Actas espanolas de psiquiatria最新文献

{"title":"The Improvement Effects of Virtual Reality-Assisted Exercise Training on Motor and Psychiatric Symptoms in Patients With Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials.","authors":"Hanwen Zhang, Xiaolei Yuan","doi":"10.62641/aep.v54i4.2301","DOIUrl":"10.62641/aep.v54i4.2301","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to systematically evaluate the combined improvement effects of virtual reality (VR)-assisted exercise training on motor function and psychiatric symptoms in patients with Parkinson's disease (PD), and to provide more scientific evidence-based support for precise clinical rehabilitation.</p><p><strong>Methods: </strong>This study searched China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP Database), PubMed, Web of Science and Scopus for randomized controlled trials (RCTs) examining VR interventions in patients with idiopathic PD covering the period from database inception to 1 March 2026. Two investigators independently performed literature screening and data extraction. Methodological quality was assessed using the Cochrane Risk of Bias Tool 2.0. Meta-analysis was conducted using Review Manager 5.4 and R 4.6.0 software.</p><p><strong>Results: </strong>A total of 37 RCTs involving 1749 patients with PD were included. Meta-analysis results showed that, compared with conventional rehabilitation training, VR-assisted training significantly improved motor outcomes, as reflected by the Berg Balance Scale (BBS; mean difference (MD) = 3.96), Timed Up and Go Test (TUGT; MD = -2.48), and Unified Parkinson's disease Rating Scale Part III (UPDRS-III; MD = -2.94). Regarding psychiatric symptoms, VR training significantly enhanced specific cognitive function (Montreal Cognitive Assessment (MoCA); MD = 1.94), alleviated subjective depressive mood (Beck Depression Inventory (BDI); MD = -1.75), and improved activity-specific balance confidence (Activities-specific Balance Confidence Scale (ABC); MD = 12.03). However, no statistically significant between-group differences were found in global cognition (MiniMental State Examination (MMSE)) and observer-rated depression (Hamilton Depression Rating Scale (HAMD)).</p><p><strong>Conclusions: </strong>VR-assisted exercise training effectively improves comprehensive motor function, specific cognition and depressive mood in patients with PD. Therapeutic efficacy may be influenced by the immersion level of equipment and intervention duration. VR confers shortterm improvements, but its long-term effects remain unknown. It may serve as a promising adjunctive therapy; however, routine clinical recommendation requires further evidence from extended follow-up studies. High-quality RCTs with prolonged follow-up periods are still warranted to clarify the long-term effects of VR interventions with varying immersion levels.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1269-1286"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Causal Relationship Between Sex Hormones and Depression by Means of Two-Sample Mendelian Randomization Analysis.","authors":"He Gao, Xiangju Du, Yuncui Huo, Hong Pan, Yongming Xu, Yanbin Hou","doi":"10.62641/aep.v54i4.2093","DOIUrl":"10.62641/aep.v54i4.2093","url":null,"abstract":"<p><strong>Background: </strong>To investigate the potential causal association between sex hormones and depression, a twosample mendelian randomization (MR) analysis was conducted.</p><p><strong>Methods: </strong>Summary statistics from Genome-wide Association Study (GWAS) on sex hormones and depression were collected. Sex-specific instruments were used to analyze seven sex hormones, including progesterone (PROG) and bioavailable testosterone (BAT). The inverse variance weighted (IVW) method was employed as the primary analysis, and sensitivity analyses were conducted to assess the robustness of the findings.</p><p><strong>Results: </strong>The IVW analysis revealed genetically significant association between PROG and depression (odds ratio (OR): 0.95, 95% confidence interval (CI): 0.92-0.98, <i>p</i> = 0.002), which remained significant after Bonferroni correction (<i>p</i> < 0.0036). A nominally significant association was observed for BAT (OR: 0.90, 95% CI: 0.82-1.00, <i>p</i> = 0.049) and depression; however, this association did not survive Bonferroni correction. Upon stratification by gender, these associations were no longer significant (<i>p</i> > 0.05). Furthermore, no substantial associations were observed between depression and other sex hormones, including total testosterone (TT), estradiol (E2), follicle-stimulating hormone, prolactin, and luteinizing hormone (<i>p</i> > 0.05). Leave-one-out analyses and funnel plots (indicating balanced pleiotropy), confirmed the reliability of these findings, supporting the robustness of the results. Significant heterogeneity was observed in seven exposures: E2_Female, TT_Male, TT_Both, BAT_Both, BAT_Male, BAT_Female, and TT_Female. Additionally, Mendelian Randomization Pleiotropy Residual Sum and Outlier (MR-PRESSO) analysis identified outliers for BAT_Both, BAT_Female, E2_Female, TT_Both, and TT_Female; however, excluding these outliers did not alter the results.