Frontiers in Psychiatry最新文献

{"title":"Network meta-analysis of the effects of traditional Chinese fitness exercises on mental health and physical benefits among college students.","authors":"Nan Wang, Hao Hong, Maolin Dong, Yaoshu Li, Lisha Lan, Junjian Zheng","doi":"10.3389/fpsyt.2026.1921373","DOIUrl":"10.3389/fpsyt.2026.1921373","url":null,"abstract":"<p><strong>Background: </strong>Traditional Chinese fitness exercises may benefit college students' mental and physical health, but their comparative effectiveness across exercise modalities and outcomes remains unclear.</p><p><strong>Objective: </strong>To compare traditional Chinese fitness exercises across mental health, body composition, and cardiorespiratory outcomes in college students.</p><p><strong>Methods: </strong>Eight databases were searched from inception through September 8, 2026. Eligible RCTs in college students were assessed with RoB 2 and synthesized using Bayesian network meta-analysis.</p><p><strong>Results: </strong>A total of 69 RCTs involving 6,065 college students were included. For depression, Tai Chi (TC, 95.40%), Yijin Jing (YJJ, 85.40%), and Baduanjin (BDJ, 69.23%) ranked highest, with several significant pairwise comparisons. For anxiety, TC significantly outperformed blank control (BC) and ranked highest (88.82%). Other traditional exercises (OTE, 84.53%), Wuqinxi (WQX, 67.72%), and Liuzijue + physical intervention (LZJ + PI, 65.82%) ranked highest for vital capacity (VC); Xingyiquan (XYQ, 82.89%) and Mawangdui Daoyinshu (MWDY, 82.07%) for VO₂max; and OTE (82.52%) and XYQ (78.81%) for the step test index. TC ranked highest for body fat rate (BFR, 86.35%), whereas LZJ (81.27%), WQX (72.38%), and PI (65.44%) ranked highest for body mass index (BMI). Surface under the cumulative ranking curve (SUCRA) rankings should be interpreted alongside effect sizes and 95% CrIs.</p><p><strong>Conclusion: </strong>Traditional Chinese fitness exercises may provide multidimensional benefits, with comparative advantages varying by outcome. Exercise selection should be outcome-oriented rather than based on a single universally optimal modality.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view, identifier CRD420261290192.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1921373"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive remediation in schizophrenia: efficacy and role of neuroplasticity in \"top-down\" and \"bottom-up\" mechanisms-a randomized, double-blind, treatment-as-usual-controlled study protocol.","authors":"Juan I Cifuentes, Constanza Orellana, Diego Tello, Cristian Ramírez, Catalina Prieto, Jessica M Guasti, Rodrigo R Nieto","doi":"10.3389/fpsyt.2026.1936475","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.1936475","url":null,"abstract":"<p><strong>Objectives: </strong>Schizophrenia is characterized by positive, negative and cognitive symptoms, including different degrees of impairment in several neurocognitive domains, such as executive function, processing speed, learning and memory, which impact a patient´s functioning and quality of life. Cognitive remediation can help restore cognitive functioning through repeated exercises, following at least two possible strategies: a \"top-down\" approach, focused on training executive functions, or perceptual training, a \"bottom-up\" approach, aimed at first addressing impairments in perceptual processing. This study aims to clarify whether both approaches have comparable efficacy in improving neurocognitive performance, and to explore the timing of their cognitive and molecular effects. It will also examine the relationship between these approaches and changes in BDNF levels, considered a biomarker of neuroplasticity.</p><p><strong>Materials and methods: </strong>In order to have a control group, patients will undergo an initial 10-week observation period receiving treatment as usual, followed by randomization into either executive training or perceptual training during the active phase of the trial. Clinical and neurocognitive assessments, as well as blood sampling, will be conducted at the beginning and end of each stage. Finally, assessments will be repeated after a 12-week follow-up period.</p><p><strong>Discussion: </strong>The study aims to answer these research questions concerning clinical efficacy and molecular mechanisms and expects to identify possible clinical or molecular biomarkers (such as BDNF levels or the Val66Met polymorphism) that could be helpful as predictors of neurocognitive treatment response for each remediation strategy, thereby contributing to a personalized treatment approach. Study registered on clinicaltrials.gov number NCT06482918.