BACKGROUND Post-stroke psychiatric complications,particularly depression and anxiety,significantly impact rehabilitation outcomes and quality of life.Despite their prevalence and clinical significance,these conditions...BACKGROUND Post-stroke psychiatric complications,particularly depression and anxiety,significantly impact rehabilitation outcomes and quality of life.Despite their prevalence and clinical significance,these conditions often remain underrecognized in routine stroke care.Understanding their clinical features and temporal patterns is crucial for improving patient outcomes.AIM To investigate the prevalence,temporal evolution,and clinical correlates of depression and anxiety post-stroke and their impact on functional recovery.METHODS In this prospective observational study,127 patients first-ever ischemic stroke were enrolled between June 2022 and June 2024.Depression and anxiety were assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale at baseline and follow-up intervals(2 weeks,1 month,3 months,and 6 months).Stroke severity was evaluated using the National Institutes of Health Stroke Scale,and functional outcomes were measured using the modified Rankin Scale.RESULTS Among 120 patients who completed follow-up(94.5%completion rate),37.5%had depression(mild:18.3%,moderate:12.5%,severe:6.7%)and 41.7%had anxiety at baseline.Depression prevalence showed a biphasic pattern,peaking at 2 weeks(37.5%),declining at 3 months(28.3%),and slightly increasing at 6 months(30.8%).Stroke severity significantly correlated with both depression(odds ratio=1.18,95%CI:1.06-1.31,P=0.003)and anxiety(odds ratio=1.15,95%CI:1.04-1.27,P=0.008).Left hemisphere lesions had a stronger association with psychiatric symptoms than right hemisphere lesions(P=0.035).Patients with psychiatric complications demonstrated poorer functional outcomes at 6 months(median modified Rankin Scale 3 vs 2,P=0.015)and longer hospital stays(mean difference:3.2 days,P=0.002).CONCLUSION Identifying the clinical and neuroanatomical correlates of depression and anxiety will enable effective risk stratification and patient management.Integrating routine psychiatric screening and early intervention is essential in stroke care.展开更多
Dysfunction of the interoceptive system is recognized as an important component of clinical symptoms,including anxiety,depression,psychosis,and other mental disorders.Non-invasive neuromodulation is an emerging clinic...Dysfunction of the interoceptive system is recognized as an important component of clinical symptoms,including anxiety,depression,psychosis,and other mental disorders.Non-invasive neuromodulation is an emerging clinical intervention approach,and over the past decade,research on non-invasive neuromodulation aimed at regulating interoception has rapidly developed.This review first outlines the pathways of interoceptive signals and assessment methods,then summarizes the interoceptive abnormalities in psychiatric disorders and current studies for non-invasive neuromodulation targeting interoception,including intervention modes,target sites,interoceptive measures,and potential neurobiological mechanisms.Finally,we discuss significant research challenges and future directions.展开更多
BACKGROUND Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety.Chronic insomnia affects approximately 15%of the global population,with hig...BACKGROUND Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety.Chronic insomnia affects approximately 15%of the global population,with higher prevalence among females and the elderly.While existing research suggests a bidirectional relationship between insomnia and emotional disorders,the specific impact of insomnia severity on depression,anxiety,and quality of life remains unclear.This study investigates the correlation between insomnia severity and these factors in psychiatric outpatients,hypothesizing that greater insomnia severity is associated with higher levels of depression and anxiety,as well as poorer quality of life.AIM To explore the correlation between insomnia severity and depression,anxiety,and quality of life in primary chronic insomnia patients.METHODS From June to December 2023,345 patients with primary insomnia in Chifeng city were recruited and divided into three groups based on Pittsburgh sleep quality index(PSQI)scores:Mild(n=137),moderate(n=162),and severe(n=46).Demographic data were collected via questionnaires.Self-rating depression scale(SDS),self-rating anxiety scale(SAS),PSQI,and short form 36(SF-36)scores were compared,and Pearson and partial correlation analyses were performed.RESULTS The greater the degree of insomnia,the greater the symptoms of depression and anxiety(P<0.001).The more severe the insomnia,the lower the SF-36 score(excluding body pain),and the difference between the three groups was statist ically significant(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SDS score and SAS score were apparently positively correlated with the severity of insomnia(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SF-36 scores were apparently positively correlated with the severity of insomnia(P<0.05).CONCLUSION Depression and anxiety are independent factors influencing insomnia severity in primary chronic insomnia patients.Higher depression/anxiety levels correlate with worse insomnia,impacting quality of life.展开更多
Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects w...Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects women and can result in significant psychological distress due to repeated dismissal of symptoms.Despite low serum alkaline phosphatase(ALP)being a key biochemical clue to HPP,it is frequently overlooked in standard diagnostic evaluations.Consequen-tly,many patients endure years of ineffective treatment,invalidation,and worse-ning psychiatric outcomes.This editorial emphasizes the need for greater clinical vigilance in distinguishing HPP from fibromyalgia,particularly when features such as chronic pain,premature tooth loss,and persistently low ALP are present.Gender biases in pain diagnosis further compound this problem,leading to gr-eater misdiagnosis rates among women and contributing to the erosion of trust in medical care.The psychiatric consequences of diagnostic delays are substantial,with affected individuals experiencing elevated rates of depression,anxiety,and emotional distress.Greater recognition of low ALP as a meaningful diagnostic clue may enhance diagnostic accuracy,improve patient outcomes,and reduce the psychological toll of misdiagnosis.展开更多
This manuscript critically evaluates the randomized controlled trial(RCT)conducted by Phiri et al,which assessed the effectiveness of virtual reality(VR)training for psychiatric staff in reducing restrictive practices...This manuscript critically evaluates the randomized controlled trial(RCT)conducted by Phiri et al,which assessed the effectiveness of virtual reality(VR)training for psychiatric staff in reducing restrictive practices(RPs).Specifically,this RCT investigated the impact of VR on the handling of aggressive patients by psychiatric staff compared to traditional training methods.Despite significant reductions in perceived discrimination in the VR group,there were no major improvements in self-efficacy or anxiety levels.The system usability scale rated the VR platform highly,but it did not consistently outperform traditional training methods.Indeed,the study shows the potential for VR to reduce RPs,although fluctuations in RP rates suggest that external factors,such as staff turnover,influenced the outcomes.This manuscript evaluates the study’s methodology,results,and broader implications for mental health training.Additionally,it highlights the need for more comprehensive research to establish VR as a standard tool for psychiatric staff education,focusing on patient care outcomes and real-world applicability.Finally,this study explores future research di-rections,technological improvements,and the potential impact of policies that could enhance the integration of VR in clinical training.展开更多
