Acta Psychiatrica Scandinavica最新文献

{"title":"Comment on: \"Means Restriction for Suicide Prevention: An Umbrella Review\".","authors":"Nosaibah Razaqi, Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.1111/acps.13787","DOIUrl":"https://doi.org/10.1111/acps.13787","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996412","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":"Altered Functional Connectivity of Prefrontal Cortex-Related Circuitry and Trait Impulsivity in Patients With Bipolar Disorder and History of Suicide Attempts.","authors":"Mao-Hsuan Huang, Yi-Hsuan Kuan, Pei-Chi Tu, Wan-Chen Chang, Yee-Lam E Chan, Tung-Ping Su","doi":"10.1111/acps.13786","DOIUrl":"https://doi.org/10.1111/acps.13786","url":null,"abstract":"<p><strong>Background: </strong>The neurobiological basis of impulsivity and its role in suicide attempt (SA) in BD remains underexplored. This study aimed to examine the functional connectivity (FC) within the prefrontal cortex (PFC) in BD patients with and without a history of SA, focusing on the role of trait impulsivity.</p><p><strong>Methods: </strong>Seventy-two euthymic BD patients (34 with a history of SA, BDSA; and 38 without, BDNS) and 55 age- and sex-matched healthy controls underwent resting-state functional MRI. FC analyses were conducted on four PFC regions: superior frontal gyrus (SFG), middle frontal gyrus (MFG), inferior frontal gyrus (IFG), and orbitofrontal cortex (OFC). Trait impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11), and its association with FC was analyzed using a general linear model, adjusting for demographic and clinical variables.</p><p><strong>Results: </strong>BDSA had higher trait impulsivity than BDNS and the controls. BDSA exhibited reduced FC between the PFC and sensorimotor (postcentral and precentral gyri) and thalamic regions compared to BDNS. These reductions in FC of the fronto-thalamic and fronto-sensorimotor circuits were significantly associated with higher trait impulsivity scores.</p><p><strong>Conclusion: </strong>The findings highlight specific PFC-based FC alterations associated with suicide attempts and trait impulsivity in BD, offering potential neurobiological markers for suicide risk in this population.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930098","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":"Recovery and Recurrence From Major Depression in Adolescence and Adulthood.","authors":"Adrian E Desai Boström, Thomas Cars, Clara Hellner, Johan Lundberg","doi":"10.1111/acps.13785","DOIUrl":"https://doi.org/10.1111/acps.13785","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to estimate 5-year recurrence rates of first-episode major depressive disorder (MDD) and assess the impact of adolescence on recurrence likelihood after the first episode, compared to adults.</p><p><strong>Methods: </strong>A pre-registered retrospective cohort study that utilized epidemiological data from the Stockholm MDD Cohort (1997-2018), including all individuals registered with a depression diagnosis in Region Stockholm from 2010 to 2018. This dataset combines longitudinal information from primary and secondary care, socioeconomic data, drug dispensations, psychotherapy sessions, brain stimulation treatments, and inpatient treatment. The study included 9124 individuals (1727 adolescents aged 13-17 and 7397 adults aged 18-40) who experienced their first MDD episode between 2011 and 2012, with at least three months of remission. Propensity score weighting balanced cohorts for biological sex, socioeconomic status, depression severity, psychiatric comorbidities, and treatments.</p><p><strong>Results: </strong>The 5-year recurrence rates were 46.1% for adolescents and 49.0% for adults. The study had over 80% power to detect a minimum absolute difference in recurrence rates of approximately 5.5 percentage points. No significant difference in recurrence likelihood (p = 0.364) or time from remission to recurrence (median 379 days for adolescents, 326 days for adults, p = 0.836) was found between groups. Findings were consistent across bootstrap replicates and sensitivity analyses with extended remission periods.</p><p><strong>Conclusions: </strong>Approximately half of individuals with a first MDD episode experience recurrence within five years. Recurrence rates were higher than expected for adults but consistent with expectations for adolescents. The study underscores the need for relapse prevention from adolescence through adulthood and indicates a similar clinical course of MDD across age groups.