Acta Psychiatrica Scandinavica最新文献

{"title":"Prevalence and correlates of ICD-11 prolonged grief disorder among adults living in Ukraine during the war with Russia","authors":"Enya Redican,&nbsp;Philip Hyland,&nbsp;Mark Shevlin,&nbsp;Dmytro Martsenkovskyi,&nbsp;Thanos Karatzias,&nbsp;Menachem Ben-Ezra","doi":"10.1111/acps.13678","DOIUrl":"10.1111/acps.13678","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although high rates of bereavement are evident in war-affected populations, no study has investigated the prevalence and correlates of probable ICD-11 prolonged grief disorder (PGD) under these circumstances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were 2050 adults who participated in a nationwide survey exploring the effects of the Ukraine-Russia war on the daily lives and mental health of Ukrainian people.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the total sample, 87.7% (<i>n</i> = 1797) of people indicated a lifetime bereavement. In the full sample, 11.4% met the diagnostic requirements for probable ICD-11 PGD, and amongst those with a lifetime bereavement, the conditional rate of probable ICD-11 PGD was 13.0%. Significant risk factors of ICD-11 PGD included the recent loss of a loved one (6 months to a year ago), being most affected by a partner or spouse's death, loved one dying in the war, no recent contact with the deceased prior to their death, and meeting depression and anxiety diagnostic requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study reveals that a significant percentage of Ukrainian bereaved individuals have probable ICD-11 PGD, and identifying risk factors, particularly war-related losses, will aid in the development of intervention and prevention programs for bereaved adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 5","pages":"425-435"},"PeriodicalIF":6.7,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140139617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can generative artificial intelligence facilitate illustration of- and communication regarding hallucinations and delusions?","authors":"Søren Dinesen Østergaard","doi":"10.1111/acps.13680","DOIUrl":"10.1111/acps.13680","url":null,"abstract":"&lt;p&gt;In the context of artificial intelligence (AI), the term “hallucinations” is used to refer to false responses generated by conversational agents/chatbots or other generative AI tools (artificial intelligence/machine learning models capable of generating content such as text, speech, images and video).&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; This metaphor is unfortunate as it is both imprecise and, due to its clear negative connotation, stigmatizing for the many individuals experiencing hallucinations—those with schizophrenia and other psychotic disorders in particular.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; While the stigma associated with the misunderstood use of the term hallucinations in relation to generative AI is highly unfortunate, this editorial will propose that it is, however, possible that generative AI may also be helpful and reduce stigma for those experiencing hallucinations and/or delusions.&lt;/p&gt;&lt;p&gt;For individuals with schizophrenia and other psychotic disorders it can be difficult to communicate the nature and quality of their hallucinations and delusions to relatives, friends as well as to the healthcare professionals involved in their treatment—often due to the recipients not handling this communication well enough.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This may lead to lack of understanding of the suffering associated with these symptoms and could, in turn, contribute to detachment from loved ones, stigma and suboptimal treatment.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Therefore, tools to facilitate communication regarding hallucinations and delusions are sorely needed.&lt;/p&gt;&lt;p&gt;This editorial will propose that AI tools capable of generating images (e.g., DALL·E&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;) and video (e.g., Sora&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;) may be used to facilitate (highly affordable) illustration of- and, thereby, communication regarding hallucinations and delusions experienced by people with schizophrenia and other psychotic disorders. Interestingly, this approach has recently been described in an ophthalmological case report, where Woods and colleagues report on the diagnosing and treatment of a patient with monocular Charles Bonnet syndrome secondary to optic neuritis, where generative AI was used to successfully illustrate the patient's visual hallucination.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Figure 1 shows three hypothetical examples of hallucinations and delusions illustrated using the version of DALL·E&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; embedded within ChatGPT-4&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; at the time of writing—along with the exact prompts that were used to generate the images. Two images of each set of symptoms are shown (read from left to right)—highlighting the importance of the wording of the prompts and the possibility to revise images if they are not accurately portraying the symptoms in question.