Harvard Review of Psychiatry最新文献

{"title":"Anti-GAD65 Encephalitis: A Cryptic Case Requiring a Multidisciplinary Approach.","authors":"Seo Ho Song, Dennis Fitzgerald, Alejandro Y Mendoza, Xing Yi Chen, Kerry L Bloomingdale, Subha Subramanian","doi":"10.1097/HRP.0000000000000455","DOIUrl":"10.1097/HRP.0000000000000455","url":null,"abstract":"<p><p>Anti-GAD65 encephalitis-like other autoimmune encephalitis conditions-poses a significant diagnostic challenge; its heterogeneous neuropsychiatric phenotypes mimic primary psychiatric disorders. The broad pathophysiological spectrum, ranging from limbic dysfunction to catatonia, underscores the need for systematic approaches that integrate immunotherapy with neuromodulation when standard interventions fail. We present a 78-year-old woman with no prior psychiatric history who developed acute-onset catatonia with visual hallucinations. Neurological evaluation revealed markedly elevated anti-GAD65 antibodies despite unremarkable neuroimaging and electroencephalography. Initial treatment with lorazepam and intravenous immunoglobulin achieved partial response. Recurrent catatonia and treatment-refractory psychosis prompted a trial of electroconvulsive therapy (ECT), which led to sustained remission through maintenance ECT. This case illustrates three critical clinical practice points: (1) late-onset catatonia necessitates comprehensive evaluation of autoimmune etiologies, including paired serum-cerebrospinal fluid antibody testing; (2) partial response to immunotherapy does not preclude more aggressive symptomatic management; and (3) ECT can effectively treat catatonia secondary to autoimmune illnesses. We conclude that successful management of anti-GAD65 encephalitis necessitates a multidisciplinary team for thorough neuro-immunological assessment, nuanced psychopharmacology, and timely neuromodulation.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"118-124"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369456","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":"Metadata in Smartphone-Based Cognitive Assessments: Current State and Emerging Evidence in Psychiatric Disorders.","authors":"Ko Woon Kim, Andrew Jin Soo Byun, Juan Castillo, Young Chul Youn, John Torous","doi":"10.1097/HRP.0000000000000453","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000453","url":null,"abstract":"<p><p>Smartphone-based cognitive assessments have emerged as promising tools for frequent and ecologically valid monitoring of cognitive function in real-world settings. These tools enable continuous capture of cognitive and behavioral patterns, including intra-individual variability, practice-related improvement, and contextual influences. Repeated assessments offer a unique opportunity to detect subtle cognitive changes over time. The interpretability and clinical utility of the metadata generated by such assessments, however, remain underexplored. In this review, we consider the current landscape of smartphone-derived cognitive metadata in the context of cognitive and affective disorders. We focus on emerging evidence linking metadata features to functional outcomes and symptom fluctuations across conditions such as schizophrenia, bipolar disorder, and depression. Additionally, we discuss methodological considerations for optimizing metadata analysis, including test design, sampling frequency, and analytical strategies. We propose that cognitive metadata may serve as sensitive indicators of early cognitive change and support personalized mental health monitoring and targeted intervention.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"85-94"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389864","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 Long-Term Mental Health Impact of Disasters: A Systematic Review and Multilevel Meta-Analysis of Longitudinal Epidemiological Studies.","authors":"Michel L A Dückers, Margaret S Stroebe, Christos Baliatsas, Peter Spreeuwenberg, Annelie Brüning, Katherine E Stroebe","doi":"10.1097/HRP.0000000000000450","DOIUrl":"10.1097/HRP.0000000000000450","url":null,"abstract":"<p><p>Scientific research on the mental health effects of disasters has primarily focused on short-term consequences. This review aims to provide a long-term perspective, examining multiple contributing factors simultaneously. We registered this review (PROSPERO 2020, CRD42020108528), and searched Medline, PsycInfo, PTSDpubs, Web of Science, and SocINDEX from inception to July 2024. After screening 33,205 titles and abstracts, we extracted epidemiological longitudinal data from 71 studies, with up to six waves and a total of 137,004 participants. Disaster type (natural/human-made), category (e.g., earthquakes, floods, terrorist attacks), mental health outcome (e.g., posttraumatic stress disorder, depression, anxiety), population type (children/adolescents, adults), disaster year, measurement month, study quality, and country income were included in a multilevel meta-analysis. Pooled average prevalence of current or recent mental health problems was 22.1% (95% CI [10.95-39.57]). When controlling for the other factors, prevalence did not differ by disaster type, category, mental health outcome, population type, year, study quality, or country income. Despite high heterogeneity, the mental health burden in exposed populations decreased from month 1 to 300 after an initial peak in the first months, followed by a second peak after approximately a decade, before declining again ( p <0.001). Mental health burdens post-disaster may be more universally distributed than previously believed. Earlier studies identifying gradual post-disaster recovery may have underestimated the long-term effects. The analysis revealed a shortage of high-quality studies with measurements beyond four years. The topic requires further investigation with consistently repeated measurements at standard intervals to confirm the presence and early predictors of both larger and smaller peaks.