Objective Elevated depressive symptoms are well-documented among geriatric adults with cardiovascular disease(CVD);however,few studies have accounted for long-term cumulative depressive symptom exposure.This study det...Objective Elevated depressive symptoms are well-documented among geriatric adults with cardiovascular disease(CVD);however,few studies have accounted for long-term cumulative depressive symptom exposure.This study determined the relationship between cumulative depressive symptoms and CVD.Methods Individual participant data were obtained from the China Health and Retirement Longitudinal Study(CHARLS)and Health and Retirement Study(HRS).Eligible participants had access to assessment information on depressive symptoms and had no history of CVD at baseline.Long-term cumulative depressive symptoms were estimated by calculating the area under the curve based on the Center for Epidemiological Studies Depression Scale.Results Herein,8,861 participants from CHARLS(mean age:58.58 years;male:48.6%)and 7,284 from HRS(60.94 years;35.0%)were enrolled.The median follow-up period was 5 years for the CHARLS and10 years for the HRS.Compared with the first quartile of cumulative depressive symptoms,the HRs(95%CI)in the fourth quartile were 1.73(1.48,2.02)for predicting CVD(P<0.001),1.83(1.52,2.19)for heart disease(P<0.001),1.53(95%CI:1.17,1.99)for stroke(P=0.002)in CHARLS.For HRS,the HRs(95%CI)were 1.41(95%CI:1.27,1.57;P<0.001),1.42(95%CI:1.26,1.59;P<0.001),and 1.30(95%CI:1.06,1.58;P=0.010)respectively.Strong dose-response relationships were observed,with similar results for the two cohorts.Conclusion Long-term cumulative depressive symptoms were significantly associated with incident CVD in middle-aged and older adults,providing insights into controlling long-term depressive symptoms to improve this cohort's health.展开更多
Sport-related concussion(SRC)and its potential neurological sequela represent an emerging global health concern,requiring improved recovery management and strategies for return-to-play(RTP)to enhance brain health in a...Sport-related concussion(SRC)and its potential neurological sequela represent an emerging global health concern,requiring improved recovery management and strategies for return-to-play(RTP)to enhance brain health in athletes.Given the dynamic and multifaceted nature of SRC recovery,the purpose of this review is to synthesize existing literature on post-SRC outcomes in adult athletes,and to outline the temporal trajectories of key recovery indicators(symptoms,cognitive function,blood biomarkers)across distinct recovery phases until resolution.In the acute phase of SRC(first 48 h),symptom scores and brain damage markers peaked immediately,while cognitive impairments and neuroinflammation emerged with a slight delay.Following the initial rise,brain damage marker concentrations rapidly dropped below baseline levels at approximately 48 h following SRC injury.During the early recovery phase,neuroinflammation and most cognitive alterations resolved after 3–5 days,though symptom burden and attention deficits persisted for up to 7 days.Despite prolonged alterations reported in some individuals,recovery markers typically returned to pre-injury levels in the transition phase(≤2 weeks),though mild attention deficits were detected up to 3 weeks,and TNF-α concentrations remained elevated throughout late recovery(>2 weeks).These results reveal distinct temporal discrepancies across recovery markers and emphasize that physiological disturbances can outlast symptom resolution,underscoring the need for both multimodal assessments and appropriately timed evaluations to accurately track recovery progression.Incorporating structured follow-ups at key time points,particularly beyond symptom resolution,may improve RTP decision-making and reduce the risk of premature return and long-term neurological consequences.展开更多
Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Va...Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Vapor Thermal Therapy(WVTT)is a minimally invasive BPH treatment,but its safety and efficacy in this setting are unclear.Case Description:We report three men with localized PCa on active surveillance who underwent WVTT for LUTS.Conclusions:WVTT appears safe and potentially effective in treating LUTS,especially in those with lower-risk disease and smaller prostate volumes.Further research is needed to confirm safety,efficacy,and optimal patient selection.展开更多
Type 2 diabetes mellitus has central complications:Diabetes,a metabolic disorder primarily characterized by hyperglycemia due to insufficient insulin secretion,or impaired insulin signaling,has significant central com...Type 2 diabetes mellitus has central complications:Diabetes,a metabolic disorder primarily characterized by hyperglycemia due to insufficient insulin secretion,or impaired insulin signaling,has significant central complications.Type 2 diabetes mellitus(T2DM),the most prevalent type of diabetes,affects more than 38 million individuals in the United States(approximately 1 in 10)and is defined by chronic hyperglycemia and insulin resistance,which refers to a reduced cellular response to insulin.展开更多
Complex genetic relationships between neurodegenerative disorders and neuropsychiatric symptoms have been shown, suggesting shared pathogenic mechanisms and emphasizing the potential for developing common therapeutic ...Complex genetic relationships between neurodegenerative disorders and neuropsychiatric symptoms have been shown, suggesting shared pathogenic mechanisms and emphasizing the potential for developing common therapeutic targets. Apolipoprotein E(APOE) genotypes and their corresponding protein(Apo E) isoforms may influence the biophysical properties of the cell membrane lipid bilayer. However, the role of APOE in central nervous system pathophysiology extended beyond its lipid transport function. In the present review article, we analyzed the links existing between APOE genotypes and the neurobiology of neuropsychiatric symptoms in neurodegenerative and vascular diseases. APOE genotypes(APOE ε2, APOE ε3, and APOE ε4) were implicated in common mechanisms underlying a wide spectrum of neurodegenerative diseases, including sporadic Alzheimer's disease, synucleinopathies such as Parkinson's disease and Lewy body disease, stroke, and traumatic brain injury. These shared pathways often involved neuroinflammation, abnormal protein accumulation, or responses to acute detrimental events. Across these conditions, APOE variants are believed to contribute to the modulation of inflammatory responses, the regulation of amyloid and tau pathology, as well as the clearance of proteins such as α-synuclein. The bidirectional interactions among Apo E, amyloid and mitochondrial metabolism, immunomodulatory effects, neuronal repair, and remodeling underscored the complexity of Apo E's role in neuropsychiatric symptoms associated with these conditions since from early phases of cognitive impairment such as mild cognitive impairment and mild behavioral impairment. Besides Apo E-specific isoforms' link to increased neuropsychiatric symptoms in Alzheimer's disease(depression, psychosis, aberrant motor behaviors, and anxiety, not apathy), the APOE ε4 genotype was also considered a significant genetic risk factor for Lewy body disease and its worse cognitive outcomes. Conversely, the APOE ε2 variant has been observed not to exert a protective effect equally in all neurodegenerative diseases. Specifically, in Lewy body disease, this variant may delay disease onset, paralleling its protective role in Alzheimer's disease, although its role in frontotemporal dementia is uncertain. The APOE ε4 genotype has been associated with adverse cognitive outcomes across other various neurodegenerative conditions. In Parkinson's disease, the APOE ε4 allele significantly impacted cognitive performance, increasing the risk of developing dementia, even in cases of pure synucleinopathies with minimal co-pathology from Alzheimer's disease. Similarly, in traumatic brain injury, recovery rates varied, with APOE ε4 carriers demonstrating a greater risk of poor long-term cognitive outcomes and elevated levels of neuropsychiatric symptoms. Furthermore, APOE ε4 influenced the age of onset and severity of stroke, as well as the likelihood of developing stroke-associated dementia, potentially due to its role in compromising endothelial integrity and promoting blood–brain barrier dysfunction.展开更多
BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyro...BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyroxine(T4),free T3(FT3),free T4(FT4),thyroid stimulating hormone(TSH)and schizophrenia.METHODS In this study,100 schizophrenia patients were selected from our hospital between April 2022 and April 2024.Their clinical data were analyzed retrospectively.Based on the Positive and Negative Syndrome Scale(PANSS)score,patients were divided into mild(1-3 points,n=39),moderate(4 points,n=45),and severe groups(5-7 points,n=16).Additionally,55 healthy individuals served as a control group.Venous blood samples were collected to measure T3,T4,FT3,FT4,TSH,and cortisol concentrations,analyzing their relationship with PANSS scores.RESULTS The serum levels of T3,FT3,FT4,TSH and cortisol in the schizophrenia group were lower than those in the control group(P<0.05).With the increase of the severity of the disease,the concentrations of T3 and T4 decreased,while the con-centrations of TSH and cortisol increased(P<0.05).The concentrations of TSH and cortisol were positively correlated with the PANSS score,while T3 and T4 were negatively correlated with the PANSS score(P<0.05).The receiver ope-rating characteristic curve results showed that T3,T4,TSH,and cortisol had good efficacy in the diagnosis of schizophrenia.Logistic results showed that decreased T3 level,decreased T4 level,decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.CONCLUSION Thyroid hormone levels are associated with the severity of schizophrenia symptoms,which can provide new solutions for the diagnosis and treatment of schizophrenia.展开更多
