Journal of Neuropsychiatry and Clinical Neurosciences最新文献

{"title":"Cognitive Trajectories After Hospitalization for COVID-19: A 36-Month Longitudinal Study.","authors":"Maria Paula Maziero, Eunyoung A Lee, Gabriela D Colpo, Lucy Couture, Livia C Merrill, Lynae Baskin, Ana E Cahuiche, Ana Petway, Huihui Fan, Elizabeth Reese, Kendra M Anderson, Louise D McCullough, Paul E Schulz, Guadalupe Javier Ortiz","doi":"10.1176/appi.neuropsych.20250267","DOIUrl":"10.1176/appi.neuropsych.20250267","url":null,"abstract":"<p><strong>Objective: </strong>Neurological symptoms are commonly reported among individuals with postacute sequelae of COVID-19 (PASC), with cognitive impairment being the most common feature, but cognitive trajectories in PASC have not been clearly defined. The authors determined long-term cognitive changes in a cohort of individuals hospitalized with COVID-19, characterized their distinct cognitive trajectories, and identified factors associated with each trajectory at 36 months posthospitalization.</p><p><strong>Methods: </strong>The sample comprised 630 patients who were hospitalized with severe COVID-19 symptoms; 214 patients returned for at least one follow-up assessment over a 36-month period. Cognitive function, including attention, cognitive flexibility, processing speed, and memory, was evaluated by using BrainCheck, a validated digital platform, at 3-6, 12, 24, and 36 months posthospitalization. Longitudinal changes in cognitive performance and their associations with demographic factors, medical history, and neuropsychiatric symptoms were analyzed with linear mixed-effects models.</p><p><strong>Results: </strong>Four distinct cognitive trajectories over 36 months were identified and characterized. Group 1 (N=103, 48%) exhibited consistent normal cognitive function, group 2 (N=14, 7%) transitioned from unimpaired to impaired, group 3 (N=29, 14%) changed from impaired to unimpaired, and group 4 (N=68, 32%) showed persistent impairment across all domains. Poorer cognitive outcomes were associated with Hispanic ethnicity, although effects varied across domains.</p><p><strong>Conclusions: </strong>As with many viral encephalitides, some patients showed stable normal or abnormal cognition or improved cognition over time. Surprisingly, however, a fourth subset exhibited delayed cognitive decline. This observation suggests that PASC-associated mechanisms, perhaps including chronic cerebral inflammation, may cause progressive cognitive impairment well after the initial infection clears.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"350-359"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The American Psychiatric Association Practice Guideline for the Prevention and Treatment of Delirium: Updated Implications for Patient Care.","authors":"Mark A Oldham, Laura J Fochtmann, Catherine Crone","doi":"10.1176/appi.neuropsych.20250203","DOIUrl":"10.1176/appi.neuropsych.20250203","url":null,"abstract":"<p><p>Delirium occurs in a significant proportion of hospitalized and older patients, contributing to increased morbidity and mortality rates, lengthier hospitalizations, increased readmissions, higher health care costs, greater odds of persistent functional decline, and psychological distress for patients, their families, and clinicians. Given that the global population continues to age, the incidence of delirium is expected to rise. The recently updated American Psychiatric Association Practice Guideline for the Prevention and Treatment of Delirium includes 15 statements to help clinicians prevent delirium, improve its detection, and optimize treatment for delirium in adult patient populations. In this analysis and commentary, the authors review each of the guideline statements, providing context and discussion of their clinical implications.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"410-415"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resting-State Functional Connectivity and Alcohol Use Disorder: A Case-Control Study.","authors":"Mahmoud Elsayed, Sabrina K Syan, Kyla L Belisario, Emily MacKillop, Michael Amlung, Lawrence H Sweet, James MacKillop","doi":"10.1176/appi.neuropsych.20240145","DOIUrl":"10.1176/appi.neuropsych.20240145","url":null,"abstract":"<p><strong>Objective: </strong>The authors examined differences in resting-state functional connectivity (rsFC) in the brain between nontreatment-seeking adults with alcohol use disorder (case group) and recreational drinkers without alcohol use disorder (control group) and explored behavioral and psychological mechanisms underlying these differences.