Journal of Psychiatric Practice最新文献

{"title":"Medicinal Cannabis Prescription Before an Inpatient Psychiatric Admission: A Retrospective Observational Audit.","authors":"Nikki Bodnar, Timothy Tanzer, Lesley Smith, Fehim Puris, Karl Winckel","doi":"10.1097/PRA.0000000000000907","DOIUrl":"10.1097/PRA.0000000000000907","url":null,"abstract":"<p><strong>Background: </strong>Prescribing of medicinal cannabis has expanded in Australia; however, evidence for benefit in psychiatric populations is limited. The goal of this study was to estimate the prevalence and characteristics of recent medicinal cannabis prescribing among psychiatric inpatients and to describe presentations associated with these admissions.</p><p><strong>Methods: </strong>We conducted a retrospective observational audit of adult patients admitted to a large metropolitan adult acute psychiatric unit in Brisbane, Australia, between September 2021 and October 2023. Electronic medical records were reviewed to identify medicinal cannabis prescriptions in the 90 days before admission. Information concerning demographics, indications, formulation, labeled potency, dispensing frequency, presentations, and length of stay were extracted for patients who had received such prescriptions.</p><p><strong>Results: </strong>Of the 752 patients who were screened, 35 patients (4.7%) were prescribed medicinal cannabis in the 90 days before admission. Most of the patients (91.4%) who had been prescribed medicinal cannabis had a prior psychiatric diagnosis. The leading indication for the prescribed medicinal cannabis was anxiety (48.6%). Nearly all of the patients who were prescribed medicinal cannabis (97.1%) were prescribed at least one product containing delta-9-tetrahydrocannabinol (THC), with a mean THC concentration of 24%. The majority of patients prescribed medicinal cannabis (88.6%) were admitted with psychosis.</p><p><strong>Conclusion: </strong>A small but clinically important proportion of psychiatric inpatients vulnerable to psychosis had recent prescriptions for medicinal cannabis, predominantly for higher-potency THC-containing products. Product type, labeled potency, and timing of the last dispensing should be documented in routine psychiatric assessment. Further work clarifying the risks and benefits of cannabis prescribing in this population is required.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"46-50"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530245","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":"Perceived Stress Is Associated With Lifetime ADHD Symptom Reporting Over and Above Anxiety and Depression: Implications for Psychiatric Evaluation and Treatment.","authors":"Mary Woloszyn, Alexandra Hernandez-Vallant, Nathan T Palladino, Briana Galindo, Mira I Leese, Fawwad Khan, Eitan Z Kimchi, Brian M Cerny, Matthew S Phillips, Jason R Soble","doi":"10.1097/PRA.0000000000000909","DOIUrl":"10.1097/PRA.0000000000000909","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosing attention deficit/hyperactivity disorder (ADHD) among adults is challenging, given reliance on retrospective symptom reporting and the overlap of core, nonspecific diagnostic symptoms with other psychiatric disorders such as depression and anxiety. This study examined the effect of perceived stress on ADHD symptom reporting.</p><p><strong>Methods: </strong>Cross-sectional data from 638 diverse adult outpatients referred for ADHD neuropsychological evaluation, who were administered the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Perceived Stress Scale (PSS), and Clinical Assessment of Attention Deficit-Adult (CAT-A), were analyzed. Linear regressions were conducted with BDI-II/BAI (block 1) and PSS (block 2) as predictor variables and ADHD symptom endorsement in childhood and adulthood (CAT-A) as the dependent variable.</p><p><strong>Results: </strong>PSS/BDI-II (r=0.648) and PSS/BAI (r=0.523) were moderately correlated. BDI-II and BAI significantly predicted overall ADHD symptom endorsement and current/adult symptom reporting, whereas only BAI predicted childhood symptoms. After entering the PSS in block 2, all models remained significant (P<0.001; R2=0.03 to 0.08), but BDI-II and BAI became nonsignificant; only perceived stress remained a significant predictor. The results were replicated after excluding those with potentially invalid ADHD symptom reporting, so that the PSS again was the only significant predictor of ADHD symptom endorsement (R2=0.02 to 0.06).</p><p><strong>Conclusions: </strong>Patients' subjective experience of stress was significantly associated with nonspecific inattention symptom endorsement among adults undergoing ADHD evaluation and shared more variance with attention complaints than active depression and anxiety symptoms. Findings emphasize routinely assessing perceived stress during psychiatric evaluation of ADHD, as high stress levels may masquerade as nonspecific inattention symptoms and contribute to misdiagnosis of ADHD if not considered/assessed, and high stress levels may also exacerbate genuine ADHD symptoms.