Annals of General Psychiatry最新文献

{"title":"Depression and the risk of myocardial infarction: evidence from a cross-sectional analysis of NHANES 2005-2020.","authors":"Dan Zhu, Fei Ying, Liping Wei, Xiaolong He","doi":"10.1186/s12991-026-00660-7","DOIUrl":"10.1186/s12991-026-00660-7","url":null,"abstract":"<p><strong>Background: </strong>Depression is recognized as being linked to atherosclerosis and adverse cardiovascular outcomes; however, robust evidence from nationally representative cohorts regarding its association with myocardial infarction (MI) is still insufficient. This study aimed to investigate the relationship between depressive symptoms, measured by the PHQ-9, and the odds of having a history of MI using data from NHANES 2005-2020, while further exploring possible nonlinear patterns and potential modifiers of this association.</p><p><strong>Methods: </strong>We included 37,139 adults aged 20 years or older (1,574 with MI) and performed weighted analyses accounting for the NHANES complex survey design. Exposure was defined as PHQ-9 scores, analyzed both continuously and by severity categories (none, mild, moderate, severe), with self-reported MI as the outcome. We fitted three progressively adjusted weighted logistic regression models and employed restricted cubic spline (RCS) analysis to evaluate nonlinearity. We further performed prespecified subgroup and interaction analyses, along with a series of sensitivity analyses.</p><p><strong>Results: </strong>Higher depressive burden was significantly associated with higher odds of MI, with MI prevalence rising progressively across depression severity groups (2.89% vs. 4.39% vs. 5.80% vs. 7.08%, p < 0.001). In the unadjusted model, every 1-point increase in PHQ-9 score corresponded to a 6.2% increase in the odds of MI (OR = 1.062, 95% CI: 1.047-1.077; p < 0.001), while severe depression was linked to approximately a 2.56-fold higher odds compared with non-depressed participants. The association remained robust after sequential full adjustment for potential confounders. Restricted cubic spline analysis revealed no evidence of nonlinearity (p > 0.05), supporting an approximately linear association. Subgroup analyses demonstrated consistent associations across most strata; however, significant interactions were detected for CHF, CHD, and higher V/MPA groups (P for interaction < 0.05), indicating attenuated associations in these groups.</p><p><strong>Conclusion: </strong>In a nationally representative sample of US adults, depressive burden was strongly associated with prevalent MI, with cardiovascular comorbidities and physical activity acting as potential modifiers of this association. These findings underscore the importance of integrating routine depression screening and holistic mind-body management into both general and high-risk populations, and highlight the necessity of prospective and interventional studies to clarify the temporal sequence and evaluate potential causality.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic predictors of lithium response in an ethiopian cohort of patients with bipolar disorder.","authors":"Abebe Ejigu Hailu, Solomon Teferra, Ephrem Engidawork","doi":"10.1186/s12991-026-00651-8","DOIUrl":"10.1186/s12991-026-00651-8","url":null,"abstract":"<p><strong>Background: </strong>Several lines of evidence suggest that genetic factors underlie variability in response to lithium, although pharmacogenetic studies, particularly in African populations, are limited. This study aimed to examine the genetic factors associated with lithium response among Ethiopian patients diagnosed with bipolar disorder (BD).</p><p><strong>Methodology: </strong>This study was conducted at Amanuel Mental Specialized Hospital (AMSH) in Addis Ababa, Ethiopia, involving 101 patients diagnosed with BD and on lithium therapy for at least six months. Participants were selected from a larger cohort recruited for the Neuropsychiatric Genetics of African Populations - Psychosis, Ethiopia (NeuroGAP-P-E) project. The study investigated the association between lithium response and genetic polymorphisms of 22 genes with 53 SNPs implicated in lithium's mechanisms of action. Clinical response to lithium was assessed using the Alda scale, where those with total Alda > 7 were categorized as good responders (GR) and those with Alda < 7 as insufficient responders (IR). Genotyping was performed using PCR-free whole-genome sequencing.