Acta Psychiatrica Scandinavica最新文献

{"title":"The Bergen 4-Day OCD Treatment: A Comprehensive Scoping Review of Evidence and Implementation","authors":"Mohammed Qutishat,&nbsp;Mohammed Albalushi,&nbsp;Loai Abu Sharour,&nbsp;Mohammed Al Alawi,&nbsp;Salim Al-Huseini,&nbsp;Hamed Al- Sinawi","doi":"10.1111/acps.70129","DOIUrl":"10.1111/acps.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Obsessive-compulsive disorder (OCD) affects 1%–3% of the population, significantly impairing daily functioning and quality of life. Traditional treatments, including cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), often face implementation challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This scoping review explores the efficacy and effectiveness of the Bergen 4-Day OCD Treatment (B4DT) across various populations and clinical settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A systematic search was conducted for studies published between 2005 and 2025, focusing on the B4DT's outcomes, patient satisfaction, and treatment acceptability. The PCC framework guided the development of the inclusion and exclusion criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve studies met the inclusion criteria, demonstrating a reduction in OCD symptoms, high response and remission rates, and strong patient satisfaction. Long-term follow-up indicated durable treatment effects, with minimal relapse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Bergen 4-Day Treatment is a viable frontline option for OCD management, warranting further research to optimize its implementation across diverse healthcare systems. Future studies should focus on enhancing patient adherence and expanding the treatment's applicability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 4","pages":"257-267"},"PeriodicalIF":4.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576224","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":"Considering Access and Methodological Rigor in Framing Results of the Bergen 4 Day Treatment Program for Obsessive-Compulsive Disorder","authors":"Eric A. Storch,&nbsp;Benjamin J. Chang","doi":"10.1111/acps.70136","DOIUrl":"10.1111/acps.70136","url":null,"abstract":"&lt;p&gt;Cognitive-behavioral therapy with exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) has consistently demonstrated superiority relative to pharmacotherapy alone, active control conditions, and pill placebo. Despite this, practicing clinicians, their patients, and clinical settings/organizations need varied adaptive strategies to effectively provide personalized treatment. Over the years, clinician scholars have examined several different adaptations to ERP, with intensive interventions—broadly defined as providing an increased dose of ERP in a focused period—being introduced as a treatment option in the 1980s through the seminal work by Foa and colleagues.&lt;/p&gt;&lt;p&gt;A recently introduced approach to intensive treatment, the Bergen 4 day OCD treatment program (B4DT), has demonstrated impressive results across a number of primarily large open trials or waitlist controlled studies conducted by the developers. Qutishat et al. [&lt;span&gt;1&lt;/span&gt;] provide a thoughtful scoping review of this literature, framing the clinical significance of the B4DT within the overall OCD literature.&lt;/p&gt;&lt;p&gt;In addition to the scholarly discussion provided by Qutishat et al. [&lt;span&gt;1&lt;/span&gt;], there are several considerations to highlight when considering the extant data on the B4DT. First, despite consistently high treatment effects demonstrated across numerous studies (often with large sample sizes), the methodological rigor of these studies tends to be rather modest with comparison to either a waitlist control or no control condition. While the accumulating literature is indeed impressive, the absence of fully powered studies with a credible control condition limits inferences that can be made. For example, is the B4DT as good or superior to the same type and amount of treatment spread out over some period? Indeed, some of the author's work demonstrated that while intensive treatment may confer somewhat better outcomes immediately, standard care weekly treatment ‘caught up’ over time and seemed to demonstrate sustained follow up gains potentially because of the ability to repeatedly practice treatment effects in the real world [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, while it is exciting to see strong response and remission rates, we also need to think critically about accessibility. It has been noted that the B4DT may improve overall accessibility (e.g., [&lt;span&gt;3&lt;/span&gt;]). Yet, this requires further reflection. For example, the B4DT is notable for a one-on-one treatment format in an overall group setting. Yet, by this writer's estimate, this very well may limit access to care. For example, if an average clinician worked for 46 weeks a year and they treated someone in the B4DT weekly during those 46 weeks, they would be able to treat 46 people per year with that additional day of the week for follow up patients. In contrast, a clinician with a caseload of 25 patients per week seeing patients for 4 months each on average would be able to see about 75 patien","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 4","pages":"255-256"},"PeriodicalIF":4.