Embracing different languages and local differences:Coconstructive patient simulation strengthens host countries’clinical training in psychiatry

BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.

Psychiatric outcomes in outpatients affected by long COVID:A link between mental health and persistence of olfactory complaint

BACKGROUND Anosmia was one of the main symptoms of coronavirus disease 2019(COVID-19).A psychiatric history(i.e.,depression)may be an independent contributor to the risk of COVID-19 diagnosis,and COVID-19 survivors appear to have an increased risk of neuropsychiatric sequelae(bidirectional association).AIM To compare the rate of psychiatric disorder among post-COVID patients without anosmia vs patients with persistent olfactory complaints.METHODS We conducted a prospective case control study from March 2020 to May 2021.Patients recruited at the ENT department of Nice University Hospital had a subjective olfactory complaint(visual analogue scale)for over 6 wk and a molecular or CT-proven severe acute respiratory syndrome coronavirus 2 diagnosis confirmed by serology.Post-COVID patients without persistent olfactory disorders were recruited at the university hospital infectiology department.Psychiatric medical histories were collected by a psychiatrist during the assessments.RESULTS Thirty-four patients with post-COVID-19 olfactory complaints were included in the first group of the study.Fifty percent of the patients were female(n=17).The group’s mean age was 40.5±12.9 years.The control group included 32 participants,of which 34.4%were female(n=11),and had a mean age of 61.2±12.2 years.The rate of psychiatric disorder among post-COVID patients with olfactory complaints was significatively higher(41.7%)than among patients without(18.8%)(χ2=5.9,P=0.015).CONCLUSION The presence of a psychiatric history may constitute a potential risk factor for the development of long COVID due to persistent anosmia.It therefore seems important to establish reinforced health monitoring after a COVID 19 infection in at-risk patients.Further prospective,translational,and collaborative studies are needed to extrapolate these results to the general population.

Phenomenology of obsessive-compulsive disorder in children and adolescents: Sample from a tertiary care center in Istanbul, Turkey

BACKGROUND Obsessive-compulsive disorder(OCD)is a heterogeneous disease in many respects and exhibits this diversity in terms of phenomenology.It also displays several different characteristics in children compared to adults.AIM To describe the socio-demographic and phenomenological features of children with OCD and to investigate the impact of these features on response to pharmacotherapy.METHODS This retrospective study was carried out with 150 children and adolescents who had been diagnosed with OCD between 2014 and 2018.Data was collected by examining the files of the patients with diagnosis of OCD and similar disorders from the hospital database.Yale-Brown Obsessive-Compulsive Scale for Children was used for the assessment of obsession-compulsion subtypes.The Clinical Global Impression(CGI)scale was used to evaluate the severity of the disease(CGI-S)and global improvement(CGI-I).The predictors of treatment response were evaluated using linear regression analysis.The level of significance for all statistic tests was set as P<0.05.RESULTS The sample was divided into prepubertal(44%)and adolescent(56%)age groups.The most prevalent obsessions were contamination and aggression obsessions,and the most frequent compulsions were washing and checking.While contamination was observed more commonly in the prepubertal age group,the religious obsession was seen more frequently in adolescents.Patients with aggression obsession presented a higher frequency of comorbid anxiety(P=0.022)and mood subgroups(P>0.05).A lower CGI-I score was linked to a lower CGI-S score(95%confidence interval 0.21-0.39,P<0.001)and the prepubertal age of admission(95%confidence interval 0.03-0.87,P=0.020).CONCLUSION The phenomenology of OCD shows differences depending on the age group and the comorbid psychiatric disorders.Earlier identification and treatment of OCD may help to prevent the impairment of the mental health of children and adolescents.

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.

