Severe mental disorders

严重精神障碍
  • 文章类型: Journal Article
    患有精神分裂症(SZ)或双相情感障碍(BP)的人表现出认知障碍,而他们的一级亲属表现在患者组和对照组之间的中等水平。然而,有一个生病的亲戚对环境的影响可能随着亲属关系的类型而变化,一些研究表明后代可能特别不利。本研究旨在调查SZ或BD父母及其7岁后代的父母与孩子认知之间的关系。以人口为基础的522名儿童队列(父母SZ,n=202;父母血压,n=120;控件,n=200),他们的父母接受了相同的评估,涵盖了广泛的认知功能。我们使用贝叶斯统计来建模性能。我们发现,非语言测试的表现在后代中比有SZ或BP的父母更好,使用控件作为参考。然而,口头测试,在BP组中,这种模式几乎没有证据,甚至没有相反的证据:父母的表现比后代更好。研究结果表明,患有SZ或BP的父母的后代在言语能力上可能特别不利。未来的研究将显示这种模式是否在整个开发过程中持续存在。
    Individuals with schizophrenia (SZ) or bipolar disorder (BP) display cognitive impairments, while their first-degree relatives perform at an intermediate level between the patient groups and controls. However, the environmental impact of having an ill relative likely varies with the type of kinship and some studies suggest that offspring may be particularly disadvantaged. The present study aimed to investigate the relationship between parent and child cognition in parents with SZ or BD and their 7-year-old offspring. A population-based cohort of 522 children (parental SZ, n = 202; parental BP, n = 120; controls, n = 200) and their parents underwent the same assessment battery covering a wide range of cognitive functions. We used Bayesian statistics to model performance. We found that performance on non-verbal tests was better in offspring than parents with SZ or BP, using the controls as reference. However, for verbal tests, there was little to no evidence for this pattern or even some evidence for the opposite in the BP group: relatively better performance in parents than offspring. The findings suggest that the offspring of parents with SZ or BP may be particularly disadvantaged in verbal abilities. Future studies will show whether this pattern persists throughout development.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    背景:精神分裂症患者患有身体健康状况,最终导致身体机能下降,给患者和社会带来巨大的成本。虽然有氧耐力和骨骼肌力量,通常在这个人口中减少,与认知和功能有关,没有研究探讨他们各自对功能技能和日常任务表现的贡献。
    方法:在一项横断面研究中,对48名患有精神分裂症谱系障碍(ICD-10;F20-25)的门诊患者(男性/女性28/20;35±11(SD)岁)进行了UCSD基于绩效的技能评估简介(UPSA-B;功能技能),特定功能水平(SLOF;功能表现)和阳性和阴性综合征(PANSS)量表。评估峰值摄氧量(V²O2peak)以及腿部按压最大肌肉力量(1RM)和机械动力。
    结果:UPSA-B性能与VäO2peak相关(r=0.28,p<0.05),占8%(p<0.05)的共享方差,但与1RM和机械动力无关。SLOF功能结构域与VO2峰(r=0.30,p<0.05)和1RM(r=0.24,p<0.05)相关,而SLOF个人护理(r=0.27,p<0.05)和活动(r=0.30,p<0.05)仅与V?O2峰相关。分层回归分析显示,虽然V²O2peak和年龄合计占身体机能差异的20%(p<0.05),调整年龄后,1RM的贡献被消除。O2peak和阴性症状联合预测个人护理和活动差异的24%和35%,分别。UPSA-B评分没有增加SLOF评分的预测。
    结论:尽管V²O2peak和1RM都与功能结果有关,的组合V♪O2peak,年龄,负面症状对功能表现的影响最大,而不是技能缺陷。
    BACKGROUND: Patients with schizophrenia suffer from physical health conditions, culminating in reduced physical functioning with enormous costs for patients and society. Although aerobic endurance and skeletal muscle strength, typically reduced in this population, relate to cognition and function, no study has explored their respective contributions to performance of functional skills and everyday tasks.
