BMJ mental health最新文献

{"title":"Beyond the methodological binary: coproduction as the third pillar of mental health science.","authors":"James Downs","doi":"10.1136/bmjment-2025-301807","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301807","url":null,"abstract":"BACKGROUNDMental health research has long been structured around qualitative and quantitative methodologies, often marginalising experiential knowledge and reinforcing hierarchies of expertise. Although coproduction has gained traction as a participatory approach, its methodological status remains contested, leading to inconsistent practices and risks of tokenism.OBJECTIVEThis paper explores whether coproduction should be recognised not merely as a participatory ideal but as a third methodological pillar in mental health research, with distinct philosophical, ethical and practical foundations.METHODSThis paper critically integrates interdisciplinary sources from empirical research and theoretical literature to examine coproduction as a distinct methodological paradigm in mental health research. The analysis is informed by the author's reflexive engagement as a lived experience researcher.FINDINGSFive inter-related challenges to meaningful coproduction are identified: persistent tokenism; the emotional labour required of lived experience contributors; power imbalances in decision-making and recognition; structural exclusions in participation and systemic barriers within academic governance and norms. In response, the paper proposes five strategies for integrating coproduction as a distinct methodological paradigm: creating sustainable fora for dialogue across difference; establishing coproduction as a core research competency; embedding a relational culture of care; fostering methodological innovation and evaluation; and challenging narrow definitions of academic value, authorship and output.CONCLUSIONSReframing coproduction as a third methodological pillar offers a way to address the exclusion of knowledge derived from lived experience and can enhance the rigour, relevance and inclusivity of mental health science. This shift requires systemic changes in how research is conceptualised, taught, funded and evaluated.CLINICAL IMPLICATIONSEmbedding coproduction as a core methodology can improve the relevance and responsiveness of research to clinical realities. Grounding research in lived experience offers insights that enhance service design, build trust and support more equitable, person-centred care, ultimately contributing to better clinical outcomes and more inclusive mental health systems.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strong association between psychiatric disorders co-occurrence and dementia: a Bayesian approach on a 14-year clinical data warehouse.","authors":"Edouard Baudouin,Emmanuelle Duron,Marie Verdoux,Matthieu Gasnier,Yann Pelloux,Hugo Bottemanne,Emmanuelle Corruble,Romain Colle","doi":"10.1136/bmjment-2025-301651","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301651","url":null,"abstract":"BACKGROUNDPsychiatric disorders alone are associated with an increased risk of developing dementia. However, the relationship between co-occurring psychiatric disorders and dementia odds remains unclear. This study aimed to assess the odds of dementia (all types) among individuals with several psychiatric disorders and identify relevant co-occurrence patterns.METHODSData were extracted from the clinical data warehouse of the psychiatry department of Bicêtre Hospital, France, between 29 August 2009 and 29 October 2023. Patients aged 45 years and older diagnosed with at least one psychiatric disorder-depressive disorders, anxiety disorders, psychotic disorders, substance use disorders, personality disorders or bipolar disorders-were included. Subgroups were created to evaluate specific patterns of psychiatric co-occurrence associated with dementia. In this case-control study, Bayesian models, including hierarchical models and logistic regression adjusted for age, sex and cardiovascular risk factors, were used to estimate posterior probabilities and ORs for dementia.RESULTSAmong 3688 subjects, the mean (SD) age at inclusion was 68.7 (12.1) in the dementia group (653 (17.7%) subjects) and 58.2 (10.5) in the non-dementia group (3035 (82.3%) individuals). Compared with those with one psychiatric disorder (2608 (70.7%) patients), the adjusted OR (95% credible interval) for dementia increased from 2.3 (1.7-3) with two comorbidities (789 (21.4%) patients) to 11.1 (5.4-22.2) with four comorbidities (65 (1.8%) subjects). Patients with co-occurrence of mood and anxiety disorders had a mean posterior probability from 48% (34.1-62.2) up to 89.6% (76.8-98.6) of dementia.CONCLUSIONSDementia odds significantly increase with the number of psychiatric comorbidities, with mood and anxiety disorder co-occurrence showing the highest posterior probabilities. Targeted screening strategies should be developed for these patients, with a special focus on patients developing more than one psychiatric disorder.