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Clinical characteristics of suicidal behavior in first hospitalization and drug-naïve patients with major depressive disorder. 首次住院及drug-naïve重性抑郁症患者自杀行为的临床特征
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-12-06 DOI: 10.1186/s12991-023-00484-9
Xianzhi Sun, Lili Yin, Yingying Zhang, Xuebing Liu, Jun Ma

Background: Major depressive disorder (MDD) is a major and common cause of suicide. The purpose of this article is to report the clinical characteristics and patterns of co-morbid suicidal behavior (SB) in first hospitalized and drug-naïve MDD patients.

Methods: A total of 345 patients with first hospitalization and drug-naïve MDD with SB were included in this study, while 183 patients without SB were included as a control group. We collected socio-demographic, general clinical data and common biochemical indicators of all participants and assessed their clinical symptoms.

Results: Compared to patients without SB, MDD with SB had more severe clinical symptoms and worse metabolic indicators. Duration of disease, depressive symptom scores, and thyroid stimulating hormone (TSH) levels was risk factors for SB and its number.

Conclusions: MDD patients with SB suffered more severe clinical symptoms and worse metabolic indicators, and risk factors for SB in this population were identified, which may provide beneficial insight and reference for clinical prevention and intervention of SB in MDD patients.

背景:重度抑郁障碍(MDD)是自杀的主要和常见原因。本文的目的是报告首次住院和drug-naïve MDD患者共病自杀行为(SB)的临床特征和模式。方法:本研究共纳入345例首次住院drug-naïve伴SB的重度抑郁症患者,183例无SB患者作为对照组。我们收集了所有参与者的社会人口学、一般临床资料和常见生化指标,并评估了他们的临床症状。结果:与无SB患者相比,伴有SB的MDD患者临床症状更严重,代谢指标更差。病程、抑郁症状评分和促甲状腺激素(TSH)水平是SB及其数量的危险因素。结论:MDD合并SB患者临床症状更严重,代谢指标更差,明确了该人群SB的危险因素,为MDD患者SB的临床预防和干预提供有益的见解和参考。
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引用次数: 0
Discontinuation of antidepressant treatment: a retrospective cohort study on more than 20,000 participants. 停止抗抑郁药物治疗:一项超过20,000名参与者的回顾性队列研究。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-11-24 DOI: 10.1186/s12991-023-00480-z
Luis M Garcia-Marin, Aoibhe Mulcahy, Enda M Byrne, Sarah E Medland, Naomi R Wray, Freddy Chafota, Penelope A Lind, Nicholas G Martin, Ian B Hickie, Miguel E Rentería, Adrian I Campos

Background: Factors influencing antidepressant treatment discontinuation are poorly understood. In the present study, we aimed to estimate the prevalence of antidepressant treatment discontinuation and identify demographic characteristics, psychiatric comorbidities, and specific side effects associated with treatment discontinuation.

Methods: We leveraged data from the Australian Genetics of Depression Study (AGDS; N = 20,941) to perform a retrospective cohort study on antidepressant treatment discontinuation. Participants were eligible if they were over 18 years of age, had taken antidepressants in the past 4 years, and provided informed consent.

Results: Among the ten antidepressants studied, the highest discontinuation rates were observed for Mirtazapine (57.3%) and Amitriptyline (51.6%). Discontinuation rates were comparable across sexes except for Mirtazapine, for which women were more likely to discontinue. The two most common side effects, reduced sexual function and weight gain, were not associated with increased odds of treatment discontinuation. Anxiety, agitation, suicidal thoughts, vomiting, and rashes were associated with higher odds for treatment discontinuation, as were lifetime diagnoses of PTSD, ADHD, and a higher neuroticism score. Educational attainment showed a negative (protective) association with discontinuation across medications.

Conclusions: Our study suggests that not all side effects contribute equally to discontinuation. Common side effects such as reduced sexual function and weight gain may not necessarily increase the risk of treatment discontinuation. Side effects linked to discontinuation can be divided into two groups, psychopathology related and allergy/intolerance.

