Annals of General Psychiatry最新文献

Extensive care needs, including frequent hospitalizations and compulsory care, are common among individuals with personality disorders (PD), yet the outcomes of such interventions remain uncertain. This study aimed to explore patient perspectives on the individual and structural factors contributing to the high demand for psychiatric interventions. Eleven high-care-consuming patients diagnosed with PD were interviewed, and data were analyzed using interpretative phenomenological analysis. The findings indicate that emergency department visits often stem from emotional turmoil and social isolation, reflecting acts of desperation. Participants described inpatient treatments as impersonal, lacking direction, and primarily focused on repeated pharmacological interventions that exacerbated feelings of hopelessness. Both inpatient and outpatient care were perceived as "a state of waiting for something that never happens," reflecting an ongoing sense of invalidation and unmet needs. These results highlight the urgent need for healthcare systems to prioritize individualized care plans, improved communication, and explore alternative approaches for managing crises or reforming emergency department practices for this group of patients. Addressing these factors could enhance patient well-being, reduce self-destructive tendencies, and alleviate reliance on the mental health system.

Background: Oxidative stress is associated with the pathophysiology of schizophrenia. Peripheral non-enzymatic antioxidants can reflect the degree of oxidative stress and antioxidant levels, and can be used as markers of oxidative stress. However, the relationships between these markers and the clinical phenotypes of first -episode adolescent-onset schizophrenia (AOS) is unclear. This study aimed to elucidate the impact of peripheral non - enzymatic antioxidants on male AOS patients and their association with clinical symptoms.

Methods: Serum albumin (ALB), total bilirubin (TBIL), and uric acid (UA) of 59 first-episode AOS patients and 55 healthy controls were measured respectively. Furthermore, schizophrenia-related clinical symptoms were evaluated using the five-factor model of the Positive and Negative Syndrome Scale (PANSS).

Results: In Han Chinese first-episode male AOS patients, levels of TBIL and UA were significantly increased (p < 0.05), while ALB decreased (p < 0.01) compared with healthy controls. Furthermore, multivariate logistic regression showed that UA, ALB, and TBIL (all p < 0.01) were independently associated with AOS. Moreover, correlation analysis revealed that ALB was positively correlated with the PANSS total, cognitive and excited factor scores (all p < 0.05); TBIL was positively correlated with the excited factor score (p < 0.01); UA was positively correlated with the PANSS total, negative, cognitive and excited factor scores (all p < 0.05). In addition, Receiver operating characteristics assessment indicated that ALB and TBIL could effectively distinguish AOS patients from healthy controls.

Conclusions: This study confirms the association of peripheral non-enzymatic antioxidants (ALB, TBIL, and UA) with clinical manifestations and pathophysiology in schizophrenia. ALB and TBIL may serve as potential biomarkers for oxidative stress and symptom severity in AOS, particularly in males, providing insights for diagnostic and therapeutic strategies.

Background: This study aimed to examine if individuals diagnosed with dissociative disorder (DD) are at a higher risk of suicidal acts compared to individuals without DD.

Methods: We conducted a matched cohort study by examining electronic health records of patients admitted to Hong Kong public hospitals between January 1, 1993, through December 31, 2022. The study included 716 patients with DD and a matched comparison cohort of 716 individuals. Participants were tracked until they either received a diagnosis of suicidal acts, died from other causes, or until the end of 2023, whichever happened first. Cox proportional hazards regression models were applied to determine the risk of suicidal acts following DD onset.

Results: During the 30-year study period, 87 individuals (12.2%) in the DD cohort and 29 individuals (4.1%) in the comparison cohort exhibited suicidal acts, with the difference being statistically significant (χ² = 25.21, p = 0.0001). The incidence rates of suicidal acts were 86.7 and 27.3 per 10,000 person-years for the DD and comparison cohorts, respectively. After adjustment, the hazard ratio for suicidal acts in the DD cohort compared with the comparison cohort was 1.89 (95% confidence interval, 1.17-3.06).

Conclusions: DD is linked to a heightened risk of suicidal acts. Future research is required to replicate these findings and to more comprehensively identify the specific risk factors contributing to suicidal acts in this patient population.

