Annals of General Psychiatry最新文献

Objectives: This study aimed to investigate the association between sleep problems and suicidal behaviors as well as healthcare utilization in Canadian adults with chronic diseases, while also examining the mediating role of mental illness.

Methods: Data were drawn from the 2015-16 cycle of the Canadian Community Health Survey, specifically from Ontario, Manitoba, and Saskatchewan - the provinces that included the optional sleep module. A total of 22,700 participants aged ≥ 18 years and diagnosed with at least one chronic disease were included in the analysis. Sleep problems were defined as extreme sleep durations (either < 5 or ≥ 10 h) and insomnia. Mental illness was classified as a self-reported mood or anxiety disorder.

Results: Participants with extreme sleep durations (compared to 7 to < 8 h) and those with insomnia (compared to no insomnia) showed a higher prevalence of suicidal ideation, suicidal plans, and increased healthcare utilization. After adjusting for multiple covariates, both extreme sleep durations and insomnia remained significantly associated with increased odds of suicidal ideation, suicidal plans, and healthcare utilization. Mediation analyses indicated that mental illness partially mediated these associations.

Conclusions: Both extreme sleep durations and insomnia were independently associated with higher odds of suicidal behaviors and increased healthcare utilization in adults with chronic diseases, with mental illness playing a partial mediating role in these relationships.

Background: The study aimed to assess the incidence of lithium-induced hypothyroidism and its associated factors in psychiatric outpatients on long-term lithium therapy.

Methods: A retrospective study at Songklanagarind Hospital (January 1, 2013, to September 30, 2022) focused on clinical (overt) and subclinical forms of lithium-induced hypothyroidism. Subclinical hypothyroidism, characterised by elevated thyroid stimulating hormone (TSH) but normal thyroxine (FT4) levels, and clinical hypothyroidism, by low FT4 and high TSH, were analysed. Patients with less than 3 months of lithium therapy or prior thyroid conditions were excluded. We used survival analysis and logistic regression to investigate incidence and factors.

Results: Among 461 on lithium maintenance therapy, 279 outpatients met the inclusion criteria; however, only 166 (59%) were monitored for thyroid functions during the study period and included in the final analyses, mostly female (53.6%) with bipolar disorder (72.9%), median age 42.0 years. The median duration of maintenance therapy was 3.7 years (IQR = 1.0-9.3). Over a decade, 30 patients developed lithium-induced hypothyroidism, primarily subclinical (28 cases), at an incidence rate of 0.0212 cases per patient-year. Hypothyroidism manifested after 14.4 months of lithium therapy (IQR = 5.2-53.2), with a prominent decline of survival curve within the first year. Younger age (adjusted OR = 0.95, P = 0.001), presence of physical comorbidities (adjusted OR = 2.69, P = 0.039), and higher lithium levels (P = 0.003) were associated with hypothyroidism.

Conclusions: Despite low incidence, regular thyroid monitoring is advised for patients on lithium. The study identifies risk factors for lithium-induced hypothyroidism, aiding in patient risk assessment and monitoring protocols.

Background: Polycystic ovarian syndrome (PCOS) is a common and increasingly prevalent reproductive and metabolic endocrine disorder that is characterized by metabolic alterations, hyperandrogenism, menstrual irregularities as well as an increased risk of depression. Available evidence suggests PCOS may also be associated with disparate aspects of suicidality. Herein, we sought to determine the prevalence of suicidal ideation, suicidal behaviours and completed suicide in the PCOS population.

Methods: We systematically searched PubMed, Ovid and Scopus databases from inception to January 7, 2024. A manual search was conducted on Google Scholar. Two reviewers independently screened the retrieved studies against the eligibility criteria (S.W. and G.H.L.). Human studies investigating suicide outcomes in women of reproductive age with a confirmed diagnosis of PCOS were included.

Results: Eleven studies meeting our eligibility criteria were included. Although results were mixed, available evidence suggests that persons with PCOS are at an increased risk of suicidal ideation, self-harm and suicide attempts and are also differentially affected by psychiatric comorbidities (e.g., depressive disorders). Notwithstanding, suicide risk was not fully accounted for by the presence of mental illness, which suggests that PCOS may also be contributory.

Conclusion: PCOS is associated with an increased risk of suicidal ideation and behaviour and associated psychiatric comorbidities. Persons with PCOS should be routinely evaluated for the presence of clinically significant suicidality. Whether increased suicidality in PCOS populations is a direct effect of the disease state and/or is largely moderated by psychiatric comorbidity is a future research vista.

