mood disorders

情绪障碍
  • 文章类型: Journal Article
    目标:暴食症(BED),尽管最近被认为是一种独特的临床综合征,是最常见的饮食失调.BED可以作为单独的现象或与其他精神障碍结合发生,增加了疾病的总体负担。由于将BED识别为一种独特的疾病的历史相对较短,这篇综述旨在总结目前有关BED与其他精神疾病并存的知识。
    方法:本综述遵循PRISMA指南。多个数据库,比如MEDLINE,MEDLINE完成,和学术搜索终极,用于确定相关研究。在最初确定的3766篇文章中,在过去13年中发表的63篇文章被纳入这篇综述。该系统评价已通过INPLASY(INPLASY202370075)注册。
    结果:与BED相关的最常见的合并症是情绪障碍,焦虑症和物质使用障碍。它们也与更严重的BED演示有关。经常与BED相关的其他精神疾病包括对严重压力和调整障碍的反应,冲动控制障碍,多动症,人格障碍,行为障碍,身体不适或身体体验的障碍,和精神病。此外,BED与自杀和睡眠障碍有关。
    结论:研究结果强调了BED与各种精神病和相关因素的相互联系的性质,阐明BED对心理健康的复杂性和更广泛的影响,以及需要适当的筛查和适当的针对性临床干预措施。
    OBJECTIVE: Binge eating disorder (BED), although relatively recently recognized as a distinct clinical syndrome, is the most common eating disorder. BED can occur as a separate phenomenon or in combination with other mental disorders, adding to the overall burden of the illness. Due to the relatively short history of recognizing BED as a distinct disorder, this review aimed to summarize the current knowledge on the co-occurrence of BED with other psychiatric disorders.
    METHODS: This review adhered to the PRISMA guidelines. Multiple databases, such as MEDLINE, MEDLINE Complete, and Academic Search Ultimate, were used to identify relevant studies. Of the 3766 articles initially identified, 63 articles published within the last 13 years were included in this review. This systematic review has been registered through INPLASY (INPLASY202370075).
    RESULTS: The most frequently observed comorbidities associated with BED were mood disorders, anxiety disorders and substance use disorders. They were also related to more severe BED presentations. Other psychiatric conditions frequently associated with BED include reaction to severe stress and adjustment disorders, impulse control disorder, ADHD, personality disorders, behavioral disorders, disorders of bodily distress or bodily experience, and psychotic disorders. Additionally, BED was linked to suicidality and sleep disorders.
    CONCLUSIONS: The findings highlight the interconnected nature of BED with various psychiatric conditions and related factors, shedding light on the complexity and broader impact of BED on mental health and the need for appropriate screening and appropriately targeted clinical interventions.
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  • 文章类型: Journal Article
    背景:尽管对该主题的研究过多,仍然没有确凿的证据表明药物治疗实际上可以降低精神疾病患者的自杀风险。在这项研究中,我们的目的是评估精神药物治疗对重度抑郁障碍(MDD)和双相情感障碍(BPD)患者自杀意念的影响,这些患者有两个年龄组:25岁以下和25岁及以上.
    方法:我们分析了312名目前有自杀念头或近期有自杀企图的情绪障碍患者。我们从基线随访参与者6个月,并使用哥伦比亚自杀严重程度评定量表(C-SSRS)评估自杀意念的变化。使用线性混合模型分析了精神药物给药对自杀意念随时间的影响。
    结果:在25岁及以上有情绪障碍的患者中,使用精神药物时,自杀意念比不使用精神药物时更严重。然而,自杀意念随着时间的推移迅速下降。在成人MDD中使用抗抑郁药和镇静剂/催眠药时,自杀意念的时间依赖性减少加速,以及在成人BPD中使用情绪稳定剂时。然而,在25岁以下的参与者中未观察到这种效应.
    结论:适当的精神药物治疗可以减少25岁及以上心境障碍患者的自杀意念。需要对精神药物进行更多研究,以有效降低患有情绪障碍的儿童和青少年的自杀风险。
    BACKGROUND: Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older.
    METHODS: We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model.
    RESULTS: In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years.
    CONCLUSIONS: Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.
