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Correlates of suicidality in young people with depressive disorders: A systematic review 青少年抑郁症患者自杀的相关性:一项系统综述
Pub Date : 2022-04-01 DOI: 10.1177/00048674221086498
Carl I Moller, C. Davey, Paul B. Badcock, A. Wrobel, Alice Cao, Sean Murrihy, Sonia Sharmin, S. Cotton
Objective: Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders. Method: Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15–25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines. Results: We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible. Conclusion: Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.
目的:抑郁症是全世界年轻人中最普遍和致残的精神健康状况之一。与抑郁症相关的健康和经济负担是巨大的。自杀和抑郁紧密地交织在一起,然而抑郁症的诊断本身缺乏对自杀行为的预测性特异性。为了更好地为年轻人提供自杀预防和早期干预策略的信息,需要更好地确定可修改的干预目标。本综述的目的是确定被诊断为广泛的单极和双相抑郁症的年轻人自杀的临床、社会心理和生物学相关性。方法:通过MEDLINE、Embase和PsycINFO进行系统检索,以确定15-25岁被诊断为单相或双相抑郁症的年轻人的研究。纳入前需要对自杀行为进行评估。报告遵循系统评价和荟萃分析2020和无荟萃分析综合指南的首选报告项目。结果:我们整合了71项研究的结果,其中包括大约24,670名临床诊断为抑郁症的年轻人。我们确定了26个与自杀相关的临床、社会心理和生物学因素。抑郁特征(类型和严重程度)、精神共病(特别是焦虑和物质使用障碍)和神经学特征与自杀结果相关的证据最多。我们汇集数据和进行有意义的定量综合的能力受到研究间巨大异质性和报告不完整的阻碍;因此,荟萃分析是不可能的。结论:本综述的发现强化了自杀是多种因素相互作用的复杂现象的观点。我们的研究结果质疑将抑郁症诊断作为年轻人自杀的特定风险因素的实用性。自杀本身就是一种跨诊断;采用跨诊断方法来调查其病因和治疗可能是有必要的。未来对特定症状或症状网络的研究,可能有助于我们进一步了解患有精神疾病的年轻人的自杀行为。
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引用次数: 7
Beware of serotonin syndrome during the COVID-19 pandemic 在COVID-19大流行期间要小心血清素综合征
Pub Date : 2022-03-31 DOI: 10.1177/00048674221090175
T. Nagamine
During the COVID-19 pandemic, patients with unknown fever require a careful differential diagnosis, and serotonin syndrome is one of the differential diseases in febrile patients taking antidepressants. A 74-year-old man developed depression last year and was in remission with fluvoxamine 150 mg/day. However, anorexia with tremor of the lower limbs appeared, which was diagnosed as an exacerbation of depression, and mirtazapine 30 mg/day was additionally administered. Two days later, high fever, anosmia and convulsions in the lower limbs appeared, and the patient was brought to our emergency room on suspicion of COVID19. On arrival, his temperature was 38.9°C, blood pressure 170/90 mm Hg, and he had tachycardia and sweating. Hyperreflexia in the lower extremities was noted, but head computed tomography (CT) showed no obvious lesions, and repeated polymerase chain reaction (PCR) tests for COVID19 were performed, all of which were negative. The patient was diagnosed as having serotonin syndrome according to the Hunter criteria (Dunkley et al., 2003), and all medications were discontinued and intravenous infusions were administered. A few days after discontinuation of antidepressants, tremor disappeared and body temperature became normal. Appetite and sense of smell recovered within a month after discontinuation of antidepressants, and a score of 5 on the Naranjo scale suggested the possibility of a relationship between serotonergic drugs and this adverse reaction. The patient’s family gave permission for the presentation. During the COVID-19 pandemic, fever, general malaise and olfactory disturbances should be considered COVID-19 infection. However, when increasing serotonergic agents, the possibility of serotonin syndrome should be considered (Silins et al., 2007). The diagnosis of serotonin syndrome is difficult, but one of the key diagnostic features is tremor with hyperreflexia. Serotonin regulates a variety of physiological functions, including food intake, reward, reproduction, sleep–wake cycle, memory, cognition, emotion and mood. Therefore, there is a danger that an excess of serotonin will alter all of these functions. The anorexia and decreased odor in the present case may be due to excess serotonergic neurotransmission rather than depression or COVID-19 symptoms. The serotonin controls the appetite center, so excess serotonin decreases appetite. Although there are no reports of transient olfactory loss in serotonin syndrome, the olfactory bulb is regulated by serotonergic neurotransmission with adult neurogenesis throughout life (Fomin-Thunemann and Garaschuk, 2022). Excess serotonin affects the neurogenesis of the olfactory bulb and may cause transient olfactory abnormalities. In conclusion, serotonin syndrome is also similar to the symptoms of COVID-19 and requires careful differential diagnosis in this pandemic situation.
