Asian journal of psychiatry最新文献

Background: Schizophrenia is a severe mental illness associated with significantly elevated mortality rates. However, factors related to the mortality risk among people with schizophrenia in low and middle-income countries remain to be examined. This study aims to explore the clinical factors for all-cause mortality in people with schizophrenia.

Methods: We conducted a 9-year retrospective cohort study on people with schizophrenia in Guangzhou, China. Cox proportional hazards regression analysis and competing risk analysis was used to identify clinical factors associated with all-cause mortality and specific-cause mortality. A propensity score matching method was performed to minimize the impact of confounding factors.

Results: The overall age-standardized mortality rate in people with schizophrenia between 2013 and 2021 was 1606.04 per 100,000 person-years. We found that medical expenses not covered by medical insurance (adjusted hazard ratio [aHR]: 2.49 [95 % CI: 2.21-2.82]), relatively-stable (aHR: 1.18 [95 % CI: 1.01-1.38]) and unstable illness (aHR: 2.65 [95 % CI: 1.90-3.68]), history of non-continuous treatment (aHR: 1.35 [95 % CI: 1.25-1.46]), and no treatment history (aHR: 1.41 [95 % CI: 1.29-1.55]) were associated with a higher risk of all-cause mortality. Frequent hospital stays (once: aHR: 0.46 [95 % CI: 0.42-0.50], more than once: aHR: 0.23 [95 % CI: 0.21-0.26]) and a family history of mental disorders (aHR: 0.50 [95 % CI: 0.40-0.64]) were associated with a lower risk of mortality.

Conclusion: We identified clinical factors associated with all-cause mortality. Targeted interventions should be developed to reduce the mortality risk in people with schizophrenia.

Deep Brain Stimulation is a form of neurostimulation where electrical stimulation is delivered via intracranial electrodes over specific subcortical targets. It has been increasingly used as an alternative to ablative procedures for psychiatric disorders refractory to standard treatments. This review describes the common psychiatric indications for DBS, the current evidence base, putative mechanisms, and future directions.

South Korea has historically relied on inpatient psychiatric care. Although the 1995 Mental Health Act aimed to promote community mental health services, progress in developing community-based interventions has been limited. This review aims to provide a concise analysis of the current state of research on evaluating community mental health care in Korea, employing a comparative perspective with the United Kingdom (UK), where community-based mental health approaches have been more extensively studied and implemented. On November 19, 2024, a literature search was conducted using PubMed. The search strategy combined keywords related to mental illness and community intervention with the terms "Korea" or "United Kingdom." The review focused on randomized controlled trials from both countries that assessed patient-level outcomes of community-based mental health interventions. The findings reveal a striking contrast: in Korea, only one randomized pilot trial focused on depression in older adults was found. In contrast, 69 studies were identified in the UK, including 13 pilot/feasibility studies and 56 main studies, with 38 of these addressing severe mental illness. This clear difference underscores the limited research and evaluation of community-based mental health interventions in Korea. The results indicate a pressing need for research to assess these interventions. Such research could guide policy reforms toward deinstitutionalization and help Korea strengthen its community-based mental health system in line with global trends.

Background: Transcranial Direct Current Stimulation (tDCS) is an emerging modality with demonstrated efficacy in Major Depressive Disorder (MDD), however, there is paucity of research in adolescent depression. This study attempts to evaluate the safety and efficacy of tDCS in adolescents with MDD as an early augmentation to drug therapy.

Methods: Adolescents with MDD aged 10-18 years were enrolled in the study and allocated to active or sham groups as per randomization. Sertraline was given in the range of 25-50 mg to each participant. After baseline assessments, 10 sessions of tDCS were given with 2 mA current for 20 minutes, keeping anode at left DLPFC and cathode at right DLPFC. Side effects were assessed and rating scales were reapplied at 2 weeks and then 6 weeks. Results were analyzed.

Results: A total of 32 patients were analysed (15-active, 17-sham). At 2 weeks, the BDI and BAI scores of the true group were significantly lower than the sham group, and the reduction in the scores of the former was statistically greater. This significance did not persist at 6 weeks, and the reduction in the scores of the two groups was significantly different from baseline to 2-weeks and 6-weeks. Response and remission rates were higher in the active group at 6 weeks. Adverse effects were comparable.

Conclusion: tDCS is safe and effective for early augmentation of drugs in adolescents with MDD. However, effects do not last long after termination of sessions. Further studies are needed with a larger sample size and longer follow-ups.

This review, in light of the Socio-Cultural Erosion Theory, addresses the alarming deterioration in mental health among Iranian youth. According to this theory, rapid socio-cultural changes, economic instability, and pervasive influences of digital media create a drift between traditional values and modern expectations that are detrimental to mental health. The major risk factors identified in order of significance were, in descending order, economic hardship, academic stress, cultural pressures, and digital exposure. It is for this reason that evidence-based, practical interventions are proposed through policy reforms, educational changes, and community-based support to assist youth in Iran in meeting these challenges. The need is for solutions that are embedded within the specific cultural, economic, and social contexts of Iran to promote resilience and mental well-being.

Child and adolescent mental health disorders in Qatar remain significantly underserved due to a critical shortage of specialists, stigma, and logistical barriers. This paper proposes implementing a Collaborative Care Model (CoCM) within Qatar's primary care settings, leveraging existing infrastructure, such as the CERNER electronic health record system, and innovations like telepsychiatry and AI-driven tools. The model integrates task-sharing among interdisciplinary teams to enhance accessibility and continuity of care. This commentary explores the model's feasibility, addressing challenges like workforce shortages and psychotropic prescribing processes. The proposed CoCM offers a sustainable solution to improve youth mental health outcomes and reduce systemic disparities.