BMC Psychiatry最新文献

Background: Narcissistic personality disorder (NPD) is associated with a complex interplay of genetic, neurobiological, and environmental factors. In this case report, we discuss the association between adverse childhood experiences (ACEs) and the development of NPD in adulthood.

Case presentation: Here, we report a clinical case of NPD to illustrate how ACEs, particularly physical and emotional neglect, combined with early life parental overvaluation, can impair emotional regulation and self-worth, contributing to the development of narcissistic traits. We analyse, in light of existing literature, how ACEs are associated with a wide spectrum of personality disorders, how parental overvaluation is linked to grandiose narcissism, and how childhood neglect and abuse are associated with vulnerable narcissism.

Conclusion: ACEs are the primary risk factor for the development of NPD in adulthood. Dysfunctional household environments and parenting practices compound the association between ACEs and pathological narcissism. It is important to address childhood trauma for the prevention and treatment of NPD. Further research is necessary to clarify how individual factors influence the relationship between ACEs and pathological narcissism.

Background: Childhood trauma (CT) is a major risk factor for psychiatric disorders. Emotional and cognitive functions are often affected in many psychiatric conditions, and these functions are mediated by the limbic system. However, previous research has primarily focused on patient populations. Therefore, we aim to examine the impact of CT on the limbic brain structure in healthy individuals.

Methods: We enrolled 48 individuals in health, evenly split into two groups: 24 healthy participants with CT (HP-CT) and 24 healthy participants without CT (HP-nCT). They underwent scale assessments and MRI data acquisition. Comparisons between the two groups were performed after subcortical subregion volume segmentation using FreeSufer. Lastly, we examined correlations between volume changes and scale scores.

Results: We found that HP-CT group had smaller volumes in several subregions of the hippocampus, amygdala, and cortical limbic structures, including the subiculum (Sub) head and body, cornu ammonis (CA)1 head, molecular layer (ML) head, granule cell layer of the dentate gyrus (GC-ML-DG) body, CA4 body, fimbria, hippocampus-amygdala transition area (HATA), whole hippocampus head and body, whole hippocampus, basal nucleus (Ba), accessory basal nucleus (AB), cortico-amygdaloid transition area (CAT), paralaminar nucleus (PL) of the left hemisphere; and hippocampal tail, presubiculum (PreSub) body, and basal forebrain of the right hemisphere. Volume changes in the CA4 body and GC-ML-DG body were correlated with sexual abuse. Changes in the volume of the right basal forebrain were linked to emotional neglect. However, these findings were not significant after correction for multiple comparisons.

Conclusion: CT impacts multiple structures of the limbic system, including the hippocampus, and amygdala. This also suggests that region-specific changes within the limbic system can serve as clinical biomarkers supporting cross-diagnostic psychiatric illnesses.

Background: To date, the clinical equivalence between branded and generic medications remains debate and may sometimes be a reason why psychiatrists are hesitant to prescribe generic medications. Depression is recognized to exacerbate suicide risk globally and selective serotonin reuptake inhibitors, such as fluoxetine are common treatment options. Therefore, this study aimed to explores differences in suicidal risks between users of branded and generic fluoxetine in Taiwan.

Methods: This cohort study used Taiwan Longitudinal Health Insurance Database, encompassing 2 million individuals covered by National Health Insurance (NHI) program. The full cohort consisted of 32,298 fluoxetine new users. Then, 7,380 branded and 7,380 propensity score matched (PSM) generic fluoxetine new users were identified. The study further utilized Cox proportional hazards models to assess risk of 5-year suicidal ideation, suicide mortality, and all-cause mortality.

Results: The study revealed that the adjusted hazard ratios (HRs) for suicidal ideation, suicide mortality and all-cause mortality in branded users were 0.766 (95% CI, 0.497 - 1.181), 0.660 (95% CI, 0.447 - 0.975), and 0.942 (95% CI, 0.849 - 1.045), respectively, when compared with matched generic fluoxetine users. Stratified and sensitivity analyses showed the lower risk of suicide mortality in specific subgroups, such as male (adjusted HRs = 0.536, 95% CI = 0.306-0.939) and young branded users (adjusted HRs = 0.549, 95% CI = 0.334-0.904).

