JAMA Psychiatry最新文献

{"title":"Temporal, Geographic, and Polysubstance Patterns in Orphine Analogue Detections","authors":"David T. Zhu,Nicole D. Fitzgerald,Joseph J. Palamar,Alex J. Krotulski","doi":"10.1001/jamapsychiatry.2026.3129","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3129","url":null,"abstract":"This cross-sectional study examines the temporal, geographic, and polysubstance patterns in orphine analogue detections.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089439","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":"How Should We Interpret the Association Between Abortion and Mild Psychiatric Illness?","authors":"Krista F Huybrechts, Kenneth J Rothman, Katherine L Wisner","doi":"10.1001/jamapsychiatry.2025.3561","DOIUrl":"10.1001/jamapsychiatry.2025.3561","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1005-1006"},"PeriodicalIF":18.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549044","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":"Longitudinal Precision Functional Mapping in Psychiatry.","authors":"Peter Manza, Charles J Lynch, Joshua S Siegel, Jacqueline A Clauss","doi":"10.1001/jamapsychiatry.2026.2393","DOIUrl":"10.1001/jamapsychiatry.2026.2393","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"999-1000"},"PeriodicalIF":18.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724065","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":"Medication and Procedural Abortion and Risk of Psychotropic Medication Use.","authors":"Julia R Steinberg, Thomas M Laursen, Øjvind Lidegaard, Trine Munk-Olsen","doi":"10.1001/jamapsychiatry.2025.3698","DOIUrl":"10.1001/jamapsychiatry.2025.3698","url":null,"abstract":"<p><strong>Importance: </strong>No recent study has examined whether method of abortion is associated with psychotropic medication use, an indicator of mild mental health problems.</p><p><strong>Objective: </strong>To examine whether medication or procedural abortions were associated with increased risk of psychotropic medication use.</p><p><strong>Design, setting, and participants: </strong>This population-based Danish registry cohort study followed the psychotropic medication redemptions of females aged 12 to 38 years having elective, first first-trimester abortions between January 1, 2000, and December 31, 2018, from 1 year before their medication or procedural abortion until their first psychotropic medication prescription claim (redemption), December 31, 2018, emigration from Denmark, or death, whichever came first. Analyses were conducted between June 2023 and June 2025.</p><p><strong>Exposure: </strong>First abortion method (first medication abortion or first procedural abortion).</p><p><strong>Main outcomes and measures: </strong>Any first psychotropic medication prescription redemption, first antidepressant medication redemption, and first antianxiety medication redemption during the study period. Incidence rate ratios (IRRs) were calculated in adjusted regression models. Bonferroni-corrected P values were used to account for multiple tests.</p><p><strong>Results: </strong>Of 67 390 females included in this study (mean [SD] age, 21.8 [4.6] years), 4575 (6.8%) had a prior psychiatric diagnosis; 33 793 had a record of a first medication abortion, 33 597 had a record of a first procedural abortion, and 19 979 (29.6%) had a first psychotropic medication redemption during the study period. In fully adjusted models, using the conventional P value level of .05, compared with the year before a medication or procedural abortion, there were small increased risks of any first psychotropic medication redemption in the first year after medication abortion (IRR, 1.10; 95% CI, 1.02-1.19; P = .01) and procedural abortion (IRR, 1.09; 95% CI, 1.01-1.16; P = .02). There were no statistically significant associations in 1 to 2 years and 2 to 5 years after abortion relative to the year before an abortion for each abortion method. There were decreased risks of any first psychotropic medication redemption more than 5 years after medication abortion (IRR, 0.85; 95% CI, 0.78-0.91; P < .001) and more than 5 years after procedural abortion (IRR, 0.83; 95% CI, 0.78-0.88; P < .001). Using the Bonferroni-corrected P value of .002, the small increased risks of psychotropic medication redemption observed in the first year after an abortion no longer met the criteria for statistical significance, while the lower risks for more than 5 years after abortion continued to meet the criteria for statistical significance.</p><p><strong>Conclusions and relevance: </strong>In this Danish population-based cohort study, compared with the year before a medication or procedural abort","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1020-1029"},"PeriodicalIF":18.