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Emergency department management of acute agitation in the reproductive age female and pregnancy

World Journal of Emergency Medicine 2024年第2期15卷 83-90页

作者： Ariella Gartenberg Kayla Levine Alexander Petrie department of Emergency Medicine Jacobi Medical Center and Montefiore Medical CenterNY 10461USA department of psychiatry and behavioral Sciences Albert Einstein College of Medicine and Montefiore Medical CenterNY 10461USA department of Emergency Medicine Jacobi Medical Center and North Central Bronx HospitalNY 10461USA

BACKGROUND:Agitation is a common presentation within emergent departments(EDs).Agitation during pregnancy should be treated as an obstetric emergency,as the distress may jeopardize both the patient and fetus.The safety of psychotropic medications in the reproductive age female has not been well established.This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.METHODS:A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.RESULTS:While nonpharmacological management is preferred,ED visits for agitation often require medical management.Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects.Adverse effects are common in pregnant females.For mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse effects.In moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics.Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy.Second generation psychotropics are often utilized as second-line therapy,including risperidone.Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.CONCLUSION:While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation,animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in utero.As the fetal risk associated with multiple doses of psychotropic medications remains unknown,weighing the risks and benefits of each agent,while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.

关键词： Agitation Pregnancy Haloperidol Ketamine Benzodiazepines

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First 150 years of catatonia:Looking back at its complicated history and forward to the road ahead

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World Journal of psychiatry 2024年第5期14卷 600-606页

作者： Levente Csihi Gabor S Ungvari Stanley N Caroff Gábor Gazdag department of psychiatry and Psychiatric Rehabilitation Jahn Ferenc South Pest HospitalBudapest 1204Hungary Division of psychiatry School of MedicineUniversity of Western AustraliaCrawley 6009Western AustraliaAustralia Section of psychiatry University of Notre DameFremantle 6160Western AustraliaAustralia behavioral Health Service Corporal Michael J CresenczVeterans Affairs Medical CenterPhiladelphiaPA 19104United States department of psychiatry University of PennsylvaniaPerelman School of MedicinePhiladelphiaPA 19104United States department of psychiatry and Psychotherapy Faculty of MedicineSemmelweis UniversityBudapest 1083Hungary

Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.

关键词： Catatonia Historical overview Psychopharmacology Diagnostic and Statistical Manual of Mental Disorders-5 Wernicke-Kleist-Leonhard school

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Why people should run after positive affective experiences instead of health benefits

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Journal of Sport and Health Science 2024年第4期13卷 445-450页

作者： Silvio Maltagliati Philippe Sarrazin Layan Fessler Mael Lebreton Boris Cheval University of Grenoble Alpes SENSGrenoble 38000France Paris School of Economics Paris 75014France Swiss Center for Affective Sciences University of GenevaGeneva 1202Switzerland Laboratory for behavioral Neurology and Imaging of Cognition Department of Fundamental NeurosciencesUniversity of GenevaGeneva 1202Switzerland Laboratory for the Study of Emotion Elicitation and Expression(E3Lab) Department of PsychologyUniversity of GenevaGeneva 1202Switzerland

Over time,physical activity(PA)has shifted from being a necessity to being an alternative.As a result,levels of PA have sharply decreased.1 Today,we are facing a worldwide pandemic of physical inactivity,with one death every 6 s attributed to insufficient PA.2 To counteract this trend,a tremendous effort is being made to promote regular PA across the lifespan,mainly through the dissemination of knowledge about the health benefits of accumulating sufficient PA.

关键词： sharply benefits attributed

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New insights into the effects of APP gene dose on synapse in Down syndrome

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Neural Regeneration Research 2024年第5期19卷 961-962页

作者： Xu-Qiao Chen Xinxin Zuo department of neurosciences University of California San DiegoLa JollaCAUSA

Synaptic dysfunction:Alzheimer’s disease(AD)is a prevalent form of dementia,affecting over 35 million people worldwide(Tzioras et al.,2023).A synapse serves as the connection point between neurons,facilitating the transmission of information from one neuron to another.Dynamic alterations in synapses,known as synaptic plasticity,play a pivotal role in cognitive processes such as learning and memory.Synaptic loss has been identified as a key contributor to cognitive decline in AD patients.Studies have shown that the soluble forms of amyloid-beta(Aβ)and tau proteins are toxic to synapses,leading to cognitive impairment in animal models(Spires-Jones and Hyman,2014).Additionally,the formation of oligomers of tau and Aβcan spread pathology through synaptic connections in the brain,emphasizing the vital role of synapses in disease progression.

