Journal of Clinical Psychopharmacology最新文献

{"title":"Cariprazine in Human Milk: Cautionary Implications for Use During Lactation.","authors":"Shreya Balamurali, Shraddha Trehan, Amy Stark, Palika Datta, Kaytlin Krutsch","doi":"10.1097/JCP.0000000000002174","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002174","url":null,"abstract":"<p><strong>Background: </strong>Cariprazine is a dopamine D2/D3 partial agonist approved for treatment-resistant depression, bipolar disorder (BD) and schizophrenia. Women with bipolar disorder face an increased risk of postpartum mania and psychosis, as childbirth often triggers episodes. While continuing cariprazine can be crucial for maternal well-being, limited data exist on its peripartum safety. The objective of this research is to assess the risk of infant exposure to maternal cariprazine via breast milk.</p><p><strong>Methods: </strong>Breast milk samples were released from the InfantRisk Human Milk Biorepository from 5 lactating women who were taking cariprazine 1.5 to 4.5 mg daily, 4 of whom continued the drug since pregnancy. Timed samples were collected and analyzed using liquid chromatography-tandem mass spectrometry for cariprazine and its active metabolites, desmethylcariprazine (DCAR) and didesmethylcariprazine (DDCAR). Infant risk was assessed by determining relative infant dose (RID%) and maternal reports of infant outcomes.</p><p><strong>Results: </strong>Cariprazine and its metabolites were detectable in all participants' milk samples. Mean RID% was 1.23% for cariprazine, 0.09% for DCAR, and 1.22% for DDCAR, yielding a cumulative exposure of 2.54% RID; the highest individual dose-standardized RID was 3.99% (cumulative). Two mothers self-reported infant lethargy, one of which resolved after maternal dose reduction.</p><p><strong>Conclusions: </strong>Estimated infant exposure to cariprazine and its active metabolites falls below standard safety thresholds. However, reported infant adverse effects and the potential for metabolite accumulation due to DDCAR's long half-life necessitate further research to examine potential long-term adverse effects while breastfeeding, particularly in infants exposed to higher maternal doses. These findings represent the first empirical data on cariprazine during lactation and highlight the need for further studies, including pharmacokinetic modeling, to inform clinical guidance.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Posttraumatic Stress Disorder Treatment Patterns: Insights from a Large Retrospective Study.","authors":"Raman Baweja, Felix M Padilla, Daniel A Waschbusch, James G Waxmonsky","doi":"10.1097/JCP.0000000000002149","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002149","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder (PTSD) is a severe psychiatric condition associated with significant impairments in daily functioning. Although psychotherapy is the recommended first-line treatment, off-label psychotropic medications are frequently used. This study examined national treatment patterns and disparities in pediatric PTSD care using a large, diverse data set.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of pediatric patients (ages: 6 to 18) diagnosed with PTSD (ICD-10: F43.1; N = 61,516) from the TriNetX Research Network. Treatment patterns were analyzed across demographic and clinical variables. Odds ratios (ORs), hazard ratios (HRs), and 95% CIs were calculated.</p><p><strong>Results: </strong>The average age at diagnosis was 11.2 years (SD = 3.67), with females comprising 58.3% of the cohort. Mood disorders (59.2%), ADHD, and anxiety disorders were common comorbidities. Antidepressants were prescribed to 51.4% of patients, most commonly sertraline and fluoxetine. Antipsychotics were used in 30.5% of cases, but only 19.2% had prior psychotherapy. Overall, psychotherapy utilization was 35.5%. Black and Hispanic youth were less likely to receive most psychotropics, and Black youth had lower odds of receiving psychotherapy (OR: 0.85, 95% CI: 0.81-0.89), though antipsychotic use did not differ significantly. After controlling for confounders, greater clinical severity was associated with increased antipsychotic use (aHR: 2.79, 95% CI: 2.68-2.90).