Acta Psychiatrica Scandinavica最新文献

{"title":"Pregnancy Outcomes in Women Diagnosed With Attention-Deficit/Hyperactivity Disorder: A Population-Based Register Study.","authors":"Anneli Andersson, Miguel Garcia-Argibay, Sofi Oskarsson, Jonas F Ludvigsson, Paul Lichtenstein, Brian M D'Onofrio, Catherine Tuvblad, Laura Ghirardi, Henrik Larsson","doi":"10.1111/acps.70039","DOIUrl":"https://doi.org/10.1111/acps.70039","url":null,"abstract":"<p><strong>Background: </strong>Maternal attention-deficit/hyperactivity disorder (ADHD) has been associated with various pregnancy outcomes, but the degree to which that association is explained by concomitant mental disorders and smoking during pregnancy remains unclear.</p><p><strong>Objective: </strong>To investigate the association between maternal ADHD and pregnancy outcomes.</p><p><strong>Methods: </strong>Through the Swedish Medical Birth Register, we identified 977,266 women who gave birth to a live singleton between January 1, 2006, and December 1, 2020 (1,617,121 pregnancies). Of these, 1.3% (12,553 women; 17,434 pregnancies) had an ADHD diagnosis prior to pregnancy. The primary outcome was preterm birth (< 37 weeks), with secondary outcomes being postterm birth (> 41 weeks), small for gestational age, large for gestational age, birth weight (≤ 2500, 2501-3500, > 4500 g), acute and planned cesarean section, assisted vaginal delivery, preeclampsia, and gestational diabetes. Generalized linear mixed-effects models adjusted for maternal age, year of childbirth, maternal education, comorbid mental disorders, and smoking during pregnancy.</p><p><strong>Results: </strong>There were 1089 (6.6%) preterm births among women with ADHD, and 73,423 (4.9%) preterm births among women without an ADHD diagnosis, corresponding to a crude OR of 1.33 (95% CI 1.25, 1.42). This association attenuated to nonsignificance after adjusting for maternal age, year of childbirth, maternal education, and comorbid mental disorders (adjOR = 1.06, 95% CI: 0.99, 1.13). Fully adjusted models revealed that ADHD was associated with an increased risk of having a large for gestational age baby (adjOR = 1.16, 95% CI: 1.06, 1.26) and undergoing a planned caesarean section (adjOR = 1.16, 95% CI: 1.06, 1.26). Sensitivity analyses using a broader ADHD definition suggested associations with preterm birth (adjOR = 1.09, 95% CI: 1.04, 1.15) and acute caesarean section (adjOR = 1.09, 95% CI: 1.04, 1.13).</p><p><strong>Conclusions: </strong>After adjustments for comorbid mental disorders and smoking during pregnancy, maternal ADHD was not associated with preterm birth. An increased risk of delivering large for gestational age babies and undergoing planned caesarean sections was found in women with ADHD.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205051","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 Cumulative Risk of Having a Family Member With a Diagnosed Mental Disorder: A Nationwide Study of Mental Disorders in Family Networks.","authors":"Anne Sofie Tegner Anker, Signe Hald Andersen","doi":"10.1111/acps.70041","DOIUrl":"https://doi.org/10.1111/acps.70041","url":null,"abstract":"<p><strong>Introduction: </strong>Mental disorders are associated with high costs-at the individual and societal level. But families also shoulder large costs in the form of caring for mentally ill family members. Yet, we do not know how common it is to have a family member with a mental disorder and whether this experience falls disproportionately on those who struggle with mental disorders themselves. To fill this gap, this study estimates the cumulative risk of having a family member with a diagnosed mental disorder.</p><p><strong>Methods: </strong>The study uses full population Danish registry data to follow individuals born in 1970 and their family members (parents, siblings, partners, and children) between 1980 and 2018. The study uses nationwide records of outpatient and inpatient hospital treatment for psychiatric disorders and cumulative incidence functions to estimate the cumulative risk of having a family member diagnosed with a mental disorder.</p><p><strong>Results: </strong>Among this cohort (N = 69,811) the cumulative risk of having a family member with a diagnosed mental disorder by age 49 is 51.4% [95% CI: 51.0%-51.8%]. Individuals diagnosed with a mental disorder themselves by age 49 (N = 9899) were 1.42 times more likely to have a family member with a mental disorder, and this difference grows for the cumulative risk of experiencing multiple family members with diagnosed mental disorders.</p><p><strong>Conclusion: </strong>This study provides novel nationwide estimates of how common it is to have a family member with a diagnosed mental disorder. The cumulative risk of having a mental disorder severe enough to result in secondary care treatment and diagnosis is estimated at 13.9% among the 1970 birth cohort, but many more (just above 50%) experience mental disorders through their family network. These results highlight how many individuals and families experience (severe) mental disorders at close hand and show the disproportionate potential caregiving burden carried by individuals who are themselves diagnosed with a mental disorder at some point.