Annals of General Psychiatry最新文献

Background: Increased levels of emotion dysregulation and impulsive behavior are overlapping symptoms in adult Attention-Deficit/Hyperactivity Disorder (aADHD) and Borderline Personality Disorder (BPD), both symptom domains reflecting on inhibitory control, although from different angles. Our aims were to describe their differences in the above conditions, investigate their associations with childhood traumatization, and to explore the potential mediation of emotion dysregulation and impulsivity between childhood traumas and personality functioning.

Methods: Young adults between 18 and 36 years diagnosed with aADHD (n = 100) and BPD (n = 63) were investigated with structured clinical interviews, while age-matched healthy controls (n = 100) were screened for psychiatric disorders. Patients with aADHD-BPD comorbidity were excluded from further analyses. The Difficulties in Emotion Regulation Scale, the Barratt Impulsiveness Scale, the Level of Personality Functioning Scale, and the Childhood Trauma Questionnaire-Short Form were administered to investigate trait measures and childhood traumatization, respectively. Behavioral impulsivity and delay aversion were assessed using selected tests of the Cambridge Neuropsychological Test Automated Battery, and a computerized decision-making paradigm based on the Rogers decision-making task, respectively.

Results: Significantly higher levels of emotion dysregulation and impulsivity were present both in the aADHD and BPD groups, however with different profiles. Waiting and stopping impulsivity was selectively higher among aADHD patients compared to healthy controls. The BPD group reported higher levels of emotion dysregulation in all domains, and demonstrated increased delay aversion among uncertain conditions in decision-making. Higher levels of childhood trauma were associated with emotion dysregulation, trait impulsivity, and delay aversion across groups. Emotion regulatory capacity played a significant mediating role between childhood traumatization and the level of personality functioning.

Conclusions: Inhibitory control profiles of the aADHD and BPD groups were divergent. Childhood traumatization was associated with lower levels of personality functioning in adulthood, independently of diagnosis, an effect mediated more by emotion dysregulation, rather than impulsivity. These findings have various clinical implications for the treatment of aADHD and BPD, including psychoeducation, pharmacological interventions, and psychotherapy targeting specific symptom domains.

Background: Seizure threshold increases with age and the frequency of electroconvulsive therapy (ECT). Therefore, therapeutic seizures can be difficult to induce, even at maximum stimulus charge with available ECT devices. Such cases are known as difficult-to-induce-seizures electroconvulsive therapy cases (DECs). However, no clinical guidelines exist for DECs; thus, clinicians often face difficulties determining treatment strategies. This study aimed to obtain a consensus among clinical experts regarding the treatment of DECs.

Methods: We asked Japanese ECT experts to rate 14 approaches under six conditions of DECs on a 9-point Likert scale (1 = "disagree" to 9 = "agree"). Based on responses from 195 experts, the approaches were classified as first-line (95% confidence interval mean ≥ 6.5), second-line (mean, 3.5-6.5), or third-line strategies (mean < 3.5). Approaches rated 9 points by at least 50% of the respondents were considered "treatments of choice."

Results: To avoid difficult seizure induction, dose reduction of benzodiazepine receptor agonist (BZRA) (8.33 ± 1.25), dose reduction or discontinuation of antiepileptic drugs (AEDs) or other drugs that may make seizure induction difficult (8.16 ± 1.18), and ensure hyperventilation (7.95 ± 1.47) were classified as treatments of choice. First-line treatment strategies were BRZA discontinuation (7.89 ± 1.45), stimulation timing adjustment (7.00 ± 2.00), and anesthetic dose reduction (6.93 ± 1.94). Dose reduction or discontinuation of AEDs or other drugs that might make seizure induction difficult and ensure hyperventilation were the treatments of choice across all patient conditions. The results of rating approaches for patients with mood disorders and schizophrenia were similar, with differences observed among the approaches for patients with catatonia, high risk of cognitive impairment, and cardiovascular events.

Conclusions: ECT expert recommendations are useful and can assist in clinical decision-making. Our results suggest that while some strategies are applicable across all conditions, others should be tailored to meet the specific needs of patients. These recommendations should be further evaluated in future clinical studies.

