Actas espanolas de psiquiatria最新文献

Background: The COVID-19 pandemic has represented a traumatic event for the general population, being associated with significant levels of uncertainty for the future, anxiety and depressive symptoms, especially in the first months of the health crisis. The adoption of strict containment measures, lockdown and interruption of all unnecessary activities have had a significant impact on the mental health of the general population. Moreover, the COVID-19 pandemic has been considered a very stressful event (which could be defined as ''traumatic''), being associated with significant morbidity and mortality and being completely unpredictable. Based on such premises, we conducted a systematic review of the available literature in order to identify all studies providing epidemiological data and statistics on the prevalence and characteristics of post-traumatic stress disorder (PTSD) in the general population during the COVID-19 pandemic.

Methods: An extensive literature search has been conducted across PubMed, Scopus, and Web of Science from the inception of each database until 15 November 2024.

Results: Forty-one papers have been included in the review; the majority of the studies have been conducted in Italy and China. A significant heterogeneity in prevalence rates, ranging from 0.5% to 70.2%, and psychometric tool used was found. The most common risk factors for developing PTSD in the framework of the COVID-19 pandemic included: female gender, social isolation, impact on daily routine. The most relevant protective factor includes older age.

Conclusions: Future research should aim to standardize assessment tools and criteria to enhance the comparability and reliability of findings in the field of trauma-related research studies.

Background: Brain-derived neurotrophic factor (BDNF) plays a key role in the pathophysiology of depression and the mechanism of action of antidepressants. This study aimed to evaluate the changes of BDNF in patients with depression and how it is affected by antidepressant treatment through meta-analysis.

Methods: Multiple databases (including PubMed, Embase and China National Knowledge Infrastructure (CNKI)) were searched for studies on BDNF levels in patients with depression published up to November 15, 2024. Meta-analyses of serum and plasma BDNF levels were performed using RevMan 5.4.1, with the effect sizes expressed as mean differences (MD) and 95% confidence intervals. Heterogeneity was assessed using I2 statistics (random-effects model if I2 ≥ 50%; fixed-effects if I2 < 50%).

Results: Serum BDNF levels in patients with depression were significantly lower than those in healthy controls [MD = -1.54, 95% confidence intervals (CI) (-2.85 to -0.24), p = 0.02]. Antidepressant drug treatment for 6 weeks significantly increased serum BDNF levels [MD = 7.42, 95% CI (1.10-13.74), p = 0.02], but the effect of 4 weeks of treatment was not statistically significant. Plasma BDNF levels showed no statistically significant differences between depressed patients and healthy controls (p > 0.05). Sensitivity analysis indicated that the meta-analysis results were robust and not unduly influenced by any single study.

Conclusion: Serum BDNF levels serve as potential biomarkers in patients with depression, but their sensitivity to short-term antidepressant treatment is limited.

Background: Post-traumatic stress disorder (PTSD), comorbid with traumatic brain injury (TBI), severely affects the mood state of patients. Trimethylamine N-oxide (TMAO), one of the key intestinal flora metabolites, strongly correlates with TBI. This study aimed to explore the role of TMAO in the development of TBI-related PTSD and assess its predictive significance.

Methods: This study included 120 TBI patients treated at the Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital between February 2022 and April 2024. The clinical data were obtained from the hospital's medical record system. Patients were divided into a PTSD group (n = 56) and a non-PTSD group (n = 64) based on the post-traumatic stress disorder self-rating scale (PTSD-SS). Furthermore, patients in the PTSD group were divided into mild and severe subgroups. Blood samples were collected, and serum TMAO levels were assessed. Additionally, the correlation between TMAO levels, PTSD incidence, and PTSD severity was evaluated. The risk factors for PTSD comorbid with TBI and its severity were evaluated using univariate and multivariate logistic regression analyses. Finally, receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic effectiveness of TMAO as a predictive marker for PTSD.

Results: Multivariate analysis showed that female gender, lower per capita monthly household income, depression, anxiety, and higher serum TMAO levels were significant risk factors for PTSD. Depression, anxiety, and higher serum TMAO levels were associated with severe PTSD, and higher per capita monthly household income and intracranial infection were protective factors. Serum TMAO levels were significantly higher in PTSD patients than in non-PTSD patients (p < 0.001), with its level profoundly elevated in severe PTSD patients than in mild PTSD patients. Furthermore, the correlation analysis revealed that TMAO was positively correlated with the severity of PTSD (r = 0.8582, p < 0.0001). ROC curve analysis indicated TMAO's sensitivity of 67.86% and specificity of 93.75% for predicting PTSD, with an area under the curve (AUC) of 0.8175.

