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Xingjia Hu,1,2,* Yating You,2,* Hui Wang,2 Yiqing Zheng,1,3 Ying Wang2 1The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 2Department of Otolaryngology Head and Neck Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, People’s Republic of China; 3Department of Otolaryngology-HNS, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yiqing Zheng, Department of Otolaryngology-HNS, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang west Road, Guangzhou, 510120, People’s Republic of China, Email zhengyiq@mail.sysu.edu.cn Ying Wang, Department of Otolaryngology Head and Neck Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, No. 818 Renmin Road, Changde, 415000, People’s Republic of China, Tel/Fax +86-0731-7788212, Email lhly_1018@163.comBackground: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), but its long-term efficacy is limited by poor patient adherence. This study aimed to develop and validate a predictive nomogram for CPAP non-adherence in patients with OSA.Methods: This is a secondary analysis of a retrospective study. A cohort of 695 Danish patients with OSA were followed for 3 years after initiating CPAP therapy. Independently associated factors were evaluated using multivariate Cox regression, and then nomogram predicting adherence to CPAP use were constructed. The discrimination of the nomogram was assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA).Results: Pulmonary disease, oxygen desaturation index (ODI), Epworth Sleepiness Score (ESS) and severity of OSA were identified as predictors and incorporated into the nomogram. The nomogram demonstrated good discrimination with concordance index in training dataset (0.73, 95% CI: 0.69– 0.78) and validation dataset (0.72, 95% CI: 0.66– 0.79). ROC curve, calibration curve, and DCA indicated the nomogram had good clinical utility.Conclusion: This study provided an effective nomogram for predicting CPAP non-adherence in OSA patients.Keywords: continuous positive airway pressure, obstructive sleep apnea, nomogram, patient adherence, predictive model

Aseel AlSaleh,1 Waqar Husain,2 Khaled Trabelsi,3,4 Hadeel Ghazzawi,5 Achraf Ammar,6,7 Zahra Saif,8 Seithikurippu R Pandi-Perumal,9,10 Maha M AlRasheed,11 Ahmed S BaHammam,12,13 Haitham Jahrami8,14 1Department of Family and Community Medicine, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain; 2Department of Humanities, COMSATS University Islamabad, Islamabad Campus, Islamabad, Pakistan; 3High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3000, Tunisia; 4Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, 3000, Tunisia; 5Nutrition and Food Technology Department, Agriculture School, The University of Jordan, Amman, Jordan; 6Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, 55099, Germany; 7Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax, 3000, Tunisia; 8Department of Psychiatry, Government Hospitals, Manama, Bahrain; 9Centre for Research and Development, Chandigarh University, Mohali, Punjab, 140413, India; 10Division of Research and Development, Lovely Professional University, Phagwara, Punjab, 144411, India; 11Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia; 12The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, King Saud University, Riyadh, Saudi Arabia; 13King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 14Department of Psychiatry, College of Medicine and Health Sciences, Arabian Gulf University, Manama, BahrainCorrespondence: Haitham Jahrami, Department of Psychiatry, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain, Email haitham.jahrami@outlook.comPurpose: The Pre-Sleep Arousal Scale (PSAS) is a well-recognized instrument utilized for measuring cognitive and somatic arousal before sleep. Although the PSAS is useful, an Arabic version of the scale has not yet been developed and validated. The current study aimed to translate the PSAS into Arabic language and evaluate its psychometric properties, such as reliability and validity, in an Arabic-speaking population.Patients and Methods: A cross-sectional survey was conducted with 438 participants who completed the Arabic version of the PSAS, along with other validated measures of insomnia, anxiety, and sleep effort.Results: The results indicated that the Arabic version of the PSAS maintained the original scale’s two-factor structure. The factor loadings for PSAS-Cognitive ranged from 0.57 to 0.75, and for PSAS-Somatic, from 0.45 to 0.70, with all loadings being statistically significant (p < 0.001). The Arabic version of the PSAS exhibited high internal consistency (McDonald’s ω = 0.86; Cronbach’s α = 0.86; Guttman’s λ 2 = 0.86; Greatest Lower Bound = 0.90) and test–retest reliability (ICC = 0.88) over two weeks. The PSAS demonstrated good concurrent and convergent validity. We documented significant large differences between individuals with “no insomnia” and those with “insomnia” symptoms across cognitive, somatic, and total pre-sleep arousal (all p < 0.001). The insomnia group consistently scored higher scores for PSAP and its subscales.Conclusion: These findings suggest that the Arabic version of the PSAS is a reliable and valid tool for assessing pre-sleep arousal in Arabic-speaking individuals.Keywords: Arabic version, insomnia, pre-sleep arousal, PSAS, psychometric properties, reliability, validity

Abstract Background Family-based treatment (FBT), the leading intervention for adolescents with anorexia nervosa (AN), is severely understudied in outpatient care settings that serve publicly-insured populations. Many individuals with public insurance are lower-income, racially and ethnically diverse, and experience barriers to accessing evidence-based interventions for eating disorders (EDs). Methods Semi-structured interviews were conducted with ten interdisciplinary providers who provide specialty care to youth with EDs in an inpatient and/or outpatient medical setting. Interview questions were focused on the interdisciplinary providers’ experiences of caring for individuals with EDs, with a focus on differences in care for those with private insurance compared to public insurance. The interviews took place two years after training in FBT was delivered to mental health providers in San Francisco County, which created opportunities to explore provider perspectives on collaborating with newly-trained mental health providers in the community implementing FBT with publicly-insured youth. Results Content analysis converged on three themes: the critical importance of supporting mental health treatment within the context of medical care, complex challenges when helping patients and their families navigate publicly-funded health care systems, and the overall positive impact of the FBT rollout in San Francisco County. Participants emphasized greater confidence in patient outcomes when collaborating with FBT providers and noted discord when working with providers not trained in EDs or FBT. Referral systems, weight-based stigma, and a lack of appropriate services were highlighted as significant barriers to care. To facilitate treatment engagement in publicly-insured populations, participants stressed the importance of clinicians providing psychoeducation and providing services with a high degree of cultural competence. Participants expressed that patients’ ability to access FBT and providers’ ability to collaborate on cases markedly improved following the county training, increasing their sense of efficacy in delivering adequate patient care. Conclusions The discussed themes highlight the importance of access to FBT for individuals in underserved communities, which can significantly reduce both provider and patient burden. Despite various barriers to utilizing FBT in publicly-funded settings, clinicians stressed that cultural adaptations increase the implementation of and facilitate family engagement in FBT, which is consistent with previous literature examining evidence-based intervention implementation science.

Plain English Summary Eating disorders (EDs) are common and can be deadly, yet treatment approaches are not currently meeting the needs of individuals in Canada requiring care. As noted in the existing literature, ED treatment is largely inaccessible in Canada and can be ineffective in facilitating long-term recovery. Recent research has suggested that improvement to publicly funded, hospital-based ED treatment for adults is necessary and that those in Canada with lived experience should be involved in the process of doing so. This paper is based on a study that set out to explore ED treatment and gather potential recommendations from eleven individuals in Canada with lived experience. Several recommendations were identified to improve ED treatment in Canada, while simultaneously addressing harmful stigma about people with lived experience with EDs. These recommendations included providing interim support, ensuring individualized care, offering dignified treatment, increasing resources, and directly targeting stigma. From this study, it is suggested that current ED treatment methods must change to improve health outcomes and reduce stigma, and exploring the perspectives of those with lived experience is a promising method for doing so.

Abstract Background Maladaptive eating behaviors are becoming increasingly prevalent among adolescents, and their relationship to exposure to media messages has been extensively examined. However, more specifically, the influence of social networks on emotional eating (EmE) has received relatively less attention in the Peruvian context. Objective To determine the association between social network addiction (SNA) and EmE among Peruvian adolescents, considering sex differences. Methods A cross-sectional study was conducted. A total of 878 adolescents were considered. The Social Network Addiction Questionnaire and the Emotional Eating Questionnaire were administered. Similarly, sociodemographic data were collected. To explore the association between SNA and EmE, we performed Poisson regression analyses with robust variance. We considered a p-value of equal to or less than 0.05 as statistically significant. Results Adolescents with an EmE score greater than 5 had significantly higher SNA scores, averaging 24.7 (± 12.3), compared to 15.5 (± 10.3) in those with an EmE score between 0 and 5 (p

Abstract Recent trials have shown promising results for the use of psychedelic-assisted therapies in treating severe refractory psychiatric illnesses, and there has been growing interest in examining the effectiveness of these therapies in treating eating disorders. To move forward in a safe, ethically sound, and scientifically rigorous manner, the field must address critical considerations. In this Comment article, we outline important risks and ethical considerations, along with methodological aspects that require careful consideration in the design of psychedelic-assisted therapy trials. We conclude by providing provisional guidelines for clinical research trials to help shape the future of this work, with the aim of investigating and employing the use of psychedelics for treating eating disorders in a manner that protects clients and research participants while maximizing methodological rigour.

