Harvard Review of Psychiatry最新文献

{"title":"The Efficacy of Bereavement Interventions: A Systematic Umbrella Review.","authors":"Kate A Avis, Marjolein Missler, Denise van Deursen, Lonneke I M Lenferink, Margaret Stroebe, Henk Schut","doi":"10.1097/HRP.0000000000000426","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000426","url":null,"abstract":"<p><strong>Abstract: </strong>In recent decades, there have been diverse reviews published on intervention program value for bereaved people. The variation and multiplicity of such reviews makes it difficult to obtain an overview of what is known about treatment effectiveness. In this systematic umbrella review, we explore the current knowledge base on psychotherapeutic bereavement intervention program efficacy. Thirty-three quantitative systematic reviews and/or meta-analyses published between January 2001 and October 2021 were included. Quality was assessed using the Assessment of Multiple Systematic Reviews criteria. Intervention efficacy was determined by rating overall conclusions into three categories according to strength of evidence: positive-unconditional, positive-conditional, and negative-no evidence. Our results indicate that bereavement interventions are generally helpful. Seven reviews indicated positive-unconditional support for bereavement interventions. Twenty-four reviews found positive-conditional support (i.e., some evidence of value, but efficacy did not apply in all circumstances or was constrained by database weaknesses or weak effects), and only two reviews indicated negative-no evidence for support. Notably, conclusions were generally limited by poor review quality and methodological concerns (e.g., lack of randomized controlled trials and follow-up studies). As such, we call for future empirical studies and review articles to abide by methodological quality standards. Furthermore, we recommend further study of the subgroup variables and intervention features that contribute to treatment efficacy.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic and Structural Dimensions in Psychiatric Prescribing: Bridging Psychedelics and Antidepressants.","authors":"Christopher W T Miller, Zofia Kozak","doi":"10.1097/HRP.0000000000000425","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000425","url":null,"abstract":"<p><strong>Abstract: </strong>As practitioners seek more personalized approaches, exploring how patients' environments, relationship templates, and mindsets factor into symptom burden can help broaden understanding of how psychotropic medications facilitate recovery. Despite increasing focus on medications to provide relief, there is an important and undeniable influence the therapeutic environment has on shaping outcomes, particularly for the patient-clinician alliance. While environmental dimensions are relevant for informing possible placebo or nocebo responses, they also build upon the pharmacodynamic and neurobiological effects of medications. By heightening neuroplasticity, some antidepressants may amplify the effects of nonmedication factors in patients' lives, including the patient-prescriber therapeutic relationship. There are important parallels between antidepressants and psychedelics in emerging literature. For instance, the preparatory and integrative work with a provider can be crucial in determining outcomes. This paper will draw from the extant literature to discuss the therapeutic relationship in psychiatric practice, including in acute care settings and instances in which psychotropic prescribing is a key aspect of treatment.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Psychotic Experiences and Psychotic Disorders in General Mental Health Treatment Settings: A Systematic Review and Meta-Analysis.","authors":"Jacqueline A Clauss, Cheryl Y S Foo, Catherine J Leonard, Katherine N Dokholyan, Corinne Cather, Daphne J Holt","doi":"10.1097/HRP.0000000000000419","DOIUrl":"10.1097/HRP.0000000000000419","url":null,"abstract":"<p><strong>Background: </strong>The absence of systematic psychosis screening within general mental health services contributes to substantial treatment delays and poor long-term outcomes for individuals with psychotic symptoms. We conducted a meta-analysis to estimate rates of subclinical psychotic symptoms for psychotic experiences (PE), clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders that were identified via studies screening treatment-seeking individuals. These rates can inform implementation recommendations for routine psychosis screening in general mental health settings.</p><p><strong>Methods: </strong>PubMed and Web of Science databases were searched to identify empirical studies with information on PE, CHR-P, or psychotic disorder prevalence identified by screening inpatients and outpatients (age < 65 years) receiving general mental health care. PE was identified using threshold scores on validated self-reported questionnaires, and CHR-P and psychotic disorder were identified using gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the restricted maximum likelihood estimator method to assess effect sizes in a random effects model.</p><p><strong>Results: </strong>The analyses included 41 independent samples (k = 32 outpatient, k = 2 inpatient, k = 7 combined settings) with a total of 25,751 patients (58% female, mean age: 24.1 years). PE prevalence was 44.3% (95% CI: 35.8-52.8%; 28 samples, n = 21,957); CHR-P prevalence was 26.4% (95% CI: 20.0-32.7%; 28 samples, n = 14,395); and psychotic disorder prevalence was 6.6% (95% CI: 3.3-9.8%; 32 samples, n = 20,371). Rates did not differ by sex, age, or setting type.</p><p><strong>Conclusions: </strong>The high prevalence of psychotic symptoms in general mental health treatment settings underscores the need for early-detection psychosis screening. These base rates can be used to plan training and allocation of resources required to conduct psychosis assessments and build capacity for delivering interventions for CHR-P and early psychosis in non-specialty mental health treatment settings.