Acta Psychiatrica Scandinavica最新文献

{"title":"Immortal Time Bias, Confounding by Indication, and Antidepressant Pooling","authors":"Itsuki Terao","doi":"10.1111/acps.13827","DOIUrl":"10.1111/acps.13827","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"318-319"},"PeriodicalIF":5.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726065","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":"Systematic Multi-Trait Study of Genetic Correlation and Causality Relationships Between General Medical Conditions and Mental Disorders","authors":"Ron Nudel,&nbsp;Maria Da Re,&nbsp;Michael E. Benros","doi":"10.1111/acps.13825","DOIUrl":"https://doi.org/10.1111/acps.13825","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Increasing evidence has highlighted bidirectional associations between mental disorders and general medical conditions, with underlying causes ranging from lifestyle habits and side effects from medications to genetic contributions. Novel methods now provide a way to estimate the shared genetic underpinnings and the possibility of a causal relationship between conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using summary statistics from large genome-wide association studies of 16 categories of general medical conditions and 12 categories of mental disorders, we estimated pairwise genetic correlations between general medical conditions and mental disorders using LD score regression. For conditions with significant, positive genetic correlations, we used the latent causal variable (LCV) model to assess the evidence for a causal relationship between them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-five out of 192 pairs of conditions were significantly genetically correlated (<i>q</i> ≤ 0.05). Strong and significant correlations were found between conditions such as infections and a psychiatric cross-disorder phenotype (<i>r</i>_g = 0.50, <i>p</i> = 1.33 × 10⁻⁶) and irritable bowel syndrome and depression (<i>r</i>_g = 0.58, <i>p</i> = 1.50 × 10⁻¹⁶). In the causality analyses, statistically significant evidence for causality was obtained for seven pairs of conditions, including infections being causal to the psychiatric cross-disorder phenotype, metabolic disorders being causal to attention deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) being causal to bone and cartilage disorders, arthropathies and epilepsy, obsessive–compulsive disorder (OCD) being causal to irritable bowel syndrome (IBS), and ADHD being causal to arthropathies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multiple pairs of general medical conditions and mental disorders were significantly genetically correlated, and for some pairs, there was genetic evidence for a causal relationship. Our findings can inform further molecular studies and clinical practice, raising awareness of the possible co-occurrence of these conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"236-249"},"PeriodicalIF":5.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768048","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":"Motor Dexterity Deficits in Individuals With First-Episode Psychosis and Their First-Degree Relatives","authors":"Manuel Sevilla-Ramos,&nbsp;Valentina Ladera,&nbsp;Ricardo García-García,&nbsp;Rosa Ayesa-Arriola","doi":"10.1111/acps.13821","DOIUrl":"https://doi.org/10.1111/acps.13821","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Motor dexterity deficits have been observed both before and during first-episode psychosis (FEP), suggesting this may be a potential endophenotype for schizophrenia spectrum disorders. We aimed to compare motor dexterity performance in FEP patients, their first-degree relatives, and controls. We also investigated whether sociodemographic, premorbid, clinical, and cognitive factors contribute to motor dexterity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample included 133 FEP patients, 244 of their first-degree relatives (146 parents, 98 siblings), and 202 controls. Motor dexterity was assessed using the Grooved Pegboard Test as part of a neuropsychological battery assessing verbal and visual memory, processing speed, working memory, executive function, attention, and theory of mind. Raw scores were converted to <i>Z</i>-scores. Intelligence quotient and global cognitive function were estimated. Group comparisons were made using analysis of covariance with post hoc tests. Age, sex, and years of education were included as covariates. Multiple linear regression models examined associations between motor dexterity and other variables within each group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a significant group difference on the Grooved Pegboard Test (<i>F</i> = 16.25, <i>p</i> &lt; 0.001). FEP patients (M = −1.26) and their parents (M = −1.14) scored lowest, while siblings (M = −0.30) and controls (M = −0.22) scored highest. The FEP group also scored lowest on other cognitive tests (<i>p</i> &lt; 0.001). A positive association between global cognitive function and Grooved Pegboard performance was found in all groups (<i>β</i> = 0.47–0.84, <i>p</i> &lt; 0.001). Group-specific associations with age, sex, education, intelligence, executive function, attention, and processing speed were also observed (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Motor dexterity deficits were observed in FEP patients and their parents, which may reflect underlying genetic liability or result from the disorder itself. The preserved motor dexterity in unaffected siblings challenges a strict endophenotypic interpretation and suggests a potential protective effect. Motor dexterity deficits were associated with broader cognitive impairment, intelligence quotient, attention, processing speed, and executive function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"216-227"},"PeriodicalIF":5.