Current Opinion in Psychiatry最新文献

{"title":"Complex posttraumatic stress disorder and borderline personality disorder: a truly complex relationship or a diagnostic artefact?","authors":"Alessandra D'Agostino, Marta Moselli, Vladan Starcevic","doi":"10.1097/YCO.0000000000001045","DOIUrl":"https://doi.org/10.1097/YCO.0000000000001045","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the relationship between borderline personality disorder (BPD) and complex posttraumatic stress disorder (CPTSD) in light of recent claims that the former might be replaced by the latter.</p><p><strong>Recent findings: </strong>The stigma associated with BPD is not a convincing reason to suggest that CPTSD is more adequate than BPD, despite the fact that there is currently less stigma attached to it. BPD and CPTSD share some core symptoms, such as affective dysregulation and interpersonal difficulties. However, several features, including impulsivity, identity disturbance, and fear of abandonment, are relatively specific for BPD and may distinguish it from CPTSD. While trauma is a major risk factor for both conditions, it is neither necessary nor sufficient for the development of BPD because it can occur in the absence of trauma. In contrast, trauma is indispensable in the development of CPTSD. Research using latent class analysis and structural equation modeling has produced mixed results, with most studies identifying overlapping symptom clusters of BPD and CPTSD and suggesting that the boundaries between the two conditions are not clear.</p><p><strong>Summary: </strong>While there are many similarities between BPD and CPTSD, they can be distinguished clinically, although the boundaries between them are not clear-cut. Current evidence strongly suggests that BPD cannot be reduced to a trauma-related condition and that it would therefore be erroneous to replace it with CPTSD.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic factors predicting risk of mood disorders in adolescents.","authors":"Swathi Hassan Gangaraju, Christel M Middeldorp, Enda M Byrne","doi":"10.1097/YCO.0000000000001044","DOIUrl":"https://doi.org/10.1097/YCO.0000000000001044","url":null,"abstract":"<p><strong>Purpose of review: </strong>Adolescence is a sensitive period for the onset of mood disorders. Many adolescents experience mood symptoms, which for some are transient and pass over time and for others lead to a mood disorder diagnosis. Mood disorders are substantially heritable and those at highest genetic risk tend to have an earlier onset. The present review summarizes recent advances in our understanding of genetic factors contributing to mood disorders in adolescents.</p><p><strong>Recent findings: </strong>Genetic predispositions play a critical part in the development of mood disorders, including major depression and bipolar disorder. Both cross-sectional and longitudinal studies have consistently found that individuals reporting mood symptoms during adolescence have higher polygenic risk for both mood disorders and other psychiatric disorders than those without symptoms. Polygenic Risk Scores (PRS) that aggregate the effects of thousands of genetic variants can improve individual risk prediction for bipolar disorder when combined with clinical and environmental factors. Genetically informative designs, either using observed genotypes summarized in PRS or the occurrence of the disorder in family members summarized in Family Genetic Risk Scores (FGRS) are also used to investigate mechanisms underlying associations with risk factors. Recent studies suggest that teens whose peers are genetically vulnerable to depression have an increased risk for depression compared to teens with the same genetic risk but whose peers are not genetically vulnerable. This indicates a direct environmental effect. These studies illustrate that both family-based and molecular-based genetic approaches can help in diagnosing and understanding the origins of mood disorders in adolescents.</p><p><strong>Summary: </strong>Adolescent-onset mood disorders are associated with increased genetic risk relative to later-onset. Although not currently clinically applicable, genetic factors, with a focus on PRS and FGRS, can help to predict onset and course of mood disorders in adolescents. The use of PRS and FGRS, combined with environmental factors, improves prediction models for mood disorders in adolescents. Additionally, it also provides information on the etiology of these disorders, for example by examining parent-offspring and peer group associations in genetically informative study designs.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069378","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":"Psychological and medical treatments for binge-eating disorder: state-of-the-art.","authors":"Anja Hilbert, Ricarda Schmidt","doi":"10.1097/YCO.0000000000001035","DOIUrl":"https://doi.org/10.1097/YCO.0000000000001035","url":null,"abstract":"<p><strong>Purpose of review: </strong>Various psychological and medical treatments have demonstrated efficacy for binge-eating disorder (BED), but further improvement is warranted. This narrative research synthesis reviews randomized controlled trials (RCTs) published between November 16, 2022, and May 15, 2025, identified via systematic literature search.