Acta Psychiatrica Scandinavica最新文献

{"title":"Clarifying the relationship between physical injuries and risk for suicide attempt","authors":"Vrinda Kabra, Rahul Mathur, Nishtha Chawla","doi":"10.1111/acps.13695","DOIUrl":"10.1111/acps.13695","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"118-119"},"PeriodicalIF":5.3,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955293","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":"Gestational exposure to benzodiazepines or z-hypnotics and neurodevelopmental disorders in offspring: Systematic review and meta-analysis","authors":"Chittaranjan Andrade,&nbsp;Natarajan Varadharajan,&nbsp;Sharmi Bascarane,&nbsp;Vikas Menon","doi":"10.1111/acps.13696","DOIUrl":"10.1111/acps.13696","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Benzodiazepine (BDZP) and/or z-hypnotic dispensing during pregnancy has increased globally, as have rates of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis aimed to estimate the association between gestational exposure to BDZP and/or z-hypnotics and diagnosis of ASD or ADHD in offspring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, EMBASE, and SCOPUS from inception till December 2023 for relevant English-language articles. Outcomes of interest were risk of ASD and ADHD, two independent primary outcomes, in children exposed anytime during pregnancy to BDZP and/or z-hypnotics versus those unexposed. Secondary outcomes were trimester-wise analyses. Using a random effects model, we pooled the overall and trimester-wise hazard ratios (HRs), with 95% confidence intervals (CIs), separately for risk of ASD and ADHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found six eligible retrospective cohort studies and no case–control studies. There was no increased risk of ASD associated with anytime gestational BDZP and/or z-hypnotic exposure (primary outcome, HR, 1.10; 95% CI, 0.81–1.50; 4 studies; <i>n</i> = 3,783,417; 80,270 exposed, 3,703,147 unexposed) nor after first trimester exposure (HR, 1.15; 95% CI, 0.83–1.58; 3 studies; <i>n</i> = 1,539,335; 70,737 exposed, 1,468,598 unexposed) or later trimester exposures. A very small but significantly increased risk of ADHD was noted with anytime gestational exposure to these drugs (primary outcome, HR, 1.07; 95% CI, 1.03–1.12; 4 studies; <i>n</i> = 2,000,777; 78,912 exposed, 1,921,865 unexposed) and also with (only) second trimester exposure (HR, 1.07; 95% CI, 1.03–1.12; 3 studies; <i>n</i> = 1,539,281; 33,355 exposed, 1,505,926 unexposed). Findings were consistent in sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gestational exposure to benzodiazepines or z-hypnotics was not associated with an increased risk of ASD and with only a marginally increased risk of ADHD in offspring. Given the likelihood of confounding by indication and by unmeasured variables in the original studies, our findings should reassure women who need these medications for severe anxiety or insomnia during pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"65-77"},"PeriodicalIF":5.3,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140943288","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":"Electroconvulsive therapy (ECT) for mania: Hiding in plain sight","authors":"Charles H. Kellner","doi":"10.1111/acps.13693","DOIUrl":"10.1111/acps.13693","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;Acta Psychiatrica Scandinavica&lt;/i&gt;, Popiolek et al. present data on the effect of effect of electroconvulsive therapy (ECT) on time to readmission in patients with bipolar disorder hospitalized for a manic episode.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This is yet another high-quality ECT research paper facilitated by the comprehensive patient registries in Sweden, which allow investigation of a myriad of clinical questions at the population level. While their main analysis did not show a difference in time to readmission in patients treated with and without ECT, a subset of patients who had hospital admissions both with ECT and without ECT, showed a trend to longer time to readmission when they had received ECT. As one might expect, patients treated with ECT had more severe lifetime bipolar illness. ECT was administered to patients in 7.3% of 12,337 admissions, which is actually quite a high rate. I suspect that if a similar study was done in the United States, it would be under 1%.&lt;/p&gt;&lt;p&gt;In another recent report using CGI data from a largely overlapping clinical cohort, the Swedish group showed an 85% response rate of mania to ECT, with greater severity of illness associated with higher response.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Indeed, the most important message from both these reports is that ECT is a very effective treatment for acute mania.&lt;/p&gt;&lt;p&gt;ECT is grossly underutilized overall, and particularly in bipolar disorder.