CNS Spectrums最新文献

{"title":"The current situation of treatment for patients suffering from schizophrenia in the Austrian forensic system.","authors":"Alexander Dvorak, Patrick Swoboda, Thomas Stompe","doi":"10.1017/S1092852924000567","DOIUrl":"10.1017/S1092852924000567","url":null,"abstract":"<p><p>Treatment of patients suffering from schizophrenia in Austria: Treatment of patients with schizophrenia in the healthcare system is generally voluntary. This applies both to outpatient care provided by specialists in private practice, hospital outpatient clinics, or social psychiatric outpatient clinics and to inpatient care in hospitals. However, there is an exceptional situation in which the patient's freedom of will is restricted by law. This is the case when acute danger to self or others caused by the disorder is present. With the involvement of the district court, the patient advocate, a possible adult representative, and an external expert, the patient's freedom of movement can be restricted for a certain period of time to enable treatment. The acceptance of psychopharmacological therapy remains the patient's decision in this situation, with the exception of explicit authorization by the court. Treatment under the consideration of proportionality, meaning that coercion is only applied in the case of an acute risk of severe bodily harm, is therefore possible for the majority of patients with schizophrenia. However, this does not mean that patients are able to connect to the care network in all cases. Some patients fail because the contact threshold is still too high. In order to reduce this, outreach care has been integrated into the existing services in many cases. These multi-professional teams often manage to establish contact with the patients and thus create a willingness to undergo treatment in order to counteract the long-term consequences, including complete social isolation and disintegration.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":"30 1","pages":"e31"},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complexities of competency and informed consent as applied to individuals with symptoms of Anosognosia.","authors":"Nina M Labovich","doi":"10.1017/S109285292400227X","DOIUrl":"10.1017/S109285292400227X","url":null,"abstract":"<p><p>Anosognosia, commonly understood as a lack of insight, renders individuals with schizophrenia and schizoaffective disorder unable to understand that they are living with a disease, often resulting in a refusal to accept treatment. Typically, to impose involuntary commitment in an effort to obtain treatment, an individual must be a danger to others or themselves. Even if involuntary commitment is imposed, however, an individual may remain competent to refuse <i>medication</i>-despite symptoms of anosognosia and an inability to understand that they are ill. This article examines the existing legal theories of competency and informed consent and proposes a statutory definition of competency that encompasses the specific needs of people with anosognosia, while considering the significant interests at stake when taking away an individual's right to choose or refuse treatment.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":"30 1","pages":"e28"},"PeriodicalIF":3.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for the unhoused individual with schizophrenia: a civilized plan.","authors":"Charles L Scott","doi":"10.1017/S109285292500001X","DOIUrl":"10.1017/S109285292500001X","url":null,"abstract":"<p><p>This article provides an overview of individuals with schizophrenia who become unhoused and explores current approaches to managing this severe illness in those who often do not want care or believe they need it. Individuals with schizophrenia and who are unhoused face numerous adverse consequences including premature mortality and increased rates of suicide. There is a dearth of research evidence demonstrating efficacy of the Housing First (HF) model and harm reduction approach in decreasing psychotic symptoms in individuals with schizophrenia. Ensuring medication adherence in individuals with psychosis, both housed and unhoused, is important to prevent delays in untreated psychosis and chronic deterioration.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":"30 1","pages":"e22"},"PeriodicalIF":3.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early or recent trauma in treatment-resistant depression: a systematic review.","authors":"Sara Fantasia, Lorenzo Conti, Debora Andreoli, Andrea Bordacchini, Berenice Rimoldi, Valerio Dell'Oste, Virginia Pedrinelli, Claudia Carmassi","doi":"10.1017/S1092852925000185","DOIUrl":"10.1017/S1092852925000185","url":null,"abstract":"<p><strong>Background: </strong>Increasing attention has been recently devoted to treatment-resistant depression (TRD); however, its clinical characteristics, potential risk factors, and course are still debated. Most recently, childhood trauma exposure has been correlated to TRD, but systematic investigation on the role of lifetime trauma is still lacking. The aim of this paper was to revise current evidence on early and recent trauma exposure in TRD.</p><p><strong>Methods: </strong>A systematic search was conducted from the 1st of June to the 20th of February 2024 in accordance with the PRISMA 2020 guidelines and using the electronic databases PubMed, Web of Science, and Embase.</p><p><strong>Results: </strong>The primary database search produced a total of 1998 record, and finally, the search yielded a total of 22 publications, including 18 clinical studies, 3 case reports, and 1 case series, all from the period 2014 to 2024.</p><p><strong>Limitations: </strong>Limitations include a small sample size of some studies and the lack of homogeneity in the definition of TRD. Furthermore, we only considered articles in English, we excluded preprints or abstracts, and we included case reports.</p><p><strong>Conclusions: </strong>This review highlights the role of early and recent trauma in TRD, even in the absence of a full-blown post-traumatic stress disorder (PTSD), highlighting the need for a thorough assessment of trauma in patients with TRD and of its role as a therapeutic target.