Abstract Background Despite a growing literature demonstrating the significant impacts of climate change on mental health, research is urgently needed to investigate how climate change-related concerns may contribute to the development, exacerbation, or re-emergence of eating disorders, as well as affect the effectiveness of existing interventions. This case report contributes to this scant knowledge base by offering empirical evidence for how responses to climate change can influence eating disorder symptoms and, importantly, limit the effectiveness of evidence-based treatments such as Cognitive Behavior Therapy-Enhanced (CBT-E). Case presentation A 24-year-old female graduate student studying environmental science presented to a specialized eating disorder clinic with worsening bulimia nervosa. Her symptoms initially improved with CBT-E; however, after three months, concerns about food waste significantly impeded further progress. The therapist, identifying symptoms of eco-anxiety, adapted standard CBT-E strategies to include psychoeducation about eco-anxiety, cognitive restructuring of beliefs about food waste and other eating-related eco-concerns, relevant exposures related to such concerns, and problem-solving to increase social support. These adaptations led to resumed progress, with the patient achieving nutritional adequacy by treatment end (38 sessions) and maintaining treatment gains through one year follow-up. Conclusions To our awareness, this is the first case report on the co-occurrence of eco-anxiety and eating disorders. This case underscores the importance of screening for concurrent eco-anxiety, suggests ways in which eating disorders and eco-anxiety can influence one another longitudinally, describes how coexisting eco-anxiety can limit standard CBT-E’s effectiveness, and provides examples of successful treatment adaptations tailored to address eco-anxiety-related concerns.

Abstract Introduction Beta-thalassemia is a prevalent autosomal recessive haemolytic disorder, particularly in the Middle East. Patients with beta-thalassemia major (βTM) require iron chelation therapy and regular blood transfusions, while those with beta-thalassemia intermedia (βTI) exhibit milder symptoms. This study aimed to evaluate cognitive function, behavioural problems, quality of life, and related aspects in individuals with βTM and βTI. Methods The cross-sectional study included 20 βTM participants, 20 βTI participants, and 19 healthy controls. Participants underwent psychiatric interviews, the Wechsler Adult Intelligence Scale (WAIS-III), Symptom Checklist-90 Revised (SCL-90R), and Short-Form Health Survey (SF-36). Clinical data and laboratory investigations were also collected. Results βTM participants exhibited lower vocabulary and picture completion scores on the WAIS-III compared to other groups. βTI participants had significantly higher scores on SCL-90R subscales for somatization, depression, anxiety, paranoid ideation, and psychoticism. Both patient groups reported poorer quality of life across all SF-36 domains compared with controls. Longer disease duration correlated with lower levels of somatization, interpersonal sensitivity, depression, anxiety, and paranoid ideation. Less frequent blood transfusions were associated with better physical and mental health summary scores but also higher somatization. Elevated serum iron levels corresponded with increased anxiety, hostility, and psychoticism symptoms, while higher serum ferritin related to more obsessive–compulsive behaviours but less somatization and psychoticism. Conclusions Individuals with thalassemia exhibit cognitive deficits, psychological disturbances, and diminished quality of life, with distinct patterns depending on disease severity. Regular monitoring and appropriate interventions are crucial for optimizing their overall well-being and functioning.

Abstract Background Admission to the university changes life conditions and thereby increases mental pressure. If the students cannot bear the psychological pressure of being a student, that may lead to suicide among the vulnerable persons. Therefore, in this research, we would like to investigate the prevalence and associated factors of suicide-related behaviors in Iranian students. Methods This online, cross-sectional survey was performed from March 18 to April 15, 2023, in Iran. The questionnaires were completed by 2181 students. In this study, Perceived Stress Scale (PSS-4), Meaning in Life Questionnaire (MLQ), Generalized Anxiety Disorder Scale (GAD-7), and Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Oslo Social Support Scale (OSSS-3) were used. Finally, we identified the factors associated with suicide-related behaviors using univariate and multiple regression. Results The prevalence of suicidal behaviors in students was 57.95%. According to the results, male gender, marriage, having meaning in life, occasional smoking, sleeping after 1 a.m., and having social support were associated with a reduced risk of suicide. In addition, a history of sexual abuse, more anxiety, and higher perceived stress were associated with an increased risk of suicide. Conclusions The prevalence of suicide-related behaviors in Iranian students was higher than expected. Urgent interventions should be considered to prevent students from committing suicide. Helping students find meaning in life, as well as eliminating the causes of students’ anxiety and stress, may be effective in this respect. Additionally, teaching students how to control anxiety and stress may be helpful.

Abstract Introduction There is increased clinical use of gabapentin, these trends appear to chronologically align with the opioid overdose crisis and particularly with the increased restrictions on opioid prescription. Objectives The study aimed to assess the clinical variables, pain quality, and severity among patients with opioid use disorder as the main substance with and without gabapentin comorbid use. Methods The research involved 60 patients diagnosed with substance use disorder, divided into two groups: opioid use as the main substance and opioid use with comorbid gabapentin. All participants were assessed using a semi-structured clinical addiction interview, the structured clinical interview for diagnostic and statistical manual of mental disorders, the Addiction Severity Index, urine drug test, McGill Pain Questionnaire, and Douleur Neuropathique en 4 Questionnaire, in one interview setting. Results The study showed that pain relief was the main desirable effect in the gabapentin group, with 66.2% of the group experiencing it. Euphoria was the desirable effect in the opioid group, while overdose was more common in the gabapentin group. Respiratory complications were also more common in the Gabapentin group. Conclusion The study concluded that patients with comorbid gabapentin use disorder had a higher frequency of overdose, history of pain, and significant neuropathic pain, while less abstinence.

Abstract Background Body image has gained increasing importance in recent times due to the fact that it is commonly recognized that having body dissatisfaction is a major indicator of eating disorders. The development of dissatisfaction with the body can often be attributed to perceived societal expectations and pressures to adhere to idealized appearance standards. The purpose of the study is to examine the relationship between social media usage and family attitude influences on eating behavior and body image satisfaction in both male and female students. The design of this study was cross-sectional to collect data from 620 students in different faculties and academic disciplines within King Abdulaziz University. Participants completed a self-reported questionnaire to measure the Eating Attitude Test, social media exposure, Body Shape Questionnaire, family influence scale, and body satisfaction. Results Among the participants, 41.1% of students are at risk of eating disorders, and 25.2% have marked concern with body shape. The correlational analysis identified significant correlations as eating disorder score demonstrated negative correlations with the Family Influences Scale, Body Shape Questionnaire, body satisfaction, and social media (r = 0.455, r = 0.388, r = 0.388, and r = 0.373, respectively) and positive correlations with the with body mass index (r = 0.166). The Family Influences Scale score displayed positive correlations with the body shape questionnaire (r = 0.487), body satisfaction (r = 0.487), and media (r = 0.582) and negative correlations with body mass index (r = 0.289). Conclusion The study highlighted the influential roles of both the media and family in shaping eating habits and body image satisfaction. Also, the results indicated that eating disorders and concerns related to the body are highly prevalent among students. Accordingly, parents and educators should identify the risks of media and eating disorders and encourage them in seeking therapy.

Abstract Background The COVID-19 pandemic has had a well-evidenced impact on adolescents, who are especially sensitive to pandemic disruptions given the critical role of socialization in their development. In Chile too, evidence shows increases in mental health complaints among adolescents over the lockdown period. Our study aimed at exploring the experiences of Chilean adolescents regarding their mental health during the lockdown and school closure (March 2020-December 2021), and during the return to on-site education (2022) as informed by adolescents and school staff, with a focus on family, school, and social sources of risk and support for adolescents’ wellbeing during these periods. Methods Using a qualitative approach, we conducted semi-structured interviews with 19 adolescents and 16 staff members from schools in an urban area of Chile. Results Through thematic analysis, we generated five themes: [1] Adolescents in a mental health crisis, comprising a range of distressing experiences and mental health problems. This crisis was fueled by alterations in the functioning of adolescents’ systems: [2] Broken support systems (peers and school); [3] The school agenda must go on, reflecting schools’ strict compliance with the educational curriculum; and [4] Blurred boundaries between home and school life and within the family. Finally [5], Development will (try to) find its way describes how most participants experienced a bouncing back to wellbeing in the course of the school year upon return, and how some developmental milestones took place despite the abnormal conditions, providing evidence for resilience amid pandemic adversity. Conclusions The findings give insight into how the exchanges between the adolescent and the social systems they are embedded in were interfered. The results help us understand the challenges for mental health during and after the pandemic, and highlight adolescents’ capacity to thrive as normality was restored. The results also underscore the importance of upholding stability across adolescents’ systems and routines, in order to mitigate impacts on wellbeing amid abnormal circumstances. The findings are relevant for development-informed initiatives in policy design in the aftermath of the pandemic and in future crisis management responses.