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  • 文章类型: Journal Article
    现有文献关注一般生活质量,肝移植(LT)后受者抑郁的程度和影响尚不清楚.因此,我们的目标是评估患病率,危险因素,以及LT后受体相关抑郁的结局。
    搜索了Medline和Embase。单臂分析使用广义线性混合模型进行汇总,并进行logistic回归分析危险因素。对二元结果进行比值比的成对比较荟萃分析。
    在1069篇摘要中,在纳入48篇文章之前,对189篇文章进行了全文审查。5170名受者的合并抑郁率为24.52%(置信区间[CI]:19.46%-30.41%)。与其他地理区域相比,抑郁症在亚洲最为普遍。移植年龄较小(P=.019)和大学教育(P=.051)对抑郁症具有保护作用。然而,接受酒精性肝病移植的患者(比值比:1.14,CI:1.10~1.18,P≤0.001)更有可能抑郁.抑郁症导致死亡率增加(比值比:1.82,CI:1.08-3.07,P=.04),移植物损失(P=0.03),和移植物排斥(P=0.01)。
    LT后抑郁症非常普遍,可能与死亡率增加和移植物结局较差有关。需要更多地强调在高风险接受者中筛查抑郁症。
    UNASSIGNED: With existing literature focusing on general quality of life, the magnitude and impact of depression among recipients after liver transplantation (LT) is unclear. Hence, we aim to evaluate the prevalence, risk factors, and outcomes for recipient-related depression after LT.
    UNASSIGNED: Medline and Embase were searched. Single-arm analysis was pooled using the generalized linear mixed model, and logistic regression was performed to analyze risk factors. Pairwise comparative meta-analysis in odds ratio was conducted for binary outcomes.
    UNASSIGNED: Of 1069 abstracts, 189 articles underwent full-text review before the inclusion of 48 articles. Pooled depression rate among 5170 recipients was 24.52% (confidence interval [CI]: 19.46%-30.41%). Depression was most prevalent in Asia compared with other geographical regions. Younger age at transplantation (P = .019) and university education (P = .051) were protective against depression. However, those transplanted for alcoholic liver disease (odds ratio: 1.14, CI: 1.10-1.18, P ≤ 0.001) were more likely to be depressed. Depression resulted in increased odds of mortality (odds ratio: 1.82, CI: 1.08-3.07, P = .04), graft loss (P = .03), and graft rejection (P = .01).
    UNASSIGNED: Depression is highly prevalent after LT and may be associated with increased mortality and poorer graft outcomes. More emphasis is needed on the screening of depression among higher risk recipients.
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  • 文章类型: Journal Article
    背景:监测电惊厥治疗(ECT)后的认知副作用对于平衡副作用和临床有效性至关重要。不幸的是,缺乏关于ECT后认知测试的循证指南.全球ECT实践中经常使用的测试是迷你精神状态检查(MMSE)。我们检查了MMSE的变化及其在识别对ECT引起的认知变化敏感的预定义神经心理学指标下降方面的表现:言语回忆和言语流畅性。
    方法:使用Wilcoxon符号秩检验比较ECT前和术后一周的平均MMSE评分。计算所有认知测量的可靠变化指数,以指示个体从ECT前到后的变化评分是否被认为具有统计学意义。计算MMSE的敏感性和特异性。
    结果:荷兰ECT联盟纳入了来自五个地点的426名抑郁症患者。平均MMSE从ECT前的26.2(SD=3.9)显着增加到ECT后的26.8(SD=3.8)(p=0.002)。36例患者(8.5%)在ECT后显示MMSE评分显着下降。MMSE对识别言语回忆或言语流畅性显着下降的患者的敏感性范围为3.6%至11.1%。MMSE在识别言语回忆或言语流畅性没有显着下降的患者方面的特异性范围为95.6%至96.6%。
    结论:鉴于MMSE的灵敏度非常低,我们建议重新考虑MMSE在ECT实践和认知监测指南中的重要性,倡导更全面的方法来评估ECT引起的认知变化。
    BACKGROUND: Monitoring cognitive side-effects following electroconvulsive therapy (ECT) is crucial for balancing side-effects and clinical effectiveness. Unfortunately, evidence-based guidelines on cognitive testing following ECT are lacking. A frequently used test in global ECT practice is the Mini Mental State Examination (MMSE). We examined the change of the MMSE and its performance in identifying a decline in predefined neuropsychological measures sensitive to ECT-induced cognitive changes: verbal recall and verbal fluency.
    METHODS: The mean MMSE scores pre- and one week post-ECT were compared using a Wilcoxon signed-rank test. The Reliable Change Index was calculated for all cognitive measures to indicate whether an individual\'s change score from pre- to post-ECT is considered statistically significant. The sensitivity and specificity of the MMSE were calculated.
