Scientia Psychiatrica

The Eye as a Window to Neuroinflammation in Psychiatric Disorders?: A Meta-Analysis of Retinal Structural and Vascular Biomarkers

Ramzi Amin — 2025-04-09

Introduction: Psychiatric disorders like schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD) represent major global health challenges with complex pathophysiology, potentially involving neuroinflammation. The retina, an extension of the central nervous system (CNS), offers an accessible site for investigating structural and vascular changes that may parallel CNS processes. Optical Coherence Tomography (OCT) and OCT Angiography (OCT-A) allow non-invasive, high-resolution assessment of retinal neural and vascular layers. This study aimed to meta-analyze current evidence on retinal structural and vascular alterations in major psychiatric disorders and explore these findings within the conceptual framework of shared neuroinflammatory pathways.

Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for studies published between January 1^st, 2013, and December 31^st, 2024. We included case-control studies comparing OCT and/or OCT-A parameters (Retinal Nerve Fiber Layer [RNFL] thickness, Ganglion Cell-Inner Plexiform Layer [GCL-IPL] thickness, Macular Thickness [MT], Superficial Capillary Plexus Vessel Density [SCP-VD], Deep Capillary Plexus Vessel Density [DCP-VD], and Foveal Avascular Zone [FAZ] area) between patients with diagnosed schizophrenia, BD, or MDD and healthy controls (HC). Data were pooled using a random-effects model, calculating Standardized Mean Differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS).

Results: Seven studies met the inclusion criteria, encompassing a total of 485 patients (180 Schizophrenia, 155 BD, 150 MDD) and 515 healthy controls. Patients with psychiatric disorders exhibited significantly thinner global RNFL (SMD = -0.68; 95% CI [-0.95, -0.41]; p < 0.00001; I²=75%), GCL-IPL (SMD = -0.75; 95% CI [-1.08, -0.42]; p < 0.0001; I²=80%), and reduced macular SCP-VD (SMD = -0.55; 95% CI [-0.88, -0.22]; p = 0.001; I²=72%) compared to HC. DCP-VD also showed a trend towards reduction (SMD = -0.40; 95% CI [-0.85, 0.05]; p = 0.08; I²=79%). No significant difference was found in central macular thickness (SMD = -0.15; 95% CI [-0.45, 0.15]; p = 0.33; I²=60%) or FAZ area (SMD = 0.20; 95% CI [-0.10, 0.50]; p = 0.19; I²=55%). High heterogeneity was observed across most analyses. Study quality varied, with NOS scores ranging from 6 to 8.

Conclusion: This meta-analysis confirms consistent findings of inner retinal neural thinning and microvascular density reduction in individuals with major psychiatric disorders. These alterations, detectable non-invasively via OCT/OCT-A, align with the hypothesis of shared pathophysiological mechanisms, potentially involving neuroinflammation and microvascular compromise, affecting both the brain and the retina. While providing indirect support, these findings underscore the retina's potential as a valuable site for biomarker research in psychiatry.

Beyond Peer Influence: The Combined Effect of Self-Driven Motivation and Strong Family Bonds on Sexual Decision-Making

Irdayani — 2025-05-16

Introduction: Adolescent engagement in risky sexual behavior remains a significant public health concern. While peer influence is widely studied, understanding the protective roles of intrinsic factors like self-driven motivation and proximal systems such as strong family bonds is crucial for comprehensive intervention strategies. This study aimed to investigate the combined effect of self-driven motivation and family bonds on sexual decision-making among adolescents in Wih Pesam District, Bener Meriah Regency, Indonesia.

Methods: A cross-sectional survey was conducted with 198 adolescents. Standardized questionnaires assessed self-driven motivation (including components of needs, drive, and goals), family bonds (overall family support and its dimensions: informational, appraisal, instrumental, emotional), and engagement in risky sexual behavior. Data analysis included descriptive statistics, bivariate chi-square tests, and multivariate logistic regression.

Results: Findings indicated that 45.5% of adolescents engaged in risky sexual behavior. A majority reported high overall self-driven motivation (46.5%) and high overall family support (49.5%). Bivariate analyses revealed significant associations between components of self-driven motivation, family support, and risky sexual behavior (all p < 0.05). The multivariate logistic regression analysis demonstrated that, after controlling for other factors, higher overall self-driven motivation (High vs. Low: OR=0.40, 95% CI [0.20–0.78], p=0.007) and higher overall family support (High vs. Low: OR=0.25, 95% CI [0.12–0.51], p<0.001) were significantly associated with reduced odds of engaging in risky sexual behavior. Family support emerged as a particularly strong protective factor. The overall multivariate model was significant (p < 0.001) and explained approximately 38% of the variance (Nagelkerke R-squared = 0.38).

Conclusion: Both self-driven motivation and strong family bonds are significant protective factors against risky sexual behavior among adolescents in this Indonesian context, with family support showing a more dominant influence. These findings underscore the importance of interventions aimed at fostering adolescents' internal resilience and strengthening positive family environments to promote healthier sexual decision-making, thereby looking beyond peer influence as the sole determinant.

