Second-generation antipsychotics for Parkinson's disease psychosis: A systematic review and network meta-analysis.

OBJECTIVE: This network meta-analysis assessed the efficacy, tolerability, and acceptability of second-generation antipsychotics (SGAs) for Parkinson's disease psychosis (PDP). METHODS: We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials investigating SGAs for PDP up to October 26, 2023. RESULTS: We included 16 trials (N = 1252) investigating clozapine, melperone, olanzapine, pimavanserin, quetiapine, ulotaront, and placebo. In comparisons between SGAs and placebo, the findings were: i) Standardized mean differences, 95% confidence intervals (SMDs, 95%CIs), for psychotic-symptom reduction revealed the first rank of clozapine (-1.31, -1.73 to -0.89), the second rank of pimavanserin, with significant inferiority of quetiapine (SMD = 0.47, 0.02 to 0.92); ii) Mean differences (MDs, 95%CIs) for abnormal movement, as assessed by the Unified Parkinson's Disease Rating Scale - Part III, indicated that clozapine had the least motor side effects (-0.92, -2.75 to 0.91); iii) Risk ratios (RRs, 95% CIs) for adverse-effect dropout rates were lowest for melperone (1.02, 0.20 to 5.24); and iv) RRs (95% CIs) for all-cause dropout rates were lowest for clozapine (0.73, 0.42 to 1.25). CONCLUSIONS: For patients with PDP, clozapine may substantially reduce psychotic symptoms with minimal abnormal movement, high acceptability, and moderate overall tolerability. Pimavanserin, not quetiapine, could be an alternative.

Medical students' attitude towards psychiatry: a comparison of past and present.

Attitude to psychiatry influences motivation for medical students to successfully achieve in studying psychiatry. With a new generation of students, it would be interesting to investigate how attitudes have changed. This study aimed to compare the attitude of fifth-year medical students toward psychiatry in recent and in the past 24 years. Two samples of fifth-year medical students at Chiang Mai University completed the 30-item attitude to psychiatry (ATP-30); 118 students completed it in 1996, whereas 242 medical students completed it in 2019. Rasch analysis was employed for examining the differences between the total score and individual item scores between the two groups. The total score of ATP in the 2019 group was significantly higher than that in the 1996 group. After misfitting individuals and biased items were removed, only 15 items were valid and useful for a comparison. Of 15 items, 11 were found highly significantly different between two groups (p < 0.001). Negatively worded items, e.g., no strong evidence indicating effectiveness, became easier to score items (increased positive attitude) whereas some positively worded items, e.g., I would like to be a psychiatrist. Nine items, became more difficult (less positive attitude) comparing between 1996 and 2019. In a comparison between the two methods using the traditional t-test and Rasch analysis, only 5 of 30 items (16.7%) agreed with each other. The overall attitude to psychiatry was significantly higher at the present compared with that in the past. Most items did not differ between the two times. Further studies regarding improving the attitude scale using item response theory such as Rasch should be encouraged.

Convergent Validity of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire (PHQ-9) in Pregnant and Postpartum Women: Their Construct Correlations with Functional Disability.

This study aimed to evaluate the convergent validity of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in Thai pregnant and postpartum women, using the 12-item WHO Disability Assessment Schedule (WHODAS) as the reference standard. Participants completed the EPDS, PHQ-9, and WHODAS during the third trimester of pregnancy (over 28 weeks in gestational age) and six weeks postpartum. The sample included 186 and 136 participants for the antenatal and postpartum data analyses, respectively. The antenatal and postpartum data showed moderate correlations between both the EPDS and the PHQ-9 scores and the WHODAS scores (Spearman's correlation coefficients = 0.53-0.66, p < 0.001). The EPDS and PHQ-9 were moderately accurate in distinguishing disability (WHODAS score ≥ 10) from non-disability (WHODAS score < 10) in pregnant and postpartum participants, but the area under the curve of the PHQ-9 receiver operating characteristic curves in postpartum participants was significantly larger than that of the EPDS, with a difference (95% CI; p-value) of 0.08 (0.16, 0.01; p = 0.044). In conclusion, the EPDS and PHQ-9 are valid for assessing PND-related disability in pregnant and postpartum women. The PHQ-9 may perform better than the EPDS in distinguishing disability from non-disability in postpartum women.

Serum oxytocin and corticotropin-releasing hormone levels in the third trimester of pregnancy for predicting postpartum depression in Thai women.