Benzodiazepines (BZDs) are a widely prescribed class of psychoactive drugs known for their rapid anxiolytic, anticonvulsant, and sedative effects. Introduced as safer alternatives to barbiturates, BZDs quickly gained popularity across clinical settings but have since become a subject of public health concern due to rising rates of misuse, dependence, and overdose, particularly when co-administered with opioids. This narrative review explores the historical development, pharmacologic mechanisms, clinical indications, and adverse outcomes associated with BZD use, while highlighting emerging areas of research such as pharmacogenetics (PGx) and genome-wide association studies (GWAS). BZDs act as positive allosteric modulators of the GABA_A receptor, enhancing inhibitory neurotransmission. This mechanism underlies both their therapeutic efficacy and their potential for physiological dependence and misuse. Clinical applications span acute anxiety, insomnia, seizure management, and alcohol withdrawal; however, long-term use carries significant risks including cognitive decline, fall-related injuries, paradoxical excitation, and withdrawal syndromes. Reinforcement and neuroadaptation processes within the mesolimbic dopamine system contribute to BZD addiction, especially with chronic exposure. Regulatory responses include Schedule IV classification under the Controlled Substances Act and FDA black box warnings. Despite declining prescription rates in recent years, misuse, including nonmedical use and use of illicit designer BZDs, remains prevalent, especially among older adults and those with comorbid psychiatric or substance use disorders. Pharmacogenomic studies have identified genetic polymorphisms in hepatic enzymes (e.g., Cyp2c19 and Cyp3a4) and GABA_A receptor subunits (e.g. Gabra2) that may influence BZD metabolism, efficacy, and addiction vulnerability, suggesting potential for personalized medicine approaches. In conclusion, the dual nature of BZDs, as essential tools in acute care and potential contributors to substance use disorders, demands a balanced, evidence-informed approach. Continued research, improved prescriber education, and integration of genetic insights into clinical care may help mitigate harm while preserving therapeutic benefit.

Objectives: This study aims to evaluate perceived social support (SS) in inpatients with mental disorders, its association with sociodemographic and clinical characteristics, and its impact on hospitalization patterns, highlighting the importance of evaluating and enhancing SS.

Methods: This hospital-based study, using a cross-sectional design, was conducted at the Psychiatric Clinic of University Hospital Larissa, Greece and included 280 consecutive admitted patients. SS was assessed with short form social support questionnaire SSQ-6, and sociodemographic and clinical characteristics were examined along with possibility of reentry during a 32-month period.

Results: Most respondents reported low SS levels, with significant differences in SS quantity across diagnostic categories. Sociodemographic factors, including age, work status, housing conditions, medical insurance and the number of cohabitants, were significantly associated with both SS quantity and satisfaction. Clinical factors, including diagnosis, illness duration and prior admissions also showed significant associations with both dimensions of SS. Multivariate analysis identified increasing age, urbanicity, homelessness, retirement, and unemployment as independent risk factors for lower SS quantity, while cohabitation and affective disorder diagnoses were protective factors. Regarding SS satisfaction, homelessness, retirement, and prolonged illness duration, emerged as risk factors, while medical adherence was protective. Notably, SS quantity was marginally negatively associated with involuntary type of admission. Low SS significantly increased the likelihood of readmission during the 32- month follow-up period.

Conclusions: The study highlights the critical role of assessing and enhancing SS in hospitalized patients with mental disorders. Sociodemographic and clinical factors significantly influence SS, with poor SS contributing to a higher risk of involuntary admission and increased readmission likelihood.

Background: Dyslipidemia and inflammation play key roles in the pathophysiology of depression and are significantly associated with the plasma atherogenic index (AIP). However, a reliable biomarker for diagnosing depression remains elusive. The hsCRP/HDL-C ratio, combining C-reactive protein (hs-CRP) and high-density lipoprotein cholesterol (HDL-C), may serve as a potential composite indicator.

Objective: This study aims to explore the relationship between the hsCRP/HDL-C ratio and depression.

Methods: NHANES data (2015-2020) from 10,357 participants were analyzed. Depression was assessed using the PHQ-9, and dyslipidemia with AIP. Participants were grouped based on their hsCRP/HDL-C ratio. Statistical methods included Student's t-test, chi-square test, logistic regression, restricted cubic spline (RCS) model, and mediation analysis.

