Asian journal of psychiatry最新文献

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.

Introduction: Homelessness embodies a prevalent societal issue that results in extensive socio-economic ramifications. Residential rehabilitation establishments, including shelters and mental health facilities, offer essential assistance to individuals with insecure housing situations. The healthcare providers within these facilities struggle to effectively tackle the underlying issues faced by homeless individuals, often due to a variety of socio-economic factors.

Aims: The study evaluates the mental health knowledge, practices, attitudes, and training needs of the care providers in the rehabilitation centres for homeless persons with mental illness.

Methods: A qualitative exploratory research design using FGDs with care providers and expert interviews. Purposive sampling has been used to recruit care providers and experts. Thematic analysis was used to analyse the data obtained.

Results: The major themes emerged out of thematic analysis were characteristics and needs of the homeless persons with mental illness admitted to the institution, concerns of care providers on the services they offer, barriers and challenges in healthcare extended in institutions, diverse rehabilitation needs of the homeless population, training needs of the care providers including mental health knowledge, preparedness to work with homeless population, managing support needs of the homeless population, and the skills in empowering the homeless persons with mental illness.

Conclusion: The findings emphasize the importance of proficient healthcare providers in aiding and enhancing the rehabilitation of homeless individuals suffering from mental disorders within institutional settings. There is an urgent need to strengthen the economic and social resources in institutions to create a more inclusive environment for the homeless population.

Introduction: Autistic symptoms in schizophrenia are reportedly associated with cognitive and social functions. However, few studies have investigated the association between autistic symptoms and clinical features in individuals with a clinical high risk for psychosis (CHR-P) and first-episode psychosis (FEP). We aimed to determine the association between autistic symptoms and clinical features in a cohort of individuals with CHR-P or FEP.

Methods: This cross-sectional study included 111 participants (CHR-P: 61, FEP: 50). Autistic symptoms were assessed using the Positive and Negative Syndrome Scale for Schizophrenia Autism Severity Scale. We assessed the association between autistic symptoms and global and social functioning, and cognitive function in individuals with CHR-P or EFP. Multiple regression analysis was also performed using age and sex as covariates to determine the association between autistic symptoms and global functioning.

Results: The participants with FEP had more severe autistic symptoms than those with CHR-P. The results of bivariate correlation analysis showed a significantly negative association of autistic symptoms with global and cognitive functions in both participants with CHR-P and those with FEP. Multiple regression analysis showed that sex, autistic symptoms, and positive symptoms were significant predictors of overall functioning in those participants.

Conclusion: These findings suggest that autistic symptoms are associated with lower global functioning with both individuals at CHR-P and those with FEP. Further longitudinal analysis is needed to characterize the association between autistic symptoms and global functioning in CHR-P and FEP.

Background: The World Psychiatric Association (WPA) Working Group on Digital Psychiatry aims to digitally supplement, support and improve mental health and care literacy, acceptance and accessibility across WPA member countries and National Psychiatric Associations (NPAs). To help with this goal, the present study was set to explore first the global status of digital mental health and care across NPAs METHODS: An international expert survey on the digitalization level across all 145 WPA NPAs was electronically distributed through Qualtrics. Descriptive statistics were carried out on the global dataset.

Results: Across all 145 responses, 57 were included for analysis (39.3 % response rate). Most NPAs reported lacking an official section on digital mental health (73.7 %), missing national (59.6 %) or regional policies (82.5 %), clinical guidelines (>60 % depending on the digital tool/program), and education/training in both medicine (77.2 %) either and psychiatry training programs (71.9 %). Telemedicine seemed to be the most regulated digital tool in more than half of all included NPAs. Telemedicine (45.6 %) and telemental healthcare (38.6 %) were generally reimbursed. The reported highest priority areas for future actions across WPA Regions were education and training, and the development of guidelines.

Conclusion: This study represents a benchmark in the work of the WG on Digital Psychiatry. It presents clear priority areas that will guide the delivery of targeted actions aimed to promote digital mental health and care, and ultimately, equitable mental health outcomes around the world. Overall, the highest priorities to be globally implemented are represented by education/training and evidence-based clinical practice guidelines.

Introduction: Agitation, a significant psychiatric issue often linked to conditions like schizophrenia, bipolar disorder, and major depression, invariably pose challenges in emergency settings. Acute agitation occurs in 2.6 % of emergency cases and up to 12.2 % among patients with schizophrenia or bipolar disorder. With limited available options for effective management of acute agitation, ketamine is emerging as a fast-onset alternative to antipsychotics like haloperidol.

Methods: This systematic review, following PRISMA guidelines, searched databases in April 2024 for studies on parenteral ketamine for acute agitation in emergency settings. Data extraction included patient demographics, ketamine administration details, sedation time, need for additional doses, adverse events, and intubation rates.

Results: The search yielded 7410 results, narrowing to 29 suitable studies with 1516 patients (mean age 35.5 ± 12.4 years, 67.9 % male). Ketamine was administered intramuscularly (IM) in 69 % of studies, intravenously (IV) in 6.9 %, and either IV or IM in 24.1 %. Most patients (86.5 %) received IM ketamine at a mean dose of 3.83 ± 1.07 mg/kg, while 13.5 % received IV ketamine at 2.09 ± 1.56 mg/kg. Sedation occurred on average in 6.1 min. However, 24.5 % needed rescue medications or additional doses. Adverse effects included tachycardia (5.1 %), hypertension (5.5 %), hypersalivation (5.6 %), nausea (2.1 %), emergence reactions (1.4 %), and, rarely, cardiac arrest (0.2). While 19.1 % required intubation, the reasons for the same could not be attributed to ketamine exclusively. Furthermore, there was no evidence for worsening or development of psychotic symptoms with ketamine.

Conclusion: This review highlights the effectiveness and safety of parenteral ketamine for managing acute agitation in emergency settings. However, further research is needed to optimize ketamine use in this challenging scenario.