BMC Psychiatry最新文献

Background: In several countries, the growing emphasis on human rights and the ratification of the Convention on the Rights of Persons with Disabilities (CRPD) have highlighted the need for changes in culture, attitudes and practices of mental health services. New approaches, such as recovery-oriented care (ROC) and trauma-informed care (TIC) emphasize the users' needs and experiences and promote autonomy and human rights.

Aims: To provide an overview of the literature on recovery-oriented care (ROC) and trauma-informed care (TIC) and their relevance to the promotion of human rights and quality of mental health care.

Method: We conducted a scoping review by searching the following databases: PubMed, Scopus, PsycINFO. We performed a qualitative synthesis of the literature aimed at reviewing: (1) current conceptualisations of recovery in mental health care; (2) recovery-oriented practices in mental health care; (3) current conceptualizations of trauma and TIC in mental health care; (4) trauma-informed practices in mental health care; (5) the relationship between ROC and TIC, with a particular focus on their shared goal of promoting alternatives to coercion, and on trauma-informed and/or recovery oriented alternatives to coercion.

Results: According to prevailing conceptual frameworks, ROC and TIC share many underlying principles and should be regarded as complementary. Both approaches affirm the conceptualization of service users as persons, foster their autonomy and rely on their involvement in designing and monitoring mental health services. Both approaches promote human rights. A wider consensus on conceptual frameworks, tools and methodologies is needed to support ROC and TIC implementation and allow comparison among practices. Recovery-oriented and trauma-informed models of care can contribute to the implementation of non-coercive practices, which show promising results but warrant further empirical study.

Conclusions: Recovery-oriented and trauma-informed practices and principles may contribute to the shift towards rights-based mental health care and to the implementation and successful uptake of alternatives to coercion. Local and international work aimed to promote and test these approaches may provide a contribution to improving mental health care world-wide. Future research should focus on the outcomes of all involved stakeholders' and include the perspectives of both staff members and service users in different contexts.

Background: Obsessive-compulsive disorder (OCD) present invasive thoughts and repetitive behaviors affecting 1-3% of the population, divided into 3-5 symptom dimensions. Self-contamination, a subtype within the contamination/washing dimension, remains poorly understood. This study aim is to investigate pathological features and treatment response in self-contamination subtype compared to other contamination subtype and checking symptoms.

Method: Seventy-one OCD patients were categorized into self-contamination (n = 15), contaminated (n = 25), and checking symptom (control, n = 31) groups. OCD symptom severity was assessed using the Japanese version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) Symptom Checklist. Comorbidities were evaluated using the Structured Clinical Interview for DSM-IV. Global functioning, anxiety, and depressive symptoms were measured using DSM-IV's Global Assessment of Functioning Scale (GAFS), State-Trait Anxiety Inventory, and Zung's Self-rating Depression Scale, respectively. Treatment involved a standardized combination of selective serotonin reuptake inhibitors and cognitive-behavioral therapy, with treatment response assessed after 1 year.

Results: Subjects in the self-contamination group showed significantly lower quality of life, GAFS scores, and higher comorbidities including major depressive disorder, social anxiety disorder, body dysmorphic disorder, and olfactory reference disorder. Treatment response was notably poorer in the self-contamination group. Multiple regression analysis identified four poor treatment outcome predictors: score on the Y-BOCS and the SDS, duration of illness, and prevalence of ORD.

Conclusion: The identification of the self-contamination subtype in OCD patients is crucial for understanding the pathophysiological and treatment response. Further research is needed to clarify the socio-cultural effects on the development of this putative subtype of OCD.

Background: Sleep disturbance is a common condition in patients with schizophrenia. Studies have shown that insufficient sleep and excessive sleep lead to adverse health outcomes. This study aimed to identify the factors associated with short and long sleep duration, as well as the prevalence of somatic comorbidities in schizophrenia patients.

Methods: This study was conducted in 24 mental health institutes of Guangdong Province using a multistage-stratified and random sampling method. All information was collected by face-to-face interview with a structured questionnaire. The association of sleep duration with sociodemographic and clinical factors was determined using multinomial logistic regressions. Subgroup analysis was performed in the various source of patients.

