JAMA Psychiatry最新文献

{"title":"Error in Visual Abstract.","authors":"","doi":"10.1001/jamapsychiatry.2026.2469","DOIUrl":"10.1001/jamapsychiatry.2026.2469","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"83 8","pages":"885"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678711","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":"Recurrent Copy Number Variants and Psychiatric Outcomes in the Context of Polygenic Scores.","authors":"Morteza Vaez, Simone Montalbano, Ryan Waples, Morten Dybdahl Krebs, Kajsa-Lotta Georgii Hellberg, Jesper Gådin, Daniel Stow, Peter Holmans, Marianne van den Bree, Anders D Børglum, Dorte Helenius, Thomas Werge, Andrew J Schork, Andrés Ingason","doi":"10.1001/jamapsychiatry.2026.1064","DOIUrl":"10.1001/jamapsychiatry.2026.1064","url":null,"abstract":"<p><strong>Importance: </strong>Although both recurrent copy number variants (rCNVs) and polygenic scores (PGSs) impart risk for psychiatric disorders, it remains unclear how they contribute jointly to this risk.</p><p><strong>Objective: </strong>To estimate and compare absolute risk of psychiatric disorders associated with rCNVs and PGSs, independently and jointly.</p><p><strong>Design, setting, and participants: </strong>This genetic association study applied data from the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) case-cohort sample of individuals born in Denmark (1981-2008) and followed up until 2015, including all individuals with a hospital diagnosis of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), schizophrenia spectrum disorder (SSD), or major depressive disorder (MDD), and a subcohort randomly drawn from the source population. Data were analyzed from September 2023 to May 2025.</p><p><strong>Exposures: </strong>Carrier status was determined at 27 autosomal rCNV loci and PGSs for psychiatric (and other) outcomes from neonatal blood samples genotyped on microarrays and summary statistics from published association studies.</p><p><strong>Main outcomes and measures: </strong>Absolute risks were estimated for ADHD, ASD, MDD, and SSD during follow-up using a weighted survival analysis framework, and joint effects of rCNV carriage and PGSs were assessed by fitting generalized linear models.</p><p><strong>Results: </strong>In 94 276 unrelated European-ancestry individuals (mean [SD] age at follow-up, 21.9 [7.0] years; 50 653 male [53.7%]), rCNV carriage was associated with increased risk of ASD, ADHD, and SSD but not MDD (β = 0.33; 95% CI, 0.27-0.39; β = 0.29; 95% CI, 0.23-0.35; β = 0.25; 95% CI, 0.17-0.33; and β = 0.04; 95% CI, -0.03 to 0.11, respectively); each PGS was positively associated with risk of the corresponding disorder (β = 0.14; 95% CI, 0.12-0.16; β = 0.28; 95% CI, 0.26-0.30; β = 0.28; 95% CI, 0.26-0.30; and β = 0.38; 95% CI, 0.36-0.40, respectively). PGSs identified more individuals than rCNV carriage at comparable levels of absolute risk, except for ASD. A negative interaction was observed between 16p13.11 duplication and ADHD-PGS on ADHD risk (β = -0.51; 95% CI, -0.86 to -0.16), and there was a trend toward negative rCNV-PGS interaction coefficients across aggregated rCNV groups and each of the 9 most common rCNVs (27 of 39 tests, P binomial = .01).</p><p><strong>Conclusions and relevance: </strong>Findings of this genetic association study highlight the complementary value of rCNVs and PGSs for risk assessment in psychiatric disorders, with indications that PGSs can stratify risk among medium- and high-impact rCNV carriers and rCNV-associated risk may, in some instances, be attenuated among individuals with low PGSs.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"827-836"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030606","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":"Electroencephalography Microstate Instability and Clinical Outcomes in Individuals at Clinical High Risk of Psychosis.","authors":"Matthias Liebrand, Holly K Hamilton, Brian J Roach, Spero Nicholas, Peter M Bachman, Aysenil Belger, Ricardo E Carrión, Erica Duncan, Jason K Johannesen, Gregory A Light, Margaret A Niznikiewicz, Jean Addington, Carrie E Bearden, Kristin S Cadenhead, Diana O Perkins, William S Stone, Elaine F Walker, Scott W Woods, Tyrone D Cannon, Thomas Koenig, Daniel H Mathalon","doi":"10.1001/jamapsychiatry.2026.1084","DOIUrl":"10.1001/jamapsychiatry.2026.1084","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Clinical criteria for identifying individuals at clinical high risk of psychosis (CHR) have been established, but their predictive accuracy remains insufficient for guiding treatment decisions. Identifying reliable biomarkers associated with mechanisms of illness and treatment in individuals at CHR is therefore a central research goal. Here, we consider resting-state electroencephalography (EEG) microstates as such a potential biomarker.