Annals Of General Psychiatry[JOURNAL]
Sun
200 papers
Salivary hormones in depression: the future in diagnosis and treatment.
Harsanyi S, Kupcova I, Csobonyeiova M … +1 more , Klein M
Ann Gen Psychiatry · 2025 Feb · PMID 39962602 · Full text
Depression is associated with a significant burden on individuals, families, and communities. It leads to impaired social and occupational functioning, increased disability, decreased quality of life, and higher mortalit...
Depression is associated with a significant burden on individuals, families, and communities. It leads to impaired social and occupational functioning, increased disability, decreased quality of life, and higher mortality rates, often due to suicide. A recent estimate from the World Health Organization (WHO) states that over 280 million people of all ages suffer from depression, which equals approximately 3.8% of the world population. Despite effective treatments for mental disorders, a dire treatment gap persists. This treatment gap could be reduced by effective and available diagnostic methods that have the potential to aid in depression diagnosis, stratification of patient subgroups, and treatment monitoring. In this regard, salivary hormones have been studied as potential markers for different types and etiologies of depression due to the convenience of non-invasive sample collection and their correlation with certain aspects of mood and mental health. The literature suggests they can help clinicians assess an individual's stress response, hormonal imbalances, and treatment response, leading to more personalized and effective interventions. In this review, we offer an up-to-date look at all studied salivary hormones associated with depression, including Cortisol, Melatonin, Oxytocin, Serotonin, Dehydroepiandrosterone, Testosterone, Progesterone, and Estradiol.
Acceptance and commitment therapy reduces perceived ostracism in suicidal patients.
Olié E, Malestroit M, Brand-Arpon V … +2 more , Courtet P, Ducasse D
Ann Gen Psychiatry · 2025 Feb · PMID 39920760 · Full text
INTRODUCTION: Ostracism increases the risk of depression and suicidal behaviors. Mindfulness training, which is at the core of third-wave behavioral therapies such as acceptance and commitment therapy (ACT), might reduce...
INTRODUCTION: Ostracism increases the risk of depression and suicidal behaviors. Mindfulness training, which is at the core of third-wave behavioral therapies such as acceptance and commitment therapy (ACT), might reduce social distress and inhibit negative affect. METHODS: This randomized controlled trial included 32 patients with a history of suicide attempt in the past year who followed seven weekly sessions of ACT or progressive relaxation therapy (PRT). To assess and compare the effects of ACT and PRT on social distress, patients performed a validated paradigm of social exclusion (the Cyberball Game) followed by completion of the Need Threat Scale (NTS) at inclusion (baseline) and within two weeks after the intervention ended (posttherapy). RESULTS: The included patients were mainly women (N = 28; 87.5%), and their mean age was 40 years (SD: 12 years). Twenty-six patients (81%) experienced current depression. The postintervention NTS score was greater (lower social distress) in the ACT group than in the PRT group (group × time interaction; β = 0.47, p < 0.05), even after controlling for depressive symptoms (β = 0.27, p < 0.05). The NTS score change (between baseline and posttherapy) was correlated with changes in dispositional mindfulness (r = 0.46, p = 0.03), cognitive fusion (r = - 0.61, p < 10) and acceptance (r = 0.57, p < 10). CONCLUSION: ACT decreased social pain independently of its effect on depression. Reduced social pain was correlated with improved therapeutic processes and decreased suicidal ideation, highlighting the therapeutic potential of ACT for managing ostracism and suicide risk.
RNA editing-based biomarker blood test for the diagnosis of bipolar disorder: protocol of the EDIT-B study.
Miranda-Mendizabal A, Vetter D, Zambrano J … +13 more , Zarp J, Chavarría V, Giménez-Palomo A, Gonzalez-Campos M, Valenti M, Walczer Baldinazzo L, Siddi S, Ferrari M, Weissmann D, Henry C, Haro JM, Vedel Kessing L, Vieta E
Ann Gen Psychiatry · 2025 Feb · PMID 39915772 · Full text
INTRODUCTION: Misdiagnosis of bipolar disorder (BD) can lead to ineffective treatment, increased risk of manic episodes, and increased severity. Objective diagnostic tests or precise tools to diagnose BD and distinguish...
INTRODUCTION: Misdiagnosis of bipolar disorder (BD) can lead to ineffective treatment, increased risk of manic episodes, and increased severity. Objective diagnostic tests or precise tools to diagnose BD and distinguish it from major depressive disorder (MDD) in depressed patients are lacking. AIM: To assess the external diagnostic validity of a blood-based test using an RNA epigenetic signature for the differential diagnosis of BD versus MDD in patients with depression. METHODS AND ANALYSIS: Multicentre cross-sectional study including an adult sample of inpatients or outpatients diagnosed with BD or MDD, currently treated for a major depressive episode. A structured diagnostic interview based on validated scales will be conducted. Sociodemographic variables, clinical history, toxic consumption, current treatment and quality of life will be assessed. Blood samples will be obtained and stored at -80 °C until RNA sequencing analysis. The EDIT-B is a blood-based test that combines RNA editing biomarkers and individual data (e.g., age, sex, and tobacco consumption). The clinical validation performance of the EDIT-B will be evaluated using the area under the curve, sensitivity, specificity, positive and negative predictive values, and likelihood ratios. ETHICS AND DISSEMINATION: The principles of the Declaration of Helsinki 2013, precision psychiatry research and good clinical practice will be followed. The Research Ethics Committees of the participating centres approved the study. Participants will receive an information sheet and must sign the informed consent before the interview. Participants' data will be pseudonymized at the research sites. Any publication will use fully anonymized data. Publications with the final study results will be disseminated in international peer-reviewed journals and presented at international conferences. STUDY REGISTRATION: This study has been registered on clinicaltrials.gov (NCT05603819). Registration date: 28-10-2022.
