Acta Psychiatrica Scandinavica最新文献

{"title":"The Role of Clinical Judgment in Psychiatry","authors":"Giovanni A. Fava,&nbsp;Jenny Guidi","doi":"10.1111/acps.70035","DOIUrl":"10.1111/acps.70035","url":null,"abstract":"<div>\u0000 \u0000 <p>Clinical judgment is currently perceived as an intuitive art that is going to be replaced by growing technology and artificial intelligence. Even though patients look for good clinical judgment when they seek medical attention and clinicians rely on it, the topic is seldom mentioned and discussed in the literature. In their everyday practice, psychiatrists use observation, description, and classification; test explanatory hypotheses; and formulate clinical decisions based on clinical judgment. The aim of this review was to examine the current role of clinical judgment in psychiatry. We first outline the importance of collecting information that supplements the use of diagnostic criteria (allostatic load, health attitudes and behavior, psychological well-being, personality and iatrogenic factors). Clinimetrics, the science of clinical measurements, provides an intellectual home for the reproduction and standardization of clinical intuitions. The clinimetric translation of clinical reasoning allows the organization of the material that has been collected (staging, building unitary concepts, subtyping, formulating pathophysiological links, and global judgments). Finally, we discuss how clinical judgment is the intermediate step between the general indications that derive from clinical trials and individualized treatment plans, encompassing patients' preferences, treatment articulation and selection, level of care, and interpretation of previous treatment response. Clinical judgment remains the basic method of medicine and psychiatry. Improving its features by clinimetric strategies is likely to yield a highly effective precision psychiatry that is available today to any practicing clinician.</p>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 1","pages":"65-73"},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Acceptability of Licensed and Off-Label Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness: A Systematic Review and Meta-Analysis of Randomised Trials","authors":"Nina Friis Bak Fuglsang,&nbsp;Nanna Marker Madsen,&nbsp;Søren Lundorff Jacobsen,&nbsp;Julie Eg Frøkjær,&nbsp;Nicolai Ladegaard,&nbsp;Marc Alberg Sørensen,&nbsp;Christoph U. Correll,&nbsp;Christian Otte,&nbsp;Mikkel Højlund,&nbsp;Ole Köhler-Forsberg","doi":"10.1111/acps.70032","DOIUrl":"10.1111/acps.70032","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A wide range of drugs is used to alleviate insomnia symptoms in individuals with severe mental illness (SMI), including licensed drugs and sedating drugs prescribed off-label. Yet, no review has gathered the evidence on illness-specific or transdiagnostic outcomes of pharmacological interventions for insomnia. We aimed to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) studying the efficacy and acceptability of pharmacological interventions for insomnia among individuals with SMI, defined as schizophrenia, bipolar disorder (BD) or major depressive disorder (MDD).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We searched for RCTs of pharmacological interventions for insomnia that used either placebo or another medication as inactive control or active comparator. Two independent reviewers performed the literature screening, data extraction and risk of bias assessment (RoB2). We performed random effects meta-analyses on the co-primary outcomes total sleep time (TST), sleep quality and acceptability (all-cause discontinuation) and the secondary outcomes safety and tolerability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The search identified 3331 hits, of which 25 RCTs (&lt;i&gt;n&lt;/i&gt; = 2476 individuals) were included, with 18 RCTs (&lt;i&gt;n&lt;/i&gt; = 2199) in MDD, 4 RCTs (&lt;i&gt;n&lt;/i&gt; = 162) in BD and 3 RCTs (&lt;i&gt;n&lt;/i&gt; = 115) in schizophrenia. Of 25 RCTs, 22 had a high risk of bias. The most frequently studied drugs were agomelatine (RCTs = 3, &lt;i&gt;n&lt;/i&gt; = 686), eszopiclone (RCTs = 3, &lt;i&gt;n&lt;/i&gt; = 599) and zolpidem (RCTs = 3, &lt;i&gt;n&lt;/i&gt; = 601). Compared to placebo, pharmacological interventions for insomnia were associated with improved sleep quality by a small effect size (RCTs = 8, &lt;i&gt;g&lt;/i&gt; = 0.24, 95% CI = 0.05–0.43) and improved TST (RCTs = 10, MD = 30.82 min, 95% CI = 19.13–42.50), with similar acceptability (RCTs = 10, RR = 1.06, 95% CI = 0.90–1.25).