Harvard Review of Psychiatry最新文献

{"title":"From Code Stroke to Cultural Formulation: A Case of Postpartum Functional Neurologic Disorder.","authors":"Omar Hamza, Lorraine Pereira, Charles De Guzman, Marcela Almeida, Michelle Weyhaupt, Polina Teslyar","doi":"10.1097/HRP.0000000000000442","DOIUrl":"10.1097/HRP.0000000000000442","url":null,"abstract":"<p><p>Functional neurologic disorder (FND) is an underrecognized but important cause of acute neurological presentations in the postpartum period, particularly among culturally diverse patient populations. We present the case of a female Nepali immigrant (G5P3023 [fifth pregnancy, three term births, zero preterm births, two pregnancies that ended before 20 weeks, three living children]) in her late 30s with no prior medical or psychiatric history. She developed sudden neurological deficits on postoperative Day 0 following an uncomplicated Cesarean delivery. Approximately 11 hours after delivery, the patient became dizzy, pale, and diaphoretic, then developed right-upper and bilateral-lower extremity paralysis with impaired eye and mouth opening. A code stroke was initiated. Extensive workup (including computed tomography head, computed tomography angiography head/neck, and magnetic resonance imaging brain) was unremarkable. Neurological deficits resolved within hours after ammonia inhalant stimulation. The patient was ultimately diagnosed with postpartum FND. This case highlights key diagnostic and management challenges in distinguishing FND from stroke, catatonia, and dissociative states in medically complex postpartum patients. It also underscores the importance of trauma-informed, culturally sensitive approaches to diagnosis and care. Our discussion explores the limited but evolving literature on postpartum FND-potentially inclusive of sensory-motor mismatch, loss of agency, hormonal shifts, and psychosocial stressors-while also exploring strategies for culturally grounded psychoeducation. Clinicians must vigilantly watch for functional presentations postpartum to avoid unnecessary interventions and promote holistic recovery. Cross-disciplinary collaboration among psychiatry, neurology, and obstetrics is essential for optimal care.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 6","pages":"328-332"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892420","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":"Case Report: Personalizing Transcranial Magnetic Stimulation Therapy for Treatment-Resistant Depression for a Patient with Complex Medical History.","authors":"Julia C Schmidt, Rachel Davis, Erica Rapp, Micol Rothman, Elizabeth Fenstermacher","doi":"10.1097/HRP.0000000000000443","DOIUrl":"10.1097/HRP.0000000000000443","url":null,"abstract":"<p><p>Patients presenting with treatment-resistant depression (TRD) often have complex medical comorbidities that can limit the use of new and novel treatments. Transcranial magnetic stimulation (TMS) is FDA-approved and, overall, has a low adverse side-effect profile. Consensus guidelines, however, are broad and lack specificity around managing individual patient risk. Therefore, individual clinicians must make significant determinations about candidacy and risk management in medically complex patient presentations. This case report details a 49-year-old male with a 10-year history of major depressive disorder with significant medical comorbidity (chronic pain, post-thyroidectomy hypocalcemia secondary to hypoparathyroidism, and basal ganglia calcifications). We illustrate how interdisciplinary care coordination can allow for safe and effective use of TMS in a medically complex patient with severe TRD. This case highlights the importance of personalized treatment planning to expand access to neuromodulation.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 6","pages":"319-327"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12594129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892444","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":"Culturally Responsive Mental Health Care for Asian Americans: A Call to Action.","authors":"Miglia Cornejo, Ron Tang, Crystal Han, Nhi-Ha Trinh","doi":"10.1097/HRP.0000000000000441","DOIUrl":"10.1097/HRP.0000000000000441","url":null,"abstract":"<p><p>Though Asian Americans (AAs) are the fastest growing racially minoritized group in the United States, their mental health care needs have not received adequate attention. AAs are less likely to seek mental health care than other minoritized groups. When they do, they often present more acutely, a trend exacerbated by events amidst the COVID-19 pandemic. During the pandemic, AAs experienced increased discrimination and anti-Asian hate crimes that still persist today. One in five AAs who has encountered racism has suffered psychological and emotional effects as a result. Recent studies have shown an increased risk of depression associated with anti-Asian crime rates. Although the psychological toll of COVID-19-related racism has led to increased prevalence of overall mental health symptoms, the likelihood that AAs seek care still remains low. This column highlights the specific challenges faced by AAs and the critical need for culturally responsive mental health initiatives and resources to better serve the unique needs of this community.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 6","pages":"333-340"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892490","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 Critical Value of High-Risk Designs and Developmental Psychopathology Frameworks for Understanding Affective Psychopathology: Insights from Research on Anhedonia.","authors":"Tina Gupta, Carly J Lenniger, T H Stanley Seah, Erika E Forbes","doi":"10.1097/HRP.0000000000000445","DOIUrl":"10.1097/HRP.0000000000000445","url":null,"abstract":"<p><p>Developmental psychopathology frameworks view development as a dynamic process that integrates multiple systems, clarifying how psychopathology develops and who develops it. High-risk study designs, such as those investigating progressive changes in youth with familial psychopathological histories, are one developmental research strategy. While much research focuses on clinical symptoms after they emerge, this approach hinders our understanding of when and how clinical symptoms and psychopathology develop and identification of risk factors, neural mechanisms, and clinical correlates. We review the critical value and advantages of using high-risk designs and developmental psychopathology frameworks to understand the emergence of affective psychopathology. We focus on anhedonia, a transdiagnostic affective symptom-defined as diminished experiences of pleasure-which emerges during adolescence, and occurs prior to onset of disorders like depression. We review the phenomenology, behavior, and neural mechanisms of anhedonia. Then we discuss the symptom from a developmental psychopathology perspective, outlining the advantages and disadvantages of using high-risk designs. From there, we synthesize the literature and conclude with clinical implications and considerations for future directions. These approaches are critical for understanding mental health, particularly affective psychopathology, and deserve more attention in the field.