</p><p><strong>Conclusions: </strong>This study highlights substantial variability in pediatric PTSD care, including frequent psychotropic use, often preceding psychotherapy, and significant racial and ethnic disparities. These findings emphasize the need for standardized protocols, better access to evidence-based care, and targeted strategies to reduce inequities.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":"46 3","pages":"249-257"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Candesartan Adjunctive Depression Trials-CADET: Study Protocols for Double-Blind, Randomized, Placebo-Controlled Trials for Bipolar Depression and Major Depressive Disorder.","authors":"Melanie M Ashton, Chun Hui J Park, Brisa S Fernandes, Judy Hope, Chee H Ng, Malcolm Hopwood, Jon-Paul Khoo, Gin S Malhi, Stella May Gwini, John Amerena, Trisha Suppes, Mary Lou Chatterton, Lana J Williams, Adam J Walker, Alyna Turner, Andre Carvalho, Andrew Nierenberg, Emily Moriarty, Lars Vedel Kessing, Mohammadreza Mohebbi, Seetal Dodd, Steven Moylan, John Tiller, Cas Schrueder, Bradley Matthews, Joel King, Jeremy Couper, Kurukula Sarangi Nanayakkara, Jessica E Green, Janardhanan C Narayanaswamy, Sarah Croce, Sylvia Lin, Elle Nguyen, Rebecca Corva, Paul Cortissos, Selin Hikmet, Sammy Russell, Jee Hyun Kim, Olivia M Dean, Michael Berk","doi":"10.1097/JCP.0000000000002156","DOIUrl":"10.1097/JCP.0000000000002156","url":null,"abstract":"<p><strong>Background: </strong>Depression in both bipolar and major depressive disorder remains a major unmet need due to treatment resistance to the existing treatments. Emerging evidence implicates the renin-angiotensin system in regulating the cellular stress response relevant to depression, suggesting it as a novel therapeutic target for depression. Candesartan, a common hypertension medication, decreases neuroinflammation, oxidative and nitrosative pathway activation, and neurotrophic signalling of angiotensin II by predominantly blocking the angiotensin II type 1 receptors (AT1R). Given AT1R-induced activities are implicated in the pathophysiology of bipolar and major depressive disorder and with supportive pharmacoepidemiology data, candesartan may represent a novel antidepressant strategy.</p><p><strong>Methods: </strong>The CADET Trials are 2 parallel 16-week double-blind randomized placebo-controlled trials of adjunctive candesartan (or placebo) for the treatment of bipolar depression (CADET-BD) and major depressive disorder (CADET-UD). Each trial aims to recruit 240 adult participants. The primary outcome is the between-group (ie, intervention vs. placebo) differential change from baseline to week 16 in depression symptoms as measured by the Montgomery Åsberg Depression Rating Scale. Secondary outcomes measure depression, mania, anxiety, quality of life, cost-effectiveness, functioning, substance use, cognition, and biological markers.</p><p><strong>Findings: </strong>Findings are not yet available as the trial is ongoing.</p><p><strong>Implications: </strong>The CADET Trials examine the efficacy of candesartan in reducing depressive symptoms in both unipolar and bipolar depression, and whether its effects are mediated through the renin-angiotensin system. Candesartan is affordable, accessible, and well-tolerated. If effective, it could quickly be adopted into clinical practice as a new adjunctive medication for the treatment of these disorders.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"258-268"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Low-Dose Adjunctive Methylphenidate Extended-Release on Cognition and Functioning in Individuals With Schizophrenia: A Randomized Open-Label Trial.","authors":"Naista Zhand, Ridha Joober, Alain Labelle, David Attwood, Fatima Al Quraish, Fatima Iftikhar, Carrie Robertson, Elizabeth Kozyra, Esther Carefoot, Philip D Harvey","doi":"10.1097/JCP.0000000000002132","DOIUrl":"10.1097/JCP.0000000000002132","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment severely disrupts functioning and recovery in schizophrenia. Methylphenidate extended-release (ER) shows promise for cognition in attention-deficit/hyperactivity disorder but has limited, inconsistent evidence in schizophrenia. This study investigates low-dose methylphenidate ER's effects on cognitive and functional outcomes in schizophrenia, addressing a critical therapeutic gap.