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"26 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying care, qualifying experiences: a systematic review of measurement-based care in psychiatry from patient and provider perspectives.","authors":"Ayan Dey,Ze'ev Lewis,Josh Posel,Rachel Yunqiu Pan,Karen Wang","doi":"10.1136/bmjment-2025-301663","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301663","url":null,"abstract":"BACKGROUNDMeasurement based care (MBC) is a patient-centered approach that is gaining popularity in healthcare systems, particularly in mental health settings. However, attitudes towards MBC vary among mental health clinicians and patients, leading to variable implementation.OBJECTIVEThis systematic review synthesises clinician and patient perspectives on the benefits and drawbacks of measurement-based care (MBC) in psychiatry.STUDY SELECTION AND ANALYSISWe searched Ovid MEDLINE, EMBASE, EBM Reviews, APA PsychINFO and CINAHL databases from inception to January 2024. After screening 1644 titles and abstracts, 48 full papers were reviewed, and 24 studies were ultimately included. Quality assessment was conducted using the Mixed Methods Appraisal Tool, and key patterns were extracted using thematic analysis.FINDINGSThe review reflects opinions of 901 patients and 2831 clinicians across various settings. Patients valued MBC for enhancing communication, self-awareness and reducing stigma. However, they expressed concerns about the adequacy of measures in reflecting their clinical state and uncertainty about how responses influence treatment decisions. Clinicians appreciated MBC for improving patient involvement, tracking treatment response and enhancing communication efficiency. Concerns included inadequate capture of clinical complexity, potential reporting biases, time constraints, insufficient training and concerns with respect to data usage and privacy.CONCLUSIONS AND CLINICAL IMPLICATIONSWhile patients and clinicians recognise significant benefits, including enhanced communication, improved insight and more structured clinical decision-making, they also identify important limitations. These include concerns about the adequacy of scales to capture complex clinical presentations, potential impacts on the therapeutic alliance and increased administrative burden. Moving forward, successful integration of MBC into routine care will require addressing these challenges through improved clinician training, clear guidelines for interpretation, greater transparency with respect to how data will be used and more seamless integration with existing clinical workflows.PROSPERO REGISTRATION NUMBERPROSPERO CRD420250651562.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying care, qualifying experiences: a systematic review of measurement-based care in psychiatry from patient and provider perspectives.","authors":"Ayan Dey, Ze'ev Lewis, Josh Posel, Rachel Yunqiu Pan, Karen Wang","doi":"10.1136/bmjment-2025-301663","DOIUrl":"10.1136/bmjment-2025-301663","url":null,"abstract":"<p><strong>Background: </strong>Measurement based care (MBC) is a patient-centered approach that is gaining popularity in healthcare systems, particularly in mental health settings. However, attitudes towards MBC vary among mental health clinicians and patients, leading to variable implementation.</p><p><strong>Objective: </strong>This systematic review synthesises clinician and patient perspectives on the benefits and drawbacks of measurement-based care (MBC) in psychiatry.</p><p><strong>Study selection and analysis: </strong>We searched Ovid MEDLINE, EMBASE, EBM Reviews, APA PsychINFO and CINAHL databases from inception to January 2024. After screening 1644 titles and abstracts, 48 full papers were reviewed, and 24 studies were ultimately included. Quality assessment was conducted using the Mixed Methods Appraisal Tool, and key patterns were extracted using thematic analysis.