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Shang Z, Fang C, Luo G, Lang X, Zhang X. Gender difference in the relationship between clinical symptoms, thyroid hormones, and metabolic parameters in young, first-episode and drug-naïve major depressive disorder patients with suicide attempts: A network analysis perspective. J Psychiatr Res 2024; 176:411-421. [PMID: 38959824 DOI: 10.1016/j.jpsychires.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/28/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Suicide attempts are one of the most serious comorbidities in patients with major depressive disorder (MDD), and the prevalence of suicide attempts is higher in younger people compared to older people, with significant gender differences. This study aimed to investigate the relationship between suicide attempts, clinical symptoms, thyroid hormones, and metabolic parameters in young first-episode and drug-naïve (FEND) MDD patients of different genders. METHODS A total of 1289 FEND MDD patients were recruited. Depression, anxiety, and psychotic symptoms were assessed using the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS) positive subscale, respectively. Thyroid hormones and glucolipid metabolism indicators were also tested. Network analysis was employed to delineate the interplay between thyroid dysfunction, clinical symptoms, and metabolic disorders. RESULTS Among young FEND MDD patients, the rate of suicide attempts was 17.4% in males and 19.8% in females, showing no significant gender difference in the incidence of suicide attempts (χ2 = 1.06, p = 0.303). In the network model, PANSS positive subscale (Expected Influence = 0.578) and HAMD scores (Expected Influence = 0.576) were identified as the individual symptoms that most affected male patients, whereas TSH (Thyroid-Stimulating Hormone) (Expected Influence = 0.972) and PANSS positive subscale (Expected Influence = 0.937) were identified as the individual symptoms that most affected female patients. In addition, we found that TSH (Expected Influence = 0.438) was a pivotal node connecting metabolic disturbances and clinical symptoms. CONCLUSION Our findings emphasize the important role of psychotic symptoms in young MDD patients with suicide attempts. Moreover, our results highlight the pivotal role of serum TSH levels in the pathophysiology of young female MDD patients with suicide attempts.
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Affiliation(s)
- ZhaoXuan Shang
- Department of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - ChunQing Fang
- Department of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - GuoShuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - XiangYang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Villa J, Campbell DG, Parrish EM, Jeon ME, Robison M, Joiner T, Pinkham AE, Harvey PD, Depp CA. Associations between fearlessness about death and suicidal ideation in individuals with psychosis. Schizophr Res 2024; 269:96-102. [PMID: 38761436 DOI: 10.1016/j.schres.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/13/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Despite high rates of suicide among people with psychosis, relatively little is known about the mechanisms underlying the transition from suicidal ideation to behavior in this population. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that fearlessness about death (FAD) may play a role in this relationship. The present study tested whether constructs of the IPTS [thwarted belongingness (TB), perceived burdensomeness (PB), and FAD] were associated with the severity of suicidal ideation in a sample of adults with histories of psychosis. METHOD 261 adults with histories of psychosis completed measures of IPTS constructs, current severity of suicidal ideation, and history of suicidal attempts. We examined differences between those with past suicide attempts and those without and conducted regression analyses to evaluate the associations among TB, PB, FAD and severity of current suicidal ideation. RESULTS Contrary to expectations, a history of suicidal behavior was not uniquely associated with FAD. Regression analyses revealed TB × PB and FAD × PB interactions emerged as significant correlates of the severity of suicidal ideation, with the relationship between PB and suicidal ideation more pronounced at higher levels of FAD and TB. Interestingly, positive symptoms of psychosis were positively associated with PB. IMPLICATIONS This study provides support for broadening the investigation of FAD as a contributor to suicidal ideation in individuals with psychotic symptoms. Future research investigating the role of other contributors that may influence capability for suicide (e.g., impulsivity) may add additional understanding of suicide in this population.
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Affiliation(s)
- Jennifer Villa
- Department of Psychology, University of Montana, Missoula, MT, United States of America.
| | - Duncan G Campbell
- Department of Psychology, University of Montana, Missoula, MT, United States of America
| | - Emma M Parrish
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
| | - Min Eun Jeon
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
| | - Morgan Robison
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States of America
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States of America
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
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Yang R, Li Z, Zhu Y, Wu Y, Lu X, Zhao X, Liu J, Du X, Zhang X. Non-linear relationship between TSH and psychotic symptoms on first episode and drug naïve major depressive disorder patients: a large sample sized cross-sectional study in China. BMC Psychiatry 2024; 24:413. [PMID: 38834989 DOI: 10.1186/s12888-024-05860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical outcomes. TSH may involve in the development of PD. This study aims to explore relationship between TSH and PD. METHODS A total of 1718 outpatients diagnosed as FEDN MDD were recruited in this study. The relationship between PD and TSH was evaluated using multivariable binary logistic regression analysis. To assess the presence of non-linear associations, a two-piecewise linear regression model was employed. Furthermore, interaction and stratified analyses were conducted with respect to sex, education, marital status, comorbid anxiety, and suicide attempt. RESULTS Multivariable logistic regression analysis revealed that TSH was positively associated with the risk of PD after adjusting for confounders (OR = 1.26, 95% CI: 1.11 to 1.43; p < 0.05). Smoothing plots showed a nonlinear relationship between TSH and PD, with the inflection point of TSH being 4.94 mIU/L. On the right of the inflection point, for each unit increase in serum TSH level on the right side of the inflection point, the probability of PD increased substantially by 47% (OR = 1.47, 95% CI: 1.25 to 1.73, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 0.87, 95% CI: 0.67 to 1.14, p = 0.32). CONCLUSION Our investigation showed a nonlinear TSH-PD relationship in FEDN MDD patients, thus contributing to effective intervention strategies for psychotic symptoms in depression patients.
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Affiliation(s)
- Ruchang Yang
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yingzhao Zhu
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yuxuan Wu
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Junjun Liu
- Nanjing Meishan Hospital, Nanjing, China
| | - Xiangdong Du
- Suzhou Medical College of Soochow University, Suzhou, China.
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Corbeil O, Anderson É, Béchard L, Desmeules C, Huot-Lavoie M, Bachand L, Brodeur S, Carmichael PH, Jacques C, Solmi M, Giroux I, Dorval M, Demers MF, Roy MA. Problem gambling in psychotic disorders: A systematic review and meta-analysis of prevalence. Acta Psychiatr Scand 2024; 149:445-457. [PMID: 38566334 DOI: 10.1111/acps.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Problem gambling (PBG) is more common in people with mental health disorders, including substance use, bipolar, and personality disorders, than in the general population. Although individuals with psychotic disorders might be expected to be more vulnerable to PBG, fewer studies have focused on this comorbidity. The aim of this review was to estimate the prevalence of PBG in people with psychotic disorders. METHODS Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of science, and ProQuest were searched on November 1, 2023, without language restrictions. Observational and experimental studies including individuals with psychotic disorders and reporting the prevalence of PBG were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal for systematic reviews of prevalence data. The pooled prevalence of PBG was calculated using a fixed effects generalized linear mixed model and presented through forest plots. RESULTS Of 1271 records screened, 12 studies (n = 3443) were included. The overall prevalence of PBG was 8.7% (95% CI = 7.8%-9.7%, I2 = 69%). A lower prevalence was found in studies with a low risk of bias (5.6%; 95% CI = 4.4%-7.0%) compared with studies with a moderate risk of bias (10.4%; 95% CI = 9.2%-11.7%). Different methods used to assess PBG also contributed to the heterogeneity found. CONCLUSION This meta-analysis found substantial heterogeneity, partly due to the risk of bias of the included studies and a lack of uniformity in PBG assessment. Although more research is needed to identify those at increased risk for PBG, its relatively high prevalence warrants routine screening for gambling in clinical practice.
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Affiliation(s)
- Olivier Corbeil
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
| | - Élizabeth Anderson
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- School of Psychology, Université Laval, Quebec, Quebec, Canada
| | - Laurent Béchard
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
| | - Charles Desmeules
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Maxime Huot-Lavoie
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | | | - Sébastien Brodeur
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Christian Jacques
- School of Psychology, Université Laval, Quebec, Quebec, Canada
- Centre Québécois d'Excellence pour la Prévention et le Traitement du Jeu, Quebec, Quebec, Canada
| | - Marco Solmi
- SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Isabelle Giroux
- School of Psychology, Université Laval, Quebec, Quebec, Canada
- Centre Québécois d'Excellence pour la Prévention et le Traitement du Jeu, Quebec, Quebec, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- CHU de Québec - Université Laval Research Centre, Quebec, Quebec, Canada
| | - Marie-France Demers
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
| | - Marc-André Roy
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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Liu J, Wang Y, Mu W, Liu Y, Tong R, Lu Z, Yuan H, Jia F, Zhang X, Li Z, Yang W, Du X, Zhang X. Association between triglyceride glucose index (TyG) and psychotic symptoms in patients with first-episode drug-naïve major depressive disorder. Front Psychiatry 2024; 15:1342933. [PMID: 38463431 PMCID: PMC10920251 DOI: 10.3389/fpsyt.2024.1342933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Major depressive disorder (MDD) sufferers frequently have psychotic symptoms, yet the underlying triggers remain elusive. Prior research suggests a link between insulin resistance (IR) and increased occurrence of psychotic symptoms. Hence, this study sought to investigate the potential association between psychotic symptoms in Chinese patients experiencing their first-episode drug-naïve (FEDN) MDD and the triglyceride glucose (TyG) index, an alternative measure of insulin resistance (IR). Methods Between September 2016 and December 2018, 1,718 FEDN MDD patients with an average age of 34.9 ± 12.4 years were recruited for this cross-sectional study at the First Hospital of Shanxi Medical University in China. The study collected clinical and demographic data and included assessments of anxiety, depression, and psychotic symptoms using the 14-item Hamilton Anxiety Rating Scale (HAMA), the 17-item Hamilton Depression Rating Scale (HAMD-17), and the positive subscales of the Positive and Negative Syndrome Scale (PANSS), respectively. Measurements of metabolic parameters, fasting blood glucose (FBG), and thyroid hormones were also gathered. To assess the correlation between the TyG index and the likelihood of psychotic symptoms, the study used multivariable binary logistic regression analysis. Additionally, two-segmented linear regression models were employed to investigate possible threshold effects in case non-linearity relationships were identified. Results Among the patients, 9.95% (171 out of 1,718) exhibited psychotic symptoms. Multivariable logistic regression analysis showed a positive correlation between the TyG index and the likelihood of psychotic symptoms (OR = 2.12, 95% CI: 1.21-3.74, P = 0.01) after adjusting for confounding variables. Moreover, smoothed plots revealed a nonlinear relationship with the TyG index, revealing an inflection point at 8.42. Interestingly, no significant link was observed to the left of the inflection point (OR = 0.50, 95% CI: 0.04-6.64, P = 0.60), whereas beyond this point, a positive correlation emerged between the TyG index and psychotic symptoms (OR = 2.42, 95% CI: 1.31-4.48, P = 0.01). Particularly, a considerable 142% rise in the probability of experiencing psychotic symptoms was found with each incremental elevation in the TyG index. Conclusions Understanding the non-linear link between the TyG index and the risk of psychotic symptoms in Chinese patients with FEDN MDD highlights the potential for targeted therapeutic approaches. By acknowledging the threshold effect observed, there is an opportunity to mitigate risk factors associated with IR-related psychiatric comorbidities through tailored interventions. These preliminary results stress the need for further longitudinal research to solidify these insights and contribute to more effective therapeutic strategies.
