In issues 2 and 3, some interesting and popular topics are presented and they may inspire new ideas in psychiatric research. A systematic review conducted by Dr Chen and her colleagues has drawn much attention to the ...In issues 2 and 3, some interesting and popular topics are presented and they may inspire new ideas in psychiatric research. A systematic review conducted by Dr Chen and her colleagues has drawn much attention to the worldwide media, that it was positive to treat anxiety symptoms by regulating intestinal flora (RIF).展开更多
BACKGROUND Depression is a common mental-health disorder worldwide.Several studies have demonstrated the effects of gut microbiota-targeting interventions,such as probiotics,prebiotics,synbiotics,and postbiotics(PPSP)...BACKGROUND Depression is a common mental-health disorder worldwide.Several studies have demonstrated the effects of gut microbiota-targeting interventions,such as probiotics,prebiotics,synbiotics,and postbiotics(PPSP),on depression.AIM To assess the potential benefits of PPSP on patients diagnosed with depressive disorder.METHODS A literature search of the PubMed,Web of Science,and Elsevier Science Direct databases for relevant studies published from database inception to March 2024 was performed.Studies that used a randomized controlled trial design and eva-luated differences in depression between PPSP and placebo were included.Depressive symptoms were assessed using a validated scale.Analysis was performed using Review Manager version 5.4(The Cochrane Collaboration,2020).RESULTS Fourteen studies comprising 906 patients with depressive symptoms were included.PPSP improved depression compared with placebo[SMD:-0.39(95%CI:-0.60 to-0.17);P<0.001].PPSP resulted in significant reductions in Hamilton Depression Rating Scale[MD:-1.72(95%CI:-2.57 to-0.88);P<0.001]and Beck Depression Inventory[MD:-2.69(95%CI:-4.67 to-0.71);P<0.001]scores.Sub-analysis confirmed the antidepressant effects of probiotics on depressive symp-toms[SMD:-0.32(95%CI:-0.48 to-0.16);P<0.001],with prebiotics exerting no apparent effect[SMD:-0.08(95%CI:-0.39 to-0.23);P=0.62],and synbiotics exerting statistically significant benefits[SMD:-1.09(95%CI:-1.45 to-0.73);P<0.001].CONCLUSION PPSP effectively alleviates depressive symptoms,and subgroup analysis supports the benefits of probiotics and synbiotics.Nevertheless,evidence supporting the use of PPSP for the treatment of depression remains insufficient.展开更多
Bipolar disorder(BD)is a severe mood disorder characterized by recurrent episodes of mania and depression,and it is prone to delayed diagnosis,which can lead to worsened outcomes,including more frequent mood episodes,...Bipolar disorder(BD)is a severe mood disorder characterized by recurrent episodes of mania and depression,and it is prone to delayed diagnosis,which can lead to worsened outcomes,including more frequent mood episodes,greater functional impairment,and comorbidities.Early diagnosis of BD remains a significant challenge,although recent advances offer promising insights,such as research in molecular biomarkers,neuroimaging,exosomes,genetics,and epigenetics.This mini-review highlights their potential for providing earlier,more accurate identification of BD and discusses the underlying reasons why current research has not yet succeeded.For instance,the high heterogeneity of symptomatic presentations leads to low consistency in study participants;delayed BD diagnosis results in the inclusion of potential BD patients in the depression group;low specificity of biomarkers stems from limited understanding of BD pathophysiology;and there is a possibility that BD is not innate but develops over the course of the disease.Deepening our understanding of BD pathology,identifying more specific biomarkers,and integrating multiomics approaches for validation studies in well-defined homogeneous cohorts hold promise for significant breakthroughs.展开更多
BACKGROUND Depression is one of the most common mental disorders,with high rates of disability,particularly among women.AIM To explore the effects of suggestion therapy on anxiety,mood,and sleep-quality in middle-aged...BACKGROUND Depression is one of the most common mental disorders,with high rates of disability,particularly among women.AIM To explore the effects of suggestion therapy on anxiety,mood,and sleep-quality in middle-aged women with depression treated with escitalopram.METHODS Overall,102 female patients with depression aged 35-49 years were divided into control and experimental groups.The control group received oral escitalopram therapy,starting at a dose of 5 mg/day,which was gradually increased to 10-20 mg/day after 1 week for a total of 8 weeks.The experimental group received the suggested therapy based on the control group.The Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS),Profile of Mood States-Short Form,and Pittsburgh Sleep Quality Index(PSQI)were used to assess depression,anxiety,mood status,and sleep quality.RESULTS Before treatment,there were no significant differences in the SDS,SAS,Profile of Mood States,and PSQI scores between the two groups(P>0.05).After treatment,compared to the control group and baseline,the SDS,SAS,tension-anxiety,depression-dejection,and confusion-bewilderment scores in the experimental group significantly decreased(P<0.05),whereas sleep efficiency,sleep disturbance,hypnotics,and PSQI scores significantly increased(P<0.05).CONCLUSION Suggestion therapy combined with escitalopram treatment can reduce the severity of depression and anxiety,change mood status,and improve sleep quality in middle-aged women with depression.展开更多
BACKGROUND Very late-onset schizophrenia-like psychosis(VLOSLP)is a subtype of schizophrenia spectrum disorders in which individuals experience psychotic symptoms for the first time after the age of 60.The incidence o...BACKGROUND Very late-onset schizophrenia-like psychosis(VLOSLP)is a subtype of schizophrenia spectrum disorders in which individuals experience psychotic symptoms for the first time after the age of 60.The incidence of VLOSLP shows a linear relationship with increasing age.However,no studies have reported alterations in spontaneous brain activity among VLOSLP patients and their correlation with cognitive function and clinical symptoms.AIM To explore VLOSLP brain activity and correlations with cognitive function and clinical symptoms using resting-state functional magnetic resonance imaging.METHODS This study included 33 VLOSLP patients and 34 healthy controls.The cognitive assessment utilized the Mini Mental State Examination,Montreal Cognitive Assessment,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).Clinical characteristic acquisition was performed via the Positive and Negative Syndrome Scale(PANSS).All participants were scanned via resting-state functional magnetic resonance imaging,and the data were processed using amplitude of low-frequency fluctuations(ALFF),fractional ALFF(fALFF),regional homogeneity,and voxelmirrored homotopic connectivity(VMHC).RESULTS The VLOSLP group presented decreased ALFF values in the left cuneus,right precuneus,right precentral gyrus,and left paracentral lobule;increased fALFF values in the left caudate nucleus;decreased fALFF values in the right calcarine fissure and surrounding cortex(CAL)and right precuneus;increased regional homogeneity values in the right putamen;and decreased VMHC values in the bilateral CAL,bilateral superior temporal gyrus,and bilateral cuneus.In the VLOSLP group,ALFF values in the right precuneus were negatively correlated with Mini Mental State Examination score and PANSS positive subscale score,and VMHC values in the bilateral CAL were negatively correlated with the RBANS total score,RBANS delayed memory score,and PANSS positive subscale score.CONCLUSION The changes of brain activity in VLOSLP are concentrated in the right precuneus and bilateral CAL regions,which may be associated with cognitive impairment and clinically positive symptoms.展开更多
