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SAGE Open Medicine 2023We aimed to conduct a systematic review to identify curricular and educational interventions to build research competency among Canadian psychiatry residents and fellows... (Review)
Review
OBJECTIVE
We aimed to conduct a systematic review to identify curricular and educational interventions to build research competency among Canadian psychiatry residents and fellows transitioning to the competency-by-design framework.
METHODS
The PRISMA guidelines were followed, searching five databases from their inception to February 2023 for relevant evaluation-type studies exploring research competency among psychiatry residents and fellows. We appraised thestudy's quality using the Joanna Briggs Institute's risk of bias tool for observational designs.
RESULTS
Overall, 36 original articles met our inclusion criteria. Surveys ( = 10) showed that participation in scholarly research, quality improvement, or educational projects relevant to psychiatry is needed in most residency programs. However, these vary significantly across programs; few need direct research experience for residency completion. The interventions spanned four categories: externally funded comprehensive research training programs ( = 5); resident research tracks ( = 11); workshops and seminars ( = 7); and specific modules ( = 3). Reported outcomes included overall program ratings, research output, and career trajectory. The quality of most studies was low because of the lack of controls or validated metrics for evaluating outcomes.
CONCLUSIONS
While many studies have explored best practices in research curricula, the current literature does not inform competency-based models for Canadian psychiatry residency programs incorporating research training requirements. Further description is needed from Canadian psychiatric training bodies regarding appropriate curricula, milestones, and metrics for evaluating research competencies.
PubMed: 38105808
DOI: 10.1177/20503121231216846 -
Frontiers in Psychiatry 2023Metacognition is the ability to reflect on one's own cognitive processes, monitor and regulate them to enhance mental performance. Social cognition involves the capacity...
INTRODUCTION
Metacognition is the ability to reflect on one's own cognitive processes, monitor and regulate them to enhance mental performance. Social cognition involves the capacity to perceive and respond to social cues from others. The study of metacognition and social cognition is an expanding research field in psychiatry. Both domains are related to neurocognition, symptoms and psychosocial functioning in schizophrenia. Understanding the relationship between social cognition and metacognition may be pivotal for enhancing the treatment of cognitive symptoms in schizophrenia.
METHODS
We conducted a PRISMA systematic review and meta-analysis on quantitative studies comparing metacognition to social cognitive outcomes in adult outpatients with a schizophrenia spectrum disorder. Reports were retrieved from the Medline, ScienceDirect and PsycINFO databases up to July 13th, 2023. Risk of bias was assessed with the Cochrane tool.
RESULTS
Our review included 1,036 participants across 17 reports, with 12 reports included in the meta-analysis. We found a significant positive correlation ( = 0.28, 95% CI: [0.14, 0.41]) between social cognition and metacognition. Subgroup analyses indicated that metacognition was specifically associated with theory of mind, attribution, and emotion processing. Different patterns of correlations were observed according to the assessment of metacognition and its subdimensions.
CONCLUSION
Despite discrepancies among the included studies, no publication bias was detected. The results suggest that metacognition and social cognition are distinct but related constructs. Those processes should be assessed and treated together, along with neurocognition, in schizophrenia.
PubMed: 38188042
DOI: 10.3389/fpsyt.2023.1285993 -
Translational Psychiatry Jun 2024Mapping brain-behaviour associations is paramount to understand and treat psychiatric disorders. Standard approaches involve investigating the association between one... (Review)
Review
Mapping brain-behaviour associations is paramount to understand and treat psychiatric disorders. Standard approaches involve investigating the association between one brain and one behavioural variable (univariate) or multiple variables against one brain/behaviour feature ('single' multivariate). Recently, large multimodal datasets have propelled a new wave of studies that leverage on 'doubly' multivariate approaches capable of parsing the multifaceted nature of both brain and behaviour simultaneously. Within this movement, canonical correlation analysis (CCA) and partial least squares (PLS) emerge as the most popular techniques. Both seek to capture shared information between brain and behaviour in the form of latent variables. We provide an overview of these methods, review the literature in psychiatric disorders, and discuss the main challenges from a predictive modelling perspective. We identified 39 studies across four diagnostic groups: attention deficit and hyperactive disorder (ADHD, k = 4, N = 569), autism spectrum disorders (ASD, k = 6, N = 1731), major depressive disorder (MDD, k = 5, N = 938), psychosis spectrum disorders (PSD, k = 13, N = 1150) and one transdiagnostic group (TD, k = 11, N = 5731). Most studies (67%) used CCA and focused on the association between either brain morphology, resting-state functional connectivity or fractional anisotropy against symptoms and/or cognition. There were three main findings. First, most diagnoses shared a link between clinical/cognitive symptoms and two brain measures, namely frontal morphology/brain activity and white matter association fibres (tracts between cortical areas in the same hemisphere). Second, typically less investigated behavioural variables in multivariate models such as physical health (e.g., BMI, drug use) and clinical history (e.g., childhood trauma) were identified as important features. Finally, most studies were at risk of bias due to low sample size/feature ratio and/or in-sample testing only. We highlight the importance of carefully mitigating these sources of bias with an exemplar application of CCA.
