BMC Psychiatry最新文献

{"title":"Bright light therapy in Parkinson's disease: a pilot study on visual pathway improvements.","authors":"Wei-Ye Xie, Hui Lou, Jia-Ying Liu, Jie-Yun Yin, Tian-Qi Zhang, Cheng-Jie Mao, Fen Wang, Chun-Feng Liu, Yun Shen","doi":"10.1186/s12888-025-06915-z","DOIUrl":"10.1186/s12888-025-06915-z","url":null,"abstract":"<p><strong>Background: </strong>Bright light therapy (BLT) has been proved to have beneficial effects on Parkinson's disease (PD), the mechanisms remained unclear. Improvements of visual pathways might be key to BLT.</p><p><strong>Objective: </strong>The aim of this study is to validate whether BLT improves clinical symptoms in PD and explore the possible mechanisms of visual pathways evaluated by optical coherence tomography (OCT), pattern electroretinogram (PERG) and visual evoked potentials (VEP).</p><p><strong>Methods: </strong>Twenty-three PD patients were enrolled in this crossover randomized placebo-controlled study. Participants received either one month of BLT or dim light therapy (DLT), separated by one-month wash-out period, followed by another intervention. Participants underwent clinical scales, and visual-related evaluations including OCT, PERG and VEP before and after each intervention. Mixed-effects regression models were used to determine the effect between BLT and DLT on improving the differentials of clinical scales (Δscales), OCT (Δretinal thickness), PERG (ΔPERG values) and VEP (ΔP100 latencies). Correlations between clinical symptoms and visual evaluations improvements were analyzed in PD patients receiving BLT.</p><p><strong>Results: </strong>Excessive daytime sleepiness, anxiety, life quality and autonomic function were improved after BLT. Compared with DLT, bilateral ΔN95 latencies for PERG and ΔP100 latencies for VEP were improved after BLT. We did not observe the changes of four quadrants retinal nerve fiber layer (RNFL) thickness after BLT or DLT.</p><p><strong>Conclusions: </strong>BLT is a valuable and safe non-pharmacological intervention for improving visual function in PD patients.</p><p><strong>Significance: </strong>These findings extend neural mechanisms of BLT to visual pathways improvements.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"476"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of a pilot feasibility study of comprehensive geriatric assessment for younger frail patients with severe mental illness.","authors":"Urska Arnautovska, Rebecca Soole, Winona Wing Ling Kwan, Natasha Reid, Andrea Baker, Emily H Gordon, Ruth E Hubbard, Dan Siskind, Nicola Warren","doi":"10.1186/s12888-025-06830-3","DOIUrl":"10.1186/s12888-025-06830-3","url":null,"abstract":"<p><strong>Background: </strong>Individuals with severe mental illness (SMI) are at risk of early-onset frailty, leading to adverse outcomes. Effective interventions for reducing frailty in this population are currently lacking.</p><p><strong>Aims: </strong>To assess the feasibility, acceptability, and preliminary efficacy of Comprehensive Geriatric Assessment (CGA), delivered by an Advanced Trainee in Geriatric Medicine, as an intervention for individuals with co-occurring frailty and SMI.</p><p><strong>Method: </strong>Participants, aged 18-64, with frailty and SMI were recruited from public community outpatient clinics between July 2022 and January 2023. Feasibility of CGA was evaluated through mixed methods. Secondary outcomes included a range of mental and physical health factors.</p><p><strong>Results: </strong>Out of 38 eligible individuals, 17 were enrolled and 14 completed the study; three dropped out post-baseline assessment and CGA. 86% were male, average age was 48.4, Body Mass Index 34.6, and Frailty Index 0.35. Participants expressed high acceptability and perceived benefits of CGA, including increased insight about one's health and receipt of multidisciplinary holistic care. While this study was inadequately powered to show statistically significant changes in secondary outcomes, positive trends were observed in overall psychosis symptoms and weekly physical activity engagement which increased by 56.6 min, reaching the recommended levels to achieve health benefits.</p><p><strong>Conclusion: </strong>The findings of this study support the feasibility of CGA as an intervention in routine care of people with SMI and provide evidence for designing future trials of frailty interventions in this population. The study underscores the significance of tailored, multidisciplinary, and individualised approaches, though further research is required to substantiate its efficacy in this priority population.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"473"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A controlled trial examining large Language model conformity in psychiatric assessment using the Asch paradigm.","authors":"Dorit Hadar Shoval, Karny Gigi, Yuval Haber, Amir Itzhaki, Kfir Asraf, David Piterman, Zohar Elyoseph","doi":"10.1186/s12888-025-06912-2","DOIUrl":"10.1186/s12888-025-06912-2","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advances in AI-driven medical diagnostics, the integration of large language models (LLMs) into psychiatric practice presents unique challenges. While LLMs demonstrate high accuracy in controlled settings, their performance in collaborative clinical environments remains unclear. This study examined whether LLMs exhibit conformity behavior under social pressure across different diagnostic certainty levels, with a particular focus on psychiatric assessment.