</p><p><strong>Conclusions: </strong>This study indicates a potential causal association between genetically predicted PROG levels and a decreased risk of depression. While BAT also suggested a potential protective effect, this association was considered suggestive after multiple testing correction and requires further validation.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1245-1256"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomophobia-Related Indicators in Court-Involved Adolescents With Child-to-Parent Violence: A Preliminary Item-Level Correlational Study.","authors":"Elisa González-Pérez, José Luis Díaz Palencia, Isabel Martínez-Álvarez","doi":"10.62641/aep.v54i4.2316","DOIUrl":"10.62641/aep.v54i4.2316","url":null,"abstract":"<p><strong>Background: </strong>Nomophobia, commonly understood as fear or distress associated with being without access to a mobile phone, has become a relevant topic in adolescent research. However, little is known about how nomophobiarelated indicators are associated with one another in adolescents involved in juvenile justice interventions for child-toparent violence (CPV).</p><p><strong>Methods: </strong>This exploratory cross-sectional study included 53 adolescents serving court-ordered measures for CPV in a specialized juvenile justice centre in Madrid, Spain. Six items from the nomophobia subscale of the Risk Scale for Adolescent Addiction to Social Networks and the Internet were analyzed. Item-level bivariate correlations were examined, and the findings were interpreted cautiously in light of the exploratory nature of the study.</p><p><strong>Results: </strong>The six items showed positive associations, with stronger correlations among indicators related to immediate replies, read-receipt confirmation, restlessness when interaction is absent, and anger when separated from the mobile phone. Items referring to perceived safety when sending messages or photographs showed weaker associations with the remaining items.</p><p><strong>Conclusions: </strong>The findings suggest a preliminary pattern of internal association among six nomophobia-related Adolescent Social Media and Internet Addiction Risk Scale Reliability and Validity (ERA-RSI) items in this specific sample of court-involved adolescents. These results should not be interpreted as evidence of the full structure of nomophobia or as causal evidence regarding family conflict or interpersonal control. Future studies should use larger multisite samples, validated nomophobia-specific instruments, longitudinal designs, and analytic strategies appropriate for ordinal data.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1132-1140"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Digital Cognitive Behavioural Therapy (dCBT) for Co-Occurring Anxiety, Depression and Chronic Pain in Adults: A Systematic Review and Meta-Analysis.","authors":"Li Zhu, Yanping Ji, Juner Le, Henan Wu","doi":"10.62641/aep.v54i4.2138","DOIUrl":"10.62641/aep.v54i4.2138","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the effectiveness of digital cognitive behavioural therapy (dCBT) in reducing pain intensity, pain interference, depression, and anxiety symptoms in adults with co-occurring chronic pain, anxiety and depression.</p><p><strong>Methods: </strong>We systematically searched in PubMed, PsycINFO, Cochrane Library and Web of Science for randomized controlled trials (RCTs) published up to October 2025. Included studies comparing dCBT with control conditions in adults with chronic pain (≥3 months), co-occurring anxiety and depression. Primary outcomes were pain intensity and depressive symptoms. Secondary outcomes were pain interference and anxiety symptoms. Pooled standardized mean difference (Hedges' g) were calculated using fixed-effects or random-effects models depending on heterogeneity.</p><p><strong>Results: </strong>We included 6 RCTs involving 737 participants with chronic pain, co-occurring anxiety and depression. Compared with control groups, dCBT did not significantly reduce pain intensity (g = -0.43, 95% confidence interval (CI) [-0.98, 0.11], <i>p</i> = 0.12; I² = 91%), but it significantly reduced depressive symptoms (g = -0.51, 95% CI [-0.66, -0.36], <i>p</i> < 0.00001; I² = 35%), pain interference (g = -0.70, 95% CI [-1.18, -0.21], <i>p</i> = 0.005; I² = 89%), and anxiety symptoms (g = -0.59, 95% CI [-0.74, -0.44], <i>p</i> < 0.00001; I² = 37%).