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Urges psychiatry to get back to human nature because the concept, together with the idea of human freedom and classic and romantic perspectives, is required to calibrate the normal and the pathological in psychiatry. Highlights balance by showing how ‘sickly’ (Goethe) pictures of human nature and human freedom have adverse effects on psychiatry, including its interface with political life. Revisits the classicl and romantic perspectives, considering them in and out of balance in different ways. Distils a tripartite picture of the relationship between human nature, human freedom and mental disorder relevant to future research and teaching on psychiatric formulation and psychiatric ethics.
Mood and anxiety disorders co-occur and share symptoms, treatments and genetic risk, but it is unclear whether combining them into a single phenotype would better capture genetic variation. The contribution of common genetic variation to these disorders has been investigated using a range of measures; however, the differences in their ability to capture variation remain unclear, while the impact of rare variation is mostly unexplored.
Aims
We aimed to explore the contributions of common genetic variation and copy number variations associated with risk of psychiatric morbidity (P-CNVs) to different measures of internalising disorders.
Method
We investigated eight definitions of mood and anxiety disorder, and a combined internalising disorder, derived from self-report questionnaires, diagnostic assessments and electronic healthcare records (EHRs). Association of these definitions with polygenic risk scores (PRSs) of major depressive disorder and anxiety disorder, as well as presence of a P-CNV, was assessed.
Results
The effect sizes of both PRSs and P-CNVs were similar for mood and anxiety disorder. Compared to mood and anxiety disorder, internalising disorder resulted in higher prediction accuracy for PRSs, and increased significance of associations with P-CNVs for most definitions. Comparison across the eight definitions showed that PRSs had higher prediction accuracy and effect sizes for stricter definitions, whereas P-CNVs were more strongly associated with EHR- and self-report-based definitions.
Conclusions
Future studies may benefit from using a combined internalising disorder phenotype, and may need to consider that different phenotype definitions may be more informative depending on whether common or rare variation is studied.
Early pregnancy loss is a common but distressing occurrence. Caring thoughtfully for women and others experiencing pregnancy loss and being able to listen to and understand their concerns can make a real and positive difference. Communication is key: communicating with patients clearly and thoughtfully, and delivering unexpected or bad news sensitively is hugely important. Health professionals may need to talk with and support patients and partners as they make difficult decisions within a short period of time, so should feel confident in talking about procedures including the benefits and risks of treatment. Equally, it is important for health professionals dealing with difficult situations to know how and where to find support for themselves, and to be aware of the resources the Miscarriage Association provides to both patients and professionals.
We studied posttraumatic stress symptoms (PTSS) and disorder (PTSD), associated factors, and quality of life (QOL) of a group of passengers (n = 58) affected by the 2023 Odisha train accident, comparing it with health professionals (n = 42) such as doctors and nurses who treated them, and individuals from the local community (n = 65). We also checked the anxiety and depression of passengers.
Methods
In a cross-sectional study, we assessed accident experience and used the PTSD checklist, WHO-QOL-BREF, General Anxiety Disorder, and Patient Health Questionnaire scales.
Results
The PTSS were common; specifically, intrusive memories (36.4%), feeling upset while reminded of the experience (33.9%), and avoidance of memories (30.9%). Strong negative feelings, loss of interest, feeling distant, and irritability or anger outbursts were significantly more common among passengers than others. PTSD was present in 20.7% of passengers, 19.0% of health professionals, and 7.7% of local participants. Seeing dead bodies significantly contributed to PTSD. Clinical levels of anxiety (58.3%) and depression (50%) were present in passengers, which were significantly associated with PTSD, along with fear of death. Passengers had the worst QOL and health satisfaction among the groups.
Conclusions
Following the train accident, stress-related psychiatric problems were common and highlighted the intervention needs of the affected people.
The COVID-19 pandemic disrupted the population’s lives. Stressful conditions during the lockdown and the reintroduction to a changed social environment emotionally affected children and adolescents. The aim of this work was to study anxiety and depressive symptoms in Italian, Spanish, and Portuguese children and adolescents aged 3 to 18 years at different moments of the COVID-19 pandemic: April 2020 (during confinement), September 2020 (with the schools’ reopening), and September 2023 (with the situation restored). Parents of 1,097 children participated in at least one assessment, completing measures of child emotional symptoms online. Cases with subclinical symptoms of anxiety and depression were higher compared to pre-pandemic studies. Overall, anxiety increased from April 2020 to September 2020, decreasing in September 2023 with no differences compared to the first assessment. Depression was high in April 2020 but decreased in September 2020, with no significant differences three years later, in September 2023. Cross-country comparisons at each point are discussed. Moreover, boys showed higher levels of depression during the pandemic compared to girls. Older children, compared to younger ones, had more anxiety and depressive symptoms throughout all the moments. These findings highlight the emotional impact of the pandemic and its conditions on children and adolescents.