Results: A total of 6 024 schizophrenia patients were enrolled in this study, among whom 8.6% (n = 521) reported short sleep duration and 47.2% (n = 2 850) had long sleep duration. The most common comorbid chronic diseases in the entire cohort were hypertension (8.0%), diabetes (6.8%) and hyperlipidemia (3.2%). Factors such as, current smoker, outpatients, benzodiazepines (BZDs), side effects, comorbidities, age of onset, and illness duration were positively associated with short sleep duration. On the other hand, personal annul income < 10 000 yuan, personal annul income ≥ 40 000 yuan, chronic patients, first-generation antipsychotics (FGAs) and side effects were positively associated with long sleep duration. In outpatient settings, overweight was associated with long sleep duration, whereas in inpatient settings, being female positively correlated with long sleep duration.

Conclusion: Disruption of sleep duration and somatic comorbidities are highly prevalent in patients with schizophrenia. This study demonstrates the complex relationships among socioeconomic information, clinical factors and sleep duration in schizophrenia, highlighting the need for developing targeted interventions and management strategies for sleep duration.

Clinical trial number: Not applicable.

Background: The impact of otolaryngological diseases on sleep quality, anxiety, and depression has garnered significant attention. However, research has primarily focused on unveiling the effects of only one or two specific diseases, without analyzing the impact of multiple concurrent diseases. Furthermore, investigation into the interaction mechanisms among these factors has been lacking.

Objectives: This study reveals the effects of different otolaryngological diseases on sleep quality, anxiety, and depression, and investigates their interaction mechanisms.

Methods: In total, 2,080 patients with otolaryngological diseases were recruited from six centers in mainland China. Data on sociodemographics, history of smoking and alcohol consumption, diagnosis, anxiety, depression, and sleep quality were collected through hospital information system queries and questionnaires. We uncovered the psychological status and sleep quality of otolaryngology outpatients with different diseases and revealed the interaction mechanisms between these diseases and anxiety, depression, and sleep quality. Multivariable polynomial linear regression models explored the impact of different otolaryngological diseases on anxiety, depression and sleep quality, and mediation analysis explored the interaction mechanisms.

Results: Chronic laryngitis, eustachian tube disorders, laryngeal swelling, laryngopharyngeal reflux, neck lymphatic inflammation, snoring, sudden deafness, tinnitus, nasopharyngeal lesions, and trauma had a significant impact on Pittsburgh Sleep Quality Index scores. Chronic tonsillitis, chronic laryngitis, and laryngopharyngeal reflux had a significant impact on Zung Self-Rating Depression Scale scores. Patients with giddiness (P = 0.006) and tinnitus (P = 0.006) tended to have higher Zung Self-Rating Anxiety Scale scores. Anxiety mediated the effect of tinnitus on sleep quality (70.41%; 95% confidence interval [CI]: 40.07, 76.00), and depression also had a mediation effect (13.24%; 95% CI: 4.46, 28.58). Other diseases also exhibited mediating effects and interactions with anxiety, depression, and sleep quality.

Conclusions: Sleep quality significantly mediates the relationships of specific otolaryngological diseases with anxiety and depression. Similarly, anxiety and depression play important mediating roles in the relationships of different diseases with sleep quality. By revealing the interactive effects of different otolaryngological diseases on anxiety, depression, and sleep quality, this study could aid early interventions aiming to reduce anxiety and depression and improve patients' sleep quality and quality of life.

People with severe mental illness have high rates of obesity, type 2 diabetes, and cardiovascular disease. Emerging evidence suggests that metabolic dysfunction may be causally linked to the risk of severe mental illness. However, more research is needed to identify reliable metabolic markers which may have an impact on mental health outcomes, and to determine the mechanisms behind their impact. In the METPSY research study, we will investigate the relationship between metabolic markers and clinical outcomes of severe mental illness in young adults. We will recruit 120 young adults aged 16-25 years living in Scotland with major depressive disorder, bipolar disorder, schizophrenia, or no severe mental illness (controls) for a prospective observational study. We will assess clinical symptoms at three in-person visits (baseline, 6 months, and 12 months) using the Structured Clinical Interview for DSM-5, and collect blood samples at each of these visits for agnostic profiling of metabolic biomarkers through an untargeted metabolomic screen, using the rapid hydrophilic interaction liquid chromatography ion mobility mass spectrometry method (RHIMMS). Participants will also complete remote assessments at 3 and 9 months after the baseline visit: Ecological Momentary Assessments to measure mental health, wrist actigraphy to measure rhythms of rest and activity, and continuous glucose monitoring to measure metabolic changes. Throughout the 12-month enrolment period, we will also measure objective markers of sleep using a radar sleep monitor (Somnofy). Using advanced statistical techniques and machine learning analysis, we will seek to better understand the mechanisms linking metabolic health with mental health in young adults with schizophrenia, bipolar disorder, and severe depression. Clinical trial number: Not applicable.