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Affiliation(s)
- Junjun Liu
- Soochow University, Suzhou, China
- Nanjing Meishan Hospital, Nanjing, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | | | - Wei Mu
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Yang Liu
- Nanjing Meishan Hospital, Nanjing, China
| | | | - Zhaomin Lu
- Nanjing Meishan Hospital, Nanjing, China
| | | | - Fengnan Jia
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wanqiu Yang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Xiangdong Du
- Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Jia H, Min Z, Yiyun C, Zhiguo W, Yousong S, Feng J, Na Z, Yiru F, Daihui P. Association between social withdrawal and suicidal ideation in patients with major depressive disorder: The mediational role of emotional symptoms. J Affect Disord 2024; 347:69-76. [PMID: 37992770 DOI: 10.1016/j.jad.2023.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The study was designed to investigate the associations between social withdrawal, emotional symptoms, and suicide ideation in patients with major depressive disorder (MDD). METHODS This cross-sectional study included 2678 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, suicide ideation, and emotional symptoms were compared in patients with different frequencies of social withdrawal. Pearson correlation, multiple linear regression analysis, and mediation analysis were employed to assess the contribution of social withdrawal to suicide ideation. RESULTS MDD patients with a higher frequency of social withdrawal were prone to have a higher frequency of suicide ideation (p for trend <0.001) and history of suicide behavior (p for trend <0.001). Multiple linear regression analysis showed that there was a dose-response relationship between social withdrawal and suicide ideation in MDD patients, but this association became insignificant after adjusting for emotional symptoms. Mediation analysis suggested that all of the emotional symptoms had significant mediating effects on the association between social withdrawal and suicide ideation in MDD patients (p < 0.05). The magnitude of mediation varied between 4.3 % and 64.3 %, with the largest mediating effect in the feeling of despair (64.3 %), helplessness (41.2 %), and loneliness (40.0 %). CONCLUSION Our study provides evidence that social withdrawal was a common clinical presentation and it may increase the risk for suicide through emotional symptoms in MDD patients. LIMITATIONS Causal conclusions could not be drawn between social withdrawal, emotional symptoms, and suicide ideation because of the cross-sectional design of the study.
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Affiliation(s)
- Huang Jia
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Zhang Min
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Cai Yiyun
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, PR China
| | - Wu Zhiguo
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Su Yousong
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Jin Feng
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Zhu Na
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Shanghai Pudong New Area Mental Health Center, Shanghai 200122, PR China
| | - Fang Yiru
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
| | - Peng Daihui
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
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Wu Y, Zhao X, Li Z, Yang R, Peng R, Zhou Y, Xia X, Deng H, Zhang X, Du X, Zhang X. Prevalence and risk factors for psychotic symptoms in young, first-episode and drug-naïve patients with major depressive disorder. BMC Psychiatry 2024; 24:66. [PMID: 38262974 PMCID: PMC10807072 DOI: 10.1186/s12888-024-05517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a common psychiatric disorder worldwide. Psychotic depression has been reported to be frequently under-diagnosed due to poor recognition of psychotic features. Therefore, the purpose of this study was to reveal the rate and risk factors of psychotic symptoms in young, drug-naïve patients with major depressive disorder at the time of their first episode. METHODS A total of 917 patients were recruited and divided into psychotic and non-psychotic subgroups based on the Positive and Negative Syndrome Scale (PANSS) positive subscale score. Anxiety symptoms and depressive symptoms were measured by the Hamilton Anxiety Rating Scale (HAMA) and the 17-item Hamilton Depression Rating Scale (HAMD-17), respectively. Several biochemical indicators such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were also measured. RESULTS The rate of psychotic symptoms among young adult MDD patients was 9.1%. There were significant differences in TSH (p<0.001), FBG (p<0.001), TC (p<0.0001), TG (p = 0.001), HDL-C (p = 0.049), LDL-C (p = 0.010), diastolic blood pressure (DP) (p<0.001), systolic blood pressure (SP) (p<0.001), and HAMD total score (p<0.001) between young MDD patients with and without psychotic depression. HAMD, TSH, TC, and severe anxiety were independently associated with psychotic symptoms in young adult MDD patients. In addition, among young MDD patients, the rate of suicide attempts in the psychotic subgroup was much higher than in the non-psychotic subgroup (45.8% vs. 16.9%). CONCLUSIONS Our findings suggest that psychotic symptoms are common in young MDD patients. Several clinical variables and biochemical indicators are associated with the occurrence of psychotic symptoms in young MDD patients.
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Affiliation(s)
- Yuxuan Wu
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruchang Yang
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruijie Peng
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yue Zhou
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Xuzhou Medical University, Xuzhou, China
| | - Xingzhi Xia
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Xuzhou Medical University, Xuzhou, China
| | - Hanxu Deng
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Xuzhou Medical University, Xuzhou, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Medical College of Soochow University, Suzhou, China.
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoying District, Beijing, 100101, China.
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Swetlitz N, Hinton L, Rivera M, Liu M, Fernandez AC, Garcia ME. Barriers and facilitators to depression care among Latino men in a primary care setting: a qualitative study. BMC PRIMARY CARE 2024; 25:30. [PMID: 38245674 PMCID: PMC10799470 DOI: 10.1186/s12875-024-02275-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND In the United States, Latinos face a wide array of cultural and structural barriers to accessing and utilizing mental health care. Latino men specifically are at high risk of receiving inadequate mental health care, possibly due to additional obstacles they experience that are related to masculinity. Among men more generally, greater adherence to emotional control and self-reliance is associated with higher depression severity and less depression help-seeking. Men experience more stigma toward depression and help-seeking and are less likely to be diagnosed with depression than women. However, Latino men's barriers and facilitators to depression care remain largely unexplored. The objective of this study was to examine barriers and facilitators to depression care that are related to masculinity among English- and Spanish-speaking Latino men in a primary care setting. METHODS We used convenience and purposive sampling to recruit primary care patients who self-identified as Latino men, spoke English or Spanish, and screened positive for depressive symptoms on the Patient Health Questionnaire-2 or had a history of depression. Semi-structured interviews were conducted between December 2020 and August 2021. The interview guide examined views and experiences of depression, masculinity, and barriers and facilitators to engaging in depression care. Utilizing consensual qualitative research and thematic analysis informed by modified grounded theory, barriers and facilitators to depression care were identified. RESULTS We interviewed thirteen participants who varied in English proficiency, education, income, and country of origin. Barriers and facilitators were placed into three domains-Self-Recognition of Depression, Seeking Help for Depression, and Depression Diagnosis and Treatment. Participants described aspects of masculinity as barriers (emotional control and pressure to provide), facilitators (honesty, courage, collaboration, practicality, and responsibility), or both (self-reliance and autonomy). CONCLUSIONS Masculinity influences barriers and facilitators for depression care among Latino men at the levels of self-recognition, seeking help, and diagnosis and treatment. Clinicians may promote Latino men's engagement in depression care by understanding patients' values and framing depression care as affirming masculinity. Providing education to primary care physicians and other healthcare professionals on gender and depression and addressing structural barriers are essential to providing access to all who need depression care.
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Affiliation(s)
- Nathan Swetlitz
- UC Berkeley, UCSF Joint Medical Program, University of California, Berkeley, Berkeley, CA, USA.
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Morgan Rivera
- University of California, Berkeley, Berkely, CA, USA
| | - Mishen Liu
- University of California, Berkeley, Berkely, CA, USA
| | - Anna Claire Fernandez
- UC Berkeley, UCSF Joint Medical Program, University of California, Berkeley, Berkeley, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria E Garcia
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, San Francisco, CA, USA
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Zhu Q, Lang X, Zhang XY. Gender differences in prevalence and clinical risk factors of suicide attempts in young adults with first-episode drug-naive major depressive disorder. BJPsych Open 2024; 10:e19. [PMID: 38179592 PMCID: PMC10790225 DOI: 10.1192/bjo.2023.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Suicide rates in adolescents with major depressive disorder (MDD) change with age and gender. Early adulthood is an important transitional stage between late adolescence and adulthood, in which an individual's mind gradually matures. However, there are fewer studies on prevalence and variables linked to the suicide attempts of young adults with MDD. AIMS To explore gender differences in the prevalence and risk factors associated with suicide attempts in young adults with first-episode drug-naive MDD. METHOD The Hamilton Rating Scale for Depression (HRSD), Hamilton Rating Scale for Anxiety (HRSA) and Positive Subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess depression, anxiety and psychotic symptoms respectively and various biochemical indicators were assessed. RESULTS Among 293 young adults with first-episode drug-naive MDD, the prevalence of suicide attempts was 15.45% (19/123) for males and 14.12% (24/170) for females. Males with suicide attempts had higher levels of thyroid-stimulating hormone (TSH) and higher PANSS Positive Subscale scores, whereas females with suicide attempts had higher TSH, serum total cholesterol, fasting blood glucose and diastolic blood pressure levels and higher scores on the HRSD, HRSA, PANSS Positive Subscale (all Bonferroni corrected P < 0.05). In males, PANSS Positive Subscale score (B = 0.17, P = 0.03, OR = 1.19, 95% CI 1.02-1.38) was a risk factor for suicide attempts. CONCLUSIONS There were significant gender differences in the risk factors for suicide attempts in young adults with first-episode drug-naive MDD.
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Affiliation(s)
- Quanfeng Zhu
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Xiaoe Lang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; and Department of Psychology, University of the Chinese Academy of Sciences, Beijing, China
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10
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Rothschild AJ. Maintenance treatment of psychotic depression: Is antipsychotic medication needed? Acta Psychiatr Scand 2024; 149:3-5. [PMID: 38086542 DOI: 10.1111/acps.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Chan Medical School and UMass Memorial Health Care, Worcester, Massachusetts, USA
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11
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Shang Z, Lang X, Wang J, Zhang X. Prevalence and risk factors of suicide attempts in young, first-episode and drug-naïve Chinese Han outpatients with psychotic major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01698-4. [PMID: 37878033 DOI: 10.1007/s00406-023-01698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
This study investigates the relationship between psychotic symptoms and suicide attempts in young first-episode, drug-naive Chinese Han outpatients diagnosed with Major Depressive Disorder (MDD). The prevalence of Psychotic Major Depressive Disorder (PMD) was found to be 8.3% among the enrolled MDD patients. The study assessed 1289 participants using various scales to evaluate the severity of clinical symptoms, including the CGI-S, the HAMD, the HAMA, and the PANSS positive subscale. Additionally, thyroid hormone and glucolipid metabolism indicators were examined. The findings indicate that among patients with PMD, 41.12% had recent suicide attempts, while 6.54% had previous suicide attempts. Patients who recently attempted suicide exhibited higher scores on the HAMA and CGI scales, along with elevated serum levels of Thyroid-Stimulating Hormone (TSH) and total cholesterol (TC), as well as higher systolic and diastolic blood pressure. Notably, TSH levels independently correlated with recent suicide attempts in PMD patients, with an impressive area under the receiver operating characteristic curve (AUROC) of 0.923. Furthermore, the subgroup of patients with previous suicide attempts displayed longer illness duration and higher HAMD scores. Duration of illness and HAMD were found to be independently associated with previous suicide attempts among PMD patients, with a combined predictive effect showing a robust AUROC of 0.910. In conclusion, this study highlights the significant prevalence of recent and previous suicide attempts among young Chinese Han outpatients with PMD. The identification of risk factors, especially the link between TSH levels and recent suicide attempts, offers valuable insights for clinicians to develop targeted interventions and preventive strategies for this vulnerable patient population.
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Affiliation(s)
- ZhaoXuan Shang
- Department of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jikun Wang
- Department of Psychology and Cognitive Science, East China Normal University, Shanghai, China.
| | - XiangYang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, Beijing, China.