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Despite their frequent use, many licensed and off-label pharmacological interventions for insomnia have never been investigated in patients with SMI. The studies that provided sufficient data for meta-analysis showed better efficacy with similar acceptability compared to placebo, but the generalizability of these results is limited by the high heterogeneity and low quality of the included studies. This underscores the need for high-quality RCTs to provide a better scientific basis for the pharmacological treatment of insomnia in SMI.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;&lt;b&gt;Trial Registration:&lt;/b&gt;","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 6","pages":"405-421"},"PeriodicalIF":5.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Accuracy and Reliability of Ratings on the Hamilton Depression Rating Scale via a Video-Based Training Program","authors":"Pernille Kølbæk,&nbsp;Botilla Dalsgaard Jensen,&nbsp;Erik Roj Larsen,&nbsp;Søren Dinesen Østergaard","doi":"10.1111/acps.70029","DOIUrl":"10.1111/acps.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The clinician-rated 17-item Hamilton Depression Rating Scale (HAM-D17) allows for a systematic severity assessment of depressive symptoms. Applying the HAM-D17 in clinical practice requires that staff members' ratings on the HAM-D17 are accurate and reliable. Here, we aimed to investigate whether such accuracy and reliability can be achieved through a brief video-based training program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One-hundred-and-ten psychiatric hospital staff members (psychologists, medical doctors, nurses, health care workers, physio-/occupational therapists, and social workers) performed baseline HAM-D17 ratings after watching a videotaped patient interview. Subsequently, a theoretical introduction video was displayed, followed by five successive videotaped patient interviews. After watching each interview, individual ratings were conducted before a video providing the gold standard rating was displayed. Accuracy was estimated by calculating the proportion of participants whose ratings did not display a deviation from the gold standard of &gt; 1 point on all individual HAM-D17 items and &gt; 6 points on the HAM-D17 total score. Reliability was calculated using Gwet's agreement coefficient (AC1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline and after the sixth rating session, 43% versus 70% of the staff members, respectively, rated within the acceptable deviation of the gold standard (<i>p</i> &lt; 0.001). At the HAM-D17 item level, baseline reliability indices were highest for item 6 (Late Insomnia) and lowest for item 14 (Sexual Interest) (AC1 = 0.97 vs. 0.47), but both improved following training (AC1 = 0.99 vs. 0.84 at the sixth rating session).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most staff members conducted accurate and reliable HAM-D17 ratings after participating in a brief video-based training program.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 6","pages":"462-472"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936543","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":"Unravelling the Link Between Body Mass Index and Cognitive Performance in Individuals With Bipolar Disorder and Exploration of PRS Moderation Effect: Findings From the PsyCourse Study","authors":"B. Solé,&nbsp;L. Montejo,&nbsp;M. Budde,&nbsp;M. Valentí,&nbsp;R. Borràs,&nbsp;S. Martín-Parra,&nbsp;A. Ruiz,&nbsp;A. Martínez-Aran,&nbsp;K. Adorjan,&nbsp;M. Heilbronner,&nbsp;A. Navarro-Flores,&nbsp;M. Oraki Kohshour,&nbsp;D. Reich-Erkelenz,&nbsp;E. C. Schulte,&nbsp;F. Senner,&nbsp;I. G. Anghelescu,&nbsp;V. Arolt,&nbsp;B. T. Baune,&nbsp;U. Dannlowski,&nbsp;D. E. Dietrich,&nbsp;A. J. Fallgatter,&nbsp;C. Figge,&nbsp;G. Juckel,&nbsp;C. Konrad,&nbsp;J. Reimer,&nbsp;E. Z. Reininghaus,&nbsp;M. Schmauß,&nbsp;C. Spitzer,&nbsp;J. Wiltfang,&nbsp;J. Zimmermann,&nbsp;P. Falkai,&nbsp;E. Vieta,&nbsp;T. G. Schulze,&nbsp;C. Torrent,&nbsp;U. Heilbronner,&nbsp;S. Papiol","doi":"10.1111/acps.70028","DOIUrl":"10.1111/acps.