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549054","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":"Psychological Interventions Targeting Auditory Hallucinations in Persons With Psychotic Disorders: A Systematic Review and Meta-Analysis.","authors":"Laura Fässler, Sarah Koop, Felix Opper, Irene Bighelli, Stefan Leucht, Michel Sabé, Malek Bajbouj, Christine Knaevelsrud, Kerem Böge","doi":"10.1001/jamapsychiatry.2026.1443","DOIUrl":"10.1001/jamapsychiatry.2026.1443","url":null,"abstract":"<p><strong>Importance: </strong>Auditory hallucinations (AHs) are a hallmark characteristic of schizophrenia spectrum disorders (SSDs) and are often associated with severe distress. Previous research lacks comprehensive evidence on the overall efficacy of approaches targeting AHs in SSDs.</p><p><strong>Objective: </strong>To evaluate the efficacy and acceptability of all available psychological and psychosocial interventions targeting AHs in SSDs.</p><p><strong>Data sources: </strong>Embase, MEDLINE, PsycArticles, PsycInfo, PSYNDEX, and the Cochrane library were searched for eligible studies published until August 18, 2025.</p><p><strong>Study selection: </strong>Randomized clinical trials that analyzed psychological interventions targeting AHs compared to controls in adults with SSDs.</p><p><strong>Data extraction and synthesis: </strong>This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two independent reviewers screened publications, extracted data, and assessed risk of bias. A random-effects meta-analysis was performed (Hedges g).</p><p><strong>Main outcomes and measures: </strong>The main outcomes were between-group differences in AHs and clinical characteristics at posttreatment and follow-up, measured with validated rating scales. Additional number-needed-to-treat (NNT) analyses and rating of evidence certainty (GRADE approach) were conducted.</p><p><strong>Results: </strong>A total of 23 studies with 2016 participants were included, with 1081 in the intervention groups across 5 different therapeutic approaches and 935 in the control groups. At posttreatment, targeted interventions reduced the severity of AHs compared with control groups (standardized mean difference [SMD], -0.18; 95% CI, -0.31 to -0.05; P = .007; NNT, 16; GRADE, low evidence). This effect was also observed for numerous secondary outcomes, comprising frequency and distress of AHs, total symptoms, positive symptoms, delusions, depression, and anxiety. Subgroup analysis showed that avatar therapy reduced the severity of AHs with the largest effect size (SMD, -0.37; 95% CI, -0.51 to -0.22; P < .001). Sensitivity analyses indicated robustness of results. Dropout rates and reports on adverse events indicated high tolerability and acceptability of treatments.</p><p><strong>Conclusion and relevance: </strong>Although targeted psychological and psychosocial interventions for AHs in SSDs were found to be effective in reducing the severity and other characteristics of AHs, with effect sizes ranging from small to medium, substantial differences were observed between approaches. In particular, avatar therapy seems to be effective at addressing AH symptoms. These findings could influence future studies and clinical care by advancing the development of targeted, novel approaches for AHs that address relevant treatment characteristics.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1007-1019"},"PeriodicalIF":18.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264660","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":"Social Determinants of Health and Neurobiology Across the Schizophrenia Course: A Systematic Review.","authors":"Jessica P Y Hua, Kaitlyn Dal Bon","doi":"10.1001/jamapsychiatry.2026.1312","DOIUrl":"10.1001/jamapsychiatry.2026.1312","url":null,"abstract":"<p><strong>Importance: </strong>Individuals with schizophrenia-spectrum psychotic conditions (SSPCs) are disproportionately exposed to adverse social determinants of health (SDOHs). These exposures drive health inequity in schizophrenia and are consistently linked to earlier illness onset, greater symptom severity, and poorer long-term outcomes. The brain-based mechanisms through which structural disadvantage becomes biologically embedded are not well characterized.</p><p><strong>Objective: </strong>To examine structural, functional, neurochemical, and plasticity brain changes associated with SDOHs with, or at risk for, SSPCs.