CNS Spectrums最新文献

{"title":"Adherence to medical recommendations in high-risk pregnancy: dispositional and situational predictors with a focus on emotional reactivity.","authors":"Manuel Glauco Carbone, Concetta Polizzi, Maria Maddalena Di Pasqua, Maria Regina Morales, Giovanna Perricone, Gaspare Cucinella, Rosalia Sutera, Sofia Burgio, Giulia Giordano","doi":"10.1017/S1092852925100436","DOIUrl":"10.1017/S1092852925100436","url":null,"abstract":"<p><strong>Objective: </strong>Therapeutic adherence during pregnancy is critical for maternal and fetal health. This study examines personality traits, sensitivity to stimuli and socio-demographic factors influencing adherence among Italian women with high-risk pregnancies.</p><p><strong>Methods: </strong>Ninety women from \"Villa Sofia-V. Cervello Hospital\", in Palermo, Italy, participated. Personality traits were assessed via the Personality Inventory (PI), covering Extraversion, Conscientiousness, Neuroticism, Mental Openness, and Friendliness. Sensitivity to stimuli was evaluated using the Highly Sensitive Person (HSP) Scale, which includes Low Sensory Threshold (LST), Ease of Excitement (EOE), and Aesthetic Sensitivity (AES). Treatment adherence was measured using the Morisky Medication Adherence Scale (MMAS).</p><p><strong>Results: </strong>Conscientiousness was identified as a positive predictor of medication adherence (OR = 1.08, p = .010), while Mental Openness (OR = 0.81, p = .003) and EOE (OR = 0.92, p = .014) were negative predictors. Higher education levels were associated with better adherence (OR = 2.34, p = .006). Significant occupational differences emerged, with office clerks exhibiting higher adherence compared to housekeepers (OR = 3.18, p = .008). Planned (OR = 0.38, p = .025) and unplanned but wanted pregnancies (OR = 0.42, p = .045) showed lower adherence. Regression analysis indicated that Neuroticism (β = -0.21, p = .032) and EOE (β = -0.28, p = .008) negatively impacted adherence.</p><p><strong>Conclusion: </strong>Specific personality traits, sensitivity, education, occupation, and pregnancy significantly influence adherence. Tailored interventions that enhance conscientiousness, address mental openness and sensitivity, and consider individual socio-demographic context are needed to promote better adherence and improve maternal and fetal health outcomes in high-risk pregnancies.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e57"},"PeriodicalIF":4.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674030","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":"Is adult-onset separation anxiety disorder a trauma-stress-related disorder? A preliminary report.","authors":"Camilla Gesi, Annalisa Cordone, Claudia Carmassi, Liliana Dell'Osso","doi":"10.1017/S1092852925000239","DOIUrl":"10.1017/S1092852925000239","url":null,"abstract":"<p><strong>Background: </strong>The DSM-5 recognized that the separation anxiety disorder (SEPAD) may span the entire life course or have an adult-onset. Epidemiological data indicated a 23%-69% prevalence of SEPAD in clinical settings and a high comorbidity with both prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD). Some authors hypothesize that while life threat represents the key trigger of PTSD, disruptions or threats to interpersonal bonds lead to PGD and SEPAD. This study aims to test the hypothesis that adult-onset SEPAD might be a trauma-related disorder, triggered by events threatening to interpersonal bonds.</p><p><strong>Methods: </strong>The sample included 106 consecutive adult outpatients with anxiety and/or mood disorders. SEPAD was diagnosed according to DSM-5 criteria by means of the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS). The Adult Separation Anxiety Checklist (ASA-27) was used to assess symptoms severity. To assess exposure to trauma, the SCID-5 criterion A form for PTSD was administered. Traumatic events were coded as directly experienced (self) or involving close ones (others). Lifetime exposure to separation events was also assessed.</p><p><strong>Results: </strong>60.4% of participants were categorized as not having SEPAD in adulthood or in childhood (NO-SEPAD), 18.9% as childhood-onset SEPAD, and 20.8% as adult-onset SEPAD. Controlling for comorbid disorders, lifetime traumatic events involving self and separation events, traumatic events involving others significantly predicted adult-onset SEPAD. A significant correlation between the age at trauma exposure and the age of SEPAD onset was found.</p><p><strong>Conclusions: </strong>Our results are consistent with the hypothesis that adult-onset SEPAD may represent an event-related disorder.