Actas espanolas de psiquiatria最新文献

Aims/background: Patients with bipolar disorder experience lipid metabolism disorders and endocrine dysregulation, which may affect emotional regulation, behavioural habits and cognitive function. This study aimed to investigate the correlations amongst lipid metabolism indicators, thyroid hormone levels, and manic episodes, aggressive behaviours, cognitive function and disease severity in patients with bipolar disorder.

Methods: This retrospective analysis included 656 patients with bipolar disorder admitted to Wuhan Mental Health Center. Baseline data, including manic symptoms (Young Mania Rating Scale), aggressive behaviours (Modified Overt Aggression Scale), cognitive function (Montreal Cognitive Assessment), disease severity (Clinical Global Impressions-Severity), lipid metabolism indicators {total cholesterol (TC), triglycerides (TGs), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and thyroid hormone levels [thyroid-stimulating hormone (TSH), total triiodothyronine (T3), total thyroxine (T4), free triiodothyronine (FT3) and free thyroxine (FT4)]}, were collected through electronic medical records.

Results: No statistically significant differences were observed in serum TC, LDL, TSH, T4 or FT3 levels between the manic episode group and the non-manic group (p > 0.05). However, the manic episode group exhibited significantly higher serum TG, T3 and FT4 levels (p < 0.05) and significantly lower HDL levels (p < 0.05) than the non-manic group. No significant differences were observed in serum TC, TG, HDL or LDL levels between the aggressive behaviour group and the non-aggressive group (p > 0.05). However, the aggressive behaviour group showed significantly higher TSH, T4, T3, FT3 and FT4 levels (p < 0.05) than the non-aggressive group. No significant differences were observed in serum TC, TG, LDL, TSH, T4, T3 or FT3 levels between the cognitive impairment and normal cognition groups (p > 0.05). However, the cognitive impairment group had significantly lower HDL and FT4 levels (p < 0.05) than the normal cognition group. No statistically significant differences were observed in the serum levels of TC, TG, HDL, LDL, TSH, T4, T3, FT3 or FT4 between the moderate and severe bipolar disorder groups (p > 0.05).

Conclusion: Changes in lipid metabolism indicators and thyroid hormone levels in patients with bipolar disorder are closely related to manic episodes, aggressive behaviours and cognitive dysfunction, but no correlation was found with disease severity. This evidence supports precision management of bipolar disorder by utilizing specific lipid and thyroid hormone profiles to guide cardiovascular screening, aggression risk assessment, and early detection of cognitive decline.

Background: Practical clinical training is a crucial part of undergraduate medical education. Assessing students' satisfaction with this training is essential for improving education programmes. While research has often focused on student satisfaction with general or theoretical education, studies on practical clinical training remain more limited. This article presents the development of a questionnaire to assess medical students' satisfaction with clinical rotations and its validation in a psychiatric clerkship.

Methods: An initial draft of the Undergraduate Rotation Satisfaction Questionnaire (URSQ) was based on a literature review, and was refined in several phases, including structured reviews by panels of psychiatric and education experts. Exploratory factor analysis was performed using principal component analysis (PCA). Internal consistency (Cronbach's alpha coefficient) and test-retest reliability were calculated.

Results: The resulting questionnaire was piloted with 30 sixth-year students who had completed their psychiatry rotation in three hospitals affiliated with the University of Valencia. It was then distributed to all sixth-year medical students completing their psychiatry rotations in these hospitals during the 2023/24 academic year (total potential n = 235). Factor analysis revealed a cohesive two-factorial structure. The final questionnaire included nine quantitative and five qualitative items. Cronbach's alpha was 0.841, and the test-retest Cohen's kappa coefficients were ≥0.444.

Conclusions: The URSQ is a valid and reliable tool to help universities assess student satisfaction with their psychiatry training programmes.

Delirium is a clinically significant complication in paediatric oncology that often leads to diagnostic delays. This case describes a 12-year-old boy with high-risk B-cell acute lymphoblastic leukaemia who developed acute neuropsychiatric symptoms, including agitation, hallucinations, seizures, and fluctuating mood states. Initially misdiagnosed with paediatric bipolar disorder, the patient was treated with antipsychotics and sedatives with limited effects. Notably, the hyperactive symptoms transitioned to a hypoactive state following the discontinuation of meropenem. This case illustrates the diagnostic challenges in distinguishing delirium from psychiatric disorders in paediatric settings, especially in the context of complex medical treatments. The case highlights the need for greater clinical awareness, routine delirium screening using validated tools, and careful evaluation of the neurotoxic potential of multiple medications in paediatric oncology patients.