</p><p><strong>Recent findings: </strong>Fourteen new RCTs were included. Cognitive-behavioral therapy (CBT) showed consistent efficacy for binge eating, abstinence, and eating disorder psychopathology; augmentation with lisdexamfetamine dimesylate (LDX) improved eating disorder psychopathology and weight loss, but not binge-eating outcome. Web-based self-help treatment reduced binge eating, eating disorder psychopathology, and impairment. Sequential designs suggested LDX and naltrexone/bupropion as maintenance options for responders, with CBT beneficial for nonresponders. Brain-based interventions showed initial evidence. Exploratory pharmacotherapy with nivasorexant was ineffective. No RCTs targeted youth.</p><p><strong>Summary: </strong>Recent RCTs support digital CBT-based self-help treatment for improving psychological symptoms, and augmentation of CBT with LDX for improving psychopathology and weight loss in BED. Sequential designs suggest CBT's role for nonresponders to behavioral and/or pharmacological weight loss treatment, while for responders continued medication may be helpful. Brain-directed treatments need further validation. Future research should elucidate mechanisms and short-term and/or long-term efficacy, and overcome the lack of evidence in younger populations.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069313","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":"Risk of depression and dementia among individuals treated with sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists.","authors":"Osvaldo P Almeida","doi":"10.1097/YCO.0000000000001001","DOIUrl":"10.1097/YCO.0000000000001001","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review whether sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists decrease the risk of depression, suicidal ideation and cognitive impairment in later life.</p><p><strong>Recent findings: </strong>The results of studies using information derived from large registries and administrative health datasets suggest that GLP-1 receptor agonists (RAs) increase the risk of suicidality, although findings have been inconsistent. One nested-case control study reported that SGLT2i decreases the risk of depression among adults with diabetes, and findings from a small trial of the SGLT2i empagliflozin provided supportive evidence. Several observational studies reported that SGLT2i and GLP-1 RAs decrease dementia risk, with a target trial finding greater cognitive benefit associated with the use of GLP-1 RAs compared with other medicines commonly used to manage diabetes.</p><p><strong>Summary: </strong>Recent results from large observational studies suggest that SGLT2i and GLP-1 RA may decrease the risk of cognitive impairment in later life. The effects of these medicines on mood have not been as well explored, but there are concerns about the potential increased risk of suicidality among GLP-1 RA users. Prescription bias could explain some of these associations, so that robust trial evidence is now needed to confirm or dismiss the reported findings.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"368-375"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515009","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 prediction for repetitive transcranial magnetic stimulation treatment.","authors":"Gábor Csukly, Boglárka Orbán-Szigeti, János M Réthelyi","doi":"10.1097/YCO.0000000000001026","DOIUrl":"10.1097/YCO.0000000000001026","url":null,"abstract":"<p><strong>Purpose of review: </strong>While rTMS is a safe therapeutic option, its efficacy remains to be improved. Patients with treatment-resistant depression show 50-60% response rates and 30-40% remission rates to standard 10 Hz rTMS protocols. Response prediction is a promising option to improve rTMS efficacy.</p><p><strong>Recent findings: </strong>Most studies test response prediction in patients with depression, schizophrenia, and OCD. Clinical data and structural MRI are primarily used for patient stratification, fMRI is employed to determine the optimal localization, and EEG is utilized for fine-tuning rTMS parameters to achieve the best efficacy. Employing magnetic resonance spectroscopy, PET, and measuring cortical excitability may also be helpful. However, only a few studies tested these methods. Furthermore, a crucial new task is to connect theta-burst accelerated protocols with response prediction, an approach applied in some recent studies.</p><p><strong>Summary: </strong>We propose planning and carrying out multicentre studies to confirm existing results and provide a definitive conclusion for clinicians. Primarily, individual alpha peak (IAPF)-based response prediction results should be replicated in large-sample, multicentre trials, as this approach is the most robust and has the best chance of being implemented in clinical practice. Structural MRI-based patient stratification and fMRI-guided stimulation are possible add-ons.