CNS Spectrums最新文献

{"title":"Living with tardive dyskinesia: understanding the patient experience.","authors":"Leslie Citrome","doi":"10.1017/S1092852926100856","DOIUrl":"10.1017/S1092852926100856","url":null,"abstract":"<p><p>After a brief overview of tardive dyskinesia, this targeted narrative review will examine the psychosocial consequences of tardive dyskinesia on patients' daily lives, including stigma, social withdrawal, and quality of life, as well as impact on physical functioning. The extant literature on the impact of tardive dyskinesia on patients and their caregivers is described and summarized, including how patients with tardive dyskinesia perceive the severity and impact of their motor symptoms and whether this aligns with clinical observations by their treaters.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e11"},"PeriodicalIF":4.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the functional connectivity between central glucagon-like peptide-1 (GLP-1) and glutamatergic signaling: a systematic review.","authors":"Sabrina Wong, Gia Han Le, Kayla Teopiz, Roger S McIntyre","doi":"10.1017/S1092852926100844","DOIUrl":"10.1017/S1092852926100844","url":null,"abstract":"<p><p>Glutamatergic neurons represent 40% of neurons in the human central nervous system. Glutamate accounts for approximately 90% of all excitatory neurotransmitters. Previous research reports the presence of glucagon-like peptide-1 (GLP-1) receptors on neurons that produce glutamate. Herein, we aim to evaluate whether GLP-1 receptor agonists' (GLP-1 RAs) modulate glutamatergic signaling and whether GLP-1 RAs' anti-obesity effects are mediated through the glutamatergic system. We conducted a systematic review of extant literature published on PubMed, Ovid and Scopus databases from inception to March, 2025. Identified studies were screened independently by two reviewers (S.W. and G.H.L.) using the Covidence platform. We sought to include in vitro, in vivo, and human clinical studies. A total of 31 studies were identified as meeting eligibility for an inclusion in this review. No human studies were identified. Across the included preclinical and pharmacologic studies, GLP-1 RAs were associated with increased glutamate release, NMDA/AMPA receptor activation and increased release of neurotrophic factors associated with neurogenesis, neurodifferentiation, and synaptic plasticity. In addition, GLP-1 RA-induced suppression of food intake was reported to be dependent on AMPA, but not NMDA, receptor signaling. The effect of GLP-1 RAs on feeding behavior is mediated via central glutamatergic signaling. A comprehensive mechanistic framework mediating GLP-1 RA activity implicates crosstalk between GLP-1 and ionotropic glutamate receptors. The aforementioned trends instantiate a need to evaluate the therapeutic efficacy of GLP-1 RAs for disparate neuropsychiatric disorders. Conducting target engagement studies of GLP-1 RAs with the glutamatergic system in humans is a future research vista.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":"31 1","pages":"e4"},"PeriodicalIF":4.6,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional dysconnectivity in reward-related circuits in adolescents with major depressive disorder with and without suicidal ideation.","authors":"Ju-Wei Hsu, Wei-Sheng Huang, Li-Kai Cheng, Li-Chi Chen, Li-Fen Chen, Ya-Mei Bai, Pei-Chi Tu, Mu-Hong Chen","doi":"10.1017/S1092852926100832","DOIUrl":"10.1017/S1092852926100832","url":null,"abstract":"<p><strong>Objective: </strong>Adult major depression (MDD) studies implicate reward- and control-network dysconnectivity in suicidality, but it is unclear whether analogous alterations characterize adolescents, whose neural systems are still maturing.</p><p><strong>Methods: </strong>Resting-state fMRI was obtained from 102 adolescents (12-17 years): 21 MDD with suicidal ideation (SI), 33 MDD without SI, and 48 matched healthy controls. Seed-based analyses targeted bilateral nucleus accumbens (NAc), ventral tegmental area (VTA), and bilateral dorsolateral prefrontal cortex (DLPFC).</p><p><strong>Results: </strong>Between-group effects were specific to NAc circuitry. Adolescents with SI showed reduced coupling of the left NAc with the left superior parietal lobule (BA7) versus controls, and diminished connectivity between the right NAc and right frontal pole (BA47) versus depressed peers without SI. No significant differences emerged for DLPFC- or VTA-seeded connectivity.</p><p><strong>Conclusions: </strong>The identified functional dysconnectivities in reward-related circuits, particularly the FCs between the NAc and both the frontal pole and superior parietal lobule, may be implicated in the manifestation of suicidality among adolescents with MD. However, the lack of significant associations for DLPFC- and VTA-seeded FC in adolescent MDSI requires further elucidation.