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"64-69"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530212","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":"Navigating Discussions of Mental Health With Iranian Americans.","authors":"Arya Nekovei, Parsa Ravanfar, Thomas Pak","doi":"10.1097/PRA.0000000000000912","DOIUrl":"10.1097/PRA.0000000000000912","url":null,"abstract":"<p><p>The Iranian diaspora is a diverse and historically complex group whose mental health needs are shaped by cultural, religious, and political factors. In this article, we provide an overview of key considerations for engaging with this population in a culturally sensitive and clinically effective manner. We begin by outlining the historical and sociopolitical context of Iranian immigration from their homeland, particularly the lasting impact of the 1979 Islamic Revolution and the Iran-Iraq War. We then explore how cultural factors such as family structure, gender roles, and stigma influence perceptions of mental illness and help-seeking behavior. Discrimination and acculturative stress are also discussed as salient contributors to psychological distress within this population. Importantly, we highlight intergenerational differences that may shape the experiences of first- and second-generation Iranians in the diaspora differently. To support mental health professionals, we provide a table of key cultural concepts, including idioms of distress and relevant Farsi terms. Finally, we present a curated list of mental health resources, including a website developed by the co-authors, tailored to the Iranian American community. By synthesizing existing literature and integrating culturally informed perspectives, this article offers clinicians practical tools to build trust and foster culturally responsive care with patients from the Iranian diaspora. In doing so, we aim to reduce barriers to mental health treatment and improve the well-being of this understudied and often misunderstood community.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"58-63"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530209","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":"Two Case Reports of Zolpidem Abuse and a Contemporary Review.","authors":"Ruixue Sun, Boheng Zhu, Jing Wei, Nana Xiong, Wei Sun","doi":"10.1097/PRA.0000000000000910","DOIUrl":"10.1097/PRA.0000000000000910","url":null,"abstract":"<p><p>Zolpidem is a short-acting nonbenzodiazepine hypnotic agent. It was commonly considered a preferable treatment for insomnia because it was associated with low risks of abuse and dependency. However, those risks were underestimated, and the withdrawal symptoms associated with zolpidem can be life-threatening. Moreover, besides the gradual discontinuation of the long-term (≥4 wk) prescription of zolpidem, other effective strategies for zolpidem detoxification are being explored. We report 2 cases of zolpidem abuse with daily doses of 800 and 240 mg, respectively. The patients were successfully detoxified with clonazepam, trazodone, quetiapine, and simplified cognitive behavioral therapy for insomnia (CBT-I) without experiencing any significant withdrawal symptoms. Shifting from zolpidem to benzodiazepines with longer half-lives and gradual dose tapering may be useful in patients with zolpidem abuse. In addition to pharmacotherapy, simplified CBT-I can be helpful.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"90-95"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530234","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":"A Comparative Analysis of the Levels of Insight Between Elderly and Nonelderly Patients Diagnosed With Schizophrenia.","authors":"Si-Sheng Huang, Wen-Yu Hsu","doi":"10.1097/PRA.0000000000000898","DOIUrl":"10.1097/PRA.0000000000000898","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to examine various dimensions of insight among elderly and nonelderly patients with schizophrenia.</p><p><strong>Materials and methods: </strong>Disease insight was assessed in 105 patients using the Self-Appraisal of Illness Questionnaire (SAIQ), while disease severity was assessed using the Positive and Negative Syndrome Scale (PANSS). Results were compared among 3 age groups: 20 to 39 years (young), 40 to 59 years (middle-aged), and 60 years or above (older), using the Kruskal-Wallis test. Factors associated with insight were identified by constructing a multiple linear regression model.</p><p><strong>Results: </strong>Total PANSS scores did not differ significantly among the age groups. The total SAIQ score was significantly higher in the young and middle-aged groups compared with the older group (P = 0.011 and 0.024). The SAIQ Worry subscale score was significantly higher in the young group than in the older group (P = 0.021), while the Presence of Illness subscale scores were higher in both the young and middle-aged groups than in the older group (P = 0.017 and 0.041). Multiple linear regression identified older age (P = 0.024) and higher PANSS negative symptom scores (P = 0.041) as significantly associated with lower SAIQ scores.</p><p><strong>Conclusions: </strong>Among those with a similar severity of disease, individuals with schizophrenia aged 60 years and older displayed the lowest levels of insight. This older cohort exhibited reduced concern regarding the impact of the illness on their social and occupational functioning and tended to underestimate the severity of their condition. In addition to age, negative symptoms of schizophrenia may also play a significant role in the relationship with deficits in insight.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"8-14"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052682","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 and AI 2.0: An Update.","authors":"Eric M Plakun","doi":"10.1097/PRA.0000000000000902","DOIUrl":"10.1097/PRA.0000000000000902","url":null,"abstract":"<p><p>This second column on psychotherapy and AI offers an update on progress in domains identified in the first column, including (1) provision of a private, secure, psychologically safe space for the patient to do the work, (2) mastery of a set of techniques grounded in the theoretical underpinnings of a given form of psychotherapy, and (3) addressing issues relevant to the therapeutic relationship and therapeutic alliance in AI psychotherapy. The column reviews several recent studies of AI psychotherapy and summarizes 5 sets of \"threes\" for categorizing and evaluating AI psychotherapy.