It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to...It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to represent a possible link in this respect. The anculeated platelets are the smallest corpuscular elements circulating in the human blood. They display different serotonergic markers which seem to reflect the central nervous serotonin metabolism. They are known as main effectors in haematological processes but recent research highlights their role in the innate and adaptive immune system. Platelets are containing a multitude of pro-inflammatory and immune-modulatory bioactive compounds in their granules and are expressing immune-competent surface markers. Research gives hint that platelets activation and reactivity is increased by mental stress. This leads to enhanced cross talk with the immune system via paracrine secretion, receptor interaction and formation of platelet leucocyteaggregates. Recently it has been demonstrated that the immune system can have a remarkable impact in the development of psychiatric disorders. Thereforeplatelets represent an interesting research area in psychiatry and their role as a possible biomarker has been investigated. We review the influence of mental stress on what is termed platelet bioactivity in this article, which subsumes the mainly immune-modulatory activity of platelets in healthy volunteers, elderly persons with chronic care-giving strain, patients with cardiovascular diseases who are prone to psychosocial stress, as well as in patients with posttraumatic stress disorder. Research data suggest that stress enhances platelet activity, reactivity and immune-modulatory capacities.展开更多
Background Non-suicidal self-injury(NSSI)is a frequent and prominent phenomenon in major depressive disorder(MDD).Even though its prevalence and risk factors are relatively well understood,the potential mechanisms of ...Background Non-suicidal self-injury(NSSI)is a frequent and prominent phenomenon in major depressive disorder(MDD).Even though its prevalence and risk factors are relatively well understood,the potential mechanisms of NSSI in MDD remain elusive.Aims To review present evidence related to the potential mechanisms of NSSI in MDD.Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines,articles for this systematic review were searched on Medline(through PubMed),Embase(through Elsevier),PsycINFO(through OVID)and Web of Science databases for English articles,as well as China National Knowledge Infrastructure(CNKI),SinoMed,Wanfang Data,and the Chongqing VIP Chinese Science and Technology Periodical(VIP)Databases for Chinese articles published from the date of inception to 2 August 2022.Two researchers(BW,HZ)independently screened studies based on inclusion and exclusion criteria and assessed their quality.Results A total of 25157 studies were searched.Only 25 of them were ultimately included,containing 3336 subjects(1535 patients with MDD and NSSI,1403 patients with MDD without NSSI and 398 HCs).Included studies were divided into 6 categories:psychosocial factors(11 studies),neuroimaging(8 studies),stress and hypothalamic-pituitary-adrenal(HPA)axis(2 studies),pain perception(1 study),electroencephalogram(EEG)(2 studies)and epigenetics(1 study).Conclusions This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors,aberrant brain functions and neurochemical metabolisms,HPA axis dysfunctions,abnormal pain perceptions and epigenetic alterations.展开更多
Schizophrenia is a severe mental illness which can have a devastating impact onan individual’s quality of life. Comorbidities are high amongst patients and lifeexpectancy is approximately 15 years less than the gener...Schizophrenia is a severe mental illness which can have a devastating impact onan individual’s quality of life. Comorbidities are high amongst patients and lifeexpectancy is approximately 15 years less than the general population. Despite thewell-known increased mortality, little is known about the impact of gastrointestinaland liver disease on patients with schizophrenia. We aimed to reviewthe literature and to make recommendations regarding future care. Literaturesearches were performed on PubMed to identify studies related to gastrointestinaland liver disease in patients with schizophrenia. High rates of chronic liverdisease were reported, with Non-Alcoholic Fatty Liver Disease being of particularconcern;antipsychotics and metabolic syndrome were contributing factors. Ratesof acute liver failure were low but have been associated with antipsychotic useand paracetamol overdose. Coeliac disease has historically been linked to schizophrenia;however, recent research suggests that a causal link is yet to be proven.Evidence is emerging regarding the relationships between schizophrenia andpeptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome;clinical vigilance regarding these conditions should be high. Patients with schizophreniapoorly engage with bowel cancer screening programmes, leading to latediagnosis and increased mortality. Clozapine induced constipation is a significantissue for many patients and requires close monitoring. There is a significantburden of gastrointestinal and liver disease amongst patients with schizophrenia.Better levels of support from all members of the medical team are essential toensure that appropriate, timely care is provided.展开更多
Neurosyphilis can mimic many neurological and psychiatric disorders.Though several of its varied central nervous system manifestations can be measured clinically and by neuroimaging,they are non-specific.Thus,this mim...Neurosyphilis can mimic many neurological and psychiatric disorders.Though several of its varied central nervous system manifestations can be measured clinically and by neuroimaging,they are non-specific.Thus,this mimicry and the relative rarity of the illness in the present era make the diagnosis elusive.However,neurosyphilis is readily treatable;therefore,it must be considered a diagnostic possibility in the routine workup of early-onset dementia.This case report is of a young man presenting with psychosis and cognitive impairment.His brain scan showed hippocampal atrophy,a finding not often seen in neurosyphilis but more common in Alzheimer’s disease.Without awareness of the various causes of mesiotemporal atrophy,clinicians may erroneously diagnose cases such as this one as a neurodegenerative disorder.展开更多