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; For some reason, it has been difficult for the field to fully embrace the use of ECT for all episode types in bipolar disorder, despite a substantial evidence base supporting its efficacy and safety for these clinical situations. When the US Food and Drug Administration reclassified the ECT device in 2018, it was for catatonia and a severe depressive episode in the context of unipolar or bipolar disorder, but there was no mention of mania.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; This is an egregious oversight and the work of our Swedish colleagues with their national register data is an extremely helpful way to bolster the evidence base. Although physicians even in the United States are not technically bound by FDA “cleared indications,” (the FDA does not regulate the practice of medicine, and physicians are free to prescribe ECT as they deem indicated, similar to the “off label” use of medications), it is still reassuring to be able to point to high-quality data for the use of ECT in manic episodes.&lt;/p&gt;&lt;p&gt;Of course, the ECT literature has been replete with such evidence for decades. A PubMed search of “electroconvulsive mania” returns nearly 500 citations; the search “electroconvulsive bipolar” returns nearly 2000. The review article, &lt;i&gt;Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience&lt;/i&gt; by Mukerjhee et al. from the &lt;i&gt;American Journal of Psychiatry&lt;/i&gt; in 1994 is a classic in the field.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; The graphical representation of PubMed citations over tim","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"3-4"},"PeriodicalIF":6.7,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13693","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140920146","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":"Phenotypic clustering of bipolar disorder supports stratification by lithium responsiveness over diagnostic subtypes","authors":"Katie Scott,&nbsp;Claire O'Donovan,&nbsp;Giulio Emilio Brancati,&nbsp;Pablo Cervantes,&nbsp;Rafaella Ardau,&nbsp;Mirko Manchia,&nbsp;Giovanni Severino,&nbsp;Janusz Rybakowski,&nbsp;Leonardo Tondo,&nbsp;Paul Grof,&nbsp;Martin Alda,&nbsp;Abraham Nunes","doi":"10.1111/acps.13692","DOIUrl":"10.1111/acps.13692","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The aim of this study was to determine whether the clinical profiles of bipolar disorder (BD) patients could be differentiated more clearly using the existing classification by diagnostic subtype or by lithium treatment responsiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included adult patients with BD-I or II (<i>N</i> = 477 across four sites) who were treated with lithium as their principal mood stabilizer for at least 1 year. Treatment responsiveness was defined using the dichotomized Alda score. We performed hierarchical clustering on phenotypes defined by 40 features, covering demographics, clinical course, family history, suicide behaviour, and comorbid conditions. We then measured the amount of information that inferred clusters carried about (A) BD subtype and (B) lithium responsiveness using adjusted mutual information (AMI) scores. Detailed phenotypic profiles across clusters were then evaluated with univariate comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two clusters were identified (<i>n</i> = 56 and <i>n</i> = 421), which captured significantly more information about lithium responsiveness (AMI range: 0.033 to 0.133) than BD subtype (AMI: 0.004 to 0.011). The smaller cluster had disproportionately more lithium responders (<i>n</i> = 47 [83.8%]) when compared to the larger cluster (103 [24.4%]; <i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Phenotypes derived from detailed clinical data may carry more information about lithium responsiveness than the current classification of diagnostic subtype. These findings support lithium responsiveness as a valid approach to stratification in clinical samples.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"91-104"},"PeriodicalIF":5.3,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13692","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140678960","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":"Liraglutide 3.0 mg once daily for the treatment of overweight and obesity in patients hospitalised at a forensic psychiatric department: A 26-week open-label feasibility study","authors":"Marie Reeberg Sass,&nbsp;Anne Mette Brandt Christensen,&nbsp;Margit Lykke Christensen,&nbsp;Ema Gruber,&nbsp;Helle Nerdrum,&nbsp;Lone Marianne Pedersen,&nbsp;Maximilian Resch,&nbsp;Troels Højsgaard Jørgensen,&nbsp;Claus T. Ekstrøm,&nbsp;Jimmi Nielsen,&nbsp;Tina Vilsbøll,&nbsp;Anders Fink-Jensen","doi":"10.1111/acps.13690","DOIUrl":"10.1111/acps.13690","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 26-week, open-label feasibility study included participants aged 18–65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of “completers”, with adherence defined as &gt;80% injections obtained in the