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"31-34"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052714","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":"Enhancing Training and Education on Treatment Readiness in Personality Disorders: A Case-based Discussion.","authors":"Connor Hawkins, David Kealy, Robert Nathan, John S Ogrodniczuk","doi":"10.1097/PRA.0000000000000899","DOIUrl":"10.1097/PRA.0000000000000899","url":null,"abstract":"<p><p>Patients with a personality disorder are frequently encountered in clinical settings, and their treatment often poses unique clinical dilemmas given specific features of the illness and treatment landscapes that are commonly austere. The past few decades have seen the emergence of new models for conceptualizing personality disorders and several new evidence-based treatments. However, the question of which patient should be matched to which treatment, and when, is a significantly under-investigated topic. We propose that one important component of answering this question is considering readiness for treatment, which has not received the same degree of attention as it has in other areas of mental health treatment. While there are currently no empirically validated tools to reliably quantify readiness for treatment, here we argue that it is still an important topic to consider when working with this patient population. We present 3 different case-based discussions where different features of personality disorders and different features of readiness are highlighted, along with several potential elements that could be included in clinical education curricula. In addition to benefiting patients, a more direct consideration of readiness for treatment may also benefit providers by reducing moral distress and the health care system more broadly by improving resource allocation.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"2-7"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052672","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 Qualitative Study of Treatment Experiences Among Youth With Misophonia and Their Parents.","authors":"Servando Rodriguez-Barajas, Sarah J Sadek, Catherine E Rast, Eric A Storch, Andrew G Guzick","doi":"10.1097/PRA.0000000000000905","DOIUrl":"10.1097/PRA.0000000000000905","url":null,"abstract":"<p><strong>Objective: </strong>Misophonia elicits strong negative emotional, behavioral, and physiological reactions to auditory stimuli. Despite its significant impact, misophonia remains underrecognized by health care providers. There is a lack of evidence-based treatment guidelines, creating challenges for affected individuals and their families in accessing appropriate care. The goal of this study was to examine the experiences of youth with misophonia and their caregivers in navigating the health care system and seeking treatment for the condition.</p><p><strong>Materials and methods: </strong>Twenty parent-child dyads participated in focused interviews concerning their experiences seeking treatment for misophonia. Thematic analysis was used to analyze interviews, involving 2 rounds of inductive abstractions.</p><p><strong>Results: </strong>Several themes emerged, primarily reflecting negative experiences, including: \"Minimal Awareness,\" \"Few Knowledgeable Professionals,\" \"Limited General Resources,\" \"Lack of Standard Treatment,\" \"Misdiagnosis,\" and \"Lack of Official Misophonia Diagnosis.\" Participants described substantial emotional impacts from these experiences, including frequent descriptions of hopelessness, frustration, and defeat. The primary positive experience described was by families who experienced \"Validation from Providers.\"</p><p><strong>Conclusions: </strong>The emotional burden associated with limited access to credible resources and knowledgeable professionals highlights the need for improved support. Families who were able to connect with empathetic providers reported considerable relief. The absence of a standardized treatment prompts individuals into a prolonged trial-and-error process in search of an approach that can provide even minimal relief from their symptoms.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"15-21"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052729","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 Brief Report on the Implementation of the Alternative Model for Personality Disorders in Clinical Practice.","authors":"Joost Hutsebaut, Laura C Weekers, Hilde De Saeger","doi":"10.1097/PRA.0000000000000901","DOIUrl":"10.1097/PRA.0000000000000901","url":null,"abstract":"<p><p>The Alternative DSM-5 Model for Personality Disorders (AMPD) was introduced in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders as a dimensional alternative to the traditional categorical model. Despite considerable research, systematic implementation in clinical practice has remained limited. This article reports on the implementation of the AMPD in an institution that specializes in the assessment and treatment of personality disorders to offer guidance for other teams considering the adoption of the AMPD. Implementation involved developing a multimethod assessment procedure and a training and supervision program, reformulating treatment inclusion criteria in AMPD terms, and developing communication strategies for internal and external stakeholders. Both barriers to and benefits of implementing the AMPD are discussed. Surveys conducted 2 and 4 months after implementation showed that clinicians were increasingly positive, reported growing competence, and generally favored AMPD-based assessments over the traditional assessments. These first experiences suggest that transitioning to the AMPD model is feasible and clinically meaningful.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"35-39"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052731","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":"From the Editor: Intensive Care.","authors":"John M Oldham","doi":"10.1097/PRA.0000000000000906","DOIUrl":"10.1097/PRA.0000000000000906","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"1"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052694","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}