JAMA Psychiatry最新文献

{"title":"Trends in Outpatient Psychotherapy Among Adults in the US.","authors":"Mark Olfson, Chandler McClellan, Samuel H Zuvekas, Melanie Wall, Carlos Blanco","doi":"10.1001/jamapsychiatry.2024.3903","DOIUrl":"10.1001/jamapsychiatry.2024.3903","url":null,"abstract":"<p><strong>Importance: </strong>While access to psychotherapy has recently increased in the US, concern exists that recent gains may be unevenly distributed despite teletherapy expansion.</p><p><strong>Objective: </strong>To characterize recent trends and patterns in outpatient psychotherapy by US adults.</p><p><strong>Design, setting, and participants: </strong>This is a repeated cross-sectional study of psychotherapy use among adults (ages ≥18 years) in the 2018 to 2021 Medical Expenditure Panel Surveys, which are nationally representative surveys of the civilian noninstitutionalized population. Data were analyzed from March to August 2024.</p><p><strong>Main outcomes and measures: </strong>Age-, sex-, and distress-adjusted differences between 2018 and 2021 in use of any psychotherapy and video-based psychotherapy (teletherapy) in 2021 with tests for trend differences (interactions) across levels of sociodemographic characteristics and distress were assessed. Psychological distress was measured using the Kessler-6 scale, with scores of 13 or higher defining serious psychological distress, 1 to 12 defining mild to moderate distress, and 0 defining no distress.</p><p><strong>Results: </strong>The analysis involved 89 619 participants (47 838 female [51.5%] and 41 781 male [48.5%]; 22 510 aged 18-34 years [29.0%], 43 371 aged 35-64 years [48.8%], and 23 738 aged ≥65 years [22.2%]). Between 2018 and 2021, psychotherapy use increased significantly faster for females (931/12 270 females [7.7%] to 1207/12 237 females [10.5%]) than males (547/10 741 males [5.2%] to 655/10 544 males [6.3%]), younger (455/6149 individuals [8.0%] to 602/5296 individuals [11.9%] aged 18-34 years) than older (217/5550 individuals [3.6%] to 304/6708 individuals [4.6%] aged ≥65 years) adults, college graduates (503/6456 adults [7.6%] to 810/7277 adults [11.4%]) than those without a high school diploma (193/3824 adults [5.5%] to 200/3593 adults [7.0%]), privately insured (881/14 387 adults [6.1%] to 1154/13 414 adults [8.9%]) than publicly insured (558/6511 adults [8.8%] to 659/7453 adults [8.8%]) individuals, adults at 2 to 4 times the poverty level (370/6670 adults [5.7%] to 488/6370 adults [8.2%]) than those below the poverty level (384/4495 adults [9.7%] to 428/4760 adults [10.0%]), employed persons overall (733/13 358 adults [5.7%] to 1082/12 365 adults [8.9%]) than unemployed persons aged 65 years and younger (547/5138 adults [10.8%] to 519/4905 adults [10.5%]), and urban (1335/20 682 adults [6.5%] to 1729/20 590 adults [8.7%]) than rural (143/2329 adults [6.4%] to 133/2191 adults [5.9%]) residents. In 2021, after controlling for distress level, teletherapy use was significantly higher among younger than middle-aged (aged 35-64 years: difference, -3.7 percentage points; 95% CI, -5.1 to -2.3) or older (aged ≥65 years: difference, -6.5 percentage points (95% CI, -8.0 to -5.0 percentage points) adults, females (difference, 1.9 percentage points; 95% CI, 0.9 to 2.9 percentag","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"253-263"},"PeriodicalIF":22.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769042","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":"Female Physician Suicide Compared to the General Population.","authors":"Elena Frank, Srijan Sen, Constance Guille","doi":"10.1001/jamapsychiatry.2024.4786","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4786","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501421","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":"National Incidence of Physician Suicide and Associated Features.","authors":"Hirsh Makhija, Judy E Davidson, Kelly C Lee, Arianna Barnes, Amanda Choflet, Sidney Zisook","doi":"10.1001/jamapsychiatry.2024.4816","DOIUrl":"10.1001/jamapsychiatry.2024.4816","url":null,"abstract":"<p><strong>Importance: </strong>Previous reports regarding comparative suicide incidence among US physicians vs nonphysicians have been inconclusive.</p><p><strong>Objective: </strong>To estimate the national incidence of male and female physician suicide and analyze associated factors, comparing findings to the general population.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study investigated suicides among physicians and nonphysicians aged 25 years and older in the US from January 2017 to December 2021. The analysis took place from November 2023 to September 2024. National Violent Death Reporting System data from 30 US states and Washington, DC, were used. Decedents with missing age or sex were excluded for incidence, and missing race, ethnicity, or marital status for further analyses.