period, weeks 12–26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m²; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was −11.4 kg [−15.4; −5.9]. The net difference in HbA1C and BMI was −2.0 mmol/mol [−4; −1] and −3.6 kg/m² [−4.7; −1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"35-47"},"PeriodicalIF":6.7,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616141","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":"Long term impact of 3-monthly paliperidone palmitate on hospitalisation in patients with schizophrenia: Six-year mirror image study","authors":"Ivana Clark,&nbsp;Phoebe Wallman,&nbsp;Siobhan Gee,&nbsp;David Taylor","doi":"10.1111/acps.13691","DOIUrl":"10.1111/acps.13691","url":null,"abstract":"&lt;p&gt;Long-acting antipsychotics are accepted to be more effective than oral antipsychotics in reducing the risk of hospitalisation and relapse in schizophrenia. In our previous 5-year mirror-image study, we reported a significant reduction in hospital admissions and fewer days spent in hospital for people prescribed 3-monthly paliperidone (PP3M) after stabilisation on 1-monthly (PP1M).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; We now report the outcomes of the sixth year of this study.&lt;/p&gt;&lt;p&gt;Our primary objective was to use a mirror image model to evaluate hospital admissions and bed days before and after the initiation of PP1M followed by PP3M in those who continued treatment for 3 years. Full details of methods used have been previously described.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The same patient cohort as previously defined was followed up for additional 12 months.&lt;/p&gt;&lt;p&gt;As before, 76 patients met inclusion criteria. Of this total baseline cohort, 52 patients (68%) continued on PPLAIs for 36 months, 19 patients (25%) discontinued within 36 months of initiation and 5 patients (7%) were lost to follow-up. The mean age on PPLAI initiation was 42 years; 54 were male. The majority of our baseline cohort was initiated on PP1M as inpatients (&lt;i&gt;n&lt;/i&gt; = 49, 69%). Ethnicity breakdown was as follows: Asian (&lt;i&gt;n&lt;/i&gt; = 4), Black (&lt;i&gt;n&lt;/i&gt; = 44), Mixed background (&lt;i&gt;n&lt;/i&gt; = 4), Other (&lt;i&gt;n&lt;/i&gt; = 2), White (&lt;i&gt;n&lt;/i&gt; = 17). On average, patients received PP1M for 10 months before starting PP3M. The most commonly prescribed maintenance dose was 100 mg a month (&lt;i&gt;n&lt;/i&gt; = 31 [44%]) followed by 150 mg (&lt;i&gt;n&lt;/i&gt; = 25, 35%), 75 mg (&lt;i&gt;n&lt;/i&gt; = 12, 17%) and 50 mg (&lt;i&gt;n&lt;/i&gt; = 3, 4%). From the original 76 starters, 19 patients discontinued over 36 months, for the following reasons: patient refusal (&lt;i&gt;n&lt;/i&gt; = 10), perceived inefficacy (&lt;i&gt;n&lt;/i&gt; = 5), unrelated health condition (‘kidney problems’ [&lt;i&gt;n&lt;/i&gt; = 1] and cancer [&lt;i&gt;n&lt;/i&gt; = 1]) and adverse effects (weight gain [&lt;i&gt;n&lt;/i&gt; = 1] and raised liver function tests [&lt;i&gt;n&lt;/i&gt; = 1]).&lt;/p&gt;&lt;p&gt;In those continuing on PPLAI for 3 years (&lt;i&gt;n&lt;/i&gt; = 52), the mean number of admissions per year was 0.53 (SD 0.49) before PPLAI initiation and 0.01 (SD 0.06) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) afterwards. The mean number of bed days a year was 31.3 days (SD 48.8) before PPLAI and 12.4 days (SD 23.6) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) after. The majority of the bed days recorded in the period after PPLAI was started were from the index admission. Only two patients registered bed days after initiation (discounting the initial admission bed days). Both patients started PPLAI as inpatients. No patient starting PPLAI as an out-patient had bed days in the 3 years after initiation.&lt;/p&gt;&lt;p&gt;The use of PP3M after stabilisation on PP1M was associated with a considerable reduction in bed days and hospital admissions. During the observational period, only 8 of 71 patients started on PP1M/3 M (9.9%) were admitted to hospital. The majority of our patient cohort (80%) had been admitted to hospital at","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"48-50"},"PeriodicalIF":6.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578230","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":"Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms: A network meta-analysis of randomized controlled trials","authors":"Ping-Tao Tseng,&nbsp;Bing-Yan Zeng,&nbsp;Hung-Yu Wang,&nbsp;Bing-Syuan Zeng,&nbsp;Chih-Sung Liang,&nbsp;Yang-Chieh Brian Chen,&nbsp;Brendon Stubbs,&nbsp;Andre F. Carvalho,&nbsp;Andre R. Brunoni,&nbsp;Kuan-Pin Su,&nbsp;Yu-Kang Tu,&nbsp;Yi-Cheng Wu,&nbsp;Tien-Yu Chen,&nbsp;Dian-Jeng Li,&nbsp;Pao-Yen Lin,&nbsp;Yen-Wen Chen,&nbsp;Chih-Wei Hsu,&nbsp;Kuo-Chuan Hung,&nbsp;Yow-Ling Shiue,&nbsp;Cheng-Ta Li","doi":"10.1111/acps.13688","DOIUrl":"10.1111/acps.13688","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite its high lifetime prevalence rate and the elevated