</p><p><strong>Findings: </strong>The review reflects opinions of 901 patients and 2831 clinicians across various settings. Patients valued MBC for enhancing communication, self-awareness and reducing stigma. However, they expressed concerns about the adequacy of measures in reflecting their clinical state and uncertainty about how responses influence treatment decisions. Clinicians appreciated MBC for improving patient involvement, tracking treatment response and enhancing communication efficiency. Concerns included inadequate capture of clinical complexity, potential reporting biases, time constraints, insufficient training and concerns with respect to data usage and privacy.</p><p><strong>Conclusions and clinical implications: </strong>While patients and clinicians recognise significant benefits, including enhanced communication, improved insight and more structured clinical decision-making, they also identify important limitations. These include concerns about the adequacy of scales to capture complex clinical presentations, potential impacts on the therapeutic alliance and increased administrative burden. Moving forward, successful integration of MBC into routine care will require addressing these challenges through improved clinician training, clear guidelines for interpretation, greater transparency with respect to how data will be used and more seamless integration with existing clinical workflows.</p><p><strong>Prospero registration number: </strong>PROSPERO CRD420250651562.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are reasons for first using cannabis associated with subsequent cannabis consumption (standard THC units) and psychopathology?","authors":"Edoardo Spinazzola, Hannah Degen, Isabelle Austin-Zimmerman, Giulia Trotta, Edward Chesney, Zhikun Li, Luis Alameda, Bok Man Leung, Yifei Lang, Andrea Quattrone, Diego Quattrone, Erika Castrignanò, Kim Wolff, Robin Murray, Tom P Freeman, Marta Di Forti","doi":"10.1136/bmjment-2025-301810","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301810","url":null,"abstract":"<p><strong>Background: </strong>Reasons for first using cannabis (RFUC) may influence later use patterns and mental health outcomes. However, limited research has explored self-medication versus social RFUCs in depth, and their associations with cannabis use patterns and psychopathology in the general population.</p><p><strong>Objectives: </strong>We examined RFUCs and their associations with (1) reasons for continuing cannabis use, (2) weekly THC (delta-9-tetrahydrocannabinol) unit consumption and (3) symptoms of paranoia, anxiety and depressive symptoms.</p><p><strong>Methods: </strong>We analysed data from the Cannabis&Me (CAMe) population survey (March 2022-July 2024), including 2573 (75.9%) current and 816 (24.1%) past cannabis users aged 18 years or older.</p><p><strong>Findings: </strong>Participants reported a mean weekly consumption of 206 THC units (SD=268). Initiating cannabis use for anxiety (β=36.22, p=3.3e-03), depression (β=40.37, p=1.74e-03) or because 'family members were using it' (β=87.43, p=1.22e-09) was associated with higher weekly THC units. RFUC to relieve physical discomfort (β=8.89, p=4.12e-07), pain (β=7.24, p=5.56e-06), anxiety (β=9.67, p=1.63e-16), depression (β=9.12, p=1.21e-13) and minor psychotic symptoms (β=16.46, p=1.2e-04) were linked to higher paranoia scores. Similar associations were observed for anxiety and depression. Conversely, starting for fun (β=-3.71, p=3.49e-05) or curiosity (β=-2.61, p=5e-03) was associated with lower paranoia and anxiety. RFUC for 'boredom' was linked to increased depression (β=1.09, p=3.8e-03).</p><p><strong>Conclusions: </strong>Initiating cannabis use for self-medication is associated with higher average THC consumption, and increased anxiety, depression and paranoia.</p><p><strong>Clinical implications: </strong>Asking individuals why they first used cannabis may serve as a cost-effective screening tool to identify those who could benefit from monitoring, support, or referral to intervention services.