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) is a severe mental disorder characterized by extreme mood swings, often accompanied by metabolic comorbidities, such as cardiovascular disease, which increase mortality and reduce quality of life. Both metabolic dysfunctions and BD are associated with cognitive dysfunction. Body mass index (BMI) is closely linked to metabolic health and cognitive performance. This study examined the link between BMI and cognitive function in individuals with BD and how genetic factors, namely polygenic risk scores (PRS) for BD and BMI, might influence this link.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Genetic (PRS scores) and phenotypic data (sociodemographic factors, clinical symptoms and cognitive function) of 341 adult patients with BD diagnosis from the PsyCourse Study, a large, multi-site, and naturalistic longitudinal study, were utilized for this study. First, we performed univariate and multivariate regression analyses to investigate associations between BMI and cognitive performance. Second, moderation analyses were conducted to examine the potential moderator effects of BD-PRS or BMI-PRS in the relationship between BMI and different cognitive outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>BMI was associated with processing speed (TMT-A) and executive function (TMT-B), with individuals with higher BMI showing poorer performance. Moderation analyses revealed that the effect of BMI on cognition was moderated by BD-PRS only regarding the processing speed. BMI-PRS did not moderate the association between BMI and cognitive variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings indicate that the relationship between BMI and cognitive impairment in BD is partially moderated by BD genetic liability but not by BMI genetic load.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 6","pages":"451-461"},"PeriodicalIF":5.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936571","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":"Psychopathic Traits Associate With Later Schizophrenia","authors":"Olli Vaurio,&nbsp;Jari Tiihonen,&nbsp;Markku Lähteenvuo,&nbsp;Johannes Lieslehto","doi":"10.1111/acps.70027","DOIUrl":"10.1111/acps.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite well-known diagnostic and neurobiological overlaps between psychopathic traits and schizophrenia, it has remained unclear whether psychopathic traits increase the risk for later schizophrenia. Former studies have proven only a weak correlation between psychopathy and DSM axis I diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We combined data from individuals who underwent forensic psychiatric evaluations (FPEs) at Niuvanniemi Hospital between 1984 and 1993 with the records from the Care Register for Health Care to examine the relationship between psychopathic traits, measured by the Psychopathy Checklist-Revised (PCL-R), and the development of schizophrenia following the evaluation. We conducted survival analyses using Kaplan–Meier estimates and Cox proportional hazards models, with a follow-up period of up to 40 years. Mortality data were obtained from the National Death Registry. Statistical analyses were adjusted for age, sex, criminal responsibility, and substance abuse disorder at the time of the FPE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 341 individuals (278 males [81.51%] and 63 females [18.49%], mean [SD] age 33.52 [11.49]) who were adults, criminally responsible, and did not have a psychotic illness, severe mental disability, or brain damage at FPE. Compared to individuals with total PCL-R scores less than or equal to 10, those with scores of 11–24 (adjusted hazard ratio [aHR] = 5.30, 95% CI = 1.21–23.25) and 25 or higher (aHR = 9.33, 95% CI = 2.04–42.76) had a significantly higher risk of later hospitalization due to schizophrenia. Also, individuals classified as psychopathic (PCL-<i>R</i> ≥ 25) had a significantly higher risk of developing schizophrenia compared with those classified as non-psychopathic (PCL-<i>R</i> &lt; 25): aHR = 2.37, 95% CI =1.17–4.80. A total of 20% of psychopaths developed schizophrenia over the follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The novel results suggest that there is a link between higher PCL-R scores and a higher risk of later-life schizophrenia outbreak among non-psychotic individuals undergoing FPE. Multiple factors can explain the finding, including substance use and mutual risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 6","pages":"432-440"},"PeriodicalIF":5.