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 6","pages":"305-318"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12768445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892467","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":"Equitable Access to Gender-Affirming Care for Transgender and Gender Diverse People with Severe Mental Illness: A Reverse Integration Approach.","authors":"Ginger Gramson, Alex S Keuroghlian","doi":"10.1097/HRP.0000000000000438","DOIUrl":"10.1097/HRP.0000000000000438","url":null,"abstract":"<p><p>Transgender and gender diverse (TGD) people with severe mental illness (SMI) face significant barriers to health care access, leading to unmet needs and inequitable health outcomes. Reverse integration models embed primary care services within mental health centers (MHCs) that serve as primary contact points to broader health care systems for people with SMI. Such models have been shown to improve health outcomes in this population by promoting access to screening, preventative care, and chronic metabolic condition management. This article highlights the benefits of gender-affirming medical care (GAMC)-including reductions in depression, at-risk substance use, and suicidality-and explores reverse integration models for promoting equitable access to GAMC for TGD people with SMI. We propose two strategies: (1) colocation of GAMC services within MHCs and (2) coordinated referrals to external GAMC practices. Additionally, we address clinical considerations for supporting GAMC access for people with SMI, emphasizing the importance of individualized, person-centered care, clinician education, care coordination, and ongoing collaboration between MHCs and gender-affirming medical practitioners to equitably serve this population. Recognizing the ethical principles of justice and autonomy, we advocate for integrating supportive GAMC pathways within MHCs to ensure access to comprehensive, affirming care in settings that foster trust and continuity.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"282-287"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872894","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":"Pharmacological Treatment of Hallucinogen Persisting Perception Disorder (HPPD): A Systematic Review.","authors":"Arjen Neven, Jan Dirk Blom","doi":"10.1097/HRP.0000000000000439","DOIUrl":"10.1097/HRP.0000000000000439","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 5","pages":"264-275"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12424536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052722","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 Impact of Firearm Ownership, Violence, and Policies on Mental Health: A Systematic Scoping Review.","authors":"Victor Hugo Spitz, Bianca Besteti Fernandes Damiano, Loyná Eua Flores E Paez, Mariana de Amorim Auler, Letícia Lopes, Loren Beiram, Guilherme Pimenta Roncete, Otávio De Lacquila Yano, Raphael Neves Dos Santos Mosqueira Gomes, Rodolfo Furlan Damiano","doi":"10.1097/HRP.0000000000000440","DOIUrl":"10.1097/HRP.0000000000000440","url":null,"abstract":"<p><strong>Background: </strong>Increased firearm accessibility and related violence have generated global debate concerning public gun policies. Although the physical dangers associated with firearms are widely acknowledged, the psychological effects of firearm use and accessibility require greater exploration. We evaluate the influences of gun ownership, violence, and policies on mental health outcomes across different populations.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across multiple databases, including PubMed, Scopus, Web of Science, and PsycInfo, yielding 467 studies. A scoping review was then performed to thematically categorize and analyze the associations between gun access and aggressive behavior, substance abuse, societal violence, and mental health outcomes.</p><p><strong>Results: </strong>Our findings identify three fundamental psychological mechanisms through which firearms affect mental health: (1) as enablers of impulsive action during distress; (2) as amplifiers of existing psychological states (e.g., aggression, fear, trauma); (3) and as symbols that transform power dynamics and vulnerability perceptions. Specifically, permissive gun policies and firearm ownership are linked to higher rates of firearm-related suicides and aggressive behavior. Exposure to gun violence significantly exacerbates psychological distress, especially among vulnerable populations, and its effects persist long after direct exposure.</p><p><strong>Discussion: </strong>This review highlights the urgent need for comprehensive policies that address firearm accessibility, promote mental health interventions, and address the social determinants of firearm-related harm. Such an integrated public health approach addressing these individual and societal factors is essential for mitigating the complex psychological pathways through which firearms affect mental health across populations.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 5","pages":"243-263"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052776","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":"Comorbid Autism, Anxiety, and ADHD in a Preadolescent Boy: Clinical Opportunities.","authors":"Elizabeth Steuber, Jason Fogler, Oscar Bukstein, Heather Potts","doi":"10.1097/HRP.0000000000000437","DOIUrl":"10.1097/HRP.0000000000000437","url":null,"abstract":"<p><p>Autism spectrum disorder (ASD) is often comorbid with other psychiatric disorders, such as anxiety and attention-deficit hyperactivity disorder (ADHD). While common, individuals with autism and their families often face challenges accessing appropriate community-based treatment for coexisting disorders. The case of a preadolescent boy with ASD and comorbid anxiety and ADHD illustrates challenges and frustrations associated with fragmented health care systems, prolonged wait times for specialized services, and limited availability of clinicians trained in neurodevelopmental and psychiatric comorbidity interventions. Evidence-based psychotherapeutic and pharmacologic treatments for neurodivergent patients with psychiatric comorbidities are also discussed. Ongoing advocacy to reduce disparities and improve outcomes for children with neurodevelopmental and mental health needs is critically needed.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 5","pages":"276-281"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052690","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":"What Does Neuroimaging Indicate in Excoriation (Skin-Picking) Disorder?","authors":"Murad Atmaca, Muhammed Fatih Tabara","doi":"10.1097/HRP.0000000000000435","DOIUrl":"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":3.4,"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":"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":3.4,"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}