The extensive spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)throughout China in late 2022 has underscored the correlation between this virus and severe psychiatric disorders.However,there remain...The extensive spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)throughout China in late 2022 has underscored the correlation between this virus and severe psychiatric disorders.However,there remains a lack of reported clinical and pathological features.Accordingly,we retrospectively reviewed the electronic medical records of psychiatric inpatients for seven days from early January 2023.Twenty-one inpatients who developed first-episode psychiatric disorders within two weeks after SARS-CoV-2 infection were recruited,while 24 uninfected first-episode psychiatric inpatients were selected as controls.Comparative analyses of clinical manifestations,routine laboratory tests,and imaging examinations were performed.Our investigation demonstrated a 330%increase in the incidence of first-episode psychiatric inpatients after SARS-CoV-2 infection in 2023,compared with the preceding year without SARS-CoV-2 infections.Most cases exhibited psychiatric symptoms within one week of SARS-CoV-2 infection,which resolved after approximately two weeks,with no residual symptoms after three months.One-way ANOVA demonstrated a significant difference in the highest fever temperature between inpatients with and without psychotic symptoms.Infected inpatients displayed elevated levels of interleukin-4,interleukin-8,and interferon-α,but decreased levels of eosinophils and basophils.These findings suggest that SARS-CoV-2 may contribute to the development of psychiatric disorders,likely mediated by the virus-induced inflammatory response and neuronal dysfunction in the context of psychological distress.展开更多
Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual p...Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual phases of their menstrual cycle,including heightened anxiety,depression,irritability,and mood swings.These exacerbations are most commonly associated with premenstrual syndrome and premenstrual dysphoric disorder that are characterized by severe emotional and physical symptoms that interfere with daily functioning.The hormonal fluctuations during the menstrual cycle,particularly changes in estrogen and progesterone levels,are believed to play a pivotal role in these exacerbations.Psychiatric disorders such as depression,anxiety,bipolar disorder,and schizophrenia may be influenced by these hormonal changes,with many females reporting an increase in symptom severity during specific phases of the cycle.The mechanisms behind this phenomenon remain complex,with both biological and psychosocial factors contributing to the heightened vulnerability.Clinical management includes careful monitoring of symptom patterns in relation to the menstrual cycle,with treatment options ranging from lifestyle modifications and psychotherapy to pharmacological interventions such as antidepressants and hormonal therapies.Understanding the link between menstruation and psychiatric disorders is essential for improving diagnosis and tailoring effective treatment strategies for affected individuals.展开更多
BACKGROUND Paracetamol overdose(POD)is the most common cause of acute hepatic failure(AHF)in the United Kingdom.Without urgent orthotopic liver transplant(OLT),mortality is high.Psychiatric assessment for transplant i...BACKGROUND Paracetamol overdose(POD)is the most common cause of acute hepatic failure(AHF)in the United Kingdom.Without urgent orthotopic liver transplant(OLT),mortality is high.Psychiatric assessment for transplant is time-pressured and often undertaken by psychiatrists without transplant experience.Assessors may identify absolute psychiatric contraindications(APCIs)precluding transplant in otherwise medically suitable patients.It is unknown how often this occurs.The combination of high but unknown mortality,time pressure,and relative inexperience is likely to provoke anxiety in assessors.This study hypothesised that the proportion of POD patients assessed for OLT who die because psychiatric contraindications preclude transplant would be small but not negligible.AIM To determine the proportion of patients with paracetamol-induced AHF,for whom psychiatric contraindications preclude transplantation,and the consequent mortality.METHODS This is an 18-year single-centre retrospective cohort study based in a national liver transplant centre.524 participants were identified from a departmental database and included if they had AHF from suspected POD and received a psychiatric assessment for OLT.For those who died before discharge,records were reviewed for medical and psychiatric contraindications to transplant,alongside age,sex,and primary psychiatric diagnosis.We calculated the proportion of patients assessed for whom APCIs precluded transplant,resulting in death.RESULTS Among 524 patients undergoing psychiatric assessment for OLT,there were 102 in-episode deaths(19.5%).APCIs were identified in 46 patients who were otherwise medically suitable for transplant and went on to die.This statistic represents 8.8%of the number of persons evaluated and 45%of the number of deaths.Within this subgroup,27(59%)were female,with a mean age of 44.6 years(ranging from 19-72 years).The most common primary psychiatric diagnosis was alcohol dependence syndrome,which accounted for 67%(n=31).CONCLUSION 8.8%of medically suitable patients with AHF following POD died with APCIs to transplant.This indicates a need for ongoing assessor training and support,and(inter)national comparisons of practice.展开更多
The inability to access brain tissue has greatly hindered our ability to study and care for individuals suffering from psychiatric and neurological conditions.Critics have questioned efforts to develop peripheral bloo...The inability to access brain tissue has greatly hindered our ability to study and care for individuals suffering from psychiatric and neurological conditions.Critics have questioned efforts to develop peripheral blood biomarkers in neurological and psychiatric disorders based on the assertion that disease pathology is limited to the brain.The discovery that all tissues,including the brain,release extracellular vesicles(Raposo and Stoorvogel,2013)and cell free DNAs(Chan et al.,2013)into various body fluids has provided a potential way to measure activity from inaccessible tissues like the central nervous system(CNS)and has given rise to the term“liquid biopsy.”The development of liquid biopsies that can diagnose and predict the course of psychiatric and neurological disorders would be transformative.The ability to predict episodic events such as mania,depression,and risk for suicide would be particularly useful for psychiatric care as it would enable the development of interventions that prevent mortality and improve outcomes.Additionally,biomarkers that are informative about drug response and aid in treatment decisions would be a significant advance in psychiatric care as it would prevent patients from having to endure multiple courses of ineffective treatments and side effects.展开更多
BACKGROUND Speech and language therapy(ST)might moderate the prognosis in children with attention deficit and hyperactivity disorder(ADHD)comorbid with speech delay.This study investigated whether ST in children with ...BACKGROUND Speech and language therapy(ST)might moderate the prognosis in children with attention deficit and hyperactivity disorder(ADHD)comorbid with speech delay.This study investigated whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.AIM To investigate whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.METHODS The population-based National Health Insurance Research Database in Taiwan was used.Hazards of subsequent psychiatric disorders were compared between those who received ST and a propensity-score matched comparison group by Cox regression analyses.RESULTS Of 11987 children with ADHD identified from the dataset,2911(24%)had received ST.The adjusted hazard ratio for any subsequent recorded psychiatric disorder was 0.72(95%confidence interval:0.63-0.82)in children who received ST compared to the matched counterparts.This protective association was only statistically significant in the subgroup that received both medication and behavioral interventions.CONCLUSION ST can moderate the effects of integrated early interventions in ADHD children with speech delay.展开更多