背景:影响抗抑郁药物停药的因素尚不清楚。在目前的研究中,我们的目的是估计抗抑郁药物治疗停止的患病率,并确定与治疗停止相关的人口统计学特征、精神合并症和特定副作用。方法:我们利用了澳大利亚抑郁症遗传学研究(AGDS;N = 20,941)进行一项关于抗抑郁药物停药的回顾性队列研究。如果参与者年满18岁,在过去4年中服用过抗抑郁药,并提供知情同意,则符合条件。结果:在所研究的10种抗抑郁药物中,米氮平(57.3%)和阿米替林(51.6%)的停药率最高。除米氮平外,停药率在两性之间是相当的,女性更有可能停药。性功能减退和体重增加这两种最常见的副作用与停药几率的增加无关。焦虑、躁动、自杀念头、呕吐和皮疹与治疗中断的几率较高有关,终身诊断为PTSD、ADHD和较高的神经质评分也是如此。受教育程度与停药呈负相关(保护性)。结论:我们的研究表明,并不是所有的副作用都会导致停药。常见的副作用如性功能减退和体重增加不一定会增加停药的风险。与停药相关的副作用可分为两组,精神病理相关和过敏/不耐受。
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引用次数: 0
Mendelian randomization studies of depression: evidence, opportunities, and challenges. 抑郁症的孟德尔随机化研究:证据、机遇和挑战。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-11-23 DOI: 10.1186/s12991-023-00479-6
Wang-Ran Ma, Lei-Lei Zhang, Jing-Ying Ma, Fang Yu, Ya-Qing Hou, Xiang-Rui Feng, Lin Yang

Background: Major depressive disorder (MDD) poses a significant social and economic burden worldwide. Identifying exposures, risk factors, and biological mechanisms that are causally connected to MDD can help build a scientific basis for disease prevention and development of novel therapeutic approaches.

Methods: In this systematic review, we assessed the evidence for causal relationships between putative causal risk factors and MDD from Mendelian randomization (MR) studies, following PRISMA. We assessed methodological quality based on key elements of the MR design: use of a full instrumental variable analysis and validation of the three key MR assumptions.

Results: We included methodological details and results from 52 articles. A causal link between lifestyle, metabolic, inflammatory biomarkers, particular pathological states and MDD is supported by MR investigations, although results for each category varied substantially.

Conclusions: While this review shows how MR can offer useful information for examining prospective treatment targets and better understanding the pathophysiology of MDD, some methodological flaws in the existing literature limit reliability of results and probably underlie their heterogeneity. We highlight perspectives and recommendations for future works on MR in psychiatry.

背景:重度抑郁症(MDD)在世界范围内造成了重大的社会和经济负担。确定与重度抑郁症有因果关系的暴露、风险因素和生物学机制,有助于为疾病预防和开发新的治疗方法建立科学基础。方法:在本系统综述中,我们从孟德尔随机化(MR)研究中评估了推定的因果危险因素与重度抑郁症之间因果关系的证据。我们根据MR设计的关键要素评估方法学质量:使用完整的工具变量分析和三个关键MR假设的验证。结果:我们纳入了52篇文章的方法学细节和结果。磁共振研究支持生活方式、代谢、炎症生物标志物、特定病理状态和重度抑郁症之间的因果关系,尽管每种类型的结果差异很大。结论:虽然这篇综述显示MR可以为检查前瞻性治疗靶点和更好地理解重度抑郁症的病理生理提供有用的信息,但现有文献中一些方法学上的缺陷限制了结果的可靠性,并可能导致结果的异质性。我们强调了未来精神病学MR工作的观点和建议。
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引用次数: 0
Nationwide consensus on the clinical management of treatment-resistant depression in Italy: a Delphi panel. 意大利难治性抑郁症临床管理的全国共识:德尔菲小组。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-11-23 DOI: 10.1186/s12991-023-00478-7
Giuseppe Maina, Marina Adami, Giuseppe Ascione, Emi Bondi, Domenico De Berardis, Dario Delmonte, Silvia Maffezzoli, Giovanni Martinotti, Alessandra Nivoli, Elena Ottavianelli, Andrea Fagiolini

Background: Treatment-resistant depression (TRD) is defined by the European Medicines Agency as a lack of clinically meaningful improvement after treatment, with at least two different antidepressants. Individual, familiar, and socio-economic burden of TRD is huge. Given the lack of clear guidelines, the large variability of TRD approaches across different countries and the availability of new medications to meet the need of effective and rapid acting therapeutic strategies, it is important to understand the consensus regarding the clinical characteristics and treatment pathways of patients with TRD in Italian routine clinical practice, particularly in view of the recent availability of esketamine nasal spray.

Methods: A Delphi questionnaire with 17 statements (with a 7 points Likert scale for agreement) was administered via a customized web-based platform to Italian psychiatrists with at least 5 years of experience and specific expertise in the field of depression. In the second-round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues' responses. Stata 16.1 software was used for the analyses.

Results: Sixty panellists, representative of the Italian territory, answered the questionnaire at the first round. For 8/17 statements more than 75% of panellists reached agreement and a high consensus as they assigned similar scores; for 4 statements the panellists assigned similar scores but in the middle of the Likert scale showing a moderate agreement with the statement, while for 5 statements there was indecision in the agreement and low consensus with the statement.