Topics: Humans; Brain; Mental Disorders; Autism Spectrum Disorder; Depressive Disorder, Major; Canonical Correlation Analysis; Attention Deficit Disorder with Hyperactivity; Least-Squares Analysis
PubMed: 38824172
DOI: 10.1038/s41398-024-02954-4 -
Journal of Affective Disorders Apr 2024Suicide and self-injury have become increasingly serious public health crises. Yet current evidence about the association between sedentary behavior (SB) and suicide is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Suicide and self-injury have become increasingly serious public health crises. Yet current evidence about the association between sedentary behavior (SB) and suicide is inconclusive. We explore the relationship between SB and suicide behavior to provide intervention measures to change the risk factors of the latter.
METHODS
We searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to September 10, 2023. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were used as effect measures. Subgroup analysis was conducted based on gender, regions and countries, age, and study type.
RESULTS
A total of 13 studies were included. According to the meta-analysis of suicide type, compared with individuals without sedentary behavior, individuals with sedentary behavior have a higher risk of suicide attempt (OR = 1.23, 95%CI: 1.15-1.37, p < 0.001), suicide ideation (OR = 1.47, 95%CI:1.28-1.68, p < 0.001) and suicide plan (OR = 1.30, 95%CI:1.16-1.44, p < 0.001). We conducted multiple subgroup analyses for different suicidal behaviors. The analysis found that SB can increase the risk of suicide attempt in different subgroups of different genders, different research centers, Africa, and adolescents; SB can increase the risk of suicide ideation in the subgroups of different genders and ages, different research centers, Asia and Africa; SB can increase the risk of suicide plan in the subgroups of different genders, multi-center study, Africa, and adolescents.
LIMITATIONS
Future research should focus on objective SB measurement and explore its dose-response relation and time limit.
CONCLUSION
A sedentary lifestyle is associated with suicide behavior risk, with varying effects across age groups and regions, as evidenced in both single-center and multi-center studies.
Topics: Adolescent; Humans; Male; Female; Sedentary Behavior; Suicide, Attempted; Suicidal Ideation; Self-Injurious Behavior; Risk Factors; Multicenter Studies as Topic
PubMed: 38266927
DOI: 10.1016/j.jad.2024.01.193 -
Psychiatry Research Nov 2023Suicide is a multifaceted event precipitated by underlying biopsychosocial risk factors. Evidence for various psychiatric morbidities underlying suicidality through... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Suicide is a multifaceted event precipitated by underlying biopsychosocial risk factors. Evidence for various psychiatric morbidities underlying suicidality through Psychological Autopsy (PA) is established in case-control studies. However, considering the possible geographical variations and the limited number of studies from developing countries, the estimates of such risk factors across the world could provide great insight into their comparative prevalence and assist in targeting the prevention of suicide.
METHODS
A systematic review of the literature from 1991 to 2020 in the English language was conducted with the protocol registration on PROSPERO ID (CRD 42021249216) to identify the pooled odds ratio of any psychiatric morbidity as a risk factor for suicide.
RESULTS
Out of 1144 articles, 43 studies were included in this review. The pooled odds ratio for any psychiatric morbidity measured across 31 studies was 16.71 (95% CI: 12.29 - 22.70, Tau = 0.58, I = 80.4%, Cochran's Q = 153.36, df = 30, p-value <0.001). The subgroup analysis for affective disorder, previous suicide attempt, WHO region-wise risk distribution, and publication year of study were not significant.
CONCLUSIONS
There is a sixteen-fold increased risk of suicide in persons with mental disorders compared to healthy controls, and the risk is similar across the geographical region and publication time. The international efforts to reduce the common risk factors for suicide would equally be helpful for all countries despite cultural variations. Early identification and treatment of sleep disorders, physical illnesses, anxiety, and personality disorders should be prioritized along with the established mental disorders to reduce suicide rates across the world.
Topics: Humans; Prevalence; Autopsy; Mental Disorders; Suicide, Attempted; Case-Control Studies
PubMed: 37783094
DOI: 10.1016/j.psychres.2023.115492 -
JAMA Network Open May 2024Noninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Noninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each disorder are unknown.
