Harvard Review of Psychiatry最新文献

{"title":"What Does Neuroimaging Indicate in Excoriation (Skin-Picking) Disorder?","authors":"Murad Atmaca, Muhammed Fatih Tabara","doi":"10.1097/HRP.0000000000000435","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000435","url":null,"abstract":"<p><strong>Learning objectives: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Analyze neuroimaging findings to identify and explain structural and functional brain differences associated with SPD, including implications for impulse control, emotional regulation, and motor coordination.</p><p><strong>Abstract: </strong>Skin-picking (excoriation) disorder (SPD), characterized by recurrent and excessive skin picking without underlying skin disease, leads to significant tissue damage. This review highlights the disorder's influences on brain function and structure. Neuroimaging and neurocognitive studies indicate that impairments in frontostriatal circuits are critical to SPD development. Abnormalities in motor control circuits also contribute to motor control issues and impulsivity, suggesting that these circuits play a role in SPD's pathophysiology. Functional imaging studies show hypoactivity in the anterior cingulate cortex, dorsal striatum, and right medial frontal areas, regions essential for motor movement formation and suppression. Structurally, patients with SPD exhibit brain volume and cortical thickness changes in frontal regions involved in impulse control, such as the inferior frontal gyrus, orbitofrontal cortex, and nucleus accumbens, compared to those with trichotillomania and healthy controls. These findings suggest that SPD has distinct neurobiological and neuroanatomical features, emphasizing the importance of further research to understand its underlying mechanisms.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 4","pages":"213-221"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608237","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 Impact of Maternal Depression on Early Parenting: A Systematic Review.","authors":"Eduarda Martins Lages, Mariana Adamoli Marques da Silva, Fernanda Cunha Soares, Tiago N Munhoz","doi":"10.1097/HRP.0000000000000434","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000434","url":null,"abstract":"<p><strong>Background: </strong>Maternal depression is an established risk factor for parenting disruptions with potential consequences for child development. Although previous studies have examined the effects of maternal depression on parenting behaviors, the most recent systematic reviews and meta-analyses only include data up to 2013. Given evolving perspectives and methodologies, updated insights are necessary. This systematic review synthesizes evidence on the association between maternal depression and parenting over the past decade.</p><p><strong>Method: </strong>Systematic searches were conducted in MEDLINE/PubMed, SciELO, BVS, LILACS, Embase, Web of Science, and PsycInfo with no language restrictions. The search focused on studies published between 2013 and 2023. Inclusion criteria were comprised of observational studies assessing parenting among mothers diagnosed with depression during their child's youth or adolescence. Of the 11,305 studies screened, 166 were fully reviewed by two independent reviewers, resulting in 29 eligible studies. No gray literature was included.</p><p><strong>Results: </strong>Among the 29 studies, 28 reported an association between maternal depression and parenting. Most were conducted in high-income countries, focused on children under 36 months, and used cross-sectional designs. Two-thirds were published after 2017. This review's limitations include studies predominantly from high-income settings, exclusive assessment of parenting practices without broader parenting constructs, and the absence of meta-analysis.</p><p><strong>Conclusion: </strong>Findings consistently highlight the association between maternal depression and negative parenting practices, influencing sensitivity, affection, attachment, involvement, commitment, responsiveness, and stimulation. Mothers experiencing depression face challenges across these domains, which may affect child development. Future research should explore these associations in diverse sociocultural contexts and include longitudinal studies to better understand long-term effects.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 4","pages":"179-190"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608235","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":"Vicarious Racism and Links to Negative Emotions and Mental Health in US Adults: A Scoping Review.","authors":"G Alice Woolverton, Wenbo Zhang, Sylvia H M Wong, Jessica J Wang, Vi Nguyen, Chang Zhao, Ritika Rastogi, Tiffany Yip, Brian TaeHyuk Keum, Cindy H Liu","doi":"10.1097/HRP.0000000000000436","DOIUrl":"10.1097/HRP.0000000000000436","url":null,"abstract":"<p><strong>Introduction: </strong>Vicarious racism, or second-hand/indirect exposure to racism, is a highly prevalent phenomenon linked to negative emotions and poor mental health. We performed a scoping review to summarize and analyze the literature on how vicarious racism is defined and measured, where it occurs, samples and study designs used, racial makeup of witnesses compared to targets, evidence connecting vicarious racism to negative emotions and poor mental health, and recommendations for future research.</p><p><strong>Methods: </strong>We followed the Population, Concept, and Context framework for scoping reviews and searched PubMed and PsycInfo for relevant studies. Five reviewers performed study selection, screening, and extraction using Covidence. We reviewed 51 empirical studies published between 2014 and 2024 using adult samples from the United States.</p><p><strong>Results: </strong>There is a lack of consensus about how vicarious racism is defined and measured. The majority of papers focused on Black and/or Asian samples; a limited number included Latine samples. Most studies used a cross-sectional design. Positive associations between vicarious racism and poor mental health were observed, with few studies reporting null findings. The two most common recommendations for future research were: (1) identifying pathways from vicarious racism to mental health outcomes and (2) increasing sample diversity.