</p><p><strong>Conclusions: </strong>dCBT effectively improves depressive symptoms, anxiety symptoms, and pain interference in patients with co-occurring chronic pain, anxiety and depression, but its direct effect on pain intensity did not reach statistical significance in this meta-analysis. dCBT is convenient and scalable, with confirmed efficacy in emotional and functional domains, making it a valuable adjunctive treatment option. Future research should investigate its true effect on pain intensity, long-term outcomes and personalized treatment approaches.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1287-1296"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Influencing Factors of Cognitive Impairment in Patients With End-Stage Renal Disease Undergoing Maintenance Haemodialysis.","authors":"Xiaoxiang Jiang, Xuequn Miao","doi":"10.62641/aep.v54i4.2260","DOIUrl":"10.62641/aep.v54i4.2260","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the clinical characteristics and influencing factors of cognitive impairment and associated behavioural and psychological symptoms in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis.</p><p><strong>Methods: </strong>This study enrolled 132 patients with ESRD receiving maintenance haemodialysis between January 2021 and January 2025. Patients were divided into a cognitively normal (CN) group and a cognitively impaired (CI) group based on post-dialysis cognitive impairment. The relationships were examined using the Montreal Cognitive Assessment (MoCA) and the Neuropsychiatric Inventory (NPI). Clinical data were collected, and logistic regression analysis was performed to identify factors associated with cognitive impairment.</p><p><strong>Results: </strong>Compared with the CN group, the CI group had significantly higher scores in abstract thinking, orientation, memory, naming, visuospatial/executive abilities, language fluency, attention and total MoCA scores (<i>p</i> < 0.05). On the NPI, the CI group had significantly lower scores (indicating fewer symptoms) than the CN group across all 12 domains, including delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor activity, nighttime behaviours/sleep disturbances, and appetite/eating disorders, as well as higher total NPI scores (p < 0.05). Logistic regression analysis identified age, dialysis duration, and serum levels of haemoglobin (Hb), higher β₂-microglobulin, 25-hydroxyvitamin D [25(OH)D], and higher intact parathyroid hormone (iPTH) as independent influencing factors associated with cognitive impairment (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Advanced age, longer dialysis duration, lower Hb, higher β₂-microglobulin, lower 25(OH)D, and higher iPTH levels were associated with cognitive impairment in patients undergoing maintenance haemodialysis for ESRD. Close monitoring of patients presenting with these risk factors is warranted for early prevention of cognitive decline.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"982-991"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Posttraumatic Stress Disorder in Mexican Psychiatric Trauma Survivors.","authors":"Laura Estefanía Mora Ortiz, Ilyamín Merlín García, Rebeca Robles García","doi":"10.62641/aep.v54i4.2253","DOIUrl":"10.62641/aep.v54i4.2253","url":null,"abstract":"<p><strong>Background: </strong>There is extensive evidence linking specific sociodemographic and clinical factors to increased vulnerability for Posttraumatic Stress Disorder (PTSD). However, most studies have focused on community samples, and little is known about how such factors shape PTSD risk in clinical psychiatric settings in Latin America, where trauma exposure is highly prevalent. The present study addresses these gaps by examining sociodemographic characteristics and specific types of traumatic events linked to PTSD diagnosis among individuals receiving care at a tertiary mental health facility in Mexico City, Mexico.</p><p><strong>Methods: </strong>A cross-sectional, observational design was employed, enrolling 160 psychiatric patients. Participants were assessed for exposure to potentially traumatic events using the Life Events Checklist for DSM-5 (LEC-5). Probable PTSD was initially identified with the PTSD Checklist for DSM-5 (PCL-5), followed by diagnostic confirmation using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Sociodemographic data, including age, sex, and educational attainment, were also collected. Multivariate logistic regression was used to identify PTSD predictors, with a significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>The frequency of PTSD in the sample was 31.9%. Multivariate logistic regression analysis revealed that sexual aggression was the strongest independent predictor of PTSD (odds ratio (OR) = 38.49; 95% confidence interval (CI): 10.59-139.95; <i>p</i> < 0.001). Other significant predictors included being female (OR = 8.09; 95% CI: 1.60-40.86; <i>p</i> < 0.001) and over 30 years old (OR = 2.86; 95% CI: 1.13-7.24; <i>p</i> < 0.05). The model demonstrated good overall fit (Pearson χ² <i>p</i> = 0.673) and explained a moderate proportion of the variance (Nagelkerke R² = 0.550).