Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

What is the relationship between exposure to environmental pollutants and severe mental disorders? A systematic review on shared biological pathways

Severe mental disorders are multi-dimensional constructs, resulting from the interaction of genetic, biological, psychosocial, and environmental factors. Among the latter, pollution and climate change are frequently being considered in the etiopathogenesis of severe mental disorders. This systematic review aims to investigate the biological mechanisms behind the relationship between environmental pollutants, climate change, and mental disorders. An extensive literature search was performed on PubMed, Scopus, and APA PsycInfo databases according to the PRISMA guidelines. Articles were considered eligible if they involved humans or animals examining the association between exposure to environmental pollutants and if the resulting biological mechanisms that may have an impact on mental health and may support or even cause severe mental disorders (SMD) are assessed. For this reason, only studies dealing with biomarkers or biological pathways were taken into account. The 47 papers included in the review were divided into two groups: those conducted on human participants (15 studies) and those utilizing animal models (31 studies); one study included both humans and animals. Studies carried out with humans, which are mainly focused on measuring the impact of particulate matter (PM2.5 and PM10) exposure on mental health, showed an increased risk of depression or psychotic relapses through the inflammation and oxidative stress pathways, or through the alteration of the hypothalamic-pituitary-adrenal (HPA) axis. Animal models showed the potential impact of pollution on brain functioning through increased inflammatory responses, oxidative stress, HPA axis disruption, hippocampal damage, and neurotransmitters dysregulation. Our findings show that environmental pollutants have an impact on human mental health through different biological pathways. The biological mechanisms by which environmental pollution and climate change influence the onset and exacerbation of severe mental disorders are complex and include gene expression, inflammation, oxidative stress, and anatomical brain changes. A better understanding of those pathways is important for the progress of knowledge on the pathophysiology of severe mental disorders according to the one health model, that promotes a collaborative, multisectoral, and transdisciplinary approach across various levels to optimize health outcomes by recognizing the interconnectedness of humans, animals, plants, and their shared environment.

Editorial Perspective: A systems approach to addressing young people's mental health

This editorial explores how adopting a social determinants and systemic perspective can enhance preventative measures to boost the mental health of young people. It argues that to effectively elevate the mental health of young people, it is essential to tackle both the overarching influences and their specific local impacts. We maintain that a strategy combining systems thinking with evidence tailored to the local environment and participatory design is essential.

Bridging animal models and humans: neuroimaging as intermediate phenotypes linking genetic or stress factors to anhedonia

BACKGROUND

Intermediate phenotypes, such as characteristic neuroimaging patterns, offer unique insights into the genetic and stress-related underpinnings of neuropsychiatric disorders like depression. This study aimed to identify neuroimaging intermediate phenotypes associated with depression, bridging etiological factors to behavioral manifestations and connecting insights from animal models to diverse clinical populations.

METHODS

We analyzed datasets from both rodents and humans. The rodent studies included a genetic model (P11 knockout) and an environmental stress model (chronic unpredictable mild stress), while the human data comprised 748 participants from three cohorts. Using the amplitude of low-frequency fluctuations, we identified neuroimaging patterns in rodent models. We then applied a machine-learning approach to cluster neuroimaging subtypes of depression. To assess the genetic predispositions and stress-related changes associated with these subtypes, we analyzed genotype and metabolite data. Linear regression was employed to determine which neuroimaging features predicted core depression symptoms across species.

RESULTS

The genetic and environmental stress models exhibited distinct neuroimaging patterns in subcortical and sensorimotor regions. Consistent patterns emerged in two neuroimaging subtypes identified across three independent depressed cohorts. The subtype resembling P11 knockout demonstrated higher genetic susceptibility, with enriched expression of risk genes in brain tissues and abnormal metabolites linked to tryptophan metabolism. In contrast, the stress animal-like subtype did not show changes in genetic risk scores but exhibited enriched risk gene expression in somatic and endocrine tissues, along with mitochondrial dysfunction in the antioxidant stress system. Notably, these distinct subcortical-sensorimotor neuroimaging patterns predicted anhedonia, a core symptom of depression, in both rodent models and depressed subtypes.

CONCLUSIONS

This cross-species validation suggests that these neuroimaging patterns may serve as robust intermediate phenotypes, linking etiology to anhedonia and facilitating the translation of findings from animal models to humans with depression and other psychiatric disorders.

An online group behavioral activation therapy for major depressive disorder: Adaptation, effectiveness, and trajectories of change in a lower-middle income country

BACKGROUND AND OBJECTIVE

Depressive disorders are common mental illnesses associated with high burden of disease. In this study, the effects of an online group behavioral activation on depressive symptoms and rumination were evaluated, and trajectories of change in patients with major depressive disorder adapted for a lower-middle income context investigated.

METHODS

This study was an online single-group non-randomized trial. Patients were recruited from various parts of the country through social media and medical university clinics. In total, 79 women with major depressive disorder were included. We measured Beck Depressive Inventory-II (BDI-II) scores, depressive rumination and behavioral activation scores, sudden gains, depression spikes, early response, and clinical change. Patients attended an online weekly ten-session behavioral activation therapy. K-nearest neighbor was used to impute missing data and estimate the importance of candidate predictors of clinical change. However, due to a high attrition rate, paired tests were performed using per-protocol analysis without data imputation.

RESULTS

The mean difference (SD) of the BDI-II score from the beginning to the end of the study was 21.10 (10.21), P < 0.001. Improvement was observed for depressive rumination (P < 0.001), and for behavioral activation (P < 0.001). Clinical change and early response were significantly related to BDI-II change (both P < 0.001). Favorable changes in behavioral activation, depressive symptoms, or rumination showed linear patterns. Clinical change (P = 0.453) and BDI-II (P = 0.050) were not statistically different between patients with moderate versus severe symptoms.

LIMITATIONS

Participants were solely women. Some patients did not attend all sessions, and participants were not followed in the post-treatment period.

CONCLUSION

online group behavioral activation therapy is suggested as an appropriate and accessible front-line treatment for moderate to severe major depressive disorder in lower-middle income countries.

Diagnosis of Cognitive and Mental Disorders: A New Approach Based on Spectral-Spatiotemporal Analysis and Local Graph Structures of Electroencephalogram Signals

BACKGROUND/OBJECTIVES

The classification of psychological disorders has gained significant importance due to recent advancements in signal processing techniques. Traditionally, research in this domain has focused primarily on binary classifications of disorders. This study aims to classify five distinct states, including one control group and four categories of psychological disorders.

METHODS

Our investigation will utilize algorithms based on Granger causality and local graph structures to improve classification accuracy. Feature extraction from connectivity matrices was performed using local structure graphs. The extracted features were subsequently classified employing K-Nearest Neighbors (KNN), Support Vector Machine (SVM), AdaBoost, and Naïve Bayes classifiers.

RESULTS

The KNN classifier demonstrated the highest accuracy in the gamma band for the depression category, achieving an accuracy of 89.36%, a sensitivity of 89.57%, an F1 score of 94.30%, and a precision of 99.90%. Furthermore, the SVM classifier surpassed the other machine learning algorithms when all features were integrated, attaining an accuracy of 89.06%, a sensitivity of 88.97%, an F1 score of 94.16%, and a precision of 100% for the discrimination of depression in the gamma band.

CONCLUSIONS

The proposed methodology provides a novel approach for analyzing EEG signals and holds potential applications in the classification of psychological disorders.