</p><p><strong>Results: </strong>Among the participants, 32.5% were classified as GR, while 67.5% were IR. Significant associations were identified between lithium's response and specific SNPs. Notably, the BDNF rs6265 variant (Val166Met) showed stronger correlation, with the CC genotype being more frequent (p = 0.0001) in IR, while the rs2030324 A allele and AA genotype were more frequent in GR (p < 0.05). Variants in GSK-3β (rs334558) and dopamine receptor genes, such as DRD1 (rs4532) and DRD2 (rs1800497) also demonstrated significant associations with treatment outcomes (p < 0.05). However, after adjustment for multiple testing using false discovery rate (FDR), only polymorphisms within BDNF and DRD1 remain statistically significant. Multivariable analysis revealed that whilst AKT1_rs10138227 TT (p < 0.05) genotypes were positive predictors, BDNF_rs962339 GG, DRD2_rs1800497 AG/GG and GSK-3β_rs334558 AG were negative predictors of good response.</p><p><strong>Conclusions: </strong>The data collectively show that variants in BDNF, dopamine receptor genes, and the AKT1/GSK3B pathway were linked to lithium's response in BD. AKT1 rs10138227 TT genotypes predicted better response, while BDNF rs962339 GG, DRD2 rs1800497 AG/GG, and GSK-3β rs334558 AG were associated with poor outcomes. These findings highlight the role of genetic variations in predicting lithium's response.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech analysis for differentiating bipolar disorder and major depressive disorder during euthymic states.","authors":"Jhen-Wu Lai, Ya-Han Hu, Ya-Mei Bai, Cheng-Che Shen","doi":"10.1186/s12991-026-00652-7","DOIUrl":"10.1186/s12991-026-00652-7","url":null,"abstract":"<p><p>OBJECTIVE: Differentiating major depressive disorder (MDD) from bipolar disorder (BP) is crucial for early diagnosis and targeted treatment. This study investigates speech, linguistic biomarkers, and machine learning models to differentiate between the MDD and BP patients using speech analysis during symptom-free periods. METHODS: Voice recordings from 191 patients (41 BP, 150 MDD) during euthymic phases were analyzed. Linguistic metrics, sentiment scores, and acoustic features were extracted and compared between the groups. Various machine learning models were employed to classify diagnoses based on these features. RESULTS: Significant differences were observed between BP and MDD patients. BP patients exhibited a shorter pause durations per total speaking duration and total word count (0.19 vs. 0.29; p < 0.05, 0.07 vs. 0.12; p < 0.05). MDD patients showed greater variability in speech intensity and peak amplitude during euthymic states. Sentiment analysis revealed no significant differences in broader emotional dimensions. Among the models tested, the Random Forest classifier achieved the highest predictive performance (AUC = 0.807), underscoring its effectiveness in differentiating BP from MDD. CONCLUSION: Speech analysis during euthymic periods reveals distinct linguistic and acoustic patterns between MDD and BP patients. These findings highlight the potential of speech features as non-invasive biomarkers for mood disorder classification, offering promising avenues for enhancing clinical decision-making. However, given the sample size, the results are preliminary and warrant replication in larger, independent cohorts. </p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global scientific trends on neuroimaging in obsessive-compulsive disorder in the early twenty-first century: a bibliometric analysis and visualization analysis.","authors":"Cong Zhou, Yan Fan, Aoxue Zhang, Xiaodong Cheng, Jian Cui, Kun Li, Chuanxin Liu, Hao Yu, Sen Li","doi":"10.1186/s12991-026-00653-6","DOIUrl":"10.1186/s12991-026-00653-6","url":null,"abstract":"<p><p>OBJECTIVE: This bibliometric analysis aims to delineate the evolution, current trends, and future directions in neuroimaging research on obsessive-compulsive disorder (OCD) from 2000 to 2024. By synthesizing global research output, collaboration networks, and technological advancements, we seek to highlight knowledge gaps and propose strategies to enhance the equity, reproducibility, and translational impact of OCD neuroimaging studies. METHODS: Data were sourced from the Web of Science Core Collection, spanning January 1, 2000, to December 31, 2024. A structured search strategy identified 2,000 eligible articles and reviews. Bibliometric analysis was conducted using CiteSpace, VOSviewer, and