Early depression screening and risk stratification of modifiable risk factors during pregnancy for women at risk of perinatal mental health conditions is important to ensure safe care delivery during prenatal care and into the postpartum period. Using psychotherapy and antidepressants together with care to avoid multiple psychotrophic medications can limit exposure of medications during pregnancy while ensuring adequate treatment of depression and other mood disorders.
Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.
Methods
A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.
Results
Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.
Conclusions
The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.
Psychological and existential distress is prevalent among patients with life-threatening cancer, significantly impacting their quality of life. Psilocybin-assisted therapy has shown promise in alleviating these symptoms. This systematic review aims to synthesize the evidence on the efficacy and safety of psilocybin in reducing cancer-related distress.
Methods
We searched MEDLINE, APA PsycINFO, Cochrane database, Embase, and Scopus from inception to February 8, 2024, for randomized controlled trials (RCTs), open-label trials, qualitative studies, and single case reports that evaluated psilocybin for cancer-related distress. Data were extracted on study characteristics, participant demographics, psilocybin and psychotherapy intervention, outcome measures, and results. Two authors independently screened, selected, and extracted data from the studies. Cochrane Risk of Bias for RCTs and Methodological Index for Non-Randomized Studies criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42024511692).
Results
Fourteen studies met the inclusion criteria, comprising three RCTs, five open-label trials, five qualitative studies, and one single case report. Psilocybin therapy consistently showed significant reductions in depression, anxiety, and existential distress, with improvements sustained over several months. Adverse effects were generally mild and transient.
Significance of results
This systematic review highlights the potential of psilocybin-assisted therapy as an effective treatment for reducing psychological and existential distress in cancer patients. Despite promising findings, further large-scale, well-designed RCTs are needed to confirm these results and address existing research gaps.
Fluvial flooding is a recurring event in the Aie River basin in Assam, India. On August 14, 2021, floodwater breached a large stretch of embankment in the Bongaigaon District and inundated several villages. Using a cross-sectional design to conduct household surveys in February and March 2022, the study investigates responses six to seven months following the August 2021 flood disasters. The purpose of this study is to determine the prevalence and risk factors of four psychological health outcomes. Being flooded is strongly and adversely associated with each of these mental health outcomes. After adjusting for the potential confounders, the strength of the relationships is reduced to four times (adjusted OR 4.62 [95% CI 2.63–8.1]; p < 0.01) for PTSD, five times (adjusted OR 5.28[95% CI 3.38–8.26]; p < 0.01) for anxiety, and three times (adjusted OR 3.45[95% CI 2.24–5.33]; p < 0.01) for depression, and 21 times for comorbid PTSD, anxiety, and depression (adjusted OR 21.68[95% CI 7.38–63.74]; p < 0.01). The robustness of flood exposure is checked in an extended model. It includes variables that indicate the severity of flooding and various secondary stressors. The present study also explores the effects of ‘loss stressors’ such as crop loss, workday loss, livestock loss, and damage to infrastructure. Located in a resource-constrained setting, the effects of these factors add value to the study. Longer duration of floodwater in the house premise increases the odds of developing anxiety (adjusted OR 1.69[95% CI 1.04–2.75]; p < 0.05) and depression (adjusted OR 1.9[95% CI 1.15–3.12]; p < 0.05). Similarly, deeper floodwater inside the house increases the odds of depression (adjusted OR 1.87[95% CI 1.07–3.28]; p < 0.05). Among all the ‘loss’ stressors, damage to houses and the cost of repairing is significantly associated with PTSD (adjusted OR 2.04[95% CI 1.09–3.82]; p < 0.05), depression (adjusted OR 2.17[95% CI 1.22–3.87]; p < 0.01) and comorbid PTSD, anxiety and depression (adjusted OR 2.16[95% CI 1.07–4.36]; p < 0.05).
Pubertal development variations have consequences for adolescent internalizing problems, which likely continue into adulthood. Key questions concern the extent of these links between pubertal timing and adult symptoms, as well as the underlying mechanisms.
