Acta Psychiatrica Scandinavica最新文献

{"title":"The relationship between blinding integrity and medication efficacy in randomised-controlled trials in patients with anxiety disorders: A systematic review and meta-analysis","authors":"Ruqayyah Haq, Laura Molteni, Nathan T. M. Huneke","doi":"10.1111/acps.13741","DOIUrl":"10.1111/acps.13741","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Blinding is thought to minimise expectancy effects and biases in double-blind randomised-controlled trials (RCTs). However, whether blinding integrity should be assessed and reported remains debated. Furthermore, it is unknown whether blinding failure influences the outcome of RCTs in anxiety disorders. We carried out a systematic review to understand whether blinding integrity is assessed and reported in anxiolytic RCTs. A secondary aim was to explore whether blinding integrity is associated with treatment efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Our protocol was pre-registered (PROSPERO CRD42022328750). We searched electronic databases for placebo-controlled, randomised trials of medication in adults with generalised and social anxiety disorders, and in panic disorder, from 1980. We extracted data regarding blinding integrity and treatment efficacy. Risk of bias was assessed with the Cochrane risk of bias tool. Where possible, we subsequently calculated Bang's Blinding Index, and assessed the association between blinding integrity and treatment effect size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 247 RCTs that met inclusion criteria, we were able to obtain assessments of blinding integrity from nine (3.64%). Overall, blinding failed in five of these trials (55.56%), but blinding was intact in 80% of placebo arms. We found a significant association between reduced blinding integrity among assessors and increased treatment effect size (betas < −1.30, <i>p</i>'s < 0.001), but this analysis involved only four studies of which two were outlying studies. In patients, we saw a non-significant trend where reduced blinding integrity in the placebo groups was associated with <i>increased</i> treatment efficacy, which was not present in active medication arms. [Correction added on 19 August 2024, after first online publication: Results of the RCTs and its assessment of blinding integrity have been updated.]</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Consistent with work in other psychiatric disorders, blinding integrity is rarely reported in anxiolytic RCTs. Where it is reported, blinding appears to often fail. We found signals that suggest unblinding of clinician assessors (driven by two studies with complete unblinding), and of patients in placebo arms, might be associated with larger treatment effect sizes. We recommend that data regarding blinding integrity, along with the reasons patients and assessors offer for their beliefs regarding group allocation, are systematically co","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"187-197"},"PeriodicalIF":5.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13741","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141910887","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":"Acoustic features from speech as markers of depressive and manic symptoms in bipolar disorder: A prospective study","authors":"Katarzyna Kaczmarek-Majer, Monika Dominiak, Anna Z. Antosik, Olgierd Hryniewicz, Olga Kamińska, Karol Opara, Jan Owsiński, Weronika Radziszewska, Małgorzata Sochacka, Łukasz Święcicki","doi":"10.1111/acps.13735","DOIUrl":"10.1111/acps.13735","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Voice features could be a sensitive marker of affective state in bipolar disorder (BD). Smartphone apps offer an excellent opportunity to collect voice data in the natural setting and become a useful tool in phase prediction in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims of the Study</h3>\u0000 \u0000 <p>We investigate the relations between the symptoms of BD, evaluated by psychiatrists, and patients' voice characteristics. A smartphone app extracted acoustic parameters from the daily phone calls of <i>n</i> = 51 patients. We show how the prosodic, spectral, and voice quality features correlate with clinically assessed affective states and explore their usefulness in predicting the BD phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A smartphone app (BDmon) was developed to collect the voice signal and extract its physical features. BD patients used the application on average for 208 days. Psychiatrists assessed the severity of BD symptoms using the Hamilton depression rating scale −17 and the Young Mania rating scale. We analyze the relations between acoustic features of speech and patients' mental states using linear generalized mixed-effect models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prosodic, spectral, and voice quality parameters, are valid markers in assessing the severity of manic and depressive symptoms. The