Actas espanolas de psiquiatria最新文献

Background: Adolescents with moderate depression and suicidal ideation constitute a high-risk psychiatric population. Major depressive disorder with suicidal ideation in this age group is a disabling psychiatric disorder. Current selective serotonin reuptake inhibitor treatments are limited by their low efficacy rates (approximately 50%-60%) and delayed onset of action. Informed by the gut-brain axis theory, this study aimed to evaluate the synergistic efficacy and anti-inflammatory mechanisms of sertraline combined with a Bacillus subtilis probiotic preparation in this high-risk population.

Methods: This retrospective cohort study included 160 adolescents meeting International Classification of Diseases 10th Revision diagnostic criteria were identified and categorised into either monotherapy (sertraline) or combination therapy (sertraline + probiotics) groups. Over a 12-week treatment period, clinical symptoms were assessed using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and Beck Scale for Suicide Ideation-Chinese Version, and serum inflammatory factors, namely, interleukin-6 (IL-6), interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and C-reactive protein (CRP) and peripheral blood inflammatory ratios, namely, platelet-to-lymphocyte, neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios, were measured.

Results: The proportion of patients with severe depression was significantly reduced in the combination group (1.25% vs. 7.5%, p = 0.004), and anxiety symptoms showed significant improvement (severe anxiety proportion: 1.25% vs. 11.25%, p = 0.008). Biomarker analysis revealed significantly reduced levels of IL-6 (p = 0.007), IL-1β (p = 0.002), TNF-α (p = 0.005) and CRP (p = 0.001) in the combination group, and IL-6 and CRP showed strong positive correlations with depression scores (r = 0.35-0.39).

Conclusions: This study confirms that modulating the intestinal smicroecology can enhance antidepressant efficacy by reducing neuroinflammation.

Background: This study aimed to investigate the effects of a combined approach of continuity of care and family supportive care on cognitive function and self-care ability in patients with Alzheimer's disease (AD).

Methods: The clinical data of 135 patients with AD, who presented to China-Japan Friendship Hospital from April 2021 to April 2023, were retrospectively analysed. On the basis of the sequential introduction of different care protocols at China-Japan Friendship Hospital, the patients were categorised into three groups: the conventional group (n = 42, receiving conventional care), the continuity group (n = 49, receiving conventional care plus continuity of care) and the family group (n = 44, receiving conventional care, continuity of care, and family supportive care). Cognitive function (assessed using the Mini-Mental State Examination and Montreal Cognitive Assessment), self-care ability measured using the Barthel Index (BI), family support evaluated using the Perceived Social Support from Family Scale (PSS-Fa), and quality of life assessed via the Quality of Life in Alzheimer's Disease scale (QOL-AD) were compared across the three groups before and 3 months after the implementation of the respective care protocols.

Results: At the 3-month mark, the family group demonstrated significantly higher BI, PSS-Fa and QOL-AD scores than the continuity and conventional groups, and the continuity group's scores on these measures were significantly higher than those of the conventional group (p < 0.05).

Conclusions: The application of continuity of care combined with family supportive care in patients with AD is associated with positive effects on cognitive function, self-care ability, family support and quality of life. This finding suggests that this integrated care model may represent a superior option for the management of patients with AD. However, given the inherent limitations of retrospective designs in fully controlling for confounding variables, further validation through prospective, large-sample studies is warranted to confirm its efficacy and generalisability.

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder that negatively affects the well-being of both patients and their caregivers. Therefore, the aim of the present study was to identify factors associated with quality of life (QoL) in patients with Parkinson's disease (PPD) and caregiver burden in their primary caregivers (PCG).

Methods: We conducted a cross-sectional study at a tertiary neurological center in Mexico. Assessments included the Parkinson's Disease Questionnaire (PDQ-39); motor severity with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III); cognition with the Montreal Cognitive Assessment (MoCA); depressive and anxiety symptoms with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7); and internalized stigma with the King Internalized Stigma Scale (ISS). Caregiver burden was measured with the Zarit Burden Interview (ZBI).

Results: We included 48 PPD (58.3% male) and 38 PCG (55.3% female). Mean disease duration was 7.3 years [standard deviations (SD) = 4.6; range 1-26 years]. Among PPD, 97.9% were on dopaminergic replacement therapy and 43.8% reported comorbidities. Anxiety severity differed between groups (χ2 = 11.7, p = 0.008). No between-group differences were observed in internalized stigma (ISS total score and subdomains). A significant discrepancy emerged regarding assistance with activities of daily living (ADLs), reported by 63.2% of PCG versus 20.8% of PPD (p < 0.001). Linear regression models showed that poorer QoL in PPD was associated with depressive and anxiety symptoms and motor severity (MDS-UPDRS III) (R2 = 0.47). Caregiver burden in PCG was associated with depressive symptoms and perceived discrimination (ISS subdomain) (R2 = 0.53).