Abstract Background Adolescents face many challenges when coping with out-of-home placement, and life story work can be helpful in this context. Typically conducted in individual settings, life story work’s high resource requirements pose a challenge for implementation in the standard care of youth welfare institutions. To address this issue, the ANKOMMEN intervention was developed as a manualized group program for adolescents in residential care focusing on processing and coping with experiences associated with their out-of-home placement. Method The intervention was evaluated in a single-arm pilot study with questionnaires administered at three time points (pre-intervention, post-intervention, and 3-month follow-up). The primary outcome was self-efficacy, while secondary outcomes included self-esteem, depressive symptoms, posttraumatic stress symptoms, and behavioral problems. A total of 31 intervention groups with 115 adolescents (M = 14.91 years; SD = 1.45; 52.2% male) were conducted between October 2020 and September 2022 in Germany. Data were analysed using mixed effect models. Results Pre-post comparisons revealed increased self-efficacy (d = −0.80) and self-esteem (d = −0.68) among participants with below-average scores prior to the intervention. Additionally, there was a decrease in self-reported depressive symptoms (d = 0.76), self-reported posttraumatic stress symptoms (d = 0.58), self-reported internalizing behavior problems (d = 0.74), caregiver-reported internalizing behavior problems (d = 0.76), and self-reported externalizing behavior problems (d = 0.52) for participants with clinically relevant scores prior to the intervention. These improvements were stable in the 3-month follow-up assessment. Furthermore, the intervention proved its feasibility in standard care within the context of the evaluation study. Conclusions The results of the pilot study provide preliminary evidence for the feasibility and potential effectiveness of ANKOMMEN but further research is needed to obtain valid evidence for the efficacy of the intervention.

Abstract Background Harsh parenting has been recognized as a risk factor for adolescent anxiety; however, the underlying mechanisms of this relationship remain unclear, and it is unknown whether this relationship is influenced by different parental roles and living arrangements. This study aimed to investigate the mediating mechanisms between harsh parenting and adolescent anxiety symptoms using a multiple mediation model and to further compare specific roles of harsh parenting and distinguish between the living arrangements. Methods A total of 3505 adolescents completed this survey, and 3295 adolescents (54.7% girls, Mage = 14.97 years) were included in the study. Participants completed self-assessments measuring harsh parenting, self-efficacy, school connectedness, Internet addiction, sleep problems, and anxiety. They were categorized into three groups based on living arrangements: living with both parents, only with the mother, or only with the father. Results Correlational analyses revealed that both maternal and paternal harsh parenting were associated with increased anxiety symptoms. Structural equation modeling (SEM) mediation analyses and multigroup analyses showed that the independent mediating effects of school connectedness, Internet addiction, and sleep problems, as well as the sequential mediating pathways involving self-efficacy → school connectedness, self-efficacy → Internet addiction, and self-efficacy → sleep problems, vary across the adolescents’ living arrangements in the association between maternal and paternal harsh parenting and adolescent anxiety symptoms. Conclusions This study elucidated the mechanisms linking harsh parenting to adolescent anxiety symptoms and validated the effects of different parental roles and living arrangements. The findings provide important insights for developing targeted interventions to address anxiety symptoms in adolescents exposed to harsh parenting.

Abstract Patients suffering from schizophrenic psychosis show reduced synaptic connectivity compared to healthy individuals, and often, the use of cannabis precedes the onset of schizophrenic psychosis. Therefore, we investigated if different types of cannabinoids impact methylation patterns and expression of schizophrenia candidate genes concerned with the development and preservation of synapses and synaptic function in a SH-SY5Y cell culture model. For this purpose, SH-SY5Y cells were differentiated into a neuron-like cell type as previously described. Effects of the cannabinoids delta-9-THC, HU-210, and Anandamide were investigated by analysis of cell morphology and measurement of neurite/dendrite lengths as well as determination of methylation pattern, expression (real time-qPCR, western blot) and localization (immunocytochemistry) of different target molecules concerned with the formation of synapses. Regarding the global impression of morphology, cells, and neurites appeared to be a bit more blunted/roundish and to have more structures that could be described a bit boldly as resembling transport vesicles under the application of the three cannabinoids in comparison to a sole application of retinoic acid (RA). However, there were no obvious differences between the three cannabinoids. Concerning dendrites or branch lengths, there was a significant difference with longer dendrites and branches in RA-treated cells than in undifferentiated control cells (as shown previously), but there were no differences between cannabinoid treatment and exclusive RA application. Methylation rates in the promoter regions of synapse candidate genes in cannabinoid-treated cells were in between those of differentiated cells and untreated controls, even though findings were significant only in some of the investigated genes. In other targets, the methylation rates of cannabinoid-treated cells did not only approach those of undifferentiated cells but were also valued even beyond. mRNA levels also showed the same tendency of values approaching those of undifferentiated controls under the application of the three cannabinoids for most investigated targets except for the structural molecules (NEFH, MAPT). Likewise, the quantification of expression via western blot analysis revealed a higher expression of targets in RA-treated cells compared to undifferentiated controls and, again, lower expression under the additional application of THC in trend. In line with our earlier findings, the application of RA led to higher fluorescence intensity and/or a differential signal distribution in the cell in most of the investigated targets in ICC. Under treatment with THC, fluorescence intensity decreased, or the signal distribution became similar to the dispersion in the undifferentiated control condition. Our findings point to a decline of neuronal differentiation markers in our in vitro cell-culture system under the application of cannabinoids.

Abstract Schizophrenia is a complex neuro-psychiatric disorder including positive symptoms, negative symptoms, and cognitive deficits. A key cognitive dysfunction in schizophrenia is a deficit in visual working memory (VWM). VWM involves three distinct stages: encoding, maintenance, and retrieval. The deficit in any one stage would produce the same symptom (i.e., poor VWM), although their causes are not the same. In this study, we used a retro-cue VWM task that provides helpful cues at different stages: early in maintenance (early cue), late in maintenance (late cue), or during retrieval (retrieval cue). This modification would help “tag” or identify the cognitive stage(s) most responsible for impaired VWM performance in schizophrenia. Additionally, we took advantage of this tagging feature and applied 6 Hz transcranial alternating current stimulation (tACS) over the right dorsolateral prefrontal cortex (DLPFC) and right posterior parietal cortex (PPC)—which has previously been shown to enhance VWM in low-performing healthy individuals—to examine whether tACS would improve a specific stage or all stages of VWM processing in schizophrenia. We observed that cues significantly enhanced performance in low-performing patients, who benefited equally from early and late maintenance cues, but not from retrieval cues. These low-performers also responded well to theta tACS in their overall VWM performance as opposed to a specific VWM stage. No improvement effect was observed in high-performing patients for both retro cue and tACS. Together, our data suggest that 1) low-performing patients’ VWM deficits likely stem from poor memory consolidation rather than retrieval, 2) right frontoparietal theta tACS can improve low-performing patients’ VWM performance, and 3) such facilitatory tACS effect is not selective of a specific VWM stage and thus is likely driven by an improvement in overall visual attention.

Abstract Cognitive deficits and overweight are prominent challenges in the treatment of psychosis, which have a direct impact on patients’ quality of life. We aim to determine whether there is an association of overweight with cognitive performance and whether there are sex differences in this association. We included 170 individuals with first-episode psychosis (FEP) (mean age 23.08 years, 32.9% females) attending an early intervention service who underwent clinical, biometric, and cognitive assessments by the MATRICS Consensus Cognitive Battery. A set of two-way analyses of covariance (ANCOVAs) were conducted for each cognitive test. Sex, overweight, and their interaction were included as factors. Nearly 34% of the participants were overweight without differences between males and females. The excess of weight did not exert any main effect on cognition; however, overweight females performed significantly worse than non-overweight females in processing speed, verbal learning and memory, reasoning and problem-solving, and global cognitive function, whereas in males, there were no differences. Our findings highlight that sex matters in the study of metabolic and cognitive factors in FEP to develop targeted interventions based on sex perspectives.