Mental health literacy among primary care providers in Hungary: a vignette-based survey.
Swisher VS, Őri D, Rihmer Z … +1 more , Wernigg R
Ann Gen Psychiatry · 2025 Jan · PMID 39875931 · Full text
OBJECTIVE: This study examined mental health literacy and predictors of disorder recognition among primary care providers (PCPs) in Hungary. METHODS: 208 PCPs in Hungary completed a survey assessing demographics, mental...
OBJECTIVE: This study examined mental health literacy and predictors of disorder recognition among primary care providers (PCPs) in Hungary. METHODS: 208 PCPs in Hungary completed a survey assessing demographics, mental health stigma, and exposure to mental health (i.e., personal experiences and having a family member/friend with a mental health condition). Participants read six vignettes describing obsessive-compulsive disorder (OCD) harm/aggression subtype (OCD-Aggression), OCD order/symmetry subtype (OCD-Order), generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and major depressive disorder (MDD) and were asked to identify each condition, perceived disorder causes, and provide treatment referrals. Descriptive analyses were used to characterize disorder recognition rates, perceived disorder causes, and treatment referrals. Binary logistic regression analyses were conducted to examine the degree to which demographic characteristics, mental health stigma, and exposure to mental health conditions predict accurate disorder recognition. RESULTS: Identification rates for each vignette were: OCD-Aggression (27.9%), OCD-Order (75.5%), SAD (34.1%), GAD (76.0%), PD (78.8%), and MDD (91.3%). First-choice treatment referrals were a psychiatrist for OCD-Aggression (63.0%), OCD-Order (53.8%), and MDD (46.6%), a psychologist/therapist for SAD (58.7%) and GAD (48.6%), and a PCP for PD (39.9%). Mislabeling conditions was significantly associated with older age (for GAD, OCD-Aggression, PD and MDD), male gender (for GAD), greater mental health stigma (for OCD-Order), and lack of exposure to mental health conditions (for SAD). CONCLUSIONS: Findings highlight strengths (e.g., depression recognition) and limitations in knowledge of mental health conditions among PCPs in Hungary and identifies targets to address to improve mental health literacy.
Impact of cariprazine on body weight and blood pressure among adults with bipolar I disorder, schizophrenia, or major depressive disorder in a real-world setting.
Correll CU, Cutler AJ, Laliberté F … +7 more , Germain G, MacKnight SD, Boudreau J, Wade SW, Nabulsi N, Nguyen HB, Parikh M
Ann Gen Psychiatry · 2025 Jan · PMID 39871357 · Full text
BACKGROUND: Atypical antipsychotics are a common treatment for serious mental illness, but many are associated with adverse effects, including weight gain and cardiovascular issues, and real-world experience may differ f...
BACKGROUND: Atypical antipsychotics are a common treatment for serious mental illness, but many are associated with adverse effects, including weight gain and cardiovascular issues, and real-world experience may differ from clinical trial data. Cariprazine has previously demonstrated a favorable safety and tolerability profile in clinical trials. Here, we evaluated the effects of cariprazine on body weight and blood pressure for bipolar I disorder (BP-I), schizophrenia, or as adjunctive treatment for major depressive disorder (MDD) using real-world data. METHODS: Symphony Health's Integrated Dataverse® with electronic medical record access (3/1/2015-10/31/2018) was used to identify adults (≥ 18 years) diagnosed with BP-I depression, BP-I mania/mixed, schizophrenia, or MDD, with ≥ 2 cariprazine dispensings (first dispensing = index) and continuous clinical activity for ≥ 12 months pre-index (baseline) and ≥ 3 months post-index. The on-treatment period spanned from index to cariprazine discontinuation, exposure to another atypical or long-acting injectable antipsychotic, or end of clinical activity/data availability. Outcomes included estimated annual linear trajectories for weight, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) during baseline and on treatment. Changes were estimated using linear mixed-effects models fitted over measurements pre-index and on treatment; 95% CIs were derived from nonparametric bootstrap procedures. RESULTS: The body weight analysis included 612 patients (BP-I, n = 331 [BP-I depression, n = 172; BP-I mania/mixed, n = 159]; schizophrenia, n = 75; MDD, n = 206). The mean patient age was 43.4 years, 75.2% were female, and the mean (SD) on-treatment period was 219 (185) days. Among patients with measurements before and during cariprazine treatment, estimated annual weight trajectories were + 3.55 (95% CI 2.38, 4.59) kg/year before cariprazine initiation and + 0.91 (- 1.17, 2.82) kg/year during cariprazine treatment. Additionally, annual linear trajectories evaluated across the on-treatment period were + 0.31 (- 0.42, 1.01) kg/m/year for BMI, - 2.38 (- 4.27, - 0.76) mmHg/year for SBP, and - 0.57 (- 1.75, 0.61) mmHg/year for DBP. CONCLUSION: In this real-world analysis, cariprazine was associated with an estimated weight gain of + 0.91 kg/year and had minimal impact on BMI and blood pressure when evaluated up to 12 months.
Expression study of Wnt/β-catenin signaling pathway associated lncRNAs in schizophrenia.
