Aaradhana Rukadikar MBA (HR), Komal Khandelwal PhD
{"title":"Harnessing AI as an enabler for access to mental health care services","authors":"Aaradhana Rukadikar MBA (HR), Komal Khandelwal PhD","doi":"10.1111/appy.12557","DOIUrl":"10.1111/appy.12557","url":null,"abstract":"","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"16 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yee-Lam E. Chan MD, Wang-Sheng Lin MD, Hui-Chen Lai MS, Chih-Yuan Hung MD, Mao-Hsuan Huang MD
Background
The effectiveness of isolated resistance training (RT) on cognitive function among older adults with schizophrenia is insufficiently investigated. This study investigated the effectiveness of 12-weeks POWER rehabilitation, a novel RT regimen, on cognitive function among older patients with schizophrenia and frailty.
Methods
Thirty-two older adults with schizophrenia and frailty were enrolled and randomized to receive either a 12-week, twice weekly POWER rehabilitation, or without add-on training. Cognitive functioning was assessed using mini-mental state examination (MMSE), digit symbol substitution test, color trail task (CTT), and digit span task (DST). Physical performance was assessed by walking speed and hand grip strength. The generalized estimating equations was used to compare pre- and post-training outcome measure between groups.
Results
Between-group analysis revealed significant improvement in CTT1 and hand grip strength in the intervention group compared to the controls. Subgroup analyses showed CTT1 performance significantly improved after 12 weeks of POWER rehabilitation in the intervention group (time, p < .001), independent of age, educational level, global cognition, depressive symptoms, and psychotropic medication use. Increased hand grip strength was significantly associated with improved performance in MMSE, CTT1, and DST forward at study endpoint.
Conclusion
A 12-week POWER rehabilitation for older patients with schizophrenia and frailty is safe and feasible, and may benefit physical and some domains of cognitive functioning.
背景：孤立的阻力训练（RT）对老年精神分裂症患者认知功能的影响尚未得到充分研究。本研究调查了为期 12 周的 POWER 康复（一种新型 RT 方案）对患有精神分裂症且身体虚弱的老年患者认知功能的影响：32名患有精神分裂症且身体虚弱的老年人被纳入研究，并随机接受为期12周、每周两次的POWER康复训练，或不接受附加训练。认知功能通过小型精神状态检查（MMSE）、数字符号替换测试、颜色追踪任务（CTT）和数字跨度任务（DST）进行评估。体能通过步行速度和手部握力进行评估。采用广义估计方程比较组间训练前后的结果：结果：组间分析显示，与对照组相比，干预组的 CTT1 和手部握力明显提高。分组分析显示，干预组在接受 12 周的 POWER 康复训练后，CTT1 的表现明显改善（时间，P 结论：POWER 康复训练是一种有效的康复训练方法：对患有精神分裂症且体弱的老年患者进行为期 12 周的 POWER 康复训练是安全可行的，而且可能对身体和认知功能的某些方面有益。
{"title":"Changes in cognitive function after a 12-week POWER rehabilitation in older adults with schizophrenia and frailty","authors":"Yee-Lam E. Chan MD, Wang-Sheng Lin MD, Hui-Chen Lai MS, Chih-Yuan Hung MD, Mao-Hsuan Huang MD","doi":"10.1111/appy.12556","DOIUrl":"10.1111/appy.12556","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The effectiveness of isolated resistance training (RT) on cognitive function among older adults with schizophrenia is insufficiently investigated. This study investigated the effectiveness of 12-weeks POWER rehabilitation, a novel RT regimen, on cognitive function among older patients with schizophrenia and frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty-two older adults with schizophrenia and frailty were enrolled and randomized to receive either a 12-week, twice weekly POWER rehabilitation, or without add-on training. Cognitive functioning was assessed using mini-mental state examination (MMSE), digit symbol substitution test, color trail task (CTT), and digit span task (DST). Physical performance was assessed by walking speed and hand grip strength. The generalized estimating equations was used to compare pre- and post-training outcome measure between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between-group analysis revealed significant improvement in CTT1 and hand grip strength in the intervention group compared to the controls. Subgroup analyses showed CTT1 performance significantly improved after 12 weeks of POWER rehabilitation in the intervention group (time, <i>p</i> < .001), independent of age, educational level, global cognition, depressive symptoms, and psychotropic medication use. Increased hand grip strength was significantly associated with improved performance in MMSE, CTT1, and DST forward at study endpoint.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A 12-week POWER rehabilitation for older patients with schizophrenia and frailty is safe and feasible, and may benefit physical and some domains of cognitive functioning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"16 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The debate about observing total versus free serum valproate levels for therapeutic drug monitoring (TDM) has been unresolved for decades. This study was planned to assess the agreement between the total versus free valproate levels and the advantage of one method over the other in TDM.
