BMC Psychiatry最新文献

Background: There is no doubt that genetic factors have the potential to predict the therapeutic outcomes of antidepressants in patients with major depressive disorder (MDD). This study investigated the association between genetic variants involved in serotonin signaling and brain-derived neurotrophic factor (BDNF) with the response to escitalopram treatment in patients with MDD. We focused on examining the influence of 5-HTTLPR (ins/del), HTR2A rs9316233, BDNF rs962369, CYP2C19 and CYP2D6 on the clinical response to escitalopram.

Methods: The patients were recruited from outpatient psychiatric clinics in Košice between 2020 and 2022. Patients received escitalopram for 12 weeks at a fixed dose of 10 mg daily. Clinical assessment was done at baseline and after 4, 8, and 12 weeks using the 21-item Hamilton Depression Rating Scale (HAMD-21).

Results: At the end of week 12, 57 (65%) patients were defined as responders to escitalopram treatment, while 31 (35%) patients were non-responders. Genotyping revealed that carriers of the short allele (S) of 5-HTTLPR exhibit a significantly lower therapeutic response to escitalopram measured by HAMD-21 than the long allele (L) carriers (p = 0.01). Adjusting for CYP2C19 and CYP2D6 metabolizer genotypes did not modify the observed relationship between 5-HTTLPR and treatment response. No significant associations were found for HTR2A rs9316233 or BDNF rs962369 variants and the treatment response.

Conclusions: These findings underscore the utility of 5-HTTLPR genotyping in guiding escitalopram therapy for MDD patients. Further research with larger cohorts is warranted to validate these results and elucidate additional genetic determinants of antidepressant efficacy.

Background: Electroconvulsive therapy (ECT) is an important treatment for several severe psychiatric conditions, yet its precise mechanism of action remains unknown. Increased inhibition in the brain after ECT seizures, mediated by γ-aminobutyric acid (GABA), has been linked to clinical effectiveness. Case series on epileptic patients report a postictal serum concentration increase of the GABA_A receptor agonist allopregnanolone. Serum allopregnanolone remains unchanged after a full ECT series, but possible transient effects directly after a single ECT seizure remain unexplored. The primary aim was to measure serum concentrations of allopregnanolone and its substrate progesterone after one ECT seizure. Secondary aims were to examine whether concentrations at baseline, or postictal changes, either correlate with seizure generalization or predict clinical outcome ratings after ECT.

Methods: A total of 130 participants (18-85 years) were included. Generalization parameters comprised peak ictal heart rate, electroencephalographic (EEG) seizure duration, and prolactin increase. Outcome measures were ratings of clinical global improvement, perceived health status and subjective memory impairment. Non-parametric tests were used for group comparisons and correlations. The prediction analyses were conducted with binary logistic and simple linear regression analyses.

Results: Allopregnanolone and progesterone remained unchanged and correlated neither with seizure generalization nor with clinical outcome. In men (n = 50), progesterone increased and allopregnanolone change correlated negatively with EEG seizure duration. In a subgroup analysis (n = 62), higher baseline allopregnanolone and progesterone correlated with postictal EEG suppression.

Conclusions: ECT seizures have different physiologic effects than generalized seizures in epilepsy. Progesterone might have implications for psychiatric illness in men.

Background: Several adversity-focused treatment trials have reported improvements to adversity sequelae (e.g., PTSD symptoms) and decreases in psychotic symptoms among individuals with psychotic disorders. Yet, no trials have examined the impact of adversity-focused treatment on substance use or examined the outcomes among an early phase psychosis population. These gaps in both the research literature and clinical practice have resulted in less knowledge about the outcomes of adversity-focused treatment at this stage of illness, including the impact on substance use.

Methods: The outcomes of an adapted prolonged exposure protocol (PE+) among an early phase psychosis population were examined using a multiple-baseline design. Nineteen adults with a psychotic disorder, current substance misuse, and a history of adversity were recruited from an early psychosis program. Participants were randomized to treatment start time and participated in a 15-session course of PE + therapy. Ten assessments were completed focusing on primary outcomes (i.e., adversity sequelae, negative psychotic symptoms, substance misuse) and secondary outcomes (i.e., functioning, hopelessness, experiential avoidance). The Reliable Change Index (RCI) was used to establish whether there were clinically significant changes to primary or secondary outcomes.

Results: Half or more of treatment completers experienced clinically significant changes to most domains of adversity sequelae, no participants experienced improvements in negative psychotic symptoms, and substance misuse increased for several participants. In terms of secondary outcomes, functioning and experiential avoidance were improved for a number of participants, while hopelessness decreased for only one participant. Participants reported high satisfaction with the PE + treatment, and exposure and coping skills were rated as the most helpful elements of treatment.