    RESULTS: 426 patients with depression from five sites were included from the Dutch ECT Consortium. The mean MMSE increased significantly from 26.2 (SD=3.9) pre-ECT to 26.8 (SD=3.8) post-ECT (p=0.002). 36 patients (8.5%) showed a significant decline in MMSE score post-ECT. The sensitivity of the MMSE in identifying patients who experienced a significant decline in verbal recall or verbal fluency ranged from 3.6% to 11.1%. The specificity of the MMSE in identifying patients who did not experience a significant decline in verbal recall or verbal fluency ranged from 95.6% to 96.6%.
    CONCLUSIONS: Given the very low sensitivity of the MMSE, we propose reconsidering the prominence of the MMSE in ECT practice and cognitive monitoring guidelines, advocating for a more comprehensive approach to assess ECT-induced cognitive changes.
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  • 文章类型: Journal Article
    目的:酒精使用障碍(AUD)是一种常见的以性别-性别差异(SGDs)为特征的精神障碍。本研究旨在评估意大利AUD治疗服务机构对调查患者中SGD的存在以及对女性AUD患者实施性别特异性治疗的态度。
    方法:最初在AUD门诊患者样本中研究了潜在的SGD,随后进行了一项针对女性AUD门诊患者采取特定干预措施的全国调查.
    结果:在525名(男性332名;女性193名)AUD门诊患者的样本中证实了SGDs的存在,包括焦虑和情绪障碍的患病率较高,与男性相比,女性AUD门诊患者的暴力和创伤发作。尽管存在这些SGD,在总共217个意大利AUD治疗服务机构中,只有<20%报告了针对女性AUD门诊患者实施特定策略.大多数服务(94%)报告调查暴力和/或创伤事件,只有在检测到这些问题时,才在很大程度上诉诸特定程序。
    结论:我们的发现证实了AUD门诊患者中存在SGDs,与男性相比,女性的焦虑和情绪障碍以及暴力和创伤发作的患病率更高。然而,只有少数服务机构在AUD治疗中采用了性别医学方法.这些结果强调了调查女性特定需求的紧迫性,男性,和非二元AUD患者,以个性化和增强AUD治疗的有效性和吸引力。
    OBJECTIVE: Alcohol use disorder (AUD) is a common mental disorder characterized by sex-gender differences (SGDs). The present study was aimed at evaluating attitudes displayed by Italian AUD treatment services towards investigating the presence of SGDs in their patients and implementing gender-specific treatments for female AUD patients.
    METHODS: Potential SGDs were initially investigated in a sample of AUD outpatients, subsequently followed by a national survey on the adoption of specific interventions for female AUD outpatients.
    RESULTS: The presence of SGDs was confirmed in a sample of 525 (332 men; 193 women) AUD outpatients, including a higher prevalence of anxiety and mood disorders, and episodes of violence and trauma among female AUD outpatients compared to males. Despite the presence of these SGDs, only <20% of a total of 217 Italian AUD treatment services reported the implementation of specific strategies for female AUD outpatients. The majority of services (94%) reported investigating episodes of violence and/or trauma, largely resorting to specific procedures only when these issues were detected.
    CONCLUSIONS: Our findings confirm the presence of SGDs among AUD outpatients, including a higher prevalence of anxiety and mood disorders and episodes of violence and trauma among females compared with males. However, only a small number of services have adopted a gender medicine approach in AUD treatment. These results underline the urgency of investigating the specific needs of female, male, and non-binary AUD patients in order to personalize and enhance the effectiveness and appeal of AUD treatment.
