Journal of Psychiatric Practice最新文献

{"title":"Clozapine-Associated Serotonin Syndrome: A Case Report and Literature Review.","authors":"Chanel Zhan, Tyler Zahrli, Benjamin Hoover","doi":"10.1097/PRA.0000000000000953","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000953","url":null,"abstract":"<p><p>Serotonin syndrome (SS) is a rare but potentially life-threatening condition resulting from increased serotoninergic activity in the central nervous system, either from exposure to a serotonin agonist or from withdrawal of a serotonin antagonist. Clozapine withdrawal has been implicated in cases of serotonin syndrome; however, clozapine exerts both agonist and antagonist properties at the serotonin receptor. We present the case of a 37-year-old male with unspecified psychosis and a structural neurological deficit who developed SS according to the Hunter Criteria while on a regimen of clozapine, paliperidone, and prednisone taper. Within an hour of receiving 400 mg of clozapine, the patient developed fever, tachycardia, diaphoresis, tremor, hyperreflexia, and inducible clonus. His symptoms resolved with supportive care, including intravenous fluids, benzodiazepines, and acetaminophen. We speculate that clozapine exerted its serotoninergic properties to induce SS symptoms in our patient, although alternative considerations and etiologies are discussed. We also include a review of the literature on cases of serotonin syndrome associated with clozapine. Five case reports were identified, all of which described SS occurring in the context of clozapine withdrawal or discontinuation. To our knowledge, ours is the first case suggestive of clozapine-induced SS. This case highlights the importance of considering SS in patients receiving clozapine, especially when concomitant medications may amplify serotoninergic effects. In addition, clinicians should exercise caution when using clozapine in patients with complex neurological conditions or in those with atypical psychiatric presentations. Close monitoring is needed when clozapine dose adjustments are made.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"293-297"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969130","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":"Psychosis Due to Lamotrigine Toxicity: Case Report.","authors":"Talia S Nasr, Alyssa C Smith, Hanna E Degen","doi":"10.1097/PRA.0000000000000950","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000950","url":null,"abstract":"<p><p>Lamotrigine toxicity may be associated with a variety of nonspecific clinical findings, and rarely with psychosis. Many previous studies have reported that the use of lamotrigine with other agents, such as valproic acid, or an overdose of lamotrigine precipitated symptoms of lamotrigine toxicity. This case involved a 31-year-old woman who experienced dizziness, emesis, and psychosis after her lamotrigine prescription had recently been increased. These symptoms resolved when lamotrigine was held after the diagnosis of lamotrigine toxicity had been made. To our knowledge, this is a rare documented case of psychosis associated with lamotrigine toxicity, independent of intentional overdose or concurrent use of valproic acid.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"298-299"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969395","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":"How Often Do QT-prolonging Drugs Really Prolong QT? A Systematic Review.","authors":"Dragos-Paul Hagiu, Lina Hamdi, Edouard Ollier, Sébastien Bruel, Paul Frappé","doi":"10.1097/PRA.0000000000000944","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000944","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically evaluate the incidence and prevalence of drug-induced QT interval prolongation and torsades de pointes (TdP) among adults exposed to QT-prolonging medications.</p><p><strong>Design: </strong>Systematic review of observational and interventional studies identified through MEDLINE (via PubMed).</p><p><strong>Setting: </strong>Primary and secondary care settings, including inpatient and outpatient populations, across multiple geographical regions.</p><p><strong>Participants: </strong>Adult patients (18 years and older) receiving QT-prolonging drugs and undergoing electrocardiographic monitoring. Studies reporting QTc prolongation using predefined thresholds were eligible. A total of 14,756 participants were included across 42 studies.</p><p><strong>Intervention: </strong>Exposure to QT-prolonging medications.</p><p><strong>Primary and secondary outcomes: </strong>The primary outcome was the incidence or prevalence of significant QTc prolongation, defined as QTc >500 ms or an increase in QTc (ΔQTc) ≥60 ms. The secondary outcome was the occurrence of TdP.</p><p><strong>Results: </strong>Of 501 records, 42 studies met the inclusion criteria: 5 were interventional and 37 observational, involving a total of 14,756 patients. Methadone was the most frequently studied drug (17 studies), with reported QTc >500 ms incidence ranging from 0% to 16.2%, and TdP prevalence up to 3.6% and incidence of up to 3.2%. Other frequently studied drugs included hydroxychloroquine (5 studies), azithromycin (4 studies), and antipsychotics such as haloperidol and quetiapine. Incidence of QTc >500 ms varied considerably across settings and drug classes, influenced by heterogeneous QTc correction formulas.</p><p><strong>Conclusions: </strong>Drug-induced QTc prolongation is not uncommon across a range of widely used medications, especially in psychiatric care, yet its monitoring and risk remain inconsistently assessed, particularly in outpatient settings. While TdP was rarely reported, QTc >500 ms occurred with notable frequency. Significant heterogeneity in QTc definitions, study populations, and ECG methodologies limits cross-study comparability, underscoring the need for greater standardization.