Acta Psychiatrica Scandinavica最新文献

{"title":"Theory of Mind Assessment in Adults With ADHD: Four Methodological Concerns","authors":"Berkan Şahin","doi":"10.1111/acps.70104","DOIUrl":"10.1111/acps.70104","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"183-184"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757623","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":"Educational Differences in Treatment of Individuals Diagnosed With Major Depression: A Register-Based Cohort Study","authors":"Thomas Wolff Rosenqvist,&nbsp;Terese Sara Høj Jørgensen,&nbsp;Anders Jørgensen,&nbsp;Martin Balslev Jørgensen,&nbsp;Frederikke Hørdam Gronemann,&nbsp;Merete Osler","doi":"10.1111/acps.70096","DOIUrl":"10.1111/acps.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In individuals with depression, lower socioeconomic position is associated with poorer prognostic outcomes, which may be attributed to inequitable care. We investigated educational differences in treatment of individuals diagnosed with depression at a psychiatric hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This nationwide register-based cohort study included 156,922 Danish citizens with a first-time psychiatric hospital diagnosis of depression (ICD-10: F32–F33) between 2000 and 2022. Highest attained educational level was categorized as short, medium, or long. Treatment data included antidepressant prescriptions, electroconvulsive therapy (ECT), and contacts with private practicing psychiatrists or psychologists. Logistic regression and Cox proportional hazard regression models with adjustments for covariates were used to estimate associations between educational level and treatment before and after diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Within 2 years before diagnosis, 72.0% of individuals had redeemed at least one antidepressant prescription, and 83.8% had initiated or continued pharmacological treatment within 2 years after diagnosis. Education was not associated with redeemed prescriptions of antidepressants regardless of type before diagnosis, whereas long education was associated with higher rates of treatment with any type of antidepressants after diagnosis. For specific antidepressants, individuals with long education were less likely to redeem prescriptions for noradrenergic and specific serotonergic antidepressants (NaSSAs) and more likely to redeem monoamine oxidase inhibitors (MAOIs) and newer antidepressants such as vortioxetine. Longer educated also more often consulted private practicing mental health specialists both before and after diagnosis, respectively. After diagnosis, individuals with long education were also more likely to receive ECT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Educational differences in pharmacological treatment and private specialist visits among individuals with depression are present both before and after their first hospital contact. Individuals with long education seem more likely to receive specialized and high-value care (ECT, MAOIs, newer antidepressants, and consultations with private psychiatrists and psychologists) compared to individuals with short or medium education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"131-141"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626579","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":"Lithium, Electroconvulsive Therapy and Cognition: A Systematic Review and Meta-Analysis","authors":"Liese Van den Eynde,&nbsp;Akihiro Takamiya,&nbsp;Kristof Vansteelandt,&nbsp;Jasmien Obbels,&nbsp;Nathalie Denayer,&nbsp;Shauni Verspecht,&nbsp;Kaat Hebbrecht,&nbsp;Pascal Sienaert","doi":"10.1111/acps.70095","DOIUrl":"10.1111/acps.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to synthesize the evidence on confusional states and neurocognitive changes associated with the concurrent use of lithium and electroconvulsive therapy (ECT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic search of PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, CINAHL, PsycArticles, and clinical trials registries up to September 2025. Eligible studies compared the incidence of confusional states or changes in neurocognitive test scores in patients receiving lithium and ECT (Li-ECT) and those receiving ECT without lithium. We performed separate meta-analyses and calculated odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes and standardized mean differences (SMD) for continuous outcomes. Additionally, case reports describing cognitive effects of Li-ECT were synthesized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen studies were included: 11 studies (<i>n</i> = 66,156) assessed confusional states and five (<i>n</i> = 341) evaluated neurocognitive changes. The Restricted Maximum-Likelihood meta-analysis showed no significant association between lithium use and confusional states (OR 2.09; 95% CI: 0.94–4.66; <i>p</i> = 0.07), whereas a Paule-Mandel sensitivity analysis suggested a significant association (OR 2.38; 95% CI: 1.20–4.74; <i>p</i> = 0.01). No significant differences were observed in changes in global cognitive functioning, autobiographical memory or verbal fluency test scores ([SMD = 0.25; 95% CI: –0.98–1.49; <i>p</i> = 0.69], [SMD = 0.27; 95% CI: −1.37; 1.9; <i>p</i> = 0.75], [SMD = −0.89; 95% CI: −3.18; 1.39; <i>p</i> = 0.44]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current evidence does not show a significant increase in cognitive side effects associated with lithium use during ECT. However, methodological limitations, sensitivity to meta-analytic assumptions and clinical heterogeneity