OBJECTIVE
To define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders.
DATA SOURCES
Studies were drawn from an updated (to April 30, 2023) previous systematic review based on a search of PubMed, OVID, and Web of Knowledge.
STUDY SELECTION
Randomized clinical trials were selected that tested transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) for any mental disorder in adults aged 18 years or older.
DATA EXTRACTION AND SYNTHESIS
Two authors independently extracted the data. A 1-stage dose-response meta-analysis using a random-effects model was performed. Sensitivity analyses were conducted to test robustness of the findings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
The main outcome was the near-maximal effective doses of total pulses received for TMS and total current dose in coulombs for tDCS.
RESULTS
A total of 110 studies with 4820 participants (2659 men [61.4%]; mean [SD] age, 42.3 [8.8] years) were included. The following significant dose-response associations emerged with bell-shaped curves: (1) in schizophrenia, high-frequency (HF) TMS on the left dorsolateral prefrontal cortex (LDLPFC) for negative symptoms (χ2 = 9.35; df = 2; P = .009) and TMS on the left temporoparietal junction for resistant hallucinations (χ2 = 36.52; df = 2; P < .001); (2) in depression, HF-DLPFC TMS (χ2 = 14.49; df = 2; P < .001); (3) in treatment-resistant depression, LDLPFC tDCS (χ2 = 14.56; df = 2; P < .001); and (4) in substance use disorder, LDLPFC tDCS (χ2 = 33.63; df = 2; P < .001). The following significant dose-response associations emerged with plateaued or ascending curves: (1) in depression, low-frequency (LF) TMS on the right DLPFC (RDLPFC) with ascending curve (χ2 = 25.67; df = 2; P = .001); (2) for treatment-resistant depression, LF TMS on the bilateral DLPFC with ascending curve (χ2 = 5.86; df = 2; P = .004); (3) in obsessive-compulsive disorder, LF-RDLPFC TMS with ascending curve (χ2 = 20.65; df = 2; P < .001) and LF TMS on the orbitofrontal cortex with a plateaued curve (χ2 = 15.19; df = 2; P < .001); and (4) in posttraumatic stress disorder, LF-RDLPFC TMS with ascending curve (χ2 = 54.15; df = 2; P < .001). Sensitivity analyses confirmed the main findings.
CONCLUSIONS AND RELEVANCE
The study findings suggest that NIBS yields specific outcomes based on dose parameters across various mental disorders and brain regions. Clinicians should consider these dose parameters when prescribing NIBS. Additional research is needed to prospectively validate the findings in randomized, sham-controlled trials and explore how other parameters contribute to the observed dose-response association.
Topics: Humans; Transcranial Magnetic Stimulation; Transcranial Direct Current Stimulation; Mental Disorders; Adult; Male; Female; Middle Aged; Randomized Controlled Trials as Topic
PubMed: 38776083
DOI: 10.1001/jamanetworkopen.2024.12616 -
Psychiatry Research Sep 2023Bulimia Nervosa is a disorder with high rates of psychiatric and medical comorbidity and substantial societal costs. Cognitive Behavioural Therapy is considered the... (Meta-Analysis)
Meta-Analysis Review
Bulimia Nervosa is a disorder with high rates of psychiatric and medical comorbidity and substantial societal costs. Cognitive Behavioural Therapy is considered the preferred treatment, but access can be problematic. Pharmacotherapy is more accessible but remains significantly underutilised. We aimed to assess the efficacy, tolerability, and safety of all available forms of pharmacotherapy for the treatment of bulimia nervosa. We conducted a comprehensive search of PubMed, EMBASE, CENTRAL, ClinicalTrials.gov, and reference lists of relevant articles up until April 2023. The primary outcomes were remission and binge frequency. 52 randomised controlled trials (RCTs) involving 3313 participants were included in the meta-analysis. Overall, no significant difference was observed between drugs and placebo in terms of remission; however, the available data were limited. Notably, drugs, particularly antidepressants, demonstrated a significant reduction in the frequency of binge episodes compared to placebo. Antidepressants were also found to be more effective than placebo in terms of treatment response and other clinically meaningful outcomes. An important limitation is that few RCTs were available for individual drugs. Our findings provide evidence supporting the increased utilisation of pharmacotherapy in clinical practice and underscore the need for further research involving larger populations and a broader range of outcomes.
