Annals of General Psychiatry最新文献

Background: In the latest research, it is proposed that the intrusions symptoms of the structure of post-traumatic stress disorder (PTSD) were divided into internally-generated and externally-generated. Additional research is required to validate this emerging theory. Moreover, few studies have employed longitudinal data to further validate the novel 8-factor model.

Aim: This study aims to explore the factor structure, gender invariance, and longitudinal invariance of the PTSD Checklist for DSM-5 (PCL-5) among children in post-pandemic era.

Methods: A survey was conducted on 1861 children using the PTSD Checklist for DSM-5 (PCL-5), and 590 children were re-investigated over three months interval. The statistical analysis includes: Kolmogorov-Smirnov normality test, the missing rates and descriptive statistics of the study variables, confirmatory factor analysis, the gender measurement invariance, longitudinal measurement invariance, and correlation of each factor within the PCL-5.

Results: Based on the DSM-5 criteria, the results indicated that 6.8% of the children in the sample exhibited symptoms suggestive of possible PTSD. The novel 8-factor model fits better than the DSM-5 model, DSM-5 dysphoric model, Dysphoric arousal model, Anhedonia model, Externalizing behaviors model, and Hybrid model. The measurement invariance results further indicated that the PCL-5 has strict invariance across gender and strong invariance across time.

Conclusion: This study validated the novel 8-factor model of DSM-5 PTSD among children in the post-pandemic era and assessed the gender and longitudinal measurement invariance of the PCL-5. The novel 8-factor model of the PCL-5 is the best DSM-5 model of PTSD symptoms and has strict measurement invariance across gender and strong measurement invariance across time. The research results extended the theoretical framework and empirical research on the DSM-5 PTSD novel 8-factor model. Through this analysis, we hope to provide more accurate tools and strategies for the evaluation and intervention of post-traumatic stress disorder in children.

Aims: It is generally known that 30% of Major depressive disorder (MDD) patients do not respond to traditional pharmacological and psychosocial therapy. Transcranial magnetic stimulation (TMS), introduced first in 1985, was a non-invasive neural network research method. Later, repetitive Transcranial Magnetic Stimulation (rTMS) was approved by the FDA to treat treatment-resistant depression (TRD) in 2008. Over the past two decades, rTMS has been extensively developed using various protocols in order to stimulate superficial brain nerve cells non-invasively. We planned to see if high-frequency accelerated left prefrontal rTMS can improve symptoms of treatment resistant depression given its convenience it provides by having patients for fewer treatment sessions.

Methods: A total of 25 patients were enrolled in the study. Inclusion criteria were age between 18 and 60 and a history of at least one failed treatment with antidepressants. The treatment was conducted over six days scattered over three weeks and each day consisted of three 30-minute sessions (83, 83, and 84 trains for each session). The sessions were separated with 15-minute breaks. rTMS protocol: 120% of the motor threshold and frequency of 10 Hz. Consisting of 2.4 s trains with an intertrain interval of 15-seconds.

Result: The study included 25 individuals (male: 12/13) with an average age of 36.88 ± 10.61. We compared outcome indicators at baseline and week three after confirming the normality of the data. After three weeks, Hamilton Depression Rating Scale and Clinician Global Impression showed a substantial improvement. There was a remission rate of 24% (6/25) and a response rate of 52% (13/25).

Conclusion: This work adds to the evidence that rTMS can treat TRD and shows that a more convenient high-frequency accelerated rTMS can improve symptoms in treatment resistant depression.

Purpose: Suicidal and non-suicidal self-injuries are types of self-directed violence that can become complex health issues. This study assessed how and to what degree the factors of self-injuries are interrelated among enrolled students.

Methods: A total of 1481 students were recruited from college and middle or secondary schools, and 1465 (98.92%) subjects comprised the final sample. Mixed graphical models were used to establish network structures. Also explore their shortest paths and conduct a regression analysis.

