Pornjira Pariwatcharakul

Background: Depressive and anxiety symptoms (depression and anxiety hereafter), and suicidality are common among psychiatric patients. This study examined the network structure of depressive and anxiety symptoms and suicidality among psychiatric patients across Asia. Methods: Data were drawn from the Research on Asian Psychotropic Prescription Patterns for Antidepressants Phase 3 study (REAP-AD3), which included 2,455 psychiatric patients from 11 Asian countries and territories. Depression and anxiety were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively, while suicidality (i.e., suicidal thoughts or acts) was assessed by a clinical interview. Expected Influence (EI) and Bridge EI were used as centrality indices in the symptom network to characterize the structure of the symptoms. Results: The point prevalence of suicidality was 30.1% (95% confidence interval [CI] = 28.2, 31.9) among the psychiatric patients. The network analysis identified PHQ2 (“Sad mood”) as the most central symptom, followed by GAD2 (“Uncontrollable worry”). Additionally, PHQ8 (“Motor disturbances”) and S (“Suicidality”) were identified as bridge nodes linking depression and anxiety with suicidality. The flow network indicated that PHQ6 (“Guilt”) and PHQ2 (“Sad mood”) had the strongest positive associations with suicidality. Conclusions: Suicidality was common among psychiatric patients across Asia. The central and bridge symptoms might represent potential clinical markers and generate hypotheses for longitudinal and interventional research on depression, anxiety, and suicidality in the future.

Objective Historical theological frameworks, particularly those rooted in Christianity, have conceptualized guilt as a defining component of melancholy. This study compared the network structures of depressive symptoms in guilt-rich and guilt-free presentations of depression using a large-scale cross-national Asian dataset.Methods We analyzed data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 (REAP-AD3), which included patients with depressive disorders from 11 Asian countries. Network analysis was used to estimate symptom interactions and identify the central symptoms in each group. Participants were dichotomized according to the presence or absence of prominent guilt symptoms, as determined by the “feeling bad about yourself” item of the Patient Health Questionnaire-9 (PHQ-9).Results The network structures of the two groups differed substantially. In the guilt-rich group, depressed mood was the central node that was closely linked to self-blame. By contrast, the guilt-free group exhibited centralized networks with a loss of energy.Conclusion Variations in symptom network structures can be partly explained as broadly consonant with early ideas of Richard Baxter and Robert Burton on melancholia. Clinically, symptoms related to moral judgment and self-criticism may indicate potentially different specific therapeutic attention from individuals with significant guilt. Conversely, for those without pronounced guilt, interventions targeting physical and motivational symptoms such as fatigue might inform hypothesis-driven treatment strategies.

Introduction: Previous studies of antidepressant prescribing patterns largely were limited to a single location or time, and very few involved Asia. This Asian Psychotropic Prescription Patterns Consortium study investigated pharmacoepidemiologic trends and factors associated with use and dosing of newer antidepressants across 12 Asian sites in 2003, 2013, and 2023. Methods: Data from each site included demographic, treatment setting, clinical features, and type and dosage of antidepressants prescribed. Sociodemographic and clinical variables were examined using univariate methods, followed by multivariable logistic and linear modeling. Results: Of 8357 adult participants (59.8% female), 82.8% received at least one modern antidepressant. Use of these drugs was strongly associated with more recent year, younger age, inpatient status, and affective or anxiety‐related disorders. Higher daily antidepressant doses were associated with inpatient status, male gender, more recent year, and younger age. Discussion: This large, multisite study provides a two‐decade overview of evolving antidepressant‐prescribing patterns in 12 Asian sites and highlights patient characteristics associated with prescription of newer antidepressants and their dosage. Needed are further studies of psychotropic prescribing practices related to specific illness subtypes and their impact on psychosocial functioning over time among Asian patients.

This case report describes the rapid clinical response to etifoxine, an oral translocator protein 18 kDa (TSPO) ligand, in a patient with severe, treatment-resistant obsessive-compulsive disorder (OCD) with comorbid bipolar I disorder. Despite extensive prior pharmacological treatments and neurosurgical interventions, the patient experienced significant symptom amelioration within days of etifoxine initiation (the Yale-Brown Obsessive-Compulsive Scale (YBOCS) score decreased from 50 to 29). We discussed the potential mechanisms underlying this rapid response, including direct γ-aminobutyric acid (GABA) receptor modulation, increased endogenous neurosteroidogenesis, reduced neuroinflammation, and modulation of the gut-brain axis. This case highlights etifoxine as a novel therapeutic option for treatment-resistant OCD and underscores the need for further research into TSPO ligands in this context.