Conclusions: This Delphi Panel showed that there is a wide heterogeneity in Italy in the management of TRD patients, and a compelling need of standardised strategies and treatments specifically approved for TRD. A high level of consensus and agreement was obtained about the importance of adding lithium and/or antipsychotics as augmentation therapies and in the meantime about the need for long-term maintenance therapy. A high level of consensus and agreement was equally reached for the identification of esketamine nasal spray as the best option for TRD patients and for the possibility to administrate without difficulties esketamine in a community outpatient setting, highlighting the benefit of an appropriate educational support for patients.

背景:难治性抑郁症(TRD)被欧洲药品管理局定义为治疗后缺乏临床意义的改善,至少使用两种不同的抗抑郁药。TRD的个人、家庭和社会经济负担是巨大的。鉴于缺乏明确的指导方针,不同国家的TRD方法存在很大差异,并且可以获得新的药物来满足有效和快速的治疗策略的需求,了解意大利常规临床实践中关于TRD患者的临床特征和治疗途径的共识非常重要,特别是考虑到最近艾氯胺酮鼻喷雾剂的可用性。方法:通过定制的网络平台,对在抑郁症领域具有至少5年经验和特定专业知识的意大利精神科医生进行德尔福问卷调查,问卷包含17项陈述(7分李克特量表表示一致性)。在第二轮测试中,医生被要求回答同样的问题,考虑到每个问题的四分位数范围作为他们同事回答的指标。采用Stata 16.1软件进行分析。结果:60名代表意大利领土的小组成员在第一轮回答了问卷。对于8/17的陈述,超过75%的小组成员达成了一致意见,因为他们给出了相似的分数;对于4个陈述,小组成员给出了相似的分数,但在李克特量表的中间显示了对该陈述的中度同意,而对于5个陈述,在同意中存在优柔寡断和对该陈述的低共识。结论:德尔菲小组显示,意大利在TRD患者的管理方面存在广泛的异质性,迫切需要针对TRD的标准化策略和治疗方法。对于添加锂和/或抗精神病药物作为增强治疗的重要性,以及同时需要长期维持治疗,获得了高度的共识和同意。对于确定艾氯胺酮鼻腔喷雾剂是TRD患者的最佳选择,以及在社区门诊环境中无困难地使用艾氯胺酮的可能性,也达成了高度的共识和同意,强调了对患者进行适当教育支持的好处。
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引用次数: 0
A multicenter, randomized controlled study on the efficacy of agomelatine in ameliorating anhedonia, reduced motivation, and circadian rhythm disruptions in patients with major depressive disorder (MDD). 一项关于阿戈美拉汀改善重度抑郁症(MDD)患者快感缺乏、动机降低和昼夜节律紊乱的疗效的多中心、随机对照研究。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-11-13 DOI: 10.1186/s12991-023-00473-y
Ping Guo, Yong Xu, Liang Lv, Min Feng, Yu Fang, Wei-Quan Huang, Shan-Fei Cheng, Min-Cai Qian, Shengliang Yang, Shi-Kai Wang, Huan-Xin Chen

Objective: To evaluate the clinical efficacy and safety of Agomelatine in improving symptoms in patients with major depressive disorder (MDD), providing more scientific evidence for the treatment of depression, and offering more effective therapeutic options for patients.

Methods: A total of 180 MDD patients in acute phase from 10 psychiatric hospitals of Grade three in Zhejiang Province were enrolled in this 12-week study with the competitive and consecutive pattern, and they were randomized into two different groups treated with flexible-dosage antidepressants of selective serotonin reuptake inhibitors (SSRI) or agomelatine, respectively. The subjects were evaluated with psychological scales of HAMD-17, HAMA, SHAPS for anhedonia, MFI-20 for fatigue, PQSI for sleep quality and MEQ for disturbances in chronobiologic rhythms at baseline, 2, 4, 8 and 12-weekend points, and TESS was used for side-effect. The results were analyzed with repeated measurement analysis of variance.

Results: The two groups each had 90 participants, and there were no significant differences at baseline. The scores of various assessment scales showed statistically significant time main effects during the visits (P < 0.01). The Agomelatine group demonstrated faster efficacy within 2 weeks, with better improvement in SHAPS, MEQ, and PSQI compared to the SSRIs group. However, the remission rate at 12 weeks was lower in the Agomelatine group than in the SSRIs group (63.3% and 72.2%), but the difference between the groups was not statistically significant. The Agomelatine group had fewer adverse reactions (14.4% and 16.7%), but there was a slightly higher incidence of liver function impairment (6.7% and 4.4%), with no statistically significant difference between the groups.