Results: Of the 1465 students, we observed intersections that connected the cluster of early experiences and psychiatric/psychological using network analysis. Shortest paths analysis and regression analysis suggest that symptoms of schizoid (edge-weights = 0.336, OR = 2.79, p < 0.01) and narcissistic (edge-weights=-0.177, OR = 0.35, p < 0.05) personality disorders (PD), acceptance (edge-weights = 0.470, OR = 12.80, p < 0.01) and positive refocusing (edge-weights=-0.171, OR = 0.12, p < 0.05) strategies of emotion-regulation, mindfulness awareness (edge-weights=-0.263, OR = 0.24, p < 0.05), and emotional-neglect in childhood (edge-weights = 0.239, OR = 5.54, p < 0.05) were found with non-suicidal self-injury (NSSI). Symptoms of anxiety (edge-weights = 0.280, OR = 2.00, p < 0.01) and avoidant-PD (edge-weights = 0.229, OR = 1.75, p < 0.01) were associated with suicidal ideation, and symptoms of borderline-PD (edge-weights = 0.432, OR = 5.38, p < 0.05) and mindfulness awareness (edge-weights=-0.180, OR = 0.28, p < 0.05) were associated with suicide attempt.

Conclusions: Relying exclusively on acceptance strategy may constitute an avoidance pattern, impeding the ability to confront emotional distress. Clinical intervention aimed at repairing father-child relationship may be helpful to recover from emotional trauma and improve current symptoms and self-injuries.

Introduction: Understanding the intricate relationship between circadian rhythms and depression is crucial for developing effective interventions and treatments for individuals affected by depression. Circadian rhythms regulate various physiological and behavioral processes, while depression manifests as persistent feelings of sadness and disturbances in sleep, appetite, and energy levels. Emerging research suggests a significant interplay between circadian rhythm disruption and depression, highlighting the need for comprehensive analysis in this area.

Methodology: A bibliometric and visual analysis of literature on circadian rhythms in depression from 2004 to 2024 was conducted using the Web of Science Core Collection. Data were analyzed using bibliometric tools including VOSviewer, CiteSpace, and Bibliometrix to identify publication trends, geographical distribution, authorship patterns, institutional collaborations, journal preferences, keyword co-occurrence, and highly cited references.

Results: Analysis revealed a steady increase in publications and citations related to circadian rhythms in depression. The United States emerged as the leading contributor, with strong global collaborations. Key journals included Chronobiology International and Journal of Affective Disorders. Top keywords included circadian rhythm, depression, sleep, melatonin, and bipolar disorder. The most cited article is a review titled "Practice parameters for the indications for polysomnography and related procedures: An update for 2005".

Conclusions: This study offers a comprehensive overview of research on circadian rhythms in depression, highlighting key trends, contributors, and interdisciplinary intersections.

Background: Caregivers of children with attention-deficit/hyperactivity disorder (ADHD) are vulnerable to increased psychological distress during COVID-19. However, specific pandemic- and child-related factors contributing to their poor mental health have not been fully investigated. We aimed to comprehensively examine prevalence and correlates of depression and anxiety among caregivers of ADHD children in Hong-Kong during the peak of fifth pandemic wave with territory-wide school closure.

Method: One-hundred-ninety-nine caregivers of ADHD children were assessed with self-rated questionnaires between 29 March-14 April, 2022. Questionnaires encompassed socio-demographics, pre-existing physical/psychiatric morbidity, COVID-19 related factors, children's ADHD and other psychiatric symptoms. Caregivers' psychological distress was quantified by Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7). Caregivers who scored ≥ 10 in PHQ-9 and GAD-7 were classified as having probable depression and probable anxiety, respectively. Univariate and multivariate logistic regression analyses were conducted to identify correlates associated with caregivers' probable depression and anxiety status.

Results: Forty-four (22.4%) and 33 (16.9%) caregivers had probable depression and anxiety, respectively. Multivariate regression analyses revealed that caregivers' pre-existing mental disorder, greater COVID-19 stressor burden, and more severe emotional symptoms and insomnia of ADHD children were independently associated with both caregivers' depression and anxiety status.

Conclusion: A significant proportion of caregivers of ADHD children experienced clinically-significant depressive and anxiety symptoms during the peak of fifth pandemic wave and school closure. Findings suggest that optimizing management of caregivers' pre-existing mental health conditions, addressing emotional and sleep symptoms in ADHD children, and implementing strategies to alleviate pandemic-related stressors may reduce caregivers' psychological distress.