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757035","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":"Does the Loss of Autobiographical Memories Contribute to the Therapeutic Effect of Electroconvulsive Therapy?","authors":"Mike van Kessel,&nbsp;Joris van der Vlugt-Molenaar,&nbsp;Isidoor O. Bergfeld,&nbsp;Eric van Exel,&nbsp;Jaap Murre,&nbsp;Jasmien Obbels,&nbsp;Pascal Sienaert,&nbsp;Kristof Vansteelandt,&nbsp;Esmée Verwijk","doi":"10.1111/acps.70116","DOIUrl":"10.1111/acps.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>For decades, a persistent claim has been that autobiographical memory loss after electroconvulsive therapy (ECT) for depression might actually contribute to ECT efficacy by reducing or even eliminating autobiographical memories. To test this claim, the primary aim of this study is to examine the association between autobiographical memory loss and remission of depression. The hypothesis is that remitted patients have more autobiographical memory loss after ECT compared to non-remitted patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 71 patients with major depressive disorder undergoing ECT, autobiographical memory consistency (Kopelman Autobiographical Memory Interview) and depression severity (Montgomery–Åsberg Depression Rating Scale) were assessed before and within 1 week after treatment. Logistic regression analyses were conducted to examine the association between both autobiographical memory loss (i.e., memory consistency) and remission (MADRS &lt; 10), including age, episode duration, baseline MADRS score, and treatment condition as covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All logistic regression models were significant. The overall autobiographical memory consistency-score (OR = 1.072, 95% CI [1.018–1.130], <i>p</i> = 0.009) and the consistency-score for recent memories (OR = 1.043, 95% CI [1.006–1.082], <i>p</i> = 0.021) were significantly associated with the odds of remission but in the opposite direction of the hypothesis. A higher age and shorter episode duration further increased the likelihood of remission. Additionally, post hoc analyses showed that the trajectories of autobiographical memory performance over time differed between remitters and non-remitters, indicating a slight decrease in autobiographical memories for more recent events in non-remitters and no change in remitters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study shows that, contrary to the hypothesis, remitted patients have less autobiographical memory loss, particularly for recent memories than non-remitters. This refutes the premise that the loss of autobiographical memories contributes to the therapeutic effectiveness of ECT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 4","pages":"286-295"},"PeriodicalIF":4.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215445","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":"Leveraging Family Genetic Risk Scores to Understand the Etiology of Suicidal Behaviors and Their Associations With Psychiatric Disorders","authors":"Séverine Lannoy,&nbsp;Henrik Ohlsson,&nbsp;Mallory Stephenson,&nbsp;Jan Sundquist,&nbsp;Kristina Sundquist,&nbsp;Kenneth S. Kendler,&nbsp;Alexis C. Edwards","doi":"10.1111/acps.70117","DOIUrl":"10.1111/acps.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Suicidal behaviors are complex phenotypes, often studied in the context of psychiatric comorbidities. However, little is known about the specific roles of psychiatric disorders and the etiology of suicidal behaviors that occur outside the context of psychiatric comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 926,040 individuals born 1980–1990 from the Swedish national registries. We conducted separate analyses for suicide attempt (SA) and suicide death (SD) and first tested whether family genetic risk scores (FGRS) for SA and SD differed across individuals with versus without a registration for psychiatric disorders. We then performed Cox proportional hazards models to evaluate the main effects of psychiatric disorders (alcohol use disorder, major depression, anxiety disorders, drug use disorders, attention-deficit/hyperactivity disorder) in risk of SA/SD, and their interaction with genetic liability (FGRS). The interaction was introduced to evaluate potential differential effects of genetic risk in those with versus without a prior psychiatric comorbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Only ~30% of individuals registered for SA/SD had a prior psychiatric diagnosis. FGRS for SA/SD was higher in those with prior psychiatric disorders. All psychiatric comorbidities were significantly related to SA (HRs 4.61-9.03) and SD (HRs 8.06-15.90). Interaction analyses indicated that, in those with no prior psychiatric disorder, the effect of genetic liability on SA/SD was higher.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Though psychiatric disorders were associated with increased risk of SA/SD, a substantial proportion of suicidal behaviors occurred outside the context of psychiatric disorders, urging the development of screening and prevention in non-psychiatric populations. Despite their low genetic liability for SA/SD, findings suggest that the effect of genetic risk on SA/SD risk is stronger in those with no psychiatric comorbidity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 4","pages":"296-304"},"PeriodicalIF":4.