</p><p><strong>Methods: </strong>This case-control study included 140 adults (N=71 with alcohol use disorder and N=69 demographically matched control individuals) who completed a 9-minute resting-state functional MRI scan. About 45% were men, and the mean±SD age was 32.7±10.4 years. Seed-based rsFC analyses were conducted. Psychological mechanisms included alcohol-reinforcing value (assessed with the Alcohol Purchase Task), immediate reward orientation (delay-discounting task), and internalizing psychopathology (a composite of depression, anxiety, and posttraumatic stress measures).</p><p><strong>Results: </strong>Significant rsFC differences were found between seed-target regions, including the inferior frontal gyrus and lingual gyrus, lingual gyrus and inferior occipital gyrus, nucleus accumbens and lingual gyrus, and supplementary motor cortex and temporal pole. Connectivity in these regions was significantly higher in the alcohol use disorder group, except for the supplementary motor cortex seed. Indirect effects of group differences in rsFC were found for alcohol-reinforcing value indicators and internalizing psychopathology but not delay discounting.</p><p><strong>Conclusions: </strong>This study provides initial evidence of diagnostically distinct rsFC patterns in alcohol use disorder, reflecting higher incentive salience for alcohol and elevated negative reinforcement motivation.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"179-187"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenoconsonance: A New Form of Neurological Analysis That Complements Anatomical Localization and Disease Pattern Recognition.","authors":"Xavier Guell, Jeremy D Schmahmann","doi":"10.1176/appi.neuropsych.20250067","DOIUrl":"10.1176/appi.neuropsych.20250067","url":null,"abstract":"<p><p>The semiology of clinical phenomena is central to neurological reasoning. When clinical manifestations occur in combination (e.g., weakness plus sensory loss), they are traditionally analyzed by considering anatomical localization (e.g., right-sided weakness and aphasia implicate the left cerebral cortex) and disease pattern recognition (e.g., tremor, bradykinesia, and rigidity indicate parkinsonism). The authors introduce a third, complementary approach-phenoconsonance-that relates neurological phenomena to each other not by their anatomical localization or disease pattern recognition but by their shared phenomenology. The authors identify the main components of the description of neurological phenomena in relation to where, what, and how neurological function is affected: examples for \"where\" include left-arm deficits in left brachial plexopathy or left hemispace neglect in right parietal lesions; examples for \"what\" include motor strength, visuospatial reasoning, or abstract planning; and examples for \"how\" include slowness, incoordination, or difficulty with initiation, because either the same function can be disrupted in qualitatively different ways-movement can be slowed or uncoordinated-or the same qualitative abnormality can apply to different functions-slowing may characterize movement, and it may also characterize thinking. The where, what, and how of neurological phenomenology correspond in the authors' synthesis to spatial phenoconsonance, domain phenoconsonance, and qualitative phenoconsonance, respectively. The historical context and conceptual underpinning of the notion of phenoconsonance are reviewed, as is its usefulness for the study of brain-behavior relationships in the evaluation and treatment of individuals with neurological and neuropsychiatric disorders.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"107-119"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Cognitive Outcomes: Linking the Mayo Clinic Study of Aging and Rochester Epidemiology Project.","authors":"Jeremy A Syrjanen, Janina Krell-Roesch, Walter K Kremers, Julie A Fields, David S Knopman, Ronald C Petersen, Maria Vassilaki, Yonas E Geda","doi":"10.1176/appi.neuropsych.20240094","DOIUrl":"10.1176/appi.neuropsych.20240094","url":null,"abstract":"<p><strong>Objective: </strong>The authors used data from the Rochester Epidemiology Project (REP) and the population-based Mayo Clinic Study of Aging (MCSA) to examine how depression relates to cognitive outcomes.