Digitally transforming community mental healthcare: Real-world lessons from algorithmic workforce integration

Community-based high intensity services for people living with severe and enduring mental illnesses face critical workforce shortages and workflow efficiency challenges. The expectation to monitor complex, dynamic patient data from ever-expanding electronic health records leads to information overload, a significant factor contributing to worker burnout and attrition. An algorithmic workforce, defined as a suite of algorithm-driven processes, can work alongside health professionals assisting with oversight tasks and augmenting human expertise. This selective review summarises lessons learned from our five-year experience (2018-22) of algorithmic workforce implementation research in two community mental health services in Australia covering both rural and urban populations. We retrace our implementation journey to illustrate four foundational processes: (i) algorithm design (ii) proof-of-concept validation (iii) workflow integration and (iv) optimization. By examining our previous studies, we discuss insights gained regarding intended human-centricity of services, potential algorithm-human misalignments, and unintended workload and accountability consequences for clinicians and organizations.

Investigating the causal pathways among psychopathological variables, cognitive impairment, and real-life functioning in people with schizophrenia

The present study aimed to investigate the causal relationships among cognitive impairment, psychopathology, and real-life functioning in a large sample of people with schizophrenia, using a data-driven causal discovery procedure based on partial ancestral graphs (PAGs). This method may provide additional insights for the identification of potential therapeutic targets to promote recovery in people with chronic schizophrenia. State-of-the-art instruments were used to assess the study variables. Two PAGs were generated at baseline and after 4 years of follow-up to model the nature of the causal relationships linking psychopathology, cognition, and functioning. The study sample was composed of more than 600 clinically stable patients with schizophrenia at two time points. The PAGs model indicated that working memory impairment is the first ancestor of the causal links, influencing all the other neurocognitive domains, social cognition, and functional capacity, which in turn affects everyday life functioning. From this domain of functioning a causal link is directed to disorganization and positive symptoms, and another to work skills and interpersonal relationships domains; the latter had a direct link to asociality and the other domains of negative symptoms. The structure of the PAGs did not differ significantly between baseline and follow-up, indicating the stability of the causal relationship model investigated cross-sectionally at both time points. The role of working memory impairment in the pathways to functional outcomes in schizophrenia highlights the importance of implementing integrated pharmacological and cognitive remediation interventions targeting neurocognition. The impact of everyday life and interpersonal functioning on the clinical presentation of schizophrenia suggests that integrated and personalized treatments, promoting relevant skills to improve these functional outcomes, may have a beneficial impact on clinical outcomes.

Association of meeting 24-hour movement guidelines with anxiety and depressive symptoms in adults

There is growing evidence on the association between meeting the recommendations of isolated movement behaviors (physical activity, sedentary time, and sleep) with anxiety and depressive symptoms. However, the joint association of meeting the 24 h movement guidelines with anxiety and depressive symptoms is still unknown. The aim of this study was to analyze the association of meeting 24-hour movement guidelines with symptoms of anxiety and of depression in adults. The sample included 212 participants. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS), while physical activity and sedentary time were evaluated by accelerometry, and daily slept hours were self-reported. Age, sex, socioeconomic status, accelerometer wear time, and waist circumference were covariates. Poisson regression models (crude and adjusted by covariates) were used to analyze association between variables. Meeting isolate recommendations of 24-hour movement guidelines were not associated with symptoms of anxiety or depression. However, meeting two or three recommendations was inversely associated with symptoms of anxiety (β= -0.235; 95%CI= -0.447; -0.024); (β= -0.569; 95%CI= -0.853; -0.285) and of depression (β= -0.275; 95%CI= -0.509; -0.040); (β= -0.551; 95%CI= -0.877; -0.224), respectively. Intervention strategies for reducing anxiety and depressive symptoms should target the meeting of more than one movement guidelines, such as increasing physical activity, reducing sedentary time, and promoting adequate sleep time for adults.

Early antibiotic exposure and risk of psychiatric and neurocognitive outcomes: systematic review and meta-analysis

BACKGROUND

The prenatal and early-life periods pose a crucial neurodevelopmental window whereby disruptions to the intestinal microbiota and the developing brain may have adverse impacts. As antibiotics affect the human intestinal microbiome, it follows that early-life antibiotic exposure may be associated with later-life psychiatric or neurocognitive outcomes.

AIMS

To explore the association between early-life (in utero and early childhood (age 0-2 years)) antibiotic exposure and the subsequent risk of psychiatric and neurocognitive outcomes.

METHOD

A search was conducted using Medline, PsychINFO and Excerpta Medica databases on 20 November 2023. Risk of bias was assessed using the Newcastle-Ottawa scale, and certainty was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) certainty assessment.

RESULTS

Thirty studies were included (n = 7 047 853 participants). Associations were observed between in utero antibiotic exposure and later development of autism spectrum disorder (ASD) (odds ratio 1.09, 95% CI: 1.02-1.16) and attention-deficit hyperactivity disorder (ADHD) (odds ratio 1.19, 95% CI: 1.11-1.27) and early-childhood exposure and later development of ASD (odds ratio 1.19, 95% CI: 1.01-1.40), ADHD (odds ratio 1.33, 95% CI: 1.20-1.48) and major depressive disorder (MDD) (odds ratio 1.29, 95% CI: 1.04-1.60). However, studies that used sibling control groups showed no significant association between early-life exposure and ASD or ADHD. No studies in MDD used sibling controls. Using the GRADE certainty assessment, all meta-analyses but one were rated very low certainty, largely owing to methodological and statistical heterogeneity.

CONCLUSIONS

While there was weak evidence for associations between antibiotic use in early-life and later neurodevelopmental outcomes, these were attenuated in sibling-controlled subgroup analyses. Thus, associations may be explained by genetic and familial confounding, and studies failing to utilise sibling-control groups must be interpreted with caution. PROSPERO ID: CRD42022304128.

The anatomy of crisis

This phenomenological study deeply explores the individual and collective lived experience of a mental health crisis. A Lifeworld approach provided the entry point to deeper insights into the anatomy of crisis as the embodied emotional, physical, cognitive, and spiritual nature of crisis. Findings uncovered rich descriptions of mental health crises and how the crisis was encountered in a shattered sense of self and relational challenges in the context of receiving crisis care. Overall, the study revealed an embodied understanding of crisis that offers practical direction in providing crisis care that is more attuned to lived experience.

Prevalence of mental disorders and related risk factors in refugees and asylum seekers in Campania

Introduction

In recent years, the increasing presence of refugees and asylum seekers displaced from their country of origin, determined significant social, economic, humanitarian and public health implications in host countries, including Italy. These populations are exposed to several potential stressful experiences which make them vulnerable to psychological distress. In fact, the majority of studies addressing the topic found a higher prevalence of mental disorders, especially post-traumatic stress disorder and major depressive disorder, in refugees and asylum seekers with respect to the general population. However, heterogeneous prevalence rates have been reported among studies, due to methodological factor as well as to the impact of a variety of risk factors related to stressful experiences lived in the country of origin, during the migration journey and in the host country.

Objectives

The aim of the present study was to assess the prevalence of the main psychiatric diagnoses in a large group of adult refugees and asylum seekers (N=303) in the reception centers of two provinces of the Campania region, as well as to investigate the impact of potential risk factors on the occurrence of psychiatric disorders.

