Actas espanolas de psiquiatria最新文献

Background and objectives: A medically serious suicide attempt (MSSA) has been defined as a suicide attempt that would be fatal if not for medical intervention. Despite the seriousness of MSSA, the risk factors are only partially understood. The main aims of the present study were to define the characteristics of patients admitted to a general hospital for MSSA and to identify the predictors of MSSA.

Methods: Prospective, observational case-control study involving adult inpatients admitted to non-psychiatric units at our institution and consecutively referred to the consultation-liaison psychiatry (CLP) unit between January 1, 2011 and December 31, 2018. Cases were patients who met clinical criteria for MSSA and controls were patients referred to the CLP unit for any other reason. All participants underwent a structured psychiatric interview. Sociodemographic, clinical, and psychosocial data were collected. Univariate and multivariate analyses were performed. Variables that were statistically significant on the univariate analysis were entered into a multivariate binomial logistic regression model.

Results: A total of 5428 patients were included: 223 (4.1%) cases and 5205 (95.9%) controls. On the multivariate analysis, the variables significantly associated with the risk of MSSA were: younger age (odds ratio [OR] = 0.98); history of previous suicide attempts (OR = 17.41): psychosocial stressors (interpersonal problems, OR = 2.33; legal problems, OR = 3.38; multiple stressors, OR = 2.28); and presence of severe mental illness (schizophrenia, OR = 6.32; mood disorder, OR = 6.77; personality disorder, OR = 6.35).

Conclusions: The findings of this study highlight the importance of early identification of individuals who present with risk factors for MSSA to enable timely intervention. The prompt intervention of CLP services plays a key role in improving patient outcomes, underscoring the importance of specialized, comprehensive psychiatric care in this patient population.

Background: Depression is a common and highly prevalent disabling mental disorder. Recent clinical data have shown that repetitive transcranial magnetic stimulation (rTMS) effectively improves depressive symptoms. Mitochondrial quality control (MQC) plays a central role in various psychiatric disorders. However, the relationship between the therapeutic mechanisms underlying rTMS and MQC remains unclear. This study aimed to evaluate the therapeutic effect of rTMS on depression and to investigate the relationship between rTMS and MQC.

Methods: A depression model was established using chronic unpredictable mild stress (CUMS). The rTMS treatment protocol was administered daily for 4 weeks at a frequency of 10 Hz (17 trains of 4 s each, with 15 s intervals), totaling 1000 pulses per day. Each session involved 10 s of stimulation followed by 50 s of rest and was divided into four groups: control, CUMS, CUMS + 10 Hz rTMS, and fluoxetine (FlX)-treated groups (six mice in each group). In this study, we used the open field test (OFT), tail suspension test (TST), sucrose preference test (SPT), and forced swimming test (FST) to assess depression in mice; immunohistochemical staining to observe changes in the prefrontal cortex (PFC), hippocampal neurons, and glial cells; and transmission electron microscopy to detect changes in mitochondrial morphology in the hippocampus.

Results: Our findings suggest that mitochondrial pre-autophagy increased after treatment (LC3Ⅰ/II, F = 34.31, p < 0.0001; FIS1, F = 6.666, p = 0.0272), hippocampal mitochondrial fusion was enhanced after treatment (NeuN, p < 0.0001; c-Fos, p < 0.001; MFN1, p = 0.0006), and that treatment significantly improved the depression-like behavior of mice in the SPT (p = 0.0024) and FST (p = 0.0025).

Conclusion: The present study demonstrates that rTMS improves depression-like behavior in mice by promoting mitochondrial fusion and enhancing autophagy.

Background: Coronary atherosclerotic heart disease (CAHD) is a major global health burden with high morbidity and mortality. Psychological comorbidities, particularly anxiety and depression, are highly prevalent in CAHD patients and significantly impact disease prognosis, quality of life, and treatment adherence. This study aimed to explore the occurrence and influencing factors of anxiety and depression in patients with CAHD.

Methods: A retrospective study design was used to collect clinical data and questionnaire results from 152 patients with CAHD who attended our hospital from January 2022 to January 2025. The Hamilton Anxiety scale, Hamilton Depression scale, Acceptance of Illness Scale and Social Support Rating Scale were used to assess the results, and statistical analyses were performed using SPSS (version 26.0) software, which included independent sample t-tests, chi-square tests and univariate and multiple logistic regression analysis.

