Methods: A cohort of 329 hospitalised schizophrenic patients is being monitored since 1 January 2013. Patients’ file review was performed to detect the CV events of interest.
Results: Out of the 329 patients with schizophrenia, with a mean study follow-up of 41.07?±?12.55?months, 29 cardiovascular events were recorded; of those events, we recorded 4 myocardial infarction, 1 stroke, 6 heart failure and 18 cardiovascular deaths. The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance (RR?=?1.90, p?=?.078). Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival (RR?=?3.35, p?=?.005).
Conclusion: The ASCVD items should be included in the medical assessment in any patient with severe mental illness.
- Key points
The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years.
The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient).
The association between survival curve of patients with high and low CVR according to FRS score tended to significance.
Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival.
The ASCVD items should be included in the medical assessment in any patient with severe mental illness.
Objectives: The aim of this article is to review the nosological significance of Cotard syndrome and to explore the disorder among patients with dementia.
Methods: Medline and Google Scholar searches were conducted for relevant articles, chapters and books published before 2018. Search terms used included Cotard delusion, Cotard syndrome and dementia, nihilistic delusion. Publications found through this indexed search were reviewed for further relevant references.
Results and conclusion: In this narrative review we emphasise the fact that cases of Cotard syndrome involving patients with dementia are reported quite infrequently. Published studies are limited to very short series or isolated cases. Clinicians are obliged to treat the disorder. They should be alert to the potential high risk inherent in this condition.
- Keypoints
Cotard syndrome is a rare condition characterised by nihilistic delusions that may range from negation of existence of parts of the body to delusion of being dead.
The prevalence and incidence of this rare syndrome are not known.
Since Cotard’s syndrome is conceptualised as part of an underlying disorder, several psychiatric and somatic diseases have been associated with the syndrome.
The syndrome may occur in patients suffering from dementia.
Clinical or methodological significance of this article: The clinical significance of this study is twofold. On the one hand, the findings of this analysis might inform the theory and practice of BPT and might directly feedback into a further development of the manual guidelines. On the other hand, common helpful factors have been identified thatmight also be relevant for the more general clinical practice concerning patients with schizophrenia.
Here, we summarize our key messages for the clinical practitioner emerging from the findings:
The inclusion of bodily aspects and a focus on pre-reflective experience in psychotherapy can help persons with schizophrenia recover the sense of being a body-mind unity.
Empowering persons with schizophrenia, instead of instructing them, seems to foster a sense of agency and self-confidence, which are crucial to the recovery process.
A twofold therapeutic stance characterized by openness towards the other and authenticity was experienced by patients as facilitating the rapport building. This might help persons with schizophrenia engage in the relation.
Social inclusion might enhance therapeutic change and recovery in schizophrenia. Group therapy might be helpful for fostering a feeling of social belonging, but the inclusion in the wider social and community context remains a critical issue.
The experience of joyful moments in psychotherapy might positively contribute to therapeutic change in that it fosters a sense of hope for the future.
Overall our paper contributes to the literature aiming at expanding the range of therapeutic modalities, focussing on the creation and use of mixed models of therapy within and beyond talking practices. 相似文献
- Key points
There is a critical need for new therapies for treatment resistant depression.
Newer therapies are expanding. In the future, these therapies, as an evidence-based adjunctive treatments, could offer a good therapeutic choice for the patients with a TRD.
The current trend in the new neuromodulation therapies is to apply a personalised treatment.
These news therapies can be complementary.
That treatment approaches can provide clinically significant benefits.
Methods: Thirty healthy volunteers and 30 patients who meet Bipolar Disorder Manic Episode diagnostic criteria were included in the study. Additionally, the changes in the patient group between manic episode and remission period were examined. We evaluated the relationship between levels of l-arginine and arginine decarboxylase in the agmatine synthesis pathway, and level of agmatinase that degrades agmatine.
Results: Levels of agmatine and l-arginine were significantly increased than control group during manic episode (p?<?.01). All parameters were increased during manic episode compared to remission period (p?<?.05). Agmatinase was significantly decreased both during manic episode (p?<?.01) and remission period (p?<?.05) in comparison to the control group. Arginine decarboxylase levels did not show a significant difference between the groups (p?>?.05).
Conclusions: This study indicate that there may be a relationship between bipolar disorder and agmatine and its metabolic pathway. Nonetheless, we believe more comprehensive studies are needed in order to reveal the role of agmatine in etiology of bipolar disorder.
- Key points
Agmantine, agmatinase, l-arginine and arginine decarboxylase levels in BD have not been explored before.
Various neuro-chemical mechanisms act to increase agmatine in BD; however, agmatine could have elevated to compensate agmatine deficit prior to the manifestation of the disease as in schizophrenia.