Methods
Longitudinal data were available for 475 female and 404 male participants. Pubertal timing was indicated by age at mid-puberty for both groups and age at menarche for female participants (both assessed continuously). Adult self-reported outcomes of recent and lifetime depression and anxiety were predicted from pubertal timing, also controlling for adolescent (then childhood) internalizing problems. Emerging adulthood self-esteem, body dissatisfaction, education level, and age at sexual initiation were examined as mediators of the pubertal timing-adult internalizing link. Multilevel models tested hypotheses.
Results
Pubertal timing had persisting and sex-dependent psychological associations. Specifically, in female, but not male, adults, early puberty was associated with all adult internalizing outcomes, and for past year and lifetime depression symptoms, even after controlling for adolescent internalizing problems. Pubertal timing links with past-year depression symptoms were mediated by age at sexual initiation, while all other persisting pubertal timing links with adult symptoms were mediated by body dissatisfaction. Most findings concerning depression held when childhood internalizing problems were also a covariate.
Conclusions
Leveraging data spanning four developmental periods, findings highlight the associations between pubertal variations and adult internalizing symptoms by revealing underlying sex-dependent behavioral pathways. Only for female participants did pubertal timing affect depression and anxiety in established adulthood, with body dissatisfaction and age at sexual initiation as unique developmental mechanisms.
Health workers are one of the work groups that have the biggest role in overcoming the crises that occur with disasters. It is very critical for health care workers to be healthy, happy and productive both for overcoming crises with minimal damage and for a healthy society. This study aimed to examine the anxiety levels of health care workers after the Kahramanmaraş earthquake and to evaluate the effect of earthquake anxiety on the level of perceived stress and work-family conflict.
Methods
It is a cross-sectional study. The sample of this study, which was conducted approximately 9 months after the earthquake, consisted of 150 health care workers working in a private hospital in Gaziantep.
Results
It was observed that the post-earthquake anxiety levels of health care workers were above average. It has been found that earthquake anxiety significantly affects both perceived stress and the level of work-family conflict. Additionally, it was determined that the explanatory nature of the model increased by 4.5% with the inclusion of perceived stress and educational level on the effect of earthquake anxiety on work-family conflict.
Conclusions
More research is needed to evaluate the mental state of health care workers after the earthquake, to ensure positive development and to put forward appropriate strategies.
In this chapter we examine the idea of Hoarding Disorder. This relatively new diagnosis was first described in the American Psychiatric Association’s Diagnostic and Statistical Manual which was published in 2013. Hoarding Disorder is used to describe hoarding which is associated with an extreme attachment to items which are hoarded. Although people with Hoarding Disorder may suffer from other problems such as depression and anxiety, in Hoarding Disorder it is thought that the hoarding is not due to another diagnosis or problem. However, how Hoarding Disorder can present with other diagnoses, as well as the concept of conditions with increased risk taking and impulsivity and how they can be linked, even in the same person with increased compulsivity and avoidance of risk. Because the concept of Hoarding Disorder has only been described relatively recently, there is a lack of research in this area. Whereas Hoarding Disorder is often described in the elderly or late middle-aged, it is thought to have its roots in childhood. In this chapter we will examine the presentation of Hoarding Disorder in all age groups.
As well as examining the description and diagnosis of Hoarding Disorder, in this chapter we will also look at the risks inherent in the hoarding itself as well as the risk of suicide. Theories and research about the possible causes of Hoarding Disorder will be discussed.
This study aims to determine the effect of death anxiety on the life satisfaction of individuals living in 11 provinces declared as earthquake zones in Turkey.
Methods
This cross-sectional and correlational study was conducted with 435 participants in earthquake zones in Turkey. Data were collected online through Google Forms using a sociodemographic form, the Revised Death Anxiety Scale (RDAS), and the Satisfaction with Life Scale (SWLS).
Results
In this study, it was determined that 48.5% of the participants exhibited moderate levels of death anxiety. The participants’ average score on the RDAS was 53.97 (SD = 16.21), and their mean score on the SWLS was 12.30 (SD = 4.33).
Conclusions
This study showed that death anxiety adversely affects life satisfaction. Higher death anxiety among participants was associated with lower satisfaction with life. Consequently, health care professionals should offer increased psychological and communication support to individuals who have experienced significant disasters like earthquakes.
As the use of guided digitally-delivered cognitive-behavioral therapy (GdCBT) grows, pragmatic analytic tools are needed to evaluate coaches’ implementation fidelity.