Background: Sunlight has profound impacts on physical and mental health, beyond vision, including effects on circadian rhythms, alertness, mood, and sleep. A family history of any mood disorders is strongly associated with psychiatric disorders including bipolar disorder. The purpose of this study was to evaluate the association between a family history of any mood disorder in patients with bipolar I disorder and solar insolation at varied international onset locations. Methods: Data for this analysis were available from 5842 patients with a diagnosis of bipolar I disorder obtained at 83 collection sites in both hemispheres. This included 4752 patients from 71 collection sites in the northern hemisphere and 1090 patients from 12 collection sites in the southern hemisphere. Patient data variables were obtained from records or interviews. Solar insolation data were obtained from The National Aeronautics and Space Administration (NASA) Power database for each onset location, and the ratio of the mean monthly minimum/mean monthly maximum solar insolation was calculated. Typically, the ratio is largest near the equator (little yearly change in solar insolation) and smallest near the poles (large yearly change in solar insolation). Results: A significant relationship was found between a family history of any mood disorder, the ratio of the mean monthly minimum/mean monthly maximum solar insolation, and gender. The odds of a family history of mood disorder increased as patient location nears the poles and decreased near the equator. Female gender also increased the odds of having a family history of a mood disorder. Conclusions: This study highlighted the association between family history, solar insolation, and gender in international patients with bipolar I disorder. Given the profound effects of sunlight on human health, the family of patients with bipolar disorder who live in the same location with the same solar insolation, and especially females, may be at increased risk for a mood disorder.

Enriching global perspectives through a regional lens: Recognition, Assessment, and Management of Tardive Dyskinesia in Southeast Asia

Background and Aim: Major depressive disorder is a prevalent psychiatric condition associated with impaired neuroplas­ticity, particularly in the hippocampus. Although selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed, their delayed onset and adverse effects highlight the need for alternative therapies. Cannabidiol (CBD), a non-psychotomi­metic cannabinoid, has shown antidepressant-like properties, but its mechanistic link to hippocampal synaptic plasticity remains unclear. This study aimed to evaluate the effects of CBD on depression-like behaviors and hippocampal neuroplas­ticity in rats subjected to chronic restraint stress (CRS). Materials and Methods: Sixty male Wistar rats were randomly divided into six groups: Non-stressed vehicle (NV), CRS vehi­cle (SV), escitalopram-treated CRS (SE, 10 mg/kg), and CBD-treated CRS at 10, 30, or 100 mg/kg (SC10, SC30, and SC100). Rats were subjected to CRS for 28 days and treated daily through intraperitoneal injection. Depression-like behaviors were assessed using the forced swim test (FST) and sucrose preference test (SPT). Locomotor activity was evaluated through the open-field test (OFT). Hippocampal dendritic spine density (Golgi–Cox staining) and long-term potentiation (LTP, electro­physiology) were measured on day 28. Results: CRS induced behavioral despair (↑ immobility in FST) and anhedonia (↓ sucrose preference in SPT), accompanied by reduced hippocampal spine density. At all doses, CBD significantly reduced immobility, comparable to escitalopram. Notably, only CBD at 100 mg/kg and escitalopram reversed anhedonia. All CBD-treated groups showed an increase in den­dritic spine density, with SC10 producing the greatest enhancement. Moreover, CBD at 100 mg/kg markedly improved hippocampal LTP at 1 h and 2 h post-stimulation, an effect not observed with escitalopram. Locomotor activity remained unaffected. Conclusion: CBD demonstrated potent antidepressant-like effects in a CRS rat model, alleviating behavioral despair and anhedonia while enhancing hippocampal dendritic spine density and synaptic strength. These findings suggest CBD as a promising candidate for stress-related mood disorders, with mechanistic actions distinct from conventional SSRIs and potential utility in patients unresponsive to current therapies. Keywords: cannabidiol, chronic stress, depression, hippocampus, long-term potentiation, synaptic plasticity.

Background/Objectives: Cariprazine, a D3/D2 partial agonist, is one of the few recommended treatment options for bipolar 1 disorder (BP1D) in Southeast Asia. This study aims to generate insights from leading experts on the safe and effective use of cariprazine for BP1D, specifically by formulating practical recommendations not thoroughly covered in the existing literature. Methods: A formal consensus methodology using the modified RAND/UCLA Appropriateness Method was employed to develop consensus recommendations. The methodology included a targeted literature search, creation of clinical scenarios, two rounds of rating of the appropriateness of each scenario on a nine-point Likert scale by an expert panel of psychiatrists from Southeast Asia (n = 13), and a face-to-face discussion among the expert panel between the two rounds of rating. In the absence of disagreement, scenarios were classified as appropriate (7–9), equivocal (4–6), or inappropriate (1–3) based on median scores. Clinical scenarios were subsequently converted to consensus recommendations upon approval by the expert panel. Results: Most experts recommended a 4–8-week trial of cariprazine for bipolar depression (85%) and 3–4 weeks for acute mania/mixed (71%). For longer treatment, 61.5% and 69% recommended >1 year for acute mania/mixed and bipolar depression, respectively. Cariprazine was also considered suitable as first-line therapy, including for first-episode bipolar depression (Mdn: 8, IQR: 7–9) and first-episode mania (Mdn: 8; IQR: 8–9). Conclusions: The consensus recommendations may serve as practical guidance for clinicians to make informed decisions regarding the management of adult patients with BP1D, while considering the preferences and circumstances of individual patients.

Objective The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.Methods We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.Results Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).Conclusion This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.