Conclusions: Comprehensive PD management, beyond motor control, should incorporate the evaluation and support of mental health, alongside stigma-reduction strategies, to enhance the well-being of both PPD and their PCG.

Background: Depression affects approximately 280 million people globally and often co-occurs with metabolic syndrome (MetS), a cluster of cardiometabolic risks that increase cardiovascular and diabetes events. This study investigates the associations among depression severity, antidepressant use and MetS components in Chinese adults.

Methods: In this cross-sectional study from a Chinese hospital (2018-2025), electronic medical records of 585 adults (aged ≥18 years, 61.54% female) were analysed using convenience sampling. Depression severity was assessed via Patient Health Questionnaire-9 (PHQ-9) scores (normal: 0-4; mild: 5-9; moderate: 10-14; severe: 15-27). MetS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III criteria (≥three components: hypertension ≥130/85 mmHg, triglycerides >150 mg/dL, high-density lipoprotein cholesterol (HDL-C) <40/50 mg/dL, waist circumference >102/88 cm for men/women and glucose ≥100 mg/dL). Logistic regression was applied to evaluate associations, including serotonin reuptake inhibitors (SSRIs) versus serotonin-norepinephrine reuptake inhibitors (SNRIs).

Results: In this hospital-based cohort, patients with severe depression exhibited a substantially increased odds for clustered MetS (adjusted odds ratio [OR] = 13.461, 95% confidence interval [CI]: 2.461-253.037, p = 0.015 for one MetS component and OR = 2.129, 95% CI: 1.080-4.130, p = 0.027 for two components). Severe depressive symptoms were significantly associated with multiple MetS components, specifically hyperglycaemia (adjusted OR = 2.022, 95% CI: 1.033-4.068, p = 0.043), increased triglycerides (adjusted OR = 2.460, 95% CI: 1.304-4.661, p = 0.005) and reduced HDL-C (adjusted OR = 2.653, 95% CI: 1.397-5.102, p = 0.003). Antidepressant use increased MetS odds (central obesity OR = 3.098, 95% CI: 2.098-4.614, p < 0.001; hyperglycaemia OR = 2.312, 95% CI: 1.566-3.446, p < 0.001), with SSRIs (95.2%, n = 317) being predominant over SNRIs (4.8%, n = 16) but having similar metabolic impacts in subgroups.

Conclusions: Depression severity and antidepressant use are significantly associated with individual components of MetS and their clustering, underscoring the need for personalised metabolic screening in affected patients. Recognising and addressing metabolic abnormalities in individuals with depression are essential to optimise treatment outcomes and mitigate long-term cardiometabolic risks.

Background: Atopic dermatitis (AD) is among the most prevalent chronic pediatric skin diseases. Beyond its cutaneous manifestations, AD imposes substantial psychosocial and economic strain on families. We quantified this burden-i.e., maternal anxiety and quality of life (QoL)-and identified its clinical and sociodemographic determinants, comparing families of children with AD to those of healthy peers.

Methods: This cross-sectional study enrolled 84 mothers of physician-diagnosed patients with AD aged 3-144 months and 90 mothers of age-matched healthy children attending routine visits. Disease severity was graded with the Scoring Atopic Dermatitis (SCORAD) index. Mothers completed the State-Trait Anxiety Inventory (STAI) and the 8-item European Health Impact Scale (EUROHIS-QoL). Additionally, the Dermatological Family Impact Scale (DeFIS) was administered to the AD group.

Results: EUROHIS-QoL scores were lower in the AD group than in controls (p = 0.016), whereas The State-Anxiety Inventory (STAI-S) scores were higher (p < 0.001); the Trait-Anxiety Inventory (STAI-T) scores did not differ (p = 0.125). In multivariable models, patient status (p = 0.006), higher STAI-T (p = 0.002), and greater income (USD 750-1500: p = 0.014; >USD 1500: p = 0.010) were independently associated with QoL. Anxiety was driven by patient status, lower QoL, and higher STAI-T, while trait anxiety was driven by lower QoL and higher STAI-S. SCORAD correlated negatively with QoL (ρ = -0.225; p = 0.040) and positively with STAI-S and DeFIS.

Conclusions: Pediatric AD significantly impairs mothers' QoL and heightens maternal situational anxiety and these effects intensify with increasing disease severity and financial strain. Multidisciplinary, family-centered care, including psychological screening and targeted support for low-income households, is essential for comprehensive AD management.

Background: The aberrant traits of the gut-metabolite-immune network in schizophrenia imply a crucial interrelationship among them. The exploration of the association between the gut-metabolite-immune network and schizophrenia will create novel opportunities for future studies on the disorder.