Topics: Humans; Bulimia Nervosa; Cognitive Behavioral Therapy; Antidepressive Agents; Comorbidity; Randomized Controlled Trials as Topic
PubMed: 37562154
DOI: 10.1016/j.psychres.2023.115357 -
European Child & Adolescent Psychiatry Jul 2023There might be differential characteristics between those who have attempted suicide once in their lifetime (single attempters) and those who have attempted suicide two... (Review)
Review
There might be differential characteristics between those who have attempted suicide once in their lifetime (single attempters) and those who have attempted suicide two or more times (multiple attempters). We aimed to identify the factors that differentiate single and multiple attempters in child and adolescents. This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the review protocol was registered in PROSPERO. We conducted a systematic literature search in three databases to identify original studies exploring the characteristics of single attempters vs. multiple attempters among adolescents. We considered a wide range for the definition of adolescent, following most recent recommendations: 10-24 years. We carried out a meta-analysis. Fourteen studies were included in the systematic review and 13 in the meta-analysis with a total sample of with a total of 4286 participants. The factors statistically significantly associated with being a multiple attempter in the meta-analysis were: anxiety disorders, depression severity, alcohol abuse, substance abuse, aggressiveness, and hopelessness. Multiple attempters have a more severe clinical profile, with greater severity of symptoms. Knowledge of the risk factors associated with being a multiple attempter could help us to predict which patients are more likely to reattempt suicide and need further monitoring and a tailored treatment. Prevention programs tailored for the adolescent population, along with identification of early risk factors, could help to prevent suicidal behavior among this vulnerable population.
PubMed: 37470845
DOI: 10.1007/s00787-023-02260-2 -
Acta Neuropsychiatrica Aug 2023Administration of antidepressant drugs - principally selective serotonin reuptake inhibitors (SSRIs) - may induce clinically significant 'apathy' which can affect... (Review)
Review
OBJECTIVES
Administration of antidepressant drugs - principally selective serotonin reuptake inhibitors (SSRIs) - may induce clinically significant 'apathy' which can affect treatment outcomes adversely. We aimed to review all relevant previous reports.
METHODS
We performed a PUBMED search of English-language studies, combining terms concerning psychopathology (e.g. apathy) and classes of antidepressants (e.g. SSRI).
RESULTS
According to certain inclusion (e.g. use of DSM/ICD diagnostic criteria) and exclusion (e.g. presence of a clinical condition that may induce apathy) criteria, 50 articles were eligible for review. Together, they suggest that administration of antidepressants - usually SSRIs - can induce an apathy syndrome or emotional blunting, i.e. a decrease in emotional responsiveness, to circumstances which would have triggered intense mood reactions prior to pharmacotherapy. The reported prevalence of antidepressant-induced apathy ranges between 5.8 and 50%, and for SSRIs ranges between 20 and 92%. Antidepressant-induced apathy emerges independently of diagnosis, age, and treatment outcome and appears dose-dependent and reversible. The main treatment strategy is dose reduction, though some data suggest the usefulness of treatment with olanzapine, bupropion, agomelatine or amisulpride, or the methylphenidate-modafinil-olanzapine combination.
CONCLUSION
Antidepressant-induced apathy needs careful clinical attention. Further systematic research is needed to investigate the prevalence, course, aetiology, and treatment of this important clinical condition.
Topics: Selective Serotonin Reuptake Inhibitors; Apathy; Olanzapine; Antidepressive Agents; Bupropion
PubMed: 36644883
DOI: 10.1017/neu.2023.6 -
Acta Psychiatrica Scandinavica Dec 2023Depression is one of the most common co-morbidities during pregnancy; with severe symptoms, antidepressants are sometimes recommended. Social determinants are often... (Review)
Review
INTRODUCTION
Depression is one of the most common co-morbidities during pregnancy; with severe symptoms, antidepressants are sometimes recommended. Social determinants are often linked with antidepressant use in the general population, and it is not known if this is the case for pregnant populations. Our objective was to determine if social determinants are associated with prenatal antidepressant intake via a systematic review and meta-analysis.
METHODS
A systematic search of five databases was conducted to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (use/continuation) and one or more social determinants: education, race, immigration status, relationship, income, or employment. Eligible studies were included in random effects meta-analyses.
RESULTS
A total of 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83; 95% CI, 0.78 to 0.89; p < 0.00001; I = 53%). Meta-analyses of antidepressant use and education, race, and relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity.
DISCUSSION
While most social determinants in this review were not linked with prenatal antidepressant intake, lower maternal education level does seem to be associated with lower rates of prenatal antidepressant continuation.
CONCLUSIONS
Education appears to be linked with prenatal antidepressant intake. The low number of included studies precludes conclusive evidence for other social determinants.
PubMed: 38145902
DOI: 10.1111/acps.13647