PURPOSE: This prospective observational study aimed to determine whether serum oxytocin (OT) or corticotrophin-releasing hormone (CRH) levels in the third trimester of pregnancy (or late pregnancy) could prospectively predict postpartum depression (PPD) at six weeks after childbirth. METHODS: We measured late pregnancy OT and CRH levels in Thai women, assessed depression using the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9), and collected mothers, labor, and newborn data. At six weeks postpartum, an EPDS score ≥ 11 or PHQ-9 score ≥ 10 was defined as the presence of PPD. Multivariable binary logistic regression analysis was performed to determine the predictors of PPD. RESULTS: Of 200 participants, 136 (68.0%) were reassessed at six weeks postpartum, and 19 of them (14.0%) had PPD. Of the 19 participants with PPD, 9 met the EPDS criterion only, 3 met the PHQ-9 criterion only, and 7 met both criteria. OT levels were not significantly different between those with and without PPD (p = 0.35). CRH levels (aOR = 1.011, 95% CI = 1.001-1.023, p = 0.041), DASS-21 stress (aOR = 1.259, 95% CI = 1.132-1.400, p < 0.001), and APGAR at 1 min (aOR = 0.425, 95% CI = 0.240-0.752, p = 0.003) were significant predictors of PPD. CONCLUSIONS: Only high CRH but not OT levels in late pregnancy may predict 6-week PPD. However, combining these CRH levels, late pregnancy stress, and newborn well-being immediately after birth seems to increase the accuracy of PPD prediction.

Borderline Personality Disorder Symptoms and Its Clinical Correlates among Chinese University Students: A Cross-Sectional Study.

Borderline personality disorder (BPD) is common among young adults. Related studies showed a wide range of prevalence among university students. Few studies regarding BPD symptoms and their correlations with different variables have been reported in the Chinese population. A cross-sectional, online survey was conducted on a sample of university students in China between November 2021 and January 2022. Sociodemographic questionnaires, the Screening Instrument for Borderline Personality Disorder (SI-Bord), the 18-item Experience in Close Relationships-Revised (ECR-R-18), the Meaning In Life Questionnaire (MLQ), the 10-item Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-9), the Rosenberg Self-Esteem Scale (RSES) and the Resilience Inventory (RI-9) were completed. Data were analyzed using Pearson's correlation methods. Among 767 participants, mean age was 20.33 ± 1.495 years, and the majority were males (53.5%). According to the SI-Bord's cut-off score >7, BPD symptoms were found in 17.5% of participants. Attachment anxiety, avoidance, depression, perceived stress, lack of meaning in life, resilience and self-esteem were significantly correlated with BPD symptoms with r's of 0.473, 0.180, 0.451, 0.481, −0.148, −0.238 and −0.388, respectively (all p's < 0.01). The prevalence of BPD symptoms is high among Chinese university students and significantly associated with mental health outcomes, suggesting that an early detection of BPD symptoms is necessary for this population.

Living through the psychological consequences of COVID-19 pandemic: a systematic review of effective mitigating interventions.

OBJECTIVE: This review assesses interventions and their effectiveness in mitigating psychological consequences from pandemic. METHOD: Published English literatures were searched from four databases (Medline, PubMed, Embase and PsycINFO) from January 2020 and September 2021. A total of 27 papers with 29 studies (one paper reported three studies) met inclusion criteria. Cochrane risk-of-bias tool is applied to assess the quality of all randomised controlled trials (RCT). RESULTS: All studies were recently conducted in 2020. Publications were from high-income (13, 44.8%), upper middle-income (12, 41.4%) and lower middle-income countries (3, 10.3%) and global (1, 3.5%). Half of the studies conducted for general population (51.7%). One-third of studies (8, 27.6%) provided interventions to patients with COVID-19 and 20.7% to healthcare workers. Of the 29 studies, 14 (48.3%) were RCT. All RCTs were assessed for risk of biases; five studies (15, 35.7%) had low risk as measured against all six dimensions reflecting high-quality study.Of these 29 studies, 26 diagnostic or screening measures were applied; 8 (30.9%) for anxiety, 7 (26.9%) for depression, 5 (19.2%) for stress, 5 (19.2%) for insomnia and 1 (3.8%) for suicide. Measures used to assess the baseline and outcomes of interventions were standardised and widely applied by other studies with high level of reliability and validity. Of 11 RCT studies, 10 (90.9%) showed that anxiety interventions significantly lowered anxiety in intervention groups. Five of the six RCT studies (83.3%) had significantly reduced the level of depression. Most interventions for anxiety and stress were mindfulness and meditation based. CONCLUSIONS: Results from RCT studies (11%, 78.6%) were effective in mitigating psychological consequences from COVID-19 pandemic when applied to healthcare workers, patients with COVID-19 and general population. These effective interventions can be applied and scaled up in other country settings through adaptation of modes of delivery suitable to country resources, pandemic and health system context.