</p><p><strong>Conclusions: </strong>Sexual aggression, female sex, and older age were significantly associated with a PTSD diagnosis among psychiatric trauma survivors. These findings underscore the importance of incorporating trauma-informed care principles and systematic screening for sexual violence into mental health settings to improve diagnostic accuracy and optimize interventions for this population.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1297-1303"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Advances in the Brain-Gut Axis in the Development and Progression of Depression.","authors":"Meinan Chen, Yanlai Xu","doi":"10.62641/aep.v54i4.2252","DOIUrl":"10.62641/aep.v54i4.2252","url":null,"abstract":"<p><p>The prevalence of depression is increasing year by year. Accumulating evidence has shown that the brain-gut axis (BGA) may contribute largely to the development and progression of depression. Gut microbial community composition and metabolites may contribute to the pathophysiological mechanisms of depression by influencing bidirectional communication with the BGA. Gut microbiota dysbiosis has been implicated in the pathogenesis of depression and may provide new potential targets for therapeutic interventions. This article reviews current academic investigations into the association between BGA and depression and discusses how to improve depressive symptoms through the BGA, seeking to offer insights for future research and clinical treatment strategies for depression.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1313-1323"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Risk and Protective Factors of NSSI in Middle School Students: A Longitudinal Study.","authors":"Xinwei Yu, Li Zhang, Ye Yu, Xuejian Su, Yipeng Su, Defa Mo, Yuwei Yang, Bo Liu, Lingyun Lai, Lifang Zhou, Xiaopeng Deng","doi":"10.62641/aep.v54i4.2086","DOIUrl":"10.62641/aep.v54i4.2086","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to use longitudinal data from 2021 to 2023 to systematically examine the risk and protective factors and mechanisms associated with nonsuicidal self-injury (NSSI) among middle school students in Jingzhou City, and to provide empirical evidence for targeted school-based psychological interventions.</p><p><strong>Methods: </strong>A baseline survey was conducted in 2021 (T1) among 652 first-year junior high school students from two schools in Jingzhou City. In 2023 (T2), 585 participants were successfully followed up (follow-up rate: 89.72%). Participants were categorized into four groups: no NSSI, incident NSSI, NSSI remission, and persistent NSSI. Intergroup differences in characteristics were analyzed using chi-square tests, Kruskal-Wallis H tests, and post hoc comparisons. Three binary logistic regression models were constructed to explore the predictive effects of baseline (T1) factors on incident, remitted, and persistent NSSI, respectively. The significance level was set at α = 0.05.  Results: The overall rate of NSSI decreased markedly from 22.05% to 8.55% over the two-year period. Multivariable analysis showed that in the model predicting NSSI remission (no NSSI group vs. remission group), individuals whose depressive symptoms decreased were significantly more likely to have discontinued NSSI (adjusted odds ratio (aOR) = 8.43, 95% confidence interval (CI): 3.01-23.60). Those with stable anxiety symptoms had a significantly higher rate of NSSI remission compared with those whose anxiety worsened (aOR = 0.35, 95% CI: 0.18- 0.67). Gender-stratified analyses showed that among boys, a reduction in internet addiction was a significantly protective factor for NSSI remission (aOR = 8.87, 95% CI: 1.81-43.48). Among girls, both a decrease in depressive symptoms (aOR = 18.53, 95% CI: 3.36-102.26) and stable anxiety symptoms (aOR = 0.31, 95% CI: 0.14-0.72) were significantly associated with NSSI remission.</p><p><strong>Conclusions: </strong>NSSI behaviors among middle school students exhibit a high remission rate (82.17%) over time. The findings underscore the close association between NSSI and dynamic psychological problems. Prevention and intervention strategies of NSSI should be developed according to the longitudinal follow-up study, such as specific interventions of internet use behaviors for males and depressive and anxiety symptoms for females.