Background: Foreign language syndrome is a rare neuropsychiatric phenomenon typically following general anesthesia. To date, foreign language syndrome has not been associated with neuroleptic malignant syndrome (NMS) in the literature. This case aims to broaden the clinical understanding of NMS by presenting an atypical manifestation of foreign language syndrome and emphasizing the need for prompt recognition of such presentations for accurate diagnosis and management.

Case presentation: A 34-year-old Caucasian male with a history of schizoaffective disorder and recurrent psychiatric hospitalizations was admitted for a depressive episode. His condition worsened hours after the administration of intramuscular chlorpromazine, leading to NMS characterized by agitation, muscle rigidity, hyperthermia, autonomic instability, abnormal laboratory findings, and altered mental status, including foreign language syndrome. Management included the discontinuation of the prior psychopharmacotherapy, intravenous hydration, and medications (biperiden, lorazepam). The patient showed significant improvement, with resolution of NMS symptoms and normalized sleep patterns by the time of discharge.

Conclusion: Foreign language syndrome is an exceptionally rare occurrence, with only nine documented cases to date, all involving male patients. This case presents a novel instance of foreign language syndrome in the context of NMS in a male patient, providing insight into the potential sex-specific mechanisms underlying this rare phenomenon. This case adds valuable evidence to the understanding of the clinical spectrum of NMS and highlights the importance of recognizing atypical presentations in managing patients with neuropsychiatric conditions.

This randomized-controlled study evaluates the effectiveness of a newly developed social cognition rehabilitation intervention, the modified Social Cognition Individualized Activity Lab (mSoCIAL), in improving social cognition and clinical and functional outcomes of persons with schizophrenia recruited in two Italian sites: University of Campania "Luigi Vanvitelli" in Naples and ASST Fatebenefratelli-Sacco in Milan. mSoCIAL consists of a social cognitive training module focusing on different domains of social cognition and of a narrative enhancement module. We assessed changes in social cognition, clinical characteristics and functional variables in patients with schizophrenia who participated in 10 weekly sessions of mSoCIAL or received treatment as usual (TAU). A paired-sample t test and a repeated-measures MANOVA were used to investigate respectively within and between-group differences. Twenty people with schizophrenia were blindly assigned to mSoCIAL and 20 to TAU. After 10 weeks, mSoCIAL significantly improved disorganization, emotion recognition, functional capacity and real-life functioning. As compared to TAU, the mSoCIAL group showed a significant improvement in minimal and enriched social inference domain of theory of mind, and in key domains of real-life functioning (interpersonal relationships, everyday life skills, and work skills). mSoCIAL improved social cognition and real-life functioning of people with schizophrenia. These results highlight the importance of social cognition deficit treatment in schizophrenia and the necessity for these interventions to be multifaced and personalized. Such an approach ensures that improvements in social cognition translate into enhanced functional outcomes.Trial registration NCT05130853, registered on 24 November 2021.

Background: Dissociative amnesia, a disorder characterized by impairments in multiple memory areas, is frequently associated with trauma. Complex post-traumatic stress disorder (CPTSD) is marked by mood dysregulation, negative self-concept, and impaired interpersonal relationships, in addition to the classic symptoms of post-traumatic stress disorder (PTSD). The relationship between CPTSD and dissociative amnesia, as well as whether CPTSD should be considered a dissociative subtype, remains uncertain in the literature. Individuals diagnosed with CPTSD tend to exhibit higher levels of dissociative symptoms than those diagnosed with PTSD.

Clinical presentation: We present the clinical report of a 42-year-old male who, after a car accident, exhibited core symptoms of PTSD along with symptoms of self-organization disorders. While these symptoms persisted, the patient developed dissociative amnesia years after the trauma. Neuroimaging studies, psychometric tests, reviewed hospital records, and clinical interviews were conducted to speculate on the differential diagnosis of organic psychiatric conditions and potential diagnoses. The possible relationship between dissociative amnesia and complex post-traumatic stress disorder was examined.

Conclusion: This case demonstrates the complexity of differentiating dissociative amnesia from organic conditions. Discussing the possible shared mechanisms between CPTSD and dissociative amnesia could contribute to a better understanding of both conditions.

