BACKGROUND Neurodevelopmental delays encompass a wide range of conditions that impair cognitive,motor,and social functioning,often increasing the risk of psychiatric comorbidities.Children with these delays frequently...BACKGROUND Neurodevelopmental delays encompass a wide range of conditions that impair cognitive,motor,and social functioning,often increasing the risk of psychiatric comorbidities.Children with these delays frequently present with disorders such as attention-deficit/hyperactivity disorder(ADHD),anxiety,and behavioral disturbances,which can significantly affect development and quality of life.While genetic predisposition has been linked to these comorbidities,growing evidence highlights the role of environmental factors,including prenatal and early-life stressors.However,the interaction between genetic susceptibility and environmental influences remains poorly understood.Identifying specific genetic variants,environmental risks,and their interactions is essential for early detection and targeted interventions.AIM To investigate the combined effects of genetic and environmental factors on psychiatric comorbidities in children with neurodevelopmental delays,elucidate underlying mechanisms,and inform clinical management strategies.METHODS This retrospective cohort study included 80 children with confirmed neurodevelopmental delays and 40 age-and sex-matched typically developing controls.Comprehensive clinical and psychiatric evaluations,genetic testing(chromosomal microarray analysis and targeted next-generation sequencing),and environmental exposure assessments were conducted.Statistical analyses explored associations between genetic variants and psychiatric comorbidities,environmental risk factors,and gene-environment interactions.RESULTS Children with neurodevelopmental delays exhibited significantly higher rates of psychiatric comorbidities(70.0%)compared to controls(15.0%),with ADHD(42.5%),anxiety disorders(28.8%),and behavioral disorders(23.8%)being the most common.Pathogenic genetic variants were identified in specific pathways associated with distinct psychiatric presentations:Glutamatergic signaling variants were linked to anxiety disorders(odds ratio=3.8),dopaminergic system variants to ADHD(odds ratio=4.2),and synaptic function variants to both behavioral and anxiety disorders.Environmental factors,particularly prenatal maternal stress,early childhood adversity,and family dysfunction were strong predictors of psychiatric outcomes(β=0.42).Significant gene-environment interactions were identified,indicating that environmental exposure can moderate the effects of genetic risks on psychiatric outcomes.CONCLUSION Psychiatric comorbidities in children with neurodevelopmental delays are significantly influenced by both genetic and environmental factors,with complex interactions between the two.These findings underscore the need for integrated assessments and targeted interventions addressing both biological and environmental contributors to improve outcomes in this vulnerable population.展开更多
BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors.Research suggests that tumor type has an effect on the prevalence of clinically relevant depression,anxiety,comorbid anxiety-depressio...BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors.Research suggests that tumor type has an effect on the prevalence of clinically relevant depression,anxiety,comorbid anxiety-depression and posttraumatic stress disorder(PTSD).AIM To identify studies that examined the prevalence of clinically relevant levels of depression,anxiety,comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.METHODS Four databases(PubMed,PsycInfo,PubPsych and the Cochrane Database)were searched and resulted in a total of 2387 articles to be screened.To be included,a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities.All articles were screened by two authors with a third author reviewing debated articles.RESULTS Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review.The studies showed heterogeneity regarding the study characteristics,number of participants,time since diagnosis,and assessment tools.Generally,all four comorbidities show higher prevalences in cancer survivors than the general population.Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety.Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities.Regarding comorbidities,a wide range in prevalence existed across the tumor types.Within one cancer site,the prevalence also varied considerably among the studies.CONCLUSION Psychiatric comorbidities are more frequent in cancer survivors than in the general population,as reflected by the prevalence of depression,anxiety,comorbid anxiety-depression and PTSD across all tumor subtypes.Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.展开更多
BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely ...BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.展开更多
The attention deficit hyperactivity disorder (ADHD), one of the most common disorders in the childhood and adolescence population, but also in the reproductive period, affects and influences learning, social relations...The attention deficit hyperactivity disorder (ADHD), one of the most common disorders in the childhood and adolescence population, but also in the reproductive period, affects and influences learning, social relations and their quality of life. There are strong neuropathological similarities between ADHD and various concomitant psychiatric conditions. ADHD frequently coexists with learning and language disabilities, sleep disorders, impulse control personality and anxiety disorders, intellectual disability, substance use disorders and mood disorders, as well as autism spectrum disorders and tic disorders. The overlapping symptoms of ADHD and other morbidities constitute challenges but also an imperative need for the experts to be able to detect and clarify so as to achieve the proper diagnosis and the relative treatment. The expression of the disease differs accordingly depending on the age group and the presence of comorbidities. In school-age, symptoms of ADHD include inattention, hyperactivity, and impulsivity. In adolescence, depending on the gender, hyperactivity decreases but the problems in learning and psychopathology still remain. Therefore, it is recommended that when ADHD coexists with other psychopathologies in childhood and adolescence to first and directly treat the most weakened condition so that the child or the adolescent can change the course of their psychiatric morbidity and improve their ability to function and socialize.展开更多