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12
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Yang W, Wang X, Kang C, Yang L, Liu D, Zhao N, Zhang X. Establishment of a risk prediction model for suicide attempts in first-episode and drug naïve patients with major depressive disorder. Asian J Psychiatr 2023; 88:103732. [PMID: 37586124 DOI: 10.1016/j.ajp.2023.103732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Suicide is common in patients with major depressive disorder (MDD) and has serious consequences for individuals and families. This study aims to establish a risk prediction model for suicide attempts in MDD patients to make the detection of suicide risk more accurate and effective. METHODS A cross-sectional survey, clinical examination, and biochemical indicator tests were performed on 1718 first-episode and drug naïve patients with major depressive disorder. We used Machine Learning to establish a risk prediction model for suicide attempts in FEDN patients with MDD. RESULTS Five predictors were identified by LASSO regression analysis from a total of 20 variables studied, namely psychotic symptoms, anxiety symptoms, thyroid peroxidase antibodies (ATPO), total cholesterol (TC), and high-density lipoprotein-cholesterol (HDL-C). The model constructed using the five predictors displayed moderate predictive ability, with an area under the ROC of 0.771 in the training set and 0.720 in the validation set. The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 22 % and 60 %. The risk threshold was found to be between 20 % and 60 % in external validation. CONCLUSION Introducing psychotic symptoms, anxiety symptoms, ATPO, TC, and HDL-C to the risk nomogram increased its usefulness for predicting suicide risk in patients with MDD. It may be useful in clinical decision-making or in discussions with patients, especially in crisis interventions.
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Affiliation(s)
- Wanqiu Yang
- School of Ethnology and Sociology, Yunnan University, Kunming, China; School of Medicine, Yunnan University, Kunming, China
| | - Xiaohong Wang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chuanyi Kang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Liying Yang
- Dalian Seventh People's Hospital (Dalian Mental Health Center), Dalian, China
| | - Di Liu
- School of Marxism, Harbin Medical University, China
| | - Na Zhao
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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13
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Marx W, Penninx BWJH, Solmi M, Furukawa TA, Firth J, Carvalho AF, Berk M. Major depressive disorder. Nat Rev Dis Primers 2023; 9:44. [PMID: 37620370 DOI: 10.1038/s41572-023-00454-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/26/2023]
Abstract
Major depressive disorder (MDD) is characterized by persistent depressed mood, loss of interest or pleasure in previously enjoyable activities, recurrent thoughts of death, and physical and cognitive symptoms. People with MDD can have reduced quality of life owing to the disorder itself as well as related medical comorbidities, social factors, and impaired functional outcomes. MDD is a complex disorder that cannot be fully explained by any one single established biological or environmental pathway. Instead, MDD seems to be caused by a combination of genetic, environmental, psychological and biological factors. Treatment for MDD commonly involves pharmacological therapy with antidepressant medications, psychotherapy or a combination of both. In people with severe and/or treatment-resistant MDD, other biological therapies, such as electroconvulsive therapy, may also be offered.
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Affiliation(s)
- Wolfgang Marx
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andre F Carvalho
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
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14
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Sarfo JO, Amoadu M, Obeng P, Gbordzoe NI, Debrah TP, Ofori COB, Hagan JE. Suicidal Behaviour among School-Going Adolescents in Saint Lucia: Analysis of Prevalence and Associated Factors. Behav Sci (Basel) 2023; 13:535. [PMID: 37503982 PMCID: PMC10376735 DOI: 10.3390/bs13070535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Suicide poses a debilitating threat to adolescents' lives worldwide. Although suicide prevention efforts are evident globally, there is limited evidence on the prevalence and correlations of suicidal behaviour among school-going adolescents in Saint Lucia. We used a dataset from the 2018 Global School-based Student Health Survey to examine the prevalence and associated factors of suicidal behaviour among 1864 students from schools in Saint Lucia. Prevalence rates of 25.5%, 22.1%, and 17.5% were found for suicidal ideation, suicide plan, and suicide attempt, respectively. After adjusting for other factors, being male and having understanding parents were protective against suicidal behaviour. However, suicidal ideation was predicted by being physically attacked and bullied, parental guidance, tobacco use, loneliness, and worry. Moreover, being a victim of physical attacks and bullying, having close friends, being lonely, and worrying were predictive of making suicidal plans among adolescents. Attempting suicide was predicted by cigarette smoking, current use of tobacco and related products, bullying, having close friends, being lonely, and worrying. School-based preventive interventions are required to help address triggers of suicidal behaviour among adolescents in Saint Lucia and to help attain the targets for suicide prevention in the global Sustainable Development Goals.
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Affiliation(s)
- Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana
| | - Mustapha Amoadu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana
| | - Paul Obeng
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana
| | | | - Timothy Pritchard Debrah
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi 00233, Ghana
| | | | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
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15
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Li Y, Liao Z, Huang Q, Wang Q, Ren H, Chen X, Lin S, Wang C, Tang Y, Hao J, Wang X, Shen H, Zhang X. Prevalence and influencing factors of suicide in first-episode and drug-naive young major depressive disorder patients with impaired fasting glucose: a cross-sectional study. Front Psychiatry 2023; 14:1171814. [PMID: 37363165 PMCID: PMC10289199 DOI: 10.3389/fpsyt.2023.1171814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background An association exists between major depression disorder (MDD), suicide attempts, and glucose metabolism, but suicide attempts in young MDD patients with comorbid impaired fasting glucose (IFG) have been less well studied. The purpose of this study was to examine the prevalence and risk factors for suicide attempts in young, first-episode, drug-naive (FEDN) MDD patients with comorbid IFG. Methods We recruited 917 young patients with FEDN MDD, 116 of whom were judged to have combined IFG because their blood glucose was >6.0. We collected anthropological and clinical data on all of them. The Hamilton Depression Scale (HAMD) score, the Hamilton Anxiety Scale (HAMA) score and the Positive and Negative Syndrome Scale (PANSS) positive subscale score were used to assess their clinical symptoms. Blood glucose, plasma thyroid function and lipid indicators were measured. Results The prevalence of suicide attempts in young MDD patients with IFG was 32.8% (38/116). Furthermore, among young MDD patients with comorbid IFG, suicide attempters had more severe depression and anxiety symptoms, more comorbid psychotic symptom, higher levels of antibody of thyroid stimulating hormone and thyroid peroxidases (TPOAb), and more severe lipid metabolism disorders than those without suicide attempts. In addition, HAMA scores and TPOAb were independently associated with suicide attempts in young patients with FEDN MDD. Conclusion Our study suggests that young MDD patients with IFG have a high rate of suicide attempts. Some clinical symptoms and thyroid function parameters may be the risk factor for suicide attempts in young MDD patients with impaired glucose metabolism.
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Affiliation(s)
- Yifan Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhenjiang Liao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuping Huang
- Department of Applied Psychology, School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, China
| | - Qianjin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Honghong Ren
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xinxin Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shuhong Lin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chenhan Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ying Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingyue Hao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xuhao Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hongxian Shen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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16
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Yang R, Zhu F, Yue Y, Lu X, Zhu P, Li Z, Zhao X, Yang X, Zhou Y, Du X. Association between thyroid function and psychotic symptoms in adolescents with major depressive disorder: A large sample sized cross-sectional study in China. Heliyon 2023; 9:e16770. [PMID: 37303557 PMCID: PMC10248252 DOI: 10.1016/j.heliyon.2023.e16770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Backgrounds Thyroid function was associated with depression and psychotic symptoms; however, little research has focused on its role in coexisting psychotic symptoms in adolescents with depressive disorder. This study aimed to explore the association between thyroid function and psychotic symptoms among depression adolescents. Methods A total of 679 adolescent patients (aged 12-18) diagnosed as depressive disorder were recruited. Their socio-demographic, clinical data and thyroid function parameters were collected. The severity of psychotic symptoms was measured according to the assessment measure in DSM-5. Based on the severity of psychotic symptoms, patients were distributed into psychotic depression (PD) and non-psychotic depression (NPD) subgroups, respectively. Results The prevalence rate of PD was 52.7% among adolescents with depressive disorder in this study. PD patients were younger (p < 0.01), with more female (p < 0.001) and non-Han nationality (p < 0.01), and presented serum FT4 level decrease (p < 0.01). PD patients displayed a higher rate of abnormal thyroid relevant parameters (p < 0.05). 35.2% of PD patients presented at least one abnormal parameter among all five parameters tested (TSH, TT3, FT3, TT4, and FT4), compared to 27.4% among NPD patients. Further logistic regression analysis indicated that increased serum FT4 level was a protective effect of PD with an adjusted odds ratio (OR) of 0.615. We did not find a statistically significant difference in the family history of mental disorders, serum TSH, TT3, FT3, and TT4 levels. Conclusions Our results suggested a high prevalence of PD among depression adolescents, associated with younger age, female, non-Han nationality, and decreased serum FT4 level. We recommend that adolescents with depressive disorder regularly screen their serum FT4 levels for better clinical outcomes.
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Affiliation(s)
- Ruchang Yang
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Feng Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yan Yue
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ping Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xuna Yang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
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Liu S, Lin K, Zhang Y, Gao Y, Wang W, Du M, Jiang T, Zhou M, Zhang X. Prevalence and risk factors of psychotic symptoms in middle-aged patients with first-episode drug-naïve major depressive disorder: A large-scale cross-sectional study. J Affect Disord 2023; 325:102-109. [PMID: 36623569 DOI: 10.1016/j.jad.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychotic symptoms are common in patients with major depressive disorder (MDD). However, few studies have assessed the incidence of comorbid psychotic symptoms in first-episode drug naïve (FEDN) MDD patients. The present study aimed to evaluate the prevalence and risk factors of psychotic symptoms in a large sample of middle-aged Chinese patients with FEDN MDD. METHODS 813 middle-aged (age range 35 to 65 years) outpatients with FEDN MDD were recruited. The 17-item Hamilton Rating Scale for Depression (HAMD), the 14-item Hamilton Anxiety Rating Scale (HAMA), and the positive subscales of the Positive and Negative Syndrome Scale (PANSS) were used to assess patient anxiety, depression and psychotic symptoms, respectively. RESULTS The prevalence of psychotic symptoms in middle-aged patients with FEND MDD was 10.95 %. Multivariate logistic regression analysis showed that HAMA score, HAMD score, TSH, TC and BMI levels were significant predictors of psychotic symptoms in MDD middle-aged patients. The HAMA score and HAMD score predicted psychotic symptoms for both male and female middle-aged patients with MDD, while higher TSH, TC and BMI levels were correlated with psychotic symptoms only in female MDD patients. Furthermore, combining the HAMA score, HAMD score, and TSH could differentiate between psychotic major depression (PMD) and nonpsychotic major depression (NPMD) in middle-aged patients. CONCLUSIONS Psychotic symptoms among middle-aged patients with MDD can be identified by integrating clinical and biological variables as early as possible during the first time see a doctor.