Conclusion: This study observed trends in the prevention effects of suicide-related risks. However, only suicide mortality was statistically significant, especially in males and those aged < 40 years. These insights may assist clinicians and policymakers in decision-making.

Clinical trial number: NA (This study is a cohort study utilizing the national health insurance database, not a clinical trial).

Background: Depression is among the leading causes of the global burden of disease and is associated with substantial morbidity in old age. The importance of providing timely intervention, particularly those with subclinical symptoms, has thus increasingly been emphasised. Despite their overall effectiveness, a small but notable subgroup tends to be less responsive to interventions. Identifying predictors of non-remission and non-response is critical to inform future strategies for optimising intervention outcomes.

Methods: A total of 4153 older adults aged 60 years and above with subclinical depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] = 5-19) were recruited from JC JoyAge, a large-scale collaborative stepped-care intervention service across Hong Kong. A wide range of clinical and modifiable risk and protective factors at baseline were assessed, including depressive symptoms, anxiety symptoms, loneliness, suicidal ideation, cognitive capacity, multimorbidity, chronic pain, need for informal care due to mental health reasons, history of abuse, and sociodemographic characteristics. Separate multivariable logistic regression models were applied to identify predictors of non-remission (PHQ-9 ≥ 5) and non-response (< 50% reduction in PHQ-9) following intervention.

Results: The rates of non-remission and non-response were 18.9% (n = 784) and 23.0% (n = 956), respectively. Comorbid anxiety symptoms (adjusted odds ratio [aOR] = 2.08, CI = 1.72-2.51; 1.28, 1.05-1.57), loneliness (2.00, 1.66-2.42; 1.67, 1.38-2.01), need for informal care (1.86, 1.49-2.33; 1.48, 1.18-1.85), lower cognitive capacity (0.95, 0.93-0.97; 0.94, 0.92-0.96), and absence of chronic pain (0.59, 0.48-0.72; 0.76, 0.64-0.91) predicted both non-remission and non-response. Meanwhile, moderate-to-severe depressive symptoms predicted higher odds of non-remission (1.41, 1.18-1.69) and lower odds of non-response (0.28, 0.23-0.34), respectively. Subgroup analyses conducted separately in older adults with mild and moderate-to-severe depressive symptoms at baseline revealed that comorbid anxiety, loneliness, need for informal care, and absence of chronic pain were consistent predictors of non-remission. Those with non-remission and non-response showed more depression-related functional impairments and poorer health-related quality of life post-intervention.

Conclusions: Older adults with subclinical depressive symptoms showing comorbid anxiety, higher loneliness, need for informal care, and chronic pain may be offered more targeted interventions in future services. A personalised risk-stratification approach may be helpful.

Trial registration: ClinicalTrials.gov identifiers: NCT03593889 (registered 29 May 2018), NCT04863300 (registered 23 April 2021).

Background: Globally, adolescent depression is prevalent. There is, however, a dearth of studies investigating behavioral intention to professional help-seeking regarding mental health problems among adolescents having probable depression. Based on the Stress Coping Theory, the hypothesis that personal resources and active coping would mediate between interpersonal resources and behavioral intention to professional help-seeking was investigated.

Methods: Students from five junior middle schools, three senior high schools, and one vocational school were selected to participate in the survey from February to March 2022 via convenient sampling. The questionnaire collected participants' characteristics, depression, peer acceptance/support, resilience, self-compassion, active coping, and behavioral intention to professional help-seeking. The final sample included 1,425 Chinese adolescents having probable depression (Patient Health Questionnaire score ≥ 10). SPSS 23.0 and Mplus 8.3 were employed to analyze the data.

Results: The prevalence of behavioral intention to professional help-seeking was 15.4%. Adjusted for background factors, peer acceptance, resilience, self-compassion, and active coping were significantly associated with behavioral intention to professional help-seeking (ORa ranged from 1.05 to 1.31). The indirect effects via active coping (β = 0.020) and a serial indirect effect via personal resources and active coping (β = 0.029) were statistically significant. The direct effect from interpersonal resources to behavioral intention to professional help-seeking was non-significant.