accuracy of the predictive generalized mixed-effect model is 70.9%–71.4%. Significant differences in the effect sizes and directions are observed between female and male subgroups. The greater the severity of mania in males, the louder (<i>β</i> = 1.6) and higher the tone of voice (<i>β</i> = 0.71), more clearly (<i>β</i> = 1.35), and more sharply they speak (<i>β</i> = 0.95), and their conversations are longer (<i>β</i> = 1.64). For females, the observations are either exactly the opposite—the greater the severity of mania, the quieter (<i>β =</i> −0.27) and lower the tone of voice (<i>β</i> = −0.21) and less clearly (<i>β</i> = −0.25) they speak — or no correlations are found (length of speech). On the other hand, the greater the severity of bipolar depression in males, the quieter (<i>β</i> = −1.07) and less clearly they speak (<i>β</i> = −1.00). In females, no distinct correlations between the severity of depressive symptoms and the change in voice parameters are found.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Speech analysis provides physiological markers of affective symptoms in B","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"358-374"},"PeriodicalIF":5.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13735","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905104","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":"Diagnostic and demographic factors of pediatric and adult catatonia hospitalizations: A 2016–2020 National Inpatient Sample Study","authors":"James Luccarelli,&nbsp;Mark Kalinich,&nbsp;Gregory Fricchione,&nbsp;Felicia Smith,&nbsp;Scott R. Beach,&nbsp;Joshua R. Smith","doi":"10.1111/acps.13744","DOIUrl":"10.1111/acps.13744","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Catatonia is a neuropsychiatric disorder that can occur in patients of any age, but it is uncertain whether patient demographics or underlying diagnoses differ between pediatric and adult patients. This study investigates patients of all ages diagnosed with catatonia during acute care hospitalizations in the United States over a 5-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients with a discharge diagnosis of catatonia between 2016 and 2020 with patients stratified by age as pediatric (≤18 years) or adult (&gt;18 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 174,776,205 hospitalizations recorded in the NIS from 2016 to 2020, 61,990 (95% CI: 60,257 to 63,723; 0.035%) involved a diagnosis of catatonia. Of these, 3255 were for pediatric patients and 58,735 were for adult patients. Compared with adult patients, pediatric catatonia patients were more likely to be male and non-White. Diagnostically, psychotic disorders, encephalitis, and neurodevelopmental disorders were more common primary discharge diagnoses in pediatric patients, while adult patients more frequently were diagnosed with mood disorders. Length of stay was not significantly different between pediatric and adult catatonia hospitalizations. Physical restraints were commonly applied for patients with catatonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pediatric and adult catatonia patients differed in sex, race, and diagnosis, although hospital length of stay was not different between pediatric and adult catatonia hospitalizations. These results may inform catatonia diagnosis in the hospital setting and point to disparities that could be targets of quality improvement efforts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"234-244"},"PeriodicalIF":5.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905105","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":"Monoamine oxidase inhibitors in depression treatment: Addressing gaps and future directions","authors":"Jen-Chin Lee,&nbsp;Lien-Chung Wei","doi":"10.1111/acps.13740","DOIUrl":"10.1111/acps.13740","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 6","pages":"573-574"},"PeriodicalIF":5.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764572","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":"Digital nature: Unveiling the impact and safety of FlowVR group intervention for depression in a feasibility trial","authors":"Franziska Miegel,&nbsp;Luzie Lohse,&nbsp;Lena Jelinek,&nbsp;Jakob Scheunemann,&nbsp;Tana Gabbert,&nbsp;Gesche Schauenburg,&nbsp;Lukas Bittner,&nbsp;Fariba Mostajeran,&nbsp;Simone Kühn,&nbsp;Jürgen Gallinat,&nbsp;Amir Yassari","doi":"10.1111/acps.13731","DOIUrl":"10.1111/acps.13731","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study addresses the limitations of existing interventions for depression, such as a deficit-oriented focus, overlooking the utilization of positive elements such as nature, and neglecting the incorporation of group effects. The present feasibility study examines FlowVR, a resource-oriented, nature-inspired virtual reality (VR)-based group therapy. Previously tested individually in a pilot study for non-clinical participants, FlowVR has demonstrated positive effects on depressive symptoms. This study assesses the impact and safety of FlowVR in a group setting within a clinical sample using a one-armed study design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Forty-two inpatients and day patients with depression were recruited. Before and after the FlowVR intervention period of 4 weeks (two sessions per week), depressive symptoms were assessed (Beck Depression Inventory-II; BDI). Symptomatology (i.e., depressive symptoms), depression-associated variables (i.e., self-efficacy), intervention-specific variables (feeling of flow), and VR-specific variables (simulator sickness) were assessed before and after each session.