BMC Psychiatry最新文献

Background: This study aims to understand the complex triadic shared decision-making process in psychiatric emergency services, focusing on the choice between inpatient and outpatient care post-triage. It also identify scenarios where patient or significant others' preferences override clinical judgment.

Methods: Conducted in the greater Rotterdam area, Netherlands, this explorative study surveyed patient and significant others' preferences for voluntary or involuntary admission versus outpatient treatment, alongside professionals' clinical indications. Descriptive statistics were used to profile participants, and preference data were used to categorize groups, revealing patterns of agreement.

Results: Among 5680 assessments involving significant others, four groups emerged: agreement among the triad on in- or outpatient care (48.2%), patient disagrees (38.5%), significant others disagree (11.0%), and professionals disagree (2.3%). Professionals' recommendations were followed more frequently (57.0%) than patient (9.4%) or significant others' preferences (11.0%).

Conclusions: We observed that consensus could often be reached among the members of the triad on inpatient or outpatient care following triage. Disagreements typically occurred when patients preferred outpatient care while others favoured inpatient care, or when significant others advocated for inpatient care while others preferred outpatient care. While professionals' recommendations held the most influence, they could be overridden in cases where valid criteria mandated involuntary care.

Background: We aimed to determine the psychometric properties of the Apathy Evaluation Scale (AES) in chronic stroke survivors.

Methods: In this study, 112 non-cognitive impairment stroke survivors participated. Acceptability, inter-rater, and test-retest reliability of the three Persian versions of AES (clinician, informant, and self-rated) were evaluated. The correlation of three AES versions with the Hospital Anxiety and Depression Scale (HADS), Modified Rankin Scale (mRS), and Barthel Index (BI) was evaluated. To assess the diagnostic accuracy of the three AES versions, stroke survivors were classified as apathetic (n = 43) and non-apathetic (n = 69) groups using the 'diagnostic criteria of apathy'.

Results: The floor and ceiling effect, skewness, and kurtosis were within acceptable range for three AES versions. Internal consistency (α = 0.88-0.91) and test-retest and inter-rater reliability (ICC_2,1 >0.90) were acceptable for all AES versions. Standard Error of Measurement and Minimal Detectable Change values for test-retest and/or inter-rater reliability ranged 1.6-2.5 and 4.42-6.93 for three versions of AES, respectively. Significant moderate to high correlation (r or ƿ = -0.34-0.69) was found between three AES versions and HADS-D, HADS-A, BI, and mRS. The cut-off point > 34 (sensitivity = 87.5%, specificity = 72.22%, and AUC = 0.80) was derived for discriminating apathetic from non-apathetic stroke survivors based on the AES- self-rated total score.

Conclusion: All three AES versions are reliable and valid screening tools to evaluate and characterize apathy in stroke survivors. The AES-self-rated had good discriminative validity for discriminating apathetic from non-apathetic subjects in non-cognitive impairment stroke survivors.

Background: Somatic Symptom Disorder (SSD) is a condition often linked to excessive health anxiety and somatic symptoms. In recent years, studies have found associations between the cerebellum and various mental illnesses, including SSD. However, the microstructure of cerebellar subregions in SSD using diffusion magnetic resonance imaging has not been fully defined.

Methods: This is a cross-sectional study, that included 30 SSD patients and 30 age- and gender-matched healthy controls to investigate the microstructure of the cerebellum using diffusion magnetic resonance imaging. SSD diagnosis followed DSM-5 criteria, excluding major psychiatric comorbidities, while healthy controls underwent rigorous screening to exclude psychiatric or neurological histories. Clinical evaluations utilized standardized scales to assess depressive, anxiety, and cognitive symptoms. MRI data were acquired using a 3T Siemens Prisma scanner, including T1-weighted and diffusion-weighted imaging (30 directions, b = 1000/2000 s/mm²). Multi-compartment diffusion magnetic resonance imaging metrics from free water elimination diffusion tensor imaging and neurite orientation dispersion and density imaging were used to observe microstructural changes in the cerebellum's white matter and gray matter subregions in SSD patients.