    METHODS: In a cross-sectional study, 48 outpatients (28/20 men/women; 35 ± 11(SD) years) with schizophrenia spectrum disorders (ICD-10; F20-25) were administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B; functional skills), Specific Level of Functioning (SLOF; functional performance) and the Positive and Negative Syndrome (PANSS) scale. Peak oxygen uptake (V̇O2peak) was assessed along with leg press maximal muscle strength (1RM) and mechanical power.
    RESULTS: UPSA-B performance was associated with V̇O2peak (r = 0.28,p < 0.05), accounting for 8 % (p < 0.05) of shared variance, but was unrelated to 1RM and mechanical power. The SLOF physical functioning domain was associated with V̇O2peak (r = 0.30,p < 0.05) and 1RM (r = 0.24,p < 0.05), while SLOF personal care (r = 0.27,p < 0.05) and activities (r = 0.30,p < 0.05) were related only to V̇O2peak. Hierarchical regression analyses revealed that while V̇O2peak and age combined to account for 20 % (p < 0.05) of the variance in physical functioning, the contribution of 1RM was eliminated after adjusting for age. V̇O2peak and negative symptoms combined predicted 24 % and 35 % of the variance in personal care and activities, respectively. UPSA-B scores did not add to the prediction of SLOF scores.
    CONCLUSIONS: Although V̇O2peak and 1RM both relate to functional outcomes, the combination of V̇O2peak, age, and negative symptoms exert the greatest detrimental influence on functional performance beyond skills deficits.
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  • 文章类型: Journal Article
    目的:这项研究的目的是确定严重精神疾病(SMI)患者与韩国普通人群之间慢性躯体疾病的关联。
    方法:本研究使用2014年至2019年的国家健康保险公司数据进行。在此期间,共有848,058人被诊断为SMI,通过按性别和年龄进行匹配,建立了相同数量的对照。对SMI患者的社会人口统计学特征进行了描述性分析。进行条件逻辑回归分析,以确定SMI患者与普通人群合并症之间的关联。SAS企业指南7.1(SASInc,凯里,NC,美国)用于进行所有统计检验。
    结果:分析显示医疗保险存在显著差异,收入水平,和Charlson合并症指数按慢性躯体疾病加权,在SMI患者和普通人群之间。两组之间的条件logistic回归分析还显示,除高血压疾病外,八种慢性躯体疾病均存在显着差异。
    结论:这项研究证实了SMI患者对慢性躯体疾病的易感性,我们能够识别出与SMI患者高度相关的慢性躯体疾病。
    OBJECTIVE: The purpose of this study was to identify the associations of chronic physical disease between patients with severe mental illness (SMI) and the general population of South Korea.
    METHODS: This study was conducted with National Health Insurance Corporation data from 2014 to 2019. A total of 848,058 people were diagnosed with SMI in this period, and the same number of controls were established by matching by sex and age. A descriptive analysis was conducted on the sociodemographic characteristics of patients with SMI. Conditional logistic regression analysis was performed to identify the associations between comorbid physical disease in patients with SMI and those of the general population. SAS Enterprise Guide 7.1 (SAS Inc, Cary, NC, USA) were used to perform all statistical tests.
    RESULTS: The analysis revealed significant differences in medical insurance, income level, and Charlson Comorbidity Index weighted by chronic physical disease, between patients with SMI and the general population. Conditional logistic regression analysis between the two groups also revealed significant differences in eight chronic physical diseases except hypertensive disease.
    CONCLUSIONS: This study confirmed the vulnerability of patients with SMI to chronic physical diseases and we were able to identify chronic physical disease that were highly related to patients with SMI.
