Annals of General Psychiatry最新文献

Background: The physician-patient relationship is essential in the care of suicidal patients, yet factors shaping this relationship remain insufficiently explored. This study aimed to explore physicians' emotional reactions to suicidal patients and how both physician- and patient-related issues influence these responses.

Methods: Interviews were conducted with six physicians from the Douglas Mental Health University Institute in Montreal. A thematic analysis was performed using Hayes' structural model of countertransference as the analytical framework.

Results: Three primary emotional reactions emerged: emotional connection/avoidance, confidence/doubts, and powerlessness attributed to own limitations/to the patient. Clinicians' core needs-the need to help, need for security, and need for efficacy-were found to be pivotal in shaping these emotional responses. Similarly, patient-related factors, notably life experiences, disease, suicidality, and attitudes significantly influenced these reactions. Patterns linking physicians' emotional responses to their underlying needs and patient-related factors were analyzed, leading to the development of a conceptual framework.

Conclusions: This framework offers implications for research, clinical supervision, and medical training, fostering deeper insight into the physician-patient relationship in the context of suicidality.

Background: Mitochondrial dysfunction has been implicated in the pathogenesis of a variety of neuropsychiatric disorders, but its causal role remains unclear. Mitochondrial DNA copy number (mtDNA-CN) and methylmalonic acid (MMA) are well-recognized biomarkers of mitochondrial function, but their association with psychiatric disorders has not yet been fully assessed.

Methods: We performed two-step two-sample Mendelian randomization (MR) analyses using genome-wide association study (GWAS) data to assess causal associations between mtDNA-CN and 13 major neuropsychiatric disorders. In addition, we conducted a cross-sectional analysis using National Health and Nutrition Examination Survey (NHANES) data 2011-2014 to examine the association between serum MMA levels and cognitive impairment and depressive symptoms to further validate the correctness and robustness of the results of the MR analysis.

Results: MR analysis showed a significant negative causal effect of mtDNA-CN on bipolar disorder, Alzheimer's disease, dementia, depressive symptoms, and autism spectrum disorders (OR ranged from 0.15 to 0.84, all p < 0.05). Reverse MR analysis showed that only depressive symptoms had a significant causal effect on reducing mtDNA-CN. NHANES analysis further showed that higher MMA levels were significantly associated with an increased risk of cognitive impairment (OR = 1.56, p = 0.036) and depression (OR = 1.53, p = 0.020), suggesting that mitochondrial dysfunction and neuropsychiatric disorders have a close association.

Conclusion: The mitochondrial function biomarkers mtDNA-CN and MMA are expected to be potential therapeutic targets for depression and cognitive dysfunction, emphasizing the need for mitochondrial function monitoring and interventions in future therapies targeting neuropsychiatric disorders.

Background: Non-suicidal self-injury (NSSI) is a common behavioral problem among children and adolescents. Previous studies of NSSI have been mostly group-based and lacked specific characterization of individuals with NSSI.

Methods: Using convenience sampling, we surveyed all students from three junior high schools in a county in China, totaling 2,376 participants (mean age 13.66, SD 0.98). Assessments included NSSI, anxiety, depression, personality traits, and family environment. Based on the network template perturbation approach, we employed three steps-constructing the reference network, constructing the perturbed network, and computing the individual differential psychopathology network (IDPN). The IDPN was then constructed from questionnaire scores to capture the degree to which abnormal individuals deviate from the normative level. K-means clustering was then applied to explore the internal heterogeneity of NSSI.

Results: Among 2,376 students, 881 (37.1%) exhibited NSSI. Following IDPN construction, we selected 8 characteristics for clustering analysis based on significant changes in at least 2% of the samples. The elbow method indicated 2 clusters. Fisher discriminant analysis showed a classification accuracy of 95.8%, reflecting a good clustering effect. Severity of NSSI in Group 1 was lower than in Group 2, with scores for 7 out of 8 characteristics also lower in Group 1, except for "Control-Organization." NSSI was associated with personality traits, depression, and family environment, with stronger connections between individual features linked to higher NSSI severity.

Conclusion: We introduced the concept of IDPN in psychometrics, which can reveal relationships among individual characteristics and identify distinct patient subgroups. Further research is needed to confirm its reproducibility and generalizability.

Objective: This study aimed to explore the efficacy and safety of Bifidobacterium combined with high-frequency repetitive transcranial magnetic stimulation (rTMS) in treating depression in adolescents.

Methods: A total of 100 patients were selected and divided into an experimental group (n = 50) and a control group (n = 50) using a random number table. Patients in the experimental group were treated with Bifidobacterium and high-frequency rTMS, and those in the control group were treated with oral escitalopram oxalate. After 8 weeks of treatment, the Hamilton Rating Scale for Depression (HAMD-24) score, serum inflammatory factors, neuroendocrine indicators and microRNAs were determined in both groups. The single-blind principle was strictly followed throughout the study.

Results: The HAMD-24 score after treatment significantly decreased in the experimental group compared with the control group, with a statistically significant difference (p < 0.05). The levels of serum tumour necrosis factor-α, interleukin (IL)-1β and IL-6 also decreased significantly in the experimental group compared with the control group (p < 0.05). Additionally, the elevated levels of dopamine, serotonin and cortisol, including dopamine, 5-hydroxytryptamine and cortisol, was more pronounced in the experimental group than in the control group. The serum levels of miR-16 and miR-195 also showed statistically significant differences (p < 0.05).

Conclusion: Bifidobacterium combined with high-frequency rTMS is effective in the treatment of depression in adolescents with a favourable safety profile, providing references for the clinical treatment of this disease.

Clinical trial number: ISRCTN16752763 ( https://doi.org/10.1186/ISRCTN16752763 ), Date: 19/03/2025.

Background: Theoretical hypotheses suggest differing oxidative stress levels in mood disorders. We evaluated eight oxidative stress-related biochemical markers for further verification in first-onset patients with bipolar disorder (BD) or major depressive disorder (MDD).

Methods: We extracted 224 first-onset patients (BD = 93 and MDD = 131) from the overall sample database of 4647 candidates. And we analyzed eight parameters: direct bilirubin (DBIL), indirect bilirubin (IBIL), uric acid (UA), lactate dehydrogenase (LDH), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), prealbumin, and progesterone.The above parameters enter the hierarchical multiple linear regression model for analysis.

Results: When compared to MDD, the BD group showed decreased prealbumin and elevated UA, LDH, and FT3 in males while decreased prealbumin and DBIL and elevated IDBIL, LDH, FT3 and progesterone in females (p's < 0.05). The model effectively differentiated between BD and MDD, achieving AUCs of 0.894 for men and 0.897 for women.

Conclusion: This result elucidates the validity of these biomarkers for identifying first-episode patients with BD or MDD. The discrimination was satisfactory, with good diagnostic accuracy for both gender subgroups.

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.