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"334-340"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706676","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":"Are modifiable risk factors for dementia really modifiable?","authors":"Etuini Ma'u, Sarah Cullum, Susanne Röhr, Emerita Carol Brayne","doi":"10.1097/YCO.0000000000001018","DOIUrl":"10.1097/YCO.0000000000001018","url":null,"abstract":"<p><strong>Purpose of review: </strong>The 2024 Lancet Commission estimates 45% of dementias worldwide are preventable if 14 potentially modifiable risk factors for dementia were eliminated. While this is unlikely, there is evidence that even modest risk factor reduction will have significant benefits. Whether this is best achieved at the level of the individual or broader population level approaches is the purpose of this review.</p><p><strong>Recent findings: </strong>To date, evidence for the efficacy of individual-level interventions in preventing cognitive decline or dementia is modest at best. Reasons for this include the sociodemographic and risk profile of study participants and complex disease causes, while overlooking the underlying social and commercial determinants of health influencing risk exposure. There is, however, growing evidence supporting population-level approaches to dementia risk reduction. Trend studies from high-income countries showing declines in dementia incidence over recent decades suggest their effectiveness.</p><p><strong>Summary: </strong>The limited evidence for the efficacy, let alone effectiveness, of individual-level interventions is in part because they operate within the influence of social and commercial determinants of health. For significant and sustained risk factor reduction, population-level interventions targeting the underlying determinants of risk factor exposure across the life course, with sensitivity to diverse contexts, are required.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"348-354"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149548","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":"Suicide in later life: the role of frailty and depression.","authors":"Brian Draper, Anne P F Wand","doi":"10.1097/YCO.0000000000001009","DOIUrl":"10.1097/YCO.0000000000001009","url":null,"abstract":"<p><strong>Purpose of review: </strong>Depression and physical illnesses have long been recognized as risk factors for suicidal behaviour in late life. Qualitative studies have previously identified frailty as being an issue in late life suicidal behaviour, but quantitative studies have been lacking. Establishing the role frailty plays in suicidal behaviour in late life has implications for suicide prevention.</p><p><strong>Recent findings: </strong>Depression and frailty are closely linked in late life, with genetic and social factors suggesting bidirectional causality. Frailty is associated with an increased risk of suicidal ideation and suicide attempts that is likely enhanced by chronicity, depression, and social factors, such as living and eating alone. In contrast, suicide is associated with lower levels of frailty.</p><p><strong>Summary: </strong>Suicide rates peak in late life with depression a consistently identified risk factor along with numerous diverse factors that include physical health and social issues. In investigating the relationship between physical health and suicidal behaviour, frailty has been neglected until recently. Interventions that reduce or prevent frailty and associated depression, such as physical training and nutritional management interventions, might have a role in preventing suicidal behaviour. Further research is required to elucidate the different associations reported between frailty and suicidal ideation/attempts and frailty and suicide.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"383-388"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957327","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":"TDP-43 proteinopathy: the complex biological and clinical findings in LATE-NC, LANS, and other mixed age-related major neurocognitive disorders.","authors":"Marcia Radanovic, Carlos Eduardo Borges Passos Neto, Luiz Henrique Monteiro, Orestes Vicente Forlenza","doi":"10.1097/YCO.0000000000001027","DOIUrl":"10.1097/YCO.0000000000001027","url":null,"abstract":"<p><strong>Purpose of review: </strong>Since the term limbic-predominant age-related TDP-43 encephalopathy (LATE) was coined in 2019, more than 200 articles addressing the subject were published. This review aims to provide an updated synthesis of knowledge regarding LATE-NC as a cause of age-related neurodegeneration and cognitive decline while addressing the challenges posed by overlapping neuropathologies in aging populations.