Acta Psychiatrica Scandinavica最新文献

{"title":"Recovery and Recurrence From Major Depression in Adolescence and Adulthood","authors":"Adrian E. Desai Boström,&nbsp;Thomas Cars,&nbsp;Clara Hellner,&nbsp;Johan Lundberg","doi":"10.1111/acps.13785","DOIUrl":"10.1111/acps.13785","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study aimed to estimate 5-year recurrence rates of first-episode major depressive disorder (MDD) and assess the impact of adolescence on recurrence likelihood after the first episode, compared to adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pre-registered retrospective cohort study that utilized epidemiological data from the Stockholm MDD Cohort (1997–2018), including all individuals registered with a depression diagnosis in Region Stockholm from 2010 to 2018. This dataset combines longitudinal information from primary and secondary care, socioeconomic data, drug dispensations, psychotherapy sessions, brain stimulation treatments, and inpatient treatment. The study included 9124 individuals (1727 adolescents aged 13–17 and 7397 adults aged 18–40) who experienced their first MDD episode between 2011 and 2012, with at least three months of remission. Propensity score weighting balanced cohorts for biological sex, socioeconomic status, depression severity, psychiatric comorbidities, and treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 5-year recurrence rates were 46.1% for adolescents and 49.0% for adults. The study had over 80% power to detect a minimum absolute difference in recurrence rates of approximately 5.5 percentage points. No significant difference in recurrence likelihood (<i>p</i> = 0.364) or time from remission to recurrence (median 379 days for adolescents, 326 days for adults, <i>p</i> = 0.836) was found between groups. Findings were consistent across bootstrap replicates and sensitivity analyses with extended remission periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Approximately half of individuals with a first MDD episode experience recurrence within five years. Recurrence rates were higher than expected for adults but consistent with expectations for adolescents. The study underscores the need for relapse prevention from adolescence through adulthood and indicates a similar clinical course of MDD across age groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"625-633"},"PeriodicalIF":5.3,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13785","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930116","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":"Genetic Confounding of the Association Between Age at First Hormonal Contraception and Depression","authors":"Jessica Mundy,&nbsp;Alisha S. M. Hall,&nbsp;Esben Agerbo,&nbsp;Clara Albiñana,&nbsp;Jette Steinbach,&nbsp;Bjarni J. Vilhjálmsson,&nbsp;Søren D. Østergaard,&nbsp;Katherine L. Musliner","doi":"10.1111/acps.13774","DOIUrl":"10.1111/acps.13774","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous research has shown that females who use hormonal contraception are at increased risk of developing depression, and that the risk is highest among adolescents. While this finding could reflect age-specific effects of exogenous hormones on mental health, genetic liability for mental disorders could be confounding the association. Our goal was to test the plausibility of this hypothesis by determining whether polygenic liabilities for major depressive disorder (MDD), bipolar disorder (BD), schizophrenia (SCZ), and attention deficit hyperactivity disorder (ADHD) are associated with younger age at hormonal contraception initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cohort study using data from the Danish iPSYCH2015 sub-cohort, a representative sample of people born in Denmark between May 1981 and December 2008. Polygenic scores (PGSs) for MDD, BD, SCZ, and ADHD were created using the most recent genome-wide association study meta-analyses from the Psychiatric Genomics Consortium. Associations between PGSs and hormonal contraception initiation in the following age categories: 10–14, 15–19, 20–24, and 25+ were examined via Cox regression. We examined any hormonal contraception, oral contraception, and non-oral contraception.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PGS-MDD and PGS-ADHD showed the strongest associations with hormonal contraception initiation at age 10–14 (PGS-ADHD: HR = 1.21 [95% CI = 1.16–1.27], <i>p</i> = 6.16 x 10⁻¹⁸; PGS-MDD: 1.21 [1.16–1.27], <i>p</i> = 1.22 x 10⁻¹⁷). The associations then steadily decreased as age at hormonal contraception initiation increased. Both PGS-MDD and PGS-ADHD were also associated with initiation at ages 15–19, but not at 20–24 or 25+. PGS-BD and PGS-SCZ were also associated, albeit not as strongly, with initiation at age 10–14 only (PGS-BD: 1.07 [1.02–1.13], <i>p</i> = 6.87 × 10⁻³; PGS-SCZ: 1.09 [1.04–1.14], <i>p</i> = 8.61 × 10⁻⁴).