Journal of Psychiatric Practice最新文献

{"title":"Analysis of the Use of Duloxetine in the High-dose Range (90 to 120 mg) in the Psychiatric Clinic for the Treatment of Patients With Major Depressive Disorder.","authors":"José Martínez-Raga, Begoña Soler-López, José Ángel Alcalá","doi":"10.1097/PRA.0000000000000945","DOIUrl":"10.1097/PRA.0000000000000945","url":null,"abstract":"<p><strong>Background and objectives: </strong>Duloxetine is a serotonin and norepinephrine reuptake inhibitor antidepressant drug. The goal of this project was to analyze the characteristics of patients with major depressive disorder (MDD) treated with duloxetine in the high-dose range (90 to 120 mg).</p><p><strong>Methods: </strong>A retrospective, multicenter study was designed to analyze 20 indicators on the clinical use of duloxetine (90 to 120 mg) in adults with MDD who were referred to the psychiatric clinic.</p><p><strong>Results: </strong>A total of 175 psychiatrists participated in the study and collected information on 1050 patients with a mean age of 51.3 years (62.9% women). A total of 55.4% had comorbid psychiatric conditions, with dysthymia (17.2%), generalized anxiety disorder (15%), and personality disorders (13.1%) being the most common. A total of 84.7% had nonpsychiatric conditions, including chronic pain (28.8%), fibromyalgia (22.4%), sleep disorders (20.5%), arterial hypertension (17.8%), dyslipidemia (16.3%), neuropathic pain (11.4%), and cognitive impairment (5.8%). In all, 45.3% of the sample were found to be markedly to extremely ill. A total of 84.3% had received 1 to more than 4 prior lines of therapy. The most common reason for prescribing duloxetine in the high-dose range was a lack of efficacy of previous treatment (41%) or because the patient showed only a partial response to lower doses of duloxetine (30.7%).</p><p><strong>Conclusion: </strong>A greater than expected proportion of patients with advanced, marked, or severe disease, psychiatric comorbidity, sleep disorders, neuropathic pain, and cognitive impairment was observed among the subjects with MDD treated with high-dose duloxetine.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"249-257"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969011","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":"Handbook of Climate Psychiatry and Psychotherapy: A Manual for Clinicians.","authors":"Andrew T Olagunju","doi":"10.1097/PRA.0000000000000949","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000949","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 5","pages":"300-301"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969142","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":"Feasibility and Acceptability of a Group Psychoeducation Program for Patients With Pathological Narcissism With or Without a Diagnosis of Narcissistic Personality Disorder.","authors":"Martin Blay, Inès Benmakhlouf, Mario Speranza, Miguel Duarte, Elsa Ronningstam","doi":"10.1097/PRA.0000000000000940","DOIUrl":"10.1097/PRA.0000000000000940","url":null,"abstract":"<p><p>Pathological narcissism (PN) and narcissistic personality disorder (NPD) are common yet highly stigmatized conditions for which no empirically validated treatment currently exists, despite growing evidence of the central role of psychoeducation. The goal of this study was to evaluate the feasibility and acceptability of our recently published group psychoeducation program for patients with PN, with or without a diagnosis of NPD. Twenty-five adult patients, who met ≥3 NPD criteria or presented with mean grandiosity and vulnerability scores ≥3 on the Pathological Narcissism Inventory-Brief Form and who were participating in our psychoeducation program, were recruited from a psychiatric outpatient center. Feasibility outcomes included attendance, completion, drop-out rates, as well as safety measures (between-session changes in state narcissism and hospitalization rates). Acceptability was assessed using a mixed-methods satisfaction questionnaire and by comparing pre- and post-group levels of trait narcissism using the Pathological Narcissism Inventory-Brief Form. Overall, attendance and completion rates were high (83% mean attendance with only 1 dropout). There were no between-session narcissistic activations and only 1 hospitalization unrelated to the group program; however, participants did report substantial emotional activation and a need for concomitant individual support. They also reported high levels of satisfaction and perceived usefulness. Exploratory pre-post changes suggested a decrease in self-reported grandiosity but not vulnerability, even though no causal conclusions could be drawn due to the uncontrolled design of the study. A major limitation of the study was the high rate of comorbidity with borderline personality disorder (92%), which limits the generalizability to all narcissistic patients. Overall, these findings support the feasibility and acceptability of a brief group psychoeducation program for PN.