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural Factors, Social Structures, and Social Determinants of Health: The Need for Clarity in Assessing Psychopathology.","authors":"Neil Krishan Aggarwal","doi":"10.1097/HRP.0000000000000407","DOIUrl":"10.1097/HRP.0000000000000407","url":null,"abstract":"<p><strong>Abstract: </strong>Over the past decade, researchers translating anthropological theories for clinical use have debated how practitioners should assess cultural factors, social structures, and social determinants of health with patients. Advocates of structural competency have suggested that clinical cultural competency programs demonstrate limited effects on health outcomes because of the static understanding of culture employed. They recommend that cultural factors be reformulated with an emphasis on social structures. In response, researchers in cultural psychiatry specializing in cultural assessments have developed three models-sociocultural formulation, the cultural-ecosocial view, and the contextual developmental assessment-to integrate cultural and structural factors. Their methods for integration, however, differ, resulting in various understandings of psychopathology mechanisms. This paper analyzes arguments from all four positions in this debate. It reveals a lack of consensus about interrelationships among these constructs, their definitions, and methods for assessment. The article concludes with recommendations, such as developing consensus definitions with broad stakeholder involvement; adopting a data-driven approach to clarify how specific cultural, social, or structural factors interact; and identifying how extant assessments capture clinically relevant factors across constructs to develop additional assessment tools.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"54-66"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Discrimination to Disease: The Role of Inflammation.","authors":"Adolfo G Cuevas, Steven W Cole","doi":"10.1097/HRP.0000000000000422","DOIUrl":"10.1097/HRP.0000000000000422","url":null,"abstract":"<p><strong>Abstract: </strong>Discrimination is an established social determinant of mental health that contributes to psychiatric illness disparities among marginalized populations. There is emerging research elucidating the biological mechanisms connecting discrimination to mental health outcomes, revealing inflammation as a key pathway. This column synthesizes evidence from existing literature on the links between discrimination and inflammation, and outlines both the opportunities and challenges in this field. The discussion highlights the necessity of a multifaceted approach to address discrimination, and thus, reduce inflammation at both individual and population levels.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"83-89"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproductive Justice Interventions in Pregnancy: Moving Toward Improving Black Maternal Perinatal and Intergenerational Mental Health Outcomes.","authors":"Simone R Dreux, Natalie Ramsey, Tre D Gissandaner, Nicole Alarcon, Cristiane S Duarte","doi":"10.1097/HRP.0000000000000424","DOIUrl":"10.1097/HRP.0000000000000424","url":null,"abstract":"<p><strong>Learning objective: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Discuss the effects of structural racism on pregnancy and obstetric care and their contributions to maternal mental health challenges and inequitable outcomes.• Outline the current understanding of interventions initiated during pregnancy or childbirth that use reproductive justice principles to improve Black maternal perinatal and intergenerational mental health outcomes.</p><p><strong>Background: </strong>There are significant racial disparities in maternal outcomes for Black compared to White birthing people in the United States (US). Maternal mental health problems negatively affect mothers and their infants. Effects of structural racism during pregnancy and obstetric care may contribute to inequitable maternal mental health challenges and negative offspring outcomes. A reproductive justice framework provides a path for addressing these inequities. This systematic review examines whether pregnancy care interventions driven by reproductive justice principles have successfully improved Black maternal perinatal and intergenerational mental health outcomes.</p><p><strong>Methods: </strong>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies identified in November 2024 in PubMed, PsycInfo, and CINAHL. The studies included randomized clinical trials of Black birthing parents in the US and their offspring. Interventions incorporating reproductive justice principles were defined as those explicitly designed to increase autonomy, community input, racial equity, and/or cultural relevance.</p><p><strong>Results: </strong>The search revealed 619 unique records. After screening and full-text review, 12 studies were included. Of these, 7 studies reported statistically significant effects on mental health outcomes. The interventions included interpersonal therapy, culturally tailored cognitive behavioral therapy, group prenatal care, community health worker home visits, and an educational online platform. Six studies reported positive effects on maternal mental health outcomes (e.g., depressive symptoms or anxiety). One study reported positive infant mental health or developmental effects.</p><p><strong>Conclusions: </strong>The effects of reproductive justice-driven interventions on Black maternal and offspring mental health outcomes are promising, but studies are limited. Future studies should further identify active intervention components and assess mental health-related outcomes in both generations to improve the mental health of Black mothers and prevent negative intergenerational effects.