Psychiatry and Clinical Neurosciences最新文献

{"title":"Public acceptance and expectations for Lecanemab: Insights from a Smallest Worthwhile Difference study.","authors":"Aran Tajika, Kenji Omae, Ethan Sahker, Yan Luo, Yoshiteru Takekita, Toshi A Furukawa","doi":"10.1111/pcn.70082","DOIUrl":"10.1111/pcn.70082","url":null,"abstract":"<p><strong>Aim: </strong>To determine the smallest worthwhile difference (SWD) for lecanemab, a disease-modifying drug for Alzheimer's disease (AD), among the general Japanese population using a benefit-harm trade-off method.</p><p><strong>Methods: </strong>We conducted an online survey with 658 participants to evaluate their preferences for the treatment effect of lecanemab, given its associated risks and high cost. We calculated SWD as the minimum required increase in the possibility of maintaining cognitive function (relative to the 50% without lecanemab) that patients would accept in exchange for the burdens of treatment (adverse effects, costs, other inconveniences). We examined the median SWD for two scenarios: a family member (SWD-families) and others (SWD-others), and analyzed subgroup differences.</p><p><strong>Results: </strong>The median SWD revealed a 15% increase for SWD-families and SWD-others. This value exceeds the drug's actual efficacy of an 8% increase. Notably, 17% of respondents reported zero SWD, driven by an intense fear of AD and possibly high expectations from media coverage. Including these participants, nearly half of the respondents considered the current effect worthwhile. No noticeable difference was found between the SWD-families and SWD-others.</p><p><strong>Conclusion: </strong>Based on Japanese clinical scenarios, the public's median expectation for lecanemab exceeds its efficacy, though its current benefit remains acceptable to nearly half the population. These findings underscore that the SWD is shaped by psychological drivers, including fear and hope, rather than just reasoned evaluation. Clinicians must manage these expectations, accounting for highly heterogeneous treatment preferences. Future research should account for emotional factors that can overshadow a rational assessment of treatment value.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":"740-747"},"PeriodicalIF":5.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of hyperbaric oxygen therapy for psychiatric disorders: A systematic review and meta-analysis.","authors":"Huda F Al-Shamali, Kirandeep Shocker, Jahnvi Thakkar, Qiaowei Lin, Reinhard Janssen-Aguilar, Wendy Lou, Joshua Granek, Shawn Rhind, Benjamin T Dunkley, Isabelle Vallee, Mike Crouzat, Rakesh Jetly, Venkat Bhat","doi":"10.1111/pcn.70077","DOIUrl":"10.1111/pcn.70077","url":null,"abstract":"<p><p>Psychiatric disorders such as major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and anxiety are leading causes of disability and remain insufficiently treated in many patients. Hyperbaric oxygen therapy (HBOT), traditionally used in neurological care, has emerged as a potential intervention by delivering 100% oxygen at supra-atmospheric pressure to modulate neuroplasticity, inflammation, and cerebral perfusion. We conducted a systematic review and meta-analysis of studies evaluating HBOT in adults with psychiatric disorders across three databases. The prespecified primary endpoint was psychiatric symptom severity at treatment's end. Random-effects models were implemented in R (v4.4.0). Seventeen studies (n = 920) met inclusion criteria; nine randomized control trials (RCTs) contributed to the meta-analysis. For depressive symptoms, HBOT was associated with a large pooled effect (Cohen's d = -0.82; I² = 82%). A clear dose-response was observed: robust benefit at 2.0 ATA (atmospheres absolute; d = -0.93) but none at 1.2 ATA. Subgroup analysis by comparator showed significant heterogeneity (P = 0.038): moderate effects versus sham (d = -0.68), large effects versus usual care/psychotherapy (d = -1.33), and no significant difference versus antidepressants (d = -0.60). For anxiety, three studies found a moderate effect (d = -0.59; I² = 42.8%). Two sham-controlled RCTs in PTSD demonstrated a large effect (d = -1.96; I² = 0%). Adverse events were mild and transient, mainly ear discomfort and brief anxiety. Evidence remains preliminary, but HBOT shows potential symptom benefits in MDD, anxiety, and PTSD, particularly at therapeutic dosing. However, effects are variable, estimates heterogeneous, and most studies small, highlighting the need for larger, rigorously designed RCTs with standardized protocols and long-term follow-up to establish its role in psychiatric care.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":"714-729"},"PeriodicalIF":5.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing social motivation deficits in treatment-resistant schizophrenia: Evidence from social incentive performance.","authors":"Simon S Y Lui, Jasmine W S Chan, Jason L F Chan, Kimi H Y Lam, Lok-Yin Choi, Raisie W K Wong, Perry B M Leung, Na Zhan, Jason W Y Wong, Mindi W Y Chiu, Jenny P H Lam, Raymond C K Chan","doi":"10.1111/pcn.70094","DOIUrl":"10.1111/pcn.70094","url":null,"abstract":"<p><strong>Aim: </strong>The Treatment-Response-and-Resistance-in-Psychosis (TRRIP) criteria recognizes negative symptoms as defining features for treatment-resistant schizophrenia (TRS). Social motivation refers to the desire to pursue social reward (and to avoid social punishment). Impaired social motivation is related to negative symptoms but has seldom been studied in TRS patients. We aimed to characterize social motivation processing in TRS patients and examine the impacts of negative symptoms on social motivation processing.