Conclusion: The prevalence of behavioral intention to professional help-seeking among adolescents with probable depression was low and might render early detection/intervention ineffective. It is important to increase the intention to seek help from professionals. One possibility is to enhance interpersonal/personal resources and active coping.

Background: Suicidal behaviors, which may lead to death (suicide) or survival (suicide attempt), are influenced by various factors. Identifying the specific risk factors for suicidal behavior mortality is critical for improving prevention strategies and clinical interventions. Predicting the outcomes of suicidal behaviors can help identify individuals at higher risk of death, enabling timely and targeted interventions. This study aimed to determine the critical risk factors associated with suicidal behavior mortality and identify an effective classification model for predicting suicidal behavior outcomes.

Materials and methods: This study utilized data recorded in the suicidal behavior registry system of hospitals in Ilam Province. In the first phase, duplicate records were removed, and the data was numerically encoded via Python version 3.11; then, the data was analyzed using chi-square and Fisher's exact tests in SPSS version 22 software to identify the factors influencing suicidal behavior mortality. In the second phase, missing data were removed, and the dataset was standardized. Five binary classification algorithms were utilized, including Random Forest, Logistic Regression, and Decision Trees, with hyperparameters optimized using the area under the receiver operating characteristic curve (AUC) and F1 score metrics. These models were compared based on accuracy, recall, precision, F1 score, and AUC.

Results: Among 3833 cases of suicidal behavior in various hospitals in Ilam Province, the results indicated that the method of suicidal behavior (P < 0.001), reason for suicidal behavior (P < 0.001), age group (P < 0.001), education level (P < 0.001), marital status (P = 0.004), and employment status (P = 0.042) were significantly associated with suicide. Variables such as the season of suicidal behavior, gender, father's education, and mother's education were not significantly related to suicidal behavior mortality. Furthermore, the random forest model demonstrated the highest area under the ROC curve (0.79) and the highest classification accuracy and F1 score on both the training data (0.85 and 0.2, respectively) and test data (0.86 and 0.31, respectively) for predicting suicidal behaviors outcomes among the models tested.

Conclusion: This study identified key factors such as older age, lower education, divorce or widowhood, employment, physical methods, and socioeconomic issues as significant predictors of suicidal behavior outcomes. A combination of statistical models for feature selection and machine learning algorithms for prediction was used, with Random Forest showing the best performance. This approach highlights the potential of integrating statistical methods with machine learning to improve suicide risk prediction and intervention strategies.

Background: The Weight-Adjusted Waist Index (WWI) is a novel indicator of obesity that accurately reflects body composition. However, the association between WWI and depression in patients with non-alcoholic fatty liver disease (NAFLD) remains unclear. This study aims to explore this relationship through a nationally representative cross-sectional analysis.

Methods: This study included adult participants diagnosed with NAFLD from NHANES 2017-2020. WWI was calculated as the waist circumference (cm) divided by the square root of body weight (kg). NAFLD diagnosis relied on vibration-controlled transient elastography (VCTE) with a controlled attenuation parameter (CAP) exceeding 248 dB/m to indicate hepatic steatosis. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores ≥ 10 indicating the presence of major depression.

Results: After adjusting for all covariates, a significant positive association was found between WWI and depression in NAFLD (OR = 1.725, 95% CI: 1.442-2.063, p < 0.00001), with a dose-response relationship indicated by restricted cubic spline analysis. The association was stronger in men and lean/normal weight NAFLD patients. Adjusting further for BMI did not alter these findings (OR = 1.643, 95% CI: 1.357-1.989, p < 0.00001). BMI's association with depression was negated after adjusting for WWI.

Conclusions: WWI had a positive association with depression in NAFLD, independent of BMI. This association was more pronounced in men and lean/normal weight NAFLD. These findings suggest that WWI may be a novel indicator of depression in NAFLD and potentially valuable in depression prevention.

Objective: State anxiety and trait anxiety are differentially mapped in brain function. However, the genetic and neurobiological basis of anxiety-related functional changes remain largely unknown.