AIM： To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms. METHODS： Forty patients with liver cirrhosis （LC, with or without lo...AIM： To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms. METHODS： Forty patients with liver cirrhosis （LC, with or without low-grade hepatic encephalopathy） were investigated using a clinical neuro-psychiatric rating scale based on a comprehensive list of neurological, psychomotor, cognitive, affective, behavioral symptoms, and symptoms of disturbed bioregulation. RESULTS： The analysis revealed that the majodty of cirrhotic patients showed, besides characteristic neurological symptoms of hepatic encephalopathy, various psychomotor, affective and bioregulatory symptoms （disturbed sleep and sexual dysfunction）. Patients were impaired in the following subscales： sleep and biorhythm disorder （75.0% of patients）, Parkinsonoid symptoms （25.0%）, affective symptoms （17.5%）, and psychomotor retardation （12.5%）. The increase of total neuro-psychiatric clinical score was significantly associated with the degree of hepatic encephalopathy. CONCLUSION： This study suggests that a substantial number of patients with LC and low-grade hepatic encephalopathy manifest various clinical neuro-psychiatric symptoms. The use of a rating scale, which explores clinical dimensions of hepatic encephalopathy, would improve the management of patients with LC.展开更多
Increasing observational and experimental trial data have shownthat mental stress can lead toan increase in adverse clinical cardiovascular events.Mental stress affects the heart by inducing ischaemia and precipitatin...Increasing observational and experimental trial data have shownthat mental stress can lead toan increase in adverse clinical cardiovascular events.Mental stress affects the heart by inducing ischaemia and precipitating myocardial infarction(MI)or direct myocardial injury.Mental stress leads to systemic inflammation.Inflammation is known to cause rapid atheromatous plaque progression,instability and thrombosis—the classic type 1 MI.Inflammation can also lead to type 2 MI or myocarditis and injury.The published data linking systemic inflammation,mental stress and cardiovascular disease will be reviewed to establish the linkage between mind and heart,thereby highlighting the importance of holistically managing the patient,not only addressing separate organ systems.Finally,recent trial evidence showing the value of anti-inflammatory drugs in cardiovascular and mental conditions will be briefly considered.展开更多
Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach ...Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach of concept analysis was applied.Results:OB was defined as a chronic form of work-related stress.Accurately,it was characterized by emotional exhaustion,depersonalization/cynicism,and reduced personal accomplishment/inefficacy.Antecedents of burnout included(a)demographic characteristics;(b)chronic exposure to work-related stressors;(c)quantitative and qualitative job demands;(d)lack of job resources;and(e)personality traits.Consequences involved(a)individual’s unfavorable quality of life;(b)negative impact on the organization;and(c)poor services quality.Although the Maslach Burnout Inventory(MBI)is perceived as an ideal tool to measure burnout and hence,it is used worldwide,whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed.Conclusions:By proposing a comprehensive definition of the concept,this analysis contributes to recognition of the process of OB of nurses.All nurses are vulnerable to OB.Hence,burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care.It proposes that the prevention of OB would be achieved through team communication training,mindfulness group,education,etc.展开更多
AIM: To study the effectiveness of Reitman Centre "Coaching, Advocacy, Respite, Education, Relationship, and Simulation"(CARERS) program, which uses problem-solving techniques and simulation to train informa...AIM: To study the effectiveness of Reitman Centre "Coaching, Advocacy, Respite, Education, Relationship, and Simulation"(CARERS) program, which uses problem-solving techniques and simulation to train informal dementia carers. METHODS: Seventy-three carers for family members with dementia were included in the pilot study. Preand post-intervention data were collected from carers using validated measures of depression, mastery, role captivity and overload, caregiving competence and burden, and coping styles. To assess program effec-tiveness, mean differences for these measures were calculated. One-way ANOVA was used to determine if change in scores is dependent on the respective baseline scores. Clinical effects for measures were expressed as Cohen's D values. RESULTS: Data from 73 carers were analyzed. The majority of these participants were female(79.5%). A total of 69.9% were spouses and 30.1% were children of the care recipient. Participants had an overall mean age of 68.34 ± 12.01 years. About 31.5% of participating carers had a past history of psychiatric illness(e.g., depression), and 34.2% sustained strained relationships with their respective care recipients. Results from carers demonstrated improvement in carers' selfperception of competence(1.26 ± 1.92, P < 0.0001), and significant reduction in emotion-focused coping(measured by the Coping Inventory of Stressful Situations,-2.37 ± 6.73, P < 0.01), Geriatric Depression scale(-0.67 ± 2.63, P < 0.05) and Pearlin's overload scale(-0.55 ± 2.07, P < 0.05), upon completion of the Program. Secondly, it was found that carers with more compromised baseline scores benefited most from the intervention, as they experienced statistically significant improvement in the following constructs: competence, stress-coping style(less emotion-oriented), sense of mastery, burden, overload. CONCLUSION: Study results supported the effectiveness of the CARERS Program in improving caregiving competence, stress coping ability and mental well-being in carers caring for family members with dementia.展开更多
Background Schizophrenia is a serious mental illness affecting approximately 20 million individuals globally.Both genetic and environmental factors contribute to the illness.If left undiagnosed and untreated,schizophr...Background Schizophrenia is a serious mental illness affecting approximately 20 million individuals globally.Both genetic and environmental factors contribute to the illness.If left undiagnosed and untreated,schizophrenia results in impaired social function,repeated hospital admissions,reduced quality of life and decreased life expectancy.Clinical diagnosis largely relies on subjective evidence,including self-reported experiences,and reported behavioural abnormalities followed by psychiatric evaluation.In addition,psychoses may occur along with other conditions,and the symptoms are often episodic and transient,posing a significant challenge to the precision of diagnosis.Therefore,objective,specific tests using biomarkers are urgently needed for differential diagnosis of schizophrenia in clinical practice.Aims We aimed to provide evidence-based and consensus-based recommendations,with a summary of laboratory measurements that could potentially be used as biomarkers for schizophrenia,and to discuss directions for future research.Methods We searched publications within the last 10 years with the following keywords:‘schizophrenia’,‘gene’,‘inflammation’,‘neurotransmitter’,‘protein marker’,‘gut microbiota’,‘pharmacogenomics’and‘biomarker’.A draft of the consensus was discussed and agreed on by all authors at a round table session.Results We summarised the characteristics of candidate diagnostic markers for schizophrenia,including genetic,inflammatory,neurotransmitter,peripheral protein,pharmacogenomic and gut microbiota markers.We also proposed a novel laboratory process for diagnosing schizophrenia in clinical practice based on the evidence summarised in this paper.Conclusions Further efforts are needed to identify schizophrenia-specific genetic and epigenetic markers for precise diagnosis,differential diagnosis and ethnicity-specific markers for the Chinese population.The development of novel laboratory techniques is making it possible to use these biomarkers clinically to diagnose disease.展开更多