Abstract Objectives This study aims to reveal the current knowledge map, research hotspots of functional magnetic resonance imaging (fMRI) studies on depression, as well as identify the brain regions associated with depression. Methods CiteSpace was conducted to analyze the publication outputs, country, institution, cited journals, author and cited author, references, keyword cocurrence and burst keywords of fMRI studies in depression from 2010 to 2024. And a meta-analysis of fMRI was used to identify brain regions associated with depression using Neurosynth. Results A total of 4,049 publications were included, and Gong Qiyong was the most prolific authors. Neuroimage, Biological Psychiatry, and Human Brain Mapping were prominent journals. Default mode network (DMN), prefrontal cortex, amygdala, and anterior cingulate cortex were the popular keywords. The fMRI studies on depression have mainly focused on major depression, especially the DMN. Functional connectivity and regional homogeneity of brain regions were research hotspots. The meta-analysis revealed significant differences in brain regions between patients with depression and healthy controls, including the Amygdala_L, Insula_R, Frontal_Inf_Oper_R, Cingulum_Post_L, Putamen_L, Thalamus_R, Angular_L, Precuneus_R, Frontal_Sup_R, Occipital_Inf_L. Conclusions This study sheds light on key issues and future directions in fMRI research on depression, elucidating the brain regions related to depression. Graphical Abstract

Abstract Introduction Bipolar disorder is a psychiatric condition commonly treated with lithium. This treatment has various biological effects on the brain; however, variability in the areas and types of changes as a result of lithium treatment has resulted in discourse over lithium’s effect. As a result, a comprehensive synthesis is needed to understand lithium’s true neurological effect. This review aims to identify a common result of lithium use in the neurobiology of bipolar patients, specifically in the amygdala, to determine whether volumetric changes in the amygdala are a common effect. Methods We conducted a preliminary search to identify key search terms across electronic databases, including Google Scholar and PubMed. After screening and application of inclusion and exclusion criteria, 9 cross-sectional studies were identified. Results The evidence from these cross-sectional studies showed either an increase or no change in amygdalar volume. While this fails to identify a definite pattern in amygdalar volume changes, it highlights a need for further research to identify sources of heterogeneity and minimize them to ascertain accurate results. Conclusions The present review may be used to influence future work concerning neurobiological changes in the amygdala as a result of lithium treatment for bipolar patients by summarizing patterns in the current literature.

Abstract Background Type 2 diabetes (T2D) is a chronic metabolic disorder that has a notable influence on mental well-being, contributing to elevated morbidity and mortality rates. Depression and anxiety disorders are the most common mental health concerns among patients with T2D worldwide. Therefore, the present study aimed to assess the impact of an online intensive lifestyle intervention (ILI) on mental health outcomes (depression and anxiety) in patients with T2D in India. Materials and methods This retrospective pre-post analysis included adult patients (aged > 18 years) diagnosed with T2D who were enrolled in a diabetes management program in India between June 2021 and June 2023. The intervention consisted of lifestyle modifications such as a customized plant-based diet, regular physical activity, psychological support through group and individual therapy, and medical management. Data were extracted from the electronic database of the clinic, including anthropometry, medical history, biochemical parameters, symptoms of depression, and anxiety (assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) scale) at the start and end of the six-month intervention period. Results Of the 1061 eligible patients (177 with prediabetes), 40.3% were female. The mean age, duration of diabetes, and HbA1c levels were 52 ± 10.4 years, 9.8 ± 7.8 years, and 8 ± 1.7%, respectively. The prevalence of symptoms of depression and anxiety (ranging from mild to severe) was 46% and 44.3%, respectively, which reduced to 28.7% and 29.2%, respectively, post-intervention. Conclusion Integrated ILI successfully improved the symptoms of anxiety and depression, highlighting the importance of a multidisciplinary approach that includes diet, physical activity, psychological support, and medical management in enhancing mental health outcomes among patients with T2D. Future prospective studies are needed to explore the long-term effects of such interventions and develop effective strategies for promoting mental health in diverse populations. Trial registration The study was approved by the Freedom from Diabetes Research Foundation Institutional Ethics Committee (approval number FFDRF/IEC/2024/7) and registered in the Clinical Trials Registry of India (CTRI/2024/03/064596, registered on March 21, 2024).

Abstract Objective Most patients with alcohol use disorder (AUD) regularly take medication. Alcohol interacts negatively with many commonly prescribed medications. Little is known about whether the risk of potential alcohol-medication and drug-drug interactions increases or decreases in patients with AUD during inpatient withdrawal treatment. The aim of our study was to determine the prevalence and characteristics of potential alcohol-medication and drug-drug interactions in patients with AUD before and after withdrawal treatment in an addiction unit. Design Prospective monocentric quasi-experimental pre-post study. Methods Medication records before and after withdrawal treatment were analyzed and screened for potential alcohol-medication (pAMI) and drug-drug interactions (pDDI) using the drugs.com classification and the AiDKlinik ® electronic interaction program, respectively. Results We enrolled 153 patients with AUD who were treated in an addiction unit of a university hospital in Germany. Of these, 67.3% experienced at least one pAMI before and 91.5% after withdrawal treatment. In total, there were 278 pAMIs classified as “mild,” “moderate,” or “severe” before and 370 pAMIs after withdrawal treatment. Additionally, there were 76 pDDIs classified as “moderate,” “severe,” or “contraindicated combinations” both before and after withdrawal treatment. Conclusion The risk of exposure to pAMIs and pDDIs increases during inpatient withdrawal treatment in patients with AUD. Improvements in the quality of prescribing should particularly focus on the use of antihypertensives and opioids.

Abstract Background Postpartumpost-traumatic stress disorder (PTSD), as a psychological stress disorder, has long-term and widespread harm. Still, compared with other postpartum psychiatric disorders, postpartum PTSD has received relatively littleattention in China. This study aims to investigate the risk factors of postpartum PTSD and to develop a convenient and rapid nomogram screening tool to help clinical staff identify high-risk pregnant womenin time and take preventative and management measures. Methods Recruited pregnant women hospitalized for delivery in Qingdao Municipal Hospital and Jinzhou Maternal and Child Health Hospital from November 2022 to October 2023 as convenient samples for the questionnaire survey. Telephone follow-up was conducted 42 days after delivery. After univariate analysis, multicollinearity analysis, and logistic regression analysis, the risk factors of postnatal PTSD were obtained, a prediction model was established, and a nomogram was drawn by R software. G*power3.1.9.7 calculated the effectiveness of the test. The model was validated internally using the Bootstrap approach, and external validation was carried out using a verification group. The accuracy of the model's predictions and its clinical application value were evaluated by the area under the curve, calibration plot, and decision curve analysis. Results A total of 602 women were recruited in this study, and the incidence of postpartum PTSD was 11.1% (67/602). Multifactorial logistic regression analysis showed that poor self-assessment of sleep status in late pregnancy (OR = 5.336), cesarean section (OR = 2.825), instrumental delivery (OR = 5.994), having fear of labor (OR = 4.857), and a high score of Five Factors Inventory Neuroticism subscale (OR = 1.244) were independent risk factors for developing postpartum PTSD. A high Quality of Relationship Index score (OR = 0.891) was a protective factor for postpartum PTSD. In the training and validation sets, the nomogram model's area under the ROC curve was 0.928 and 0.907, respectively. The calibration curves showed that the nomogram model was well-fitted, and the Decision Curve Analysis indicated that the nomogram model had good value for clinical application. Conclusions With its strong predictive capacity, the prediction model built using postpartum PTSD risk factors can help clinical caregivers identify high-risk pregnant women early on and implement timely preventive intervention strategies.

Abstract Background Assertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams. Methods Our explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment. Results After two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team’s fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start. Conclusions ACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.

Abstract Background and objective Genetic polymorphism studies in families and twins indicated the heritability of depression. However, the association between genes with genetic polymorphism and depression provides various findings and remains unclear. Therefore, we conducted a systematic review and meta-analysis to determine the genes with their polymorphism associated with the symptomatic depression known as major depressive disorder (MDD). Materials and methods PubMed and Scopus were searched for relevant studies published before May 22, 2023 (1968–2023), and 62 were selected for this review. The study’s bias risk was investigated using the Newcastle–Ottawa scale. Gene functional enrichment analysis was investigated for molecular function (MF) and biological process (BP) and pathways. A meta-analysis of the studied genes that were replicative in the same single nucleotide polymorphism was conducted using a random-effect model. Results The 49 genes involved in MDD were studied and engaged in several pathways, such as tryptophan metabolism or dopaminergic and serotonergic synapses. Based on gene overlapping in MF and BP, 13 genes with polymorphisms were identified as related to MDD. Most of them were only studied once. Solute carrier family 6 member 4 (SLC6A4) overlapping between MF and BP and brain-derived neurotrophic factor (BDNF) as unique to BP were replicative studied and used in the meta-analysis. The polymorphism of SLC6A4 SS and LS genotypes increased the occurrence of MDD development but not significantly [odd ratio (OR) = 1.39; 95% confidence interval (CI) = 0.87–2.22; P = 0.16 and OR = 1.13; 95% CI = 0.84–1.53; P = 0.42, respectively]. A similar result was observed for BDNF rs6265 GG (OR = 1.26; 95% CI = 0.78–2.06; P = 0.35) and BDNF rs6265 AA genotypes (OR = 1.12; 95% CI = 0.77–1.64; P = 0.56). These studies indicated low bias and significant heterogeneity. Conclusion At least 13 studied genes with polymorphisms were involved in MDD development according to MF and BP, but not significantly. These results suggest that MDD development risk factors might require genetic and other factors for interaction and induction.

