JAMA Psychiatry最新文献

{"title":"Mental Health Research in the Department of Veterans Affairs.","authors":"Mark A Reger,Miriam J Smyth","doi":"10.1001/jamapsychiatry.2025.1808","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1808","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"7 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory Exposure and Depression in Older Adults With Insomnia: A Randomized Clinical Trial.","authors":"Michael R Irwin,Chloe C Boyle,Joshua H Cho,Dominique Piber,Nina Sadeghi,Daisy Castillo,Michael T Smith,Naomi I Eisenberger,Richard Olmstead","doi":"10.1001/jamapsychiatry.2025.1327","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1327","url":null,"abstract":"ImportanceInsomnia and inflammation are prevalent in older adults, and both are risk factors for late-life depression. Older adults with insomnia who are exposed to inflammatory challenge may be more vulnerable to depression.ObjectiveTo determine whether inflammatory exposure induces greater increases in depressive mood and symptoms in older adults with insomnia disorder compared to those without insomnia.Design, Setting, and ParticipantsThis assessor-blinded, parallel-condition randomized clinical trial was conducted from August 2017 to November 2022 at a single site in Los Angeles, California, among a community-based sample of 160 nondepressed adults aged 60 years or older (53 with insomnia disorder and 107 without insomnia, or control). Data analysis occurred from July 2023 to August 2024.InterventionsParticipant groups stratified by insomnia status were randomized to 2 conditions: endotoxin or placebo.Main Outcomes and MeasuresThe primary outcome was depressed mood, assessed by the Profiles of Mood States depression subscale (POMS-D). Secondary outcomes were depressive symptom severity and inflammatory cytokines.ResultsAmong 160 randomized participants eligible for the study (mean [SD] age, 65.9 [4.6] years; 84 female participants [52.5%]), 79 participants (26 with insomnia, 53 control participants) were randomized to endotoxin and 81 (27 with insomnia, 54 control participants) to placebo. All randomized participants completed the protocol. Compared to placebo, endotoxin induced increases in POMS-D to a significantly greater extent in those with insomnia than controls (condition × group interaction, F10,1478 = 4.7; P < .001), with a similar effect for observer-rated POMS-D mood (condition × group interaction, F3,450 = 5.5; P = .001), as well as clinically meaningful increases in observer-rated measures of depressive symptoms. Endotoxin induced similar increases in inflammatory cytokines in both groups. Moderation analyses found that the inflammatory response was associated with increases in POMS-D in the insomnia group (β = 0.33; 95% CI, 0.26-0.41; P < .001) but not in control participants.Conclusions and RelevanceIn this randomized clinical trial, older adults with insomnia showed an exaggerated vulnerability to depressive mood and symptoms in response to inflammatory challenge. Older adults with insomnia should undergo vigilant depression monitoring during periods of inflammatory exposure; selective depression prevention strategies that target both insomnia and inflammatory phenotypes are needed.Trial RegistrationClinicalTrials.gov Identifier: NCT03256760.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"24 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Errors in Numbers in Meta-Analysis.","authors":"","doi":"10.1001/jamapsychiatry.2025.1716","DOIUrl":"10.1001/jamapsychiatry.2025.1716","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issues With Person-Time and Repetitive Event Calculation.","authors":"Wan-Ting Chen,Yi-Chih Shiao,Chih-Sung Liang","doi":"10.1001/jamapsychiatry.2025.1649","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1649","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"43 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issues With Person-Time and Repetitive Event Calculation-Reply.","authors":"M Haisum Maqsood,Sean P Heffron","doi":"10.1001/jamapsychiatry.2025.1652","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1652","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"12 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US Abortion Restrictions and the Neuropsychiatric Health of Pregnant Individuals and Families.","authors":"Lauren M Osborne,Paul Appelbaum,Katie Watson,Kimberly Yonkers,Inger Burnett-Zeigler,C Neill Epperson,Catherine Monk,Katherine L Wisner","doi":"10.1001/jamapsychiatry.2025.1376","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1376","url":null,"abstract":"ImportanceRecent changes in the legal landscape in the United States have affected access to abortion, and this restricted access has profound effects on both physical and mental health of reproductive-aged women and their families.ObservationsDenial of abortion care has substantial consequences for the mental health of pregnant individuals and their children. We review rates of mental health symptoms and disorders in abortion-seeking individuals, those who are denied care, and those who are subject to laws restricting care. We also cover how these effects are experienced by those in marginalized communities, including rural populations and those of limited financial resources, and how resulting distress affects children born to those denied abortions. Finally, we review the current and shifting legal landscape and how it affects clinicians aiming to care for those experiencing mental health sequelae from the denial of abortion care.Conclusions and RelevanceThere is an urgent need for research on strategies to manage psychiatric disorders associated with restricted reproductive health services. The health of the mother is a critical element in fetal and infant well-being. Individuals who are forced to continue an unwanted pregnancy deserve the social and resource support required to deliver healthy infants who can be raised in an environment that allows the family to thrive.