Annals of General Psychiatry最新文献

Background: Depression, characterized by significant psychological and physiological alterations, has been proved to tightly associate with insulin resistance (IR) and hallmarks of biological aging. Phenotypic Age Acceleration (PhenoAgeAccel), which quantifies the discrepancy between biological and chronological age, serves as a robust indicator of accelerated aging. However, the interplay between depression, IR, and accelerated aging remains unclear. This study aims to explore the relationship between depression and PhenoAgeAccel, and the potential mediating role of IR in this association.

Methods: A total of 4,555 adults participants from the National Health and Nutrition Examination Survey (NHANES) database with complete data on depression, PhenoAgeAccel, and other essential covariates were included in this study. Depression severity was assessed by the nine-item Patient Health Questionnaire (PHQ-9), with a PHQ-9 score ≥ 10 used to define depression. Four indicators, including triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), TyG-waist height ratio (TyG-WHTR), and metabolic score for insulin resistance (METS-IR), were used to assess IR. Weighted multivariable linear regression analyses were performed to identify the association of depression/PHQ-9 score with PhenoAgeAccel. Moreover, subgroup analyses, interaction tests, and adjusted restricted cubic spline (RCS) analyses were employed to explore the robustness, stability, and potential nonlinearity of the associations between PHQ-9/depression and PhenoAgeAccel. Additionally, mediation analysis was conducted to investigate the mediating role of IR biomarkers in the association between PHQ-9 score and PhenoAgeAccel.

Results: In the fully-adjusted model, being depressive and one-unit increment in PHQ-9 score were associated with a 1.93-year (95% CI: 0.95-2.92) and 0.14-year (95% CI: 0.07-0.21) increase in PhenoAgeAccel, respectively. A positive linear dose-response relationship between PHQ-9 score and PhenoAgeAccel was identified via RCS analysis (P for overall = 0.001, P_{non-linearity}=0.867). Subgroup analyses and interaction tests revealed a more pronounced association between depression/PHQ-9 and PhenoAgeAccel in subgroups with diabetes, moderate-to-heavy alcohol consumption, and higher education levels (all P_interaction<0.05). IR biomarkers were observed to mediated 3.6-8.4% of the total effect, with METS-IR showing the highest mediation (8.4%, 95% CI: 0.024-0.222).

Conclusions: Depression was associated with accelerated PhenoAgeAccel, with insulin resistance acting as a partial mediator. In depression management, interventions targeting metabolic issues like insulin resistance should also be considered to mitigate depression-associated aging.

Background: There are limited reviews to report the different levels of anxiety and stress symptoms among students studying nursing, pharmacy, and allied health.

Objective: To calculate the global prevalence of different levels of anxiety and stress symptoms among healthcare students and examine the factors that affect the different levels of prevalence estimates.

Methods: A three-step comprehensive search of 10 databases was conducted. Meta-analysis, subgroup analyses, and meta-regression were performed using the meta package in R software. The Newcastle-Ottawa Scale and Grading of Recommendations Assessments, Development and Evaluation criteria were utilised for the quality appraisal of included studies and the certainty of the evidence, respectively.

Results: A total of 112 studies with 42,331 healthcare students across 43 countries were selected. The prevalences of unspecified, mild, moderate, severe, and extremely severe anxiety symptoms were 41% (95% CI: 33-50), 15% (95% CI: 12-19), 22% (95% CI: 19-26), 10% (95% CI: 8-13), 14% (95% CI: 11-17), respectively. The prevalences of unspecified, mild, moderate, severe, and extremely severe stress symptoms were 36% (95% CI: 25-47), 15% (95% CI: 12-18), 32% (95% CI: 25-40), 11% (95% CI: 8-15), 4% (95% CI: 2-5), respectively. A series of subgroup and meta-regression analyses identified geographic region, use of an instrument, type of healthcare students, sample size and study quality were significantly impacted prevalence estimates.

Conclusion: Findings can contribute as evidence to raising awareness about different levels of anxiety and stress symptoms. Early screening and tailored preventive interventions can help eliminate the prevalence in healthcare students.

Background: Schizophrenia is a complex psychiatric disorder frequently complicated by comorbidities that contribute to functional impairment, poor treatment adherence, and elevated mortality. Among the most prevalent and burdensome are affective symptoms, sexual dysfunction, metabolic disturbances, and substance use disorders, which remain underrecognized and insufficiently addressed in routine care.