Methods

The diagnosis of psychiatric disorders and the identification of subjects at high risk to develop psychosis were carried out by means of structured diagnostic interviews. The following variables were explored as potential risk/protective factors to the occurrence of psychiatric disorders: socio-demographic variables, migration status (refugees/asylum seekers) and characteristics of the reception center,assessed by means of an ad hoc questionnaire; cognitive indices assessed by using standardized neuropsychological tests; traumatic experiences and level of political terror in the country of origin, assessed by means of reliable and valid self-report questionnaires.

Results

At least one mental disorder was found in 29.7% of the sample. Most prevalent diagnoses were depressive disorders, anxiety disorders and PTSD. Women showed, with respect to men, a higher prevalence of anxiety disorders, higher trauma levels, and came from more at-risk countries. Higher trauma levels, better cognitive abilities and unemployment and refugee status were associated to the presence of a current psychiatric disorder in the whole sample.

Conclusions

Our findings showed a higher prevalence of depressive disorders and PTSD in the sample of refugees and asylum seekers with respect to the general population and highlighted the role of potential risk factors whose identification may guide the implementation of preventive strategies and early treatments in these people.

Persuasive design principle of social support in digital interventions targeting mental health symptoms: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis evaluates the available evidence on efficacy of social support strategies, as defined by the persuasive system design framework, in internet-based and mobile-based interventions (IMI) targeting mental health.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials comparing IMI implementing a social support strategy for mental health symptoms to various control conditions. Publications up to June 2023 (date of search 6 June 2023) were considered.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened and extracted data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Risk of Bias Tool V.2.0. Data were pooled based on a random-effects model.

RESULTS

After screening 6484 records, a total of 45 studies met our inclusion criteria. At 96%, social support was predominantly implemented through the strategy of social facilitation, by which users recognising others using the intervention (eg, discussion forum). IMI implementing social support strategies showed moderate effect sizes of Hedges' g=-0.34 (95% CI -0.47 to -0.21, p<0.001) in comparison to different control conditions. Heterogeneity was considerable (I2=73.6%; 95% CI 64.8 to 80.3). Subgroup analyses revealed a significant influence of targeted psychological condition (p<0.001), type of social support (p<0.001) and control condition (p<0.001). In k=11 component studies (ie, comparison to a disentangled version of the same intervention), IMI with social support strategies were not significantly more effective in comparison to the same IMI without social support (Hedges' g=-0.08 (95% CI -0.22 to 0.05, p=0.19, I2=0%). 64% (k=7) of component studies reported higher adherence rates in IMI with social support.

CONCLUSIONS

Based on a small number of component studies, implementing social support strategies in IMI that target mental health symptoms has no significant incremental benefit on effectiveness. To draw more robust conclusions, the potential of other social support strategies besides social facilitation should be exploited in future component studies.

PROSPERO REGISTRATION NUMBER

CRD42020222810.

Let's fail better: Using philosophical tools to improve neuroscientific research in psychiatry

Despite predictions that neuroscientific discoveries would revolutionize psychiatry, decades of research have not yet led to clinically significant advances in psychiatric care. For this reason, an increasing number of researchers are recognizing the limitations of a purely biomedical approach in psychiatric research. These researchers call for reevaluating the conceptualization of mental disorders and argue for a non-reductionist approach to mental health. The aim of this paper is to discuss philosophical assumptions that underly neuroscientific research in psychiatry and offer practical tools to researchers for overcoming potential conceptual problems that are derived from those assumptions. Specifically, we will discuss: the analogy problem, questioning whether mental health problems are equivalent to brain disorders, the normativity problem, addressing the value-laden nature of psychiatric categories and the priority problem, which describes the level of analysis (e.g., biological, psychological, social, etc.) that should be prioritized when studying psychiatric conditions. In addition, we will explore potential strategies to mitigate practical problems that might arise due to these implicit assumptions. Overall, the aim of this paper is to suggest philosophical tools of practical use for neuroscientists, demonstrating the benefits of a closer collaboration between neuroscience and philosophy.

Medicinal plants and plant-based traditional medicine: Alternative treatments for depression and their potential mechanisms of action

Background

Clinical depression is a serious public health issue that affects 4.7 % of the world's population and can lead to suicide tendencies. Although drug medications are available, only 60 % of the depressed patients respond positively to the treatments, while the rest experience side effects that resulted in the discontinuation of their medication. Thus, there is an urgent need for developing a new anti-depressant with a distinct mode of action and manageable side effects. One of the options is using medicinal plants or plant-based traditional medicine as alternative therapies for psychiatric disorders.

Objectives

Therefore, the objective of this review was twofold; to identify and critically evaluate anti-depressant properties of medicinal plants or those incorporated in traditional medicine; and to discuss their possible mechanism of action as well as challenges and way forward for this alternative treatment approach.

Methods

Relevant research articles were retrieved from various databases, including Scopus, PubMed, and Web of Science, for the period from 2018 to 2020, and the search was updated in September 2024. The inclusion criterion was relevance to antidepressants, while the exclusion criteria included duplicates, lack of full-text availability, and non-English publications.

Results

Through an extensive literature review, more than 40 medicinal plant species with antidepressant effects were identified, some of which are part of traditional medicine. The list of the said plant species included Albizia zygia (DC.) J.F.Macbr., Calculus bovis Sativus, Celastrus paniculatus Willd., Cinnamomum sp., Erythrina velutina Willd., Ficus platyphylla Delile, Garcinia mangostana Linn., Hyptis martiusii Benth, and Polygonum multiflorum Thunb. Anti-depressant mechanisms associated with those plants were further characterised based on their modes of action such as anti-oxidation system, anti-inflammation action, modulation of various neurotransmitters, neuroprotective effect, the regulation of hypothalamic-pituitary-adrenal (HPA) axis and anti-depressant mechanism. The challenges and future outlook of this alternative and complementary medicine are also explored and discussed.

Conclusion

This pool of identified plant species is hoped to offer health care professionals the best possible alternatives of anti-depressants from natural phytocompounds that are efficacious, safe and affordable for applications in future clinical settings.

Treatment Preferences in Acute Psychosis: A Comparison of Patient and Staff Perspectives on Symptom Prioritization and Biopsychosocial Interventions

Patients with acute psychosis are often confronted with the prejudice that they refuse all treatment due to lack of insight. This study examined and compared the aims and preferences for treatment of patients with acute psychosis and of psychiatric inpatient staff. A total of 142 inpatients being treated for a psychotic disorder on either a locked or an open ward indicated which of a range of symptoms they want to be treated and which of various biopsychosocial treatment options they would like to receive. Staff members from the same wards reported which psychiatric symptoms they deemed relevant in the treatment of psychosis and which treatment options should be offered. Patients assigned the highest treatment need to neurocognitive symptoms, followed by affective and positive symptoms. In contrast, staff assigned the highest treatment need to positive symptoms, followed by neurocognitive and affective symptoms. Patients and staff on open wards expressed more treatment needs overall than did patients and staff on locked wards. Patients' desire for treatment differed across treatment types. In comparing patients on locked versus open wards, patients on open wards expressed higher approval of medication than patients on locked wards. Even patients with highly acute psychosis being treated on locked psychiatric wards endorsed treatment. Treatment preferences of this group deviated markedly in some instances from staffs' preferences. Considering their specific needs may contribute to increasing patient self-efficacy, and improving adherence to treatment.