Results: Amongst 152 patients with CAHD, the detection rate of anxiety symptoms was 42.76% (65 cases), and the detection rate of depressive symptoms was 46.05% (70 cases). Multiple logistic regression analysis showed that the number of coronary artery lesion branches (odds ratio (OR) = 3.15, 95% CI: 1.25-7.96, p = 0.015), the amount of long-term medication (OR = 3.26, 95% CI: 1.42-7.50, p = 0.005), and disease acceptance (OR = 0.81, 95% CI: 0.73-0.90, p < 0.001) and social support (OR = 0.88, 95% CI: 0.83-0.94, p < 0.001) were independent influencing factors of anxiety. Disease course (OR = 2.52, 95% CI: 1.18-5.41, p = 0.017), disease acceptance (OR = 0.92, 95% CI: 0.86-0.99, p = 0.047) and social support (OR = 0.95, 95% CI: 0.91-0.99, p = 0.047) were independent influencing factors of depression.

Conclusion: Disease acceptance and social support are the main influencing factors. Therefore, routine screening for anxiety and depression, coupled with tailored interventions, is recommended for patients with CAHD.

Background: Treatment-resistant depression (TRD) is a complex and heterogeneous condition affecting a considerable subset of patients who do not respond to conventional antidepressants. Given the limitations of traditional treatment strategies, there is a growing need for alternative and personalized approaches.

Objective: This review explores the neurobiological underpinnings of TRD and examines the efficacy of emerging pharmacological and neuromodulatory interventions. We also highlight the potential role of the bipolar spectrum in TRD and the need for tailored treatment strategies.

Methods: A systematic review of literature from 2015 to 2025 was conducted using PubMed and Scopus. Studies on TRD treatment modalities, including augmentation strategies, mood stabilizers, atypical antipsychotics, and neuromodulation techniques, were analyzed.

Results: Our findings indicate that novel interventions, such as ketamine, esketamine, psychedelics, and neuromodulation therapies (e.g., repetitive transcranial magnetic stimulation, magnetic seizure therapy) show promise in addressing TRD. Additionally, biomarker-driven and pharmacogenetic approaches may enhance treatment selection and improve outcomes. Evidence suggests that a subset of patients with TRD could fall within the bipolar spectrum, requiring mood stabilizers and antipsychotics rather than standard antidepressant regimens.

Conclusion: A multidisciplinary and precision-based approach is essential for optimizing TRD management. Future research should focus on biomarker-driven treatment selection, artificial intelligence-assisted decision making, and large-scale trials to refine personalized therapeutic strategies.

Background: Bipolar disorder (BD) and inflammatory bowel disease (IBD) frequently co-occur, posing unique treatment challenges and implicating shared inflammatory mechanisms. Although each condition has been extensively studied in isolation, the clinical and pathophysiological interplay between BD and IBD remains poorly characterized.

Methods: We conducted a narrative review of peer-reviewed literature from January 2000 through May 2025, retrieved from PubMed, Web of Science, and PsycINFO. Search terms included "bipolar disorder", "inflammatory bowel disease", "comorbidity", and related inflammatory markers. Titles/abstracts were screened by two reviewers, and eligible studies reporting clinical, epidemiological, or mechanistic data on BD-IBD overlap were included.

Results: Prevalence estimates suggest that BD affects approximately 3-7% of IBD patients, compared with 1-2% in the general population. Comorbid BD-IBD is associated with increased hospitalization rates, more severe gastrointestinal and psychiatric symptoms, and reduced quality of life. Treatment interactions are complex: mood stabilizers and antipsychotics may exacerbate gastrointestinal inflammation, while corticosteroids and biologics can destabilize mood. Mechanistic studies highlight dysregulated cytokine profiles (e.g., elevated Interleukin-6, Tumor Necrosis Factor-alpha I), gut-microbiome alterations, and genetic pleiotropy as convergent pathways.

Conclusions: The intersection of BD and IBD underscores a bidirectional gut-brain neuroimmune axis, with systemic inflammation as a central mediator. Recognizing and managing this comorbidity requires integrated multidisciplinary care. Future research should focus on longitudinal studies and targeted anti-inflammatory interventions to improve outcomes in this high-risk population.