Aims
We evaluated how natural language processing (NLP) and machine learning (ML) methods might automate the monitoring of coaches’ implementation fidelity to GdCBT delivered as part of a randomized controlled trial.
Method
Coaches served as guides to 6-month GdCBT with 3,381 assigned users with or at risk for anxiety, depression, or eating disorders. CBT-trained and supervised human coders used a rubric to rate the implementation fidelity of 13,529 coach-to-user messages. NLP methods abstracted data from text-based coach-to-user messages, and 11 ML models predicting coach implementation fidelity were evaluated.
Results
Inter-rater agreement by human coders was excellent (intra-class correlation coefficient = .980–.992). Coaches achieved behavioral targets at the start of the GdCBT and maintained strong fidelity throughout most subsequent messages. Coaches also avoided prohibited actions (e.g. reinforcing users’ avoidance). Sentiment analyses generally indicated a higher frequency of coach-delivered positive than negative sentiment words and predicted coach implementation fidelity with acceptable performance metrics (e.g. area under the receiver operating characteristic curve [AUC] = 74.48%). The final best-performing ML algorithms that included a more comprehensive set of NLP features performed well (e.g. AUC = 76.06%).
Conclusions
NLP and ML tools could help clinical supervisors automate monitoring of coaches’ implementation fidelity to GdCBT. These tools could maximize allocation of scarce resources by reducing the personnel time needed to measure fidelity, potentially freeing up more time for high-quality clinical care.
Anxiety disorders are among the most common mental disorders worldwide, and most previous studies have focused solely on alcohol drinking or tobacco smoking as risk factors for anxiety.
Aim
This study investigated the associations of alcohol drinking and tobacco smoking with anxiety.
Method
The data of 30 836 individuals in the Taiwan Biobank were retrieved and analysed in our study. To investigate the associations of tobacco and alcohol use with anxiety, we analysed Patient Health Questionnaire 4 (specifically scores for the first two questions assessing generalised anxiety disorder) results of the included participants and data on their tobacco and alcohol use, and other covariates.
Results
Participants who used only tobacco and those using both tobacco and alcohol were more likely to experience anxiety than were those who did not use tobacco or alcohol. Among men, the use of alcohol and/or tobacco was associated with a significantly higher risk of anxiety. Among women, the use of both alcohol and tobacco was associated with a significantly higher risk of anxiety. Older age was associated with a lower risk of anxiety.
Conclusions
Tobacco and alcohol use significantly influence the risk of anxiety, particularly in men, and older age also influences this risk. The associations of anxiety with tobacco and alcohol use in women may change because of the increasing prevalence of their use among women in Taiwan in recent years.
Late-life affective disorders (LLADs) are common and are projected to increase by 2050. There have been several studies linking late-life depression to an increased risk of dementia, but it is unclear if bipolar affective disorder or anxiety disorders pose a similar risk.
Aims
We aimed to compare the risk of LLADs progressing to all-cause dementia, and the demographic and clinical variables mediating the risk.
Methods
We used the South London and Maudsley National Health Service Foundation Trust Clinical Records Interactive Search system to identify patients aged 60 years or older with a diagnosis of any affective disorder. Cox proportional hazard models were used to determine differences in dementia risk between late-life anxiety disorders versus late-life depression, and late-life bipolar disorder versus late-life depression. Demographic and clinical characteristics associated with the risk of dementia were investigated.
Results
Some 5695 patients were identified and included in the final analysis. Of these, 388 had a diagnosis of bipolar affective disorder, 1365 had a diagnosis of an anxiety disorder and 3942 had a diagnosis of a depressive disorder. Bipolar affective disorder was associated with a lower hazard of developing dementia compared to depression (adjusted model including demographics and baseline cognition, hazard ratio: 0.60; 95% CI: 0.41–0.87). Anxiety disorders had a similar hazard of developing dementia (adjusted hazard ratio: 1.05; 95% CI: 0.90–1.22). A prior history of a depressive disorder reduced the risk of late-life depression progressing to dementia – suggesting the new onset of a depressive disorder in later life is associated with higher risk – but a prior history of anxiety disorders or bipolar affective disorder did not alter risk.
Conclusions
LLADs have a differential risk of developing all-cause dementia, with demographic- and illness-related factors influencing the risk. Further prospective cohort studies are needed to explore the link between LLADs and dementia development, and mediators of the lower risk of dementia associated with late-life bipolar disorder compared to late-life depression.
