Psychiatry research communications最新文献

Background

Early adversity (EA) predicts later internalizing, and trait diatheses also play a role in how this risk manifests. However, research is mixed on whether these factors function independently or interactively. Furthermore, recent work questions whether three trait diatheses thought to be distinct—neuroticism, dysfunctional attitudes, and brooding rumination—may be modeled as a single latent negative emotionality factor. The present study tests if brooding rumination and dysfunctional attitudes are better modeled with neuroticism as part of negative emotionality, as opposed to separate constructs, and whether negative emotionality and EA interact to predict latent internalizing or operate independently.

Methods

768 emerging adults (71.1% minoritized race/ethnicity) completed self-report surveys for this study. Latent moderated structural equation models were conducted to test associations between EA, trait diatheses, and internalizing.

Results

Brooding rumination and dysfunctional attitudes were best modeled as latent factors separate from—but highly correlated with—latent neuroticism. Latent trait diatheses and EA did not significantly interact to predict internalizing symptoms; however, there were significant main effects of latent brooding rumination and neuroticism. Although EA and dysfunctional attitudes had significant associations with internalizing when examined alone, their effects were negligible once neuroticism and brooding rumination were included in models.

Conclusions

Our findings suggest neuroticism most strongly confers risk for internalizing, which may help to inform preventive intervention efforts.

Patients with Borderline Personality Disorder (BPD), particularly with comorbid trauma-disorders, show an attentional bias towards angry facial expressions. This is often interpreted to reflect increased anxiety and sensitivity to social threats. Given BPDs severe problems in reacting to and interpreting social communication, we investigated whether this threat bias extends to social orienting. Using a gaze-cueing task, we assessed whether centrally presented dynamic fearful and happy gaze stimuli promote the detection of peripherally presented targets. Groups with BPD (N = 50) and other personality disorders (OPD, N = 51) were compared to healthy controls (HC, N = 46), and evaluated on the independent influence of traumatic experience, trait anxiety and trait anger. Across groups we find reliable gaze-cueing. In line with earlier evidence, trait anxiety predicts faster detection of targets signaled by a fearful gaze in HCs. This threat bias is however not present in BPDs and OPDs, thus the threat bias in BPD does not extend to social orienting. Instead, self-experienced trauma predicts amplified gaze-cueing in BPDs, but reduced gaze-cueing in OPDs. This not only emphasizes the importance of evaluating trauma exposure in personality disorders, but also suggests that the childhood adversity typically associated with the development of BPD promotes increased social orienting.

Postpartum Depression (PPD) is one of the most common conditions in the childbearing period, with prominent impairments for the mother and the newborn. Esketamine has shown potent antidepressant effects and appears to be a promising agent in preventing PPD. We aimed to evaluate the potential effect of esketamine in preventing PPD within the first week and within four and six weeks post-delivery as the primary outcome; assess changes in the Edinburgh Postnatal Depression Scale (EPDS) one week and 42 days post-delivery; and evaluate tolerability and changes in inflammatory markers as secondary outcomes. A subanalysis was conducted considering different intervention protocols. A systematic review and meta-analysis (ID: CRD42024513598) were performed considering Randomized Clinical Trials (RCTs) in MEDLINE (PubMed), Embase, and Web of Science from inception until May 5, 2024. The ROB-2 tool assessed the risk of bias. Eleven RCTs were included, totaling 2316 participants. The occurrence of PPD was significantly lower in the intervention group within one week post-delivery (RR 0.44, 95% CI 0.30–0.64, p < 0.01; z = −4.25, tau² = 0.1531, I² = 54%, p = 0.03) and within four/six weeks post-delivery (RR 0.56, 95% CI 0.39–0.76, p < 0.01; z = −3.55, tau² = 0.1444, I² = 60%, p < 0.01). The presence of dizziness, drowsiness, and nausea was not significantly different between groups. Changes in EPDS score within one week post-delivery were not statistically significant and neither were changes 42 days post-delivery. No significant differences in inflammatory marker levels were found. Our updated meta-analysis suggests that esketamine is an effective agent in preventing PPD within six weeks post-delivery.

Introduction

Patients with bipolar disorder (BD) face disproportionate rates of cardiovascular disease. While several mechanisms have been proposed for this association, both are multifactorial and heterogeneous illnesses, and it is unlikely that any individual factor can account for a significant portion of their association. Potential mediators have been mostly studied in isolation even though they are interrelated. Furthermore, few studies have accounted for baseline cardiovascular functioning or burden of illness.

Methods

We sought to analyze the association between burden of illness, phase of the illness (e.g., depressive) and heart rate variability (HRV) in 48 patients diagnosed with BD using canonical correlation analysis. We hypothesized that the association between burden of illness and HRV measures would be different depending on the clinical phase (i.e., euthymia, depression or (hypo)mania).

Results

A longer duration of (hypo)manic episodes was associated with higher rates of hypertension and increased sympathetic activation, along with lower rates of migraine and family history of suicide. In the second canonical variable, a later age at onset of (hypo)manic episodes was associated with higher parasympathetic activity.

Limitations

Small sample size; while the magnitudes of correlations for these top functions were large, none of the models were statistically significant.

Conclusions

There are different dimensions to the association between burden of illness and HRV in BD. The first dimension could comprise higher sympathetic activation in the context of longer (hypo)manic episodes, with lower rates for clinical variables that have been associated with a predominant depressive polarity (e.g., family history of suicide and migraine).

