to evaluate individual brain age. The brain age gap (BAG) is the difference between the predicted brain age and chronological age.

Results: Patients with FES had more pronounced BAG compared to healthy subjects, and this difference was primarily driven by those who did not respond adequately after 12 weeks of treatment. BAG did not worsen significantly over the 12-week period, indicating a lack of prominent brain-ageing effect induced by the early antipsychotic exposure per se. However, highly symptomatic patients had a more prominent increase in BAG, while patients with higher BAG when initiating treatment later showed lower gains in global functioning upon treatment, highlighting the prognostic value of BAG measures in FES.

Conclusions: Accelerated brain aging is a feature of first-episode schizophrenia that is more likely to be seen among those who will not respond adequately to first-line antipsychotic use. Given that early poor response indicates later treatment resistance, measuring BAG using structural MRI in the first 12 weeks of treatment initiation may provide useful prognostic information when considering second-line treatments in schizophrenia.

研究目的大脑加速衰老,即与年龄相关的大脑结构变化比预期的年龄提前出现,是精神分裂症的一个特征。它通常被解释为精神分裂症典型的渐进性病理生理过程的一个特征,但其与预后的相关性仍不清楚。我们研究了它在首发精神分裂症患者对抗精神病治疗的反应中的作用:方法:我们招募了 49 名未接受过药物治疗的精神分裂症患者,他们接受了利培酮治疗,标准剂量为 2-6 毫克/天。我们对他们进行了为期 3 个月的随访,以对他们的反应状态进行分类。我们获取了T1加权解剖图像,并使用XGboost方法评估了个体脑龄。脑年龄差距(BAG)是预测脑年龄与实际年龄之间的差值:结果:与健康受试者相比,FES 患者的脑年龄差距更为明显,这种差异主要是由那些在 12 周治疗后仍未做出充分反应的患者造成的。在12周的治疗期间,BAG并没有明显恶化,这表明早期抗精神病药物接触本身并没有引起明显的脑老化效应。然而,症状严重的患者的BAG增加更为明显,而开始治疗时BAG较高的患者在治疗后的整体功能改善程度较低,这凸显了BAG测量在FES中的预后价值:大脑加速衰老是首发精神分裂症的一个特征,更有可能出现在那些对一线抗精神病药物治疗反应不佳的患者中。鉴于早期反应不佳预示着日后的治疗耐药性,在开始治疗的前12周内使用结构性核磁共振成像测量BAG可能会在考虑精神分裂症二线治疗时提供有用的预后信息。
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引用次数: 0
Physical Activity as a Predictor of Internet Gaming Disorder in a Swiss Male Cohort (C-SURF): L'activité physique comme prédicteur des troubles liés aux jeux vidéo en ligne dans une cohorte de jeunes hommes suisses (C-SURF). 体力活动是瑞士男性队列(C-SURF)中网络游戏障碍的预测因素:体力活动是瑞士男性队列(C-SURF)中网络游戏障碍的预测因素。
IF 4.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-08 DOI: 10.1177/07067437241293979
Adam Nowotarski, Stephane Rothen, Filip Kasina, Daniele Zullino, Gabriel Thorens

History and objectives: This study addresses the increasing global concerns surrounding Internet gaming disorder (IGD) by exploring their connection to physical activity (PA) as a potential preventive and early intervention measure. The research aims to examine the relationship between PA and the progression of IGD.

Methods: Longitudinal data from the Cohort research on Substance Use Risk Factors involving young Swiss men undergoing army conscription was employed. PA levels were assessed using the International PA Questionnaire (IPAQ), while the Game Addiction Scale (GAS) and Compulsive Internet Use Scale determined IGD presence. Analysis involved zero-inflated negative binomial regression models.

Results: Higher PA levels were associated with lower IGD risk. Notably, individuals engaging in high physical exercise exhibited a lower IGD prevalence compared to those with moderate or low activity levels.

Discussion: The study suggests that intensive physical exercise might serve as a preventive strategy against developing IGD. This protective effect could stem from various mechanisms. However, the study's limitations, such as a male-only sample and a small low-activity group, should be considered when interpreting results.

Conclusion: The longitudinal study demonstrates the positive influence of intense physical exercise on mitigating gaming-related issues. These findings underscore the potential of PA interventions in addressing the growing problem of IGDs and their impact on health. Further research is necessary to uncover underlying mechanisms behind the PA-IGD relationship and validate these findings across diverse demographics.