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Affiliation(s)
- Shilin Liu
- Department of Neurocritical Care Unit, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Keyi Lin
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Public Health Clinical Center, Hefei, Anhui, 230001, China
| | - Yang Zhang
- Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Yaotian Gao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Public Health Clinical Center, Hefei, Anhui, 230001, China
| | - Wei Wang
- Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Mengcheng Du
- Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Tao Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Public Health Clinical Center, Hefei, Anhui, 230001, China; Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Provincial Institute of Translational Medicine, Hefei, Anhui, 230001, China.
| | - Min Zhou
- Department of Neurocritical Care Unit, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
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18
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Global prevalence of depression in older adults: A systematic review and meta-analysis of epidemiological surveys. Asian J Psychiatr 2023; 80:103417. [PMID: 36587492 DOI: 10.1016/j.ajp.2022.103417] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The reported prevalence of depressive symptoms (depression hereafter) among older adults varied widely across different studies. This was a meta-analysis to systematically examine the global prevalence of depression among older populations and its associated factors. METHODS A systematic literature search was performed in PubMed, EMBASE, PsycINFO, and Web of Science. Due to the differences in demographic and clinical characteristics between studies, random-effects model was used to calculate the pooled prevalence of depression and its 95% confidence interval (95% CI). RESULTS In total, 55 studies with 59,851 individuals met the study criteria and were included in the analyses. The overall prevalence of depression was 35.1% (95%CI: 30.2-40.4%). Subgroup analyses revealed that different sampling methods (Q=10592.49, p = 0.037), Geriatric Depression Scale versions (Q=13712.55, p < 0.001) and income levels (Q=14.028, P < 0.001) were significantly associated with the pooled prevalence of depression in older adults. In the meta-regression analyses, time of survey (B=0.012, z = 2.30, p = 0.029) was positively associated, and mean age (B=-0.018, z = 2.10, p = 0.044) was negatively associated with the prevalence of depression in older populations. The funnel plot and Egger's test did not reveal any significant publication bias (Egger's test: t = 1.93, p = 0.059). CONCLUSION This meta-analysis found that over a third of older populations globally had depression. Effective preventive measures, regular screening and timely interventions are needed to address this highly prevalent public health problem among older adults.
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Paljärvi T, Tiihonen J, Lähteenvuo M, Tanskanen A, Fazel S, Taipale H. Psychotic depression and deaths due to suicide. J Affect Disord 2023; 321:28-32. [PMID: 36280195 DOI: 10.1016/j.jad.2022.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to establish the risk of suicide associated with incident psychotic depression (PD) compared to incident non-psychotic severe depression (NPD). METHODS This cohort study used routine data from nationwide health registers in Finland. Eligible participants were aged 18-59 years at the index diagnosis. Causes of death were defined by the International Classification of Diseases, 10th revision codes. The follow-up time was up to five years. Adjusted Cox regression models were used to analyse risk of death by method of suicide. RESULTS We included 17,331 individuals with incident PD and 85,989 individuals with incident NPD. Most of the deaths due to suicides occurred within the first two years after the index diagnosis. Compared to NPD, PD was associated with an overall two-fold increased risk of suicide (adjusted hazard ratio, (aHR) 2.19, 95 % confidence interval (CI) 1.95, 2.46), after adjusting for psychiatric comorbidities. In PD, the highest relative risks were for impact-related suicides (aHR 3.03, 95%CI 2.23, 4.13) and for suffocation-related suicides (aHR 2.72, 95%CI 2.23, 3.30), whereas the lowest relative risk was for intentional poisonings (aHR 1.66, 95%CI 1.37, 2.02). LIMITATIONS Information on all potential confounders is not available in studies using routine data. CONCLUSIONS Psychotic symptoms doubled the risk of suicides over and above of the risk that was associated with severe depression, after controlling for comorbid psychiatric disorders. The severity of suicidal ideation may be higher in PD than in NPD, which then leads to more lethal methods of self-harm.
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Affiliation(s)
- Tapio Paljärvi
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, OX3 7JX Oxford, United Kingdom
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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Paljärvi T, Tiihonen J, Lähteenvuo M, Tanskanen A, Fazel S, Taipale H. Mortality in psychotic depression: 18-year follow-up study. Br J Psychiatry 2023; 222:37-43. [PMID: 36250518 PMCID: PMC10895511 DOI: 10.1192/bjp.2022.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on the role of co-occurring psychiatric disorders in mortality associated with psychotic depression is limited. AIMS To estimate the risk of cause-specific mortality in psychotic depression compared with severe non-psychotic depression while controlling for comorbid psychiatric disorders. METHOD This cohort study used routine data from nationwide health registers in Finland. Eligible participants had their first diagnosis for psychotic depression or for severe non-psychotic depression between the years 2000 and 2018, had no pre-existing diagnoses for schizophrenia spectrum disorders or bipolar disorder, and were aged 18-65 years at the index diagnosis. Causes of death were defined by ICD-10 codes. The follow-up time was up to 18 years. RESULTS We included 19 064 individuals with incident psychotic depression and 90 877 individuals with incident non-psychotic depression. Half (1199/2188) of the deaths in those with psychotic depression occurred within 5 years from the index diagnosis and the highest relative risk was during the first year after the diagnosis. Compared with individuals with non-psychotic depression, those with psychotic depression had a higher risk of all-cause mortality (adjusted hazard ratio, aHR = 1.59, 95% CI 1.48-1.70), suicides (aHR = 2.36, 95% CI 2.11-2.64) and fatal accidents (aHR 1.63, 95% CI 1.26-2.10) during the subsequent 5-year period after the index diagnosis. CONCLUSIONS Psychotic symptoms markedly added to the mortality risk associated with severe depression after controlling for psychiatric comorbidity. Prompt treatment and enhanced monitoring for psychotic symptoms is warranted in all patients with severe depression to prevent deaths because of suicides and other external causes.
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Affiliation(s)
- Tapio Paljärvi
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; and Department of Psychiatry, Oxford University, Warneford Hospital, UK
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; and Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; and Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Seena Fazel
- Department of Psychiatry, Oxford University, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and School of Pharmacy, University of Eastern Finland, Finland
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21
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Bio-behavioural changes in treatment-resistant socially isolated FSL rats show variable or improved response to combined fluoxetine-olanzapine versus olanzapine treatment. IBRO Neurosci Rep 2022; 13:284-298. [PMID: 36204253 PMCID: PMC9529672 DOI: 10.1016/j.ibneur.2022.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/14/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
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22
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Liu X, Liu M, Li H, Mo L, Liu X. Transition from Depression to Suicidal Attempt in Young Adults: The Mediation Effect of Self-Esteem and Interpersonal Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14342. [PMID: 36361235 PMCID: PMC9656722 DOI: 10.3390/ijerph192114342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Depression increases the risk of suicide. Depression and suicide attempts are significantly impacted by low self-esteem and interpersonal needs (i.e., thwarted belongingness (TB) and perceived burdensomeness (PB)). More research is required to clarify how these factors affected the change from depression to suicidal attempts, which would dramatically lower the suicide fatality rate. We sought to examine the mediating roles of self-esteem, TB, and PB in Chinese young adults, since previous research shows that self-esteem has a strong relationship with TB, while TB and PB have strong relationships with suicide attempts. METHODS Measures on depression, interpersonal needs, and attempted suicide were completed by a sample of 247 Chinese social media users who had stated suicidal ideation online. RESULTS The findings showed that people who attempted suicide had significantly higher levels of TB and PB. Suicidal attempts were also impacted by depression via the mediational chains, which included self-esteem, TB, and PB. CONCLUSIONS Our findings might contribute to the expansion of the interpersonal theory of suicide and have an impact on effective suicide prevention.
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Affiliation(s)
- Xingyun Liu
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan 430079, China
| | - Miao Liu
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan 430079, China
| | - He Li
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Liuling Mo
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiaoqian Liu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
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23
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Grover LE, Jones R, Bass NJ, McQuillin A. The differential associations of positive and negative symptoms with suicidality. Schizophr Res 2022; 248:42-49. [PMID: 35933743 DOI: 10.1016/j.schres.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/27/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Suicide is one of the leading causes of death in people with schizophrenia. Identifying risk factors for suicide in schizophrenia is therefore an important clinical and research priority. METHOD A cross-sectional secondary analysis was conducted on the DNA Polymorphisms in Mental Illness Study (DPIM) data. Suicidality data was extracted, and the number of positive and negative symptoms were established for a total of 1494 participants. Logistic and negative binomial regression analyses were conducted to assess for associations between positive or negative symptoms and suicidal ideation, attempt, or number of attempts, whilst adjusting for potential confounders. RESULTS Negative symptoms were associated with a reduction in the risk of suicidal ideation (odds ratio [OR]: 0.83; 95 % CI: 0.75-0.91) and suicide attempt (OR: 0.79; 95 % CI: 0.71-0.88) after adjusting for age and sex. Positive symptoms were associated with an increased risk of suicidal ideation (OR: 1.06; 95 % CI: 1.03-1.09), suicide attempt (OR: 1.04; 95 % CI: 1.00-1.07) and number of suicide attempts (incidence rate ratio [IRR]: 1.05; 95 % CI: 1.01-1.08). Further adjusting for depressive symptoms slightly increased the magnitude of associations with negative symptoms but attenuated associations between positive symptoms and suicidality to the null. CONCLUSIONS Negative symptoms are associated with a reduced risk of suicidality, whilst positive symptoms are associated with an increased risk of suicidality. Depressive symptoms may confound or mediate these associations.
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Affiliation(s)
- Laura E Grover
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
| | - Rebecca Jones
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Nicholas J Bass
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
| | - Andrew McQuillin
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
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24
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Ye G, Li Z, Yue Y, Wu Y, Yang R, Wang H, Wu S, Zhou Y, Zhao X, Lv X, Yuan N, Li R, Zhang G, Ganapathi PB, Wu HE, Du X, Zhang XY. Suicide attempt rate and the risk factors in young, first-episode and drug-naïve Chinese Han patients with major depressive disorder. BMC Psychiatry 2022; 22:612. [PMID: 36114485 PMCID: PMC9479358 DOI: 10.1186/s12888-022-04254-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/06/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In recent years, the rates of suicide among young people have been increasing, and major depressive disorder (MDD) is regarded to be its main cause. Many factors such as thyroid dysfunction and metabolic abnormalities are thought to mediate this process, but the conclusions are inconsistent. This study investigated the rate of suicide attempts and associated risk factors among young, first-episode and drug-naïve Chinese Han patients with MDD. METHODS A total of 917 patients with MDD (aged 18 ~ 35 years) were recruited. Demographic and clinical data were collected and thyroid function, fasting blood glucose and lipid profiles were measured. The Hamilton Depression Rating Scale-17 items (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), positive symptom subscale of Positive and Negative Syndrome Scale (PANSS) and clinical global impression of severity scale (CGI-S) were adopted to assess depression, anxiety, psychotic symptoms and disease severity respectively. RESULTS The rate of suicide attempts was 19.5% in young MDD patients. There were significant differences in age (p = 0.003), education level (p = 0.001), age of onset (p = 0.004) and disease duration (p = 0.001) between patients with and without suicide attempts. Compared with patients without suicide attempts, patients with suicide attempts had significantly higher scores on the HAMD-17, HAMA, PANSS positive symptom subscale and CGI-S (all p < 0.001). Patients with suicide attempts had significantly higher levels of TSH (p < 0.001), TgAb (p = 0.004), TPOAb (p < 0.001), TG (p = 0.016), TC (p < 0.001), LDL (p < 0.001), and fasting glucose (p < 0.001), but significantly lower levels of HDL (p < 0.001). Logistic regression analysis showed that marital status (OR = 0.515, 95%CI: 0.280-0.950, p = 0.515), disease duration (OR = 1.100, 95%CI: 1.013-1.194, p = 0.024), HAMA score (OR = 1.313, 95%CI: 1.205-1.430, p < 0.001), CGI-S score (OR = 1.875, 95%CI: 1.339-2.624, p < 0.001), levels of FT3(OR = 0.717, 95%CI: 0.536-0.959, p = 0.025), TPOAb (OR = 1.004, 95%CI: 1.002-1.006, p < 0.001), TC (OR = 1.330, 95%CI: 1.011-1.750, p = 0.042) and LDL (OR = 0.736, 95%CI: 0.558-0.971, p = 0.030) were all independently associated with suicide attempts in young MDD patients. CONCLUSIONS In China, the rate of suicide attempts in young patients with MDD is quite high and thyroid dysfunction and metabolic abnormalities may be implicated in its pathogenesis.
