World Psychiatry最新文献

{"title":"Trends, advances and directions in cognitive-behavioral therapy for adolescent anxiety","authors":"Philip C. Kendall, Marisa Meyer, Julia S. Ney","doi":"10.1002/wps.21247","DOIUrl":"https://doi.org/10.1002/wps.21247","url":null,"abstract":"<p>Adolescence is a time of dramatic change in physical, behavioral, emotional, cognitive and social domains, and the context in which one matures plays a crucial role. The early 2020s provided a unique context for adolescent development, filled with unprecedented events across multiple levels of life. These contextual forces potentially impacted what we know from previously studied developmental trajectories during adolescence.</p>\u0000<p>Here we briefly highlight recent research on adolescent anxiety associated with social media use and the COVID-19 pandemic, and focus on the latest trends and advances in cognitive-behavioral therapy (CBT) for treating anxiety in youth. We emphasize the importance of behavioral exposure tasks and the necessity of “flexibility within fidelity”<span><sup>1</sup></span> in manual-based CBT interventions. Lastly, we identify future research directions for evaluating the development, maintenance and treatment of anxiety in adolescents.</p>\u0000<p>Rates of anxiety among youth – as well as depression, suicidality, and other mental health conditions – have increased in recent years. Specifically, anxiety symptoms increased during the COVID-19 pandemic, with 20% of surveyed youth experiencing these symptoms, compared to 11% before the pandemic<span><sup>2</sup></span>. Further, across all socioeconomic levels, about 70% of adolescents reported believing that anxiety and depression are major problems among people of their age in their community<span><sup>3</sup></span>. Widening disparities in anxiety prevalence have been noted among girls relative to boys, and among sexual minority youth compared to heterosexual ones<span><sup>2, 4</sup></span>.</p>\u0000<p>Adolescents currently face stressors that may contribute to increases in anxiety. The COVID-19 pandemic took a toll on youth psychological well-being, including disrupted milestones, loss of peer interactions, and social isolation<span><sup>2</sup></span>. Adolescents are heavy consumers of digital technology and social media: this has the potential to provide benefits to youth through opportunities to strengthen social relationships. However, social media may also lead to an increase in anxiety symptoms. In a longitudinal study of adolescents aged 12-15, those spending more than three hours per day on social media were prospectively more likely to experience internalizing problems (i.e., anxiety and depression<span><sup>5</sup></span>). It is not a stretch to see the double-edged features of heavy adolescent social media use.</p>\u0000<p>Recent research continues to bolster the large body of existing evidence demonstrating the efficacy<span><sup>6</sup></span> and effectiveness<span><sup>7</sup></span> of CBT in treating adolescent anxiety, with the latest studies parsing treatment effects according to intervention modality and emphasis on key components (e.g., psychoeducation, cognitive restructuring, exposure tasks). When comparing CBT modalities to waitlist controls based on anxie","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"194 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The problem with borderline personality disorder","authors":"Peter J. Tyrer, Roger T. Mulder","doi":"10.1002/wps.21249","DOIUrl":"https://doi.org/10.1002/wps.21249","url":null,"abstract":"<p>In the late 1980s, the ICD-10 Working Party on Personality Disorders had little evidence on which to base its decisions and, understandably, followed the lead of the DSM, with its well-funded and popular third and subsequent editions.</p>\u0000<p>When the Working Party came to the sensitive subject of individual personality disorders, it found that the evidence for “borderline personality disorder” was insufficient for it to be included. But a lobby of supporters did not allow this, and eventually two extra personality disorder groupings were included under the heading of “emotionally unstable personality disorder” (F60.3) – an “impulsive type” (F60.30), characterized by a “tendency to act unexpectedly” and to show “quarrelsome behaviour” and an “unstable and capricious mood”; and a “borderline type” (F60.31), characterized by uncertain self-image, unstable relationships, efforts to avoid abandonment, and recurrent self-harm.</p>\u0000<p>We have yet to see much evidence that the impulsive type (F60.30) has been used in practice. On the contrary, the borderline type is by far the most commonly used personality disorder diagnosis, so much so that the original splitting of the “emotionally unstable personality disorder” into two groups has been forgotten entirely.