Conclusion: Serum TMAO levels were significantly elevated in PTSD patients comorbid with TBI and were closely associated with PTSD severity. Furthermore, TMAO may aid in the early identification of high-risk, severe PTSD patients following TBI, thus helping to optimize intervention strategies.

Objectives: This investigation evaluates the interventional effects of electroencephalogram-based bioelectric stimulation (EBBS) on intellectual development and behavioural symptoms in children with autism spectrum disorder (ASD) and comorbid intellectual disability (ID).

Methods: By utilising a retrospective cohort design, the research team analysed 310 clinically diagnosed cases of ASD and ID that were stratified into two intervention groups: a conventional group (n = 163) receiving conventional interventions (behavioural applied behaviour analysis (ABA) therapy and structured instruction) and an observation group (n = 147) receiving the same behavioural interventions combined with EBBS. Before and following the treatment, the childhood autism rating scale (CARS), Montreal cognitive assessment (MoCA), developmental age and developmental quotient (DQ) and infants-junior middle school students' social-life abilities scale (S-M) were employed to assess symptom alleviation, cognitive capabilities and quality of life. The levels of serum 25-hydroxyvitamin D [25(OH)D], folic acid (FA) and brain-derived neurotrophic factor (BDNF) were also measured.

Results: After treatment, the observation group showed significantly lower CARS scores; increased post-treatment serum levels of 25(OH)D, FA and BDNF; and improved MoCA scores than the conventional group (p < 0.05). Regarding developmental age and DQ, the observation group demonstrated significant improvements in the subscales of fine motor skills, language, adaptive ability and social interaction after intervention (p < 0.05). Additionally, the S-M total scores and all quality-of-life indicators were superior in the observation group (p < 0.05).

Conclusion: EBBS has the potential to collaboratively enhance the cognitive function, behavioural symptoms and quality of life of children with comorbid ASD and ID.

Background: Cognitive impairment is a core feature of schizophrenia, for which pharmacological interventions have limited efficacy. Cognitive remediation (CR) is the gold standard for addressing cognitive deficits, yet its effect remains in the low-to-medium range, thus enhanced treatment approaches are needed. Emerging evidence supports the cognitive benefits of Aerobic Exercise (AE), suggesting that a combined intervention of AE and CR could lead to greater cognitive enhancements. This study aims at evaluating, with a randomized controlled trial, cognitive improvements following a combined intervention of CR+AE, compared to either CR or AE alone in patients diagnosed with schizophrenia.

Methods: Sixty patients with schizophrenia were randomized into three groups (AE, CR, or CR+AE), and assessed for cognition, with the MATRICS Consensus Cognitive Battery at baseline, post-intervention, and at a 3-month follow-up.

Results: CR+AE group showed significantly greater improvements in several domains including attention (p = 0.02), verbal learning (p = 0.03), and working memory (p = 0.04) compared to CR group, as well as processing speed (p = 0.002), verbal learning (p = 0.03), and working memory (p = 0.05) compared to AE group. At 3-months follow-up, evaluating CR+AE vs CR, further significant improvements were observed for social cognition (p = 0.01) in the CR+AE group, as well as for processing speed (p = 0.03) in the CR group.

Conclusions: While preliminary, these findings suggest that a combined intervention of CR+AE allows greater improvements across core cognitive domains. In a wider perspective, this study also underscores the potential value of implementing aerobic exercise in rehabilitative approaches aimed at addressing cognitive dysfunction in schizophrenia.

Background: Children with depression frequently experience sleep disorders, which may significantly impact their cognitive function and quality of life. Investigating the relationship between sleep quality, cognitive performance, and quality of life in this population is essential for developing targeted interventions.

Methods: From February 2022 to January 2024, 78 children diagnosed with depression at the Hunan Children's Hospital were assessed using the 17-item Hamilton Rating Scale for Depression (HAMD-17). Based on their HAMD-17 scores, participants were categorized into mild, moderate, and severe depression groups, with 26 children in each group. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), cognitive function was assessed via the Wisconsin Card Sorting Test (WCST), and quality of life was measured using the 36-item Short Form Health Survey (SF-36). Correlations between PSQI, WCST, and SF-36 scores were analyzed for all groups.

