BMC Psychiatry最新文献

Background: Psychedelic-assisted therapy has gained growing interest to improve a range of mental health outcomes. In response, numerous training programs have formed to train the necessary workforce to deliver psychedelic therapy. These include both legal and 'underground' (i.e., unregulated) programs that use psychedelics as part of their training. Prolonged adverse experiences (PAEs) may arise from psychedelic use, though they are poorly characterized in the clinical literature. Thus, understanding the potential harms related to psychedelic use is critical as psychedelic therapy training programs consider strategies to potentially integrate psychedelic use into therapy training.

Case presentation: We present the case of a psychologist who underwent psychedelic therapy training that involved repeated high doses of psilocybin-containing mushrooms and subsequently developed prolonged adverse effects including severe sleep impairment, anhedonia, and suicidal ideation requiring hospitalization. Despite worsening symptoms, her psychedelic therapy trainers advised her against seeking psychiatric support, delaying treatment. Ultimately, the patient's symptoms resolved after a course of electroconvulsive therapy (ECT).

Conclusions: This case highlights the tensions between legal and underground psychedelic use within psychedelic therapy training programs, psychiatry and neo-shamanism, and the use of psychiatric interventions (i.e., ECT) and energy medicine to address prolonged adverse effects from psychedelics. Clinicians should be aware of these potential conflicts between psychiatric conceptualizations of PAEs and frameworks maintained in psychedelic community practices and their impacts on patients' presenting symptoms, decision making, and emotional challenges.

There are no reported randomized trials testing exercise versus an active comparator for Posttraumatic Stress Disorder (PTSD). This randomized clinical trial assessed the effectiveness of group exercise versus psychoeducation to improve quality of life and reduces symptomatic severity in Veterans with PTSD. Veterans who met criteria for current PTSD (DSM-5) and/or endorsed moderate levels of PTSD symptoms (CAPS 5 score ≥ 23) were randomly assigned to treatment. Integrative Exercise (IE) combines fitness exercises (aerobics, resistance training, stretching) with mindful body/breath awareness versus Recovery Class (REC) psychoeducation control condition. A total of 84 participants were enrolled of which 41 participants were randomized to IE and 43 participants to REC. There were no significant pre-post differences in change in the WHOQOL Psychological Domain in either group. There was a modest reduction in the total CAPS-5 score in both groups (IE: -8.2 (9.9), p < .001: REC: -7.8 (2.0), p < .001) but no differences across the two conditions. In the IE subsample that was remote, there was a greater improvement in PTSD symptom severity (F[1, 50] = 4.62, p = .036) and in in the WHOQOL Psychological Domain (F(1, 47) = 6.46, p = .014) in those who attended more sessions. Trial registration ClinicalTrials.gov Identifier: NCT02856412 (registration date: February 27, 2017).

Background: Recent genome-wide association studies have linked voltage-gated calcium channel genes to bipolar disorder (BD), in which CACNB2 gene rs11013860 is respectively reported. Less is known, though, about how precisely its polymorphism affects both the structure and function of the brain.

Methods: 173 BD patients and 207 healthy controls (HCs) were underwent structural and functional magnetic resonance imaging scan and genotyped for CACNB2 rs11013860. Grey matter volume (GMV), regional homogeneity (ReHo) and degree centrality (DC) were used to examine the brain structure, functional activity and connectivity of these participants.

Results: The emotional circuits in BD patients, such as cerebellum, insula, cingulate gyrus, fusiform gyrus, superior frontal gyrus, superior / middle temporal gyrus, middle occipital gyrus, lingual gyrus, precuneus, putamen, hippocampus and parahippocampal gyrus, were the main areas where GMV, ReHo, and DC differed from HCs. And the right anterior and posterior cerebellar lobes, parahippocampal gyrus as well as lingual gyrus showed an interaction between CACNB2 rs11013860 genotypes and diagnoses in GMV. In addition, there was a significant step-wise increase of GMV with decreased dosage of the A risk allele in HCs, but this pattern of relationship was absent in BD patients. No interaction between BD and CACNB2 rs11013860 was found in ReHo and DC.

Conclusions: These results suggest that the polymorphism of CACNB2 rs11013860 in BD patients may be associated with brain structural abnormalities in cerebellar, limbic system and other brain regions, perhaps contributing to the disease.