</p><p><strong>Methods: </strong>In an 8-week, open-label, randomized crossover trial, 24 stable adults with Diagnostic and Statistical Manual of Mental Disorders, 5th edition, diagnosis of schizophrenia spectrum disorder received 4 weeks of methylphenidate ER or treatment-as-usual (TAU), with crossover at week 4, and follow-up at week 12. The primary outcome was improvement in functional capacity, measured by the Virtual Reality Functional Capacity Assessment Tool (VRFCAT), while secondary outcomes included cognitive performance, assessed by the Brief Assessment of Cognition in Schizophrenia (BACS), and symptom severity evaluated by Positive and Negative Symptoms Scale (PANSS).</p><p><strong>Results: </strong>VRFCAT scores improved significantly over time; in the first period (baseline to week 4), the medication-first arm showed improvement versus the TAU-first arm, with overall gains from baseline to week 8 of 303.47 seconds and 159.91 seconds, respectively, sustained post medication. BACS showed significant improvements in the TAU-first arm during the medication phase for Symbol Coding and Tower of London. PANSS-6 improved significantly while on study medication, notably in delusions and social withdrawal, without psychosis exacerbation. At 2-month follow-up, 75% resumed methylphenidate ER.</p><p><strong>Conclusions: </strong>While results are interpreted cautiously due to the open-label design and small sample size, this trial suggests low-dose methylphenidate ER may enhance functional capacity, specific cognitive domains, and symptoms in schizophrenia without exacerbating psychosis.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"280-288"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testosterone-Associated Onset of Skin Picking and Nail Biting in an Adolescent With Micropenis: A Case Report.","authors":"Ismail Akaltun","doi":"10.1097/JCP.0000000000002163","DOIUrl":"10.1097/JCP.0000000000002163","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"353-354"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cardiac Cost of Lithium: Two Case Reports of Bradycardia.","authors":"Aadhya Jagadish, Ravindra Neelakanthappa Munoli, Suma T Udupa, Samir Kumar Praharaj, Sivapriya Vaidyanathan, Ashok Jammigumpula, Rashmi Vishwanath, Tom Devasia","doi":"10.1097/JCP.0000000000002161","DOIUrl":"10.1097/JCP.0000000000002161","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"356-358"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amantadine as an Alternative to VMAT2 Inhibitors for Tardive Dyskinesia in Patients at Risk of Depression and Suicidality: A Case Report.","authors":"Ming-I Wei, Hong-Ci Lin, Pao-Yuan Ching, Cheng-Yu Chung, Chen-San Su, Ying-Sheng Li, Yen-Chung Chen, Cheng-Ho Chang","doi":"10.1097/JCP.0000000000002169","DOIUrl":"10.1097/JCP.0000000000002169","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"339-342"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Use of Dextromethorphan-Bupropion for Severe, Treatment-Resistant Major Depressive Disorder.","authors":"Thomas DePietro, Christina La Croix, Kathleen Flanagan","doi":"10.1097/JCP.0000000000002143","DOIUrl":"10.1097/JCP.0000000000002143","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"344-347"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etifoxine-A Novel Treatment Approach for Attenuating Premenstrual Exacerbation of Depressive Disorder: A Case Report.","authors":"Veena Ramesh, Stuti Dhavalkumar Dave, Vanteemar S Sreeraj, Ganesan Venkatasubramanian","doi":"10.1097/JCP.0000000000002151","DOIUrl":"10.1097/JCP.0000000000002151","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"352-353"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of Compulsive Shopping on Tirzepatide: A Case Report.","authors":"Anna I Guerdjikova, Lorene L Walter, Susan L McElroy","doi":"10.1097/JCP.0000000000002135","DOIUrl":"10.1097/JCP.0000000000002135","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"338-339"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}