Results: Compared to the control group, the depression group of children with depression had significantly higher levels of depression and significantly lower levels of quality of life, sleep quality, and cognitive function (p < 0.05). Further analysis showed that sleep quality in children with depression worsened with increasing severity of depression, as evidenced by a gradual increase in PSQI scores (p < 0.05). Cognitive function assessment (WCST scores) revealed that with increasing depression severity, the number of classifications completed by children decreased, while the total number of errors, perseverative errors, and non-perseverative errors all significantly increased (p < 0.001). Quality of life assessment (SF-36 scores) showed that increasing depressive symptoms significantly affected the quality of life of children, with an overall significant decrease in scores (p < 0.05). Correlation analysis further revealed that cognitive function was closely related to sleep quality in children with depression. Specifically, the number of classifications completed was significantly negatively correlated with PSQI scores (r = -0.5534, p < 0.0001), while the total number of errors, perseverative errors, and non-perseverative errors were all significantly positively correlated with PSQI scores (r = 0.6769, 0.6988, and 0.6937, respectively, all p < 0.0001). In addition, four dimensions of quality of life (social function, physical function, role function, and cognitive function) were all significantly negatively correlated with sleep quality (r = -0.6866, -0.5309, -0.5823, -0.5698, respectively, all p < 0.0001).

Conclusion: Poor sleep quality in children with depression is positively correlated with poor cognitive function and poor quality of life. Routine evaluation of sleep disturbances in this population can provide critical insights for timely intervention and management.

Background: As an intravenous general anaesthetic, esketamine has rapid and evident antidepressant effects and therefore helps prevent post-partum depression (PPD). This study aimed to observe the effect of intraoperative esketamine application on patients with PPD undergoing caesarean section and to explore whether this effect varies among patients with different personality types.

Methods: A total of 280 patients who underwent elective caesarean section under spinal anaesthesia were randomly divided into esketamine and control groups. On the day before the surgery, each patient was assessed using the Edinburgh Post-partum Depression Scale (EPDS), Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale (SDS) and Eysenck Personality Questionnaire. Additionally, the pressure-pain threshold was measured. The esketamine group received a single intravenous injection of esketamine at a dose of 0.25 mg/kg (diluted to 5 mL and administered intravenously within 10 min after foetus removal). The control group received 5 mL of 0.9% normal saline. The primary outcome was PPD incidence, assessed using the EPDS on the 3rd post-operative day. The secondary outcomes included post-operative pain score and esketamine safety assessment.

Results: Statistically significant differences in PPD incidence were observed among patients with different personality types (introverted unstable, 66.70%; extroverted unstable, 45.50%; extroverted stable, 19.40%; and introverted stable, 15.00%, p < 0.05). The patients with an extroverted-stable personality in the esketamine group had a lower PPD incidence than those in the control group (11.90% vs. 25.70%, p < 0.05). No statistical difference in total PPD incidence was observed between the two groups (35.7% vs. 29.3%, p > 0.05). Pain scores in the esketamine group were lower than those in the control group while at rest (4, 24 and 48 h) and during movement (4 and 8 h) after surgery (p < 0.05). The mean arterial pressure and heart rate in the esketamine group were higher than those in the control group during surgery (p < 0.05).

Conclusion: A single intravenous administration of esketamine had no apparent effect on the overall PPD incidence among patients undergoing caesarean section. It may have a beneficial effect in reducing PPD incidence in patients with an extroverted-stable personality.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2100050976, 09/09/2021, http://www.chictr.org.cn.

Background: Globally, the prevalence of depression among adolescents is on the rise, posing serious societal problems. Dialectical behaviour therapy (DBT) and selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are two commonly employed therapeutic approaches that have shown good clinical outcomes. This study aims to investigate the therapeutic effects of DBT with or without sertraline on adolescent depression.

Methods: This retrospective analysis reviewed 88 cases of adolescent depression treated at our hospital and compared them with 60 healthy adolescents. The patients with depression were divided into three groups: sertraline alone, DBT alone, and combined DBT and sertraline (DBT+sertraline) treatment. In the Sertraline-only and DBT+sertraline groups, sertraline was administered orally for a continuous period of 24 weeks. In the DBT-only and the DBT+sertraline groups, DBT treatment lasted for 13 weeks, followed by an observation period of another 11 weeks. DBT treatment efficacy was evaluated using the Hamilton Depression Rating Scale (HAMD) and the Cognitive Emotion Regulation Questionnaire (CERQ) at baseline and after 5, 9, 13 and 24 weeks of treatment.