Conclusion: Agomelatine, as a novel antidepressant, shows certain advantages in improving depression and anxiety symptoms and is comparable to SSRIs in terms of safety. However, its long-term efficacy and safety on MDD or other depressive subtypes still require further observation and research.

目的:评价阿戈美拉汀改善重度抑郁症(MDD)患者症状的临床疗效和安全性,为抑郁症的治疗提供更科学的依据,为患者提供更有效的治疗选择。方法:选取浙江省10家三级精神病院的180例重度抑郁症急性期患者,采用竞争与连续模式,随机分为两组,分别使用灵活剂量的选择性5 -羟色胺再摄取抑制剂(SSRI)和阿戈美拉汀治疗。采用心理量表HAMD-17、HAMA、SHAPS(快感缺乏症)、MFI-20(疲劳)、PQSI(睡眠质量)和MEQ(基线、2、4、8和12周末时时间生物节律紊乱)对受试者进行评估,副反应采用TESS量表。对结果进行重复测量方差分析。结果:两组各90人,基线无显著差异。结论:阿戈美拉汀作为一种新型抗抑郁药,在改善抑郁和焦虑症状方面具有一定优势,其安全性与SSRIs相当。然而,其对重度抑郁症或其他抑郁亚型的长期疗效和安全性仍需进一步观察和研究。
{"title":"A multicenter, randomized controlled study on the efficacy of agomelatine in ameliorating anhedonia, reduced motivation, and circadian rhythm disruptions in patients with major depressive disorder (MDD).","authors":"Ping Guo, Yong Xu, Liang Lv, Min Feng, Yu Fang, Wei-Quan Huang, Shan-Fei Cheng, Min-Cai Qian, Shengliang Yang, Shi-Kai Wang, Huan-Xin Chen","doi":"10.1186/s12991-023-00473-y","DOIUrl":"10.1186/s12991-023-00473-y","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy and safety of Agomelatine in improving symptoms in patients with major depressive disorder (MDD), providing more scientific evidence for the treatment of depression, and offering more effective therapeutic options for patients.</p><p><strong>Methods: </strong>A total of 180 MDD patients in acute phase from 10 psychiatric hospitals of Grade three in Zhejiang Province were enrolled in this 12-week study with the competitive and consecutive pattern, and they were randomized into two different groups treated with flexible-dosage antidepressants of selective serotonin reuptake inhibitors (SSRI) or agomelatine, respectively. The subjects were evaluated with psychological scales of HAMD<sub>-17</sub>, HAMA, SHAPS for anhedonia, MFI-20 for fatigue, PQSI for sleep quality and MEQ for disturbances in chronobiologic rhythms at baseline, 2, 4, 8 and 12-weekend points, and TESS was used for side-effect. The results were analyzed with repeated measurement analysis of variance.</p><p><strong>Results: </strong>The two groups each had 90 participants, and there were no significant differences at baseline. The scores of various assessment scales showed statistically significant time main effects during the visits (P < 0.01). The Agomelatine group demonstrated faster efficacy within 2 weeks, with better improvement in SHAPS, MEQ, and PSQI compared to the SSRIs group. However, the remission rate at 12 weeks was lower in the Agomelatine group than in the SSRIs group (63.3% and 72.2%), but the difference between the groups was not statistically significant. The Agomelatine group had fewer adverse reactions (14.4% and 16.7%), but there was a slightly higher incidence of liver function impairment (6.7% and 4.4%), with no statistically significant difference between the groups.</p><p><strong>Conclusion: </strong>Agomelatine, as a novel antidepressant, shows certain advantages in improving depression and anxiety symptoms and is comparable to SSRIs in terms of safety. However, its long-term efficacy and safety on MDD or other depressive subtypes still require further observation and research.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":"22 1","pages":"46"},"PeriodicalIF":3.7,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92152355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Randomized clinical trial of low dose suramin intravenous infusions for treatment of autism spectrum disorder. 小剂量苏拉明静脉滴注治疗自闭症谱系障碍的随机临床试验。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-11-06 DOI: 10.1186/s12991-023-00477-8
David Hough, Alice R Mao, Michael Aman, Reymundo Lozano, Constance Smith-Hicks, Veronica Martinez-Cerdeno, Michael Derby, Zachary Rome, Niel Malan, Robert L Findling

Background: There is a critical need for effective treatment of the core symptoms of autism spectrum disorder (ASD). The purinergic antagonist suramin may improve core symptoms through restoration of normal mitochondrial function and reduction of neuro-inflammation via its known antagonism of P2X and P2Y receptors. Nonclinical studies in fragile X knockout mice and the maternal immune activation model support these hypotheses.