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936516","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":"Metabolic Adverse Effects of Low-Dose Quetiapine: A Systematic Review and Meta-Analysis","authors":"Pedro Sonim,&nbsp;Rui M. Ferreira,&nbsp;Inês Lourenço,&nbsp;Lia Fernandes,&nbsp;Ana Rita Ferreira","doi":"10.1111/acps.70023","DOIUrl":"10.1111/acps.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The use of off-label, low doses of second-generation antipsychotics (SGAs), in particular quetiapine, has risen significantly. SGAs are known to cause metabolic adverse effects, including weight gain. The aim of this systematic review and meta-analysis was to assess the impact of low-dose quetiapine on metabolic outcomes, such as weight, glycemic, and lipid metabolism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following the PRISMA statement, PubMed, Web of Science Core Collection, Cochrane Library, ClinicalTrials.gov, Google Scholar, and PsycINFO were systematically searched for randomized controlled trials &gt; 4 weeks, reporting metabolic outcomes of quetiapine &lt; 200 mg. RoB2 was used to assess bias. SPSS was used for quantitative data management and aggregation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight unique studies (<i>n</i> = 3085) were included, six of which were included in the meta-analysis. Low doses of quetiapine led to significant weight gain (mean difference [MD] = 0.58 kg, 95% CI: 0.32–0.83) and HDL cholesterol reduction (MD = −1.25 mg/dL, 95% CI: −1.86 to −0.65). Patients gaining ≥ 7% of baseline weight was 2.12 times more likely to have taken quetiapine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite limited generalizability, these findings suggest that, even at low doses, quetiapine has an impact on metabolism. Further research is needed to clarify its role in metabolic dysregulation. This study was registered in the international database of prospectively registered systematic reviews (PROSPERO CRD420250588527).</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"328-340"},"PeriodicalIF":5.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793018","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":"How to Quickly Diagnose Catatonia, and a Farewell Salute to Max Fink, MD","authors":"Dirk Dhossche,&nbsp;Lee Elizabeth Wachtel","doi":"10.1111/acps.70024","DOIUrl":"10.1111/acps.70024","url":null,"abstract":"&lt;p&gt;We dedicate this editorial to Max Fink, MD, who died on June 15, 2025 at 102. Max was a paragon of psychiatry, an astute practitioner and researcher, prolific writer, fierce polemist, and advocate for electroconvulsive therapy (ECT), and generous mentor to younger colleagues, including both of us. Max was the strongest advocate for catatonia as an independent syndrome across many disorders and conditions, and inspired the making of The Catatonia Foundation, https://www.thecatatoniafoundation.org, a new organization established in 2022 by a parent in the aftermath of her daughter's significantly delayed catatonia diagnosis and lifesaving course of ECT in order to bring sorely needed awareness about catatonia and connect patients and families globally with treatment providers.&lt;/p&gt;&lt;p&gt;Max made several contributions to &lt;i&gt;Acta Psychiatrica Scandinavica&lt;/i&gt;, including the 1996 papers [&lt;span&gt;1, 2&lt;/span&gt;] establishing the Bush Francis Catatonia Rating Scale (BFCRS) and Bush Francis Catatonia Screening Instrument (BFCSI) as standards worldwide and promoting benzodiazepines (BZDs) and ECT as their primary treatments.