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1936475"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise for the negative symptoms of schizophrenia: a review.","authors":"Charles Trevelyan, Hina Mohsin","doi":"10.3389/fpsyt.2026.2001262","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.2001262","url":null,"abstract":"<p><p>Negative symptoms of schizophrenia, comprising avolition, asociality, anhedonia, blunted affect, and alogia, are a primary driver of functional impairment, tend to persist, and have no treatment approved specifically for them. Exercise has drawn interest as a low-cost, widely available, adjunctive intervention. This review synthesizes three recent evidence syntheses: an umbrella review of previously published meta-analyses and two network meta-analyses of randomized controlled trials. All three report significant reductions in negative symptoms, with yoga consistently the most effective modality; aerobic and mind-body exercise also show benefit, while the evidence for resistance exercise is inconsistent across analyses. Reported effect sizes range from small to large, and this divergence appears to reflect differences in comparator group and analytic method rather than differences in study quality. A dose-response analysis estimated an optimal total dose of 1200 metabolic equivalent minutes per week but proved unstable under sensitivity analysis. Certainty of evidence was rated low to very low throughout. Two constraints recur across the literature: the rating scales used cannot distinguish primary from secondary negative symptoms, and avolition itself likely limits sustained participation in exercise. Exercise is a reasonable adjunctive intervention, but its specific benefit for primary negative symptoms remains poorly understood.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"2001262"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of direct transcranial photobiomodulation: a history of dose, depth, and delivery.","authors":"Luis De Taboada, Jackson Streeter","doi":"10.3389/fpsyt.2026.1970464","DOIUrl":"10.3389/fpsyt.2026.1970464","url":null,"abstract":"<p><p>Direct transcranial photobiomodulation (dtPBM) delivers red or near-infrared light through the scalp and skull with the aim of affecting brain tissue. The field has produced encouraging findings but inconsistent clinical results. We reconstruct its development as a history of scientific and engineering decisions in which optical access, target depth, and dose repeatedly shaped what could be tested. The clinical lineage began with light therapy for ischemic myocardium and moved to stroke, where cadaver measurements established that near-infrared light could traverse the human scalp and skull and defined a historical design target of approximately 7.5 mW/cm² at the dura. The NEST clinical program then carried a fixed 808-nm regimen into three stroke trials: NEST-1 met its primary endpoint, NEST-2 showed a nonsignificant overall trend (p = 0.094) with a published <i>post hoc</i> signal in moderate stroke (p = 0.044), and NEST-3 stopped for futility. An unpublished, exploratory NEST-2 reanalysis described larger treatment differences for superficial lesions; this observation motivates prospective testing but does not establish depth-dependent efficacy. After NEST, treatment moved to the forehead, where target geometry was more reproducible. The ELATED trials adopted a more practical LED platform at substantially lower irradiance while preserving broadly similar treatment-site radiant exposure, whereas the TRIADE R61 trial deliberately varied optical parameters and found optical-parameter-dependent, bidirectional BOLD power responses. The historical record also leaves biological mechanism unresolved: mitochondrial/redox, neurovascular, glial-inflammatory, network-mediated, and diffuse or systemic pathways remain plausible at different levels of evidence, and a distributed physiological response does not by itself identify where the effect begins. These observations support a constrained historical inference: dose, depth, and delivery site are biological variables, not merely device specifications. We distinguish focal-local, diffuse/systemic, and local-stimulation/network-mediated accounts of action and identify prospective tests that can discriminate among them. The next phase of dtPBM development should prioritize indications in which optical access, target engagement, and a disease-relevant network or biomarker can be specified prospectively rather than inferred after a clinical outcome.