</p><p><strong>Recent findings: </strong>LATE-NC is marked by TDP-43 deposition in limbic structures, such as the amygdala and hippocampus, and is often associated with cognitive decline resembling Alzheimer's disease, though with a slower progression in isolated cases. The frequent coexistence of LATE-NC with other neuropathologies, particularly Alzheimer's disease neuropathologic changes (ADNC) and Lewy body dementia (LBD), exacerbates dementia severity and complicates diagnosis and treatment. Recent efforts have established clinical criteria for in-vivo diagnosis, including neuroimaging markers like hippocampal atrophy and limbic hypometabolism. Genetic studies have identified key risk genes, including GRN , TMEM106B , SORL1 , and APOE , while biomarker development in cerebrospinal fluid (CSF) and blood remains in its early stages.</p><p><strong>Summary: </strong>The review underscores the need for multidisciplinary research and clinical approaches to address the complexities of neurodegenerative diseases involving TDP-43 proteinopathy, improve diagnostic accuracy, and develop effective treatments tailored to individual patient profiles.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"361-367"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706677","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":"Understanding late-life depression: focus on inflammation.","authors":"Antonio L Teixeira, Aline S de Miranda, Venugopal Reddy Venna, Jayandra J Himali, Moises E Bauer","doi":"10.1097/YCO.0000000000001022","DOIUrl":"10.1097/YCO.0000000000001022","url":null,"abstract":"<p><strong>Purpose of review: </strong>Late-life depression (LLD) is a prevalent condition and frequently complicated by higher rates of medical comorbidities and cognitive decline. We review the current evidence implicating inflammation in the pathophysiology of LLD and the potential of related molecules and pathways to be used as biomarkers or pharmacological targets.</p><p><strong>Recent findings: </strong>A growing body of evidence implicates chronic low-grade inflammation in the pathophysiology and progression of LLD. Inflammatory cytokines, stress-related neuroendocrine pathways, oxidative stress, mitochondrial dysfunction, and blood-brain barrier permeability all synergize with aging to worsen depressive symptoms. Moreover, LLD presents marked biological heterogeneity, with inflammation-related subtypes exhibiting worse clinical outcomes. Several biomarkers and novel therapeutic targets, including cytokines, gut microbiota, and mitochondrial DNA, are identified.</p><p><strong>Summary: </strong>Inflammation is a key modifiable contributor to LLD and may serve as both a biomarker and therapeutic target. Although current clinical trials of anti-inflammatory treatments show promise, findings remain inconsistent. Future research should focus on identifying inflammatory subtypes of LLD and validating personalized, mechanism-based interventions to improve treatment outcomes in aging populations.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"376-382"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706680","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":"Transcranial magnetic stimulation for the management of late life depression: a critical appraisal of available evidence.","authors":"Leandro Valiengo, Valeria Richinho","doi":"10.1097/YCO.0000000000001020","DOIUrl":"10.1097/YCO.0000000000001020","url":null,"abstract":"<p><strong>Purpose of review: </strong>Late-life depression (LLD) is a prevalent and often underdiagnosed condition in older adults, associated with significant cognitive, functional, and medical burdens. Conventional treatments frequently present limitations in this population, underscoring the need for safer, more effective alternatives. This review evaluates the growing body of evidence supporting transcranial magnetic stimulation (TMS) as a promising nonpharmacological treatment for LLD.</p><p><strong>Recent findings: </strong>Recent meta-analyses and randomized controlled trials suggest that TMS is effective and well tolerated in older adults, even in cases of treatment resistance. Protocol adaptations, such as increased stimulation intensity and the use of theta burst or deep TMS, have demonstrated improved outcomes in this population. TMS also shows potential cognitive benefits and fewer systemic side effects compared to pharmacotherapy. However, barriers such as limited accessibility, insurance restrictions, and logistical challenges persist.</p><p><strong>Summary: </strong>TMS represents a valuable therapeutic option for managing LLD, particularly in patients who are medication-intolerant or at high risk for adverse effects. While evidence supports its efficacy and safety, further research is needed to optimize protocols, identify predictors of response, and assess long-term outcomes. Addressing implementation challenges will be essential for translating these advances into routine clinical practice.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"389-394"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706679","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}