Conclusions: Reductions in adversity sequelae were observed following PE + treatment, suggesting that adversity-focused treatment may be beneficial for an early psychosis population. Yet, few positive changes to psychotic symptoms or substance use were observed. Further integrating treatment strategies for psychosis and substance use into PE + may be required to effectively treat the links between psychosis, adversity sequelae, and substance use. Future studies should make efforts to integrate substance use strategies into adversity treatment trials for people with psychotic disorders.

Trial registration: Clinicaltrials.gov, NCT04546178; registration posted 11/09/2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1 .

Background: Men and women differ in the mental health issues they typically face. This study aims to describe gender differences in preferences for mental health treatment options and specifically tries to identify participants who prefer AI-based therapy over traditional face-to-face therapy.

Method: A nationally representative sample of 2,108 participants (53% female) aged 18 to 74 years completed a choice-based conjoint analysis (CBCA). Within the CBCA, participants evaluated twenty choice sets, each describing three treatment variants in terms of provider, content, costs, and waiting time.

Results: Costs (relative importance [RI] = 55%) emerged as the most critical factor when choosing between treatment options, followed by provider (RI = 31%), content (RI = 10%), and waiting time (RI = 4%). Small yet statistically significant differences were observed between women and men. Women placed greater importance on the provider, while men placed greater importance on cost and waiting time. Age and previous experience with psychotherapy and with mental health apps were systematically related to individual preferences but did not alter gender effects. Only a minority (approximately 8%) of participants preferred AI-based treatment to traditional therapy.

Conclusions: Overall, affordable mental health treatments performed by human therapists are consistently favored by both men and women. AI-driven mental health apps should align with user preferences to address psychologist shortages. However, it is uncertain whether they alone can meet the rising demand, highlighting the need for alternative solutions.

Background: Previous research has indicated that personality traits, loneliness, and problematic internet use (PIU) significantly contribute to the prevalence of adolescent depression. However, the specific interrelationships among these variables in explaining the occurrence of depression remain unclear. Drawing upon susceptibility theory and cognitive-behavioral theory, this study explored whether personality traits influences adolescent depression through loneliness and PIU.

Methods: A total of 2476 adolescents (aged 12-18) from all over the country completed a psycho-social test, including the 10-Item Big Five Personality Inventory (BFI-10), three-Item Loneliness Scale (T-ILS), Problematic Internet Use Questionnaire-Short Form (PIUQ-SF-6) and the Patient Health Questionnaire-9 (PHQ-9). The mediation model was built and bootstrap method was used to test the mediating effect.

Results: Results showed that neuroticism, conscientiousness, openness, and agreeableness have a direct role on depression. Loneliness and PIU partially mediated the relationship between neuroticism, conscientiousness, agreeableness and depression, and completely mediated the relationship between extroversion and depression.

Conclusions: The results suggest that loneliness and PIU play important mediating roles in the relationship between personality traits and depression. This remind us that alleviating sense of loneliness and reducing overuse of the internet are a strategy for improve depression among adolescents.

Background: Suicide and its associated risk factors are of public health importance across the globe. The affected persons are mostly the youth. Empirical research in this crucial area of public health is generally lacking, especially among undergraduate university students in Ghana. This study sought to determine the prevalence of suicide ideation, and its associated risk factors that statistically predict suicide ideation among undergraduate students.

Methods: A descriptive cross-sectional quantitative survey was conducted. A structured online questionnaire was used to elicit information on the prevalence of suicide ideation and its correlates. A systematic sampling technique was used to sample 400 respondents. Of this number, 53.25% were male and 46.75% were female. Data were analyzed using SPSS v26. Results were presented in charts, tables, and cross-tabulations. A regression analysis was also done to model suicide ideation with socio-demographic variables.

Results: The prevalence of suicide ideation among participants was 24.5%. Significant risk factors for suicide ideation found in the study were academic stress and victimization. Suicide ideation was predicted with statistical significance by the presence of victimization (OR = 3), and academic stress (OR = 2).

Conclusion: The prevalence of suicide ideation among participants is real and will need combined efforts of university management and, the counseling unit to put in place interventions that will help avert suicide ideation and its dreaded squeal of completed suicide.

Background: Depersonalization-Derealization Disorder (DPD), a prevalent psychiatric disorder, fundamentally disrupts self-consciousness and could significantly impact the quality of life of those affected. While existing research has provided foundational insights for this disorder, the limited exploration of brain dynamics in DPD hinders a deeper understanding of its mechanisms. It restricts the advancement of diagnosis and treatment strategies. To address this, our study aimed to explore the brain dynamics of DPD.