Methods: This study utilised the Mendelian randomisation (MR) method to examine the causal relationships among gut microbiota, plasma metabolites, immune cells, blood cells, cytokines and schizophrenia. Additionally, mediation analysis was performed to identify and verify potential mediators involved in the pathway linking gut microbiota to schizophrenia.

Results: A total of 62 traits with causal connections to schizophrenia were identified from the gut microbiota, plasma metabolites, immune cells, blood cells and cytokines (11 traits from the gut microbiota [odds ratio (OR) = 0.683-2.104, p = 0.005-0.047], 35 traits from plasma metabolites [OR = 0.596-1.597, p = 0.005-0.049], 14 traits from immune cells [OR = 0.813-1.105, p = 0.005-0.049], 1 trait from blood cells [OR = 1.112, p = 0.038] and 1 trait from cytokines [OR = 0.864, p = 0.041]). Among them, 30 traits were classified as risk factors for schizophrenia. Additionally, we determined nine pathways by which gut microbiota influences schizophrenia (via 7 plasma metabolites and 2 immune cells). Moreover, in our MR analyses, several sensitivity analyses were employed to eliminate heterogeneity and horizontal pleiotropy, ensuring reliable MR results. Meanwhile, the outcomes of various analyses revealed that the gut microbiota most significantly associated with schizophrenia belonged to the Firmicutes phylum.

Conclusions: These discoveries not only deepen our understanding of the pathogenic mechanism of schizophrenia but also offer significant impetus for the development of future diagnostic studies and therapeutic strategies.

Background: A resilience scale tailored for individuals with eating disorders (EDs) could significantly enhance our understanding and treatment of EDs. Therefore, we developed and psychometrically evaluated a new Resilience in Eating Disorders scale (RED) following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

Method: Informed by prior qualitative interviews, the new RED scale underwent an initial pilot test among patients with EDs (n = 52) and field tests among patients with EDs (n = 169), ED-recovered individuals (n = 61), and a normative sample of the general population (n = 349), all aged between 27.9 and 29.8 years and residing in Spain. In this study, the participants completed the RED scale, Resilience Scale-25 (RS-25), Eating Attitudes Test-26 (EAT-26), World Health Organisation Quality of Life Scale - Brief Version (WHOQOL-BREF), and Hospital Anxiety and Depression Scale (HADS). Data were collected at baseline and after 1 year. Alongside machine learning techniques, exploratory and confirmatory analyses were employed to evaluate the reliability, construct validity, convergent validity, known-groups validity, predictive validity and responsiveness of the RED scale.

Results: The original 52-item version of the RED scale was refined to 44 items following the pilot phase, and ultimately reduced to a 5-item version (RED-5) after field testing and psychometric evaluation. The RED-5 demonstrated strong psychometric properties, with excellent model fit indices (Root Mean Square Error of Approximation (RMSEA) = 0.03, and Comparative Fit Index (CFI) = 0.99) and acceptable internal consistency (Cronbach's alpha = 0.71). Additionally, the RED-5 scale effectively predicted quality of life, anxiety, depression, and ED symptomatology over a 1-year period.

Conclusions: The RED-5 is a concise, psychometrically robust scale specifically developed to assess resilience in patients with EDs. It significantly predicts ED symptoms and quality-of-life outcomes, making it a valuable tool for both clinical practice and research. The RED-5 allows for quick administration and easy scoring. It provides mental health professionals with a tool to guide resilience-informed assessment and more personalized treatment planning.

Background: As a result of individual genetic variations, some patients show no response to initial antidepressant medications. This study aims to investigate the association between specific genetic polymorphisms and the efficacy of antidepressant drugs and to improve the accuracy and effectiveness of treatment under the guidance of genetic testing.

Methods: A retrospective screening was conducted on medical records from, Suixian People's Hospital between January 2022 and December 2024. A total 202 patients with depression carrying the CYP2C19 gene were selected after the application of exclusion criteria. They were assigned to three groups in accordance with their genetic metabolism types: the rapid metabolism group (Group A, n = 65), the intermediate metabolism group (Group B, n = 94) and the poor metabolism group (Group C, n = 43). All three groups were treated with sertraline for a six-week treatment cycle. The observation indicators included scores on the Hamilton Depression Scale (HAMD); onset time of drug effect; rates of response and remission; scores on the Clinical Global Impression-Improvement (CGI-I) scale; levels of the neurotransmitter factors 5-hydroxytryptamine (5-HT), γ-aminobutyric acid (GABA) and brain-derived neurotrophic factor (BDNF); incidence of adverse events; and scores on the Morisky Medication Adherence Scale-8 (MMAS-8).