&lt;/p&gt;&lt;p&gt;While this is, by no means, a formal assessment of the quality of the generated illustrations or their usefulness, it does seem that this approach has the potential to aid communication r","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 6","pages":"441-444"},"PeriodicalIF":6.7,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140130222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased oxytocin levels related to social cognition impairment in borderline personality disorder","authors":"Alejandra Galvez-Merlin,&nbsp;José M. López-Villatoro,&nbsp;Pilar de la Higuera-González,&nbsp;Alejandro de la Torre-Luque,&nbsp;Karina McDowell,&nbsp;Marina Díaz-Marsá,&nbsp;Juan C. Leza,&nbsp;José L. Carrasco","doi":"10.1111/acps.13679","DOIUrl":"10.1111/acps.13679","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Dysfunctions in the oxytocin system have been reported in patients with borderline personality disorder (BPD). Deficits could be related to interpersonal hypersensitivity, which has been previously associated with failures in social cognition (SC) in this disorder, especially in Theory of Mind (ToM) skills. The aim of this work is to study the links between the oxytocin system and SC impairments in patients with BPD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Plasma oxytocin levels (OXT) and protein expression of oxytocin receptors in blood mononuclear cells (OXTR) were examined in 33 patients with a diagnosis of BPD (age: <i>M</i> 28.85, DT = 8.83). Social cognition was assessed using the Movie for the Assessment of Social Cognition (MASC). Statistical associations between biochemical factors and different response errors in MASC were analyzed through generalized linear regression controlling for relevant clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Generalized linear regression showed a significant relationship between lower OXTR and overmentalization in BPD patients (OR = 0.90).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This work supports the relationship between alterations in the oxytocin system and ToM impairments observed in BPD patients, enhancing the search for endophenotypes related to the phenotypic features of the disorder to improve current clinical knowledge and address more specific therapeutic targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 6","pages":"458-466"},"PeriodicalIF":6.7,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140108457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotherapy duration and work disability: A prospective Finnish register study","authors":"Sanna Selinheimo,&nbsp;Kia Gluschkoff,&nbsp;Johanna Kausto,&nbsp;Jarno Turunen,&nbsp;Ari Väänänen","doi":"10.1111/acps.13677","DOIUrl":"10.1111/acps.13677","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD-related work disability and the change in psychotropic drug purchases is scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a register-based cohort representing 33% of the Finnish population. The participants included working-age individuals (<i>N</i> = 12,047, 76% women, mean age = 36) who initiated long-term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration-dependent changes in CMD-related work disability (primary outcome, operationalized as depression or anxiety-related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the &lt;1-year duration group (88% decline for SA and 43%–44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Work disability outcomes and duration varied among individuals, even with similar initial mental health-related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 5","pages":"415-424"},"PeriodicalIF":6.7,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140020364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying the relationship between physical injuries and risk for suicide attempt in a Swedish national sample","authors":"Mallory Stephenson,&nbsp;Henrik Ohlsson,&nbsp;Séverine Lannoy,&nbsp;Jan Sundquist,&nbsp;Kristina Sundquist,&nbsp;Alexis C. Edwards","doi":"10.1111/acps.13675","DOIUrl":"10.1111/acps.13675","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The Interpersonal-Psychological Theory of Suicide proposes that capability for suicide is acquired through exposure to painful and provocative events (PPEs). Although there is robust evidence for a positive association between aggregate measures of PPEs and risk for suicidal behavior, little is known about the contributions of physical injuries. The present study investigated the relationship between injuries and risk of subsequent suicide attempt (SA).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data were from Swedish population-based registers. All individuals born in Sweden between 1970 and 1990 were included (&lt;i&gt;N&lt;/i&gt; = 1,011,725 females and 1,067,709 males). We used Cox regression models to test associations between 10 types of injuries (eye injury; fracture; dislocation/sprain/strain; injury to nerves and spinal cord; injury to blood vessels; intracranial injury; crushing injury; internal injury; traumatic amputation; and other or unspecified injuries) and risk for later SA. Analyses were stratified by sex and adjusted for year of birth and parental education. Additional models tested for differences in the pattern of associations based on age group and genetic liability for SA. In co-relative models, we tested the association between each injury type and risk for SA in relative pairs of varying genetic relatedness to control for unmeasured familial confounders.