历史和目标:本研究通过探讨网络游戏障碍(IGD)与体育锻炼(PA)之间的关系,将其作为一种潜在的预防和早期干预措施,从而解决全球日益关注的网络游戏障碍问题。研究旨在探讨体育锻炼与 IGD 进展之间的关系:方法:研究人员采用了瑞士应征入伍青年药物使用风险因素队列研究的纵向数据。研究采用了 "国际业余爱好问卷"(IPAQ)对业余爱好水平进行评估,同时采用 "游戏成瘾量表"(GAS)和 "强迫性网络使用量表 "来确定是否存在 IGD。分析采用零膨胀负二项回归模型:结果:较高的体育锻炼水平与较低的 IGD 风险相关。值得注意的是,与中等或低活动水平的人相比,进行大量体育锻炼的人的 IGD 患病率较低:讨论:这项研究表明,加强体育锻炼可作为一种预防 IGD 的策略。这种保护作用可能源于多种机制。然而,在解释研究结果时应考虑到研究的局限性,如仅有男性样本和一小部分低活动量群体:这项纵向研究表明,高强度体育锻炼对缓解游戏相关问题有积极影响。这些发现强调了体育锻炼干预在解决日益严重的 IGD 问题及其对健康的影响方面的潜力。有必要开展进一步研究,以揭示体育锻炼与 IGD 关系背后的潜在机制,并在不同人群中验证这些发现。
{"title":"Physical Activity as a Predictor of Internet Gaming Disorder in a Swiss Male Cohort (C-SURF): L'activité physique comme prédicteur des troubles liés aux jeux vidéo en ligne dans une cohorte de jeunes hommes suisses (C-SURF).","authors":"Adam Nowotarski, Stephane Rothen, Filip Kasina, Daniele Zullino, Gabriel Thorens","doi":"10.1177/07067437241293979","DOIUrl":"10.1177/07067437241293979","url":null,"abstract":"<p><strong>History and objectives: </strong>This study addresses the increasing global concerns surrounding Internet gaming disorder (IGD) by exploring their connection to physical activity (PA) as a potential preventive and early intervention measure. The research aims to examine the relationship between PA and the progression of IGD.</p><p><strong>Methods: </strong>Longitudinal data from the Cohort research on Substance Use Risk Factors involving young Swiss men undergoing army conscription was employed. PA levels were assessed using the International PA Questionnaire (IPAQ), while the Game Addiction Scale (GAS) and Compulsive Internet Use Scale determined IGD presence. Analysis involved zero-inflated negative binomial regression models.</p><p><strong>Results: </strong>Higher PA levels were associated with lower IGD risk. Notably, individuals engaging in high physical exercise exhibited a lower IGD prevalence compared to those with moderate or low activity levels.</p><p><strong>Discussion: </strong>The study suggests that intensive physical exercise might serve as a preventive strategy against developing IGD. This protective effect could stem from various mechanisms. However, the study's limitations, such as a male-only sample and a small low-activity group, should be considered when interpreting results.</p><p><strong>Conclusion: </strong>The longitudinal study demonstrates the positive influence of intense physical exercise on mitigating gaming-related issues. These findings underscore the potential of PA interventions in addressing the growing problem of IGDs and their impact on health. Further research is necessary to uncover underlying mechanisms behind the PA-IGD relationship and validate these findings across diverse demographics.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437241293979"},"PeriodicalIF":4.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term Impact of the Bloor Viaduct Suicide Barrier on Suicides in Toronto: A Time-Series Analysis: Effet à long terme de la barrière anti-suicide du viaduc Bloor sur les suicides à Toronto : une analyse chronologique. 布卢尔高架桥自杀障碍对多伦多自杀事件的长期影响:时间序列分析》(Bloor Viaduct Suicide Barrier on Suicides in Toronto: A Time-Series Analysis)。
IF 4.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-05 DOI: 10.1177/07067437241293978
Mark Sinyor, Vera Yu Men, Prudence Po Ming Chan, Daniel Sanchez Morales, Anthony J Levitt, Ayal Schaffer

Background: A suicide prevention barrier was installed at Toronto's Bloor Viaduct bridge in 2003. It was associated with short-term location substitution, possibly mediated by media effects that did not persist over 1 decade. The long-term impact of the barrier is unknown.

Methods: We examined rates of suicides by jumping from the Bloor Viaduct, other bridges and by other methods using coroner's records in Toronto (1998-2020). We used interrupted time-series Poisson regression analyses to model changes in quarterly bridge-related suicides after barrier installation. A secondary analysis explored the potential substitution effects of suicide by other methods.

Results: Of 5219 suicides from 1998 to 2020, 303 were by jumping from bridges. After controlling for covariates, installation of the Bloor Viaduct suicide barrier was associated with a 49% step decrease in bridge-related suicide in the next quarter in Toronto (incidence rate ratio [IRR] = 0.51, 95% CI, 0.30 to 0.86) with no rebound increase in bridge-related suicide during the subsequent 17 years after the original drop (IRR = 0.99, 95% CI, 0.96 to 1.03). There was also no associated change in suicides by other methods after the barrier (IRR = 1.04, 95% CI, 0.90 to 1.20).

Conclusions: Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier. They support the long-term utility of structural interventions at high-frequency sites for suicide.