Background: The eyes serve as a portal to the brain and are highly connected neurologically, making them the only externally visible part of the brain. Moreover, the correlation between the physical attributes of the eye and psychiatric disorders has been increasingly established in recent years. Therefore, this study examined the association between iris color density and bipolar I disorder (BD).

Methods: In a case-control study, 48 subjects diagnosed with BD are compared to an equal number of healthy controls. A semi-structured interview questionnaire is designed to collect sociodemographic, psychiatric, medical history, and clinical data from all participants. The Group with BD is diagnosed based on clinical assessment by the Consultant/specialist by using a semi-structured clinical interview for DSM 5 Clinician Version (SCID-5-CV) to diagnose BD's current episode and to exclude the other comorbid mental disorders. Additionally, the group with BD is further assessed by The Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) to evaluate the severity of manic and depressive symptoms. The iris color of participants in both groups was evaluated using a standardized photographic system for iris imaging.

Results: It showed a statistically significant increase in the percentage of the colored iris in the patients' group compared with the control group, and the presence of a colored iris significantly increases the risk of BD by 2.36 folds. There is no statistically significant difference between iris color and either hospitalization, suicide, Electroconvulsive Therapy (ECT), family history, medical history, duration, or frequency of episodes.

Conclusion: Our findings revealed a strong association between iris color and bipolar disorder (BD) but no significant association between iris color and clinical factors such as hospitalization, suicide, electroconvulsive therapy (ECT), family history, medical history, or the duration and frequency of episodes. These results suggest that iris color may serve as a trait marker rather than a state marker in BD, potentially offering a simple and non-invasive indicator of bipolarity.

Introduction: Borderline Personality Disorder (BPD) is a complex neuropsychiatric condition characterized by four main symptom domains: emotion dysregulation, behavioral dysregulation, self-image disturbances, and interpersonal instability. While psychotherapy remains the primary treatment, there is a need for additional effective interventions. Given the neuromodulatory effects of non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), these methods may hold potential for addressing BPD symptoms.

Methods: A systematic review and network meta-analysis were conducted following PRISMA guidelines. A literature search (PubMed, Scopus, Web of Science, Cochrane CENTRAL) identified comparative studies assessing the effects of NIBS in BPD. The primary outcome was impulsivity, measured by the Barratt Impulsivity Scale (BIS-11). Secondary outcomes included Depressive symptoms, which were evaluated using different scales such as the Hamilton Depression Rating Scale (HAMD) and the Beck depression Inventory (BDI) scale, and anxiety symptoms were evaluated using the Hamilton Anxiety Rating Scale (HAMA).

Results: Five studies with a total of 103 patients were included. Regarding impulsivity, tDCS 2 mA showed a significant reduction compared to the control group (MD = -11.67, 95% CI [-21.44, -1.90]). For depressive symptoms, TMS 20 Hz ranked highest (SMD = -1.97, 95% CI [-3.51, -0.43]), followed by tDCS 2 mA (SMD = -1.65, 95% CI [-2.97, -0.34]). In terms of anxiety, both TMS 5 Hz (MD = -12.29, 95% CI [-24.57, -0.01]) and tDCS 2 mA (MD = -11.81, 95% CI [-17.39, -6.23]) showed significant differences.

Conclusion: Preliminary evidence suggests potential efficacy of non-invasive brain stimulation for BPD, with well-tolerated side effects with well-tolerated side effects. Although there are noticeable statistically significant differences between the interventions and control groups, the results are inconclusive due to the small sample.

Background: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. Despite its significance, no large-scale epidemiological study assessing ADHD, and its associated comorbidities in children and adolescents has been conducted in China.

Methods: Within a national epidemiological survey of 73,992 children and adolescents aged between 6 and 16 in China, we used the CBCL, MINI-KID, and DSM-IV to identify ADHD and its comorbid conditions. Chi-square tests were utilized to compare the prevalence estimates across varied age and sex groups.