Results: RCS regression analysis showed a nonlinear relationship between the hsCRP/HDL-C ratio and depression. The two-piece logistic regression model was used to calculate the threshold effect, and the likelihood ratio test (p < 0.05) indicated that the inflection point for hs-C/H was 11.608. When the hsCRP/HDL-C ratio was below this threshold, a positive correlation with depression was observed (OR: 1.04, 95% CI: 1.01-1.07). When the hsCRP/HDL-C ratio was equal to or greater than the threshold, a negative correlation was found (OR: 0.99, 95% CI: 0.97-1.00). Subgroup analysis showed consistent results, with marital status being the only factor that significantly influenced this relationship. Mediation analysis revealed that AIP partially mediated the relationship between hsCRP/HDL-C ratio and depression, explaining 11.2% of the total effect (95% CI: 2.26%-27.00%).

Conclusions: A higher hsCRP/HDL-C ratio is associated with increased depression risk. Interventions targeting CRP levels and lipid abnormalities may help reduce this risk.

Background: Treatment-resistant depression (TRD) remains a major clinical challenge worldwide and across the Gulf Cooperation Council (GCC) countries, where the burden of mental health disorders continues to rise. Conventional TRD therapies, including antidepressants, augmentation strategies, and electroconvulsive therapy (ECT), often result in incomplete remission and are associated with significant adverse effects, highlighting the need for innovative therapeutic approaches.

Objective: This narrative review explores the mechanisms, clinical evidence, regional adoption, and recent advances of ketamine, esketamine, and rTMS in TRD, while examining barriers to implementation and outlining future directions for care in the GCC.

Key findings: Esketamine adoption is increasing in the GCC, with the United Arab Emirates (UAE) and Qatar leading implementation efforts. In both countries, esketamine and related treatments are currently administered in controlled clinical settings within leading psychiatry clinics. Region-specific governmental strategies, such as Qatar's national mental health initiatives, have further supported the structured introduction of these therapies. rTMS is also being gradually integrated into regional mental health services, with notable expansion through private providers in the UAE and Hamad Medical Corporation (HMC) in Qatar. Despite these advancements, access remains limited due to regulatory challenges, high costs, and infrastructure constraints. Implementation of these therapies may serve as a foundation for future regional mental health policies, although cultural stigma, limited insurance coverage, and workforce shortages continue to pose barriers.

Conclusions: Novel therapies for TRD demonstrate clinical efficacy and feasibility in the GCC. Nevertheless, their wider adoption requires addressing accessibility challenges, reducing stigma, and expanding professional training. Strategic investments, policy reforms, and awareness initiatives will be critical to embedding these treatments into mental health systems and transforming TRD care in the region.

Introdcution: Negative symptoms are a central feature of the schizophrenia spectrum and also appear subclinically in healthy individuals, being associated with poor functional outcomes. Although clinician-rated measures remain the gold standard, self-report tools offer efficiency and a direct insight into subjective experiences.

Objective: This study presents the development and validation of the Negative Symptoms Anticipation Scale (NSAS), a novel self-report instrument designed to assess anticipatory cognitions related to negative symptoms.

Method: In a pilot study, an initial 28-item version was refined to a final 16-item version organized into three factors: [Kirkpatrick B, Fenton WS, Carpenter WT, Marder SR 1;32(2):214-9:2006] Anticipation of Social Difficulties [Sicras-Mainar A, Maurino J, Ruiz-Beato E, Navarro-Artieda R 14(1):225:2014], Anticipation of Relationship Difficulties, and [Stahl SM, Buckley PF 115(1):4-11:2007] Anticipation of Low Energy in Daily Activities.

Results: In a community sample (N = 3,237), the NSAS demonstrated excellent internal consistency (α = 0.927; ω = 0.926; α ordinal = 0.949) and test-retest reliability, as well as a robust factor structure confirmed via confirmatory exploratory analysis (CFI ≥ 0.997; RMSEA ≤ 0.025). Factorial invariance was established across gender and age, and ROC curve analysis indicated outstanding predictive ability for identifying individuals at risk for transitioning to psychosis (AUC = 0.905). Convergent validity was supported by moderate to high correlations with established measures of negative symptoms and negative schizotypy. Hierarchical linear regression showed that, when controlling for social anhedonia and depression, the anticipatory component contributed approximately 7-25% of the variance in negative symptoms.

Conclusions: These findings support the validity of the NSAS and suggest that its application could facilitate early detection and intervention in psychosis.