Background: Bipolar disorder is associated with a high prevalence of suicidal ideation, and comorbid anxiety may further increase suicide risk. The psychological mechanisms linking anxiety to suicidal ideation, especially the roles of social support and self-esteem, remain unclear. This study constructed a chain mediation model to examine how anxiety, social support and self-esteem relate to suicidal ideation in patients with bipolar disorder.

Methods: From March 2022 to May 2023, 450 inpatients with bipolar disorder were recruited from six hospitals in Anhui Province. Standardised scales assessed anxiety, social support, self-esteem and suicidal ideation. Pearson correlation examined associations between variables, binary logistic regression identified factors associated with suicidal ideation, and Hayes' PROCESS macro tested the chain mediation model.

Results: Logistic regression showed that higher anxiety increased the odds of suicidal ideation, whereas higher social support and self-esteem reduced the odds. Suicidal ideation was positively correlated with anxiety and negatively correlated with social support and self-esteem, and mediation analysis demonstrated a significant direct effect of anxiety and significant independent and chain mediating effects of social support and self-esteem (all p < 0.001).

Conclusions: Anxiety is related to suicidal ideation in patients with bipolar disorder both directly and indirectly through reduced social support and self-esteem. The indirect pathway via self-esteem showed the largest effect, underscoring the need to enhance social support and self-esteem in suicide prevention for this population.

Background: As a more efficient variant of repetitive transcranial magnetic stimulation (rTMS), intermittent theta-burst stimulation (iTBS) has been shown to effectively treat major depressive disorder (MDD). Resting-state functional connectivity (FC) is believed to help explain how iTBS exerts its therapeutic effects. Research findings regarding FC changes induced by iTBS targeting the left dorsolateral prefrontal cortex (DLPFC) are inconsistent, warranting exploratory investigations. In this study, we analyzed the effects of a 10-day iTBS treatment on changes in resting-state FC in patients with MDD.

Methods: This study enrolled 29 patients with MDD from Tianjin Anding Hospital between February 2023 and November 2024. These patients received 10 days of left DLPFC iTBS treatment, with its efficacy closely monitored. A FC matrix was constructed using the Human Brainnetome Atlas as a template. Changes in FC were analyzed, and correlation analysis was conducted between baseline FC in different brain regions and depressive symptoms. Regression analysis was then performed to predict depressive symptoms improvement based on baseline FC.

Results: Our results demonstrate that iTBS treatment yields a significant therapeutic effect, with response and remission rates of 62.07% and 31.03%, respectively. FC analysis revealed a reduction in positive FC between the ventromedial putamen (vmPu), precentral gyrus (PrG), and postcentral gyrus (PoG). The correlation between baseline FC of vmPu and PrG (r = 0.529, p = 0.003), as well as between vmPu and PoG (r = 0.545, p = 0.002), was found to be positively associated with improvements in depressive symptoms. Additionally, linear regression analysis indicated that these baseline FC predicted the extent of therapeutic improvement.

Conclusion: Intervention with iTBS has demonstrated promising therapeutic effects in the treatment of depression. This study identified FC that correlates with treatment response and could predict improvement in depressive core symptoms.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2100054793).

Background: Autism Spectrum Disorder (ASD) has rising global prevalence and lifelong impacts. We quantified its 1990-2021 burden using Estimated Annual Percent Change (EAPC) trends, decomposition analysis, and the Nordpred model to project burdens to 2045.

Methods: This study analyzed the global, regional, and national ASD burden from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database, assessing prevalent cases, Disability-Adjusted Life Years (DALYs), Age-Standardized Prevalence Rate (ASPR), and Age-Standardized Disability-Adjusted Life Years Rate (ASDR). It used EAPC to analyze trends, decomposition analysis to examine contributors, and the Nordpred model for predictions to 2045.

Results: From 1990 to 2021, prevalent cases rose from 41,929,995.80 to 61,823,539.64, males more affected. ASPR increased from 773.25 to 788.34/100,000, ASDR from 144.51 to 147.56/100,000. The number of DALYs increased by 3.68 million (95 % Uncertainty Interval 3.20-4.10 million) from 1990 to 2021. Middle Socio-demographic Index (SDI) regions saw the largest increases, High SDI regions minimal growth. Among 21 GBD regions, high-income Asia Pacific grew fastest, Oceania declined. Nationally, Japan, South Korea, and Singapore had the highest 2021 ASPR/ASDR, Bangladesh, Brazil, and Nepal the lowest. Decomposition analysis showed population growth drove prevalent cases and DALYs increases, aging caused declines. Predictive models estimate 71,782,946 cases by 2045, DALYs peaking at 13,365,467 years. ASPR and ASDR expected to peak in 2029 (792.16/100,000) and 2034 (148.55/100,000), then decline.

