Psychopathology

精神病理学
  • 文章类型: Journal Article
    背景:儿童虐待在全球范围内造成了巨大的心理健康负担。不同的儿童虐待措施是不等同的,可能会捕捉到有意义的差异。特别是,虐待的前瞻性和回顾性措施可识别不同的个体群体,并与精神病理学差异相关。然而,这些差异背后的原因尚未全面绘制。
    方法:在这篇综述中,我们借鉴了多学科研究,并提出了一个综合框架来解释虐待测量分歧。
    结果:我们确定了三个相互关联的域。首先,与测量和数据收集方法相关的方法论问题。第二,记忆在影响虐待回顾性报道中的作用。最后,个人可能不得不披露的动机,扣留,或者捏造关于虐待的信息。
    结论:对虐待测量分歧的更多理解可能指向概念化和评估虐待的新方法。此外,它可能有助于揭示虐待相关精神病理学的潜在机制和新干预措施的目标。
    BACKGROUND: Childhood maltreatment contributes to a large mental health burden worldwide. Different measures of childhood maltreatment are not equivalent and may capture meaningful differences. In particular, prospective and retrospective measures of maltreatment identify different groups of individuals and are differentially associated with psychopathology. However, the reasons behind these discrepancies have not yet been comprehensively mapped.
    METHODS: In this review, we draw on multi-disciplinary research and present an integrated framework to explain maltreatment measurement disagreement.
    RESULTS: We identified three interrelated domains. First, methodological issues related to measurement and data collection methods. Second, the role of memory in influencing retrospective reports of maltreatment. Finally, the motivations individuals may have to disclose, withhold, or fabricate information about maltreatment.
    CONCLUSIONS: A greater understanding of maltreatment measurement disagreement may point to new ways to conceptualise and assess maltreatment. Furthermore, it may help uncover mechanisms underlying maltreatment-related psychopathology and targets for novel interventions.
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  • 文章类型: Journal Article
    慢性疼痛可以在没有组织损伤的情况下发展,损伤,或潜在的疾病。有几种生物干预,心理,和社会因素涉及其外观,显着影响日常生活活动。它还与显著的情绪焦虑和/或功能障碍有关。这篇综述系统分析了过去五年发表的评估慢性原发性肌肉骨骼疼痛(CPMP)的精神病理学症状和神经心理障碍的作品。进行了书目搜索,以使用Medline识别2018年1月至2023年3月之间以英语发表的文章,Scopus,PsycInfo,和发布的数据库。使用PRISMA选择方法获得了20篇文章。这项研究的主要结果提供了患有肌肉骨骼疼痛的患者存在中度和重度慢性疼痛的证据。疼痛强度的增加与更大的精神病理学症状相关,比如抑郁症,焦虑,失眠,缺乏关注,多动/冲动,以及适应不良应对策略的使用。此外,CPMP患者存在与注意力和疼痛处理相关的脑结构功能障碍。这篇综述可能有助于开发和优化适应这种疾病引起的缺陷的多学科治疗方法。
    Chronic pain can develop without tissue damage, injury, or underlying illness. There are several intervening biological, psychological, and social factors involved in its appearance that significantly affect the activities of daily life. It is also associated with significant emotional anxiety and/or functional disability. This review systematically analyses works published in the last five years that evaluate the psychopathological symptomatology and neuropsychological disorders of chronic primary musculoskeletal pain (CPMP). A bibliographic search was carried out to identify articles published in English between January 2018 and March 2023 using the Medline, Scopus, PsycInfo, and Pubmed databases. Twenty articles were obtained using the PRISMA selection method. The main results of this study provided evidence of the presence of moderate and severe chronic pain in patients suffering from musculoskeletal pain. This increase in the intensity of pain correlates with greater psychopathological symptomatology, such as depression, anxiety, insomnia, lack of attention, and hyperactivity/impulsiveness, as well as the use of maladaptive coping strategies. Furthermore, there exists dysfunction in the cerebral structures related to attention and the processing of pain in patients with CPMP. This review may help to develop and optimise the multidisciplinary treatments adapted to the deficits caused by this illness.