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197715","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":"Barriers to Clozapine Use in Europe: A New Hope.","authors":"Hélène Verdoux, Alexis Lepetit, Peter F J Schulte","doi":"10.1111/acps.70040","DOIUrl":"https://doi.org/10.1111/acps.70040","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184311","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":"Childhood Maltreatment and Cognitive Performance in Bipolar Disorder: The Potential Role of Inflammation.","authors":"Marzieh Majd, Jennifer Nicoloro-SantaBarbara, Katharine Burns, Maura De Laney, Emma V Galante, Julia Lebovitz, Megan Shanahan, Katherine E Burdick","doi":"10.1111/acps.70033","DOIUrl":"https://doi.org/10.1111/acps.70033","url":null,"abstract":"<p><strong>Background: </strong>Cognitive deficits are common in individuals with bipolar disorder (BD), but there is considerable variability in cognitive functioning. Childhood maltreatment (CM), which is frequently reported in BD, has been linked to poorer cognitive performance, potentially through mechanisms such as inflammation. However, the relationship between CM and global cognition and the mediating role of inflammation in BD warrant further investigation.</p><p><strong>Methods: </strong>The study sample consisted of 112 BD individuals and 83 healthy controls (HCs). Participants completed the MATRICS Consensus Cognitive Battery (MCCB), the Wisconsin Card Sorting Test, and the Childhood Trauma Questionnaire (CTQ). A composite inflammation index was created using blood levels of C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α, and was used in primary analyses.</p><p><strong>Results: </strong>The BD group, compared to HC, showed higher levels of inflammation and CM. Across the entire sample, higher total CM was associated with poorer global cognitive performance, with a medium effect size, even after accounting for diagnostic status. The associations were evident across all CM subscales. Specific cognitive domains affected included speed of processing, working memory, visual learning, and reasoning and problem solving. The association between CM and poorer global cognitive performance was partially mediated by inflammation (indirect effect: β = -0.048, CI = -0.10, -0.009). Within the BD group, higher total CM was similarly associated with worse global cognitive performance. The associations were evident across all CM subscales, except for physical neglect. Significant associations were observed between total CM and MCCB domains of speed of processing, attention and vigilance, working memory, visual learning, reasoning and problem solving, as well as cognitive flexibility. Within the HC group, only emotional neglect and physical neglect were associated with poorer global cognition.</p><p><strong>Conclusions: </strong>This study provides evidence that total CM and its subscales are associated with poorer global cognitive performance in a sample of individuals with BD and HC, with stronger associations found within the BD group. In addition, inflammation partially mediated the relationship between CM and global cognition. These findings highlight the importance of trauma-informed and cognition-focused interventions aimed at enhancing cognitive outcomes and slowing cognitive decline in individuals with BD who have a history of CM. Furthermore, the results suggest that while inflammation plays a role in the CM-cognition link, its effects are complex and likely interact with other biological and environmental factors.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136001","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":"Pediatric Somatic and Psychiatric Hospital Contacts in Denmark: A National Overview of Risk Factors, Admissions, and Mortality.","authors":"Lone Graff Stensballe, Andreas Jensen","doi":"10.1111/acps.70036","DOIUrl":"https://doi.org/10.1111/acps.70036","url":null,"abstract":"<p><strong>Objectives: </strong>Prior studies have identified comorbidity between pediatric somatic and psychiatric diseases within specific diagnostic groups. However, population-level data on these associations and their impact on mortality and morbidity are limited. This study aimed to examine these associations in the Danish pediatric population.</p><p><strong>Methods: </strong>We conducted a national cohort study using Danish register data, including 1,413,177 children and adolescents from 2019 to 2023. We assessed background factors, mortality, and hospital contacts across three patient groups: somatic-only, psychiatric-only, and somatic-psychiatric. A new-user design classified patients as somatic-only or psychiatric-only if they had no hospital contacts in the preceding 12 months. Patients with subsequent contacts for the other condition were reclassified into the somatic-psychiatric group.