Methods
The present cross-sectional study was done on 93 patients with bipolar disorder. The intraclass correlation coefficient, Bland Altman analysis, and Lin's concordance analysis were done to assess the agreement between the total and free valproate concentrations. Linear and polynomial models were constructed to evaluate the relation between the two measurements. Receiver operating characteristics analysis was done to compare the accuracy for differentiating remission from non-remission on Young's mania rating scale (YMRS).
Results
The intraclass correlation coefficient and Lin's concordance correlation coefficient were 0.491 (p = .002) and 0.055 (95% CI:0.037, 0.073), respectively. Bland Altman's analysis showed proportional bias. A polynomial model of second order was found to be the best fit for the prediction of free valproate from the data for total valproate, and 81.4% of the variability in free valproate could be explained when adjusted for albumin levels. The area under the curve for total valproate was 0.60 when compared to free valproate 0.56 for differentiating between remission and non-remission, but the comparison between the two ROC analyses was not statistically significant.
Conclusion
Free valproate does not provide any added advantage over the total valproate levels; hence, total valproate levels may continue to be used as the marker for drug monitoring.
{"title":"Total valproate versus free valproate in therapeutic drug monitoring for bipolar disorder: A cross-sectional study","authors":"Mullezhath Babu Nimesh Krishna MD, Jyothsna Chinnapura Seetharam MD, Archana Mishra DM, Rituparna Maiti MD, Biswa Ranjan Mishra MD, Anand Srinivasan DM","doi":"10.1111/appy.12555","DOIUrl":"https://doi.org/10.1111/appy.12555","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The debate about observing total versus free serum valproate levels for therapeutic drug monitoring (TDM) has been unresolved for decades. This study was planned to assess the agreement between the total versus free valproate levels and the advantage of one method over the other in TDM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present cross-sectional study was done on 93 patients with bipolar disorder. The intraclass correlation coefficient, Bland Altman analysis, and Lin's concordance analysis were done to assess the agreement between the total and free valproate concentrations. Linear and polynomial models were constructed to evaluate the relation between the two measurements. Receiver operating characteristics analysis was done to compare the accuracy for differentiating remission from non-remission on Young's mania rating scale (YMRS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intraclass correlation coefficient and Lin's concordance correlation coefficient were 0.491 (<i>p</i> = .002) and 0.055 (95% CI:0.037, 0.073), respectively. Bland Altman's analysis showed proportional bias. A polynomial model of second order was found to be the best fit for the prediction of free valproate from the data for total valproate, and 81.4% of the variability in free valproate could be explained when adjusted for albumin levels. The area under the curve for total valproate was 0.60 when compared to free valproate 0.56 for differentiating between remission and non-remission, but the comparison between the two ROC analyses was not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Free valproate does not provide any added advantage over the total valproate levels; hence, total valproate levels may continue to be used as the marker for drug monitoring.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"16 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140343065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meiqi Wang MD, Yunxi Zhong MD, Yifan Chen MD, Qixiu Li MD, Xiaoying Su MD, Zhen Wei PhD, Long Sun PhD
Introduction
Suicide and early alcohol use initiation are public health concerns. Previous studies have explored the associations between age of alcohol use initiation and suicidal behaviors, which progresses from ideation to action. Distinguishing between the various associations can help gain a deeper understanding of suicidal behaviors and aid in developing social suicide prevention strategies.