</p><p><strong>Methods: </strong>Using an adapted Asch paradigm, we conducted a controlled trial examining GPT-4o's performance across three domains representing increasing levels of diagnostic uncertainty: circle similarity judgments (high certainty), brain tumor identification (intermediate certainty), and psychiatric assessment using children's drawings (high uncertainty). The study employed a 3 × 3 factorial design with three pressure conditions: no pressure, full pressure (five consecutive incorrect peer responses), and partial pressure (mixed correct and incorrect peer responses). We conducted 10 trials per condition combination (90 total observations), using standardized prompts and multiple-choice responses. The binomial test and chi-square analyses assessed performance differences across conditions.</p><p><strong>Results: </strong>Under no pressure, GPT-4o achieved 100% accuracy across all domains. Under full pressure, accuracy declined systematically with increasing diagnostic uncertainty: 50% in circle recognition, 40% in tumor identification, and 0% in psychiatric assessment. Partial pressure showed a similar pattern, with maintained accuracy in basic tasks (80% in circle recognition, 100% in tumor identification) but complete failure in psychiatric assessment (0%). All differences between no pressure and pressure conditions were statistically significant (P <.05), with the most severe effects observed in psychiatric assessment (χ²₁=16.20, P <.001).</p><p><strong>Conclusions: </strong>This study reveals that LLMs exhibit conformity patterns that intensify with diagnostic uncertainty, culminating in complete performance failure in psychiatric assessment under social pressure. These findings suggest that successful implementation of AI in psychiatry requires careful consideration of social dynamics and the inherent uncertainty in psychiatric diagnosis. Future research should validate these findings across different AI systems and diagnostic tools while developing strategies to maintain AI independence in clinical settings.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"478"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examine the relationship between self-injurious behaviors and emotion regulation in Iranian adolescent athletes.","authors":"Ebrahim Norouzi","doi":"10.1186/s12888-025-06921-1","DOIUrl":"10.1186/s12888-025-06921-1","url":null,"abstract":"<p><strong>Objective: </strong>Non-suicidal self-injury (NSSI) represents a significant public health concern, particularly among adolescents. Understanding the prevalence of NSSI within specific at-risk populations, such as athletes, is crucial for developing effective prevention programs. Given the unique stressors and pressures experienced by young athletes, it is essential to examine the factors contributing to their vulnerability. This study aimed to determine the occurrence of NSSI in adolescent athletes and to investigate the role of emotional regulation in their self-injurious behaviors.</p><p><strong>Method: </strong>This study involved 456 adolescent athletes, aged 13 to 18 (mean age 14.66 years, SD = 2.80), recruited in Tehran in 2024. The sample consisted of 183 female (40.1%) and 273 male (59.9%) participants. Participants completed surveys measuring self-injury behaviors, cognitive emotion regulation and behavioral emotion regulation strategies. Data analysis employed Pearson correlation coefficients and regression testing.</p><p><strong>Results: </strong>The findings revealed a concerning prevalence of self-injury among the adolescent athletes in Tehran. A significant relationship was found between self-injury and cognitive and behavioral emotion regulation. The regression model indicated that self-injury could be predicted by the level of behavioral emotion regulation, followed by cognitive emotion regulation.</p><p><strong>Conclusion: </strong>This study highlights the importance of considering emotion regulation in understanding and addressing self-injurious behaviors among adolescent athletes. The findings suggest that interventions aimed at improving cognitive and behavioral emotion regulation strategies may be beneficial in reducing NSSI among this population.