Annals of General Psychiatry最新文献

Background: Posttraumatic stress symptoms are prevalent mental phenomenon in women with previous perinatal loss due to high grief, high perinatal depression and anxiety or low social support. Although posttraumatic stress symptoms are known to have serious negative implications for women with previous perinatal loss, families and society, the mechanism through which it functions is less clear.

Objective: The aim of this study was to examine the moderated mediating effect of social support on perinatal anxiety and depression and its associations with grief and posttraumatic stress symptoms in women with previous perinatal loss. We hypothesized that perinatal depression and anxiety would mediate relationships between grief and posttraumatic stress symptoms and that its mediating effects would differ depending on social support.

Methods: This study was a multicentre cross-sectional survey conducted from December 2021 to October 2022, involving 346 women during hospitalization for perinatal loss as participants from two public hospitals in China. Self-reported scales were used to measure the level of perinatal depression and anxiety, grief, posttraumatic stress symptoms and social support. The Pearson's correlation analysis, the PROCESS Macro Model 4 and Model 14 on SPSS were used to analyse the available data.

Results: The positive effect of perinatal grief on posttraumatic stress symptoms was found to be mediated by perinatal depression and anxiety, and this mediating effect was moderated according to social support: the more social support, the weaker the mediating effect of perinatal depression and anxiety was between perinatal grief and posttraumatic stress symptoms. The positive effect of perinatal depression and anxiety on posttraumatic stress symptoms was lowest in the high social support group.

Conclusions: Healthcare providers should closely monitor the psychological well-being of pregnant individuals and implement targeted interventions-such as antenatal education course, group-based prenatal care models, and mindfulness-based therapies (e.g., cognitive behaviour therapy) -to mitigate perinatal anxiety and depression. These measures may also significantly reduce post-traumatic stress symptoms in women with previous perinatal loss and high perinatal grief, particularly among those with insufficient social support.

Background: Over the past decade, sleep disturbances and stress have markedly increased within the general population. Conditions such as insomnia and poor stress management are linked to a range of physical and psychological symptoms, including cardiovascular diseases, sleep disorders, depression, or anxiety. Recent studies have shown that heat-treated Lacticaseibacillus paracasei PS23 (PS23) can alleviate anxiety in clinical nurses experiencing high stress. However, the potential benefits of live PS23- particularly its effects on sleep quality, anxiety, and stress- remain unexplored.

Methods: This study recruited office workers aged 20-65 years who reported moderate to high levels of perceived stress. Participants in the intervention group received a daily dose of 20 billion colony-forming units of live PS23 for six weeks, while the control group received two placebo capsules containing microcrystalline cellulose powder. Outcomes were assessed at baseline and at the end of the trial, including measures of stress, anxiety, sleep quality, fatigue, activity levels, depression, and overall quality of life. Additionally, changes in salivary stress markers and antioxidant levels were evaluated.

Results: Of the 50 eligible participants initially enrolled, 45 completed the six-week trial with high compliance (> 80%), including 24 in the PS23 group and 21 in the placebo group. Compared to the placebo group, the PS23 group showed statistically significant improvements in overall insomnia symptoms (group × time interaction, p = 0.011), sleep latency (p = 0.045), sleep maintenance (p = 0.002), and trait anxiety levels (group × time interaction, p = 0.044).

Conclusion: This pilot randomized controlled trial suggests that live L. paracasei PS23 may offer meaningful improvements in sleep quality and anxiety reduction among office workers experiencing elevated stress levels.

Registration: ClinicalTrials.gov Identifier: NCT05826704; registration date: 4/11/2023. Exploring the Effects of Lactobacillus paracasei PS23 on Workplace-related Stress Symptoms Among Office Workers; URL: https://clinicaltrials.gov/study/NCT05826704.

Background: The relationship between schizophrenia (SCZ) and lung cancer (LC) remains inadequately understood, necessitating further exploration through a genetic perspective.

Methods: Utilizing extensive genome-wide association study databases, a comprehensive multi-level genetic analytical framework was implemented to examine the genetic association patterns between SCZ and distinct LC subtypes. Initially, genome-wide genetic correlations were assessed through linkage disequilibrium score regression and high-definition likelihood approaches. Subsequently, local variance association analysis (LAVA) was employed to identify key genomic regions exhibiting significant genetic associations. Mendelian randomization (MR) was employed to assess causal effects. Finally, the degree of genetic overlap and shared genetic loci between these diseases were quantitatively evaluated by integrating the conditional/conjunctional false discovery rate methodology.