Abstract Background Gilles de la Tourette syndrome (GTS) is a persistent neurological disorder that profoundly affects the quality of life for afflicted individuals, however, tailored health-related quality of life (QOL) measures for Chinese pediatric GTS patients are lacking. This pioneering study aims to develop a QOL scale for Chinese children with GTS. Methods A cohort of 1,121 children (aged 6–16 years) diagnosed with GTS participated in scale development. Internal consistency was evaluated using Cronbach’s alpha. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to assess the factor structure of the GTS-QOL-Chinese, examining goodness-of-fit indices, factor loadings of individual items, and covariances between factors. Validity was determined through interscale correlations and comparisons with external measures to establish convergent and discriminant validity. Results Following reliability and validity analyses, a Chinese version of the 24-item GTS-specific quality of life scale was conclusively established, encompassing five subscales (psychological, compulsive, cognitive, physical, social). The scale demonstrated high internal consistency with a Cronbach’s alpha coefficient of 0.93, and validity was substantiated through interscale correlations ranging from 0.46 to 0.68. EFA identified five factors, explaining 61.26% of the total variation. CFA further confirmed the scale’s robustness, with all goodness-of-fit indicators meeting acceptable criteria (AGFI = 0.86, PCFI = 0.78, GFI = 0.89, CFI = 0.89, RMSEA = 0.07, SRMR = 0.06). Conclusions The Chinese version of the GTS-QOL scale has exhibits robust reliability and validity and is valuable for assessing the quality of life of Chinese children and adolescents with GTS. This scale may assist in tailoring interventions and improving patient care.

Abstract Background Readmissions in psychiatric inpatient care may reflect problems in the provision of care, but the underlying factors are not well known. We examined the associations of patient characteristics (sociodemographic factors, diagnoses), treatment (duration, previous episodes, neuromodulation) and ward overload with psychiatric inpatient readmissions and multiple readmissions in Finland. Methods We used a routinely collected data pool from one hospital district and followed all 2052 hospitalizations that started in 2018. The outcomes were readmission within 30 days and one year, and among those with readmission, the number of readmissions. Results Of the patients, 11% had readmission within 30 days and 33% had readmission within one year. Women, those with previous hospitalizations, those with an ICD-10 diagnosis from the ‘behavioural syndromes associated with physiological disturbances and physical factors / disorders of adult personality and behaviour’ group, those with a diagnosis from the ‘neurotic, stress-related and somatoform disorders’ group, those with psychotic disorders, and those who received neuromodulation treatment were more likely to have readmissions. Having a diagnosis of ‘disorders of psychological development’ or ‘behavioural and emotional disorders with onset usually occurring in childhood and adolescence’ was associated with a lower likelihood of readmission. The duration of treatment and ward overload during the index period were not associated with readmission. Conclusions The findings of this study suggest possible risk factors for readmission and can be used to plan psychiatric care. To some degree, the risk factors varied between different readmission types. It is important to examine whether there are unmet treatment needs in psychiatric inpatient care for children and adolescents.

Abstract Background The exact mechanisms underlying depression are not well understood. Chronic, low-grade inflammation is believed to play an important role in its development. The present study investigates the potential association between depressive symptoms and the neutrophil-to-lymphocyte ratio (NLR). Methods Seven data cycles of the National Health and Nutrition Examination Survey were extracted. Multivariable logistic regression and a generalized additive model were employed to determine the association. Results Thirty thousand eight hundred ninety-six subjects were analyzed. The results indicated that anhedonia and fatigue were significantly associated with NLR. Additionally, the generalized additive model results indicated a non-linear relationship between anhedonia, sleep disturbance and NLR. Subgroup analyses demonstrated that the correlation between anhedonia and NLR was significant in the above-60-year-old group (OR: 1.63, 95% CI: 1.14–2.33) and the male group (OR: 1.50, 95% CI: 1.07–2.10). Sleep disturbance was associated with NLR in the female group (OR: 1.36, 95% CI: 1.04–1.77). Fatigue was associated with NLR (OR: 1.30, 95% CI: 1.02–1.67) in the female group, as was the case in the non-Hispanic White group (OR: 1.32, 95% CI: 1.02–1.70). Conclusions There were associations between NLR and specific symptoms, and these associations varied across demographic subgroups. There was a non-linear association between anhedonia, sleep disturbance and NLR. These findings could potentially contribute to the advancement of precision medicine within the field of mental health.

Abstract Background Previous studies assessing the hypothesis that the construct of ‘aberrant salience’ is associated with psychosis and psychotic symptoms showed conflicting results. For this reason, the association between measures to index aberrant salience and subclinical psychotic symptoms in a general population sample was analysed. In addition, genetic vulnerability was added to the analysis as a modifier to test the hypothesis that modification by genetic vulnerability may explain variability in the results. Methods The TwinssCan project obtained data from general population twins (N = 887). CAPE (Community Assessment of Psychic Experience) scores were used to index psychotic experiences. Aberrant salience was assessed with white noise task and ambiguous situations task. Results Measures of aberrant salience were not associated with psychotic experiences, nor was there evidence for an interaction with genetic predisposition in this association (Z = 1.08, p = 0.282). Conclusions Various studies including the present could not replicate the association between aberrant salience and psychotic experiences in general population samples. The conflicting findings might be explained by moderation by genetic vulnerability, but results are inconsistent. If there was evidence for a main effect or interaction, this was in the positive symptom scale only. On the other hand, the association was more robust in so-called ‘ultra-high risk’ patients and first episode psychosis patients. Thus, this association may represent a state-dependent association, present only at the more severe end of the psychosis spectrum.

Abstract Background Major Depressive Disorder (MDD) poses a significant global health challenge, with symptom presentation potentially varying between adolescents and adults. Adolescence is a critical period marked by heightened vulnerability to interpersonal stresses, yet the impact of these stresses on the structure of depressive symptoms is not well understood. Recognizing the cultural nuances in how depression manifests among adolescents is crucial. To this end, this paper employs a network analysis approach, utilizing a comprehensive symptom checklist from the Multidimensional Depression Assessment Scale (MDAS). Our study investigates the role of interpersonal symptoms within the broader cluster of emotional, cognitive, and somatic symptoms and explores variations in adolescent groups in four Asian and European regions. Methods We recruited a diverse sample of 6,348 adolescents aged 12 to 18 from Hong Kong, Taiwan, the UK, China, and the Netherlands using the Qualtrics platform. Employing the Gaussian Graphical Model, we established a network model of depressive symptoms as measured by the MDAS, segregating the sample into Asian and European regions to examine the interconnections between them. The study focused on identifying central symptom nodes and comparing the network structures between the two groups. Results The analysis identified feeling worthless, low energy, being a burden to others, and low mood as central symptoms of depression. Notably, there were significant differences in the connections between depressive symptoms among Asian (Hong Kong, China and Taiwan) and European (UK and the Netherlands) adolescents, highlighting cultural variations in how interpersonal symptoms interact with emotional, cognitive, and somatic symptoms. Conclusion This study is pioneering in applying network analysis to include interpersonal symptoms in examining depression among a diverse adolescent population. It demonstrates that interpersonal symptoms are integral to the central features of depressive symptoms. Furthermore, our findings suggest that, compared to their UK and Dutch peers, interpersonal symptoms in Asian adolescents are uniquely connected to other symptom clusters, reflecting distinct cultural patterns. Limitations: The study engaged a broad community sample; however, future research could benefit from including a larger sample size to allow for a more detailed analysis of a greater number of symptom nodes.

Abstract Background Olfactory function is closely related to mood and the endocrine system. However, the role of olfactory function in bipolar disorder combined with metabolic syndrome remains unclear. The purpose of this study was to explore the associations among olfactory function, tumor necrosis factor alpha (TNF-α), and metabolic syndrome and its components in patients with bipolar disorder. Methods Ninety-six bipolar disorder patients were divided into two groups with and without metabolic syndrome. We also included 46 healthy controls. Olfactory function was assessed using the Sniffin’ Sticks test. Blood samples were collected to measure metabolic indicators and serum TNF-α levels. Results Significant differences in olfactory function were found among the three groups. Compared with the healthy controls, the bipolar disorder without metabolic syndrome group showed poorer olfactory identification ability (P

Abstract Psychological help-seeking for suicidal ideation is a critical aspect of effective suicide prevention. Past research has documented low help-seeking amongst rural residents in China. This study investigates the patterns and predictors of help-seeking intentions for suicidal ideation versus mental (depression) and physical (heart disease) health conditions among Chinese rural residents using General Help-Seeking Questionnaire Vignette version. A total of 143 rural participants from sixteen villages in Hubei province of China completed the survey via home-visiting interviews. Results revealed a general trend that the help-seeking intentions decreased as the helping sources shifted from close others (spouses, family, etc.) to professional helpers and online sources. Additionally, rural residents with higher educational levels, high self-efficacy, and more severe suicide ideations were more willing to seek help; and suicide literacy was found to be negatively associated with help-seeking intentions. The implications of the research findings are discussed.