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"59-72"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Haloperidol, Agitation, and the QTc: Misconceptions and Heuristics.","authors":"Erik Levinsohn, Varsha Radhakrishnan, Sunita Singh, Christopher M Celano, Scott R Beach","doi":"10.1097/HRP.0000000000000456","DOIUrl":"10.1097/HRP.0000000000000456","url":null,"abstract":"<p><p>Clinicians are commonly asked to make complex and potentially risky decisions in the face of uncertainty and incomplete information. Physicians frequently employ heuristics, or mental shortcuts, to convert challenging clinical questions into much simpler ones. Psychiatrists often encounter such challenges when asked to comment on the safety of intravenous haloperidol (IVH), particularly regarding risks of prolonging the corrected QT interval (QTc) or developing Torsades de Pointes (TdP). In light of the 2007 Food and Drug Administration warning about the risk of developing TdP with IVH, some providers, and even some institutions, have used QTc cut-off values to indicate when one can and cannot use IVH safely for managing acute agitation. In this perspective, we argue that (1) this practice represents an inappropriate use of a heuristic rather than a necessary risk-benefit calculation, and (2) that our updated understanding of the complex relationships among IVH, QTc, and TdP does not support the use of QTc cut-off values. We address some common misconceptions about the associations among IVH, QTc, and TdP, and discuss how reframing the decision-making process related to this dilemma may improve clinical care.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"95-107"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369541","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":"Data Disaggregation for Asian Americans: Where We Are Now.","authors":"Mara Xiong, Lauren Berger, Lisa Heng Demetrio","doi":"10.1097/HRP.0000000000000451","DOIUrl":"10.1097/HRP.0000000000000451","url":null,"abstract":"<p><p>As a racial group, Asian Americans are often perceived as having few or no mental health issues. Such a perception is perpetuated by data that has, historically, captured the experiences of Asian Americans in the aggregate. While there is growing recognition of heterogeneity among Asian Americans, the recent political climate threatens to undo efforts toward reaching mental health equity. In this perspective article, we argue for the importance of data disaggregation among Asian Americans to identify and reduce mental health disparities. We contextualize the social experiences of different Asian American ethnic groups and highlight how their mental health experiences can differ. We also review current obstacles to data disaggregation and mental health equity, outline a potential path forward, and examine limitations.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"108-117"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369444","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 Efficacy of Transdiagnostic Cognitive Behavioral Therapy Compared to a Waitlist Control for Emotional Disorders in Adolescents: A Meta-Analysis of Randomized Controlled Trials.","authors":"Ayesha Muhammad, Shahla Ali, Rana Muhammad Afaq, Haroon Shabbir","doi":"10.1097/HRP.0000000000000454","DOIUrl":"10.1097/HRP.0000000000000454","url":null,"abstract":"<p><strong>Learning objectives: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Explain the evidence supporting the efficacy of tCBT in reducing anxiety and depression symptoms in adolescents.• Discuss the impact of tCBT on adolescent's overall functioning.• Identify factors that may influence treatment outcomes, including the role of parental involvement.</p><p><strong>Introduction: </strong>Transdiagnostic cognitive behavioral therapy (tCBT) is an emerging treatment modality that targets shared psychological mechanisms across disorders. Use of tCBT for treating emotional disorders in adolescents compared to a waitlist control, however, remains underexplored. This study assessed the efficacy of tCBT in treating emotional disorders among adolescents through a meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>This meta-analysis included RCTs that examined tCBT interventions delivered to adolescents (aged 10-19) with clinically diagnosed anxiety, depression, and/or mixed emotional disorders. Eligible studies used standardized cognitive behavioral therapy-based transdiagnostic protocols and compared outcomes with waitlist control groups. Searched databases included PubMed, Cochrane Library, and ClinicalTrials.gov. Seven trials with a combined sample of 324 participants met inclusion criteria. Primary outcomes included changes in anxiety and depression symptoms, with overall functioning as a secondary outcome. Standardized mean differences (SMDs) were pooled using a random-effects model. Subgroup analyses were performed based on parental involvement.</p><p><strong>Results: </strong>tCBT significantly improved anxiety (SMD = -0.59; 95% CI: -0.95, -0.23; p= 0.001), depression (SMD = -0.57; 95% CI: -0.98, -0.16; p = 0.006), and overall functioning (SMD = -0.56; 95% CI: -0.99, -0.13; p = 0.01) compared to waitlist controls. Subgroup analyses indicated that greater parental involvement associated with stronger treatment effects, particularly for depressive symptoms. The risk of bias was low in most included studies.