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1042-1054"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Predictors of Mechanical Restraint in Involuntary Patients in an Open-Door Inpatient Psychiatric Unit.","authors":"Aurea Fernandez-Ribas, Beltran Jimenez-Fernandez, Manuel Vasquez, Laura Vargas-Puertolas, Encarnacion Romero-Diaz, Marina Delgado-Mari, Laura Miro-Mezquita, Jorge Cuevas-Esteban","doi":"10.62641/aep.v54i4.2328","DOIUrl":"10.62641/aep.v54i4.2328","url":null,"abstract":"<p><strong>Background: </strong>Mechanical restraint (MR) remains one of the most controversial interventions in psychiatry, particularly in involuntarily admitted patients. This study examined the prevalence and clinical predictors of MR in an open-door psychiatric unit in Spain, a context where national MR rates remain among the highest in Europe.</p><p><strong>Methods: </strong>A retrospective descriptive study of all involuntarily admitted patients (n = 81) was conducted in a 20-bed open-door acute psychiatric unit between June and December 2024. Sociodemographic, diagnostic, and treatment variables were extracted from electronic health records. Bivariate analyses based on exact tests and Firth penalized-likelihood logistic regression were used to identify independent correlates of MR.</p><p><strong>Results: </strong>MR was applied in 14.8% of patients. In Firth penalized-likelihood multivariable analysis, schizophrenia was the strongest independent correlate of MR (odds ratio [OR] = 9.58, 95% confidence interval [CI]: 1.71-65.89, p = 0.010). Male gender showed a significant bivariate association but lost significance after adjustment. MR co-occurred with intramuscular psychotropic medication in 91.7% of cases.</p><p><strong>Conclusions: </strong>Within this single-centre, exclusively involuntary cohort, care delivered in an open-door setting with structured de-escalation interventions was associated with a comparatively low rate of MR. Schizophrenia emerged as the strongest correlate of MR and may represent a priority target for prevention strategies. The results align with convergent evidence from German, Swiss, and Norwegian studies supporting the safety and effectiveness of open-door approaches, and provide the first Spanish data on MR in this model of care. These findings are preliminary and require confirmation in larger, multicentre samples.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"963-970"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectory Patterns of Perioperative Anxiety and Depressive Symptoms in Patients With Digestive System Malignancies and Their Impact on Postoperative Outcomes.","authors":"Yige Zhao, Mengmeng Li","doi":"10.62641/aep.v54i4.2266","DOIUrl":"10.62641/aep.v54i4.2266","url":null,"abstract":"<p><strong>Background: </strong>To identify perioperative anxiety and depressive symptom trajectories in patients with digestive system malignancies undergoing surgery and to examine their associations with biomarkers and postoperative outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included 285 patients with digestive system malignancies who underwent elective surgery from January 2019 to December 2025 at Zhejiang Xinan International Hospital. Anxiety and depressive symptoms were assessed using repeated Hospital Anxiety and Depression Scale (HADS) total scores at T1 (1-3 days preoperatively), T2 (postoperative day 3), and T3 (postoperative day 7). Self-Rating Anxiety Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Social Support Rating Scale scores were also extracted. Biomarkers, including cortisol, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and brain-derived neurotrophic factor (BDNF), were obtained from routine laboratory records. Latent class growth analysis was used to identify symptom trajectories. Multivariate logistic regression was performed to identify predictors of chronic trajectory membership.</p><p><strong>Results: </strong>Three trajectories were identified: resilient (42.1%), recovery (38.2%), and chronic (19.6%). Stage III patients had higher HADS scores than Stage I patients (18.6 ± 4.8 vs. 12.4 ± 3.6, <i>p</i> < 0.001). The chronic group showed higher postoperative IL-6 (8.2 ± 2.4 vs. 4.8 ± 1.6 pg/mL), TNF-α (18.6 ± 5.2 vs. 10.2 ± 3.4 pg/mL), and CRP levels, and lower BDNF levels than the resilient group. Chronic trajectory membership was associated with higher complication rates, longer hospital stay, higher 30-day readmission, and lower Quality of Recovery-15 (QoR-15) scores. Independent predictors included Stage III disease, psychiatric history, preoperative sleep disturbance, and reduced social support. The prediction model showed good (area under the receiver operating characteristic curve (AUC) = 0.856).</p><p><strong>Conclusions: </strong>Perioperative psychological distress follows distinct trajectories in patients with digestive system malignancies. Persistent distress is associated with inflammatory activation and poorer postoperative recovery, supporting early risk stratification and targeted psychological intervention.</p>","PeriodicalId":7251,"journal":{"name":"Actas espanolas de psiquiatria","volume":"54 4","pages":"1220-1233"},"PeriodicalIF":2.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}