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e35"},"PeriodicalIF":3.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the relationship between emotional responsiveness and psychopathy across assessment types: a systematic review and meta-analysis.","authors":"Hedwig Eisenbarth, Femi Carrington, Matthew S Shane, Kasia Uzieblo, Sally Olderbak, David S Kosson","doi":"10.1017/S109285292500015X","DOIUrl":"10.1017/S109285292500015X","url":null,"abstract":"<p><p>Although psychopathic personality traits are widely reported to be related to reduced reactivity to emotion-eliciting situations, findings are not consistent. It has been argued that these differences could be related to variations in the way psychopathy is measured. To examine whether measurement variance resulting from the use of clinical assessment versus self-report assessment could be driving such differences, this systematic review and meta-analysis investigated the comparability of relations between psychopathic traits and responsiveness to emotion-inducing tasks for clinical versus self-report measures. The systematic review resulted in eight studies and 131 effect sizes, which included studies of emotion categorization, emotion regulation, decision-making, and executive functioning tasks. Robust Variance Estimation correlated effects models revealed no significant differences between effect sizes for clinical (PCL-R) versus self-report (PPI, SRP, and LSRP) assessment-based psychopathic traits and emotion tasks. Despite the small number of studies that included both clinical and self-report assessments of psychopathy, these results do not provide any evidence for an assessment-based difference in correlations with emotional responsiveness across tasks. The findings also show no associations between scores on emotional responsiveness and indices of psychopathy. Future research on emotional responsiveness in psychopathy should include both assessment types to be able to increase the research basis for the comparison.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e32"},"PeriodicalIF":3.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SSRIs: exploring controversies, conundrums, and contentions-epiphenomenon or empirical ingenuity? A comparative panorama for untangling enigma in children and youths.","authors":"Mayank Gupta, Theodore A Petti","doi":"10.1017/S1092852925000161","DOIUrl":"10.1017/S1092852925000161","url":null,"abstract":"<p><p>The role of serotonin reuptake inhibitors (SSRIs) in treating psychiatric disorders has been a subject of heated debate since their introduction. Initially celebrated for their potential to address various mental health conditions during the late 1980s and 1990s, SSRIs have since faced significant scrutiny. Critics argue that their benefits may not be as substantial as initially believed. Over the past two decades, concerns have intensified with the emergence of boxed warnings about the risks associated with SSRIs, particularly regarding their link to increased suicidal thoughts in youth. This controversy is further complicated by questions about the integrity of early industry-sponsored trials and the reliability of subsequent National Institute of Mental Health (NIMH) trials. These issues have raised ongoing critical concerns about the effectiveness and safety of SSRIs, especially for treating a range of disorders in children and adolescents. This review seeks to critically appraise by presenting empirical evidence that addresses these controversies. It explores the validity of the monoamine theory, examines the fidelity of early and recent trials, and considers the broader implications for clinical practice. By answering specific, targeted questions, this article aims to clarify the ongoing debate and enhance the understanding of SSRIs' role in mental health treatment. The goal is to support clinicians in making more informed decisions when prescribing these medications and to ensure consideration of the balance between potential benefits and risks for young patients with mental health disorders.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e18"},"PeriodicalIF":3.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do antipsychotic medications work: An exploration using competency to stand trial as the functional outcome.","authors":"Ambarin Faizi, Barbara E McDermott, Katherine Warburton","doi":"10.1017/S1092852924002372","DOIUrl":"10.1017/S1092852924002372","url":null,"abstract":"<p><p>This study explores the effectiveness of antipsychotic medications in restoring competency to stand trial in individuals with severe mental illness, particularly psychotic disorders. While antipsychotic medications are known for reducing symptoms of psychosis, this research focuses on their ability to improve functional outcomes necessary for competency to stand trial (CST). Among over 3,000 patients in California's forensic state hospital system, 86.5% were successfully restored to competency, with 98.8% discharged on antipsychotic medications. Patients on antipsychotic monotherapy demonstrated higher restoration rates compared to those requiring additional mood stabilizers, suggesting that more complex cases demand more intensive treatment. Delusional disorder, traditionally seen as more resistant to treatment, showed a high restoration rate of 93.8% with antipsychotic use.Our findings emphasize the pivotal role of antipsychotics in not only reducing symptoms but also in restoring critical functional abilities for participation in legal proceedings. The functional improvements they enable extend beyond the courtroom. Incorporation of antipsychotic medication as an integral evidence-based mechanism in facilitating community reintegration for individuals with severe mental illness supports the broader goal of transitioning individuals from the legal system back into society, consistent with the ultimate promise of deinstitutionalization.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e29"},"PeriodicalIF":3.