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Affiliation(s)
- Gang Ye
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China
| | - Zhe Li
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China
| | - Yan Yue
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China ,grid.263761.70000 0001 0198 0694Medical College of Soochow University, Suzhou, China
| | - Yuxuan Wu
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China ,grid.263761.70000 0001 0198 0694Medical College of Soochow University, Suzhou, China
| | - Ruchang Yang
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China ,grid.263761.70000 0001 0198 0694Medical College of Soochow University, Suzhou, China
| | - Haitao Wang
- grid.440734.00000 0001 0707 0296School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Siqi Wu
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China ,grid.440734.00000 0001 0707 0296School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Yue Zhou
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China ,grid.417303.20000 0000 9927 0537Xuzhou Medical University, Xuzhou, China
| | - Xueli Zhao
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China
| | - Xiaoli Lv
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China
| | - Nian Yuan
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China
| | - Ronghua Li
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China
| | - Guangya Zhang
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137 Suzhou, Jiangsu Province PR China
| | - Pallavi B. Ganapathi
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Hanjing Emily Wu
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, 215137, Suzhou, Jiangsu Province, PR China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Li X, Mu F, Liu D, Zhu J, Yue S, Liu M, Liu Y, Wang J. Predictors of suicidal ideation, suicide attempt and suicide death among people with major depressive disorder: A systematic review and meta-analysis of cohort studies. J Affect Disord 2022; 302:332-351. [PMID: 35101521 DOI: 10.1016/j.jad.2022.01.103] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Xinming Li
- School of Mental Health, Jining Medical University, Jining 272013, China; Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan 250014, China
| | - Fuqin Mu
- School of Basic Medicine, Jinzhou Medical University, Jinzhou 121002, China
| | - Debiao Liu
- School of Mental Health, Jining Medical University, Jining 272013, China
| | - Jin Zhu
- School of Mental Health, Jining Medical University, Jining 272013, China; Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining 272013, China; Shandong Collaborative Innovation Center for Diagnosis & Treatment & Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining 272013, China; Center of Evidence-Based Medicine, Jining Medical University, Jining 272013, China
| | - Song Yue
- School of Mental Health, Jining Medical University, Jining 272013, China; Department of Pathology, Weifang Medical University, Weifang 261053, China
| | - Min Liu
- School of Mental Health, Jining Medical University, Jining 272013, China
| | - Yan Liu
- School of Mental Health, Jining Medical University, Jining 272013, China; Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining 272013, China; Shandong Collaborative Innovation Center for Diagnosis & Treatment & Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining 272013, China; Center of Evidence-Based Medicine, Jining Medical University, Jining 272013, China.
| | - JianLi Wang
- School of Mental Health, Jining Medical University, Jining 272013, China; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa K1Z 7K4, Canada; The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa K1Z 7K4, Canada.
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26
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Xin LM, Su YA, Yan F, Yang FD, Wang G, Fang YR, Lu Z, Yang HC, Hu J, Chen ZY, Huang Y, Sun J, Wang XP, Li HC, Zhang JB, Li JT, Si TM. Prevalence, clinical features and prescription patterns of psychotropic medications for patients with psychotic depression in China. J Affect Disord 2022; 301:248-252. [PMID: 35038478 DOI: 10.1016/j.jad.2022.01.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the prevalence of psychotic depression and the differences in sociodemographic and clinical characteristics and prescription patterns of psychotropic medications between patients with psychotic depression (PD) and patients with nonpsychotic depression (NPD) in China. METHODS We conducted a cross-sectional study in 13 major psychiatric hospitals or the psychiatric units of general hospitals in China from September 1, 2010, to February 28, 2011. PD was defined according to the psychotic disorder section of the Mini International Neuropsychiatric Interview (MINI). The sociodemographic and clinical characteristics and the prescription patterns of psychotropic medications were compared between the PD and NPD groups. Multivariate logistic regression analysis was used to investigate factors associated with an increased likelihood of PD. RESULTS Among 1172 MDD patients, the prevalence of psychotic features was 9.2% in the present study. The logistic regression analysis indicated that unmarried (OR = 2.08, p < 0.001), frequent depressive episodes (OR = 2.10, p = 0.020), depressive episodes with suicidal ideation and attempts (OR = 1.91, p = 0.004), and patients who were prescribed any antipsychotics (OR = 2.94, p < 0.001) were associated with psychotic features in patients with MDD. LIMITATIONS Cross-sectional design, retrospective recall of some data CONCLUSION: The prevalence of PD is high in China, and there were some differences in demographic and clinical characteristics between patients with PD and patients with NPD. Clinicians should regularly assess psychotic symptoms and consider intensive treatment and close monitoring when treating subjects with PD.
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Affiliation(s)
- Li-Min Xin
- Beijing Huilongguan Hospital, Beijing, China
| | - Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.
| | - Feng Yan
- Beijing Huilongguan Hospital, Beijing, China
| | - Fu-De Yang
- Beijing Huilongguan Hospital, Beijing, China
| | - Gang Wang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Lu
- Shanghai Tongji Hospital, Tongji University Medical School, Shanghai, China
| | - Hai-Chen Yang
- Division of Mood Disorders, Shenzhen Mental Health Centre, Shenzhen, Guangdong Province, China
| | - Jian Hu
- The First Hospital of Harbin Medical University, Harbin, China
| | - Zhi-Yu Chen
- Hangzhou Seventh People's Hospital, Hangzhou, China
| | - Yi Huang
- West China Hospital, Sichuan University, Chengdu, China
| | - Jing Sun
- The Affiliated Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Ping Wang
- The Second Xiangya Hospital, Mental Health Institute, Central South University, Changsha, China
| | - Hui-Chun Li
- The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jin-Bei Zhang
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ji-Tao Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Tian-Mei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.
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Clinical Approaches to Late-Onset Psychosis. J Pers Med 2022; 12:jpm12030381. [PMID: 35330384 PMCID: PMC8950304 DOI: 10.3390/jpm12030381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/10/2022] Open
Abstract
Psychosis can include schizophrenia, mood disorders with psychotic features, delusional disorder, active delirium, and neurodegenerative disorders accompanied by various psychotic symptoms. Late-onset psychosis requires careful intervention due to the greater associated risks of secondary psychosis; higher morbidity and mortality rates than early-onset psychosis; and complicated treatment considerations due to the higher incidence of adverse effects, even with the black box warning against antipsychotics. Pharmacological treatment, including antipsychotics, should be carefully initiated with the lowest dosage for short-term efficacy and monitoring of adverse side effects. Further research involving larger samples, more trials with different countries working in consortia, and unified operational definitions for diagnosis will help elaborate the clinical characteristics of late-onset psychosis and lead to the development of treatment approaches.
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28
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Iverson GL, Deep-Soboslay A, Hyde TM, Kleinman JE, Erskine B, Fisher-Hubbard A, deJong JL, Castellani RJ. Suicide in Older Adult Men Is Not Related to a Personal History of Participation in Football. Front Neurol 2021; 12:745824. [PMID: 34899570 PMCID: PMC8662809 DOI: 10.3389/fneur.2021.745824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: It is reasonable to estimate that tens of millions of men in the United States played high school football. There is societal concern that participation in football confers risk for later-in-life mental health problems. The purpose of this study is to examine whether there is an association between a personal history of playing high school football and death by suicide. Methods: The subjects were obtained from the Lieber Institute for Brain Development (LIBD) brain donation program in collaboration with the Office of the Medical Examiner at Western Michigan University Homer Stryker MD School of Medicine. Donor history was documented via medical records, mental health records, and telephone interviews with the next-of-kin. Results: The sample included 198 men aged 50 or older (median = 65.0 years, interquartile range = 57-75). There were 34.8% who participated in contact sports during high school (including football), and 29.8% participated in high school football. Approximately one-third of the sample had suicide as their manner of death (34.8%). There was no statistically significant difference in the proportions of suicide as a manner of death among those men with a personal history of playing football compared to men who did not play football or who did not play sports (p = 0.070, Odds Ratio, OR = 0.537). Those who played football were significantly less likely to have a lifetime history of a suicide attempt (p = 0.012, OR = 0.352). Men with mood disorders (p < 0.001, OR = 10.712), substance use disorders (p < 0.020, OR = 2.075), and those with a history of suicide ideation (p < 0.001, OR = 8.038) or attempts (p < 0.001, OR = 40.634) were more likely to have suicide as a manner of death. Moreover, those men with a family history of suicide were more likely to have prior suicide attempts (p = 0.031, OR = 2.153) and to have completed suicide (p = 0.001, OR = 2.927). Discussion: Suicide was related to well-established risk factors such as a personal history of a mood disorder, substance abuse disorder, prior suicide ideation, suicide attempts, and a family history of suicide attempts. This study adds to a steadily growing body of evidence suggesting that playing high school football is not associated with increased risk for suicidality or suicide during adulthood.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Amy Deep-Soboslay
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, United States
| | - Thomas M. Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, United States
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Joel E. Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, United States
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brittany Erskine
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Amanda Fisher-Hubbard
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Joyce L. deJong
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Takamiya A, Dols A, Emsell L, Abbott C, Yrondi A, Soriano Mas C, Jorgensen MB, Nordanskog P, Rhebergen D, van Exel E, Oudega ML, Bouckaert F, Vandenbulcke M, Sienaert P, Péran P, Cano M, Cardoner N, Jorgensen A, Paulson OB, Hamilton P, Kampe R, Bruin W, Bartsch H, Ousdal OT, Kessler U, van Wingen G, Oltedal L, Kishimoto T. Neural Substrates of Psychotic Depression: Findings From the Global ECT-MRI Research Collaboration. Schizophr Bull 2021; 48:514-523. [PMID: 34624103 PMCID: PMC8886602 DOI: 10.1093/schbul/sbab122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Psychotic major depression (PMD) is hypothesized to be a distinct clinical entity from nonpsychotic major depression (NPMD). However, neurobiological evidence supporting this notion is scarce. The aim of this study is to identify gray matter volume (GMV) differences between PMD and NPMD and their longitudinal change following electroconvulsive therapy (ECT). Structural magnetic resonance imaging (MRI) data from 8 independent sites in the Global ECT-MRI Research Collaboration (GEMRIC) database (n = 108; 56 PMD and 52 NPMD; mean age 71.7 in PMD and 70.2 in NPMD) were analyzed. All participants underwent MRI before and after ECT. First, cross-sectional whole-brain voxel-wise GMV comparisons between PMD and NPMD were conducted at both time points. Second, in a flexible factorial model, a main effect of time and a group-by-time interaction were examined to identify longitudinal effects of ECT on GMV and longitudinal differential effects of ECT between PMD and NPMD, respectively. Compared with NPMD, PMD showed lower GMV in the prefrontal, temporal and parietal cortex before ECT; PMD showed lower GMV in the medial prefrontal cortex (MPFC) after ECT. Although there was a significant main effect of time on GMV in several brain regions in both PMD and NPMD, there was no significant group-by-time interaction. Lower GMV in the MPFC was consistently identified in PMD, suggesting this may be a trait-like neural substrate of PMD. Longitudinal effect of ECT on GMV may not explain superior ECT response in PMD, and further investigation is needed.