BACKGROUND At present,the influencing factors of social function in patients with residual depressive symptoms are still unclear.Residual depressive symptoms are highly harmful,leading to low mood in patients,affectin...BACKGROUND At present,the influencing factors of social function in patients with residual depressive symptoms are still unclear.Residual depressive symptoms are highly harmful,leading to low mood in patients,affecting work and interpersonal communication,increasing the risk of recurrence,and adding to the burden on families.Studying the influencing factors of their social function is of great significance.AIM To explore the social function score and its influencing factors in patients with residual depressive symptoms.METHODS This observational study surveyed patients with residual depressive symptoms(case group)and healthy patients undergoing physical examinations(control group).Participants were admitted between January 2022 and December 2023.Social functioning was assessed using the Sheehan Disability Scale(SDS),and scores were compared between groups.Factors influencing SDS scores in patients with residual depressive symptoms were analyzed by applying multiple linear regression while using the receiver operating characteristic curve,and these RESULTS The SDS scores of the 158 patients with depressive symptoms were 11.48±3.26.Compared with the control group,the SDS scores and all items in the case group were higher.SDS scores were higher in patients with relapse,discon-tinuous medication,drug therapy alone,severe somatic symptoms,obvious residual symptoms,and anxiety scores≥8.Disease history,medication compliance,therapy method,and residual symptoms correlated positively with SDS scores(r=0.354,0.414,0.602,and 0.456,respectively).Independent influencing factors included disease history,medication compliance,therapy method,somatic symptoms,residual symptoms,and anxiety scores(P<0.05).The areas under the curve for predicting social functional impairment using these factors were 0.713,0.559,0.684,0.729,0.668,and 0.628,respectively,with sensitivities of 79.2%,61.8%,76.8%,81.7%,63.6%,and 65.5%and specificities of 83.3%,87.5%,82.6%,83.3%,86.7%,and 92.1%,respectively.CONCLUSION The social function scores of patients with residual symptoms of depression are high.They are affected by disease history,medication compliance,therapy method,degree of somatic symptoms,residual symptoms,and anxiety.展开更多
Objectives To identify core symptoms and symptom clusters in patients with neuromyelitis optica spectrum disorder(NMOSD)by network analysis.Methods From October 10 to 30,2023,140 patients with NMOSD were selected to p...Objectives To identify core symptoms and symptom clusters in patients with neuromyelitis optica spectrum disorder(NMOSD)by network analysis.Methods From October 10 to 30,2023,140 patients with NMOSD were selected to participate in this online questionnaire survey.The survey tools included a general information questionnaire and a self-made NMOSD symptoms scale,which included the prevalence,severity,and distress of 29 symptoms.Cluster analysis was used to identify symptom clusters,and network analysis was used to analyze the symptom network and node characteristics and central indicators including strength centrality(r_(s)),closeness centrality(r_(c))and betweeness centrality(r_(b))were used to identify core symptoms and symptom clusters.Results The most common symptom was pain(65.7%),followed by paraesthesia(65.0%),fatigue(65.0%),easy awakening(63.6%).Regarding the burden level of symptoms,pain was the most burdensome symptom,followed by paraesthesia,easy awakening,fatigue,and difficulty falling asleep.Six clusters were identified:somatosensory,motor,visual,and memory symptom clusters,bladder and rectum symptom clusters,sleep symptoms clusters,and neuropsychological symptom clusters.Fatigue(r_(s)=12.39,r_(b)=68.00,r_(c)=0.02)was the most central and prominent bridge symptom,and motor symptom cluster(r_(s)=2.68,r_(c)=0.10)was the most central symptom cluster among the six clusters.Conclusions Our study demonstrated the necessity of symptom management targeting fatigue,pain,and motor symptom cluster in patients with NMOSD.展开更多
BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity va...BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity variables affect MDD.We hypothesize that high-level trait-and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.AIM To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.METHODS In this prospective study,281 MDD patients were enrolled from a tertiary care setting.High-level stress-sensitivity factors were classified as trait anxiety,state anxiety,perceived stress,and neuroticism,with a total score in the top quartile of the research cohort.The cumulative effects of stress-sensitivity factors on cognitive dysfunction,disability and functional impairment,suicide risk,and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis.Correlations were investigated further using multiple regression analysis.RESULTS Regarding high-level stress-sensitivity factors,53.40%of patients had at least one at baseline,and 29.61%had two or more.Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline(all P<0.001).Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms(partialη^(2)=0.153;standardizedβ=0.195;P<0.05).The follow-up outcomes were significantly impacted only by the high-level trait-related components,mainly when it came to depressive symptoms and suicide risk,which were predicted by trait anxiety and neuroticism,respectively(partialη^(2)=0.204 and 0.156;standardizedβ=0.247 and 0.392;P<0.05).CONCLUSION To enhance outcomes of MDD and lower the suicide risk,screening for stress-sensitivity factors and considering multifaceted measures,mainly focusing on trait-related ones,should be addressed clinically.展开更多
BACKGROUND Revisiting the epidemiology of posttraumatic stress symptoms(PTSSs)among university students during the coronavirus disease 2019(COVID-19)pandemic as well as understanding the mental health help-seeking beh...BACKGROUND Revisiting the epidemiology of posttraumatic stress symptoms(PTSSs)among university students during the coronavirus disease 2019(COVID-19)pandemic as well as understanding the mental health help-seeking behavior of individuals with PTSSs has critical implications for public mental health strategies in future medical pandemics.AIM To investigate the prevalence and correlates of PTSSs among university students during the first wave of the COVID-19 pandemic in China and to examine mental health help-seeking behaviors among these students.METHODS A total of 2507 Chinese university students were recruited via snowball sampling.The students completed the Seven-item Screening Scale for Post-traumatic Stress Disorder during the first wave of the COVID-19 pandemic in China.Sociodemo-graphic characteristics,pandemic-related characteristics,and mental health help-seeking behaviors of students with PTSSs were also collected.RESULTS The prevalence of PTSSs among the participants was 28.0%.Seven significant correlates of PTSSs were identified(odds ratio=1.23-3.65,P≤0.024):Female sex,being 19 years old or older,living with others or alone,a low level of family economic status,fair or poor interpersonal relationships,severe or very severe local pandemic,and having family members diagnosed with COVID-19.However,only 3.28%of the students with PTSSs reported seeking help from mental health specialists.Among the 23 students who sought help from mental health specialists,13 opted for online or telephone-based psychological consultation.CONCLUSION Our data suggest that there was a high risk of PTSSs among university students and a high level of unmet mental health needs during the COVID-19 pandemic.The delivery of mental health services online or via telephone is a promising approach to address these unmet needs.展开更多
Background Dynamic interpersonal therapy(DIT)is a short-term psychodynamic psychotherapy that has been shown to effectively reduce depressive symptoms in patients with major depressive disorder(MDD).In DIT,the depress...Background Dynamic interpersonal therapy(DIT)is a short-term psychodynamic psychotherapy that has been shown to effectively reduce depressive symptoms in patients with major depressive disorder(MDD).In DIT,the depressive symptoms are formulated as responses to impaired mentalisation.DIT aims to alleviate depressive symptoms by improving mentalising.Aims This study aimed to examine the effect of DIT on improving mentalising and the mediating effect of mentalising in changes in depressive symptoms.Methods Outpatients received either DIT combined with antidepressant medication treatment(DIT group)or antidepressant medication treatment alone(ADM group)for 16 weeks.The Hamilton Depression Rating Scale(HAMD),Patient Health Questionnaire(PHQ)and Reflective Functioning Questionnaire(RFQ)were used.The intention-to-treat principle,mixed linear models,multiple imputation,Pearson's correlation analysis and mediation analysis were conducted.The per-protocol principle was used as sensitivity analysis.Results The DIT group had significantly lower HAMD(least-squares(LS)mean difference=-3.756,p<0.001),PHQ(LS mean difference=-4.188,p<0.001),uncertainty about mental states in the RFQ(RFQ-U,LS mean difference=-2.116,p<0.001)and higher certainty about mental states in the RFQ(RFQ-C,LS mean difference=2.214,p=0.028)scores than the ADM group at post-treatment.The change in RFQ-C was marginally significantly correlated with the change in HAMD(r=-0.218,poretao=0.090),The change in RFQ-U was significantly correlated with the change in HAMD(r=-0.269,poroco-0.024)and the change in PHQ(r=-0.43,Peoretceo l<e0.001).When using RFQ-U as the mediating variable and PHQ as the dependent variable,a significant mediating effect was found(p=0.043,95% confidence interval 0.024 to 1.453).Conclusions The DIT group yielded better outcomes compared with the ADM group in reducing depressive symptoms and improving mentalising.Improvements in mentalising were associated with reductions in depressive symptoms.These findings support that mentalising may contribute to the therapeutic effects of DIT in MDD.展开更多