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"475"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlations between major depressive disorder, splenic morphology, and immune function.","authors":"Zouqing Lin, Xiaoyan Xu, Kai Zhang, Tenglong Wang, Leiming Cao, Zhiqiang Wang, Guoqiang Wang","doi":"10.1186/s12888-025-06853-w","DOIUrl":"10.1186/s12888-025-06853-w","url":null,"abstract":"<p><p>To analyze the symptoms, courses, and severities of depressive disorder, as well as the morphological changes in the spleens and related immune mechanisms, we recruited patients with first-episode or recurrent major depressive disorder (MDD) (patient group) and healthy controls (normal group) matched in age and gender. We measured their plasma MICB (pg/ml), ULBP1 (ng/ml), and splenic volume (cm³) at baseline. The patient group was randomly assigned to receive (S)-ketamine (study group) or saline (control group), and the above indices were collected again on the 4th weekend after administration. At baseline, both MICB and splenic volume were significantly higher in the patient group than in the normal group. A positive correlation was observed between MICB and splenic volume in the patient group. After (S)-ketamine administration, the elevated splenic volume and MICB levels decreased. These results suggest that the pathogenesis of MDD may involve abnormal MICB expression and splenic morphology. (S)-ketamine may ameliorate inflammation and enhance splenic function, thereby relieving MDD symptoms.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"477"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between a stress-is-enhancing mindset and internet gaming disorder was mediated by behavioral disengagement among medical undergraduate students: a multi-center survey in China.","authors":"Haiyan Xiang, Lijing Liu, Xin Su, Ying Yang, Haifeng Xue, Bo Liu, Yanling Tu, Ruxin Wang, Xinxin Mo, Hongye Luo, Lijuan Li, Xianzhang Tian, Yanjie Yang, Zhengxue Qiao, Liping Li, Tong Xie, Siman Li, Joseph T F Lau, Yanqiu Yu","doi":"10.1186/s12888-025-06910-4","DOIUrl":"10.1186/s12888-025-06910-4","url":null,"abstract":"<p><strong>Background: </strong>The stress-is-enhancing mindset has beneficial effects on physical, psychological, and emotional well-being. However, its association with internet gaming disorder (IGD) had not been investigated. By integrating stress mindset into the cognitive evaluation process of commonly used stress coping theories, this study examined the association between stress mindset and IGD and explored relevant mediation mechanisms via behavioral disengagement. The gender differences in the above associations and mediations were also explored.</p><p><strong>Methods: </strong>An online, anonymous, cross-sectional survey was conducted among medical undergraduate students from seven cities (Baotou, Qiqihar, Harbin, Wenzhou, Guangxi, Dali, and Shantou) in China from December 2023 to February 2024. The final sample size was 8,552 (a mean response rate of 71.0%). The DSM-5 IGD Checklist, the Stress Mindset Measure-General, and the behavioral disengagement subscale of Brief-Coping Orientation to Problems Experienced Inventory were used to assess IGD, stress mindset, behavioral disengagement, respectively. Multivariate logistic regression analyses were conducted to test the significance and direction of the determinants of IGD. Path analysis was performed to examine the mediation mechanisms and the moderation effect of gender. All these analyses were adjusted for background factors.</p><p><strong>Results: </strong>Of all participants, the prevalence of IGD was 7.5%, and males had significantly higher prevalence than females (14.7% versus 7.4%, p < 0.001). Multivariate logistic regression analyses found that the stress-is-enhancing mindset was negatively associated with IGD (ORa = 0.94, 95% CI: 0.92 ~ 0.97) while behavioral disengagement was positively associated with IGD (ORa = 1.66, 95% CI: 1.57 ~ 1.76). Path analysis found that behavioral disengagement fully mediated the association between stress mindset and IGD, i.e., the stress-is-enhancing mindset was negatively associated with behavioral disengagement, which in turn was positively associated with IGD. However, gender did not significantly moderate the associations between stress mindset and behavioral disengagement, between behavioral disengagement and IGD, and between stress mindset and IGD.</p><p><strong>Conclusions: </strong>This study observed the relatively high prevalence of IGD among Chinese medical undergraduate students. It also revealed that the stress-is-enhancing mindset was potentially protective against IGD, and behavioral disengagement might fully explain such a beneficial effect. Future longitudinal and interventional studies are needed to verify and extend these findings.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"472"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight restoration in patients with anorexia nervosa after stereotactic surgery and brain morphometric insights.","authors":"Fengting Wang, Wei Liu, Halimureti Paerhati, Zhengyu Lin, Kuanghao Ye, Lulin Dai, Tao Wang, Zhaohui Lan, Dianyou Li, Yijie Lai, Bomin Sun, Shikun Zhan","doi":"10.1186/s12888-025-06890-5","DOIUrl":"10.1186/s12888-025-06890-5","url":null,"abstract":"<p><strong>Background: </strong>Bilateral anterior capsulotomy and deep brain stimulation (DBS) of the nucleus accumbens (NAc) represent investigational treatment options for severe, treatment-refractory anorexia nervosa (AN). However, follow-up studies evaluating postoperative outcomes in these patients remain limited, and the clinical and neuroanatomical characteristics associated with treatment response have yet to be elucidated.