Acta Psychiatrica Scandinavica最新文献

{"title":"Involuntary Clozapine Treatment: A Systematic Review.","authors":"Hélène Verdoux, Alexis Lepetit, Peter F J Schulte","doi":"10.1111/acps.70076","DOIUrl":"10.1111/acps.70076","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to synthesize the information relevant for clinical practice on involuntary clozapine treatment.</p><p><strong>Methods: </strong>Articles were identified with MEDLINE, Web of Sciences and PsycINFO search from inception through September 2025 (PROSPERO database registration CRD420251234475). We included all articles addressing issues related to involuntary clozapine treatment irrespective of the route of administration, i.e., oral, intra-muscular (IM) or nasogastric. Data were synthesized narratively.</p><p><strong>Results: </strong>Of the 29 identified articles, most clinical studies (n = 18) on people prescribed involuntary clozapine treatment (n = 236) were case reports/series or chart reviews. IM or nasogastric routes were the last-resort treatment for people with extremely severe psychotic disorders presenting with risky behavior. The decisional process was often lengthy due to the complex legal and ethical issues raised by involuntary treatment and restricted access to the unlicensed IM formulation. In nearly half of cases, the oral route was accepted after the decision to perform IM or nasogastric administration. Pain at the injection site was the most frequent adverse event after IM administration. Transition to this route occurred rapidly in the vast majority of the other cases, most often allowing a dramatic reduction in the severity of target symptoms and coercive measures. Clozapine was maintained orally after the acute phase in the majority of people with involuntary administration.</p><p><strong>Conclusions: </strong>Although the body of evidence supporting the use of involuntary clozapine treatment is mostly drawn from small observational studies, their findings suggest that this last-resort option may save the life and promote recovery of people for whom other treatments have failed. Access to IM clozapine is currently restricted in most countries. Whether this barrier to clozapine treatment for severely ill people with impaired decision-making capacities should be overcome in other countries needs to be further addressed.</p><p><strong>Registration: </strong>PROSPERO database registration CRD420251234475.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"595-609"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Gap for People With Schizophrenia Spectrum Disorders: An Elephant in the Room?","authors":"Alain Braillon","doi":"10.1111/acps.70070","DOIUrl":"10.1111/acps.70070","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"667"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Risk Factors for Mortality in Patients Admitted to a Psychiatric Acute Ward: A Prospective Cohort Study\".","authors":"","doi":"10.1111/acps.70080","DOIUrl":"10.1111/acps.70080","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"668"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Accelerated Atherosclerosis and High-Sensitivity C-Reactive Protein Levels in Bipolar Disorder and Schizophrenia.","authors":"Shang-Ying Tsai, Yao-Tung Lee, Martha Sajatovic, Shan Hung, Pao-Huan Chen, Ting-Hsuan Chang, Yu-Jui Huang","doi":"10.1111/acps.70083","DOIUrl":"10.1111/acps.70083","url":null,"abstract":"<p><strong>Background: </strong>Individuals with bipolar disorder (BPD) and schizophrenia (SCZ) are at increased risk for cardiovascular disease and have been reported to exhibit inflammatory activation. This study examined the link between systemic inflamm-ation and accelerated atherosclerosis, focusing on whether high-sensitivity C-reactive protein (hs-CRP) is associated with carotid intima-media thickness (cIMT) in these populations.</p><p><strong>Methods: </strong>Physically healthy outpatients with bipolar I disorder or schizophrenia (DSM-5) as well as healthy controls, aged 20-60 years, were recruited to assess cIMT via high-resolution carotid ultrasound. Fasting venous blood samples were collected to measure levels of hs-CRP and lipid profiles on the day of ultrasonography. Clinical data were obtained from medical records and interviews.</p><p><strong>Results: </strong>Patients with BPD (n = 111) and SCZ (n = 115) demonstrated significantly higher cIMT and hs-CRP levels compared to healthy controls (n = 84). In the BPD group, age, BMI, hs-CRP levels, duration of illness, and lithium daily dosage were identified as significant correlates of cIMT in bivariate analyses. In the multivariate analyses, hs-CRP levels were independently associated with increased cIMT after adjustment for age, body mass index, sex, and smoking habit, explaining 5.6% of the variance. In SCZ group, only age was significantly associated with cIMT. Smoking status and lipid profiles were not significantly associated with cIMT in either group.