Methods: We conducted a 14 week, randomized, double-blind, placebo-controlled proof -of-concept study (N = 52) to test the efficacy and safety of suramin intravenous infusions in boys aged 4-15 years with moderate to severe ASD. The study had 3 treatment arms: 10 mg/kg suramin, 20 mg/kg suramin, and placebo given at baseline, week 4, and week 8. The Aberrant Behavior Checklist of Core Symptoms (ABC-Core) (subscales 2, 3, and 5) was the primary endpoint and the Clinical Global Impressions-Improvement (CGI-I) was a secondary endpoint.

Results: Forty-four subjects completed the study. The 10 mg/kg suramin group showed a greater, but statistically non-significant, numeric improvement (- 12.5 ± 3.18 [mean ± SE]) vs. placebo (- 8.9 ± 2.86) in ABC-Core at Week 14. The 20 mg/kg suramin group did not show improvement over placebo. In exploratory analyses, the 10 mg/kg arm showed greater ABC Core differences from placebo in younger subjects and among those with less severe symptoms. In CGI-I, the 10 mg/kg arm showed a statistically significant improvement from baseline (2.8 ± 0.30 [mean ± SE]) compared to placebo (1.7 ± 0.27) (p = 0.016). The 20 mg/kg arm had a 2.0 ± 0.28 improvement in CGI-I, which was not statistically significant compared to placebo (p = 0.65).

Conclusion: Suramin was generally safe and well tolerated over 14 weeks; most adverse events were mild to moderate in severity. Trial Registration Registered with the South African Health Authority, registration number DOH-27-0419-6116.

Clinicaltrials: Gov registration ID is NCT06058962, last update posted 2023-09-28.

背景:迫切需要有效治疗自闭症谱系障碍(ASD)的核心症状。嘌呤能拮抗剂苏拉明可以通过恢复正常线粒体功能和通过已知的P2X和P2Y受体拮抗作用减少神经炎症来改善核心症状。对脆性X基因敲除小鼠和母体免疫激活模型的非临床研究支持这些假设。方法:我们进行了一项为期14周的随机、双盲、安慰剂对照的概念验证研究(N = 52)来测试静脉输注苏拉明对4-15岁患有中度至重度ASD的男孩的疗效和安全性。该研究有3个治疗组:在基线、第4周和第8周给予10 mg/kg苏拉明、20 mg/kg苏拉明和安慰剂。核心症状异常行为检查表(ABC核心)(分量表2、3和5)是主要终点,临床总体印象改善(CGI-I)是次要终点。结果:44名受试者完成了研究。10 mg/kg苏拉明组显示出更大但统计学上无显著的数值改善(-12.5 ± 3.18[平均值 ± SE])与安慰剂(-8.9 ± 2.86)。20 mg/kg苏拉明组与安慰剂组相比没有改善。在探索性分析中,在年轻受试者和症状较轻的受试者中,10 mg/kg组与安慰剂组的ABC核心差异更大。在CGI-I中,10 mg/kg组与基线相比有统计学意义的改善(2.8 ± 0.30[平均值 ± SE])与安慰剂(1.7 ± 0.27)(p = 0.016)。20mg/kg组的 ± 0.28 CGI-I改善,与安慰剂相比无统计学意义(p = 0.65)。结论:苏拉明在14周内总体安全且耐受良好;大多数不良事件的严重程度为轻度至中度。在南非卫生局注册的试验注册,注册号DOH-27-0419-6116。临床试验:政府注册ID为NCT06058962,最后更新发布于2023-09-28。
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引用次数: 0
Borderline personality disorder and early psychosis: a narrative review. 边缘型人格障碍与早期精神病:叙述性综述。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-11-02 DOI: 10.1186/s12991-023-00475-w
Arianna Biancalani, Lorenzo Pelizza, Marco Menchetti

Background: The purpose of the present review was to summarize the main literature contribution on the relationship between borderline personality disorder (BPD) and early psychosis. While retracing the historical path of the term "borderline", specific attention was paid to psychotic and psychotic-like symptoms in BPD. Its relationship with At Risk Mental State was evaluated, as well.

Methods: This search was conducted on PUBMED/MEDLINE and PsycInfo, looking for "Borderline personality disorder, First Episode Psychosis, Early Psychosis, Ultra-High Risk AND/OR Clinical High Risk" for psychosis.