</p><p><strong>Exposure: </strong>Physician occupation.</p><p><strong>Main outcome and measures: </strong>Suicide incidence rate ratios (IRRs) and odds ratios (aORs) adjusted by age, sex, race, ethnicity, and marital status were used to compare preceding circumstances, primary method, and substances.</p><p><strong>Results: </strong>A total of 448 physician (354 [79%] male and 94 [21%] female; mean [SD] age, 60 [16] years) and 97 467 general population (76 697 [79%] male and 20 770 [21%] female; mean [SD] age, 51 [17] years) suicides were identified. Female physicians had higher rates of suicide than female nonphysicians in 2017 (IRR, 1.88; 95% CI, 1.19-2.83) and 2019 (IRR, 1.75; 95% CI, 1.09-2.65), with overall higher 2017 to 2021 suicide risk (IRR, 1.53; 95% CI, 1.23-1.87). Male physicians had lower 2017 to 2021 suicide risk than male nonphysicians (IRR, 0.84; 95% CI, 0.75-0.93). Compared to the general population and including all available jurisdiction data, physicians had higher odds of depressed mood (aOR, 1.35; 95% CI, 1.14-1.61; P < .001) as well as mental health (aOR, 1.66; 95% CI, 1.39-1.97; P < .001), job (aOR, 2.66; 95% CI, 2.11-3.35; P < .001), and legal (aOR, 1.40, 95% CI, 1.06-1.84; P = .02) problems preceding suicide as well as use of poisoning (aOR, 1.85; 95% CI, 1.50-2.30; P < .001) and sharp instruments (aOR, 4.58; 95% CI, 3.47-6.06; P < .001). Physicians also had higher odds of positive toxicology for caffeine; poison; cardiovascular agents; benzodiazepines; anxiolytics, nonbenzodiazepines, or hypnotics; and drugs not prescribed for home use.</p><p><strong>Conclusion and relevance: </strong>These findings show a higher incidence of suicide for US female physicians compared to female nonphysicians. Comprehensive and multimodal suicide prevention strategies remain warranted.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501370","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":"Genetic Correlates of Treatment-Resistant Depression.","authors":"Bohan Xu, Katherine L Forthman, Rayus Kuplicki, Jonathan Ahern, Robert Loughnan, Firas Naber, Wesley K Thompson, Charles B Nemeroff, Martin P Paulus, Chun Chieh Fan","doi":"10.1001/jamapsychiatry.2024.4825","DOIUrl":"10.1001/jamapsychiatry.2024.4825","url":null,"abstract":"<p><strong>Importance: </strong>Treatment-resistant depression (TRD) is a major challenge in mental health, affecting a significant number of patients and leading to considerable burdens. The etiological factors contributing to TRD are complex and not fully understood.</p><p><strong>Objective: </strong>To investigate the genetic factors associated with TRD using polygenic scores (PGS) across various traits and explore their potential role in the etiology of TRD using large-scale genomic data from the All of Us (AoU) Research Program.</p><p><strong>Design, setting, and participants: </strong>This study was a cohort design with observational data from participants in the AoU Research Program who have both electronic health records and genomic data. Data analysis was performed from March 27 to October 24, 2024.</p><p><strong>Exposures: </strong>PGS for 61 unique traits from 7 domains.</p><p><strong>Main outcomes and measures: </strong>Logistic regressions to test if PGS was associated with treatment-resistant depression (TRD) compared with treatment-responsive major depressive disorder (trMDD). Cox proportional hazard model was used to determine if the progressions from MDD to TRD were associated with PGS.</p><p><strong>Results: </strong>A total of 292 663 participants (median [IQR] age, 57 (41-69) years; 175 981 female [60.1%]) from the AoU Research Program were included in this analysis. In the discovery set (124 945 participants), 11 of the selected PGS were found to have stronger associations with TRD than with trMDD, encompassing PGS from domains in education, cognition, personality, sleep, and temperament. Genetic predisposition for insomnia (odds ratio [OR], 1.11; 95% CI, 1.07-1.15) and specific neuroticism (OR, 1.11; 95% CI, 1.07-1.16) traits were associated with increased TRD risk, whereas higher education (OR, 0.88; 95% CI, 0.85-0.91) and intelligence (OR, 0.91; 95% CI, 0.88-0.94) scores were protective. The associations held across different TRD definitions (meta-analytic R2 >83%) and were consistent across 2 other independent sets within AoU (the whole-genome sequencing Diversity dataset, 104 388, and Microarray dataset, 63 330). Among 28 964 individuals followed up over time, 3854 developed TRD within a mean of 944 days (95% CI, 883-992 days). All 11 previously identified and replicated PGS were found to be modulating the conversion rate from MDD to TRD.