Abstract Background Bernstein’s heuristic model of personal strengths describes 16 positive attributes of the healthy adult self, grouped into four higher-order factors: self-directedness (identity, self-reflection, self-confidence, self-assertion, imagination/creativity), self-regulation (emotional balance, resilience, self-control, self-care, reality testing), connection (empathy, compassion, humour, responsibility), and transcendence (gratitude and wisdom). The study aimed to explore the factorial validity of Bernstein’s Strengths Scale developed for the assessment of these constructs. Furthermore, we explored the association of strengths with attention-deficit hyperactivity (ADHD) symptoms and mental health in a nonclinical sample using a network approach. Methods Five hundred and twenty-eight adults filled out an online questionnaire, including Bernstein’s Strengths Scale (BSS), the Mental Health Continuum – Short Form (MHC-SF), and the Adult ADHD Self-Report Scale (ASRS). Results Though our data showed an acceptable fit to the 16-factor model, the Self-control subscale and item 28 of the Compassion subscale were excluded because of reliability issues. The final model with 15 factors and 44 items showed excellent fit, χ2(797) = 1130.149, p

Abstract Background Self-stigma is associated with low self-esteem, high shame and reduced drinking-refusal self-efficacy in people with alcohol use disorder (AUD). The Self-Stigma in Alcohol-Dependence Scale-Short Form (SSAD-SF) was designed to enable a brief, but valid assessment of AUD self-stigma. Methods We reduced the 64-item SSAD, originally derived from 16 stereotypes towards people with AUD, by removing the most offensive items based on perspectives of people with lived experience. The newly created scale was then assessed and validated in a cross-sectional study involving 156 people reporting alcohol issues in various treatment settings. Results The 20-item SSAD-SF includes five stereotypes, with good internal consistency for each subscale and the overall scale. It reflects the four-stage progressive model of self-stigmatization with decreasing scores over the stages awareness of stereotypes, agreement with stereotypes, self-application of stereotypes, and harmful consequences for self-esteem, and highest correlations between adjacent stages. The subscales apply and harm were associated with internalized stigma, shame, reduced self-esteem, and lower drinking-refusal self-efficacy, as supported by multivariate regression models. Discussion The SSAD-SF is a valid instrument for measuring the process of self-stigmatization in people with AUD. Self-stigma is a consistent predictor of reduced self-esteem, higher shame and lower drinking-refusal self-efficacy in people with AUD. We discuss merits of the progressive model for understanding and addressing self-stigma in AUD.

Abstract Background Depression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored. Methods This prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk. Results After full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10–9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13–3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57–7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12–2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn’t find interactions between depression and hs-CRP or anxiety and hs-CRP. Conclusion In patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients.

Abstract Background The study aimed to explore the influence of gender on the prevalence of various somatic symptoms and their associations with suicidal ideation (SI) among patients with major depressive disorder (MDD). Methods We recruited 3,275 patients with MDD from the National Survey on Symptomatology of Depression (NSSD), among whom 1,745 patients had SI. The clinical characteristics and the prevalence of somatic symptoms across 20 dimensions in MDD patients with SI were compared between male and female patients. Spearman correlation analysis and logistic regression analysis were used to explore the relationship between somatic symptoms and SI. Results In patients with SI, 32.2% of female participants attributed the onset of MDD to physical concerns, whereas 27% of male patients held a similar perspective (P = 0.032). Female patients exhibited a higher prevalence of early insomnia (64.6% vs. 70.2%) and a lower prevalence of hypersomnia (17.2% vs. 12.9%) and urinary system symptoms (25.0% vs. 17.8%). Logistic regression analysis indicated that female patients displayed a broader range of somatic symptoms identified as risk factors for SI, including increased appetite, respiratory symptoms, circulatory system symptoms, limb pain, and various others. Conclusion This study unveils gender-specific patterns in somatic symptoms among MDD patients with SI, highlighting the clinical significance of these symptoms in diagnosis and intervention. Understanding how physical concerns contribute to MDD, especially among females, underscores the need for tailored clinical approaches. Recognizing and addressing these symptoms could guide more effective suicide prevention strategies and enhance MDD management in clinical practice.

Abstract Background Previous studies have suggested a significant association between mobile phone addiction (MPA) and non-suicidal self-injury (NSSI) in general adolescents. However, limited research has analyzed this relationship in clinical populations, such as those with major depressive disorder (MDD), and the potential mediation mechanisms remain unclear. Methods This cross-sectional observational study analyzed data from 2343 adolescents with MDD (77.9% females; mean age = 14.99 years, SD = 1.65). Using mediation models, we explored the roles of self-esteem and depression severity (measured by Patient Health Questionnaire-9) in the relationship between MPA and NSSI. Additionally, we evaluated the associations between existing school-implemented mobile phone usage policies and levels of MPA, self-esteem, depression symptoms, and NSSI. Results MPA was significantly associated with NSSI, with low self-esteem and increased depression severity almost entirely mediating this effect (log-odds = 0.016, 95%CI = 0.02–0.013). Subdomains of MPA, including inability to control craving, feelings of anxiety, and productivity loss, followed similar mediation models, while the subdomain of withdrawal/escape had a partial effect mediated by depression severity. Additionally, enforced restrictions on mobile phone usage in schools did not show positive effects on related variables and even exacerbated MPA by increasing cravings and reducing productivity. Conclusion Our study suggests that MPA in adolescents with MDD may be an important risk factor for NSSI occurrence, and that reducing the negative impact of mobile phone usage on self-esteem and depressive symptoms, rather than simply restricting usage, may be crucial for effective intervention.

Abstract Background Schizophrenia is a debilitating mental disorder affecting about 1% of the global population, characterized by significant cognitive impairments and a strong hereditary component. Carnitine, particularly Levo-carnitine and its derivatives, plays a crucial role in cellular metabolism and mitochondrial function, with evidence suggesting a link between levo-carnitine deficiency and schizophrenia pathology. This study aims to investigate the causal relationship between different subtypes of levo-carnitine and the susceptibility to schizophrenia using Mendelian randomization analysis. Methods Forward Mendelian randomization analysis was conducted using levo-carnitine and its derivatives as exposure and schizophrenia as the outcome. Candidate data were obtained from the Open-GWAS database. Instrumental variables were identified as single nucleotide polymorphisms closely associated with exposure and harmonized with the outcome data after removing confounders and outliers. Mendelian randomization analysis was performed using inverse variance weighting as the primary approach, and sensitivity analysis was conducted to assess the reliability and robustness of the results. Finally, a reverse Mendelian randomization analysis was carried out using the same analytical procedures. Results The Mendelian randomization results indicate a significant negative causal relationship between isovaleryl-levo-carnitine and schizophrenia (P 0.05). Additionally, the reverse Mendelian randomization analysis did not identify any causal relationship between schizophrenia and levo-carnitine related exposures (P > 0.05). Sensitivity analyses, including pleiotropy and heterogeneity analysis, did not reveal any potential bias in the Mendelian randomization results (P > 0.05). Conclusion The results suggest that elevated levels of isovaleryl-levo-carnitine may potentially mitigate the risk of developing schizophrenia, highlighting the prospective therapeutic and preventive implications of isovaleryl-levo-carnitine in the clinical management of schizophrenia.

Abstract Background The primary objective of this trial is to examine the mechanisms of time-restricted eating (TRE) as an adjunct to psychiatric care for people with bipolar disorder (BD) with sleep or circadian disruptions. This study builds on prior studies of circadian disruption in BD as well as growing evidence that TRE improves circadian functioning. Methods One-hundred fifty participants diagnosed with BD 1 or II will be recruited via advertising in the local community. Main inclusion criteria include: obtaining medical treatment for BD; current sleep or circadian problems; self-reported eating period of ≥ 12 h; no eating disorder or other health conditions that would hinder or limit the safety of following TRE; and not currently experiencing a mood episode, acute suicidality, psychosis, alcohol or substance use disorder. Participants will be asked to complete a baseline period in which daily food intake is logged online for two weeks. After baseline, participants will be asked to follow TRE for 8 weeks and to continue to complete daily food logging during this time. Symptom severity interviews will be conducted by phone or videoconference at baseline, mid-intervention (6 weeks post-baseline), end of intervention (10 weeks post-baseline), and 6 months post-baseline. Self-rated symptom severity and quality of life data will be gathered online at the same time points as symptom severity interviews, and at 16 weeks post-baseline (6 weeks after the TRE period ends). To assess potential mechanisms of change, we will examine the change in diurnal amplitude of ‘clock’ gene expression as a primary mediator at 8 weeks compared to baseline. We will further test whether diurnal amplitude of clock gene expression is predictive above and beyond the role of two covariate potential mediators, glucose tolerance and inflammation at 8 weeks relative to baseline. To provide an index of whether TRE successfully decreases emotional lability, participants will be asked to complete 5 mood assessments per day for 7 days at baseline and at 10 weeks. These mood assessments will be optional. Discussion The planned research will provide novel and important information on whether TRE improves sleep/circadian rhythm problems, along with reductions in mood symptoms and improvements in quality of life, for individuals with BD. Trial registration ClinicalTrials.gov ID: NCT06555406.