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  • 文章类型: Journal Article
    目的:本系统评价旨在评估音乐疗法和音乐干预对中度和重度精神障碍患者神经精神预后的影响。与常规隔离治疗相比。方法:审查遵循系统审查和荟萃分析指南的首选报告项目。2021年11月16日,使用以下数据库和搜索界面进行了全面搜索:护理和相关健康文献的累积指数,Embase,Scopus,WebofScience;PubMed,PsycINFO,LiteraturaLatino-AmericanaedoCaribeemCiènciasdaSaúde,和科学电子图书馆在线。两位作者独立评估了纳入标准的研究,提取数据,并使用关键评估工具评估纳入研究的质量。结果:总的来说,包括17项研究,其中9项为随机对照试验。实验研究涉及5,082名成人和老年患者。研究中评估的最普遍的症状是焦虑,抑郁症,以及精神病的阳性和阴性症状。音乐干预主要由音乐治疗师和护士进行,提供由治疗师和患者选择音乐曲目的被动干预。音乐干预发生的频率在会话持续时间方面差异很大,每周的次数,以及白天的次数。确定的研究设计包括临床和准实验研究。在方法质量方面,临床研究显示,与预期干预措施的偏差存在缺陷.结论:音乐疗法和音乐干预对中重度精神障碍患者神经精神症状的治疗效果在准实验和临床研究中都是明显的,方法学质量令人满意。音乐干预,在各种形式的应用中,代表一个跨学科的治疗工具,补充和增强常规治疗。与常规治疗不同,音乐干预的身临其境和整合的性质允许在精神痛苦时期访问内部和人际维度。这些发现强调了研究人员解决方法论局限性的重要性,例如偏离预期的干预措施,并倡导在社区治疗环境中扩大音乐的使用。
    Objective: This systematic review aims to assess the impact of music therapy and musical interventions on neuropsychiatric outcomes among patients with moderate and severe mental disorders, in comparison with conventional treatment in isolation. Methods: The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was conducted on November 16, 2021, using the following databases and search interfaces: Cumulative Index to Nursing and Allied Health Literature, Embase, SCOPUS, Web of Science; PubMed, PsycINFO, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and Scientific Electronic Library Online. Two authors independently assessed the studies for inclusion criteria, extracted the data, and evaluated the quality of the included studies using critical appraisal tools. Results: In total, 17 studies were included, 9 of which were randomized controlled trials. The experimental studies involved 5,082 adult and elderly patients. The most prevalent symptoms assessed in the studies were anxiety, depression, and positive and negative symptoms of psychotic disorders. Music interventions were predominantly conducted by music therapists and nurses, providing passive interventions with the selection of musical repertoire by therapists and patients. The frequency with which musical interventions occurred varied greatly in terms of session duration, number of times per week, and number of times during the day. The identified study designs included clinical and quasi-experimental studies. In terms of methodological quality, clinical studies showed weaknesses regarding deviations from intended interventions. Conclusion: The effectiveness of music therapy and musical interventions for neuropsychiatric symptoms in patients with moderate and severe mental disorders was evident in quasi-experimental and clinical studies with satisfactory methodological quality. Musical interventions, in various forms of application, represent an interdisciplinary therapeutic tool that complements and enhances conventional treatment. Unlike conventional treatments, the immersive and integrative nature of music interventions allows access to both intrapersonal and interpersonal dimensions during periods of psychic suffering. These findings highlight the importance of researchers addressing methodological limitations, such as deviations from intended interventions, and advocate for the expansion the use of music in community treatment settings.
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  • 文章类型: Journal Article
    目的:本研究旨在确定18岁以上人群中严重精神障碍与口腔健康之间的关系。
    方法:在六个电子数据库和灰色文献中进行了电子搜索。对符合纳入标准的研究进行了定性和定量分析。使用JoannaBriggs研究所关键评估工具评估了纳入研究的方法。对具有随机效应的比例进行了荟萃分析。使用GRADE工具评估证据的确定性。
    结果:搜索数据库后,检索到5,734个参考文献,并选择了20篇文章进行合成。考虑到精神障碍患者与对照组之间的DMFT指数,在精神分裂症患者[MD=5.27;95%CI=4.13~6.42;I2=35%]和双相情感障碍患者[MD=1.90;95%CI=0.87~2.93]中,DMFT指数值较高.强迫症患者的数值较低[MD=-0.85;95%CI=-1.46-0.24]。16项研究的偏倚风险被认为较低,其中4人被归类为中度偏倚风险.证据的确定性很低。
    结论:精神分裂症和双相情感障碍患者的衰变频率增加,失踪,或填充牙齿。牙周探查深度没有影响,菌斑指数,还有TMD,但是这个结果的证据仍然不确定。
    结论:这些发现强调了全面健康方法的必要性。
    OBJECTIVE: This study aims to determine the association between severe mental disorders and oral health among individuals over 18 years of age.
