Journal of Psychiatric Practice最新文献

{"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":"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":1.1,"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":"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":1.1,"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":"War and Upheaval.","authors":"John M Oldham","doi":"10.1097/PRA.0000000000000922","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000922","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"101"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839285","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":"Dispositional Mindfulness and Perceived Stress in Psychiatric and Nonpsychiatric Physicians: A Facet-level Pilot Study.","authors":"Mohammad Asif Sheikh","doi":"10.1097/PRA.0000000000000926","DOIUrl":"10.1097/PRA.0000000000000926","url":null,"abstract":"<p><strong>Objectives: </strong>Perceived stress is a significant concern among health care professionals, with potential consequences for mental health and clinical performance. This study examined associations between dispositional mindfulness and perceived stress among Indian physicians working in psychiatric and nonpsychiatric specializations within hierarchical systems with limited institutional support.</p><p><strong>Methods: </strong>In this cross-sectional pilot study, 62 clinicians (39 nonpsychiatric and 23 psychiatric physicians) completed the Perceived Stress Scale and the Five Facet Mindfulness Questionnaire-Short Form. Independent samples t tests compared perceived stress and mindfulness scores between the groups. Correlations and linear regression analyses were conducted to examine relationships between mindfulness and perceived stress.</p><p><strong>Results: </strong>No statistically significant differences were found between psychiatric and nonpsychiatric physicians in perceived stress, t(59)=0.98, P=0.329, d=0.27, or total mindfulness, t(59)=-1.31, P=0.186, d=0.35. Across the sample, higher dispositional mindfulness was strongly associated with lower perceived stress, r(60)=-0.65, P<0.001, r²=0.43, particularly for the Describe and Acting with Awareness facets. Linear regression indicated that mindfulness was significantly related to perceived stress, β=-0.65, t=-6.66, P<0.001, accounting for 42.5% of the variance.</p><p><strong>Conclusions: </strong>These findings cautiously suggest that dispositional mindfulness may serve as a potential psychological resource for stress regulation and burnout prevention among clinicians. Further research is warranted to validate these associations in larger and more diverse samples and to explore practical applications within wellness initiatives.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 3","pages":"144-152"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839277","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":"Medicinal Cannabis Prescribing.","authors":"John M Oldham","doi":"10.1097/PRA.0000000000000911","DOIUrl":"10.1097/PRA.0000000000000911","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"45"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530171","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":"High-dose Olanzapine Versus Clozapine in Treatment-resistant Schizophrenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Martin Kotochinsky, Pandora Eloa Oliveira Fonseca, Laura Mora, Diogo Carrazzoni Godoi, Luisa Mendes Araujo, João Pedro Gonçalves Pacheco","doi":"10.1097/PRA.0000000000000916","DOIUrl":"10.1097/PRA.0000000000000916","url":null,"abstract":"<p><strong>Background: </strong>Treatment-resistant schizophrenia (TRS), which affects about one-third of patients with schizophrenia, remains a major challenge in psychiatric treatment. Although clozapine is the gold standard therapy for TRS, its adverse effect profile has led to growing interest in alternatives such as high-dose olanzapine (HDO), whose clinical utility remains under scrutiny.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials comparing HDO versus clozapine for TRS. Statistical analysis was carried out using R software. Outcomes of interest included the Clinical Global Impressions Scale and the Positive and Negative Syndrome Scale (PANSS), as well as incidence rates of adverse effects. Mean differences and relative risk with P values <0.05 were considered statistically significant.</p><p><strong>Results: </strong>Five studies and 469 patients, of which 236 (50.3%) received HDO, were included. The follow-up periods ranged from 14 to 24 weeks. No statistically significant differences were observed between the HDO and clozapine groups on the Clinical Global Impressions Scale or the PANSS Positive score. In contrast, HDO use was significantly associated with improvements in PANSS Negative scores. Moreover, incidences of the adverse events hypersalivation and postural hypotension were significantly higher in the clozapine group. The incidence of weight gain was similar in the 2 groups.</p><p><strong>Conclusions: </strong>While this meta-analysis revealed no significant difference in efficacy between clozapine and HDO for most outcomes, HDO did show a significant efficacy advantage over clozapine in the treatment of negative symptoms in adults with TRS. Adverse events were more frequently reported in the clozapine group, suggesting a more favorable safety profile for HDO. These results support HDO as a viable and potentially safer alternative to clozapine in the management of TRS.