</p><p><strong>Results: </strong>Most individuals were included in the somatic-only group (n = 532,324), with fewer in the psychiatric-only group (n = 21,501) or somatic-psychiatric group (n = 23,108). Psychiatric patients were more often boys and from lower socioeconomic backgrounds. Somatic hospital contacts often involved less severe symptoms. In contrast, psychiatric contacts involved specific diagnoses, including suicide attempts. Pediatric patients with both conditions had a higher 3-year readmission risk (12.1%, 95% CI: 11.6%-12.6%) compared to somatic-only patients (9.4%, 95% CI: 9.3%-9.5%), and longer average hospital stays (6.32 vs. 1.97 h). Psychiatric patients also had significantly higher all-cause mortality.</p><p><strong>Conclusion: </strong>Somatic hospital contacts were more common, but children with psychiatric conditions faced significantly higher mortality and morbidity. These findings are relevant amid rising pediatric psychiatric diagnoses and recent Danish policy to integrate psychiatric and somatic care. Further research is needed to replicate these findings and inform optimal resource allocation for pediatric psychiatric care.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038669","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":"Predicting Remission in Schizophrenia Using Machine Learning-Assessing the Impact of Sample Size and Predictor Overinclusion.","authors":"Fredrik Hieronymus, Magnus Hieronymus, Axel Sjöstedt, Staffan Nilsson, Jakob Näslund, Alexander Lisinski, Søren Dinesen Østergaard","doi":"10.1111/acps.70037","DOIUrl":"https://doi.org/10.1111/acps.70037","url":null,"abstract":"<p><strong>Introduction: </strong>Machine learning studies sometimes include a high number of predictors relative to the number of training cases. This increases the risk of overfitting and poor generalizability. A recent study hypothesized that between-trial heterogeneity precluded generalizable outcome prediction in schizophrenia from being achieved. However, an alternative explanation is that predictor overinclusion might explain the low generalizability in that analysis.</p><p><strong>Methods: </strong>Positive and Negative Syndrome Scale (PANSS) item-data, age, sex, and treatment allocation (antipsychotic/placebo) from 18 placebo-controlled trials of risperidone and paliperidone, in schizophrenia or schizoaffective disorder, were used as predictors for training five supervised learning models to predict symptom remission after 4 weeks of treatment. Sensitivity analyses varying the number of training cases and including simulated uninformative predictors were conducted to assess model performance, as were analyses on simulated data.</p><p><strong>Results: </strong>Better-than-chance predictions could be achieved for all models using as few as 384 training cases (BAC 0.60, SD 0.035 for an ensemble model). Model performance increased with the number of training cases (n = 4384, BAC 0.63, SD 0.041) and was higher when validated on a set of unseen trials without placebo controls (n = 1508, BAC 0.68, SD 0.013). Predictive performance was substantially decreased by including simulated uninformative predictors. Analyses of simulated data suggest that considerably larger sample sizes than commonly used might be required to effectively separate weakly informative from uninformative predictors.</p><p><strong>Conclusion: </strong>Supervised learning models can generate better-than-chance predictions in schizophrenia from small datasets, but this requires that not too many uninformative predictors are included. Since highly predictive models have not yet been established for schizophrenia-and since strong linear predictors are easy to identify-commonly collected clinical trial data likely do not contain predictors with strong linear relations to clinically relevant outcomes. If correct, future machine learning analyses should focus on maximizing the probability of identifying weakly predictive features.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028636","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":"Pharmacological and Mechanistic Interventions for Cognitive Impairment Associated With Schizophrenia: A Review of Registered Clinical Trials.","authors":"Bahareh Peyrovian, Lena Palaniyappan, Theodore T Kolivakis, Howard C Margolese","doi":"10.1111/acps.70034","DOIUrl":"https://doi.org/10.1111/acps.70034","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is characterized by positive, negative, and cognitive symptoms. Current pharmacological treatments often fail to address cognitive deficits. In this review of clinical trials, we aim to identify studies that explore neurobiological (non-psychological) strategies to address Cognitive Impairment Associated with Schizophrenia (CIAS).