Psychiatry research communications最新文献

Oxcarbazepine is often utilized off-label for bipolar and depressive disorders in outpatient settings despite limited evidence. We performed a retrospective chart review on 38 adult outpatients diagnosed with bipolar and depressive disorders (ICD-10 codes F30-39), treated with oxcarbazepine by psychiatrists and psychiatric nurse practitioners between 2015 and 2021. Primary outcomes were Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I) scores, assigned retrospectively from clinical documentation. Patients were predominantly female (70%), aged 20–76 (mean 36), with a mean of 1.8 DSM diagnoses (range 1–4) and 1.7 (range 0–5) concurrent psychotropic medications. A starting mean oxcarbazepine dose of 489 mg/day, titrated to a mean final dose of 663 mg/day, was associated with a CGI-I of 2.5 [2.25, 2.75] and a pre-to-post treatment decrease in CGI-S from 3.4 to 2.4. Overall response and remission rates were 52% and 29%, respectively. Limitations of this study include potential sample bias, documentation bias and rater bias among other limitations inherent to retrospective study designs.

Background

Substance dependency is a global problem and significantly affects the geriatric population in the United States. This study aims to determine how self-help group (SHG) attendance affects substance use treatment outcomes among older adults in the US.

Methods

This cross-sectional study used the 2020 discharge treatment episodes data set (TEDS-D)fromthe Substance Abuse and Mental Health Services Administration (SAMHSA). Multivariable logistic regression was used to evaluate the relationship between self-help group attendance and treatment outcomes among older adults.

Results

We included 3,424 older adults (19.2% female). The primary substance use was alcohol in more than two-thirds of the participants (67.9%), while heroin (17.1%), cocaine (5.8%), and other opiates/synthetics (3.3%) were the other common primary substance of abuse among other participants. In the multivariate logistic regression analysis, SHG attendance at discharge from treatment facility was significantly associated with reduced frequency of use of primary substance -FUPS (p-value = 0.013) and increased odds of treatment completion (p-value <0.001) but no significant association with arrests at discharge from treatment facility (p-value = 0.101). SHG attendance on admission into treatment facility was associated with reduced odds of treatment completion (p-value <0.001). Having a living arrangement at discharge was found to be associated with reduced FUPS (p-value <0.001) but with lower odds of treatment completion (p-value <0.001).

Conclusion

Association of SHG attendance with positive treatment outcomes indicates the need to enhance access to this service in the geriatric population.

Recent research suggests that delusional ideation (DI) may have social component to its phenomenology and underlying mechanisms. This study investigated associations between delusional ideation and factors of social imagery in healthy adults using the COVID-19 pandemic as a context of increased social threat perception. 1,854 participants completed an online survey. DI was assessed using the Peters Delusional Ideation (PDI) scale, and social imagery was investigated using the Other Experiences Questionnaire (OEQ, felt presence), the Liebowitz Social Anxiety Scale (LSAS), the Interpersonal Reactivity Index (IRI, empathy), and the UCLA Loneliness Scale. All aspects of social imagery were positively associated with DI. The strongest predictor of PDI score was felt presence, followed by loneliness, LSAS social fear dimension, IRI (empathic concern and empathy for fictional characters) scales. We propose that delusions and social imagery may share common mechanisms and increased propensity for imagining others may contribute to development of delusions.

The purpose of this study was to conduct a naturalistic assessment of the efficacy of four distinct fast tranquilization techniques (intramuscular haloperidol, midazolam, haloperidol plus promethazine, or haloperidol plus midazolam) over a period of 12 h. The sample included 1603 people who were psychiatric emergency room patients at Hospital Geral de Palmas in Brazil between January 2018 and June 2022. The primary outcome was the number and proportion of patients who achieved the ideal response of the rapid tranquilization concept: tranquil without sedation in all assessments (measure by BARS scale), without restraint, without additional medication and without side effects. The secondary outcomes were mild agitation, tranquil or asleep over 12 h, the need for additional medication, use of physical restraints, and side effects. Among all patients, the proportion of rapid tranquilization over 12 h was 14.1% besides (32.9% for haloperidol, 29.2% for midazolam, 4.1% for haloperidol plus promethazine, and 5.4% for haloperidol plus midazolam) there is response some time in 97%. Logistic regression assessed the rapid tranquilization concept with to haloperidol as parameter: midazolam Exp(B) = 0.718 (95% CI 0.362–1.421), p = 0.341, had no difference; haloperidol plus promethazine Exp(B) = 0.011 (95% CI 0.004–0.026), p < 0.001] and haloperidol plus midazolam Exp(B) = 0.019 (95% CI 0.07–0.050) p < 0.001] had higher chance to fail. Secondary outcomes are described in manuscript. Data suggest that the use of monotherapy should be encouraged, and the use of associations does not produce better results to reach rapid tranquilization over 12 h.

We examined the associations between metabolic syndrome (MetS) and neurocognitive function in patients with first-episode schizophrenia spectrum disorders (FES) compared to controls assessed using the Repeatable Battery for the Assessment of Neuropsychological Status. In patients, psychopathology was assessed using the Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia. First, we found illness- and domain-specific associations between the individual MetS features and neurocognitive performance in patients, but not in controls. Second, body mass index and total cholesterol levels were lower in patients than controls, which in turn correlated with increased global psychopathology severity and cognitive deficits. Third, negative symptoms moderated the association between low HDL cholesterol and poorer immediate verbal memory performance in patients. Our findings suggest that distinct lipid profile alterations are associated with cognitive performance and psychopathology severity in patients with FES. Further studies are needed to explore the associations of MetS with neurocognition over time, as well as how these relationships are affected by socio-demographic and clinical factors, including depression, anxiety, and related psychopathology.