</p><p><strong>Conclusions and relevance: </strong>Results of this cohort study suggest that genetic predisposition related to neuroticism, cognitive function, and sleep patterns had a significant association with the development of TRD. These findings underscore the importance of considering psychosocial factors in managing and treating TRD. Future research should focus on integrating genetic data with clinical outcomes to enhance understanding of pathways leading to treatment resistance.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501423","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":"Looking Back, Moving Forward-Reflecting on a Career in Psychiatric Research.","authors":"Charles F Reynolds","doi":"10.1001/jamapsychiatry.2024.4936","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4936","url":null,"abstract":"<p><p>The arc of my career has focused on the integration of clinical care, mentoring, and research, leading to meaningful research questions and intervention trials advancing the field. In this Special Communication, I first offer a brief synopsis of my work as an academic psychiatrist, highlighting mission, themes and publications, sponsors, and collaborators. I then discuss activities as a mentor, focusing on 2 National Institute of Mental Health (NIMH)-funded research career development programs. As the past recipient of K01, K02, and K05 awards from the NIMH (1980-2000), I have taken to heart the obligation to pay it forward: to support, advise, instruct, and guide younger colleagues, challenging them academically and professionally. For 20 years, my P30 infrastructure center grant provided a platform for institutional training grants (T32s) and psychiatric research education grants (R25s) to serve as a foundation for training the next generation of clinical scientists in late life mood disorders, as well as a nidus for interdisciplinary collaboration. I have benefitted greatly from having had mentors and wise friends, particularly David Kupfer, MD; Ellen Frank, PhD; and Thomas Detre, MD, of the University of Pittsburgh School of Medicine; colleagues in the Aging Branch of NIMH throughout my 40-year career as a physician scientist; Dilip Jeste, MD, University of California at San Diego; Daniel Blazer, MD, PhD, Duke University School of Medicine; George Alexopoulos, MD, Weill Cornell School of Medicine; John Rush, MD, University of Texas Southwestern School of Medicine; Alan Schatzberg, MD, Stanford University School of Medicine; M. Katherine Shear, MD, Columbia University Schools of Social Work and of Medicine; Helena Kraemer, PhD, Stanford University School of Medicine; and Edmund Ricci, PhD, University of Pittsburgh Graduate School of Public Health. These colleagues are good listeners, flexible, diverse in perspectives, knowledgeable, nonjudgmental, and able to give constructive feedback, network, and help find resources. I have sought to do likewise with many younger colleagues, both men and women, physicians and PhDs, and persons of different professional, racial, and ethnic backgrounds-totaling about 25 K awardees. I conclude with recommendations for future clinical practice and research in late-life depression, describing a broad spectrum of approaches aiming both to reduce its public health burden and to enhance wisdom, resilience, and well-being in later life.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501364","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":"An Approach to Providing Timely Mental Health Services to Diverse Youth Populations.","authors":"Srividya N Iyer, Patricia Boksa, Ridha Joober, Jai Shah, Rebecca Fuhrer, Neil Andersson, Shalini Lal, Giuseppe D'Andrea, Nora Morrison, Valerie Noel, Daniel Rabouin, Tovah Cowan, Kathleen MacDonald, Mary Anne Levasseur, Feodor Poukhovski-Sheremetyev, Amal Abdel-Baki, Lacey Augustine, Kevin Friese, Isabelle Godin, Katherine Hay, Daphne Hutt-MacLeod, Vickie Plourde, Norma Rabbitskin, Paula Reaume-Zimmer, Cécile Rousseau, Heather Rudderham, Adam Abba-Aji, Diane Aubin, Liana Urichuk, Helen Vallianatos, Shirin Golchi, Ina Winkelmann, Jessica Chisholm-Nelson, Ashok Malla","doi":"10.1001/jamapsychiatry.2024.4880","DOIUrl":"10.1001/jamapsychiatry.2024.4880","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Accessing mental health care is challenging for youths, especially those facing intersectional disadvantages, but whether enhancing youth services increases reach and timeliness has rarely been investigated. ACCESS Open Minds (ACCESS-OM) transformed services at urban, rural, and Indigenous sites in Canada using 5 principles (early identification, rapid access, appropriate care, no age-based transitions from 11-25 years, and youth and family engagement).