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether EEG microstate features are associated with future conversion to psychosis and other future clinical outcomes in individuals at CHR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Baseline EEG microstate data were collected from October 2009 through August 2014 as part of the 8-site case-control North American Prodrome Longitudinal Study-2 (NAPLS-2) during eyes-open resting-state conditions with continuous auditory white noise. Data were recorded from healthy control (HC) individuals and participants at CHR, including those at CHR with conversion to psychosis (CHR-C) and those with nonconversion (CHR-NC), followed up for 24 months. Individuals with CHR-NC were further divided into those with remission (CHR-R) or those with ongoing symptomatology (CHR-S) subgroups. A total of 241 individuals at CHR (52.4%) completed the full 24-month follow-up. Data were analyzed between January and November 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Resting-state EEG microstate features (coverage, duration, and occurrence) across 7 distinct microstate classes, along with cognitive test battery scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with HC participants (n = 183; 103 [56.3%] male; mean [SD] age, 20.2 [5.0] years), individuals at CHR (n = 460; 265 [57.6%] male; mean [SD] age, 19.2 [4.4] years) showed reduced microstate duration (Cohen d, 0.28; 95% CI, 0.07 to 0.49) and increased occurrence (Cohen d, 0.12; 95% CI, 0.03 to 0.21) across classes, reflecting reduced microstate temporal stability. Moreover, individuals with CHR-C (n = 56) exhibited greater instability than those with CHR-R (n = 70) and HC participants but not compared to those with CHR-S (n = 115). Within the CHR group, lower stability was associated with earlier conversion to psychosis and with increased positive symptoms. While individuals at CHR demonstrated cognitive deficits relative to HC participants, including attention scores, lower microstate stability was associated with better attention scores in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, EEG microstate stability, irrespective of class, was reduced in individuals at CHR compared to HC participants and was especially diminished in future CHR converters. The association between lower stability and better attention suggests that instability may at least partly reflect a compensatory mechanism for attention deficits. EEG microstate instability shows promise a","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"837-846"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13234755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149755","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":"Strategies for Establishing Clinical-Decision Thresholds in Psychiatry: A Review.","authors":"Yuliya Kotelnikova, Lee Anna Clark, Camilo J Ruggero, Whitney Ringwald, William E Narrow, Geoffrey M Reed, Andrew E Skodol, Peter J Tyrer, Mark Zimmerman, Roman Kotov","doi":"10.1001/jamapsychiatry.2026.1078","DOIUrl":"10.1001/jamapsychiatry.2026.1078","url":null,"abstract":"<p><strong>Importance: </strong>Nearly all psychopathology is inherently continuous, but both clinical practice and research often require categorical decisions (eg, treat or wait, pay for treatment or decline, enroll in study or not); therefore, thresholds are applied to continuous phenomena to guide these decisions. The most common strategy is to select cutoffs by focusing on diagnoses, but this may be unhelpful in many decisions (eg, selective prevention, choice between treatment options). This review evaluates strategies for developing thresholds for psychopathology dimensions that may enhance clinical decision-making, drawing on methods used in psychiatry, psychology, internal medicine, and health economics.</p><p><strong>Observations: </strong>One strategy used extensively in neuropsychology, child psychiatry, clinical psychology, and laboratory medicine is to define multiple thresholds (eg, mild, moderate, and severe), using statistical deviance vis-à-vis the general population. A second strategy is to select thresholds in reference to functional impairment, as has been done for some psychopathology measures. A third approach, common in internal medicine but underused in psychiatry, references probability of a negative outcome (eg, mortality). A fourth option, gaining momentum in European psychiatry, is to select thresholds based on costs and benefits of a clinical action at different levels of severity or risk. Common examples of these 4 strategies are reviewed, comparing their strengths and limitations. They are relevant not only to clinical measures but also research instruments. Value judgments are inherent in approaches 2, 3, and 4; thus, selection of such thresholds requires stakeholder input. Importantly, clinicians make decisions by considering all information, and thresholds are only 1 factor.