Background: Mood instability, characterized by sudden and unpredictable mood shifts, is prevalent in psychiatric disorders and as a personality trait. Its association with gastrointestinal diseases has been recognized but remains poorly understood in terms of causality.

Methods: This study aims to investigate the causal relationship between mood instability and a spectrum of gastrointestinal diseases by univariable and multivariable mendelian randomization analysis. The exposure and outcome data were retrieved from the IEU open GWAS database, the UK biobank and the FinnGen study. Instrumental variables were selected to meet relevance, independence, and exclusion restriction criteria. GWAS datasets for mood instability and 28 gastrointestinal diseases were utilized, incorporating diverse populations and genders. Univariable and multivariable Mendelian randomization analyses were conducted using R software. MR statistics from different datasets for the same disease were meta-analyzed to maximize the study population.

Results: In univariable MR analysis, genetic predisposition to mood instability showed significant associations with increased risk for several gastrointestinal diseases, including: gastroesophageal reflux disease, gastric ulcer, acute gastritis, irritable bowel syndrome, internal hemorrhoids, cirrhosis, cholecystitis, cholelithiasis, acute pancreatitis, chronic pancreatitis. In multivariable MR analysis, after adjusting for major depression, bipolar disorder, anxiety disorder, and schizophrenia, associations with the following gastrointestinal diseases remained statistically significant: internal hemorrhoids, cirrhosis, acute pancreatitis, chronic pancreatitis.

Conclusion: This study provides compelling evidence for a potential causal relationship between mood instability and certain gastrointestinal diseases underscoring the importance of considering mood instability as a potential risk factor for gastrointestinal diseases as well as the positive role of maintaining mood stability in the prevention of gastrointestinal disorders.

Opioid Use Disorder (OUD) is a pervasive and devastating public health crisis that continues to take a heavy toll on individuals and communities across the United States. In 2021, approximately 473,000 veterans misused opioids in the past year. In the context of their military service and post-service life, Veterans with OUD often encounter unique barriers to recovery, including the reintegration into civilian society and the pursuit of stable, meaningful employment. The path to recovery from OUD is inextricably linked to the restoration of a stable and purposeful life, a fact underscored by the interplay of substance use, mental health, and employment outcomes. These factors necessitate a comprehensive approach to treatment that extends beyond mere pharmacological interventions. One such approach is Individual Placement and Support (IPS), a well-established evidence-based practice that focuses on supporting individuals with severe mental illness in their pursuit of competitive employment. The primary objective of this manuscript is to describe a two-arm, multi-site RCT designed to rigorously evaluate the efficacy of IPS when provided to veterans with OUD and provide the baseline demographics and characteristics of the participants who have enrolled to date. The central hypothesis guiding this research is that IPS can significantly improve vocational, psychosocial, and treatment outcomes of veterans in recovery from OUD, ultimately leading to a more successful reintegration into civilian life. Our study is timely as the VA has expanded IPS services to veterans with SUD this past year. Thus, this study is one of the first to examine IPS in a subpopulation of veterans with a SUD and may provide actionable data to support sustainment of IPS with this population.

Aims: Non-suicidal self-injury (NSSI) is a serious issue that is increasingly prevalent among children and adolescents, especially in rural areas. Developing a suitable predictive model for NSSI is crucial for early identification and intervention.

Methods: This study included 2090 Chinese rural children and adolescents. Participants' sociodemographic information, symptoms of anxiety as well as depression, personality traits, family environment and NSSI behaviors were collected through a questionnaire survey. Gender, age, grade, and all survey results except sociodemographic information were used as relevant factors for prediction. Support vector machines, decision tree and random forest models were trained and validated by the train set and valid set, respectively. The metrics of each model were tested and compared to select the most suitable one. Furthermore, the mean decrease Gini index was calculated to measure the importance of relevant factors.