</p><p><strong>Methods: </strong>The retrospective study analyzed the preoperative imaging data of AN patients who underwent bilateral anterior capsulotomy or nucleus accumbens (NAc) DBS from 2019 to 2023. Voxel-based morphometry (VBM) was employed to assess structural differences between AN patients and healthy controls (HCs), as well as to identify brain regions associated with postoperative changes in body mass index (BMI).</p><p><strong>Results: </strong>Nineteen patients were included in the analysis, six of whom received NAc DBS. The mean (standard deviation, SD) BMI of patients significantly increased from 13.4 (2.5) kg/m² preoperatively to 20.7 (5.3) kg/m² postoperatively (t = 5.45, p < 0.001). A significant smaller gray matter volume was observed in widespread regions in AN patients compared to HCs including the cerebellum, the thalamus, the temporal, orbital frontal gyrus and the sensorimotor gyrus in VBM analysis (P_FWE < 0.001, cluster size > 30 voxels). After controlling for age, sex, surgical type, and total intracranial volume (TIV), no clusters passed the correction for multiple comparisons in the correlational analysis with BMI changes after surgeries. The volume of the left caudate and the right middle frontal gyrus showed a positive correlation with the percentage of BMI changes, while the volume of the right supplementary motor area, the right parahippocampal gyrus, the right precuneus, and the left cerebellum exhibited a negative correlation in peak-level analysis (P_uncorrected < 0.001).</p><p><strong>Conclusions: </strong>Both ablative and DBS surgeries demonstrate efficacy in promoting weight restoration in severe AN patients. The structural integrity of specific brain regions may play a role in predicting postoperative BMI recovery. Further studies with a larger number of patients are warranted to better evaluate the outcome of the surgeries and the predictive value of the imaging characteristics.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"474"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interplay between depressive symptoms, body mass index change patterns in adulthood, and all-cause mortality risk: a population-based study.","authors":"Zhixiao Xu, Chengshui Chen, Xiong Lei","doi":"10.1186/s12888-025-06924-y","DOIUrl":"10.1186/s12888-025-06924-y","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have suggested body mass index (BMI) change patterns in adulthood may be crucial for depression. This purpose of this study is to evaluate the impact of adult BMI change patterns on depression.</p><p><strong>Methods: </strong>The National Health and Nutrition Examination Survey 2007 to 2018 generated the data. The relationships between adult BMI change patterns and depression / Patient Health Questionnaire 9 (PHQ-9) were investigated using logistic regression and generalized linear model with a Poisson distribution. The relationships between BMI change patterns, depressive symptoms, and all-cause mortality were examined by Cox proportional hazards models. Kaplan-Meier curves were employed to illustrate the cumulative incidence over time. To explore whether adult BMI change patterns mediate this link between depression and all-cause mortality, mediation analysis was conducted.</p><p><strong>Results: </strong>A total of 10,448 participants were included, with 7.8% reporting depression. Significant differences were observed in demographic, lifestyle, and health characteristics across BMI change patterns. The high-increase pattern was linked to a1.61 times greater odds of depression after adjustment (odds ratio = 1.61, 95% confidence interval (CI): [1.16, 2.24], P = 0.006) compared to the non-overweight pattern. Gender and age differences were also observed. The higher PHQ-9 was correlated with increased all-cause mortality risk, even after adjustment (hazard ratio: 1.03; 95%CI: 1.02-1.05). Mediation analysis revealed that adult BMI change patterns mediated 26.98% of the correlation between depressive symptoms and all-cause mortality.</p><p><strong>Conclusion: </strong>Persistent obesity in adulthood rises the risk of depression, and BMI change patterns playing a modest role in mediating the link between depressive symptoms and all-cause mortality. Early intervention in individuals at-risk BMI change patterns might reduce depression risk. Future research should investigate whether modifying BMI change patterns can lower depression incidence.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"479"},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of antidepressant medication for adolescent depression: a network meta-analysis and systematic review.","authors":"Tianwei Wu, Fan Song, Weili Cao, Chengjiang Liu, Shuangzhen Jia","doi":"10.1186/s12888-025-06941-x","DOIUrl":"https://doi.org/10.1186/s12888-025-06941-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the success rate of different antidepressants in addressing depression among teenagers, while also offering substantiation for the efficacy and tolerability of these treatments in this demographic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants were adolescents aged 6-18 years diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , Chinese Classification of Mental Disorders (CCMD-3) or equivalent diagnostic criteria (e.g., Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-4) , International Classification of Diseases, Tenth/Eleventh Revision(ICD10/11) ) . We conducted a systematic search of major databases (PubMed, Cochrane Library, and Web of Science) for randomized controlled trials (RCTs) published up to October 2024. The search strategy included the following keywords: \"Depression,\" \"Depressive Disorders,\" \"Emotional Disorders,\" \"adolescent,\" \"young adult, \" \"minors,\" \"fluoxetine,\" \"sertraline,\" \"paroxetine,\" \"agomelatine,\" \"vilazodone,\" \"escitalopram,\" and \"venlafaxine.