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;All 10 injury types were associated with elevated risk for SA (hazard ratios [HRs] = 1.2–7.0). Associations were stronger in the first year following an injury (HRs = 1.8–7.0), but HRs remained above 1 more than 1 year after injury exposure (HRs = 1.2–2.6). The strength of associations varied across injury type, sex, age, and genetic liability for SA. For example, the magnitude of the association between crushing injury and risk for SA was larger in females than males, whereas other injuries showed a similar pattern of associations across sex. Moreover, there was evidence to support positive additive interaction effects between several injury types and aggregate genetic liability for SA (relative excess risk due to interaction [RERI] = 0.1–0.3), but the majority of these interactions became non-significant or changed direction after accounting for comorbid psychiatric and substance use disorders. In co-relative models, the pattern of associations differed by injury type, such that there was evidence to support a potential causal effect of eye injury, fracture, dislocation/sprain/strain, intracranial injury, and other and unspecified injuries on risk for SA. For the remaining injury types, HRs wer","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 5","pages":"389-403"},"PeriodicalIF":6.7,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13675","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139981840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient admissions and mortality of anorexia nervosa patients according to their preceding psychiatric and somatic diagnoses","authors":"Natalie C. Momen,&nbsp;Jindong Ding Petersen,&nbsp;Zeynep Yilmaz,&nbsp;Birgitte D. Semark,&nbsp;Liselotte Vogdrup Petersen","doi":"10.1111/acps.13676","DOIUrl":"10.1111/acps.13676","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Anorexia nervosa (AN) is associated with increased risk of mortality, but little is known about the risk of inpatient admissions and mortality outcomes in individuals with diagnoses of both AN and other psychiatric and somatic conditions. We aimed to investigate the inpatient admissions and mortality among people with AN and other diagnosed conditions using Danish national registers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This retrospective cohort study included individuals diagnosed with AN in Denmark, born 1977–2010. We identified other mental and somatic conditions in this population. We used Cox proportional hazards regression to estimate the risk of inpatient admission and mortality, focusing on (i) the number of other diagnosed conditions, and (ii) specific combinations of conditions diagnosed prior to the AN diagnosis. Categories of inpatient admissions considered were due to: (i) AN, (ii) any psychiatric disorder, and (iii) any somatic disorder. Additionally, competing risks survival analysis was used to calculate the cumulative incidence of inpatient admission and all-cause mortality over the follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study population included 11,489 individuals. The most common conditions individuals had prior to their AN diagnosis were other eating disorders (34.5%) and anxiety disorders (32.7%). During the follow-up, 3184 (27.7%), 4604 (40.1%), and 6636 (57.8%) individuals were admitted for AN, any psychiatric disorder, and any somatic disorder, respectively; and in total 106 (0.9%) died. The risk of all outcomes was highest among those who had received a higher number of other diagnoses. For most combinations, the risks of admission and mortality were increased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our study presents the prevalence of other conditions in patients with AN in Denmark and elucidates their association with higher rates of inpatient admission and mortality. Our findings highlight the need for comprehensive, multidisciplinary care of patients with AN considering the spectrum of other diagnosed conditions to improve health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 5","pages":"404-414"},"PeriodicalIF":6.7,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139970105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a private sector residential early parenting program on clinically significant postnatal depressive symptoms experienced by women: Audit of routinely collected data","authors":"Jane Fisher,&nbsp;Karin Stanzel,&nbsp;Hau Nguyen,&nbsp;Patsy Thean,&nbsp;Danielle French,&nbsp;Sally Popplestone,&nbsp;Thach Tran","doi":"10.1111/acps.13668","DOIUrl":"10.1111/acps.13668","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Early parenting services in Australia offer brief structured residential programs to address moderate to severe non-psychotic mental health problems among women and unsettled infant/toddler behaviours. The aims were to (1) estimate the immediate and medium-term impact of a five-night psychoeducational residential early parenting program on postpartum depressive symptoms and (2) identify the factors associated with improvement or worsening of postpartum depressive symptoms after completing the program and six weeks post-discharge.