A cohort study of adolescents with depression in China:tracking multidimensional outcomes and early biomarkers for intervention

Background Depression in adolescents is recognised as a global public health concern,but little is known about the trajectory of its clinical symptoms and pathogenesis.Understanding the nature of adolescents with depression and identifying earlybiomarkers can facilitatepersonalised intervention andreducediseaseburden.Aims To track multidimensional outcomes of adolescents with depression and develop objective biomarkers for diagnosis,as well as response to treatment,prognosis and guidance for early identification and intervention.Methods This is a multidimensional cohort study on the Symptomatic trajectory and Biomarkers of Early Adolescent Depression(sBEAD).We planned to recruit more than 1000 adolescents with depression and 300 healthy controls within 5 years.Multidimensional clinical presentations and objective indicators are collected at baseline,weeks 4,8,12 and 24,and years 1,2,3,4 and 5.Conclusions To the best of our knowledge,this is the first longitudinal cohort study that examines multidimensional clinical manifestations and multilevel objective markers in Chinese adolescents with depression.This study aims at providing early individualised interventions for young,depressed patients to reduce the burden of disease.

Adolescent anxiety disorders and the developing brain: comparing neuroimaging findings in adolescents and adults

Adolescence is the peak period for the incidence of anxiety disorders.Recent findings have revealed the immaturity of neural networks underlying emotional regulation in this population.Brain vulnerability to anxiety in adolescence is related to the unsynchronised development of anxiety-relevant brain functional systems.However,our current knowledge on brain deficits in adolescent anxiety is mainly borrowed from studies on adults.Understanding adolescent-specific brain deficits is essential for developing biomarkers and brain-based therapies targeting adolescent anxiety.This article reviews and compares recent neuroimaging literature on anxiety-related brain structural and functional deficits between adolescent and adult populations,and proposes a model highlighting the differences between adolescence and adulthood in anxiety-related brain networks.This model emphasises that in adolescence the emotional control system tends to be hypoactivated,the fear conditioning system is immature,and the reward and stress response systems are hypersensitive.Furthermore,the striatum’s functional links to the amygdala and the prefrontal cortex are strengthened,while the link between the prefrontal cortex and the amygdala is weakened in adolescence.This model helps to explain why adolescents are vulnerable to anxiety disorders and provides insights into potential brain-based approaches to intervene in adolescent anxiety disorders.

Sleep problems, strengths and difficulties in elementary school children

Aim: To assess behavioral and sleep disturbances in childhood, it is necessary to implement standardized brief questionnaires for children and their parents. Especially complaints of insomnia often are underdiagnosed in pediatric medicine. Methods: We developed a sleep questionnaire (K?SI-KJ) and used it together with German versions of the SDQ (parent and child reports) for epidemiologic studies in Cologne. The sleep questionnaire obtains 33 items for parents and 28 items for children. Ratings were dichotomized for this analysis in “sometimes/ often present” versus “not present”. The German versions of SDQ contain 5 subscales each with 5 items. Data from a sample of 1490 children of fourth grade in elementary schools inCologne(age ranged from 8 to 11 years) are shown. Results: Children indicate signs of sleep disturbances in higher frequency than their parents do. Concerning gender and ethnical group, there no significant differences can be shown. Children with signs of insomnia, dyssomnia, daytime sleepiness or restless sleep?showed significantly higher scores for all relevant SDQ subscales in parental and children's reports. Children with signs of parasomnia showed higher scores concerning emotional problems and the SDQ total score. Children with enuresis showed higher scores for all SDQ subscales and the total score.

Stabilization of Circadian Rhythm, Its Augmentation by Bright Light Treatment and Its Importance for ADHD and Depression of Adolescents

Objective: ADHD is characterized by the progressive development of, impulsiveness, attentional difficulties and sometimes also excessive hyperactivity. Main biological reason is a quantitative reduction of the neurotransmitter dopamine in the forebrain. A lack of dopamine is also typical for depressive disorders. Methods: Bright light therapy is proven to be effective in treating depression. Purpose of our study is to verify the therapeutic effectiveness of Bright light therapy in subjects affected by ADHD. Results: Results show a significant improvement which lasts for at least 4 weeks, which is superposed by regulation of the circadian rhythm. Initial decrease of especially morning saliva melatonin levels, due to regular sleep under in-patient conditions, is followed by symptom improvement and a raising evening melatonin level, due to activation during the day. This level decreases as soon as activation is ceased. Conclusion: Bright light therapy seems to be effective as add-on therapy for ADHD, but in fact, stabilization of the circadian rhythm is the most important therapeutic intervention, either for ADHD or for depression, as demonstrated in another study.