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and Relevance</h3>\u0000 \u0000 <p>These results suggest that genetic confounding could explain some of the association between early hormonal contraception use and depression. Where possible, researchers studying this important topic should account for possible confounding by genetic liability for mental disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"529-536"},"PeriodicalIF":5.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918647","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":"From Genetics to Psychosocial Functioning: Unraveling the Mediating Roles of Cognitive Reserve, Cognition, and Negative Symptoms in First-Episode Psychosis","authors":"M. Florencia Forte,&nbsp;Derek Clougher,&nbsp;Àlex G. Segura,&nbsp;Gisela Mezquida,&nbsp;Ana Maria Sánchez-Torres,&nbsp;Eduard Vieta,&nbsp;Marina Garriga,&nbsp;Antonio Lobo,&nbsp;Ana M González-Pinto,&nbsp;Covadonga M. Diaz-Caneja,&nbsp;Alexandra Roldan,&nbsp;Anabel Martínez-Arán,&nbsp;Elena de la Serna,&nbsp;Anna Mané,&nbsp;Sergi Mas,&nbsp;Carla Torrent,&nbsp;Kelly Allot,&nbsp;Miquel Bernardo,&nbsp;Silvia Amoretti,&nbsp;PEPs Group","doi":"10.1111/acps.13779","DOIUrl":"10.1111/acps.13779","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies have shown associations between polygenic risk scores for educational attainment (PRS_EA), cognitive reserve (CR), cognition, negative symptoms (NS), and psychosocial functioning in first-episode psychosis (FEP). However, their specific interactions remain unclear. This study aimed to investigate the mediating roles of CR, cognition, and NS in the relationship between PRS_EA and psychosocial functioning one year after a FEP. Additionally, we sought to explore the impact of two NS subtypes on this relationship: diminished Expression (EXP-NS) and Motivation and Pleasure (MAP-NS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 138 FEP participants, predominantly male (70%), with a mean age of 24.77 years (SD = 5.29), underwent genetic, clinical, and cognitive assessments two months after study enrollment. Functioning evaluation followed at one-year follow-up. To investigate the mediating role of CR, cognition, and NS in the relationship between PRS_EA and functioning, a serial mediation model was employed. Two further mediation models were tested to explore the differential impact of EXP-NS and MAP-NS. Mediation analysis was performed using the PROCESS macro version 4.1 within SPSS version 26.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The serial mediation model revealed a causal chain for PRS_EA &gt; CR &gt; cognition &gt; NS &gt; Functioning (<i>β</i> = −3.08, 95%CI [−5.73, −0.43], <i>p</i> = 0.023). When differentiating by type of NS, only EXP-NS were significantly associated in the casual chain (<i>β</i> = −0.17, 95% CI [−0.39, −0.01], <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CR, cognition and NS -specifically EXP-NS- mediate the association between PRS_EA and psychosocial functioning at one-year follow-up in FEP patients. These results highlight the potential for personalized interventions based on genetic predisposition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"600-612"},"PeriodicalIF":5.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890602","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":"Means Restriction for Suicide Prevention: An Umbrella Review","authors":"Adriana G. Nevarez-Flores,&nbsp;Vandana Pandey,&nbsp;Adriana Perez Angelucci,&nbsp;Amanda L. Neil,&nbsp;Brett McDermott,&nbsp;David Castle","doi":"10.1111/acps.13783","DOIUrl":"10.1111/acps.13783","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this umbrella review is to summarise existing international evidence on means restriction activities for the prevention of suicide, and provide evidence of their success or lack thereof. The consolidated and integrated information can help inform potential public health interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An overview of published systematic reviews in English was undertaken. There were no time restrictions. Six major repositories of systematic reviews databases were searched for relevant studies and the reference lists of all selected systematic reviews searched for identifying reviews not retrieved within the database searches. Included studies needed to be Cochrane or non-Cochrane systematic reviews (with or without meta-analyses) that explored means restriction activities for suicide prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 670 records were identified across the searches; 11 reviews were eligible for inclusion. Three further reviews were identified through list searches with one eligible for inclusion. Thus, 12 systematic reviews were included in this umbrella review. Activities