Prevalence of psychiatric disorders among the adult population in a rural community of Jammu, India: a cross-sectional study

Background

Mental health is crucial for overall well-being, but rural areas often face difficulties in accessing mental health services and understanding psychiatric disorders.

Aim

This study aimed to address these issues by assessing the prevalence of psychiatric disorders among adults in rural Jammu and examining how socio-cultural and demographic factors are related to these disorders.

Methods

A sample of 1,016 adults from rural Jammu was surveyed using the Mini International Neuropsychiatric Interview (MINI). Data were collected through house-to-house visits conducted by trained investigators. Descriptive and inferential statistics, including frequency distribution and odds ratio, were employed to analyze the data respectively.

Results

Overall, 20.67% of the participants had a psychiatric disorder. Alcohol dependence was the most common condition, affecting 12.30% of the individuals, followed by generalized anxiety disorder at 3.14%. The study found significant associations between psychiatric disorders and several factors. Specifically, older people were more likely to have psychiatric disorders, with an odds ratio of 3.7 [2.07-6.59]. Married individuals also had a higher likelihood of experiencing psychiatric disorders (OR: 2.3 [1.55-3.54]). Those with less schooling were at an increased risk, with an odds ratio of 7.77 [2.31-26.09], and people from lower socioeconomic backgrounds were more likely to have these disorders as well (OR: 5.1 [2.4-10.5]).

Discussion and conclusion

The findings underscore the complex association between socio-demographic factors and mental health outcomes in rural areas of Jammu region. Addressing these disparities requires targeted interventions and policies that account for the unique socio-cultural contexts of rural populations. By understanding the specific challenges faced by these communities, policymakers and healthcare providers can develop more effective strategies to enhance mental health services and promote well-being.

Acculturation stress and mental health outcomes in a sample of migrant inpatients: Findings from a naturalistic study

INTRODUCTION

Migrants face numerous risk factors for mental disorders, including stressors and traumatic events during the pre-, peri-, and post-migratory phases. Acculturation stress, a significant post-migratory stressor, can adversely affect mental health during the cultural adaptation process. This study aims to assess the clinical implications of acculturation stress in migrants admitted to a psychiatric intensive care unit, with a focus on identifying predictors of acculturative stress and their impact on clinical outcomes.

METHODS

We conducted a retrospective study of 268 immigrant patients hospitalized between 2004 and 2019 at the psychiatric inpatient unit of the University of Foggia. We collected socio-demographic and clinical data using ad hoc schedules and validated assessment instruments, including the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF), and the Clinical Global Impression (CGI). Diagnoses were based on DSM-IV-TR/DSM-5 criteria. We analyzed associations between demographic and clinical characteristics of patients reporting acculturative stress and those not reporting it, using appropriate statistical methods.

RESULTS

The majority of patients were diagnosed with affective (45.1%) or psychotic disorders (31.7%), with 57.1% experiencing their first psychiatric episode. Acculturation stress was reported by 51.9% of patients (N = 139), predominantly among males (71.9%), single individuals (80.9%), and those of Islamic faith (56.8%). Patients experiencing acculturation stress were more likely to be unemployed (57.6%) and without a residence permit (63.3%). This stress was particularly prevalent among patients with psychotic disorders (25.9%) and first-episode psychiatric cases (64.7%). At discharge, patients with acculturation stress showed less improvement on CGI, GAF, and BPRS scores compared to those without such stress.

CONCLUSIONS

Acculturation stress is influenced by several socio-demographic factors and is crucial for the full symptomatic remission of migrant patients. Culturally-oriented mental health services, including language and cultural integration programs, are essential in reducing acculturative stress and improving the overall well-being of immigrants.

Development and Validation of Dimensional Clinical Personality Inventory 2 (IDCP-2) Algorithms to Assess ICD-11 Personality Trait Domain Qualifiers

With the advent of the new diagnostic model for personality disorders in the 11th revision of the International Classification of Diseases (ICD-11), researchers and practitioners in World Health Organization signatory countries are urged to implement it. This study aims to develop a brief, reliable, and valid scale for assessing maladaptive personality traits according to the ICD-11 model, using the item pool of the Dimensional Clinical Personality Inventory (IDCP-2). Quantitative and qualitative criteria for item selection were applied to a sample of 251 Brazilian adults. As a result, the 25 items (five items per factor) were selected, demonstrating promising evidence of validity based on the internal structure with a database of 1,659 Brazilian adults. In addition, we found good evidence of validity based on relationships with external variables, particularly those related to personality pathology, in a sample of 617 Brazilian adults. The implications of these findings are discussed.

Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.

Using a natural language processing toolkit to classify electronic health records by psychiatric diagnosis

Objective: We analyzed a natural language processing (NLP) toolkit's ability to classify unstructured EHR data by psychiatric diagnosis. Expertise can be a barrier to using NLP. We employed an NLP toolkit (CLARK) created to support studies led by investigators with a range of informatics knowledge. Methods: The EHR of 652 patients were manually reviewed to establish Depression and Substance Use Disorder (SUD) labeled datasets, which were split into training and evaluation datasets. We used CLARK to train depression and SUD classification models using training datasets; model performance was analyzed against evaluation datasets. Results: The depression model accurately classified 69% of records (sensitivity = 0.68, specificity = 0.70, F1 = 0.68). The SUD model accurately classified 84% of records (sensitivity = 0.56, specificity = 0.92, F1 = 0.57). Conclusion: The depression model performed a more balanced job, while the SUD model's high specificity was paired with a low sensitivity. NLP applications may be especially helpful when combined with a confidence threshold for manual review.

Diagnostic accuracy of large language models in psychiatry

INTRODUCTION

Medical decision-making is crucial for effective treatment, especially in psychiatry where diagnosis often relies on subjective patient reports and a lack of high-specificity symptoms. Artificial intelligence (AI), particularly Large Language Models (LLMs) like GPT, has emerged as a promising tool to enhance diagnostic accuracy in psychiatry. This comparative study explores the diagnostic capabilities of several AI models, including Aya, GPT-3.5, GPT-4, GPT-3.5 clinical assistant (CA), Nemotron, and Nemotron CA, using clinical cases from the DSM-5.

METHODS

We curated 20 clinical cases from the DSM-5 Clinical Cases book, covering a wide range of psychiatric diagnoses. Four advanced AI models (GPT-3.5 Turbo, GPT-4, Aya, Nemotron) were tested using prompts to elicit detailed diagnoses and reasoning. The models' performances were evaluated based on accuracy and quality of reasoning, with additional analysis using the Retrieval Augmented Generation (RAG) methodology for models accessing the DSM-5 text.

RESULTS

The AI models showed varied diagnostic accuracy, with GPT-3.5 and GPT-4 performing notably better than Aya and Nemotron in terms of both accuracy and reasoning quality. While models struggled with specific disorders such as cyclothymic and disruptive mood dysregulation disorders, others excelled, particularly in diagnosing psychotic and bipolar disorders. Statistical analysis highlighted significant differences in accuracy and reasoning, emphasizing the superiority of the GPT models.

DISCUSSION

The application of AI in psychiatry offers potential improvements in diagnostic accuracy. The superior performance of the GPT models can be attributed to their advanced natural language processing capabilities and extensive training on diverse text data, enabling more effective interpretation of psychiatric language. However, models like Aya and Nemotron showed limitations in reasoning, indicating a need for further refinement in their training and application.