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Linear mixed effect models showed that symptomatology (depression, negative affect, current anxiety), depression-associated constructs (self-efficacy, motivation), and intervention-specific variables (flow) improved over the course of the sessions. No variable deteriorated more in one session compared to any other session. The lasso regression identified five potential predictors for the change in depression (BDI-II), yet these could not be validated in a subsequent linear regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To conclude, FlowVR had the hypothesized positive impact over the course of the sessions, showing, for example, improvements in symptomatology. The sessions have demonstrated safety with no notable deteriorations. Therefore, FlowVR is deemed safe for clinical patients and group settings. However, further research is needed to explore predictors for the change in depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"304-316"},"PeriodicalIF":5.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141755823","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":"Glucagon-like peptide agonists for weight management in antipsychotic-induced weight gain: A systematic review and meta-analysis","authors":"Maarten Bak,&nbsp;Bea Campforts,&nbsp;Patrick Domen,&nbsp;Therese van Amelsvoort,&nbsp;Marjan Drukker","doi":"10.1111/acps.13734","DOIUrl":"10.1111/acps.13734","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Managing body weight in patients with antipsychotic-induced weight gain (AIWG) is challenging. Besides lifestyle interventions, pharmacological interventions may contribute to weight loss. This systematic review and meta-analysis evaluated the effect on weight loss and adverse effects of glucagon-like peptide-1 (GLP-1) agonists in patients with AIWG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we performed a meta-analysis of blinded and open-label randomised controlled trials (RCTs), non-randomised controlled trials and cohort studies that evaluated treatment with GLP-1 in patients with AIWG, regardless of psychiatric diagnosis. PubMed, Embase, PsycINFO and Cochrane Library databases were searched. Primary outcome measures were changes in body weight and BMI. Secondary outcomes were changes in adverse effects and severity of psychopathology due to GLP-1 agonists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Only data for exenatide and liraglutide could be included, that is, five RCTs and one cohort study. For exenatide the mean weight loss was −2.48 kg (95% Confidence Interval (CI) −5.12 to +0.64; <i>p</i> = 0.07), for liraglutide the mean weight loss was −4.70 kg (95% CI −4.85 to −4.56; <i>p</i> &lt; 0.001). The mean change in BMI was −0.82 (95% CI −1.56 to −0.09; <i>p</i> = 0.03) in the exenatide groups and −1.52 (95% CI −1.83 to −1.22; <i>p</i> &lt; 0.001) in the liraglutide groups. Exenatide and liraglutide did not adversely affect psychopathology. The most common adverse events were nausea, vomiting, and diarrhoea.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The GLP-1 agonists exenatide and liraglutide are promising drugs for inducing weight loss in patients with AIWG. The adverse effects are acceptable, and the addition of GLP-1 does not increase the severity of psychopathology. However, more research is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 6","pages":"516-529"},"PeriodicalIF":5.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141755824","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":"A cross-dataset study on automatic detection of autism spectrum disorder from text data","authors":"Aleksander Wawer,&nbsp;Izabela Chojnicka,&nbsp;Justyna Sarzyńska-Wawer,&nbsp;Małgorzata Krawczyk","doi":"10.1111/acps.13737","DOIUrl":"10.1111/acps.13737","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The goals of this article are as follows. First, to investigate the possibility of detecting autism spectrum disorder (ASD) from text data using the latest generation of machine learning tools. Second, to compare model performance on two datasets of transcribed statements, collected using two different diagnostic tools. Third, to investigate the feasibility of knowledge transfer between models trained on both datasets and check if data augmentation can help