Asian journal of psychiatry最新文献

Background

Despite the widespread use of attention-deficit hyperactivity disorder (ADHD) medications and their known sympathomimetic effects on the cardiovascular system, cardiovascular risk assessment of these medications using comprehensive global data is limited. This study investigated the association between individual ADHD medications and cardiovascular disease (CVD) using global pharmacovigilance data.

Methods

Reports from the World Health Organization international pharmacovigilance database were utilized (1967–2023; total reports, n=131,255,418). Reporting odds ratios (ROR), and information components (IC) were calculated to evaluate the association between each medication and specific CVDs.

Results

We identified 13,344 CVD cases related to ADHD medications out of 146,489 cases of all reports on ADHD medications. Cumulative reports on ADHD medications have shown a steady increase, notably in adults since 2010. ADHD medications were associated with a higher risk of CVD overall (ROR [95 % CI], 1.60 [1.58–1.63]; IC [IC_0.25], 0.63 [0.60]), with a higher association observed in females than in males. Among specific CVDs, all drugs were associated with an increased risk of torsade de pointes/QT prolongation, cardiomyopathy, and myocardial infarction. Conversely, heart failure, stroke, and cardiac death/shock were exclusively associated with amphetamines. Lisdexamfetamine showed a weaker association with all CVDs compared to amphetamines, and methylphenidate exhibited the lowest overall association with CVD. Atomoxetine had the second-highest association with torsade de pointes/QT prolongation.

Conclusions

The associations between CVDs and ADHD medications vary, with amphetamines posing a higher risk, while lisdexamfetamine and methylphenidate exhibit better safety profiles.

Background

Major psychiatric illnesses often cluster in families, and their impact on affected and unaffected members within families may reflect the consequence of both genetic and social liability.

Methods

Data was derived from 202 families with multiple affected individuals. Affected individuals (N = 259) had a diagnosis of schizophrenia, bipolar disorder, obsessive-compulsive disorder or substance use disorder. For comparison, we used the unaffected siblings from the same families (N = 229) and a matched random subset of healthy control (HC) data (N = 229) from India’s National Mental Health Survey, 2016 (NMHS). We compared the three groups' educational attainment, functional marital status, and occupational status.

Results

The highest educational attainment was significantly different between the groups. The affected and unaffected siblings had poorer educational attainment compared to HC. Similarly, the affected and unaffected siblings more often remained single, in contrast to HC. Moreover, employment rates were significantly higher in the unaffected siblings, especially female siblings. Overall, females had spent fewer years at school, were primarily married, and were majority homemakers across the three groups compared to males.

Discussion

Affected and unaffected siblings had lower education and marriage rates than HC. The unaffected siblings were more likely to be employed than HC. Whether the poor educational attainment and lower marriage rates in unaffected siblings is a biological marker of shared endophenotype or the effect of the social burden of having an affected family member requires further systematic evaluation.

Background

Electroconvulsive therapy (ECT) is considered to be a treatment of choice in patients with catatonia, who do not respond to lorazepam, irrespective of the underlying aetiology. Although, significant data is available for successful use of ECT in patients with catatonia secondary to affective and psychotic disorders, little information is available for use of ECT in organic catatonia.

Aim

To assess demographic and clinical profile of patients with organic catatonia receiving ECT.

Methodology

Using a retrospective study design, ECT register of the department was reviewed for the period of 2019–2023 to identify the patients with organic catatonia, who received ECT. The treatment records of these patients were reviewed to extract the demographic and clinical profile.

Results

During the study period, out of the 926 patients who received ECT, 12 (1.3 %) patients diagnosed with organic catatonia received ECT. The mean age of study sample was 41.67 (SD- 20.68) years and mean number of ECTs given in a course of ECT were 8 (SD- 4.3). In majority of the patients, ECT was considered after the failure of lorazepam challenge test. Majority (75 %) of the patients showed good response to ECT and only 16.67 % of the patients experienced complications during the course of ECT.

Conclusion

ECT is an effective and well-tolerated treatment for organic catatonia.