Background Patients with C0VID-19 are at high risk of developing mental health problems;however,the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear.Aims We aime...Background Patients with C0VID-19 are at high risk of developing mental health problems;however,the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear.Aims We aimed to investigate the mental health problems of patients infected with C0VID-19 and to identify the role of psychiatrists in the clinical treatment team during the pandemic.We also share the experience of psychiatric consultations of patients with COVID-19 in Shanghai,China.Methods We analysed data from the psychiatric medical records of 329 patients with COVID-19 in the Shanghai Public Health Clinical Center from 20 January to 8 March 2020.We collected information including sociodemographic characteristics,whether patients received psychiatric consultation,mental health symptoms,psychiatric diagnoses,psychiatric treatments and severity level of COVID-19.Results Psychiatric consultations were received by 84(25.5%)patients with COVID-19.The most common symptoms of mental health problems were sleep disorders(75%),anxiety(58.3%)and depressive symptoms(11.9%).The psychiatric consultation rate was highest in critically ill patients(69.2%),with affective symptoms or disturbed behaviour as their main mental health problems.Psychiatric diagnoses for patients who received consultation included acute stress reaction(39.3%),sleep disorders(33.3%),anxiety(15.5%),depression(7.1%)and delirium(4.8%).In terms of psychiatric treatments,86.9%of patients who received psychiatric consultation were treated with psychotropic medications,including non-benzodiazepine sedative-hypnotic agents(54.8%),antidepressants(26.2%),benzodiazepines(22.6%)and antipsychotics(10.7%).Among the 76 patients who were discharged from the hospital,79%had recovered from mental health problems and were not prescribed any psychotropic medications.The symptoms of the remaining 21%of patients had improved and they were prescribed medications to continue the treatment.Conclusions This is the first study to report psychiatric consultations for patients with COVID-19.Our study indicated that a considerable proportion of patients with COVID-19,especially critically ill cases,experienced mental health problems.Given the remarkable effect of psychiatric treatments,we recommend that psychiatrists be timely and actively involved in the treatment of COVID-19.展开更多
AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rap...AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic encephalopathy.METHODS: A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was investigated.RESULTS: Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy. CONCLUSION: The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.展开更多
Voice hearing, a complex perceptual phenomenon, is reportedly common in the general population yet understudied in nursing. Nurses meet voice hearers from diverse cultures;their understandings influence assessment. Th...Voice hearing, a complex perceptual phenomenon, is reportedly common in the general population yet understudied in nursing. Nurses meet voice hearers from diverse cultures;their understandings influence assessment. The aim was to explore voice hearing in everyday life in a non-patient population, revealing insights for assessing voice hearing. Method: Interview data was transcribed, translated into English and analyzed by qualitative content analysis. Outcome measures are thematic descriptions. Results: Voice hearing over time involved past (about year 2000) and recent (2009) time periods. Four main themes were: “Transitioning from not-being-at home when home alone to being at-home”, “Shifting overtime from frequent, repetitive voice hearing to inferquent intermittent voice hearing overtime”, “Changing from being disempowered to being empowered” and “Progressing from absence of significant others to presence of significant others”. Study Limitations: Interviewing a single participant residing in Scandinavia produced in-depth descriptions consistent with the study’s aim. The participant had no known psychiatric diagnosis and had not received mental health care when recruited and interviewed. However, we cannot be certain that her voice hearing was or was not non-pathological which raises issues concerning truth value of the study. Conclusions: The results reflect life world existential themes of lived time, lived space, lived body and lived human relation, and offers a framework for guiding and challenging nurses’ assessments of voice hearing. Voice hearing can be understood as a bereavement-grief response. Further research is needed in western and non-western cultures and non-patient populations.展开更多
Schizophrenia patients have difficulties in focusing their attention, when distracting information must be ignored. Although it is adaptive in some situations to monitor the background for potentially relevant changes...Schizophrenia patients have difficulties in focusing their attention, when distracting information must be ignored. Although it is adaptive in some situations to monitor the background for potentially relevant changes to a certain degree, voluntary attentional processes seem to be more severely disrupted by distracting information in schizophrenia patients compared to healthy controls. Reorienting processes associated with the detection of potentially relevant information outside the current focus of attention have previously shown to activate a bilateral prefronto-parietal network. The aim of the current study was to investigate whether this network is dysregulated in schizophrenia patients using fMRI during the performance in a combined oddball-incongruence task, in which relevant processing must be shielded from distracting irrelevant salient or conflicting information. During the occurrence of both oddballs and incongruence patients exhibited an increased activation of the intraparietal cortex—a saliency sensitive part of the prefronto-parietal network associated with background-monitoring. As this hyperactivation was accompanied by an increased activation in the dopaminergic midbrain, the results of our study link the finding of a hyperactive salience sensitive cortical region to the finding of the hyperdopaminergic state in schizophrenia, supporting the predominant view of psychosis as a state of aberrant salience.展开更多
文摘In issues 2 and 3, some interesting and popular topics are presented and they may inspire new ideas in psychiatric research. A systematic review conducted by Dr Chen and her colleagues has drawn much attention to the worldwide media, that it was positive to treat anxiety symptoms by regulating intestinal flora (RIF).