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"90-101"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the Structural, Social, and Biological Domains Converge: The Case of Neighborhood Ethnic Density and Psychosis.","authors":"Deidre M Anglin, Alexandria T Selloni","doi":"10.1097/HRP.0000000000000420","DOIUrl":"10.1097/HRP.0000000000000420","url":null,"abstract":"<p><strong>Abstract: </strong>Biological mechanisms associated with psychosis risk are often formed by generations of social-environmental experiences within families, communities, and neighborhoods, and further shaped by structural policies. This column first describes conceptual work that integrates macrolevel structural, individual-level social, and biological domains to better understand psychosis risk. It then highlights the interconnection of low neighborhood ethnic density and racial exclusion as an example of how social determinants connect to social and biological consequences associated with psychosis outcomes. Neighborhood ethnoracial diversity may be protective against social and biological mechanisms connected to psychosis outcomes among minoritized groups at risk for psychosis. This is particularly salient during childhood because such diversity attenuates stress processes associated with social exclusion and discrimination. Moreover, ethnoracially diverse communities foster close relationships and social connection. We provide supportive literature to illustrate the importance of multilevel/multifactorial approaches for identifying psychosis risk and protective factors. Investing further in integrative approaches for understanding psychosis risk and prognosis may translate into more substantial improvements for individuals with these lived experiences.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"78-82"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 Social Determinants in Racial and Ethnic Mental Health Disparities: Getting It Right.","authors":"Margarita Alegría, Mara Xiong, Mayra L Sánchez González","doi":"10.1097/HRP.0000000000000421","DOIUrl":"10.1097/HRP.0000000000000421","url":null,"abstract":"<p><strong>Abstract: </strong>Despite increased research on and attention to mental health, significant racial and ethnic disparities in this area persist. We propose that racial and ethnic disparities in mental health should be examined through the lens of social determinants of mental health (SDoMH). In this perspective article, we review current definitions and frameworks of SDoMH, discuss their strengths and shortcomings, and provide recommendations for a framework to better capture the causal pathways of mental health for racially and ethnically minoritized populations. We also discuss efforts to address SDoMH, focusing on policy-level SDoMH interventions, and review progress and challenges in integrating SDoMH approaches into mental health care.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"67-77"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction to the Special Issue.","authors":"Neil Krishan Aggarwal, Roberto Lewis-Fernández","doi":"10.1097/HRP.0000000000000423","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000423","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"51-53"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Use of Benzodiazepine in Older Adults and Its Relationship with Dementia: A Systematic Review and Meta-Analysis.","authors":"Juan Rivas, Mauricio Hernández, Jose Miguel Erazo, María Juliana Martínez, Carlos González, María Paulina Cortés, Jhonny Muñoz, Carlos Miranda","doi":"10.1097/HRP.0000000000000414","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000414","url":null,"abstract":"<p><strong>Learning objective: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Explain current understanding of the relationship between chronic benzodiazepine use and dementia.</p><p><strong>Background: </strong>Chronic use of benzodiazepines (BZ) for managing conditions such as anxiety disorders, depression, sleep disorders, and other chronic diseases is widespread; yet, there is considerable controversy regarding its potential links to dementia risk. This systematic review and meta-analysis aims to clarify this relationship by synthesizing and analyzing the available evidence to provide a clearer understanding of whether prolonged BZ use contributes to developing dementia.</p><p><strong>Methods: </strong>This study adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO to ensure methodological rigor and transparency. The research strategy incorporated terms such as \"benzodiazepines\" OR \"benzodiazepine\" AND \"cognitive dysfunction\" OR \"dementia\" AND \"adult\" OR \"elderly\" OR \"aged.\" We included prospective and retrospective observational studies, as well as case-control studies. Data were meticulously extracted regarding chronic BZ use and dementia risk. Each study's risk of bias was assessed to ensure result validity. Statistical analysis was performed using hazard ratios (HR) as the primary meta-analysis summary measure to provide a precise evaluation of associated risk.</p><p><strong>Results: </strong>Analysis of five studies showed that chronic BZ use was associated with a nonsignificant risk of dementia-without specification of cause-with an HR of 1.17 (95% CI: 0.96-1.43). Regarding Alzheimer's disease, three studies found no significant association with an HR of 1.00 (95% CI: 0.87-1.15).</p><p><strong>Conclusions: </strong>Our findings did not reach statistical significance, suggesting no strong link between chronic BZ use and dementia. Further research is needed to clarify this potential association.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 1","pages":"1-7"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}