undertaken around the world were implemented for the prevention of suicide by firearms, jumping from heights and in front of a moving object, and suicide by hazardous agents. A variety of factors associated with the success and/or failure of mean restriction activities were identified, including the prevalence of method and presence or lack of a substitution effect. Most reviews found means restriction activities successful in the prevention of suicide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Means restriction is an empirically proven strategy that should be considered for the prevention of suicide. Priority should be given to the most prevalent methods of suicide and implementation of locally relevant solutions, including the cultural context of the targeted population. Other important factors such as minimisation of any substitution effect need to be considered when implementing means restriction activities for suicide prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"653-667"},"PeriodicalIF":5.3,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880766","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":"The Effectiveness of Immersive Virtual Reality-Based Treatment for Mental Disorders: A Systematic Review With Meta-Analysis","authors":"Fatime Zeka,&nbsp;Lars Clemmensen,&nbsp;Lucia Valmaggia,&nbsp;Wim Veling,&nbsp;Carsten Hjorthøj,&nbsp;Louise Birkedal Glenthøj","doi":"10.1111/acps.13777","DOIUrl":"10.1111/acps.13777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The increasing number of studies of immersive virtual reality (VR) interventions for mental disorders call for an examination of the current level of evidence on their effectiveness. The findings may guide scalability and contribute to the advancement and optimization of immersive VR-based interventions for mental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search across four databases screened 2443 studies. Outcomes were disorder-specific symptoms, cognition, function, and quality of life. The study is registered on PROSPERO (CRD42023465845) and follows the reporting standards outlined in the PRISMA guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-five studies involving a total of 3031 participants covering 10 mental disorders were included in the analysis. VR interventions demonstrated statistically significant effects of post-treatment compared to active control conditions for alcohol use disorder (reduced state anxiety, <i>g</i> = 0.89, 95% CI[0.24, 1.55]) and schizophrenia spectrum disorders (reduced psychotic symptoms, <i>g</i> = 0.37, 95% CI[0.04, 0.70]). Compared to passive control conditions, statistically significant effects of VR interventions were observed for panic and agoraphobia (<i>g</i> = 1.28, 95% CI [0.47, 2.10]), social anxiety disorder (<i>g</i> = 0.83, 95% CI [0.49, 1.17]), specific phobias (<i>g</i> = 1.07, 95% CI[0.22, 1.92]), depression symptoms in PTSD (<i>g</i> = 0.67, 95% CI [0.22;1.13]). In contrast, no significant differences were found between VR interventions and active control conditions for functioning and quality of life in schizophrenia spectrum disorder and panic or agoraphobia. No meta-analyses were conducted on cognition due to insufficient data. Over 50% of the included studies were assessed as having a high risk of bias. According to the GRADE assessment, evidence for VR-based interventions across various mental disorders was generally of low to very low certainty, with a few exceptions rated as moderate certainty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VR interventions may potentially have benefits, particularly when compared to passive control conditions, however, the evidence remains uncertain necessitating more large-scale, methodologically robust studies. Current findings can thus only be considered indicative. Recommendations on future directions of the VR field are discussed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"210-230"},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875399","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":"Author's Response to Letter to the Editor Concerning “Glucagon-Like Peptide Agonists for Weight Management in Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis”","authors":"Bea Campforts,&nbsp;Maarten Bak,&nbsp;Patrick Domen,&nbsp;Therese van Amelsvoort,&nbsp;Marjan Drukker","doi":"10.1111/acps.13784","DOIUrl":"10.1111/acps.13784","url":null,"abstract":"&lt;p&gt;We would like to express our gratitude to the authors for their interest in our review and for the time they dedicated to reviewing and commenting on our work [&lt;span&gt;1&lt;/span&gt;]. We are pleased with the underlining of the potential impact glucagon-like peptide-1 (GLP-1) agonists may have on psychopathology. This represents a significant avenue for future investigation, particularly given the influence of GLP-1 agonists on dopamine homeostasis in reward-related brain regions. This topic has yet to be sufficiently explored. Previous trials utilising GLP-1 agonists for the treatment of the metabolic side effects associated with antipsychotic medications have generally ignored the interaction with psychopathological changes as a potential side effect.