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Affiliation(s)
- Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan,Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Annemiek Dols
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Louise Emsell
- Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Carles Soriano Mas
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain,CIBERSAM, Carlos III Health Institute, Madrid, Spain,Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Balslev Jorgensen
- Psychiatric Centre Copenhagen, Copenhagen, Denmark,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pia Nordanskog
- Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience (CSAN), Linköping University, Linköping, Sweden
| | - Didi Rhebergen
- Mental Health Care Institute, GGZ Centraal, Amersfoort, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Filip Bouckaert
- Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Pascal Sienaert
- Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)—KU Leuven, Kortenberg, Belgium
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Marta Cano
- CIBERSAM, Carlos III Health Institute, Madrid, Spain,Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Barcelona, Spain,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Narcis Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Barcelona, Spain
| | - Anders Jorgensen
- Psychiatric Centre Copenhagen, Copenhagen, Denmark,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiological Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Paul Hamilton
- Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience (CSAN), Linköping University, Linköping, Sweden
| | - Robin Kampe
- Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience (CSAN), Linköping University, Linköping, Sweden
| | - Willem Bruin
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hauke Bartsch
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway,Department of Research and Innovation, Haukeland University Hospital, Bergen, Norway,Department of Informatics, University of Bergen, Bergen, Norway
| | - Olga Therese Ousdal
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway,Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway,Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Leif Oltedal
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan,To whom correspondence should be addressed; Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; tel: +81-3-5363-3829; fax: +81-3-5379-0187; e-mail:
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Jalenques I, Rachez C, Jalenques UT, Nechifor SA, Morel L, Blanchard F, Pereira B, Lauron S, Rondepierre F. Cross-cultural evaluation of the French version of the Delusion Assessment Scale (DAS) and Psychotic Depression Assessment Scale (PDAS). PLoS One 2021; 16:e0250492. [PMID: 33901242 PMCID: PMC8075211 DOI: 10.1371/journal.pone.0250492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Major depressive disorder with psychotic features (MDDPsy), compared to nonpsychotic MDD, involves an increased risk of suicide and failure to achieve treatment response. Symptom scales can be useful to assess patients with MDDPsy. The aim of the present study was to validate French versions of the Delusion Assessment Scale (DAS) and Psychotic Depression Assessment Scale (PDAS). METHODS One hundred patients were included. The scales were filled out by psychiatrists. Data from participants who accepted a second interview were used for inter-judge reliability. The scalability and psychometric properties of both scales were assessed. RESULTS Data from 94 patients were used. Owing to low score variability between patients, the predefined threshold for scalability (≥0.40) was not reached for both scales. Factorial analysis of the DAS identified five factors, different from those of the original version. Five factors were also identified in the PDAS, of which two comprised items from the HDRS and the other three items from the BPRS. Floor and ceiling effects were observed in both scales, due in part to the construction of certain subscales. Unlike the PDAS, the DAS had good internal consistency. Multiple correlations were observed between the DAS dimensions but none between those of the PDAS. Both scales showed good inter-judge reliability. Convergent validity analyses showed correlations with HDRS, BPRS and CGI. LIMITATIONS Inter-judge reliability was calculated from a relatively small number of volunteers. CONCLUSIONS The good psychometric properties of the French versions of the DAS and PDAS could help in assessing MDDPsy, in particular its psychotic features, and hence improve response to treatment and prognosis.
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Affiliation(s)
- Isabelle Jalenques
- Service de Psychiatrie de l’Adulte et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, Centre Hospitalier Universitaire Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Chloé Rachez
- Service de Psychiatrie de l’Adulte et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Lucile Morel
- Centre Hospitalier Spécialisé Sainte-Marie, Le Puy-en-Velay, France
| | | | - Bruno Pereira
- Direction de la Recherche Clinique et de l’Innovation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Sophie Lauron
- Service de Psychiatrie de l’Adulte et Psychologie Médicale, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Service de Psychiatrie de l’Adulte et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
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Pharmacotherapy Prescriptions for Relapse Prevention of Psychotic Depression After Electroconvulsive Therapy. J Clin Psychopharmacol 2021; 41:196-199. [PMID: 33587400 DOI: 10.1097/jcp.0000000000001354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Electroconvulsive therapy (ECT) is effective in the treatment of acute episodes of psychotic depression. However, no adequately powered studies have directly investigated the efficacy of antipsychotic pharmacotherapy in relapse prevention of psychotic depression after ECT. In the absence of such literature, we reviewed the clinical practice of 4 academic medical centers that have made research contributions in the treatment of psychotic depression over the past 20 years. METHODS/PROCEDURES We reviewed medical records of patients with a diagnosis of psychotic depression who received 1 or more acute courses of ECT over the span of 3 years. Chi-square tests were used to compare pharmacotherapy prescribed at the time of completion of ECT. FINDINGS/RESULTS A total of 163 patients received 176 courses of ECT for separate episodes of psychotic depression. The combination of an antidepressant plus an antipsychotic was the most common regimen, ranging from 61.9% to 85.5% of all prescriptions. One center added lithium in 45.5% of cases treated with the combination of an antidepressant plus an antipsychotic. An antipsychotic alone was prescribed in less than 10% of cases. An antidepressant alone or other drug combinations were rare. IMPLICATIONS/CONCLUSIONS The combination of an antidepressant plus an antipsychotic was the most commonly prescribed regimen at the completion of ECT for relapse prevention in patients with psychotic depression acutely treated with ECT. Although this report offers a view of the clinical practice of 4 academic medical centers, it also points to the need of randomized controlled trials on continuation pharmacotherapy after treatment of psychotic depression with ECT.
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Externalizing the threat from within: A new direction for researching associations between suicide and psychotic experiences. Dev Psychopathol 2021; 34:1034-1044. [PMID: 33402232 DOI: 10.1017/s0954579420001728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A recent suicidal drive hypothesis posits that psychotic experiences (PEs) may serve to externalize internally generated and self-directed threat (i.e., self-injurious/suicidal behavior [SIB]) in order to optimize survival; however, it must first be demonstrated that such internal threat can both precede and inform PEs. The current study conducted the first known bidirectional analysis of SIB and PEs to test whether SIB could be considered as a plausible antecedent for PEs. Prospective data were utilized from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins, that captured SIB (any self-harm or suicidal attempt) and PEs at ages 12 and 18 years. Cross-lagged panel models demonstrated that the association between SIB at age 12 and PEs at age 18 was as strong as the association between PEs at age 12 and SIB at age 18. Indeed, the best representation of the data was a model where these paths were constrained to be equal (OR = 2.48, 95% CI = 1.63-3.79). Clinical interview case notes for those who reported both SIB and PEs at age 18, revealed that PEs were explicitly characterized by SIB/threat/death-related content for 39% of cases. These findings justify further investigation of the suicidal drive hypothesis.
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Mncube K, Möller M, Harvey BH. Post-weaning Social Isolated Flinders Sensitive Line Rats Display Bio-Behavioural Manifestations Resistant to Fluoxetine: A Model of Treatment-Resistant Depression. Front Psychiatry 2021; 12:688150. [PMID: 34867504 PMCID: PMC8635751 DOI: 10.3389/fpsyt.2021.688150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/29/2021] [Indexed: 12/16/2022] Open
Abstract
Treatment-resistant depression (TRD) complicates the management of major depression (MD). The underlying biology of TRD involves interplay between genetic propensity and chronic and/or early life adversity. By combining a genetic animal model of MD and post-weaning social isolation rearing (SIR), we sought to produce an animal that displays more severe depressive- and social anxiety-like manifestations resistant to standard antidepressant treatment. Flinders Sensitive Line (FSL) pups were social or isolation reared from weaning [postnatal day (PND) 21], receiving fluoxetine (FLX) from PND 63 (10 mg/kg × 14 days), and compared to Sprague Dawley (SD) controls. Depressive-, anxiety-like, and social behaviour were assessed from PND 72 in the forced swim test (FST) and social interaction test (SIT). Post-mortem cortico-hippocampal norepinephrine (NE), serotonin (5-HT), and dopamine (DA), as well as plasma interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-α), corticosterone (CORT), and dopamine-beta-hydroxylase (DBH) levels were assayed. FSL rats displayed significant cortico-hippocampal monoamine disturbances, and depressive- and social anxiety-like behaviour, the latter two reversed by FLX. SIR-exposed FSL rats exhibited significant immobility in the FST and social impairment which were, respectively, worsened by or resistant to FLX. In SIR-exposed FSL rats, FLX significantly raised depleted NE and 5-HT, significantly decreased DBH and caused a large effect size increase in DA and decrease in CORT and TNF-α. Concluding, SIR-exposed FSL rats display depressive- and social anxiety-like symptoms that are resistant to, or worsened by, FLX, with reduced plasma DBH and suppressed cortico-hippocampal 5-HT, NE and DA, all variably altered by FLX. Exposure of a genetic animal model of MD to post-weaning SIR results in a more intractable depressive-like phenotype as well as changes in TRD-related biomarkers, that are resistant to traditional antidepressant treatment. Given the relative absence of validated animal models of TRD, these findings are especially promising and warrant study, especially further predictive validation.
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Affiliation(s)
- Khulekani Mncube
- Centre of Excellence for Pharmaceutical Sciences (PharmaCen), Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Marisa Möller
- Centre of Excellence for Pharmaceutical Sciences (PharmaCen), Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Brian H Harvey
- Centre of Excellence for Pharmaceutical Sciences (PharmaCen), Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa.,South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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34
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Cai H, Xie XM, Zhang Q, Cui X, Lin JX, Sim K, Ungvari GS, Zhang L, Xiang YT. Prevalence of Suicidality in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Comparative Studies. Front Psychiatry 2021; 12:690130. [PMID: 34603096 PMCID: PMC8481605 DOI: 10.3389/fpsyt.2021.690130] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/13/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Suicidality is common in major depressive disorder (MDD), but there has been no systematic review published about all aspects of suicidality. This meta-analysis and systematic review compared the prevalence of the whole range of suicidality comprising suicidal ideation (SI), suicide plan (SP), suicide attempt (SA), and completed suicide (CS), between patients with MDD and non-MDD controls. Methods: Major international (PubMed, PsycINFO, Web of Science, EMBASE) and Chinese (Chinese Nation Knowledge Infrastructure and WANFANG) databases were systematically and independently searched from their inception until January 12, 2021. Results: Fifteen studies covering 85,768 patients (12,668 in the MDD group and 73,100 in the non-MDD group) were included in the analyses. Compared to non-MDD controls, the odds ratios (ORs) for lifetime, past month, past year, and 2-week prevalence of SI in MDD were 2.88 [95% confidence interval (CI) = 0.30-27.22, p = 0.36], 49.88 (95% CI = 2-8.63, p < 0.001), 13.97 (95% CI = 12.67-15.41, p < 0.001), and 24.81 (95% CI = 15.70-39.22, p < 0.001), respectively. Compared to non-MDD controls, the OR for lifetime SP in MDD was 9.51 (95% CI = 7.62-11.88, p < 0.001). Compared to non-MDD controls, the ORs of lifetime and past-year prevalence of SA were 3.45 (95% CI = 1.58-7.52, p = 0.002), and 7.34 (95% CI = 2.14-25.16, p = 0.002), respectively, in MDD patients. No difference in the prevalence of CS between MDD and controls was found (OR = 0.69, 95% CI = 0.23-2.02, p = 0.50). Conclusions: MDD patients are at a higher risk of suicidality, compared to non-MDD controls. Routine screening for a range of suicidality should be included in the management of MDD, followed by timely treatment for suicidal patients. Systematic Review Registration: Identifier [INPLASY202120078].