CONCLUSION

AI holds significant promise for enhancing psychiatric diagnostics, with certain models demonstrating high potential in interpreting complex clinical descriptions accurately. Future research should focus on expanding the dataset and integrating multimodal data to further enhance the diagnostic capabilities of AI in psychiatry.

Uncovering the determinants of brain functioning, behavior and their interplay in the light of context

Notwithstanding the huge progress in molecular and cellular neuroscience, our ability to understand the brain and develop effective treatments promoting mental health is still limited. This can be partially ascribed to the reductionist, deterministic and mechanistic approaches in neuroscience that struggle with the complexity of the central nervous system. Here, I introduce the Context theory of constrained systems proposing a novel role of contextual factors and genetic, molecular and neural substrates in determining brain functioning and behavior. This theory entails key conceptual implications. First, context is the main driver of behavior and mental states. Second, substrates, from genes to brain areas, have no direct causal link to complex behavioral responses as they can be combined in multiple ways to produce the same response and different responses can impinge on the same substrates. Third, context and biological substrates play distinct roles in determining behavior: context drives behavior, substrates constrain the behavioral repertoire that can be implemented. Fourth, since behavior is the interface between the central nervous system and the environment, it is a privileged level of control and orchestration of brain functioning. Such implications are illustrated through the Kitchen metaphor of the brain. This theoretical framework calls for the revision of key concepts in neuroscience and psychiatry, including causality, specificity and individuality. Moreover, at the clinical level, it proposes treatments inducing behavioral changes through contextual interventions as having the highest impact to reorganize the complexity of the human mind and to achieve a long-lasting improvement in mental health.

Insight in cognitive impairment assessed with the Cognitive Assessment Interview in a large sample of patients with schizophrenia

The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). The present study aimed at assessing, in a large sample of SCZ (n = 601), the agreement between patients and their informants on CAI ratings, to explore patients' insight in their cognitive deficits and its relationships with clinical and functional indices. Agreement between patient- and informant-based ratings was assessed by the Gwet's agreement coefficient. Predictors of insight in cognitive deficits were explored by stepwise multiple regression analyses. Patients reported lower severity of cognitive impairment vs. informants. A substantial to almost perfect agreement was observed between patients' and informants' ratings. Lower insight in cognitive deficits was associated to greater severity of neurocognitive impairment and positive symptoms, lower severity of depressive symptoms, and older age. Worse real-life functioning was associated to lower insight in cognitive deficit, worse neurocognitive performance, and worse functional capacity. Our findings indicate that the CAI is a valid co-primary measure with the interview to patients providing a reliable assessment of their cognitive deficits. In the absence of informants with good knowledge of the subject, the interview to the patient may represent a valid alternative.

Exploring the Relationship Between Psychological Constructs and Decision-Making Preferences in Psychiatric Outpatients

Objective

This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population.

Methods

A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings.

Results

Significant correlations were found between patients' control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes.

Conclusion

 The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients' control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles.

Study of the Clinical Profiling and Assessment of Poisoning Cases in a Tertiary Care Hospital

Introduction Accidental and intentional poisoning is a major cause of morbidity and mortality. Pesticide poisoning is particularly common in India, where a large percentage of the population works in agriculture. This study aims to evaluate admission profiles, management trends, and outcome status among poisoning cases in a tertiary care hospital. Methodology A prospective observational study was carried out from May to July 2022 in the medicine ward of a tertiary care hospital, which is associated with a government medical college. Demographic characteristics, history of poisoning, clinical presentation at the time of admission, and intervention for treatment were recorded once the patient was diagnosed with poisoning or when there was a suspicion. Data regarding outcomes was also collected from this section. The appropriateness of the decontamination, support, and specific treatments was assessed. The collected data was subjected to descriptive statistical analysis. Results The most common agent was pesticides, involved in 44 (43.56%) cases out of a total of 101 poisoning cases, with the predominant subtype being organophosphate. Bites accounted for 18 (17.82%) cases, mainly snake bites. Household products were responsible for eight (7.92%) cases, and medicinal products for four (3.96%) cases. Decontamination, when indicated, was properly applied in 98 (97.02%) cases; supportive treatments were administered in 95 (94.05%) cases; and specific detoxifying measures were taken in 59 (58.41%) cases. A majority of the patients (60, or 59.41%) reached the hospital within three hours of poisoning, which dramatically reduced morbidity and mortality. Conclusion In summary, the study indicates that pesticide poisoning is prevalent in rural India, and, as such, there is an urgent need for appropriate regulation of agrochemicals and behavioural education to protect farmers. On average, the appropriateness of decontamination and supportive treatments was high (i.e., >85%), reflecting adequate initial responses. In contrast, the low level of appropriateness for specific treatments highlights gaps regarding institutional medical protocols and training. There is a need to educate the public about timely medical intervention, which can help in decreasing the mortality and morbidity associated with cases of poisoning.

The clinical utility and relevance in clinical practice of DSM-5 specifiers for major depressive disorder: A Delphi expert consensus study

Major depressive disorder (MDD) is a heterogeneous syndrome, associated with different levels of severity and impairment on the personal functioning for each patient. Classification systems in psychiatry, including ICD-11 and DSM-5, are used by clinicians in order to simplify the complexity of clinical manifestations. In particular, the DSM-5 introduced specifiers, subtypes, severity ratings, and cross-cutting symptom assessments allowing clinicians to better describe the specific clinical features of each patient. However, the use of DSM-5 specifiers for major depressive disorder in ordinary clinical practice is quite heterogeneous. The present study, using a Delphi method, aims to evaluate the consensus of a representative group of expert psychiatrists on a series of statements regarding the clinical utility and relevance of DSM-5 specifiers for major depressive disorder in ordinary clinical practice. Experts reached an almost perfect agreement on statements related to the use and clinical utility of DSM-5 specifiers in ordinary clinical practice. In particular, a complete consensus was found regarding the clinical utility for ordinary clinical practice of using DSM-5 specifiers. The use of specifiers is considered a first step toward a "dimensional" approach to the diagnosis of mental disorders.

Psychiatric Diagnosis: A Clinical Guide to Navigating Diagnostic Pluralism

ABSTRACT

The controversies surrounding the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases have generated significant debate across the psy-sciences. This debate has been further fueled by the launch of the Research Domain Criteria as a framework to facilitate advances in neuroscientific research, a renewed emphasis on dimensional models of psychopathology, currently exemplified by the Hierarchical Taxonomy of Psychopathology, and development of the Psychodynamic Diagnostic Manual by the psychodynamic community. In this article, we provide a clinical overview of recent debates surrounding categorical and dimensional approaches to psychiatric diagnosis, offer a critical assessment of proposed alternatives, and discuss how clinicians can navigate a plurality of diagnostic frameworks. Our discussion emphasizes that diagnostic frameworks need to be contextualized within the process of a comprehensive clinical evaluation, and their advantages and disadvantages should be understood in relationship to the theoretical orientations and practical needs of clinicians.