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"51-57"},"PeriodicalIF":1.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530175","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 Practice of Electroconvulsive Therapy, Third Edition: Recommendations for Treatment, Training, and Privileging (A Task Force Report of the American Psychiatric Association).","authors":"Jeremy Chaikind","doi":"10.1097/PRA.0000000000000914","DOIUrl":"10.1097/PRA.0000000000000914","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"96-97"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530226","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":"Behind the Mask: The Buffering Role of Self-efficacy on COVID-related Trauma-related and Stressor-related Symptoms Among Mental Health Workers.","authors":"Connie Guo, Marjolaine Rivest-Beauregard, Justine Fortin, Adam D Brown, Michelle Lonergan, Alain Brunet","doi":"10.1097/PRA.0000000000000919","DOIUrl":"10.1097/PRA.0000000000000919","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has challenged everyone's adaptive resources. However, a limited number of studies have examined its effects on mental health workers, a population at increased risk for vicarious traumatization.</p><p><strong>Methods: </strong>A mediation model was tested using longitudinal self-report data (N=1597). The association among occupation, severity of trauma-related and stressor-related (TSR) symptoms during the first wave of the COVID-19 pandemic, and self-efficacy was explored.</p><p><strong>Results: </strong>Mental health workers reported greater self-efficacy than other survey participants (health care workers, general population) (unstandardized β=1.53, P<0.001), and greater self-efficacy was associated with lower TSR symptoms (-0.09, P<0.001). Hence, mental health workers reported lower TSR symptoms through both direct (-0.80, P=0.005) and indirect associations (-0.94, P<0.001), with higher self-efficacy compared with other survey participants.</p><p><strong>Conclusions: </strong>Despite being at greater risk for vicarious traumatization, mental health workers fared well during the first wave of COVID-19. Increasing self-efficacy in high-risk populations in the context of stressful/traumatic events may have some value, an avenue requiring further investigation.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"79-85"},"PeriodicalIF":1.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530173","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":"Intermediate Levels of Care and the 3 Mechanisms of Therapeutic Action.","authors":"Eric M Plakun","doi":"10.1097/PRA.0000000000000908","DOIUrl":"10.1097/PRA.0000000000000908","url":null,"abstract":"<p><p>This column describes 3 mechanisms of therapeutic action in the treatment of mental and substance use disorders. These mechanisms include biomedical interventions, dyadic interventions, and interventions involving transdyadic social learning. Combining mechanisms of action offers the potential to augment treatment response. Intermediate levels of care (Intensive Outpatient Programs, Partial Hospital Programs, and Residential Treatment Centers) are generally designed to provide treatment combining all 3 mechanisms of therapeutic action in the service of helping patients better use outpatient treatment to pursue recovery.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"75-78"},"PeriodicalIF":1.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530201","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":"Fraud-induced Psychosis: A Case Series.","authors":"Siti Khadijah Binti Ahmad, Muhammad Akmal Bin Zakaria, Risha Devi K S Mani, Poh Khuen Lim, Chong Guan Ng","doi":"10.1097/PRA.0000000000000918","DOIUrl":"10.1097/PRA.0000000000000918","url":null,"abstract":"<p><p>Online fraud cases have increased significantly and globally during the past decade. In Malaysia, a total of 36,936 fraud cases were reported in 2023, involving a total loss of $12.8 billion per year. Online commercial transactions, including but not limited to financial borrowing, were among the most reported fraud cases. Financial insecurity, social isolation, and loneliness are some of the multiple factors that predispose an individual to be susceptible to fraud-related activities. Victims of online fraud have been found to be older and female and to have higher scores on the impulsivity measures of urgency and sensation seeking, and higher addiction measures. The impact of fraud on the victims can lead to both physical and mental health problems and adverse mental health outcomes. This report describes 2 cases of brief psychotic disorder that were associated with stress from being victimized by online fraud-related behavior. Both cases involved individuals experiencing psychological distress following an online fraud.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 2","pages":"86-89"},"PeriodicalIF":1.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530216","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}