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are reasons for first using cannabis associated with subsequent cannabis consumption (standard THC units) and psychopathology?","authors":"Edoardo Spinazzola,Hannah Degen,Isabelle Austin-Zimmerman,Giulia Trotta,Edward Chesney,Zhikun Li,Luis Alameda,Bok Man Leung,Yifei Lang,Andrea Quattrone,Diego Quattrone,Erika Castrignanò,Kim Wolff,Robin Murray,Tom P Freeman,Marta Di Forti","doi":"10.1136/bmjment-2025-301810","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301810","url":null,"abstract":"BACKGROUNDReasons for first using cannabis (RFUC) may influence later use patterns and mental health outcomes. However, limited research has explored self-medication versus social RFUCs in depth, and their associations with cannabis use patterns and psychopathology in the general population.OBJECTIVESWe examined RFUCs and their associations with (1) reasons for continuing cannabis use, (2) weekly THC (delta-9-tetrahydrocannabinol) unit consumption and (3) symptoms of paranoia, anxiety and depressive symptoms.METHODSWe analysed data from the Cannabis&Me (CAMe) population survey (March 2022-July 2024), including 2573 (75.9%) current and 816 (24.1%) past cannabis users aged 18 years or older.FINDINGSParticipants reported a mean weekly consumption of 206 THC units (SD=268). Initiating cannabis use for anxiety (β=36.22, p=3.3e-03), depression (β=40.37, p=1.74e-03) or because 'family members were using it' (β=87.43, p=1.22e-09) was associated with higher weekly THC units. RFUC to relieve physical discomfort (β=8.89, p=4.12e-07), pain (β=7.24, p=5.56e-06), anxiety (β=9.67, p=1.63e-16), depression (β=9.12, p=1.21e-13) and minor psychotic symptoms (β=16.46, p=1.2e-04) were linked to higher paranoia scores. Similar associations were observed for anxiety and depression. Conversely, starting for fun (β=-3.71, p=3.49e-05) or curiosity (β=-2.61, p=5e-03) was associated with lower paranoia and anxiety. RFUC for 'boredom' was linked to increased depression (β=1.09, p=3.8e-03).CONCLUSIONSInitiating cannabis use for self-medication is associated with higher average THC consumption, and increased anxiety, depression and paranoia.CLINICAL IMPLICATIONSAsking individuals why they first used cannabis may serve as a cost-effective screening tool to identify those who could benefit from monitoring, support, or referral to intervention services.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of pharmacogenomic-guided versus unguided antidepressant treatment in major depressive disorder: new insights from subgroup and cumulative meta-analyses.","authors":"Yuan Zhang,Yiyuan Gao,Yazhu Zou,Yu Ye,Fugui Jiang,Zuxing Wang,Jian Qiu,Zhili Zou","doi":"10.1136/bmjment-2025-301726","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301726","url":null,"abstract":"QUESTIONHow effective is pharmacogenomic (PGx)-guided antidepressant treatment compared with treatment-as-usual (TAU) in major depressive disorder (MDD), and how do ethnicity, disease severity and genetic panel scope influence outcomes?STUDY SELECTION AND ANALYSISThis systematic review and meta-analysis comprised 13 randomised controlled trials (2013-2024) comparing PGx-guided therapy with TAU in MDD. PubMed, Ovid Embase, Ovid Medline, Ovid PsycINFO and the Cochrane Library were searched up to December 2024. Outcomes included response and remission rates at 8 and 12 weeks. Subgroup analyses examined ethnicity and MDD severity. Cumulative meta-analyses assessed gene panel size. The pooled risk ratios (RRs) with 95% CIs were calculated to estimate the overall effect.FINDINGSPGx-guided treatment significantly improved response rates at 8 weeks (RR 1.23, 95% CI 1.05 to 1.43) and 12 weeks (RR 1.29, 95% CI 1.17 to 1.43). Remission was significant at 8 weeks (RR 1.37, 95% CI 1.19 to 1.57) but not at 12 weeks (RR 1.56, 95% CI 0.93 to 2.61). Benefits appeared stronger in the Asian country subgroup compared with non-Asian country subgroup (interaction p=0.02), but this requires validation due to the smaller Asian country sample size. No significant subgroup differences were observed between the MDD not-specified and MDD difficult-to-treat subgroups, despite the latter demonstrating significant improvements in both response and remission rates with PGx-guided treatment compared with TAU at 8 weeks. Cumulative analyses showed effect sizes plateaued, with broader panels offering minimal incremental gains.CONCLUSIONSPGx-guided treatment seems to offer moderate benefits for antidepressant efficacy, with potential advantages in Asian and difficult-to-treat subgroups. Genetic and ethnic variability in drug metabolism underscores the need for population-specific approaches. While multigene panels show clinical benefits plateau, suggesting cost-benefit optimisation is critical. Future research should address adverse events, the cost-effectiveness of expanded panels, long-term remission outcomes and treatment efficacy across more precisely stratified disease severity levels to maximise clinical relevance.PROSPERO REGISTRATION NUMBERCRD42024570014.