Manafzadeh F, Baradaran B, Noor Azar SG … +4 more , Javidi Aghdam K, Dabbaghipour R, Shayannia A, Ghafouri-Fard S
Ann Gen Psychiatry · 2025 Jan · PMID 39806445 · Full text
Schizophrenia is one of the most debilitating mental illnesses affecting any age group. The mechanism and etiology of schizophrenia are extremely complex and multiple signaling pathways recruit genes implicated in the et...
Schizophrenia is one of the most debilitating mental illnesses affecting any age group. The mechanism and etiology of schizophrenia are extremely complex and multiple signaling pathways recruit genes implicated in the etiology of this disease. While the role of Wnt/β-catenin signaling in this disorder has been verified, the impact of long noncoding RNAs (lncRNAs) associated with this pathway has not been studied in schizophrenia. The objective of this study was to examine the expression levels of Wnt/β-catenin-related lncRNAs, namely CCAT2, SNHG5, PTCSC3, and DANCR, as well as the CTNNB1 gene encoding beta-catenin protein in two groups of schizophrenia patients (drug-naïve and medicated) compared with healthy individuals. This study included 50 medicated patients in the remission phase of the disease, 25 drug-naive patients in the acute phase, and 50 control subjects. There was no significant difference in CTNNB1 gene expression in the medicated patients compared to controls (P value = 0.9754). However, the expression of this gene was significantly decreased in drug-naïve first-episode patients compared with controls (P value < 0.001). In contrast, expression of DANCR, PTCSC3, SNHG5, and CCAT2 genes was significantly higher in medicated (P values < 0.001, < 0.001, = 0.01, < 0.001, respectively) and drug-naive first-episode patients (P value < 0.001) compared to control subjects. ROC curve analysis revealed that DANCR, PTCSC3, SNHG5, and CCAT2 genes had diagnostic power with specificity and sensitivity of 80% and above in separation between study subgroups. In brief, our data demonstrated dysregulation of Wnt/β pathway related genes and lncRNAs in the peripheral blood of patients with schizophrenia and their potential as biomarkers for this disorder.
Emotion dysregulation and impulsivity as overlapping symptoms in adult Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder: severity profiles and associations with childhood traumatization and personality functioning.
Kenézlői E, Balogh L, Somogyi S … +5 more , Lévay EE, Halmai Z, Nemoda Z, Unoka ZS, Réthelyi JM
Ann Gen Psychiatry · 2025 Jan · PMID 39806432 · Full text
BACKGROUND: Increased levels of emotion dysregulation and impulsive behavior are overlapping symptoms in adult Attention-Deficit/Hyperactivity Disorder (aADHD) and Borderline Personality Disorder (BPD), both symptom doma...
BACKGROUND: Increased levels of emotion dysregulation and impulsive behavior are overlapping symptoms in adult Attention-Deficit/Hyperactivity Disorder (aADHD) and Borderline Personality Disorder (BPD), both symptom domains reflecting on inhibitory control, although from different angles. Our aims were to describe their differences in the above conditions, investigate their associations with childhood traumatization, and to explore the potential mediation of emotion dysregulation and impulsivity between childhood traumas and personality functioning. METHODS: Young adults between 18 and 36 years diagnosed with aADHD (n = 100) and BPD (n = 63) were investigated with structured clinical interviews, while age-matched healthy controls (n = 100) were screened for psychiatric disorders. Patients with aADHD-BPD comorbidity were excluded from further analyses. The Difficulties in Emotion Regulation Scale, the Barratt Impulsiveness Scale, the Level of Personality Functioning Scale, and the Childhood Trauma Questionnaire-Short Form were administered to investigate trait measures and childhood traumatization, respectively. Behavioral impulsivity and delay aversion were assessed using selected tests of the Cambridge Neuropsychological Test Automated Battery, and a computerized decision-making paradigm based on the Rogers decision-making task, respectively. RESULTS: Significantly higher levels of emotion dysregulation and impulsivity were present both in the aADHD and BPD groups, however with different profiles. Waiting and stopping impulsivity was selectively higher among aADHD patients compared to healthy controls. The BPD group reported higher levels of emotion dysregulation in all domains, and demonstrated increased delay aversion among uncertain conditions in decision-making. Higher levels of childhood trauma were associated with emotion dysregulation, trait impulsivity, and delay aversion across groups. Emotion regulatory capacity played a significant mediating role between childhood traumatization and the level of personality functioning. CONCLUSIONS: Inhibitory control profiles of the aADHD and BPD groups were divergent. Childhood traumatization was associated with lower levels of personality functioning in adulthood, independently of diagnosis, an effect mediated more by emotion dysregulation, rather than impulsivity. These findings have various clinical implications for the treatment of aADHD and BPD, including psychoeducation, pharmacological interventions, and psychotherapy targeting specific symptom domains.
Approaches for difficult-to-induce-seizures electroconvulsive therapy cases (DEC): a Japanese expert consensus.
Takekita Y, Suwa T, Yasuda K … +12 more , Kawashima H, Omori W, Kurimoto N, Tsuboi T, Noda T, Aoki N, Wada K, Inada K, Takebayash M, Expert Consensus Development Working Group, Electroconvulsive Therapy Committee, Japanese Society of General Hospital Psychiatry
Ann Gen Psychiatry · 2025 Jan · PMID 39800695 · Full text
BACKGROUND: Seizure threshold increases with age and the frequency of electroconvulsive therapy (ECT). Therefore, therapeutic seizures can be difficult to induce, even at maximum stimulus charge with available ECT device...