Methods
The study utilized the Youth Risk Behavior Survey to investigate this association. A total of 17 209 students were finally included in the study. Conditional suicidal behaviors included no suicidal behavior (NS), suicidal ideation without a plan or attempt (SINPA), suicide plan without an attempt (SPNA) and suicide attempt (SA).
Results
Among 17 209 students, the prevalence of suicidal ideation, suicide plan, and suicide attempt were 21.4%, 17.3%, and 11.1%, respectively. Moreover, 15.2% of the students used alcohol before age 13, whereas 31.7% of students used alcohol at age 13 or older. Compared to NS, students using alcohol showed significant associations with SA (OR = 2.34, p < .001; OR = 1.29, p < .01), SPNA (OR = 1.68, p < .001; OR = 1.19, p < .05) and SINPA (OR = 1.55, p < .001; OR = 1.40, p < .001). Comparing with SINPA and SNPA, students using alcohol before age 13 were associated with SA (OR = 1.61, p < .001; OR = 1.46, p < .001), whereas those using alcohol at or after the age 13 were not associated with SA (OR = 0.98, p > .05; OR = 1.09, p > .05).
Discussion
This study demonstrated that early alcohol use initiation was significantly associated with suicide attempts among students with suicidal ideations or plans.
{"title":"Differentiating the association between age of alcohol use initiation and conditional suicidal behaviors among adolescents","authors":"Meiqi Wang MD, Yunxi Zhong MD, Yifan Chen MD, Qixiu Li MD, Xiaoying Su MD, Zhen Wei PhD, Long Sun PhD","doi":"10.1111/appy.12554","DOIUrl":"10.1111/appy.12554","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Suicide and early alcohol use initiation are public health concerns. Previous studies have explored the associations between age of alcohol use initiation and suicidal behaviors, which progresses from ideation to action. Distinguishing between the various associations can help gain a deeper understanding of suicidal behaviors and aid in developing social suicide prevention strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study utilized the Youth Risk Behavior Survey to investigate this association. A total of 17 209 students were finally included in the study. Conditional suicidal behaviors included no suicidal behavior (NS), suicidal ideation without a plan or attempt (SINPA), suicide plan without an attempt (SPNA) and suicide attempt (SA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 17 209 students, the prevalence of suicidal ideation, suicide plan, and suicide attempt were 21.4%, 17.3%, and 11.1%, respectively. Moreover, 15.2% of the students used alcohol before age 13, whereas 31.7% of students used alcohol at age 13 or older. Compared to NS, students using alcohol showed significant associations with SA (OR = 2.34, <i>p</i> < .001; OR = 1.29, <i>p</i> < .01), SPNA (OR = 1.68, <i>p</i> < .001; OR = 1.19, <i>p</i> < .05) and SINPA (OR = 1.55, <i>p</i> < .001; OR = 1.40, <i>p</i> < .001). Comparing with SINPA and SNPA, students using alcohol before age 13 were associated with SA (OR = 1.61, <i>p</i> < .001; OR = 1.46, <i>p</i> < .001), whereas those using alcohol at or after the age 13 were not associated with SA (OR = 0.98, <i>p</i> > .05; OR = 1.09, <i>p</i> > .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study demonstrated that early alcohol use initiation was significantly associated with suicide attempts among students with suicidal ideations or plans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Philip M. Jones BSc, MBBS, MBiostat, FACEM, Amy Sweeny BSc, RN, MPH, Grace Branjerdporn PhD, BOccThy(Hons I), CHIA, CertIV Tesol, Gerben Keijzers MBBS, MSc, FACEM, PhD, Andrea P. Marshall RN, PhD, Ya-Ling Huang RN, PhD, Emma J. Hall BN, GradCertCritCareNurs, Jamie Ranse BNurs, GradCertClinEd, GradCertClinEpi, MCritCareNurs, PhD, Dinesh Palipana OAM, LLB, GradDipLP, MD, EMC, Yang D. Teng PhD, MD, Julia Crilly OAM, BN, MEmergN(Hons), PhD, the COVERED COVID study investigators
Background
The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data.