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Affiliation(s)
- Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macao, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, Macao, SAR China
| | - Xiao-Meng Xie
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Macao, Macao, SAR China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Macao, Macao, SAR China
| | - Xiling Cui
- Department of Business Administration, Hong Kong Shue Yan University, Hong Kong, Hong Kong, SAR China
| | - Jing-Xia Lin
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, Hong Kong, SAR China
| | - Kang Sim
- West Region, Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, WA, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Macao, Macao, SAR China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macao, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, Macao, SAR China
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Effect of adjunctive pimavanserin on suicidal ideation in patients with major depression: Analysis of the CLARITY study. J Affect Disord 2020; 277:478-485. [PMID: 32871535 DOI: 10.1016/j.jad.2020.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/30/2020] [Accepted: 08/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Up to 15% of patients with major depressive disorder (MDD) attempt suicide and up to 2% complete suicide. This was a post-hoc analysis aimed to evaluate the risk of suicide ideation and behavior associated with adjunctive pimavanserin treatment in adults with MDD. METHODS CLARITY was a randomized, double-blind, placebo-controlled study in patients with MDD and an inadequate response to a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI). For this post-hoc analysis, the primary endpoint was mean change from baseline for HAMD item 3 (suicide). The incidence of suicidal ideation or behavior was also assessed from the Columbia-Suicide Severity Rating Scale (C-SSRS) and reports of adverse events. RESULTS During Stage 1, LS mean change for HAMD Item 3 was reduced from baseline at each week with pimavanserin with a significant difference between pimavanserin and placebo at Week 3 (p=0.012, effect size: 0.431). At any post-baseline assessment, suicidal ideation on the C-SSRS was reported in 28 (18.1%) of patients with placebo and 9 (17.3%) with pimavanserin during Stage 1 and in 7 (20.7%) with placebo and 4 (13.8%) with pimavanserin during Stage 2. No events of suicidal behavior were observed with either placebo or pimavanserin. LIMITATIONS The post hoc nature, exclusion of patients with any history of suicide from the primary study, and the small number of patients who demonstrated evidence of suicidal ideation. CONCLUSIONS Adjunctive pimavanserin was not associated with an increase in suicidal ideation in patients with MDD. Further study is needed to verify these results.
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Baldaçara L, Rocha GA, Leite VDS, Porto DM, Grudtner RR, Diaz AP, Meleiro A, Correa H, Tung TC, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. ACTA ACUST UNITED AC 2020; 43:525-537. [PMID: 33111773 PMCID: PMC8555650 DOI: 10.1590/1516-4446-2020-0994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/21/2020] [Indexed: 12/28/2022]
Abstract
Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Gislene A Rocha
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil.,Serviço Especializado em Reabilitação em Deficiência Intelectual, Associação de Pais e Amigos dos Excepcionais, Montes Claros, MG, Brazil
| | - Verônica da S Leite
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria Municipal de Saúde de Palmas, Palmas, TO, Brazil
| | - Deisy M Porto
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Associação Catarinense de Psiquiatria, Florianópolis, SC, Brazil
| | - Roberta R Grudtner
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Núcleo de Dor e Neuromodulação, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Secretaria Estadual da Saúde, Porto Alegre, RS, Brazil
| | - Alexandre P Diaz
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | | | - Humberto Correa
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Teng C Tung
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.,Serviços de Pronto Socorro e Interconsultas, IPq, HCFMUSP, São Paulo, SP, Brazil
| | - João Quevedo
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Antônio G da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Asociación Psiquiátrica de América Latina (APAL)
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Costa FBPD, Trachtenberg E, Boni A, Primo de Carvalho Alves L, Magalhães PVDS, Rocha NS. Psychotic depression in hospitalized patients: Longitudinal outcomes of psychotic vs. nonpsychotic depression among inpatients. J Psychiatr Res 2020; 129:73-79. [PMID: 32615470 DOI: 10.1016/j.jpsychires.2020.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022]
Abstract
Even though psychotic depression is related to worse outcomes than nonpsychotic depression, there is increasing evidence that this greater severity is not solely explained by the depressive symptoms. We evaluated the socio-demographic and clinical characteristics, as well as the differences in clinical outcomes of psychiatric hospitalization between psychotic and non-psychotic depression. Two-hundred-eighty-eight depressive inpatients were assessed within 72 h after hospitalization and 24 h before discharge. We compared scores of Hamilton Depression Rating Scale 17-items (HDRS-17), Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), and Global Assessment of Functioning (GAF) between psychotic and nonpsychotic patients. Instruments were compared both cross-sectionally - on admission and discharge - and longitudinally. Longitudinal outcomes were corrected for potential confounders (sex, age, age at disease onset, years of study, previous history of mania/hypomania, electroconvulsive therapy in current hospitalization, history of attempted suicide, number of suicide attempts, and previous hospitalizations). One-hundred-thirty-one depressive inpatients (45.4%) presented psychotic features. Both groups showed similar HDRS-17 scores at admission and discharge. However, psychotic patients had worse scores on BPRS, CGI, and GAF at both timepoints. Both groups had similar improvement on HDRS-17 (P = 0.75), CGI (P = 0.5), and GAF (P = 0.84), but psychotic patients had greater improvement on BPRS (P < 0.001). Psychotic inpatients showed worse clinical and functional parameters. Nonetheless, the groups did not differ in depressive symptom severity. These findings reinforce the hypothesis that depressive episode with psychotic features is a more severe form of the disease irrespective of intensity of affective symptomatology.
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Affiliation(s)
- Felipe Bauer Pinto da Costa
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Innovations and Interventions for Quality of Life Research Group, Brazil.
| | - Eduardo Trachtenberg
- São Pedro Psychiatric Hospital, Porto Alegre, RS, Brazil; Mario Martins University Foundation, Department of Psychopharmacology, Porto Alegre, RS, Brazil
| | - Aline Boni
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lucas Primo de Carvalho Alves
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Innovations and Interventions for Quality of Life Research Group, Brazil; Clinical Research Center of Hospital de Clínicas de Porto Alegre, Brazil; Experimental Research Center of Hospital de Clínicas de Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; National Institute for Translational Medicine, Porto Alegre, RS, Brazil; Clinical Research Center of Hospital de Clínicas de Porto Alegre, Brazil; Experimental Research Center of Hospital de Clínicas de Porto Alegre, Brazil
| | - Neusa Sica Rocha
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Innovations and Interventions for Quality of Life Research Group, Brazil; Clinical Research Center of Hospital de Clínicas de Porto Alegre, Brazil; Experimental Research Center of Hospital de Clínicas de Porto Alegre, Brazil
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Shen Y, Wei Y, Yang XN, Zhang G, Du X, Jia Q, Zhu X, Ma Y, Lang X, Luo X, Zhang XY. Psychotic symptoms in first-episode and drug naïve patients with major depressive disorder: Prevalence and related clinical factors. Depress Anxiety 2020; 37:793-800. [PMID: 32383260 DOI: 10.1002/da.23026] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/10/2019] [Accepted: 04/19/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Many patients with major depressive disorder (MDD) have been found to have psychotic symptoms. However, few studies have reported the prevalence of comorbid psychotic symptoms in first-episode drug naïve (FEDN) MDD patients. This study was to investigate the prevalence of psychotic symptoms and related risk factors in a large sample size of FEDN MDD patients in a Chinese population. METHODS A total of 573 patients with diagnosis of MDD at their first episode were recruited with their demographic and clinical data. Positive scale of the Positive and Negative Syndrome Scale was utilized for psychotic symptoms, Hamilton Anxiety Rating Scale (HAMA) for anxiety symptoms, and Hamilton Depression Rating Scale (HAMD) for depressive symptoms. RESULTS The prevalence of psychotic symptoms in these MDD patients was 9.8%. MDD patients with psychotic symptoms had significantly higher HAMD and HAMA total scores than those without psychotic symptoms (both p < .001). A strong association was found between psychotic MDD and anxiety or suicide, with odds ratio of 33.097 for severe anxiety, and 5.012 for suicide. CONCLUSIONS Our results suggest that psychotic symptoms are common in MDD patients at their first episode. The strong association between psychotic MDD and anxiety or suicide attempts demonstrates the importance of reducing anxiety symptoms in the treatment of psychotic MDD patients as well as the necessity to regularly assess suicide risk in MDD patients with psychotic symptoms to better prevent suicidal behavior.
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Affiliation(s)
- Yanmei Shen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Psychiatry, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Ying Wei
- Department of Psychiatry, Changshu Third Hospital of People, Changshu, Jiangshu, China
| | - Xu-Na Yang
- Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Guangya Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Qiufang Jia
- Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yuejiao Ma
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Psychiatry, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - XiaoE Lang
- Department of Psychiatry, The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuerong Luo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Psychiatry, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Xiang Yang Zhang
- Psychological Counseling Center, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Structural brain networks in remitted psychotic depression. Neuropsychopharmacology 2020; 45:1223-1231. [PMID: 32109935 PMCID: PMC7235256 DOI: 10.1038/s41386-020-0646-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Abstract
Major depressive disorder with psychotic features (psychotic depression) is a severe disorder. Compared with other psychotic disorders such as schizophrenia, relatively few studies on the neurobiology of psychotic depression have been pursued. Neuroimaging studies investigating psychotic depression have provided evidence for distributed structural brain abnormalities implicating the insular cortex and limbic system. We examined structural brain networks in participants (N = 245) using magnetic resonance imaging. This sample included healthy controls (n = 159) and the largest cross-sectional sample of patients with remitted psychotic depression (n = 86) collected to date. All patients participated in the Study of Pharmacotherapy of Psychotic Depression II randomized controlled trial. We used a novel, whole-brain, data-driven parcellation technique-non-negative matrix factorization-and applied it to cortical thickness data to derive structural covariance networks. We compared patients with remitted psychotic depression to healthy controls and found that patients had significantly thinner cortex in five structural covariance networks (insular-limbic, occipito-temporal, temporal, parahippocampal-limbic, and inferior fronto-temporal), confirming our hypothesis that affected brain networks would incorporate cortico-limbic regions. We also found that cross-sectional depression and severity scores at the time of scanning were associated with the insular-limbic network. Furthermore, the insular-limbic network predicted future severity scores that were collected at the time of recurrence of psychotic depression or sustained remission. Overall, decreased cortical thickness was found in five structural brain networks in patients with remitted psychotic depression and brain-behavior relationships were observed, particularly between the insular-limbic network and illness severity.
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40
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Li H, Huang Y, Wu F, Lang X, Zhang XY. Prevalence and related factors of suicide attempts in first-episode and untreated Chinese Han outpatients with psychotic major depression. J Affect Disord 2020; 270:108-113. [PMID: 32339099 DOI: 10.1016/j.jad.2020.03.093] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Major depressive depression (MDD) is often accompanied by suicidal behavior. Increasing evidence shows that MDD patients display psychotic symptoms. However, the relationship between psychotic symptoms and suicide attempt in MDD has not been reported. Therefore, this study was to identify the prevalence and associated factors of suicide attempts in first-episode and untreated Chinese Han outpatients comorbid with psychotic major depression (PMD). METHODS 1718 first-episode and untreated MDD outpatients were assessed with Positive Symptom Scale of Positive and Negative Syndrome Scale (PANSS), the 17-item Hamilton Depression Scale, Hamilton Anxiety Scale, and clinical global impression of severity scale (CGI-S). Some glycolipid metabolism and thyroid hormone parameters were measured. RESULTS In MDD patients, the percentage of PMD was 10.0%. The incidence of attempted suicide in PMD patients was 51.5%, which was more than 3 times higher than that in non-PMD patients (16.7%). In PMD patients, compared to non-attempters, suicide attempters were older, had a longer course of disease, scored higher on all scales, as well as had higher levels of thyroid stimulating hormone (TSH), thyroid peroxidases antibody, anti-thyroglobulin and blood glucose. PANSS positive symptom, CGI, diastolic blood pressure and TSH were independently associated with suicide attempts of PMD. CONCLUSIONS PMD patients have a higher prevalence of suicide attempt than non-PMD patients. Some demographic and clinical parameters are relevant factors for suicide attempt in PMD patients.