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"166-173"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536353","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":"Diagnosis and Treatment of Neurosyphilis Complicated by Implicit Clinician Bias and Unconscious Stigma: A Case Report and Literature Review.","authors":"Eduardo Andres Calagua-Bedoya, Diana K Fox, Eileen A McGarry, Christine T Finn","doi":"10.1097/PRA.0000000000000935","DOIUrl":"10.1097/PRA.0000000000000935","url":null,"abstract":"<p><p>Syphilis, a condition known as \"the great imitator,\" is a sexually transmitted infection caused by the bacterium Treponema pallidum that can present with a myriad of symptoms, including psychiatric and neurological changes. Severe complications of syphilis are rare nowadays due to the widespread availability of antibiotics. Nonetheless, the incidence has been increasing over the past few years. We describe the case of a middle-aged man who presented with neuropsychiatric symptoms that were initially thought to be secondary to substance use and who was eventually diagnosed with neurosyphilis. A brief review of the most common features of this condition, as well as treatment options, is presented. As this patient was part of a minority group and had a history of substance misuse that delayed the diagnosis of neurosyphilis, we will also comment on stigmas, disparities, and biases in clinical settings, and some mitigation strategies that can be implemented to prevent adverse health outcomes in marginalized populations.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"218-225"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536364","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":"Psychiatry, Social Media, Artificial Intelligence: A Call for Engagement.","authors":"Kelila Kahane, John Torous","doi":"10.1097/PRA.0000000000000939","DOIUrl":"10.1097/PRA.0000000000000939","url":null,"abstract":"<p><p>The rapid adoption of social media and now artificial intelligence (AI)-based chatbots has outpaced formal clinical guidelines on their use. Cases of alleged harm from both social media and AI use have accumulated in 2026. The recent Meta social media verdict hinged on a clinical question answered outside the clinical context. A similar pattern is repeating with AI, where litigation is moving faster than psychiatric consensus and even the pace of technological change. Assessing the risks and benefits of AI is thus critical but remains challenging, as harms may vary across rapidly evolving models, and benefits can change as well. Thus, clinicians need to be well informed about AI, and we present a framework for clinician competency in AI, including fundamentals of how AI is trained, how to ask about patient uses, and how to evaluate for risky engagement. We also propose using a familiar approach, the biopsychosocial formulation, to document and conceptualize AI use within a patient's life for a more nuanced assessment. With this discussion, we inaugurate the Digital Psychiatry column in the Journal of Psychiatric Practice and welcome submissions on the intersection of technology and mental health.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"209-211"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536459","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":"First Responders.","authors":"John M Oldham","doi":"10.1097/PRA.0000000000000937","DOIUrl":"10.1097/PRA.0000000000000937","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"165"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536314","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":"Providing Mental Health Care to First Responders: A Brief Introduction.","authors":"Douglas V Brennan, Alexandra Clay, Rachel D Tester, Hilary S Connery","doi":"10.1097/PRA.0000000000000938","DOIUrl":"10.1097/PRA.0000000000000938","url":null,"abstract":"<p><p>First responders, correctional officers, and military personnel face heightened risks for mental health disorders such as posttraumatic stress disorder, depression, substance use disorders, and suicidal behavior, yet they are often reluctant to seek care due to stigma, job-related consequences, and structural barriers. These populations are also prone to occupational injuries and chronic health conditions linked to physically demanding, high-stress roles involving repeated exposure to trauma and dangerous environments. This article provides an overview of the unique occupational stressors and barriers to care across different service sectors in the United States, including law enforcement, firefighting, emergency medical services, corrections, and the military. This review also offers guidance for community mental health providers in delivering context-sensitive, collaborative psychiatric care. With increasing societal stressors, including civil unrest and public scrutiny, supporting the psychological well-being of these frontline professionals is both a clinical and social imperative.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"174-180"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536416","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 2000 Through 2026: A Personal Perspective.","authors":"Sheldon H Preskorn","doi":"10.1097/PRA.0000000000000936","DOIUrl":"10.1097/PRA.0000000000000936","url":null,"abstract":"<p><p>The first column in this 2-part series covered the history of clinical psychopharmacology from the author's perspective from 1975 to 2000. This column covers the last 26 years of clinical psychopharmacology as experienced by the author from 2000 to 2026. It focuses on the following major areas: (1) system-level neurobiology of neuropsychiatric drugs with an early focus on antidepressants; (2) circuit-based drug discovery; (3) pharmacokinetic, pharmacodynamic, and metabolic determination of psychotropic drug response as encompassed by Preskorn's Organizing Equation; (4) therapeutic drug monitoring (TDM) and pharmacology safety based on the use of TDM's ability to measure the functional as opposed to just the genetic capability of a patient to metabolize a medication; (5) enzyme-mediated drug-drug interactions; (6) multiple medication use in everyday clinical practice; (7) the results and implications of the results of the NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study; and (8) early phase clinical investigation of novel central nervous system mechanisms. The column illustrates the author's goal to bring science to the practice of psychiatry, beginning in the mid-1970s, when psychoanalysis dominated psychiatric thinking, up through 2026, within our current limits of understanding. It also illustrates how, at least for one psychiatrist, knowledge in our field has evolved and his reason for having this goal.