Speech Sound Disorder

THURSDAY, Nov. 21, 2024 -- In individuals without a history of psychosis, the risk for developing a schizophrenia spectrum disorder (SSD) is increased for individuals with an emergency department visit involving hallucinogen use, according to a study published online Nov. 13 in JAMA Psychiatry . Daniel T. Myran, M.D., M.P.H., from the University of Ottawa in Ontario, Canada, and colleagues conducted a population-based, retrospective cohort study involving all individuals aged 14 to 65 years in Ontario with no history of psychosis (SSD- or substance-induced) to examine whether an emergency department visit involving hallucinogen use is associated with an increased risk for developing an SSD. The study included 9,244,292 individuals without a history of psychosis who were followed for a median of 5.1 years. The researchers found that 0.1 percent of the participants had an incident emergency department visit involving hallucinogen use. Between 2008 and 2012, the annual rates of incident emergency department visits involving hallucinogens were stable and then increased by 86.4 percent between 2013 and 2021 from 3.4 to 6.4 per 100,000 individuals. Compared with the general population, individuals with emergency department visits involving hallucinogens had a greater risk for being diagnosed with an SSD within three years (absolute proportion with SSD at three years: 3.99 versus 0.15 percent; age- and sex-adjusted hazard ratio, 21.32). The increased risk persisted after adjustment for comorbid substance use and mental health conditions (hazard ratio, 3.53). In the fully adjusted model, compared with emergency department visits involving alcohol and cannabis, emergency department visits involving hallucinogens were associated with an increased risk for SSD within three years. "Given rapid increases in interest in and adult use of hallucinogens and the increase in emergency department visits involving hallucinogens found in this study, ongoing research is needed to clarify the observed association between hallucinogen use and development of SSD," the authors write. Two authors disclosed ties to the pharmaceutical industry.

A multi-sector partnership involving the National Healthcare Group and Nanyang Technological University is building voice AI and a community intervention programme to detect an early form of depression among the elderly. The three-year project also engages the NHG Polyclinics and Institute of Mental Health (IMH) and two NTU Singapore schools – Lee Kong Chian School of Medicine (LKCMedicine) and College of Computing and Data Science (CCDS). WHAT IT'S ABOUT The project – dubbed SoundKeepers – will involve more than 600 senior individuals aged 55 and above who are connected to Hougang and Woodlands polyclinics. Voice records of the participants from casual conversation or passage reading will be collected with consent and identified as a representative sample for the AI model. The voice samples will be anonymised and stored in a central storage terminal. The AI, to be jointly developed by NTU Singapore's LKCMedicine and CCDS, will then analyse these sample recordings for their acoustic properties, including pitch, volume, timbre, rhythm, shimmer, jitter, and harmonics-to-noise ratio. "When we use our voice, we are activating and coordinating more than a hundred different muscles and neurobiological processes. A change in speech acoustic features can reveal abnormalities in these neurobiological processes," explained Dr Lee Eng Sing, co-principal project investigator. He is also an assistant professor and the clinical director of NTU LKCMedicine's Primary Care and Family Medicine research programme. Meanwhile, a second component of the project is a 24-week community intervention programme led by the IMH. It will comprise module-based psychoeducation, community activities (such as exercise and recreational activities), and befriending. The programme will be delivered with assistance from social service agencies, Fei Yue Community Services and Club HEAL. Moreover, a randomised controlled trial – to be led by the NHG Polyclinics – will recruit 300 participants with those observed having early depression to compare their levels of loneliness, anxiety, well-being, and depression literacy before and after the intervention programme. These will also be compared to a control group. This cluster-wide project has received S$5.6 million ($4.2 million) in funding from the Lien Foundation. WHY IT MATTERS The NHG-based project targets the condition called subsyndromal depression (SSD), an emergent form of depression observed among seniors. The project partners consider the condition as a "largely unaddressed health risk." In a statement, they claim that SSD is five times more likely to become depression within a year; individuals with this condition are reportedly 12 times at higher risk of dementia. There are five times more people with SSD than those diagnosed with depression over a year, they noted. The condition is also said to affect around 13% of seniors living in community homes, based on self-reported assessments – which may be an underestimation. Additionally, it was observed that seniors with early depression incur more healthcare costs as well as have a higher uptake of outpatient services than those without it. "Currently, SSD is not actively diagnosed or treated," admitted Dr Mythily Subramaniamad, also a co-principal investigator of the SoundKeepers project. She is also the assistant chair of the Research Medical Board at IMH. Their project, Dr Subramaniamad added, will "facilitate the early detection and diagnosis of SSD with a tool that can be easily used in the community setting." "[A]s while previous studies have demonstrated the feasibility of detecting depression through vocal analysis, little work has been done on the more subtle SSD," claimed NTU CDDS professor Guan Cuntai, another co-principal investigator of the project. Once proven effective, SoundKeepers is hoped to be expanded to cover more polyclinics, GP clinics, and participant cohorts. Project partners also see the voice AI-driven project as potentially becoming part of Singapore's national mental health ecosystem through such existing government-funded community programmes as CREST and COMIT. THE LARGER TREND Another social service agency in Singapore, Lion Befrienders, is also leveraging AI and mobile technologies to monitor and improve the mental conditions of community-dwelling seniors. In 2021, it started a two-year pilot with software company Opsis to check the mental state of over 4,000 seniors by capturing and analysing their facial expressions. Last year, the Singapore University of Technology and Design worked with Lion Befrienders to launch a mobile application to prevent dementia among seniors through multilingual instructions. The app, called Ami, has been installed in over a thousand digital tablets used in one of the service's active ageing centres. ON THE RECORD "We need new ways to listen to our seniors. While they may not express their worries through words, we can now try to hear it through their voices," Lien Foundation CEO Lee Poh Wah underscored in a statement.