BACKGROUND: Seizure threshold increases with age and the frequency of electroconvulsive therapy (ECT). Therefore, therapeutic seizures can be difficult to induce, even at maximum stimulus charge with available ECT devices. Such cases are known as difficult-to-induce-seizures electroconvulsive therapy cases (DECs). However, no clinical guidelines exist for DECs; thus, clinicians often face difficulties determining treatment strategies. This study aimed to obtain a consensus among clinical experts regarding the treatment of DECs. METHODS: We asked Japanese ECT experts to rate 14 approaches under six conditions of DECs on a 9-point Likert scale (1 = "disagree" to 9 = "agree"). Based on responses from 195 experts, the approaches were classified as first-line (95% confidence interval mean ≥ 6.5), second-line (mean, 3.5-6.5), or third-line strategies (mean < 3.5). Approaches rated 9 points by at least 50% of the respondents were considered "treatments of choice." RESULTS: To avoid difficult seizure induction, dose reduction of benzodiazepine receptor agonist (BZRA) (8.33 ± 1.25), dose reduction or discontinuation of antiepileptic drugs (AEDs) or other drugs that may make seizure induction difficult (8.16 ± 1.18), and ensure hyperventilation (7.95 ± 1.47) were classified as treatments of choice. First-line treatment strategies were BRZA discontinuation (7.89 ± 1.45), stimulation timing adjustment (7.00 ± 2.00), and anesthetic dose reduction (6.93 ± 1.94). Dose reduction or discontinuation of AEDs or other drugs that might make seizure induction difficult and ensure hyperventilation were the treatments of choice across all patient conditions. The results of rating approaches for patients with mood disorders and schizophrenia were similar, with differences observed among the approaches for patients with catatonia, high risk of cognitive impairment, and cardiovascular events. CONCLUSIONS: ECT expert recommendations are useful and can assist in clinical decision-making. Our results suggest that while some strategies are applicable across all conditions, others should be tailored to meet the specific needs of patients. These recommendations should be further evaluated in future clinical studies.
Bilingual side effect: a case of foreign language syndrome following chlorpromazine-induced neuroleptic malignant syndrome.
Andric Petrovic S, Maric NP
Ann Gen Psychiatry · 2025 Jan · PMID 39748424 · Full text
BACKGROUND: Foreign language syndrome is a rare neuropsychiatric phenomenon typically following general anesthesia. To date, foreign language syndrome has not been associated with neuroleptic malignant syndrome (NMS) in...
BACKGROUND: Foreign language syndrome is a rare neuropsychiatric phenomenon typically following general anesthesia. To date, foreign language syndrome has not been associated with neuroleptic malignant syndrome (NMS) in the literature. This case aims to broaden the clinical understanding of NMS by presenting an atypical manifestation of foreign language syndrome and emphasizing the need for prompt recognition of such presentations for accurate diagnosis and management. CASE PRESENTATION: A 34-year-old Caucasian male with a history of schizoaffective disorder and recurrent psychiatric hospitalizations was admitted for a depressive episode. His condition worsened hours after the administration of intramuscular chlorpromazine, leading to NMS characterized by agitation, muscle rigidity, hyperthermia, autonomic instability, abnormal laboratory findings, and altered mental status, including foreign language syndrome. Management included the discontinuation of the prior psychopharmacotherapy, intravenous hydration, and medications (biperiden, lorazepam). The patient showed significant improvement, with resolution of NMS symptoms and normalized sleep patterns by the time of discharge. CONCLUSION: Foreign language syndrome is an exceptionally rare occurrence, with only nine documented cases to date, all involving male patients. This case presents a novel instance of foreign language syndrome in the context of NMS in a male patient, providing insight into the potential sex-specific mechanisms underlying this rare phenomenon. This case adds valuable evidence to the understanding of the clinical spectrum of NMS and highlights the importance of recognizing atypical presentations in managing patients with neuropsychiatric conditions.
Effectiveness of a social cognition remediation intervention for patients with schizophrenia: a randomized-controlled study.
Giuliani L, Pezzella P, Mucci A … +8 more , Palumbo D, Caporusso E, Piegari G, Giordano GM, Blasio P, Mencacci C, Torriero S, Galderisi S
Ann Gen Psychiatry · 2024 Dec · PMID 39732701 · Full text
This randomized-controlled study evaluates the effectiveness of a newly developed social cognition rehabilitation intervention, the modified Social Cognition Individualized Activity Lab (mSoCIAL), in improving social cog...
This randomized-controlled study evaluates the effectiveness of a newly developed social cognition rehabilitation intervention, the modified Social Cognition Individualized Activity Lab (mSoCIAL), in improving social cognition and clinical and functional outcomes of persons with schizophrenia recruited in two Italian sites: University of Campania "Luigi Vanvitelli" in Naples and ASST Fatebenefratelli-Sacco in Milan. mSoCIAL consists of a social cognitive training module focusing on different domains of social cognition and of a narrative enhancement module. We assessed changes in social cognition, clinical characteristics and functional variables in patients with schizophrenia who participated in 10 weekly sessions of mSoCIAL or received treatment as usual (TAU). A paired-sample t test and a repeated-measures MANOVA were used to investigate respectively within and between-group differences. Twenty people with schizophrenia were blindly assigned to mSoCIAL and 20 to TAU. After 10 weeks, mSoCIAL significantly improved disorganization, emotion recognition, functional capacity and real-life functioning. As compared to TAU, the mSoCIAL group showed a significant improvement in minimal and enriched social inference domain of theory of mind, and in key domains of real-life functioning (interpersonal relationships, everyday life skills, and work skills). mSoCIAL improved social cognition and real-life functioning of people with schizophrenia. These results highlight the importance of social cognition deficit treatment in schizophrenia and the necessity for these interventions to be multifaced and personalized. Such an approach ensures that improvements in social cognition translate into enhanced functional outcomes.Trial registration NCT05130853, registered on 24 November 2021.