disability caused by posttraumatic stress disorder (PTSD), treatments exhibit modest efficacy. In consideration of the abnormal connectivity between the dorsolateral prefrontal cortex (DLPFC) and amygdala in PTSD, several randomized controlled trials (RCTs) addressing the efficacy of different noninvasive brain stimulation (NIBS) modalities for PTSD management have been undertaken. However, previous RCTs have reported inconsistent results. The current network meta-analysis (NMA) aimed to compare the efficacy and acceptability of various NIBS protocols in PTSD management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched ClinicalKey, Cochrane Central Register of Controlled Trials, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov to identify relevant RCTs. The targeted RCTs was those comparing the efficacy of NIBS interventions, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and transcutaneous cervical vagal nerve stimulation, in patients with PTSD. The NMA was conducted using a frequentist model. The primary outcomes were changes in the overall severity of PTSD and acceptability (to be specific, rates of dropouts for any reason).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 14 RCTs that enrolled 686 participants. The NMA demonstrated that among the investigated NIBS types, high-frequency rTMS over bilateral DLPFCs was associated with the greatest reduction in overall PTSD severity. Further, in comparison with the sham controls, excitatory stimulation over the right DLPFC with/without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms, including depression and anxiety symptoms, and overall PTSD severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This NMA demonstrated that excitatory stimulation over the right DLPFC with or without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms.</p>\u0000 \u0000 <p><i>Trial registration:</i> PROSPERO CRD42023391562.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"5-21"},"PeriodicalIF":6.7,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578444","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":"Speech based natural language profile before, during and after the onset of psychosis: A cluster analysis","authors":"Tyler C. Dalal, Liangbing Liang, Angelica M. Silva, Michael Mackinley, Alban Voppel, Lena Palaniyappan","doi":"10.1111/acps.13685","DOIUrl":"https://doi.org/10.1111/acps.13685","url":null,"abstract":"Background and HypothesisSpeech markers are digitally acquired, computationally derived, quantifiable set of measures that reflect the state of neurocognitive processes relevant for social functioning. “Oddities” in language and communication have historically been seen as a core feature of schizophrenia. The application of natural language processing (NLP) to speech samples can elucidate even the most subtle deviations in language. We aim to determine if NLP based profiles that are distinctive of schizophrenia can be observed across the various clinical phases of psychosis.DesignOur sample consisted of 147 participants and included 39 healthy controls (HC), 72 with first‐episode psychosis (FEP), 18 in a clinical high‐risk state (CHR), 18 with schizophrenia (SZ). A structured task elicited 3 minutes of speech, which was then transformed into quantitative measures on 12 linguistic variables (lexical, syntactic, and semantic). Cluster analysis that leveraged healthy variations was then applied to determine language‐based subgroups.ResultsWe observed a three‐cluster solution. The largest cluster included most HC and the majority of patients, indicating a ‘typical linguistic profile (TLP)’. One of the atypical clusters had notably high semantic similarity in word choices with less perceptual words, lower cohesion and analytical structure; this cluster was almost entirely composed of patients in early stages of psychosis (EPP – early phase profile). The second atypical cluster had more patients with established schizophrenia (SPP – stable phase profile), with more perceptual but less cognitive/emotional word classes, simpler syntactic structure, and a lack of sufficient reference to prior information (reduced givenness).ConclusionThe patterns of speech deviations in early and established stages of schizophrenia are distinguishable from each other and detectable when lexical, semantic and syntactic aspects are assessed in the pursuit of ‘formal thought disorder’.","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"45 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578505","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":"Association between electroconvulsive therapy and time to readmission after a manic episode","authors":"Katarzyna Popiolek,&nbsp;Tor Arnison,&nbsp;Susanne Bejerot,&nbsp;Katja Fall,&nbsp;Mikael Landén,&nbsp;Axel Nordenskjöld","doi":"10.1111/acps.13689","DOIUrl":"10.1111/acps.13689","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The majority of patients hospitalized for treatment of a manic episode are readmitted within 2 years despite maintenance treatment. Electroconvulsive therapy (ECT) has been associated with lower rehospitalization rates in some psychiatric conditions, but its association with readmission after a manic episode has not been investigated. Therefore, the aim of this study was to determine whether the time to readmission in patients with mania treated with ECT was longer than in patients not treated with ECT and whether there were subgroups of patients that benefited more.