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e58"},"PeriodicalIF":4.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674031","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":"Choosing among the long-acting injectable antipsychotics: an evidence-based pragmatic guide.","authors":"Leslie Citrome","doi":"10.1017/S1092852925100400","DOIUrl":"10.1017/S1092852925100400","url":null,"abstract":"<p><p>In this review, the aim is to differentiate between the 3 second-generation antipsychotics available as long-acting injectables (risperidone/paliperidone, aripiprazole, and olanzapine) and their varied formulations. Differences and similarities among the available products are discussed, including the amenities of care: route of administration (intramuscular or subcutaneous), injection frequency, needle gauge and length, injection volume, injection site, reconstitution procedures, initiation with oral medication or multiple injections, refrigeration requirements, post-injection observation requirements, drug-drug interactions preventing use or requiring dosing adjustments, adjustments requirements for late or missed doses, availability of patient assistance programs, and access barriers for off-label use. Effectiveness in acute and maintenance treatment are reviewed using the metrics of number needed to treat and number needed to harm.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e73"},"PeriodicalIF":4.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658519","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":"From betel nuts to Cobenfy: how an ancient recreational drug gave rise to a new class of schizophrenia medications.","authors":"Justin Fortune Creeden, Siddharth M Machiraju, Johansen B Amin, Stephen M Stahl","doi":"10.1017/S1092852925100424","DOIUrl":"10.1017/S1092852925100424","url":null,"abstract":"<p><p>The term \"betel\" most accurately refers to the betel pepper (<i>Piper betle</i>). Confusingly, this term is also frequently used to refer to a street drug that often-but not always-includes the betel leaf as a constituent. This linguistic misdirection only intensifies with terms such as \"betel nut,\" which, in common usage, may refer to this same composite street drug or to a single isolated constituent of that street drug: the nut of the areca palm (<i>Areca catechu</i>), which is otherwise wholly unrelated to the betel pepper. This composite street drug, colloquially referred to as \"betel\" or \"betel nut\" or \"betel quid,\" is one of the most frequently used psychoactive substances in the world. It carries a cultural legacy spanning over 10,000 years and a current user base numbering in the hundreds of millions. Its primary psychoactive constituent is arecoline, a well-established parasympathomimetic agent. Early studies exploring arecoline's ability to modulate cholinergic signaling pathways and exert therapeutic psychiatric effects on conditions such as Alzheimer's disease were initially mired by intolerable parasympathetic side effects. Indeed, over the course of its long history, various hints regarding the therapeutic utility of arecoline have been obfuscated by a variety of challenges which have only recently been overcome. Now, developments in psychopharmacology and our growing understanding of neurochemical brain circuitry have unlocked a new mechanism of action by which arecoline-derived medications interact with dopaminergic processes to improve outcomes for schizophrenia patients. One such medication, xanomeline-trospium (Cobenfy), has emerged as the first such agent to receive U.S. Food and Drug Administration (FDA) approval for the treatment of schizophrenia and represents an entirely new class of pro-cholinergic medication within the field of psychiatry. Many in the field believe that this heralds the beginning of a new era of psychopharmacology: the era of muscarinic agonism. This article briefly described the fascinating journey from ancient betel nuts to modern muscarinic therapeutics.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e55"},"PeriodicalIF":4.