Results: The overall ADHD prevalence was estimated at 6.4% (95% CI: 6.2-7.0%). Broken down by subtypes, ADHD-I had a prevalence of 3.9%, ADHD-C was at 1.7%, and ADHD-H was at 0.9%. Boys and the younger age bracket recorded higher prevalence rates for ADHD and its subtypes (p < 0.001). Among ADHD-diagnosed individuals, 53% exhibited at least one comorbid psychiatric disorder. Oppositional defiant disorder/conduct disorder (ODD/CD) was the most prevalent comorbidity for ADHD-C and ADHD-H, at 58%, while anxiety disorders, at 17%, were predominant among ADHD-I cases. ODD/CD was notably higher among younger subjects (p < 0.001). In contrast, anxiety disorders were more frequent in older children and in girls (p < 0.001). Tic disorders showed a higher prevalence in younger boys, whereas mood and substance use disorders were more common in older boys (p < 0.001).

Conclusions: ADHD is a common neurodevelopmental disorder with high comorbidity rates that vary substantially across subtypes, age, and sex. These clinical heterogeneities complicate management and highlight the need for tailored interventions.

Background: Late-life depression (LLD) stands as a prevalent mental health issue among older adults, frequently intertwined with cardiovascular and cerebrovascular diseases as well as cognitive decline. The occurrence of LLD in the older adults, who often present with multiple aging-related conditions, frequently results in this disorder being overlooked. However, the astronomical treatment costs and the considerable societal burden associated with LLD necessitate urgent and sustained attention.

Materials and methods: Utilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), we extracted incidence rates and disability-adjusted life years (DALYs) of LLD in individuals aged 60 and older. The extracted data underwent rigorous evaluation through the application of age-period-cohort models, the health inequality concentration index, and frontier analysis.

Results: From 1990 to 2021, a global increase was observed in both the age-standardized incidence rate (ASIR) and DALY rate of LLD. Specifically, the ASIR ascended by 0.01 per 100,000 annually, while the DALY rate rose by 0.03 per 100,000 each year. Notably, a statistically significant inverse relationship was identified between ASIR and the Socio-demographic Index (SDI) (p < 0.001). Additionally, a notable linear correlation was discerned between age-standardized death rate (ASDR) and SDI, albeit without a discernible downward trend (p < 0.001). According to the SDI, the Estimated average percentage change (EAPC) of five SDI districts showed no increase or decrease. Globally, the incidence of LLD showed an upward trend in the high SDI, middle SDI, and low-middle SDI regions, a downward trend in the high-middle SDI region, and no significant increase or decrease in the low SDI region. In the age-period-cohort analysis, we found that the incidence of LLD increased with age in high and middle SDI regions compared with low SDI regions, and the results were the opposite in low SDI regions, with significant regional characteristics. The period effect analysis revealed that irrespective of gender, the trends in incidence and DALY rates remained relatively unchanged globally from 1992 to 2021. As SDI levels rose, the SDI-adjusted disparities in incidence and DALY rates tended to stabilize. A comparative analysis of data from 1990 to 2021 highlighted a relative decline in health inequalities.

Conclusion: This comprehensive assessment of the disease burden of LLD among the global population aged 60 and older underscores significant accomplishments while simultaneously emphasizing areas requiring ongoing vigilance. In the context of relentless population growth and aging, the favorable downturns in incidence and DALY rates reflect tangible advancements in managing LLD.

Schizophrenia is a complex, heterogeneous, and highly disabling severe mental disorder whose pathogenesis has not yet been fully elucidated. Epigenetics, as a bridge between genetic and environmental factors, plays an important role in the pathophysiology of schizophrenia. Over the past decade, epigenetic-wide association studies have rapidly become an important branch of psychiatric research, especially in deciphering the molecular mechanisms of schizophrenia. This review systematically analyzes recent advances in epigenome-wide association studies (EWAS) of schizophrenia, focusing on technological developments. We synthesize findings from large-scale EWAS alongside emerging evidence on DNA methylation patterns, histone modifications, and regulatory networks, emphasizing their roles in disease mechanisms and treatment responses. In addition, this review provides a prospective outlook, evaluating the impact that technological developments may have on future studies of schizophrenia. With the continuous advancement of high-throughput sequencing technology and the increasing maturity of big data analysis methods, epigenetics is expected to have a significant impact on the early diagnosis, prognosis assessment and even personalized treatment of schizophrenia.