Journal of Clinical Psychopharmacology最新文献

{"title":"Sugarless Candy in Treatment-Resistant Clozapine-Induced Sialorrhea.","authors":"Felipe S Camelo, Mark P Sullivan","doi":"10.1097/JCP.0000000000002204","DOIUrl":"10.1097/JCP.0000000000002204","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"638-639"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470919","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":"Toward Precision Psychiatry: Using Clinical and Pharmacokinetic Data to Increase Antidepressant Dose or Change Treatment in Late-Life Depression.","authors":"Helena K Kim, Xiaoyu Men, Samar S M Elsheikh, Daniel J Müller, Daniel M Blumberger, Jordan F Karp, Eric J Lenze, Laura B Ramsey, Charles F Reynolds, Zachary L Taylor, Benoit H Mulsant","doi":"10.1097/JCP.0000000000002182","DOIUrl":"10.1097/JCP.0000000000002182","url":null,"abstract":"<p><strong>Purpose: </strong>Decision trees can use clinical predictors to determine whether to continue the same antidepressant or switch to a different treatment in older patients with major depressive disorder (MDD). We examined whether pharmacogenetic and pharmacokinetic variables could improve their performance.</p><p><strong>Procedures: </strong>We analyzed 191 participants from the Incomplete Response in Late-Life Depression: Getting to Remission (IRL-Grey) trial who had not responded fully after 4 weeks of venlafaxine XR (150 mg/d) and for whom venlafaxine up to 300 mg/d was continued for 8 additional weeks. CYP2D6 genotypes were determined; venlafaxine, o-desmethylvenlafaxine (ODV), and active moiety (AM) exposures at week 4 were calculated using population pharmacokinetic modeling. Decision tree analysis was performed using 5 early clinical predictors of eventual nonresponse identified in previous research and 4 pharmacogenetic and pharmacokinetic potential predictors. One decision tree was designed to optimize specificity (k=0.3), and another to optimize sensitivity (k=0.7).</p><p><strong>Results: </strong>Longer episode duration and lack of partial response at week 4 were retained as clinical predictors, and lower AM and ODV exposures were identified as additional predictors. Negative predictive values (NPVs) of the high-specificity and high-sensitivity trees (77.7% and 73.0%, respectively) were similar to NPVs in trees based solely on clinical predictors.</p><p><strong>Implications: </strong>Our methods can guide future studies combining clinical and biomarker data to address applied pharmacological questions relevant to day-to-day practice.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"556-563"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772757","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":"Reading the Signal: What Psychedelic Trials in Depression Still Can't Tell Us.","authors":"Samela Mariano Brown, Vania Modesto Lowe, Margaret Chaplin","doi":"10.1097/JCP.0000000000002239","DOIUrl":"10.1097/JCP.0000000000002239","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"655-656"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592011","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":"Memantine Augmentation for Obsessive-Compulsive Symptoms in Bipolar Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Hamzeh Rostami, Zahra Dorafshan, Neda Sadrizadeh Irani, Sedighe Mofradnejad, Shahin Norouzi","doi":"10.1097/JCP.0000000000002188","DOIUrl":"10.1097/JCP.0000000000002188","url":null,"abstract":"<p><strong>Background: </strong>Obsessive-compulsive symptoms are frequently observed in patients with bipolar disorder and present a significant therapeutic challenge. This study evaluated the efficacy and safety of memantine as an adjunctive therapy for obsessive-compulsive disorder in patients with bipolar disorder.</p><p><strong>Methods: </strong>In this randomized, double-blind, placebo-controlled trial, 46 patients with bipolar disorder and obsessive-compulsive disorder, stabilized on quetiapine and lithium, were randomly assigned to receive either memantine (n = 23) or placebo (n = 23) for 6 weeks.</p><p><strong>Results: </strong>The memantine group showed a significant reduction in Yale-Brown Obsessive-Compulsive Scale scores compared with the placebo group (Cohen d = 1.57 vs 0.42, P < 0.001). Nausea was the most common side effect, but overall adverse effects were minimal.</p><p><strong>Conclusion: </strong>Memantine appears to be a safe and effective adjunctive treatment for obsessive-compulsive disorder in patients with bipolar disorder, warranting further investigation.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"564-570"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720555","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":"Intramuscular Clozapine: A Systematic Scoping Review of Clinical Feasibility, Safety, and Efficacy.","authors":"Noori Dhaliwal, Sid Kaladharan, Jana Waldmann, Dan Siskind, Stephen Parker","doi":"10.1097/JCP.0000000000002198","DOIUrl":"10.1097/JCP.0000000000002198","url":null,"abstract":"<p><strong>Background: </strong>The use of oral clozapine for treatment-resistant schizophrenia (TRS) is often limited by acute psychotic symptoms and medical instability. Intramuscular (IMI) clozapine has been infrequently used as a bridge to oral therapy. This literature review considers the available evidence regarding IMI clozapine's feasibility, effectiveness, and safety.</p><p><strong>Methods: </strong>A systematic scoping review with a protocol preregistered on the OSF Registry. Records extracted from Ovid MEDLINE, CINAHL, Embase, PsycInfo, Web of Science Core Collection, Scopus, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Google Scholar. Risk of bias and quality assessments were conducted.</p><p><strong>Results: </strong>Twenty records met the inclusion criteria, primarily consisting of case reports or series; no randomized trials were identified. Half of the included studies were rated as either \"fair\" or \"good\" quality (n=11/20). Most records addressed the initiation of clozapine in the context of oral (PO) refusal, with services describing IMI clozapine as feasible within strict governance guidelines and pharmacy support. IMI clozapine was reported to provide a bridge to PO administration, with transitions commonly occurring within days, and the use of coercive measures decreasing over time. Patient-reported data were limited; however, safety profiles mirrored those of oral clozapine; route-specific adverse effects were localized, and serious events were infrequently reported.