Background: Schizophrenia patients frequently present with structural and functional abnormalities of the hippocampus (Hipp). Further, these abnormalities are often associated with specific symptom profiles.

Aim: To determine whether schizophrenia patients show specific functional connectivity (FC) and activity abnormalities in each hippocampal subregion compared to the BD (bipolar disorder) and HC (healthy control) groups.

Methods: Basal activation state and functional connectivity (FC) in four subregions of the bilateral Hipp were examined: left caudal (cHipp_L), right caudal (cHipp_R), left rostral (rHipp_L), and right rostral (rHipp_R). Resting-state functional magnetic resonance images were obtained from 62 schizophrenia patients, 57 bipolar disorder (BD) patients, and 45 healthy controls (HCs), and analyzed for fractional amplitude of low-frequency fluctuations (fALFF) as a measure of basal neural activity and for whole-brain FC based on the hippocampal subregions.

Results: The schizophrenia group exhibited greater fALFF in bilateral cHipp (the caudal part of hippocampus) and rHipp (the rostral part of hippocampus) subregions compared to BD and HC groups as well as increased FC between the bilateral cHipp and multiple brain regions, including the thalamus, putamen, middle frontal gyrus, parietal cortex, and precuneus. Moreover, fALFF values of the bilateral cHipp were positively correlated with the severity of clinical symptoms as measured by the Positive and Negative Syndrome Scale.

Conclusions: These findings confirm an important contribution of hippocampal dysfunction, especially of the cHipp, in schizophrenia. Further, hyper-connectivity and hyperactivity of the cHipp could serve as a biomarker for therapeutic development.

Background: Evidence shows that vitamin D affects brain function. Transcription of over 1000 genes is known to be controlled by vitamin D, potentially contributing to the neurotrophic and neuroprotective effects that can influence suicidal behavior. Several investigations with contradicting findings have identified an association between suicidal behaviors (SBs) or depressive symptoms and low vitamin D levels. This meta-analysis aimed to analyze the pooled association between vitamin D deficiency and the risk of suicide, suicide attempt (SA), and suicidal ideation (SI).

Methods: A systematic search was performed through PubMed, Web of science (ISI), Scopus, Embase, and grey literature up to 10 October 2024. Meta-analysis included observational studies that assessed the association between SBs and vitamin D blood serum level and/or vitamin D deficiency. After screening and quality assessment, meta-analysis and sensitivity analysis using random effects model were carried out to estimate the pooled odds ratios (ORs) for the risk of suicide, SA, and SI. We also calculated pooled standard mean difference (SMD) of vitamin D levels between control subjects and patients with SBs.

Results: A total of 14,095 records were identified. Finally, 13 studies participating 515,406 subjects were included in the meta-analysis after eligibility assessment. Vitamin D deficiency non-significantly increased the risk of suicide, SA, and SI (OR = 1.7; 95% CI: 0.93 - 3.12), (OR = 1.65; 95% CI: 0.98 - 2.80), and (OR = 1.15; 95% CI: 0.94 - 1.41), respectively. However, levels of vitamin D in patients with SBs were significantly lower than in controls without any SBs (SMD = -0.69; 95% CI: -0.89 - -0.49).

Conclusion: The results of this meta-analysis indicated that vitamin D levels are lower among patients with SBs. These findings can inform suicide prevention programs, particularly for target groups experiencing significant vitamin D deficiency.

Background: Post-traumatic stress disorder (PTSD) is a potentially disabling condition that can lead to long-term impairments, with a significant proportion of adolescents being affected by trauma. Studies have suggested that trauma-focused cognitive behavioral therapy (TF-CBT) is an effective treatment for PTSD in adolescents, however, little is known about the relative advantages of different mind-body interventions. The network meta-analysis aims to evaluate and compare the efficacy of various mind-body interventions in alleviating PTSD symptoms in adolescents.

Methods: A systematic search was conducted across multiple databases including PubMed, Embase, Web of Science, Scopus, The Cochrane Library, CNKI, WFDSP, and VIP databases. Randomized controlled trials (RCTs) evaluating the effects of mind-body interventions on PTSD in adolescents were included. A network meta-analysis (NMA) was conducted to evaluate the effectiveness of various mind-body intervention therapies using the Surface Under the Cumulative Ranking curve (SUCRA). SUCRA calculates the mean of the cumulative percent area under the curve for each therapy, providing a comprehensive ranking of treatment efficacy. The primary outcomes measured were changes in PTSD symptom scores post-treatment and at follow-ups ranging from 1 to 12 months.