    METHODS: An electronic search was conducted in six electronic databases and gray literature. Qualitative and quantitative analyses were performed on studies that met the inclusion criteria. The methodology of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool. A meta-analysis of proportions with a random effect was carried out. The certainty of evidence was evaluated using the GRADE tool.
    RESULTS: After searching the databases, 5,734 references were retrieved, and twenty articles were selected for synthesis. Considering the DMFT index between the groups with mental disorders and the control group, the values of the DMFT index were higher among individuals with schizophrenia [MD = 5.27; 95% CI = 4.13 - 6.42; I2 = 35%] and bipolar disorder [MD = 1.90; 95% CI = 0.87 - 2.93]. Values were lower among individuals with obsessive-compulsive disorder [MD = -0.85; 95% CI = -1.46-0.24]. The risk of bias was considered low for 16 studies, and four were classified with a moderate risk of bias. The certainty of evidence was very low.
    CONCLUSIONS: Patients with schizophrenia and bipolar disorder exhibit increased frequency in the number of decayed, missing, or filled teeth. There was no effect in relation to periodontal probing depth, plaque index, and TMD, but the evidence is still uncertain for this outcome.
    CONCLUSIONS: These findings underscore the need for a comprehensive health approach.
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  • 文章类型: Journal Article
    背景:严重的精神障碍会给患者及其家人造成严重而持久的困扰,并因需要护理和生产力损失而产生高昂的成本。本研究测试DIALOG+,基于应用程序的干预措施,使常规的患者-临床医生会议在治疗上有效。它将患者满意度的结构化评估与以解决方案为中心的方法相结合。
    方法:我们进行了一项定性研究,基于一项对照临床试验,其中9名精神科医生和18名患者在六个月内每月使用DIALOG+。半结构化访谈用于探索参与者的经验,并在归纳主题分析中进行了分析,重点是哥伦比亚背景下干预的可行性和效果。
    结果:经验分为五个总体主题:a)干预措施对咨询和医患关系的影响;b)对患者的影响和促进变化;c)使用支持应用程序,和d)干预措施对哥伦比亚医疗保健系统的适应性。
    结论:DIALOG+被大多数参与者正面评价。与会者认为,这对例行磋商是有益的,改善沟通,使患者能够在护理中发挥主导作用。需要做更多的工作来确定最受益于DIALOG+的患者群体,并调整它,特别是为了适应简短的咨询时间,这样它就可以在哥伦比亚的医疗保健系统中成功推出。
    BACKGROUND: Severe mental disorders can cause significant and lasting distress for patients and their families and generate high costs through the need for care and loss of productivity. This study tests DIALOG+, an app-based intervention to make routine patient-clinician meetings therapeutically effective. It combines a structured evaluation of patient satisfaction with a solution-focused approach.
    METHODS: We conducted a qualitative study, based on a controlled clinical trial, in which 9 psychiatrists and 18 patients used DIALOG+ monthly over a six-month period. Semi-structured interviews were used to explore the experiences of participants and analysed in an inductive thematic analysis focusing on the feasibility and effects of the intervention in the Colombian context.
    RESULTS: Experiences were grouped into five overall themes: a) impact of the intervention on the consultation and the doctor-patient relationship; b) impact on patients and in promoting change; c) use of the supporting app, and d) adaptability of the intervention to the Colombian healthcare system.