preclude definitive conclusions. Large prospective studies using standardized cognitive assessments are needed to confirm the tolerability of concurrent lithium and ECT use. While our findings support the cautious continuation of lithium during ECT, individualized clinical decision-making remains crucial to maximize efficacy and minimize cognitive burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"116-130"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632014","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":"No Effect of Low-Dose Aspirin Versus Placebo as Add-On Treatment in Bipolar Disorder—Results From a Randomised Controlled Trial (the A-Bipolar RCT)","authors":"Sharaz Ahmed,&nbsp;Shubha Bagri,&nbsp;Nishtha Chawla","doi":"10.1111/acps.70099","DOIUrl":"10.1111/acps.70099","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"181-182"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669382","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":"Comparative Clinical Trajectories Across Cannabis-Related and Nonsubstance-Related Psychoses","authors":"Antti Mustonen,&nbsp;Solja Niemelä,&nbsp;Alexander Denissoff,&nbsp;Antti Tanskanen,&nbsp;Ellenor Mittendorfer-Rutz,&nbsp;Markku Lähteenvuo,&nbsp;Jari Tiihonen,&nbsp;Heidi Taipale","doi":"10.1111/acps.70097","DOIUrl":"10.1111/acps.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research indicates that first-episode psychosis (FEP) with cannabis use disorder (CUD) carries a substantial disease burden, but more granular clinical trajectories of cannabis-related psychoses remain unclear. This study examines the clinical trajectories of first clinically diagnosed FEP&amp;CUD and cannabis-induced psychosis (CIP) in comparison with FEP without substance use disorder (SUD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From the linkage of nationwide administrative and medical registers of Sweden (2006–2021), we identified 1772 individuals (84.1% men) with incident CIP, 1360 individuals (84.3% men) with FEP&amp;CUD and matched individuals with FEP but without SUD and followed them up until 2023. We compared annual prevalence of psychiatric diagnoses before and after cohort entry, medication use, days in inpatient care, and the risks of hospitalization for psychosis and death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age at first diagnosis was 26.6 years (SD 8.3) for incident CIP and 26.9 years (SD 8.4) for FEP&amp;CUD and FEP without SUD. Individuals in the FEP without SUD cohort were more likely to have a record of schizophrenia diagnosis compared to the FEP&amp;CUD and CIP cohorts during the first (14.41%, 6.25%, 2.37%) and second year (10.88%, 7.13%, 3.27%) after cohort entry. However, FEP&amp;CUD and CIP cohorts had a more pronounced burden of inpatient treatment as well as elevated risks of hospitalization for psychosis (aHR = 1.66; 95% CI 1.49–1.86 and aHR = 1.47; 1.32–1.64) and death (aHR = 2.02; 1.44–2.82 and aHR = 1.80; 1.30–2.50) compared to individuals with FEP without SUD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cannabis-related psychoses, that is, FEP&amp;CUD and CIP, were associated with poor outcomes, including high risk of hospitalization for psychosis and increased mortality, underscoring the need for targeted interventions. Moreover, the overlapping clinical trajectories suggest that cannabis-related psychoses may not represent clinically distinct entities but instead lie on a continuum.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"142-152"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637405","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":"Selective Serotonin Reuptake Inhibitor Treatment in Adolescence and Subsequent Risk of Nonaffective Psychosis: A Quasi-Experimental Study","authors":"Ioanna Kougianou,&nbsp;Animesh Talukder,&nbsp;Kirstie O′ Hare,&nbsp;Colm Healy,&nbsp;Ian Kelleher","doi":"10.1111/acps.70098","DOIUrl":"10.1111/acps.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Psychotic disorders are frequently preceded by common mental disorders (CMDs), like depression and anxiety. It remains unclear whether treating CMDs in adolescence can reduce subsequent psychosis risk. We applied quasi-experimental methods to national register data to assess whether a causal relationship exists between selective serotonin reuptake inhibitor (SSRI) treatment in adolescence and subsequent risk of psychosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the secure anonymized information linkage databank, we identified individuals living in Wales (born between 1991 and 1998) with depression who attended Child and Adolescent Mental Health Services. We employed an instrumental variable (IV) analysis, using regional variation in SSRI prescribing practice to estimate the causal effect of cumulative SSRI treatment on psychosis risk, applying two-stage least squares and IV probit models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our cohort included <i>n</i> = 6615 individuals with adolescent depression. We found no evidence that cumulative SSRI prescription influenced the psychosis risk across intervention windows (1 year: <i>β</i>: 0.114, CI: −0.049, 0.276; 2 years: <i>β</i> 0.062, CI: −0.114, 0.239; 3 years: <i>β</i> 0.021, CI: −0.125, 0.168).