Objectives: This expert consensus aimed to develop comorbidity-informed pharmacological strategies for schizophrenia, grounded in real-world challenges and individualized treatment needs.

Methods: A multidisciplinary panel of 10 European psychiatrists convened for an in-person meeting. Four expert-led presentations, each addressing a key comorbidity, were followed by open discussion. A modified two-round Delphi process was subsequently used to validate the consensus statements, which were thematically synthesized into actionable recommendations.

Results: Consensus-based recommendations were developed across four comorbidity domains, integrating current evidence with real-world clinical expertise. The panel emphasized the importance of individualized, patient-centered pharmacological strategies that balance efficacy, tolerability, and long-term functional outcomes. Partial dopamine agonists and other metabolically or hormonally favorable agents were identified as clinically useful across several comorbid profiles. Recommendations also addressed the optimization of antipsychotic selection, management of treatment-emergent side effects, and coordinated care for patients with dual diagnosis (also referred to as co-occurring disorders). Measurement-based monitoring and integrated service models were consistently highlighted as essential for improving outcomes.

Conclusions: Effective management of schizophrenia requires a shift toward comorbidity-informed, recovery-oriented pharmacological care. These expert recommendations provide practical strategies to support individualized treatment planning in real-world clinical settings.

Background: In the United States, milk-alkali syndrome or calcium-alkali syndrome is the third most common cause of hypercalcemia, after primary hyperparathyroidism and malignancy. Clinically, patients present with a triad of hypercalcemia, acute kidney injury, and metabolic alkalosis. Classically, it has been associated with excessive intake of calcium and absorbable alkali, and recently it has become more common in postmenopausal females who ingest calcium supplements for osteoporosis.

Case presentation: Here, we present the case of a 72-year-old Caucasian female with a longstanding diagnosis of bipolar I disorder who presented to the Emergency Department (ED) with a sudden onset of generalized weakness, multiple falls, and altered mental status over the course of several days. On admission, she had elevated serum calcium, acute kidney injury, and metabolic alkalosis.

Conclusions: This case underscores the importance of thorough medical and psychiatric assessment in patients presenting with altered mental status, particularly in those with a history of overdosing. It also highlights the need for close collaboration between psychiatry and internal medicine in the management of metabolic disturbances that may mimic or exacerbate psychiatric symptoms. A stepwise approach to the diagnosis and treatment of hypercalcemia is reviewed, with particular attention to considerations unique to psychiatric populations.

Background: The study's objective was to (1) assess the prevalence among women and associated factors of major depressive disorder (MDD) and generalized anxiety disorder (GAD); (2) identify associated factors and regional variations in the relationship between GAD-7 and PHQ-9 scores; and (3) yield insights to support and strengthen mental health policy and service delivery in Bangladesh.

Methods: Data from 19,987 women (aged 15-49 years) who participated in the 2022 Bangladesh Demographic and Health Survey and completed the mental health module were analyzed. Descriptive statistics assessed MDD/GAD prevalence. SEM analyzed factors associated with psychological distress, and regional variations were examined via linear regression.

Results: Among 2388 Bangladeshi women aged 15-49 who had MDD and/or GAD, who provided complete responses for all related variables, sociodemographic factors, resource-related determinants, and negative life events were significantly associated with higher levels of depression and anxiety. The path analysis model indicated that sociodemographic factors (β = 0.69), resource-related factors (β = 0.19), and negative life events (β = 0.05) contributed to depression (PHQ score: β = 0.81, p < 0.001) and anxiety (GAD score: β = 0.84, p < 0.001). Age (β = 0.21, p < 0.001) and marital status (β = 0.20, p < 0.001) were the strongest sociodemographic factors associated with psychological distress, while education (β = 0.41, p < 0.001) and wealth status (β = 0.41, p < 0.001) were the most important resource-related factors. The model demonstrated an acceptable to good fit (Chi-square = 240.67, df = 63, RMSEA = 0.050, GFI = 0.967, AGFI = 0.952, and CFI = 0.826). Regionally, Sylhet City indicated the strongest relationship between GAD and MDD (R² = 0.567), followed by Khulna (R² = 0.543) and Rajshahi (R² = 0.508). An R² Value of 0.567 indicated that approximately 57% of the variability in MDD score in Sylhet can be explained by GAD score.