*仅供医学专业人士阅读参考认知功能缺陷是精神分裂症谱系障碍（SSDs）的重要症状之一，涵盖注意力、专注力、记忆等多个方面，对疾病进程和患者生活质量有着深远影响。作为SSDs患者的关键治疗手段，抗精神病药物虽然不是专门用于改善认知功能的药物，但由于其受体结合特性，被认为可能对认知功能产生不同程度的影响。然而结果有些差强人意。德国慕尼黑工业大学的Stefan Leucht团队完成了迄今为止最全面的关于抗精神病药物与精神分裂症谱系障碍（SSDs）患者认知功能关系的网络荟萃分析，结果于近日发表在《JAMA·精神病学》期刊上。他们基于包含近千名SSD患者的68项试验数据进行分析后发现，抗精神病药物整体上对认知功能有轻微的改善效果，略胜于安慰剂，但不具有统计学意义。每种药物之间的效果差异不大，其中氯氮平、氟哌啶醇、氟奋乃静在认知功能的改善方面表现垫底，逊色于安慰剂。研究者们表示，抗精神病药物对认知功能的轻微改善可能更多是由于其减少了思维紊乱和其它阳性症状（比如激动、妄想、幻觉等），而非直接作用于认知功能本身。论文首页截图在这项研究中，Stefan Leucht等人通过系统回顾和随机效应网络荟萃分析，评估了抗精神病药物对精神分裂症谱系障碍（SSDs）患者认知功能的影响。研究的主要数据来源于Cochrane精神分裂症组试验注册库，截至2023年6月25日，共筛选并纳入68项随机对照试验，涉及9525名SSDs患者。这些患者的平均年龄为35.1岁，男性占70%。研究的主要结局是患者整体认知功能的变化，次要结局是患者具体认知领域（如处理速度、工作记忆、语言学习等）、生活质量和社会功能的变化。结果显示，整体上，抗精神病药物对认知功能的改善效果有限，虽然相比安慰剂表现出一定的优势，但效应值（SMD）较小，并且不同药物之间的差异不明显。具体来说，在改善认知的效果上，吗茚酮（Molindone，MOL）和盐酸硫利达嗪（Thioridazine，THIOR）分别排名第一和第二。不过这两种药物的分析结果都是基于单项小规模研究（15-22人数），且仅改善大脑处理速度这一个认知领域。同样，位列第五的氯丙嗪（Chlorpromazine，CPZ）也存在这个问题，但尽管相关研究数量多了些，总参与人数依然较少（N=101），且数据来源于二十世纪六七十年代的随机临床试验。相比之下，位列第三、第四的帕利哌酮（Paliperidone，PAL）和舍吲哚（Sertindole，SER），其分析结果基于近年来的研究数据，与安慰剂相比，表现出中等效果（SMD -0.43，95%CI  -0.93至0.08 ；SMD -0.57，95%CI -1.03至 -0.11）。排名倒数的三位，则是氟奋乃静（Fluphenazine，FLU）（SMD = 0.15, 95% CI = -0.39至0.69）、氟哌啶醇（Haloperidol，HAL）（SMD 0.04，95%CI -0.25至0.33）、氯氮平（Clozapine，CLZ）（SMD 0.12，95%CI -0.23至0.48），落后于安慰剂。这一结果与它们的强效多巴胺型受体阻断作用相符。其他排名靠前的药物还有喹硫平（Quetiapine，QUE）、布瑞吡唑（Brexpiprazole，BRE）、利培酮（Risperidone，RIS）、唑吡坦（Zotepine，ZOT）、奥氮平（Olanzapine，OLA）、氨磺必利（Amisulpride，AMI）、鲁拉西酮（Lurasidone，LUR）、阿立哌唑（Aripiprazole，ARI）、齐拉西酮（Ziprasidone，ZIP）。排名（PLB-安慰剂）在额外的探索性事后分析中，研究按照抗精神病药物的结合受体将其分为四个组。结果显示，作用于肾上腺素能受体、5-羟色胺能药物、毒蕈碱型受体、多巴胺受体的四组药物，相比于安慰剂对患者认知功能都有改善的趋势。按作用受体分类时，每组抗精神病药物都有点小优但不明显某些药物在个别领域表现出较为积极的效果，比如刚才提到的吗茚酮和盐酸硫利达嗪对于SSD患者大脑处理速度的提高。相比于安慰剂，布瑞吡唑在视觉学习方面显示出小幅但显著的积极效果，帕利哌酮在语言学习和工作记忆方面有改善的趋势。研究还评估了患者的生活质量和社会功能，然而整体来看抗精神病药物在这些方面的表现同样有限，未能显著优于安慰剂，而且纳入分析的各项研究中认知评估工具所提供的证据也不明确。药物对具体认知功能的改善效果过去相关的荟萃分析和网络荟萃分析存在时效性不足、新药物的纳入有限、方法学质量较低等限制，并缺乏对抗精神病药物与安慰剂的直接比较。这项研究迄今为止最大的相关领域研究，表明尽管某些药物显示出小幅认知改善，但大多数抗精神病药物的效应较小，且部分药物的结果因样本小而不具备足够的意义，很难区分这些改善是否源于减少思维紊乱等症状。这些结果为临床实践中抗精神病药物的选择提供了有价值的最新见解，同时也强调了统一认知评估标准的重要性，以便未来研究能够更有效地比较不同药物的效果。另外，研究者们呼吁开发新的抗精神病药物，特别是那些针对认知缺陷的新型机制药物，以更好地满足SSDs患者的治疗需求。参考文献：[1]https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2825154本文作者丨张艾迪