在新冠肺炎大流行期间,不明原因发热患者需要仔细鉴别诊断,血清素综合征是服用抗抑郁药发热患者的鉴别疾病之一。一名74岁男子去年患上抑郁症,服用氟伏沙明150毫克/天后缓解。但出现厌食症伴下肢震颤,诊断为抑郁症加重,加用米氮平30 mg/天。两天后,患者出现高烧、嗅觉丧失、下肢抽搐等症状,疑似感染新冠肺炎被送至我院急诊室。到达时体温38.9°C,血压170/90 mm Hg,心动过速,出汗。下肢反射亢进,但头部CT未见明显病变,多次进行新冠病毒聚合酶链反应(PCR)检测均为阴性。根据Hunter标准(Dunkley et al., 2003),患者被诊断为血清素综合征,停用所有药物并静脉输注。停用抗抑郁药几天后,震颤消失,体温恢复正常。食欲和嗅觉在停用抗抑郁药后一个月内恢复,纳兰霍量表的5分表明,5 -羟色胺类药物与这种不良反应之间可能存在关系。病人家属同意了这次展示。在COVID-19大流行期间,发烧、全身不适和嗅觉障碍应考虑为COVID-19感染。然而,当增加血清素能药物时,应考虑血清素综合征的可能性(Silins et al., 2007)。血清素综合征的诊断是困难的,但一个关键的诊断特征是震颤与反射性亢进。血清素调节多种生理功能,包括食物摄入、奖励、生殖、睡眠-觉醒周期、记忆、认知、情感和情绪。因此,过量的血清素有可能改变所有这些功能。本病例的厌食和气味减少可能是由于过度的血清素能神经传递,而不是抑郁症或COVID-19症状。血清素控制食欲中枢,所以过量的血清素会降低食欲。虽然没有5 -羟色胺综合征的短暂性嗅觉丧失的报道,但嗅球在成年神经发生过程中受到5 -羟色胺能神经传递的调节(famin - thunemann和Garaschuk, 2022)。过量的血清素会影响嗅球的神经发生,并可能导致短暂的嗅觉异常。总之,血清素综合征也与COVID-19的症状相似,在这种大流行的情况下需要仔细鉴别诊断。
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引用次数: 1
The evidence for the use of long-term benzodiazepines in the setting of treatment-refractory anxiety disorders 长期使用苯二氮卓类药物治疗难治性焦虑症的证据
Pub Date : 2022-03-18 DOI: 10.1177/00048674221087163
P. Tibrewal, Milanduth K Kanigere, J. Looi, S. Allison, T. Bastiampillai
American Psychiatric Association (APA) (1990) Benzodiazepine Dependence, Toxicity, and Abuse: A Task Force Report of the American Psychiatric Association (APA). APA. Available at: https:// books.google.com.au/books?id=FoTursyqFP8C (accessed 2021). Calcaterra NE and Barrow JC (2014) Classics in chemical neuroscience: Diazepam (valium). ACS Chemical Neuroscience 5(4): 253–260. Committee on the Review of Medicines (CRM) (1980) Systematic review of the benzodiazepines: Guidelines for data sheets on diazepam, chlordiazepoxide, medazepam, clorazepate, lorazepam, oxazepam, temazepam, triazolam, nitrazepam, and flurazepam. Committee on the Review of Medicines. British Medical Journal 280(6218): 910. Greenblatt D, Shader R, Divoll M, et al. (1981) Benzodiazepines: A summary of pharmacokinetic properties. British Journal of Clinical Pharmacology 11: 11S–16S. Hollister LE (1981) Benzodiazepines: An overview. British Journal of Clinical Pharmacology 11: 117S–119S. Laughren TP, Battey Y, Greenblatt DJ, et al. (1982) A controlled trial of diazepam withdrawal in chronically anxious outpatients. Acta Psychiatrica Scandinavica 65: 171–179. Maletzky BM and Klotter J (1976) Addiction to diazepam. International Journal of the Addictions 11: 95–115. Marks J (1983) The benzodiazepines: An international perspective. Journal of Psychoactive Drugs 15: 137–149. Rickels K (1983) Benzodiazepines in emotional disorders. Journal of Psychoactive Drugs 15: 49–54. Silberman E, Balon R, Starcevic V, et al. (2020) Benzodiazepines: It’s time to return to the evidence. The British Journal of Psychiatry 218: 125–127. Sullivan W (1963) WARNING IS ISSUED ON TRANQUILIZERS; Some of most popular drugs can be addictive, expert tells science meeting BUT VALUE IS STRESSED doctor at U.S. Center cites usefulness, but declares caution is necessary six are specified increases in doses WARNING IS ISSUED ON TRANQUILIZERS. New York Times, 30 December, p. 23. Tibrewal P, Haeusler C, Kanigere MK, et al. (2021a) Are the benefits of benzodiazepines for anxiety disorders underestimated and their risks overestimated? Australian and New Zealand Journal of Psychiatry 55: 1109–1110. Vorspan F, Barré T, Pariente A, et al. (2018) Faut-il limiter la durée des traitements par benzodiazépines ? La Presse Médicale 47(10): 892–898.