</p><p><strong>Conclusions: </strong>Comprehensive definitions of vicarious racism and gold-standard measures are necessary for the unified progression of knowledge. Increasing sample diversity in future research will lead to more generalizable findings. Identifying pathways from vicarious racism to mental health outcomes is critical for intervention and prevention among those most vulnerable.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 4","pages":"191-212"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608236","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":"After Patient Suicide: Fostering a Culture of Patient Safety and Clinician Well-Being to Improve Quality of Care.","authors":"Ashwini Nadkarni, David S Kroll, David A Silbersweig","doi":"10.1097/HRP.0000000000000431","DOIUrl":"10.1097/HRP.0000000000000431","url":null,"abstract":"<p><strong>Abstract: </strong>Clinician well-being and patient safety culture play critical roles in how clinicians respond to adverse events. These elements, in turn, affect clinician experience and future patient access to care, both key drivers of health care quality. While there is literature on the relationship between well-being and safety culture, in this column we critically examine their importance after patient suicide, a most devastating medical outcome. We discuss the definition of well-being and safety culture; clarify their relationship; and offer recommendations to achieve both following patient suicide to mitigate future risk.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 4","pages":"239-241"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608233","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":"Badge of Courage: Pain and Suffering After Military Service in a Nonveteran.","authors":"Seo Ho Song, J Nicholas Shumate, Rohn S Friedman, Eric Y Drogin, James J Feldman, Elizabeth Dunn","doi":"10.1097/HRP.0000000000000433","DOIUrl":"10.1097/HRP.0000000000000433","url":null,"abstract":"<p><strong>Abstract: </strong>Feigning and fabrication by a patient can evoke anger and distress in staff and generate diagnosis and management challenges. When faced with difficulties that can lead to moral injury among health care providers, and even risk compromised patient care, clinical teams must balance empathy with appropriate boundaries. This case report examines an individual with a history of polysubstance use and acute-on-chronic pain whose persistent patterns of fabrication-spanning exaggerated military service, terminal illness, family trauma, and academic accomplishments-posed substantial risk-assessment and treatment-planning challenges across multiple clinical presentations. Insights from three expert discussants with distinct specializations in psychodynamic formulation, distress management, and forensic psychiatry are provided. Through their analyses, the complex interplay among chronic pain, inadequate distress tolerance, personality pathology, and health care utilization are evaluated in conjunction with evidence-based approaches to differential diagnosis and management. This article presents practical recommendations for preserving therapeutic engagement while protecting appropriate boundaries and, ultimately, working toward optimized care delivery for such challenging, vulnerable patients.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 4","pages":"232-238"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608234","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":"Health Economic Perspective on Internet-Based Psychological Interventions for the Prevention and Management of Eating Disorders.","authors":"Shun Zeng, Nanna Liu, Na Duan, Zue Mo, Chunqi Ai","doi":"10.1097/HRP.0000000000000432","DOIUrl":"10.1097/HRP.0000000000000432","url":null,"abstract":"<p><strong>Background: </strong>Internet-based psychological interventions are becoming a feasible substitute for conventional in-person therapy. This article provides a perspective on health economic evaluations of internet-based interventions employed for preventing and managing eating disorders (EDs).</p><p><strong>Methods: </strong>A comprehensive search was undertaken from January 2000 to December 2023 across five general medical and three health economic databases. The goal was to identify complete economic evaluations of internet-based strategies for managing and preventing EDs.</p><p><strong>Results: </strong>A total of seven economic evaluations were found, carried out across four countries. The studies utilized internet-based cognitive behavioral therapy, Featback, and virtual Body Project groups as experimental interventions. The controls were either wait-list comparison groups or recipients of face-to-face cognitive behavioral therapy. Among the seven studies evaluated, five indicated that internet-based interventions were more advantageous in terms of cost and clinical benefits based on both societal and health care perspectives. One study supported implementation of the internet-based intervention primarily based on cost, and one study's findings were inconclusive.</p><p><strong>Conclusion: </strong>From both societal and health care perspectives, internet-based interventions offer significant benefits in terms of cost and clinical effectiveness. The current body of evidence, however, is limited by the small number of studies and methodological variations. It is also essential to understand that these intervention outcomes may be influenced by comparator choice and thresholds for willingness to pay.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"222-231"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173597","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":"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":"10.1097/HRP.0000000000000426","url":null,"abstract":"<p><strong>Learning objectives: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Summarize findings from systematic reviews and meta-analyses on the efficacy of psychotherapeutic bereavement interventions.