Results: Compared to the control group, patients with SSD exhibited significant alterations in white matter microstructure. These changes were characterized by increased free water-eliminated fractional anisotropy and neurite density index, as well as decreased free water-eliminated mean diffusivity and radial diffusivity. Furthermore, the cerebellum displayed varying microstructural changes across 26 gray matter subregions. These changes included reduced mean diffusivity, free water-eliminated axial diffusivity, and free water-eliminated radial diffusivity, alongside increased neurite density index and orientation dispersion index. Importantly, the study identified significant correlations between these microstructural changes and clinical symptoms. Specifically, Vermis X and the left lobule VIIb showed significant associations with both depression and anxiety scores.

Conclusions: The findings suggest greater neurite density and enhanced diffusion restriction in the cerebellum of patients with SSD, which may indicate possible adaptive changes associated with chronic stress.

Introduction: The 11th revision of the World Health Organization's International Classification of Diseases (ICD-11) introduces a new disorder called complex posttraumatic stress disorder. This disorder is heterogeneous, and identifying its core symptoms is important for understanding its different aspects. The network approach to psychopathology allows for examining the structure of Complex PTSD at a symptom level, which helps in analyzing direct interactions between symptoms. This study aimed to explore the symptom structure of complex PTSD and identify critical symptoms in the treatment-seeking population in Iran.

Methods: Participants consisted of 463 people referred to comprehensive health centers in Tehran from September to December 2023 with psychopathological syndromes who had a history of trauma at different developmental stages. Complex PTSD symptoms were assessed using the International Trauma Questionnaire (ITQ) and International Measurement of Exposure to Traumatic Event checklist. Network analysis was applied to identify the most central symptoms (nodes) and associations between symptoms (edges) by the graphical LASSO algorithm and the EBCglasso method for network estimation.

Results: The result showed that the network of estimated symptoms for Complex PTSD in Iranian culture was highly accurate and stable. The most central symptoms in this network were feelings of failure and worthlessness. Additionally, "long-term upset" was identified as the connection between PTSD symptoms and DSO.

Conclusions: The study determined that feelings of failure and worthlessness are the most central symptoms in the Complex PTSD network. It was suggested that these symptoms should be given priority in theoretical and treatment models of Complex PTSD.

Background: Childhood adversity is known to predispose to a wide array of psychopathology in adolescence and early adulthood. Identity development, being a crucial developmental task during adolescence, has been suggested to affect this association. Nonetheless, research on the role of identity processes is scarce. The current study aims to investigate how identity processes of exploration and commitment may impact the association between childhood adversity and psychopathology.

Methods: We cross-sectionally investigated the association between childhood adversity, identity processes (i.e., exploration in breadth and depth, commitment making, identification with commitment and ruminative exploration) and depressive, anxiety and psychosis symptoms in 869 Flemish adolescents between 14 and 20 years old (mean = 15.52, SD = 1.28).

Results: Childhood adversity was associated with increased ruminative exploration, which itself was associated with increased psychopathology. On the other hand, commitment making, identification with commitment and exploration in breadth were associated with decreased psychopathology. Processes of exploration in breadth and commitment making attenuated the association between childhood adversity and psychopathology. Moreover, identification with commitment and ruminative exploration potentially mediated this association.

Conclusion: These findings underscore the importance of healthy identity processes in adolescents, with and without exposure to childhood adversity. Measures of identity structure and identity processes should be combined to fully capture identity.

Background: Self-medication, defined by the World Health Organization (WHO) as using medicines for self-diagnosed conditions, can lead to misdiagnosis, adverse effects, and ethical issues. Given that psychiatrists and psychiatry residents face unique mental health stigma and other barriers, this study investigates their knowledge and attitudes regarding self-medication.