关键词： alterations Aβ tau

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Digital psychiatry in low-and-middle-income countries:New developments and the way forward

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World Journal of psychiatry 2024年第3期14卷 350-361页

作者： Subho Chakrabarti department of psychiatry Postgraduate Institute of Medical Education and ResearchChandigarh 160012UTIndia

Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.

关键词： Digital psychiatry Low-and middle-income countries Developments Mental health

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Acute symptomatic seizures in newborns:a narrative review

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Acta Epileptologica 2024年第1期7卷 1-13页

作者： Carlotta Spagnoli Francesco Pisani Child Neurology Unit Pediatric DepartmentAzienda USL-IRCCS Di Reggio EmiliaReggio Emilia42123Italy Child Neurology and psychiatry Unit Department of Human NeurosciencesSapienza University of RomeRome00185Italy Azienda Ospedaliero Universitaria Policlinico Umberto I Rome00185Italy

Acute symptomatic seizures are the main sign of neurological dysfunction in newborns.This is linked to the unique characteristics of the neonatal brain,making it hyperexcitable compared to older ages,and to the common occurrence of some forms of acquired brain injury,namely hypoxic-ischemic encephalopathy.In this narrative review we will provide an overview of neonatal seizures definition,their main underlying etiologies,diagnostic work-up and differential diagnoses,and will discuss about therapeutic options and prognostic outlook.The latest publications from the ILAE Task Force on Neonatal Seizures will be presented and discussed.Of note,they highlight the current lack of robust evidence in this field of clinical neurology.We will also report on specificities pertaining to low-and-middle income countries in terms of incidence,main etiologies and diagnosis.The possibilities offered by telemedicine and automated seizures detection will also be summarized in order to provide a framework for future directions in seizures diagnosis and management with a global perspective.Many challenges and opportunities for improving identification,monitoring and treatment of acute symptomatic seizures in newborns exist.All current caveats potentially represent different lines of research with the aim to provide better care and reach a deeper understanding of this important topic of neonatal neurology.

关键词： Acute symptomatic Neonatal seizures EEG Newborn Outcome Diagnosis Etiologies

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Incidence and risk factors of depression in patients with metabolic syndrome

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World Journal of psychiatry 2024年第2期14卷 245-254页

作者： Li-Na Zhou Xian-Cang Ma Wei Wang department of psychiatry The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina

BACKGROUND Many studies have explored the relationship between depression and metabolic syndrome(MetS),especially in older people.China has entered an aging society.However,there are still few studies on the elderly in Chinese communities.AIM To investigate the incidence and risk factors of depression in MetS patients in China's Mainland and to construct a predictive model.METHODS Data from four waves of the China Health and Retirement Longitudinal Study were selected,and middle-aged and elderly patients with MetS(n=2533)were included based on the first wave.According to the center for epidemiological survey-depression scale(CESD),participants with MetS were divided into depression(n=938)and non-depression groups(n=1595),and factors related to depression were screened out.Subsequently,the 2-,4-,and 7-year follow-up data were analyzed,and a prediction model for depression in MetS patients was constructed.RESULTS The prevalence of depression in middle-aged and elderly patients with MetS was 37.02%.The prevalence of depression at the 2-,4-,and 7-year follow-up was 29.55%,34.53%,and 38.15%,respectively.The prediction model,constructed using baseline CESD and Physical Self-Maintenance Scale scores,average sleep duration,number of chronic diseases,age,and weight had a good predictive effect on the risk of depression in MetS patients at the 2-year follow-up(area under the curve=0.775,95%confidence interval:0.750-0.800,P<0.001),with a sensitivity of 68%and a specificity of 74%.CONCLUSION The prevalence of depression in middle-aged and elderly patients with MetS has increased over time.The early identification of and intervention for depressive symptoms requires greater attention in MetS patients.