文摘BACKGROUND Depression is a common mental-health disorder worldwide.Several studies have demonstrated the effects of gut microbiota-targeting interventions,such as probiotics,prebiotics,synbiotics,and postbiotics(PPSP),on depression.AIM To assess the potential benefits of PPSP on patients diagnosed with depressive disorder.METHODS A literature search of the PubMed,Web of Science,and Elsevier Science Direct databases for relevant studies published from database inception to March 2024 was performed.Studies that used a randomized controlled trial design and eva-luated differences in depression between PPSP and placebo were included.Depressive symptoms were assessed using a validated scale.Analysis was performed using Review Manager version 5.4(The Cochrane Collaboration,2020).RESULTS Fourteen studies comprising 906 patients with depressive symptoms were included.PPSP improved depression compared with placebo[SMD:-0.39(95%CI:-0.60 to-0.17);P<0.001].PPSP resulted in significant reductions in Hamilton Depression Rating Scale[MD:-1.72(95%CI:-2.57 to-0.88);P<0.001]and Beck Depression Inventory[MD:-2.69(95%CI:-4.67 to-0.71);P<0.001]scores.Sub-analysis confirmed the antidepressant effects of probiotics on depressive symp-toms[SMD:-0.32(95%CI:-0.48 to-0.16);P<0.001],with prebiotics exerting no apparent effect[SMD:-0.08(95%CI:-0.39 to-0.23);P=0.62],and synbiotics exerting statistically significant benefits[SMD:-1.09(95%CI:-1.45 to-0.73);P<0.001].CONCLUSION PPSP effectively alleviates depressive symptoms,and subgroup analysis supports the benefits of probiotics and synbiotics.Nevertheless,evidence supporting the use of PPSP for the treatment of depression remains insufficient.
基金Supported by Research Plan Project of Tianjin Municipal Education Commission,No.2022KJ264.
文摘Bipolar disorder(BD)is a severe mood disorder characterized by recurrent episodes of mania and depression,and it is prone to delayed diagnosis,which can lead to worsened outcomes,including more frequent mood episodes,greater functional impairment,and comorbidities.Early diagnosis of BD remains a significant challenge,although recent advances offer promising insights,such as research in molecular biomarkers,neuroimaging,exosomes,genetics,and epigenetics.This mini-review highlights their potential for providing earlier,more accurate identification of BD and discusses the underlying reasons why current research has not yet succeeded.For instance,the high heterogeneity of symptomatic presentations leads to low consistency in study participants;delayed BD diagnosis results in the inclusion of potential BD patients in the depression group;low specificity of biomarkers stems from limited understanding of BD pathophysiology;and there is a possibility that BD is not innate but develops over the course of the disease.Deepening our understanding of BD pathology,identifying more specific biomarkers,and integrating multiomics approaches for validation studies in well-defined homogeneous cohorts hold promise for significant breakthroughs.
文摘BACKGROUND Depression is one of the most common mental disorders,with high rates of disability,particularly among women.AIM To explore the effects of suggestion therapy on anxiety,mood,and sleep-quality in middle-aged women with depression treated with escitalopram.METHODS Overall,102 female patients with depression aged 35-49 years were divided into control and experimental groups.The control group received oral escitalopram therapy,starting at a dose of 5 mg/day,which was gradually increased to 10-20 mg/day after 1 week for a total of 8 weeks.The experimental group received the suggested therapy based on the control group.The Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS),Profile of Mood States-Short Form,and Pittsburgh Sleep Quality Index(PSQI)were used to assess depression,anxiety,mood status,and sleep quality.RESULTS Before treatment,there were no significant differences in the SDS,SAS,Profile of Mood States,and PSQI scores between the two groups(P>0.05).After treatment,compared to the control group and baseline,the SDS,SAS,tension-anxiety,depression-dejection,and confusion-bewilderment scores in the experimental group significantly decreased(P<0.05),whereas sleep efficiency,sleep disturbance,hypnotics,and PSQI scores significantly increased(P<0.05).CONCLUSION Suggestion therapy combined with escitalopram treatment can reduce the severity of depression and anxiety,change mood status,and improve sleep quality in middle-aged women with depression.
基金Supported by Wuxi Municipal Health Commission Major Project,No.202107and Wuxi Taihu Talent Project,No.WXTTP 2021.