The predominance of pituitary adenoma in the etiology of sellar masses often leads to the diagnostic fallacy of“availability bias”so that pituitary adenoma is almost always considered the most likely diagnosis of al...The predominance of pituitary adenoma in the etiology of sellar masses often leads to the diagnostic fallacy of“availability bias”so that pituitary adenoma is almost always considered the most likely diagnosis of all sellar masses,even when clinical evidence suggests otherwise.Primary sellar atypical teratoid/rhabdoid tumor(AT/RT)is the most aggressive sellar tumor.Most patients with sellar AT/RT are initially misdiagnosed with pituitary macroadenoma.Early diagnosis of sellar AT/RT is of paramount importance to counsel patients and family on the grave prognosis and to avoid futile surgical procedures.Since there are no discerning imaging features to differentiate AT/RT from other sellar tumors,the acuity of sellar compression symptoms characteristic of AT/RT is the only evidence indicative of the AT/RT diagnosis.Based on the biological and anatomical properties of the sella turcica and its surrounding structures,the nature,order of manifestation,and acuity of the sellar compression symptoms in response to sellar content expansion are mostly predictable.It is concluded that rapidly progressive headache and subsequent similarly rapidly progressive visual symptoms in a female with a large sellar mass are pathognomonic of sellar AT/RT(the“Yu rule”).展开更多
BACKGROUND Examining patterns of media consumption and their associations with mental health outcomes in the general population during the coronavirus disease 2019(COVID-19)pandemic has implications for public mental ...BACKGROUND Examining patterns of media consumption and their associations with mental health outcomes in the general population during the coronavirus disease 2019(COVID-19)pandemic has implications for public mental health in future pandemics.AIM To investigate patterns of media consumption and their associations with depressive and anxiety symptoms among adults affected by the COVID-19 pandemic.METHODS A total of 8473 adults were recruited through snowball sampling for an online cross-sectional survey.The participants were asked to report the three media sources from which they most frequently acquired knowledge about COVID-19 from a checklist of nine media sources.Depression and anxiety were assessed with the Patient Health Questionnaire and the Generalized Anxiety Disorder Scale,respectively.A two-step cluster analysis was performed to identify distinct clusters of consumption of media sources.RESULTS Seven clusters were identified.The lowest prevalence of depression and anxiety(29.1%and 22.8%,respectively)was observed in cluster one,which was labeled“television and news portals and clients,minimal social media”.The highest prevalence of depression(43.1%)was observed in cluster three,labeled“WeChat,MicroBlog,and news portals,minimal traditional media”.The greatest prevalence of anxiety(35.8%)was observed in cluster seven,which was labeled“news clients and WeChat,no newspaper,radio,or news portals”.Relative to cluster one,a significantly elevated risk of depression and anxiety was found in clusters three,six(labeled“news portals and clients,WeChat,no newspaper and radio”)and seven(adjusted odds ratio=1.28-1.46,P≤0.011).Multiple logistic regression analyses revealed that the risk of COVID-19 infection and knowledge about COVID-19 partially explained the variations in the prevalence of depression and anxiety across the seven clusters.CONCLUSION Communication policies should be designed to channel crucial pandemic-related information more effectively through traditional and digital media sources.Encouraging the use of these media and implementing regulatory policies to reduce misinformation and rumors on social media,may be effective in mitigating the risk of depression and anxiety among populations affected by the pandemic.展开更多
BACKGROUND Blonanserin,a novel antipsychotic,has demonstrated efficacy in treating both positive and negative symptoms.However,limited research exists on its dose-dependent effectiveness and safety in patients with an...BACKGROUND Blonanserin,a novel antipsychotic,has demonstrated efficacy in treating both positive and negative symptoms.However,limited research exists on its dose-dependent effectiveness and safety in patients with and without prominent nega-tive symptoms(PNS).AIM To evaluate the effectiveness and safety of blonanserin monotherapy for first-episode schizophrenia in real-world clinical settings and to explore the efficacy and safety of different doses of blonanserin for patients with PNS and without PNS.METHODS A 12-week,multicenter,prospective post-marketing surveillance was conducted.In this study,we included patients with first-episode schizophrenia who received blonanserin monotherapy.Patients were divided into those with PNS and without PNS,based on the Brief Psychiatric Rating Scale(BPRS)negative symptoms subscale scores.Additionally,patients were labeled as high-dose and low-dose was evaluated through the incidence of adverse drug reactions(ADRs).RESULTS A total of 653 patients were included in the analysis,with 613 completing the study.The BPRS total score decreased significantly from 47.94±16.31 at baseline to 26.88±9.47 at 12 weeks(P<0.001).A significant interaction of PNS×dose×time was observed for BPRS total scores(F=3.47,P=0.040)and negative symptom subscale scores(F=6.76,P=0.002).In the PNS group,the high-dose group showed greater reductions in BPRS total scores(P=0.001)and negative symptom subscale scores(P=0.003)than the low-dose group in week 12.In the without PNS group,no significant difference was observed between the high-dose and low-dose groups at any visit.Most adverse reactions were mild or moderate,with extrapyramidal symptoms(9.3%)being most common;1.5%of patients gained≥7%body weight at 12 weeks.CONCLUSION Blonanserin effectively alleviated the clinical symptoms of first-episode schizophrenia with an acceptable safety profile.High-dose blonanserin is particularly beneficial for patients with PNS in the acute phase of first-episode schizophrenia.However,due to the limitation of ADR reporting the real world,the ADR incidence observed in this study may be underestimated.展开更多
BACKGROUND Patients with schizophrenia may lack awareness of the importance of posttracheotomy care due to the impact of their condition,often showing resistance or misunderstanding of care measures.When coupled with ...BACKGROUND Patients with schizophrenia may lack awareness of the importance of posttracheotomy care due to the impact of their condition,often showing resistance or misunderstanding of care measures.When coupled with the impact of negative symptoms and the risk of complications after tracheotomy,patients may experience emotional fluctuations,restlessness,anxiety,and hostile behaviors,which pose significant challenges to nursing work.CASE SUMMARY We have reported the case of an 87-year-old male patient who was admitted to the hospital because of negative symptoms of schizophrenia and who underwent tracheotomy for severe pneumonia.In this study,we have summarized the nursing experience of a patient with negative symptoms of schizophrenia who underwent tracheotomy.The key nursing strategies included proper tracheotomy care,the management of psychiatric symptoms,a thorough assessment and implementation of enteral and parenteral nutrition,effective skincare,infection prevention,and comprehensive mental care.Individualized nursing skills helped stabilize the patient’s condition,followed by isolation and observation in a psychiatric hospital.CONCLUSION Effective postoperative tracheostomy care in patients with schizophrenia necessitates a tailored,multidisciplinary approach that addresses their psychiatric,physical,and emotional needs to achieve optimal clinical outcomes.展开更多
BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechani...BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.展开更多