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13821","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768049","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":"Expanding the Utilization of Pharmacological Treatments for Alcohol Use Disorder: Reflections on a Swedish Nationwide Study","authors":"Szu-Chieh Chiu,&nbsp;Lien-Chung Wei","doi":"10.1111/acps.13823","DOIUrl":"https://doi.org/10.1111/acps.13823","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"250-251"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767935","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":"Antidepressant Remission and Manic Switch in Bipolar Depression: A Propensity Score Analysis","authors":"Paul A. Vöhringer,&nbsp;Sergio A. Barroilhet,&nbsp;Bárbara A. Palma,&nbsp;Roy H. Perlis","doi":"10.1111/acps.13822","DOIUrl":"https://doi.org/10.1111/acps.13822","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Antidepressants remain among the most widely used class of drugs in treating bipolar disorder, despite their minimal efficacy in randomized clinical trials and concern for association with manic episodes. This study sought to evaluate the outcomes of antidepressant treatment in bipolar depression in a large naturalistic cohort study, STEP-BD, in terms of symptomatic remission as well as emergence of mania, using a propensity score (PS) analysis to reduce indication bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Propensity scores were developed to estimate the probability of antidepressant exposure using multivariate logistic regression models; these scores were then used to match antidepressant-exposed and non-exposed individuals. Cox regression models were used to estimate hazard ratios for manic switch and time to remission, adjusted for these scores in the matched population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total sample included 2166 individuals, of whom 1085 were exposed to AD and 1081 were unexposed to AD; mean follow-up duration was 182.5 (SD: 44.6) days (median = 126, ICR: 87.4). Cox regression models for manic switch with antidepressant exposure versus non-exposure yielded an unadjusted hazard ratio (HR) of 0.93 (95% CI 0.67–1.14) and PS-adjusted HR of 0.77 (95% CI 0.51–1.08), neither of which was statistically significantly different from 1. Probability of symptomatic remission was also not significantly associated with antidepressant exposure, with unadjusted and PS-adjusted HR of 1.15 (95% CI 0.97–1.37) and 1.02 (95% CI 0.87–1.23), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With PS adjustment, there was no evidence of increased likelihood of manic switch or achievement of symptomatic remission associated with antidepressant use in bipolar depression. Our results underscore the ongoing need to identify alternative strategies for effective treatment of bipolar depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"228-235"},"PeriodicalIF":5.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768092","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":"Treatment of Early-Onset Specified and Unspecified Bipolar Disorders: A Systematic Review and Strategies for Identifying and Managing a Thermally Dysregulated Subtype in Children","authors":"Demitri F. Papolos,&nbsp;Martin H. Teicher,&nbsp;Robert M. Post","doi":"10.1111/acps.13817","DOIUrl":"https://doi.org/10.1111/acps.13817","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD), characterized by extreme mood shifts between mania and depression, can manifest in childhood, and pose treatment challenges. Treatment for full-criteria BD I or II in children has been partially described in the literature, but major uncertainties exist regarding non-classic presentations, which were originally designated as bipolar “not otherwise specified” (BP-NOS) in DSM-IV and in DSM-5 and ICD-11 as either other specified or unspecified BD (S-USBD). This review aims to provide literature-based recommendations on the treatment of S-USBD, with a focus on a fear of harm (FOH) subtype, now termed temperature and sleep dysregulation disorder (TSDD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A broad systematic literature review with AI assistance was conducted to identify all articles in PubMed providing data on the treatment of children with either atypical BD, BD-NOS, USBD, specified BD, rapid cycling BD, or a phenotype of BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Given the paucity of pharmacological treatment literature on any of the earliest forms of BD prior to their achieving a BP I or BP II diagnosis, it was felt that there was a critical need to review the existent literature on the earliest presentations and prodromes, which now fall under the rubric of specified (BD S-USBD). Here, the focus is on the prevalent BP-NOS subtype, which meets all the classical presentations of BP except for the brief durations of mania, and a more newly recognized form of S-USBD called TSDD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven family-focused psychotherapy studies were identified, including nine randomized controlled trials (RCTs) with uniformly positive results versus the comparative group, which was treatment as usual (TAU) for unclear subtypes and subtypes of S-USBD. Only three psychopharmacological RCTS were reported, and only one on aripiprazole in unspecified subtypes of S-USBD in high-risk children showed a significant difference from placebo. None of the controlled trials and only two case series provided separate outcome data on the S-USBD subtypes, except for one that focused exclusively on the TSDD subtype. These two case series reports preliminarily defined the TSDD subtype and provided novel pharmacological treatment data, including lithium, clonidine, and ketamine, which led to good outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Good support was pr","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"156-179"},"PeriodicalIF":5.