&lt;/p&gt;&lt;p&gt;Almost 30 years later, Luccarelli et al. [&lt;span&gt;3&lt;/span&gt;] have distilled a list of 4 catatonic symptoms (excitement, mutism, staring, and posturing) from the original 14-item BFCSI. The presence of only one of those four symptoms assures 97% sensitivity compared to the BFCSI. This makes the new screening instrument, coined the Catatonia Quick Screen (CQS) a perfect tool to improve recognition, diagnosis, and treatment of catatonia.&lt;/p&gt;&lt;p&gt;Catatonia has a storied history. Catatonia was likely first formally described in 16th century England by Phillip Barrough who wrote &lt;i&gt;Of congelation or taking&lt;/i&gt; and mostly aptly commented upon the “lethargic” and “frenetic” poles of a disorder now recognized to often be characterized by both psychomotor agitation and retardation [&lt;span&gt;4&lt;/span&gt;]. King Henry VI may have suffered from catatonia, with historians noting that he was unable to speak, walk or hold up his head after being informed of a military loss in Gascony in 1453, furthermore described as “smitten with a frenzy and his wit and reason withdrawn.” Catatonia may also have been present since the early days of humankind, with the potential for catatonia underscored in Lot's Wife, the Prophet Ezekiel and the unfortunate individuals who gazed upon Medusa and turned into stone [&lt;span&gt;5&lt;/span&gt;]. Vagal intimations and the role of the fight, flight or freeze response in evolution further suggests that catatonia may be an intimate part of the human experience [&lt;span&gt;6&lt;/span&gt;] and opens up new vistas on the role of psychological, traumatic, environmental, and social risk factors in catatonia [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The formal term catatonia was coined in 1874 by Kahlbaum [&lt;span&gt;8&lt;/span&gt;] as a novel clinical entity with distinct motor, vocal, and behavioral symptoms that he observed in the Reimer Sanitarium in Gorlitz, then part of the Kingdom of ","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"325-327"},"PeriodicalIF":5.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144797613","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":"Generative Artificial Intelligence Chatbots and Delusions: From Guesswork to Emerging Cases","authors":"Søren Dinesen Østergaard","doi":"10.1111/acps.70022","DOIUrl":"10.1111/acps.70022","url":null,"abstract":"&lt;p&gt;When I proposed the hypothesis that generative artificial intelligence chatbots (chatbots hereafter) might trigger delusions in individuals prone to psychosis in August 2023 [&lt;span&gt;1&lt;/span&gt;], I was venturing into unknown territory. Indeed, in the virtual absence of evidence, the editorial was merely based on guesswork—stemming from my own use of these chatbots and my interest in the mechanisms underlying and driving delusions.&lt;/p&gt;&lt;p&gt;Following publication of the editorial, my charting of the territory slowly began as I started to receive the occasional email from chatbot users, their worried family members, and journalists. Most of these emails described situations where users' interactions with chatbots seemed to spark or bolster delusional ideation. The stories differed with regard to the specific topic at hand but were yet very similar: Consistently, the chatbots seemed to interact with the users in ways that aligned with, or intensified, prior unusual ideas or false beliefs—leading the users further out on these tangents, not rarely resulting in what, based on the descriptions, seemed to be outright delusions.&lt;/p&gt;&lt;p&gt;Over the past couple of months, I have noticed that the number of emails I have received on this topic from near and far has only increased. I have been working with psychiatric research for more than 15 years and can say, without a doubt, that none of my prior publications have led to this level of direct engagement with the public. Coinciding completely with the increase in the number of correspondences, the number of views of my 2023 editorial suddenly spiked dramatically, rising from a very modest plateau around 100 per month to approximately 750 views in May 2025 and 1375 views in June 2025.