文摘BACKGROUND Very late-onset schizophrenia-like psychosis(VLOSLP)is a subtype of schizophrenia spectrum disorders in which individuals experience psychotic symptoms for the first time after the age of 60.The incidence of VLOSLP shows a linear relationship with increasing age.However,no studies have reported alterations in spontaneous brain activity among VLOSLP patients and their correlation with cognitive function and clinical symptoms.AIM To explore VLOSLP brain activity and correlations with cognitive function and clinical symptoms using resting-state functional magnetic resonance imaging.METHODS This study included 33 VLOSLP patients and 34 healthy controls.The cognitive assessment utilized the Mini Mental State Examination,Montreal Cognitive Assessment,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).Clinical characteristic acquisition was performed via the Positive and Negative Syndrome Scale(PANSS).All participants were scanned via resting-state functional magnetic resonance imaging,and the data were processed using amplitude of low-frequency fluctuations(ALFF),fractional ALFF(fALFF),regional homogeneity,and voxelmirrored homotopic connectivity(VMHC).RESULTS The VLOSLP group presented decreased ALFF values in the left cuneus,right precuneus,right precentral gyrus,and left paracentral lobule;increased fALFF values in the left caudate nucleus;decreased fALFF values in the right calcarine fissure and surrounding cortex(CAL)and right precuneus;increased regional homogeneity values in the right putamen;and decreased VMHC values in the bilateral CAL,bilateral superior temporal gyrus,and bilateral cuneus.In the VLOSLP group,ALFF values in the right precuneus were negatively correlated with Mini Mental State Examination score and PANSS positive subscale score,and VMHC values in the bilateral CAL were negatively correlated with the RBANS total score,RBANS delayed memory score,and PANSS positive subscale score.CONCLUSION The changes of brain activity in VLOSLP are concentrated in the right precuneus and bilateral CAL regions,which may be associated with cognitive impairment and clinically positive symptoms.
文摘It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to represent a possible link in this respect. The anculeated platelets are the smallest corpuscular elements circulating in the human blood. They display different serotonergic markers which seem to reflect the central nervous serotonin metabolism. They are known as main effectors in haematological processes but recent research highlights their role in the innate and adaptive immune system. Platelets are containing a multitude of pro-inflammatory and immune-modulatory bioactive compounds in their granules and are expressing immune-competent surface markers. Research gives hint that platelets activation and reactivity is increased by mental stress. This leads to enhanced cross talk with the immune system via paracrine secretion, receptor interaction and formation of platelet leucocyteaggregates. Recently it has been demonstrated that the immune system can have a remarkable impact in the development of psychiatric disorders. Thereforeplatelets represent an interesting research area in psychiatry and their role as a possible biomarker has been investigated. We review the influence of mental stress on what is termed platelet bioactivity in this article, which subsumes the mainly immune-modulatory activity of platelets in healthy volunteers, elderly persons with chronic care-giving strain, patients with cardiovascular diseases who are prone to psychosocial stress, as well as in patients with posttraumatic stress disorder. Research data suggest that stress enhances platelet activity, reactivity and immune-modulatory capacities.
基金This study was funded by Shanghai Science and Technology Committee(grant no.20ZR1448500,YDZX20213100001003,22YF1439100)the National Natural Science Foundation of China(grant no.82201678).
文摘Background Non-suicidal self-injury(NSSI)is a frequent and prominent phenomenon in major depressive disorder(MDD).Even though its prevalence and risk factors are relatively well understood,the potential mechanisms of NSSI in MDD remain elusive.Aims To review present evidence related to the potential mechanisms of NSSI in MDD.Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines,articles for this systematic review were searched on Medline(through PubMed),Embase(through Elsevier),PsycINFO(through OVID)and Web of Science databases for English articles,as well as China National Knowledge Infrastructure(CNKI),SinoMed,Wanfang Data,and the Chongqing VIP Chinese Science and Technology Periodical(VIP)Databases for Chinese articles published from the date of inception to 2 August 2022.Two researchers(BW,HZ)independently screened studies based on inclusion and exclusion criteria and assessed their quality.Results A total of 25157 studies were searched.Only 25 of them were ultimately included,containing 3336 subjects(1535 patients with MDD and NSSI,1403 patients with MDD without NSSI and 398 HCs).Included studies were divided into 6 categories:psychosocial factors(11 studies),neuroimaging(8 studies),stress and hypothalamic-pituitary-adrenal(HPA)axis(2 studies),pain perception(1 study),electroencephalogram(EEG)(2 studies)and epigenetics(1 study).Conclusions This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors,aberrant brain functions and neurochemical metabolisms,HPA axis dysfunctions,abnormal pain perceptions and epigenetic alterations.
文摘Schizophrenia is a severe mental illness which can have a devastating impact onan individual’s quality of life. Comorbidities are high amongst patients and lifeexpectancy is approximately 15 years less than the general population. Despite thewell-known increased mortality, little is known about the impact of gastrointestinaland liver disease on patients with schizophrenia. We aimed to reviewthe literature and to make recommendations regarding future care. Literaturesearches were performed on PubMed to identify studies related to gastrointestinaland liver disease in patients with schizophrenia. High rates of chronic liverdisease were reported, with Non-Alcoholic Fatty Liver Disease being of particularconcern;antipsychotics and metabolic syndrome were contributing factors. Ratesof acute liver failure were low but have been associated with antipsychotic useand paracetamol overdose. Coeliac disease has historically been linked to schizophrenia;however, recent research suggests that a causal link is yet to be proven.Evidence is emerging regarding the relationships between schizophrenia andpeptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome;clinical vigilance regarding these conditions should be high. Patients with schizophreniapoorly engage with bowel cancer screening programmes, leading to latediagnosis and increased mortality. Clozapine induced constipation is a significantissue for many patients and requires close monitoring. There is a significantburden of gastrointestinal and liver disease amongst patients with schizophrenia.Better levels of support from all members of the medical team are essential toensure that appropriate, timely care is provided.
文摘Neurosyphilis can mimic many neurological and psychiatric disorders.Though several of its varied central nervous system manifestations can be measured clinically and by neuroimaging,they are non-specific.Thus,this mimicry and the relative rarity of the illness in the present era make the diagnosis elusive.However,neurosyphilis is readily treatable;therefore,it must be considered a diagnostic possibility in the routine workup of early-onset dementia.This case report is of a young man presenting with psychosis and cognitive impairment.His brain scan showed hippocampal atrophy,a finding not often seen in neurosyphilis but more common in Alzheimer’s disease.Without awareness of the various causes of mesiotemporal atrophy,clinicians may erroneously diagnose cases such as this one as a neurodegenerative disorder.