</p><p><strong>Conclusions: </strong>The existing literature suggests that IMI clozapine may be used as a time-limited intervention to support continued PO administration. Further prospective studies with standardized procedures, patient-centered outcomes, and extended follow-up periods are necessary to inform clinical practice and policy development.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"625-635"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015706","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":"Breaking the Cycle: Intravenous Dexmedetomidine for Refractory Agitation and Impending Rhabdomyolysis to Prevent Acute Kidney Injury.","authors":"Xiaoyuan Han, Yixuan Song, Junxi Wen, Ningning Liu, Ming Cha","doi":"10.1097/JCP.0000000000002212","DOIUrl":"10.1097/JCP.0000000000002212","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"648-651"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204807","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":"Intermediate Steps in the Practice of Psychopharmacology: The Role of Clinical Judgment.","authors":"Giovanni A Fava, Steven L Dubovsky, Richard Balon","doi":"10.1097/JCP.0000000000002206","DOIUrl":"10.1097/JCP.0000000000002206","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"521-524"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163373","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":"Higher Neutrophil-to-Lymphocyte Ratio Is Associated With Better Response to Esketamine in Treatment-Resistant Depression: A Post Hoc Exploratory Analysis of Real-World Data.","authors":"Matteo Carminati, Mattia Tondello, Chiara Morana, Michele Prato, Raffaella Zanardi","doi":"10.1097/JCP.0000000000002190","DOIUrl":"10.1097/JCP.0000000000002190","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence links inflammation with major depressive disorder (MDD) and treatment resistance. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a simple peripheral marker of systemic inflammation and immune balance and it may capture clinically meaningful heterogeneity in inflammatory burden, potentially contributing to variability in antidepressant response and vulnerability to treatment resistance. This study exploratively investigated whether baseline NLR values are associated with clinical response in patients with treatment-resistant depression (TRD) treated with intranasal esketamine in routine clinical practice.</p><p><strong>Methods: </strong>This retrospective observational study included patients with TRD treated with adjunctive intranasal esketamine at the Mood Disorder Unit of San Raffaele Hospital (Milan, Italy). Baseline NLR was calculated from complete blood count samples collected 1 to 7 days before treatment initiation. Clinical outcome was assessed after 7 months using the Clinical Global Impression-Improvement scale (CGI-I). Patients were classified as responders (CGI-I ≤2) or non-responders (CGI-I ≥3). An analysis of covariance (ANCOVA) was conducted to examine differences in baseline NLR while adjusting for age.</p><p><strong>Results: </strong>The final sample included 16 patients (8 responders and 8 non-responders). Responders showed higher baseline NLR values compared with non-responders (1.81±0.81 vs. 1.23±0.29). After controlling for age, baseline NLR differed significantly between the 2 outcome groups ( P =0.003).</p><p><strong>Conclusions: </strong>Higher baseline NLR was associated with sustained clinical improvement after 6 months of esketamine treatment in patients with TRD. Although preliminary and limited by the small sample size and retrospective design, these findings suggest that a patient's inflammatory status at baseline may affect their treatment response. Larger prospective studies are needed to clarify the role of inflammatory markers as predictors of response to esketamine.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"598-602"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815664","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":"Hypnopompic Hallucinations: A Pitfall of Polypharmacy and CYP2D6 Inhibition.","authors":"Brendan Olson, Nathan Harward, Kerry Anderson, Gibson Aguwom, Kayode Giwa, Gina Jamal","doi":"10.1097/JCP.0000000000002211","DOIUrl":"10.1097/JCP.0000000000002211","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"647-648"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149482","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":"Deciphering Mental Illness: Neurons vs. Neuroglia.","authors":"Arif Khan, Rashmi Prakash, Anshu Arora, Aishwarya Prasad","doi":"10.1097/JCP.0000000000002216","DOIUrl":"10.1097/JCP.0000000000002216","url":null,"abstract":"<p><p>Although more than 60 psychotropic drugs are currently approved for mental illness, their therapeutic index remains modest, with limited efficacy over placebo and substantial adverse effects. Initial concerns that glucagon-like peptide-1 (GLP-1) analogs might produce starvation-related central nervous system (CNS) effects, like those of anorexia nervosa, have been subverted by their largely positive outcomes. Clinical observations of reduced \"food noise\", altered reward behaviors, and improved mood have prompted trials evaluating these agents for their potential as psychotropics. This serendipitous paradox compels re-evaluation of prevailing psychiatric disease models. The focus on small-molecule neurotransmitters operating at synapses appears insufficient to explain complex psychiatric illness or the effects of larger molecules like GLP-1. Notably, psychiatric disorders, though familial, do not follow Mendelian inheritance and show considerable heterogeneity in symptoms, suggesting that DNA sequence variation alone is inadequate as a unifying explanation. Alan Turing's pre-DNA morphogenesis model, emphasizing chemical gradients and developmental divergence, offers an alternative framework. While Virchow and Cajal established neuron-centered paradigms, later reinforced by neurochemical and monoaminergic discoveries, emerging evidence increasingly implicates neuroglia, particularly astrocytes, in higher mental functions, and their disruption in psychiatric diseases. This nascent and fragmented field warrants integration. Herein, we review astrocyte phylogenetics across vertebrates, their regional specialization within the human brain, and their synthesis of diverse small and large molecules. We propose adopting a model in which neurons and neuroglia act together in syncytial constellations that underlie complex mental functions, mediated by their molecular products. Finally, we outline strategies for drug-development and therapeutics harnessing syncytial constellations and astrocyte-derived molecules.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"536-548"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}