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This quasi-experimental study found no evidence of a causal relationship between SSRI treatment in adolescence and later psychosis risk. Our findings do not support the hypothesis that SSRI treatment of CMDs in adolescence prevents later psychosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"153-162"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626545","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":"Blood Alcohol Concentration in Finnish Suicide Deaths and Associated Risk Factors, 2016–2024","authors":"Tristan Pokornyi,&nbsp;Marjut Grainger,&nbsp;Timo Partonen","doi":"10.1111/acps.70100","DOIUrl":"10.1111/acps.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>There is limited research examining the relationship between blood alcohol concentration (BAC) and other risk factors among suicide deaths in Finland. Our study aimed to investigate the relationship of an elevated (more than zero) blood alcohol concentration with medical history, including sociodemographic characteristics and disease diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data was collected from suicide deaths in Finland from 2016 to 2024 and verified by official cause-of-death investigations, which included forensic autopsy, toxicology results, and other key information from death certificates and national healthcare registries. A condition recorded in both the death certificate (autopsy) and healthcare register was considered as confirmed diagnosis. BAC, as expressed as a percentage, was grouped into three categories: nil (BAC = 0.000), low-to-medium (BAC = 0.010%–0.099%), and high (BAC = 0.100%–0.500%). Descriptive statistics, correlation, and stepwise logistic regression to estimate odds ratios (ORs) for BAC categories were undertaken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of suicide deaths from 2016 to 2024 in Finland was <i>n</i> = 6892, with 5183 men (75.2%) and 1709 women (24.8%). BAC reports were available for <i>n</i> = 6835. Independent factors associated with a low-to-medium or high BAC at death were alcohol use (ORs: 41.80–275.27), longer than 1 day since last healthcare visit (ORs: 1.54–2.53), previous suicide attempt(s) (ORs: 1.42–1.65), and female gender (only for high BAC, OR: 1.30). There were reduced odds for schizophrenia spectrum diagnosis (OR: 0.17), bipolar disorder (OR: 0.29), age groups 10–19 (ORs: 0.30–0.65), 80 and over (ORs: 0.15–0.39), and 70–79 years (only for high BAC, OR: 0.43).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings show that individuals with documented habitual alcohol use, female gender, previous suicide attempts, and less frequent healthcare visits had higher odds of intoxication at suicide. Meanwhile, being aged under 20, over 70, or diagnosed with schizophrenia or bipolar disorders reduced the odds. The results highlight the need for proactive healthcare engagement and integrated alcohol-use interventions in suicide prevention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"163-180"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715329","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 Effect of Benzodiazepines on Catatonia: A Systematic Review and Meta-Analysis","authors":"L. Bot,&nbsp;B. Schotsman,&nbsp;E. Oostra,&nbsp;A. W. Hoogendoorn,&nbsp;B. W. C. Storosum,&nbsp;C. H. M. Planting,&nbsp;H. M. Heller,&nbsp;J. J. B. van der Vlugt,&nbsp;J. G. van Mill,&nbsp;L. J. C. A. Smarius,&nbsp;M. S. Oudijn,&nbsp;M. S. van Noorden,&nbsp;S. M. M. Lange,&nbsp;Y. D. van der Werf,&nbsp;E. van Exel","doi":"10.1111/acps.70102","DOIUrl":"10.1111/acps.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Catatonia is a complex psychomotor syndrome associated with various psychiatric and somatic underlying disorders. Current treatment protocols include benzodiazepines and electroconvulsive therapy (ECT). Despite their widespread use, systematic evidence regarding efficacy and optimal benzodiazepine dosage remains limited. This systematic review and meta-analysis aims to evaluate the effectiveness of benzodiazepines in treating catatonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search of PubMed, Embase, APA PsychInfo, and Cochrane central identified studies reporting benzodiazepine treatment outcomes in catatonia. Screening and data extraction were done by two independent researchers. A targeted meta-analysis was performed on cases and studies that provided clear documentation of the Bush Francis Catatonia Rating Scale (BFCRS) scores before and after treatment, along with well-defined dosage regimens. Finally, the relationship between dosage and BFCRS improvement was explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1336 screened articles, 53 met inclusion criteria. Most were case series using lorazepam (a benzodiazepine) to treat catatonia, with dosages ranging from 2 to 60 mg/day with a median dose of 8 mg/day. The overall remission rate was 55%; overall response was 77%. Treatment duration varied, but predominantly did not exceed 1 week. Our targeted analysis showed an overall effect of −11.88 points on the BFCRS when a benzodiazepine was used in the treatment of catatonia with a Cohen's <i>d</i> = −3.15. In a meta regression, no significant dose–response relationship was found.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Benzodiazepines are highly effective for treating catatonia, but optimal dosing remains unclear. The absence of a clear dose-effect relationship highlights the need for individualized treatment strategies and well-designed controlled studies to establish stronger evidence-based treatment guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 2","pages":"99-115"},"PeriodicalIF":4.