</p><p><strong>Conclusions and relevance: </strong>Although diagnosis-focused thresholds are sometimes valuable, the field would be served best by also considering the aforementioned alternative strategies. These approaches have been greatly underused in psychiatry, and studies are urgently needed to address this gap. Herein, recommendations are offered for this research.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"870-879"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030642","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":"Confounding and Circularity in Actigraphy Prediction-Reply.","authors":"Andre C Tonon, Benicio N Frey","doi":"10.1001/jamapsychiatry.2026.1293","DOIUrl":"10.1001/jamapsychiatry.2026.1293","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"884-885"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030594","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":"Evaluating Reduced Use and Abstinence as Outcomes in Pharmacotherapy Trials for Stimulant Use Disorder: A Meta-Analysis of 12 Randomized Controlled Trials.","authors":"Masoumeh Amin-Esmaeili, Mehdi Farokhnia, Ramin Mojtabai, Lorenzo Leggio, Renee M Johnson, Ryoko Susukida","doi":"10.1001/jamapsychiatry.2026.1092","DOIUrl":"10.1001/jamapsychiatry.2026.1092","url":null,"abstract":"<p><strong>Importance: </strong>Cocaine and methamphetamine use disorders are major public health challenges with no approved pharmacological treatments. Reliance on complete abstinence as the sole end point in randomized controlled trials (RCTs) may hinder identification of effective therapies, as it is often overly stringent, whereas reduced stimulant use is a promising alternative given its association with improved health outcomes.</p><p><strong>Objectives: </strong>To evaluate the treatment effect of pharmacological interventions tested in RCTs for stimulant use disorder, comparing reduced use to total abstinence.</p><p><strong>Design, setting, and participants: </strong>A meta-analysis was conducted of 12 US National Institute on Drug Abuse-sponsored multisite RCTs conducted between 2001 and 2011 evaluating pharmacological interventions among people seeking treatment for cocaine or methamphetamine dependence. One-stage individual participant meta-analysis was used, and analyses were performed between August 2024 and November 2025.</p><p><strong>Exposure: </strong>Tested pharmacotherapies included topiramate, bupropion, modafinil, ondansetron, tiagabine, cabergoline, reserpine, selegiline, and baclofen, each compared to placebo in double-blind trials. All participants received cognitive behavioral therapy regardless of treatment assignment.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was reduced drug use based on self-report, defined as a transition from high frequency (≥5 days/month) to low frequency (1-4 days/month) of stimulant use or transition to abstinence. Abstinence, verified by urine toxicology, served as the secondary outcome. Mixed-effects logistic regression models with random study effects and inverse probability weighting were used to estimate pooled treatment effects.</p><p><strong>Results: </strong>A total of 2000 participants were included (1134 in cocaine RCTs and 866 in methamphetamine RCTs), of whom 587 (29.4%) were women, with a mean (SD) age of 39.7 (8.6) years. Overall, 446 participants (31.2%, weighted) achieved reduced use, whereas 184 (13.3%, weighted) achieved abstinence at the trial end point. No significant differences were observed between the pooled active treatment and placebo groups for either outcome, overall or when stratified by stimulant type. In analyses of individual medications, cabergoline showed positive effect sizes (Cohen h, 0.352; 95% CI, 0.115-0.590), indicating significantly higher rates of reduced cocaine use with cabergoline than pooled placebo.</p><p><strong>Conclusions and relevance: </strong>The present findings of this meta-analysis underscore the importance of evaluating a continuum of outcomes rather than focusing solely on abstinence in RCTs. The results suggest that reductions in stimulant use may serve as meaningful efficacy signals that could be underestimated when relying solely on stringent outcomes, such as abstinence.