Preventing Cognitive Decline in Late-Life Depression: A Longitudinal Study on the Efficacy of Omega-3 Fatty Acid Supplementation in Older Adults in Palembang, Indonesia

Sony Sanjaya — 2025-06-03

Introduction: Late-life depression (LLD) is a prevalent condition in older adults and a significant risk factor for cognitive decline and dementia. In Indonesia, with its aging population and specific dietary patterns, understanding interventions for LLD-associated cognitive impairment is crucial. Omega-3 polyunsaturated fatty acids (PUFAs) offer potential neuroprotective benefits. This study aimed to assess the efficacy of long-term omega-3 PUFA supplementation in mitigating cognitive decline among older adults with LLD in Palembang, Indonesia.

Methods: This 24-month, randomized, double-blind, placebo-controlled trial was conducted in Palembang. Three hundred sixty older adults (aged ≥60 years) with a current DSM-5 diagnosis of Major Depressive Disorder (MDD) and subjective cognitive complaints were randomized (1:1) to receive either daily oral supplementation of 2.2 grams of omega-3 PUFAs (containing 1320 mg eicosapentaenoic acid [EPA] and 880 mg docosahexaenoic acid [DHA]) or a matched placebo (corn oil). The primary outcome was the change in the Indonesian version of the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog-INA) score over 24 months. Secondary outcomes included changes in the Montreal Cognitive Assessment-Indonesian version (MoCA-INA), Geriatric Depression Scale (GDS-30), Instrumental Activities of Daily Living (IADL), serum Brain-Derived Neurotrophic Factor (BDNF), and high-sensitivity C-Reactive Protein (hs-CRP).

Results: Over 24 months, the omega-3 group exhibited significantly less decline on the ADAS-Cog-INA compared to the placebo group (mean difference: -2.1 points; 95% CI: -3.8 to -0.4; p=0.018). Statistically significant benefits for the omega-3 group were also observed in MoCA-INA scores (mean difference: 1.5 points; p=0.025) and GDS-30 scores (mean difference: -2.5 points; p=0.011). BDNF levels increased significantly in the omega-3 group relative to placebo (p=0.008), while hs-CRP levels showed a non-significant trend towards reduction (p=0.072).

Conclusion: Long-term supplementation with 2.2 g/day of EPA-rich omega-3 PUFAs resulted in a modest but statistically significant attenuation of cognitive decline and improvement in depressive symptoms in older adults with LLD in Palembang. These findings suggest that omega-3 PUFAs could be a valuable adjunctive therapeutic strategy in this specific Southeast Asian population.

The Impact of Tuina Massage Therapy on Sensory Processing, Sleep Disturbances, and Maladaptive Behaviors in Young Children with Autism Spectrum Disorder in Jakarta, Indonesia: A Controlled Clinical Study

Fatimah Mursyid — 2025-06-04

Introduction: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by challenges in social communication, restricted interests, and repetitive behaviors, often accompanied by sensory processing abnormalities, sleep disturbances, and maladaptive behaviors. Current interventions offer variable efficacy, prompting exploration of complementary therapies. Tuina, a form of therapeutic massage in Traditional Chinese Medicine (TCM), has shown potential in pediatric neurodevelopmental issues. This study aimed to investigate the impact of Tuina massage therapy on sensory processing, sleep quality, and maladaptive behaviors in young children with ASD in Jakarta, Indonesia.

Methods: A controlled clinical study was conducted with 88 children aged 3-7 years, diagnosed with ASD according to DSM-5 criteria and confirmed using the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). Participants were recruited from specialized pediatric clinics in Jakarta and assigned to either an intervention group (n=44) receiving a standardized Tuina protocol thrice weekly for 12 weeks alongside standard care, or a control group (n=44) receiving standard care only. Standard care included established interventions such as behavioral therapy, speech therapy, occupational therapy, or special education programs. Outcome measures included the Sensory Profile 2 (SP-2), the Children's Sleep Habits Questionnaire (CSHQ), and the Aberrant Behavior Checklist-Community (ABC-C), administered at baseline, week 6, week 12 (post-intervention), and at a 3-month follow-up (week 24).

Results: At 12 weeks, the Tuina group demonstrated statistically significant improvements compared to the control group in sensory processing, specifically in auditory filtering (mean difference [MD] -8.5, 95% CI -11.2 to -5.8, p<0.001) and tactile sensitivity (MD -7.9, 95% CI -10.5 to -5.3, p<0.001) on SP-2 quadrant scores. Total CSHQ scores indicated significantly better sleep in the Tuina group (MD -6.8, 95% CI -9.1 to -4.5, p<0.001), particularly in subscales of bedtime resistance and sleep anxiety. ABC-C scores for irritability (MD -5.2, 95% CI -7.0 to -3.4, p<0.001) and hyperactivity (MD -6.1, 95% CI -8.3 to -3.9, p<0.001) were also significantly lower in the Tuina group. These improvements were largely maintained at the 3-month follow-up. No serious adverse events were reported.

Conclusion: This study provides evidence that Tuina massage therapy, as an adjunct to standard care, can significantly improve sensory processing, reduce sleep disturbances, and mitigate maladaptive behaviors in young children with ASD in an Indonesian context. These findings suggest Tuina may be a valuable complementary intervention for managing core and associated symptoms of ASD. Further research with larger, diverse samples and longer follow-up periods is warranted.