Conclusion: Path analysis highlighted a multidimensional approach to understanding psychological distress. Sociodemographic, resource factors, and negative life events as determinants collectively serve as associated factors of psychological distress among Bangladeshi females, highlighting the need for culturally tailored interventions with early anxiety screening and coping skills training to improve mental health outcomes.

Purpose: Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation therapy that is a potential treatment for major depressive disorder (MDD). Acceptability impacts patient preference, treatment adherence and outcomes, however, it has typically been assessed through measures of attrition, self-reported satisfaction levels, or adverse events. We sought to explore participant acceptability using structured questionnaires and individual interviews.

Methods: Acceptability was assessed in a fully remote, multisite, double-blind, placebo-controlled, randomized superiority trial of a 10-week course of home-based tDCS for MDD. Questionnaires were conducted at baseline and at the 10-week end of treatment. Participants were 174 adults (120 women) with MDD in a current depressive episode of at least moderate severity. Active or sham tDCS was self-administered over 10 weeks with remote supervision at regular intervals. A thematic analysis was conducted.

Results: Four themes were revealed: acceptability, ease of use, side effects, and trial participation. The themes indicated generally high acceptability of tDCS as a treatment of MDD in both the active and sham treatment groups. Some participants noted concerns about the technical functionality of the device and the impact of side effects.

Conclusions: The first three themes are central to understanding participant perspectives of tDCS and its feasibility as a treatment option. In addition, the theme of trial participation highlights the value of participant support when introducing a new treatment, which may underscore treatment options in general. Furthermore, acceptability is a dynamic concept as participant views changed during treatment.

Trial registration: NCT05202119, registered on 9th January 2022.

Background: Children's mental health in high-altitude areas is influenced by various environmental, socioeconomic, and biological factors. This study aims to explore the knowledge framework and key research areas in this domain, using bibliometric methods to analyze trends, collaboration patterns, and essential themes related to children's mental health at high altitudes.

Methods: A bibliometric analysis was conducted on publications from 1979 to 2024 retrieved from the Web of Science Core Collection database. The R package "Bibliometrix," VOSviewer, and CiteSpace were used to analyze publication trends, collaboration patterns, and research themes.

Results: A total of 520 English-language articles were included. The United States was the most prolific country (226 articles), and Duke University was the leading institution (66 articles). The Journal of the American Academy of Child and Adolescent Psychiatry was the most influential journal. E. Jane Costello was the most prolific author (50 publications). Co-occurrence network analysis identified four major clusters: possible mechanisms, outcomes, psychopathology, and management of mental health issues. Academic research in very high HDI countries focuses more on quality-of-life and mental health issues, whereas low and medium HDI countries prioritize fundamental public health and common disease prevention.

Conclusions: This study provides a bibliometric foundation for quantitatively assessing research trends on mental health among children in high-altitude regions. Current research primarily focuses on underlying mechanisms, outcomes, mental health conditions, and management strategies. For countries at different development levels, research should be tailored to their specific social development stages and health challenges.

Background: This systematic review aimed to assess the efficacy and safety of acupuncture for generalized anxiety disorder (GAD), with a particular focus on acupuncture alone and acupuncture combined with medication, compared with medication or sham acupuncture.

Methods: We searched MEDLINE/PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database for Chinese Technical Periodicals, Chinese Biomedical Literature Database (CBM), and ClinicalTrials.gov up to August 31, 2025. Randomized controlled trials (RCTs) of acupuncture for GAD were independently screened and extracted by two reviewers following strict quality assessment. Risk of bias was evaluated using the RoB 2.0 tool, evidence certainty was assessed with the GRADE approach, and meta-analyses were conducted with RevMan 5.3. Subgroup analyses were performed according to comparator type and acupuncture parameters (treatment modality, duration, frequency, and sessions).

Results: A total of 41 RCTs involving 3,209 participants were included. Meta-analysis showed that acupuncture alone (MD -1.79, 95% CI -2.69 to -0.88; 19 studies) and acupuncture combined with medication (MD -2.26, 95% CI -3.05 to -1.48; 20 studies) were superior to medication alone in reducing Hamilton Anxiety Rating Scale (HAMA) scores. Acupuncture also outperformed sham acupuncture (MD -3.46, 95% CI -4.76 to -2.16; 3 studies). Significant improvements were also observed in total effective rate, Self-Rating Anxiety Scale (SAS) scores, and Clinical Global Impression-Efficacy Index (CGI-EI), with lower rates of adverse events in the acupuncture groups. Subgroup analyses suggested that a treatment duration of 4-6 weeks was associated with better outcomes; for stand-alone acupuncture, a frequency of seven sessions per week was more effective than medication, while for combined therapy, a frequency of 2-4 sessions per week was more effective than medication.