Online Social Skills Group Training for Adolescents and Young Adults with 22q11.2 Deletion Syndrome (22q11.2DS)

Somatic, cognitive and psychiatric obstacles contribute to social impairment in 22q11.2DS and prevent adequate responses during interactions. We adapted the autism-specific SOSTA-FRA program for use during online group sessions with geographically-isolated 22q11DS adolescents or adults. The 12 weekly sessions targeted communication, emotional awareness, and reciprocity. Twenty-two participants were evaluated on behaviour, social responsiveness, and cognition pre- and post-intervention. Parents completed a questionnaire to ascertain whether the intervention met their needs. Parents were satisfied with the format and curriculum contents and reported improved emotional awareness, well-being, and reciprocity post-intervention. Pre-post results suggest large effects on social awareness and small to medium effects on social motivation. Results indicate that online social skills training is feasible and effective for individuals with 22q11.2DS.

Cancer: Education and Primary Prevention Starts in Childhood and Adolescence

At least one third of all newly diagnosed cancers could be prevented if lifestyle factors were changed. The University Cancer Center Dresden initiated two programs aiming at cancer awareness and intentions to engage in health-promoting behavior among children and adolescents. Study 1 examined sun protection knowledge of 80 preschool children in a non-randomized design and Study 2 inspected 235 7th grade students’ knowledge of cancer and its behavioral risk-factors as well as intentions on health-promoting behavior using a randomized pre-post design on group-level. Study 1 showed significant improvement of sun protection knowledge in preschool children (p 0.05). Study 2 was effective in increasing knowledge about risk factors for cancer (p 0.001) and in increasing intentions to engage in health-promoting behavior (p 0.001). Communicating health-related behavior in preschools as well as school-based programs targeting multiple cancer-related risk factors are promising tools for primary prevention of cancer.

Deliberate self-harm among pediatric psychiatric inpatients in China:A single-center retrospective study

BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.

Fear of missing out: A brief overview of origin, theoretical underpinnings and relationship with mental health

Fear of missing out(FoMO)is a unique term introduced in 2004 to describe a phenomenon observed on social networking sites.FoMO includes two processes;firstly,perception of missing out,followed up with a compulsive behavior to maintain these social connections.We are interested in understanding the complex construct of FoMO and its relations to the need to belong and form stable interpersonal relationships.It is associated with a range of negative life experiences and feelings,due to it being considered a problematic attachment to social media.We have provided a general review of the literature and have summarized the findings in relation to mental health,social functioning,sleep,academic performance and productivity,neuro-developmental disorders,and physical well-being.We have also discussed the treatment options available for FoMo based on cognitive behavior therapy.It imperative that new findings on FoMO are communicated to the clinical community as it has diagnostic implications and could be a confounding variable in those who do not respond to treatment as usual.

Mental health in the post-COVID-19 era:challenges and the way forward

The COVID-19 pandemic has posed a serious threat to global mental health.Multiple lines of evidence suggest that there is a varying yet considerable increase in mental health issues among the general population and vulnerable groups.12 The aftermath is obscure and speculative from a social,economic,individual and public mental health perspective.Recently published studies support the existence of an emotional epidemic curve,describing a high probability of an increase in the burden of mental health issues in the post-pandemic era.34 Furthermore,previous major public health emergencies showed that more than half of the population devel-oped mental health problems and required mental health intervention.45 There is,therefore,an urgent need to reorganise existing mental health services to address the current unmet needs for mental health and to prepare for future challenges in the postpandemic era in terms of prevention and management.