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Affiliation(s)
- Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
| | - XiaoE Lang
- Department of Psychiatry, The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xiang Yang Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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41
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Violence and Suicide Risk Assessment in Youth with Psychotic Disorders: Practical Considerations for Community Clinicians. Child Adolesc Psychiatr Clin N Am 2020; 29:43-55. [PMID: 31708052 DOI: 10.1016/j.chc.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Psychosis is a unique and significant risk factor associated with violent and suicidal behavior and warrants special consideration. This article presents a careful review of the literature on violence risk and psychosis and suicide risk and psychosis as it pertains to youth or those who have been newly diagnosed with or are at high risk for psychotic disorders. Each topic is covered in reference to general considerations and specific psychotic symptoms (eg, hallucinations, delusions, paranoia). The reader can refer to practical boxes to assist in identifying relevant risk factors and examples of questions to ask the patient and family.
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Squassina A, Meloni A, Chillotti C, Pisanu C. Zinc finger proteins in psychiatric disorders and response to psychotropic medications. Psychiatr Genet 2019; 29:132-141. [PMID: 31464994 DOI: 10.1097/ypg.0000000000000231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Zinc finger proteins are a large family of abundantly expressed small motifs that play a crucial role in a wide range of physiological and pathophysiological mechanisms. Findings published so far support an involvement of zinc fingers in psychiatric disorders. Most of the evidence has been provided for the zinc finger protein 804A (ZNF804A) gene, which has been suggested to be implicated in schizophrenia and bipolar disorder. This evidence has been corroborated by a wide range of functional studies showing that ZNF804A regulates the expression of genes involved in cell adhesion and plays a crucial role in neurite formation and maintenance of dendritic spines. On the other hand, far less is known on other zinc finger proteins and their involvement in psychiatric disorders. In this review, we discussed studies exploring the role of zinc finger proteins in schizophrenia, bipolar disorder, and major depressive disorder as well as in pharmacogenetics of psychotropic drugs.
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Affiliation(s)
- Alessio Squassina
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy Department of Psychiatry, Dalhousie University, Halifax, NS, Canada Department of Neuroscience, Unit of Functional Pharmacology, Uppsala University, Uppsala, Sweden
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43
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Dong M, Zeng LN, Lu L, Li XH, Ungvari GS, Ng CH, Chow IHI, Zhang L, Zhou Y, Xiang YT. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med 2019; 49:1691-1704. [PMID: 30178722 DOI: 10.1017/s0033291718002301] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD. METHODS A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed. RESULTS In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27-34%], 1-year prevalence was 8% (95% CI 3-14%) and 1-month prevalence was 24% (95% CI 15-34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting. CONCLUSION This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Liang-Nan Zeng
- Department of Neurosurgery,The Affiliated Hospital of Southwest Medical University,Luzhou,China
| | - Li Lu
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University,Beijing,China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - Chee H Ng
- Department of Psychiatry,University of Melbourne,Melbourne, Victoria,Australia
| | - Ines H I Chow
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics,School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology,Beijing,China
| | - Yuan Zhou
- CAS Key Laboratory of Behavioral Science & Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences,Beijing,China
| | - Yu-Tao Xiang
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
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Li X, Liu H, Hou R, Baldwin DS, Li R, Cui K, Liu C, Sun Q, Wang G, Tan Q, Xu X, Zhao J, Ning Y, Sun X. Prevalence, clinical correlates and IQ of suicidal ideation in drug naïve Chinese Han patients with major depressive disorder. J Affect Disord 2019; 248:59-64. [PMID: 30711870 DOI: 10.1016/j.jad.2018.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Suicidal ideation (SI) is a common and serious clinical concern in people with major depressive disorder (MDD). Inconsistent evidence suggests that individuals with SI may have a lower measured intelligence quotient (IQ) than those without SI. The aims of this study were to examine SI prevalence and its associations with demographic, clinical variables and IQ in Chinese drug-naïve MDD patients. METHODS 488 drug-naïve Chinese Han patients (male: 203, 41.6%) meeting a DSM-IV diagnosis of MDD were enrolled in a cross-sectional study involving seven hospitals. All participants were asked to complete a series of questionnaires, which include information on socio-demographic and clinical variables. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and Brief Psychiatric Rating Scale (BPRS) were also administered. Verbal IQ (VIQ), performance IQ (PIQ) and full-scale IQ (FIQ) scores were measured using the Chinese version of the Wechsler Adult Intelligence Scale-Ⅲ (WAIS-Ⅲ). We categorized patients with SI based on a cut-off score of ≥3 on HAMD item 3. RESULTS An estimated prevalence 32.8% (160/488) of drug-naïve MDD patients experienced SI during the current episode of illness. Patients with SI were more likely to be divorced (x2 = 6.93, p = 0.031), male (x2 = 6.04, p = 0.014), had higher severity of depression and anxiety symptoms (t = -8.14, p < 0.001, t = -3.28, p < 0.001, respectively), comorbid psychotic features (t = -5.71, p < 0.001), and lower FIQ levels (t = -4.21, p < 0.001), when compared to patients without SI. Using logistic regression analysis and adjusting for confounding variables, the following variables were independently associated with SI: divorced marital status compared to married (OR=4.674, 95% CI: 1.676~13.036), severity of depression symptoms (OR=1.312, 95% CI: 1.196~1.440), psychotic features (OR=1.044; 1.012~1.077), and FIQ /PIQ levels which expressed in OR per SD increase in IQ score (OR=0.740, 95% CI: 0.561~0.977; OR=0.744, 95% CI: 0.557~0.994, respectively). LIMITATIONS A cross-sectional study which did not assess the influence of severity of SI. CONCLUSIONS The prevalence of SI in drug-naive Chinese patients with MDD is high, and associated with marital status, severity of depression, psychotic features and measured IQ. Further research is needed to further explore these and other potentially relevant risk factors which might affect clinical outcomes.
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Affiliation(s)
- Xirong Li
- Department of Psychiatry, Shandong Mental Health Center, Jinan, China; Department of Psychiatry, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Haixia Liu
- Department of Psychiatry, Shandong Mental Health Center, Jinan, China
| | - Ruihua Hou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Renjun Li
- Department of Psychiatry, Shandong Mental Health Center, Jinan, China
| | - Kaiyan Cui
- Department of Psychiatry, Shandong Mental Health Center, Jinan, China
| | - Chuanxin Liu
- Department of Psychiatry, Jining Medical University, Jining, China
| | - Qian Sun
- Beijing Anding Hospital of Capital University of Medical Sciences, Beijing, China
| | - Gang Wang
- Beijing Anding Hospital of Capital University of Medical Sciences, Beijing, China
| | - Qingrong Tan
- Department of Psychiatry, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingping Zhao
- Mental Health Institute, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuping Ning
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xueli Sun
- Department of Psychiatry, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
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Guilt Delusional Beliefs Increase the Risk of Suicidal Attempt in Elderly Unipolar Psychotic Depressives. J Nerv Ment Dis 2019; 207:29-33. [PMID: 30575705 DOI: 10.1097/nmd.0000000000000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the differential effect of various delusion categories, namely, guilt, paranoid, impending disaster, and somatic on suicidal attempts in elderly patients experiencing unipolar psychotic major depression (PMD), because the evidence on this is scarce. The sample consisted of 65 consecutively admitted patients 60 years or older, experiencing PMD, and assessed by means of Structured Clinical Interview for DSM-4 (Patient Edition), Hamilton Depression Rating Scale, Mini-Mental Status Examination (MMSE), and by a physical impairment rating scale. Patients with guilt delusional beliefs had 5.31 times higher odds (95% confidence interval, 1.37-25.40) of a suicidal attempt than the patients without guilt delusional beliefs, controlling for sex, age, prior history of suicide attempt, MMSE, and hallucinations. In addition, 17 PMD patients with lifetime suicidal attempt compared with 48 PMD patients without lifetime suicidal attempt presented only higher age of disorder onset (p = 0.008). Of the four categories of delusions assessed, only guilt delusions were associated with an increased risk for suicidal attempt.
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Ferreira GM, Zanini NV, de Menezes GB, Albertella L, Destree L, Fontenelle LF. When patients with OCD decide to seek, and not to avoid harm: The problem of suicidality in OCD. Bull Menninger Clin 2018; 82:360-374. [DOI: 10.1521/bumc.2018.82.4.360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic, distressing, and disabling condition associated with a high risk of suicidal behavior and death by suicide. In this study, the authors describe two cases of OCD patients who developed recurrent suicidal behaviors in response to stressful life events that appeared to “confirm” their obsessive beliefs (termed “confirmatory events”). In both cases, the authors used accepted strategies for treating suicidality in other contexts (such as antidepressants, lithium, and electroconvulsive therapy), which proved unsuccessful. Future studies should investigate personalized strategies to treat suicidality and prevent suicide in OCD patients.
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Affiliation(s)
- Gabriela M. Ferreira
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Clinic Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Natalie V. Zanini
- Clinic Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Gabriela B. de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Lucy Albertella
- Brain and Mental Health Research Hub, School of Psychological Sciences and the Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Louise Destree
- Brain and Mental Health Research Hub, School of Psychological Sciences and the Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Leonardo F. Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Brain and Mental Health Research Hub, School of Psychological Sciences and the Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
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47
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Affiliation(s)
- Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA, USA
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48
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Gournellis R, Tournikioti K, Touloumi G, Thomadakis C, Michalopoulou PG, Michopoulos I, Christodoulou C, Papadopoulou A, Douzenis A. Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis. Ann Gen Psychiatry 2018; 17:39. [PMID: 30258483 PMCID: PMC6150953 DOI: 10.1186/s12991-018-0207-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It remains unclear whether psychotic features increase the risk of completed suicides in unipolar depression. The present systematic review coupled with a meta-analysis attempts to elucidate whether unipolar psychotic major depression (PMD) compared to non-PMD presents higher rates of suicides. METHODS A systematic search was conducted in Scopus, PubMed, and "gray literature" for all studies providing data on completed suicides in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. All articles were independently extracted by two authors using predefined data fields. RESULTS Nine studies with 33,873 patients, among them 828 suicides, met our inclusion criteria. PMD compared to non-PMD presented a higher lifetime risk of completed suicides with fixed-effect pooled OR 1.21 (95% CI 1.04-1.40). In a sub-analysis excluding a very large study (weight = 86.62%), and comparing 681 PMD to 2106 non-PMD patients, an even higher pooled OR was found [fixed-effect OR 1.69 (95% CI 1.16-2.45)]. Our meta-analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression. The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD's suicide risk. The lack of accurate diagnosis at the time of suicide, PMD's diagnostic instability, and the use of ICD-10 criteria constitute the main study limitations. CONCLUSIONS The presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide. Thus, the implementation of an effective treatment both for psychotic depression and patients' suicidality constitutes a supreme priority.
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Affiliation(s)
- Rossetos Gournellis
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Kalliopi Tournikioti
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Giota Touloumi
- 2Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Thomadakis
- 2Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiota G Michalopoulou
- 3Cognition, Schizophrenia, Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Ioannis Michopoulos
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Christos Christodoulou
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Athanasia Papadopoulou
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Athanasios Douzenis
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
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