Suicide has become one of the leading causes of death in adolescents and is a direct consequence in patients with depressive disorders. Recently, neuroinflammation has been shown to play a role in the development of depression. This study examined serum chemokine levels in adolescents with depressive disorders at different suicide stages to identify chemokines that discriminate between suicidal behaviors. This study enrolled 111 adolescent patients with depressive disorders who were further subdivided into three groups based on the presence of suicidal behavior or ideation: suicide attempt group (n = 45), suicidal ideation group (n = 44), and non-suicidal depression group (n = 22), along with 23 healthy controls. Eight inflammatory chemokines were detected using the mesoscale discovery method. Patients in the suicide attempters group had higher levels of IL8, MCP-1, Eotaxin, and Eotaxin-3 than those in the non-suicide depression group. Eotaxin-2 had the greatest effect on suicidal behaviors of all factors.

Background: Mild Cognitive Impairment (MCI) and Mild Behavioral Impairment (MBI) are important constructs in the context of cognitive decline. MBI can be assessed with the Mild Behavioral Impairment Checklist (MBI-C). However, the instrument has deficits in psychometrics and content, thus indicating a need for improvement. The aim of this study was to develop a complementary short instrument, the Mild Behavioral Impairment Scale (MBI-S), designed to measure MBI as a short-term modifiable state criterion, and to validate it in a non-clinical sample of people 18 years of age or older.

Methods: Most of the items on the MBI-S stem from the MBI-C and were chosen to represent the dimensions of the Neuropsychiatric Inventory Questionnaire. The MBI-S was validated on self-reported data from 175 individuals. In an item analysis, the discriminatory power and item difficulties were examined. Cronbach's alpha was calculated to assess the internal consistency, and a principal component analysis was conducted to determine the structure of the instrument. Construct validity was established by testing four hypotheses about relationships between the MBI-S and other instruments by calculating correlation coefficients.

Results: After the item analysis, two items were removed from the final version of the scale on the basis of insufficient discriminatory power and the finding that the internal consistency of the total score increased when the items were deleted. The principal component analysis yielded a single-component structure for the MBI-S. Two more items were excluded from the scale due to insufficiently low loadings on the extracted component. Cronbach's alpha for the final eight-item scale was 0.79. The final MBI-S score was strongly related to that of the MBI-C and a loneliness score as well as moderately related to maladaptive coping. There was no association with respondents' level of education.

Conclusion: The MBI-S is a valid short instrument for the assessment of MBI. It has high test economy and measures current neuropsychiatric symptoms and their intensity as a state criterion. Therefore, the MBI-S can be used for the longitudinal measurement of MBI.

Background: Suicidal behavior represents a significant public health challenge, and identifying biological markers associated with its risk is critical for prevention and intervention. Emerging evidence suggests a link between inflammation and suicidality, highlighting the role of inflammatory markers as potential biomarkers and therapeutic targets.

Methods: We conducted a systematic search across four electronic databases, including PubMed, Web of Science, EMBASE, and PsycINFO, to identify studies examining the association between inflammatory markers (e.g., C-reactive protein, interleukin-6, tumor necrosis factor-alpha) and suicidal ideation or behavior.

Results: 31 studies met the inclusion criteria. Elevated levels of inflammatory markers were consistently associated with an increased risk of suicidal behavior across diverse populations. This relationship's mechanisms likely involve cytokine-mediated alterations in neurotransmitter systems, neuroplasticity, and stress response pathways. Though robust clinical trials are scarce, preliminary evidence suggests that anti-inflammatory interventions may reduce suicidality.

Conclusions: Inflammation appears to play a significant role in the pathophysiology of suicidal behavior, offering promising avenues for biomarker development and novel therapeutic strategies. Future research should prioritize longitudinal studies, standardized methodologies, and exploration of personalized anti-inflammatory treatments to better elucidate the inflammation-suicidality link and enhance clinical applicability.

Background: Aquatic athletes may face unique pressures related to body aesthetics and weight management, potentially increasing their risk of eating disorders (EDs). This systematic review and meta-analysis aimed to estimate the prevalence of EDs in aquatic athletes and assess the quality of the available evidence.

Methods: A systematic search was conducted in PubMed, Embase, and Web of Science for studies published in English that reported on the prevalence of EDs among aquatic athletes. After screening and eligibility assessments, eight studies met the inclusion criteria, comprising a total of 715 athletes from various countries, including Poland, Canada, Brazil, Norway, the United States, and the United Kingdom. Quality assessment was performed using an adapted Newcastle-Ottawa Scale (NOS), and a random-effects meta-analysis was conducted to estimate pooled prevalence. Sensitivity analysis and a Doi plot were utilized to evaluate the publication bias.

Results: The meta-analysis estimated a pooled prevalence of EDs in aquatic athletes at 27.56% (95% CI: 14.27-46.50%), with a heterogeneity (I²) of 76%, indicating substantial variability in study designs and participant characteristics. Sensitivity analysis confirmed the robustness of the findings, and the Doi plot indicated significant asymmetry (LFK index = -3.44), suggesting potential publication bias or variability across studies.