Methods: Participants aged 18-30 from the community underwent resting-state fMRI and were assessed with the State-Trait Anxiety Inventory. Using a general linear regression model, we analyzed the effects of state and trait anxiety, as well as their sum and difference (delta), on regional homogeneity (ReHo) in cortical areas. ReHo patterns denote the spatial distribution of ReHo associated with anxiety scores. We further explored the spatial correlations between ReHo patterns and neuromaps, including gene expression, neurotransmitter receptor density, myelination, and functional connectivity gradients, to elucidate the genetic and molecular substrates of these ReHo patterns.

Results: Our findings demonstrated robust spatial correlations between whole-brain ReHo patterns for state and trait anxiety, with trait anxiety and the delta value exhibiting stronger network correlations, notably in the dorsal attention, salience, visual, and sensorimotor networks. Genes highly correlated with ReHo patterns exhibited unique spatiotemporal expression patterns, involvement in oxidative stress, metabolism, and response to stimuli, and were expressed in specific cell types. Furthermore, ReHo patterns significantly correlated with neuromaps of neurotransmitter receptor density, myelination, and functional connectivity gradients.

Conclusions: The ReHo patterns associated with anxiety may be driven by genetic and neurobiological traits. Our findings contribute to a deeper understanding of the pathogenesis of anxiety from a genetic and molecular perspective.

Background: Although the positive association between impairments in metacognitive capacity and negative symptoms in people with schizophrenia spectrum disorders is widely evidenced in the literature, the explaining mechanisms of this association are still less known and poorly understood. This study aims to bridge this knowledge gap by testing the hypothesis that COMT rs4680 variants will act as moderators in the relationship between certain metacognitive domains and negative symptoms' severity.

Method: A cross-sectional study was carried-out during the period between February and March 2024. A total of 115 biologically unrelated Arab (Lebanese) patients with schizophrenia were included.

Results: After controlling for sex and duration of illness as a potential confounder, moderation analyses showed that the AG genotype of the COMT rs4680 served as a significant moderator between maladaptive metacognitive beliefs about cognitive confidence (i.e. lack of confidence in memory) and negative symptoms. In non-carriers of the COMT rs4680 AG genotype, lower cognitive confidence (i.e., more "lack of cognitive confidence") is significantly associated with greater negative symptoms.

Conclusion: Findings suggest that metacognition may be a relevant treatment target in the management of negative symptoms particularly in non-carriers of the COMT rs4680 AG genotype. Therefore, genetic testing could potentially be used to match patients with metacognitive interventions that are more likely to be effective in supporting recovery from negative symptoms.

Background: Psychotic depression (PD) and schizophrenia (SCZ) share overlapping symptoms yet differ in etiology, progression, and treatment approaches. Differentiating these disorders through symptom-based diagnosis is challenging, emphasizing the need for a clearer understanding of their distinct cognitive and neural mechanisms.

Aim: This study aims to compare cognitive impairments and brain functional activities in PD and SCZ to pinpoint distinguishing characteristics of each disorder.

Methods: We evaluated cognitive function in 42 PD and 30 SCZ patients using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and resting-state functional magnetic resonance imaging (rs-fMRI). Regional homogeneity (ReHo) values were derived from rs-fMRI data, and group differences in RBANS scores were analyzed. Additionally, Pearson correlation analysis was performed to assess the relationship between cognitive domains and brain functional metrics.

Results: (1) The SCZ group showed significantly lower RBANS scores than the PD group across all cognitive domains, particularly in visuospatial/constructional ability and delayed memory (p < 0.05); (2) The SCZ group exhibited a significantly higher ReHo value in the left precuneus compared to the PD group (p < 0.05); (3) A negative correlation was observed between visuospatial construction, delayed memory scores, and the ReHo value of the left precuneus.

Conclusion: Cognitive impairment is more pronounced in SCZ than in PD, with marked deficits in visuospatial and memory domains. Enhanced left precuneus activity further differentiates SCZ from PD and correlates with cognitive impairments in both disorders, providing neuroimaging-based evidence to aid differential diagnosis and insights into cognitive dysfunction mechanisms, while also paving a clearer path for psychiatric research.