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  • 文章类型: Journal Article
    背景:患有精神病和情绪障碍的人会经历工作记忆的中断;然而,潜在的机制仍然未知。我们关注两个潜在的机制:第一,注意力参与不良应该与脑电图内刺激前α带活动水平升高有关,而工作记忆编码受损应该与刺激后α抑制减少有关。
    方法:我们收集了68名精神分裂症患者的脑电图数据,43名有精神病史的双相情感障碍患者,和53名患有严重抑郁症的人,以及90名健康比较受试者(HCS),当他们完成空间工作记忆任务时。我们量化了注意力流失,内存精度,和行为反应的记忆容量,并且我们使用传统的小波分析以及一种新颖的方法来量化alpha,以从EEG信号的非周期性元素中隔离振荡alpha功率。
    结果:我们发现(1)使用传统小波分析估计的更大的刺激前α功率可预测行为错误;(2)患者组的刺激后α抑制减少;(3)抑制减少与较低的记忆存储可能性相关。然而,我们还观察到,与患者相比,刺激前的α在HCS中更大,单试验分析表明,正是刺激前脑电图的非周期性元素-而不是振荡α-预测了行为错误。
    结论:这些结果表明,严重精神疾病中的工作记忆障碍主要反映了刺激后编码过程的损害,而不是刺激开始前注意力参与的减少。
    BACKGROUND: People with psychosis and mood disorders experience disruptions in working memory; however, the underlying mechanism remains unknown. We focused on two potential mechanisms: first, poor attentional engagement should be associated with elevated levels of pre-stimulus alpha-band activity within the EEG, whereas impaired working memory encoding should be associated with reduced post-stimulus alpha suppression.
    METHODS: We collected EEG data from 68 people with schizophrenia, 43 people with bipolar disorder with a history of psychosis, and 53 people with major depressive disorder, as well as 90 healthy comparison subjects (HCS), while they completed a spatial working memory task. We quantified attention lapsing, memory precision, and memory capacity from the behavioral responses, and we quantified alpha using both traditional wavelet analysis as well as a novel approach for isolating oscillatory alpha power from aperiodic elements of the EEG signal.
    RESULTS: We found that (1) greater pre-stimulus alpha power estimated using traditional wavelet analysis predicted behavioral errors; (2) post-stimulus alpha suppression was reduced in the patient groups; and (3) reduced suppression was associated with lower likelihood of memory storage. However, we also observed that pre-stimulus alpha was larger among HCS compared to patients, and single-trial analyses showed that it was the aperiodic elements of the pre-stimulus EEG-not oscillatory alpha-that predicted behavioral errors.
    CONCLUSIONS: These results suggest that working memory impairments in serious mental illness primarily reflect an impairment in the post-stimulus encoding processes rather than reduced attentional engagement prior to stimulus onset.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    更年期过渡期是女性一生中的一个重要时期,在此期间,她患情绪障碍的风险增加。绝经过渡期间的雌激素和孕酮波动以及绝经后雌二醇水平非常低对中枢神经系统(CNS)产生深远的影响,导致兴奋性和抑制性输入之间的不平衡。随着雌二醇戒断而发生的神经传递和神经元相互作用的变化破坏了正常的神经平衡,并且可能与更年期症状有关。潮热,抑郁情绪和焦虑都是更年期的症状,是中枢神经系统发生复杂变化的结果,涉及许多信号通路和神经递质(即γ-氨基丁酸,血清素,多巴胺),神经类固醇(即别孕烯醇酮),和神经肽(即kisspeptin,神经激肽B)。所有这些途径都是紧密相连的,和存在的复杂相互作用尚未完全理解。这篇综述总结了绝经过渡期中枢神经系统的神经内分泌变化,特别强调那些情绪变化的基础。
    The menopause transition is an important period in a woman\'s life, during which she is at an increased risk of mood disorders. Estrogen and progesterone fluctuations during the menopausal transition and very low levels of estradiol after menopause have a profound effect on the central nervous system (CNS), causing an imbalance between excitatory and inhibitory inputs. Changes in neurotransmission and neuronal interactions that occur with estradiol withdrawal disrupt the normal neurological balance and may be associated with menopausal symptoms. Hot flushes, depressed mood and anxiety are all symptoms of menopause that are a consequence of the complex changes that occur in the CNS, involving many signaling pathways and neurotransmitters (i.e. γ-aminobutyric acid, serotonin, dopamine), neurosteroids (i.e. allopregnanolone), and neuropeptides (i.e. kisspeptin, neurokinin B). All these pathways are closely linked, and the complex interactions that exist are not yet fully understood. This review summarizes the neuroendocrine changes in the CNS during the menopausal transition, with particular emphasis on those that underlie mood changes.