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Audit of routinely collected medical record data from pre-admission, pre-discharge and post-discharge assessments of a consecutive cohort of women admitted, with their infants/toddlers in a 15-month period to Masada Private Hospital Early Parenting Centre. Data included structured questions assessing: demographic characteristics, access to family and social support, past and current mental health problems, reproductive and obstetric health, chronic health conditions, breastfeeding problems, coincidental major life events, health risk behaviours and infant/toddler feeding, sleeping and crying behaviours. Standardised instruments included the Partner Interaction after Birth Scale (PIBS), the MacLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Modified Fatigue Assessment Scale (FAS) and selected items from the Karitane Parenting Confidence Scale. The primary outcomes were Edinburgh Postnatal Depression Scale scores at pre-discharge and follow up assessments. Data were analysed using multinomial logistic regression models in which individual and psychosocial characteristics at pre-admission were included as predictors of the likelihood of the changes of the outcomes from pre-admission to pre-discharge and follow up.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Complete data from 1220 of 1290 (95%) eligible women were available to assess pre-admission to pre-discharge and from 559 (45.8%) to assess pre-discharge to six-week follow-up changes. The mean pre-admission EPDS score was 11.7 (95% CI: 11.5; 12.0), pre-discharge it was 7.1 (95% CI: 6.9; 7.4) and at six-week follow up it was 5.7 (95% CI: 5.3; 6.1). We found that almost all women experienced a clinically meaningful and rapid improvement in depressive symptoms of at least this magnitude (reduction in mean EPDS scores of 4.6 points from pre-admission to pre-discharge (five nights) and a further reduction of 1.2 points pre-discharge to follow up) (six weeks) and we identified an interpretable set of risk factors for symptoms that did not improve or worsened. The a","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 5","pages":"458-473"},"PeriodicalIF":5.3,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13668","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139970104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antipsychotic agents in anxiety disorders: An umbrella review","authors":"Amir Garakani,&nbsp;Frank D. Buono,&nbsp;Mona Salehi,&nbsp;Melissa C. Funaro,&nbsp;Anna Klimowicz,&nbsp;Harshit Sharma,&nbsp;Clara G. F. Faria,&nbsp;Kaitlyn Larkin,&nbsp;Rafael C. Freire","doi":"10.1111/acps.13669","DOIUrl":"10.1111/acps.13669","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Although not approved for the treatment of anxiety disorders (except trifluoperazine) there is ongoing off-label, unapproved use of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) for anxiety disorders. There have been systematic reviews and meta-analyses on the use of antipsychotics in anxiety disorders, most of which focused on SGAs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The specific aims of this umbrella review are to: (1) Evaluate the evidence of efficacy of FGAs and SGAs in anxiety disorders as an adjunctive treatment to traditional antidepressant treatments and other nonantipsychotic medications; (2) Compare monotherapy with antipsychotics to first-line treatments for anxiety disorders in terms of effectiveness, risks, and side effects. The review protocol is registered on PROSPERO (CRD42021237436).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;An initial search was undertaken to identify systematic reviews and meta-analyses from inception until 2020, with an updated search completed August 2021 and January 2023. The searches were conducted in PubMed, MEDLINE (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), CINAHL Complete (EBSCOhost), and the Cochrane Library through hand searches of references of included articles. Review quality was measured using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) scale.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The original and updated searches yielded 1796 and 3744 articles respectively, of which 45 were eligible. After final review, 25 systematic reviews and meta-analyses were included in the analysis. Most of the systematic reviews and meta-analyses were deemed low-quality through AMSTAR-2 with only one review being deemed high-quality. In evaluating the monotherapies with antipsychotics compared with first-line treatments for anxiety disorder there was insufficient evidence due to flawed study designs (such as problems with randomization) and small sample sizes within studies. There was limited evidence suggesting efficacy of antipsychotic agents in anxiety disorders other than quetiapine in generalized anxiety disorder (GAD).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This umbrella review indicates a lack of high-quality studies of antipsychotics in anxiety disorders outside of the use of quetiapine in GAD. Although potentially effective for anxiety disorders, FGAs and SGAs may have risks and side effects that outweigh their efficacy, although there were limited data. Further long-term and larger-scale","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 4","pages":"295-312"},"PeriodicalIF":6.7,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139928981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obsessive-compulsive disorder: Taking the long view","authors":"Robert Stewart,&nbsp;Lieuwe de Haan,&nbsp;Richard D. Hayes","doi":"10.1111/acps.13672","DOIUrl":"10.1111/acps.13672","url":null,"abstract":"&lt;p&gt;The study by Klenfeldt et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; in this issue presents a valuable long-term picture of obsessive-compulsive disorder (OCD) stability and comorbidities over a nearly 50-year follow-up period. With its appropriate (and possibly near-unique) three-generation authorship, the paper illustrates the need for, and challenges facing, long-duration prospective studies in mental health research.