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e3"},"PeriodicalIF":4.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the duration of untreated illness (DUI) in generalized anxiety disorder: a cross-sectional, multicenter study.","authors":"Letizia Maria Affaticati, Elisa Giglio, Enrico Capuzzi, Irene Riva, Davide La Tegola, Fabrizia Colmegna, Massimo Clerici, Massimiliano Buoli","doi":"10.1017/S1092852925100758","DOIUrl":"10.1017/S1092852925100758","url":null,"abstract":"<p><strong>Objective: </strong>A longer duration of untreated illness (DUI) has been associated with poorer outcomes across several mental disorders; however, few studies have investigated DUI in anxiety disorders, particularly in generalized anxiety disorder (GAD). This study aimed to identify sociodemographic and clinical factors associated with a longer DUI in GAD.</p><p><strong>Methods: </strong>We conducted a cross-sectional, multicenter study, retrospectively reviewing the medical records of GAD patients from three mental health services. Sociodemographic and clinical variables were extracted for analysis. One-way analyses of variance and Pearson's correlations were used to examine the relationship between DUI and categorical and quantitative variables, respectively. A multivariate linear regression model was then conducted to identify variables independently associated with DUI.</p><p><strong>Results: </strong>The total sample included 243 patients; the mean DUI was 30.92 (±65.25) months. In the final model, a longer DUI was associated with an earlier age at onset (<i>B</i> = -0.428; <i>p</i> = 0.023), a longer duration of illness (<i>B</i> = -0.431; <i>p</i> < 0.001), and the presence of multiple side effects (<i>B</i> = 55.778; <i>p</i> < 0.001). There was a trend toward statistical significance for the association between a longer DUI and multiple medical comorbidities (<i>B</i> = 13.122; <i>p</i> = 0.076).</p><p><strong>Conclusions: </strong>Our findings suggest that reducing the time between the onset of GAD and the initiation of appropriate pharmacological treatment may improve clinical outcomes, mitigating the risk of a chronic course of illness. Further studies are needed to elucidate the role of DUI as a prognostic factor in GAD.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":"31 1","pages":"e2"},"PeriodicalIF":4.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing a special collection of CME articles about long-acting injectable antipsychotics.","authors":"Leslie Citrome","doi":"10.1017/S1092852925100722","DOIUrl":"10.1017/S1092852925100722","url":null,"abstract":"<p><p>Long-acting injectable (LAI) antipsychotics are not routinely offered and, thus, are underutilized despite their many advantages over oral formulations. In this special collection of articles, the reader will find overviews of the art and science of prescribing this important treatment option. Guidance is offered regarding incorporating LAIs in treatment planning, including inpatient, outpatient, and jail settings. Reviewed is the evidence surrounding the use of LAIs for patients in their first episode of schizophrenia, as well as switching from oral agents and other common issues that come up in day-to-day practice. Also provided is a comprehensive summary of each of the currently available formulations of LAIs, and some pragmatic reasons why one would be considered over another. In the end, the reader will come away with the notion that LAIs are not a \"last resort\" but an important and useful treatment modality that ought to be considered more often.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":"30 S1","pages":"S43-S44"},"PeriodicalIF":4.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145818224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solutions to common issues in the use of LAIs.","authors":"Stephen R Saklad","doi":"10.1017/S1092852925100552","DOIUrl":"10.1017/S1092852925100552","url":null,"abstract":"<p><p>Long-acting injectable (LAI) antipsychotics are highly effective tools for managing serious mental illness, yet their clinical utility is often compromised by logistical and pharmacological complexities. This review serves as a practical guide to optimizing LAI therapy by addressing common clinical hurdles. Maintaining a consistent injection schedule is essential to successful treatment. To improve adherence, clinicians should implement proactive reminder systems-such as phone calls or text messages-and involve family or caregivers