Excel to examine publication trends, geographic and institutional collaborations, keyword co-occurrence, citation patterns, and journal influence. RESULTS: OCD neuroimaging research has shown sustained growth, with a shift from metabolic studies to network neuroscience, driven by advances in functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and artificial intelligence (AI). High-income countries dominated research output, with the United States contributing 36.5% of publications. However, low- and middle-income countries (LMICs) remain underrepresented. Keyword analysis revealed emerging themes such as transdiagnostic biomarkers and neuromodulation therapies. High-impact journals like Biological Psychiatry and American Journal of Psychiatry dominated citations, while specialized journals struggled with visibility. Methodological heterogeneity and limited data sharing posed significant challenges to reproducibility. CONCLUSION: This bibliometric analysis maps the transformation of OCD neuroimaging into a central pillar of translational psychiatry, revealing sustained growth, a paradigm shift toward network-based methods, and persistent geographical disparities. These documented trends collectively highlight that advancing equitable and reproducible research requires prioritized global collaboration and the adoption of open science frameworks. Therefore, addressing these specific gaps is crucial for developing neuroimaging-informed biomarkers and interventions with broad clinical applicability. </p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of aerobic exercise as a combination therapy for depression compared to standardized therapy: a systematic review and meta-analysis of randomized controlled trials.","authors":"Chengcheng Zhu, Karen M von Deneen, Halijah Binti Ibrahim, Puyan Chi, Mingrui Shao, Weiping Du, Xueying Zhu, Xin Wei, Zeyu Wu, Aiping Chi, Ting Peng, Linfeng Hou","doi":"10.1186/s12991-026-00650-9","DOIUrl":"10.1186/s12991-026-00650-9","url":null,"abstract":"<p><p>BACKGROUND: Utilizing aerobic exercise prevails as a popular choice for physical activity, serving as the predominant exercise intervention for addressing depression. It is also used as supplementary therapy to standardized treatments, including pharmacotherapy, psychotherapy, and treatment as usual (TAU). Despite this, the therapeutic mechanism of aerobic exercise as an adjunctive therapy, as well as its interaction with standardized treatments, has not been fully elucidated. The primary goal of the current study was to evaluate the effectiveness of aerobic exercise as an adjunct to these standardized treatments in enhancing the antidepressant effect, compared with standardized treatment alone. METHOD: We systematically searched randomized controlled trials that compared the efficacy of combining aerobic exercise with standardized therapy against standardized therapy alone in treating depression. The final analysis incorporated 20 trials, with a total of 914 participants. Calculation of the pooled standardized mean difference between aerobic exercise combined therapy and standardized therapy was conducted using a random-effects model. RESULTS: Compared with standardized therapy alone, aerobic exercise combined therapy demonstrated a significant moderate effect (SMD = -0.72 [-0.96, -0.47], p < 0.00001, I² = 66%). In subgroup analyses, older patients showed a numerically larger effect, but the age subgroup difference was not statistically significant (p = 0.06). In analyses stratified by standardized treatment modality, aerobic exercise combined with pharmacotherapy showed the largest effect (SMD = -0.97 [-1.41, -0.54], p < 0.0001, I² = 78%), and the between-subgroup difference was significant (p = 0.02). In addition to antidepressant effects, aerobic exercise combined therapy was also associated with improvements in other health-related outcomes. Subgroup findings further suggested that both low- and moderate-intensity aerobic exercise were associated with favorable treatment outcomes, with low-intensity exercise showing potential in patients with lower baseline physical fitness or more severe depressive symptoms. Moreover, a higher total exercise dose was generally associated with greater therapeutic benefit. CONCLUSIONS: Aerobic exercise may be a useful adjunct to standardized treatment for depression and may help improve overall treatment outcomes. However, these findings should be interpreted