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282920","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":"Electroconvulsive Therapy and Time to Psychiatric Readmission in Schizophrenia","authors":"Linnea Stenmark,&nbsp;Mussie Msghina,&nbsp;Axel Nordenskjöld","doi":"10.1111/acps.70115","DOIUrl":"10.1111/acps.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is evidence that electroconvulsive therapy (ECT) can augment the effects of antipsychotics in schizophrenia. However, there is limited evidence from Western populations on whether ECT reduces the risk of relapse compared to non-ECT treatment in schizophrenia. This study aimed to compare time to psychiatric readmission or suicide among inpatients with schizophrenia treated with or without ECT, as well as those receiving index series with or without continuation ECT (C-ECT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Register-based study utilizing data from Swedish nationwide registers. Patients with schizophrenia who received both inpatient ECT and non-ECT treatment between 2011 and 2020 were included. Each patient served as their own control, contributing one admission with and without ECT. Admissions with or without ECT, as well as index series with or without C-ECT, were compared in univariate Cox regression analyses regarding time to psychiatric readmission or suicide within 30 days, 90 days, 180 days, and 1 year from discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 351 patients were included. Of these patients, 64.1% were male and the mean (SD) age was 48.2 (14.4) years. ECT was associated with longer time to readmission or suicide compared to non-ECT treatment within 30 days (HR: 0.66; 95% CI: 0.50–0.87; <i>p</i> = 0.003), 90 days (HR: 0.70; 95% CI: 0.56–0.87; <i>p</i> = 0.001), 180 days (HR: 0.68; 95% CI: 0.56–0.82; <i>p</i> = &lt; 0.001), and 1 year from discharge (HR: 0.77; 95% CI: 0.65–0.91; <i>p</i> = 0.003). Furthermore, 15 patients received C-ECT, which was associated with longer time to readmission or suicide compared to index series without C-ECT within 90 days (HR: 0.13; 95% CI: 0.02–0.91; <i>p</i> = 0.040) and 180 days from discharge (HR: 0.26; 95% CI: 0.08–0.81; <i>p</i> = 0.021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study suggests that ECT can be associated with a longer time to relapse compared to non-ECT treatment in schizophrenia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 4","pages":"277-285"},"PeriodicalIF":4.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161141","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":"Patients Receiving 100 or More Electroconvulsive Therapy Treatments in a Nationwide Cohort.","authors":"Masahiro Hata, Yuki Miyazaki, Shun Takahashi","doi":"10.1111/acps.70137","DOIUrl":"https://doi.org/10.1111/acps.70137","url":null,"abstract":"<p><strong>Introduction: </strong>Very high cumulative exposure to electroconvulsive therapy (ECT) has primarily been described in individual case reports. We examined cumulative ECT exposure in a nationwide Japanese claims database to characterize patients receiving very high numbers of treatments.</p><p><strong>Methods: </strong>We identified 3,733 patients who received ECT and classified them according to cumulative ECT exposure. Clinical characteristics of patients receiving 100 or more treatments were examined.</p><p><strong>Results: </strong>Among 3,733 patients who received ECT, 39 (1.0%) received 100 or more treatments. These patients had treatment durations of several years and substantially greater numbers of psychiatric hospitalizations and cumulative hospitalization days. Clozapine use increased across cumulative ECT exposure categories, although it was recorded in only 13% of patients receiving 100 or more treatments.</p><p><strong>Conclusion: </strong>Patients receiving 100 or more ECT treatments represent an identifiable subgroup of ECT recipients characterized by prolonged and recurrent psychiatric care.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816856","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 Association Between Lithium Use and Physical Comorbidities Across Age Groups: A Cross-Sectional Study From the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project.","authors":"Ni Xu, Orestes V Forlenza, Peijun Chen, Soham Rej, Ariel G Gildengers, Osvaldo P Almeida, Hilary P Blumberg, Annemiek Dols, James E Emanuel, Lisa T Eyler, Esther Jiménez, Federica Klaus, Jennifer B Levin, Laura Montejo, Benoit Mulsant, Regan E Patrick, Tarek K Rajji, Shangying Tsai, Eduard Vieta, Sara Weisenbach, Sigfried Schouws, Joaquim Radua, Bartholomeus C M Haarman, Martin Alda, Tomas Hajek, Andrew Toyin Olagunju, Stephen Olamide Oluwaniyi, Beny Lafer, Kürşat Altınbaş, Antonio L Teixeira, Izabela G Barbosa, Jair C Soares, Giovana B Zunta-Soares, Vicent Balanzá-Martínez, Sonia Ll Vidal-Rubio, Christian Simhandl, Nicole Korten, Martha Sajatovic, Xin Yu","doi":"10.1111/acps.70134","DOIUrl":"https://doi.org/10.1111/acps.70134","url":null,"abstract":"<p><strong>Introductions: </strong>Lithium remains the first-line maintenance treatment for bipolar disorder (BD), yet its safety in older-age BD (OABD) is uncertain due to limited large-scale data. OABD patients often experience more severe physical comorbidities compared to younger BD patients, but systematic evidence regarding lithium's association with these conditions is lacking. This study examined the association between lithium use and physical comorbidities across age groups using the international Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) dataset.