in the care plan. When injections are delayed, management strategies must be tailored to the specific medication and the length of the \"dosing window\". For example, aripiprazole monohydrate (Abilify Maintena) allows a ±7 day window, whereas paliperidone palmitate (Invega Sustenna) provides a +14 day window. If these windows are exceeded, catch-up protocols may involve administering the next dose as soon as possible, utilizing supplemental oral antipsychotics for a bridge period (e.g., 14 days for aripiprazole or 21 days for risperidone), or restarting initiation loading regimens entirely. Clinically significant drug interactions, such as the reduction of aripiprazole or risperidone levels by carbamazepine, can lead to symptom breakthrough. Conversely, CYP450 inhibitors like fluvoxamine or fluoxetine may increase antipsychotic concentrations, necessitating dose reductions. Adverse effects, including drug-induced Parkinsonism and akathisia, should be managed by reducing the LAI dose or switching to agents with lower risk profiles, such as aripiprazole-based products. For akathisia, short-term adjunctive treatments like vitamin B6 or mirtazapine may be utilized until dose adjustments reach steady state. Patient-centered care requires a collaborative approach to substance use, which can exacerbate symptoms or interfere with LAI effectiveness. Clinicians must also engage in nonjudgmental discussions when patients request a return to oral therapy, carefully considering the pharmacokinetic properties of the LAI to time the transition safely. Ultimately, a proactive management plan that addresses these clinical variables is essential for reducing relapse risk and improving long-term quality of life.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"S45-S50"},"PeriodicalIF":4.6,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding long-acting injectables in the context of treatment planning for schizophrenia: crafting a strategy.","authors":"Leslie Citrome, Desiree Matthews","doi":"10.1017/S1092852925100680","DOIUrl":"10.1017/S1092852925100680","url":null,"abstract":"<p><p>Long-acting injectable antipsychotics (LAIs) can lead to improved outcomes for people with schizophrenia, schizoaffective disorder, and bipolar disorder, as they guarantee medication delivery during the injection interval. Contemporary guidance on the use of LAIs includes considering not only patients with poor or uncertain adherence but also patients who would prefer monthly administration (or longer) of their maintenance medication, including those in their first episode of illness. This narrative review discusses the incorporation of LAIs in treatment planning across different settings: acute inpatient units, community mental health outpatient clinics, and jails. Implementing this treatment modality requires the recognition of eligible patients, providing information to patients and their families about the benefits and drawbacks of LAIs, and educating all members of the treatment team.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"S51-S56"},"PeriodicalIF":4.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lies and LAIs: why accuracy of information is the key to understanding the benefits and the resistance to using long-acting formulation.","authors":"Peter J Weiden","doi":"10.1017/S1092852925100692","DOIUrl":"10.1017/S1092852925100692","url":null,"abstract":"<p><p>The failure to make LAI the default route over the same oral when both are available is a lost opportunity to improve outcomes for people with schizophrenia. A striking example is the lost opportunity to improve life expectancy. A sophisticated pharmacoepidemiologic study from Sweden matched antipsychotic prescriptions with mortality rates and found that receiving an LAI version improved longevity by about 30% compared to its equivalent oral counterpart. Published a decade ago, it seems to have had little impact within US mental health services. This paper attempts to explain some of the reasons for complacency in adapting LAIs as a preferred approach for oral that have an LAI option available. Hypotheses include (1) not appreciating the importance of accurate information to guide present and future treatment recommendations, (2) considering LAIs primarily for adherence interventions rather than their more general benefit as a superior information platform, (3) how fear of disclosing nonadherence is a primary cause of misinformation, and (4) complacency with status quo acceptance of misinformation without fully appreciating how it harms future outcomes. The outcome benefits that come from changing from the oral to the LAI, if available, will continue. Advances in formulation technology have greatly improved the safety and flexibility of recent LAIs compared to earlier formulations, and formulation advances will allow for additional antipsychotics currently limited to oral formulation to expand to having an LAI version readily available.