Results: Results showed that all three treatment modalities significantly reduced HAMD scores (p < 0.001, η = 0.749). The combined treatment group achieved the fastest reduction in HAMD score at the initial treatment stage. Whilst the Sertraline group showed a pronounced reduction by Week 13, it later exhibited a rebound in scores at 24 weeks, unlike the DBT-containing groups. In terms of emotional regulation strategies, CERQ scores indicated that DBT+sertraline significantly increased positive emotional regulation strategy scores, followed by DBT alone (DBT+sertraline vs DBT, p < 0.001), whilst the sertraline-alone group had the smallest increase (DBT+sertraline vs sertraline, p < 0.001) This pattern was particularly pronounced in the Positive Reappraisal subscale. Negative emotional regulation strategy scores were significantly reduced across all treatment groups, especially for the Self-blame item, with the largest reduction observed in the DBT+sertraline group, followed by the DBT alone (DBT+sertraline vs DBT, no significance) and sertraline-alone (DBT+sertraline vs sertraline, p < 0.001) groups.

Conclusions: This study's findings demonstrate that DBT and sertraline can improve emotional regulation abilities and effectively alleviate symptoms of depression in adolescents. In particular, superior outcomes were observed in the combined treatment group compared to the individual treatment groups. These findings aim to provide guidance and reference for clinicians, mental health professionals, policymakers and families of patients.

Background: Borderline personality disorder (BPD) has a high prevalence, presenting with self-injurious behaviors, suicide attempts and other psychiatric comorbidities. This condition is accompanied by high levels of stigma and self-stigma, driving to deleterious effects on prognosis. The present study aimed to compare demographic and clinical characteristics of women diagnosed with BPD with low and high internalized stigma and to address internalized stigma dimensions severity (disclosure, positive aspects, and discrimination) between the source of perceived stigma.

Methods: A total of 106 women with a diagnosis of BPD were evaluated for sociodemographic data, sources of stigma, the severity of the symptomatology and internalized stigma, evaluated with the Borderline Evaluation of Severity Over Time (BEST) and the Spanish version of King's Internalized Stigma Scale (ISS), respectively.

Results: Participants with high internalized stigma reported greater symptom severity. Regarding the reported sources of stigma, in almost all sources of stigma, discrimination was perceived as greater (p < 0.05) (friends, co-workers, doctors, psychiatrists and nurses) as well as the perceived global internalized stigma (p < 0.05) for friends, co-workers and nursing staff.

Conclusion: It is necessary to address stigmatizing behaviors by health personnel and the support network close to the patient in addition to improving awareness about associated internalized stigma which is related to worse outcomes.

Background: Mild cognitive impairment (MCI) is a critical stage in the development of Alzheimer's disease, and early intervention in patients during this stage may reverse or delay their disease progression. As one of the regions with severe aging in China, it is necessary to understand the prevalence of MCI in Huzhou and adopt effective intervention measures. The study was aimed to investigate the prevalence rate and influencing factors of MCI in the elderly population in Huzhou city.

Methods: A cross-sectional study was conducted involving 800 elderly residents of Huzhou city. The Montreal Cognitive Assessment (MoCA) and the activity of daily living (ADL) were used to assess the occurrence of MCI in the elderly. The influencing factors of MCI were investigated by univariate analysis and multi-factor analysis.

Results: A total of 800 questionnaires were sent out in this survey, and 778 were effectively collected, with an effective recovery rate of 97.25%. Among 778 elderly people in Huzhou city, 668 had normal cognitive function, 82 had MCI, and 28 had dementia, the prevalence rate of MCI was 10.54% (82/778). According to the presence or absence of MCI, the patients were divided into an MCI group (n = 82) and a non-MCI group (n = 668). Female (p = 0.026), high age (p = 0.009), low Community Screening Instrument for Dementia (CSI-D) score (p = 0.007), high Dementia Screening Questionnaire (AD8) score (p < 0.001), high Patient Health Questionnaire Depression Scale (PHQ-9) score (p = 0.037) were all risk factors for MCI in the urban elderly population of Huzhou City.

Conclusion: The prevalence of MCI in the elderly population in Huzhou City is high, and its occurrence is closely related to many factors. It is necessary to increase attention to the high-risk population of MCI and implement targeted intervention measures to improve their cognitive function and improve the quality of life of the elderly population.