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"229-241"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969290","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":"Medical Student Utilization of Mental Health Services: Mixed Method Analysis of Factors That Impact Where Students Seek Treatment.","authors":"Kyle D Webster, Alyssa C Smith, Katharine MacMillan, Sarah Kong, Elizabeth Miller, Alla Sikorskii, Amara E Ezeamama","doi":"10.1097/PRA.0000000000000951","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000951","url":null,"abstract":"<p><strong>Objective: </strong>Medical students are disproportionately affected by mental health conditions. It is therefore crucial to improve access to care for this population. To do this requires an understanding of where students seek treatment and what guides this decision. The goal of this study was to examine what motivates students to seek care based on a survey of medical students at the Michigan State University College of Osteopathic Medicine (MSUCOM).</p><p><strong>Methods: </strong>All medical students at MSUCOM were offered a survey that inquired about demographics; if they had sought mental health treatment, and if so, where they had sought treatment (internal vs. external to the institution); if they had not sought treatment, where they would prefer to seek treatment; and what factors influenced these decisions. This survey was conducted before the COVID-19 pandemic.</p><p><strong>Results: </strong>A total of 354 students (25.3%) completed the survey. Of these, 167 (47%) sought mental health care during medical school, 108 of whom (65%) sought care internally in the institution, and 59 of whom (35%) sought care externally (eg, in the community). Statistically significant factors that influenced students' decisions to seek care internally at their training institution included concerns with confidentiality (OR=0.24, 95% CI: 0.12, 0.49), convenience (OR=2.29, 95% CI: 1.19, 4.40), trust/comfort with provider (OR=2.01, 95% CI: 1.02, 3.97), age (OR=0.56, 95% CI: 0.43, 0.73), and year of medical education (OR=0.49, 95% CI: 0.35, 0.67).</p><p><strong>Conclusions: </strong>As medical schools increase the internal availability of mental health services for their students, these results highlight the importance of ensuring confidentiality and accessibility of services. As more than 1 in every 3 students seeking care preferred external resources, it is important for medical schools to also provide information on community resources.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"258-264"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969335","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":"Chatbots and Mental Health: Past, Present, and Future.","authors":"Allen Frances, Jill Noorily, Deven Dees, Luciana Ramos, Katie Beaver","doi":"10.1097/PRA.0000000000000942","DOIUrl":"10.1097/PRA.0000000000000942","url":null,"abstract":"<p><p>Tens of millions of people are already using chatbots as psychotherapists. Many find them helpful, but some are gravely harmed. This column helps clinicians understand the long history of chatbots; why they have suddenly burst on the scene now; current indications and contraindications; future risks and benefits; and how to identify and treat chatbot-induced disorders. A hybrid model will likely become increasingly prevalent, with human clinicians and chatbots working together to synergize each other's strengths and cancel each other's weaknesses. Chatbots are rapidly infiltrating our field. Clinicians cannot afford to be complacent in learning to adapt to the rapidly changing mental health landscape.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"288-292"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969116","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":"The Need for Integrated Treatment: Synergistic Aspects of Psychotherapy, Psychopharmacology, and Patient-Provider Dynamics in Clinical Practice.","authors":"Susan He, Yakov Shapiro","doi":"10.1097/PRA.0000000000000952","DOIUrl":"10.1097/PRA.0000000000000952","url":null,"abstract":"<p><p>Psychiatry has long been considered a biopsychosocial discipline, but, in the age of evidence-based medicine, clinical care is becoming increasingly fragmented and manualized. We continue to separate \"biological\" and \"psychological\" modalities in spite of mounting evidence that psychotherapy has a direct impact on brain physiology, and that psychopharmacological treatments carry meaning that often determines its real-life effectiveness. Evidence-based treatments (EBTs) focus clinical attention on the patient's symptomatic presentation and functional capacity that define their generic DSM-5 diagnosis. Yet, understanding the person of our patients and their experience of the illness goes beyond static diagnostic labels and involves exploration of their unique subjective and relational dynamics. Therapeutic alliance, a major factor in the treatment outcome across both psychotherapeutic and psychopharmacological modalities, has become increasingly marginalized as more psychiatrists shift toward single consultation practices, where the full scope of the relational meaning is largely lost. Conversely, the minority of practitioners who continue to offer psychotherapy are often less familiar with psychopharmacological modalities. Although psychopharmacology and psychotherapy are both clinically effective, their outcomes and cost-effectiveness are further enhanced when they are applied in tandem, in the context of a nurturing relationship with the treatment provider. Below, we examine the limitations of the current EBT paradigm and the evidence for an individualized integrated wellness model that relies on empirically supported principles of care.