&lt;/p&gt;&lt;p&gt;The authors have raised methodological concerns about our meta-analysis [&lt;span&gt;2&lt;/span&gt;]. Nevertheless, we believe that the arguments and assumptions made by the authors are not entirely accurate.&lt;/p&gt;&lt;p&gt;First, it should be noted that our inclusion criteria were explicitly defined as encompassing both randomised clinical trials (RCTs), and non-randomised controlled trials, as well as cohort studies [&lt;span&gt;2&lt;/span&gt;]. The rationale behind the inclusion of RCTs as well as non-RCTs may be open to debate. However, the objective was to include as many valid trials of GLP-1 agonists in this population as possible. Despite RCTs being regarded as the gold standard, it remains to be seen whether the populations included in RCTs are fully representative of the clinical population in mental health services. Moreover, non-RCTs are not, by definition, inherently inferior in terms of quality or outcome status. A recent analysis by Taipale et al. estimated that only approximately 20% of patients with schizophrenia spectrum disorders may be represented in RCTs [&lt;span&gt;3&lt;/span&gt;]. This leaves 80% of patients in this population generally excluded from RCTs. Cohort studies are often considered to have a lower level of evidence than RCTs, but the inclusion of cohort studies increases the external validity. In light of the aforementioned evidence, the decision to include non-randomised studies is justifiable, with due consideration of the limitations of both RCTs and non-RCTs.&lt;/p&gt;&lt;p&gt;Second, we do not understand why the exclusion of Prasad's case series [&lt;span&gt;4&lt;/span&gt;] is being questioned. While the study is undoubtedly intriguing, it has to be excluded while it fails to meet the a priori defined inclusion criterion that explicitly prohibits the inclusion of studies employing multiple weight reduction interventions simultaneously. The authors explicitly indicate that the majority of patients were still using metformin at the time of the introduction of semaglutide. If the intervention with metformin was unsuccessful, why not switch to a GLP-1 agonist, in this case semaglutide, rather than adding it? It is not possible to discern or assess the effect of semaglutide in isolation from metformin in this specific study. There","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"644-645"},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13784","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875628","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":"Antipsychotics or Mood Stabilizers in Bipolar Disorder: Towards Evidence-Based Personalised Medicine","authors":"Marie Tournier","doi":"10.1111/acps.13780","DOIUrl":"10.1111/acps.13780","url":null,"abstract":"&lt;p&gt;Lintunen et al. [&lt;span&gt;1&lt;/span&gt;] publish in previous issue an article entitled &lt;i&gt;Dosing Levels of Antipsychotics and Mood Stabilizers in Bipolar Disorder: A Nationwide Cohort Study on Relapse Risk and Treatment Safety&lt;/i&gt;. This nationwide study estimates doses of antipsychotics and mood stabilizers associated with the most favourable benefit–risk ratio. Benefit corresponded to a decreased risk of psychiatric hospitalization (prevention of relapse) and risk to an increase in non-psychiatric hospitalization (adverse events). The authors followed individuals with bipolar disorder from diagnosis over an average of 8 years. They compared outcomes over periods with and without antipsychotics or with and without mood stabilizers within individuals, by distinguishing low (&lt; 0.9 DDD), standard (0.9– &lt; 1.1 DDD) and high doses (≥ 1.1 DDD). Only monotherapies and individuals with both treatment changes and outcomes contributed to the findings. This design might have selected individuals with most severe disorders or those who did not receive an effective medication on a first line of treatment, but allowed comparing various treatment patterns.