BACKGROUND Depression is a significant risk factor for diabetes,particularly type 2 diabetes.However,depressive symptoms differ from clinical depression.Previous research has not fully considered the relationship betw...BACKGROUND Depression is a significant risk factor for diabetes,particularly type 2 diabetes.However,depressive symptoms differ from clinical depression.Previous research has not fully considered the relationship between the trajectory of depressive symptoms and the risk of developing diabetes over time.AIM To investigate the association between depressive symptoms,their trajectories,and the risk of developing diabetes in two prospective cohort studies.METHODS In the first phase we analyzed the association between depressive symptoms and the risk of developing diabetes separately using the Health and Retirement Study(HRS).Depressive symptom trajectories were assessed by examining changes in depressive symptoms at baseline and again 8 years later.We then identified specific depressive symptom trajectories that increased the risk of diabetes in the second phase.Finally,we confirmed the association between depressive symptoms and their trajectories with diabetes risk using the English Longitudinal Study of Ageing(ELSA)as a validation study.Depressive symptom trajectories were categorized into five states based on changes in the modified 8-item Center for Epidemiological Studies-Depression scores:Persistently high;increasing;fluctuating;decreasing;and persistently low.Diabetes mellitus was defined as self-reported,physician-diagnosed diabetes.Cox proportional hazards models were used to assess hazard ratios(HR)and 95%confidence intervals(CI),adjusting for potential confounders.RESULTS In the first phase a total of 27658 participants were included(HRS:18633,ELSA:9025),among whom 6582 had depressive symptoms(HRS:4547,ELSA:2035),6407 had somatic depressive symptoms(HRS:4414,ELSA:1993),and 26415 had cognitive-affective depressive symptoms(HRS:17755,ELSA:8660).We found that overall depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.18,95%CI:1.03-1.34)and somatic depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.25,95%CI:1.10-1.42)increased the risk of diabetes,while cognitive depressive symptoms were not associated with diabetes risk.Over an 8-year follow-up we identified 19729 trajectories of overall,somatic,and cognitive-affective depressive symptoms(HRS:13918,ELSA:5811).In the second phase we found that persistently high(HRS:HR=1.22,95%CI:1.06-1.40,ELSA:HR=1.54,95%CI:1.16-2.05 in total and HRS:HR=1.24,95%CI:1.07-1.43,ELSA:HR=1.79,95%CI:1.36-2.35 in somatic)and fluctuating(HRS:HR=1.09,95%CI:1.01-1.17,ELSA:HR=1.33,95%CI:1.14-1.55 in total and HRS:HR=1.10,95%CI:1.02-1.18,ELSA:HR=1.31,95%CI:1.13-1.53 in somatic)trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while increasing trajectories may also raise diabetes risk.However,decreasing trajectories were not associated with diabetes risk.Cognitive-affective depressive symptoms showed no association with diabetes risk regardless of trajectory changes.Sensitivity analyses confirmed the reliability of the findings.CONCLUSION Persistently high and fluctuating trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while decreasing trajectories were not associated with diabetes risk.In contrast trajectories of cognitiveaffective depressive symptoms show no relationship with diabetes risk.Focusing on depressive symptom trajectories,particularly those of somatic depressive symptoms,represented a viable strategy for future diabetes prevention.展开更多
Background Persistent somatic symptoms are a common feature in many psychiatric disorders.Moderate-to-severe cases often necessitate treatment in specialised inpatient psychiatric settings.Aims This study evaluated th...Background Persistent somatic symptoms are a common feature in many psychiatric disorders.Moderate-to-severe cases often necessitate treatment in specialised inpatient psychiatric settings.Aims This study evaluated the efficacy,safety and acceptability of resonant breathing(personalised slow breathing to maximise heart rate variability(HRV))as adjunctive treatment for hospitalised patients with psychiatric disorders presenting with persistent somatic symptoms on admission,when patients typically present with high symptom severity.Methods This multicentre,randomised,placebo-controlled cross-over study included 78 patients diagnosed with somatic symptom disorder or affective disorders with persistent somatic symptoms.Participants underwent lightguided resonant breathing and sham light therapy two times per day for 5weekdays each,starting an average of 11days after admission.The primary outcomes were changes in self-reported somatic well-being and arousal(efficacy),and adverse effects(safety).Secondary outcomes included somatic,anxiety,depression and insomnia symptoms,HRV measures and patient satisfaction(acceptability).The trial was preregistered in the German Clinical Trial Register(ID:DRKS00027323)and funded by the Austrian Research Promotion Agency(Grant ID.F0999886082).Results Resonant breathing rates were six breaths per minute in 60%of patients and higher in the remaining participants.The study found no intervention-specific effect on primary outcomes of self-reported somatic well-being and arousal.Patients reported no adverse effects and expressed high satisfaction with the breathing intervention.Resonant breathing significantly reduced secondary outcomes of self-reported anxiety(η^(2)_(p)=0.09,95%confidence interval(CI)0.01 to 0.22)and insomnia symptoms(η^(2)_(p)=0.10,95%CI 0.01 to 0.23)after 10sessions.It also significantly improved several HRV measures acutely(η^(2)_(p)range:0.23(95%CI 0.09 to 0.38)to0.51(95%CI 0.35 to 0.62)).Conclusions While resonant breathing did not improve somatic well-being or arousal,it was safe,well-tolerated and effective at reducing anxiety and insomnia symptoms during early hospitalisation.These findings support further investigation into resonant breathing for these specific indications over extended periods.展开更多
Cancer patients are often accompanied by serious psychosomatic symptoms such as depression,anxiety,insomnia and pain,which seriously affect the quality of life and prognosis of patients.However,these symptoms are ofte...Cancer patients are often accompanied by serious psychosomatic symptoms such as depression,anxiety,insomnia and pain,which seriously affect the quality of life and prognosis of patients.However,these symptoms are often under-appreciated and poorly treated.At present,the domestic consensus on the management of cancer lacks the content of psychosomatic symptoms.Therefore,this consensus systematically describes the clinical management methods of psychosomatic symptoms related to cancer patients,combining relevant literature and integrating practical management tools.It comprehensively answers the important questions of physician-patient communication.展开更多
BACKGROUND Diabetes mellitus(DM)is a rapidly growing global health emergency of the 21st century.Comorbidities,such as DM and depression,are common,presenting challenges to the healthcare system.AIM To investigate the...BACKGROUND Diabetes mellitus(DM)is a rapidly growing global health emergency of the 21st century.Comorbidities,such as DM and depression,are common,presenting challenges to the healthcare system.AIM To investigate the prevalence of depression and its associated factors in patients with DM and to strengthen the management of depression in this patient group.METHODS Participants were selected from the 2018 China Health and Retirement Longitudinal Study.Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale,with a score of 10 or more indicating depression.Group differences were compared using analysis of variance andχ^(2)tests.Binary logistic regression was conducted to explore the odds ratios(ORs)of independent variables.Following Andersen’s behavioral model,predisposing,enabling,health need,and health behavior variables were introduced stepwise into the logistic model.RESULTS Of the 1673 patients with diabetes,41.4%had depressive symptoms.Regarding the predisposing characteristics,patients who were male(OR 0.426,P<0.05),married(OR 0.634,P<0.05),and received a high school education or higher(OR 0.432,P<0.05)reported fewer depressive symptoms.Healthcare needs,including better self-rated health(OR 0.458 for fair and OR 0.247 for good,P<0.05)and more sleep(OR 0.642,P<0.05),were associated with a lower likelihood of depressive symptoms.In contrast,pain(OR 1.440 for mild and OR 2.644 for severe,P<0.05)and impairment in the basic activities of daily living(OR 1.886,P<0.05)were inversely associated.Additionally,patients highly satisfied with healthcare services(OR 0.579,P<0.05)were less likely to have depressive symptoms.CONCLUSION Nearly half of the patients with DM reported depressive symptoms,which were strongly associated with predisposing characteristics and healthcare needs,particularly physical pain and impairment in basic activities of daily living.Our study emphasizes the significance of enhanced screening and intervention for depression in diabetes care along with improved management of functional impairments.展开更多
基金supported by the Guangdong Basic and Applied Basic Research Foundation(2021A1515011629)Construction of High-level University of Guangdong(G623330580and G621331128)Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme(2019)。
文摘Objective Elevated depressive symptoms are well-documented among geriatric adults with cardiovascular disease(CVD);however,few studies have accounted for long-term cumulative depressive symptom exposure.This study determined the relationship between cumulative depressive symptoms and CVD.Methods Individual participant data were obtained from the China Health and Retirement Longitudinal Study(CHARLS)and Health and Retirement Study(HRS).Eligible participants had access to assessment information on depressive symptoms and had no history of CVD at baseline.Long-term cumulative depressive symptoms were estimated by calculating the area under the curve based on the Center for Epidemiological Studies Depression Scale.Results Herein,8,861 participants from CHARLS(mean age:58.58 years;male:48.6%)and 7,284 from HRS(60.94 years;35.0%)were enrolled.The median follow-up period was 5 years for the CHARLS and10 years for the HRS.Compared with the first quartile of cumulative depressive symptoms,the HRs(95%CI)in the fourth quartile were 1.73(1.48,2.02)for predicting CVD(P<0.001),1.83(1.52,2.19)for heart disease(P<0.001),1.53(95%CI:1.17,1.99)for stroke(P=0.002)in CHARLS.For HRS,the HRs(95%CI)were 1.41(95%CI:1.27,1.57;P<0.001),1.42(95%CI:1.26,1.59;P<0.001),and 1.30(95%CI:1.06,1.58;P=0.010)respectively.Strong dose-response relationships were observed,with similar results for the two cohorts.Conclusion Long-term cumulative depressive symptoms were significantly associated with incident CVD in middle-aged and older adults,providing insights into controlling long-term depressive symptoms to improve this cohort's health.