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  • 文章类型: Journal Article
    性创伤(ST)在美国(U.S.)以儿童性虐待(CSA)和成年性侵犯(ASA)的形式以惊人的频率发生。众所周知,ST的影响是普遍的,ST可能是几种精神疾病发展的危险因素。然而,CSA和ASA之间可能产生不同的心理后果或神经相关性的可能性很少受到关注.此外,尽管性再害率很高,与每种形式的ST本身相比,CSA和ASA的组合效应研究不足。在当前的审查中,我们介绍了临床心理学和神经科学研究对CSA和ASA影响的结果,描述主要的心理,生物心理社会,以及每种ST形式的神经影像学检查结果。我们进一步强调了研究现状和未来研究所需领域的局限性,以更好地理解独特的,重叠,以及ST在儿童期和成年期的累积效应。本研究总结了有关这种严重创伤形式的文献状况,并为未来的临床研究实践提供了建议,以减轻ST的有害后果。
    Sexual trauma (ST) occurs with alarming frequency in the United States (U.S.) in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well-established that the effects of ST are pervasive, and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.
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  • 文章类型: Journal Article
    灵性与宗教信仰之间的关系及其对心理健康的影响是复杂且未充分研究的。这篇探索性综述旨在阐明这些结构的不同作用,强调他们对心理健康和临床实践的贡献。通过剖析灵性和宗教信仰对心理健康的影响,这项研究的重点是他们在塑造治疗方法和理论理解领域的个体和组合作用。使用PubMed进行了文献综述,专注于讨论灵性的文章,宗教信仰,以及他们与心理健康和精神病理学的交集。在312篇已确定的文章中,在筛选相关性后,纳入了69篇同行评审的文章。结果表明,灵性和宗教信仰显着影响心理健康,但经常混为一谈,导致研究不一致和临床挑战。灵性,作为一条广阔而个人主义的道路,增强个人幸福感和韧性,经常超越有组织的宗教习俗。相比之下,宗教信仰,凭借其结构化的社区支持,有时会施加约束,加剧特定理论压力下的压力。神经生物学证据表明,这两种结构都与认知过程和大脑功能相互作用,影响情绪调节和应激反应。研究得出的结论是,区分灵性和宗教信仰对于精确的学术话语和有效的临床实践至关重要。这种区别允许更个性化的治疗方法,容纳个人的精神和宗教背景。作者为未来的研究和治疗应用提出了一个完善的框架,以对个人的细微差别体验敏感,并在临床环境中更好地定制干预措施。
    The relationship between spirituality and religiosity and their impact on mental health is intricate and underexplored. This exploratory review aims to elucidate the distinct effects of these constructs, highlighting their contributions to psychological well-being and clinical practices. By dissecting the impacts of spirituality and religiosity on mental health, the study focuses on their individual and combined roles in shaping therapeutic approaches and theoretical understandings in the field. A literature review was conducted using PubMed, focusing on articles discussing spirituality, religiosity, and their intersection with mental health and psychopathology. Out of 312 identified articles, 69 peer-reviewed articles were included after screening for relevance. The results indicate that spirituality and religiosity significantly influence mental health yet are often conflated, leading to research inconsistencies and clinical challenges. Spirituality, as a broad and individualistic pathway, enhances personal well-being and resilience, often transcending organized religious practices. In contrast, religiosity, with its structured community support, sometimes imposes constraints that exacerbate stress under specific doctrinal pressures. Neurobiological evidence suggests that both constructs interact with cognitive processes and brain function, influencing emotional regulation and stress response. The study concludes that distinguishing between spirituality and religiosity is essential for precise academic discourse and effective clinical practice. This differentiation allows for more personalized therapeutic approaches, accommodating an individual\'s spiritual and religious contexts. The authors propose a refined framework for future research and therapeutic applications to be sensitive to the nuanced experiences of individuals and to better tailor interventions in clinical settings.
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  • 文章类型: Journal Article
    深经颅磁刺激(dTMS)作为精神分裂症干预措施的有效性和安全性尚不清楚。本系统评价了dTMS治疗精神分裂症的疗效和安全性。
    对中文(万方和中文期刊网)和英文数据库(PubMed,EMBASE,PsycINFO,和Cochrane图书馆)进行了。
    在分析中包括包含80名患者的三个随机临床试验(RCT)。活性dTMS在改善总精神病理学方面与假治疗相当,阳性症状,阴性症状,和通过阳性和阴性综合征量表(PANSS)测量的幻听,阳性症状评估量表(SAPS),阴性症状评估量表(SANS),和听觉幻觉评定量表(AHRS),分别。只有一个RCT报告了剑桥神经心理学测试自动电池(CANTAB)对神经认知功能的影响,这表明DTMS可能只会改善剑桥措施的一种丝袜(即,五个移动问题的后续时间)。所有三项研究都报告了总体停药率,从16.7%到44.4%不等。仅在一个RCT中报告了不良事件,最常见的是刺痛/抽搐(30.0%,3/10),头部/面部不适(30.0%,3/10),和背痛(20.0%,2/10).