Mood instability and risk of gastrointestinal diseases - a univariable and multivariable mendelian randomization study.
Liu RL, Song QC, Liu LM … +2 more , Yang YF, Zhu WH
Ann Gen Psychiatry · 2024 Dec · PMID 39702383 · Full text
BACKGROUND: Mood instability, characterized by sudden and unpredictable mood shifts, is prevalent in psychiatric disorders and as a personality trait. Its association with gastrointestinal diseases has been recognized bu...
BACKGROUND: Mood instability, characterized by sudden and unpredictable mood shifts, is prevalent in psychiatric disorders and as a personality trait. Its association with gastrointestinal diseases has been recognized but remains poorly understood in terms of causality. METHODS: This study aims to investigate the causal relationship between mood instability and a spectrum of gastrointestinal diseases by univariable and multivariable mendelian randomization analysis. The exposure and outcome data were retrieved from the IEU open GWAS database, the UK biobank and the FinnGen study. Instrumental variables were selected to meet relevance, independence, and exclusion restriction criteria. GWAS datasets for mood instability and 28 gastrointestinal diseases were utilized, incorporating diverse populations and genders. Univariable and multivariable Mendelian randomization analyses were conducted using R software. MR statistics from different datasets for the same disease were meta-analyzed to maximize the study population. RESULTS: In univariable MR analysis, genetic predisposition to mood instability showed significant associations with increased risk for several gastrointestinal diseases, including: gastroesophageal reflux disease, gastric ulcer, acute gastritis, irritable bowel syndrome, internal hemorrhoids, cirrhosis, cholecystitis, cholelithiasis, acute pancreatitis, chronic pancreatitis. In multivariable MR analysis, after adjusting for major depression, bipolar disorder, anxiety disorder, and schizophrenia, associations with the following gastrointestinal diseases remained statistically significant: internal hemorrhoids, cirrhosis, acute pancreatitis, chronic pancreatitis. CONCLUSION: This study provides compelling evidence for a potential causal relationship between mood instability and certain gastrointestinal diseases underscoring the importance of considering mood instability as a potential risk factor for gastrointestinal diseases as well as the positive role of maintaining mood stability in the prevention of gastrointestinal disorders.
Can dissociative amnesia be a residual symptom of prolonged complex post-traumatic stress disorder?
Metin İÇ, Yıldırım S, Karahan A
Ann Gen Psychiatry · 2024 Dec · PMID 39702275 · Full text
BACKGROUND: Dissociative amnesia, a disorder characterized by impairments in multiple memory areas, is frequently associated with trauma. Complex post-traumatic stress disorder (CPTSD) is marked by mood dysregulation, ne...
BACKGROUND: Dissociative amnesia, a disorder characterized by impairments in multiple memory areas, is frequently associated with trauma. Complex post-traumatic stress disorder (CPTSD) is marked by mood dysregulation, negative self-concept, and impaired interpersonal relationships, in addition to the classic symptoms of post-traumatic stress disorder (PTSD). The relationship between CPTSD and dissociative amnesia, as well as whether CPTSD should be considered a dissociative subtype, remains uncertain in the literature. Individuals diagnosed with CPTSD tend to exhibit higher levels of dissociative symptoms than those diagnosed with PTSD. CLINICAL PRESENTATION: We present the clinical report of a 42-year-old male who, after a car accident, exhibited core symptoms of PTSD along with symptoms of self-organization disorders. While these symptoms persisted, the patient developed dissociative amnesia years after the trauma. Neuroimaging studies, psychometric tests, reviewed hospital records, and clinical interviews were conducted to speculate on the differential diagnosis of organic psychiatric conditions and potential diagnoses. The possible relationship between dissociative amnesia and complex post-traumatic stress disorder was examined. CONCLUSION: This case demonstrates the complexity of differentiating dissociative amnesia from organic conditions. Discussing the possible shared mechanisms between CPTSD and dissociative amnesia could contribute to a better understanding of both conditions.
Study protocol and preliminary baseline characteristics of a VA multi-site, mixed methods, randomized controlled study evaluating supported employment provided to veterans with opioid use disorder.
Mumba M, Granger T, Mugoya G … +7 more , Brackett S, Lu J, Lund E, Lynn C, Ghera A, Gay W, Davis L
Ann Gen Psychiatry · 2024 Dec · PMID 39696630 · Full text
Opioid Use Disorder (OUD) is a pervasive and devastating public health crisis that continues to take a heavy toll on individuals and communities across the United States. In 2021, approximately 473,000 veterans misused o...
Opioid Use Disorder (OUD) is a pervasive and devastating public health crisis that continues to take a heavy toll on individuals and communities across the United States. In 2021, approximately 473,000 veterans misused opioids in the past year. In the context of their military service and post-service life, Veterans with OUD often encounter unique barriers to recovery, including the reintegration into civilian society and the pursuit of stable, meaningful employment. The path to recovery from OUD is inextricably linked to the restoration of a stable and purposeful life, a fact underscored by the interplay of substance use, mental health, and employment outcomes. These factors necessitate a comprehensive approach to treatment that extends beyond mere pharmacological interventions. One such approach is Individual Placement and Support (IPS), a well-established evidence-based practice that focuses on supporting individuals with severe mental illness in their pursuit of competitive employment. The primary objective of this manuscript is to describe a two-arm, multi-site RCT designed to rigorously evaluate the efficacy of IPS when provided to veterans with OUD and provide the baseline demographics and characteristics of the participants who have enrolled to date. The central hypothesis guiding this research is that IPS can significantly improve vocational, psychosocial, and treatment outcomes of veterans in recovery from OUD, ultimately leading to a more successful reintegration into civilian life. Our study is timely as the VA has expanded IPS services to veterans with SUD this past year. Thus, this study is one of the first to examine IPS in a subpopulation of veterans with a SUD and may provide actionable data to support sustainment of IPS with this population.