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930116","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":"Genetic Confounding of the Association Between Age at First Hormonal Contraception and Depression","authors":"Jessica Mundy,&nbsp;Alisha S. M. Hall,&nbsp;Esben Agerbo,&nbsp;Clara Albiñana,&nbsp;Jette Steinbach,&nbsp;Bjarni J. Vilhjálmsson,&nbsp;Søren D. Østergaard,&nbsp;Katherine L. Musliner","doi":"10.1111/acps.13774","DOIUrl":"10.1111/acps.13774","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous research has shown that females who use hormonal contraception are at increased risk of developing depression, and that the risk is highest among adolescents. While this finding could reflect age-specific effects of exogenous hormones on mental health, genetic liability for mental disorders could be confounding the association. Our goal was to test the plausibility of this hypothesis by determining whether polygenic liabilities for major depressive disorder (MDD), bipolar disorder (BD), schizophrenia (SCZ), and attention deficit hyperactivity disorder (ADHD) are associated with younger age at hormonal contraception initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cohort study using data from the Danish iPSYCH2015 sub-cohort, a representative sample of people born in Denmark between May 1981 and December 2008. Polygenic scores (PGSs) for MDD, BD, SCZ, and ADHD were created using the most recent genome-wide association study meta-analyses from the Psychiatric Genomics Consortium. Associations between PGSs and hormonal contraception initiation in the following age categories: 10–14, 15–19, 20–24, and 25+ were examined via Cox regression. We examined any hormonal contraception, oral contraception, and non-oral contraception.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PGS-MDD and PGS-ADHD showed the strongest associations with hormonal contraception initiation at age 10–14 (PGS-ADHD: HR = 1.21 [95% CI = 1.16–1.27], <i>p</i> = 6.16 x 10⁻¹⁸; PGS-MDD: 1.21 [1.16–1.27], <i>p</i> = 1.22 x 10⁻¹⁷). The associations then steadily decreased as age at hormonal contraception initiation increased. Both PGS-MDD and PGS-ADHD were also associated with initiation at ages 15–19, but not at 20–24 or 25+. PGS-BD and PGS-SCZ were also associated, albeit not as strongly, with initiation at age 10–14 only (PGS-BD: 1.07 [1.02–1.13], <i>p</i> = 6.87 × 10⁻³; PGS-SCZ: 1.09 [1.04–1.14], <i>p</i> = 8.61 × 10⁻⁴).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and Relevance</h3>\u0000 \u0000 <p>These results suggest that genetic confounding could explain some of the association between early hormonal contraception use and depression. Where possible, researchers studying this important topic should account for possible confounding by genetic liability for mental disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"529-536"},"PeriodicalIF":5.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918647","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":"From Genetics to Psychosocial Functioning: Unraveling the Mediating Roles of Cognitive Reserve, Cognition, and Negative Symptoms in First-Episode Psychosis.","authors":"M Florencia Forte, Derek Clougher, Àlex G Segura, Gisela Mezquida, Ana Maria Sánchez-Torres, Eduard Vieta, Marina Garriga, Antonio Lobo, Ana M González-Pinto, Covadonga M Diaz-Caneja, Alexandra Roldan, Anabel Martínez-Arán, Elena de la Serna, Anna Mané, Sergi Mas, Carla Torrent, Kelly Allot, Miquel Bernardo, Silvia Amoretti","doi":"10.1111/acps.13779","DOIUrl":"https://doi.org/10.1111/acps.13779","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown associations between polygenic risk scores for educational attainment (PRS_EA), cognitive reserve (CR), cognition, negative symptoms (NS), and psychosocial functioning in first-episode psychosis (FEP). However, their specific interactions remain unclear. This study aimed to investigate the mediating roles of CR, cognition, and NS in the relationship between PRS_EA and psychosocial functioning one year after a FEP. Additionally, we sought to explore the impact of two NS subtypes on this relationship: diminished Expression (EXP-NS) and Motivation and Pleasure (MAP-NS).