&lt;/p&gt;&lt;p&gt;Considering sensitivity analyses that omitted the 30-day period following treatment changes and selected stable treatments, among antipsychotics, only low and standard doses of aripiprazole (&lt; 16.5 mg/day) were able to prevent relapse. High doses and quetiapine at any dose were associated with an increase in psychiatric hospitalization. While the association between high doses and relapse might be due to confounding by indication (relapse justifying the increase in dose), the absence of preventive effectiveness of antipsychotic monotherapies is alarming and contrasts with their extensive use [&lt;span&gt;2&lt;/span&gt;]. Previous publications highlighted the lack of evidence of efficacy of antipsychotics in the maintenance treatment of bipolar disorders, RCTs showing selection bias (enrichment design limiting generalizability, inclusion of bipolar disorder type I only), attrition bias (considerable dropout levels), insufficient duration to demonstrate preventive efficacy, possible adverse effects of abrupt medication discontinuation in the placebo-group with beneficial effects of treatment and possible reporting bias [&lt;span&gt;3, 4&lt;/span&gt;]. Parallelly, Lintunen et al. [&lt;span&gt;1&lt;/span&gt;] found an increased risk of non-psychiatric hospitalization except for standard doses of olanzapine, risperidone and aripiprazole and low dose of aripiprazole, questioning the benefit–risk ratio of these monotherapies. These safety concerns are added to previous ones concerning mortality or cognitive functioning [&lt;span&gt;2, 5, 6&lt;/span&gt;]. A real utility of antipsychotics was shown at short- and mid-term in acute bipolar episodes and in association with mood stabilizers with synergistic effects [&lt;span&gt;7, 8&lt;/span&gt;]. Their place in the therapeutic strategy might be re-thought and, for example, re-focused on acute episodes and patients with d","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"107-108"},"PeriodicalIF":5.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833221","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":"Randomized Controlled Trials of Psilocybin-Assisted Therapy in the Treatment of Major Depressive Disorder: Systematic Review and Meta-Analysis","authors":"Vikas Menon,&nbsp;Parthasarathy Ramamurthy,&nbsp;Sandesh Venu,&nbsp;Chittaranjan Andrade","doi":"10.1111/acps.13778","DOIUrl":"10.1111/acps.13778","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is growing interest in the use of psychedelic-assisted therapy (PAT) for major depressive disorder (MDD), including treatment-resistant depression. We used randomized controlled trial (RCT) data to compare summary estimates of change in depression ratings with PAT versus comparator treatments in MDD. We also compared response and remission rates, and adverse effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials (CENTRAL), and SCOPUS from inception till April 2024. Our primary efficacy outcome was 1-week (or nearest) between-group change in depression ratings. Secondary efficacy outcomes were changes in depression ratings at days 2, 14, and 42 (or nearest) and study-defined response and remission rates at week 1 (or nearest). Safety outcomes were reported adverse effects. We pooled outcomes in random-effects meta-analyses using standardized mean difference (SMD; Hedges <i>g</i>) for continuous outcomes and risk ratio (RR) for categorical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found 6 eligible RCTs (pooled <i>N</i> = 427), all on psilocybin. The pooled SMD for 1-week between-group change in depression ratings was −0.72 [95% CI, −0.95 to −0.49; <i>I</i>2 = 17%; 5 RCTs; <i>n</i> = 403], favouring PAT; results were similar at days 2, 14, and 42. The response [RR = 3.42; 95% CI, 2.35–4.97; <i>I</i>2 = 0%; 4 RCTs; <i>n</i> = 373] and remission [RR = 3.66; 95% CI, 2.26–5.92; <i>I</i>2 = 0%; 4 RCTs; <i>n</i> = 373] rates also favored PAT. The PAT group had a small but significantly increased risk of developing any adverse event [RR = 1.20; 95% CI, 1.01–1.42; <i>I</i>2 = 43%; 4 RCTs; <i>n</i> = 373] and a significantly higher risk of experiencing headache [RR = 1.78; 95% CI, 1.10–2.86; <i>I</i>2 = 52%; 4 RCTs; <i>n</i> = 373] and dizziness [RR = 6.52; 95% CI, 1.19–35.87; <i>I</i>2 = 0%; 3 RCTs; <i>n</i> = 269]. Low heterogeneity characterized most analyses and findings were similar in sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Antidepressant effects of psilocybin-assisted therapy are superior (with at least medium effect sizes) to comparator interventions for at least up to 6 weeks postintervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"557-571"},"PeriodicalIF":5.