Prediction of non-suicidal self-injury (NSSI) among rural Chinese junior high school students: a machine learning approach.
Jiang Z, Cui Y, Xu H … +7 more , Abbey C, Xu W, Guo W, Zhang D, Liu J, Jin J, Li Y
Ann Gen Psychiatry · 2024 Dec · PMID 39643917 · Full text
AIMS: Non-suicidal self-injury (NSSI) is a serious issue that is increasingly prevalent among children and adolescents, especially in rural areas. Developing a suitable predictive model for NSSI is crucial for early iden...
AIMS: Non-suicidal self-injury (NSSI) is a serious issue that is increasingly prevalent among children and adolescents, especially in rural areas. Developing a suitable predictive model for NSSI is crucial for early identification and intervention. METHODS: This study included 2090 Chinese rural children and adolescents. Participants' sociodemographic information, symptoms of anxiety as well as depression, personality traits, family environment and NSSI behaviors were collected through a questionnaire survey. Gender, age, grade, and all survey results except sociodemographic information were used as relevant factors for prediction. Support vector machines, decision tree and random forest models were trained and validated by the train set and valid set, respectively. The metrics of each model were tested and compared to select the most suitable one. Furthermore, the mean decrease Gini index was calculated to measure the importance of relevant factors. RESULTS: The prevalence of NSSI was 38.3%. Out of the 6 models assessed, the random forest model demonstrated the highest suitability in predicting the prevalence of NSSI. It achieved sensitivity, specificity, AUC, accuracy, precision, and F1 scores of 0.65, 0.72, 0.76, 0.70, 0.57, and 0.61, respectively. Anxiety and depression were the top two contributing factors in the prediction model. Neuroticism and conflict were the factors that contributed the most to personality traits and family environment, respectively, in terms of prediction. In addition, demographic factors contributed little to the prediction in this study. CONCLUSION: This study focused on Chinese children and adolescents in rural areas and demonstrated the potential of using machine learning approaches in predicting NSSI. Our research complements the application of machine learning methods to psychiatric and psychological problems.
Psychotropic drug-induced adverse drug reactions in 462,661 psychiatric inpatients in relation to age: results from a German drug surveillance program from 1993-2016.
Seifert J, Reinhard MA, Bleich S … +5 more , Erfurth A, Greil W, Toto S, Grohmann R, Glocker C
Ann Gen Psychiatry · 2024 Nov · PMID 39558338 · Full text
BACKGROUND: Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal s...
BACKGROUND: Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal symptoms (EPS), metabolic disorders, sedation, and delirium are particularly worrisome and often associated with psychotropic drugs. METHODS: This observational study investigated the risk for psychotropic drug-related ADRs in older (n = 99,099) and younger adults (n = 363,562) in psychiatric inpatients using data from the German pharmacovigilance program "Arzneimittelsicherheit in der Psychiatrie" (AMSP) from 1993-2016. The aim was to assess whether age influenced the risk of specific ADR types and if certain psychotropic drugs posed particular concerns. RESULTS: The risk for ADRs did not differ between older and younger patients (relative risk 0.98, 95% confidence interval 0.92-1.05). However, older patients had a higher risk for delirium (2.35, 1.85-2.99), hyponatremia (3.74, 2.85-4.90), and orthostatic syncope (2.37, 1.72-3.26), as well as certain types of EPS, e.g., parkinsonism (1.89, 1.45-2.48) and Pisa-/metronome syndrome (3.61, 2.51-5.18). The risk for other ADRs, such as acute dystonia (0.20, 0.10-0.37), akathisia (0.47, 0.29-0.76), liver dysfunction (0.63, 0.48-0.82), weight gain (0.07, 0.04-0.14), sexual dysfunction (0.03, CI 0.00-0.25), and hyperprolactinemia/galactorrhea (0.05, 0.02-0.17) was significantly lower for older patients. Older patients treated with any type of antidepressant drug (1.33, 1.26-1.40)-especially selective serotonin reuptake inhibitors (1.57, 1.26-1.40) and selective serotonin-norepinephrine reuptake inhibitors (2.03, 1.80-2.29)-and lithium (1.74, 1.52-2.00) had a higher ADR risk than younger patients. Second-generation antipsychotic drugs had a lower (0.74, 0.71-0.77) and low-potency first-generation antipsychotic drugs a higher (1.19, 1.07-1.33) ADR risk in older patients. The risk for ADRs involving multiple drugs was higher in older patients (1.28, 1.22-1.34). ADRs in older patients were 6.4 times more likely to result in death. CONCLUSIONS: Clinicians and pharmacists should be aware of the types of ADRs and high-risk drugs across age groups and provide appropriate monitoring. Pharmacovigilance is crucial in psychiatric patients of all ages and should not be neglected, even for drugs generally considered "safe".
Clinical patterns of metabolic syndrome in young, clinically stable, olanzapine-exposed patients with schizophrenia.