</p><p><strong>Conclusions: </strong>Even physically healthy patients with BPD and SCZ exhibit accelerated atherosclerosis before geriatric age, reflected by increased cIMT. The association between hs-CRP and cIMT is observed in BPD, but not in SCZ, suggesting a greater role of chronic low-grade inflammation in BPD-related early vascular changes.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"656-664"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Swedish National Quality Register for Repetitive Transcranial Magnetic Stimulation.","authors":"S Melker Hagsäter, Axel Nordenskjöld, Pia Nordanskog, Johan Lundberg, Carl Johan Ekman, Fredrik Hieronymus, Robert Bodén","doi":"10.1111/acps.70082","DOIUrl":"10.1111/acps.70082","url":null,"abstract":"<p><strong>Objective: </strong>Repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to be an effective and well tolerated treatment for depression, and it is being investigated also for other indications. This study presents the Swedish National Quality Register for rTMS (Q-rTMS). The registry comprises epidemiological data, data from standardized rating scales, details on treatment settings, and a registry-specific patient questionnaire.</p><p><strong>Methods: </strong>A presentation of the Q-rTMS including the types of data collected, the organizational structure of the register, as well as a brief overview of the volume of data accumulated between the registry's inception in 2018 and the end of 2024.</p><p><strong>Results: </strong>As of 2024, the register contained data from a total of 3083 unique individuals and 3842 treatment series, collected from 27 different rTMS providers. The most common indication for rTMS was depression (International Classification of Diseases, Tenth Revision diagnoses (ICD-10): F32-F34, 74.1%) followed by bipolar affective disorder (ICD-10: F31, 14.2%). The average age was 43.2 years, and 56.5% were women. The register included matched pre- and post-treatment data exceeding 60% completeness for the Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), the Clinical Global Impression-Severity (CGI-S), and the EuroQol five-dimensional questionnaire (EQ-5D-5L).</p><p><strong>Conclusion: </strong>The Q-rTMS combines high coverage with longitudinal documentation of clinically relevant outcome measures and may hence contribute to population-based real-world effectiveness research in rTMS for depression.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"649-655"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Recovery and Recurrence From Major Depression in Adolescence and Adulthood\".","authors":"","doi":"10.1111/acps.70081","DOIUrl":"10.1111/acps.70081","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"669"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147342990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute-Phase Interventions After Self-Harm for Preventing Suicide and Recurrence: A Systematic Review and Meta-Analysis.","authors":"Guilherme Pimenta Roncete, Luis C Farhat, Loren Beiram, Bianca Besteti Fernandes Damiano, Craig J Bryan, Karina L Ramirez, Euripedes Constantino Miguel, Rodolfo Furlan Damiano","doi":"10.1111/acps.70085","DOIUrl":"10.1111/acps.70085","url":null,"abstract":"<p><strong>Introduction: </strong>Suicide risk is markedly elevated following presentation after self-harm, yet the evidence base for interventions initiated in the immediate post-presentation period has not been synthesized with specific attention to this high-risk window. Clarifying which early interventions may reduce adverse outcomes is essential for informing psychiatric care and prevention strategies.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized clinical trials enrolling individuals presenting to clinical services after self-harm, with interventions initiated within 1 month of the index episode. PubMed, Embase, PsycINFO, the WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov were searched from inception through April 24, 2025. Two reviewers independently screened studies and extracted data using standardized forms. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated with GRADE. Random-effects meta-analyses with Hartung-Knapp adjustment were conducted for intervention categories with at least three trials, and prediction intervals were calculated. Prespecified meta-regressions examined participant- and intervention-level moderators.