Results: Eight pertinent papers were identified on this topic. Their main findings were then discussed. The term "borderline" has undergone different changes in meaning and use, despite always referring to states considered on the fence between neurosis and psychosis. However, considering the history of psychopathology and its relationship with diagnostic manuals, little attention has been given to its psychotic features. Being those symptoms highly burdensome, this neglect has often led to misdiagnosis and under-treatment.

Conclusions: Psychotic symptoms in BPD can be severe and distressing. Nonetheless they can be easily neglected, and when found they challenge clinicians in defining a differential diagnosis to distinguish between BPD and Psychosis Spectrum Disorders. Given specific needs and interventions for these different conditions, a dimensional, rather than categorical, approach should be considered, as well as specific care pathways and monitoring should be advised.

背景:本综述的目的是总结关于边缘型人格障碍(BPD)与早期精神病之间关系的主要文献贡献。在追溯“边界”一词的历史路径时,特别关注BPD中的精神病和精神病样症状。它与危险心理状态的关系也进行了评估。方法:在PUBMED/MEDLINE和PsycInfo上搜索精神病的“边缘型人格障碍、首发精神病、早期精神病、超高危和/或临床高危”。结果:就这一主题发表了八篇相关论文。然后讨论了他们的主要发现。“临界”一词在含义和用法上发生了不同的变化,尽管它总是指被认为处于神经症和精神病之间的状态。然而,考虑到精神病理学的历史及其与诊断手册的关系,很少关注其精神病特征。由于这些症状非常繁重,这种忽视往往导致误诊和治疗不足。结论:BPD的精神症状可能严重且令人痛苦。尽管如此,它们很容易被忽视,当被发现时,它们对临床医生定义鉴别诊断以区分BPD和精神病谱系障碍提出了挑战。鉴于这些不同情况的具体需求和干预措施,应考虑一种维度而非分类的方法,并建议具体的护理途径和监测。
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引用次数: 0
A shift in psychiatry through AI? Ethical challenges. 通过人工智能改变精神病学?道德挑战。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-11-02 DOI: 10.1186/s12991-023-00476-9
Saskia Wilhelmy, Giancarlo Giupponi, Dominik Groß, Klaus Eisendle, Andreas Conca

The digital transformation has made its way into many areas of society, including medicine. While AI-based systems are widespread in medical disciplines, their use in psychiatry is progressing more slowly. However, they promise to revolutionize psychiatric practice in terms of prevention options, diagnostics, or even therapy. Psychiatry is in the midst of this digital transformation, so the question is no longer "whether" to use technology, but "how" we can use it to achieve goals of progress or improvement. The aim of this article is to argue that this revolution brings not only new opportunities but also new ethical challenges for psychiatry, especially with regard to safety, responsibility, autonomy, or transparency. As an example, the relationship between doctor and patient in psychiatry will be addressed, in which digitization is also leading to ethically relevant changes. Ethical reflection on the use of AI systems offers the opportunity to accompany these changes carefully in order to take advantage of the benefits that this change brings. The focus should therefore always be on balancing what is technically possible with what is ethically necessary.

数字化转型已经进入社会的许多领域,包括医学。虽然基于人工智能的系统在医学学科中广泛存在,但它们在精神病学中的应用进展较慢。然而,他们承诺在预防选择、诊断甚至治疗方面彻底改变精神病实践。精神病学正处于这种数字化转型之中,因此问题不再是“是否”使用技术,而是“如何”使用它来实现进步或改进的目标。这篇文章的目的是认为,这场革命不仅给精神病学带来了新的机会,而且也给精神病学带来新的伦理挑战,特别是在安全、责任、自主性或透明度方面。例如,精神病学中医生和患者之间的关系将得到解决,在这种关系中,数字化也导致了伦理上的相关变化。对人工智能系统使用的伦理反思为谨慎地伴随这些变化提供了机会,以利用这种变化带来的好处。因此,重点应该始终放在平衡技术上可能的与道德上必要的。
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引用次数: 0
Psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression and its relationship to affective symptoms. 抑郁症患者阴性症状临床评估访谈的心理测量特性及其与情感症状的关系。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-10-26 DOI: 10.1186/s12991-023-00474-x
Johan Bengtsson, Parya Rad, Martin Cernvall, Robert Bodén

Background: There is a conceptual overlap between negative and depressive symptoms, requiring further exploration to advance the understanding of negative symptoms. The aim of this study was to examine psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression, and to explore the relationship between the negative and affective symptoms domains.

Methods: Fifty-one patients with a depressive episode were included and interviewed with the CAINS and the Brief Psychiatric Rating Scale-Expanded (BPRS-E). Self-reported depressive symptoms were collected with the Montgomery-Asberg Depression Rating Scale (MADRS-S). Inter-rater agreement, internal consistency and validity measures were examined, as were correlations between negative and affective symptoms.