cautiously given the substantial heterogeneity across studies, the conceptual breadth of “standardized therapy,” and the limited evidence available for several secondary outcomes. Future studies should further clarify the optimal exercise prescription, underlying mechanisms, and long-term effectiveness across different patient subgroups. </p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations in serum melatonin, IL-6 and BDNF levels and their clinical correlations in first-episode major depressive disorder.","authors":"Chunyu Yan, Yayun Xu, Jun Liang, Qingrong Xia, Feng Shan","doi":"10.1186/s12991-026-00657-2","DOIUrl":"10.1186/s12991-026-00657-2","url":null,"abstract":"<p><strong>Objective: </strong>Melatonin, a key regulator of circadian rhythms and sleep-wake cycles, is implicated in the pathophysiology of major depressive disorder (MDD). Emerging evidence supports its anti-inflammatory, cytoprotective, and neuroprotective roles, including promotion of neuroplasticity. This study aims to investigate alterations in serum melatonin, interleukin-6 (IL-6), and brain-derived neurotrophic factor (BDNF) levels in first-episode MDD patients, and explores their clinical correlations.</p><p><strong>Methods: </strong>A total of 74 first-episode patients diagnosed with MDD and 72 healthy controls were enrolled in this study. The severity of depressive symptoms was assessed using the 24-item Hamilton Depression Rating Scale (HAMD-24). All blood samples were collected in the morning, and serum levels of melatonin, IL-6, and BDNF were quantified via enzyme-linked immunosorbent assay (ELISA). Baseline serum concentrations of melatonin, IL-6, and BDNF were compared between the MDD group and the control group. Additionally, the discriminative ability of these biomarkers (melatonin, IL-6, and BDNF) in distinguishing MDD patients from healthy controls was evaluated using receiver operating characteristic (ROC) curve analysis. Pearson correlation analysis or Spearman's rank correlation analysis was performed to explore the relationships between serum melatonin levels and clinical disease severity, as well as with IL-6 and BDNF levels, in patients with MDD.</p><p><strong>Results: </strong>Compared with the control group, the MDD group showed significantly higher serum levels of melatonin (Z = -3.861, P < 0.001) and IL-6 (Z = -4.240, P < 0.001), but significantly lower serum BDNF levels (t = 9.537, P < 0.001). Moreover, the combined panel of BDNF, IL-6, and melatonin achieved high accuracy in distinguishing MDD patients from healthy controls, with an area under the curve (AUC) of 0.905. Additionally, no significant correlations were found between serum melatonin levels and clinical disease severity (assessed by HAMD-24 scores), IL-6 levels, or BDNF levels in MDD patients (all P > 0.05).</p><p><strong>Conclusions: </strong>These findings suggest that dysregulation of melatonin, IL-6, and BDNF may contribute to the pathophysiology of first-episode MDD, with their combined measurement offering strong diagnostic potential.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147571658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Apolipoprotein B (ApoB) and suicidal ideation: a cross-sectional study and Mendelian randomization analysis.","authors":"Mixue Guo, Haifeng Zhang, Chang Fu, Hongli Wan, Xintian Cai, Huqiang Dong, Hongping Cheng","doi":"10.1186/s12991-026-00645-6","DOIUrl":"10.1186/s12991-026-00645-6","url":null,"abstract":"<p><strong>Background: </strong>Research suggests that lipid levels may be associated with suicide risk. However, the specific relationship between Apolipoprotein B and suicidal ideation remains unclear. The aim of this study was to investigate the association between ApoB levels and suicidal ideation and to further explore the causal relationship using Mendelian randomization.</p><p><strong>Methods: </strong>A cross-sectional study of 6520 U.S. adults was conducted using the 2011-2016 National Health and Nutrition Examination Survey (NHANES) dataset. Multiple logistic regression, smoothed curve fitting, stratified analyses, and interaction tests were used to reveal the relationship between ApoB levels and suicidal ideation. MR analyses were conducted using inverse variance weighting (IVW), GSMR, Maximum likelihood method, and cML-MA-BIC MR method. Sensitivity analyses included MR-Egger intercept test, MR-PRESSO global test, and leave-one-out (LOO) analysis.