There is an ongoing debate regarding whether ICD-11 complex PTSD and DSM-5 borderline personality disorder (BPD) are the same syndrome. Little is known about the extent to which these two conditions overlap and whether they exhibit distinct clinical correlates in Asian cultures. This study examined the co-occurrence of ICD-11 complex PTSD and DSM-5 BPD in a sample of treatment seekers in Hong Kong (N = 220). Participants completed validated self-report measures which assessed if they met the respective diagnostic criteria. In this sample, 30.9 % met the ICD-11 criteria for complex PTSD only, 10.0 % met the DSM-5 criteria for BPD only, and 28.2 % met the criteria for both conditions. Complex PTSD symptoms were most strongly associated with depressive symptoms (β =.347, p <.001) and trauma-related maladaptive beliefs (β =.337, p <.001), while BPD symptoms were most strongly associated with dissociative symptoms (β =.281, p <.001). This study is the first to show that ICD-11 complex PTSD and DSM-5 BPD commonly co-occurred but were not the same construct in the Asian context, and their symptoms were associated with different sets of demographic and clinical factors. Future editions of DSM and ICD should not merge the two conditions into a single diagnosis.

Mental disorders are becoming increasingly prevalent worldwide, and accurate incidence forecasting is crucial for effective mental health strategies. This study developed a long short-term memory (LSTM)-based recurrent neural network model to predict schizophrenia in inpatients in Taiwan. Data was collected on individuals aged over 20 years and diagnosed with schizophrenia between 1998 and 2015 from the National Health Insurance Research Database (NHIRD). The study compared six models, including LSTM, exponential smoothing, autoregressive integrated moving average, particle swarm optimization (PSO), PSO-based support vector regression, and deep neural network models, in terms of their predictive performance. The results showed that the LSTM model had the best accuracy, with the lowest mean absolute percentage error (2.34), root mean square error (157.42), and mean average error (154,831.70). This finding highlights the reliability of the LSTM model for forecasting mental disorder incidence. The study's findings provide valuable insights that can help government administrators devise clinical strategies for schizophrenia, and policymakers can use these predictions to formulate healthcare education and financial planning initiatives, fostering support networks for patients, caregivers, and the public.

Major depressive disorder (MDD) is a complex mental disorder, potentially linked to the gut-microbiota-brain axis. Probiotics like Lactobacillus plantarum PS128 (PS128) may improve depressive symptoms by modulating the gut microbiota based on our previous open trial. We conducted an 8-week double-blind, placebo-controlled trial to investigate the impact of PS128 on depression severity, markers of inflammation and gut permeability, and the gut microbiota composition in 32 patients with MDD with stable antidepressant treatment but moderate symptom severity. Following the 8-week intervention, both the Hamilton Depression Rating Scale-17 score (HAMD), and Depression and Somatic Symptoms Scale (DSSS) showed a significant decrease in both groups (p<0.001). However, there was no significant difference in the change of depression severity between groups (p=0.203). Moreover, alterations in serum levels of high sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-α, and intestinal fatty acid binding protein, as well as changes in the gut microbiota composition, did not exhibit significant differences before and after intervention or between the groups. In comparison to the placebo group, our study did not find significant effects of PS128 on depressive symptoms, biomarkers of inflammation and gut permeability, and the overall gut microbiota composition. Nonetheless, we observed a potential impact of PS128 on the symbiosis of specific taxa. To comprehensively understand the psychophysiological effects of PS128 in patients with MDD, further research with a larger sample size is imperative.

Mental health is a vital part of the bigger well-being picture in the Middle East, which faces specific challenges. In history, mental health has had a bad reputation and low access to services but this is changing as stakeholders are now promoting mental wellbeing. This literature review examines new ways to advance mental health in the Middle East. It explores cultural context, educates on mental health issues, integrates primary care and mental health services, uses technology for communication purposes, builds community support, and advocates for policy reform towards improved mental healthcare outcomes. A comprehensive review across all academic databases was published between 2018 and 2023 using search terms “mental health” and “Middle East”. The study highlights the importance of understanding cultural and social factors that contribute to people’s comprehension of their minds. Additionally, it suggests methods of raising awareness against stigma like digital platforms and community-based education among others. It also points out two measures: first, it indicates that integrating MHI into Primary Health Care (PHC) Systems increases accessibility; secondly, it proposes that a technology-supported personalized approach can be used to support individuals when needed. On this note, the paper underscores the necessity of utilizing local players within communities at large. The review puts a lot of stress on the significance of approaches that are community-based and involve all people living within an area. This review is very timely and comprehensive in its framework meant to improve mental health in the Middle East. The results could be useful in providing insights for devising appropriate culturally sensitive interventions aimed at promoting mental health in this region. In highlighting particular difficulties as well as possibilities, however, the review guides policy makers, healthcare practitioners, and societies aiming to improve their collective response to mental health problems.