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using combined Wave 1 and 2 data from GAGE-BD project, encompassing 37 studies from 20 sites worldwide. Participants aged ≥ 18 years with BD were classified according to current lithium use. Physical comorbidities were harmonised into eight organ-system domains. Sociodemographic and clinical variables were compared between individuals receiving lithium treatment and those not prescribed lithium. Generalised linear mixed models adjusted for age, site and lithium × age interaction were applied to evaluate associations with physical comorbidities.</p><p><strong>Results: </strong>Of the 2873 total participants included in the study, 1069 were currently receiving lithium treatment and 1804 were not prescribed lithium. Participants treated with lithium showed a lower overall prevalence of physical comorbidities compared with those not receiving lithium. Regression analyses revealed significant age-by-lithium interactions for cardiovascular (χ² = 9.27, p = 0.002), respiratory (χ² = 7.56, p = 0.006), genitourinary (χ² = 8.66, p = 0.003) and endocrine (χ² = 16.96, p < 0.001) comorbidities. Model-estimated curve crossings occurred at approximately 43 years (cardiovascular), 32 years (respiratory), 51 years (genitourinary) and 59 years (endocrine), above which predicted prevalence was lower among participants treated with lithium, whereas no differences were observed for gastrointestinal, hepatic, renal or musculoskeletal systems.</p><p><strong>Conclusions: </strong>Lithium use in OABD was associated with a lower burden of specific physical comorbidities, particularly cardiovascular, respiratory and endocrine conditions. Although prescription bias cannot be excluded, the findings challenge the perception that lithium exacerbates physical health risks in older adults. Instead, they support lithium's continued use-with appropriate monitoring-as a safe and effective treatment option for OABD, and highlight the need for prospective studies to further clarify the relationship between lithium exposure and physical health outcomes.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148785794","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":"Associations Between Dissociation and Childhood Trauma in Borderline Personality Disorder and Affective Disorders: A Network Analytic Approach.","authors":"Philipp Wülfing, Carsten Spitzer, Judy Leibowitz, Stephen Pilling, Peter Fonagy, P Read Montague, Tobias Nolte","doi":"10.1111/acps.70131","DOIUrl":"https://doi.org/10.1111/acps.70131","url":null,"abstract":"<p><strong>Background: </strong>Dissociation and childhood trauma are strongly associated with borderline personality disorder (BPD), yet it remains unclear whether this reflects disorder-specific mechanisms or differences in symptom severity within a shared transdiagnostic structure.</p><p><strong>Objective: </strong>Using network analysis, we examined whether the conditional dependency architecture linking childhood trauma, dissociation, posttraumatic stress symptoms, and general psychological distress differs between individuals diagnosed with BPD and affective disorders (AD).</p><p><strong>Method: </strong>Participants were drawn from a large outpatient clinical sample and matched on age, gender, and global symptom severity (BSI-GSI). Networks were estimated using regularized partial correlation models including CTQ subscales, DES subscales, PTSD symptom clusters, and overall distress. Network Comparison Tests assessed structural invariance and global strength differences between diagnostic groups.</p><p><strong>Results: </strong>As expected, individuals with BPD reported significantly higher levels of childhood trauma and dissociation than those with AD. However, despite these marked differences in severity, the overall network structure did not significantly differ between groups, and global connectivity was comparable. Bridge centrality analyses indicated similar patterns of interconnection across trauma, dissociation, and PTSD domains in both diagnoses.</p><p><strong>Conclusions: </strong>These findings suggest that BPD is characterized by elevated severity within a largely shared trauma-dissociation architecture, rather than by a qualitatively distinct network configuration. The results support a transdiagnostic model in which childhood trauma and dissociative processes are embedded within a common psychopathological structure, with diagnostic distinctions reflecting differences in magnitude rather than rewiring of interrelations. This severity-versus-architecture distinction has implications for understanding mechanisms of vulnerability and for targeting shared pathways across diagnostic categories.