文摘Sport-related concussion(SRC)and its potential neurological sequela represent an emerging global health concern,requiring improved recovery management and strategies for return-to-play(RTP)to enhance brain health in athletes.Given the dynamic and multifaceted nature of SRC recovery,the purpose of this review is to synthesize existing literature on post-SRC outcomes in adult athletes,and to outline the temporal trajectories of key recovery indicators(symptoms,cognitive function,blood biomarkers)across distinct recovery phases until resolution.In the acute phase of SRC(first 48 h),symptom scores and brain damage markers peaked immediately,while cognitive impairments and neuroinflammation emerged with a slight delay.Following the initial rise,brain damage marker concentrations rapidly dropped below baseline levels at approximately 48 h following SRC injury.During the early recovery phase,neuroinflammation and most cognitive alterations resolved after 3–5 days,though symptom burden and attention deficits persisted for up to 7 days.Despite prolonged alterations reported in some individuals,recovery markers typically returned to pre-injury levels in the transition phase(≤2 weeks),though mild attention deficits were detected up to 3 weeks,and TNF-α concentrations remained elevated throughout late recovery(>2 weeks).These results reveal distinct temporal discrepancies across recovery markers and emphasize that physiological disturbances can outlast symptom resolution,underscoring the need for both multimodal assessments and appropriately timed evaluations to accurately track recovery progression.Incorporating structured follow-ups at key time points,particularly beyond symptom resolution,may improve RTP decision-making and reduce the risk of premature return and long-term neurological consequences.
文摘Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Vapor Thermal Therapy(WVTT)is a minimally invasive BPH treatment,but its safety and efficacy in this setting are unclear.Case Description:We report three men with localized PCa on active surveillance who underwent WVTT for LUTS.Conclusions:WVTT appears safe and potentially effective in treating LUTS,especially in those with lower-risk disease and smaller prostate volumes.Further research is needed to confirm safety,efficacy,and optimal patient selection.
基金supported by grants from NIH T32(DK007260,to WC)the Steno North American Fellowship awarded by the Novo Nordisk Foundation(NNF23OC0087108,to WC)+6 种基金STI2030-Major Projects(2021ZD0202700,to HY)the National Natural Science Foundation of China(32241004,to HY)the Natural Science Foundation of Zhejiang Province of China(LR24C090001,to HY)Key R&D Program of Zhejiang Province(2024SSYS0017,to HY)CAMS Innovation Fund for Medical Sciences(2019-12M-5-057,to HY)Fundamental Research Funds for the Central Universities(226-2022-00193,to HY)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2023-PT310-01,to HY)。
文摘Type 2 diabetes mellitus has central complications:Diabetes,a metabolic disorder primarily characterized by hyperglycemia due to insufficient insulin secretion,or impaired insulin signaling,has significant central complications.Type 2 diabetes mellitus(T2DM),the most prevalent type of diabetes,affects more than 38 million individuals in the United States(approximately 1 in 10)and is defined by chronic hyperglycemia and insulin resistance,which refers to a reduced cellular response to insulin.
文摘Complex genetic relationships between neurodegenerative disorders and neuropsychiatric symptoms have been shown, suggesting shared pathogenic mechanisms and emphasizing the potential for developing common therapeutic targets. Apolipoprotein E(APOE) genotypes and their corresponding protein(Apo E) isoforms may influence the biophysical properties of the cell membrane lipid bilayer. However, the role of APOE in central nervous system pathophysiology extended beyond its lipid transport function. In the present review article, we analyzed the links existing between APOE genotypes and the neurobiology of neuropsychiatric symptoms in neurodegenerative and vascular diseases. APOE genotypes(APOE ε2, APOE ε3, and APOE ε4) were implicated in common mechanisms underlying a wide spectrum of neurodegenerative diseases, including sporadic Alzheimer's disease, synucleinopathies such as Parkinson's disease and Lewy body disease, stroke, and traumatic brain injury. These shared pathways often involved neuroinflammation, abnormal protein accumulation, or responses to acute detrimental events. Across these conditions, APOE variants are believed to contribute to the modulation of inflammatory responses, the regulation of amyloid and tau pathology, as well as the clearance of proteins such as α-synuclein. The bidirectional interactions among Apo E, amyloid and mitochondrial metabolism, immunomodulatory effects, neuronal repair, and remodeling underscored the complexity of Apo E's role in neuropsychiatric symptoms associated with these conditions since from early phases of cognitive impairment such as mild cognitive impairment and mild behavioral impairment. Besides Apo E-specific isoforms' link to increased neuropsychiatric symptoms in Alzheimer's disease(depression, psychosis, aberrant motor behaviors, and anxiety, not apathy), the APOE ε4 genotype was also considered a significant genetic risk factor for Lewy body disease and its worse cognitive outcomes. Conversely, the APOE ε2 variant has been observed not to exert a protective effect equally in all neurodegenerative diseases. Specifically, in Lewy body disease, this variant may delay disease onset, paralleling its protective role in Alzheimer's disease, although its role in frontotemporal dementia is uncertain. The APOE ε4 genotype has been associated with adverse cognitive outcomes across other various neurodegenerative conditions. In Parkinson's disease, the APOE ε4 allele significantly impacted cognitive performance, increasing the risk of developing dementia, even in cases of pure synucleinopathies with minimal co-pathology from Alzheimer's disease. Similarly, in traumatic brain injury, recovery rates varied, with APOE ε4 carriers demonstrating a greater risk of poor long-term cognitive outcomes and elevated levels of neuropsychiatric symptoms. Furthermore, APOE ε4 influenced the age of onset and severity of stroke, as well as the likelihood of developing stroke-associated dementia, potentially due to its role in compromising endothelial integrity and promoting blood–brain barrier dysfunction.