Compulsory admission (CA) refers to the process of hospitalization of an individual to a psychiatric ward or hospital, without their consent, due to severe mental health conditions. While it is an established and legally framed practice in many countries, it raises a number of ethical issues in terms of personal liberty and risks of potential misuse. Ethnicity, male gender and psychosis are the main risk factors for compulsory admission to psychiatric wards/hospitals in general population. Previous studies documented that CA is even more frequently used in prison, yet its determinants are still unknown. To address this issue, we explored the clinical, demographic and criminological determinants of compulsory admission in 317 detainees admitted to a psychiatric acute care secure ward located in the central prison of Geneva. We distinguished three groups: voluntary admissions only (VA), CA only and mixed admissions (MA). Judicial status and types of offenses were also recorded. Sociodemographic data included age, gender, and origin. Clinical parameters included previous compulsory admissions, previous hospital stays, number of admissions, length of stay, number of suicide attempts, short-term seclusions and ICD-10 clinical diagnoses. Fisher's exact, Chi² and Kruskal Wallis tests were used for group comparisons. Logistic regression analysis was used to explore the association between the legal status of hospital stays and clinical diagnosis. There was no significant difference between the three groups in respect to sociodemographic factors. Past compulsory admissions were significantly more frequent in the CA compared to the VA group. Both the mean number of admissions and length of stay differed significantly between the three groups. The number of suicidal attempts was significantly higher in MA compared to both VA and CA groups. Short-term seclusion was significantly more frequent in CA and MA compared to VA. Psychotic disorders were much more frequent in CA (55.1%) and MA (54.8%) compared to VA cases (23.9%). In contrast, depressive and anxiety disorders were significantly less frequent in CA (12.3%) and MA (14.3%) than VA (29.5%). Of importance, neither the type of offenses nor the judicial status differed between the three groups. In regression models, CA was strongly and positively associated with psychotic disorders. The inverse was true for depressive, anxiety as well as adjustment disorders. The present findings reveal that, in contrast to the general population, sociodemographic factors have no impact on the frequency of CA in a population of detainees. The main risk factors for the adoption of this measure are past CA and presence of acute psychosis. In contrast, the presence of depressive and anxiety symptoms limits the recourse to this disputed measure.

Background: Although comorbid medical diseases are important determinants of outcome among the critically ill, the role of psychiatric comorbidity is not well defined. The objective of this study was to determine the occurrence of psychiatric comorbidity and its effect on the outcome of patients admitted to adult intensive care units (ICU) in Queensland.

Methods: Admissions among adults to 12 ICUs in Queensland during 2015-2021 were included and clinical and outcome information was obtained through linkages between the ANZICS Adult Patient Database, the state-wide Queensland Hospital Admitted Patient Data Collection, and death registry.

Results: A total of 89,123 admissions were included among 74,513 individuals. Overall, 7,178 (8.1%) admissions had psychiatric co-morbidity with 6,270 (7.0%) having one major psychiatric diagnosis and 908 (1%) having two or more. Individual diagnoses of mood, psychotic, anxiety, or affective disorders were present in 1,801 (2.0%), 874 (1.0%), 3,241 (3.6%) and 354 (0.4%) admissions respectively. Significant differences were observed among the main groups (mood, affective, anxiety, psychotic, or multiple disorders) and those without psychiatric comorbidity with respect to main diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) score, sex, age, and medical comorbidity. Crude 30-day case-fatality rates were significantly lower (5.1%) compared to the general ICU population (10.1%) (p < 0.001). After controlling for confounding variables in the logistic regression model, patients with psychiatric comorbidity were at lower odds of death.