Background: Anxiety and depression are widespread mental health disorders with substantial global influence. dietary exposures have been proposed as modifiable risk factors of these diseases, but their causal relationships remain uncertain. This study aimed to elucidate the causal effects of specific dietary exposures on the risks of anxiety and depression using Mendelian randomisation (MR).

Methods: Two-sample MR analysis was performed using summary-level data from large-scale genome-wide association studies of European populations. Nineteen dietary exposures, including beef, cereals, tea, non-oily fish and unsalted peanuts, were analysed. Causal estimates were obtained using the inverse variance weighted (IVW) method, MR-Egger regression and weighted median approach. Sensitivity analyses were conducted to assess heterogeneity and horizontal pleiotropy.

Results: High consumption of beef (odds ratio [OR] = 0.95, 95% confidence interval [CI]: 0.9182-0.9854, p < 0.01) and cereals (OR = 0.99, 95% CI: 0.9723-0.9982, p = 0.026) was associated with a reduced risk of depression, Whereas high tea consumption (OR = 1.01, 95% CI: 1.0009-1.0176, adjusted p = 0.029) was linked to an increased risk. Regarding anxiety disorders, non-oily fish intake (OR = 1.01, 95% CI: 1.0024-1.0121, p < 0.01) was positively associated with this risk, whereas unsalted peanuts (OR = 0.98, 95% CI: 0.9527-0.9986, p = 0.038) showed a protective effect.

Conclusions: This MR study provides genetic evidence supporting the role of specific dietary exposures in influencing the risks of anxiety and depression. The findings highlight the potential of targeted dietary interventions in the prevention and management of mental health disorders.

Background: Major depressive disorder (MDD) is a prevalent neuropsychiatric condition associated with significant functional impairment and reduced quality of life. Environmental enrichment (EE), a model encompassing cognitive, social, and physical activities, has demonstrated antidepressant effects in animal models through mechanisms involving brain plasticity. In humans, the influence of EE on depressive symptoms and its clinical significance remain under investigation. This study evaluated the relationship between EE domains and the clinical symptoms of MDD, focusing on the possible modulatory effects of EE on depressive symptomatology.

Methods: We conducted an observational, cross-sectional study involving 50 adults diagnosed with MDD. Depressive symptoms were assessed using the 17-items Hamilton Depression Rating Scale (17-HDRS), and EE levels were measured using the Environmental Enrichment Indicator (EEI), which evaluates cognitive, social, and physical activity domains. Correlations between depressive symptoms and EEI domains were analyzed.

Results: Participants with higher 17-HDRS scores generally exhibited lower levels of EE. Additionally, individuals with more severe depressive symptoms were less likely to engage in cognitive activities compared to those with milder symptoms; however, this difference was not statistically significant (Kruskal-Wallis test, H = 3.82, df = 2, p = 0.14). Notably, higher EE levels were observed among younger participants.

Conclusions: The level of EE in individuals with depression may affect symptom severity. Further studies in clinical populations are needed to clarify the relationship between EE and depressive symptoms.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has exacerbated mental health difficulties among couples. Factors such as chronic physical illness, perceived threat of COVID-19, dyadic coping, and relationship quality may influence levels of psychological distress, including symptoms of anxiety, depression, and stress. This study aimed to examine how these individual and relational variables are associated with psychological outcomes in cohabiting couples during the first national lockdown in Portugal.

Methods: A mixed-methods study was conducted with a sample of 956 individuals (83.9% women), aged 18 to 81 years (M = 40.76, SD = 10.42), living with a romantic partner for at least one year. Participants completed validated self-report instruments: Depression, Anxiety, and Stress Scales - 21 Items (DASS-21) to assess anxiety, depression, and stress; the Brief Illness Perception Questionnaire (B-IPQ) to evaluate COVID-19 threat perception; the Perceived Relationship Quality Component - Short Version (PRQC-SV) to assess relationship quality; and the Dyadic Coping Inventory (DCI) to measure dyadic coping. Hierarchical linear regression and fuzzy-set Qualitative Comparative Analysis (fsQCA) were used to examine associations between variables. The study received prior approval from the Ethics Committee of the Faculty of Psychology and Educational Sciences of the University of Coimbra.

Results: The regression models accounted from between 17% to 21% of the variances of the dependent variables. In the case of the Qualitative Comparative Analysis (QCA) models, the models explained between 11% and 85% of the cases. Hierarchical regression models (HRMs) showed that COVID-19 threat perception and relationship quality were significantly associated with mental health outcomes. In QCA models, low threat perception and high relationship quality and coping skills correlated with lower psychological distress.

Conclusions: Chronic illness was not significantly associated with psychological distress when compared to COVID-19 threat perception, relationship quality, and dyadic coping. These insights are vital for managing mental health of couples during crises. By underscoring the importance of threat perception, relationship quality, and coping for psychological well-being management during health crises, this study offers valuable insights for supporting couples through periods of adversity.