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"S37-S42"},"PeriodicalIF":4.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive rehabilitation for functional neurological disorder.","authors":"Ryan Van Patten, Eva Keatley","doi":"10.1017/S1092852925100825","DOIUrl":"10.1017/S1092852925100825","url":null,"abstract":"<p><p>Cognitive problems represent one of the most common symptom dimensions in functional neurological disorder (FND; >80% of patients) and are frequently associated with distress, disability, and difficulties engaging in evidence-based treatments such as psychotherapy. Cognitive difficulties occur across the FND subtypes (eg, seizures, movement disorders, dizziness) but are largely underrecognized and undertreated by healthcare providers. That is, although a variety of interventions are available for primary functional symptoms and mental health comorbidities, there have not been any systematic efforts to date to specifically target cognitive functioning in FND, leaving an important gap in the literature.Cognitive rehabilitation is a flexible approach utilizing diverse techniques aimed at improving cognition and enhancing functional independence in people with neuropsychiatric disorders. Cognitive rehabilitation can have positive impacts (moderate effect sizes) on cognition and everyday functioning across a variety of conditions, including traumatic brain injury, mild cognitive impairment, long COVID, PTSD, and others. Given the transdiagnostic clinical utility of cognitive rehabilitation, it has potential for benefit in many patients with FND if adapted and applied appropriately.In this review, we highlight the utility of cognitive rehabilitation for FND, with a focus on clinically actionable advice and guidance. We describe fundamental principles of cognitive rehabilitation, evidence for its efficacy and effectiveness across neuropsychiatric disorders, and methods for avoiding potential pitfalls when applying it in FND. We then discuss a Case Vignette in order to emphasize the application of cognitive rehabilitation principles in an individual patient. We conclude with future directions for research and clinical care.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e1"},"PeriodicalIF":4.6,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Problematic usage of the internet is associated with orthorexia nervosa tendency in adults.","authors":"Sophie Boutouis, Jon E Grant","doi":"10.1017/S1092852925100771","DOIUrl":"10.1017/S1092852925100771","url":null,"abstract":"<p><strong>Background: </strong>The link between problematic usage of the internet (PUI) and eating disorder symptoms is well-established. However, less is known about this association in the context of orthorexia nervosa (ON), an excessive preoccupation with healthy eating. This study aimed to investigate the relationship between PUI, including various problematic online behaviors, and ON tendency in a sample of US adults.</p><p><strong>Methods: </strong>Three hundred adults completed an online survey via prolific (mean age = 37.40, 54.6% female). The survey included demographic questions, the ORTO-R to measure ON symptoms, and the Internet Severity and Activities Addiction Questionnaire (ISAAQ-10) to assess PUI and the extent of engagement in several online activities, such as gaming, shopping, social networking, cyberchondria, pornography, and cyberbullying.</p><p><strong>Results: </strong>Women had higher ORTO-R scores than men (<i>p</i> < .05). ISAAQ-10 scores predicted ORTO-R scores in a regression model (<i>β</i> = .375, <i>p</i> < .001) even after controlling for age, gender, and an eating disorder diagnosis. ON risk was associated with a high engagement in cyberchondria, researching healthy food choices on the internet, cyberbullying perpetration, and online shopping.</p><p><strong>Conclusions: </strong>Results indicate that PUI is associated with ON symptoms even after considering other predictors. Maladaptive use of nutrition and medical-related resources may play a significant role in this association. However, it remains unclear whether exposure to this content increases ON risk or if people with ON symptoms seek this information online. The directionality of this relationship is an important area for future research.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":"30 1","pages":"e96"},"PeriodicalIF":4.6,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}