The Inner World and Formation of the Paranoid Personality Type in Persons with Intellectual Disabilities

This study investigates the progression of paranoid personality disorder (PPD) and its influence on social interactions. Contemporary research indicates that genetic predispositions and extrinsic variables, such as crisis events, play a role in the development of PPD. Individuals with PPD frequently struggle to form enduring social relationships as a result of their prevailing negative thoughts, hostility, and unwillingness to compromise. The study emphasizes the need for prompt psychological support in overcoming stereotyped cognition and diminishing social seclusion among individuals with personality disorders. The study employs a theoretical and methodological framework that integrates analytical research methodologies and content analysis of psychotherapy interventions for individuals with neuropsychiatric conditions. The findings uncover challenges about psychological adjustment, emotional control, and interpersonal communication abilities among patients with PPD. This article also presents contemporary psychotherapy approaches that aid in recovering mental well-being. Furthermore, a pragmatic framework for the diagnosis and treatment of PPD in psychotherapy has been created. The findings collected in this study hold great importance for professionals in the fields of education and social work, as well as practical value for psychologists and psychotherapists who offer support to those at risk of developing neuropsychiatric illnesses.

Factors Affecting Length of Stay of Patients in a General Psychiatric Hospital in Bahrain: A Retrospective Study

BACKGROUND

 Length of stay (LOS) in a psychiatric facility can be used as a measurement of the quality of healthcare. Prolonged stays impact the quality of life of psychiatric patients as well as have a huge burden on healthcare expenditures.

MATERIALS AND METHODS

A retrospective study targeting 153 patients admitted to a general adult ward in a psychiatric hospital in Bahrain, with the final diagnosis based on ICD-10 criteria. The collected data was analyzed using IBM SPSS Statistics for Windows, Version 26 (IBM Corp., Armonk, NY).

RESULTS

The median LOS was 22 days. LOS among schizophrenia and schizoaffective disorder as well as bipolar affective disorder was significantly longer than other groups. There was no significant difference among groups in terms of gender, age, marital status, social class, and alcohol or substance abuse. The presence of extrapyramidal side effects, history of electroconvulsive therapy (ECT) and the use of restraints during admission were associated with longer LOS. A higher number of previous admissions and number of current medications given during admission in the psychiatric hospital predicted a longer stay in the hospital.

CONCLUSION

Future studies should focus on the effect of better treatment options as well as occupational rehabilitation in ensuring better outcomes for inpatients as well as shorter stays in a psychiatric hospital.

Annual Meeting Content Analysis: Leveraging Annual Meetings to Promote Diversity, Equity, Inclusion, and Belonging in the Academy of Consultation-Liaison Psychiatry

BACKGROUND

There is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education. Although professional medical organizations' annual meetings play an instrumental role in continuing medical education for physicians, there are no studies describing DEI content in the annual meeting programming of professional medical organizations, including the Academy of Consultation-Liaison Psychiatry (ACLP), the primary professional organization for consultation-liaison psychiatrists.

OBJECTIVE

To examine the ACLP annual meeting titles using Content Analysis.

METHODS

We examined the publicly available ACLP annual meeting content titles on the ACLP website from 2010 to 2021. National DEI leaders from ACLP's DEI subcommittee iteratively generated keywords that covered a broad scope of DEI-related themes. Each annual meeting's content was independently coded by 2 members of the DEI subcommittee with discrepancies adjudicated by 2 additional members. Descriptive statistics were used to characterize the content of the annual meeting.

RESULTS

Of the 2615 annual meeting titles from 2010 to 2021 that were analyzed, 2531 were not coded to have DEI themes. Three percent (n = 84) of titles were coded to have a DEI theme as follows: Culture/diversity (n = 20, 24%), bias/disparities (n = 17, 20%), race/racism (n = 17, 20%), social justice (n = 12, 14%), gender/sexism (n = 10, 12%), and LGBTQ+ (n = 8, 10%). The frequency of DEI titles each year ranged from 1% (2010, 2018) to 17% (2021) with an increase in DEI content in 2021 (n = 24, 17%).

CONCLUSIONS

Although professional medical organizations like the ACLP are poised to leverage their continuing medical education platforms embedded in annual meeting programming to train consultation-liaison psychiatrists on DEI topics, our findings suggest more work is needed to develop and promote DEI-focused educational programming for their annual meetings.

Electrophysiological Correlates of Reward Anticipation in Subjects with Schizophrenia: An ERP Microstate Study

The current study aimed to investigate alterations of event-related potentials (ERPs) microstate during reward anticipation in subjects with schizophrenia (SCZ), and their association with hedonic experience and negative symptoms. EEG data were recorded in thirty SCZ and twenty-three healthy controls (HC) during the monetary incentive delay task in which reward, loss and neutral cues were presented. Microstate analysis and standardized low-resolution electromagnetic tomography (sLORETA) were applied to EEG data. Furthermore, analyses correlating a topographic index (the ERPs score), calculated to quantify brain activation in relationship to the microstate maps, and scales assessing hedonic experience and negative symptoms were performed. Alterations in the first (125.0-187.5 ms) and second (261.7-414.1 ms) anticipatory cue-related microstate classes were observed. In SCZ, reward cues were associated to shorter duration and earlier offset of the first microstate class as compared to the neutral condition. In the second microstate class, the area under the curve was smaller for both reward and loss anticipation cues in SCZ as compared to HC. Furthermore, significant correlations between ERPs scores and the anticipation of pleasure scores were detected, while no significant association was found with negative symptoms. sLORETA analysis showed that hypo-activation of the cingulate cortex, insula, orbitofrontal and parietal cortex was detected in SCZ as compared to HC. Abnormalities in ERPs could be traced already during the early stages of reward processing and were associated with the anticipation of pleasure, suggesting that these dysfunctions might impair effective evaluation of incoming pleasant experiences. Negative symptoms and anhedonia are partially independent results.

Philosophy of psychiatry: theoretical advances and clinical implications

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

Precision psychiatry: predicting predictability

Precision psychiatry is an emerging field that aims to provide individualized approaches to mental health care. An important strategy to achieve this precision is to reduce uncertainty about prognosis and treatment response. Multivariate analysis and machine learning are used to create outcome prediction models based on clinical data such as demographics, symptom assessments, genetic information, and brain imaging. While much emphasis has been placed on technical innovation, the complex and varied nature of mental health presents significant challenges to the successful implementation of these models. From this perspective, I review ten challenges in the field of precision psychiatry, including the need for studies on real-world populations and realistic clinical outcome definitions, and consideration of treatment-related factors such as placebo effects and non-adherence to prescriptions. Fairness, prospective validation in comparison to current practice and implementation studies of prediction models are other key issues that are currently understudied. A shift is proposed from retrospective studies based on linear and static concepts of disease towards prospective research that considers the importance of contextual factors and the dynamic and complex nature of mental health.

Enhancing psychiatric rehabilitation outcomes through a multimodal multitask learning model based on BERT and TabNet: An approach for personalized treatment and improved decision-making

Evaluating the rehabilitation status of individuals with serious mental illnesses (SMI) necessitates a comprehensive analysis of multimodal data, including unstructured text records and structured diagnostic data. However, progress in the effective assessment of rehabilitation status remains limited. Our study develops a deep learning model integrating Bidirectional Encoder Representations from Transformers (BERT) and TabNet through a late fusion strategy to enhance rehabilitation prediction, including referral risk, dangerous behaviors, self-awareness, and medication adherence, in patients with SMI. BERT processes unstructured textual data, such as doctor's notes, whereas TabNet manages structured diagnostic information. The model's interpretability function serves to assist healthcare professionals in understanding the model's predictive decisions, improving patient care. Our model exhibited excellent predictive performance for all four tasks, with an accuracy exceeding 0.78 and an area under the curve of 0.70. In addition, a series of tests proved the model's robustness, fairness, and interpretability. This study combines multimodal and multitask learning strategies into a model and applies it to rehabilitation assessment tasks, offering a promising new tool that can be seamlessly integrated with the clinical workflow to support the provision of optimized patient care.