BACKGROUND Brain-computer interface(BCI)technology is rapidly advancing in psychiatry.Informed consent competency(ICC)assessment among psychiatric patients is a pivotal concern in clinical research.AIM To analyze the ...BACKGROUND Brain-computer interface(BCI)technology is rapidly advancing in psychiatry.Informed consent competency(ICC)assessment among psychiatric patients is a pivotal concern in clinical research.AIM To analyze the assessment of ICC and form a framework with multi-dimensional elements involved in ICC of BCI clinical research among psychiatric disorders.METHODS A systematic review of studies regarding ICC assessments of BCI clinical research in patients with six kinds of psychiatric disorders was conducted.A systematic literature search was performed using PubMed,ScienceDirect,and Web of Science.Peer-reviewed articles and full-text studies were included in the analysis.There were no date restrictions,and all studies published up to February 27,2025,were included.RESULTS A total of 103 studies were selected for this review.Fifty-eight studies included ICC factors,and forty-five were classified in ICC related ethical issues of BCI research in six kinds of psychiatric disorders.Executive function impairment is widely recognized as the most significant factor impacting ICC,and processing speed deficits are observed in schizophrenia,mood disorders,and Alzheimer’s disease.Memory dysfunction,particularly episodic and working memory,contributes to compromised ICC.Five core ethical issues in BCI research should be addressed:BCI specificity,vulnerability,autonomy,dynamic ICC,comprehensiveness,and uncertainty.CONCLUSION A Five-Dimensional evaluative framework,including clinical,ethical,sociocultural,legal,and procedural dimensions,is constructed and proposed for future ICC research in BCI clinical research involving psychiatric disorders.展开更多
Atrial fibrillation(AF)is a very common tachyarrhythmia in clinical practice.Several risk factors,such as higher inflammatory marker levels,diabetes mellitus,hypertension,valvular disease,ischemic heart disease,heart ...Atrial fibrillation(AF)is a very common tachyarrhythmia in clinical practice.Several risk factors,such as higher inflammatory marker levels,diabetes mellitus,hypertension,valvular disease,ischemic heart disease,heart failure,and obesity have been proposed to enhance the risk of AF,contributing to higher healthcare system utilization rates and socioeconomic costs.Some interesting studies also investigated the link between AF and psychiatric diseases.This article debates this link between AF and psychiatric diseases from the perspective of Ca^(2+)/cAMP signaling.展开更多
Psychiatric disorders significantly impact surgical outcomes,presenting unique challenges in perioperative care.The intricate relationship between preoperative psychiatric conditions and surgical complications involve...Psychiatric disorders significantly impact surgical outcomes,presenting unique challenges in perioperative care.The intricate relationship between preoperative psychiatric conditions and surgical complications involves complex mechanisms,including altered coagulation,cardiovascular function,and pain perception.Common psychiatric disorders in surgical patients,such as anxiety,depression,and substance use disorders,vary in prevalence and manifestation.Demographic factors,comorbidities,and psychotropic medications further modulate these effects on surgical outcomes.Effective screening and assessment strategies are crucial,yet they present both opportunities and limitations in the preoperative setting.Preoperative psychological interventions,including cognitive-behavioral therapy,supportive care,and mind-body techniques,show promise in mitigating psychological distress and improving surgical outcomes.Multidisciplinary approaches,involving collaborative efforts between psychiatric and surgical teams,are essential to provide comprehensive patient care.Emerging inter-ventions,technological innovations,and personalized medicine approaches offer exciting possibilities to advance preoperative psychiatric care.By understanding the complex interplay between psychiatric disorders and surgical outcomes,healthcare professionals can implement integrated,patient-centered approaches to optimize perioperative care and improve overall patient outcomes.展开更多
Insulin plays a crucial role in the metabolic priming and proliferation of neural stem cells(NSCs).However,insulin resistance(IR)is associated with impaired NSC proliferation and cognitive dysfunction,which are the ha...Insulin plays a crucial role in the metabolic priming and proliferation of neural stem cells(NSCs).However,insulin resistance(IR)is associated with impaired NSC proliferation and cognitive dysfunction,which are the hallmarks of psychiatric disorders(PDs).In addition to insulin,de novo lipogenesis(DNL)also plays an essential role in NSC proliferation and function as it supplies fatty acids for membrane phospholipid synthesis and cell signaling.However,enhanced DNL is associated with lipid/fatty acid accumulation,IR,and impaired NSC proliferation.Intriguingly,data from lipidomic studies suggest that DNL could be enhanced before the onset of classical symptoms in patients with PDs.Further,evidence suggests that patients with PDs may develop IR during childhood or before adolescence;therefore,DNL could be enhanced preceding the development of IR.Regarding treatment,while most antidepressants and antipsychotic drugs have been shown to further deteriorate IR and stimulate DNL,various adjunctive drugs/therapies,including chemical,physical,and stem cell therapy,which have shown promising success in treating PDs,reduce DNL while enhancing insulin sensitivity,NSC proliferation,and cognitive function in laboratory animals.Preliminary clinical outcomes and future prospects of these adjunctive drugs/therapies,especially stem cell therapy in treating PDs including schizophrenia and depression,are discussed.展开更多
Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.T...Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs.Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitte rs.Among these candidate neurotransmitters,lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years.Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses;animal experiments have also shown that the supply of exogenous la ctate exerts an antidepressant effect.In this review,we have described how medications targeting newer neurotransmitte rs offer promise in psychiatric diseases;we have also summarized the advances in the use of lactate(and its corresponding signaling pathways)as a signaling molecule.In addition,we have described the alterations in brain lactate levels in depression,anxiety,bipolar disorder,and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.展开更多
Recent studies highlight the strong correlation between infectious diseases and the development of neuropsychiatric disorders.In this editorial,we comment on the article“Anti-infective therapy durations predict psych...Recent studies highlight the strong correlation between infectious diseases and the development of neuropsychiatric disorders.In this editorial,we comment on the article“Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients”by Zhang et al,published in the recent issue of the World Journal of Psychiatry 2023;13(11):903-911.Our discussion highlighted the potential consequences of anxiety,depression,and psychosis,which are all linked to bacterial,fungal,and viral infections,which are relevant to the impact of inflammation on the sequelae in mental health as those we are observing after the coronavirus disease 2019 pandemic.We focus specifically on the immune mechanisms triggered by inflammation,the primary contributor to psychiatric complications.Importantly,pathophysiological mechanisms such as organ damage,post-injury inflammation,and infectioninduced endocrine alterations,including hypocortisolism or autoantibody formation,significantly contribute to the development of chronic low-grade inflammation,promoting the emergence or development of psychiatric alterations in susceptible individuals.As inflammation can have long-term effects on patients,a multidisciplinary treatment plan can avoid complications and debilitating health issues,and it is crucial to recognize and address the mental health implications.展开更多