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether the number of youths referred (hypothesis 1), offered evaluation appointments within 72 hours of referral (hypothesis 2), and receiving services within 30 days of the first appointment (hypothesis 3) increased over the course of ACCESS-OM's implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study included youths (aged 11-25 years) at 11 sites referred between March 2016 and December 2020. Data were analyzed from April 2022 to April 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Existing primary and/or community services implemented ACCESS-OM's core components: broad-spectrum mental health services, outreach, youth-friendly walk-in spaces, open systems accepting referrals from multiple sources, and response-time benchmarks (72 hours to evaluation and 30 days to start treatment).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes were the referral rate and the probability of being offered a first evaluation within 72 hours and receiving services within 30 days. Dates of referral and/or help-seeking, first offered appointment, first evaluation, and first services received were recorded. Multilevel negative binomial regression was used for hypothesis 1, and time-to-event analyses followed by multilevel accelerated failure time (AFT) models were used for hypotheses 2 and 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 7889 youths were referred; 4519 (mean [SD] age, 19.3 [3.4] years; 2440 [54%] cisgender women; 1049 [23.21%] Indigenous; 991 [21.93%] Visible Minority [Arab, Black, Chinese, Filipino, Japanese, Korean, Latin American, South Asian, Southeast Asian, West Asian, other ethnicity, and multiple ethnicities]; and 1525 [49.10%] White) were evaluated before March 2020. Each 6-month progression after implementation was associated with a 10% increase in referral rates (IRR, 1.10; 95% CI, 1.07-1.13). The probability of being offered an initial appointment (χ22 = 20.30; P &lt; .001) and receiving services (χ22 = 4.48; P = .01) after any given delay differed significantly over the 3 years. In adjusted AFT models, each 6-month progression was associated with a 3% decrease in time to offered evaluation (time ratio [TR], 0.97; 95% CI, 0.95-0.99) and first services (TR, 0.97; 95% CI, 0.94-1.00). Moderate to severe mental health problems were associated with longer delays to offered first appointments (TR, 1.14; 95% CI, 1.06-1.24) and services (TR, 1.11; 95% CI, 1.01-1.22).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Concl","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501420","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":"Predicting Diagnostic Progression to Schizophrenia or Bipolar Disorder via Machine Learning","authors":"Lasse Hansen, Martin Bernstorff, Kenneth Enevoldsen, Sara Kolding, Jakob Grøhn Damgaard, Erik Perfalk, Kristoffer Laigaard Nielbo, Andreas Aalkjær Danielsen, Søren Dinesen Østergaard","doi":"10.1001/jamapsychiatry.2024.4702","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4702","url":null,"abstract":"ImportanceThe diagnosis of schizophrenia and bipolar disorder is often delayed several years despite illness typically emerging in late adolescence or early adulthood, which impedes initiation of targeted treatment.ObjectiveTo investigate whether machine learning models trained on routine clinical data from electronic health records (EHRs) can predict diagnostic progression to schizophrenia or bipolar disorder among patients undergoing treatment in psychiatric services for other mental illness.Design, Setting, and ParticipantsThis cohort study was based on data from EHRs from the Psychiatric Services of the Central Denmark Region. All patients aged 15 to 60 years with at least 2 contacts (at least 3 months apart) with the Psychiatric Services of the Central Denmark Region between January 1, 2013, and November 21, 2016, were included. Analysis occurred from December 2022 to November 2024.ExposuresPredictors based on EHR data, including medications, diagnoses, and clinical notes.Main Outcomes and MeasuresDiagnostic transition to schizophrenia or bipolar disorder within 5 years, predicted 1 day before outpatient contacts by means of elastic net regularized logistic regression and extreme gradient boosting (XGBoost) models. The area under the receiver operating characteristic curve (AUROC) was used to determine the best performing model.ResultsThe study included 24 449 patients (median [Q1-Q3] age at time of prediction, 32.2 [24.2-42.5] years; 13 843 female [56.6%]) and 398 922 outpatient contacts. Transition to the first occurrence of either schizophrenia or bipolar disorder was predicted by the XGBoost model, with an AUROC of 0.70 (95% CI, 0.70-0.70) on the training set and 0.64 (95% CI, 0.63-0.65) on the test set, which consisted of 2 held-out hospital sites. At a predicted positive rate of 4%, the XGBoost model had a sensitivity of 9.3%, a specificity of 96.3%, and a positive predictive value (PPV) of 13.0%. Predicting schizophrenia separately yielded better performance (AUROC, 0.80; 95% CI, 0.79-0.81; sensitivity, 19.4%; specificity, 96.3%; PPV, 10.8%) than was the case for bipolar disorder (AUROC, 0.62, 95% CI, 0.61-0.63; sensitivity, 9.9%; specificity, 96.2%; PPV, 8.4%). Clinical notes proved particularly informative for prediction.Conclusions and RelevanceThese findings suggest that it is possible to predict diagnostic transition to schizophrenia and bipolar disorder from routine clinical data extracted from EHRs, with schizophrenia being notably easier to predict than bipolar disorder.