Conclusion: This study revealed a high prevalence of EDs among aquatic athletes. Further research is required on the factors associated with these disorders. Standardized assessment tools and routine screening in aquatic sports settings are recommended to promote early detection and prevention of EDs, ultimately enhancing athlete well-being and performance.

Background: Recognizing the integral role of parental emotional and behavioral health in shaping a supportive family environment crucial for a child's emotional well-being, a practical tool for evaluating mental health in both preschool children and their mothers are necessary. In this methodological study conducted across eight provinces in Turkey, we aimed to develop and assess the psychometric properties of a single-item mental health measure for physically healthy children aged 2-5 years and their mothers.

Method: The study included 411 child-mother pairs recruited from tertiary care hospitals, with subjects selected from well-child departments. Various psychometric assessments were employed, including the Strengths and Difficulties Questionnaire (SDQ) for children, Depression, Anxiety, and Stress Scale (DASS-21), Patient Health Questionnaire-4 (PHQ-4) for mothers, and single-item measures for both child and maternal mental health [mother-reported mental health of child (MRCMH) and self-reported mental health of mother (SRMH)]. Data were collected at two time points: baseline evaluation for validity testing and test-retest evaluation at the 3rd week.

Results: The MRCMH indicated excellent validity, with sensitivity and specificity for detecting borderline and abnormal mental health difficulties in children at 90%, 100%, and 83%, respectively. The SRMH revealed sensitivity and specificity of 62% and 78% for identifying maternal depression, 57% and 76% for anxiety, 63% and 76% for stress, and 54% and 87% for psychological distress, respectively. Construct validity analyses revealed significant correlations between MRCMH and SDQ scores, as well as between SRMH and DASS-21 and PHQ-4 scores. Test-retest reliability, assessed through intraclass correlation coefficients, indicated varying agreement levels, with the highest agreement observed for SDQ total difficulties and the lowest for SRMH. Further exploration of the measures' sensitivity and specificity revealed noteworthy accuracy in detecting child mental difficulties and maternal psychological distress. Correlational analyses between baseline and 3-week scores highlighted the stability of MRCMH and SRMH over time.

Conclusion: This research contributes valuable insights into the psychometric properties of single-item measures for child and maternal mental health, offering a potential tool for clinicians and researchers. The outcomes can inform public health strategies and interventions aimed at promoting positive mental health outcomes in preschool children and their mothers.

Adolescent suicide represents a critical global health issue. While research has identified numerous risk factors, the specific impact of parental dysfunction on adolescent suicide remains understudied, especially in Chinese contexts. This study explores how parental dysfunction manifests in suicide notes and affects adolescent mental health. We collected data from Chinese social media platforms using web crawlers, yielding 30 valid suicide notes for analysis. Using the AI-aided content analysis platform DiVoMiner^®, we conducted high-frequency word and semantic network analyses. Our findings reveal that parents are a central concern for suicidal youth. We identified three primary patterns of parental dysfunction: excessive emphasis on instrumental goals, neglect of basic emotional needs, and inadequate protection from life traumas. These dysfunctions contribute to severe psychological distress, identity loss, and negative coping behaviors among youth. The research highlights two significant phenomena in contemporary Chinese family dynamics: the "short-sightedness" of prioritizing short-term instrumental goals over long-term social-emotional development, and the remarkably high prevalence of "lack of autonomy" in parenting approaches. Our study extends the literature by exploring mechanisms through which parental dysfunctions contribute to suicidal behaviors in young people. These findings emphasize the need for collaborative efforts among parents, educators, policymakers, and mental health professionals to foster nurturing environments characterized by emotional support, autonomy encouragement, and balanced academic expectations-all crucial for adolescent well-being.

Aim: This paper evaluates the clinical efficacy, safety, and practical implications of Trazodone Prolonged Release (PR) in managing depression, anxiety, and sleep disorders, with a focus on its multimodal mechanism of action and advantages over traditional therapies.

Methodology: A critical review of recent literature (2020-2024) [1-3] was conducted, analyzing data from clinical trials, real-world studies, and European treatment guidelines to assess the pharmacodynamics, pharmacokinetics, and therapeutic outcomes of Trazodone PR.

Results: Trazodone PR demonstrates efficacy in addressing complex symptoms of depression, anxiety, and sleep disturbances, with a favorable safety profile and reduced risk of sexual dysfunction and weight gain compared to other antidepressants. Its ability to modulate serotonin, norepinephrine, dopamine, and histamine systems enhances mood, sleep quality, and cognitive recovery.

Conclusion: Trazodone PR is a versatile and well-tolerated treatment option for patients with comorbid conditions and treatment-resistant cases. Its multimodal action, combined with benefits like improved neuroplasticity through BDNF production, makes it a suitable choice for the long-term management of mood disorders and associated conditions [4-6].