alleviate the problem of a small number of observations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We explore two techniques to detect ASD. The first one is based on fine-tuning HerBERT, a BERT-based, monolingual deep transformer neural network. The second one uses the newest, multipurpose text embeddings from OpenAI and a classifier. We apply the methods to two separate datasets of transcribed statements, collected using two different diagnostic tools: thought, language, and communication (TLC) and autism diagnosis observation schedule-2 (ADOS-2). We conducted several cross-dataset experiments in both a zero-shot setting and a setting where models are pretrained on one dataset and then training continues on another to test the possibility of knowledge transfer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Unlike previous studies, the models we tested obtained average results on ADOS-2 data but reached very good performance of the models in TLC. We did not observe any benefits from knowledge transfer between datasets. We observed relatively poor performance of models trained on augmented data and hypothesize that data augmentation by back translation obfuscates autism-specific signals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The quality of machine learning models that detect ASD from text data is improving, but model results are dependent on the type of input data or diagnostic tool.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"259-269"},"PeriodicalIF":5.3,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730787","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":"Sex differences in self-harm and suicide in young autistic adults","authors":"Laura Hull,&nbsp;Isidora Stark,&nbsp;Michael Lundberg,&nbsp;Viktor H. Ahlqvist,&nbsp;Selma Idring Nordström,&nbsp;Anna Ohlis,&nbsp;Gergö Hadlaczky,&nbsp;Dheeraj Rai,&nbsp;Cecilia Magnusson","doi":"10.1111/acps.13736","DOIUrl":"10.1111/acps.13736","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Both suicide and self-harm are disproportionately common in autistic people. Sex differences in risk of self-harm and suicide are observed in the general population, but findings are mixed for autistic people. Self-cutting may be a particularly risky self-harm behaviour for suicide in autistic people. We aimed to explore sex differences and differences in method of self-harm in the association between self-harm and suicide in autistic and non-autistic adolescents and young adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a total population register of 2.8 million Swedish residents. Participants were followed from age 12 until December 2021 for medical treatment because of self-harm, and death from suicide. We used Cox proportional hazard regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of death from suicide following self-harm, and Relative Excessive Risk due to Interaction (RERI) to explore the interaction between self-harm and autism in females and males.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 85,143 autistic individuals (31,288 female; 53,855 male) and 2,628,382 non-autistic individuals (1,286,481 female; 1,341,901 male) aged 12–37 years. Incidence of suicide following self-harm was higher in autistic males (incidence per 100,000 risk-years = 169.0 [95% CI 135.1, 211.3]) than females (125.4 [99.4, 158.3]). The relative risk was higher for autistic females (HR 26.1 [95% CI 20.2, 33.7]) than autistic males (12.5 [9.9, 15.8]). An additive effect of both autism and self-harm was observed in both females (RERI = 9.8) and males (2.0). Autistic individuals who self-harmed through cutting were at greatest risk of death from suicide (HR 25.1 [17.9, 35.2]), compared to other methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Autistic males and females are at increased risk of death from suicide following severe self-harm, particularly self-cutting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"223-233"},"PeriodicalIF":5.3,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730728","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":"Exploring actigraphy as a digital phenotyping measure: A study on differentiating psychomotor agitation and retardation in depression","authors":"Julia Maruani,&nbsp;Sibylle Mauries,&nbsp;Feriel Zehani,&nbsp;Michel Lejoyeux,&nbsp;Pierre A. Geoffroy","doi":"10.1111/acps.13739","DOIUrl":"10.1111/acps.13739","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Psychomotor activity stands out as a crucial symptom in characterizing behaviors associated with depression. This study aims to explore the potential of actigraphy as a tool for digital phenotyping in characterizing symptoms of psychomotor agitation and retardation, which are clinically challenging dimensions to capture, in patients diagnosed with major depressive episode (MDE) according to DSM-5 criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared rest-activity circadian rhythm biomarkers measured by the Motion Watch 