Methods
This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018–March 8, 2020), Statewide Lockdown (March 9, 2020–June 28, 2020), and Restrictions Easing (June 29, 2020–June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts.
Results
Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast).
Conclusions
Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context.
{"title":"The impact of COVID-19 on emergency department presentations for mental health disorders in Queensland, Australia: A time series analysis","authors":"Philip M. Jones BSc, MBBS, MBiostat, FACEM, Amy Sweeny BSc, RN, MPH, Grace Branjerdporn PhD, BOccThy(Hons I), CHIA, CertIV Tesol, Gerben Keijzers MBBS, MSc, FACEM, PhD, Andrea P. Marshall RN, PhD, Ya-Ling Huang RN, PhD, Emma J. Hall BN, GradCertCritCareNurs, Jamie Ranse BNurs, GradCertClinEd, GradCertClinEpi, MCritCareNurs, PhD, Dinesh Palipana OAM, LLB, GradDipLP, MD, EMC, Yang D. Teng PhD, MD, Julia Crilly OAM, BN, MEmergN(Hons), PhD, the COVERED COVID study investigators","doi":"10.1111/appy.12553","DOIUrl":"10.1111/appy.12553","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018–March 8, 2020), Statewide Lockdown (March 9, 2020–June 28, 2020), and Restrictions Easing (June 29, 2020–June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/appy.12553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140100945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chuhao Zhang MSc, Yeqing Dong PhD, ShuHua Li PhD, Meijuan Li PhD, Ying Gao MSc, Yuan Liu PhD, Xueying Liu MSc, Chi Zhou MSc, Jie Li MD, PhD
Background
Major depressive disorder (MDD) is one of the global burdens of disease, and its pathogenesis remains unclear. An increasing amount of research indicates that ghrelin regulates mood in patients with MDD. Still, current results are inconsistent, and the mechanisms underlying how ghrelin modulates depressive symptoms are inconclusive, especially in first-episode drug-naïve MDD patients. Therefore, this study aims to investigate the relationship and potential mechanism between ghrelin and first-episode drug-naïve MDD.
Methods
Ninety first-episode drug-naïve MDD patients and 65 healthy controls (HCs) were included. Hamilton Depression Scale (HAMD-17) as a measure of depressive symptoms. Plasma levels of ghrelin and hypothalamic–pituitary–adrenal axis (HPA-axis) hormones were measured in all participants.
Results
Compared to HCs, the ghrelin levels were higher in the MDD (p < .001) and still showed significance after covarying for sex, age, and Body Mass Index (BMI). Ghrelin was positively related to corticotropin-releasing-hormone (CRH) levels (r = .867, p < .001), adrenocorticotropic hormone (ACTH) levels (r = .830, p < .001), and cortisol levels (r = .902, p < .001) in partial correlation analysis. In addition, there was a positive correlation between HAMD total score and ghrelin levels (r = .240, p = .026). Other than that, the HAMD total score also had a positive correlation with the CRH (r = .333, p = .002) and cortisol (r = .307, p = .004) levels. Further mediation analysis demonstrated that the relationship between ghrelin and HAMD total score was mediated by CRH (ab-path; β = .4457, 95% CI = 0.0780–1.0253, c-path; β = .2447, p = .0260, c′-path; β = −.2009, p = .3427).
Conclusions
These findings revealed that plasma ghrelin provides a pivotal link to depressive symptoms in first-episode drug-naive MDD patients. CRH mediated the relationship between ghrelin and HAMD total score. It might provide new insights into understanding the pathogenesis of MDD, contributing to intervention and treatment from this approach.