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147727794","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":"Psychotic Symptoms in Unipolar and Bipolar Depression and Their Impact on Disease Prognosis: A Systematic Review","authors":"Helena Andreu,&nbsp;Vincenzo Oliva,&nbsp;Iñaki Ochandiano,&nbsp;Guadalupe Cabeza,&nbsp;Anna Giménez-Palomo,&nbsp;Luis Olivier,&nbsp;Òscar de Juan,&nbsp;Lidia Ilzarbe,&nbsp;Eduard Vieta,&nbsp;Isabella Pacchiarotti","doi":"10.1111/acps.70089","DOIUrl":"10.1111/acps.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Psychotic depression (PD) is a severe form of depression that can occur in both major depressive disorder (MDD) and bipolar disorder (BD). Although relatively prevalent, the prognostic impact of psychotic symptoms in depression remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To systematically review the available evidence comparing PD and non-psychotic depression (NPD) in terms of clinical course, functional outcomes, and treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of electronic databases (PubMed, Cochrane Library and Web of Science) following PRISMA guidelines was conducted from inception to 31st January 2025 to integrate current evidence about the impact of psychotic symptoms in both unipolar and bipolar depressed patients. This study was registered in PROSPERO (CRD42024563172).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourty-one studies met inclusion criteria. Compared to NPD, PD was associated with greater clinical severity, longer hospitalizations, and higher inpatient treatment rates. Several studies showed lower remission rates and greater chronicity in PD. Relapse, readmission, or shorter time to recurrence were also more common in PD. Evidence indicated a higher risk of suicide and poorer functional outcomes in PD. Treatment patterns showed more frequent use of ECT and pharmacological combinations in PD, although no consistent drug-specific differences emerged. Overall, heterogeneity across designs and outcome measures was substantial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite heterogeneity, evidence across 41 studies indicates that PD is a higher-risk depressive subtype, characterized by greater service use, higher relapse liability, lower sustained remission, increased suicidality, and poorer functioning. These findings support the need for intensified assessment and management and highlight the importance of large, standardized prospective studies, especially in BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 1","pages":"6-35"},"PeriodicalIF":5.0,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508033","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":"Effectiveness of a Psychiatrist-Led Clinic for Metabolic Health in Severe Mental Illness: A Retrospective Chart Review Study","authors":"Nicolette Stogios,&nbsp;Femin Prasad,&nbsp;Riddhita De,&nbsp;Kateryna Maksyutynska,&nbsp;Akash PrasannaKumar,&nbsp;Vittal Korann,&nbsp;Tariq Ahmed,&nbsp;Marcos Sanches,&nbsp;Leah Burton,&nbsp;Mohammed A. Alarabi,&nbsp;Tanner Isinger,&nbsp;Michelle Desanti,&nbsp;Rebecca Oliveira,&nbsp;Daphne J. Korczak,&nbsp;Ariel Graff-Guerrero,&nbsp;Gary Remington,&nbsp;Margaret K. Hahn,&nbsp;Sri Mahavir Agarwal","doi":"10.1111/acps.70093","DOIUrl":"10.1111/acps.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Psychotropic medications are associated with serious metabolic adverse effects, which contribute to an increased risk of cardiometabolic comorbidities in patients with severe mental illness (SMI). Several intervention strategies are available to mitigate these metabolic adverse effects; however, data on their utility in real-world settings are limited. The aim of this study was to evaluate the impact of a psychiatrist-led, integrated model of care that combines nonpharmacological and pharmacological interventions to manage metabolic dysfunction in individuals with SMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective chart review of all patients attending the Mental Health and Metabolism Clinic at the Centre for Addiction and Mental Health (CAMH) between 2016 and 2023. The primary outcome measure was the percentage of patients in the clinic that lost ≥ 5% of their baseline weight over a 12-month study period. Secondary outcomes included the percentage of patients that lost ≥ 5% of their baseline weight with each individual metabolic intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 378 patients, 132/378 (37.5%) patients lost ≥ 5% of their baseline body weight during the 12-month study period. In terms of individual intervention strategies, 29/83 (34.9%) lost ≥ 5% of their baseline body weight with nonpharmacological interventions alone, 79/214 (36.9%) with add-on metformin, 6/13 (46.2%) with add-on topiramate, and 7/11 (77.8%) with add-on semaglutide. Across all interventions, a significant effect of the clinic on body weight over time was observed (<i>F</i> = 7.72; <i>p</i> &lt; 0.001), with a mean change of −1.24 ± 1.45 kg from baseline at 12 months across all interventions. The presumptive number needed to treat was three for nonpharmacological interventions, metformin, and topiramate, and two for semaglutide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This large naturalistic retrospective cohort study suggests that psychiatrist-led care for metabolic dysfunction in mental illness is effective in reducing psychotropic-induced weight gain. This approach may streamline the implementation of monitoring strategies and interventions in a systematic manner.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"154 1","pages":"74-88"},"PeriodicalIF":5.0,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524990","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}