美国精神病学协会(APA)(1990)《苯二氮卓类药物依赖、毒性和滥用:美国精神病学协会(APA)的一份特别工作组报告》。美国心理学协会。可在https:// books.google.com.au/books?id=FoTursyqFP8C(2021年访问)。Calcaterra NE和Barrow JC(2014)化学神经科学经典:安定(安定)。化学学报,5(4):253-260。药物审查委员会(CRM)(1980):苯二氮卓类药物的系统评价:地西泮、氯二氮平、美达西泮、氯拉西泮、劳拉西泮、恶西泮、替马西泮、三唑仑、硝西泮和氟西泮的数据表指南。药品审查委员会。英国医学杂志280(6218):910。Greenblatt D, Shader R, Divoll M等。(1981)苯二氮卓类药物:药代动力学性质综述。英国临床药理学杂志11:11S-16S。Hollister LE(1981)苯二氮卓类药物综述。英国临床药理学杂志11:117S-119S。(1982)安定戒断对慢性焦虑门诊患者的影响。精神病学杂志65:171-179。(1976)安定成瘾。国际成瘾杂志11:95-115。Marks J(1983)苯二氮卓类药物:国际视角。精神药物杂志15:137-149。(1983)苯二氮卓类药物在情绪障碍中的作用。精神药物杂志15:49-54。Silberman E, Balon R, starceevic V等。(2020)苯二氮卓类药物:是时候回归证据了。英国精神病学杂志218:125-127。沙利文W(1963)对镇定剂的警告;专家在科学会议上说,一些最流行的药物可能会上瘾,但价值是强调的,美国中心的医生指出有用,但声明谨慎是必要的,有六种药物被指定增加剂量。《纽约时报》12月30日,第23页。Tibrewal P, Haeusler C, Kanigere MK,等。(2021a)苯二氮卓类药物治疗焦虑症的益处是否被低估,风险是否被高估?澳大利亚和新西兰精神病学杂志55:1109-1110。Vorspan F, barr T, Pariente A,等。(2018)fat -il限制la dursamae des tratrements par benzodiazsampines ?医学通报,47(10):892-898。
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引用次数: 2
Cerebrospinal fluid Alzheimer disease biomarkers for assessing cognitive and neuropsychiatric symptoms: Expanding the ‘toolkit’ in the psychiatrist’s diagnostic armamentarium 评估认知和神经精神症状的脑脊液阿尔茨海默病生物标志物:扩大精神科医生诊断设备中的“工具箱”
Pub Date : 2022-03-08 DOI: 10.1177/00048674221084245
D. Eratne, Qiao-Xin Li, S. Loi, M. Walterfang, S. Farrand, A. Evans, R. Mocellin, C. Masters, S. Collins, D. Velakoulis
Australian & New Zealand Journal of Psychiatry, 56(7) Cerebrospinal fluid Alzheimer disease biomarkers for assessing cognitive and neuropsychiatric symptoms: Expanding the ‘toolkit’ in the psychiatrist’s diagnostic armamentarium Dhamidhu Eratne1,2,3,4 , Qiao-Xin Li4, Samantha M Loi1,2,3 , Mark Walterfang1,2,3, Sarah Farrand1,2 , Andrew Evans1, Ramon Mocellin5, Colin L Masters4, Steven Collins4,6 and Dennis Velakoulis1,2,3
脑脊髓液阿尔茨海默病生物标志物在认知和神经精神疾病诊断工具箱中的应用[j] .中华精神病学杂志,56(7):Eratne1,2,3,4,李乔欣4,Samantha M lo1,2,3, Mark Walterfang1,2,3, Sarah Farrand1,2, Andrew Evans1, Ramon Mocellin5, Colin L master4, Steven collin4,6, Dennis Velakoulis1,2,3
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引用次数: 1
You can’t have one without the other: The case for integrated perinatal and infant mental health services 缺一不可:围产期和婴幼儿综合心理健康服务
Pub Date : 2022-03-08 DOI: 10.1177/00048674221083874
Izaak Lim, Vesna Newman-Morris, R. Hill, Elisabeth Hoehn, N. Kowalenko, Rochelle Matacz, C. Paul, R. Powrie, Lynn E. Priddis, Vibhay Raykar, Tanya Wright, L. Newman, S. Sundram
Perinatal and infant psychiatry has been described as ‘a specialty in search of a home’ (Newman, 2020), referring to its awkward placement between adult and child mental health services. Inherent tension comes from bringing together two distinct clinical traditions – infant mental health, with its focus on parent–child relationships and infant development, and perinatal psychiatry, with its focus on maternal mental illness in pregnancy and the postpartum. The practical challenge lies in holding the interests of parents and infants in mind as one works with a parent–child dyad. At a systems level, this can produce structurally separate services for parents and infants, resulting in the fragmentation of care for families in need. A fundamental challenge