Conclusion: The rising ASD burden requires immediate action, particularly in middle SDI regions and high-income Asia Pacific, where growth is speeding up. Early intervention and equitable resource distribution for high-risk groups like males and fast-growing populations are essential to cut projected case and DALY increases by 2045.

Background: Suicide is increasing among adolescents and young adults worldwide, so its prevention is a topic of great educational interest. In this context, several prevention programs have been developed. However, this problem continues to increase among young people.

Methods: The objective of this study is to systematically analyze the concordance between the risk factors addressed in suicide prevention programs in school settings and the suicide risk factors (RFs) described in the literature (systematic and meta-analyses). Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol, this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the code CRD42023431649. After launching the search algorithm in the various databases, Web of Science (WOS), SCOPUS, Education Resources Information Center (ERIC), ProQuest Psychology, and PubMed, duplicate references were removed using the bibliographic reference management software Zotero. Two independent researchers assessed their possible eligibility. A third judge resolved any disagreements on the inclusion/exclusion of the selected articles. For the quality assessment, the Joanna Briggs Institute (JBI) was employed. Finally, 24 articles published between January 1, 2000, and February 1, 2025, were selected. The data extraction and qualitative analysis were divided in three phases: (1) Scoping umbrella review of suicide risk factors; (2) Systematic review of suicide risk factors addressed in child and adolescent suicide prevention programs and their efficacy; (3) Systematic analysis of the concordance between suicide risk factors found in the literature of systematic reviews and meta-analyses and their inclusion in prevention programs.

Results: The risk factors more frequently addressed in the programs are anxiety, depression, peer support, and social relationships. Sexual orientation and bullying/cyberbullying are two risk factors whose role in adolescence is crucial and which are barely or not addressed in current prevention programs. Multi-modal interventions provide the best indicators of effectiveness. In addition, the inclusion of working with the family appears to be a component that affects the effectiveness of the programs. A relationship was found between a higher number of risk factors addressed in the programs and their effectiveness.

Conclusion: There is a need to update and create new programs for Generation Z and Alpha students.

Background: Schizophrenia is a heterogeneous mental health disorder associated with severe disability. Approximately 30% of patients do not respond to pharmacological treatment, a condition known as treatment-resistant schizophrenia (TRS). Emerging digital solutions could help to improve the treatment of this population. Although the importance of characterising the patient journey (PJ) is widely recognised, and previously published in schizophrenia, this has never been done in patients with TRS to identify their specific needs and select digital approaches to fill the healthcare gaps. Therefore, this study aimed to (1) characterise the PJ in patients with TRS, (2) determine the key needs of these patients, and (3) identify digital solutions that could help to address those needs.

Methods: Three focus groups were constituted: (1) patients with TRS (n = 6); (2) informal caregivers (n = 4); and (3) social/healthcare professionals (n = 16). An advisory board (n = 11) was also created. We used the PJ and patient experience (PEx) methodologies, which place the user experience at the centre of the process. A five-step process was used to define the PJ, to identify patient and caregiver archetypes, to determine the needs and preferences of patients and caregivers, and to identify solutions (technological and others) to address those needs.

Results: We identified the archetypes of patients with TRS and informal caregivers. Nine stages of the PJ were identified: previous symptomatology; emergency care; hospitalization; therapeutic guidelines; outpatient care; diagnosis; disorder control; exacerbations; and risk behaviours. Six key needs were identified: better care during emergencies; improved understanding of the disorder and adverse events; better communication during diagnosis; better control and monitoring of the disorder; better identification of early warning signs; and immediate professional attention. Twenty-six specific initiatives aimed at improving the PEx and care processes were defined.

Conclusions: This study characterised the PJ in patients with TRS. The findings of this study reveal the key areas of the recovery process that need improvement. Importantly, we developed a set of twenty-six specific initiatives to improve clinical outcomes. The main need identified by participants was for non-pharmacological interventions.

Trial registration: ClinicalTrials.gov NCT05345977.