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648776","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":"Central nervous system stimulants in recreational and medical use.","authors":"Seetal Dodd, Laura Ospina-Pinillos, John S Markowitz","doi":"10.1017/S1092852925100357","DOIUrl":"10.1017/S1092852925100357","url":null,"abstract":"<p><p>Stimulants that act on the central nervous system have been used since antiquity for ritual and other uses. Organic chemistry techniques, especially those developed in Germany in the late 1800s, resulted in the isolation and structural determination of several important stimulants. Synthetic pathways for amphetamine and related stimulants were developed in the first half of the 19th century, and these new drugs were widely marketed. Awareness of abuse potential emerged soon after but was contested. Stimulants have been used to counteract fatigue and promote wakefulness during military operations, as well as to treat sleep disorders, since the 1930s. Methylphenidate was approved to treat children with behavioral problems in 1962, predating the recognition of attention deficit hyperactivity disorder (ADHD). Stimulant abuse became a political concern in the post-war period, initially with the use of \"pep-pills\" by long-haul truck drivers and later as drug dealing became common in night clubs, with new laws limiting availability passed in the early 1960s. They have also been used to increase athletic and cognitive performance. Stimulants are still first-line therapies for ADHD and some sleep disorders; however, newer-generation drugs have been developed with better safety profiles and lower abuse potential. Illicit stimulant use continues to be common in many countries.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e52"},"PeriodicalIF":3.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625502","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 four principles of bioethics in cases of Anosognosia.","authors":"Rennie Burke, Katherine D Warburton","doi":"10.1017/S1092852925100369","DOIUrl":"10.1017/S1092852925100369","url":null,"abstract":"<p><p>Anosognosia, a term that denotes a lack of insight into one's own condition, is a defining characteristic of many psychotic illnesses. As a result, generations of psychiatrists have pursued a paternalistic approach to care. Yet in the past century, the overall trend in patient care has been toward autonomy. What does it mean to respect the autonomy of patients whose lack of insight may bring them harm? This chapter will explore these questions through each of the four principles generally employed in bioethical analysis: beneficence, nonmaleficence, justice, and autonomy. Each will have an illustrative case study and explore how anosognosia can further complicate already perplexing ethical scenarios.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e78"},"PeriodicalIF":4.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625503","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 intervention for schizophrenia: a pathway to improved clinical outcomes.","authors":"Takesha Cooper","doi":"10.1017/S1092852925100394","DOIUrl":"10.1017/S1092852925100394","url":null,"abstract":"<p><p>Roger was a 60-year-old man living with both HIV and schizophrenia who was admitted to the hospital for treatment of a chronic obstructive pulmonary disease exacerbation. He was referred to the psychiatry consultation-liaison team due to persistent psychotic symptoms that had not responded to multiple antipsychotic trials. Roger's psychiatric history revealed a diagnosis of schizophrenia in early adulthood, marked by hallucinations and delusions of grandeur. Over the next 4 decades, he cycled through jails, prisons, shelters, and periods of homelessness. Though intermittently connected with outpatient care, his illness remained poorly controlled.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e69"},"PeriodicalIF":4.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599594","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":"Canadian mental health laws: a review of involuntary admission and treatment pending appeal.","authors":"Lyndal Christine Petit, Karen Shin, Nicole Fielding, Mathieu Dufour, John Gray","doi":"10.1017/S1092852925100321","DOIUrl":"10.1017/S1092852925100321","url":null,"abstract":"<p><p>This review article explores the legislative differences across Canadian jurisdictions with respect to involuntary admission and treatment pending appeal. Some jurisdictions restrict involuntary admission for mental illness to when there is a risk for serious bodily harm or physical impairment. However, the majority of jurisdictions recognize non-bodily harms or substantial mental or physical deterioration as grounds for involuntary admission when other criteria are met. Once a person is involuntarily admitted, jurisdictions differ on how treatment is authorized and whether treatment can commence while a person contests a finding of incapacity to treatment to the courts. Some jurisdictions permit treatment pending appeal while others do not. This article compares Canadian jurisdictions' mental health legislation and addresses discrepancies through the lens of the Canadian Charter of Rights and Freedoms and the Canada Health Act.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e56"},"PeriodicalIF":4.