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a nationwide register-based, observational study. All patients diagnosed with bipolar disorder, manic episode, admitted to any hospital in Sweden between 2012 and 2021 were included. Patients contributed data to the study for every admission. All admissions were followed up until psychiatric readmission, death, or the end of the study (December 31, 2021). Association between ECT and time to readmission was analyzed. A paired samples model was performed for 377 patients with at least two admissions for mania, treated with ECT at one admission and without ECT at the other admission. Times to readmission were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 12,337 admissions were included; mean (SD) age 47.7 (17.2), 5443 (44.1%) men. Readmission rate within 1 year was 54.6%. ECT was administered in 902 (7.3%) admissions. Within 30 days after admission, 182 out of 894 (20.4%) patients treated with ECT versus 2105 out of 11,305 (18.6%) patients treated without ECT were readmitted. There was no association between ECT and time to readmission (aHR 1.00, 95% CI 0.86–1.16, <i>p</i> = 0.992) in the model with all admissions. The paired samples model included 754 admissions (377 patients), mean (SD) age during admission without ECT was 45.6 (16.5), and with ECT 46.6 (16.4), 147 (39.0%) were men. In that model, readmission rate within 30 days for treatment with ECT was 19.0%, and for treatments without ECT, 24.1% (aHR 0.75, 95% CI 0.55–1.02, <i>p</i> = 0.067).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Readmission rates after inpatient treatment of mania were high. ECT was not significantly associated with longer time to readmission, but there was a trend toward a protective effect of ECT when admissions with and without ECT were compared within the same patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"22-34"},"PeriodicalIF":6.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13689","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578327","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":"Development and validation of a machine learning model for prediction of type 2 diabetes in patients with mental illness","authors":"Martin Bernstorff, Lasse Hansen, Kenneth Enevoldsen, Jakob Damgaard, Frida Hæstrup, Erik Perfalk, Andreas Aalkjær Danielsen, Søren Dinesen Østergaard","doi":"10.1111/acps.13687","DOIUrl":"https://doi.org/10.1111/acps.13687","url":null,"abstract":"BackgroundType 2 diabetes (T2D) is approximately twice as common among individuals with mental illness compared with the background population, but may be prevented by early intervention on lifestyle, diet, or pharmacologically. Such prevention relies on identification of those at elevated risk (prediction). The aim of this study was to develop and validate a machine learning model for prediction of T2D among patients with mental illness.MethodsThe study was based on routine clinical data from electronic health records from the psychiatric services of the Central Denmark Region. A total of 74,880 patients with 1.59 million psychiatric service contacts were included in the analyses. We created 1343 potential predictors from 51 source variables, covering patient‐level information on demographics, diagnoses, pharmacological treatment, and laboratory results. T2D was operationalised as HbA1c ≥48 mmol/mol, fasting plasma glucose ≥7.0 mmol/mol, oral glucose tolerance test ≥11.1 mmol/mol or random plasma glucose ≥11.1 mmol/mol. Two machine learning models (XGBoost and regularised logistic regression) were trained to predict T2D based on 85% of the included contacts. The predictive performance of the best performing model was tested on the remaining 15% of the contacts.ResultsThe XGBoost model detected patients at high risk 2.7 years before T2D, achieving an area under the receiver operating characteristic curve of 0.84. Of the 996 patients developing T2D in the test set, the model issued at least one positive prediction for 305 (31%).ConclusionA machine learning model can accurately predict development of T2D among patients with mental illness based on routine clinical data from electronic health records. A decision support system based on such a model may inform measures to prevent development of T2D in this high‐risk population.","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"51 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602614","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}