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  • 文章类型: Journal Article
    线粒体-内质网接触(MERC)介导两个细胞器之间的紧密而连续的通讯,这对于钙和脂质向线粒体的转移至关重要。细胞信号和代谢途径所必需的。它们的结构和分子表征表明,许多蛋白质参与了桥接两个细胞器的膜并保持这些接触的结构稳定性和功能。两个细胞器之间的串扰是正常神经元功能的基础,现在被认为是许多神经系统疾病的组成部分。事实上,越来越多的MERC蛋白参与了影响神经系统的病理的分子和细胞基础。在这里,我们回顾了已经报道的这些病变的MERC的改变,从神经发育和神经精神疾病到神经退行性疾病。尽管这些衰弱状态下的线粒体异常广泛归因于神经元的高能量需求,MERC的独特作用正在成为一个新的研究领域。了解这种改变的分子细节可能会为治疗干预的新途径开辟道路。
    Mitochondria-endoplasmic reticulum contacts (MERCs) mediate a close and continuous communication between both organelles that is essential for the transfer of calcium and lipids to mitochondria, necessary for cellular signalling and metabolic pathways. Their structural and molecular characterisation has shown the involvement of many proteins that bridge the membranes of the two organelles and maintain the structural stability and function of these contacts. The crosstalk between the two organelles is fundamental for proper neuronal function and is now recognised as a component of many neurological disorders. In fact, an increasing proportion of MERC proteins take part in the molecular and cellular basis of pathologies affecting the nervous system. Here we review the alterations in MERCs that have been reported for these pathologies, from neurodevelopmental and neuropsychiatric disorders to neurodegenerative diseases. Although mitochondrial abnormalities in these debilitating conditions have been extensively attributed to the high energy demand of neurons, a distinct role for MERCs is emerging as a new field of research. Understanding the molecular details of such alterations may open the way to new paths of therapeutic intervention.
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  • 文章类型: Journal Article
    目的:先前的研究表明,听音乐有可能对卒中后认知障碍(PSCI)患者的认知功能和情绪产生积极影响。偏好自我选择的音乐可能会产生更好的结果。然而,没有足够的临床证据表明在常规康复护理中使用音乐聆听治疗PSCI.这项随机对照试验(RCT)旨在研究个性化音乐聆听对情绪改善的影响。日常生活活动(ADL),以及PSCI患者的认知功能。
    方法:将34例PSCI患者随机分为音乐组和对照组。音乐组的患者接受了为期三个月的个性化音乐收听干预。干预涉及收听针对每个人的文化量身定制的个性化播放列表,民族,社会背景,生活经历,和个人音乐偏好。相比之下,对照组患者听白噪声作为安慰剂。认知功能,神经功能,心情,和ADLs进行了评估。
    结果:治疗三个月后,与对照组相比,音乐组显示出明显更高的蒙特利尔认知评估(MoCA)得分(p=0.027),特别是在延迟召回(p=0.019)和定向(p=0.023)领域。此外,音乐小组在美国国立卫生研究院卒中量表(NIHSS)中表现出明显更好的得分(p=0.008),Barthel指数(BI)(p=0.019),与对照组相比,Zarit照顾者负担访谈(ZBI)(p=0.008)。通过汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)测量,未发现对情绪的影响。
    结论:个性化听音乐可促进认知和神经功能的恢复,改进ADL,减少PSCI患者的护理负担。
    OBJECTIVE: Previous studies have suggested that music listening has the potential to positively affect cognitive functions and mood in individuals with post-stroke cognitive impairment (PSCI), with a preference for self-selected music likely to yield better outcomes. However, there is insufficient clinical evidence to suggest the use of music listening in routine rehabilitation care to treat PSCI. This randomized control trial (RCT) aims to investigate the effects of personalized music listening on mood improvement, activities of daily living (ADLs), and cognitive functions in individuals with PSCI.
    METHODS: A total of 34 patients with PSCI were randomly assigned to either the music group or the control group. Patients in the music group underwent a three-month personalized music-listening intervention. The intervention involved listening to a personalized playlist tailored to each individual\'s cultural, ethnic, and social background, life experiences, and personal music preferences. In contrast, the control group patients listened to white noise as a placebo. Cognitive function, neurological function, mood, and ADLs were assessed.
    RESULTS: After three months of treatment, the music group showed significantly higher Montreal Cognitive Assessment (MoCA) scores compared to the control group (p=0.027), particularly in the domains of delayed recall (p=0.019) and orientation (p=0.023). Moreover, the music group demonstrated significantly better scores in National Institutes of Health Stroke Scale (NIHSS) (p=0.008), Barthel Index (BI) (p=0.019), and Zarit Caregiver Burden Interview (ZBI) (p=0.008) compared to the control group. No effects were found on mood as measured by the Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD).
    CONCLUSIONS: Personalized music listening promotes the recovery of cognitive and neurological functions, improves ADLs, and reduces caregiver burden in patients with PSCI.
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