&lt;/p&gt;&lt;p&gt;The time trend described above has been paralleled by media coverage of the topic. Indeed, the New York Times [&lt;span&gt;2&lt;/span&gt;], Rolling Stone [&lt;span&gt;3&lt;/span&gt;], and many other outlets have published articles based on interviews and accounts from online fora [&lt;span&gt;4&lt;/span&gt;] that are all compatible with people experiencing onset or worsening of delusions during intense and typically long interactions with chatbots (that do not grow tired of chatting) [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The timing of this spike in the focus on potential chatbot-fuelled delusions is likely not random as it coincided with the April 25th 2025 update to the GPT-4o model—a recent version of the popular ChatGPT chatbot from OpenAI [&lt;span&gt;5-7&lt;/span&gt;]. This model has been accused of being overly “sycophantic” (insincerely affirming and flattering) toward users, caused by the model training leaning too hard on user preferences communicated via thumbs-up/thumbs-down assessments in the chatbot (so-called Reinforcement Learning from Human Feedback (RLHF)) [&lt;span&gt;8&lt;/span&gt;]. OpenAI acknowledged this issue: “On April 25th, we rolled out an update to GPT-4o in ChatGPT that made the model noticeably more sycophantic. It aimed to please the user, not just as flattery, but also as","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"257-259"},"PeriodicalIF":5.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783001","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":"Association Between Age at Diagnosis of Coronary Heart Disease and Incident Depression and Anxiety","authors":"Jie Liang,&nbsp;Qiongwei Li,&nbsp;Yang Pan,&nbsp;Wenya Zhang,&nbsp;Darui Gao,&nbsp;Yanyu Zhang,&nbsp;Jingya Ma,&nbsp;Yuling Liu,&nbsp;Yiwen Dai,&nbsp;Mengmeng Ji,&nbsp;Menghan Zhu,&nbsp;Xvyang Diao,&nbsp;Xinqing Yang,&nbsp;Yichi Zhang,&nbsp;Wuxiang Xie,&nbsp;Fanfan Zheng","doi":"10.1111/acps.70021","DOIUrl":"10.1111/acps.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Whether younger age at diagnosis of coronary heart disease (CHD) is associated with a higher risk of incident depression and anxiety or not remains unexamined. This study aimed to explore the association between age at diagnosis of CHD and incident depression and anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were from the UK Biobank. Information on the diagnosis of CHD, depression, and anxiety was collected at baseline and follow-ups. Cox proportional hazards models and the propensity score matching method were applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 438,376 adults were included, of which 49,620 had CHD (median follow-up: 13.8 years). Compared with participants without CHD, participants with CHD were at an increased risk of incident depression and anxiety. Younger age at diagnosis of CHD (per 10-year decrement) was associated with a higher risk of depression (HR = 1.73, 95% CI: 1.65–1.82, <i>p</i> &lt; 0.001) and anxiety (HR = 1.66, 95% CI: 1.57–1.74, <i>p</i> &lt; 0.001). In propensity score matching analysis, CHD patients were at a higher risk of depression and anxiety than matched controls without CHD among all diagnosis age groups, and the HRs gradually elevated with descending age at CHD diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals diagnosed with CHD at a younger age were at an elevated risk of incident depression and anxiety than individuals diagnosed at an older age, underscoring the necessity to pay attention to their mental health and conduct timely interventions to attenuate the subsequent risk of depression and anxiety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 6","pages":"422-431"},"PeriodicalIF":5.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783000","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":"Response to: “In the Assessment of Childhood Maltreatment and Cognitive Function in Bipolar Disorder All Variables Should be Taken Into Consideration”","authors":"Natalia E. Fares-Otero,&nbsp;Anaid Pérez-Ramos,&nbsp;Ricardo Lopez-Escribano,&nbsp;Sara Martin-Parra,&nbsp;Luis Alameda,&nbsp;Sarah L. Halligan,&nbsp;Kamilla W. Miskowiak,&nbsp;Eduard Vieta","doi":"10.1111/acps.70020","DOIUrl":"10.1111/acps.70020","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"399-401"},"PeriodicalIF":5.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783002","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}