</p>\u0000<p>In the ICD-11 revision group, more than two decades later, the same conclusion was reached: borderline personality disorder was not considered to be a suitable diagnosis for inclusion and was ignored, as indeed were all other categories of personality disorder in the new dimensional system<span><sup>1</sup></span>. But, as with the ICD-10, the borderline diagnosis was not to be spurned by others. There was general dissatisfaction with its omission<span><sup>2</sup></span>, and a strong appeal for it to be included in some form. Thus, the “borderline pattern specifier” was added as a compromise<span><sup>3</sup></span>.</p>\u0000<p>How do we explain that, after two revision groups decided to exclude this condition as unsatisfactory, borderline personality disorder continues to be supported as a diagnosis? The standard explanations are that it is useful in clinical practice, is widely used, and gives options for treatment, unlike other personality disorders. However, the same could be said, almost exactly, of the diagnosis of neurasthenia between 1870 and 1990 (it appeared apologetically in the ICD-10), which has now been recognized to be redundant, as it was vaguely defined, was so prevalent that it lacked discrimination, and became toxic through criticism and stigma.</p>\u0000<p>These same concerns apply to borderline personality disorder. It is like a large bubble wrap over all personality disorders, easily recognized on the surface but obscuring the disorders that lie beneath. Personality abnormality is identifiable through traits that are persistent, exactly as normal personality traits. The features of borderline personality disorder are not traits, but symptoms and fluctuating behaviours<span><","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"14 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pre-trauma recreational drug use on mental health outcomes among survivors of the Israeli Nova Festival terrorist attack","authors":"Nitsa Nacasch, Tal Malka, Joseph Zohar, Yarden V. Dejorno, Gal Levi, Raz Gross, Mark Weiser, Hagit Cohen","doi":"10.1002/wps.21254","DOIUrl":"https://doi.org/10.1002/wps.21254","url":null,"abstract":"<p>On October 7, 2023, about 4,000 civilians attending the Nova open-air music festival in southern Israel were the victims of a sudden terrorist attack. They had to swiftly react to the attack by running and hiding for extended periods of time to protect their lives.</p>\u0000<p>At the time of the attack, a significant proportion of these people were under the influence of various recreational drugs. We hypothesized that the pre-trauma use of psychostimulants or hallucinogens would be significantly associated with the severity of peri-traumatic dissociation, anxiety, depression, and acute stress disorder (ASD) symptoms in survivors of the attack.</p>\u0000<p>Two hundred thirty-two survivors sought assistance at the Chaim Sheba Medical Center and underwent clinical evaluation. They were considered for this study if they had no severe physical injuries; no first-degree family member killed during the attack; and no history of mental disorders, including post-traumatic stress disorder (PTSD).</p>\u0000<p>Of the 232 survivors screened for the study, 126 met the above criteria and provided informed consent to participate. However, two of them who reported using hallucinogenic mushrooms, and one who reported using ketamine prior to the traumatic event, were excluded from the analysis, due to the small sample size for these drugs, leaving a sample of 123 participants. Their mean age (±SE) was 28.4±0.7 years; 75 of them (60.9%) were male; 68.9% were never married, and 68.2% were holding a high-school degree or equivalent.</p>\u0000<p>Seventy-one of them (57.7%) reported using psychoactive drugs at the festival – 12 only alcohol, nine only lysergic acid (LSD), seven only 3,4-methylenedioxymethamphetamine (MDMA), six only cannabis, three only methylmethcathinone (MMC), 15 various drug combinations including alcohol, and 19 various drug combinations excluding alcohol.</p>\u0000<p>All participants completed several questionnaires, assessing peri-traumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire, PDEQ), post-traumatic anxiety (Generalized Anxiety Disorder-7, GAD-7; and Visual Analog Scale for Anxiety, VAS-A), depression (Patient Health Questionnaire-9, PHQ-9), and ASD symptoms (Posttraumatic Diagnostic Scale, PDS-5).