背景:2003 年,在多伦多布卢尔高架桥上安装了预防自杀屏障。它与短期的地点替代有关,可能是受媒体效应的影响,但这种影响不会持续十年。该障碍物的长期影响尚不清楚:我们使用多伦多验尸官的记录(1998-2020 年)研究了从布卢尔高架桥、其他桥梁和其他方法跳桥自杀的比率。我们使用间断时间序列泊松回归分析来模拟安装护栏后每季度与桥梁相关的自杀事件的变化。一项辅助分析探讨了其他自杀方式的潜在替代效应:在 1998 年至 2020 年的 5219 起自杀事件中,有 303 起是跳桥自杀。在控制协变量后,布卢尔高架桥自杀屏障的安装与多伦多下一季度与桥梁相关的自杀率下降 49% 有关(发病率比 [IRR] = 0.51,95% CI,0.30 至 0.86),在最初下降后的 17 年中,与桥梁相关的自杀率没有反弹增加(IRR = 0.99,95% CI,0.96 至 1.03)。障碍之后,通过其他方式自杀的人数也没有相关变化(IRR = 1.04,95% CI,0.90 至 1.20):与最初的研究结果相反,这些结果表明布卢尔高架桥自杀屏障具有持久的自杀预防效果。这些结果支持在自杀高发地点采取结构性干预措施的长期效用。
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引用次数: 0
Access to University Mental Health Services: Understanding the Student Experience: L'accès aux services universitaires de santé mentale : comprendre l'expérience des étudiants. 获得大学心理健康服务:了解学生的经历。
IF 4.3 3区 医学 Q2 PSYCHIATRY Pub Date : 2024-11-04 DOI: 10.1177/07067437241295640
Nathan King, William Pickett, Kurtis Pankow, Gina Dimitropoulos, Emma Cullen, Stephen McNevin, Scott B Patten, Anne Duffy

Objective: To describe student access to university mental health services and barriers and gaps in support.

Methods: This multiple cohort study used self-report data from 4,138 undergraduate students who completed the U-Flourish Well-Being Survey at the start and completion of first year from 2018 to 2023. The survey incorporated validated measures of mental health symptoms, barriers to care, and open-text questions about the mental health care experience and perceived gaps. Quantitative analyses summarized utilization patterns and barriers. An interpretive qualitative analysis identified common themes about support services and opportunities for improvement from the student perspective.

Results: At university entry, 43% of students screened positive for anxiety and/or depression, 30% reported a lifetime mental disorder and 23% a lifetime history of self-harm. Over first year, 15% of students surveyed accessed university mental health services. Access was more likely in students identifying as older, gender diverse, female, having a prior mental disorder and those who screened positive for anxiety or depression. Common attitudinal and practical barriers reported included thinking problems would resolve (74%), being uncomfortable sharing (73%), and not knowing how to get help (50%). Common stigma barriers included concerns about what family or friends might think. Students expressed that both campus-based well-being and mental health care offered during flexible hours and accessible through online booking were important.

Conclusions: Student-tailored mental health literacy may be a sustainable approach to address the attitudinal and practical barriers identified. If such barriers are reduced, an increased service demand would be expected and improved efficiencies needed. A clear Statement of Services, an online singular point of access with embedded triage to signpost students to indicated levels of care, and clearly worked-out care pathways including to community-based services would better align with a stepped care model, improve efficiency and access, and foster realistic expectations around university mental health support.

目的描述学生获得大学心理健康服务的情况,以及获得支持的障碍和差距:这项多队列研究使用了 4138 名本科生的自我报告数据,这些学生在 2018 年至 2023 年间的一年级开始和结束时完成了 U-Flourish Well-Being Survey。调查纳入了心理健康症状、护理障碍的有效测量方法,以及有关心理健康护理体验和感知差距的开放文本问题。定量分析总结了利用模式和障碍。一项解释性定性分析从学生的角度确定了有关支持服务和改进机会的共同主题:在大学入学时,43% 的学生焦虑和/或抑郁筛查呈阳性,30% 的学生报告有终生精神障碍,23% 的学生有终生自残史。在大学一年级,15% 的受访学生接受了大学心理健康服务。年龄较大、性别多元化、女性、曾有精神障碍以及焦虑或抑郁筛查呈阳性的学生更有可能获得心理健康服务。据报告,常见的态度和实际障碍包括:认为问题会解决(74%),不愿意与人分享(73%),不知道如何获得帮助(50%)。常见的耻辱感障碍包括担心家人或朋友的看法。学生们表示,以校园为基础的心理健康服务和在灵活时间内提供的心理健康护理以及通过网上预约获得的心理健康护理都很重要:结论:为学生量身定制的心理健康扫盲可能是解决态度和实际障碍的一种可持续方法。如果这些障碍减少了,服务需求就会增加,就需要提高效率。明确的服务声明、在线单一访问点(内嵌分流功能,可为学生提供指示性的护理服务)、清晰的护理路径(包括社区服务)将更好地与阶梯式护理模式保持一致,提高效率和获取途径,并促进对大学心理健康支持的现实期望。
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引用次数: 0
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Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie
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