文摘BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyroxine(T4),free T3(FT3),free T4(FT4),thyroid stimulating hormone(TSH)and schizophrenia.METHODS In this study,100 schizophrenia patients were selected from our hospital between April 2022 and April 2024.Their clinical data were analyzed retrospectively.Based on the Positive and Negative Syndrome Scale(PANSS)score,patients were divided into mild(1-3 points,n=39),moderate(4 points,n=45),and severe groups(5-7 points,n=16).Additionally,55 healthy individuals served as a control group.Venous blood samples were collected to measure T3,T4,FT3,FT4,TSH,and cortisol concentrations,analyzing their relationship with PANSS scores.RESULTS The serum levels of T3,FT3,FT4,TSH and cortisol in the schizophrenia group were lower than those in the control group(P<0.05).With the increase of the severity of the disease,the concentrations of T3 and T4 decreased,while the con-centrations of TSH and cortisol increased(P<0.05).The concentrations of TSH and cortisol were positively correlated with the PANSS score,while T3 and T4 were negatively correlated with the PANSS score(P<0.05).The receiver ope-rating characteristic curve results showed that T3,T4,TSH,and cortisol had good efficacy in the diagnosis of schizophrenia.Logistic results showed that decreased T3 level,decreased T4 level,decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.CONCLUSION Thyroid hormone levels are associated with the severity of schizophrenia symptoms,which can provide new solutions for the diagnosis and treatment of schizophrenia.
文摘BACKGROUND At present,the influencing factors of social function in patients with residual depressive symptoms are still unclear.Residual depressive symptoms are highly harmful,leading to low mood in patients,affecting work and interpersonal communication,increasing the risk of recurrence,and adding to the burden on families.Studying the influencing factors of their social function is of great significance.AIM To explore the social function score and its influencing factors in patients with residual depressive symptoms.METHODS This observational study surveyed patients with residual depressive symptoms(case group)and healthy patients undergoing physical examinations(control group).Participants were admitted between January 2022 and December 2023.Social functioning was assessed using the Sheehan Disability Scale(SDS),and scores were compared between groups.Factors influencing SDS scores in patients with residual depressive symptoms were analyzed by applying multiple linear regression while using the receiver operating characteristic curve,and these RESULTS The SDS scores of the 158 patients with depressive symptoms were 11.48±3.26.Compared with the control group,the SDS scores and all items in the case group were higher.SDS scores were higher in patients with relapse,discon-tinuous medication,drug therapy alone,severe somatic symptoms,obvious residual symptoms,and anxiety scores≥8.Disease history,medication compliance,therapy method,and residual symptoms correlated positively with SDS scores(r=0.354,0.414,0.602,and 0.456,respectively).Independent influencing factors included disease history,medication compliance,therapy method,somatic symptoms,residual symptoms,and anxiety scores(P<0.05).The areas under the curve for predicting social functional impairment using these factors were 0.713,0.559,0.684,0.729,0.668,and 0.628,respectively,with sensitivities of 79.2%,61.8%,76.8%,81.7%,63.6%,and 65.5%and specificities of 83.3%,87.5%,82.6%,83.3%,86.7%,and 92.1%,respectively.CONCLUSION The social function scores of patients with residual symptoms of depression are high.They are affected by disease history,medication compliance,therapy method,degree of somatic symptoms,residual symptoms,and anxiety.
基金supported by the Specific Research Fund for Top-notch Talents of Guangdong Provincial Hospital of Chinese Medicine(No.2022KT1188).
文摘Objectives To identify core symptoms and symptom clusters in patients with neuromyelitis optica spectrum disorder(NMOSD)by network analysis.Methods From October 10 to 30,2023,140 patients with NMOSD were selected to participate in this online questionnaire survey.The survey tools included a general information questionnaire and a self-made NMOSD symptoms scale,which included the prevalence,severity,and distress of 29 symptoms.Cluster analysis was used to identify symptom clusters,and network analysis was used to analyze the symptom network and node characteristics and central indicators including strength centrality(r_(s)),closeness centrality(r_(c))and betweeness centrality(r_(b))were used to identify core symptoms and symptom clusters.Results The most common symptom was pain(65.7%),followed by paraesthesia(65.0%),fatigue(65.0%),easy awakening(63.6%).Regarding the burden level of symptoms,pain was the most burdensome symptom,followed by paraesthesia,easy awakening,fatigue,and difficulty falling asleep.Six clusters were identified:somatosensory,motor,visual,and memory symptom clusters,bladder and rectum symptom clusters,sleep symptoms clusters,and neuropsychological symptom clusters.Fatigue(r_(s)=12.39,r_(b)=68.00,r_(c)=0.02)was the most central and prominent bridge symptom,and motor symptom cluster(r_(s)=2.68,r_(c)=0.10)was the most central symptom cluster among the six clusters.Conclusions Our study demonstrated the necessity of symptom management targeting fatigue,pain,and motor symptom cluster in patients with NMOSD.
基金Supported by Science and Technology Innovation 2030-Major Projects,No.2021ZD0202000National Key Research and Development Program of China,No.2019YFA0706200+2 种基金National Natural Science Foundation of China,No.82371535Science and Technology Innovation Program of Hunan Province,No.2023RC3083Fundamental Research Funds for the Central Universities of Central South University,No.2023ZZTS0838.
文摘BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity variables affect MDD.We hypothesize that high-level trait-and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.AIM To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.METHODS In this prospective study,281 MDD patients were enrolled from a tertiary care setting.High-level stress-sensitivity factors were classified as trait anxiety,state anxiety,perceived stress,and neuroticism,with a total score in the top quartile of the research cohort.The cumulative effects of stress-sensitivity factors on cognitive dysfunction,disability and functional impairment,suicide risk,and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis.Correlations were investigated further using multiple regression analysis.RESULTS Regarding high-level stress-sensitivity factors,53.40%of patients had at least one at baseline,and 29.61%had two or more.Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline(all P<0.001).Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms(partialη^(2)=0.153;standardizedβ=0.195;P<0.05).The follow-up outcomes were significantly impacted only by the high-level trait-related components,mainly when it came to depressive symptoms and suicide risk,which were predicted by trait anxiety and neuroticism,respectively(partialη^(2)=0.204 and 0.156;standardizedβ=0.247 and 0.392;P<0.05).CONCLUSION To enhance outcomes of MDD and lower the suicide risk,screening for stress-sensitivity factors and considering multifaceted measures,mainly focusing on trait-related ones,should be addressed clinically.
文摘BACKGROUND Revisiting the epidemiology of posttraumatic stress symptoms(PTSSs)among university students during the coronavirus disease 2019(COVID-19)pandemic as well as understanding the mental health help-seeking behavior of individuals with PTSSs has critical implications for public mental health strategies in future medical pandemics.AIM To investigate the prevalence and correlates of PTSSs among university students during the first wave of the COVID-19 pandemic in China and to examine mental health help-seeking behaviors among these students.METHODS A total of 2507 Chinese university students were recruited via snowball sampling.The students completed the Seven-item Screening Scale for Post-traumatic Stress Disorder during the first wave of the COVID-19 pandemic in China.Sociodemo-graphic characteristics,pandemic-related characteristics,and mental health help-seeking behaviors of students with PTSSs were also collected.RESULTS The prevalence of PTSSs among the participants was 28.0%.Seven significant correlates of PTSSs were identified(odds ratio=1.23-3.65,P≤0.024):Female sex,being 19 years old or older,living with others or alone,a low level of family economic status,fair or poor interpersonal relationships,severe or very severe local pandemic,and having family members diagnosed with COVID-19.However,only 3.28%of the students with PTSSs reported seeking help from mental health specialists.Among the 23 students who sought help from mental health specialists,13 opted for online or telephone-based psychological consultation.CONCLUSION Our data suggest that there was a high risk of PTSSs among university students and a high level of unmet mental health needs during the COVID-19 pandemic.The delivery of mental health services online or via telephone is a promising approach to address these unmet needs.
