CNS Spectrums最新文献

{"title":"The Association Between Dextromethorphan/Bupropion with Alcohol and Substance Misuse: Reports to the Food and Drug Administration Adverse Event Reporting System (FAERS) - CORRIGENDUM.","authors":"Angela T H Kwan, Roger S McIntyre","doi":"10.1017/S1092852924002384","DOIUrl":"https://doi.org/10.1017/S1092852924002384","url":null,"abstract":"","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799508","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":"What is schizophrenia - symptomatology.","authors":"Joan M Striebel","doi":"10.1017/S1092852924000622","DOIUrl":"10.1017/S1092852924000622","url":null,"abstract":"<p><p>Schizophrenia is a highly heterogenous disorder with substantial interindividual variation in how the illness is experienced and how it presents clinically. The disorder is composed of primary symptom clusters-positive symptoms, negative symptoms, disorganization, neurocognitive deficits, and social cognitive impairments. These, along with duration, severity, and excluding other possible etiologies, comprise the diagnostic criteria for the disorder outlined in the two commonly used diagnostic classification systems-the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and the International Classification of Diseases, 11^th Revision. These primary symptoms as well as accessory symptoms (mood disturbances, anxiety, violence) and comorbidities (substance use, suicidality) bear upon each other to varying degrees and impact functional outcomes. The following review presents two patient cases illustrating the clinical heterogeneity of schizophrenia, the natural history of the illness and diagnosis, followed by the current understanding of the primary symptom clusters, accessory symptoms, and comorbidities. In addition to noting symptom prevalence, onset, and change over time, attention is paid to the impact of symptoms on functional outcome.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e12"},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766959","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 unified understanding of the human mind - a neuroethical perspective.","authors":"Alberto Carrara","doi":"10.1017/S109285292400049X","DOIUrl":"10.1017/S109285292400049X","url":null,"abstract":"<p><p>This article, titled \"A Unified Understanding of the Human Mind - A Neuroethical Perspective,\" examines the evolution of the concept of the human mind in Western thought and its integration with neuroscience, psychology, psychiatry, and relational dimensions. The author explores how the understanding of the mind has changed over time, influenced by shifts in philosophical paradigms, scientific advancements, and societal perspectives. The article traces the historical development of the mind's concept, starting from ancient Greece, through influential thinkers like Plato and René Descartes, and progressing to contemporary perspectives. It highlights various philosophical and scientific approaches, including structuralism, functionalism, empiricism, and associationism, which have shaped our understanding of the mind. The article also delves into contemporary integration, where advancements in neuroimaging and the rise of holistic approaches offer a more nuanced understanding of the human mind. The author emphasizes the importance of the relational dimension and the interconnectedness of mental processes, the brain, and the external environment. This integrated perspective can benefit psychiatric treatment and psychological assessments by fostering a holistic approach to mental health. In conclusion, the article advocates for a multidimensional perspective that bridges subjective and objective aspects of human experience, offering promise for theoretical knowledge and practical applications in psychology, psychiatry, and neuroscience.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e5"},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766860","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":"How antipsychotics work in schizophrenia: a primer on mechanisms.","authors":"Jonathan M Meyer","doi":"10.1017/S1092852924002244","DOIUrl":"10.1017/S1092852924002244","url":null,"abstract":"<p><p>Antipsychotics effective for schizophrenia approved prior to 2024 shared the common mechanism of postsynaptic dopamine D₂ receptor antagonism or partial agonism. Positive psychosis symptoms correlate with excessive presynaptic dopamine turnover and release, yet this postsynaptic mechanism improved positive symptoms only in some patients, and with concomitant risk for off-target motor and endocrine adverse effects; moreover, these agents showed no benefit for negative symptoms and cognitive dysfunction. The sole exception was data supporting cariprazine's superiority to risperidone for negative symptoms. The muscarinic M₁/M₄ agonist xanomeline was approved in September 2024 and represents the first of a new antipsychotic class. This novel mechanism improves positive symptoms by reducing presynaptic dopamine release. Xanomeline also lacks any D₂ receptor affinity and is not associated with motor or endocrine side effects. Of importance, xanomeline treated patients with higher baseline levels of cognitive dysfunction in clinical trials data saw cognitive improvement, a finding likely related to stimulation of muscarinic M₁ receptors. Treatment resistance is seen in one-third of schizophrenia patients. These individuals do not have dopamine dysfunction underlying their positive symptoms, and therefore show limited response to antipsychotics that target dopamine neurotransmission. Clozapine remains the only medication with proven efficacy for resistant schizophrenia, and with unique benefits for persistent impulsive aggression and suicidality. New molecules are being studied to address the array of positive, negative and cognitive symptoms of schizophrenia; however, until their approval, clinicians must be familiar with currently available agents and be adept at prescribing clozapine.