Journal of Clinical Psychopharmacology最新文献

{"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}

{"title":"Menorrhagia Associated With Extended-Release Methylphenidate in an Adult Woman.","authors":"Giuseppe Guaiana","doi":"10.1097/JCP.0000000000002223","DOIUrl":"10.1097/JCP.0000000000002223","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"641-642"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446998","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":"Roger E. Meyer, MD.","authors":"Steven Mirin","doi":"10.1097/JCP.0000000000002247","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002247","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":"46 5","pages":"525"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840306","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":"Comparison of Standard and Two-Injection Start Regimens of Long-Acting Injectable Aripiprazole Monohydrate in Female Patients With Schizophrenia and Bipolar Disorder: A Retrospective Cohort Study.","authors":"Sumeyye Y Calli, Yagmur S Fidan, Arda Kızılsert, Filiz Izci, Alp Ucok","doi":"10.1097/JCP.0000000000002183","DOIUrl":"10.1097/JCP.0000000000002183","url":null,"abstract":"<p><strong>Background: </strong>Long-acting injectable (LAI) antipsychotics improve adherence and reduce relapse in severe mental illnesses. A new two-injection start (TIS) regimen of aripiprazole monohydrate LAI has recently been introduced as an alternative to the standard initiation regimen. Evidence on its clinical benefits, particularly in females with schizophrenia or bipolar disorder, remains limited.</p><p><strong>Methods: </strong>This retrospective cohort study included 87 female inpatients diagnosed with schizophrenia or bipolar disorder. Participants were divided into two groups according to initiation protocol: The standard regimen (400 mg injection plus 14 days of oral aripiprazole) or the TIS regimen (two 400 mg injections with a single 20 mg oral dose). Clinical outcomes were compared between groups, including time to discharge, rehospitalization rates, and symptom change.</p><p><strong>Results: </strong>Of the total sample, 47 patients received the TIS regimen and 40 the standard regimen. Baseline demographic and clinical features were comparable between groups. Time to discharge was significantly shorter in the TIS regimen group (mean 8.1 vs. 11.8 d, P = 0.042). Rehospitalization rates within 1 year were lower in the TIS regimen group (17.0% vs. 37.5%, P = 0.031), and time to rehospitalization was longer ( P = 0.027). Adherence patterns favored the TIS regimen, with a higher proportion of regular use. In the schizophrenia subgroup, PANSS reductions from admission to discharge were greater with the TIS regimen. Adverse events were infrequently documented.</p><p><strong>Conclusions: </strong>Aripiprazole monohydrate LAI initiation with the TIS regimen was associated with shorter hospitalization and more favorable rehospitalization outcomes compared with the standard protocol in female patients.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"584-588"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592427","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":"Aripiprazole Withdrawal-Associated Restless Legs Syndrome During Clozapine Treatment in an Adolescent With Schizoaffective Disorder: A Case Report.","authors":"Michele Poletti, Sara Santi","doi":"10.1097/JCP.0000000000002184","DOIUrl":"10.1097/JCP.0000000000002184","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"642-644"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375881","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":"Are the 8 Finnish Deaths Explained by Agranulocytosis More Important than the Thousands of Suicide Deaths Associated with the Lack of Use of Clozapine? Reflections on Clozaphobia.","authors":"Jose de Leon","doi":"10.1097/JCP.0000000000002218","DOIUrl":"10.1097/JCP.0000000000002218","url":null,"abstract":"<p><strong>Background: </strong>In 1975 clozapine was associated with 8 agranulocytosis deaths in Finland, leading to clozaphobia. In 1989 clozapine was approved in the United States (US) by the Food and Drug Administration (FDA) for treatment-resistant schizophrenia and in 2003 for suicide prevention. The FDA contributed to clozaphobia by focusing on the risk of agranulocytosis while ignoring other risks. On November 19, 2024, an FDA clozapine meeting reported 140,000 annual prescriptions and 0.03% mortality from agranulocytosis, and allowed patients' advocates to argue that the restrictions were costing millions of lives. In June 2025 the package insert eliminated the centralized database and hematological monitoring became \"recommended\".</p><p><strong>Methods: </strong>Four 2025 clozapine articles from this journal are used to initiate a rational discussion on suicide prevention and agranulocytosis risk. Suicide takes 5% of patients with schizophrenia, while long-term treatment with clozapine may prevent up to 80% of these deaths.</p><p><strong>Results: </strong>US prescribers not willing to use clozapine need to consider long-acting injectable antipsychotics unless they want to contribute to the future 194,000 suicide deaths in patients with schizophrenia. For every future increase of 10,000 long-term clozapine prescriptions in schizophrenia, 400 US lives will be saved from suicide, costing 3 from agranulocytosis.</p><p><strong>Implications: </strong>More widespread clozapine usage may save an unknown number of lives among other treatment-resistant US psychiatric patients and in other countries. Worldwide, 4 million people with schizophrenia will kill themselves in the coming years; every 10% increase in clozapine usage may lead to saving 320,000 lives at a cost of 2,400 deaths from agranulocytosis.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"526-535"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391083","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":"Comparative Pharmacovigilance Analysis of Pulmonary Embolism Across Antipsychotics in VigiBase.","authors":"Carlos De Las Cuevas, Emilio J Sanz, Jose de Leon","doi":"10.1097/JCP.0000000000002213","DOIUrl":"10.1097/JCP.0000000000002213","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) may be associated with antipsychotics or an underlying serious mental illness (SMI). This pharmacovigilance study in VigiBase studied the association between 6 antipsychotics and PE by using statistical analyses: (1) from VigiBase, or (2) developed by the authors based on fatal outcomes.</p><p><strong>Methods: </strong>VigiBase PE data are included from the onset through July 1, 2025, for 6 antipsychotics (clozapine, olanzapine, risperidone, quetiapine, aripiprazole, and haloperidol). The disproportionality analyses used the information component (IC) and its confidence intervals (CIs). An IC=0 indicates no association. Logistic regression models explored PE fatal versus nonfatal outcomes.</p><p><strong>Findings: </strong>Olanzapine had the highest IC=1.2 (1.1 to 1.3) with 592 PE cases (257 expected). Clozapine's IC=0.93 (0.85 to 1.0) with 1314 PE cases (688 expected). Other antipsychotics provided very low signals. The percentage of fatal outcomes was 41% (538/1313) on clozapine, 28% (161/579) on olanzapine but no clozapine, and 21% (225/1092) on other antipsychotics but no clozapine or olanzapine. In the logistic regression model of 2984 PEs, the adjusted odds ratios (ORs) for fatal outcomes were 1.5 (95% CI: 1.2-1.9) for olanzapine and 2.5 (95% CI: 2.1-3.0) for clozapine.</p><p><strong>Implications: </strong>This large sample from VigiBase, despite its limitations, including using voluntary reports, provided a PE signal that was statistically significant for olanzapine and clozapine, while not significant for other antipsychotics. Future studies will need to explore the contribution of SMI versus olanzapine and clozapine. Clinicians need to be aware that the proportion of fatal outcomes is around 40% in patients on clozapine and those on complex antipsychotic polytherapy.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"589-597"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412141","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":"Reframing Psychopharmacology Education: Competency, Integration, and Contemporary Standards.","authors":"Matthew Macaluso, Holly A Swartz, Joseph F Goldberg, Dan V Iosifescu, Carlos A Zarate, Anita H Clayton","doi":"10.1097/JCP.0000000000002222","DOIUrl":"10.1097/JCP.0000000000002222","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"654-655"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470865","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}