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700306","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":"Age-Stratified Patterns of Suicide Methods in Bipolar Disorder: A Nationwide Cohort Study.","authors":"Meng-Chiao Chou, Po-Yu Chen, Yueh-Pin Lin, Win-Yin Chen, Sheng-Siang Su, Shang-Ying Tsai, Chiao-Chicy Chen, Chian-Jue Kuo","doi":"10.1111/acps.70132","DOIUrl":"https://doi.org/10.1111/acps.70132","url":null,"abstract":"<p><strong>Objectives: </strong>Age-stratified suicide methods in bipolar disorder remain underexplored. This study compared method selection between suicide decedents with bipolar disorder and the general population.</p><p><strong>Methods: </strong>We identified 47,488 individuals with bipolar disorder between 2003 and 2023 from Taiwan's nationwide health database and linked mortality records to ascertain suicide deaths. Using a decedent-only design, we compared the distribution of suicide methods between suicide decedents with bipolar disorder and those from the general population. Age-stratified (< 30, 30-49, 50-64, and ≥ 65 years) multivariable logistic regression analyses were performed with adjustment for sex, age at death, urbanization level, and employment status.</p><p><strong>Results: </strong>Among 1452 suicide deaths over 478,729 person-years (incidence: 303.3 per 100,000), the most common methods were hanging (28.0%), charcoal burning and other gas poisoning (20.9%), jumping from a high place (18.0%), drug overdose (16.9%), and drowning (11.4%). Suicide decedents in the bipolar cohort had higher odds of drowning (adjusted odds ratio [aOR]: 1.70, 95% confidence interval [CI]: 1.44-2.00) and jumping from a high place (aOR: 1.31, 95% CI: 1.14-1.50) but lower odds of charcoal burning and other gas poisoning (aOR: 0.69, 95% CI: 0.60-0.79) and hanging (aOR: 0.87, 95% CI: 0.77-0.98) than did general-population decedents (n = 81,159). Age-stratified analyses showed charcoal burning concentrated in younger and middle-aged decedents, drowning consistently elevated across age strata, and jumping elevated in middle-aged and older decedents.</p><p><strong>Conclusion: </strong>Individuals with bipolar disorder who die by suicide exhibit distinct, age-dependent patterns of suicide methods. Therefore, prevention strategies should be tailored to both age groups and methods.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676329","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":"Repetitive Transcranial Magnetic Stimulation (rTMS) for Adolescent Depression: A Systematic Review and Meta-Analysis of Treatment Response and Suicidal Ideation Reduction","authors":"Lidija Rakic,&nbsp;Floris Tas,&nbsp;Miao Chen,&nbsp;Indira Tendolkar,&nbsp;Philip van Eijndhoven,&nbsp;Jozarni Dlabac-de Lange,&nbsp;Mieke Klein Hofmeijer,&nbsp;Adriaan Hoogendoorn,&nbsp;Didi Rhebergen","doi":"10.1111/acps.70110","DOIUrl":"10.1111/acps.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Major depressive disorder (MDD) affects 11%–19% of adolescents globally. Early treatment is vital, but the risk of relapse is high, with 46% relapse within 5 years, which threatens a chronic course. Hence, better solutions are needed. Repetitive transcranial magnetic stimulation (rTMS) is effective in adults, but its use in adolescents is limited. While studies—including trials and meta-analyses—exist, their generalizability is unclear. This review evaluates rTMS's efficacy and safety for adolescent MDD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, a comprehensive literature review was conducted using English-language databases Embase, PubMed, PsycINFO, and the Cochrane Database of Systematic Reviews. We included studies published up to February 2025. Data were pooled to calculate standardized mean change (SMC), proportions, log odds ratios, and their respective 95% confidence intervals (CI), measuring effectiveness, response rate, and suicidality. We systematically described adverse effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 687 studies, 42 underwent full-text assessment, and 19 were included. The within-intervention group pooled SMC between pre-post scores of depression severity was −2.15 (95% CI [−2.58, −1.73]), indicating a strong effect but with high heterogeneity (<i>I</i>\u0000 ² = 87.13%). For RCT-only studies, the pooled SMC was −0.90 (95% CI [−1.90, 0.11]), showing a smaller effect. The pooled response rate was 54% (95% CI [42%; 66%]) with similarly high heterogeneity (<i>I</i>\u0000 ² = 82.25%). A large reduction in suicidal ideation was observed (pooled SMC = −2.78, 95% CI [−5.98, 0.42]), albeit this was based on a limited number of studies (<i>n</i> = 3) and the SMC was not statistically significant. Mild and transient adverse effects were reported. The majority of studies were rated as having a high risk of bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings demonstrated that rTMS is effective, safe, and well-tolerated by adolescents with MDD. However, high heterogeneity of methods, bias, and inclusion of uncontrolled trials demand more rigorous trials, whereby adaptive designs could potentially increase the empirical availability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 3","pages":"187-202"},"PeriodicalIF":4.7,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136053","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}