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e6"},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766802","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":"Eye-tracking technology: a tool to enhance understanding of memory complaints in COVID-19 survivors.","authors":"Julián Benito-León, José Lapeña-Motilva, Cecilia García-Cena","doi":"10.1017/S1092852924002426","DOIUrl":"10.1017/S1092852924002426","url":null,"abstract":"","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"534-535"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930834","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":"Are glucagon-like peptide-1 receptor agonists anti-consummatory drugs?","authors":"Rodrigo B Mansur, Joshua D Di Vincenzo, Sebastian Badulescu, Hartej Gill, Aniqa Tabassum, Cristian Llach López, Joshua D Rosenblat, Roger S McIntyre","doi":"10.1017/S109285292400244X","DOIUrl":"10.1017/S109285292400244X","url":null,"abstract":"<p><p>Incretin-based treatments, such as glucagon-like peptide-1 receptor (GLP-1R) agonists (eg liraglutide and semaglutide), have rapidly transformed obesity treatment. The well-documented weight loss effect from these agents is considered to be primarily a result of their actions on food intake, but frequent anecdotal reports from varied sources have suggested that they might also broadly affect consummatory behavior, including alcohol and drugs of abuse, suggesting a potential modulatory effect on reward behavior. Herein, we critically review the extant literature on the behavioral effects of GLP-1R agonists in humans, including their impact on feeding behavior, alcohol/drug intake, and overall reward response. We also consider the physiological and neurobiological underpinnings of GLP-1 actions, with a focus on its distinct central and peripheral roles, as well as its relationships with the broader energy homeostasis network. We conclude with a discussion on the implications of this line of research on how behavior is conceptualized, and the potential future directions for research.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"536-541"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969972","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":"Opioid antagonists: clinical utility, pharmacology, safety, and tolerability.","authors":"Roger S McIntyre, Marni E Harris, Mark S Todtenkopf, Sarah Akerman, Joshua Burgett","doi":"10.1017/S1092852924002189","DOIUrl":"10.1017/S1092852924002189","url":null,"abstract":"<p><p>Opioid antagonists block opioid receptors, a mechanism associated with utility in several therapeutic indications. Here, we review the sites of action, clinical uses, pharmacology, and general safety profiles of US Food and Drug Administration (FDA)-approved opioid antagonists. A review of the literature and product labels of opioid antagonists was conducted. The unique clinical uses of approved opioid antagonists are related to their ability to block opioid receptors centrally and/or peripherally. Centrally acting opioid antagonists treat opioid and alcohol use disorders (AUDs) and reverse opioid overdose. Because the opioid system influences weight and metabolism, one opioid antagonist combination product is approved for chronic weight management; another, approved for adults with schizophrenia or bipolar I disorder, mitigates olanzapine-associated weight gain. Peripherally acting opioid antagonists are approved for opioid-induced constipation; another accelerates gastrointestinal recovery after bowel surgery. Opioid antagonists are generally well tolerated; they are not associated with physiologic dependence or abuse. However, opioid antagonists can precipitate acute opioid withdrawal in patients using or undergoing withdrawal from opioid agonists. Likewise, their use can confer a risk for opioid overdose if attempts are made to overcome opioid antagonist blockade of opioid receptors via the intake of additional opioids. Opioid receptor antagonists have diverse therapeutic benefits based on their respective pharmacology and sites of action; understanding their respective nuances facilitates the safe and effective use of these agents.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"542-548"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709412","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":"Advances in suicide prevention: critical overview of the gaps in suicide risk assessments, multimodal strategies, medicolegal risks, and the emerging evidence.","authors":"Mayank Gupta, Priyal Khurana, Nihit Gupta","doi":"10.1017/S109285292400230X","DOIUrl":"10.1017/S109285292400230X","url":null,"abstract":"<p><p>The CDC reports that the United States has the highest suicide rates in over 80 years. Numerous public policies aimed at reducing the rising suicide rates, such as Aetna's partnership with the American Foundation for Suicide Prevention (AFSP) and the zero-suicide initiative, continue to challenge these attempts. It, therefore, remains imperative to explore the shortcomings of these efforts that hamper their efficiency in reducing suicide rates. Advancements in research over time have sparked scientific skepticism, encouraging re-evaluation of established concepts. The current paper tests prevalent assumptions and arguments to uncover a scientifically informed approach to addressing rising suicide rates in clinical settings.