</p><p><strong>Methods: </strong>A total of 138 FEP participants, predominantly male (70%), with a mean age of 24.77 years (SD = 5.29), underwent genetic, clinical, and cognitive assessments two months after study enrollment. Functioning evaluation followed at one-year follow-up. To investigate the mediating role of CR, cognition, and NS in the relationship between PRS_EA and functioning, a serial mediation model was employed. Two further mediation models were tested to explore the differential impact of EXP-NS and MAP-NS. Mediation analysis was performed using the PROCESS macro version 4.1 within SPSS version 26.</p><p><strong>Results: </strong>The serial mediation model revealed a causal chain for PRS_EA > CR > cognition > NS > Functioning (β = -3.08, 95%CI [-5.73, -0.43], p = 0.023). When differentiating by type of NS, only EXP-NS were significantly associated in the casual chain (β = -0.17, 95% CI [-0.39, -0.01], p < 0.05).</p><p><strong>Conclusions: </strong>CR, cognition and NS -specifically EXP-NS- mediate the association between PRS_EA and psychosocial functioning at one-year follow-up in FEP patients. These results highlight the potential for personalized interventions based on genetic predisposition.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890602","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":"Means Restriction for Suicide Prevention: An Umbrella Review.","authors":"Adriana G Nevarez-Flores, Vandana Pandey, Adriana Perez Angelucci, Amanda L Neil, Brett McDermott, David Castle","doi":"10.1111/acps.13783","DOIUrl":"https://doi.org/10.1111/acps.13783","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this umbrella review is to summarise existing international evidence on means restriction activities for the prevention of suicide, and provide evidence of their success or lack thereof. The consolidated and integrated information can help inform potential public health interventions.</p><p><strong>Methods: </strong>An overview of published systematic reviews in English was undertaken. There were no time restrictions. Six major repositories of systematic reviews databases were searched for relevant studies and the reference lists of all selected systematic reviews searched for identifying reviews not retrieved within the database searches. Included studies needed to be Cochrane or non-Cochrane systematic reviews (with or without meta-analyses) that explored means restriction activities for suicide prevention.</p><p><strong>Results: </strong>A total of 670 records were identified across the searches; 11 reviews were eligible for inclusion. Three further reviews were identified through list searches with one eligible for inclusion. Thus, 12 systematic reviews were included in this umbrella review. Activities undertaken around the world were implemented for the prevention of suicide by firearms, jumping from heights and in front of a moving object, and suicide by hazardous agents. A variety of factors associated with the success and/or failure of mean restriction activities were identified, including the prevalence of method and presence or lack of a substitution effect. Most reviews found means restriction activities successful in the prevention of suicide.</p><p><strong>Conclusions: </strong>Means restriction is an empirically proven strategy that should be considered for the prevention of suicide. Priority should be given to the most prevalent methods of suicide and implementation of locally relevant solutions, including the cultural context of the targeted population. Other important factors such as minimisation of any substitution effect need to be considered when implementing means restriction activities for suicide prevention.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880766","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 Effectiveness of Immersive Virtual Reality-Based Treatment for Mental Disorders: A Systematic Review With Meta-Analysis","authors":"Fatime Zeka,&nbsp;Lars Clemmensen,&nbsp;Lucia Valmaggia,&nbsp;Wim Veling,&nbsp;Carsten Hjorthøj,&nbsp;Louise Birkedal Glenthøj","doi":"10.1111/acps.13777","DOIUrl":"10.1111/acps.13777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The increasing number of studies of immersive virtual reality (VR) interventions for mental disorders call for an examination of the current level of evidence on their effectiveness. The findings may guide scalability and contribute