</p><p><strong>Methods: </strong>Depression data were acquired from electronic medical records (EMRs) via the REP for a sample of MCSA participants who were cognitively unimpaired at baseline. Participants were classified as having depression if a depression diagnosis was noted in the EMR or if a medication for depression was indicated. The authors calculated hazard ratios (HRs) with Cox proportional hazards models to elucidate the relationship between depression and incident mild cognitive impairment (MCI) and dementia. Linear mixed-effects models were used to study depression with the outcomes of global and domain-specific cognitive z scores. All models were adjusted for pertinent covariates.</p><p><strong>Results: </strong>The study included 1,805 community-dwelling adults (51% men) with a mean±SD age of 74.5 ± 7.3 years. Depression was associated with a significantly increased risk for progression to MCI (HR=1.37, 95% CI=1.13 to 1.65) and dementia (HR=1.33, 95% CI=1.04 to 1.70). In sensitivity analyses, only participants taking antidepressants were at increased risk for progressing to these outcomes, relative to those without depression. Depression was also associated with lower baseline cognitive z scores in all domains except memory. Associations with longitudinal cognitive trajectories were noted only when the timing of depression (no depression, before MCSA baseline only, at MCSA baseline only, or at both times) was considered.</p><p><strong>Conclusions: </strong>Depression was associated with baseline and longitudinal measures of cognition among community-dwelling older adults. Only individuals receiving antidepressants had a significantly increased risk for incident MCI and dementia.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"38 1","pages":"45-52"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12831016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mild Behavioral Impairment: A Population-Based Study.","authors":"Maria Vassilaki, Jeremy A Syrjanen, Janina Krell-Roesch, Jonathan Graff-Radford, Prashanthi Vemuri, Julie A Fields, Walter K Kremers, Clifford R Jack, David S Knopman, Constantine G Lyketsos, Ronald C Petersen, Yonas E Geda","doi":"10.1176/appi.neuropsych.20240155","DOIUrl":"10.1176/appi.neuropsych.20240155","url":null,"abstract":"<p><strong>Objective: </strong>The authors conducted a population-based investigation of mild behavioral impairment (MBI) in the Mayo Clinic Study of Aging setting. MBI refers to new onset of neuropsychiatric symptoms (NPS) among adults ages ≥50 that is not due to a psychiatric disorder and that may be a precursor of cognitive decline or dementia.</p><p><strong>Methods: </strong>The Neuropsychiatric Inventory Questionnaire was used in a cross-sectional study of participants ≥50 years without dementia to assess for NPS. Linear and logistic regression models were estimated and adjusted for age, sex, and education.</p><p><strong>Results: </strong>The study sample comprised 2,713 participants (mean±SD age=74.6±9.5 years, 47% women). Overall, 11% of the participants had MBI at the first follow-up; 2,498 were cognitively unimpaired (10% of whom had MBI), and 215 had mild cognitive impairment (MCI; 29% of whom had MBI). Having MBI was associated with significantly higher odds of MCI (OR=3.47, 95% CI=2.46-4.84) and lower cognitive scores. Severe MBI was associated with even higher MCI odds (OR=5.15, 95% CI=2.73-9.37) and lower cognitive scores.</p><p><strong>Conclusions: </strong>In this study of older adults, participants with MCI were almost three times more likely than cognitively unimpaired participants to have MBI. Having MBI was associated with increased odds of having MCI and lower cognitive scores.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"134-143"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression Symptoms Associated With Clinical Symptoms, Disability, and Functional Connectivity After Traumatic Brain Injury.","authors":"Joshitha Arora, Alexandra Ossowski, Abigail Patchell, Keith W Jamison, Amy Kuceyeski, Jayden Singh, Jacob Garetti, Maddie Cappillo, Lilah Hamill, Emily Blunt, Ulrike W Kaunzner, Robert Winchell, Stephanie Yee-Oleksy, Shahenda Khedr, Kristen Dams-O'Connor, Nicholas D Schiff, Conor Liston, Sudhin Shah, Abhishek Jaywant","doi":"10.1176/appi.neuropsych.20240262","DOIUrl":"10.1176/appi.neuropsych.20240262","url":null,"abstract":"<p><strong>Objective: </strong>Depression is known to be highly heterogeneous, with distinct clusters of symptoms. Whether this heterogeneity exists after traumatic brain injury (TBI) and how clusters of depression symptoms after TBI may relate to clinical symptoms, functional outcomes, and underlying neurobiology are largely unknown.