</p><p><strong>Results: </strong>Multivariate logistic regression analysis showed that serum ApoB levels were positively associated with suicidal ideation, and the association remained significant even after multiple covariates (P = 0.0463). Subgroup analyses showed that the risk of suicidal ideation was significantly increased in the highest tertile (T3) of the population compared to the lowest tertile (T1) of ApoB levels (OR = 1.48, 95% CI: 1.04-2.12, P = 0.0312). In addition, the association between ApoB and suicidal ideation was more significant in the smoking subgroup (P interaction = 0.034). However, MR analysis failed to confirm a significant causal effect of ApoB levels on suicidal ideation (P > 0.05), and these results were robust to sensitivity analyses.</p><p><strong>Conclusion: </strong>The present study found a significant positive association between serum ApoB levels and suicidal ideation, especially among smokers. MR analysis failed to provide causal evidence of ApoB on suicidal ideation. More research is needed to clarify the potential role of ApoB in the development of suicidal ideation.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divergent prefrontal activation between genders in depression during verbal fluency task: evidence from a large-scale fNIRS study.","authors":"Yan Zhang, Zhe Zhang, Minxiao Zheng, Yuming Wang, Dongmei Zhu, Qiang Xiao, Qiang Wei","doi":"10.1186/s12991-026-00648-3","DOIUrl":"10.1186/s12991-026-00648-3","url":null,"abstract":"<p><strong>Background: </strong>Depression exhibits marked sex differences in prevalence and clinical presentation, yet its neural underpinnings remain poorly understood. This study aimed to identify abnormal brain activation patterns during cognitive tasks in depressed males and females using functional near-infrared spectroscopy (fNIRS), providing neurobiological evidence for sex-specific therapeutic strategies.</p><p><strong>Methods: </strong>Prefrontal activation was measured with fNIRS during verbal fluency task in a large sample of young adults, including 431 individuals with depression and 422 healthy controls.</p><p><strong>Results: </strong>Compared with male healthy controls, the male depression group showed reduced oxyhemoglobin activation in the right frontal eye field. In contrast, the female depression group exhibited lower oxyhemoglobin activation in left dorsolateral prefrontal cortex than the female healthy controls. Furthermore, a significant difference in oxyhemoglobin activation was observed between male and female depression groups in the left dorsolateral prefrontal cortex.</p><p><strong>Conclusions: </strong>The findings revealed dissociable neural patterns of depression across sexes, moving beyond a uniform model of prefrontal hypoactivation. The neurological basis of depression in males may involve the right frontal eye field, while in females it may be linked to the left dorsolateral prefrontal cortex. The left dorsolateral prefrontal cortex appeared to be a key region for sex-specific brain alterations in depression.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review on trazodone as a multimodal and multifunctional antidepressant: clinical relevance of formulations, dosing, and pharmacokinetic/pharmacodynamic targets.","authors":"Alessandro Cuomo, Maurizio Pompili, Antonio Vita, Edoardo Spina, Filippo Caraci, Andrea Fagiolini","doi":"10.1186/s12991-026-00643-8","DOIUrl":"10.1186/s12991-026-00643-8","url":null,"abstract":"<p><strong>Background: </strong>Trazodone, an antidepressant, has only been approved for use in major depressive disorder (MDD), but has demonstrated potent therapeutic potential in various conditions, such as insomnia and anxiety. It targets multiple serotonergic, adrenergic, and histaminergic receptors. Given this multimodal and multifunctional profile, we aimed to provide a comprehensive overview of the pharmacodynamic and pharmacokinetic properties of trazodone and its clinical applications across various conditions.</p><p><strong>Main text: </strong>Trazodone demonstrates sedative and anxiolytic effects even at a low dose (25-75 mg) and a full antidepressant effect at higher doses (150-300 mg). The availability of trazodone in immediate-release, extended-release, intravenous, and intramuscular formulations enables flexible and personalized treatment based on the patient's symptoms, medical history, tolerability, and clinical settings. Clinical evidence also demonstrates that trazodone is effective and well-tolerated across various conditions, including MDD, treatment-resistant depression, insomnia (off-label), neurological disorders, dementia, and delirium, highlighting its versatility. Additionally, the low risk of sexual dysfunction, limited withdrawal symptoms, and weight-neutral effects make it suitable for use in patients with comorbid conditions.