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"161 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of pharmacogenomic-guided versus unguided antidepressant treatment in major depressive disorder: new insights from subgroup and cumulative meta-analyses.","authors":"Yuan Zhang, Yiyuan Gao, Yazhu Zou, Yu Ye, Fugui Jiang, Zuxing Wang, Jian Qiu, Zhili Zou","doi":"10.1136/bmjment-2025-301726","DOIUrl":"10.1136/bmjment-2025-301726","url":null,"abstract":"<p><strong>Question: </strong>How effective is pharmacogenomic (PGx)-guided antidepressant treatment compared with treatment-as-usual (TAU) in major depressive disorder (MDD), and how do ethnicity, disease severity and genetic panel scope influence outcomes?</p><p><strong>Study selection and analysis: </strong>This systematic review and meta-analysis comprised 13 randomised controlled trials (2013-2024) comparing PGx-guided therapy with TAU in MDD. PubMed, Ovid Embase, Ovid Medline, Ovid PsycINFO and the Cochrane Library were searched up to December 2024. Outcomes included response and remission rates at 8 and 12 weeks. Subgroup analyses examined ethnicity and MDD severity. Cumulative meta-analyses assessed gene panel size. The pooled risk ratios (RRs) with 95% CIs were calculated to estimate the overall effect.</p><p><strong>Findings: </strong>PGx-guided treatment significantly improved response rates at 8 weeks (RR 1.23, 95% CI 1.05 to 1.43) and 12 weeks (RR 1.29, 95% CI 1.17 to 1.43). Remission was significant at 8 weeks (RR 1.37, 95% CI 1.19 to 1.57) but not at 12 weeks (RR 1.56, 95% CI 0.93 to 2.61). Benefits appeared stronger in the Asian country subgroup compared with non-Asian country subgroup (interaction p=0.02), but this requires validation due to the smaller Asian country sample size. No significant subgroup differences were observed between the MDD not-specified and MDD difficult-to-treat subgroups, despite the latter demonstrating significant improvements in both response and remission rates with PGx-guided treatment compared with TAU at 8 weeks. Cumulative analyses showed effect sizes plateaued, with broader panels offering minimal incremental gains.</p><p><strong>Conclusions: </strong>PGx-guided treatment seems to offer moderate benefits for antidepressant efficacy, with potential advantages in Asian and difficult-to-treat subgroups. Genetic and ethnic variability in drug metabolism underscores the need for population-specific approaches. While multigene panels show clinical benefits plateau, suggesting cost-benefit optimisation is critical. Future research should address adverse events, the cost-effectiveness of expanded panels, long-term remission outcomes and treatment efficacy across more precisely stratified disease severity levels to maximise clinical relevance.</p><p><strong>Prospero registration number: </strong>CRD42024570014.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence for reduced synaptic protein SNAP-25 in cerebrospinal fluid in major depressive disorder and schizophrenia.","authors":"Petra Steinacker,Leonie Werner,Alexander Tarabuko,Ilyas Al-Ali,Naguib Mechawar,Christopher R Pryce,Nadia Cattane,Giulia Poggi,Mhd Rami Al Shweiki,Heiko Graf,Henning Großkopf,Steffen Halbgebauer,Patrick Oeckl,Lorenzo Barba,Laura Meier,Samir Abu-Rumeileh,Hugh Marston,Klaus D Bornemann,Bastian Hengerer,Karin M Danzer,Carlos Schönfeldt-Lecuona,Markus Otto","doi":"10.1136/bmjment-2025-301752","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301752","url":null,"abstract":"BACKGROUNDDecreased cerebrospinal fluid (CSF) levels of synaptic proteins, possibly reflecting impaired synaptic function, have been observed in major depressive disorder (MDD).OBJECTIVETo investigate the diagnostic utility of the soluble N-ethylmaleimide-sensitive-factor attachment receptor (SNARE) complex protein, synaptosomal-associated protein of 25 kDa (SNAP-25), for MDD.METHODSOverall, 208 participants with one of MDD, schizophrenia (SCZ) or bipolar disorder (BD), and healthy controls (HCs) were retrospectively enrolled. CSF levels of SNAP-25 were assessed relative to MDD characteristics and the diagnostic potential was analysed. In subgroups of patients, CSF levels of presynaptic neurexin 3 (NRXN3), postsynaptic neurogranin (NRGN) and Alzheimer's disease biomarkers were measured for comparison.FINDINGSSNAP-25 levels, but not the levels of the other synaptic markers, were significantly decreased in MDD compared with HCs, allowing for discrimination with 68% sensitivity and 