Attachment in Children with ADHD

Objective: Parallels in findings of attachment and ADHD research suggest a connection between both constructs. However, the few articles dealing with that tie investigate children with all conceivable expressions of ADHD and have not found sufficient evidence regarding the connection between ADHD and attachment. This study sought to collect evidence of a possible connection between the two aspects among children with the predominantly inattentive ADHD type. Method: The sample consisted of 93 children aged 5 - 9 years, 48 of whom had an ADHD diagnosis of the predominantly inattentive type. Attachment was coded using the German adaptation of the Attachment Story Completion Task, externalizing behavior problems were rated using the Child Behavior Checklist 4 - 18. ADHD was assessed using both clinical diagnoses as well as the German ADHD Rating scale. Results: Results revealed a large difference in the distribution of attachment classification between children with ADHD and those without ADHD. Regression analysis, however, showed no independent effect on ADHD when externalizing behavior problems were controlled for. Conclusions: Both constructs seem to be connected, however, in the investigation of the influence of attachment on the disorder, ADHD as a global construct is too unspecific. As opposed to previous studies, considering only the inattentive type, the relation might completely be moderated by externalizing behavior problems. Subsequent studies should first focus on specific symptom patterns which at best should be analyzed within longitudinal studies.

Age-trends in Cognitive Function and Quality of Life: Sex Differences in a Community Population in Taiwan region,China

Population aging has developed into a significant area of concern in developed countries, especially in relation to thepreservation of functional independence and the quality of life (QoL). However, information on the contribution ofsex differences in quality of life and cognitive function is scarce. Therefore, this study aimed to investigate potentialdifferences in cognitive function and QoL between males and females. For this study, we recruited 382 healthy subjectsaged 19–79 years from communities in Southern Taiwan region,China. Cognitive function and QoL were assessed using the UCSD Performance-based Skills Assessment, Brief Version (UPSA-B) and World Health Organization Quality ofLife Instruments (WHOQOL-BREF), respectively. The effects of sex, age groups, and interaction of sex and ageon the UPSA-B and WHOQOL-BREF scores were examined. We found that the financial and communicationdomains of the UPSA-B showed declining trends with age in both sexes, although these trends were more obviousin females than in males. In the domain of Physical Capacity, QoL showed an age-increased trend in males, whileQoL in the Environment domain showed an age-increased trend in females. Regarding the relationships betweencognitive function and QoL, we found that the financial skill and communication skill of UPSA-B was positivelycorrelated to the psychological well-being domain of WHOQOL-BREF, in males of age <40 years. In conclusion,our findings demonstrate differential relationships between cognitive function and QoL between males and females,which could serve as a basis for further study between cognitive function and quality of life in communities.

Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis

BACKGROUND In children and adolescents compared to adults,clinical high-risk of psychosis(CHR)criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant.Based on high rates of non-converters to psychosis,especially in children and adolescents,it was suggested that CHR criteria were:(1)Pluripotential;(2)A transdiagnostic risk factor;and(3)Simply a severity marker of mental disorders rather than specifically psychosis-predictive.If any of these three alternative explanatory models were true,their prevalence should differ between persons with and without mental disorders,and their severity should be associated with functional impairment as a measure of severity.AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.METHODS In the mainly cross-sectional examinations,8–17-year-old community subjects(n=233)randomly chosen from the population register of the Swiss Canton Bern,and inpatients(n=306)with primary diagnosis of attention-deficit/hyperactivity disorder(n=86),eating disorder(n=97),anxiety including obsessive–compulsive disorder(n=94),or autism spectrum disorder(n=29),not clinically suspected to develop psychosis,were examined for CHR symptoms/criteria.Positive items of the Structured Interview for Psychosis-Risk Syndromes(SIPS)were used to assess the symptomatic ultra-high-risk criteria,and the Schizophrenia Proneness Instrument,Child and Youth version(SPI-CY)was used to assess the 14 basic symptoms relevant to basic symptom criteria.We examined group differences in frequency and severity of CHR symptoms/criteria usingχ^(2) tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes,and their association with functioning using correlation analyses.RESULTS The 7.3%prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5%rate in inpatients.Frequency and severity of CHR criteria never differed between the community and the four inpatient groups,while the frequency and severity of CHR symptoms differed only minimally.Group differences were found in only four CHR symptoms:suspiciousness/persecutory ideas of the SIPS[χ2(4)=9.425;P=0.051,Cramer’s V=0.132;and Z=-4.281,P<0.001;Rosenthal’s r=0.184],and thought pressure[χ^(2)(4)=11.019;P=0.026,Cramer’s V=0.143;and Z=-2.639,P=0.008;Rosenthal’s r=0.114],derealization[χ2(4)=32.380;P<0.001,Cramer’s V=0.245;and Z=-3.924,P<0.001;Rosenthal’s r=0.169]and visual perception disturbances[χ^(2)(4)=10.652;P=0.031,Cramer’s V=0.141;and Z=-2.822,P=0.005;Rosenthal’s r=0.122]of the SPI-CY.These were consistent with a transdiagnostic risk factor or dimension,i.e.,displayed higher frequency and severity in inpatients,in particular in those with eating,anxiety/obsessive–compulsive and autism spectrum disorders.Low functioning,however,was at most weakly related to the severity of CHR criteria/symptoms,with the highest correlation yielded for suspiciousness/persecutory ideas(Kendall’s tau=-0.172,P<0.001).CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes,or merely markers of symptom severity.