</p><p><strong>Conclusions: </strong>Transdiagnostic CBT appears to be an effective intervention for managing emotional disorders in adolescents, offering benefits across anxiety, depression, and functioning.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"73-84"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369621","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":"Perspectives on Integrating Biological Assessments to Address the Health Effects of Childhood Adversities.","authors":"Emily J Blevins, Natalie Slopen, Karestan C Koenen, Caley Mikesell, Archana Basu","doi":"10.1097/HRP.0000000000000413","DOIUrl":"10.1097/HRP.0000000000000413","url":null,"abstract":"<p><p>A majority of adults in the United States report a range of stressful and potentially traumatic childhood experiences (e.g., physical or sexual abuse, witnessing violence, neglect). Such adversities are associated with a range of mental (e.g., anxiety, mood, and behavioral difficulties) and physical (e.g., cardiovascular illnesses, diabetes, asthma) health problems. Increasingly, precision medicine approaches seek to prevent and treat such multifinal downstream health problems by identifying common etiological pathways (e.g., inflammation and immune pathways) and candidate biomarkers to target interventions. In this context, we review the rationale for continued research to identify biomarkers of childhood adversity. Building on the bioecological theory, we emphasize that individual neurobiological profiles develop within multiple ecological levels (individual, family, neighborhood, macrosocial) that confer both risk and protective factors that can attenuate or amplify biological effects of childhood adversity. Given the limited data on adversity-associated biomarkers for children and adolescents, we discuss future recommendations for research, implications for clinical care, and ethical considerations. Preventing childhood adversity and supporting adversity- and trauma-informed systemic intervention approaches remains our primary recommendation. We highlight the continued need to consider both biomarkers of risk and protective factors across ecological levels in future research.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"44-56"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785125","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 \"Learning\" Birth Cohort: A New Approach to Catalyze Preventative Psychiatry.","authors":"Joshua L Roffman, Erin C Dunn","doi":"10.1097/HRP.0000000000000449","DOIUrl":"10.1097/HRP.0000000000000449","url":null,"abstract":"<p><p>Converging evidence indicates the importance of prenatal life to subsequent risk for psychopathology across the lifespan, suggesting that potential intervention during this period of heightened brain plasticity may also have enduring protective effects. We describe a novel experimental approach, the \"learning\" birth cohort, that couples observational and interventional methods over multiple investigation cycles, wherein high-throughput data collected in each wave are canvassed to discover, develop, and implement new interventions in subsequent waves. As illustrated, we can harness both family- and population-level data to effect iterative changes in the prenatal environment, with the goal of improved neurodevelopmental outcomes.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 1","pages":"3-6"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911302","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 Code Stroke to Cultural Formulation: A Case of Postpartum Functional Neurologic Disorder: Erratum.","authors":"Omar Hamza, Lorraine Pereira, Charles De Guzman, Marcela Almeida, Michelle Weyhaupt, Polina Teslyar","doi":"10.1097/HRP.0000000000000452","DOIUrl":"10.1097/HRP.0000000000000452","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 1","pages":"58"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911287","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":"Epigenetic Insights into the Impact of Disaster-Related Prenatal Stress: A Narrative Review.","authors":"Lei Cao-Lei, Daphne Vrantsidis, Gerald F Giesbrecht","doi":"10.1097/HRP.0000000000000446","DOIUrl":"10.1097/HRP.0000000000000446","url":null,"abstract":"<p><p>Disaster-related prenatal maternal stress, whether due to natural or human-made crises, can have profound effects on offspring health and development. This narrative review synthesizes research findings on the epigenetic mechanisms through which prenatal maternal stress influences long-term offspring health outcomes. Focusing primarily on DNA methylation, we examine how exposure to stress during gestation alters the epigenetic profile and may contribute to mental, cognitive, and physical health vulnerabilities. Studies were categorized based on disaster type, including time-limited events such as hurricanes, floods, and earthquakes, and stressors like the COVID-19 pandemic and famine. Key findings highlight the timing of exposure, sex-specific epigenetic effects, and the potential for epigenetic markers to mediate stress-induced health outcomes. While considerable progress has been made, our review emphasizes the need for further research on how epigenetics may mediate mental health outcomes and the development of interventions that target these molecular mechanisms.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 1","pages":"7-22"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911319","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}