Current Opinion in Psychiatry最新文献

{"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":"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":"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":"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}

{"title":"Transactive response DNA-binding protein 43 (TDP-43) proteinopathy: the complex biological and clinical findings in limbic-predominant age-related TDP-43 encephalopathy (LATE) neuropathological changes, limbic-predominant amnestic neurodegenerative syndrome, 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.0000000000001025","DOIUrl":"10.1097/YCO.0000000000001025","url":null,"abstract":"<p><strong>Purpose of review: </strong>As the term limbic-predominant age-related transactive response DNA-binding protein 43 (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 highlights the importance of multidisciplinary research and clinical approaches in addressing the complexities of neurodegenerative diseases involving TDP-43 proteinopathy, enhancing diagnostic accuracy, and developing effective treatments tailored to individual patient profiles.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"341-347"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706678","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":"Antiamyloid treatment for dementia: concerns outweigh hopes.","authors":"Leon Flicker","doi":"10.1097/YCO.0000000000001021","DOIUrl":"10.1097/YCO.0000000000001021","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review the association between Alzheimer pathology and dementia and the role of mAbs targeting amyloid in the treatment of people with dementia and mild cognitive impairment.</p><p><strong>Recent findings: </strong>There is an association, but Alzheimer pathology explains less than 40% of the attributable risk of dementia when other pathologies such as vascular, Lewy Body and TDP-43 are accounted. Recent trials of passive immunization with MABs, including Aducanumab Lecanemab and Donanemab, have demonstrated some benefits but the effects are small in size and may be due to bias. The side effect of amyloid-related imaging abnormalities (ARIA) is common and potentially serious. The costs of assessments for treatment and actual treatment costs are large compared with potentially modest benefits.</p><p><strong>Summary: </strong>It is still uncertain about the place of MABs in the treatment of Alzheimer's dementia. Further research is required regarding the long-term benefits and risks.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"355-360"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of gut microbiota in psychiatric disorders: current findings.","authors":"Ivona Šimunović Filipčić, Ivana Kolčić, Vladimir Grošić, Igor Filipčić","doi":"10.1097/YCO.0000000000001019","DOIUrl":"10.1097/YCO.0000000000001019","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gut microbiota and its alterations have been increasingly implicated in the pathophysiology of major psychiatric disorders via the microbiota-gut-brain axis. This narrative review aims to highlight current findings from recent systematic reviews and meta-analyses (published between September 2023 and March 2025), addressing the role of gut microbiota in major depressive disorder (MDD) and schizophrenia, with particular attention to the effects of psychotropic medications and microbiota-targeted interventions.</p><p><strong>Recent findings: </strong>In MDD, consistent changes in gut microbiota composition, such as depletion of Faecalibacterium and enrichment of Bifidobacterium, have been reported, although alpha diversity findings remain inconsistent. Antidepressants may modulate microbiota in both humans and animal models, while probiotic and synbiotic interventions yield modest reductions in depressive symptoms and inflammatory markers. In schizophrenia, observational studies showed stable alpha diversity, but altered beta diversity, with taxa like Bifidobacterium , Lactobacillus , and Roseburia linked to symptom severity, cognition, and antipsychotic exposure. Interventional studies, though limited, suggest small-to-moderate clinical improvements with probiotic supplementation, and emerging evidence supports potential benefits for both cognition and reducing metabolic side effects of psychotropic medications.</p><p><strong>Summary: </strong>Across depressive and psychotic disorders, growing evidence supports a multifaceted and indispensable role of gut microbiota in clinical symptomatology, treatment response, and cognition of patients. However, substantial variability of methodological frame, limited sample sizes, lack of mechanistic precision, and heterogeneity between published studies result in unequivocal conclusions on the exact effect of microbiota on mental health in general, and on major psychiatric disorders. While microbiota-targeted therapies remain adjunctive and exploratory, recent findings reinforce them as a promising target for more successful treatment of mental health disorders in the near future. In order to reach that goal, we need more rigorous, longitudinal, and integrative studies to guide the clinical implementation.</p>","PeriodicalId":11022,"journal":{"name":"Current Opinion in Psychiatry","volume":" ","pages":"327-333"},"PeriodicalIF":4.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282764","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}