</p><p><strong>Methods: </strong>A search of clinical trial databases was conducted through US National Institutes of Health's ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (ICTRP) on August 2, 2024, with complementary searches performed on July 4 and 10, 2025, for each respective database to update the results.</p><p><strong>Results: </strong>We identified 510 relevant interventional studies that objectively measured cognitive performance. Most trials were conducted in the United States (36.4%) and focused on treatment (79%), with randomized designs (88%), investigating drugs (56%), devices (33%), and dietary supplements (10%). Of these trials, 17% reported positive pro-cognitive evidence. Glutamate modulators were the most studied drug category (63 trials), with positive results for sarcosine, BI425809 (Iclepertin), d-serine, d-cycloserine, and minocycline in small-scale trials, although the results were not replicated in larger studies. Nicotinic receptor modulators like ABT-126 and encenicline also showed some cognitive benefits. Device-based interventions, particularly rTMS and iTBS, demonstrated improvements in global cognition, working memory, attention, and processing speed in a subset of trials.</p><p><strong>Conclusion: </strong>In this comprehensive overview of clinical trials on pro-cognitive agents in schizophrenia, we identify emerging opportunities but also acknowledge a lack of replicated evidence. Despite extensive attempts to address CIAS, it remains an undertreated domain, and future trials should explore better ways to treat this important condition.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999213","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":"Influence of Sex and Diagnosis on Clinical Variables and Neurocognitive Performance in Severe Mental Illness. Results From the PsyCourse Study.","authors":"Maria Serra-Navarro, Maria Heilbronner, Brisa Solé, Roger Borràs, Anabel Martinez-Arán, Kristina Adorjan, Alba Navarro-Flores, Mojtaba Oraki Kohshour, Daniela Reich-Erkelenz, Eva C Schulte, Fanny Senner, Ion-George Anghelescu, Volker Arolt, Bernhard T Baune, Udo Dannlowski, Detlef E Dietrich, Andreas J Fallgatter, Christian Figge, Markus Jäger, Georg Juckel, Carsten Konrad, Jens Reimer, Eva Z Reininghaus, Max Schmauß, Andrea Schmitt, Carsten Spitzer, Jens Wiltfang, Jörg Zimmermann, Sergi Papiol, Urs Heilbronner, Peter Falkai, Thomas G Schulze, Eduard Vieta, Carla Torrent, Monika Budde, Silvia Amoretti","doi":"10.1111/acps.70026","DOIUrl":"https://doi.org/10.1111/acps.70026","url":null,"abstract":"<p><strong>Introduction: </strong>Bipolar disorder (BD) and schizophrenia (SZ) are serious mental illnesses (SMI) with overlapping symptoms but distinct differences in onset and course. Sex differences are an area of growing interest in SMI. This study aims to examine potential interactions between sex and diagnosis across a broad range of variables, to compare males and females within SZ and BD, and to investigate sex-specific group differences.</p><p><strong>Methods: </strong>A total of 1516 individuals were included in a cross-sectional study using baseline data from the multicenter PsyCourse Study, including BD (n = 543), SZ (n = 517), and healthy controls (HC) (n = 456). Sociodemographic characteristics, clinical symptoms, psychosocial functioning, quality of life, neurocognitive performance, and somatic comorbidities were assessed. Generalized linear models were used to analyze differences between groups and sexes. False Discovery Rate (FDR) and Bonferroni post hoc comparisons were performed.</p><p><strong>Results: </strong>Significant interactions were identified in age (p = 0.001), age at treatment (p = 0.05), illness duration (p = 0.03), illicit drug use (p = 0.01), and smoking (p = 0.05). Differences in substance use were observed across groups and sexes, with the highest rates found in males with SZ. The BD group showed better functioning and neurocognitive performance compared with the SZ group. Within the BD group, females reported better performance in verbal memory (p = 0.003) and psychomotor speed (p < 0.001) than males. Moreover, both females and males with SMI showed higher rates of thyroid alterations compared with HC (p = 0.01 for females and p = 0.002 for males).</p><p><strong>Conclusions: </strong>Significant sex differences were observed in substance use and somatic comorbidities. Interactions between diagnosis and sex underscore the importance of considering both factors in clinical assessments. These findings highlight the need to tailor sex-specific treatment for each patient. Further research is needed to explore the role of sex hormones and other biological and societal factors in the presentation and course of these disorders.