Harvard Review of Psychiatry最新文献

{"title":"Retinal Biomarkers of Cognition in Schizophrenia: A Systematic Review and Meta-Analysis.","authors":"Sai Spoorthy Mamidipalli, Anu Franco, Janani Duraisamy, Avinash Damodar Segu, Nithin Kondapuram, Sreya Mariyam Salim, Cemal Demirlek, Paulo Lizano, Steven M Silverstein, Sai Krishna Tikka","doi":"10.1097/HRP.0000000000000480","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000480","url":null,"abstract":"<p><p>Individuals with schizophrenia consistently show thinning retinal layers, which can potentially serve as neural biomarkers. The association between retinal morphology and core symptom domains like cognitive functioning, however, has not been systematically synthesized. We hypothesize that deficits in retinal structure are associated with cognitive dysfunction in schizophrenia. This systematic review and meta-analysis looks at studies available from inception to June 9, 2026. Outcome measures include correlation coefficients between cognition scores and retinal thickness values (both macular and peripapillary-total and sector-wise) assessed using optical coherence tomography in patients with schizophrenia and related disorders. We assessed risk of bias with the Joanna Briggs Institute critical appraisal tool. Meta-analysis was conducted using the restricted maximum-likelihood method and Fisher's r-to-z transformation. Data from 16 studies (n=1,475 eyes; 847 patients) were included in a series of 88 pooled analyses. Overall cognitive ability correlated with thickness of the macular-retinal nerve fiber layer (mRNFL) (pooled-r=0.180; p=.002; k=7) and the superior-quadrant of the peripapillary RNFL (pRNFL) (pooled-r=0.214; p=.026; k=7). Attention correlated with mRNFL (pooled-r=0.210; p<.001; k=6), macular-inner plexiform layer (mIPL) (pooled-r=0.142; p=.012; k=8), and pRNFL (pooled-r=0.207; p<.001; k=9) thicknesses. Processing speed correlated with foveal thickness (FT) (pooled-r=0.206; p=.008; k=7), mIPL (pooled-r=0.194; p=.001; k=6), and pRNFL (pooled-r=0.211; p<.001; k=5) thicknesses. Executive function correlated with macular thickness (pooled-r=0.099; p=.018; k=10) and mRNFL (pooled-r=0.159; p=.009; k=6). Age, sex, cardiometabolic comorbidities, and smoking moderated these correlations. We provide evidence suggesting that retinal layer thickness is associated with poorer cognitive functioning in schizophrenia, supporting retinal changes as indicators of disease-related neural processes. The small number of available studies limits these conclusions.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127333","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":"Seclusion and Restraint in Emergency Settings: A Narrative Review.","authors":"Mariel L Cataldi, Mia Giles, Abigail L Donovan","doi":"10.1097/HRP.0000000000000482","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000482","url":null,"abstract":"<p><p>In psychiatry, restraints are considered last resort interventions to manage agitation and aggression. They are sometimes necessary, however, to ensure patient and staff safety. There are several types of restraints, including seclusion and various forms of physical and chemical restraints. While national guidelines emphasize using the least restrictive intervention, there is little empirical data to support the relative restrictiveness and safety of different restraint modalities. In this narrative perspective, we examine the rates, risks, and perceived relative benefits of these interventions in emergency settings, including emergency departments and psychiatric emergency services. Findings reveal a large variation in rates and types of restraint use. Additionally, there is a lack of high-quality research, with wide variability in definitions, study designs, and outcomes measures. This gap hinders development of evidence-based clinical guidelines and contributes to substantial variation in practice across different institutions and settings. The absence of rigorous data may allow institutional culture and individual bias to shape clinical decision-making surrounding one of the most restrictive interventions in psychiatry. Further research using consistent definitions and robust methodologies is essential to inform safer, more effective, and patient-centered practices.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108904","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":"Genes Do Not Read DSM: Tuberous Sclerosis Complex May Dominate with Multi-Neuropsychiatric Symptoms.","authors":"Wenqi Lü, Linyuan Sun, Taolin Chen, Mingli Li, Rong Ren, Jin Li, Azimatul Karimah, Qinghuan Yang, Pillai Rajapillai, Weihong Kuang","doi":"10.1097/HRP.0000000000000479","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000479","url":null,"abstract":"<p><p>Tuberous sclerosis complex (TSC) is a multisystem genetic disorder frequently accompanied by epilepsy and TSC-associated neuropsychiatric disorders. Psychiatric-predominant seizure presentations may, however, delay recognition. This clinical challenge describes a 26-year-old woman with recurrent panic-like episodes characterized by dyspnea, choking sensations, palpitations, and derealization, followed by depressive symptoms. The episodes persisted despite treatment with selective serotonin reuptake inhibitors and benzodiazepines. Further examination revealed hypomelanotic