One-year efficacy of a lifestyle behavioural intervention on physical and mental health in people with severe mental disorders: results from a randomized controlled trial

This multicentric randomized controlled trial (RCT), carried out in six Italian University mental health sites, aims to test the efficacy of a six-month psychosocial intervention (LYFESTYLE) on Body Mass Index (BMI), body weight, waist circumference, fasting glucose, triglycerides, cholesterol, Framingham and HOmeostasis Model Assessment of insulin resistance (HOMA-IR) indexes in patients with schizophrenia, bipolar disorder, and major depression. Moreover, the efficacy of the intervention has also been tested on several other physical and mental health domains. Patients were randomly allocated to receive the six-month experimental intervention (LIFESTYLE) or a behavioural control intervention. All enrolled patients were assessed at baseline and after one year. We recruited 401 patients (206 in the experimental and 195 in the control group) with a diagnosis of schizophrenia or other psychotic disorder (29.9%), bipolar disorder (43.3%), or major depression (26.9%). At one year, patients receiving the experimental intervention reported an improvement in body mass index, body weight, waist circumference, HOMA-IR index, anxiety and depressive symptoms and in quality of life. Our findings confirm the efficacy of the LIFESTYLE intervention in improving physical and mental health-related outcomes in patients with severe mental illnesses after one year.

Facts and myths about use of esketamine for treatment-resistant depression: a narrative clinical review

Introduction and aims

Treatment-resistant depression (TRD) occurs when at least two different antidepressants, taken at the right dosage, for adequate period of time and with continuity, fail to give positive clinical effects. Esketamine, the S-enantiomer of ketamine, was recently approved for TRD treatment from U.S. Food and Drug Administration and European Medicine Agency. Despite proved clinical efficacy, many misconceptions by clinicians and patients accompany this medication. We aimed to review the most common "false myths" regarding TRD and esketemine, counterarguing with evidence-based facts.

Methods

The keywords "esketamine", "treatment resistance depression", "depression", "myth", "mythology", "pharmacological treatment", and "misunderstanding" were entered in the main databases and combined through Boolean operators.

Results

Misconceptions regarding the TRD prevalence, clinical features and predictors have been found. With respect of esketamine, criteria to start treatment, dissociative symptoms, potential addiction and aspects of administration and monitoring, were found to be affected by false beliefs by clinicians and patients.

Discussion and conclusion

TRD represents a challenging condition, requiring precise diagnosis in order to achieve patient's full recovery. Esketamine has been proved as an effective medication to treat TRD, although it requires precautions. Evidence can inform clinical practice, in order to offer this innovative treatment to all patients with TRD.

Enhancing General Surgery Clerkships: The Application and Value of Standardized Patient-Based Situational Simulation Teaching

OBJECTIVE

We explored the value of a standardized patient-based situational simulation teaching method in general surgery internships.

METHODS

A prospective, single-blind, randomized controlled trial was conducted with clinical medicine undergraduates from the 2020 cohort of our university as subjects. These students were randomly divided into a traditional teaching (TT) group and a combined teaching (CT) group based on their internship schedules. The TT group followed the conventional teaching model, while the CT group engaged in the standardized patient-based situational simulation teaching method. The study compared differences in pre-internship theoretical scores, post-internship theoretical scores, medical record writing quality, and student satisfaction between the two groups.

RESULTS

The CT group (n=108) significantly outperformed the TT group (n=104) in post-internship theoretical scores and medical record writing quality (all P<0.05) and showed marked improvement in stimulating students' interest in learning (P=0.015), enhancing clinical diagnostic and treatment abilities (P<0.001), improving doctor‒patient communication skills (P<0.001), strengthening medical mission sense (P<0.001), reinforcing physicians' sense of responsibility (P<0.001), and facilitating the application of learned knowledge (P<0.001). These differences were statistically significant.

CONCLUSION

The standardized patient-based situational simulation teaching method (CT) in general surgery internships has been highly recognized by students and can enhance their clinical competency, offering considerable value for broader.

Identification of factors associated with hospitalization in an outpatient population with mental health conditions: a case-control study

Introduction

Addressing relevant determinants for preserved person-centered rehabilitation in mental health is still a major challenge. Little research focuses on factors associated with psychiatric hospitalization in exclusive outpatient settings. Some variables have been identified, but evidence across studies is inconsistent. This study aimed to identify and confirm factors associated with hospitalization in a specific outpatient population.

Methods

A retrospective monocentric case-control study with 617 adult outpatients (216 cases and 401 controls) from a French community-based care facility was conducted. Participants had an index outpatient consultation between June 2021 and February 2023. All cases, who were patients with a psychiatric hospitalization from the day after the index outpatient consultation and up to 1 year later, have been included. Controls have been randomly selected from the same facility and did not experience a psychiatric hospitalization in the 12 months following the index outpatient consultation. Data collection was performed from electronic medical records. Sociodemographic, psychiatric diagnosis, historical issues, lifestyle, and follow-up-related variables were collected retrospectively. Uni- and bivariate analyses were performed, followed by a multivariable logistic regression.

Results

Visit to a psychiatric emergency within a year (adjusted odds ratio (aOR): 13.02, 95% confidence interval (CI): 7.32-23.97), drug treatment discontinuation within a year (aOR: 6.43, 95% CI: 3.52-12.03), history of mental healthcare without consent (aOR: 5.48, 95% CI: 3.10-10.06), medical follow-up discontinuation within a year (aOR: 3.17, 95% CI: 1.70-5.95), history of attempted suicide (aOR: 2.50, 95% CI: 1.48-4.30) and unskilled job (aOR: 0.26, 95% CI: 0.10-0.65) are the independent variables found associated with hospitalization for followed up outpatients.

Conclusions

Public health policies and tools at the local and national levels should be adapted to target the identified individual determinants in order to prevent outpatients from being hospitalized.

Operational criteria application does not change clinicians' opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study

Objective

Our objective was to check if the ICD-10 operational criteria application changes non-operational, prototype-based diagnoses obtained in a real-life scenario.

Methods

Psychiatry residents applied the diagnostic criteria of the ICD-10 as a "diagnostic test" to five outpatient patients they were already following who had a prototype-based diagnosis. Tests were used to ascertain whether changes in opinion were significant and if any of the diagnostic groups were more prone to change than others. The present paper is part of the study with UTN U1111-1260-1212.

Results

Seventeen residents reviewed their last five case files, retrieving 85 diagnostic pairs of non-operational-based vs. operational-based diagnoses. The Stuart-Maxwell test did not indicate a significant opinion change (χ2 = 5.25, p = 0.39; power = 0.94) besides 30% of diagnostic changes. Despite not being statistically significant, 20.2% of all evaluations resulted in a change that would affect treatment choices. Using ICD-10 operational criteria slightly increased the number of observed diagnoses, but probably without clinical relevance. None of the non-operational diagnoses have a higher tendency to change with operational criteria application (χ2 = 11.6, p = 0.07). The female gender was associated with a higher diagnostic change tendency.

Conclusion

Applying ICD-10 operational criteria as a diagnostic test does not induce a statistically significant diagnostic opinion change in residents and no diagnostic group seems more sensible to diagnostic change. Gender-related differences in diagnostic opinion changes might be evidence of sunk cost bias. Although not statistically significant, using operational criteria after diagnostic elaboration might help to deal with subjects without adequate treatment response.