    这项系统评价表明,dTMS不能减轻精神分裂症患者的精神病症状,但它显示了改善执行功能的潜力。未来的RCT具有更大的样本量,专注于dTMS对精神分裂症精神病性症状和神经认知功能的影响,有必要进一步探索这些发现。
    UNASSIGNED: The efficacy and safety of deep transcranial magnetic stimulation (dTMS) as an intervention for schizophrenia remain unclear. This systematic review examined the efficacy and safety of dTMS for schizophrenia.
    UNASSIGNED: A systematic search of Chinese (WanFang and Chinese Journal Net) and English databases (PubMed, EMBASE, PsycINFO, and Cochrane Library) were conducted.
    UNASSIGNED: Three randomized clinical trials (RCTs) comprising 80 patients were included in the analyses. Active dTMS was comparable to the sham treatment in improving total psychopathology, positive symptoms, negative symptoms, and auditory hallucinations measured by the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Auditory Hallucinations Rating Scale (AHRS), respectively. Only one RCT reported the effects on neurocognitive function measured by the Cambridge Neuropsychological Test Automated Battery (CANTAB), suggesting that dTMS may only improve one Stockings of Cambridge measure (i.e., subsequent times for five move problems). All three studies reported overall discontinuation rates, which ranged from 16.7% to 44.4%. Adverse events were reported in only one RCT, the most common being tingling/twitching (30.0%, 3/10), head/facial discomfort (30.0%, 3/10), and back pain (20.0%, 2/10).
    UNASSIGNED: This systematic review suggests that dTMS does not reduce psychotic symptoms in schizophrenia, but it shows potential for improving executive functions. Future RCTs with larger sample sizes focusing on the effects of dTMS on psychotic symptoms and neurocognitive function in schizophrenia are warranted to further explore these findings.
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  • 文章类型: Journal Article
    近年来,一些理论模型被认为是眼球运动脱敏和后处理治疗的适应性信息处理模型的补充。对这些模型进行了叙述性审查,以评估每个模型的贡献,以及它们的融合,矛盾,和潜在的互补性。确定了七个理论模型。所有的重点是EMDR治疗作为一种综合心理治疗方法的效果及其原则,程序,和协议。有几个是指与命题或预测处理理论相关的概念。总的来说,这些提案的贡献似乎确实支持了夏皮罗最初的AIP模型,可能为临床实践中的病例概念化和治疗计划提供更多的深度和广度,以及更精确的理论理解。当前的探索性比较分析可以作为初步基线,以指导研究建议的理论建议的相对优点,以提高EMDR治疗的临床实践和教学的现行标准。
    In recent years, several theoretical models have been suggested as complementary to the adaptative information processing model of eye movement desensitization and reprocessing therapy. A narrative review of such models was conducted to assess the contributions of each, as well as their convergences, contradictions, and potential complementarity. Seven theoretical models were identified. All focus on the effects of EMDR therapy as a comprehensive psychotherapy approach with its principles, procedures, and protocols. Several refer to concepts related to propositional or predictive processing theories. Overall, the contribution of these proposals does appear to bolster Shapiro\'s original AIP model, potentially offering additional depth and breadth to case conceptualization and treatment planning in clinical practice, as well as a more precise theoretical understanding. The current exploratory comparative analysis may serve as a preliminary baseline to guide research into the relative merit of suggested theoretical proposals to enhance current standards for the clinical practice and teaching of EMDR therapy.