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765048","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":"Initiation of Antipsychotics During the First Year After First-Episode Psychosis: A Population-Based Study","authors":"I. Odsbu,&nbsp;A. Hamina,&nbsp;V. Hjellvik,&nbsp;M. Handal,&nbsp;M. Haram,&nbsp;M. Tesli,&nbsp;A. Tanskanen,&nbsp;H. Taipale","doi":"10.1111/acps.13776","DOIUrl":"10.1111/acps.13776","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antipsychotics are recommended after first-episode psychosis. Knowledge on the current use patterns in real-world settings is thus important to inform clinical practice. We aimed to describe antipsychotic initiation during 1 year after first-episode psychosis and its associated factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Population-based cohort study using linked nationwide health and population registers from Norway. The study population comprised 8052 persons aged 16–45 years with first-episode psychosis diagnosed in secondary care (ICD-10 F20, F22–F29) in the period 2011–2019. Initiation of antipsychotic use was defined as being dispensed antipsychotics (ATC N05A, excl. lithium) at least once from −90 to +365 days from secondary care diagnosis of first-episode psychosis. Antipsychotic polypharmacy during follow-up was defined as having at least 90 days with overlapping drug use periods modeled using the Prescriptions to Drug Use Periods method. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for the association between socioeconomic and clinical factors and initiation of antipsychotic use were calculated using modified Poisson regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 4413 persons (54.8%) initiated antipsychotic use after first-episode psychosis with proportions ranging from 45.5% in 2012 to 62.1% in 2019. Oral formulations of olanzapine (34.9%), quetiapine (21.2%), and aripiprazole (11.6%) were most common at initiation, whereas long-acting injectables (LAIs) and clozapine were rarely used. Among the initiators, 13.8% started a polypharmacy period lasting more than 90 days. Factors associated with antipsychotic initiation were lower age (aRR 1.14, 95% CI 1.08–1.21; 26–35 years vs. 36–45 years), higher education (1.11, 1.05–1.18), being employed (1.04, 1.00–1.09), being hospitalized (1.13, 1.09–1.18), being diagnosed late in the study period (1.16, 1.11–1.22; 2017–2019 vs. 2011–2013), or with previously diagnosed bipolar disorder, depression, or anxiety disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The antipsychotic use pattern is largely within the current clinical guideline. Primary non-compliance and disease severity may explain the socioeconomic and clinical differences related to initiation of antipsychotic use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"537-547"},"PeriodicalIF":5.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754364","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":"More rTMS pulses or more sessions? The impact on treatment outcome for treatment resistant depression","authors":"E. Oostra,&nbsp;P. Jazdzyk,&nbsp;V. Vis,&nbsp;I. Dalhuisen,&nbsp;A. W. Hoogendoorn,&nbsp;C. H. M. Planting,&nbsp;P. F. van Eijndhoven,&nbsp;Y. D. van der Werf,&nbsp;O. A. van den Heuvel,&nbsp;E. van Exel","doi":"10.1111/acps.13768","DOIUrl":"10.1111/acps.13768","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Repetitive transcranial magnetic stimulation (rTMS) is effective for treatment-resistant depression (TRD). Optimal rTMS parameters remain unclear, especially whether number of sessions or amount of pulses contribute more to treatment outcome. We hypothesize that treatment outcome depends on the number of sessions rather than on the amount of pulses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched databases for randomized clinical trials (RCTs) on high-frequent (HF) or low-frequent (LF)-rTMS targeting the left or right DLPFC for TRD. Treatment efficacy was measured using standardized mean difference (SMD), calculated from pre- and post-treatment depression scores. Meta-regressions were used to explore linear associations between SMD and rTMS pulses, pulses/session and sessions for HF and LF-rTMS, separately for active and sham-rTMS. If these variables showed no linear association with SMD, we divided the data into quartiles and explored subgroup SMDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-seven RCTs were included: 67 studied HF-rTMS, eleven studied LF-rTMS, and nine studied both. No linear association was found between SMD and amount of pulses or pulses/session for HF and LF-rTMS. Subgroup analyses showed the largest SMDs for 1200–1500 HF-pulses/session and 360–450 LF-pulses/session. The number of sessions was significantly associated with SMD for active HF (<i>β</i> = 0.09, <i>p</i> &lt; 0.05) and LF-rTMS (<i>β</i> = 0.06, <i>p</i> &lt; 0.01). Thirty was the maximal number of sessions, in the included RCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>More rTMS sessions, but not more pulses, were associated with improved treatment outcome, in both HF and LF-rTMS. Our findings suggest that 1200–1500 HF-pulses/session and 360–450 LF-pulses/session are already sufficient, and that a treatment course should consist of least 30 sessions for higher chance of response.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"485-505"},"PeriodicalIF":5.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13768","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680028","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}