Abstract Background Gesture difficulties have been reported in later-born siblings of children with autism spectrum disorder (ASD). Careful observation of gesture development during the first two years of children at elevated likelihood (EL) of developing ASD may identify behavioral indicators that facilitate early diagnosis. Methods This study enrolled 47 EL infants and 27 low-likelihood (LL) infants to explore gesture developmental trajectories and the predictive value of gesture to expedite the early detection of core characteristics of ASD. Gesture frequency, communication function, and integration ability were observed and coded from a semi-structured assessment administered longitudinally across 9–19 months of age. We conducted the Autism Diagnostic Observation Schedule assessment at 18–19 months for ASD’s core characteristics. Results The development of joint attention (JA) gestures was slower in the EL than in the LL group. The trajectories of the two groups began to diverge at 14–18 months. Children who reached the diagnostic cutoff point for ASD showed reductions in social interaction gestures at 12–13 months, in gestures integrated with any two communication skills (G-M) at 15–16 months; and in gestures integrated with eye contact (G-E) at 18–19 months. Overall gesture and G-M integration were associated with an overall ADOS communication and social interaction score. Conclusions The developmental trajectories of JA gestures of EL and LL children differed. G-M gestures represent early indicators that may be a predictor of ASD.

Abstract Background Pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) is a controversial diagnosis with limited evidence-based treatment guidelines available, particularly for severe and treatment-resistant cases. Case presentation : This report describes a 9-year-old male presenting with sudden onset, severe obsessive-compulsive disorder (OCD) symptoms one month following a streptococcus infection. His symptoms included suicidality and recurrent self-injurious behaviors, which led to multiple inpatient hospitalizations. He was diagnosed with PANDAS and was treated with psychotropic medications, antibiotics, immunotherapy, and a tonsillectomy. Over the two years since initial admission, the patient’s condition improved, with a decrease in symptom severity and an increase in adaptive functioning, though symptom remission was slow to occur. Conclusions This paper explores the controversies surrounding the PANDAS diagnosis, reviews potential treatments, and discusses the dilemmas of medical decision-making in the setting of severe treatment-resistant symptoms and limited evidence-based guidelines. We hope that this case report will be valuable to healthcare providers facing similar presentations and inspire further investigation into this complex condition.

Abstract Background The concept of recovery has become internationally widespread. To promote personal recovery of individuals with mental disorders, it is important that they live life on their own terms. Many people with mental disorders wish to build intimate relationships and marry. However, people with mental disorders face obstacles in building such relationships and communicating with their partners. The program AIRIKI, which means “power to love,” was developed to help people with mental disorders gain confidence in building intimate relationships. The AIRIKI pilot study with one-group pre post test showed positive effects on self-esteem, hope, and communication. Therefore, the purpose of the proposed randomized controlled trial (RCT) is to determine the effects of the videoconferencing program on self-esteem, hope, and self-confidence in communication among un-married people with mental disorders. Methods The proposed randomized controlled trial has two arms (intervention group and control group). After baseline questionnaire assessment, participants will be allocated randomly. Within two months of allocation, the intervention group will participate in videoconferences about intimate relationships and marriage with 2–5 participants and 3 facilitators, which will last 3 h, for two days. Three facilitators will support participants in each session. The intervention group will complete a questionnaire for outcome assessment at termination and one month after the program. The control group will complete the outcome questionnaire at one month after baseline and two months after baseline. The questionnaire will include the Rosenberg Self-Esteem Scale (RSES), Herth Hope Index (HHI), and Self-confidence in Communication Scale (SCS). Control group members can participate in a videoconference program, which will be held separately from the intervention group, after completing their outcome assessments. Discussion This trial is the first randomized controlled trial of which we are aware to test the effects of an online program for un-married people with mental disorders to consider and discuss their romantic relationship and marriage. The results will provide information on the effectiveness of an online program for people with mental disorders to imagine their romantic relationships and marriages. Trial registration This trial has been registered with the UNIN Clinical Trials Registry (UMIN000052027; 2023/08/28).

Abstract Background It was reported that more than 96% of autism spectrum disorder (ASD) children are accompanied with different degrees of sensory processing abnormalities, and up to 50% of ASD children exhibit abnormal auditory response. Studies have confirmed that some ASD children’s abnormal auditory response may be related to their abnormal auditory processing. Prior research demonstrated that ASD children’s auditory processing has high heterogeneity, thus, ASD children’s auditory processing may have different developmental trajectories. However, no study has concentrated on the developmental trajectories of ASD children’s auditory processing. In addition, auditory processing plays a crucial role in ASD children’s language development, thus, ASD children’s different language development outcomes may be related to different auditory processing development tracks. Therefore, this study aims to explore the developmental trajectory of auditory processing in ASD children and analyze the relationship between different developmental trajectories of auditory processing and language impairment. Methods/Design In this study, 220 ASD children aging 3 years and 0 months to 4 years and 11 months are recruited as the research objects, and their demographic characteristics are collected. The subjects are tested for peripheral hearing, intelligence, and autism symptoms. Furthermore, ASD children’s auditory processing and language development are evaluated at baseline, 1 year, and 2 years later. In addition, ASD children’s auditory processing is evaluated by electrophysiological test and the Preschool Auditory Processing Assessment Scale. Moreover, ASD children’s language skills are assessed using the Language Development Assessment Scale for Children Aged 1–6. The various categories of the developmental trajectory of ASD children’s auditory processing are examined through the latent category growth model. Additionally, a hierarchical regression model is developed to analyze the predictive impact of different auditory processing development trajectories on language impairment in ASD children. Discussion This longitudinal study will explore the categories of auditory processing developmental trajectories in ASD children, and analyze the relationship between different categories of auditory processing developmental trajectories and language development, providing new ideas and targeted targets for the rehabilitation training of language impairment in ASD children, as well as promoting early and accurate interventions for ASD children.

Abstract Background Depression is among known mental health conditions and students in schools of medicine are not immune to it. In this investigative study, 211 clinical medical students of two private universities from North-Central Nigeria were examined on depression prevalence, the contributory factors and their coping strategies. Methods The Patient Health Questionnaire 9 (PHQ-9), the Medical Student’s Stressor Questionnaire (MSSQ) and identified coping strategies according to Coping Oriented to Problems Experienced Inventory (COPE) were instruments of data collection. Results The results were obtained by both descriptive analysis and test of association between some categorical variables. The depression prevalence amongst the participants was 159 (75.4%). Females (124 (78.0%)) were more depressed than males (35 (22.0%)). Factors identified as contributing to depression were the heavy academic workload (124 (78.5%)), insufficient family time (93 (58.1%)) and financial constraints (54 (34.0%)). The most utilized method of coping with their stress was engaging on social media (133 (84.2%)), followed by talking with relatives or friends (99 (62.7%)) and use of recreational drugs (20 (12.8%)). The findings from this study have shown that more than three-quarters of the respondents suffered from varying degrees of depression from mild, 63 (29.9%), moderate, 53 (25.1%) to severe, 43 (20.4%). Conclusions The heavy academic workload was a major source of depression. Colleges of Medicine should take pro-active steps towards their students’ mental health and academic workload should be well spaced to reduce the stress imposed by the frequency of examinations.

Abstract Objectives Sleep characteristics such as duration, continuity, and irregularity are associated with the risk of hypertension. This study aimed to investigate the association between sleep timing (including bedtime, wake-up time, and sleep midpoint) and the prevalence of hypertension. Methods Participants were selected from the Sleep Heart Health Study (n = 5504). Bedtime and wake-up times were assessed using sleep habit questionnaires. The sleep midpoint was calculated as the halfway point between the bedtime and wake-up time. Restricted cubic splines and logistic regression analyses were performed to explore the association between sleep timing and hypertension. Results A significant nonlinear association was observed between bedtime (Poverall 12:00AM and 23:01PM to 12:00AM) and early (≤ 22:00PM) bedtimes were associated with an increased risk of hypertension compared to bedtimes between 22:01PM and 23:00PM. In addition, individuals with late (> 7:00AM) and early (≤ 5:00AM) wake-up times had a higher prevalence of hypertension than those with wake-up times ranging between 5:01AM and 6:00AM. Delaying the sleep midpoint (> 3:00AM) was also associated with an increased risk of hypertension. Furthermore, no significant interaction effect was found in the subgroup analyses stratified by age, sex, or apnea-hypopnea index. Conclusions Our findings identified a nonlinear association between sleep timing and hypertension. Individuals with both early and late sleep timing had a high prevalence of hypertension.