关键词： Depression Metabolic syndrome Prevalence Risk factor

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Transcranial direct current stimulation as early augmentation in adolescent obsessive compulsive disorder:A pilot proof-of-concept randomized control trial

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World Journal of Clinical Pediatrics 2024年第2期13卷 161-170页

作者： Aditya Agrawal Vivek Agarwal Sujita Kumar Kar Amit Arya department of psychiatry King George Medical UniversityUttar PradeshLucknow 226003India

BACKGROUND Transcranial direct current stimulation(tDCS)is proven to be safe in treating various neurological conditions in children and adolescents.It is also an effective method in the treatment of OCD in adults.AIM To assess the safety and efficacy of tDCS as an add-on therapy in drug-naive adolescents with OCD.METHODS We studied drug-naïve adolescents with OCD,using a Children’s Yale-Brown obsessive-compulsive scale(CY-BOCS)scale to assess their condition.Both active and sham groups were given fluoxetine,and we applied cathode and anode over the supplementary motor area and deltoid for 20 min in 10 sessions.Reassessment occurred at 2,6,and 12 wk using CY-BOCS.RESULTS Eighteen adolescents completed the study(10-active,8-sham group).CY-BOCS scores from baseline to 12 wk reduced significantly in both groups but change at baseline to 2 wk was significant in the active group only.The mean change at 2 wk was more in the active group(11.8±7.77 vs 5.25±2.22,P=0.056).Adverse effects between the groups were comparable.CONCLUSION tDCS is safe and well tolerated for the treatment of OCD in adolescents.However,there is a need for further studies with a larger sample population to confirm the effectiveness of tDCS as early augmentation in OCD in this population.

关键词： Adolescents Early augmentation Obsessive compulsive disorder Safety Transcranial direct current stimulation

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Effect of novel accelerated intermittent theta burst stimulation on suicidal ideation in adolescent patients with major depressive episode:a randomised clinical trial

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General psychiatry 2024年第2期37卷 292-296页

作者： Dong Huang Shuming Zhong Xiaodong Song Rongxu Zhang Shunkai Lai Yanbin Jia department of psychiatry First Affiliated Hospital of Jinan UniversityGuangzhouGuangdongChina

To the editor:Affective disorders,including major depressive disorder(MDD)and bipolar disorder,have emerged as the primary cause of adolescent suicide.Moreover,suicide mostly occurs in the major depressive episode(MDE)of affective disorders.Suicidal ideation(SI)has been identified as an immediate precursor to suicide,such that reducing its severity is conducive to suicide prevention in adolescents.

关键词： prevention editor stimulation

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Clinical effects of nonconvulsive electrotherapy combined with mindfulness-based stress reduction and changes of serum inflammatory factors in depression

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World Journal of psychiatry 2024年第5期14卷 653-660页

作者： Zhi-Wen Gu Chun-Ping Zhang Li-Ping Chen Xiong Huang department of psychiatry Guangzhou First People's HospitalSouth China University of TechnologyGuangzhou 510180Guangdong ProvinceChina department of psychiatry The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou HuiAi Hospital)Guangzhou 510370Guangdong ProvinceChina

BACKGROUND Depression is a common and serious psychological condition,which seriously affects individual well-being and functional ability.Traditional treatment methods include drug therapy and psychological counseling;however,these methods have different degrees of side effects and limitations.In recent years,nonconvulsive electrotherapy(NET)has attracted increasing attention as a noninvasive treatment method.However,the clinical efficacy and potential mechanism of NET on depression are still unclear.We hypothesized that NET has a positive clinical effect in the treatment of depression,and may have a regulatory effect on serum inflammatory factors during treatment.AIM To assess the effects of NET on depression and analyze changes in serum inflammatory factors.METHODS This retrospective study enrolled 140 patients undergoing treatment for depression between May 2017 and June 2022,the observation group that received a combination of mindfulness-based stress reduction(MBSR)and NET treatment(n=70)and the control group that only received MBSR therapy(n=70).The clinical effectiveness of the treatment was evaluated by assessing various factors,including the Hamilton Depression Scale(HAMD)-17,self-rating idea of suicide scale(SSIOS),Pittsburgh Sleep Quality Index(PSQI),and levels of serum inflammatory factors before and after 8 wk of treatment.The quality of life scores between the two groups were compared.Comparisons were made using t and χ^(2) tests.RESULTS After 8 wk of treatment,the observation group exhibited a 91.43%overall effectiveness rate which was higher than that of the control group which was 74.29%(64 vs 52,χ^(2)=7.241;P<0.05).The HAMD,SSIOS,and PSQI scores showed a significant decrease in both groups.Moreover,the observation group had lower scores than the control group(10.37±2.04 vs 14.02±2.16,t=10.280;1.67±0.28 vs 0.87±0.12,t=21.970;5.29±1.33 vs 7.94±1.35,t=11.700;P both<0.001).Additionally,there was a notable decrease in the IL-2,IL-1β,and IL-6 in both groups after treatment.Furthermore,the observation

关键词： Depression Nonconvulsive electrotherapy Mindfulness-based stress reduction Serum inflammatory factors Clinical effect Hamilton Depression Scale

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