While many children in Africa face notable psychological problems, the majority do not receive needed mental health services. The My FRIENDS Youth Program, a universal cognitive-behavioral intervention for anxiety prevention and resilience enhancement, has demonstrated effectiveness across cultures in children and adolescents. This study explores whether the program’s effectiveness extends to Zambian children. Participants were 75 children and adolescents (53% female, ages 10–15) attending low-income schools in Zambia. Four schools were randomly assigned to an intervention (n = 44) or waitlist control (n = 31). The intervention consisted of 10 weekly sessions plus two booster sessions administered in group format. Assessments were conducted at pre-intervention, immediately post-intervention and 3-month follow-up. Data were analyzed using longitudinal multilevel modeling and controlled for child and parent sociodemographic characteristics. Intervention participation did not lead to reductions in anxiety, depression or parent-child relationship conflict but was associated with reductions in parent-reported internalizing and externalizing symptoms, attention problems and increases in positive parent-child relationships. However, both the intervention and control groups exhibited lower anxiety symptoms from Post-Intervention to 3-Month Follow-Up, suggesting potentially delayed effects. Future research may need to adapt this intervention to meet the needs of children in Zambia.
Loneliness can be found in many life experiences, such as loss, rejection, illness, failure, as well as in success, creativity, or meditation. This chapter is unique because it includes loneliness as part of the social and emotional intelligences. The author helps readers shift their perception of loneliness from something to be avoided or defended against to a necessary exploration of their solitude in the universe. Solitude is argued as a necessary experience for developing social and emotional intelligences. This chapter explores the benefits of solitude for wellbeing and growth across the lifespan.
Because pediatric anxiety disorders precede the onset of many other problems, successful prediction of response to the first-line treatment, cognitive-behavioral therapy (CBT), could have a major impact. This study evaluates whether structural and resting-state functional magnetic resonance imaging can predict post-CBT anxiety symptoms.
Methods
Two datasets were studied: (A) one consisted of n = 54 subjects with an anxiety diagnosis, who received 12 weeks of CBT, and (B) one consisted of n = 15 subjects treated for 8 weeks. Connectome predictive modeling (CPM) was used to predict treatment response, as assessed with the PARS. The main analysis included network edges positively correlated with treatment outcome and age, sex, and baseline anxiety severity as predictors. Results from alternative models and analyses are also presented. Model assessments utilized 1000 bootstraps, resulting in a 95% CI for R2, r, and mean absolute error (MAE).
Results
The main model showed a MAE of approximately 3.5 (95% CI: [3.1–3.8]) points, an R2 of 0.08 [−0.14–0.26], and an r of 0.38 [0.24–0.511]. When testing this model in the left-out sample (B), the results were similar, with an MAE of 3.4 [2.8–4.7], R2−0.65 [−2.29–0.16], and r of 0.4 [0.24–0.54]. The anatomical metrics showed a similar pattern, where models rendered overall low R2.
Conclusions
The analysis showed that models based on earlier promising results failed to predict clinical outcomes. Despite the small sample size, this study does not support the extensive use of CPM to predict outcomes in pediatric anxiety.
The cumulative effects of long-term exposure to pandemic-related stressors and the severity of social restrictions may have been important determinants of mental distress in the time of COVID-19.
Aim
This study aimed to investigate mental health among a cohort of Chinese university students over a 28-month period, focusing on the effects of lockdown type.
Methods
Depression, anxiety, stress and fear of COVID-19 infection were measured ten times among 188 Chinese students (females 77.7%, meanage = 19.8, s.d.age = 0.97), every 3 months: from prior to the emergence of COVID-19 in November 2019 (T1) to March 2022 (T10).
Results
Initially depression, anxiety and stress dipped from T1 to T2, followed by a sudden increase at T3 and a slow upward rise over the remainder of the study period (T3 to T10). When locked down at university, participants showed greater mental distress compared with both home lockdown (d = 0.35–0.48) and a no-lockdown comparison period (d = 0.28–0.40). Conversely, home lockdown was associated with less anxiety and stress (d = 0.19 and 0.21, respectively), but not with depression (d = 0.13) compared with a no-lockdown period.
Conclusions
This study highlights the cumulative effects of exposure to COVID-19 stressors over time. It also suggests that the way in which a lockdown is carried out can impact the well-being of those involved. Some forms of lockdown appear to pose a greater threat to mental health than others.