Abstract Background One of the main causes of health-related issues in children is neurodevelopmental disorders (NDDs), which include attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and Tourette syndrome (TS). Nonetheless, there is relatively little prior research looking at the link between immunological inflammation and NDDs. Our work uses a two-sample Mendelian Randomization (MR) approach to provide a thorough evaluation of the causal effects of immune traits on ADHD, ASD, and TS. Methods As exposures, 731 immunological traits’ genetic associations were chosen, and the outcomes were genome-wide association data for ADHD, ASD, and TS. The inverse-variance weighted (IVW), weighted median (WM), and MR-Egger methods were used to conduct MR analysis. The results’ robustness, heterogeneity, and horizontal pleiotropy were confirmed using extensive sensitivity analysis. Results With single-nucleotide polymorphisms serving as instruments and false discovery rate (FDR) correction applied, the study found that significantly higher expression of CD62L on CD62L+ myeloid DC (IVW, OR: 0.926, 95% CI 0.896~0.958, P = 9.42 × 10–6, FDR = 0.007) and suggestively higher absolute cell count (AC) of CD28 + DN (CD4-CD8-) (IVW, OR: 0.852, 95% CI = 0.780 ∼ 0.932, P-value = 4.65 × 10−4, FDR = 0.170) was associated with a lower risk of ADHD. There was no pleiotropy, and the causal relationships were strong according to sensitivity, leave-one-out, and MR-Steiger directionality tests. For ASD and TS, no harmful or protective immune traits were observed. Conclusions The results of the study lend credence to the theory that deficiency in CD62L on CD62L+ myeloid DC and CD28 + DN (CD4-CD8) AC may contribute to the onset of ADHD.

Abstract Background Borderline Personality Disorder (BPD) is a prevalent and debilitating psychiatric condition often accompanied by Post-Traumatic Stress Disorder (PTSD), with a substantial prevalence of trauma history among affected individuals. The clinical, cognitive, and cerebral parallels shared with PTSD suggest a trauma-related etiology for BPD. Studies consistently demonstrate a reduction in hippocampal volume in individuals with BPD, echoing findings in PTSD. However, the interpretation of this shared neurobiological profile remains contentious, with ongoing debates regarding the independence of these pathologies or the potential exacerbation of diminished hippocampal volume in BPD due to concurrent PTSD. Differential impacts on hippocampal subfields across both disorders may further complicate interpretation, suggesting the volume of hippocampal subfields as a potential discriminant biomarker. This study aims to characterize the multidimensional specific and shared profiles of BPD and PTSD-related alterations, with a particular emphasis on hippocampal subfields during adolescence, a crucial period in BPD development. Methods This study focuses on female adolescents, who are more prevalent in the BPD population. Participants are categorized into three groups: BPD, BPD with comorbid PTSD, and a control group of matched healthy individuals. Data collection encompasses clinical, cognitive, and neuroimaging domains commonly affected in both disorders, utilizing various imaging markers (including gray matter macrostructure, white matter microstructural integrity, and regional functional connectivity). Discussion This study examines adolescent BPD with and without comorbid PTSD on clinical, neuroimaging, and cognitive levels. It is the first to use a comprehensive multi-modal approach within the same sample. Additionally, it uniquely explores hippocampal subfield volume differences in adolescents. Analysis of the relationship between the investigated domains and the effects of PTSD comorbidity will elucidate specific and shared alteration profiles in both disorders. Trial registration IDRCB number 2019-A00366-51 / clinicaltrials.gov ID: NCT0485274. Registered on 21/04/2021.

Abstract Background Resilience is a protective feature against anxiety and depression disorders. However, the precise relationship and structure of resilience and anxiety and depression remain poorly understood. This study sought to investigate the link among resilience’ components and anxiety as well as depression. Methods 1,279 clinical nurses were recruited. 10-item Connor-Davidson Resilience Scale, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 were employed to evaluate resilience, anxiety, and depression, respectively. The regularized partial-correlation network was generated utilizing data from cross-sectional survey and the bridge expected influence index was utilized to quantify bridge components. Results The rates of anxiety and depression within clinical nurses were 67.3% and 67.2%, accordingly. Four strongest bridge edges appeared in the resilience-anxiety network, like “Adapt to change”- “Fear that something might happen”, and “Stay focused under pressure”- “Uncontrollable worry”. Two strongest bridge edges appeared in the resilience-depression network, like “Adapt to change”- “Concentration difficulties” and “Stay focused under pressure”- “Fatigue”. “Adapt to change” was recognized as bridging nodes in both the resilience-anxiety network and the resilience-depression network. Conclusions Interventions targeting the bridge component “Adapt to change” within resilience, may mitigate the intensity of anxiety and depression symptoms among clinical nurses.

BackgroundCurrently， there has been a gradual increase in the incidence of mental diseases， becoming a problem that has attracted great concern of the general public. Zhuhai is a core city of the Guangdong-Hong Kong-Macao Greater Bay Area， and the local government have attached great importance to the mental health of residents. The systematic study on the mental health has focused largely on pregnant women and medical workers， yet few are on the adult residents.ObjectiveTo investigate the prevalence and its influencing factors of anxiety and depression among adult residents in Zhuhai， so as to provide references for formulating targeted psychological intervention strategies.MethodsFrom September 1 to December 1， 2021， a cohort of 5 600 permanent residents aged 18 years and above in Zhuhai were selected through multistage sampling. All participants were subjected to complete Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， Generalized Anxiety Disorder Scale-7 item （GAD-7） and National Mental Health Literacy Questionnaire based on Wenjuanxing software. Then Logistic regression was employed to identify the factors associated with anxiety and depression among the residents.ResultsAmong the 5 600 residents， depressive symptoms were detected in 842 （15.04%） residents and anxiety symptoms in 579 （10.34%） residents. Logistic regression analysis yielded that female gender （OR=1.488）， living in Doumen district （OR=1.942）， junior college/undergraduate level （OR=3.602）， postgraduate and above （OR=5.904）， irregular meal pattern （OR=3.320）， comorbid chronic diseases （OR=3.244）， disqualification of self-assessment （OR=3.414） and disqualification of mental health skill （OR=2.131） were risk factors for depression symptoms， whereas age ≥25 years old （of all age groups OR20 000 yuan （OR=0.438） and exercising ≥3 times a week （OR=0.431） were protective factors for depression symptoms. Age of 25~34 years old （OR=2.051）， living in Jinwan district （OR=1.729） or Doumen district （OR=1.901）， junior college/undergraduate level （OR=2.955）， postgraduate and above （OR=6.662）， irregular meal pattern （OR=2.741）， comorbid chronic diseases （OR=3.535）， disqualification of self-assessment （OR=3.325） and disqualification of mental health skill （OR=1.838） were risk factors for anxiety symptoms， while monthly per capita income of 6 001~9 000 yuan （OR=0.665） and exercising ≥3 times a week （OR=0.572） were protective factors for anxiety symptoms.ConclusionThe mental health status of adult residents in Zhuhai is affected by various factors， including gender， age， region of residence， education level， meal pattern， exercise frequency and chronic diseases. ［Funded by 2023 Zhuhai Medical Research Project （number， 2220009000227）］

BackgroundResults of genetic testing for antipsychotic drugs can guide the rational use of drugs in clinical practice and help improve the clinical symptoms of patients with schizophrenia. However， there is currently limited evidence in China regarding the impact of genetic testing results on medication adherence， social function and drug side effects of antipsychotic drug treatment.ObjectiveTo explore the improvement of clinical symptoms， medication adherence and social function in patients with schizophrenia under the guidance of antipsychotic drug gene testing results and examine the safety of drug treatment， so as to provide references for ifor precise treatment of schizophrenia patients.MethodsPatients with acute schizophrenia who received hospitalization at Dazhou Minkang Hospital from July 2019 to August 2021 as well as met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10） were selected as research subjects （n=144）. Based on random number table， subjects were divided into study group and control group， with 72 cases in each group. Control group received drug treatment based on the doctor's clinical experience， while study group received drug treatment based on the results of gene testing for antipsychotic drug. Both treatments lasted for 12 weeks. At baseline as well as 2， 4， 8 and 12 weeks after treatment， Positive and Negative Syndrome Scale （PANSS）， 8-item Morisky Medication Adherence Scale （MMAS-8）， Social Functional Rating Scale （SFRS） and Treatment Emergent Symptom Scale （TESS） were adopted for assessment.ResultTime effect and group effect of the reducing rate of PANSS， MMAS-8 and SFRS scores in the groups were statistically significant （Ftime=95.251， 6.650， 14.101， Fgroup=38.055， 58.175， 128.221， P