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13817","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767502","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":"The Catatonia Quick Screen (CQS): A Rapid Screening Tool for Catatonia in Adult and Pediatric Populations","authors":"James Luccarelli,&nbsp;Mark Kalinich,&nbsp;Jo Ellen Wilson,&nbsp;Jonathan P. Rogers,&nbsp;Jinyuan Liu,&nbsp;D. Catherine Fuchs,&nbsp;Andrew Francis,&nbsp;Stephan Heckers,&nbsp;Gregory Fricchione,&nbsp;Joshua Ryan Smith","doi":"10.1111/acps.13820","DOIUrl":"https://doi.org/10.1111/acps.13820","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Catatonia is a potentially lethal and frequently underdiagnosed neuropsychiatric disorder marked by significant disturbances in motor, cognitive, and affective functioning. To enhance clinical detection of catatonia, this study aimed to develop and independently validate a rapid, sensitive Catatonia Quick Screen (CQS) using a reduced set of catatonic signs to facilitate screening in both adult and pediatric patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Training data were derived from two retrospective cohorts totaling 446 patients (254 adults, 192 children) who screened positive for catatonia using the Bush Francis Catatonia Screening Instrument (BFCSI). The sensitivity of every potential combination of BFCSI signs was calculated from these data, with sensitivity defined as the proportion of patients identified by each combination of signs relative to the full BFCSI. The CQS was developed by selecting the combination of signs from the BFCSI that offered high sensitivity, ease of assessment by non-expert providers, and relevance to diverse catatonia presentations. The CQS was then validated in an independent 1456 patient cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using only four of the full BFCSI's 14 signs—excitement, mutism, staring, and posturing—yielded a sensitivity of 97% (95% CI: 95%–98%) relative to the BFCSI across both pediatric and adult patients within the training data. The CQS showed only a modest decrease in sensitivity (91%; 95% CI: 90%–93%) relative to the BFCSI when tested on the independent 1456 patient validation cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CQS provides an independently validated, high sensitivity, rapid, and easy to use screening alternative to the BFCSI, potentially improving early detection of catatonia in clinical settings. A positive CQS should lead to a more detailed and definitive assessment for catatonia. Future prospective studies are necessary to determine the specificity of the CQS in diverse clinical populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"341-349"},"PeriodicalIF":5.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145196580","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":"Impact of Obstetric Complications in Subjects at Clinical High Risk for Psychosis: A Systematic Review and Meta-Analysis","authors":"Inmaculada Baeza,&nbsp;Jordina Tor,&nbsp;Elena de la Serna,&nbsp;Gisela Sugranyes,&nbsp;Fàtima Crispi,&nbsp;Montserrat Izquierdo-Renau,&nbsp;Marta del Olmo,&nbsp;Montserrat Dolz,&nbsp;Clemente García-Rizo","doi":"10.1111/acps.13816","DOIUrl":"https://doi.org/10.1111/acps.13816","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Exposure to obstetric complications (OCs) increases the risk of developing psychosis and schizophrenia in offspring. However, studies with subjects at clinical high risk for psychosis (CHR) have reported inconsistent results. We conducted a systematic review and meta-analysis to evaluate the prevalence of OCs among CHR subjects and controls and examine their impact on the transition to psychosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Four databases (Web of Science, PubMed, Latindex, and Dialnet) were systematically searched for articles published between 1995 and June 6, 2024. The risk of bias was assessed using the Newcastle–Ottawa scale. Articles providing data on OCs in CHR subjects were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 6037 records were retrieved through systematic and citation searches. Nine articles met the inclusion criteria for our systematic review and provided data for meta-analysis. A total of 555 CHR participants were included. Meta-analysis showed a significantly higher prevalence of OCs in CHR subjects versus controls: RR = 1.45 (95% CI: 1.16, 1.81), (<i>Z</i> = 3.27, <i>p</i> = 0.0011). Data from three longitudinal studies assessed transition to psychosis and our meta-analysis found a trend toward an increased risk of transition in CHR subjects with a history of OCs compared to others: RR = 2.05 (95% CI: 0.98, 4.26), <i>Z</i> = 1.91, <i>p</i> = 0.056.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CHR for psychosis was associated with OCs, though their role in the transition to psychosis requires further study. OCs should be recorded and analyzed in CHR individuals, considering their potential clinical implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 2","pages":"81-93"},"PeriodicalIF":5.