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1970464"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased frequency of rare damaging variants in <i>PLIN4</i> in patients with anorexia nervosa.","authors":"Michael Lutter, Lucas G Casten, Jacob J Michaelson, Guido K W Frank, Alenka Čopič, Michael S Mazei-Robison, Alfred J Robison","doi":"10.3389/fpsyt.2026.1937613","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.1937613","url":null,"abstract":"<p><strong>Background: </strong>Anorexia nervosa (AN) is a severe psychiatric disorder characterized by pathological fear of weight gain, persistent restriction of energy intake, and pervasive body image disturbance. Although AN is substantially heritable, the rare coding variants contributing to susceptibility remain incompletely defined. Pedigree-based whole-exome sequencing studies can help to identify rare, high-effect protein-coding variants and thereby elucidate disease mechanisms.</p><p><strong>Methods: </strong>Whole-exome sequencing was performed on AN-dense family pedigrees to identify candidate genes. The frequency of rare (minor allele frequency <1%), putatively damaging [combined annotation-dependent depletion (CADD) >15, including predicted loss-of-function (LOF)] variants in 32 candidate genes was assessed in 154 unrelated probands of European ancestry. Carrier counts were compared against gnomAD v4 non-Finnish European reference using a TRAPD-style coverage-adjusted denominator (maximum allele number/2 across qualifying sites per gene). Significance was assessed by one-sided Fisher exact test, Bonferroni-corrected across 32 candidate genes.</p><p><strong>Results: </strong><i>PLIN4</i> was the only gene enriched in AN cases at Bonferroni-corrected significance: 17 of 154 patients (11.0%) carried a rare damaging variant versus 3.2% in gnomAD non-Finnish Europeans [odds ratio (OR) 3.86, 95% confidence interval (CI) 2.35 to 6.35; one-sided Fisher <i>p</i> = 9.98e-06; Bonferroni-corrected <i>p</i> = 3.19e-04]. The result is preserved with the index proband removed (<i>n</i> = 153; OR 3.64, 95% CI 2.18 to 6.07; corrected <i>p</i> = 1.13e-03). Six of 154 patients carried predicted LOF variants; 4 of 6 had at least one AN-affected first- or second-degree relative carrying the same variant, providing co-segregation evidence. The LOF-only burden did not survive Bonferroni correction in isolation.</p><p><strong>Conclusions: </strong>Patients with AN carry a statistically significant excess of rare, putatively damaging variants in <i>PLIN4</i>, at a threshold surviving Bonferroni correction across 32 candidate genes. These findings implicate lipid-droplet biology as a candidate contributor to AN pathophysiology.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1937613"},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability of digital medicine systems in patients with schizophrenia or schizoaffective disorder.","authors":"Taishiro Kishimoto, Harumasa Takano, Ryo Kanzaka, Hisateru Tachimori, Hideki Oi, Hiroyuki Ogino, Kyosuke Sawada, Fumiaki Kumagai, Masayuki Tomita, Iku Nakayama, Yoshiyuki Shibasaki, Toshiaki Kikuchi, Hiroyoshi Takeuchi, Kazuyuki Nakagome","doi":"10.3389/fpsyt.2026.1903689","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.1903689","url":null,"abstract":"<p><strong>Objective: </strong>To assess the usability and performance of digital medication management systems (DMS) for patients with stable ambulatory schizophrenia and schizoaffective disorder.</p><p><strong>Methods: </strong>This prospective, interventional study comprised a screening phase (up to 4 weeks), training phase (3 weeks: system use under the support), and independent phase (5 weeks under the minimized support) with a follow-up period of 2 weeks. Based on the DSM-5 criteria, patients with a diagnosis of schizophrenia or schizoaffective disorder, taking an atypical antipsychotic as their primary medication, and having access to a smartphone were included in this study.</p><p><strong>Results: </strong>A total of 30 patients participated in the study. The main characteristics of the patients were as follows: age, 43.5 ± 11.4 years; male percentage, 40% (n = 12); duration of antipsychotic drug use, 14.2 ± 11.7 years; educational period, 13.3 ± 2.1 years; chlorpromazine (CP) equivalent dose, 369.6 ± 253.6 mg/day; and Brief Psychiatric Rating Scale (BPRS), 23.6 ± 4.8. The patients applied patches with the sensor of the DMS embedded in (hereinafter, a wearable sensors) for 93.2% of the study period. The patients could apply the patch independently and successfully and synchronize it with a smartphone application that allowed them to monitor their medication intake in 15.2 ± 8.1 days (median, 9.0; interquartile range (IQR), 1.0-15.0 days after initiation). Thirty-eight adverse events that were reported in 17 patients were classified as mild or moderate, and were related to wearable sensor use.