&lt;/p&gt;&lt;p&gt;Although the importance of the clinical viewpoint is rightly emphasised in mental health research, it can often be misleading. By definition, this experience is skewed towards short-term care for people in periods of crisis, who are categorised into diagnoses based primarily on contemporaneous symptoms, and whose duration of contact with specialists is ever more constrained as service pressures encourage discharge at the first evidence of remission. It is rare nowadays to have the luxury of a genuinely long-term perspective on the course and outcome of mental disorders. Indeed, this idea of follow-up over many decades now seems a distant memory of the asylum-era studies from which our specialty emerged.&lt;/p&gt;&lt;p&gt;More commonly, the long view is glimpsed accidentally. For one of us (R.S.), an influential encounter in early clinical practice was with a man in his 30s who happened to be attending a routine outpatient clinic, who was perfectly healthy and functioning very well in work and relationships, but whose case notes (in the old paper days) were thick with repeated self-harm and other crisis presentations from a decade or so earlier. Plenty of research shows that many mental disorders, including some described as enduring disorders of personality, are transient or fluctuating rather than persistent and unremitting; however, this truth can be hard to appreciate at times of morbidity. In addition to transience and fluctuations in syndrome severity, it is well established that diagnostic categories are unstable—again frequently under-appreciated in clinical practice and missed in short-term research studies. Common mental disorders are particularly susceptible to variation, with mixed anxiety and depression considerably more prevalent in community surveys than discrete syndromes, and a high likelihood of switches between diagnoses over time.&lt;/p&gt;&lt;p&gt;Impressions from clinical practice, where people who successfully recover from an illness episode frequently have no need or wish for further service involvement, can therefore understandably be blinkered by its focus on new presentations, relapses and treatment resistance. This can be compounded in research where studies are often cross-sectional or have relatively short follow-up periods, therefore only providing ‘snapshot’ images of mental disorders, their course and treatment outcomes, not to mention the additional limitations of participation bias and unrepresentative clinical samples. In particular, clinical and research follow-up of patients with diminished insight (e.g., psychotic disord","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 4","pages":"281-283"},"PeriodicalIF":6.7,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139928982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative responses to 17 different antidepressants in major depressive disorder: Results from a 2-year long-term nation-wide population-based study emulating a randomized trial","authors":"Lars Vedel Kessing,&nbsp;Simon Christoffer Ziersen,&nbsp;Frederik Mølkjær Andersen,&nbsp;Thomas Gerds,&nbsp;Esben Budtz-Jørgensen","doi":"10.1111/acps.13673","DOIUrl":"10.1111/acps.13673","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long-term studies comparing nonresponse to antidepressants for major depressive disorder (MDD) are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To present systematic population-based nation-wide register data on comparative 2-year non-response within six antidepressant drug classes and 17 different antidepressants in patients with MDD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The study included all 106,920 patients in Denmark with a first main index diagnosis of MDD at a psychiatric hospital inpatient or outpatient contact and who subsequently had a purchase of an antidepressant in the period from 1995 to 2018. Non-response to first antidepressant within a 2-year study period was defined as switch to or add-on of another antidepressant, antipsychotic medication, lithium, or hospitalization. Analyses emulated a targeted trial in populations standardized according to age, sex, socioeconomic status, and comorbidity with psychiatric and physical disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with sertraline, there was no difference for citalopram (RR: 1.00 [95% CI: 0.98–1.02]) but fluoxetine (1.13 [95% CI: 1.10–1.17]), paroxetine (1.06 [95% CI: 1.01–1.10]) and escitalopram (1.22 [95% CI: 1.18–1.25]) were associated with higher risk ratio of non-responses. Within selective noradrenaline reuptake inhibitors, sertraline outperformed reboxetine; within serotonin-norepinephrine reuptake inhibitors, venlafaxine outperformed duloxetine; within <i>noradrenergic and specific serotonergic antidepressants</i>, mirtazapine outperformed mianserin and within the class of other antidepressants, sertraline outperformed agomelatine and vortioxetine. Within tricyclic antidepressants, compared to amitriptyline, nortriptyline, dosulepin, and clomipramine had higher non-response, whereas there was no difference for imipramine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These analyses emulating a randomized trial of “real world” observational register-based data show that 2-year long-term non-responses to some antidepressants within six different drug classes are increased over others.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 5","pages":"378-388"},"PeriodicalIF":6.7,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139911540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}