Methods: In our study, we recruited 84 right-handed DPD patients and 67 healthy controls (HCs), assessing them using the Cambridge Depersonalization Scale and a subliminal self-face recognition task. We also conducted a Transcranial Direct Current Stimulation (tDCS) intervention to understand its effect on brain dynamics, evidenced by Functional Magnetic Resonance Imaging (fMRI) scans. Our data preprocessing and analysis employed techniques such as Independent Component Analysis (ICA) and Dynamic Functional Network Connectivity (dFNC) to establish a comprehensive disease atlas for DPD. We compared the brain's dynamic states between DPDs and HCs using ANACOVA tests, assessed correlations with patient experiences and symptomatology through Spearman correlation analysis, and examined the tDCS effect via paired t-tests.

Results: We identified distinct brain networks corresponding to the Frontoparietal Network (FPN), the Sensorimotor Network (SMN), and the Default Mode Network (DMN) in DPD using group Independent Component Analysis (ICA). Additionally, we discovered four distinct dFNC states, with State-1 displaying significant differences between DPD and HC groups (F = 4.10, P = 0.045). Correlation analysis revealed negative associations between the dwell time of State-2 and various clinical assessment factors. Post-tDCS analysis showed a significant change in the mean dwell time for State-2 in responders (t-statistic = 4.506, P = 0.046), consistent with previous clinical assessments.

Conclusions: Our study suggests the brain dynamics of DPD could be a potential biomarker for diagnosis and symptom analysis, which potentially leads to more personalized and effective treatment strategies for DPD patients.

Trial registrations: The trial was registered at the Chinese Clinical Trial Registry on 03/01/2021 (Registration number: ChiCTR2100041741, https://www.chictr.org.cn/showproj.html?proj=66731 ) before the trial.

Background: Postpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS.

Methods: Four focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis.

Results: Analysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety.

Conclusions: Findings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication.

Background: Major psychotic disorders (MPD), including schizophrenia (SCZ) and schizoaffective disorder (SAD), are severe neuropsychiatric conditions with unclear causes. Understanding their pathophysiology is essential for better diagnosis, treatment, and prognosis. Recent research highlights the role of inflammation and the immune system, particularly the Interleukin 17 (IL-17) family, in these disorders. Elevated IL-17 levels have been found in MPD, and human IL-17 A antibodies are available. Changes in chemokine levels, such as CCL20, are also noted in SCZ. This study investigates the relationship between serum levels of IL-17 A and CCL20 in MPD patients and their clinical characteristics.

Method: We conducted a case-control study at the Ibn Sina Psychiatric Hospital (Mashhad, Iran) in 2023. The study involved 101 participants, of which 71 were MPD patients and 30 were healthy controls (HC). The Positive and Negative Symptom Scale (PANSS) was utilized to assess the symptoms of MPD patients. Serum levels of CCL20 and IL-17 A were measured using Enzyme-Linked Immunosorbent Assay (ELISA) kits. We also gathered data on lipid profiles and Fasting Blood Glucose (FBS).

Results: The mean age of patients was 41.04 ± 9.93 years. The median serum levels of CCL20 and IL-17 A were significantly elevated in MPD patients compared to HC (5.8 (4.1-15.3) pg/mL and 4.2 (3-5) pg/mL, respectively; p < 0.001). Furthermore, CCL20 and IL-17 A levels showed a positive correlation with the severity of MPD. MPD patients also had significantly higher FBS, cholesterol, and Low-Density Lipoprotein (LDL) levels, and lower High-Density Lipoprotein (HDL) levels compared to HC. No significant relationship was found between PANSS components and blood levels of IL17 and CCL20.

Conclusion: The current study revealed that the serum levels of IL-17 A and CCL20 in schizophrenia patients are higher than those in the control group. Metabolic factors such as FBS, cholesterol, HDL, and LDL also showed significant differences between MPD and HC. In conclusion, the findings suggest that these two inflammatory factors could serve as potential therapeutic targets and prognostic biomarkers for schizophrenia.

Background and purpose: Among patients with solid tumors, those with breast cancer (BC) experience the most severe psychological issues, exhibiting a high global prevalence of depression that negatively impacts prognosis. Depression can be easily missed, and clinical markers for its diagnosis are lacking. Therefore, this study in order to investigate the diagnostic markers for BC patients with depression and anxiety and explore the specific changes of metabolism.

Method and results: Thirty-eight BC patients and thirty-six matched healthy controls were included in the study. The anxiety and depression symptoms of the participants were evaluated by the 17-item Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA). Plasma levels of glial fibrillary acidic protein (GFAP) and lipocalin-2 (LCN2) were evaluated using enzyme linked immunosorbent assay, and plasma lactate levels and metabolic characteristics were analyzed.

Conclusion: This study revealed that GFAP and LCN2 may be good diagnostic markers for anxiety or depression in patients with BC and that plasma lactate levels are also a good diagnostic marker for anxiety. In addition, specific changes in metabolism in patients with BC were preliminarily explored.