Conclusions: Psychiatric comorbidity is common among ICU presentations and is associated with a lower risk of death. This association is likely to be more complex than being a simple protective factor, and future research needs to further delineate how psychiatric comorbidity informs outcomes of specific ICU presentations.

Background: The co-occurrence of depression and anxiety is relatively more common among adolescents. Emerging evidence suggests that adaptability might affect this phenomenon. Network analysis can provide insight into the dynamics between symptoms of mental disorders. Therefore, we used network analysis 1) to explore symptom networks and 2) to investigate the association between adaptability and symptoms based on a longitudinal design.

Methods: 833 Chinese adolescents (449 males and 384 female) were recruited, with adaptability, depressive and anxiety symptoms measured at T1, 426 of them were followed up one year later at T2. Symptom networks were constructed for all participants and for the two groups based on their adaptability scores at T1. Furthermore, mediation analysis was performed to examine the relationship between adaptability and bridge symptoms at both timepoints.

Results: Irritable and Guilty showed the highest expected value at T1 (p < 0.05). The high adaptability group's symptom network (HGN) was less connected than the low adaptability group's symptom network (LGN) (p < 0.001). Furthermore, Irritable (T1) and adaptability (T2) were sequential mediators (p < 0.001) between adaptability (T1) and Irritable (T2).

Conclusions: These findings suggest that adaptability might affect the network dynamics, underscoring its importance to the occurrence of depression and anxiety among adolescents. Irritable and Guilty being the bridge symptoms may indicate the interventions to target in adolescents with comorbid depression and anxiety.

Background: Individuals undergoing fertility treatments often experience heightened stress levels compared to the general population. With the increasing number of women facing recurrent failed in vitro fertilization (IVF) cycles, this research aimed to assess the effectiveness of positive thinking counseling and cognitive reconstruction in reducing perceived stress among infertile women.

Methods: A randomized controlled clinical trial was conducted with 57 women who had undergone unsuccessful IVF cycles at the Fatemiyeh Infertility Center in Hamadan, Western Iran. Using block randomization, participants were randomly assigned to the control group (29 participants)and the intervention group (28 participants). The intervention group received individual face-to-face positive thinking counseling and cognitive reconstruction in eight sessions, each lasting 45 to 60 min. Stress levels were measured using the Cohen Perceived Stress Scale at the beginning of the study and on the embryo transfer day for both groups. Data were analyzed using Stata-13, with a significance levelof p < 0.05.

Results: Both groups' mean perceived stress scores showed no statistically significant differences before the intervention (p = 0.168). However, after the intervention, the mean perceived stress scores in the intervention group were significantly lower than those in the control group (p < 0.001).

Conclusions: It appears that the use of these counseling approaches leads to a reduction in perceived stress among infertile women.

Trial registration: Registration Number: IRCT20120215009014N474, registered on May15, 2023.

Background: Depression and anxiety are the emotional problems most frequently experienced by older adults. We aimed to investigate the associations between successful aging (SA) and depression and anxiety in older adults from Ningbo, China.

Methods: A cross-sectional study of 6,672 community-dwelling adults aged 65 years or older was performed. SA, depression, and anxiety symptoms were self-reported and measured using the Successful Aging Inventory (SAI), Patient Health Questionnaire-9 item (PHQ-9), and the 7-item Generalized Anxiety Disorder scale (GAD-7), respectively. Linear and logistic regression analyses were used to estimate the associations of SA with depression and anxiety.

Results: After multivariate adjustment, we found that the SAI score was independently associated with the PHQ-9 and GAD-7 scores (β = -0.069 and - 0.048, respectively). Multivariate-adjusted spline regression models showed negative, nonlinear dose-response associations between the SAI score and both depression and anxiety symptoms (P_{for nonlinearity} = 0.001 for both). With the highest quartile set as the reference, we determined that the lowest SAI score quartile was independently associated with both depression symptoms (OR = 16.131, 95% CI: 8.423, 30.892) and anxiety symptoms (odds ratio [OR] = 10.926, 95% confidence interval [CI]: 5.268, 22.664). In subgroup analyses, the association between the SAI score and depression symptoms was significantly higher in rural than in urban areas (P_{for interaction} = 0.024).

Conclusion: Among older adults in Ningbo, China, SA was found to play an important role in depression and anxiety symptoms, suggesting the need for effective and feasible interventions to promote SA in Chinese older adults.