</p><p><strong>Methods: </strong>The authors investigated depression symptom clusters after subacute TBI and evaluated their clinical, functional, and neural correlates. Community-dwelling participants with complicated mild, moderate, or severe TBI (N=53) were evaluated on average 5 months postinjury. Participants were administered the 17-item Hamilton Depression Rating Scale (HDRS), the Rivermead Post-Concussion Symptom Questionnaire, the Glasgow Outcome Scale-Extended, and a neuropsychological test battery. A subset of participants completed a resting-state functional MRI scan.</p><p><strong>Results: </strong>Principal component analysis on the HDRS items yielded a two-component solution that accounted for 40% of the variance. Component 1 encompassed mood and affective symptoms as well as agitation and loss of libido, and component 2 encompassed anxiety, insomnia, and most somatic symptoms of the HDRS. Component 2 was associated with greater TBI symptom burden and disability and worse executive functions but not resting-state functional connectivity. Component 1 was not related to TBI symptom burden, neuropsychological function, or disability, but there was a trend-level association between higher negative affect scores and greater functional connectivity between the dorsal attention and default mode networks.</p><p><strong>Conclusions: </strong>The findings suggest that depression after TBI may not be a unitary syndrome but rather may be composed of clusters of symptoms that have different associations with TBI symptom burden, disability, and brain connectivity.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"93-98"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationships Among Dementia, Parental Death, and Other Adverse Childhood Experiences: Systematic Review and Meta-Analysis.","authors":"Erin Logue, Jared F Benge, Albert Chung, D Jeffrey Newport, Charles B Nemeroff","doi":"10.1176/appi.neuropsych.20250154","DOIUrl":"10.1176/appi.neuropsych.20250154","url":null,"abstract":"<p><p>Examining risk factors for the development of dementia, a devastating condition, is of increasing importance in clinical research. Adverse childhood experiences (ACEs) represent one set of potentially modifiable dementia risk factors with known impacts on neurodevelopment and health. Refining approaches used in previous reviews, the authors of this review and meta-analysis sought to answer the question, What is the strength of the association between ACEs and dementia in later life? The authors searched PubMed, EMBASE, and Web of Science, including peer-reviewed studies involving adults exposed to ACEs and a comparison group of unexposed adults. The outcome of interest was dementia of any etiology, and study quality was assessed. Separate meta-analyses were performed with odds ratios and hazard ratios (HRs). The literature search yielded 2,032 articles, of which 13 were included for analysis. ACE exposure (OR=1.54, 95% CI=1.38-1.71, p<0.001; HR=1.51, 95% CI=1.24-1.84, p<0.001) and exposure to parental death in childhood (OR=1.42, 95% CI=1.16-1.74, p<0.001) were associated with increased odds of or risk for developing dementia, respectively. This meta-analytic review is the most extensive examination of the ACE-dementia relationship to date, and its findings suggest that several ACEs are associated with increased dementia odds and risk. Although the number of studies reviewed was small and the studies were mostly of fair quality, necessitating caution in interpretation, nearly all of their results supported the association between ACE and dementia. High-quality prospective cohort studies incorporating biomarkers to measure ACE outcomes will be essential.