macules, prompting neurologic and systemic evaluation. Brain imaging demonstrated findings consistent with cortical tubers and subependymal nodules, while video electroencephalography captured frequent focal seizures without impaired awareness arising from the left frontotemporal region. Positron emission tomography/computed tomography identified a corresponding frontal abnormality. Although genetic testing detected a nonclassical TSC1 variant, the TSC diagnosis was established on clinical grounds. Treatment with lacosamide eliminated detectable epileptiform activity and substantially reduced the frequency and severity of her panic-like episodes; depressive and anxiety symptoms also improved with combined lacosamide and duloxetine treatment. This case illustrates how focal seizures involving frontal, temporal, and limbic-autonomic networks may mimic primary panic disorder. Stereotyped, brief, recurrent, and treatment-refractory psychiatric episodes-particularly when accompanied by neurocutaneous findings-should prompt electroencephalography and brain imaging. The case also emphasizes that an uninformative or uncertain genetic result does not exclude clinically established TSC or alter recommended surveillance and multidisciplinary management.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108883","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":"Perinatal Bipolar Disorder Management: Lithium in the Setting of Obstetric Complications.","authors":"Amanda M Koire, David Silver, Crystal T Clark, Veerle Bergink, Polina Teslyar","doi":"10.1097/HRP.0000000000000481","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000481","url":null,"abstract":"<p><p>Managing bipolar disorder in the perinatal period relies on psychopharmacologic treatment due to high rates of postpartum recurrence in the absence of mood-stabilizing medications. Lithium is classically recommended for postpartum bipolar episodes, yet lithium management during pregnancy, labor, and postpartum is complex and clinical practice varies even among reproductive psychiatrists. This case report details a 37-year-old woman with bipolar I disorder whose unexpectedly elevated lithium levels during pregnancy heralded preeclampsia. This case highlights the treatment challenges that arise when complicated psychiatric histories interact with complicated obstetric histories. We address conceptual questions about balancing psychiatric and obstetric risk when developing a medication regimen and illustrate continued dialogue regarding optimal lithium monitoring in the peripartum period.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108878","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":"Beyond Reflection: A Culturally Responsive, Mentalization-Based Balint Model for Medical Education.","authors":"Rick Peter Fritz Wolthusen, Andres Diocares, James Phillip Lefler, Paul Allen Riordan","doi":"10.1097/HRP.0000000000000483","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000483","url":null,"abstract":"<p><p>Balint groups are a widely used form of reflective practice in medical education that offer clinicians a structured space to examine the emotional and relational dimensions of patient care. A substantial body of evidence suggests that participation can enhance empathy, communication skills, and professional resilience. Traditional Balint formats, however, do not explicitly address two critical areas: (1) cultural humility, recognition of how identity, power, and social context shape clinical encounters; and (2) mentalization, the ability to understand one's own and others' thoughts, feelings, and intentions. In this column, we revisit the foundations and evidence base of Balint groups, with particular attention to their role in psychiatric training. We draw on, cultural psychiatry, mentalization-based theory, and medical education to introduce an adapted model that brings mentalization and cultural humility more explicitly into the group process. A composite case example and early experiences across training settings illustrate how focusing these processes can deepen reflection and shift discussion tone. Participants reported that naming culture and mentalization deepened discussion, enhanced empathy, and supported tolerance of ambiguity, while also highlighting challenges such as resistance, time constraints, and the need for facilitation. We outline practical considerations for implementation, including session structure, facilitator competencies, and strategies for managing cultural and emotional complexity. We also discuss limitations and propose future directions. By combining conceptual grounding with actionable guidance, our model aims to strengthen the educational and clinical impact of Balint groups and support more inclusive, emotionally attuned, and developmentally meaningful reflective practice in medical education.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108829","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":"MDMA-Assisted Therapy May Decrease PTSD Symptoms, Dissociation, Depression, and Functional Disability: A Systematic Review and Meta-Analysis.","authors":"Warwick M Green, Sanket B Raut, Fionnghuala L J James, David M Benedek, Robert J Ursano, Vincent F Capaldi, Luke R Johnson","doi":"10.1097/HRP.0000000000000478","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000478","url":null,"abstract":"<p><p>There is a need for new effective treatment options for posttraumatic stress disorder (PTSD), as many people with PTSD do not fully recover despite current treatments. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy (MDMA-AT) is emerging as a new treatment option. We assessed the current body of MDMA-AT evidence for effectiveness in treating PTSD, associated impairments, and quality of life by conducting a systematic review and meta-analysis of randomized controlled trials. Databases from ClinicalTrials.gov, MEDLINE, PsycInfo, PsycArticles, and Cochrane Library were searched from inception to June 2025. Data from seven randomized control trials (both published and unpublished) compared MDMA-AT with low-dose MDMA or placebo control combined with psychotherapy. Identified studies were not included in recent article retractions. Effect sizes were calculated using standardized mean difference for Clinician-Administered PTSD Scale scores and mean difference for secondary measures. MDMA-AT may significantly improve PTSD, dissociation, depression, and functional impairment, compared to controls, but not sleep quality. These results support MDMA-AT for PTSD core symptoms and quality-of-life measures. The evidence, however, is limited by small sample sizes in some studies, challenges with blinding in psychedelic studies, use of non-standardized therapies, and a common sponsor for all trials. While limitations exist, these findings provide evidence for a new emerging treatment option for PTSD.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906197","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":"Using Islamic Mindfulness-Based Interventions as a Compass for Improving Muslim Mental Health Outcomes: A Scoping Review.","authors":"Yusra Ahmad, Wai Lun Alan Fung, Heba Khan, Yusra Rahman, Aiesha Ahmad, Kenneth Fung, Ahmed N Hassan","doi":"10.1097/HRP.0000000000000476","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000476","url":null,"abstract":"<p><strong>Objective: </strong>Muslim communities in North America face significant mental health challenges that are exacerbated by Islamophobia, social isolation, and spiritual incongruence. Spiritually adapted mindfulness-based interventions (MBIs) tailored to Islamic principles have emerged as promising approaches. This scoping review explores how Islamic mindfulness practices are defined and implemented to enhance Muslim mental health outcomes.</p><p><strong>Methods: </strong>We conducted a systematic scoping review using Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines, searching seven databases from May 2024 to June 2025. The final analysis included 53 studies after a rigorous screening process.</p><p><strong>Results: </strong>The literature has expanded substantially in recent years, emphasizing Islamic practices such as dhikr, salah, Qur'anic recitation, and muraqabah as central components of mindfulness interventions. Integrating Islamic values into existing MBIs (e.g., mindfulness-based stress reduction and cognitive behavioral therapy [CBT]) shows enhanced cultural relevance and therapeutic engagement. Emerging neurophysiological evidence demonstrates effectiveness, including cortisol and dopamine regulation. Standardized, manualized approaches suitable for diverse Muslim populations, however, remain absent.</p><p><strong>Conclusions: </strong>Islamic mindfulness interventions offer substantial potential for improving mental health among Muslims. Future research should prioritize developing standardized, culturally responsive MBIs tailored to diverse Muslim communities.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 5","pages":"292-323"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944746","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":"Integrative Residential Treatment of Co-Occurring Borderline and Narcissistic Personality Dysfunction: Perspectives from the Gunderson Residence.","authors":"Karen L Jacob, Brandon T Unruh","doi":"10.1097/HRP.0000000000000475","DOIUrl":"10.1097/HRP.0000000000000475","url":null,"abstract":"<p><p>Individuals with co-occurring borderline personality disorder and narcissistic personality disorder often present with severe emotional dysregulation, interpersonal instability, identity disturbance, and entrenched patterns of shame, vulnerability, and defensiveness that challenge traditional treatment approaches. This article describes the treatment model of the Gunderson Residence, a highly specialized residential program that provides intensive, milieu-based care for individuals with complex personality pathology through an integrated, evidence-based framework. Grounded in empirically supported therapies primarily driven by Gunderson's good psychiatric management, treatment emphasizes recovery by helping residents understand the connections among their personality vulnerabilities, emotional experiences, and interpersonal functioning while simultaneously promoting engagement in meaningful life roles. Within a structured therapeutic community, residents participate in an integrated model that draws from mentalization-based treatment, transference-focused psychotherapy, and dialectical behavior therapy. Individual psychotherapy, skills training, group therapy, family work, psychiatric care, and the milieu interplay to create a therapeutic