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  • 文章类型: Journal Article
    这篇综述阐述了社会上关于孤独的关键发现,神经生物学和临床领域。从翻译的角度来看,包括对人类和动物的研究结果,专注于社交互动,精神和身体疾病以及催产素在孤独中的作用。在社会交往方面,孤独的个体倾向于表现出一系列基于功能失调的社会认知的异常行为,这使得他们难以形成有意义的关系。神经生物学,孤独和下丘脑肽激素催产素之间已经建立了联系。由于社会互动,尤其是社会接触调节催产素信号,孤独的人可能有催产素失衡,这反过来又会影响他们的健康和幸福。临床上,孤独感是身体和精神疾病的预测因子,并导致发病率和死亡率增加。有证据表明,精神病理学既是孤独的原因,也是孤独的结果。这篇综述的最后一部分总结了来自社会、神经生物学和临床观点提出了一种新的孤独感复杂结构模型。
    This review addresses key findings on loneliness from the social, neurobiological and clinical fields. From a translational perspective, results from studies in humans and animals are included, with a focus on social interaction, mental and physical illness and the role of oxytocin in loneliness. In terms of social interactions, lonely individuals tend to exhibit a range of abnormal behaviors based on dysfunctional social cognitions that make it difficult for them to form meaningful relationships. Neurobiologically, a link has been established between loneliness and the hypothalamic peptide hormone oxytocin. Since social interactions and especially social touch regulate oxytocin signaling, lonely individuals may have an oxytocin imbalance, which in turn affects their health and well-being. Clinically, loneliness is a predictor of physical and mental illness and leads to increased morbidity and mortality. There is evidence that psychopathology is both a cause and a consequence of loneliness. The final section of this review summarizes the findings from social, neurobiological and clinical perspectives to present a new model of the complex construct of loneliness.
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  • 文章类型: Journal Article
    Klinefelter综合征(KS),男性的特征是额外的X染色体,表现为广泛的神经内分泌和精神症状。患有KS的人经常面临荷尔蒙功能障碍的风险增加,导致抑郁和焦虑,尽管在儿科和青少年年龄的扩展研究仍然有限。这个关键阶段,对KS儿童来说是决定性的,受遗传因素的影响,环境和家庭因素,影响大脑可塑性。在这份报告中,我们回顾了,以叙事的形式,儿童中至关重要的KS精神病理学标志。为了更好地描述KS患儿的神经内分泌和神经精神结局,我们介绍了一个11岁的患有马赛克KS的青春期前儿童的案例,由于他的学习成绩下降,他被转诊到我们的发育精神病理学中心。在过去的几个月中,白天过度疲劳和分心增加。家族史显示一级和二级亲属患有精神疾病,包括最近离婚的父母和一个15岁的妹妹。诊断为早发性持续性抑郁症和焦虑特征。及时识别易感儿童,彻底检查家族精神病史,环境影响和神经认知特征,除了有针对性的干预措施,可能会减轻儿童和青少年KS病例中与精神病理学相关的终身残疾,包括那些马赛克KS。
    Klinefelter syndrome (KS), characterized by an additional X-chromosome in males, manifests in a wide range of neuroendocrine and psychiatric symptoms. Individuals with KS often face increased risks of hormonal dysfunction, leading to depression and anxiety, although extended research during pediatric and adolescent age is still limited. This critical phase, decisive for KS children, is influenced by a combination of genetic, environmental and familial factors, which impact brain plasticity. In this report, we reviewed, in a narrative form, the crucial KS psychopathological hallmarks in children. To better describe neuroendocrine and neuropsychiatric outcomes in children with KS, we presented the case of an 11-year-old prepubertal child with mosaic KS who was referred to our Center of Developmental Psychopathology due to a decline in his academic performance, excessive daytime fatigue and increased distractibility over the past few months. Family history revealed psychiatric conditions among first- and second-degree relatives, including recently divorced parents and a 15-year-old sister. Early-onset persistent depressive disorder and anxious traits were diagnosed. Timely identification of susceptible children, with thorough examination of familial psychiatric history, environmental influences and neurocognitive profile, alongside targeted interventions, could potentially mitigate lifelong psychopathology-related disabilities in pediatric and adolescent KS cases, including those with mosaic KS.