Results: Genetic correlation analyses demonstrated significant positive associations between SCZ and LC, particularly its squamous cell subtype, at the genome-wide level, whereas no statistically significant associations were detected concerning lung adenocarcinoma or small cell lung cancer. Moreover, LAVA identified distinct genetic association patterns within multiple chromosomal segments. A systematic evaluation incorporating a joint false discovery rate confirmed the existence of genetic overlap phenomena between these diseases and successfully pinpointed multiple shared pathogenic risk loci.

Conclusion: This study furnishes novel theoretical evidence regarding the comorbidity mechanisms linking various LC subtypes with SCZ from a genetic perspective, thereby enhancing the comprehension of their intrinsic interconnections.

Background: Deep brain stimulation (DBS) is regarded as an efficacious treatment for treatment-resistant depression (TRD), exhibiting a response rate of approximately 60%. However, certain patients exhibit limited responsiveness to DBS, necessitating further exploration of alternative interventions. In this paper, we present two cases of TRD patients who exhibited poor response to DBS surgery but showed significant improvement after receiving psychotherapy.

Case presentation: In case 1, a 20-year-old female patient exhibited a slight initial positive response after DBS surgery; however, her symptoms continued to deteriorate progressively. Following systematic cognitive behavioral therapy (CBT), she demonstrated remarkable improvement in depressive symptoms. In case 2, a 36-year-old male patient experienced short-term symptomatic improvement post-DBS surgery but relapsed due to treatment interruption caused by financial constraints. After CBT intervention, the symptoms of his depression exhibited significant improvement.

Conclusions: No previous studies have reported on the effects of CBT in postoperative depressive symptoms following DBS. The combination of DBS surgery and postoperative psychological therapy may enhance the therapeutic outcomes of DBS. This study emphasizes the significance of incorporating psychotherapy into the management after DBS surgery and calls for future research to further investigate the potential and mechanisms underlying this comprehensive treatment strategy.

Background: The antidepressant vortioxetine is available as an immediate-release (IR) tablet formulation and as a bioequivalent oral drops solution (20 mg/mL) to allow personalised titration.

Methods: This pharmacokinetic modelling analysis used data from a single-dose, crossover study to simulate the time taken to reach steady-state plasma concentrations using 'low and slow' titration approaches with drops compared with standard IR-tablet schedules.

Results: All dosing regimens approached 10 mg steady-state concentrations within 2 weeks. The time to reach full steady-state was 12 days when starting with a 10 mg IR-tablet, 14 days when starting with 5 mg drops and increasing to 10 mg (1 mg/day increments), 17 days when starting with a 5 mg IR-tablet for 7 days before increasing to 10 mg, and 18 days when starting with 1 mg drops and increasing to 10 mg (1 mg/day increments).

Conclusions: These data support the utility of vortioxetine drops in offering flexibility for personalised titration without relevant impact on the time taken to reach steady-state plasma concentrations.

Objective: Antipsychotic-induced metabolic disturbance (AIMD) represents a prevalent adverse effect associated with antipsychotic medications, with genetic factors partially contributing to the variability in susceptibility observed among patients with schizophrenia (SCZ). This study examined the effect of ANKK1 (rs1800497) polymorphism on glucose and lipid metabolism in Chinese patients diagnosed with SCZ and undergoing olanzapine treatment.

Methods: A cohort of 104 SCZ patients receiving olanzapine treatment was recruited retrospectively for the investigation. The polymorphism in the ANKK1 (rs1800497) gene were identified and analyzed. The clinical and demographic characteristics of subjects with ANKK1 (rs1800497) genotypes were compared at baseline. The associations between ANKK1 rs1800497 genotypes and glucose and lipid indicators at baseline were examined. Following a 4-week olanzapine treatment, changes in glucose and lipid indicators among subjects with ANKK1 (rs1800497) genotypes were evaluated. Additionally, the relationship between these genotypes and the alterations in glucose and lipid indicators after olanzapine treatment was analyzed.