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13816","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524731","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":"The Safety of 12-Weekly Monitoring of Neutrophil Count in Long-Term Clozapine Patients","authors":"David Taylor,&nbsp;Siobhan Gee,&nbsp;Marinka Helthuis,&nbsp;Ebenezer Oloyede","doi":"10.1111/acps.13818","DOIUrl":"https://doi.org/10.1111/acps.13818","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Clozapine is the only truly effective treatment for refractory schizophrenia, but its use is constrained by the requirements for frequent monitoring of neutrophil counts. In the UK during the COVID-19 pandemic, the frequency of clozapine blood monitoring was reduced in some units from 4-weekly to 12-weekly. We aimed to investigate the outcomes of reduced monitoring in long-term clozapine patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an anonymous, retrospective, observational cohort study. No restrictions were applied regarding care setting (i.e., outpatients or inpatients). All patients who registered for reduced frequency haematological monitoring from 1 March 2020 to 1 November 2022 were included and followed up till 1 August 2024. The primary outcome was death resulting from clozapine-induced agranulocytosis (CIA). Secondary outcomes were the proportion of patients with mild to moderate neutropenia during the follow-up period and the proportion of patients who reverted to standard monitoring during the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Amongst 1025 patients, there were no cases of agranulocytosis over 3365.9 patient-years of 12-weekly blood monitoring (incident rate 0.0 per 100 person-years). There were 43 episodes of mild neutropenia (so-called amber results—1.5–2.0 × 10⁹/L) or neutropenia (red results &lt; 1.5 × 10⁹/L), an overall incident rate of 1.28 per 100 person-years. During follow-up, 41 patients (4%) reverted permanently to standard 4-weekly monitoring, and 157 patients (15%) temporarily interrupted reduced frequency monitoring but restarted 12-weekly monitoring before the end of the follow-up period. In total, 42 patients (4%) died during the observation period—no death was related to agranulocytosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Reducing the frequency of clozapine haematological monitoring to 12-weekly was safe in a group of long-term patients. No cases of agranulocytosis occurred and no deaths due to agranulocytosis were recorded. Most patients remained on extended-interval monitoring.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"187-192"},"PeriodicalIF":5.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767603","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":"Beyond Highs and Lows: Unraveling Cannabis Withdrawal-Induced Mania—A Two-Year Observational Study of Hospital Admissions From 2015 to 2019","authors":"Iñaki Ochandiano,&nbsp;Sergi Salmerón,&nbsp;Helena Andreu,&nbsp;Luis Olivier,&nbsp;Oscar de Juan,&nbsp;Tabatha Fernández-Plaza,&nbsp;Lluc Colomer,&nbsp;Roger Borràs,&nbsp;Marc Valentí,&nbsp;Michael Berk,&nbsp;Ana Cristina Andreazza,&nbsp;Eduard Vieta,&nbsp;Anna Giménez-Palomo,&nbsp;Isabella Pacchiarotti","doi":"10.1111/acps.13819","DOIUrl":"https://doi.org/10.1111/acps.13819","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) is a chronic and recurrent psychiatric illness characterized by alternating episodes of mania and/or hypomania and depression. The endocannabinoid system (ECS) is a vast network of chemical signals and cellular receptors that are densely packed throughout the brain. It is involved in the most critical central nervous system functions, such as learning and memory, and also mood regulation. Despite this, there is only anecdotal evidence on the potential role of the ECS in the pathophysiology of BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to retrospectively assess clinical and sociodemographic variables of patients who presented a manic episode that was chronologically associated with the suspension of cannabis use, compared to patients with a manic episode with no relation to cannabis use or suspension. The objective of the study is to investigate the presence of a specific group of patients with BDs, with potential clinical and therapeutic implications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated all admitted patients to the acute psychiatry unit at Hospital Clinic of Barcelona from 2015 to 2019 who were hospitalized for a manic episode. Cannabis withdrawal-induced mania (CWIM) was considered if cessation of regular cannabis use up to 21 days before the initial manic symptoms was mentioned in clinical and toxicological history and symptoms were prolonged for longer than 15 days after cessation. We used descriptive statistics to extract most of the information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2015 and 2019, 282 patients were admitted to the acute psychiatry unit with a diagnosis of a manic episode. Twenty of them (7.09%) met criteria for CWIM, and they were compared retrospectively with the rest of the patients with non-cannabis related manic (<i>n</i> = 262). Patients with CWIM group were more frequently men (<i>p</i> = 0.015) and younger (<i>p</i> &lt; 0.001), were not married or in a relationship (<i>p</i> = 0.018) and less frequently had somatic illnesses (<i>p</i> = 0.041) compared to patients with non-cannabis-related manic. Moreover, patients with CWIM had their first manic episode and had their first psychiatry admission at a significantly younger age compared with the other group (<i>p</i> = 0.008 and <i>p</i> = 0.004, respectively). Previous treatment with any antipsychotic medication was significantly less frequent in the CWIM group (<i>p</i> = 0.022). According to follow-up, there were no significant differences in relapse after 3 years (<i>p</i> = 0.936) among the two groups.</p>\u0000","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"193-202"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767429","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}