Ma J, Zhang L, Huang Z … +1 more , Wang G
Ann Gen Psychiatry · 2024 Nov · PMID 39538330 · Full text
BACKGROUND: Schizophrenia (SCZ) is a chronic, disabling mental illness with a high disease burden and is often comorbid with metabolic syndrome (MetS). The aim of this study was to determine the prevalence of MetS in you...
BACKGROUND: Schizophrenia (SCZ) is a chronic, disabling mental illness with a high disease burden and is often comorbid with metabolic syndrome (MetS). The aim of this study was to determine the prevalence of MetS in young, clinically stable, olanzapine-exposed patients with SCZ and to explore predictive factors affecting the development and severity of MetS. METHODS: A total of 274 patients with SCZ who met the inclusion criteria were enrolled in this study, and their demographic data and general clinical information were collected. Concurrently, patients were assessed for psychopathology, illness severity, and antipsychotic drug-related adverse effects. RESULTS: The prevalence of MetS in the target population was 35.77%, and the MetS subtype of abdominal obesity + high triglycerides + low level of high-density lipoprotein cholesterol accounted for the majority of patients in the MetS subgroup. Binary logistic regression showed that body mass index (BMI), uric acid (UA), thyroid-stimulating hormone, and QT-c interval could significantly and positively predict the development of MetS. Multiple linear regression showed that olanzapine concentration, BMI, and UA could significantly and positively predict higher MetS scores. CONCLUSION: This study reports the clinical patterns of MetS in young, clinically stable, olanzapine-exposed patients with SCZ and identifies the correlations influencing the development and severity of MetS. These findings could potentially be applied toward the prevention of and intervention in MetS.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) as treatment for nicotine cessation in psychiatric populations: a systematic review.
Lee S, Li M, Le GH … +9 more , Teopiz KM, Vinberg M, Ho R, Au HCT, Wong S, Valentino K, Kwan ATH, Rosenblat JD, McIntyre RS
Ann Gen Psychiatry · 2024 Nov · PMID 39529123 · Full text
BACKGROUND: Nicotine use and nicotine use disorder (NUD) are the leading causes of preventable death in the United States. Persons with mental disorders (e.g., bipolar disorder) are differentially susceptible to nicotin...
BACKGROUND: Nicotine use and nicotine use disorder (NUD) are the leading causes of preventable death in the United States. Persons with mental disorders (e.g., bipolar disorder) are differentially susceptible to nicotine use. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are indicated for type 2 diabetes mellitus (T2DM) and obesity and show preliminary evidence of efficacy in addiction-related behaviours. Herein, we synthesize extant preclinical and clinical evidence evaluating the effect of GLP-1RAs on neurobiological systems and behaviours salient to nicotine consumption and cessation. METHODS: Online databases (MedLine, Embase, AMED, PsychINFO, JBI EBP Database, PubMed, Web of Science, Google Scholar) were searched from inception to May 21, 2024. Relevant studies were also extracted from the reference lists of the obtained articles. All articles were screened against inclusion and exclusion criteria. RESULTS: Administration of GLP-1RAs reduced nicotine self-administration and nicotine-seeking behaviour in animal models that, in some cases, is sustained beyond exposure to the agent. GLP-1RAs also mitigated post-nicotine cessation weight gain, craving, withdrawal, and hyperphagia. The preceding effects are attributable to modulation of reward-related brain regions (e.g., mesolimbic dopamine system), resulting in nicotine aversion. GLP-1RAs were also efficacious as adjunctive therapies [e.g., in combination with nicotine replacement therapies (NRTs)]. CONCLUSION: The multi-effect characteristics in NUD paradigms provide a compelling rationale for large, adequately powered, long-term, randomized controlled trials of GLP-1RAs in the treatment and prevention of NUD. The replicated effect on mitigating post-nicotine cessation weight gain is a differentiating feature of GLP-1RAs from extant proven therapies for NUD.
A pooled analysis of the efficacy of sertraline in women, with a focus on those of childbearing age.
Fagiolini A, Mariano MP, Biesheuvel E … +1 more , Purushottamahanti P
Ann Gen Psychiatry · 2024 Nov · PMID 39511616 · Full text
INTRODUCTION: Gender- and age-specific research on medications is essential for personalizing treatment plans, optimizing dosing, minimizing adverse effects and improving outcomes. Women are twice as likely to be diagnos...
INTRODUCTION: Gender- and age-specific research on medications is essential for personalizing treatment plans, optimizing dosing, minimizing adverse effects and improving outcomes. Women are twice as likely to be diagnosed with major depressive disorder (MDD), and it is commonly reported during their reproductive years. This post-hoc pooled analysis evaluated the efficacy of sertraline (one of the most studied medications in women) in women of reproductive age (18-44 years). METHODS: Data was pooled from nine clinical trials of sertraline that included 1832 subjects with MDD. The analysis set included 1097 women, 651 of those were of reproductive age. Sertraline was compared with placebo for changes in total HAM-D17 and CGI scores measured over time through MMRM analysis. The change from baseline to the end of study (-week 8) was assessed using ANCOVA. RESULTS: The changes from baseline in total HAM-D17 and CGI scores were significantly higher for sertraline than for placebo at the end of 8 weeks for all women (LS Mean difference, 95% CI: -1.81(-3.01,-0.62), P = 0.0029; -0.38(-0.55,-0.20), P < 0.0001, respectively). For women of reproductive age these changes (LS Mean difference, 95% CI: -2.08(-3.52,-0.64), P = 0.0047; -0.44(-0.66,-0.22), P < 0.0001, respectively), were significant from week 2 (HAM-D17) and week 1 (CGI) till the end of study. LIMITATIONS: Only sertraline and placebo arms were included in the analysis. The dosing varied between studies, and the effect of dose was not addressed. CONCLUSIONS: Sertraline is an effective option for treatment of MDD in women, including those in the childbearing age.