67% specificity. SNAP-25 was not associated with MDD severity or antidepressant medication. Compared with HCs, SCZ also displayed decreased SNAP-25 enabling discrimination with 64% sensitivity and 77% specificity. There were strong correlations between levels of synaptic proteins and established Alzheimer pathology markers, with subtle differences in the association pattern between disorders.DISCUSSIONOur data suggest that SNAP-25, NRXN3 and NRGN versus beta-amyloid and phosphorylated tau protein 181 (ptau) are regulated differentially across psychiatric disorders and that SNAP-25 has a moderate diagnostic potential for MDD and SCZ. We propose that CSF SNAP-25 level might represent an integrated readout of reduced synaptic function, rather than of synaptic degeneration, in MDD. Further studies are needed to analyse whether this potential can be increased by using multimarker measurements and whether it will be possible to subtype psychiatric disorders according to synaptic involvement in pathophysiology.CLINICAL IMPLICATIONSSNAP-25 and other synaptic proteins in CSF might aid diagnosis and subtyping of MDD and SCZ. The current development of sensitive methods to also determine synaptic proteins in blood samples from patients will advance the validation of the biomarker potential and contribute to understanding of synaptic involvement in the pathophysiology of MDD and SCZ.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence of differences in diurnal electrodermal, temperature and heart rate patterns by mental health status in free-living data.","authors":"Daniel McDuff, Isaac Galatzer-Levy, Seamus Thomson, Andrew Barakat, Conor Heneghan, Samy Abdel-Ghaffar, Jacob Sunshine, Ming-Zher Poh, Lindsey Sunden, John B Hernandez, Allen Jiang, Xin Liu, Ari Winbush, Benjamin Nelson, Nicholas B Allen","doi":"10.1136/bmjment-2024-301307","DOIUrl":"10.1136/bmjment-2024-301307","url":null,"abstract":"<p><strong>Background: </strong>Electrodermal activity (EDA) is a measure of sympathetic arousal that has been linked to depression in laboratory experiments. However, the inability to measure EDA passively over time and in the real world has limited conclusions that can be drawn about EDA as an indicator of mental health status outside of controlled settings.</p><p><strong>Objective: </strong>Recent smartwatches have begun to incorporate wrist-worn continuous EDA sensors that enable longitudinal measurement of sympathetic arousal in everyday life. This work (n=237, 4-week observation period) examines the association between passively collected, diurnal variations in EDA and symptoms of depression, anxiety and perceived stress in a large community sample.</p><p><strong>Methods: </strong>We conducted a prospective, non-randomised study to investigate patterns and relationships between digital device use patterns, including sensor data from phones and wearables reflecting both behavioural and physiological processes, and self-reported measures of mental health and well-being. We recruited 395 participants who had a Fitbit Sense 2 device with the electrodermal sensor activated. We use a non-linear cosinor fitting method to estimate the difference in mesor, amplitude and phase, between the diurnal rhythms in heart rate (HR), heart rate variability (HRV) root mean square of successive differences, EDA, skin temperature and steps.</p><p><strong>Findings: </strong>Subjects who exhibited elevated depressive and anxiety symptoms had higher tonic EDA, skin temperature and heart rate, despite not engaging in greater physical activity, compared with those that were not depressed or anxious. In contrast, subjects who exhibited elevated stress only exhibited higher skin temperature. Most strikingly, differences in EDA between those with high versus low symptoms were most prominent during the early morning. We did not observe amplitude or phase differences in the diurnal patterns.</p><p><strong>Conclusions: </strong>Results indicate that participants with elevated depressive and anxiety symptoms have different diurnal physiological patterns. Specifically, EDA differences suggest elevated sympathetic activity throughout the day and in particular in the early morning.</p><p><strong>Clinical implications: </strong>Our work suggests that electrodermal sensors may be practical and useful in measuring the physiological correlates of mental health symptoms in free-living contexts and that recent consumer smartwatches might be a tool for doing so.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}