Results: A total of 20 studies involving 5 interventions and 2085 adolescents were included in the analysis. No inconsistencies were found between direct and indirect evidence. TF-CBT consistently demonstrated the most significant effect in reducing PTSD symptoms compared to routine care and no-treatment groups. The ranking of intervention efficacy from highest to lowest was as follows: TF-CBT (SUCRA = 87.3%), meditation, CBT, yoga combined with meditation and mindfulness (SUCRA = 32.3%). Due to limited evidence, the follow-up results for PTSD symptom changes remained inconclusive.

Conclusion: Five mind-body interventions were found to be effective in treating PTSD symptoms in adolescents, with TF-CBT emerging as the most effective treatment. Findings suggest that yoga combined with meditation and mindfulness may have promising effects, however, further research is needed to confirm these results due to the limited evidence available.

Background: This study explores changes in treatment adherence and alliance during a novel parent- and child-psychotherapy for pediatric irritability. Associations between in-session therapeutic processes and symptom change were examined.

Methods: Forty participants (Mean age = 11.23, SD = 1.85; 37.5% female, 77.5% white) with severe irritability, and their parents, received 12 sessions of exposure-based cognitive behavioral therapy (CBT) with parent management training (PMT). Measures included clinician-rated adherence to the manual, alliance scales (Alliance Scale for Children-revised; TASC-r, and Working Alliance Inventory; WAI, respectively), and clinician-, parent- and child-reported irritability scales (Affective Reactivity Index; ARI). Linear mixed models examined session-by-session changes and associations between adherence/alliance and subsequent irritability, and vice versa.

Results: First, adherence to standard treatment elements decreased over time (Bs ≥ - 0.03, ps ≤ 0.010), while the focus on specific treatment components increased (i.e., exposure: B = 0.15, p = 0.001; PMT: B = 0.07, p = 0.002). Second, adherence to standard treatment elements were associated with decreased clinician-reported irritability (Bs ≥ - 2.23, p ≤ 0.042). For the alliance measures, parent-reported alliance increased over time (Bs ≥ 0.10, p ≤ 0.01); child-reported alliance did not change. Bidirectional associations were found between alliance and symptoms; specifically, child-reported alliance predicted clinician-rated irritability at next session (Bs ≥ - 0.66, p ≤ 0.053), and decreases in clinician- (Bs ≥ - 0.02, ps ≤ 0.043) and parent- (B = - 0.15, p = 0.024) reported irritability predicted increased alliance at next session.

Conclusions: Findings underscore the predictive role of treatment adherence and therapeutic alliance on outcomes, in exposure-based CBT for pediatric irritability.

Trial registration: ClinicalTrials.gov identifier: NCT02531893; date of registration: 25/08/2015.

Background: Breast cancer is the most commonly diagnosed cancer and a leading cause of cancer-related deaths among women globally. The cases of breast cancer have continued to rise in Nigeria and surgery remains one of the commonest treatment modalities. However, little is known about the psychosocial wellbeing of patients with breast cancer following surgery in Sub-Saharan Africa. The study investigates the psychosocial well-being and its determinants among patients with breast cancer post-surgery.

Methods: This cross-sectional study was conducted among 72 patients with breast cancer post-surgery in Northern Nigeria. A clinico-demographic questionnaire, the World Health Organization Quality of Life Brief (WHOQOL-BREF), and the 12-item General Health Questionnaire (GHQ-12) were administered to all participants to gather information on their background and psychosocial wellbeing.

Results: The participants' mean (± SD) age was 45.94 (± 9.05) years. The prevalence of psychological distress was 36.1% based on GHQ-12. A three-factor analysis of the GHQ-12 showed participants' mean (± SD) scores for anxiety/depression, social dysfunction, and loss of confidence were 9.25 (± 3.93), 14.17 (± 5.62) and 4.59 (± 1.97) respectively. About 15% (n = 11) of the participants reported their QoL as poor with mean total score of 50.91 (± 12.62), and social relationship 9.81 (± 5.09) was mostly affected across the four domains of WHOQOL-BREF. A lack of psychological counseling pre-surgery, unemployment, low level of education, post-surgical complications, and presence of psychological distress were associated with poor QoL. However, a lack of psychological counseling, post-surgical complications, and psychological distress were key predictors of poor QoL after controlling for cofounders.