Results: The prevalence of NSSI was 38.3%. Out of the 6 models assessed, the random forest model demonstrated the highest suitability in predicting the prevalence of NSSI. It achieved sensitivity, specificity, AUC, accuracy, precision, and F1 scores of 0.65, 0.72, 0.76, 0.70, 0.57, and 0.61, respectively. Anxiety and depression were the top two contributing factors in the prediction model. Neuroticism and conflict were the factors that contributed the most to personality traits and family environment, respectively, in terms of prediction. In addition, demographic factors contributed little to the prediction in this study.

Conclusion: This study focused on Chinese children and adolescents in rural areas and demonstrated the potential of using machine learning approaches in predicting NSSI. Our research complements the application of machine learning methods to psychiatric and psychological problems.

Background: Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal symptoms (EPS), metabolic disorders, sedation, and delirium are particularly worrisome and often associated with psychotropic drugs.

Methods: This observational study investigated the risk for psychotropic drug-related ADRs in older (n = 99,099) and younger adults (n = 363,562) in psychiatric inpatients using data from the German pharmacovigilance program "Arzneimittelsicherheit in der Psychiatrie" (AMSP) from 1993-2016. The aim was to assess whether age influenced the risk of specific ADR types and if certain psychotropic drugs posed particular concerns.

Results: The risk for ADRs did not differ between older and younger patients (relative risk 0.98, 95% confidence interval 0.92-1.05). However, older patients had a higher risk for delirium (2.35, 1.85-2.99), hyponatremia (3.74, 2.85-4.90), and orthostatic syncope (2.37, 1.72-3.26), as well as certain types of EPS, e.g., parkinsonism (1.89, 1.45-2.48) and Pisa-/metronome syndrome (3.61, 2.51-5.18). The risk for other ADRs, such as acute dystonia (0.20, 0.10-0.37), akathisia (0.47, 0.29-0.76), liver dysfunction (0.63, 0.48-0.82), weight gain (0.07, 0.04-0.14), sexual dysfunction (0.03, CI 0.00-0.25), and hyperprolactinemia/galactorrhea (0.05, 0.02-0.17) was significantly lower for older patients. Older patients treated with any type of antidepressant drug (1.33, 1.26-1.40)-especially selective serotonin reuptake inhibitors (1.57, 1.26-1.40) and selective serotonin-norepinephrine reuptake inhibitors (2.03, 1.80-2.29)-and lithium (1.74, 1.52-2.00) had a higher ADR risk than younger patients. Second-generation antipsychotic drugs had a lower (0.74, 0.71-0.77) and low-potency first-generation antipsychotic drugs a higher (1.19, 1.07-1.33) ADR risk in older patients. The risk for ADRs involving multiple drugs was higher in older patients (1.28, 1.22-1.34). ADRs in older patients were 6.4 times more likely to result in death.

Conclusions: Clinicians and pharmacists should be aware of the types of ADRs and high-risk drugs across age groups and provide appropriate monitoring. Pharmacovigilance is crucial in psychiatric patients of all ages and should not be neglected, even for drugs generally considered "safe".

Background: Schizophrenia (SCZ) is a chronic, disabling mental illness with a high disease burden and is often comorbid with metabolic syndrome (MetS). The aim of this study was to determine the prevalence of MetS in young, clinically stable, olanzapine-exposed patients with SCZ and to explore predictive factors affecting the development and severity of MetS.

Methods: A total of 274 patients with SCZ who met the inclusion criteria were enrolled in this study, and their demographic data and general clinical information were collected. Concurrently, patients were assessed for psychopathology, illness severity, and antipsychotic drug-related adverse effects.

Results: The prevalence of MetS in the target population was 35.77%, and the MetS subtype of abdominal obesity + high triglycerides + low level of high-density lipoprotein cholesterol accounted for the majority of patients in the MetS subgroup. Binary logistic regression showed that body mass index (BMI), uric acid (UA), thyroid-stimulating hormone, and QT-c interval could significantly and positively predict the development of MetS. Multiple linear regression showed that olanzapine concentration, BMI, and UA could significantly and positively predict higher MetS scores.

Conclusion: This study reports the clinical patterns of MetS in young, clinically stable, olanzapine-exposed patients with SCZ and identifies the correlations influencing the development and severity of MetS. These findings could potentially be applied toward the prevention of and intervention in MetS.