Psychiatric comorbidity is common in symptombased diagnoses like autism spectrum disorder(ASD),attention/deficit hyper-activity disorder(ADHD),and obsessivecompulsive disorder(OCD).However,these co-occurring symptoms ...Psychiatric comorbidity is common in symptombased diagnoses like autism spectrum disorder(ASD),attention/deficit hyper-activity disorder(ADHD),and obsessivecompulsive disorder(OCD).However,these co-occurring symptoms mediated by shared and/or distinct neural mechanisms are difficult to profile at the individual level.Capitalizing on unsupervised machine learning with a hierarchical Bayesian framework,we derived latent disease factors from resting-state functional connectivity data in a hybrid cohort of ASD and ADHD and delineated individual associations with dimensional symptoms based on canonical correlation analysis.Models based on the same factors generalized to previously unseen individuals in a subclinical cohort and one local OCD database with a subset of patients undergoing neurosurgical intervention.Four factors,identified as variably co-expressed in each patient,were significantly correlated with distinct symptom domains(r=–0.26–0.53,P<0.05):behavioral regulation(Factor-1),communication(Factor-2),anxiety(Factor-3),adaptive behaviors(Factor-4).Moreover,we demonstrated Factor-1 expressed in patients with OCD and Factor-3 expressed in participants with anxiety,at the degree to which factor expression was significantly predictive of individual symptom scores(r=0.18–0.5,P<0.01).Importantly,peri-intervention changes in Factor-1 of OCD were associated with variable treatment outcomes(r=0.39,P<0.05).Our results indicate that these data-derived latent disease factors quantify individual factor expression to inform dimensional symptom and treatment outcomes across cohorts,which may promote quantitative psychiatric diagnosis and personalized intervention.展开更多
It is known that in psychiatry, despite the introduction of standardized system, there is still a portion of diagnostic instability. This study aims to evaluate the stability of psychiatric diagnoses in a cohort of pa...It is known that in psychiatry, despite the introduction of standardized system, there is still a portion of diagnostic instability. This study aims to evaluate the stability of psychiatric diagnoses in a cohort of patients with dual diagnosis, under treatment of the Dependence Department of the Local Health Unit n.8 Veneto, Italy. 34 patients with opioid dependence, in treatment with methadone or buprenorphine, have been evaluated. They had participated to a previous study in 2006, in which psychiatric comorbidity was documented. These 34 patients have been retested with some of the tests already used in 2006： M.I.N.I. （for Axis I） and S.C.I.D. II （for Axis II）. The preceding evaluations and those current have been compared to assess the stability of psychiatric diagnosis. Almost all patients （95%） had at least a change of diagnosis. Psychoses are the most stable diagnoses. Also the substance use disorder is quite stable （80%）. Neuroses are more unstable. Personality disorders showed greater variability. Personality disorders appear more unstable in dual diagnosis. The diagnosis of personality disorder based on DSM, common in drug addicts, requires caution. Anyway, the longitudinal observation is important for a correct diagnosis.展开更多
Autism spectrum disorder(ASD)and psychosis are traditionally considered distinct psychiatric conditions with divergent developmental trajectories,yet emerging evidence suggests they may share overlapping neurodevelopm...Autism spectrum disorder(ASD)and psychosis are traditionally considered distinct psychiatric conditions with divergent developmental trajectories,yet emerging evidence suggests they may share overlapping neurodevelopmental characteristics.This study examined whether the cognitive profile associated with co-occurring autism and first-episode psychosis(FEP)reflects additive or interactive influences of the two conditions.Neuropsychological profiles were compared across four age-,sex-,intelligence quotient-,and education level-matched groups of adolescents and young adults(n=45;aged 13-21):individuals with co-occurring ASD and FEP(FEP-ASD),FEP without ASD(FEP-O),ASD without FEP,and non-autistic controls.The FEP-ASD group exhibited an uneven cognitive profile characterised by relative strengths in visuospatial processing and recognition memory,alongside marked impairments in information processing speed,attentional control,and working memory.This pattern resembled the ASD profile but at a lower overall performance level,consistent with the additive impact of psychosis on ASD-related cognitive characteristics.FEP-ASD participants outperformed FEP-O in recognition memory,a domain usually preserved in ASD but impaired in psychosis.These preliminary findings suggest that co-occurring ASD and psychosis may produce a cognitive profile shaped by influences from both conditions.Larger longitudinal and multimodal studies are needed to clarify the underlying mechanisms.展开更多