Results: At baseline, individuals carrying the T allele of the ANKK1 rs1800497 polymorphism exhibited significantly lower serum total cholesterol (TC) levels compared to those possessing the CC genotype (P = 0.024). Moreover, under an additive allelic model (coded as 1 = CC, 2 = CT, 3 = TT), the TT genotype of the ANKK1 rs1800497 polymorphism demonstrated a negative correlation with serum TC (r = -0.237, P = 0.015) and glucose levels (r = -0.276, P = 0.005). Furthermore, following olanzapine treatment, patients who were carriers of the TT genotype of ANKK1 rs1800497 had a smaller reduction in glucose levels compared to those with the CC genotype (P = 0.027). Additionally, the TT genotype of the ANKK1 rs1800497 polymorphism demonstrated a positive correlation with changes in glucose levels (r = 0.237, P = 0.015).

Conclusion: These findings suggest a potential association between the ANKK1 rs1800497 polymorphism and blood glucose variability in Chinese patients with SCZ undergoing olanzapine treatment.

Background: Increasing evidence suggests a link between major depressive disorder (MDD) and inflammatory pathways. Sertraline, a commonly used selective serotonin reuptake inhibitor (SSRI), may influence inflammatory cytokine levels. This systematic review and meta-analysis aimed to elucidate the association between the antidepressant sertraline and inflammatory processes and to delineate the roles of key cytokines within this context.

Methods: Electronic searches of the Web of Science, MEDLINE, and Embase databases (from inception to August 8, 2025) yielded 890 unique records. The included studies measured serum concentrations of inflammatory cytokines in patients with major depressive disorder (MDD) before and after sertraline treatment, with subsequent analysis of the effects of sertraline on these biomarkers. Two independent investigators performed the literature screening and data extraction. Pooled effect estimates were calculated using random effects meta-analysis models.

Results: Eleven studies (406 participants) were included. The results demonstrated significant increases in both IL-6 levels (SMD = 0.87; 95% CI: 0.16 to 1.58; Z = 2.41; p = 0.02) and TNF-α levels (SMD = 0.76; 95% CI: 0.14 to 1.71; Z = 2.30; p = 0.02) following sertraline treatment.

Conclusion: Sertraline significantly modulates IL-6/TNF-α levels, suggesting that this pathway may partly mediate its antidepressant effects.

Background: Both cognitive dysfunction and sleep disturbances are individually linked to heightened risks of chronic illnesses and mortality. However, their combined impact on all-cause and cardiovascular mortality remains underexplored.

Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, focusing on participants aged ≥ 60 years who completed cognitive tests and sleep-related questionnaires. Cognitive function was evaluated using three standardized tests: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Animal Fluency Test, and the Digit Symbol Substitution Test. Participants with global cognitive z-scores below - 1 were classified as having low cognitive function. Sleep disturbance was identified based on self-reported diagnoses of sleep disorders or complaints of trouble sleeping. Mortality data were sourced from the National Death Index. Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHR) for all-cause and cardiovascular mortality, with adjustments for potential confounders.

Results: A total of 3,170 participants ≥ 60 years of age were included for analysis. Participants with low cognitive function alone had an adjusted hazard ratio (aHR) of 1.59 (95% CI: 1.12-2.26) for all-cause mortality. The risk increased to an aHR of 1.73 (95% CI: 1.07-2.79) when both low cognitive function and sleep disturbances were present. Stratified analyses revealed that the associations between cognitive function, sleep disturbance, and mortality risks varied across sex, BMI, and chronic kidney disease status.

Conclusions: The combination of low cognitive function and sleep disturbances is associated with a higher risk of all-cause and cardiovascular mortality, exceeding the risk of either condition alone. These findings emphasize the need to consider both factors together when assessing mortality risk in older adults.

Clozapine is uniquely effective for treatment-resistant schizophrenia, treatment-resistant mania, and for aggression, suicide, or psychogenic polydipsia related to schizophrenia. Among its adverse effects, sialorrhea is an important barrier to clozapine treatment. Topical anticholinergic medications show limited efficacy, while systemic anticholinergics carry elevated risks of constipation, bowel impaction, or ileus. A superior treatment option for clozapine-induced sialorrhea exists in the form of periodic injection of major salivary glands with botulinum neurotoxin. This paper describes the feasibility and logistical issues involved in establishing a botulinum treatment clinic within a forensic psychiatric hospital. Critical elements in establishing a successful botulinum clinic for treatment of sialorrhea include adequate hospital administrative support, sufficient nursing staff, clinician injection training, education of treating psychiatrists regarding the availability and effectiveness of botulinum treatment for sialorrhea, and development of a clinic protocol, including procedural elements and relevant rating scales. Finally, botulinum treatment was evaluated to be cost-effective.