</p><p><strong>Conclusion: </strong>It was concluded that most patients completed the task for the DMS with minimal assistance early in the study and continued to apply wearable sensors throughout the study period. Moreover, the results confirmed the feasibility of DMS in clinical practical use in stable schizophrenia.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1903689"},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital behavior patterns and ADHD symptoms in late adolescents and young adults.","authors":"Shu Chen, Guangying He, Jingbo Zhao","doi":"10.3389/fpsyt.2026.1968257","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.1968257","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital media use has become deeply embedded in the daily lives of late adolescents and young adults, yet less is known about how specific digital behavior patterns are associated with ADHD symptom dimensions. This study focused on three emerging digital behaviors-speed watching, fragmented information consumption, and media multitasking-and examined their associations with inattention and hyperactivity-impulsivity within an ecologically informed multidomain framework encompassing demographic, perceived environmental, and family correlates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 3,418 high school and university students aged 15-25 years (M_age = 18.60, SD = 1.05; 60.56% female) participated in the study, including 1,929 high school students (56.44%) and 1,489 university students (43.56%). They completed self-report measures of ADHD symptoms, digital behavior patterns, perceived physical environment, family environment, and demographic characteristics. ADHD symptoms were assessed in two dimensions: inattention and hyperactivity-impulsivity. Digital behavior patterns included speed watching, fragmented information consumption, and media multitasking. Pearson correlation analyses and hierarchical regression models were conducted to examine bivariate associations and the incremental explanatory value of digital behavior patterns after accounting for demographic, perceived environmental, and family variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fragmented information consumption showed the strongest bivariate correlations with both inattention (r = 0.588) and hyperactivity-impulsivity (r = 0.488). In the hierarchical regression models, entering the digital behavior variables after the demographic, perceived environmental, and family variables accounted for an additional 22.3% of the variance in inattention and 14.5% of the variance in hyperactivity-impulsivity. Fragmented information consumption remained the strongest statistical correlate of both inattention (&lt;i&gt;β&lt;/i&gt; = 0.379, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and hyperactivity-impulsivity (&lt;i&gt;β&lt;/i&gt; = 0.256, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), followed by media multitasking. The final models explained 44.0% and 34.9% of the variance in inattention and hyperactivity-impulsivity, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Among the examined ecological correlates, digital behavior patterns-particularly fragmented information consumption and media multitasking-showed the most pronounced associations with ADHD symptoms in late adolescents and young adults. These findings suggest that distinguishing among specific forms of digital engagement may provide useful behavior-specific information about ADHD symptom variation. Because total screen time was not assessed, the findings do not establish that these behaviors are more informative than overall screen exposure. Given the cross-sectional and self-report design, the findings should be interpreted as associations rather than evidence of causal effects.&lt;","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1968257"},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing the body for psilocybin therapy: receptive and generative interoception in cancer patients.","authors":"Anthony L Back, Cynthia J Price, Bonnie A McGregor, Andrew Markell","doi":"10.3389/fpsyt.2026.1890966","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.1890966","url":null,"abstract":"<p><p>Cancer patients arrive for psilocybin therapy with bodies altered by illness and treatment - bodies that they have learned to brace against, dissociate from, or scan for threat. Research on psilocybin-assisted therapy for cancer-related depression and anxiety consistently identifies