for perinatal and infant psychiatry is integration. Psychiatrists working in this field must attend to the mental health of new and expectant parents, the socialemotional well-being and development of young children, the quality of parent–child and co-parenting relationships, and the cohesion of the family-as-a-whole. Such a holistic and complex view of the life of families with young children demands interdisciplinary collaboration, as the different perspectives brought to bear by clinicians from various professional backgrounds help shed light on the distinct but interconnected facets of this crucial developmental transition. At the heart of integrated care is a commitment to prioritising the needs and perspectives of families who use these services, a recognition that the whole is greater than the sum of the parts, and an understanding of the primacy of relationships – within the family, between the family and the service system, and between various parts of the system that support families. We present the case for an integrated approach to perinatal and infant mental health (PIMH) services, to help guide review and reform.
围产期和婴儿精神病学被描述为“寻找家的专业”(Newman, 2020),指的是它在成人和儿童精神卫生服务之间的尴尬位置。内在的紧张来自于将两种不同的临床传统结合在一起——婴儿心理健康,其重点是亲子关系和婴儿发展,以及围产期精神病学,其重点是怀孕和产后的母亲精神疾病。实际的挑战在于,当一个人在处理亲子关系时,要考虑到父母和婴儿的利益。在系统一级,这可能产生结构上分开的父母和婴儿服务,导致对有需要的家庭的照顾支离破碎。围产期和婴儿精神病学的一个基本挑战是整合。在这一领域工作的精神科医生必须关注新父母和准父母的心理健康、幼儿的社会情感健康和发展、亲子和共同养育关系的质量以及整个家庭的凝聚力。这种对有幼儿的家庭生活的整体和复杂的看法需要跨学科的合作,因为来自不同专业背景的临床医生带来的不同观点有助于阐明这一关键发展转变的独特但相互关联的方面。综合护理的核心是承诺优先考虑使用这些服务的家庭的需求和观点,认识到整体大于部分之和,并理解家庭内部、家庭与服务系统之间以及支持家庭的系统各部分之间关系的首要地位。我们提出的情况下,综合方法围产期和婴儿心理健康(PIMH)服务,以帮助指导审查和改革。
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引用次数: 0
The challenges ahead for psychedelic ‘medicine’ 迷幻“药”面临的挑战
Pub Date : 2022-03-04 DOI: 10.1177/00048674221081763
S. Muthukumaraswamy, A. Forsyth, R. Sumner
With the extensive public, commercial and scientific interest from what has been widely termed the psychedelic renaissance, it is important that the scientific practices and results obtained from its implementation into medicine are put under a critical microscope. While there are numerous works on the potential benefits and applications of psychedelics as medicines, relatively little has been written about the challenges this field will face when incorporated into modern medical practice. Indeed, as a new or at least revived area of investigation, psychedelic medicine has a particular set of challenges which need to be addressed. In this viewpoint, we identify a number of these challenges. First, challenges related to the design of individual research studies are discussed, particularly focusing on current practices surrounding blinding, expectancy, the use of therapy and sources of bias. Second, the broader context of the research environment is considered, including how medical science typically establishes evidence, funding bodies and the impact of psychedelics being scheduled at odds with their risk profile. Finally, we describe challenges relating to the implementation of psychedelic therapies into modern medicine, considering the social and economic context. Alongside, we provide suggestions for what could be included into current research protocols to mitigate these challenges.