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"593-603"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892331","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":"Association of antidepressants with cataracts and glaucoma: a disproportionality analysis using the reports to the United States Food and Drug Administration Adverse Event Reporting System (FAERS) pharmacovigilance database.","authors":"Gia Han Le, Sabrina Wong, Angela T H Kwan, Joshua D Rosenblat, Rodrigo B Mansur, Kayla M Teopiz, Roger Ho, Taeho Greg Rhee, Maj Vinberg, Bing Cao, Sonya Liao, Roger S McIntyre","doi":"10.1017/S1092852924002360","DOIUrl":"10.1017/S1092852924002360","url":null,"abstract":"<p><strong>Background: </strong>Antidepressants are commonly prescribed for mood disorders. Epidemiological studies suggest antidepressant use may be associated with cataracts and glaucoma. We aim to investigate the association between antidepressants and cataracts and glaucoma.</p><p><strong>Methods: </strong>Data was collected from the United States Food and Drug Administration Adverse Event Reporting System. Reporting odds ratio (ROR) and Bayesian information components (IC₀₂₅) were calculated for antidepressants (ie, selective serotonin reuptake inhibitors [SSRIs], selective norepinephrine reuptake inhibitors [SNRIs], serotonin-norepinephrine-dopamine reuptake inhibitors, serotonin modulators and stimulators, serotonin antagonists and reuptake inhibitors [SARIs], norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, tricyclic antidepressants [TCAs], tetracyclic antidepressants [TeCAs], and monoamine oxidase inhibitors [MAOIs]). The reference agent was acetaminophen.</p><p><strong>Results: </strong>TeCAs and MAOIs were significantly associated with a decreased risk of cataracts (ROR = 0.11-0.65 and 0.16-0.69, respectively). TCAs, brexanolone, esketamine, and opipramol reported an increased cataract risk (ROR = 1.31-12.81). For glaucoma, SSRIs, SNRIs, SARIs, TCAs, MAOIs, and other investigated antidepressants reported significant RORs ranging from 1.034 to 21.17. There was a nonsignificant association of angle closure glaucoma (ACG) and open angle glaucoma (OAG) with the investigated antidepressants.</p><p><strong>Limitations: </strong>For adverse event cases, multiple suspected product names are listed, and as cases are not routinely verified, there may be a possibility of duplicate reports and causality cannot be established.</p><p><strong>Conclusion: </strong>Most of the investigated antidepressants were associated with a lower risk of cataract reporting. TCAs, brexanolone, esketamine, and opipramol were associated with greater odds of cataract. For most antidepressants, there was an insignificant increase in reports of ACG and OAG.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"682-696"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930822","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":"Clozapine rechallenge following myocarditis: a systematic review of rechallenge cases.","authors":"Laura McMahon, Maddison Giudice, Elias Wagner, Alkomiet Hasan, Matthew K Burrage, John Amerena, Cooper Fox, Karl Winckel, Timothy Tanzer, Lesley Smith, Nicola Warren, Dan Siskind, Nicole Korman","doi":"10.1017/S1092852924002219","DOIUrl":"10.1017/S1092852924002219","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Clozapine is the antipsychotic medication with the greatest efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, clozapine is ceased in approximately 0.2% to 8.5% of people due to concerns about clozapine-associated myocarditis (CAM). The opportunity for clozapine rechallenge is important for people with TRS and CAM, due to limited alternative treatments. However, there is a lack of consensus regarding the optimal process, monitoring, and dose titration to achieve successful clozapine rechallenge. The study aimed to review the process, monitoring, and dose titration within cases of clozapine rechallenge after CAM, to identify features associated with successful rechallenge.</p><p><strong>Methods: </strong>A systematic review of clozapine rechallenge cases following CAM was conducted. PubMed, EMBASE, Cinahl, and PsycINFO were searched for cases. Reference lists of retrieved articles and field experts were consulted to identify additional studies.</p><p><strong>Results: </strong>Forty-five cases were identified that described clozapine rechallenge, 31 of which were successful. Successful rechallenge cases generally used a slower dose titration regime with more frequent monitoring than standard clozapine initiation protocols; however, this data was not always completely recorded within cases. Six cases referred to published rechallenge protocols to guide their rechallenge.</p><p><strong>Conclusions: </strong>The process, monitoring, and dose titration of clozapine rechallenge are inconsistently reported in the literature. Despite this, 69% of case reports detailed a successful rechallenge post CAM; noting limitations associated with reliance on case data. Ensuring published clozapine rechallenge cases report standardised data, including titration speed and monitoring frequencies, is required to guide the development and validation of guidelines for clozapine rechallenge.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"585-592"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863587","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}