</p><p><strong>Conclusion: </strong>Trazodone is a multimodal and multifunctional antidepressant that exhibits a broad range of therapeutic effects in MDD and other comorbid conditions. Further research on the pharmacokinetic and pharmacodynamic relationship of trazodone, its parenteral use in acute settings, and the development of prescribing algorithms for predicting treatment responses may enhance its therapeutic outcomes in patients with MDD.</p>","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric consultation for suicidal behaviour in emergency departments: a comparison between the university hospital Systems of Alessandria and Novara.","authors":"Eleonora Gambaro, Carla Maria Gramaglia, Daniela Ferrante, Valeria Franchino, Carlo Mauceri, Massimo Prelati, Francesco Gavelli, Mattia Bellan, Patrizia Zeppegno","doi":"10.1186/s12991-026-00647-4","DOIUrl":"10.1186/s12991-026-00647-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Suicide attempts constitute a significant public health emergency, with Emergency Departments (EDs) serving as a primary point of contact for individuals in acute psychiatric crisis. This observational, multicentric study aimed to analyse and compare the profiles of psychiatric consultations provided in the EDs of the University Hospital Systems (AOU) of Novara and Alessandria between January and December 2024, focusing on suicidal behaviours, clinical characteristics, and intervention outcomes. We hypothesised that territorial differences in patient demographics and service organisation would lead to distinct management patterns: Novara, expecting younger patients with chronic histories requiring hospitalisation, versus Alessandria, with older, self-referred cases, favouring territorial approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Sociodemographic and clinical data were collected anonymously and pseudonymized from institutional software (Track Care, PsNet, REDCap). A total of 1,196 accesses requiring psychiatric evaluation were recorded. Multilevel logistic regression was performed to account for centre-level clustering (ICC = 0.12).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The Novara cohort was significantly younger (mean age 42.5 vs. 47.1 years, p = 0.001) with more complex psychiatric histories (76.3% previous psychiatric history vs. 57.3%, p = 0.001) and higher rates of suicidal ideation and self-harm. Novara showed higher rates of acute pharmacological therapy (51.13% vs. 39.59%, p = 0.001) and voluntary hospital admissions (40.74% vs. 25.85%, p = 0.001). Conversely, Alessandria's older population (mean age 47.1 years) exhibited greater conscious suicidal intent (39.68% vs. 23.36%, p = 0.024) and used high-lethality methods. Alessandria adopted a more territorial management approach with higher discharge rates (27.23% vs. 18.89%) and community mental health centre (CMHC) referrals (21.23% vs. 17.96%). Substantial methodological differences were observed in substance use screening protocols. Novara reported 67.84% positive screens versus Alessandria's 12.22% (naive OR 14.2, 95% CI 11.0-18.3). Multilevel analysis accounting for centre-level effects reduced this estimate to OR 5.3 (95% CI 3.8-7.4, ICC = 0.12), representing a 63% attenuation. Sensitivity analysis restricted to the 537 patients uniformly screened yielded OR 4.9 (95% CI 3.5-6.8). These findings underscore that the apparent centre difference is substantially attributable to measurement bias rather than true epidemiological prevalence. Multivariate logistic regression confirmed a significant association between female sex and self-harming behaviours (OR 1.57, 95% CI 1.13-2.19, p = 0.008).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This multicentric study revealed significant territorial differences in psychiatric emergency management between Novara and Alessandria. The Novara centre manages a younger population with complex, chronic psychiatric disorders, requiring a","PeriodicalId":7942,"journal":{"name":"Annals of General Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}