    CONCLUSIONS: DIALOG+ was positively valued by most of the participants. Participants felt that it was beneficial to the routine consultation, improved communication and empowered patients to take a leading role in their care. More work is required to identify the patient groups that most benefit from DIALOG+, and to adjust it, particularly to fit brief consultation times, so that it can be rolled out successfully in the Colombian healthcare system.
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  • 文章类型: Journal Article
    评估患有严重精神疾病(SMI)的个人的康复状况需要对多模态数据进行全面分析,包括非结构化文本记录和结构化诊断数据。然而,有效评估康复状况的进展仍然有限。我们的研究开发了一种深度学习模型,通过后期融合策略将变形金刚(BERT)和TabNet的双向编码器表示集成,以增强康复预测。包括转诊风险,危险的行为,自我意识,和药物依从性,SMI患者。BERT处理非结构化文本数据,如医生的笔记,而TabNet管理结构化的诊断信息。该模型的可解释性功能可帮助医疗保健专业人员理解模型的预测性决策,改善患者护理。我们的模型对所有四个任务都表现出出色的预测性能,精度超过0.78,曲线下面积为0.70。此外,一系列测试证明了模型的鲁棒性,公平,和可解释性。本研究将多模态和多任务学习策略结合到一个模型中,并将其应用于康复评估任务,提供了一种有前途的新工具,可以与临床工作流程无缝集成,以支持提供优化的患者护理。
    Evaluating the rehabilitation status of individuals with serious mental illnesses (SMI) necessitates a comprehensive analysis of multimodal data, including unstructured text records and structured diagnostic data. However, progress in the effective assessment of rehabilitation status remains limited. Our study develops a deep learning model integrating Bidirectional Encoder Representations from Transformers (BERT) and TabNet through a late fusion strategy to enhance rehabilitation prediction, including referral risk, dangerous behaviors, self-awareness, and medication adherence, in patients with SMI. BERT processes unstructured textual data, such as doctor\'s notes, whereas TabNet manages structured diagnostic information. The model\'s interpretability function serves to assist healthcare professionals in understanding the model\'s predictive decisions, improving patient care. Our model exhibited excellent predictive performance for all four tasks, with an accuracy exceeding 0.78 and an area under the curve of 0.70. In addition, a series of tests proved the model\'s robustness, fairness, and interpretability. This study combines multimodal and multitask learning strategies into a model and applies it to rehabilitation assessment tasks, offering a promising new tool that can be seamlessly integrated with the clinical workflow to support the provision of optimized patient care.
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  • 文章类型: Journal Article
    背景:精神障碍患者的堕胎行为对女性健康构成主要障碍。然而,很少有研究报道中国严重精神障碍妇女流产的患病率和相关因素。因此,本研究旨在调查农村社区女性患者的流产率,并确定潜在的健康风险。
    方法:这是一项针对山东省农村276名18岁及以上严重精神障碍妇女的横断面研究。中国。怀孕史,采用问卷调查法调查妇女的流产史和社会人口学特征。采用Logistic回归分析不同流产行为的相关因素。
    结果:研究显示82.61%(228/276)的患者有妊娠史。在有妊娠史的患者中,43.42%(99/228)报告说至少有一次流产,15.79%(36/228)有一个以上。在另一边,31.58%(72/228)的患者发生自然流产,12.72%(29/228)发生人工流产。首次妊娠年龄(aOR0.80,95%CI0.70-0.90)和最后妊娠年龄(aOR1.17,95%CI1.07-1.27)均与流产有关。焦虑与自发性(aOR1.08,95%CI1.02-1.15)和重复流产(aOR1.10,95%CI1.01-1.19)有关。此外,宗教(AOR10.47,95%CI2.81-39.01),儿童数量≥2(aOR0.18,95%CI0.04-0.77),家庭功能(aOR1.31,95%CI1.06-1.63)与人工流产有关。
    结论:农村地区患有严重精神障碍的妇女流产率明显高于一般女性,特别是自然流产。妊娠患者的孕龄和焦虑情绪值得关注,并采取预防措施,以避免流产的结局。
    BACKGROUND: Abortion behaviors among individuals with mental disorders presented major obstacles to women\'s health. However, few studies reported the prevalence and associated factors of abortion among women with severe mental disorders in China. Consequently, this study aims to investigate the prevalence of abortion among female patients in rural communities and identify potential health risks.