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"49 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444019","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":"Mapping Lesions That Cause Psychosis to a Human Brain Circuit and Proposed Stimulation Target","authors":"Andrew R. Pines, Summer B. Frandsen, William Drew, Garance M. Meyer, Calvin Howard, Stephan T. Palm, Frederic L. W. V. J. Schaper, Christopher Lin, Konstantin Butenko, Michael A. Ferguson, Maximilian U. Friedrich, Jordan H. Grafman, Ari D. Kappel, Clemens Neudorfer, Natalia S. Rost, Lauren L. Sanderson, Joseph J. Taylor, Ona Wu, Isaiah Kletenik, Jacob W. Vogel, Alexander L. Cohen, Andreas Horn, Michael D. Fox, David Silbersweig, Shan H. Siddiqi","doi":"10.1001/jamapsychiatry.2024.4534","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4534","url":null,"abstract":"ImportanceIdentifying anatomy causally involved in psychosis could inform therapeutic neuromodulation targets for schizophrenia.ObjectiveTo assess whether lesions that cause secondary psychosis have functional connections to a common brain circuit.Design, Setting, and ParticipantsThis case-control study mapped functional connections of published cases of lesions causing secondary psychosis compared with control lesions unassociated with psychosis. Published cases of lesion-induced psychosis were analyzed in a computational laboratory. Participants had documented brain lesions associated with new-onset psychotic symptoms without a history of psychosis. Control cases included 1156 patients with lesions not associated with psychosis. Generalizability across lesional datasets was assessed using an independent cohort of 181 patients with brain lesions who subsequently underwent neurobehavioral testing. Data were analyzed from June 2022 to April 2024.ExposuresLesions causing secondary psychosis.Main Outcomes and MeasuresPsychosis or no psychosis.ResultsA total of 153 lesions from published cases were determined to be causal of psychosis, 42 of which were described as schizophrenia or schizophrenia-like (71 [46%] patients were male, 82 [54%] female; mean [SD] age, 50.0 [20.8] years). Lesions that caused secondary psychosis mapped to a common brain circuit defined by functional connectivity to the posterior subiculum of the hippocampus (84% functional overlap, family-wise error [FWE] rate corrected &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; 5 × 10&lt;jats:sup&gt;−5&lt;/jats:sup&gt;). At a lower statistical threshold (&amp;amp;gt;75% overlap, FWE-corrected &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; 5 × 10&lt;jats:sup&gt;−4&lt;/jats:sup&gt;), this circuit included the ventral tegmental area, retrosplenial cortex, lobule IX and dentate nucleus of the cerebellum, and the mediodorsal and midline nuclei of the thalamus. This circuit was consistent when derived from schizophrenia-like cases (spatial &lt;jats:italic&gt;r&lt;/jats:italic&gt; = 0.98). We repeated these analyses after excluding lesions intersecting the hippocampus (n = 47) and found a consistent functional connectivity profile (spatial &lt;jats:italic&gt;r&lt;/jats:italic&gt; = 0.98) with the posterior subiculum remaining the center of connectivity (&amp;amp;gt;75% overlap, FWE-corrected &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; 5 × 10&lt;jats:sup&gt;−5&lt;/jats:sup&gt;), demonstrating a circuit-level effect. In an independent observational cohort of patients with penetrating head trauma (n = 181), lesions associated with symptoms of psychosis exhibited significantly similar connectivity profiles to the lesion-derived psychosis circuit (suspiciousness, &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .03; unusual thought content, &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .046). Voxels in the rostromedial prefrontal cortex are highly correlated with this psychosis circuit (spatial &lt;jats:italic&gt;r&lt;/jats:italic&gt; = 0.82), suggesting the rostromedial prefrontal cortex as a promising transcrani","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"18 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393150","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":"Making Progress in Clinical Trials for Suicide Prevention","authors":"Samuel T. Wilkinson, Craig