Precision medicine is transforming psychiatric treatment by tailoring personalized healthcare interventions based on clinical,genetic,environmental,and lifestyle factors to optimize medication management.This study in...Precision medicine is transforming psychiatric treatment by tailoring personalized healthcare interventions based on clinical,genetic,environmental,and lifestyle factors to optimize medication management.This study investigates how artificial intelligence(AI)and machine learning(ML)can address key challenges in integrating pharmacogenomics(PGx)into psychiatric care.In this integration,AI analyzes vast genomic datasets to identify genetic markers linked to psychiatric conditions.AI-driven models integrating genomic,clinical,and demographic data demonstrated high accuracy in predicting treatment outcomes for major depressive disorder and bipolar disorder.This study also examines the pressing challenges and provides strategic directions for integrating AI and ML in genomic psychiatry,highlighting the importance of ethical considerations and the need for personalized treatment.Effective implementation of AI-driven clinical decision support systems within electronic health records is crucial for translating PGx into routine psychiatric care.Future research should focus on developing enhanced AI-driven predictive models,privacy-preserving data exchange,and robust informatics systems to optimize patient outcomes and advance precision medicine in psychiatry.展开更多
BACKGROUND The interplay between inflammation,immune dysregulation,and the onset of neurological disorders,including epilepsy,has become increasingly recognized.Interleukin(IL)-6,a pro-inflammatory cytokine,is suspect...BACKGROUND The interplay between inflammation,immune dysregulation,and the onset of neurological disorders,including epilepsy,has become increasingly recognized.Interleukin(IL)-6,a pro-inflammatory cytokine,is suspected to not only mediate traditional inflammatory pathways but also contribute to neuroinflammatory responses that could underpin neuropsychiatric symptoms and broader psychiatric disorders in epilepsy patients.The role of IL-6 receptor(IL6R)blockade presents an intriguing target for therapeutic intervention due to its potential to attenuate these processes.neuropsychiatric conditions due to neuroinflammation.METHODS Mendelian randomization(MR)analysis employing single nucleotide poly-morphisms(SNPs)in the vicinity of the IL6R gene(total individuals=408225)was used to evaluate the putative causal relationship between IL6R blockade and epilepsy(total cases/controls=12891/312803),focal epilepsy(cases/controls=7526/399290),and generalized epilepsy(cases/controls=1413/399287).SNP weights were determined by their effect on C-reactive protein(CRP)levels and integrated using inverse variance-weighted meta-analysis as surrogates for IL6R effects.To address potential outlier and pleiotropic influences,sensitivity analyses were conducted employing a variety of MR methods under different modeling assumptions.RESULTS The genetic simulation targeting IL6R blockade revealed a modest but significant reduction in overall epilepsy risk[inverse variance weighting:Odds ratio(OR):0.827;95%confidence interval(CI):0.685-1.000;P=0.05].Subtype analysis showed variability,with no significant effect observed in generalized,focal,or specific childhood and juvenile epilepsy forms.Beyond the primary inflammatory marker CRP,the findings also suggested potential non-inflammatory pathways mediated by IL-6 signaling contributing to the neurobiological landscape of epilepsy,hinting at possible links to neuroinflammation,psychiatric symptoms,and associated mental disorders.CONCLUSION The investigation underscored a tentative causal relationship between IL6R blockade and decreased epilepsy incidence,likely mediated via complex neuroinflammatory pathways.These results encouraged further in-depth studies involving larger cohorts and multifaceted psychiatric assessments to corroborate these findings and more thoroughly delineate the neuro-psychiatric implications of IL-6 signaling in epilepsy.The exploration of IL6R blockade could herald a novel therapeutic avenue not just for seizure management but also for addressing the broader psychiatric and cognitive disturbances often associated with epilepsy.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)and alcohol-related liver disease(Ar-LD)constitute the primary forms of chronic liver disease,and their incidence is progressively increasing with changes in lifestyl...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)and alcohol-related liver disease(Ar-LD)constitute the primary forms of chronic liver disease,and their incidence is progressively increasing with changes in lifestyle habits.Earlier studies have do-cumented a correlation between the occurrence and development of prevalent mental disorders and fatty liver.AIM To investigate the correlation between fatty liver and mental disorders,thus ne-cessitating the implementation of a mendelian randomization(MR)study to elu-cidate this association.METHODS Data on NAFLD and ArLD were retrieved from the genome-wide association studies catalog,while information on mental disorders,including Alzheimer's disease,schizophrenia,anxiety disorder,attention deficit hyperactivity disorder(ADHD),bipolar disorder,major depressive disorder,multiple personality dis-order,obsessive-compulsive disorder(OCD),post-traumatic stress disorder(PTSD),and schizophrenia was acquired from the psychiatric genomics consor-tium.A two-sample MR method was applied to investigate mediators in signifi-cant associations.RESULTS After excluding weak instrumental variables,a causal relationship was identified between fatty liver disease and the occurrence and development of some psychia-tric disorders.Specifically,the findings indicated that ArLD was associated with a significantly elevated risk of developing ADHD(OR:5.81,95%CI:5.59-6.03,P<0.01),bipolar disorder(OR:5.73,95%CI:5.42-6.05,P=0.03),OCD(OR:6.42,95%CI:5.60-7.36,P<0.01),and PTSD(OR:5.66,95%CI:5.33-6.01,P<0.01).Meanwhile,NAFLD significantly increased the risk of developing bipolar disorder(OR:55.08,95%CI:3.59-845.51,P<0.01),OCD(OR:61.50,95%CI:6.69-565.45,P<0.01),and PTSD(OR:52.09,95%CI:4.24-639.32,P<0.01).CONCLUSION Associations were found between genetic predisposition to fatty liver disease and an increased risk of a broad range of psychiatric disorders,namely bipolar disorder,OCD,and PTSD,highlighting the significance of preven-tive measures against psychiatric disorders in patients with fatty liver disease.展开更多
Psychiatric disorders and heart abnormality are closely interconnected.Previous knowledge has been well-established that psychiatric disorders can lead to increased cardiovascular morbidity and even sudden cardiac dea...Psychiatric disorders and heart abnormality are closely interconnected.Previous knowledge has been well-established that psychiatric disorders can lead to increased cardiovascular morbidity and even sudden cardiac death.Conversely,whether heart abnormality contributes to psychiatric disorders remains rarely studied.The work by Zhang et al pointed out that chronic heart failure had effects on the anxiety and depression(AD)severity,and indices including left ventricular ejection fraction,N-terminal pro-brain natriuretic peptide and interleukin-6 were independent risk factors for AD severity.In addition to the aforementioned AD,we herein find that heart failure might additionally impact the development of autism spectrum disorder and post-traumatic stress disorder(albeit P>0.05),and significantly protects against the presence of attention deficit hyperactivity disorder(ADHD),[odds ratio(OR)=0.61,P=0.0071]by using a Mendelian randomization analysis.Bradycardia is also a protective factor for ADHD(OR=0.61,P=0.0095),whereas hypertrophic cardiomyopathy is a mild risk factor for schizophrenia(OR=1.02,P=0.032).These data suggest a wide spectrum of psychiatric disorders secondary to heart abnormality,and we highlight more psychiatric care that should be paid to patients with heart abnormality.展开更多
基金the 2023 Fuyang Municipal Scientific Research Projects in Health and Wellness,No.FY2023-0.