Discussions: This meta-analysis indicates that acupuncture, either as a monotherapy or in combination with medication, may provide superior efficacy to medication and sham acupuncture, with fewer adverse events. However, most included studies were rated as having "some concerns" in risk of bias by RoB 2.0, and GRADE assessment suggested low or very low certainty of evidence for the primary outcome (HAMA). Egger's test indicated no significant publication bias in HAMA. Further high-quality, large-scale RCTs are required to confirm these findings.

Registration: The protocol of the review was registered in PROSPERO (CRD42015016033).

Background: Disturbances of the minimal self, or anomalous self-experiences (ASEs), are increasingly regarded as a core feature of primary psychotic disorders (PPDs). However, it remains unclear whether similar self-disorders are present in substance-induced psychosis (SIP), a condition that often mimics PPDs in its early stages.

Objective: The study aims to compare ASEs between PPD and SIP using the EASE interview, to evaluate the diagnostic specificity of ASEs and determine whether these disturbances are exclusive to primary psychoses or also present in SIP.

Methods: A total of 54 clinically stable patients were recruited from psychiatric centers in Italy (27 with schizophrenia spectrum disorders (SSD), mean age ≈ 27 years; 27 with substance-induced psychosis, mean age ≈ 28 years).. Diagnoses were established according to DSM-5 criteria. ASEs were assessed using the Examination of Anomalous Self-Experience (EASE) interview, and scores were compared across five experiential domains. Non-parametric statistics and logistic regression were employed to identify domain-specific differences and their diagnostic utility.

Results: While total EASE scores did not differ significantly between groups, Domain 4 (Demarcation/Transitivism) was significantly higher in the SIP group (p < .0001, r = .72), contrary to classical phenomenological models that typically associate self-world boundary disturbances with schizophrenia spectrum disorders. In contrast, Domain 2 (Self-awareness and Presence) trended higher in the PPD group (p = .049, r = .27) and Domain 5 (Existential Reorientation) showed a similar trend (p = .098, r = .22)., aligning with classical phenomenological models of schizophrenia. Logistic regression confirmed the predictive value of these domains for group classification.

Conclusion: ASEs are not exclusive to PPDs and may also manifest in SIP, particularly in the domain of "self-world boundary" disturbances. These findings challenge the assumption that self-disorders are unique to endogenous psychosis and highlight the need for refined phenomenological assessment in early diagnostic work. Longitudinal studies are needed to clarify whether ASEs in SIP represent transient phenomena or prodromal markers of schizophrenia.

Introduction: The study assesses proinflammatory factors in major depressive disorder (MDD) patients with and without suicidal behaviors, and healthy controls, to identify potential biomarkers for suicidal behaviors and prevention strategies.

Methods: We conducted a systematic review, which we have registered in Prospero (#CRD42024547764), and searched through five databases until March 2024. We included observational studies in English that reported on depressed patients with and without suicidal behaviors, as well as healthy controls, and measured the levels of pro-inflammatory cytokines. The Newcastle- Ottawa Scale was used for quality evaluation of the studies and the main analysis was performed using Stata 17.

Results: One systematic review resulted in 4,369 articles but only 24 were selected for the review. The meta-analysis showed depressed patients with suicidal behaviors had significantly higher interleukin (IL)-6 levels compared to the control group with a standardized mean difference (SMD) of 1.26 [0.07, 2.45]; I² = 98.81%. There was no significant difference noted between the depressed patients suffering from suicidal behaviors and those not suffering (SMD 0.42 [-0.58, 1.42]; I² = 98.50%). There is no significant difference between the groups in the levels of tumor necrosis factor-alpha (TNF-α) and IL-10. Further analysis of IL-4, IL-2, IL-1β, IF-γ, and TGF-β1 also indicated no significant group differences.

Conclusion: The review found no significant cytokine differences (including IFN-γ, IL-1β, IL-2, IL-4, IL-8, IL-10, TGF-β1, TNF-α) between depressed individuals with or without suicidal ideation and controls. Variations likely reflect methodological differences, highlighting the need for standardized, longitudinal research.