J. Bryan, Larry D. Alphs, Carla M. Canuso, Michael J. Ostacher, Rebecca B. Price, Michael H. Bloch, Carlos A. Zarate, Taeho Greg Rhee","doi":"10.1001/jamapsychiatry.2024.4810","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4810","url":null,"abstract":"ImportanceSuicide is a public health crisis, and despite renewed efforts to confront this problem, suicide rates continue to rise in the US. While suicide prevention encompasses a broad array of strategies, treatment development is lagging. Within this realm, clinical trials are the criterion standard for evaluating safety and efficacy of new treatments.ObservationsMost clinical trials conducted among patients with mental illness have excluded patients at risk of suicide. Historical reasons for this include regulatory challenges, liability concerns, ethical questions, discomfort working directly with high-risk patients, and the belief that research is too risky for individuals at elevated risk for suicide.Conclusions and RelevanceSeveral considerations are provided for investigators in the design of trials targeting at-risk populations, including thoughtful selection of study outcome, use of time-to-event design and analysis (which may simultaneously satisfy ethical concerns and scientific aims), enrolling an enriched sample (eg, among patients recently discharged from the hospital), and provision of usual care in the comparator group. Caution should be exercised to avoid excessive or unreasonable safety requirements, which may lead participants to minimize self-report of suicidal ideation or to drop out of trials. Where possible, regulatory bodies (institutional review boards [IRBs] and data and safety monitoring boards) should consult with or include as members those with direct clinical experience with this high-risk population. An important ethical principle for IRB members and other regulators to consider is that suicide-related events are expected in this clinical population.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"30 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393148","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":"Integrated Nicotine Replacement and Behavioral Support to Reduce Smoking in Opioid Agonist Therapy","authors":"Karl Trygve Druckrey-Fiskaaen, Tesfaye Madebo, Jan Tore Daltveit, Jørn Henrik Vold, Einar Furulund, Fatemeh Chalabianloo, Torgeir Gilje Lid, Lars Thore Fadnes","doi":"10.1001/jamapsychiatry.2024.4801","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4801","url":null,"abstract":"ImportanceApproximately 85% of individuals receiving opioid agonist therapy for opioid dependence smoke tobacco. Despite the significant health risks associated with smoking-related diseases, there has been limited evaluation of smoking interventions tailored to this population.ObjectiveTo determine the effectiveness of an intervention combining nicotine replacement with brief behavioral support in reducing cigarette use.Design, Setting, and ParticipantsThis multicenter randomized clinical trial was conducted from April 2022 to October 2023 in 7 specialized opioid agonist therapy clinics in Bergen and Stavanger, Norway. The analyst was blinded to patient groupings. Assessors (study nurses) were not fully blinded to participant allocation. Individuals diagnosed with opioid dependency receiving opioid agonist therapy at participating clinics and smoking at least 1 cigarette per day were eligible for participation. Data analysis was performed from December 2023 through October 2024.InterventionIn addition to standard opioid agonist therapy, participants in the intervention group received a 16-week integrated treatment combining nicotine replacement with brief behavioral support. Participants in the control group received only standard opioid agonist therapy.Main Outcomes and MeasuresThe primary outcome was at least a 50% reduction in the number of cigarettes smoked, self-reported as cigarette use in the past 7 days at week 16. The analysis followed intention-to-treat principles. Cigarette use was self-reported as per the timeline-follow-back method.ResultsAmong the 259 participants (mean [SD] age, 48.5 [10.4] years; 80 [30.9%] female), 135 were allocated to the intervention group and 124 to the control group. The odds ratio of at least halving the number of cigarettes smoked was 2.07 (95% CI, 1.14-3.75) in the intervention group compared with the control group.Conclusions and RelevanceProviding integrated nicotine replacement and behavioral support at opioid agonist treatment clinics effectively helped opioid-dependent participants reduce the number of cigarettes smoked.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT05290025\">NCT05290025</jats:ext-link>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393146","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}