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forensic assertive community treatment: an emerging best practice.","authors":"J Steven Lamberti, Robert L Weisman","doi":"10.1017/S1092852925000069","DOIUrl":"10.1017/S1092852925000069","url":null,"abstract":"<p><p>People with serious mental illness (SMI) are over-represented throughout the US criminal justice system. To address this issue, forensic assertive community treatment has recently emerged as a best-practice intervention. Also known as forensic ACT, ForACT, or most commonly as \"FACT,\" forensic assertive community treatment is an adaptation of the assertive community treatment (ACT) model. Unlike ACT, however, FACT is purposefully designed to prevent arrest and incarceration among people with SMI who have histories of involvement with the criminal justice system (i.e., \"justice-involved\" individuals). Although FACT was recognized as a best practice by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2019, FACT teams vary widely in their structure and daily operations. This lack of a standard FACT model continues to impede FACT program implementation and outcomes research. This article begins with a review of FACT origins, followed by a discussion of what we know (and do not know) about FACT operation and effectiveness. Based on the authors' experience, the article then discusses key components of FACT and concludes with a discussion of current challenges and research recommendations for FACT model development.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e34"},"PeriodicalIF":3.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attenuated mental symptoms in the general population: first data from the observational cross-sectional ATTENTION study in Greece.","authors":"Michaela Koummati, Jelena Vrublevska, Marc De Hert, Allan H Young, Paolo Fusar-Poli, Rajiv Tandon, Afzal Javed, Konstantinos N Fountoulakis","doi":"10.1017/S1092852925000112","DOIUrl":"10.1017/S1092852925000112","url":null,"abstract":"<p><strong>Background: </strong>It has been reported that abnormal experiences could be common in the general \"healthy\" population, with the vast majority of individuals never proceeding to manifest a frank mental disorder.</p><p><strong>Aims: </strong>This study aimed to quantify subthreshold psychiatric symptoms in the general population.</p><p><strong>Methods: </strong>The protocol included clinicodemographic data and a mental symptoms questionnaire, and additionally, the CES-D, STAI-S, RASS, and the GloDiS to assess depression, anxiety, suicidality, and functional impairment, respectively. The data were collected online and anonymously from 1504 persons (75.66% females; 23.73% males). Descriptive statistics, risk ratios, and factor analysis were utilized.</p><p><strong>Results: </strong>Clinical depression was present in approximately 10%, any somatic disorder in 20.21% (9.90% both), and a history of any mental disorder was present in 42.75%. The healthy individuals (46.94% of the study sample) were experiencing distress (8.6%) and subthreshold mental symptoms (attenuated psychotic, schizotypal distrust, emotional lability, conformity, and interpersonal and social functioning). Attenuated psychotic symptoms are present in almost 10%, and the conversion rate to any kind of psychosis was probably 0.5% per year until the age of 40, with one-third of these persons eventually converting. Beyond the age of 40, no conversion to psychosis seems to occur. All aspects of symptoms correlated weakly but significantly with aspects of functional impairment.</p><p><strong>Conclusions: </strong>The results of the current study are in accord with the literature and suggest that a significant number of persons in the general population experience attenuated psychiatric symptoms and mild functional impairment without ever manifesting an overt mental disorder. There is a need for further research on this matter to confirm these findings and to explore their implications both for mental and somatic health and the provision of health care.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e27"},"PeriodicalIF":3.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of glucagon-like peptide-1 and glucose dependent insulinotropic polypeptide receptor agonists on neurogenesis, differentiation, and plasticity (Neuro-GDP): potential mechanistically informed therapeutics in the treatment and prevention of mental disorders.","authors":"Roger S McIntyre, Natalie Rasgon, Joseph Goldberg, Sabrina Wong, Gia Han Le, Rodrigo B Mansur, Joshua D Rosenblat, Kayla M Teopiz, Stephen M Stahl","doi":"10.1017/S1092852925000124","DOIUrl":"10.1017/S1092852925000124","url":null,"abstract":"<p><p>Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists (RAs) mimic naturally occurring GLP-1 and GIP and are highly effective anti-diabetic and anti-obesity agents. In addition to their robust acute and long-term effects on weight, metabolism, and blood pressure, these agents also reduce cardiovascular mortality as well as stroke risk and associated consequences. A replicated and convergent body of preclinical evidence also indicates that incretin receptor agonists activate molecular effectors critical to neuroplasticity, neuroprotection, and anti-apoptosis. Herein, we propose that GLP-1 RAs and GIP RAs are promising transdiagnostic mechanistically informed therapeutics in the treatment and prevention of multiple domains of psychopathology, including general cognitive, reward, and motivation systems and mental disorders. Major neurocognitive disorders (eg, Alzheimer's Disease, Parkinson's Disease), alcohol and substance use disorders, traumatic brain injury, and depressive disorders are near-term therapeutic targets. In addition, GLP-1 RAs and GIP RAs have robust effects on comorbidities that differentially affect persons with mental disorders (eg, cardiovascular, cerebrovascular, and metabolic disorders) and psychotropic drug-related weight gain.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e23"},"PeriodicalIF":3.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}