{"title":"Ghrelin and depressive symptoms in patients with first-episode drug-naïve major depressive disorder: The mediating role of hypothalamic-pituitary-adrenal axis","authors":"Chuhao Zhang MSc, Yeqing Dong PhD, ShuHua Li PhD, Meijuan Li PhD, Ying Gao MSc, Yuan Liu PhD, Xueying Liu MSc, Chi Zhou MSc, Jie Li MD, PhD","doi":"10.1111/appy.12552","DOIUrl":"10.1111/appy.12552","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Major depressive disorder (MDD) is one of the global burdens of disease, and its pathogenesis remains unclear. An increasing amount of research indicates that ghrelin regulates mood in patients with MDD. Still, current results are inconsistent, and the mechanisms underlying how ghrelin modulates depressive symptoms are inconclusive, especially in first-episode drug-naïve MDD patients. Therefore, this study aims to investigate the relationship and potential mechanism between ghrelin and first-episode drug-naïve MDD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ninety first-episode drug-naïve MDD patients and 65 healthy controls (HCs) were included. Hamilton Depression Scale (HAMD-17) as a measure of depressive symptoms. Plasma levels of ghrelin and hypothalamic–pituitary–adrenal axis (HPA-axis) hormones were measured in all participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to HCs, the ghrelin levels were higher in the MDD (<i>p</i> < .001) and still showed significance after covarying for sex, age, and Body Mass Index (BMI). Ghrelin was positively related to corticotropin-releasing-hormone (CRH) levels (<i>r</i> = .867, <i>p</i> < .001), adrenocorticotropic hormone (ACTH) levels (<i>r</i> = .830, <i>p</i> < .001), and cortisol levels (<i>r</i> = .902, <i>p</i> < .001) in partial correlation analysis. In addition, there was a positive correlation between HAMD total score and ghrelin levels (<i>r</i> = .240, <i>p</i> = .026). Other than that, the HAMD total score also had a positive correlation with the CRH (<i>r</i> = .333, <i>p</i> = .002) and cortisol (<i>r</i> = .307, <i>p</i> = .004) levels. Further mediation analysis demonstrated that the relationship between ghrelin and HAMD total score was mediated by CRH (ab-path; <i>β</i> = .4457, 95% CI = 0.0780–1.0253, c-path; <i>β</i> = .2447, <i>p</i> = .0260, c′-path; <i>β</i> = −.2009, <i>p</i> = .3427).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings revealed that plasma ghrelin provides a pivotal link to depressive symptoms in first-episode drug-naive MDD patients. CRH mediated the relationship between ghrelin and HAMD total score. It might provide new insights into understanding the pathogenesis of MDD, contributing to intervention and treatment from this approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139721424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicollette L. R. Thornton BA/BSc, BHlthSc (Hons), Warwick Black MBBS, FRANZCP, Adrian Bognar BNurs, Daniel Dagge MBBS, FRANZCP, Teresia Gitau BNurs, Bruce Hua BPharm, Gero Joks PharmD, MSc, PhD, MBA, Jarrad King BSc, MIPH, Andrew Lord BPharm (Hons), Elizabeth M. Scott BSc, MBBS, FRANZCP, DMedSc, Jelena Smit Callander BNurs, GradCertMHlthN, Serena Ting BNurs, Dennis Liu MBBS, PhD, FRANZCP
Background
Major depressive disorder (MDD) can have severe impacts on function and quality of life. Up to one third of patients will have an inadequate response to their first line of treatment, with subsequent lines of therapy associated with lower remission rates and higher relapse rates. Recently esketamine has become available for Australian patients, and this agent provides an additional treatment option for those with MDD who have had an inadequate response to two or more antidepressant therapies during the current moderate to severe depressive episode. This paper provides an expert panel's practical recommendations and clinical guidance for establishing esketamine clinics in Australia.
Methods
An expert panel (n = 11) comprising psychiatrists, mental health care nurses, pharmacists, and individuals with experience establishing esketamine clinics was convened in Sydney. The panel developed practical recommendations and clinical guidance, which were then further refined.