文摘BACKGROUND Post-stroke psychiatric complications,particularly depression and anxiety,significantly impact rehabilitation outcomes and quality of life.Despite their prevalence and clinical significance,these conditions often remain underrecognized in routine stroke care.Understanding their clinical features and temporal patterns is crucial for improving patient outcomes.AIM To investigate the prevalence,temporal evolution,and clinical correlates of depression and anxiety post-stroke and their impact on functional recovery.METHODS In this prospective observational study,127 patients first-ever ischemic stroke were enrolled between June 2022 and June 2024.Depression and anxiety were assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale at baseline and follow-up intervals(2 weeks,1 month,3 months,and 6 months).Stroke severity was evaluated using the National Institutes of Health Stroke Scale,and functional outcomes were measured using the modified Rankin Scale.RESULTS Among 120 patients who completed follow-up(94.5%completion rate),37.5%had depression(mild:18.3%,moderate:12.5%,severe:6.7%)and 41.7%had anxiety at baseline.Depression prevalence showed a biphasic pattern,peaking at 2 weeks(37.5%),declining at 3 months(28.3%),and slightly increasing at 6 months(30.8%).Stroke severity significantly correlated with both depression(odds ratio=1.18,95%CI:1.06-1.31,P=0.003)and anxiety(odds ratio=1.15,95%CI:1.04-1.27,P=0.008).Left hemisphere lesions had a stronger association with psychiatric symptoms than right hemisphere lesions(P=0.035).Patients with psychiatric complications demonstrated poorer functional outcomes at 6 months(median modified Rankin Scale 3 vs 2,P=0.015)and longer hospital stays(mean difference:3.2 days,P=0.002).CONCLUSION Identifying the clinical and neuroanatomical correlates of depression and anxiety will enable effective risk stratification and patient management.Integrating routine psychiatric screening and early intervention is essential in stroke care.
基金supported by grants from the National Natural Science Foundation of China(82101582)the Shanghai Science and Technology Committee(22Y11903600 and 23Y11906000)the Shanghai Municipal Health Commission(202240266).
文摘Dysfunction of the interoceptive system is recognized as an important component of clinical symptoms,including anxiety,depression,psychosis,and other mental disorders.Non-invasive neuromodulation is an emerging clinical intervention approach,and over the past decade,research on non-invasive neuromodulation aimed at regulating interoception has rapidly developed.This review first outlines the pathways of interoceptive signals and assessment methods,then summarizes the interoceptive abnormalities in psychiatric disorders and current studies for non-invasive neuromodulation targeting interoception,including intervention modes,target sites,interoceptive measures,and potential neurobiological mechanisms.Finally,we discuss significant research challenges and future directions.
文摘BACKGROUND Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety.Chronic insomnia affects approximately 15%of the global population,with higher prevalence among females and the elderly.While existing research suggests a bidirectional relationship between insomnia and emotional disorders,the specific impact of insomnia severity on depression,anxiety,and quality of life remains unclear.This study investigates the correlation between insomnia severity and these factors in psychiatric outpatients,hypothesizing that greater insomnia severity is associated with higher levels of depression and anxiety,as well as poorer quality of life.AIM To explore the correlation between insomnia severity and depression,anxiety,and quality of life in primary chronic insomnia patients.METHODS From June to December 2023,345 patients with primary insomnia in Chifeng city were recruited and divided into three groups based on Pittsburgh sleep quality index(PSQI)scores:Mild(n=137),moderate(n=162),and severe(n=46).Demographic data were collected via questionnaires.Self-rating depression scale(SDS),self-rating anxiety scale(SAS),PSQI,and short form 36(SF-36)scores were compared,and Pearson and partial correlation analyses were performed.RESULTS The greater the degree of insomnia,the greater the symptoms of depression and anxiety(P<0.001).The more severe the insomnia,the lower the SF-36 score(excluding body pain),and the difference between the three groups was statist ically significant(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SDS score and SAS score were apparently positively correlated with the severity of insomnia(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SF-36 scores were apparently positively correlated with the severity of insomnia(P<0.05).CONCLUSION Depression and anxiety are independent factors influencing insomnia severity in primary chronic insomnia patients.Higher depression/anxiety levels correlate with worse insomnia,impacting quality of life.
文摘Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects women and can result in significant psychological distress due to repeated dismissal of symptoms.Despite low serum alkaline phosphatase(ALP)being a key biochemical clue to HPP,it is frequently overlooked in standard diagnostic evaluations.Consequen-tly,many patients endure years of ineffective treatment,invalidation,and worse-ning psychiatric outcomes.This editorial emphasizes the need for greater clinical vigilance in distinguishing HPP from fibromyalgia,particularly when features such as chronic pain,premature tooth loss,and persistently low ALP are present.Gender biases in pain diagnosis further compound this problem,leading to gr-eater misdiagnosis rates among women and contributing to the erosion of trust in medical care.The psychiatric consequences of diagnostic delays are substantial,with affected individuals experiencing elevated rates of depression,anxiety,and emotional distress.Greater recognition of low ALP as a meaningful diagnostic clue may enhance diagnostic accuracy,improve patient outcomes,and reduce the psychological toll of misdiagnosis.
基金Supported by Basic Science Research Program Through the National Research Foundation of Korea(NRF)Funded by the Ministry of Education,No.NRF-RS-2023-00237287 and No.NRF-2021S1A5A8062526Local Government-University Cooperation-Based Regional Innovation Projects,No.2021RIS-003.