基金funded by Science and Technology Commission of Shanghai Municipality(No.21Y11905400)National Natural ScienceFoundationof China(General Program,No.82371555).
文摘Background Dynamic interpersonal therapy(DIT)is a short-term psychodynamic psychotherapy that has been shown to effectively reduce depressive symptoms in patients with major depressive disorder(MDD).In DIT,the depressive symptoms are formulated as responses to impaired mentalisation.DIT aims to alleviate depressive symptoms by improving mentalising.Aims This study aimed to examine the effect of DIT on improving mentalising and the mediating effect of mentalising in changes in depressive symptoms.Methods Outpatients received either DIT combined with antidepressant medication treatment(DIT group)or antidepressant medication treatment alone(ADM group)for 16 weeks.The Hamilton Depression Rating Scale(HAMD),Patient Health Questionnaire(PHQ)and Reflective Functioning Questionnaire(RFQ)were used.The intention-to-treat principle,mixed linear models,multiple imputation,Pearson's correlation analysis and mediation analysis were conducted.The per-protocol principle was used as sensitivity analysis.Results The DIT group had significantly lower HAMD(least-squares(LS)mean difference=-3.756,p<0.001),PHQ(LS mean difference=-4.188,p<0.001),uncertainty about mental states in the RFQ(RFQ-U,LS mean difference=-2.116,p<0.001)and higher certainty about mental states in the RFQ(RFQ-C,LS mean difference=2.214,p=0.028)scores than the ADM group at post-treatment.The change in RFQ-C was marginally significantly correlated with the change in HAMD(r=-0.218,poretao=0.090),The change in RFQ-U was significantly correlated with the change in HAMD(r=-0.269,poroco-0.024)and the change in PHQ(r=-0.43,Peoretceo l<e0.001).When using RFQ-U as the mediating variable and PHQ as the dependent variable,a significant mediating effect was found(p=0.043,95% confidence interval 0.024 to 1.453).Conclusions The DIT group yielded better outcomes compared with the ADM group in reducing depressive symptoms and improving mentalising.Improvements in mentalising were associated with reductions in depressive symptoms.These findings support that mentalising may contribute to the therapeutic effects of DIT in MDD.
文摘The predominance of pituitary adenoma in the etiology of sellar masses often leads to the diagnostic fallacy of“availability bias”so that pituitary adenoma is almost always considered the most likely diagnosis of all sellar masses,even when clinical evidence suggests otherwise.Primary sellar atypical teratoid/rhabdoid tumor(AT/RT)is the most aggressive sellar tumor.Most patients with sellar AT/RT are initially misdiagnosed with pituitary macroadenoma.Early diagnosis of sellar AT/RT is of paramount importance to counsel patients and family on the grave prognosis and to avoid futile surgical procedures.Since there are no discerning imaging features to differentiate AT/RT from other sellar tumors,the acuity of sellar compression symptoms characteristic of AT/RT is the only evidence indicative of the AT/RT diagnosis.Based on the biological and anatomical properties of the sella turcica and its surrounding structures,the nature,order of manifestation,and acuity of the sellar compression symptoms in response to sellar content expansion are mostly predictable.It is concluded that rapidly progressive headache and subsequent similarly rapidly progressive visual symptoms in a female with a large sellar mass are pathognomonic of sellar AT/RT(the“Yu rule”).
基金Supported by National Natural Science Foundation of China,No.71774060the Young Top Talent Program in Public Health from Health Commission of Hubei Province,No.EWEITONG[2021]74.
文摘BACKGROUND Examining patterns of media consumption and their associations with mental health outcomes in the general population during the coronavirus disease 2019(COVID-19)pandemic has implications for public mental health in future pandemics.AIM To investigate patterns of media consumption and their associations with depressive and anxiety symptoms among adults affected by the COVID-19 pandemic.METHODS A total of 8473 adults were recruited through snowball sampling for an online cross-sectional survey.The participants were asked to report the three media sources from which they most frequently acquired knowledge about COVID-19 from a checklist of nine media sources.Depression and anxiety were assessed with the Patient Health Questionnaire and the Generalized Anxiety Disorder Scale,respectively.A two-step cluster analysis was performed to identify distinct clusters of consumption of media sources.RESULTS Seven clusters were identified.The lowest prevalence of depression and anxiety(29.1%and 22.8%,respectively)was observed in cluster one,which was labeled“television and news portals and clients,minimal social media”.The highest prevalence of depression(43.1%)was observed in cluster three,labeled“WeChat,MicroBlog,and news portals,minimal traditional media”.The greatest prevalence of anxiety(35.8%)was observed in cluster seven,which was labeled“news clients and WeChat,no newspaper,radio,or news portals”.Relative to cluster one,a significantly elevated risk of depression and anxiety was found in clusters three,six(labeled“news portals and clients,WeChat,no newspaper and radio”)and seven(adjusted odds ratio=1.28-1.46,P≤0.011).Multiple logistic regression analyses revealed that the risk of COVID-19 infection and knowledge about COVID-19 partially explained the variations in the prevalence of depression and anxiety across the seven clusters.CONCLUSION Communication policies should be designed to channel crucial pandemic-related information more effectively through traditional and digital media sources.Encouraging the use of these media and implementing regulatory policies to reduce misinformation and rumors on social media,may be effective in mitigating the risk of depression and anxiety among populations affected by the pandemic.
文摘BACKGROUND Blonanserin,a novel antipsychotic,has demonstrated efficacy in treating both positive and negative symptoms.However,limited research exists on its dose-dependent effectiveness and safety in patients with and without prominent nega-tive symptoms(PNS).AIM To evaluate the effectiveness and safety of blonanserin monotherapy for first-episode schizophrenia in real-world clinical settings and to explore the efficacy and safety of different doses of blonanserin for patients with PNS and without PNS.METHODS A 12-week,multicenter,prospective post-marketing surveillance was conducted.In this study,we included patients with first-episode schizophrenia who received blonanserin monotherapy.Patients were divided into those with PNS and without PNS,based on the Brief Psychiatric Rating Scale(BPRS)negative symptoms subscale scores.Additionally,patients were labeled as high-dose and low-dose was evaluated through the incidence of adverse drug reactions(ADRs).RESULTS A total of 653 patients were included in the analysis,with 613 completing the study.The BPRS total score decreased significantly from 47.94±16.31 at baseline to 26.88±9.47 at 12 weeks(P<0.001).A significant interaction of PNS×dose×time was observed for BPRS total scores(F=3.47,P=0.040)and negative symptom subscale scores(F=6.76,P=0.002).In the PNS group,the high-dose group showed greater reductions in BPRS total scores(P=0.001)and negative symptom subscale scores(P=0.003)than the low-dose group in week 12.In the without PNS group,no significant difference was observed between the high-dose and low-dose groups at any visit.Most adverse reactions were mild or moderate,with extrapyramidal symptoms(9.3%)being most common;1.5%of patients gained≥7%body weight at 12 weeks.CONCLUSION Blonanserin effectively alleviated the clinical symptoms of first-episode schizophrenia with an acceptable safety profile.High-dose blonanserin is particularly beneficial for patients with PNS in the acute phase of first-episode schizophrenia.However,due to the limitation of ADR reporting the real world,the ADR incidence observed in this study may be underestimated.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-033A。
文摘BACKGROUND Patients with schizophrenia may lack awareness of the importance of posttracheotomy care due to the impact of their condition,often showing resistance or misunderstanding of care measures.When coupled with the impact of negative symptoms and the risk of complications after tracheotomy,patients may experience emotional fluctuations,restlessness,anxiety,and hostile behaviors,which pose significant challenges to nursing work.CASE SUMMARY We have reported the case of an 87-year-old male patient who was admitted to the hospital because of negative symptoms of schizophrenia and who underwent tracheotomy for severe pneumonia.In this study,we have summarized the nursing experience of a patient with negative symptoms of schizophrenia who underwent tracheotomy.The key nursing strategies included proper tracheotomy care,the management of psychiatric symptoms,a thorough assessment and implementation of enteral and parenteral nutrition,effective skincare,infection prevention,and comprehensive mental care.Individualized nursing skills helped stabilize the patient’s condition,followed by isolation and observation in a psychiatric hospital.CONCLUSION Effective postoperative tracheostomy care in patients with schizophrenia necessitates a tailored,multidisciplinary approach that addresses their psychiatric,physical,and emotional needs to achieve optimal clinical outcomes.