Conclusion: Evidence informed holistic care is indicated among individuals with surgical treatment for breast cancer. There is a need for resources, capacity development and training of healthcare professionals involved in the management of breast cancer to deliver holistic care to enhance their psychosocial wellbeing. Future prospective studies are needed to inform evidence-based psychosocial interventions.

Background: Anemia has been linked to psychiatric disorders including depression, bipolar disorder, and schizophrenia. Studies have demonstrated an association between anemia and worsening clinical presentation and treatment outcomes of these disorders. This study aimed to assess the prevalence and factors associated with anemia among adult patients admitted at Mirembe National Mental Health Hospital (MNMH) in Dodoma, Tanzania.

Methods: A cross-sectional analytical study was conducted at MNMH among 265 adults admitted at the hospital. Socio-demographic and clinical variables were collected using a closed-ended questionnaire, and anemia and other hematological indices were assessed via complete blood count (CBC). Data were entered into an Open Data Kit (ODK) app and analyzed using SAS version 9.4. Chi-squared test was used initially to assess association between individual exposures and the outcome, anemia. Variables with a p-value < 0.20 from the chi squared analysis were fitted into a logistic regression model to determine their odds of association with anemia. Odds ratios from adjusted regression analysis were used to identify factors independently associated with anemia. Significance level was set at p value < 0.05.

Results: The prevalence of anemia among adult patients admitted at MNMH was 44% (CI 38.08, 50.36). The majority of participants had mild anemia (74.36%). Microcytic hypochromic and normocytic normochromic were the common types of anemia (47% and 46% respectively). Being male, institutionalization, and using Olanzapine was associated with anemia among participants at bivariate analysis, however, only institutionalization remained as a statistically significant factor associated with anemia at multivariable analysis (AOR:5.742, 95% CI 2.048, 16.105).

Conclusions: Comprehensive care strategies addressing anemia among psychiatric inpatients are crucial, extending beyond psychiatric symptoms to address factors related to prolonged admission, such as nutritional considerations. It is recommended that regular screening for anemia be implemented among psychiatric inpatients and efforts should be made to investigate and address the underlying causes of anemia among this population.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social interaction and repetitive behaviors (RBs). Therapies specifically targeting RBs have been underexplored despite advances in understanding their neurobiological basis. This study aims to evaluate whether high-definition transcranial direct current stimulation (HD-tDCS) can reduce dysfunctional RBs in autistic children and investigate whether improvements differ between lower-order and higher-order RBs based on the brain regions stimulated.

Methods: The study entails a multi-session, sham-controlled, site-controlled, double-blind, and between-subjects design. The study will include participants with an ASD diagnosis (aged 8-13 years; IQ ≥ 70), who will undergo the HD-tDCS intervention for 10 sessions. Participants will be randomly assigned to three conditions: (1) Pre-Motor Active Group (active HD-tDCS over pre-SMA cortex); (2) Frontal Active Group (active HD-tDCS over dlPFC); (3) Placebo Control Group. In the active HD-tDCS conditions, the current will be delivered through a 4 × 1 montage; small circular electrodes will be used with the cathode placed centrally with a current intensity of 0.5 mA for a total of 20 min (30 s ramp up/down) per session. Participants during the sham condition will undergo the same procedures as those in the both active conditions actual placement of electrodes, and turning on the HD-tDCS equipment (30 s). The assessment will be completed at baseline (T0), immediately after the end of the intervention (T1) and 3 months after the end of the intervention (T2). The primary outcome measure will be the Total Score of the Repetitive Behavior Scale-Revised. The secondary outcomes measures will comprise ASD symptoms, sensory processing pattern, emotional/behavioral problems, sleep functioning, parental stress, neuropsychological features and High-Density EEG connectivity. We hypothesize that active HD-tDCS will lead to significant reduction in the total score of the primary outcome compared to Sham Group, with site-specific effects on lower-order and higher-order RBs.

Discussion: HD-tDCS is an easy-to-deliver, time-efficient, neurobiologically-driven intervention that could be performed as add-on to reduce the time of conventional therapy for ASD. Given the inherent limitations of specific interventions for RBs, tDCS represents an important "third" treatment arm to address the burden of interventions for ASD.

Trial registration details: The trial has been registered at ClinicalTrials.gov (ID: NCT06645587). Registered 17 October 2024.