Results: The intraclass correlation for the CAINS motivation and pleasure subscale (CAINS-MAP) was 0.98 (95% CI 0.96-0.99) and that for the expressional subscale (CAINS-EXP) was 0.81 (95% CI 0.67-0.89). Cronbach's alpha was 0.71 (95% CI 0.57-0.82) for the CAINS-MAP and 0.86 (95% CI 0.79-0.92) for the CAINS-EXP. The correlation with the negative symptoms subscale of the BPRS-E was 0.35 (p = 0.011, blinded/different raters) or 0.55 (p < 0.001, not blinded/same rater). The CAINS-MAP correlated with the affective symptoms subscale of the BPRS-E (r = 0.39, p = 0.005) and the MADRS-S total score (r = 0.50, p < 0.001), but not with anxiety symptoms.

Conclusions: Negative symptoms in depression can be assessed with the CAINS with good inter-rater agreement and acceptable internal consistency and validity. There are associations between negative and depressive symptoms that call for further exploration.

背景:消极症状和抑郁症状之间存在概念上的重叠,需要进一步探索以促进对消极症状的理解。本研究的目的是检验抑郁症患者消极症状临床评估访谈(CAINS)的心理测量特性,并探讨消极症状和情感症状领域之间的关系。方法:采用CAINS和简明精神病评定量表(BPRS-E)对51例抑郁症患者进行访谈。采用Montgomery-Asberg抑郁评定量表(MADR-S)收集自我报告的抑郁症状。调查了评分者之间的一致性、内部一致性和有效性指标,以及负面症状和情感症状之间的相关性。结果:CAINS-动机和快乐分量表(CAINS-MAP)的组内相关性为0.98(95%CI 0.96-0.99),表达分量表(CAINS-EXP)的组间相关性为0.81(95%CI 0.67-0.89)。BPRS-E与阴性症状分量表的相关性为0.35(p = 0.011,盲法/不同评分者)或0.55(p 结论:CAINS可以评估抑郁症的阴性症状,具有良好的评分者间一致性和可接受的内部一致性和有效性。消极症状和抑郁症状之间存在联系,需要进一步探索。
{"title":"Psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression and its relationship to affective symptoms.","authors":"Johan Bengtsson,&nbsp;Parya Rad,&nbsp;Martin Cernvall,&nbsp;Robert Bodén","doi":"10.1186/s12991-023-00474-x","DOIUrl":"10.1186/s12991-023-00474-x","url":null,"abstract":"<p><strong>Background: </strong>There is a conceptual overlap between negative and depressive symptoms, requiring further exploration to advance the understanding of negative symptoms. The aim of this study was to examine psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression, and to explore the relationship between the negative and affective symptoms domains.</p><p><strong>Methods: </strong>Fifty-one patients with a depressive episode were included and interviewed with the CAINS and the Brief Psychiatric Rating Scale-Expanded (BPRS-E). Self-reported depressive symptoms were collected with the Montgomery-Asberg Depression Rating Scale (MADRS-S). Inter-rater agreement, internal consistency and validity measures were examined, as were correlations between negative and affective symptoms.</p><p><strong>Results: </strong>The intraclass correlation for the CAINS motivation and pleasure subscale (CAINS-MAP) was 0.98 (95% CI 0.96-0.99) and that for the expressional subscale (CAINS-EXP) was 0.81 (95% CI 0.67-0.89). Cronbach's alpha was 0.71 (95% CI 0.57-0.82) for the CAINS-MAP and 0.86 (95% CI 0.79-0.92) for the CAINS-EXP. The correlation with the negative symptoms subscale of the BPRS-E was 0.35 (p = 0.011, blinded/different raters) or 0.55 (p < 0.001, not blinded/same rater). The CAINS-MAP correlated with the affective symptoms subscale of the BPRS-E (r = 0.39, p = 0.005) and the MADRS-S total score (r = 0.50, p < 0.001), but not with anxiety symptoms.</p><p><strong>Conclusions: </strong>Negative symptoms in depression can be assessed with the CAINS with good inter-rater agreement and acceptable internal consistency and validity. There are associations between negative and depressive symptoms that call for further exploration.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":"22 1","pages":"42"},"PeriodicalIF":3.7,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10604520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54227383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stress, depression, anxiety, and quality of life among the healthcare workers during COVID-19 pandemic in Syria: a multi-center study. 叙利亚新冠肺炎大流行期间医护人员的压力、抑郁、焦虑和生活质量:一项多中心研究。
IF 3.7 3区 医学 Q1 PSYCHIATRY Pub Date : 2023-10-16 DOI: 10.1186/s12991-023-00470-1
Hasan Nabil Al Houri, Abdullah Alhouri, Douaa Mohammad Nazir Arrouk, Ahmad Nabil Al Houri, Sami Jomaa, Alaa Sharabi, Hussein Kannout, Youssef Latifeh

Background: The COVID-19 pandemic emerged as an expected source of stress and anxiety as the healthcare workers had to work for long hours in close contact with infected patients, thus increasing the probability of medical errors and threatening the patients' safety. This study aims to measure the levels of depressive symptoms, anxiety symptoms, and stress among Syrian healthcare workers and their quality of life during the COVID-19 pandemic.