Antidepressants for depressed patients with type 2 diabetes mellitus: A systematic review and network meta-analysis of short-term randomized controlled trials.

This network meta-analysis compared the short-term treatment effects of different antidepressants on depression severity and HbA1c in depressed patients with type 2 diabetes mellitus (T2DM). We searched 8- to 24-week randomized-controlled trials (RCTs) in PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov on November 22, 2021. We included 12 RCTs (N = 792) studying agomelatine, citalopram, escitalopram, fluoxetine, nortriptyline, no treatment, paroxetine, sertraline, vortioxetine, and placebo. Compared to placebo, the standardized mean differences and 95% confidence intervals (SMD, 95%CIs) for depression severity reduction revealed that escitalopram ranked first (-2.93, -3.92 to -1.94), followed by agomelatine (-0.68, -1.15 to -0.20). Compared to placebo, the mean differences (MDs, 95%CIs) for HbA1c reduction suggested that vortioxetine ranked first (-2.35, -4.13 to -0.57), followed by escitalopram (-1.00, -1.42 to -0.57) and agomelatine (-0.79, -1.16 to -0.42). Limited evidence from short-term trials in depressed patients with T2DM suggests that escitalopram and agomelatine may have a favorable profile in reducing depression and controlling glycemic goals, but more trials are required.

Efficacy and dropout rates of antipsychotic medications for methamphetamine psychosis: A systematic review and network meta-analysis.

BACKGROUND: This study aimed to compare the treatment effects of different antipsychotics for methamphetamine psychosis (MAP). METHODS: Clinical Trials, Cochrane Library, Pubmed, Scopus, and Web of Science were searched for short-term, randomized controlled trials (RCTs) from the inception to June 15, 2020. Standardized mean differences (SMDs) and odds ratios (ORs) were aggregated using random-effects pairwise comparisons and frequentist network meta-analyses (NMAs). Primary outcomes of interest were the main psychotic symptoms and dropout rates. We also rated the quality of NMA estimates. RESULTS: This NMA included six RCTs of 395 patients with MAP. Six studied antipsychotics were aripiprazole, haloperidol, olanzapine, paliperidone extended-release, quetiapine, and risperidone. Risperidone is the most frequently studied antipsychotic, being investigated in four trials. Low quality of evidence was available to determine the efficacy of those antipsychotics for main psychotic symptoms. Aripiprazole was significantly inferior to olanzapine (SMD = 1.36, 95 % CI = 0.46-2.26), quetiapine (SMD = 1.13, 95 % CI = 0.28-1.98), haloperidol (SMD = 0.87, 95 % CI = 0.14-1.60), and paliperidone extended-release (SMD = 0.60, 95 % CI = 0.06-1.14). Olanzapine and quetiapine were superior to risperidone (SMD = -1.09, 95 % CI = -1.89 to -0.28 and SMD = -0.86, 95 % CI = -1.61 to -0.11, respectively). The dropout rates were not significantly different among the studied antipsychotics. CONCLUSIONS: This analysis suggests that olanzapine or quetiapine may be a preferred antipsychotic for MAP, although the evidence for this was rated low-quality due to the high risk of bias or indirectness/intransitivity.

Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation for prevention and treatment of perinatal depression: a systematic review and meta-analysis of randomized-controlled trials.

BACKGROUND: Available interventions for preventing and treating perinatal depression remain unsatisfactory. AIMS: We examined the prophylactic and therapeutic effects, as well as adverse effects, of n-3 PUFA supplementation in reducing depressive symptoms during perinatal periods. METHODS: We included randomized, placebo-controlled trials that reported the changes of depression severity after the perinatal participants received n-3 PUFA supplementation. After the comprehensive searches in October 2019, we selected the trials, extracted the data, and assessed the quality of included trials. We compared the standardized mean differences (SMD) of depression score changes between groups using a random-effect model. RESULTS: We included 11 trials in the meta-analysis and one more trial for qualitative analysis (N = 3,181). The pooled standardized mean of decreased depression scores revealed no statistically significant difference between the n-3 PUFA and the placebo groups (N = 920, SMDs = -0.05, 95% CI -0.20 to 0.10, I2 = 21%). The pooled SMDs showed no statistically significant efficacy of n-3 PUFA supplementation for prevention (N = 779, SMDs = -0.03, 95% CI -0.20 to 0.13, I2 = 24%) and treatment (N = 141, SMDs = -0.14, 95% CI -0.55 to 0.27, I2 = 31%) of perinatal depression. The efficacy of n-3 PUFA supplementation was not associated with the daily doses of DHA, EPA, or DHA plus EPA. No trial reported any serious adverse effect of n-3 PUFA supplements. CONCLUSIONS: Although n-3 PUFA supplementation may improve maternal and infant outcomes, our meta-analysis found insufficient evidence to determine its benefit for perinatal depression.