Longitudinal trajectories of psychosocial functioning in patients with pre-existing mental disorders after one year of COVID-19 pandemic

Aims of the present study were to prospectively assess psychosocial functioning trajectories during the COVID pandemic and the possible impact of sociodemographic variables, as well as of COVID-19 pandemic-related factors, on these trajectories, in a sample of patients with pre-existing severe mental disorders. Moreover, we aimed at identifying predictors of impairment in psychosocial functioning over a period of 9 months of COVID-19 pandemic. Patients were recruited during the 3rd wave of the COVID-19 pandemic (T0, March-April 2021) while strict containment measures were applied in Italy, and reassessed after 3 months (T1, June-July 2021), and after 6 months from T1 (T2- November-December 2021), during the 4th wave of COVID pandemic. A sample of 300 subject (out of the 527 subjects recruited at baseline) completed the T2 evaluation. Patients were assessed by: Work and Social Adjustment Scale (WSAS) for psychosocial functioning, Generalized Anxiety Disorder 7-Item (GAD-7) for anxiety symptoms, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms and the Impact of Events Scale-Revised, for post-traumatic symptoms. Cluster analyses identified 4 trajectories of functioning: the High, Stable Functioning group (N = 77), the Improvement Functioning group (N = 62), the Progressive Impairment group (N = 83) and the Persistent Severe Impairment group (N = 78) respectively. We found that predictors of higher WSAS score at T2 were higher WSAS score at T0 (B = 0.43, p < .001), PHQ scores at baseline >10 (B = 2.89, p < .05), while not living alone was found to be a protective factor (B = -2.5, p < .05). Results of the present study provides insights into the vulnerability of individuals with psychiatric disorders during times of crisis. Study findings can contribute to a better understanding of the specific needs of this population and inform interventions and support strategies.

Critical review of self-diagnosis of mental health conditions using artificial intelligence

The advent of artificial intelligence (AI) has revolutionised various aspects of our lives, including mental health nursing. AI-driven tools and applications have provided a convenient and accessible means for individuals to assess their mental well-being within the confines of their homes. Nonetheless, the widespread trend of self-diagnosing mental health conditions through AI poses considerable risks. This review article examines the perils associated with relying on AI for self-diagnosis in mental health, highlighting the constraints and possible adverse outcomes that can arise from such practices. It delves into the ethical, psychological, and social implications, underscoring the vital role of mental health professionals, including psychologists, psychiatrists, and nursing specialists, in providing professional assistance and guidance. This article aims to highlight the importance of seeking professional assistance and guidance in addressing mental health concerns, especially in the era of AI-driven self-diagnosis.

Longitudinal trajectories of anxiety and depression in subjects with different mental disorders after one year in the COVID-19 pandemic

The aim of this study was to prospectively assess the development and trajectories of anxiety and depressive symptoms among subjects with different mental disorders, during the 3rd wave of the COVID-19 pandemic (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A sample of 527 subjects, with different DSM-5 diagnoses, was enrolled at nine Italian psychiatric outpatient services. Assessments at T0 and T1 included the Generalized Anxiety Disorder 7-Item (GAD-7) for anxiety symptoms, and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Differences in anxiety and depressive symptoms rates emerged across different mental disorders and a general improvement at T1 was detected for all of them in both the GAD-7 and PHQ-9 scores, except for Psychosis and Obsessive-Compulsive Disorder (OCD). Patients with Feeding and Eating Disorders (FED) reported statistically significantly higher: GAD-7 scores than those with Bipolar Disorder (BD), at both times, and Anxiety Disorders at baseline; PHQ-9 scores than all other diagnostic categories, at both times. Unemployment, no COVID-19 infection, OCD were predictive variables related to GAD-7 scores at T1, while being unmarried, BD or FED related to PHQ-9 scores at T1. Subjects with mental disorders reported anxiety and depressive symptoms during the third pandemic wave and most of patients showed an improvement over a 3-month follow-up, despite differences emerged among diagnostic categories and for the variables involved. Further studies are needed to deepen knowledge on pandemic impact on patients with mental disorders.

Artificial intelligence significantly facilitates development in the mental health of college students: a bibliometric analysis

Objective

College students are currently grappling with severe mental health challenges, and research on artificial intelligence (AI) related to college students mental health, as a crucial catalyst for promoting psychological well-being, is rapidly advancing. Employing bibliometric methods, this study aim to analyze and discuss the research on AI in college student mental health.

Methods

Publications pertaining to AI and college student mental health were retrieved from the Web of Science core database. The distribution of publications were analyzed to gage the predominant productivity. Data on countries, authors, journal, and keywords were analyzed using VOSViewer, exploring collaboration patterns, disciplinary composition, research hotspots and trends.

Results

Spanning 2003 to 2023, the study encompassed 1722 publications, revealing notable insights: (1) a gradual rise in annual publications, reaching its zenith in 2022; (2) Journal of Affective Disorders and Psychiatry Research emerged were the most productive and influential sources in this field, with significant contributions from China, the United States, and their affiliated higher education institutions; (3) the primary mental health issues were depression and anxiety, with machine learning and AI having the widest range of applications; (4) an imperative for enhanced international and interdisciplinary collaboration; (5) research hotspots exploring factors influencing college student mental health and AI applications.

Conclusion

This study provides a succinct yet comprehensive overview of this field, facilitating a nuanced understanding of prospective applications of AI in college student mental health. Professionals can leverage this research to discern the advantages, risks, and potential impacts of AI in this critical field.

Radix Bupleuri aqueous extract attenuates MK801-induced schizophrenia-like symptoms in mice: Participation of intestinal flora

Schizophrenia (SCZ) is a psychotic mental disorder characterized by cognitive, behavioral, and social impairments. However, current pharmacological treatment regimens are subpar in terms of effectiveness. This study aimed to investigate the function of Radix Bupleuri aqueous extract in SCZ in mouse models. The SCZ mouse model was established by MK-801 injection and feeding of Radix Bupleuri aqueous extract or combined antibiotics. Radix Bupleuri aqueous extract significantly improved the aberrant behaviors and neuronal damage in SCZ mice, upregulated SYP and PSD-95 expression and BDNF levels in hippocampal homogenates, down-regulated DA and 5-HT levels, and suppressed microglial activation in SCZ mice. Moreover, Radix Bupleuri aqueous extract improved the integrity of the intestinal tract barrier. The 16 S rRNA sequencing of feces showed that Radix Bupleuri extract modulated the composition of gut flora. Lactobacillus abundance was decreased in SCZ mice and reversed by Radix Bupleuri aqueous extract administration which exhibited a significant negative correlation with IL-6, IL-1β, DA, and 5-HT, and a significant positive correlation with BDNF levels in hippocampal tissues. The abundance of Parabacteroides and Alloprevotella was increased in SCZ mice. It was reversed by Radix Bupleuri aqueous extract administration, which exhibited a positive correlation with IL-6, IL-1β, and 5-HT and a negative correlation with BDNF. In conclusion, Radix Bupleuri aqueous extract attenuates the inflammatory response in hippocampal tissues and modulates neurotransmitter levels, exerting its neuroprotective effect in SCZ. Meanwhile, the alteration of intestinal flora may be involved in this process, which is expected to be an underlying therapeutic option in treating SCZ.