文摘This manuscript critically evaluates the randomized controlled trial(RCT)conducted by Phiri et al,which assessed the effectiveness of virtual reality(VR)training for psychiatric staff in reducing restrictive practices(RPs).Specifically,this RCT investigated the impact of VR on the handling of aggressive patients by psychiatric staff compared to traditional training methods.Despite significant reductions in perceived discrimination in the VR group,there were no major improvements in self-efficacy or anxiety levels.The system usability scale rated the VR platform highly,but it did not consistently outperform traditional training methods.Indeed,the study shows the potential for VR to reduce RPs,although fluctuations in RP rates suggest that external factors,such as staff turnover,influenced the outcomes.This manuscript evaluates the study’s methodology,results,and broader implications for mental health training.Additionally,it highlights the need for more comprehensive research to establish VR as a standard tool for psychiatric staff education,focusing on patient care outcomes and real-world applicability.Finally,this study explores future research di-rections,technological improvements,and the potential impact of policies that could enhance the integration of VR in clinical training.
基金supported by the National Natural Science Foundation of China(Grant Nos.81971289 and 81871344)。
文摘The extensive spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)throughout China in late 2022 has underscored the correlation between this virus and severe psychiatric disorders.However,there remains a lack of reported clinical and pathological features.Accordingly,we retrospectively reviewed the electronic medical records of psychiatric inpatients for seven days from early January 2023.Twenty-one inpatients who developed first-episode psychiatric disorders within two weeks after SARS-CoV-2 infection were recruited,while 24 uninfected first-episode psychiatric inpatients were selected as controls.Comparative analyses of clinical manifestations,routine laboratory tests,and imaging examinations were performed.Our investigation demonstrated a 330%increase in the incidence of first-episode psychiatric inpatients after SARS-CoV-2 infection in 2023,compared with the preceding year without SARS-CoV-2 infections.Most cases exhibited psychiatric symptoms within one week of SARS-CoV-2 infection,which resolved after approximately two weeks,with no residual symptoms after three months.One-way ANOVA demonstrated a significant difference in the highest fever temperature between inpatients with and without psychotic symptoms.Infected inpatients displayed elevated levels of interleukin-4,interleukin-8,and interferon-α,but decreased levels of eosinophils and basophils.These findings suggest that SARS-CoV-2 may contribute to the development of psychiatric disorders,likely mediated by the virus-induced inflammatory response and neuronal dysfunction in the context of psychological distress.
文摘Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual phases of their menstrual cycle,including heightened anxiety,depression,irritability,and mood swings.These exacerbations are most commonly associated with premenstrual syndrome and premenstrual dysphoric disorder that are characterized by severe emotional and physical symptoms that interfere with daily functioning.The hormonal fluctuations during the menstrual cycle,particularly changes in estrogen and progesterone levels,are believed to play a pivotal role in these exacerbations.Psychiatric disorders such as depression,anxiety,bipolar disorder,and schizophrenia may be influenced by these hormonal changes,with many females reporting an increase in symptom severity during specific phases of the cycle.The mechanisms behind this phenomenon remain complex,with both biological and psychosocial factors contributing to the heightened vulnerability.Clinical management includes careful monitoring of symptom patterns in relation to the menstrual cycle,with treatment options ranging from lifestyle modifications and psychotherapy to pharmacological interventions such as antidepressants and hormonal therapies.Understanding the link between menstruation and psychiatric disorders is essential for improving diagnosis and tailoring effective treatment strategies for affected individuals.
文摘BACKGROUND Paracetamol overdose(POD)is the most common cause of acute hepatic failure(AHF)in the United Kingdom.Without urgent orthotopic liver transplant(OLT),mortality is high.Psychiatric assessment for transplant is time-pressured and often undertaken by psychiatrists without transplant experience.Assessors may identify absolute psychiatric contraindications(APCIs)precluding transplant in otherwise medically suitable patients.It is unknown how often this occurs.The combination of high but unknown mortality,time pressure,and relative inexperience is likely to provoke anxiety in assessors.This study hypothesised that the proportion of POD patients assessed for OLT who die because psychiatric contraindications preclude transplant would be small but not negligible.AIM To determine the proportion of patients with paracetamol-induced AHF,for whom psychiatric contraindications preclude transplantation,and the consequent mortality.METHODS This is an 18-year single-centre retrospective cohort study based in a national liver transplant centre.524 participants were identified from a departmental database and included if they had AHF from suspected POD and received a psychiatric assessment for OLT.For those who died before discharge,records were reviewed for medical and psychiatric contraindications to transplant,alongside age,sex,and primary psychiatric diagnosis.We calculated the proportion of patients assessed for whom APCIs precluded transplant,resulting in death.RESULTS Among 524 patients undergoing psychiatric assessment for OLT,there were 102 in-episode deaths(19.5%).APCIs were identified in 46 patients who were otherwise medically suitable for transplant and went on to die.This statistic represents 8.8%of the number of persons evaluated and 45%of the number of deaths.Within this subgroup,27(59%)were female,with a mean age of 44.6 years(ranging from 19-72 years).The most common primary psychiatric diagnosis was alcohol dependence syndrome,which accounted for 67%(n=31).CONCLUSION 8.8%of medically suitable patients with AHF following POD died with APCIs to transplant.This indicates a need for ongoing assessor training and support,and(inter)national comparisons of practice.
基金supported by Department of Defense grant HT9425-24-1-0030 a grant from the Stanley Medical Research Institute(to SS).
文摘The inability to access brain tissue has greatly hindered our ability to study and care for individuals suffering from psychiatric and neurological conditions.Critics have questioned efforts to develop peripheral blood biomarkers in neurological and psychiatric disorders based on the assertion that disease pathology is limited to the brain.The discovery that all tissues,including the brain,release extracellular vesicles(Raposo and Stoorvogel,2013)and cell free DNAs(Chan et al.,2013)into various body fluids has provided a potential way to measure activity from inaccessible tissues like the central nervous system(CNS)and has given rise to the term“liquid biopsy.”The development of liquid biopsies that can diagnose and predict the course of psychiatric and neurological disorders would be transformative.The ability to predict episodic events such as mania,depression,and risk for suicide would be particularly useful for psychiatric care as it would enable the development of interventions that prevent mortality and improve outcomes.Additionally,biomarkers that are informative about drug response and aid in treatment decisions would be a significant advance in psychiatric care as it would prevent patients from having to endure multiple courses of ineffective treatments and side effects.