Results: The baseline data of the three groups of patients were comparable before medication (p > 0.05). Compared with those in Groups A and B, patients in Group C showed a significantly greater reduction in HAMD scores (all p < 0.05), along with higher response rates (all p < 0.05) and remission rates (all p < 0.05). Amongst the three groups, Group C had a shorter onset time of drug effect (all p < 0.05); more significant improvement in CGI-I scores (all p < 0.05); and more prominent upregulation of neurotransmitter factors, namely, 5-HT (all p < 0.05), GABA (all p < 0.05) and BDNF (all p < 0.05). Regarding the incidence of adverse events, Group C had the highest rate, whereas Group A had the lowest (10.8% vs. 24.5% vs. 41.9%). Compared with other groups, Group B exhibited a more significant increase in MMAS-8 scores (all p < 0.05).

Conclusions: Metabolic phenotype exerts substantial effects on the therapeutic outcome of sertraline in patients with depression carrying the CYP2C19 gene. Amongst groups, Group C showed better therapeutic efficacy but an elevated incidence of adverse events and lower medication adherence; Group A had relatively poor efficacy; and Group B demonstrated superior adherence. In clinical practice, individualised treatment can be implemented on the basis of CYP2C19 metabolic typing to improve therapeutic efficacy and reduce adverse events and medical burden.

Background: With population ageing, the number of elderly cancer chemotherapy survivors has been increasing. In addition, the elderly often face problems, such as pain, sleep disorders, anxiety and depression, which seriously affect their quality of life. We explored the effects of hospice care on pain, sleep quality, anxiety, depression, quality of life, chemotherapy-related adverse reactions and readmission rate in elderly cancer survivors after chemotherapy to supply evidence for the clinical promotion of this nursing model.

Methods: A total of 240 elderly cancer survivors who completed at least 4 cycles of chemotherapy (January 2022-June 2024) and had a 3-month follow-up were retrospectively enrolled. They were divided into the observation (hospice care + routine nursing, n = 124) and control (routine nursing, n = 116) groups. After 1:1 propensity score matching, 98 cases per group were analysed. Core (Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Short Form-36 Health Survey (SF-36)) and extended indicators (chemotherapy-related adverse reactions, 3-month readmission rate and nursing satisfaction) were compared pre- and postintervention.

Results: Pre-intervention, no significant differences were found between groups (p > 0.05). Post-intervention, the observation group had significantly lower VAS (2.08 ± 0.85), PSQI (5.25 ± 1.32), SAS (38.15 ± 4.15) and SDS (38.86 ± 4.40) scores than the control group (4.68 ± 1.33, 8.92 ± 1.65, 49.32 ± 5.40 and 50.65 ± 5.80, respectively; all p < 0.05). The observation group showed significant improvements in all eight dimensions of SF-36 (p < 0.05), with a larger improvement range than the control group. In addition, the observation group had lower incidence of chemotherapy-related adverse reactions (nausea and vomiting: 8.16%, fatigue: 16.33%), lower readmission rate (7.14%) and higher nursing satisfaction (95.92%) than the control group (24.49%, 31.63%, 19.39% and 82.65%, respectively; all p < 0.05).

Conclusions: Hospice care can effectively alleviate pain, sleep disorders, anxiety and depression in elderly cancer chemotherapy survivors, improve their quality of life, reduce adverse reactions and readmission rate and enhance nursing satisfaction and is thus worthy of clinical promotion.

Background: Professors play a crucial role in the educational process, making their well-being a key area of interest in research on universities as health-promoting settings. The scientific literature emphasizes that various contextual, personal, and behavioral factors have a direct impact on faculty health. To estimate the prevalence of stress, anxiety, and depression among Spanish university professors, and to examine their associations with lifestyle habits and indicators of physical and mental health.

Methods: A cross-sectional study was conducted with 1560 participants (mean age 47.39 ± 11.29 years) from thirteen universities that are part of the Spanish Network of Health-Promoting Universities. The variables assessed included stress, anxiety, depression, burnout, health-related quality of life, physical activity, sedentary behaviour, dietary patterns, sleep quality, and vocal fatigue.

Results: Regression analyses revealed that, across all three outcomes, lower mental well-being, greater emotional exhaustion, and more frequent sleep disturbances were significant predictors of psychological distress. For stress and anxiety, being female and younger also emerged as significant demographic predictors. Stress was additionally associated with increased emotional eating and reduced vocal recovery, whereas anxiety was linked to greater physical vocal discomfort. Depression was predicted exclusively by lower mental well-being, higher emotional exhaustion, and more sleep problems.

Conclusions: The psychological health of university faculty is influenced by a complex interplay of well-being, occupational, and lifestyle factors. Interventions aimed at enhancing emotional regulation, promoting sleep hygiene, ensuring balanced workloads, and providing psychosocial support, along with institutional measures that address early-career vulnerabilities and gender disparities, may help mitigate stress, anxiety, and depression among university professors.