    METHODS: This was a cross-sectional study of 276 women aged 18 years and older with severe mental disorders in rural areas of Shandong Province, China. The pregnancy history, abortion history and socio-demographic characteristics of women were investigated by questionnaire. Logistic regression analysis was employed to examine the associated factors for different abortion behaviors.
    RESULTS: The study showed that 82.61 % (228/276) of patients had a pregnancy history. Among the patients with a pregnancy history, 43.42 % (99/228) reported having had at least one abortion, and 15.79 % (36/228) had more than one. In the other side, 31.58 % (72/228) of them experienced spontaneous abortion, while 12.72 % (29/228) experienced induced abortion. Age at first gestation (aOR 0.80, 95 % CI 0.70-0.90) and age at last gestation (aOR 1.17, 95 % CI 1.07-1.27) were both associated with abortion. Anxiety was related to spontaneous (aOR 1.08, 95 % CI 1.02-1.15) and repeat abortions (aOR 1.10, 95 % CI 1.01-1.19). In addition, religion (aOR 10.47, 95 % CI 2.81-39.01), number of children≥2 (aOR 0.18, 95 % CI 0.04-0.77), and family functioning (aOR 1.31, 95 % CI 1.06-1.63) were associated with induced abortion.
    CONCLUSIONS: Women with severe mental disorders in rural regions have notably higher rates of abortion compared to the general female population, particularly for spontaneous abortions. Gestational age and anxiety of pregnant patients deserve attention and preventive measures to avoid the outcomes of abortion.
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  • 文章类型: Journal Article
    患有严重精神疾病(PwSMI)的人由于持续的认知而面临受害的风险,情感,和行为症状,这可能成为有效重返社区的潜在威胁。共有217个PwSMI,从三级医院接受精神病门诊治疗,被筛查虐待,如果他们被认定为虐待,然后有关导致滥用的上下文因素的信息,社会人口统计学,家庭,并创建了临床和法律档案。总的来说,150名PwSMI受害,其中56%是女性,50.7%已婚,20.7%的人受过中学教育,31.4%是家庭主妇。最常见的诊断形式是精神分裂症(43.3%),平均患病时间为14年。所有受害的PwSMI都遭受了情感虐待。由于对疾病的知识和了解不足,PwSMI更有可能成为多个家庭成员的受害者(24%)。大多数PwSMI已将滥用(62.7%)披露给非正式来源(33.3%),而临床文件中没有文档(82.7%)。PwSMI经历持续的虐待,更有可能再次受害,这增加了对定期筛查以及对文化敏感和全面的社区协调护理和支持的需求。
    Persons with severe mental illness (PwSMI) are at risk of being victimized due to persistent cognitive, emotional, and behavioral symptoms, which can become potential threats for effective reintegration into the community. A total of 217 PwSMI, receiving outpatient psychiatric treatment from a tertiary hospital, were screened for abuse, and if they were identified as abuse, then information about contextual factors contributing to abuse, sociodemographic, family, and clinical and legal profiles was created. Overall, 150 PwSMI were victimized, of which 56% were females, 50.7% were married, 20.7% were educated up to middle school, and 31.4% were homemaker. The most common form of diagnosis was schizophrenia (43.3%), with a mean duration of illness of 14 years. All the victimized PwSMI were subjected to emotional abuse. PwSMI were more likely to be victimized by multiple family members due to poor knowledge and understanding about illness (24%). The majority of the PwSMI had disclosed abuse (62.7%) to nonformal sources (33.3%) with no documentation in the clinical file (82.7%). PwSMI experience ongoing abuse and are more likely to be re-victimized, which increases the need for regular screening and culturally sensitive and comprehensive community-coordinated care and support.
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