Acta Psychiatrica Scandinavica最新文献

{"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":"Cost-Effectiveness of rTMS as a Next Step in Antidepressant Non-Responders: A Randomized Comparison With Current Antidepressant Treatment Approaches","authors":"Iris Dalhuisen,&nbsp;Kim Bui,&nbsp;Anne Kleijburg,&nbsp;Iris van Oostrom,&nbsp;Jan Spijker,&nbsp;Eric van Exel,&nbsp;Hans van Mierlo,&nbsp;Dieuwertje de Waardt,&nbsp;Martijn Arns,&nbsp;Indira Tendolkar,&nbsp;Philip van Eijndhoven,&nbsp;Ben Wijnen","doi":"10.1111/acps.13782","DOIUrl":"10.1111/acps.13782","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although repetitive transcranial magnetic stimulation (rTMS) is an effective and commonly used treatment option for treatment-resistant depression, its cost-effectiveness remains much less studied. In particular, the comparative cost-effectiveness of rTMS and other treatment options, such as antidepressant medication, has not been investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An economic evaluation with 12 months follow-up was conducted in the Dutch care setting as part of a pragmatic multicenter randomized controlled trial, in which patients with treatment-resistant depression were randomized to treatment with rTMS or treatment with the next pharmacological step according to the treatment algorithm. Missing data were handled with single imputations using predictive mean matching (PMM) nested in bootstraps. Incremental cost-effectiveness and cost-utility ratios (ICERs/ICURs) were calculated, as well as cost-effectiveness planes and cost-effectiveness acceptability curves (CEACs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher QALYs, response, and remission rates were found for lower costs when comparing the rTMS group to the medication group. After 12 months, QALYs were 0.618 in the rTMS group and 0.545 in the medication group. The response was 27.1% and 24.4% and remission was 25.0% and 17.1%, respectively. Incremental costs for rTMS were −€2.280, resulting in a dominant ICUR for QALYs and ICER for response and remission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>rTMS appears to be a cost-effective treatment option for treatment-resistant depression when compared to the next pharmacological treatment step. The results support the implementation of rTMS as a step in the treatment algorithm for depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The trial is registered within the Netherlands Trial Register (code: NL7628, date: March 29, 2019)</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"613-624"},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13782","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875630","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":"Editorial: Special Issue on Digital Psychiatry","authors":"Louise Birkedal Glenthøj,&nbsp;Maria Faurholt-Jepsen","doi":"10.1111/acps.13781","DOIUrl":"10.1111/acps.13781","url":null,"abstract":"<p>Despite a growing recognition of mental health challenges worldwide, there remains a significant gap between the demand for and the availability of mental health services. The WHO estimates that globally, up to 71% of individuals with severe mental illnesses such as psychosis receive no treatment, and access is even more limited in low-income countries. Barriers such as stigma, resource shortages, and insufficiently trained professionals may exacerbate this issue [<span>1, 2</span>].</p><p>Given the limited resources available, a recent report by the World Health Organization stated that “the use of mobile and wireless technologies (mhealth) to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe” [<span>3</span>]. On a global scale, it is not feasible to propose that practices based entirely on in-person care will ever be able to meet the demand and need for treatment. Thus, even before the emergence of the COVID-19 pandemic, there was growing interest in the potential role of new technologies to extend care.</p><p>The rapid advancement and integration of technology is transforming mental health care delivery, accessibility, and research methodologies. Digital tools, including wearable devices, telepsychiatric platforms, smartphone apps, virtual reality (VR), and electronic health record data are reshaping the landscape of clinical practice, research, and patient engagement [<span>4</span>]. Similarly, digital phenotyping, artificial intelligence (AI), and advanced machine learning methods offer deeper, real-time insights into patients' behaviors and symptoms, potentially leading to earlier diagnoses, prediction models, and more personalized treatment plans [<span>5, 6</span>]. AI-enabled programs can analyze and contextualize data to provide information or automatically trigger actions without human interference, where machine-learning methods learn insights and recognize patterns from data.</p><p>These innovations address critical challenges in mental health care, particularly the pervasive gap between the demand for treatment and the limited capacity of traditional systems to meet this need. Furthermore, digital solutions may empower patients to actively engage in their treatment through tools for self-monitoring, psychoeducation, and immersive, engaging interventions that may enhance their therapeutic experience.</p><p>The term “digital phenotyping” has been defined as the “moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices” [<span>7, 8</span>]. Although not unanimous, some authors [<span>9</span>] divide digital phenotyping into two subgroups, called “active data” and “passive data.” Active data refer to data that requires active input from the users to be generated, whereas passive data, such as sensor data and phone usage patterns, are collected without requiring any active participation from","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"177-179"},"PeriodicalIF":5.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13781","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811607","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":"Social Support, Delivery Mode, and Cultural Factors in Twin Parents' Postpartum Depression: A Response to Egsgaard et al.","authors":"Yu-Ren Wen,&nbsp;Lien-Chung Wei","doi":"10.1111/acps.13775","DOIUrl":"10.1111/acps.13775","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Egsgaard et al. (2024) highlight the temporal patterns of postpartum depression (PPD) risk in twin parents versus singleton parents. However, additional factors such as social support systems, delivery mode, and cultural influences require exploration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To discuss the role of structured postpartum care, cesarean sections, and mother-infant bonding in moderating PPD risk, especially within cultural contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These factors may explain the gender-specific temporal patterns observed by Egsgaard et al. Future research should integrate sociocultural and clinical variables to inform interventions for twin parents at risk of PPD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"173-174"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765058","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}