文摘AIM： To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms. METHODS： Forty patients with liver cirrhosis （LC, with or without low-grade hepatic encephalopathy） were investigated using a clinical neuro-psychiatric rating scale based on a comprehensive list of neurological, psychomotor, cognitive, affective, behavioral symptoms, and symptoms of disturbed bioregulation. RESULTS： The analysis revealed that the majodty of cirrhotic patients showed, besides characteristic neurological symptoms of hepatic encephalopathy, various psychomotor, affective and bioregulatory symptoms （disturbed sleep and sexual dysfunction）. Patients were impaired in the following subscales： sleep and biorhythm disorder （75.0% of patients）, Parkinsonoid symptoms （25.0%）, affective symptoms （17.5%）, and psychomotor retardation （12.5%）. The increase of total neuro-psychiatric clinical score was significantly associated with the degree of hepatic encephalopathy. CONCLUSION： This study suggests that a substantial number of patients with LC and low-grade hepatic encephalopathy manifest various clinical neuro-psychiatric symptoms. The use of a rating scale, which explores clinical dimensions of hepatic encephalopathy, would improve the management of patients with LC.
文摘Increasing observational and experimental trial data have shownthat mental stress can lead toan increase in adverse clinical cardiovascular events.Mental stress affects the heart by inducing ischaemia and precipitating myocardial infarction(MI)or direct myocardial injury.Mental stress leads to systemic inflammation.Inflammation is known to cause rapid atheromatous plaque progression,instability and thrombosis—the classic type 1 MI.Inflammation can also lead to type 2 MI or myocarditis and injury.The published data linking systemic inflammation,mental stress and cardiovascular disease will be reviewed to establish the linkage between mind and heart,thereby highlighting the importance of holistically managing the patient,not only addressing separate organ systems.Finally,recent trial evidence showing the value of anti-inflammatory drugs in cardiovascular and mental conditions will be briefly considered.
基金This project was supported by Medical Research Fund of Guangdong Province(No.A2018440).
文摘Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach of concept analysis was applied.Results:OB was defined as a chronic form of work-related stress.Accurately,it was characterized by emotional exhaustion,depersonalization/cynicism,and reduced personal accomplishment/inefficacy.Antecedents of burnout included(a)demographic characteristics;(b)chronic exposure to work-related stressors;(c)quantitative and qualitative job demands;(d)lack of job resources;and(e)personality traits.Consequences involved(a)individual’s unfavorable quality of life;(b)negative impact on the organization;and(c)poor services quality.Although the Maslach Burnout Inventory(MBI)is perceived as an ideal tool to measure burnout and hence,it is used worldwide,whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed.Conclusions:By proposing a comprehensive definition of the concept,this analysis contributes to recognition of the process of OB of nurses.All nurses are vulnerable to OB.Hence,burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care.It proposes that the prevention of OB would be achieved through team communication training,mindfulness group,education,etc.
基金Supported by Social Development Partnerships Program,Human Resources and Skills Development Canada,No.8470775
文摘AIM: To study the effectiveness of Reitman Centre "Coaching, Advocacy, Respite, Education, Relationship, and Simulation"(CARERS) program, which uses problem-solving techniques and simulation to train informal dementia carers. METHODS: Seventy-three carers for family members with dementia were included in the pilot study. Preand post-intervention data were collected from carers using validated measures of depression, mastery, role captivity and overload, caregiving competence and burden, and coping styles. To assess program effec-tiveness, mean differences for these measures were calculated. One-way ANOVA was used to determine if change in scores is dependent on the respective baseline scores. Clinical effects for measures were expressed as Cohen's D values. RESULTS: Data from 73 carers were analyzed. The majority of these participants were female(79.5%). A total of 69.9% were spouses and 30.1% were children of the care recipient. Participants had an overall mean age of 68.34 ± 12.01 years. About 31.5% of participating carers had a past history of psychiatric illness(e.g., depression), and 34.2% sustained strained relationships with their respective care recipients. Results from carers demonstrated improvement in carers' selfperception of competence(1.26 ± 1.92, P < 0.0001), and significant reduction in emotion-focused coping(measured by the Coping Inventory of Stressful Situations,-2.37 ± 6.73, P < 0.01), Geriatric Depression scale(-0.67 ± 2.63, P < 0.05) and Pearlin's overload scale(-0.55 ± 2.07, P < 0.05), upon completion of the Program. Secondly, it was found that carers with more compromised baseline scores benefited most from the intervention, as they experienced statistically significant improvement in the following constructs: competence, stress-coping style(less emotion-oriented), sense of mastery, burden, overload. CONCLUSION: Study results supported the effectiveness of the CARERS Program in improving caregiving competence, stress coping ability and mental well-being in carers caring for family members with dementia.
基金This study was funded by Shanghai Natural Science fund Project under grant(20ZR1447700)The National Key Development Plan for Precision Medicine Research(2017YFC0910002)+4 种基金the hospital-level project of Shanghai Mental Health Center under grant(2020-YJ05)Special Fund for Clinical Research of Wu Jieping Medical Foundation(320675015232)the Hospital level project of Shanghai Mental Health Center(2016-YJ-09)Chinese medicine research project of Shanghai Health and Family Planning Commission(2018LP024)the characteristic discipline construction project of Shanghai Mental Health Center(2017-TSXK-07),China Public Health Alliance(first batch)(GWLM202014).