Mediation model of comorbid anxiety disorders in late-life depression.

BACKGROUND: A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD. METHODS: Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects. RESULTS: Being female was associated with comorbid anxiety disorders with an indirect effect (ß = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (ß = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (ß = 0.412, P = < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06. CONCLUSION: Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.

Frontal lobe meningioma presenting with schizophrenia-like symptoms: an organic cause of psychotic disorder.

A 51-year-old woman had been diagnosed and treated for schizophrenia for 10 years. Two weeks prior to admission, she developed headache and diplopia. Then, she was found unconscious and was sent to the hospital. A tumour in the left frontal lobe of the brain, causing brain herniation, was diagnosed and surgical excision of tumour was performed immediately. The psychotic symptoms of the patient were completely resolved after surgery. The histological diagnosis was meningioma. This case demonstrates an uncommon presentation of meningioma, the most common primary brain tumour. Patients presenting with psychotic symptoms may be misdiagnosed with schizophrenia, when a tumour is present, allowing the tumour to grow and causing associated complications. Early diagnosis and treatment could prevent mortality and morbidity. The treating physician should be aware of organic possibilities and carefully search for atypical presentations of psychiatric disorders in their patients.

Development and validation of a 6-item Revised UCLA Loneliness Scale (RULS-6) using Rasch analysis.

OBJECTIVE: The UCLA Loneliness Scale, containing 20 items, is one of the commonly used loneliness scales. Some shorter versions have been developed using factor analysis. The study aimed to shorten the UCLA Loneliness Scale using Rasch and factor analysis methods and test the psychometric properties of the new scale. METHODS: The full sample of the study included 719 respondents, divided into three subsamples (205, 324, and 190 for samples 1-3, respectively). The original, 20-item Revised UCLA Loneliness Scale (R-ULS) was shortened using 205 students (sample 1); the shortened scale was then validated for construct and concurrent validity with 324 students (sample 2) and 190 clinical participants (sample 3). Confirmatory factor analysis and Rasch analysis were used for construct validity. Convergent, discriminant, and concurrent validity were assessed by exploring the correlation with other psychological measurements. RESULTS: In sample 1, the R-ULS was shortened to a 6-item scale (RULS-6) that fits the Rasch model. The RULS-6 met the criteria of unidimensionality and local independence without differential item functioning due to age and sex, and good targeting the clinical sample. Person Separation Index (PSI) reflected that reliability from the Rasch perspective was acceptable. However, collapsing categories 2 (sometime) and 3 (rarely) may be required in a clinical sample. When tested in samples 2 and 3, the RULS-6 fits the Rasch measurement model. Convergent and discriminant validity were demonstrated with interpersonal problems and attachment scales. As expected, a positive correlation was found between RULS-6 and anxiety, depression subscale, interpersonal difficulties, and somatization subscales denoting concurrent validity. Cronbach's alpha of the RULS-6 was good (.83). CONCLUSION: Using Rasch analysis, the proposed RULS-6 constituted a 70% reduction of the number of original items, yet preserved the psychometric properties in independent samples of students and psychiatric outpatients. Statement of contribution What is already known on this subject? The UCLA Loneliness Scale is a common instrument used to gauge loneliness levels. The 20-item revised scale (R-ULS) has acceptable psychometric properties but its construct varies. Due to the length of the questionnaire, administration of R-ULS is not always practical. Short versions vary in items and were developed with classic test theory (e.g., factor analysis). Rasch analysis - providing more accuracy based on measurement theory - could be used instead. What does this study add? Using a Rasch analysis approach, a 6-item scale of loneliness (RULS-6) was created. The RULS-6 was tested in student and clinical samples, meeting Rasch measurement model criteria. The RULS-6 showed promising psychometrics to be used in both non-clinical and clinical samples.

Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings.

PURPOSE: The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors. PATIENTS AND METHODS: This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis. RESULTS: Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive-compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated. CONCLUSION: The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.