</p><p><strong>Evidence review: </strong>PsycInfo, PubMed, and Web of Science databases were searched from database inception until January 2026 to identify original, empirical studies that reported on the association between SDOHs (early life adversity, social disconnection, racism/discrimination, poverty, food insecurity) and neurobiological measures (brain structure, brain function, neurochemical, neuroplasticity) in individuals across the schizophrenia spectrum. Quality assessment scores using the Joanna Briggs Institute Checklist weighed the impact of individual study findings on the overall outcome summary.</p><p><strong>Findings: </strong>The systematic literature search yielded 14 500 articles, with 114 articles meeting full inclusion criteria. Most articles examined early life adversity (n = 95) with the remaining articles focused on social disconnection (n = 13), racism/discrimination (n = 4), poverty (n = 2), and food insecurity (n = 1). Regarding brain measures, 83 articles reported on structural brain measures, 23 on functional brain measures, 10 on neurochemical measures, and none on neuroplasticity. Together, these studies recruited 10 921 participants across the schizophrenia spectrum (high schizotypy n = 250; familial high-risk n = 1825; clinical high-risk for psychosis n = 3538; first-episode psychosis n = 1169; recent-onset psychosis n = 506; chronic schizophrenia n = 3754). Strong evidence that greater exposure to adverse SDOHs may be associated with neurobiological abnormalities, including cortical thinning, regional brain volume reduction, decreased structural connectivity and functional activation, and abnormal neurochemical levels was found.</p><p><strong>Conclusions and relevance: </strong>These findings support the hypothesis that social adversity becomes biologically embedded, providing evidence for an intermediary link between SDOHs and clinical outcomes in SSPC. Integrating neuroscience with social epidemiology can advance psychosis prevention, refine treatment, and address structural drivers of mental health disparities.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1070-1079"},"PeriodicalIF":18.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264668","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":"Mental Health and Substance Use Disorder Expenditures in the US","authors":"Carlos Blanco, Chandler McClellan, Samuel H. Zuvekas, Mark Olfson","doi":"10.1001/jamapsychiatry.2026.3120","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3120","url":null,"abstract":"Importance Understanding spending on mental health could help inform policymakers on decisions about where to direct mental health care resources and help evaluate whether spending aligns with public health priorities. Despite this, the magnitude and distribution of mental health expenditures in the US remain poorly characterized. Objective To estimate aggregate mental health expenditures by sociodemographic characteristics, type of insurance, mental health disorders, and type of service. Design, Setting, and Participants This was a cross-sectional analysis of the 2021-2023 Medical Expenditure Panel Survey (MEPS), an annual, nationally representative survey of the civilian noninstitutionalized US population. Analyses focused on individuals who made at least 1 outpatient mental health visit in 2021, 2022, or 2023. Data analysis was conducted from August 2025 to January 2026. Exposure Outpatient mental health visits. Main Outcomes and Measures Overall and per-100-person expenditures stratified by sociodemographic characteristics and diagnostic categories. Results The analysis included all survey participants (N = 67 532 person-year observations; mean [SD] age, 39.8 [0.25] years; 35 608 [50.7%] female) and identified those with reported outpatient mental health visits in 2021, 2022, and 2023 (n = 15 407; mean [SD] age, 45.0 [0.36] years; 9500 [60.0%] female). The estimated annualized aggregate total health care expenditures as measured in the MEPS in 2021-2023 were $2.5 trillion (95% CI, $2.3 trillion to $2.7 trillion), with $174 billion (95% CI, $152 billion to $196 billion) in mental health expenditures representing 7.0% (95% CI, 6.4%-7.7%) of all medical expenditures. This represented an annual mean of $523 (95% CI, $474-$571) per person overall and $2473 (95% CI, $2266-$2679) per person among those with any treated mental health disorder. Mood disorders and anxiety and fear-related disorders accounted for the highest aggregate expenditures ($74 billion [95% CI, $62 billion to $86 billion] and $69 billion [95% CI, $58 billion to $81 billion], respectively). Expenditures per treated individual were highest for substance use disorders ($9569 [95% CI, $6943-$12 195]), schizophrenia ($9370 [95% CI, $6685-$12 055]), and bipolar disorders ($7382 [95% CI, $6027-$8737]). Overall, expenditures on ambulatory services accounted for $107 billion (95% CI, $93 billion