• Identify and apply key moderating factors (e.g., symptom severity, timing, age, gender) that influence intervention outcomes.• Analyze methodological limitations in the bereavement literature, including study design and review quality issues.</p><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":"127-148"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105970/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disrupted Cortico-Striato-Thalamo-Cortical Circuitry and Sleep Disturbances in Obsessive-Compulsive Spectrum, Chronic Tic, and Attention-Deficit/Hyperactivity Disorders.","authors":"Margaret D Hall, Kevin S Gipson, Shih Yee-Marie Tan Gipson, Mary K Colvin, Stephanie T T Nguyen, Erica Greenberg","doi":"10.1097/HRP.0000000000000429","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000429","url":null,"abstract":"<p><strong>Abstract: </strong>The bidirectional relationship between sleep and obsessive-compulsive spectrum disorders (OCSDs), chronic tic disorders (CTDs), and attention-deficit/hyperactivity disorder (ADHD) is not well understood. To better treat individuals with these co-occurring sleep and developmental neuropsychiatric conditions, it is necessary to determine the common neural underpinnings to then target with treatment. Research has implicated dysregulated cortico-striatal-thalamo-cortical (CSTC) neurocircuitry in the development of CTDs, OCSDs, and ADHD. We review current literature to assess the state of knowledge about the neurocircuitry of OCSDs, CTDs, and ADHD, and their related sleep disturbances. Our review consistently implicates CSTC-pathway disruptions in OCSDs, CTDs, and ADHD, as well as dopamine and GABA dysregulation, primary neurotransmitters in CSTC circuitry, in sleep disorders. In addition, we highlight reports of subjective poor sleep and insomnia in adults with OCSDs, CTDs, and ADHD, and sleep movement disorders in adults with CTDs. The limited sleep research on youth with these conditions has demonstrated some similar findings. Unfortunately, much of the current research to date has not employed polysomnographic methods for objective sleep-related assessments. Future research should further clarify the neural association between these neuropsychiatric conditions and sleep disturbances to better guide potential therapeutic targets. Determining the most effective treatments for subjective sleep-related complaints in patients with these conditions will be crucial, particularly for determining treatment course-whether to prioritize treatment of the underlying condition, the specific sleep symptoms, or both simultaneously.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 3","pages":"114-126"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980664","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":"Community Health Workers Research: Where Are We Now? A Narrative Review of an Expanding Workforce for Mental Health.","authors":"Taysha N Bruno Ortiz, Sofia Chu DeChristofaro, Michelle Cheng, Margarita Alegría","doi":"10.1097/HRP.0000000000000427","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000427","url":null,"abstract":"<p><strong>Abstract: </strong>In an evolving health care landscape, community health workers (CHWs) have emerged as invaluable assets, bridging gaps to mental health service access and fostering community resilience. In this article, we explore the multifaceted responsibilities shouldered by CHWs, encompassing outreach, education, and support, and underscore their unique abilities to establish trust within diverse communities. We also highlight evolving recognition of CHWs as integral health care team members and examine the growing body of evidence on CHW effectiveness in enhancing mental health outcomes, reducing disparities, and promoting preventative measures. Additionally, we review how, in the wake of the COVID-19 pandemic, the CHW role has shifted with increased demand for their services within the mental health care landscape. The pandemic laid bare the vulnerabilities in existing health care structures, disproportionately affecting communities with limited resource access, including mental health support. Furthermore, we review six primary research domains that could potentially help expand the CHW workforce: standardization and training, sustainability and retention, integration into health systems, impact measurement, cost-effectiveness and financing, and scaling up and adaptation. Last, we examine the pandemic's transformative effects on CHWs; we shed light on their resilience and adaptability in the face of unprecedented challenges and underscore their heightened relevance within the evolving health care response paradigm post-COVID.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 3","pages":"103-113"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992951","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 Shared Decision-Making Breaks Down: Solving Moral Dilemmas in Antipsychotic Deprescribing.","authors":"Helene Speyer, Ju Zhang, John Lysaker, David Roe","doi":"10.1097/HRP.0000000000000430","DOIUrl":"10.1097/HRP.0000000000000430","url":null,"abstract":"<p><strong>Abstract: </strong>Many individuals diagnosed with psychosis make multiple attempts to discontinue antipsychotic medications. In this clinical challenge, we examine three snapshots in which shared decision-making (SDM) breaks down due to ongoing disagreement between the service user and the health care provider. We offer three perspectives on how to think about such disagreement: philosophical, psychological, and psychiatric perspectives. Finally, we propose shared deliberation as a potential model for when SDM fails, emphasizing an iterative process of mutual value sharing that avoids binary yes/no responses.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 3","pages":"170-177"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009648","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}