Methods: A descriptive cross-sectional survey was conducted among 246 psychiatrists and psychiatry residents in Türkiye. Using convenience sampling, participants completed an anonymous online question form designed by researchers to assess sociodemographic factors, self-medication behaviors, and attitudes. Data were analyzed using descriptive statistics with SPSS 25.0.

Results: Findings indicated that 83% of participants engaged in self-medication in the past year, primarily with antidepressants. Although 80.9% of respondents reported knowledge of self-medication, many were unaware of legal and ethical guidelines. Major reasons for self-medication included viewing problems as minor, previous positive experiences with self-medication, and time constraints limiting help-seeking.

Conclusions: The study reveals that self-medication among psychiatrists and psychiatry residents is prevalent and potentially influenced by insufficient training on ethical implications. Many psychiatrists and psychiatry residents consider self-medication acceptable for minor issues, indicating a need for educational reforms and improved support systems. Addressing these gaps can promote a culture of professional help-seeking, ultimately enhancing psychiatrists' well-being and patient care quality.

Background: Challenges with social functioning, which is a hallmark of opioid use disorder (OUD), are a drawback in treatment adherence and maintenance. Yet, little research has explored the underlying mechanisms of this impairment. Impulsivity and corresponding neural alterations may be at the center of this issue. Childhood adversity, which has been linked to both impulsivity and poorer treatment outcomes, could also affect this relationship. This study explores the relationship between impulsivity, social functioning, and their neural correlates in the prefrontal cortex, while examining the potential moderating effects of childhood trauma in individuals recovering from OUD.

Methods: Participants with (N = 16) and without (N = 19) social impairment completed a survey (e.g., social functioning, Barrat's Impulsivity Scale, Adverse Childhood Experiences (ACEs) and cognitive tasks while undergoing neuroimaging. Functional near infrared spectroscopy (fNIRS), a modern, portable, wearable and low-cost neuroimaging technology, was used to measure prefrontal cortex activity during a behavioral inhibition task (Go/No-Go task).

Results: Those who social functioning survey scores indicated social impairment (n = 16) scored significantly higher on impulsivity scale (t [33]= -3.4, p < 0.01) and reported more depressive symptoms (t [33] = -2.8, p < 0.01) than those reporting no social impairment (n = 19). Social functioning was negatively correlated with impulsivity (r=-0.7, p < 0.001), such that increased impulsivity corresponded to decreased social functioning. Childhood trauma emerged as a moderator of this relationship, but only when controlling for the effects of depression, B=-0.11, p = 0.023. Although both groups had comparable Go/No-Go task performance, the socially impaired group displayed greater activation in the dorsolateral (F(1,100.8) = 7.89, p < 0.01), ventrolateral (F(1,88.8) = 7.33, p < 0.01), and ventromedial (F(1,95.6) = 7.56, p < 0.01) prefrontal cortex duringthe behavioral inhibition task.

Conclusion: In addition to being more impulsive, individuals with social impairment exhibited greater activation in the prefrontal cortex during the Go/No-Go task. Furthermore, the impact of impulsivity on social functioning varies depending on ACEs, such that higher levels of ACEs corresponded to a stronger negative relationship between impulsivity and social functioning, highlighting its importance in treatment approaches. These findings have implications for addressing social needs and impulsivity of those in recovery, highlighting the importance of a more personalized, integrative, and trauma-informed approach to intervention.

Background: Structural neuroimaging findings in Subthreshold depression (StD) patients at different ages are highly heterogeneous. This study aims to investigate the pathophysiology of StD across different ages.

Methods: Literature searches for MRI studies of StD were conducted in 11 databases, including PubMed and Embase, from database inception to June 18, 2024. An activation likelihood estimation (ALE) meta-analysis was performed on the studies across different ages.