文摘BACKGROUND Speech and language therapy(ST)might moderate the prognosis in children with attention deficit and hyperactivity disorder(ADHD)comorbid with speech delay.This study investigated whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.AIM To investigate whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.METHODS The population-based National Health Insurance Research Database in Taiwan was used.Hazards of subsequent psychiatric disorders were compared between those who received ST and a propensity-score matched comparison group by Cox regression analyses.RESULTS Of 11987 children with ADHD identified from the dataset,2911(24%)had received ST.The adjusted hazard ratio for any subsequent recorded psychiatric disorder was 0.72(95%confidence interval:0.63-0.82)in children who received ST compared to the matched counterparts.This protective association was only statistically significant in the subgroup that received both medication and behavioral interventions.CONCLUSION ST can moderate the effects of integrated early interventions in ADHD children with speech delay.
基金Supported by the Ministry of Science and Technology of the People's Republic of China(2021ZD0201900)Project 5,No.2021ZD0201905Capital’s Funds for Health Improvement and Research,No.CFH 2022-2-4115.
文摘BACKGROUND Brain-computer interface(BCI)technology is rapidly advancing in psychiatry.Informed consent competency(ICC)assessment among psychiatric patients is a pivotal concern in clinical research.AIM To analyze the assessment of ICC and form a framework with multi-dimensional elements involved in ICC of BCI clinical research among psychiatric disorders.METHODS A systematic review of studies regarding ICC assessments of BCI clinical research in patients with six kinds of psychiatric disorders was conducted.A systematic literature search was performed using PubMed,ScienceDirect,and Web of Science.Peer-reviewed articles and full-text studies were included in the analysis.There were no date restrictions,and all studies published up to February 27,2025,were included.RESULTS A total of 103 studies were selected for this review.Fifty-eight studies included ICC factors,and forty-five were classified in ICC related ethical issues of BCI research in six kinds of psychiatric disorders.Executive function impairment is widely recognized as the most significant factor impacting ICC,and processing speed deficits are observed in schizophrenia,mood disorders,and Alzheimer’s disease.Memory dysfunction,particularly episodic and working memory,contributes to compromised ICC.Five core ethical issues in BCI research should be addressed:BCI specificity,vulnerability,autonomy,dynamic ICC,comprehensiveness,and uncertainty.CONCLUSION A Five-Dimensional evaluative framework,including clinical,ethical,sociocultural,legal,and procedural dimensions,is constructed and proposed for future ICC research in BCI clinical research involving psychiatric disorders.
文摘Atrial fibrillation(AF)is a very common tachyarrhythmia in clinical practice.Several risk factors,such as higher inflammatory marker levels,diabetes mellitus,hypertension,valvular disease,ischemic heart disease,heart failure,and obesity have been proposed to enhance the risk of AF,contributing to higher healthcare system utilization rates and socioeconomic costs.Some interesting studies also investigated the link between AF and psychiatric diseases.This article debates this link between AF and psychiatric diseases from the perspective of Ca^(2+)/cAMP signaling.
文摘Psychiatric disorders significantly impact surgical outcomes,presenting unique challenges in perioperative care.The intricate relationship between preoperative psychiatric conditions and surgical complications involves complex mechanisms,including altered coagulation,cardiovascular function,and pain perception.Common psychiatric disorders in surgical patients,such as anxiety,depression,and substance use disorders,vary in prevalence and manifestation.Demographic factors,comorbidities,and psychotropic medications further modulate these effects on surgical outcomes.Effective screening and assessment strategies are crucial,yet they present both opportunities and limitations in the preoperative setting.Preoperative psychological interventions,including cognitive-behavioral therapy,supportive care,and mind-body techniques,show promise in mitigating psychological distress and improving surgical outcomes.Multidisciplinary approaches,involving collaborative efforts between psychiatric and surgical teams,are essential to provide comprehensive patient care.Emerging inter-ventions,technological innovations,and personalized medicine approaches offer exciting possibilities to advance preoperative psychiatric care.By understanding the complex interplay between psychiatric disorders and surgical outcomes,healthcare professionals can implement integrated,patient-centered approaches to optimize perioperative care and improve overall patient outcomes.
文摘Insulin plays a crucial role in the metabolic priming and proliferation of neural stem cells(NSCs).However,insulin resistance(IR)is associated with impaired NSC proliferation and cognitive dysfunction,which are the hallmarks of psychiatric disorders(PDs).In addition to insulin,de novo lipogenesis(DNL)also plays an essential role in NSC proliferation and function as it supplies fatty acids for membrane phospholipid synthesis and cell signaling.However,enhanced DNL is associated with lipid/fatty acid accumulation,IR,and impaired NSC proliferation.Intriguingly,data from lipidomic studies suggest that DNL could be enhanced before the onset of classical symptoms in patients with PDs.Further,evidence suggests that patients with PDs may develop IR during childhood or before adolescence;therefore,DNL could be enhanced preceding the development of IR.Regarding treatment,while most antidepressants and antipsychotic drugs have been shown to further deteriorate IR and stimulate DNL,various adjunctive drugs/therapies,including chemical,physical,and stem cell therapy,which have shown promising success in treating PDs,reduce DNL while enhancing insulin sensitivity,NSC proliferation,and cognitive function in laboratory animals.Preliminary clinical outcomes and future prospects of these adjunctive drugs/therapies,especially stem cell therapy in treating PDs including schizophrenia and depression,are discussed.
基金financially supported by the National Nature Science Foundation of China,Nos.82271508(to YC)82001384(to YC)82271316(to HG)。
文摘Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs.Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitte rs.Among these candidate neurotransmitters,lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years.Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses;animal experiments have also shown that the supply of exogenous la ctate exerts an antidepressant effect.In this review,we have described how medications targeting newer neurotransmitte rs offer promise in psychiatric diseases;we have also summarized the advances in the use of lactate(and its corresponding signaling pathways)as a signaling molecule.In addition,we have described the alterations in brain lactate levels in depression,anxiety,bipolar disorder,and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.
基金Supported by the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz,No.NC23189.0.
文摘Recent studies highlight the strong correlation between infectious diseases and the development of neuropsychiatric disorders.In this editorial,we comment on the article“Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients”by Zhang et al,published in the recent issue of the World Journal of Psychiatry 2023;13(11):903-911.Our discussion highlighted the potential consequences of anxiety,depression,and psychosis,which are all linked to bacterial,fungal,and viral infections,which are relevant to the impact of inflammation on the sequelae in mental health as those we are observing after the coronavirus disease 2019 pandemic.We focus specifically on the immune mechanisms triggered by inflammation,the primary contributor to psychiatric complications.Importantly,pathophysiological mechanisms such as organ damage,post-injury inflammation,and infectioninduced endocrine alterations,including hypocortisolism or autoantibody formation,significantly contribute to the development of chronic low-grade inflammation,promoting the emergence or development of psychiatric alterations in susceptible individuals.As inflammation can have long-term effects on patients,a multidisciplinary treatment plan can avoid complications and debilitating health issues,and it is crucial to recognize and address the mental health implications.