Substance misuse in individuals with psychiatric disorders is associated with worsening symptoms and hospitalization. The present retrospective, observational study analyzed inpatient psychiatry hospital EHR data from 2013 to 2020 (N = 12,742) in patients with co-occurring psychiatric disorders and substance misuse. Substance use was categorized as cannabis-only, alcohol-only, or illicit/poly-substance. Two outcome variables were evaluated using multiple-regression: (1) Global Assessment of Functioning (GAF) Score at admission, and (2) 30-day readmission rate. Covariates included primary Axis I disorder, living situation, Race/Ethnicity, education, sex, age, and total same-hospital readmissions (>30 days). Controlling for all covariates, the cannabis-only group had (1) significantly higher GAF score at admission (less severity) vs. both other groups; and (2) lower 30-day readmission rates vs. the illicit/poly-substance use group only. Post-hoc analyses revealed the results for the cannabis-only group vs. other drug use groups were robust, holding across all primary psychiatric diagnoses. Study limitations included lack of formal SUD diagnosis, lack of information in the EHR to quantify substance use patterns, retrospective study design, and lack of data to examine an appropriate psychiatric inpatient group free of substance misuse. Results are discussed in terms of the putative therapeutic efficacy of THC and cannabidiol on modulation of sleep, anxiety, and agitation.

Attentional bias (AB) has been identified as a cognitive mechanism underlying cigarette use. Recent studies suggest that attentional fluctuation between vigilance and avoidance is an important cognitive deficit related to various psychopathologies. This study aimed to examine the role of AB in cigarette and Electronic Nicotine Delivery System (ENDS) use in young adults. Results indicated that ENDS users showed greater temporal attentional fluctuation towards ENDS stimuli compared to cigarette users and non-smokers. Attentional fluctuation predicted the ENDS use status. Attentional fluctuation may be a potential risk factor associated with ENDS use among this population.

Melancholia represents a particular subtype of depressive symptomatology. Unlike Major Depressive Disorder (MDD), Melancholia has not been conclusively associated with peripheral inflammation, although there may be some methodological reasons confounding that finding. To overcome some of those methodological limitations, the correlation between one index of peripheral inflammation (C-Reactive Protein: CRP) and Melancholia was investigated in a community sample of 40 male and 51 female participants (aged 18–75 years) who provided a blood sample and self-report data on an established measure of Melancholia (MEL). Results indicated that females had significantly higher concentrations of CRP than males, and that there were different patterns of association between the MEL items and CRP for males and females. Although the predominant differences were for the MEL symptoms of cognitive confusion (females only) and feelings of low self-worth (males only), each sex had distinct networks of associations between CRP and the eight MEL items used here. These findings may provide some explanation of the lack of clear results regarding the CRP-Melancholia link in the previous literature, and also argue for development of clinical assessment and treatment approaches that differ for males and females.

This study aimed to establish evidence of the psychometric properties of the Centre for Epidemiologic Studies Depression Scale Revised – Vietnamese Version (CESDR-V) for use among adolescents in Vietnam. We selected 1084 Grade-10 students in Hanoi using a multiple-stage sampling method. The factorial structure of the CESDR-V was evaluated using exploratory factor analysis. Internal consistency was tested using Cronbach's alpha coefficient. Measurement invariance between male and female participants was tested using multiple group confirmatory factor analysis. Convergent and divergent validity were tested using Pearson's correlation coefficients between CESDR-V and the Depression Anxiety and Stress Subscales of Depression (DASS21-D), Anxiety (DASS21-A), and Stress (DASS21-S) and a measure of mental well-being, Mental Health Continuum Short Form (MHC-SF). The CESDR-V was found to be unidimensional. Cronbach's alpha coefficient of CESDR-V was 0.92. All levels of measurement invariance between male and female participants for the CESDR-V were supported well. The CESDR-V was positively correlated with DASS21-D at stronger levels (convergent pattern) than with DASS21-A/DASS21-S (discriminant pattern). The CESDR-V was negatively correlated with MHC-SF at a lower level than with the DASS21 subscales (discriminant pattern). This study strongly supports the use of the CESDR-V to screen for depression in adolescents in Vietnam who are attending school.

Problems with sleep appear a key feature in psychological distress emerging as suicidal thoughts at its worst. As part of a nationwide health examination study on 4387 participants, aged 18–97 years, we analyzed, whether suicidal thoughts during the past 7 days as scored on the Hopkins Symptom Checklist were associated with current sleep disturbances including difficulties in falling or staying asleep, daytime tiredness, loss of sleep over worry, insufficient sleep, and the usage of sleeping pills. In the stepwise regression analysis of the recent suicidal thoughts, the current daytime tiredness showed the significant association most robustly, whereas by adding clinically relevant information to analysis, the current difficulties falling or staying asleep, the use of mental health services during the past 12 months, and the level of education predicted the recent suicidal thoughts significantly. To conclude, recent suicidal thoughts were significantly associated with current sleep disturbances.