Asian journal of psychiatry最新文献

Introduction: Stressful life events (SLEs) are common exposures and act as major proximal and distal risk factors for perinatal depression. Pregnancy represents a critical period in which SLE-related psychosocial vulnerability may manifest as depressive symptoms.

Aim: This study investigated the presence of major SLE occurring during pregnancy, and examined their associations with depressive symptomatology, relevant psychological and clinical variables.

Methods: A multicentre cohort of 2633 women in their third trimester was recruited within a regional perinatal depression screening program and women reporting depressive symptoms were followed postpartum (7 days, 1 month, and 6 months). Longitudinal follow-up assessments were restricted to participants screening positive for depressive symptoms, in accordance with the screening program design. Major SLE were assessed using the Holmes-Rahe Stress Scale, while depressive symptoms, personality, attachment, resilience, coping strategies, and quality of life were all measured with validated instruments.

Results: 4.9% (n = 128) of participants experienced major stressful life events (SE ≥150), independent of age, education, employment, or obstetric history. Women exposed to major SLE showed higher baseline and early postpartum depressive symptoms, greater neuroticism, insecure attachment, lower resilience, and poorer quality of life (all p < 0.0001). Major stress exposure was also associated with reduced caregiving support and higher partner psychiatric morbidity. Multivariate analysis identified depressive symptoms, neuroticism, lower psychological wellbeing, absence of a caregiver, and prior perinatal psychopathology as factors independently associated with major stressful life events.

Conclusions: These findings highlight the need for comprehensive psychosocial screening in perinatal care. Targeted interventions aimed at strengthening resilience, adaptive coping, and relational support may mitigate stress-related risk and prevent perinatal psychopathology.

Objective: To systematically review and meta-analyze randomized controlled trials (RCTs) and non-randomized studies (non-RCTs) evaluating the efficacy of transcranial magnetic stimulation (TMS) for anhedonia in adults with mood disorders.

Methods: PubMed, Scopus, and ClinicalTrials.gov were searched through March 2025. Studies were included if they specifically assessed the effects of TMS on anhedonia in adults (≥18 years) with major depressive disorder or bipolar depression. The primary outcome was change in anhedonia severity measured by the Snaith-Hamilton Pleasure Scale (SHAPS), the Temporal Experience of Pleasure Scale (TEPS), and the Dimensional Anhedonia Rating Scale (DARS). Secondary outcome was change in depression severity. Random-effects meta-analyses with Hartung-Knapp adjustment were performed for sham-controlled RCTs.

Results: Fourteen studies (eight RCTs, six non-RCTs) were included. Sham-controlled RCTs showed a small but statistically significant improvement in anhedonia favoring active TMS (SMD = 0.27, 95% CI 0.02, 0.52; p = 0.042). Exploratory analyses of studies using TEPS demonstrated a significant effect on anticipatory anhedonia (Hedges' g = 0.27, 95% CI 0.09, 0.45). No significant effect was observed for depression severity in RCTs (SMD = -0.14, 95% CI -0.45, 0.17; p = 0.30). Non-RCTs reported larger improvements in both anhedonia and depression; however, studies have substantial heterogeneity and are not directly comparable to sham-controlled RCT findings.

Conclusions: TMS is associated with a small improvement in anhedonia. The absence of a significant effect on depression severity should be interpreted cautiously and may suggest that anhedonia could represent a partially distinct neuromodulation target; however, this interpretation remains hypothesis-generating given the limited number of studies and statistical power. Unmet needs include the standardization of anhedonia assessment favoring multidimensional scales and powered designs with anhedonia as a primary outcome.

Aim: This scoping review aims to explore the Indian literature on behavioural and psychological symptoms of dementia (BPSD) published over the past two decades, focusing on epidemiology, symptom profiles, clinical and psychosocial correlates, caregiver burden, and management strategies.

Methods: The databases PubMed, EMBASE, and Scopus were searched for Indian studies addressing BPSD. Observational, interventional, qualitative, and mixed-methods studies were included. Data were extracted on study characteristics, dementia subtypes and severity, assessment tools, BPSD correlates, caregiver burden, and management.

Results: Thirty-three studies published between 2006 and 2025 across diverse Indian regions were included. Commonly reported BPSD included sleep disturbances, apathy, irritability, agitation, and affective symptoms, with variation across dementia subtypes. Severity was highest in frontotemporal dementia and dementia with Lewy bodies. BPSD intensity was consistently associated with severity of cognitive impairment, illness duration, pain and sociodemographic factors. Caregiver burden was strongly associated with BPSD severity in addition to cognitive decline. Most interventions evaluated were non-pharmacological therapies which reduced BPSD severity and caregiver distress. Pharmacological studies were limited, largely examining prescribing patterns and providing preliminary evidence for herbal formulations.

Conclusion: Indian literature highlights the burden of BPSD, its subtype specific presentation and the associated caregiver burden. Although non-pharmacological approaches have shown substantial promise, the evidence base remains heterogenous, limited by majority of cross-sectional study designs, warranting further research in the form of longitudinal studies.