to $121 billion), while expenditures on medication accounted for $36 billion (95% CI, $31 billion to $40 billion) and those for home health care and inpatient treatment accounted for $20 billion (95% CI, $11 billion to $29 billion) and $12 billion (95% CI, $8 billion to $15 billion), respectively. Conclusions and Relevance This cross-sectional study found that expenditures on mental health disorders in the US vary widely at the per-person and population levels, but they are consistently low relative to the societal burden of mental disorders. Research that leads to more effective treatments, decr","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"222 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077672","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":"Updating Treatment Goals for Schizophrenia","authors":"Bita Moghaddam","doi":"10.1001/jamapsychiatry.2026.2862","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2862","url":null,"abstract":"This article discusses research providing renewed reasons to revisit the utility of glutamatergic drugs for treating schizophrenia.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"17 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089468","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":"Transferable Design Principles for Scalable Mental Health Systems","authors":"Rick Peter Fritz Wolthusen, Florence Jaguga, Linnet Ongeri, Kristina Adorjan, Thomas G. Schulze, Lukoye Atwoli, Delali Kudzo Fiagbe","doi":"10.1001/jamapsychiatry.2026.3125","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3125","url":null,"abstract":"Importance Mental disorders are a leading cause of disability worldwide, and their burden continues to increase across Africa. Despite growing need, access to care remains limited, with treatment gaps reaching up to 90% in some settings. These gaps reflect longstanding constraints in workforce, financing, infrastructure, and sociocultural factors, alongside uneven policy implementation. At the same time, countries and communities across the continent are developing new approaches to mental health care that can complement conventional, specialist-centered models and offer transferable lessons for mental health system transformation globally. Observations This Special Communication proposes 4 transferable design principles for scalable and culturally responsive mental health systems, synthesized into a comprehensive conceptual framework and context-sensitive implementation road map: (1) workforce and educational transformation, (2) community-based care architecture, (3) systems integration, and (4) cultural and pluralistic care. Evidence from multiple African countries demonstrates that nonspecialist clinicians, including community health workers and peer supporters, can deliver screening and brief psychological interventions when reinforced by training and supervision. Community-based models are increasingly shifting care closer to where people live, incorporating recovery-oriented approaches that emphasize social reintegration. Integration of mental health into primary care, HIV services, and maternal health platforms has shown promise, though sustainability remains dependent on broader health system capacity. At the same time, pluralistic care systems, in which individuals engage biomedical and traditional professionals, highlight the need for approaches that are culturally responsive and grounded in human rights. Across these design principles, progress is evident, but implementation remains uneven, and much of the current evidence is limited by short-term evaluations and reliance on symptom-based measures. Conclusions and Relevance Closing the treatment gap in Africa will require more than scaling existing services. It will depend on strengthening locally led research and context-sensitive implementation, embedding innovations within national systems, and investing in workforce development, supervision, and governance. African mental health innovations are not only responses to constrained resources, but also contributions to the broader understanding of how scalable, equitable, and culturally responsive mental health systems can be designed across diverse global settings.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077671","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":"Prior Evidence on Auditory Hallucinations Overlooked","authors":"Natasha Sigala,Melis Cobandag","doi":"10.1001/jamapsychiatry.2026.3139","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3139","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"36 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089443","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}