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  • 文章类型: Journal Article
    无家可归者的人格障碍对医学界和社会构成挑战,需要为这些超级困难的患者提供专门的方法。无家可归人群的人格障碍患病率高于普通人群。然而,在经历无家可归的人中存在关于人格障碍的知识差距,这种缺乏认可的影响是巨大的。本文简要叙述了无家可归者中的人格障碍。这些疾病在该人群中的主要重要性和特异性仍未被探索。我们在2023年2月和11月使用关键词“无家可归”和“人格障碍”搜索了PubMed和WebofScience数据库,并选择了58项研究纳入本文献综述。结果的主要主题是无家可归者的人格障碍和合并症精神病;危险因素和其他心理和行为数据;临床和干预结果;以及与评估相关的挑战,治疗,和干预。无家可归的人口经历显著的诊断变异性和人格障碍的诊断仍在不断发展,导致诊断困难,评估,和治疗。未来的挑战是提高临床意识和优化研究知识,评估,以及对患有精神疾病的无家可归者的人格障碍的干预。
    Personality disorders in homeless people pose a challenge to the medical community and society, requiring specialized approaches for these super-difficult patients. The prevalence of personality disorders is higher in homeless populations than in the general population. However, there is a knowledge gap regarding personality disorders among people experiencing homelessness, and the implications of this lack of recognition are substantial. This paper provides a brief narrative review of personality disorders among homeless individuals. The primary importance and specificity of these disorders in this population remain unexplored. We searched PubMed and Web of Science databases in February and November 2023 using the keywords \'homeless\' and \'personality disorder\', and selected fifty-eight studies to be included in this literature review. The main themes of the results were personality disorders in homeless individuals and comorbid psychiatric disorders; risk factors and other psychological and behavioral data; clinical and intervention outcomes; and challenges linked to assessment, treatment, and intervention. The homeless population experiences significant diagnostic variability and the diagnosis of personality disorders is still evolving, contributing to difficulties in diagnosis, assessment, and treatment. A future challenge is to raise clinical awareness and optimize research knowledge, assessment, and intervention in personality disorders among homeless individuals with comorbid psychiatric disorders.
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  • 文章类型: Journal Article
    超过20%的美国成年人患有精神疾病,其中许多人对治疗有抵抗力或继续出现症状。需要其他方法来改善精神保健,包括预防。微生物组的作用已成为精神和身体健康及其相互联系(幸福)的中心原则。在正常情况下,健康的微生物组通过维持肠道和大脑屏障的完整性来促进宿主体内的稳态,从而促进主人的福祉。由于微生物组和神经内分泌免疫系统之间的多向串扰,微生物群内的生态失调是免疫介导的全身和神经炎症的主要驱动因素,可以促进疾病进展,并且对广泛的福祉特别是心理健康有害。在易感个体中,免疫失调可以转变为自身免疫,尤其是在存在身体或心理触发因素的情况下。慢性应激反应涉及免疫系统,它与肠道微生物组密切相关,特别是在免疫教育过程中。这种相互联系形成了微生物群-肠道-免疫-脑轴,并促进了心理健康或疾病。在这个简短的审查,我们的目标是强调压力之间的关系,心理健康,和肠道微生物组,以及在微生物群-肠道-免疫-脑轴的背景下,菌群失调和免疫系统失调可以转变为自身免疫反应并伴随神经心理学后果的方式。最后,我们旨在回顾基于证据的预防策略和潜在的治疗靶点.
    More than 20% of American adults live with a mental disorder, many of whom are treatment resistant or continue to experience symptoms. Other approaches are needed to improve mental health care, including prevention. The role of the microbiome has emerged as a central tenet in mental and physical health and their interconnectedness (well-being). Under normal conditions, a healthy microbiome promotes homeostasis within the host by maintaining intestinal and brain barrier integrity, thereby facilitating host well-being. Owing to the multidirectional crosstalk between the microbiome and neuro-endocrine-immune systems, dysbiosis within the microbiome is a main driver of immune-mediated systemic and neural inflammation that can promote disease progression and is detrimental to well-being broadly and mental health in particular. In predisposed individuals, immune dysregulation can shift to autoimmunity, especially in the presence of physical or psychological triggers. The chronic stress response involves the immune system, which is intimately involved with the gut microbiome, particularly in the process of immune education. This interconnection forms the microbiota-gut-immune-brain axis and promotes mental health or disorders. In this brief review, we aim to highlight the relationships between stress, mental health, and the gut microbiome, along with the ways in which dysbiosis and a dysregulated immune system can shift to an autoimmune response with concomitant neuropsychological consequences in the context of the microbiota-gut-immune-brain axis. Finally, we aim to review evidenced-based prevention strategies and potential therapeutic targets.
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