文摘BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.
文摘BACKGROUND Depression is a significant risk factor for diabetes,particularly type 2 diabetes.However,depressive symptoms differ from clinical depression.Previous research has not fully considered the relationship between the trajectory of depressive symptoms and the risk of developing diabetes over time.AIM To investigate the association between depressive symptoms,their trajectories,and the risk of developing diabetes in two prospective cohort studies.METHODS In the first phase we analyzed the association between depressive symptoms and the risk of developing diabetes separately using the Health and Retirement Study(HRS).Depressive symptom trajectories were assessed by examining changes in depressive symptoms at baseline and again 8 years later.We then identified specific depressive symptom trajectories that increased the risk of diabetes in the second phase.Finally,we confirmed the association between depressive symptoms and their trajectories with diabetes risk using the English Longitudinal Study of Ageing(ELSA)as a validation study.Depressive symptom trajectories were categorized into five states based on changes in the modified 8-item Center for Epidemiological Studies-Depression scores:Persistently high;increasing;fluctuating;decreasing;and persistently low.Diabetes mellitus was defined as self-reported,physician-diagnosed diabetes.Cox proportional hazards models were used to assess hazard ratios(HR)and 95%confidence intervals(CI),adjusting for potential confounders.RESULTS In the first phase a total of 27658 participants were included(HRS:18633,ELSA:9025),among whom 6582 had depressive symptoms(HRS:4547,ELSA:2035),6407 had somatic depressive symptoms(HRS:4414,ELSA:1993),and 26415 had cognitive-affective depressive symptoms(HRS:17755,ELSA:8660).We found that overall depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.18,95%CI:1.03-1.34)and somatic depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.25,95%CI:1.10-1.42)increased the risk of diabetes,while cognitive depressive symptoms were not associated with diabetes risk.Over an 8-year follow-up we identified 19729 trajectories of overall,somatic,and cognitive-affective depressive symptoms(HRS:13918,ELSA:5811).In the second phase we found that persistently high(HRS:HR=1.22,95%CI:1.06-1.40,ELSA:HR=1.54,95%CI:1.16-2.05 in total and HRS:HR=1.24,95%CI:1.07-1.43,ELSA:HR=1.79,95%CI:1.36-2.35 in somatic)and fluctuating(HRS:HR=1.09,95%CI:1.01-1.17,ELSA:HR=1.33,95%CI:1.14-1.55 in total and HRS:HR=1.10,95%CI:1.02-1.18,ELSA:HR=1.31,95%CI:1.13-1.53 in somatic)trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while increasing trajectories may also raise diabetes risk.However,decreasing trajectories were not associated with diabetes risk.Cognitive-affective depressive symptoms showed no association with diabetes risk regardless of trajectory changes.Sensitivity analyses confirmed the reliability of the findings.CONCLUSION Persistently high and fluctuating trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while decreasing trajectories were not associated with diabetes risk.In contrast trajectories of cognitiveaffective depressive symptoms show no relationship with diabetes risk.Focusing on depressive symptom trajectories,particularly those of somatic depressive symptoms,represented a viable strategy for future diabetes prevention.
基金funded by the Austrian Research Promotion Agency(Grant ID.F0999886082)。
文摘Background Persistent somatic symptoms are a common feature in many psychiatric disorders.Moderate-to-severe cases often necessitate treatment in specialised inpatient psychiatric settings.Aims This study evaluated the efficacy,safety and acceptability of resonant breathing(personalised slow breathing to maximise heart rate variability(HRV))as adjunctive treatment for hospitalised patients with psychiatric disorders presenting with persistent somatic symptoms on admission,when patients typically present with high symptom severity.Methods This multicentre,randomised,placebo-controlled cross-over study included 78 patients diagnosed with somatic symptom disorder or affective disorders with persistent somatic symptoms.Participants underwent lightguided resonant breathing and sham light therapy two times per day for 5weekdays each,starting an average of 11days after admission.The primary outcomes were changes in self-reported somatic well-being and arousal(efficacy),and adverse effects(safety).Secondary outcomes included somatic,anxiety,depression and insomnia symptoms,HRV measures and patient satisfaction(acceptability).The trial was preregistered in the German Clinical Trial Register(ID:DRKS00027323)and funded by the Austrian Research Promotion Agency(Grant ID.F0999886082).Results Resonant breathing rates were six breaths per minute in 60%of patients and higher in the remaining participants.The study found no intervention-specific effect on primary outcomes of self-reported somatic well-being and arousal.Patients reported no adverse effects and expressed high satisfaction with the breathing intervention.Resonant breathing significantly reduced secondary outcomes of self-reported anxiety(η^(2)_(p)=0.09,95%confidence interval(CI)0.01 to 0.22)and insomnia symptoms(η^(2)_(p)=0.10,95%CI 0.01 to 0.23)after 10sessions.It also significantly improved several HRV measures acutely(η^(2)_(p)range:0.23(95%CI 0.09 to 0.38)to0.51(95%CI 0.35 to 0.62)).Conclusions While resonant breathing did not improve somatic well-being or arousal,it was safe,well-tolerated and effective at reducing anxiety and insomnia symptoms during early hospitalisation.These findings support further investigation into resonant breathing for these specific indications over extended periods.
文摘Cancer patients are often accompanied by serious psychosomatic symptoms such as depression,anxiety,insomnia and pain,which seriously affect the quality of life and prognosis of patients.However,these symptoms are often under-appreciated and poorly treated.At present,the domestic consensus on the management of cancer lacks the content of psychosomatic symptoms.Therefore,this consensus systematically describes the clinical management methods of psychosomatic symptoms related to cancer patients,combining relevant literature and integrating practical management tools.It comprehensively answers the important questions of physician-patient communication.
基金Supported by National Natural Science Foundation of China,No.72104058Open Bidding for Selecting the Best Candidates,Guangzhou University of Chinese MedicineUniversity of Macao Research Funding,No.QRCM-IRG2022-001.
文摘BACKGROUND Diabetes mellitus(DM)is a rapidly growing global health emergency of the 21st century.Comorbidities,such as DM and depression,are common,presenting challenges to the healthcare system.AIM To investigate the prevalence of depression and its associated factors in patients with DM and to strengthen the management of depression in this patient group.METHODS Participants were selected from the 2018 China Health and Retirement Longitudinal Study.Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale,with a score of 10 or more indicating depression.Group differences were compared using analysis of variance andχ^(2)tests.Binary logistic regression was conducted to explore the odds ratios(ORs)of independent variables.Following Andersen’s behavioral model,predisposing,enabling,health need,and health behavior variables were introduced stepwise into the logistic model.RESULTS Of the 1673 patients with diabetes,41.4%had depressive symptoms.Regarding the predisposing characteristics,patients who were male(OR 0.426,P<0.05),married(OR 0.634,P<0.05),and received a high school education or higher(OR 0.432,P<0.05)reported fewer depressive symptoms.Healthcare needs,including better self-rated health(OR 0.458 for fair and OR 0.247 for good,P<0.05)and more sleep(OR 0.642,P<0.05),were associated with a lower likelihood of depressive symptoms.In contrast,pain(OR 1.440 for mild and OR 2.644 for severe,P<0.05)and impairment in the basic activities of daily living(OR 1.886,P<0.05)were inversely associated.Additionally,patients highly satisfied with healthcare services(OR 0.579,P<0.05)were less likely to have depressive symptoms.CONCLUSION Nearly half of the patients with DM reported depressive symptoms,which were strongly associated with predisposing characteristics and healthcare needs,particularly physical pain and impairment in basic activities of daily living.Our study emphasizes the significance of enhanced screening and intervention for depression in diabetes care along with improved management of functional impairments.