Results: A total of 24 studies were included. The results revealed that the significant convergent brain regions in StD patients across different ages were primarily located within the frontostriatal circuit. Age-related differences were observed. For adolescent patients, the significant convergent brain regions were the caudate, putamen, anterior cingulate cortex (ACC), and medial frontal gyrus (MFG). For young adult patients, the significant convergent brain regions were the inferior frontal gyrus, parahippocampal gyrus, insula, putamen, claustrum, and medial globus pallidus. For middle-aged and older patients, the significant convergent brain regions were the ACC, the MFG, and the superior frontal gyrus.

Conclusions: This study revealed that abnormalities in the frontostriatal circuit were neuroimaging features common in StD patients across different ages. Additionally, unique different brain regions were identified between age groups. These findings elucidated the mechanisms of StD and provided a theoretical basis for its prevention and treatment.

Background: Previous studies indicate vitamin D impacts autism spectrum disorder (ASD), but its relationship with brain function is unclear. This study investigated the association between serum 25-hydroxyvitamin D [25(OH)D] levels and brain function in preschool children with ASD using resting-state functional magnetic resonance imaging (rs-fMRI), and explored correlations with clinical symptoms.

Methods: A total of 226 ASD patients underwent rs-fMRI scanning and serum 25(OH)D testing. Clinical symptoms were assessed using Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). Patients were categorized into mild and severe groups based on the CARS, and further divided into normal (NVD), insufficient (VDI), and deficient (VDD) serum 25(OH)D levels. Changes in brain function among these groups were analyzed using regional homogeneity (ReHo), with ABC scores used for correlation analysis.

Results: In mild ASD, ReHo increased in the right postcentral gyrus and left precuneus in the VDI and VDD groups compared to NVD, and decreased in the bilateral middle cingulate gyrus and left superior frontal gyrus in the VDD group compared to VDI. In severe ASD, ReHo decreased in the right middle occipital gyrus and increased in the right insula in the VDI group compared to NVD, and increased in the right superior frontal gyrus in the VDD group compared to VDI. Correlation analysis revealed that in mild ASD, ReHo in the right postcentral gyrus was positively correlated with body and object use scores in the NVD and VDI groups, while ReHo in the right middle cingulate gyrus was negatively correlated with relating scores in the VDD and VDI groups. In severe ASD, ReHo in the right insula was positively correlated with language scores in the NVD and VDI groups.

Conclusions: ASD patients with lower serum 25(OH)D levels show multiple brain functional abnormalities, with specific brain region alterations linked to symptom severity. These findings enhance our understanding of vitamin D's impact on ASD and suggest that future research may explore its therapeutic potential.

Background: Subclinical depression (ScD), serving as a significant precursor to depression, is a prevalent condition in college students and imposes a substantial health service burden. However, the brain network topology of ScD remains poorly understood, impeding our comprehension of the neuropathology underlying ScD.

Methods: Functional networks of individuals with ScD (n = 26) and healthy controls (HCs) (n = 33) were constructed based on functional magnetic resonance imaging data. These networks were then optimized using a small-worldness and modular similarity-based network thresholding method to ensure the robustness of functional networks. Subsequently, graph-theoretic methods were employed to investigated both global and nodal topological metrics of these functional networks.

Results: Compared to HCs, individuals with ScD exhibited significantly higher characteristic path length, clustering coefficient, and local efficiency, as well as a significantly lower global efficiency. Additionally, significantly lower nodal centrality metrics were found in the default mode network (DMN) regions (anterior cingulate cortex, superior frontal gyrus, precuneus) and occipital lobe in ScD, and the nodal efficiency of the left precuneus was negatively correlated with the severity of depression.

Conclusions: Altered global metrics indicate a disrupted small-world architecture and a typical shift toward regular configuration of functional networks in ScD, which may result in lower efficiency of information transmission in the brain of ScD. Moreover, lower nodal centrality in DMN regions suggest that DMN dysfunction is a neuroimaging characteristic shared by both ScD and major depressive disorder, and might serve as a vital factor promoting the development of depression.