Journal of Psychiatric Practice最新文献

{"title":"A Case of GLP-1 Receptor Agonist-Induced Lithium Neurotoxicity.","authors":"Anuhya Kotta, Sahar Ashraf, Mehreen Khan, Dustin DeMoss, Michael Rafferty, Augustus John Rush","doi":"10.1097/PRA.0000000000000921","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000921","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a hoped-for intervention to reduce nonadherence to psychotropic medications due to metabolic syndrome and, potentially, to reduce metabolic syndrome-related premature cardiovascular death among those undergoing treatment for bipolar disorder. GLP-1 RAs are currently approved by the US Food and Drug Administration for weight loss in patients with type 2 diabetes, for patients with cardiovascular disease, obesity, and type 2 diabetes, and for reduction of risk of sustained low estimated glomerular filtration rate in patients with chronic kidney disease or end-stage renal disease. Research into the use of GLP-1 RAs in patients with metabolic dysfunction-associated steatohepatitis and other conditions is ongoing. The expanding research into indications for the use of GLP-1 RAs will likely include individuals with bipolar disorder and, among them, patients treated with lithium carbonate. Here, we report a case of GLP-1 RA-induced lithium neurotoxicity, which suggests the need for further investigation and enhanced surveillance for lithium toxicity in patients who are coadministered lithium and GLP-1 RAs.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"156-159"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839202","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":"Birthdays as a Risk Factor for Inpatient Psychiatric Hospitalization: A Case-Crossover Study.","authors":"Keiko Kunitoki, Amira Bajracharya, Riti Srivastava, Dean J Atkinson, Scott D Lane","doi":"10.1097/PRA.0000000000000925","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000925","url":null,"abstract":"<p><strong>Background: </strong>Birthdays are typically a joyous occasion, but they can paradoxically conjure negative feelings, including reflections on failures and underachievement. In this study, we investigated a relationship between admission dates and patients' birthdays.</p><p><strong>Methods: </strong>Electronic health records from the Dunn Center hospitals were obtained from April 2021 to June 2024. Patients who were 12 to 80 years of age, except for those in competency restoration units, were included in the analysis. Any admissions occurring 2 weeks before and after the patient's birthday were defined as birthday-associated admissions. A case-crossover analysis was employed to examine the plausible temporal relationship between the birthday period and the acute psychiatric hospitalization. A conditional logistic regression model was used to test the odds of birthday-associated admission versus non-birthday-associated admission. Relevant covariates consisted of age, sex, primary diagnosis, and social determinants of health.</p><p><strong>Results: </strong>A total of 17,847 admissions were included. The case-crossover analysis found that patients were approximately twice as likely (OR=2.08, 95% CI=1.89-2.30, P<0.0001) to be admitted 14 days before or after their birthday relative to a 28-day control window randomly selected within each calendar year. Potentially confounding variables, such as age, admission diagnosis, and social determinants of health, showed no difference in the likelihood of admission.</p><p><strong>Conclusions: </strong>This analysis supports the hypothesis that, for persons with psychiatric disorders, birthdays may represent periods of increased risk/stress that can manifest in increased inpatient psychiatric admissions. With these results, we can supplement education efforts to inform patients, families, and providers to recognize birthdays as a possible risk factor for worsening psychiatric symptoms.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"120-124"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839224","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 Between Sensory Sensitivity and Psychological and Interpersonal Difficulties in Anxious Youth.","authors":"Sarah J Sadek, Erika S Trent, Megan M Dailey, Juliana E Avery, Gifty Amos Nwankwo, Jane Clinger, Minjee Kook, Catherine E Rast, Whitney S Shepherd, Andrew G Guzick, Eric A Storch","doi":"10.1097/PRA.0000000000000923","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000923","url":null,"abstract":"<p><strong>Objective: </strong>Childhood anxiety disorders are prevalent and impair children's socioemotional functioning. Abnormalities in sensory processing may play a role in the presentation of anxiety disorders. One important domain of sensory processing is sensory sensitivity, referring to heightened or diminished responses to sensory stimuli. While anxiety and sensory sensitivity frequently co-occur, research thus far has primarily focused on associations among autistic children, with limited investigation in anxious children. This study examined the associations between sensory sensitivity and anxiety symptom severity, externalizing problems, emotion dysregulation, and quality of peer and family relationships in children with elevated anxiety symptoms without neurodevelopmental disorders.