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"272-283"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969321","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":"Therapy-Interfering Interfering Behavior.","authors":"Lauren M Borges, Sean M Barnes, Ryan Holliday, Bridget B Matarazzo, Hal S Wortzel","doi":"10.1097/PRA.0000000000000943","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000943","url":null,"abstract":"<p><p>Therapy-interfering behavior (TIB), although commonly encountered in clinical practice, often goes unaddressed. But if behaviors preventing treatment engagement are not addressed, patients will struggle to achieve their treatment goals, will remain at high chronic risk for suicide, and may drop out of treatment. Therefore, to truly help our patients approach their stated goals and target suicide risk, it is critical to address TIB. In this first column of a 2-part series, we discuss how to identify TIBs in both patients and providers to facilitate therapeutic risk management of patients at risk for suicide.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"284-287"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969364","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":"An Audit of Adherence to the Agitation and Arousal Chart on an Inpatient Child and Adolescent Psychiatric Ward.","authors":"Wendy Hulme, Vincenzo Martino, Hugo A E Morandini, Pradeep Rao","doi":"10.1097/PRA.0000000000000946","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000946","url":null,"abstract":"<p><strong>Background: </strong>Evidence has shown that pro re nata (PRN) medications are often prescribed to manage agitation and disruptive behaviors. They require meticulous monitoring to prevent adverse effects and medication overuse. This article describes an audit that evaluated staff adherence to the use of an \"agitation and arousal\" chart that monitored PRN medication use on a child and adolescent psychiatric ward.</p><p><strong>Methods: </strong>The audit was conducted using the Plan-Do-Study-Act cycle design. Results from the first cycle were analyzed and presented in multiple formats. The second cycle was undertaken 4 months later. Adherence to the chart was re-evaluated with the expected audit standard set at 100%.</p><p><strong>Results: </strong>Sample sizes were similar in both cycles. Across the 2 cycles, 53% to 64% of inpatients were prescribed PRN medications and required use of the chart. There was an overall improvement in staff adherence across all areas of the chart, but the expected audit standard was only achieved in \"medication choice as per guideline\" and \"medication dose as per guideline.\"</p><p><strong>Conclusions: </strong>The audit highlighted improved staff adherence to the expected audit standards in most areas following staff education, but the desired 100% compliance with standards in all areas was not achieved. Ongoing education and monitoring were recommended.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"242-248"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969446","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":"Psychopharmacology at an Inflection Point: From Syndromes to Stratified Mechanisms, Circuit-Based Treatments, and Precision Psychiatry.","authors":"Matthew Macaluso","doi":"10.1097/PRA.0000000000000947","DOIUrl":"10.1097/PRA.0000000000000947","url":null,"abstract":"<p><p>Psychopharmacology, once propelled by a series of serendipitous mid-20th-century discoveries, has matured into a field defined by mechanistic diversity, translational neuroscience, and an expanding array of circuit-based interventions. Despite more than 100 approved psychiatric drugs, remission rates for major depressive disorder and other serious mental disorders remain modest, underscoring the biological heterogeneity embedded within syndromic diagnoses. Roughly 60% of patients with major depressive disorder respond to monoaminergic treatments, while others respond preferentially to glutamatergic agents such as ketamine or esketamine, and a smaller subset remains minimally responsive to both. These differential response patterns challenge the notion of a singular depressive disorder and highlight the need for biologically informed patient stratification. Contemporary psychopharmacology extends well beyond classic neurotransmitter modulation, encompassing synaptic plasticity, circuit regulation, inflammatory pathways, neurosteroids, muscarinic systems, drug-assisted psychotherapies, and computational neuroscience. Parallel advances in neuromodulation, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation, focused ultrasound, and adaptive deep brain stimulation, reflect a shift from region-based to network-based conceptualizations of psychiatric illness. Simultaneously, advances in pharmacogenomics, neuroimaging, artificial intelligence, and biomarker identification are beginning to make precision psychiatry a practical, though still emerging, reality. With these broadly described advances in mind, this column reflects on the historical trajectory of psychopharmacology, explores the convergence of pharmacology and neuromodulation, and considers the future of psychiatry through the lens of mechanism-based and personalized care. In doing so, it aims to carry forward the disciplined, mechanistically grounded scholarship that has long characterized this column.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"265-271"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969329","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":"Guest Editorial: Two Screens, Two Kinds of Waiting: Iranian Mental Health in an Age of Uncertainty.","authors":"Mehdi Sayyah","doi":"10.1097/PRA.0000000000000948","DOIUrl":"10.1097/PRA.0000000000000948","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"227-228"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969200","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}