to the advancement and optimization of immersive VR-based interventions for mental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search across four databases screened 2443 studies. Outcomes were disorder-specific symptoms, cognition, function, and quality of life. The study is registered on PROSPERO (CRD42023465845) and follows the reporting standards outlined in the PRISMA guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-five studies involving a total of 3031 participants covering 10 mental disorders were included in the analysis. VR interventions demonstrated statistically significant effects of post-treatment compared to active control conditions for alcohol use disorder (reduced state anxiety, <i>g</i> = 0.89, 95% CI[0.24, 1.55]) and schizophrenia spectrum disorders (reduced psychotic symptoms, <i>g</i> = 0.37, 95% CI[0.04, 0.70]). Compared to passive control conditions, statistically significant effects of VR interventions were observed for panic and agoraphobia (<i>g</i> = 1.28, 95% CI [0.47, 2.10]), social anxiety disorder (<i>g</i> = 0.83, 95% CI [0.49, 1.17]), specific phobias (<i>g</i> = 1.07, 95% CI[0.22, 1.92]), depression symptoms in PTSD (<i>g</i> = 0.67, 95% CI [0.22;1.13]). In contrast, no significant differences were found between VR interventions and active control conditions for functioning and quality of life in schizophrenia spectrum disorder and panic or agoraphobia. No meta-analyses were conducted on cognition due to insufficient data. Over 50% of the included studies were assessed as having a high risk of bias. According to the GRADE assessment, evidence for VR-based interventions across various mental disorders was generally of low to very low certainty, with a few exceptions rated as moderate certainty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VR interventions may potentially have benefits, particularly when compared to passive control conditions, however, the evidence remains uncertain necessitating more large-scale, methodologically robust studies. Current findings can thus only be considered indicative. Recommendations on future directions of the VR field are discussed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"210-230"},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875399","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":"Author's Response to Letter to the Editor Concerning \"Glucagon-Like Peptide Agonists for Weight Management in Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis\" by Anders Fink-Jensen|Christoph U. Correll.","authors":"Bea Campforts, Maarten Bak, Patrick Domen, Therese van Amelsvoort, Marjan Drukker","doi":"10.1111/acps.13784","DOIUrl":"https://doi.org/10.1111/acps.13784","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875628","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":"Cost-Effectiveness of rTMS as a Next Step in Antidepressant Non-Responders: A Randomized Comparison With Current Antidepressant Treatment Approaches.","authors":"Iris Dalhuisen, Kim Bui, Anne Kleijburg, Iris van Oostrom, Jan Spijker, Eric van Exel, Hans van Mierlo, Dieuwertje de Waardt, Martijn Arns, Indira Tendolkar, Philip van Eijndhoven, Ben Wijnen","doi":"10.1111/acps.13782","DOIUrl":"https://doi.org/10.1111/acps.13782","url":null,"abstract":"<p><strong>Background: </strong>Although repetitive transcranial magnetic stimulation (rTMS) is an effective and commonly used treatment option for treatment-resistant depression, its cost-effectiveness remains much less studied. In particular, the comparative cost-effectiveness of rTMS and other treatment options, such as antidepressant medication, has not been investigated.</p><p><strong>Methods: </strong>An economic evaluation with 12 months follow-up was conducted in the Dutch care setting as part of a pragmatic multicenter randomized controlled trial, in which patients with treatment-resistant depression were randomized to treatment with rTMS or treatment with the next pharmacological step according to the treatment algorithm. Missing data were handled with single imputations using predictive mean matching (PMM) nested in bootstraps. Incremental cost-effectiveness and cost-utility ratios (ICERs/ICURs) were calculated, as well as cost-effectiveness planes and cost-effectiveness acceptability curves (CEACs).