\"&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our network meta-analysis(NMA) included 15 RCTs involving 12,258 participants. The included studies were assessed using the Cochrane risk of bias tool. The majority of studies had low risk of bias in terms of randomization and allocation concealment, while some studies had unclear implementation of blinding or outcome assessment. The NMA results showed that in several major indicators Children's Depression Rating Scale-Revised (CDRS-R) , Clinical Global Impression-Severity (CGI-S) and Children's Global Assessment Scale (CGAS) , agomelatine (MD = -0.34, 95 % CI = -0.59, -0.09), fluoxetine (MD = -0.31, 95 % CI = -0.42, -0.21), sertraline (MD = -0.27, 95 % CI = -0.47, -0.06) were significantly better than placebo in improving CDRS-R. In terms of CGI-S, sertraline (MD = -4.39, 95 % CI = -4.77, -4.01) was more effective. In contrast to the placebo, escitalopram (MD = 2.08,95 % CI = 1.33,2.84) was more effective in CGAS; Surface Under the Cumulative Ranking Curve (SUCRA) values showed that escitalopram (96.1 % and 86.4 %) could achieve better therapeutic effects in CGAS and Clinical Global Impressions-Improvement (CGI-I) , and agomelatine (86.4 %) was more effective in improving CDRS-R scores than other drugs. Sertraline (100 %) appears to be the most likely strategy to decelerate the increase in CGI-I scores. The effectiveness of paroxetine (99.9%) in the management of Montgomery-Asberg Depression Rating Scale (MADRS) was significantly better than that of several other drugs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;For symptom severity scales, agomelatine (CDRS-R: SUCRA 86.4%) and paroxetine (MADRS: SUCRA 99.9%) demonstrated the greatest efficacy. For functional improvement, escitalopram ranked highest on CGAS (SUCRA 96.1%). Sertraline showed superiority in clinician-rated severity (CGI-S: SUCRA 100%) and improvement (CGI-I: S","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"471"},"PeriodicalIF":3.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of cognitive behavioral therapy for insomnia and lemborexant medication for different subtypes of chronic insomnia: study protocol for a randomized controlled trial.","authors":"Si-Jing Chen, Hans Ivers, Thien Thanh Dang-Vu, Colin M Shapiro, Colleen E Carney, Rébecca Robillard, Charles M Morin","doi":"10.1186/s12888-025-06878-1","DOIUrl":"https://doi.org/10.1186/s12888-025-06878-1","url":null,"abstract":"<p><strong>Introduction: </strong>Insomnia is a prevalent yet under-characterized disorder, particularly regarding the heterogeneity of patients and their associated responses to different treatment modalities. This often leads to suboptimal management. There is a need to consider personalized approaches tailored to the characteristics of insomnia phenotypes with regard to objective evidence of shortened sleep duration (< 6 h). This study will examine whether there is a differential treatment response to cognitive behavioral therapy for insomnia (CBT-I) versus pharmacotherapy (lemborexant) as a function of insomnia phenotypes (i.e., ± 6 h of sleep).</p><p><strong>Methods: </strong>This study is a three-arm pragmatic randomized clinical trial, which will enroll 90 adults with chronic insomnia disorder and anxiety/depressive symptoms. Eligible participants will be randomized to one of three conditions (1:1:1) involving CBT-I, lemborexant (Dual Orexin Receptor Antagonist) or placebo medication. Treatment outcomes will be assessed at post-treatment and 6-month follow-up. Insomnia symptom severity as measured by the Insomnia Severity Index will serve as the primary outcome for treatment comparisons. Secondary outcomes will include daily sleep/wake variables derived from the Consensus Sleep Diary, subjective measures of fatigue, mood, mental well-being, functional impairments, and sleep-related beliefs and attitudes. In addition, changes in cognitive performance will be examined as an exploratory outcome. Sleep reactivity and arousal level will be evaluated as potential mediators of treatment-related changes in CBT-I and pharmacotherapy.</p><p><strong>Discussion: </strong>This study will contribute to the development of personalized medicine for managing different insomnia phenotypes and will have implication for knowledge mobilization of sleep research.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov. Identifier: NCT06779149. Registered on 12 January 2025.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"25 1","pages":"470"},"PeriodicalIF":3.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}