文摘BACKGROUND Neurodevelopmental delays encompass a wide range of conditions that impair cognitive,motor,and social functioning,often increasing the risk of psychiatric comorbidities.Children with these delays frequently present with disorders such as attention-deficit/hyperactivity disorder(ADHD),anxiety,and behavioral disturbances,which can significantly affect development and quality of life.While genetic predisposition has been linked to these comorbidities,growing evidence highlights the role of environmental factors,including prenatal and early-life stressors.However,the interaction between genetic susceptibility and environmental influences remains poorly understood.Identifying specific genetic variants,environmental risks,and their interactions is essential for early detection and targeted interventions.AIM To investigate the combined effects of genetic and environmental factors on psychiatric comorbidities in children with neurodevelopmental delays,elucidate underlying mechanisms,and inform clinical management strategies.METHODS This retrospective cohort study included 80 children with confirmed neurodevelopmental delays and 40 age-and sex-matched typically developing controls.Comprehensive clinical and psychiatric evaluations,genetic testing(chromosomal microarray analysis and targeted next-generation sequencing),and environmental exposure assessments were conducted.Statistical analyses explored associations between genetic variants and psychiatric comorbidities,environmental risk factors,and gene-environment interactions.RESULTS Children with neurodevelopmental delays exhibited significantly higher rates of psychiatric comorbidities(70.0%)compared to controls(15.0%),with ADHD(42.5%),anxiety disorders(28.8%),and behavioral disorders(23.8%)being the most common.Pathogenic genetic variants were identified in specific pathways associated with distinct psychiatric presentations:Glutamatergic signaling variants were linked to anxiety disorders(odds ratio=3.8),dopaminergic system variants to ADHD(odds ratio=4.2),and synaptic function variants to both behavioral and anxiety disorders.Environmental factors,particularly prenatal maternal stress,early childhood adversity,and family dysfunction were strong predictors of psychiatric outcomes(β=0.42).Significant gene-environment interactions were identified,indicating that environmental exposure can moderate the effects of genetic risks on psychiatric outcomes.CONCLUSION Psychiatric comorbidities in children with neurodevelopmental delays are significantly influenced by both genetic and environmental factors,with complex interactions between the two.These findings underscore the need for integrated assessments and targeted interventions addressing both biological and environmental contributors to improve outcomes in this vulnerable population.
文摘BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors.Research suggests that tumor type has an effect on the prevalence of clinically relevant depression,anxiety,comorbid anxiety-depression and posttraumatic stress disorder(PTSD).AIM To identify studies that examined the prevalence of clinically relevant levels of depression,anxiety,comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.METHODS Four databases(PubMed,PsycInfo,PubPsych and the Cochrane Database)were searched and resulted in a total of 2387 articles to be screened.To be included,a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities.All articles were screened by two authors with a third author reviewing debated articles.RESULTS Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review.The studies showed heterogeneity regarding the study characteristics,number of participants,time since diagnosis,and assessment tools.Generally,all four comorbidities show higher prevalences in cancer survivors than the general population.Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety.Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities.Regarding comorbidities,a wide range in prevalence existed across the tumor types.Within one cancer site,the prevalence also varied considerably among the studies.CONCLUSION Psychiatric comorbidities are more frequent in cancer survivors than in the general population,as reflected by the prevalence of depression,anxiety,comorbid anxiety-depression and PTSD across all tumor subtypes.Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.
文摘BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
文摘The attention deficit hyperactivity disorder (ADHD), one of the most common disorders in the childhood and adolescence population, but also in the reproductive period, affects and influences learning, social relations and their quality of life. There are strong neuropathological similarities between ADHD and various concomitant psychiatric conditions. ADHD frequently coexists with learning and language disabilities, sleep disorders, impulse control personality and anxiety disorders, intellectual disability, substance use disorders and mood disorders, as well as autism spectrum disorders and tic disorders. The overlapping symptoms of ADHD and other morbidities constitute challenges but also an imperative need for the experts to be able to detect and clarify so as to achieve the proper diagnosis and the relative treatment. The expression of the disease differs accordingly depending on the age group and the presence of comorbidities. In school-age, symptoms of ADHD include inattention, hyperactivity, and impulsivity. In adolescence, depending on the gender, hyperactivity decreases but the problems in learning and psychopathology still remain. Therefore, it is recommended that when ADHD coexists with other psychopathologies in childhood and adolescence to first and directly treat the most weakened condition so that the child or the adolescent can change the course of their psychiatric morbidity and improve their ability to function and socialize.