</p><p><strong>Results: </strong>Higher QALYs, response, and remission rates were found for lower costs when comparing the rTMS group to the medication group. After 12 months, QALYs were 0.618 in the rTMS group and 0.545 in the medication group. The response was 27.1% and 24.4% and remission was 25.0% and 17.1%, respectively. Incremental costs for rTMS were -€2.280, resulting in a dominant ICUR for QALYs and ICER for response and remission.</p><p><strong>Conclusion: </strong>rTMS appears to be a cost-effective treatment option for treatment-resistant depression when compared to the next pharmacological treatment step. The results support the implementation of rTMS as a step in the treatment algorithm for depression.</p><p><strong>Trial registration: </strong>The trial is registered within the Netherlands Trial Register (code: NL7628, date: March 29, 2019).</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875630","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":"Antipsychotics or Mood Stabilizers in Bipolar Disorder: Towards Evidence-Based Personalised Medicine","authors":"Marie Tournier","doi":"10.1111/acps.13780","DOIUrl":"10.1111/acps.13780","url":null,"abstract":"&lt;p&gt;Lintunen et al. [&lt;span&gt;1&lt;/span&gt;] publish in previous issue an article entitled &lt;i&gt;Dosing Levels of Antipsychotics and Mood Stabilizers in Bipolar Disorder: A Nationwide Cohort Study on Relapse Risk and Treatment Safety&lt;/i&gt;. This nationwide study estimates doses of antipsychotics and mood stabilizers associated with the most favourable benefit–risk ratio. Benefit corresponded to a decreased risk of psychiatric hospitalization (prevention of relapse) and risk to an increase in non-psychiatric hospitalization (adverse events). The authors followed individuals with bipolar disorder from diagnosis over an average of 8 years. They compared outcomes over periods with and without antipsychotics or with and without mood stabilizers within individuals, by distinguishing low (&lt; 0.9 DDD), standard (0.9– &lt; 1.1 DDD) and high doses (≥ 1.1 DDD). Only monotherapies and individuals with both treatment changes and outcomes contributed to the findings. This design might have selected individuals with most severe disorders or those who did not receive an effective medication on a first line of treatment, but allowed comparing various treatment patterns.&lt;/p&gt;&lt;p&gt;Considering sensitivity analyses that omitted the 30-day period following treatment changes and selected stable treatments, among antipsychotics, only low and standard doses of aripiprazole (&lt; 16.5 mg/day) were able to prevent relapse. High doses and quetiapine at any dose were associated with an increase in psychiatric hospitalization. While the association between high doses and relapse might be due to confounding by indication (relapse justifying the increase in dose), the absence of preventive effectiveness of antipsychotic monotherapies is alarming and contrasts with their extensive use [&lt;span&gt;2&lt;/span&gt;]. Previous publications highlighted the lack of evidence of efficacy of antipsychotics in the maintenance treatment of bipolar disorders, RCTs showing selection bias (enrichment design limiting generalizability, inclusion of bipolar disorder type I only), attrition bias (considerable dropout levels), insufficient duration to demonstrate preventive efficacy, possible adverse effects of abrupt medication discontinuation in the placebo-group with beneficial effects of treatment and possible reporting bias [&lt;span&gt;3, 4&lt;/span&gt;]. Parallelly, Lintunen et al. [&lt;span&gt;1&lt;/span&gt;] found an increased risk of non-psychiatric hospitalization except for standard doses of olanzapine, risperidone and aripiprazole and low dose of aripiprazole, questioning the benefit–risk ratio of these monotherapies. These safety concerns are added to previous ones concerning mortality or cognitive functioning [&lt;span&gt;2, 5, 6&lt;/span&gt;]. A real utility of antipsychotics was shown at short- and mid-term in acute bipolar episodes and in association with mood stabilizers with synergistic effects [&lt;span&gt;7, 8&lt;/span&gt;]. Their place in the therapeutic strategy might be re-thought and, for example, re-focused on acute episodes and patients with d","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"107-108"},"PeriodicalIF":5.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833221","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}