Methods: A cross-sectional study was conducted in six central hospitals in Damascus, Syria. Data were collected from 1 to 30 June-2021. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress among healthcare workers. Quality of life was assessed using the EUROHIS-QOL 8-item index.

Results: A total of 700 participants were included in this study. 61.6% (n = 431) were males and 38.4% (n = 269) were females. Younger ages (18-29 years old) were significantly associated with higher levels of depression and stress (p < 0.0083). Female healthcare workers had higher significant levels of anxiety (p < 0.05). Significant anxiety and stress levels were reported when healthcare workers had contact with COVID-19 patients, even if they had protective equipment (p < 0.05). Half of the participants (50%; n = 349) reported a good quality of life.

Conclusion: Stress levels and depressive symptoms were remarkably higher in healthcare workers of ages 18 and 29 years old, whereas anxiety levels were significantly higher and more severe in female healthcare workers. Moreover, direct interaction with COVID-19 patients was associated with higher levels of stress and anxiety symptoms.

背景:新冠肺炎大流行成为压力和焦虑的预期来源,因为医护人员不得不长时间与感染患者密切接触,从而增加了医疗差错的可能性,并威胁到患者的安全。本研究旨在测量新冠肺炎大流行期间叙利亚医护人员的抑郁症状、焦虑症状和压力水平及其生活质量。方法:在叙利亚大马士革的六家中心医院进行横断面研究。数据收集于2021年6月1日至30日。抑郁-焦虑-压力量表-21(DAS-21)用于评估医护人员的抑郁、焦虑和压力。使用EUROHIS-POL 8项指数评估生活质量。结果:共有700名参与者被纳入本研究。61.6%(n = 431)为男性,38.4%(n = 269)为女性。年龄较小(18-29岁)与较高的抑郁和压力水平显著相关(p 结论:18岁和29岁的医护人员的压力水平和抑郁症状明显更高,而女性医护人员的焦虑水平明显更高且更严重。此外,与新冠肺炎患者的直接互动与更高水平的压力和焦虑症状相关。
{"title":"Stress, depression, anxiety, and quality of life among the healthcare workers during COVID-19 pandemic in Syria: a multi-center study.","authors":"Hasan Nabil Al Houri, Abdullah Alhouri, Douaa Mohammad Nazir Arrouk, Ahmad Nabil Al Houri, Sami Jomaa, Alaa Sharabi, Hussein Kannout, Youssef Latifeh","doi":"10.1186/s12991-023-00470-1","DOIUrl":"10.1186/s12991-023-00470-1","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic emerged as an expected source of stress and anxiety as the healthcare workers had to work for long hours in close contact with infected patients, thus increasing the probability of medical errors and threatening the patients' safety. This study aims to measure the levels of depressive symptoms, anxiety symptoms, and stress among Syrian healthcare workers and their quality of life during the COVID-19 pandemic.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in six central hospitals in Damascus, Syria. Data were collected from 1 to 30 June-2021. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress among healthcare workers. Quality of life was assessed using the EUROHIS-QOL 8-item index.</p><p><strong>Results: </strong>A total of 700 participants were included in this study. 61.6% (n = 431) were males and 38.4% (n = 269) were females. Younger ages (18-29 years old) were significantly associated with higher levels of depression and stress (p < 0.0083). Female healthcare workers had higher significant levels of anxiety (p < 0.05). Significant anxiety and stress levels were reported when healthcare workers had contact with COVID-19 patients, even if they had protective equipment (p < 0.05). Half of the participants (50%; n = 349) reported a good quality of life.</p><p><strong>Conclusion: </strong>Stress levels and depressive symptoms were remarkably higher in healthcare workers of ages 18 and 29 years old, whereas anxiety levels were significantly higher and more severe in female healthcare workers. Moreover, direct interaction with COVID-19 patients was associated with higher levels of stress and anxiety symptoms.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":"22 1","pages":"41"},"PeriodicalIF":3.7,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Annals of General Psychiatry
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