Elevated agmatine degradation resulting from excess expression of agmatinase which is suggested to be effective in pathogenesis of mood disorders was compensated by this way.
Elevated agmatine may be one of the causes which play a role in mania development.
Elevated agmatine levels are also suggested to trigger psychosis and be related with the etiology of manic episode and lead to BD.
Plain-language summary
In verbal psychotherapy, a strong therapeutic alliance between client and therapist is necessary to achieve therapeutic goals. In art therapy, this alliance includes a third object: the art medium, comprised of art materials, artmaking and artworks.
In this study, we developed and tested a new questionnaire for art therapy service users which measures the client-art medium alliance formed in art therapy. The new questionnaire is based on the Working Alliance Inventory, a well-known measure used in psychotherapy (Horvath & Greenberg, 1989) and is called the Art Therapy-Working Alliance Inventory.
In order to measure the alliance between the client and the art medium, the Art Therapy-Working Alliance Inventory asks about three main areas: the client’s perception of the art medium as a therapeutic tool (Art-Task), the client’s affective experience of his/her artwork (Art Experience), and the client’s acceptance/rejection of the art-therapist’s interventions in the art medium (Art Therapist Acceptance).
We asked 104 art therapy students to assume the role of clients in simulated art therapy sessions and then fill out the questionnaire at the end. We found a strong association between the two alliance scores; in other words, the stronger the alliance between the client and the art therapist, the stronger the alliance between the client and the art medium.
Thus, we concluded that the Art Therapy-Working Alliance Inventory can serve as a useful tool in the research of art therapy practice.
- Practice implications
Long-acting injectable antipsychotics are effective treatment options for the maintenance of patients with schizophrenia and related disorders, and to ensure treatment adherence. This study describes the evolution of patients over six months of treatment with aripiprazole long-acting injectable. The results from this study support previous data on the efficacy and safety of this atypical antipsychotic. This study may be of wide interest to the community of psychiatrists and may help clinicians optimise treatment adherence in patients with schizophrenia spectrum disorders.
- Key points
Aripiprazole long-acting injectable is an atypical antipsychotic intended to improve treatment adherence and prevent relapses.
This multicentre prospective study evaluated the effectiveness of aripiprazole long-acting injectable over six months of treatment on the control of a comprehensive set of clinical variables.
Clinical rating scales showed that treatment with aripiprazole long-acting injectable improved clinical symptoms and social functioning, and reduced the severity of adverse events.
Aripiprazole long-acting injectable contributed to the maintenance of adequate metabolic profiles and the normalisation of prolactin levels.
Patients significantly decreased co-administered antipsychotic drugs after 6-month treatment with aripiprazole.
Method: A cross-sectional survey was applied in a Chinese general hospital. A questionnaire set, including sociodemographic variables, Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7), was completed by the participants. Clinically significant depression (CSD) and clinically significant anxiety (CSA) were defined as a score above 10 on the two scales. CSD and CSA are proxy measures but not specific diagnoses of mental disorders.
Results: Data from 1329 patients were included in the final analysis. 422 (31.8%) reported clinically significant depressive symptoms, 83 (6.3%) reported frequent suicidal ideation, and 204 (15.3%) reported clinically significant anxiety. Household income was negatively associated with CSD. Inpatients with lower household incomes and educational levels had higher rates of CSA. Middle-aged inpatients were more prone to suicidal ideation, and stable marital status was related to less suicidal ideation.
Conclusion: Depression, anxiety, and suicidal ideation were determined to be common psychological problems in Chinese inpatients. Chinese medical personnel must pay attention to the mental health conditions of inpatients, particularly inpatients with lower income, educational levels, and poor marital status.
- Key Points
This is one of the first studies focusing on the prevalence of depression and anxiety in Chinese hospitalized inpatients in non-psychiatric departments of a general hospital.
The PHQ-9 and GAD-7 were determined to be potential screening tools to aid Chinese medical workers in recognizing depression and anxiety in nonpsychiatric departments.
The prevalence of depression, anxiety and suicidal ideation was observed to be relatively high in inpatients, which requires more attention from Chinese clinicians.
Methods: Portuguese adolescents and young adults (N?=?548: 16–26?years) completed the Generalized Problematic Internet Use Scale-2, the UCLA Loneliness Scale, and the general functioning subscale of the McMaster Family Assessment Device. They also reported if they had a committed romantic relationship, and if being online did not leave them time to be with partner, spend with family and socialise face-to-face with friends.
Results: Social networking was reported as among the main preferences by 90.6% of the females and 88.6% of the males. Perceived loneliness was associated with PIU independently of age and indicators of social support.