</p><p><strong>Results: </strong>Sixty randomized clinical trials, including 22,654 participants, met the inclusion criteria. Across pooled analyses, no intervention category was associated with a statistically significant reduction in repeat self-harm at any follow-up interval. For suicide deaths, problem-solving therapy was associated with lower mortality at medium-term follow-up (6-12 months; OR 0.45, 95% CI 0.29-0.70; I ² = 0%), and brief intervention and contact was associated with lower mortality at long-term follow-up (> 12 months; OR 0.34, 95% CI 0.15-0.79; I ² = 0%). Meta-regression analyses indicated that younger mean sample age and trial inclusion based on suicidal intent moderated effects on repeat self-harm at > 6-12 months.</p><p><strong>Conclusions: </strong>Among trials initiating treatment within 1 month of self-harm presentation, effects on repeat self-harm were small and not statistically significant, likely reflecting outcome heterogeneity in the acute post-presentation period. In contrast, structured problem-solving and brief contact-based interventions were associated with lower suicide mortality at medium- and long-term follow-up. These findings support the use of scalable early interventions in psychiatric services and highlight priorities for future trials powered to detect effects on suicide mortality.</p><p><strong>Trial registration: </strong>PROSPERO: CRD42023458233.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"610-626"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Associations of Antenatal Corticosteroids and Maternal Postpartum Mental Health-A Cohort Study\".","authors":"","doi":"10.1111/acps.70088","DOIUrl":"10.1111/acps.70088","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"670"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative Artificial Intelligence (AI) and the Outsourcing of Scientific Reasoning: Perils of the Rising Cognitive Debt in Academia and Beyond.","authors":"Søren Dinesen Østergaard","doi":"10.1111/acps.70069","DOIUrl":"10.1111/acps.70069","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"665-666"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146016721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Dantrolene in Neuroleptic Malignant Syndrome: A Nationwide Retrospective Study.","authors":"Akira Suekane, Atsushi Senda, Koji Morishita, Kiyohide Fushimi","doi":"10.1111/acps.70073","DOIUrl":"https://doi.org/10.1111/acps.70073","url":null,"abstract":"<p><strong>Introduction: </strong>Neuroleptic malignant syndrome (NMS) is a life-threatening adverse reaction to antipsychotic medications. Dantrolene is commonly used to manage NMS; however, supportive evidence from large-scale clinical studies remains limited. This study aimed to evaluate the clinical impact of early dantrolene administration in intensive care unit (ICU)-admitted patients with NMS using a nationwide inpatient database in Japan.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the Japanese Diagnosis Procedure Combination database from April 2010 to March 2023. Patients aged ≥ 16 years diagnosed with NMS and admitted to the ICU were included. The exposure of interest was dantrolene administration within the first 2 days of admission. The primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. Baseline adjustment between the dantrolene-treated and untreated groups was performed using two methods: propensity score matching (PSM) and generalized linear mixed models (GLMMs).</p><p><strong>Results: </strong>A total of 2234 patients met the inclusion criteria, including 1475 treated with dantrolene and 759 without. In both analyses, dantrolene use was associated with an increase in in-hospital mortality (adjusted OR: 2.03, 95% CI: 1.16-3.54; p = 0.01 in GLMM, adjusted OR: 1.92, 95% CI: 1.17-3.24; p = 0.01 in PSM). Dantrolene was also associated with prolonged ICU stay (mean difference: 1.66, 95% CI: 1.05-2.26; p < 0.001 in GLMM and 2.03, 95% CI: 1.31-2.76; p < 0.001 in PSM) and hospital stay (mean difference: 6.85, 95% CI: 3.48-10.21; p < 0.001 in GLMM and 6.81 days, 95% CI: 3.46-10.16; p < 0.001 in PSM). Subgroup analyses stratified by age (< 65 vs. ≥ 65 years) yielded similar trends.</p><p><strong>Conclusions: </strong>In the largest study of NMS to date, early initiation of dantrolene was associated with higher in-hospital mortality and prolonged ICU/hospital stay. These findings suggest that routine use of dantrolene in NMS should be reevaluated.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 6","pages":"627-635"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}