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"799-806"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13234748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149685","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":"Electroencephalography Microstates-A Biomarker for Psychosis?","authors":"Marion Brickwedde, Dario Gordillo, Peter P J Uhlhaas","doi":"10.1001/jamapsychiatry.2026.0939","DOIUrl":"10.1001/jamapsychiatry.2026.0939","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"785-786"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149747","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 Treatment Can Promote Recovery.","authors":"Nancy H Covell, Kenneth Minkoff","doi":"10.1001/jamapsychiatry.2026.1380","DOIUrl":"10.1001/jamapsychiatry.2026.1380","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"882-883"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149756","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":"Stop Counting Conversions-The Clinical High Risk for Psychosis Field Needs a New North Star.","authors":"Vijay A Mittal, Victor J Pokorny, Danielle N Pratt","doi":"10.1001/jamapsychiatry.2026.1386","DOIUrl":"10.1001/jamapsychiatry.2026.1386","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"781-782"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149831","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":"Nationwide Transdiagnostic Age and Sex Patterns in Mental Disorder Disease Development.","authors":"Eva N S Wandall, Per K Andersen, Rune H B Christensen, Michael E Benros","doi":"10.1001/jamapsychiatry.2026.0882","DOIUrl":"10.1001/jamapsychiatry.2026.0882","url":null,"abstract":"<p><strong>Importance: </strong>Individuals with mental disorders often experience multiple disease episodes and diagnostic changes after initial psychiatric contact. However, studies that comprehensively investigate heterogeneity in disease development beyond pairs of comorbid diseases and mortality from a transdiagnostic perspective have been lacking.</p><p><strong>Objective: </strong>To comprehensively study sex and age patterns of disease development for 7 major groups of mental disorders.</p><p><strong>Design, setting, and participants: </strong>This cohort study included data from linkage of national Danish registers of all adult individuals living in Denmark between 2000 and 2018. Adult individuals with 1 of the following first-time mental disorder diagnoses were included: substance use disorder, schizophrenia, psychotic disorder other than schizophrenia, mania and bipolar disorder, major depressive disorder, anxiety-related disorders, or personality disorders. Data were analyzed from August 2023 to December 2025.</p><p><strong>Main outcome and measures: </strong>For each of the 7 mental disorder categories, age- and sex-specific estimates of (1) the number of diagnostic shifts, (2) the absolute risk of pairwise diagnostic shifts, (3) the absolute risk of diagnostic recurrence, and (4) the number of psychiatric contacts encompassing inpatient admissions, outpatient treatment courses, and emergency department visits were calculated using age groups 18 to 24 years, 25 to 39 years, 40 to 59 years, and 60 years or older and male and female sex.</p><p><strong>Results: </strong>A total of 273 400 individuals (mean [SD] age at first contact, 41.4 [18.7] years; 150 349 female [55.0%]) with mental disorders were included and followed up for 2.1 million person-years. Diagnostic shifts were observed among 66 474 individuals (24.3%), and 30 558 (11.8%) had multiple diagnostic shifts. Individuals with psychotic disorders had the highest number of psychiatric contacts and diagnostic shifts. Younger age at first contact was associated with more psychiatric contacts and higher number of diagnostic shifts irrespective of diagnosis given at first contact as well as higher probabilities for most pairwise diagnostic shifts and diagnostic recurrence. Males showed a pattern of higher absolute risk of diagnostic shifts to substance use disorders and schizophrenia spectrum disorders than females, whereas females had a higher probability of diagnostic shifts to mood disorders, anxiety-related disorders, and personality disorders.</p><p><strong>Conclusions and relevance: </strong>This study found that disease development across the 4 outcomes was highly dependent on the specific diagnosis given at first contact as well as the patient's sex and age group. These findings are important for treatment planning and follow-up strategies to ensure that preventive initiatives are offered to high-risk individuals.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"789-798"},"PeriodicalIF":18.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147929562","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}