Conclusions: Evolution created neurophysiological mechanisms to recognize satisfying social relationships based on sensory information and bodily feedback present in face-to-face interactions. These are greatly absent in online communication. Hence, online communication likely engenders feelings of loneliness.
- Keypoints
Problematic internet use (PIU) has been related to loneliness and social networking.
Online communication was shown to increase loneliness.
Lack of romantic relationships did not explain the association of PIU with loneliness.
Poorer family environment did not explain the association of PIU with loneliness.
Lack of face-to-face interactions due to time online also did not explain it.
Lack of adequate sensory cues and bodily feedback in online contacts might facilitate it.
- Key points
Binge-eating disorder is common, under-recognised, and associated with untoward physical and health sequelae.
The neurobiological basis of binge-eating disorder is unclear; cognitive testing may offer insights.
Many prior cognitive studies have not controlled for potential confounds, especially group differences in body mass indices (BMI). Obesity in itself has been linked with cognitive dysfunction.
Here, we compared cognition between people with binge-eating disorder and controls, matched for BMI and other measures.
Binge-eating disorder was associated with impaired response inhibition and executive planning.
These results inform neurobiological models of binge-eating disorder and may suggest new treatment targets for this condition.
- Key points
The MoCA total score is a reliable cognitive measure.
All three MoCA versions are largely equivalent.
Age, education and intelligence are predictors of MoCA performance in healthy participants.
Future studies should focus on collecting normative data for age, education and intelligence for use in clinical practice.
- Key Points
Implication of core beliefs about negative-self in neuroticism was examined.
Neuroticism was predicted by higher levels of these core beliefs.
These core beliefs may be involved in negative emotionality of neuroticism.
- KEY POINTS
The positive predicted value of the LAS-10 score was 26.9%.
Its negative predicted value was 95.2%.
People with scores above 13.5 be referred to a health care professional for further assessment.
The LAS-10 is a tool can be used in clinical practice and research to screen for anxiety.
Future studies are needed to validate the LAS-10 in other countries.
- Keypoints
Patients with alexithymia showed increased PTSD severity, a higher score on TEMPS-A subscales, and more severe suicide ideation.
The Difficulty in Identifying Feelings (DIF) dimension of TAS-20 was associated with suicide ideation in patients with PTSD.
Homocysteine did not correlate with any studied variables.
This study was exploratory and cross-sectional: further larger and prospective studies are needed.
- Keypoints
We observed that testosterone levels were significant higher in bipolar women compared to women with MDD.
The use of valproate could be associated with the testosterone levels in female patients with BD.
Evaluation of women suffering BD should include a testosterone levels determination, particularly when they are taking valproate.
- Key points
?Patients with ADHD, without OCD or ASD comorbidity, still present subclinical obsessive thoughts (36% of our sample). ??Subclinical obsessive thoughts could be a part of thought content in patients with ADHD.
???Subclinical obsessive thoughts as measured by the CPT-II are not correlated with attention function in patients with ADHD.
???ADHD patients with subclinical obsessive symptoms present more impairment in response inhibition than the ones without.
???Results on subclinical obsessive thoughts are similar to those on another type of thought content called ‘mind wandering’.
???A clinical improvement strategy for patients with ADHD could be using executive function remediation rather than classical attention function remediation, according to both to our and previous results.
Methods: Fifty-four patients with ACI and 51 healthy controls were included in our study. Baseline characteristics and blood samples were collected for further analysis. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the serum miR-124 levels. The dual-luciferase reporter assay was used to evaluate the effect of miR-124 on iASPP, a protein that inhibits apoptosis stimulating proteins in the p53 family.
Results: Compared with normal controls, the miR-124 levels in the ACI group rapidly decreased at phase 1 (within 24?h after ischemia) (p?<?0.001) and then gradually increased at phase 2 (48?~?72?h after ischemia) (p?<?0.001) and phase 3 (the 7th day after ischemia) (p?<?0.001). The dual-luciferase reporter assay showed that miR-124 down-regulates iASPP expression in 293T cells.
Conclusion: The miR-124 levels are down-regulated in ACI patients. The dynamic changes of miR-124 might provide a possible method for the detection of ischemic stroke.
- Highlights
The difference in miR-124 expression levels between ACI patients and normal controls.
Dynamic changes of miR-124 expression levels in ACI patients.
The down-regulation of miR-124 upon iASPP expression.
- Keypoints
Psoriasis affects the patients’ psychophysical health.
Depressive symptoms and/or sleep disturbances are frequent among psoriatic patients.
This study investigates these issues comparing the sub-populations of mild and moderate-to-severe psoriatic patients, with special attention to the association between sleep and pruritus.
In clinical practice, the link between psychopathological disturbances and psoriasis should not be underestimated.