Results
Five key areas were identified: practical considerations for esketamine clinic set-up, including multidisciplinary care considerations; patient selection; administering esketamine; adverse event management and long-term follow-up.
Conclusions
Guidance presented in this paper should assist Australian clinicians to set up an esketamine clinic, and provide practical advice on the infrastructure and clinical requirements for treatment of patients with this agent.
{"title":"Establishing an esketamine clinic in Australia: Practical recommendations and clinical guidance from an expert panel","authors":"Nicollette L. R. Thornton BA/BSc, BHlthSc (Hons), Warwick Black MBBS, FRANZCP, Adrian Bognar BNurs, Daniel Dagge MBBS, FRANZCP, Teresia Gitau BNurs, Bruce Hua BPharm, Gero Joks PharmD, MSc, PhD, MBA, Jarrad King BSc, MIPH, Andrew Lord BPharm (Hons), Elizabeth M. Scott BSc, MBBS, FRANZCP, DMedSc, Jelena Smit Callander BNurs, GradCertMHlthN, Serena Ting BNurs, Dennis Liu MBBS, PhD, FRANZCP","doi":"10.1111/appy.12550","DOIUrl":"10.1111/appy.12550","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Major depressive disorder (MDD) can have severe impacts on function and quality of life. Up to one third of patients will have an inadequate response to their first line of treatment, with subsequent lines of therapy associated with lower remission rates and higher relapse rates. Recently esketamine has become available for Australian patients, and this agent provides an additional treatment option for those with MDD who have had an inadequate response to two or more antidepressant therapies during the current moderate to severe depressive episode. This paper provides an expert panel's practical recommendations and clinical guidance for establishing esketamine clinics in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An expert panel (<i>n</i> = 11) comprising psychiatrists, mental health care nurses, pharmacists, and individuals with experience establishing esketamine clinics was convened in Sydney. The panel developed practical recommendations and clinical guidance, which were then further refined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five key areas were identified: practical considerations for esketamine clinic set-up, including multidisciplinary care considerations; patient selection; administering esketamine; adverse event management and long-term follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Guidance presented in this paper should assist Australian clinicians to set up an esketamine clinic, and provide practical advice on the infrastructure and clinical requirements for treatment of patients with this agent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"15 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/appy.12550","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From the Editor in Chief","authors":"Allan Tasman MD","doi":"10.1111/appy.12551","DOIUrl":"10.1111/appy.12551","url":null,"abstract":"","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"15 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jin Pyo Hong MD, PhD, Akramul Zikri Abd Malek MBBS, Dr (Psych), Cheng-Ta Li MD, PhD, Jong-Woo Paik MD, PhD, Ahmad Hatim Sulaiman MBBS, MPM, PhD, Gilbert Madriaga DPT, MSc, Jianmin Zhuo PhD, Sarah Siggins PhD, Dong-Jing Fu MD, PhD, Po-Chung Ju PhD
This post-hoc analysis evaluated the efficacy and safety of intranasal esketamine in the Asian subgroup from ASPIRE I. Patients with major depressive disorder and suicidal ideation with intent received intranasal esketamine (n = 26) or placebo (n = 27), plus standard of care for 25 days. The primary endpoint was the change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to Day 2. The MADRS score improved in favor of esketamine (least squares mean difference: −3.8). No unexpected safety concerns were noted. The Asian subgroup showed a similar efficacy and safety profile as the total ASPIRE I cohort.