文摘Background Schizophrenia is a serious mental illness affecting approximately 20 million individuals globally.Both genetic and environmental factors contribute to the illness.If left undiagnosed and untreated,schizophrenia results in impaired social function,repeated hospital admissions,reduced quality of life and decreased life expectancy.Clinical diagnosis largely relies on subjective evidence,including self-reported experiences,and reported behavioural abnormalities followed by psychiatric evaluation.In addition,psychoses may occur along with other conditions,and the symptoms are often episodic and transient,posing a significant challenge to the precision of diagnosis.Therefore,objective,specific tests using biomarkers are urgently needed for differential diagnosis of schizophrenia in clinical practice.Aims We aimed to provide evidence-based and consensus-based recommendations,with a summary of laboratory measurements that could potentially be used as biomarkers for schizophrenia,and to discuss directions for future research.Methods We searched publications within the last 10 years with the following keywords:‘schizophrenia’,‘gene’,‘inflammation’,‘neurotransmitter’,‘protein marker’,‘gut microbiota’,‘pharmacogenomics’and‘biomarker’.A draft of the consensus was discussed and agreed on by all authors at a round table session.Results We summarised the characteristics of candidate diagnostic markers for schizophrenia,including genetic,inflammatory,neurotransmitter,peripheral protein,pharmacogenomic and gut microbiota markers.We also proposed a novel laboratory process for diagnosing schizophrenia in clinical practice based on the evidence summarised in this paper.Conclusions Further efforts are needed to identify schizophrenia-specific genetic and epigenetic markers for precise diagnosis,differential diagnosis and ethnicity-specific markers for the Chinese population.The development of novel laboratory techniques is making it possible to use these biomarkers clinically to diagnose disease.
基金This work was supported by Shanghai Clinical Research Center for Mental Health,Shanghai,China(SCRC-MH(19MC1911100)).
文摘Background Patients with C0VID-19 are at high risk of developing mental health problems;however,the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear.Aims We aimed to investigate the mental health problems of patients infected with C0VID-19 and to identify the role of psychiatrists in the clinical treatment team during the pandemic.We also share the experience of psychiatric consultations of patients with COVID-19 in Shanghai,China.Methods We analysed data from the psychiatric medical records of 329 patients with COVID-19 in the Shanghai Public Health Clinical Center from 20 January to 8 March 2020.We collected information including sociodemographic characteristics,whether patients received psychiatric consultation,mental health symptoms,psychiatric diagnoses,psychiatric treatments and severity level of COVID-19.Results Psychiatric consultations were received by 84(25.5%)patients with COVID-19.The most common symptoms of mental health problems were sleep disorders(75%),anxiety(58.3%)and depressive symptoms(11.9%).The psychiatric consultation rate was highest in critically ill patients(69.2%),with affective symptoms or disturbed behaviour as their main mental health problems.Psychiatric diagnoses for patients who received consultation included acute stress reaction(39.3%),sleep disorders(33.3%),anxiety(15.5%),depression(7.1%)and delirium(4.8%).In terms of psychiatric treatments,86.9%of patients who received psychiatric consultation were treated with psychotropic medications,including non-benzodiazepine sedative-hypnotic agents(54.8%),antidepressants(26.2%),benzodiazepines(22.6%)and antipsychotics(10.7%).Among the 76 patients who were discharged from the hospital,79%had recovered from mental health problems and were not prescribed any psychotropic medications.The symptoms of the remaining 21%of patients had improved and they were prescribed medications to continue the treatment.Conclusions This is the first study to report psychiatric consultations for patients with COVID-19.Our study indicated that a considerable proportion of patients with COVID-19,especially critically ill cases,experienced mental health problems.Given the remarkable effect of psychiatric treatments,we recommend that psychiatrists be timely and actively involved in the treatment of COVID-19.
文摘AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic encephalopathy.METHODS: A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was investigated.RESULTS: Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy. CONCLUSION: The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.
文摘Voice hearing, a complex perceptual phenomenon, is reportedly common in the general population yet understudied in nursing. Nurses meet voice hearers from diverse cultures;their understandings influence assessment. The aim was to explore voice hearing in everyday life in a non-patient population, revealing insights for assessing voice hearing. Method: Interview data was transcribed, translated into English and analyzed by qualitative content analysis. Outcome measures are thematic descriptions. Results: Voice hearing over time involved past (about year 2000) and recent (2009) time periods. Four main themes were: “Transitioning from not-being-at home when home alone to being at-home”, “Shifting overtime from frequent, repetitive voice hearing to inferquent intermittent voice hearing overtime”, “Changing from being disempowered to being empowered” and “Progressing from absence of significant others to presence of significant others”. Study Limitations: Interviewing a single participant residing in Scandinavia produced in-depth descriptions consistent with the study’s aim. The participant had no known psychiatric diagnosis and had not received mental health care when recruited and interviewed. However, we cannot be certain that her voice hearing was or was not non-pathological which raises issues concerning truth value of the study. Conclusions: The results reflect life world existential themes of lived time, lived space, lived body and lived human relation, and offers a framework for guiding and challenging nurses’ assessments of voice hearing. Voice hearing can be understood as a bereavement-grief response. Further research is needed in western and non-western cultures and non-patient populations.
文摘Schizophrenia patients have difficulties in focusing their attention, when distracting information must be ignored. Although it is adaptive in some situations to monitor the background for potentially relevant changes to a certain degree, voluntary attentional processes seem to be more severely disrupted by distracting information in schizophrenia patients compared to healthy controls. Reorienting processes associated with the detection of potentially relevant information outside the current focus of attention have previously shown to activate a bilateral prefronto-parietal network. The aim of the current study was to investigate whether this network is dysregulated in schizophrenia patients using fMRI during the performance in a combined oddball-incongruence task, in which relevant processing must be shielded from distracting irrelevant salient or conflicting information. During the occurrence of both oddballs and incongruence patients exhibited an increased activation of the intraparietal cortex—a saliency sensitive part of the prefronto-parietal network associated with background-monitoring. As this hyperactivation was accompanied by an increased activation in the dopaminergic midbrain, the results of our study link the finding of a hyperactive salience sensitive cortical region to the finding of the hyperdopaminergic state in schizophrenia, supporting the predominant view of psychosis as a state of aberrant salience.