随着公众、商业和科学界对迷幻药复兴的广泛兴趣,将其应用于医学的科学实践和结果置于批判的显微镜下是很重要的。虽然有许多关于迷幻药作为药物的潜在益处和应用的著作,但相对而言,很少有关于将这一领域纳入现代医学实践时将面临的挑战的著作。事实上,作为一个新的或至少是复兴的研究领域,迷幻药有一系列特殊的挑战需要解决。在这个观点中,我们确定了一些这样的挑战。首先,讨论了与个人研究设计相关的挑战,特别关注当前围绕盲法、期望、治疗方法的使用和偏见来源的实践。其次,考虑研究环境的更广泛背景,包括医学科学通常如何建立证据、资助机构和迷幻药的影响与它们的风险状况不一致。最后,考虑到社会和经济背景,我们描述了与迷幻疗法在现代医学中的实施有关的挑战。此外,我们还就当前的研究方案中可以包括哪些内容提出了建议,以减轻这些挑战。
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引用次数: 15
Psychostimulants as antidepressants: Their nuanced role? 精神兴奋剂作为抗抑郁药:它们的微妙作用?
Pub Date : 2022-03-03 DOI: 10.1177/00048674221079218
G. Parker
While effectively the ‘first antidepressants’, the psychostimulants are rarely prescribed as antidepressant drugs seemingly in light of their judged low effectiveness, side effects, tolerance as well as concerns about dependency and abuse. Recent meta-analyses do find some support for them as being effective antidepressants for those with major depression, but they have not been closely evaluated in terms of their specific nuanced role for treating treatment-resistant (unipolar and bipolar) melancholic depression. The author has so prescribed them for over a decade and offers a case for their benefits for a distinct percentage of those with such conditions and notes their relatively few side effects.
虽然精神兴奋剂是有效的“第一抗抑郁药”,但很少被当作抗抑郁药开处方,似乎是考虑到它们的有效性低、副作用、耐受性以及对依赖性和滥用的担忧。最近的荟萃分析确实发现了一些支持它们对重度抑郁症患者有效的抗抑郁药,但它们在治疗难治性(单极和双相)忧郁性抑郁症方面的具体微妙作用还没有得到仔细评估。作者已经开了十多年的处方,并提供了一个案例,说明它们对患有这种疾病的人有明显的好处,并指出它们的副作用相对较少。
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引用次数: 2
Empty sella and periodic mental symptoms: A report of two cases 空腔伴周期性精神症状:附2例报告
Pub Date : 2022-03-02 DOI: 10.1177/00048674221078165
Xiaoyu Zhu, Ran Li, Yu Zhu, Xiaole Han, Yunlong Tan
Eratne D, Loi SM, Li Q, et al. (2022) Cerebrospinal fluid neurofilament light chain differentiates primary psychiatric disorders from rapidly progressive, Alzheimer’s disease and frontotemporal disorders in clinical settings. Alzheimer’s & Dementia. Epub ahead of print 1 February. DOI: 10.1002/alz.12549. Loi SM, Goh AMY, Mocellin R, et al. (2020) Time to diagnosis in younger-onset dementia and the impact of a specialist diagnostic service. International Psychogeriatrics. Epub ahead of print 28 August. DOI: 10.1017/S1041610220001489. Shaw LM, Arias J, Blennow K, et al. (2018) Appropriate use criteria for lumbar puncture and cerebrospinal fluid testing in the diagnosis of Alzheimer’s disease. Alzheimer’s & Dementia 14: 1505–1521. Table 1. Details of five patients with changed diagnoses and impacts on clinical care and management.
Eratne D, Loi SM,李强,等。(2022)脑脊液神经丝轻链在临床环境中对原发性精神疾病与快速进展性阿尔茨海默病和额颞叶疾病的鉴别。阿尔茨海默病和痴呆症。2月1日印刷前出版。DOI: 10.1002 / alz.12549。李晓明,吴晓梅,Mocellin R,等。(2020)年轻发病痴呆的诊断时间及专科诊断服务的影响。国际老人精神科。8月28日付印。DOI: 10.1017 / S1041610220001489。肖晓明,陈晓明,陈晓明,等。(2018)腰椎穿刺和脑脊液检测在阿尔茨海默病诊断中的应用标准。阿尔茨海默病与痴呆症14:1505-1521。表1。5例患者诊断改变及其对临床护理和管理的影响。
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引用次数: 0
RANZCP Abstracts RANZCP抽象
Pub Date : 2021-05-01 DOI: 10.1177/00048674211004750
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引用次数: 3
Thanks to Reviewers 感谢审稿人
Pub Date : 2021-03-01 DOI: 10.1177/0004867421991746
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引用次数: 0
期刊
Australian & New Zealand Journal of Psychiatry
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