8 actigraphy between 58 (78.4%) patients with MDE and psychomotor retardation (PMR), and 16 (21.6%) patients with MDE and psychomotor agitation (PMA), according to DSM-5 criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Actigraphy allowed to objectively report PMA through heightened activity over a 24-h period, while PMR manifests as reduced activity during the most active 10 h. Lower rest-activity rhythm (RAR) amplitude in PMR was accompanied by increased irregularities in intra- and inter-day rhythms. Interestingly, actigraphy emerges as an objective tool to measure the characteristics of the active and rest periods, free from the confounding effects of sleep disturbances. Indeed, no differences in sleep disturbances were identified between patients exhibiting psychomotor agitation and those displaying PMR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Digital phenotyping through actigraphy may aid in distinguishing psychomotor retardation and psychomotor agitation allowing for a more precise characterization of the depression phenotype. When integrated with clinical assessment, measurements from actigraphy could offer additional insights into activity rhythms alongside subjective assessments and hold the potential to augment existing clinical decision-making processes in psychiatry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"401-411"},"PeriodicalIF":5.3,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730727","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":"Switching concerns: Bipolar disorder and the antidepressant dilemma","authors":"René Ernst Nielsen","doi":"10.1111/acps.13738","DOIUrl":"10.1111/acps.13738","url":null,"abstract":"&lt;p&gt;In a serene, picturesque town, there lived a devoted gardener named Lily. Known for her vibrant and diverse garden, Lily was cherished by her community for her meticulous care of her plants, which brought a splash of color and joy to everyone around. One summer, inspired by an article in a gardening magazine, Lily decided to experiment with a new type of fertilizer reputed to enhance the vibrancy and speed of her flowers' bloom. Initially, the results were spectacular—her garden transformed into an extraordinary display of vivid hues, earning widespread admiration from her neighbors. However, as days passed, an unexpected and troubling pattern emerged. Some plants grew uncontrollably, sprawling beyond their intended spaces, while others, previously healthy, began to wilt and die. Lily, distressed and bewildered, questioned whether the new fertilizer was to blame or if other factors, like the unusual summer weather, were at play.&lt;/p&gt;&lt;p&gt;This scenario mirrors the complexities faced in psychiatry when treating depressive episodes with antidepressants. Just as Lily's garden experienced unforeseen consequences, patients treated with antidepressants may experience shifts from euthymia to manic symptoms, potentially leading to a diagnostic transition from unipolar depression to bipolar disorder. In cases of bipolar disorder, the use of antidepressants potentially carries the risk of switching patients from depression through euthymia to hypomania or mania. The causal relationship between antidepressant treatment and these mood changes remains a topic of ongoing debate.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Clinicians often grapple with whether these changes are direct effects of the medication or if they reflect a natural progression and fluctuations of the mood disorder itself. Are antidepressants directly accountable, does the treatment more frequently result in euthymia and perhaps a greater risk of mania or are the antidepressant treatment not linked to switch of polarity? Tools like the Naranjo scale can help assess causality by evaluating the emergence of symptoms in relation to timing of treatment initiation, dose escalation, or recurrence after repeated administration, alongside side-effect symptom reduction following discontinuation or dose reduction.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Randomized controlled trials (RCTs) on antidepressants for unipolar depression show significant improvements in symptoms, particularly in severely affected patients.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; For bipolar disorder, RCTs have demonstrated the efficacy of treatments such as olanzapine plus fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine on depressive symptoms during a depressive episode.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Given the DSM-5 classification of bipolar disorder into types I and II based on the occurrence of mania, treatment responses and primary end-point of treatment may vary accordingly, with a greater focus on depressive symptoms in bipol","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 3","pages":"123-125"},"PeriodicalIF":5.3,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141618654","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}