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936578","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 Role of Clinical Judgment in Psychiatry.","authors":"Giovanni A Fava, Jenny Guidi","doi":"10.1111/acps.70035","DOIUrl":"https://doi.org/10.1111/acps.70035","url":null,"abstract":"<p><p>Clinical judgment is currently perceived as an intuitive art that is going to be replaced by growing technology and artificial intelligence. Even though patients look for good clinical judgment when they seek medical attention and clinicians rely on it, the topic is seldom mentioned and discussed in the literature. In their everyday practice, psychiatrists use observation, description, and classification; test explanatory hypotheses; and formulate clinical decisions based on clinical judgment. The aim of this review was to examine the current role of clinical judgment in psychiatry. We first outline the importance of collecting information that supplements the use of diagnostic criteria (allostatic load, health attitudes and behavior, psychological well-being, personality and iatrogenic factors). Clinimetrics, the science of clinical measurements, provides an intellectual home for the reproduction and standardization of clinical intuitions. The clinimetric translation of clinical reasoning allows the organization of the material that has been collected (staging, building unitary concepts, subtyping, formulating pathophysiological links, and global judgments). Finally, we discuss how clinical judgment is the intermediate step between the general indications that derive from clinical trials and individualized treatment plans, encompassing patients' preferences, treatment articulation and selection, level of care, and interpretation of previous treatment response. Clinical judgment remains the basic method of medicine and psychiatry. Improving its features by clinimetric strategies is likely to yield a highly effective precision psychiatry that is available today to any practicing clinician.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991073","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":"Efficacy and Acceptability of Licensed and Off-Label Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness: A Systematic Review and Meta-Analysis of Randomised Trials.","authors":"Nina Friis Bak Fuglsang, Nanna Marker Madsen, Søren Lundorff Jacobsen, Julie Eg Frøkjær, Nicolai Ladegaard, Marc Alberg Sørensen, Christoph U Correll, Christian Otte, Mikkel Højlund, Ole Köhler-Forsberg","doi":"10.1111/acps.70032","DOIUrl":"https://doi.org/10.1111/acps.70032","url":null,"abstract":"<p><strong>Background: </strong>A wide range of drugs is used to alleviate insomnia symptoms in individuals with severe mental illness (SMI), including licensed drugs and sedating drugs prescribed off-label. Yet, no review has gathered the evidence on illness-specific or transdiagnostic outcomes of pharmacological interventions for insomnia. We aimed to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) studying the efficacy and acceptability of pharmacological interventions for insomnia among individuals with SMI, defined as schizophrenia, bipolar disorder (BD) or major depressive disorder (MDD).</p><p><strong>Methods: </strong>We searched for RCTs of pharmacological interventions for insomnia that used either placebo or another medication as inactive control or active comparator. Two independent reviewers performed the literature screening, data extraction and risk of bias assessment (RoB2). We performed random effects meta-analyses on the co-primary outcomes total sleep time (TST), sleep quality and acceptability (all-cause discontinuation) and the secondary outcomes safety and tolerability.</p><p><strong>Results: </strong>The search identified 3331 hits, of which 25 RCTs (n = 2476 individuals) were included, with 18 RCTs (n = 2199) in MDD, 4 RCTs (n = 162) in BD and 3 RCTs (n = 115) in schizophrenia. Of 25 RCTs, 22 had a high risk of bias. The most frequently studied drugs were agomelatine (RCTs = 3, n = 686), eszopiclone (RCTs = 3, n = 599) and zolpidem (RCTs = 3, n = 601). Compared to placebo, pharmacological interventions for insomnia were associated with improved sleep quality by a small effect size (RCTs = 8, g = 0.24, 95% CI = 0.05-0.43) and improved TST (RCTs = 10, MD = 30.82 min, 95% CI = 19.13-42.50), with similar acceptability (RCTs = 10, RR = 1.06, 95% CI = 0.90-1.25).</p><p><strong>Discussion: </strong>Despite their frequent use, many licensed and off-label pharmacological interventions for insomnia have never been investigated in patients with SMI. The studies that provided sufficient data for meta-analysis showed better efficacy with similar acceptability compared to placebo, but the generalizability of these results is limited by the high heterogeneity and low quality of the included studies. This underscores the need for high-quality RCTs to provide a better scientific basis for the pharmacological treatment of insomnia in SMI.</p><p><strong>Trial registration: </strong>CRD42023413787.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936550","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}