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"329-340"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Among Pain, Depression, Cognition, and Motor Function in Parkinson's Disease.","authors":"Nour Alkaduhimi, Roos Meijer, Annemarie Vlaar, Henk Berendse, Henry Weinstein, Erik Scherder","doi":"10.1176/appi.neuropsych.20250228","DOIUrl":"10.1176/appi.neuropsych.20250228","url":null,"abstract":"<p><strong>Objective: </strong>The authors examined the associations among depression, pain, motor function, and cognitive performance in Parkinson's disease (PD) to determine whether these relationships differ between the tremor-dominant (TD) and postural instability and gait difficulty (PIGD) motor subtypes of PD.</p><p><strong>Methods: </strong>Cognitive performance was assessed with a broad neuropsychological test battery. Pain was measured with the King's Parkinson's Disease Pain Scale, Numeric Rating Scale, Color Analog Scale, and Douleur Neuropathique 4; motor function with the Movement Disorder Society Unified Parkinson's Disease Rating Scale (Part III and selected Part II items); and mood with the Hospital Anxiety and Depression Scale. Composite scores were derived via factor analysis. Mediation analyses (hierarchical regression and Sobel test) were performed with data from the full sample and stratified by motor subtype.</p><p><strong>Results: </strong>Motor function significantly mediated the relationship between depression and cognitive performance in the full sample and in the PIGD group, but not in the TD group. Pain was not significantly associated with cognition. Patients with the PIGD subtype had greater motor impairment, higher depression scores, and lower cognitive performance than those with the TD subtype.</p><p><strong>Conclusions: </strong>Motor dysfunction may represent a significant pathway that links depressive symptoms and cognitive performance in PD, particularly in the PIGD subtype. Pain lacked a significant association with cognition. These findings underscore the clinical relevance of jointly assessing motor and nonmotor symptoms in PD, particularly among patients with the PIGD subtype.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"395-400"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Diagnostic Disagreement Among Individuals With Functional Movement Disorders.","authors":"Adriano Mollica, Nima Nahiddi, Gabriela S Gilmour, Laura Kathleen Langer, Lindsey MacGillivray, Sarah Lidstone","doi":"10.1176/appi.neuropsych.20250221","DOIUrl":"10.1176/appi.neuropsych.20250221","url":null,"abstract":"<p><strong>Objective: </strong>Diagnostic agreement influences treatment outcomes, but studies on persistent diagnostic disagreement (PDD) in functional movement disorder (FMD) are lacking. The authors propose a definition for PDD and identified associated factors in a clinical cohort of patients with FMD.</p><p><strong>Methods: </strong>The authors retrospectively reviewed clinical data of 158 FMD patients seen in an integrated movement disorders program from July 2019 to December 2021. Patients self-reported diagnostic agreement before an initial assessment (as disagree, unsure, or agree). PDD status was determined by a specialist assessment on the basis of observable behaviors. Exploratory logistic regression and a least absolute shrinkage and selection operator (LASSO) model were used to examine associations of demographic and clinical features with PDD. Alignment between referring clinician impressions and patient self-reports was also evaluated.</p><p><strong>Results: </strong>Of 158 patients, 116 had complete data for both baseline self-reports and specialist PDD determination. Forty-seven patients (41%) were classified as having PDD. PDD was observed for 52% (N=15 of 29) of those who self-reported disagreement, 71% (N=17 of 24) who self-reported ambivalence, and 24% (N=15 of 63) who self-reported agreement. Variables associated with PDD included low agency, cluster B traits, lower readiness to change, inability to notice symptom variability, and lower self-reported agreement; only low agency was retained in the LASSO analysis. Among 78 patients with complete data including referring physician impressions, concordance with patient self-reported disagreement was low (weighted κ=0.21, p<0.001).</p><p><strong>Conclusions: </strong>PDD was common in FMD, was not accurately identified by referral impressions or patients' self-reports, and may be linked to modifiable psychological processes.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"369-378"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}