Sleep problems are common in individuals with ADHD; however, the exact underlying mechanism is unknown. I Data from the Lundbeck Foundation Initiative for Integrative Psychiatric Research (N = 27,076), the Taiwan Biobank (N = 2373) and the Hamamatsu Birth Cohort for Mothers and Children (N = 726) were used for analysis. Linkage disequilibrium score-based genetic correlation showed a genetic correlation between melatonin secretion and ADHD diagnosis (r_g[SD] = -0.134 [0.012], P < 0.001). Polygenic risk score analyses revealed that genetic variants related to melatonin secretion were associated with ADHD symptoms (beta [SD] = -0.077[0.033], P = 0.019). Dysregulation of melatonin secretion may be associated with the risk of ADHD.

Sex and gender differences in childhood trauma (CT) and its relationships with symptom profiles were examined in 77 patients with first-episode schizophrenia spectrum disorders compared to 64 controls. In patients, but not in controls, we found independent associations of sex vs. gender with abuse vs. neglect. In patients, there were also sex and gender differences in age of onset and psychopathology. Sex-specific associations between CT and symptom profiles were also found. Our results indicated that the assessment of both sex and gender provides a more nuanced insight into CT associations with symptoms compared to sex in isolation.

Patients with a diagnosis of Borderline Personality Disorder (BPD) often experience difficulties in psychosocial functioning, which reduces the ability of individuals to engage socially. This review seeks to determine whether atypical antipsychotics (AAPs) are more effective than placebo at alleviating these difficulties in adults with a diagnosis of BPD.

We identified six Randomized Control Trials, conducted between 1994 and 2024, with 1012 patients that were treated with either: Olanzapine, Quetiapine, Ziprasidone or Aripiprazole. Using a meta-analysis, we found evidence that atypical antipsychotics induce a small improvement treating psychosocial functioning in patients with a diagnosis of border line personality. In particular, AAPs improved General Assessment of Functioning (GAF) more than placebo. Combining GAFs P-values from several studies indicated this effect was significant. AAPs were also superior to placebo at improving quality of interpersonal relationships, occupational functioning and family life. There was a positive improvement tendency in social life and leisure activities. AAPs also induced known secondary effects like weight gain and sedation as previously described.

AAPs were beneficial for improving general functioning and its subcomponents. However, the magnitude of the benefit above that of placebo was small and its clinical meaningfulness is thus debatable. More randomised-controlled trials are required.

Veterans' suicide rates exceed those of non-Veteran adults, and Veteran suicides more often involve firearms. However, the relationship between Veteran characteristics and suicide method is not well understood. Using the Veteran Health Administration suicide prediction algorithm, we assessed differences in suicide method by predicted risk among Veteran suicide decedents. Significant predictors of firearm involvement included lower algorithm-predicted suicide risk, no recent suicide attempts, male sex, and older age. Non-firearm methods were most common at high tiers of suicide risk. Firearm safety counseling is important for all Veterans and non-firearm lethal means safety counseling may be particularly important for high-risk Veterans.

Recent studies have documented that post-traumatic stress disorder (PTSD) symptoms are robustly associated with depressive symptoms and may mediate the relationship between trauma exposure and depressive symptoms. However, no study has explored the differential mediating effects of four specific PTSD symptom clusters. This study made the first attempt to examine the mediating effects of different PTSD symptom clusters on the linkage between trauma exposure and depressive symptoms. We analyzed data from two large samples of Chinese middle school students (N = 693 and 957) who had experienced the 2013 Ya'an earthquake. Participants completed standardized measures of trauma exposure, PTSD symptoms, and depressive symptoms. The prevalence of probable PTSD was 3.4% and 3.6%, respectively, in the two samples. Mediation analyses revealed that negative alterations in cognitions and mood and alterations in arousal and reactivity were statistically significant mediators in the relationship between trauma exposure during the earthquake and depressive symptoms. The results are very consistent in both samples. The findings suggest that symptom-specific tailored management of these two specific PTSD symptom clusters might have the potential to change the trajectory of developing depressive symptoms among trauma-exposed populations.

Regardless of baseline psychiatric symptom severity, individuals can improve from psychotherapy, including from low-intensity psychosocial treatments. We conducted a secondary analysis of a randomized trial of low-intensity mindfulness interventions to explore if and how specific indices of baseline symptom severity were associated with well-being trajectories during treatment and follow-up. In the original study, participants (N = 4, 411) with physical and mental health conditions were randomly assigned to one of two low-intensity mindfulness interventions (eight-session mindfulness-based cognitive therapy or a three-session mindfulness intervention). In this secondary analysis, we pooled across treatment groups and stratified participants into subgroups based on self-reported baseline levels of anxiety, depression, and social functioning. We used linear mixed effects models and descriptive trajectory plots to evaluate differences in well-being trajectories between subgroups. Baseline symptom severity was associated with well-being trajectory such that those with more severe anxiety, depression, or social functioning at baseline had generally lower well-being across time. All subgroups experienced initial improvement in well-being during the treatment period, though individuals with worse symptom severity tended not to sustain improvements and rebounded back towards baseline well-being levels during follow-up. These data suggest that, for individuals with more severe mental health symptoms, eight or three-session mindfulness-based interventions may still be clinically useful (as patients with more severe symptoms in this study were able to experience initial improvement in well-being from such interventions). However, for such patients, offering these mindfulness-based interventions for a longer duration may have prevented symptom rebounding.