the quality of the acute subjective experience - reflected in constructs such as acceptance, surrender, boundlessness, and emotional breakthrough - as a key predictor of therapeutic benefit. Yet most preparation protocols focus on cognitive intention-setting and basic mindfulness while neglecting to address the body directly. We propose that anxiety and depression in this setting may involve a somatic substrate that has not been adequately specified. We distinguish two capacities to 'feel into the body' relevant to psychedelic therapy: interoception as perception (the perceptual access to bottom-up bodily signal) and interoceptive engagement (the broader capacity that links bodily perception to posture, breath, structural intent, and affective stance). We describe a six-category phenomenological taxonomy of somatic experiences in psilocybin therapy (exteroceptive, deep somatic, visceral, vestibular, nociceptive, emergent). We also map receptive practices, designed to improve interoception as perception, and generative practices, designed to improve interoceptive engagement. The framework is grounded in current predictive-coding accounts of interoception, but does not depend on any single neuroscientific model. An ongoing Phase 2 trial of group retreat psilocybin therapy for metastatic cancer patients will provide an initial test of our hypothesis that interoceptive training may influence therapeutic outcomes in psilocybin therapy for patients with cancer.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1890966"},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Psychotherapy initiation is associated with discontinuation of psychotropic medications without dose escalation: a ten-year real-world cohort study (2014-2024).","authors":"Teresa Dolores Pomares Carreres, Guillermo Martínez Conesa, Francisco Navarrete","doi":"10.3389/fpsyt.2026.1991337","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.1991337","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fpsyt.2026.1841866.].</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1991337"},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 tyrosine hydroxylase deficiency-associated dopa-responsive dystonia treated with antipsychotics and rTMS: a case report.","authors":"Yue Shen, Hai-Zhi Chen, Liang Lv, Lan-Lan Fang","doi":"10.3389/fpsyt.2026.1920048","DOIUrl":"https://doi.org/10.3389/fpsyt.2026.1920048","url":null,"abstract":"<p><strong>Background: </strong>Tyrosine hydroxylase deficiency (THD) is a rare autosomal recessive disorder caused by mutations in the <i>TH</i> gene. THD encompasses a broad phenotypic spectrum that includes dopamine-responsive dystonia (DRD) as its milder presentation, alongside severe infantile parkinsonism and progressive infantile encephalopathy. Although non-motor manifestations-such as depression, anxiety, and sleep disturbances-have garnered increasing attention, psychotic symptoms including hallucinations and delusions remain rarely reported in THD.</p><p><strong>Case summary: </strong>This report describes a genetically confirmed woman with THD who presented with infantile-onset dystonia. Auditory hallucinations and erotomanic delusions emerged approximately five years after levodopa initiation and persisted despite one-month levodopa withdrawal. Although levodopa markedly improved her dystonia, antipsychotic treatment posed a therapeutic dilemma: risperidone exacerbated motor symptoms, and aripiprazole was limited by poor adherence. A multimodal regimen comprising aripiprazole, quetiapine, and low-frequency repetitive transcranial magnetic stimulation (rTMS) targeting the left temporoparietal cortex was associated with progressive improvement of psychotic symptoms without clinically apparent worsening of dystonia. The independent contribution of rTMS could not be determined given the concurrent pharmacological titration.</p><p><strong>Conclusion: </strong>Selecting appropriate antipsychotic medication in THD patients with prominent psychotic symptoms poses a considerable challenge. The combination of aripiprazole, quetiapine, and rTMS may represent a potential therapeutic option. To our knowledge, this is the first reported case of genetically confirmed DRD due to THD presenting with prominent psychotic symptoms, and among the few documenting rTMS use in this population. These observations are based on clinical assessment without standardized quantitative measures; the independent efficacy of rTMS cannot be established from this case.</p>","PeriodicalId":12605,"journal":{"name":"Frontiers in Psychiatry","volume":"17 ","pages":"1920048"},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}