Treatment satisfaction and effectiveness of Lurasidone on quality of life and functioning in adult patients with schizophrenia in the real-world Italian clinical practice: a prospective 3-month observational study.
De Filippis S, Vita A, Cuomo A … +16 more , Amici E, Giovanetti V, Lombardozzi G, Pardossi S, Altieri L, Cicale A, Dosoli M, Galluzzo A, Invernizzi E, Rodigari P, Mascagni P, Santini C, Falsetto N, Manes MA, Micillo M, Fagiolini A
Ann Gen Psychiatry · 2024 Nov · PMID 39501351 · Full text
BACKGROUND: Although second-generation antipsychotics (SGAs) have proven to be effective therapeutic options for patients with schizophrenia, there is a notable lack of evidence on patients' subjective perspectives regar...
BACKGROUND: Although second-generation antipsychotics (SGAs) have proven to be effective therapeutic options for patients with schizophrenia, there is a notable lack of evidence on patients' subjective perspectives regarding their well-being, quality of life, and satisfaction with these medications. This study aimed to evaluate the treatment satisfaction and effectiveness of lurasidone on quality of life and functioning in adult patients with schizophrenia in real-world Italian clinical practice. METHODS: This was a multicentre, national, non-interventional, single-arm, 3-month prospective study. Patients who were naive to lurasidone treatment and whose treating physician had decided to start them on this medication were enrolled and evaluated over a 3-month period. Eligible patients were adults (≥ 18 years of age) with a primary diagnosis of schizophrenia who were being treated with lurasidone (for the first time [i.e., they were lurasidone naive]) as part of routine clinical practice. Efficacy endpoints were changes in patient/caregiver treatment satisfaction (seven-point Likert scale from the Treatment Satisfaction Questionnaire for Medication), patient quality of life and functioning (QLS), investigator-rated global assessment of functioning (CGI-S, IAQ) after 6 weeks and 3 months of lurasidone, and number of relapses and hospitalizations. RESULTS: Sixty-one patients were enrolled and 59 completed the study. The median dosage of lurasidone at baseline was 37.00 mg/day. The median duration of titration was 86.0 days (Min 28; Max 115 days); the median number of dosage changes was 1.0. At the end of 3-month observation period, the median dose of lurasidone was 74.00 mg/day. QoL and Functioning Score showed a trend of improvement over time, reaching a mean change from baseline of 9.8 at the end of the study. According to the CGI-S, the percentage of patients who were "markedly or severely ill" showed a continuous decrease from baseline to 3 months, from 62.29% to 8.20%. Patient satisfaction increased over time, with 80.32% of patients reporting that they were somewhat, fairly, or very satisfied (including 63.93% who were completely or very satisfied) at the end of the study. No relapses/hospitalizations for psychiatric reasons were reported. Lurasidone was well tolerated with no safety concerns or discontinuations due to AEs. CONCLUSIONS: Lurasidone represents a valid option for the treatment of schizophrenia and positively affects subjective well-being, quality of life and satisfaction. TRIAL REGISTRATION: NCT06527885 retrospectively registered (01/08/2024).
Effectiveness of 8-week TReatment with vortioxetine on depressive symptoms in major depressive disorder patients with comorbid generalized anxiety disorder in UAE (TRUE).
Badr B, Gailani HA, Alkhoori S … +14 more , Butt H, Daher M, Dheyaa B, Hindy NE, Eid MW, Elsaadouni N, Faia V, Haweel A, Khammas T, Omar H, Tadros G, Yacoub C, Talaat T, El-Shafei A
Ann Gen Psychiatry · 2024 Nov · PMID 39487479 · Full text
BACKGROUND: Major Depressive Disorder (MDD) is a leading cause of disability and results in excessive utilization of healthcare resources worldwide. The Middle East and North Africa (MENA) region shows a high prevalence...
BACKGROUND: Major Depressive Disorder (MDD) is a leading cause of disability and results in excessive utilization of healthcare resources worldwide. The Middle East and North Africa (MENA) region shows a high prevalence of depressive disorders. Generalized Anxiety Disorder (GAD) and MDD have the highest rate of comorbidity of all mood and anxiety disorders, ranging from 40 to 98% in drug studies. Comorbid GAD results in more significant impairment in MDD and increases the severity of symptoms. Although several clinical trials supported the safety and effectiveness of vortioxetine, no data regarding these aspects has been revealed in the MENA region. This study aimed to assess the safety and efficacy of vortioxetine in patients with comorbid GAD in the United Arab Emirates (UAE). METHOD: In a multicenter observational study, 118 patients with confirmed anxiety and depressive disorders were evaluated over four visits (baseline visit, two weeks, four weeks, and eight weeks) using MADRS and HAM-A scales to assess depression and anxiety severity, respectively by calculating mean change and the percent using Kendall's W test. RESULTS: A significant mean difference in MADRS score was observed, with a gradual decrease of mean MADRS total scores over the assessment weeks (p < 0.001) as well as in HAM-A scores, from severe to moderate-severe anxiety through the four visits (p < 0.001). Furthermore, only one case was reported as a serious side effect. Nausea and insomnia were the most predominant side effects reported among the studied population. CONCLUSION: Vortioxetine was found effective and safe among patients with MDD and comorbid GAD.
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