</p><p><strong>Method: </strong>Ninety-four children aged 8 to 17 years (mean age=12.41, SD=2.55 y) with elevated anxiety symptoms but without neurodevelopmental disorders completed self-report assessments of sensory sensitivity, anxiety symptom severity, externalizing behaviors, emotion dysregulation, and quality of peer and family relationships. Participants' parents completed a parent-report assessment of children's externalizing behaviors.</p><p><strong>Results: </strong>Sensory sensitivity and anxiety symptom severity were not statistically significantly associated. Controlling for anxiety symptom severity and relevant sociodemographic covariates, sensory sensitivity explained a statistically significant amount of variance in youth-reported (but not parent-reported) externalizing symptoms, emotion dysregulation, and quality of family but not peer relationships.</p><p><strong>Conclusion: </strong>Anxious youth with sensory sensitivity may experience externalizing symptoms, emotion dysregulation, and difficulties with family relationships. Study limitations included a racially/ethnically homogeneous sample and a cross-sectional design. Further research is necessary to better understand the causal impact of sensory sensitivity on behavioral difficulties and quality of life, identify potential protective factors, and test intervention strategies for this population.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"102-111"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839200","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":"Pharmacy of the Mind: The Uncanny Origins of Psychiatric Drugs, and The World That Shaped Them.","authors":"Joseph McCullen Truett","doi":"10.1097/PRA.0000000000000924","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000924","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"162-163"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839272","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":"Developments in Clinical Psychopharmacology From 1975 Through 2000: A Personal Perspective.","authors":"Sheldon H Preskorn","doi":"10.1097/PRA.0000000000000930","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000930","url":null,"abstract":"<p><p>As I prepare to step down from my position as Psychopharmacology Columnist for the Journal of Psychiatric Practice after over 30 years in that role, it seemed appropriate to look back and discuss some major developments in psychopharmacology that have occurred over the course of the 50+ years of my career. To keep this narrative manageable in a column format, it is divided into 2 columns. Neither this column nor the next will cover everything-that would require a textbook. Instead, I will cover selected topics from a personal perspective. This column will principally focus on the first 25 years of my career and covers 5 main topics: therapeutic drug monitoring, which led to pharmacogenomics, studies in child and adolescent psychiatry, drug development research, neurobiology, and forensic psychiatry.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"125-129"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839205","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":"Prescribing Under Pressure: History and Legal Insights Into Boxed Warnings for Psychotropic Drugs.","authors":"Robert T Esterquest, William J Newman","doi":"10.1097/PRA.0000000000000929","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000929","url":null,"abstract":"<p><p>A boxed warning, or \"black box\" warning, represents the US Food and Drug Administration's most serious cautionary statement for prescription drugs. These warnings communicate clinically significant risks that may alter prescribing decisions, patient consent, and medicolegal responsibility. This narrative review explores the regulatory history, creation, and modification of boxed warnings, emphasizing their role in psychopharmacology. Using the case of varenicline (Chantix) as a focal example, we trace how emerging postmarketing data led to the implementation and subsequent removal of its boxed warning. We then summarize major boxed warnings across psychotropic classes, highlighting practical implications for prescribing, documentation, and informed consent. Finally, we discuss strategies for integrating boxed warning awareness into clinical decision-making and patient communication. Boxed warnings serve not merely as restrictions but as instruments of safety, vigilance, and shared decision-making that enhance the quality of psychiatric care.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"135-143"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839346","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":"A Case of GLP-1 Receptor Agonist-Induced Dysphoria and Aggression in a Patient With Underlying Major Depressive Disorder.","authors":"Mia Hofstad, Izabella De Abreu","doi":"10.1097/PRA.0000000000000920","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000920","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have recently emerged as a promising therapeutic option for patients to aid in weight loss; however, little is known about the potential psychiatric side effects of these medications. In this report, we present the case of a 64-year-old man who was started on the GLP-1 RA tirzepatide (Zepbound) and subsequently developed increased impulsivity, dysphoria, and aggression, which resolved with medication cessation. We suggest a potential relationship between GLP-1 RAs and mood, and we caution physicians to weigh the potential risks of the medications against the known benefits.