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"196-202"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536372","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":"Neuropsychiatric Diagnostic and Treatment Conundrums: Case Study of an Inpatient With a Complex Illness Presenting With Overlapping Features of Frontotemporal and Lewy Body Dementia.","authors":"Sabrina P Iddir, Elizabeth A Troy, Jason R Soble, Eitan Z Kimchi","doi":"10.1097/PRA.0000000000000934","DOIUrl":"10.1097/PRA.0000000000000934","url":null,"abstract":"<p><p>Frontotemporal dementia (FTD) and Lewy body dementia (LBD) are distinct neurodegenerative disorders that rarely co-occur. However, their overlapping features can obscure diagnosis and complicate management. We present the case of a 65-year-old man with a history of alcohol use disorder, diabetes, and blindness who developed acute behavioral changes, catatonia, and fluctuating mental status. He exhibited signs consistent with a behavioral variant FTD, including disinhibition, executive dysfunction, and hypersexuality, as well as features associated with LBD, including visual hallucinations, autonomic instability, and waxing-and-waning impairment in cognition. His hospital course was marked by episodic disorientation, variable language use, and persecutory delusions. Neuroimaging, cerebrospinal fluid analysis, and serial neuropsychological testing yielded mixed and inconclusive results, contributing to the diagnostic ambiguity. Treatment included lorazepam, which improved catatonic symptoms but was discontinued due to risk of delirium, and aripiprazole, which was tapered due to suspected neuroleptic sensitivity. The patient was ultimately discharged to memory care with a diagnosis of an unspecified dementia. This case underscores the challenges of diagnosing and managing patients with overlapping features of multiple neurodegenerative disorders. Recognizing points of overlap between syndromes like FTD and LBD is key to tailoring interventions and avoiding harm. Serial cognitive assessments, functional neuroimaging, and biomarker analysis may improve diagnostic accuracy, although these tools have limitations. A deeper understanding of the pathophysiology of overlapping dementia syndromes is crucial for improving diagnostic clarity and guiding treatment strategies.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"212-217"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536402","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":"Impact of a Psychological Stratified Intervention on Anxiety, Depression, and Pregnancy Outcomes in Pregnant Women.","authors":"Jia Liu, Nai-Fen Zhu, Jia Liu, Yan-Yan Shao","doi":"10.1097/PRA.0000000000000932","DOIUrl":"10.1097/PRA.0000000000000932","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to systematically investigate the efficacy of a psychological stratified intervention in alleviating anxiety and depression symptoms and optimizing pregnancy outcomes among pregnant women.</p><p><strong>Methods: </strong>A prospective, single-center, randomized controlled trial was conducted. Between March and July 2024, 80 pregnant women who underwent prenatal care registration at Suzhou Hospital Affiliated to Nanjing Medical University and tested positive for anxiety or depression [scoring ≥ 5 on the Generalized Anxiety Disorder 7-item scale (GAD-7) or ≥ 9 on the Edinburgh Postpartum Depression Scale (EPDS)] were recruited. Participants were randomly allocated into an intervention group (n=40), who received a customized psychological stratified intervention, and a control group (n=40), who received conventional nursing care. The primary outcomes included changes in anxiety/depression scores, whereas secondary outcomes encompassed pregnancy-related metrics, such as the incidence of postpartum hemorrhages.</p><p><strong>Results: </strong>The intervention group demonstrated significantly lower EPDS scores than the control group during the third-trimester and postpartum follow-up phases (both P<0.05). Notably, the incidence of postpartum hemorrhage in the intervention group was lower than that in the control group, and the difference was statistically significant (P=0.034).</p><p><strong>Conclusions: </strong>The psychological stratified intervention, as an evidence-based, tiered psychological support approach, effectively mitigates late-pregnancy and postpartum depressive symptoms, enhances maternal mental health, and reduces the risk of postpartum hemorrhage. These findings underscore its potential as a valuable addition to antenatal care protocols and support its widespread implementation in clinical settings.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 4","pages":"181-186"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536336","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}