文摘Precision medicine is transforming psychiatric treatment by tailoring personalized healthcare interventions based on clinical,genetic,environmental,and lifestyle factors to optimize medication management.This study investigates how artificial intelligence(AI)and machine learning(ML)can address key challenges in integrating pharmacogenomics(PGx)into psychiatric care.In this integration,AI analyzes vast genomic datasets to identify genetic markers linked to psychiatric conditions.AI-driven models integrating genomic,clinical,and demographic data demonstrated high accuracy in predicting treatment outcomes for major depressive disorder and bipolar disorder.This study also examines the pressing challenges and provides strategic directions for integrating AI and ML in genomic psychiatry,highlighting the importance of ethical considerations and the need for personalized treatment.Effective implementation of AI-driven clinical decision support systems within electronic health records is crucial for translating PGx into routine psychiatric care.Future research should focus on developing enhanced AI-driven predictive models,privacy-preserving data exchange,and robust informatics systems to optimize patient outcomes and advance precision medicine in psychiatry.
文摘BACKGROUND The interplay between inflammation,immune dysregulation,and the onset of neurological disorders,including epilepsy,has become increasingly recognized.Interleukin(IL)-6,a pro-inflammatory cytokine,is suspected to not only mediate traditional inflammatory pathways but also contribute to neuroinflammatory responses that could underpin neuropsychiatric symptoms and broader psychiatric disorders in epilepsy patients.The role of IL-6 receptor(IL6R)blockade presents an intriguing target for therapeutic intervention due to its potential to attenuate these processes.neuropsychiatric conditions due to neuroinflammation.METHODS Mendelian randomization(MR)analysis employing single nucleotide poly-morphisms(SNPs)in the vicinity of the IL6R gene(total individuals=408225)was used to evaluate the putative causal relationship between IL6R blockade and epilepsy(total cases/controls=12891/312803),focal epilepsy(cases/controls=7526/399290),and generalized epilepsy(cases/controls=1413/399287).SNP weights were determined by their effect on C-reactive protein(CRP)levels and integrated using inverse variance-weighted meta-analysis as surrogates for IL6R effects.To address potential outlier and pleiotropic influences,sensitivity analyses were conducted employing a variety of MR methods under different modeling assumptions.RESULTS The genetic simulation targeting IL6R blockade revealed a modest but significant reduction in overall epilepsy risk[inverse variance weighting:Odds ratio(OR):0.827;95%confidence interval(CI):0.685-1.000;P=0.05].Subtype analysis showed variability,with no significant effect observed in generalized,focal,or specific childhood and juvenile epilepsy forms.Beyond the primary inflammatory marker CRP,the findings also suggested potential non-inflammatory pathways mediated by IL-6 signaling contributing to the neurobiological landscape of epilepsy,hinting at possible links to neuroinflammation,psychiatric symptoms,and associated mental disorders.CONCLUSION The investigation underscored a tentative causal relationship between IL6R blockade and decreased epilepsy incidence,likely mediated via complex neuroinflammatory pathways.These results encouraged further in-depth studies involving larger cohorts and multifaceted psychiatric assessments to corroborate these findings and more thoroughly delineate the neuro-psychiatric implications of IL-6 signaling in epilepsy.The exploration of IL6R blockade could herald a novel therapeutic avenue not just for seizure management but also for addressing the broader psychiatric and cognitive disturbances often associated with epilepsy.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)and alcohol-related liver disease(Ar-LD)constitute the primary forms of chronic liver disease,and their incidence is progressively increasing with changes in lifestyle habits.Earlier studies have do-cumented a correlation between the occurrence and development of prevalent mental disorders and fatty liver.AIM To investigate the correlation between fatty liver and mental disorders,thus ne-cessitating the implementation of a mendelian randomization(MR)study to elu-cidate this association.METHODS Data on NAFLD and ArLD were retrieved from the genome-wide association studies catalog,while information on mental disorders,including Alzheimer's disease,schizophrenia,anxiety disorder,attention deficit hyperactivity disorder(ADHD),bipolar disorder,major depressive disorder,multiple personality dis-order,obsessive-compulsive disorder(OCD),post-traumatic stress disorder(PTSD),and schizophrenia was acquired from the psychiatric genomics consor-tium.A two-sample MR method was applied to investigate mediators in signifi-cant associations.RESULTS After excluding weak instrumental variables,a causal relationship was identified between fatty liver disease and the occurrence and development of some psychia-tric disorders.Specifically,the findings indicated that ArLD was associated with a significantly elevated risk of developing ADHD(OR:5.81,95%CI:5.59-6.03,P<0.01),bipolar disorder(OR:5.73,95%CI:5.42-6.05,P=0.03),OCD(OR:6.42,95%CI:5.60-7.36,P<0.01),and PTSD(OR:5.66,95%CI:5.33-6.01,P<0.01).Meanwhile,NAFLD significantly increased the risk of developing bipolar disorder(OR:55.08,95%CI:3.59-845.51,P<0.01),OCD(OR:61.50,95%CI:6.69-565.45,P<0.01),and PTSD(OR:52.09,95%CI:4.24-639.32,P<0.01).CONCLUSION Associations were found between genetic predisposition to fatty liver disease and an increased risk of a broad range of psychiatric disorders,namely bipolar disorder,OCD,and PTSD,highlighting the significance of preven-tive measures against psychiatric disorders in patients with fatty liver disease.
基金Supported by the National Natural Science Foundation of China,No.82070285,No.82322033 and No.82470265.
文摘Psychiatric disorders and heart abnormality are closely interconnected.Previous knowledge has been well-established that psychiatric disorders can lead to increased cardiovascular morbidity and even sudden cardiac death.Conversely,whether heart abnormality contributes to psychiatric disorders remains rarely studied.The work by Zhang et al pointed out that chronic heart failure had effects on the anxiety and depression(AD)severity,and indices including left ventricular ejection fraction,N-terminal pro-brain natriuretic peptide and interleukin-6 were independent risk factors for AD severity.In addition to the aforementioned AD,we herein find that heart failure might additionally impact the development of autism spectrum disorder and post-traumatic stress disorder(albeit P>0.05),and significantly protects against the presence of attention deficit hyperactivity disorder(ADHD),[odds ratio(OR)=0.61,P=0.0071]by using a Mendelian randomization analysis.Bradycardia is also a protective factor for ADHD(OR=0.61,P=0.0095),whereas hypertrophic cardiomyopathy is a mild risk factor for schizophrenia(OR=1.02,P=0.032).These data suggest a wide spectrum of psychiatric disorders secondary to heart abnormality,and we highlight more psychiatric care that should be paid to patients with heart abnormality.