Background: The escalating prevalence of mental health issues and sleep disturbances among Chinese adolescents has become a pressing public health concern. Despite increasing recognition of this issue, there remains a paucity of research elucidating the intricate interplay between anxiety symptoms and sleep patterns. To address this critical gap, this study employs advanced network analysis to explore the complex relationships between these two domains, offering novel insights into their interconnectedness.

Methods: We conducted a large-scale, online, cross-sectional survey encompassing 48,074 adolescents. Anxiety symptoms were assessed using the Generalised Anxiety Disorder Scale-7 (GAD-7), while sleep quality was evaluated via the Pittsburgh Sleep Quality Index (PSQI). Daytime sleepiness and fatigue symptoms were measured using the Chinese Adolescent Daytime Sleepiness Scale and the Fatigue Symptom Scale (FSS). Demographic data were analysed using chi-square tests, and continuous variables were examined via t-tests. To investigate symptom-level relationships, we employed network and mediation effect analysis, providing a robust methodological framework.

Results: Our findings reveal a concerning prevalence of anxiety and insomnia symptoms among adolescents, at rates of 32.1% and 39.9%, respectively. Adolescents exhibiting anxiety symptoms reported significantly higher levels of insomnia, fatigue, and daytime sleepiness. Mediation effect analysis uncovered a chain mediation pathway, whereby insomnia and fatigue symptoms sequentially mediated the relationship between anxiety and daytime sleepiness. Network analysis further identified GAD2 (uncontrollable worry) and PSQI7 (daytime function) as pivotal core symptoms, with FSS (fatigue symptoms) demonstrating the highest expected impact within the network.

Conclusions: This study underscores the persistent severity of anxiety and sleep pattern disturbances among adolescents. These findings highlight the importance of addressing core symptoms-particularly GAD2 and PSQI7-in therapeutic interventions. The results provide a solid foundation for developing more effective, symptom-specific strategies to improve adolescent mental health and sleep quality.

Aims: Visceral adipose tissue (VAT) is associated with major depressive disorder (MDD) in observational studies, but these findings are susceptible to confounding and reverse causation. This study employed a two-sample Mendelian randomisation (MR) approach to assess the causal relationship between VAT and MDD.

Methods: We selected 221 single nucleotide polymorphisms associated with VAT mass in 325,153 individuals of European ancestry from UK Biobank as instrumental variables. Summary-level genetic data for MDD (59,851 cases and 113,154 controls) were accessible from the Psychiatric Genomics Consortium database. Primary MR analysis used the inverse-variance weighted (IVW) method, with weighted median and MR-Egger approaches as sensitivity analyses. Additional tests, including MR-Pleiotropy RESidual Sum and Outlier (PRESSO) and leave-one-out analysis, were conducted to evaluate pleiotropy and robustness.

Results: Genetically predicted higher VAT was significantly associated with increased MDD risk (odds ratio (OR) 1.179, 95% confidence interval (CI) 1.082-1.285, p < 0.001) based on IVW analysis. Sensitivity analyses yielded consistent results (weighted median OR 1.269, 95% CI 1.139-1.414, p < 0.001; MR-Egger OR 1.330, 95% CI 1.023-1.728, p = 0.034). Heterogeneity was observed (Cochran's Q = 353.14, p < 0.001), with no evidence of horizontal pleiotropy (MR-Egger intercept p = 0.342).

Conclusion: Our findings supported a causal relationship between increased VAT mass and elevated MDD risk. These results suggested that reducing VAT may be a potential strategy for preventing or mitigating MDD.

There is a need for new medications in the treatment of bipolar disorders. One such prospect is the development of ligands for the trace amine-associated receptors (TAARs). There are six functional TAARs in humans (TAAR1, TAAR2, TAAR5, TAAR6, TAAR8 and TAAR9), four of which are expressed at low levels in key areas of the limbic system. Ulotaront is a TAAR1 agonist that has advanced to Phase III with Food and Drug Administration (FDA) breakthrough status in schizophrenia. The drug is now also undergoing clinical development for both major depressive disorder (MDD) and generalized anxiety disorder (GAD). Herein, we review all currently available data that link the TAARs with common abnormalities in bipolar disorders. Some members of the TAAR family regulate fundamental neurological functions such as plasticity, adult neurogenesis, response inhibition, in addition to dopamine and serotonin signaling. This constitutes a theoretical basis for transdiagnostic applications. The evidence particularly favors the TAARs as novel targets in the treatment of bipolar disorders, thus warranting a dedicated effort at drug discovery.

No abstract present.