基金supported by the National Natural Science Foundation(82151303)the National Key R&D Program of China(2021ZD0204002)+3 种基金the Key-Area Research and Development Program of Guangdong Province(2019B030335001)Shanghai Municipal Science and Technology Major Project(2018SHZDZX05)Strategic Priority Research Program of Chinese Academy of Science(XDB32000000)supported in part by the Postdoctoral Fellowship of the Peking-Tsinghua Center for Life Sciences.GSP data were provided by the Brain Genomics Superstruct Project of Harvard University and the Massachusetts General Hospital,(Principal Investigators:Randy Buckner,Joshua Roffman,and Jordan Smoller),with support from the Center for Brain Science Neuroinformatics Research Group,the Athinoula A.Martinos Center for Biomedical Imaging,and GSP Open Access Documentation the Center for Human Genetic Research.20 individual investigators at Harvard and MGH generously contributed data to the overall project.
文摘Psychiatric comorbidity is common in symptombased diagnoses like autism spectrum disorder(ASD),attention/deficit hyper-activity disorder(ADHD),and obsessivecompulsive disorder(OCD).However,these co-occurring symptoms mediated by shared and/or distinct neural mechanisms are difficult to profile at the individual level.Capitalizing on unsupervised machine learning with a hierarchical Bayesian framework,we derived latent disease factors from resting-state functional connectivity data in a hybrid cohort of ASD and ADHD and delineated individual associations with dimensional symptoms based on canonical correlation analysis.Models based on the same factors generalized to previously unseen individuals in a subclinical cohort and one local OCD database with a subset of patients undergoing neurosurgical intervention.Four factors,identified as variably co-expressed in each patient,were significantly correlated with distinct symptom domains(r=–0.26–0.53,P<0.05):behavioral regulation(Factor-1),communication(Factor-2),anxiety(Factor-3),adaptive behaviors(Factor-4).Moreover,we demonstrated Factor-1 expressed in patients with OCD and Factor-3 expressed in participants with anxiety,at the degree to which factor expression was significantly predictive of individual symptom scores(r=0.18–0.5,P<0.01).Importantly,peri-intervention changes in Factor-1 of OCD were associated with variable treatment outcomes(r=0.39,P<0.05).Our results indicate that these data-derived latent disease factors quantify individual factor expression to inform dimensional symptom and treatment outcomes across cohorts,which may promote quantitative psychiatric diagnosis and personalized intervention.
文摘It is known that in psychiatry, despite the introduction of standardized system, there is still a portion of diagnostic instability. This study aims to evaluate the stability of psychiatric diagnoses in a cohort of patients with dual diagnosis, under treatment of the Dependence Department of the Local Health Unit n.8 Veneto, Italy. 34 patients with opioid dependence, in treatment with methadone or buprenorphine, have been evaluated. They had participated to a previous study in 2006, in which psychiatric comorbidity was documented. These 34 patients have been retested with some of the tests already used in 2006： M.I.N.I. （for Axis I） and S.C.I.D. II （for Axis II）. The preceding evaluations and those current have been compared to assess the stability of psychiatric diagnosis. Almost all patients （95%） had at least a change of diagnosis. Psychoses are the most stable diagnoses. Also the substance use disorder is quite stable （80%）. Neuroses are more unstable. Personality disorders showed greater variability. Personality disorders appear more unstable in dual diagnosis. The diagnosis of personality disorder based on DSM, common in drug addicts, requires caution. Anyway, the longitudinal observation is important for a correct diagnosis.
文摘Autism spectrum disorder(ASD)and psychosis are traditionally considered distinct psychiatric conditions with divergent developmental trajectories,yet emerging evidence suggests they may share overlapping neurodevelopmental characteristics.This study examined whether the cognitive profile associated with co-occurring autism and first-episode psychosis(FEP)reflects additive or interactive influences of the two conditions.Neuropsychological profiles were compared across four age-,sex-,intelligence quotient-,and education level-matched groups of adolescents and young adults(n=45;aged 13-21):individuals with co-occurring ASD and FEP(FEP-ASD),FEP without ASD(FEP-O),ASD without FEP,and non-autistic controls.The FEP-ASD group exhibited an uneven cognitive profile characterised by relative strengths in visuospatial processing and recognition memory,alongside marked impairments in information processing speed,attentional control,and working memory.This pattern resembled the ASD profile but at a lower overall performance level,consistent with the additive impact of psychosis on ASD-related cognitive characteristics.FEP-ASD participants outperformed FEP-O in recognition memory,a domain usually preserved in ASD but impaired in psychosis.These preliminary findings suggest that co-occurring ASD and psychosis may produce a cognitive profile shaped by influences from both conditions.Larger longitudinal and multimodal studies are needed to clarify the underlying mechanisms.