{"title":"Efficacy and safety of esketamine nasal spray in addition to standard of care in patients with major depressive disorder who have active suicidal ideation with intent: A subgroup analysis of the Asian cohort of ASPIRE I (a randomized, double-blind, placebo-controlled study)","authors":"Jin Pyo Hong MD, PhD, Akramul Zikri Abd Malek MBBS, Dr (Psych), Cheng-Ta Li MD, PhD, Jong-Woo Paik MD, PhD, Ahmad Hatim Sulaiman MBBS, MPM, PhD, Gilbert Madriaga DPT, MSc, Jianmin Zhuo PhD, Sarah Siggins PhD, Dong-Jing Fu MD, PhD, Po-Chung Ju PhD","doi":"10.1111/appy.12548","DOIUrl":"10.1111/appy.12548","url":null,"abstract":"<p>This post-hoc analysis evaluated the efficacy and safety of intranasal esketamine in the Asian subgroup from ASPIRE I. Patients with major depressive disorder and suicidal ideation with intent received intranasal esketamine (<i>n</i> = 26) or placebo (<i>n</i> = 27), plus standard of care for 25 days. The primary endpoint was the change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to Day 2. The MADRS score improved in favor of esketamine (least squares mean difference: −3.8). No unexpected safety concerns were noted. The Asian subgroup showed a similar efficacy and safety profile as the total ASPIRE I cohort.</p>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"15 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41096030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleiman Andary B. Physio (Hons), Jason Bassani B. Physio (Hons), Gus Burrell B. Physio (Hons), Eliza Cole B. Physio (Hons), Rhiannon Evans B. Physio (Hons), Emily Redman B. Physio (Hons), Saravana Kumar B. App.Sc (Physio), Grad Dip (Digital Learning), MPT (Manipulative and Sports), PhD
While the importance of mental health and its impact on overall health and well-being has been widely recognized, there continue to be ongoing barriers to accessing mental health services. This is particularly poignant in countries in Southeast Asia (SEA) where there may be further stigma in accessing mental health services. As no reviews have been undertaken on this topic, this review aims to outline the barriers and enablers to access and utilization of mental health care services in SEA. Searches were undertaken in commercially produced and gray literature sources. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the Health Belief Model (HMB) as a framework. Twelve studies were included in the review. Under the HBM, barriers were grouped into: stigma, poor health literacy, internalized reasons, cultural beliefs, lack of training of health professionals, quality of service, and poor distribution of resources. Enablers included: social support, outreach services, structural stigma, self-awareness, resources and information, accessibility and affordability, and positive attitudes and beliefs about health professionals. Those accessing mental health care in SEA are confronted by complex barriers and few enablers. Ongoing stigma and a distinct lack of resources pose the greatest challenges, which are even more amplified for those in rural areas and minority groups. A multifaceted strategy that improves the structures, processes, and outcomes of mental health is required within these communities.
{"title":"Barriers and enablers to access and utilization of mental health care services across Southeast Asia: A preliminary scoping review","authors":"Sleiman Andary B. Physio (Hons), Jason Bassani B. Physio (Hons), Gus Burrell B. Physio (Hons), Eliza Cole B. Physio (Hons), Rhiannon Evans B. Physio (Hons), Emily Redman B. Physio (Hons), Saravana Kumar B. App.Sc (Physio), Grad Dip (Digital Learning), MPT (Manipulative and Sports), PhD","doi":"10.1111/appy.12549","DOIUrl":"10.1111/appy.12549","url":null,"abstract":"<p>While the importance of mental health and its impact on overall health and well-being has been widely recognized, there continue to be ongoing barriers to accessing mental health services. This is particularly poignant in countries in Southeast Asia (SEA) where there may be further stigma in accessing mental health services. As no reviews have been undertaken on this topic, this review aims to outline the barriers and enablers to access and utilization of mental health care services in SEA. Searches were undertaken in commercially produced and gray literature sources. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the Health Belief Model (HMB) as a framework. Twelve studies were included in the review. Under the HBM, barriers were grouped into: stigma, poor health literacy, internalized reasons, cultural beliefs, lack of training of health professionals, quality of service, and poor distribution of resources. Enablers included: social support, outreach services, structural stigma, self-awareness, resources and information, accessibility and affordability, and positive attitudes and beliefs about health professionals. Those accessing mental health care in SEA are confronted by complex barriers and few enablers. Ongoing stigma and a distinct lack of resources pose the greatest challenges, which are even more amplified for those in rural areas and minority groups. A multifaceted strategy that improves the structures, processes, and outcomes of mental health is required within these communities.</p>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"15 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/appy.12549","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41113165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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