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"153-155"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839408","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":"Alcohol Withdrawal Seizures: Neurobiological Mechanisms, Clinical Predictors, and Evidence- Based Management.","authors":"Valentin Skryabin, Alexandra Malygina, Svetlana Sokolova","doi":"10.1097/PRA.0000000000000927","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000927","url":null,"abstract":"<p><strong>Background: </strong>Alcohol withdrawal (AW) seizures are acute symptomatic seizures occurring in the context of alcohol cessation in dependent individuals. Although often self-limited, seizures are associated with an increased risk of complications such as delirium tremens, prolonged hospitalization, and neurocognitive decline. This review synthesizes recent findings on the neurobiological underpinnings, clinical features, genetic risk factors, and treatment strategies for AW seizures.</p><p><strong>Methods: </strong>We conducted a focused narrative review using PubMed and Scopus databases, covering studies published between 2000 and 2024. Key words included alcohol withdrawal seizures, pathophysiology, GABA, NMDA receptors, kindling, carbamazepine, hippocampal neurogenesis, and genetic susceptibility. Additional references were identified through manual review of citations from the key articles. Only peer-reviewed studies in English were considered. Particular emphasis was placed on high-quality clinical trials, translational animal models, and recent reviews integrating neurobiological and therapeutic insights.</p><p><strong>Results: </strong>AW seizures arise from a neuroadaptive imbalance between inhibitory GABAergic and excitatory glutamatergic systems, which is exacerbated by abrupt alcohol cessation. Hippocampal neurogenesis and dentate gyrus dysregulation have been identified as key contributors to seizure susceptibility. Genetic polymorphisms-particularly in SLC6A3 and APOE-appear to modulate individual vulnerability. While benzodiazepines remain the first-line treatment for AW seizures, carbamazepine has demonstrated efficacy as an adjunct or alternative in high-risk cases where benzodiazepines are contraindicated or ineffective. AW seizures are predictive of further withdrawal complications and long-term cognitive deficits, highlighting the importance of early recognition and personalized management strategies.</p><p><strong>Conclusions: </strong>AW seizures represent a critical clinical and neurobiological marker in the course of alcohol use disorders. Improved understanding of their pathophysiology and prognosis supports a stratified treatment approach incorporating both acute symptom control and long-term relapse prevention.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"112-119"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839184","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":"Commentary on the Risks of Prescription GLP-1 Agonists in Patients on Psychiatric Medications.","authors":"Amir Garakani","doi":"10.1097/PRA.0000000000000931","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000931","url":null,"abstract":"<p><p>There is a growing literature on the concurrent use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with psychiatric disorders, and their safety and risks, in addition to potential therapeutic benefits in some disorders. The 2 cases presented in this issue report on potential adverse reactions from the combination of a GLP-1 RA and the patient's current psychiatric medication regimen. The first case involves a woman with bipolar disorder who developed lithium toxicity after being started on tirzepatide, which normalized after both medications were discontinued. The second case reports on a man with major depressive disorder who developed mood lability, irritability, and aggression after starting tirzepatide, which abated after the medication was stopped. These cases highlight the importance of monitoring all patients' medications to ensure that a GLP-1A RA does not affect the metabolism of medications through its potential gastrointestinal effects, while also evaluating any possible mood changes that may occur with this class of medications, despite growing evidence that they are not associated with worsening depression or suicidal thoughts. Further studies are needed to better understand the effects of GLP-1A RAs in patients with comorbid psychiatric disorders.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"160-161"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839241","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":"Psychotherapy Selection Algorithm (PSA) 1.0: A Work in Progress.","authors":"Eric M Plakun, Meiram Bendat, Susan Lazar, Linda Michaels","doi":"10.1097/PRA.0000000000000928","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000928","url":null,"abstract":"<p><p>This column presents a first draft of the Psychotherapy Selection Algorithm (PSA 1.0), developed by a workgroup of the American Psychoanalytic Association. The goal of PSA 1.0 is to address bias in psychotherapy selection and to reexamine treatment selection so that it is based on evidence that includes the effectiveness and efficacy of psychodynamic therapy and psychoanalysis.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"130-134"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839254","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}