Are early maladaptive schemas, temperament and character dimensions correlated?

Objective: Aim of the study is to examine the relationships between early maladaptive schemas and the character and temperament aspects of personality, which are known as two approaches to the understanding of personality structure. Methods: We conducted the study using the Young Schema Questionnaire-Short Form (YSQ-SF) and the Cloninger’s Temperament and Character Inventory (TCI) in 122 university students from different schools. Results and Conclusion: Results demonstrated that there are high level of positive as well as negative correlations between most of TCI items and some of the sub-scales of the YSQ, including vulnerability, social isolation and defectiveness. In consistent with the Halvorsen et al.’s findings, our study demonstrated that harm avoidance had a positive relationship with several EMSs, including emotional deprivation, deficiency, dependence, failure, subjugation and selfsacrifice. More importantly, we obtained the results consistent with theirs regarding the negative correlations between self-directedness and almost all of EMSs, with the exception of the schema of subjugation. We concluded that although some of the personality characteristics contained in the YSQ and the TCI are appeared to be related to each other, we need more studies to support the Young et al.’s suggestion that early maladaptive schemas (EMSs) are likely to reflect underlying characterological factors of personality.

Tardive sensory syndrome related to lurasidone:A case report

BACKGROUND Tardive sensory syndrome(TSS)is a subtype of tardive syndrome(TS),and its etiology is still uncertain.Lurasidone is an atypical antipsychotic that has high affinity for dopamine D2-and serotonergic 5HT2A-and 5-HT7-receptors.CASE SUMMARY A 52-year-old woman,previously diagnosed with schizophrenia,and with no history of movement disorders and no sensory paresthesia,had taken lurasidone,initiate dose 40 mg daily then up titration to 120 mg daily,since March 2021,and developed mandibular sensory(pain)paresthesia after 3 mo of administration.After switching from lurasidone to quetiapine,she reported obvious improvement in her mandibular pain.CONCLUSION It is noteworthy that TSS is a rare subtype of TS,and lurasidone,an atypical antipsychotic,usually has a lower risk of causing TS.In light of the temporal relationship,it is therefore concluded that use of lurasidone might have caused TSS in this patient.We reported this rare case as a reminder that clinicians should adopt a cautious approach when prescribing atypical antipsychotics,so as to prevent TS.

AGNP精神科治疗药物监测共识指南：2011

治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从"强烈推荐"到"可能有用"的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的"治疗参考浓度范围"和"剂量相关参考浓度范围"呈现给大家。本共识指南引入了"实验室警戒浓度"的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中获益。

神经精神药理学治疗药物监测共识指南:2017版

治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。