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574963","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":"A single-blind, randomized controlled trial of transcranial direct current stimulation in adults with obsessive-compulsive disorder as early augmentation.","authors":"Lokesh Kumar, Bandna Gupta, Adarsh Tripathi, Mohita Joshi, Sujita Kumar Kar","doi":"10.1017/S1092852925000173","DOIUrl":"10.1017/S1092852925000173","url":null,"abstract":"<p><strong>Background: </strong>Transcranial direct current stimulation (tDCS) has emerged as a promising neuromodulation technique for managing obsessive-compulsive disorder (OCD). Early intervention with tDCS may lead to improved treatment outcomes for individuals with OCD, offering hope for more effective and timely intervention strategies. This study aimed to evaluate the safety and efficacy of tDCS as an early augmentation strategy in adults with OCD.</p><p><strong>Methods: </strong>Drug-free adult patients with OCD were randomized into active and sham groups and received fluoxetine 20 mg (up to 60 mg). The protocol involved placing the cathode over the left supplementary motor area and the anode over the left dorsolateral prefrontal cortex, using a 2-mA current for 20 minutes, with a ramp time of 10 seconds. A total of 10 sessions were given over 2 weeks. Following the baseline assessment, both illness severity and side effects were measured periodically at 2, 4, and 6 weeks.</p><p><strong>Results: </strong>A total of 40 patients completed this study (20 in each group). The active group demonstrated a significant reduction in Yale-Brown Obsessive-Compulsive Scale scores at 2, 4, and 6 weeks compared with the sham group, with a number needed to treat of 2.5. Additionally, the effect size of the intervention at 2 weeks was calculated to be 0.58, indicating a moderate effect according to Cohen's <i>d.</i> Side effects were milder, tolerable, and uncommon.</p><p><strong>Conclusion: </strong>Early augmentation with tDCS is a safe and effective method for rapidly reducing symptom severity in adult patients with OCD.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e50"},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526661","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":"Ketamine in clinical practice: transitioning from anesthetic agent to psychiatric therapeutic.","authors":"Jose Manuel Quintero, Rosa Helena Bustos, Sharon Lechtig-Wassermann, Stephania Beltran, Carlos A Zarate","doi":"10.1017/S1092852925100333","DOIUrl":"10.1017/S1092852925100333","url":null,"abstract":"<p><p>Ketamine, originally synthesized in 1962, has gained increasing attention due to its rapid and sustained antidepressant effects in treatment-resistant depression (TRD). Unlike traditional antidepressants, ketamine acts on multiple neurotransmitter systems, including NMDA receptor antagonism and AMPA receptor potentiation, offering a novel mechanism for mood regulation. Beyond psychiatry, ketamine remains a valuable anesthetic and analgesic agent with applications in acute and chronic pain management. Its anti-inflammatory, neuroprotective, and potential antitumor properties further underscore its versatility in clinical medicine. Despite its therapeutic promise, ketamine poses challenges due to its dissociative and hallucinogenic effects, contributing to widespread recreational use. Chronic misuse is associated with adverse health outcomes, including bladder dysfunction and hepatobiliary complications. As a result, ketamine has been subject to increasing regulatory scrutiny, balancing its medical utility with concerns about abuse potential. The rediscovery of ketamine's antidepressant effects in the early 2000s has revolutionized psychiatric treatment, particularly in TRD and suicidality. Recent studies have also explored its efficacy in bipolar depression, posttraumatic stress disorder, obsessive-compulsive disorder, and substance use disorders, expanding its therapeutic applications. Additionally, ongoing research aims to elucidate its long-term effects and optimize dosing regimens to maximize clinical benefits while minimizing risks. This review highlights ketamine's multifaceted pharmacological properties, its evolution from an anesthetic to a novel psychiatric treatment, and its broader medical applications. As research advances, a comprehensive understanding of ketamine's mechanisms and clinical implications will be crucial for optimizing its therapeutic potential while mitigating its risks.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e51"},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526662","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}