context in which challenging interpersonal patterns emerge, can be understood, and are addressed in real time. Particular attention is given to helping residents develop greater capacity for mentalization, emotion regulation, identity integration, and reflective functioning while reducing reliance on rigid narcissistic and borderline defenses. The residential setting provides repeated opportunities to practice new ways of relating, tolerate emotional vulnerability, and receive immediate feedback from peers and staff. The overarching goal extends beyond symptom stabilization; the aim is to foster durable personality change by helping residents develop insight into their vulnerabilities, strengthen interpersonal effectiveness, and generalize these capacities to relationships, work, and independent living following discharge.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"345-359"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706359","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":"Use of Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder in the Context of a Comorbid Delusional Disorder.","authors":"Yunong Bai, Rafael Tamargo, Margaret Achee, Heather Burrell Ward, Julia M Sheffield","doi":"10.1097/HRP.0000000000000471","DOIUrl":"10.1097/HRP.0000000000000471","url":null,"abstract":"<p><p>We present a case of repetitive transcranial magnetic stimulation (rTMS) use to treat a 38-year-old male with initial diagnostic uncertainty between major depressive disorder (MDD) with psychotic features and MDD with co-occurring delusional disorder, persecutory type. This patient reported a long-standing history of depressive symptoms and recent onset of paranoid delusions. Prior to receiving rTMS, the patient was treated for three years with a combination of antidepressants, antipsychotics, and cognitive behavioral therapy for psychosis. During this period, his delusions persisted irrespective of changes in mood symptoms, confirming his diagnosis of MDD with co-occurring delusional disorder. He received rTMS for severe, treatment-refractory depression that worsened in the setting of psychosocial stressors. Following treatment, his mood symptoms significantly improved while his paranoid beliefs persisted. This case is significant due to treatment planning difficulty given initial diagnostic uncertainty between MDD with psychotic features and MDD with co-occurring delusional disorder. Additionally, paranoia and delusions respond poorly to current psychotropic medication and psychotherapy treatment options. This case highlights the need for better treatment for delusions and the importance of iteratively assessing treatment response and updating patient formulation when navigating diagnostic uncertainty. In this clinical challenge, experts discuss considerations in differentiating MDD with psychotic features and MDD with co-occurring delusional disorder. Additionally, they weigh implications for rTMS treatment candidacy, evidence supporting rTMS for psychotic disorders, the role of psychotherapy in treating paranoia, and the neural circuits involved in persecutory delusions.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"360-368"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520072","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":"Beyond Symptom Recognition: Toward a Comprehensive Multidimensional Framework of Insight in Depression.","authors":"Asala Halaj, Mark Zimmerman","doi":"10.1097/HRP.0000000000000474","DOIUrl":"10.1097/HRP.0000000000000474","url":null,"abstract":"<p><p>Insight in psychiatry has historically been defined through symptom awareness, illness attribution, and recognition of need for treatment-constructs developed primarily in the context of psychosis. When applied to major depressive disorder, psychosis-derived models fail to capture the cognitive-emotional complexity of the depressive experience. This paper proposes a comprehensive, multidimensional framework of insight in depression that integrates three domains: cognitive awareness (symptom recognition, perceived treatment need, and normalization/minimization bias), emotional interpretation (self-blame, guilt/shame, rumination, moral self-evaluation, internalized stigma, and emotional validation), and clinical/relational engagement (help-seeking, adherence, clinician trust, alliance, and recovery orientation). We delineate the limitations of psychosis-based models, outline depression-specific mechanisms, and demonstrate how these elements shape engagement and outcomes, even when symptom recognition is intact. The framework addresses critical gaps in current assessment and treatment approaches, particularly for the substantial population with depression that delays or never seeks professional help. We discuss implications for assessment and the need for depression-specific measures. Additionally, we map future research priorities, including validation studies, longitudinal designs, and intervention trials targeting the emotional and cognitive dimensions of insight. Integrating emotional and cognitive self-appraisal into insight models offers a more valid and clinically actionable understanding of depression.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"281-291"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792255","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}