</p>\u0000<p>Both the GAD-7 scores and the PDS-5 hyperarousal scores were significantly higher in the drug-user than in the drug-free group (p<0.05 and p<0.008, respectively). The scores of most participants were above the clinical threshold for these instruments (>10 for GAD-7 in 70.4%, and >28 for PDS-5 in 81.3% of the participants), indicating a very high level of anxiety- and hyperarousal-related symptoms in both groups. Both the PDEQ and PHQ-9 scores were higher in the drug-user than in the drug-free group, but the differences were not significant. No significant differences were found between the groups in the VAS-A, total PDS-5, and PDS-5 subscales. The VAS-A scores of 51.9% of the participants were higher than 6, which is the cli","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"36 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications","authors":"Julianne Holt-Lunstad","doi":"10.1002/wps.21224","DOIUrl":"https://doi.org/10.1002/wps.21224","url":null,"abstract":"Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the public. Despite the breadth of evidence, several challenges remain, including the need for a common language to reconcile the diverse relevant terms across scientific disciplines, consistent multi-factorial measurement to assess risk, and effective solutions to prevent and mitigate risk. The urgency for future health is underscored by the potentially longer-term consequences of the COVID-19 pandemic, and the role of digital technologies in societal shifts, that could contribute to further declines in social, mental and physical health. To reverse these trends and meet these challenges, recommendations are offered to more comprehensively address gaps in our understanding, and to foster social connection and address social isolation and loneliness.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"8 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions.","authors":"Roger S McIntyre, Mohammad Alsuwaidan, Bernhard T Baune, Michael Berk, Koen Demyttenaere, Joseph F Goldberg, Philip Gorwood, Roger Ho, Siegfried Kasper, Sidney H Kennedy, Josefina Ly-Uson, Rodrigo B Mansur, R Hamish McAllister-Williams, James W Murrough, Charles B Nemeroff, Andrew A Nierenberg, Joshua D Rosenblat, Gerard Sanacora, Alan F Schatzberg, Richard Shelton, Stephen M Stahl, Madhukar H Trivedi, Eduard Vieta, Maj Vinberg, Nolan Williams, Allan H Young, Mario Maj","doi":"10.1002/wps.21120","DOIUrl":"10.1002/wps.21120","url":null,"abstract":"<p><p>Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.</p>","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 3","pages":"394-412"},"PeriodicalIF":73.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503923/pdf/WPS-22-394.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10359288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The WPA Expert International Advisory Panel for Early Intervention in Psychosis in Low- and Middle-Income Countries: an update on recent relevant activities.","authors":"Swaran P Singh, Afzal Javed, Rangaswamy Thara, Rakesh Chadda, Srividya Iyer, Nikos Stefanis","doi":"10.1002/wps.21130","DOIUrl":"10.1002/wps.21130","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 3","pages":"489-490"},"PeriodicalIF":73.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503914/pdf/WPS-22-489.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving mental health through fostering healthy lifestyles in young people: one of the targets in the WPA Action Plan 2023-2026.","authors":"Danuta Wasserman, Celso Arango, Andrea Fiorillo, Saul Levin, Andrew Peters, Prasad Rao, Thelma Sanchez-Villanueva, Aida Sylla","doi":"10.1002/wps.21146","DOIUrl":"10.1002/wps.21146","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 3","pages":"488-489"},"PeriodicalIF":73.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503912/pdf/WPS-22-488.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An update from the WPA Working Group on Digitalization in Mental Health and Care.","authors":"Umberto Volpe, Rodrigo Ramalho, Laura Orsolini, Ramdas Ransing, Renato de Filippis, Ahmet Gürcan, Shreyasta Samal, Wolfgang Gaebel","doi":"10.1002/wps.21143","DOIUrl":"10.1002/wps.21143","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 3","pages":"494-495"},"PeriodicalIF":73.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503917/pdf/WPS-22-494.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10358837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management.","authors":"Michael Berk, Ole Köhler-Forsberg, Megan Turner, Brenda W J H Penninx, Anna Wrobel, Joseph Firth, Amy Loughman, Nicola J Reavley, John J McGrath, Natalie C Momen, Oleguer Plana-Ripoll, Adrienne O'Neil, Dan Siskind, Lana J Williams, Andre F Carvalho, Lianne Schmaal, Adam J Walker, Olivia Dean, Ken Walder, Lesley Berk, Seetal Dodd, Alison R Yung, Wolfgang Marx","doi":"10.1002/wps.21110","DOIUrl":"10.1002/wps.21110","url":null,"abstract":"<p><p>Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.</p>","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 3","pages":"366-387"},"PeriodicalIF":73.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503929/pdf/WPS-22-366.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labour market marginalization in children of persons with major psychiatric disorders: a Swedish national cohort study.","authors":"Ashley E Nordsletten, Kayoko Isomura, James J Crowley, Matti Cervin, Henrik Larsson, Paul Lichtenstein, David Mataix-Cols, Anna Sidorchuk","doi":"10.1002/wps.21127","DOIUrl":"10.1002/wps.21127","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 3","pages":"483-484"},"PeriodicalIF":73.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503925/pdf/WPS-22-483.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}