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"108 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Dilemmas of Antipsychotic Discontinuation","authors":"Helene Speyer, John Lysaker, David Roe","doi":"10.1001/jamapsychiatry.2025.1702","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1702","url":null,"abstract":"This Viewpoint discusses the process of shared decision-making between clinicians and patients when considering the discontinuation of antipsychotic medication and proposes a shift toward an alternative process of shared deliberation.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"30 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid 1115 Waivers for Mental Health-Time for Redesign?","authors":"K John McConnell,Jennifer D Hall,Benjamin F Miller","doi":"10.1001/jamapsychiatry.2025.1607","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1607","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"146 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Nature of Antidepressant Discontinuation Symptoms: A Systematic Review and Meta-Analysis.","authors":"Michail Kalfas,Dimosthenis Tsapekos,Matthew Butler,Robert A McCutcheon,Toby Pillinger,Rebecca Strawbridge,Bhagyashree Bhaskar Bhat,Peter M Haddad,Philip J Cowen,Oliver D Howes,Dan W Joyce,David J Nutt,David S Baldwin,Carmine M Pariante,Gemma Lewis,Allan H Young,Glyn Lewis,Joseph F Hayes,Sameer Jauhar","doi":"10.1001/jamapsychiatry.2025.1362","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1362","url":null,"abstract":"ImportanceThe incidence and nature of discontinuation symptoms following antidepressant cessation remain unclear.ObjectiveTo examine the presence of discontinuation symptoms using standardized scales (eg, Discontinuation-Emergent Signs and Symptoms [DESS]) and the incidence of individual discontinuation symptoms in individuals who stop taking antidepressants.Data SourcesThe databases Embase, PsycINFO, Ovid MEDLINE, and Cochrane Library were systematically searched from inception until November 7, 2023.Study SelectionRandomized clinical trials (RCTs) reporting discontinuation symptoms using a standardized scale or individual symptoms (eg, adverse events) following antidepressant cessation were included.Data Extraction and SynthesisData extracted were cross-checked by 2 reviewers. Additional unpublished data from 11 RCTs were included. A random-effects meta-analysis was conducted to calculate standardized mean difference between individuals who discontinued an antidepressant vs those who continued an antidepressant or discontinued placebo. A proportion and odds ratio (OR) meta-analysis was performed to assess incidence of individual discontinuation symptoms compared to placebo. Subgroup analyses were conducted to compare different antidepressants. Data analysis was conducted between September 2024 and December 2024.Main Outcomes and MeasuresThe primary outcomes were incidence and nature of antidepressant discontinuation symptoms measured using standardized or unstandardized scales.ResultsA total of 50 studies were included, 49 of which were included in meta-analyses. The 50 studies included 17 828 participants in total, with 66.9% female participants and mean participant age of 44 years. Follow-up was between 1 day and 52 weeks. The DESS meta-analysis indicated increased discontinuation symptoms at 1 week in participants stopping antidepressants (standardized mean difference, 0.31; 95% CI, 0.23-0.39; number of studies [k] = 11; n = 3915 participants) compared to those taking placebo or continuing antidepressants. The effect size was equivalent to 1 more symptom on the DESS. Discontinuation of antidepressants was associated with increased odds of dizziness (OR, 5.52; 95% CI, 3.81-8.01), nausea (OR, 3.16; 95% CI, 2.01-4.96), vertigo (OR, 6.40; 95% CI, 1.20-34.19), and nervousness (OR, 3.15; 95% CI, 1.29-7.64) compared to placebo discontinuation. Dizziness was the most prevalent discontinuation symptom (risk difference, 6.24%). Discontinuation was not associated with depression symptoms, despite being measured in people with major depressive disorder (k = 5).Conclusions and RelevanceThis systematic review and meta-analysis indicated that the mean number of discontinuation symptoms at week 1 after stopping antidepressants was below the threshold for clinically significant discontinuation syndrome. Mood worsening was not associated with discontinuation; therefore, later presentation of depression after discontinuation is indicative of depression relapse","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"21 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Position and Future Direction of Inflammation in Neuropsychiatric Disorders: A Review.","authors":"Rachel Upthegrove,Fabiana Corsi-Zuelli,Amalie C M Couch,Nicholas M Barnes,Anthony C Vernon","doi":"10.1001/jamapsychiatry.2025.1369","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1369","url":null,"abstract":"ImportanceThere has been a large increase in research focusing on inflammation across psychiatric disorders, with the hope of achieving breakthroughs seen with this approach in cancer and other conditions. Current findings suggest that immune-related pathophysiological processes involving inflammation could play a key role for many major mental illnesses. How far reaching this role would be and how soon we can expect translation into treatment, however, remain open questions.ObservationsIn this narrative review, new evidence from clinical populations, new trials, and preclinical models was summarized. Converging evidence suggests that inflammation plays a significant role in subgroups of patients with psychosis, depression, and autism. Interleukin (IL) 6, T-cell control, immune-metabolic function, and the complement system represent fundamental areas of further research. New treatments have yet to reach clinical impact, but targeted trials are ongoing. Developing and refining human cellular models will aid mechanistic target validation and further understanding of causal pathways and networks.Conclusions and RelevanceTo advance to and achieve clinical impact, investigations need to include a collaborative, united effort, pulling information across disciplines and translational scales. A focused approach is needed to validate key emerging targets, where evidence and potential for new and repurposed treatments are strongest.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"28 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}