</p><p><strong>Methods: </strong>We recruited 60 TRS patients, 60 remitted schizophrenia patients and 60 controls. In the Social Incentive Delay (SID) task, participants had to hit the targets within the response window to seek positive/neutral/negative social outcomes in emoji formats; and they also rated their emotions during the anticipation and receipt of social outcomes. Generalized-estimation-equation (GEE) models examined the impacts of TRS/remitted schizophrenia, negative symptoms, and the interaction between clinical-group-status and cue-valence on the SID performance, that is, hit-or-not, anticipatory pleasure, and consummatory pleasure.</p><p><strong>Results: </strong>The interaction between TRS status and social reward/punishment significantly predicted anticipatory pleasure, implicating that TRS patients' anticipatory pleasure was less subject to social reward/punishment compared to controls. Moreover, the interaction between TRS and social reward significantly predicted consummatory pleasure, implicating that TRS patients' consummatory pleasure was less subject to social reward compared to controls. Negative symptoms significantly predicted the SID accuracy in clinical participants, supporting its relationship with social motivation processing.</p><p><strong>Conclusion: </strong>TRS patients have altered social motivation processing, affecting anticipatory and consummatory pleasure. Social motivation deficit may be an intervention target for negative symptoms and social functioning impairments in TRS patients.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":"773-784"},"PeriodicalIF":5.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unrecognized sleep-related hypermotor epilepsy emerging in a patient with REM sleep behavior disorder: A case report.","authors":"Takashi Fukao, Masaki Fujiwara, Kazuhide Nakanishi, Shinji Sakamoto, Manabu Takaki","doi":"10.1111/pcn.70108","DOIUrl":"10.1111/pcn.70108","url":null,"abstract":"","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":"785-786"},"PeriodicalIF":5.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between initial 30-day cumulative clozapine dose and risk of agranulocytosis: A nationwide register-based cohort study.","authors":"Yuki Kikuchi, Xue Li, Hiroshi Komatsu, Norio Yasui-Furukori, Ken Inada, Hiroaki Tomita","doi":"10.1111/pcn.70092","DOIUrl":"10.1111/pcn.70092","url":null,"abstract":"<p><strong>Aims: </strong>Clozapine-induced agranulocytosis (CIA) is traditionally considered an idiosyncratic, dose-independent reaction. However, emerging evidence suggests that clozapine-related inflammatory events may exhibit dose-dependent characteristics, leading us to hypothesize that CIA risk may similarly relate to early cumulative exposure.</p><p><strong>Methods: </strong>Using Japan's nationwide Clozaril Patient Monitoring Service database (2009-2024), the 30-day cumulative dose following initiation was calculated for all treated patients. Participants were stratified into quartiles (Q1-Q4). CIA was defined as two consecutive absolute neutrophil counts <500/mm³. The incidence of CIA was compared across quartiles using Kaplan-Meier survival curves and Cox proportional hazards models adjusted for age and sex.</p><p><strong>Results: </strong>Among 18,189 patients (mean age 42.9 [SD 12.7]; 46.4% female), 138 (0.76%) developed CIA, with no cases occurring within the first 30 days. The incidence rates of CIA in Q1, Q2, Q3, and Q4 were 0.44%, 0.66%, 0.74%, and 1.20%, respectively. Compared with Q1, hazard ratios (HRs) over 180 days were 1.78 (95% confidence interval [CI] 0.96-3.30; P = 0.0659), 2.01 (95% CI 1.10-3.66; P = 0.0233), and 3.07 (95% CI 1.74-5.42; P < 0.001) for Q2, Q3, and Q4, respectively. Male sex and age >40 years were identified as independent risk factors. E-values for Q4 HR were 5.59 (point estimate) and 2.88 (95% CI), indicating high robustness against unmeasured confounders such as co-medications.</p><p><strong>Conclusions: </strong>Higher early cumulative clozapine exposure was associated with increased CIA risk. These findings suggest that early exposure may serve as a clinically relevant marker of CIA risk, although causal inference is limited and further research is needed.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":"765-772"},"PeriodicalIF":5.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Hyperbaric oxygen therapy in psychiatry.","authors":"Yoji Hirano","doi":"10.1111/pcn.70098","DOIUrl":"10.1111/pcn.70098","url":null,"abstract":"","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":"713"},"PeriodicalIF":5.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From public preferences to clinical tasks in anti-amyloid therapy for Alzheimer's disease.","authors":"Kyohei Otani","doi":"10.1111/pcn.70128","DOIUrl":"https://doi.org/10.1111/pcn.70128","url":null,"abstract":"<p><p>Tajika and colleagues found that, among Japanese respondents willing to consider lecanemab, the median smallest worthwhile difference exceeded the absolute benefit used in their study scenario. This commentary argues that this expectation-efficacy gap should be translated into concrete clinical tasks across the anti-amyloid care pathway, including expectation assessment, biomarker and eligibility counseling, shared decision-making, treatment monitoring, support for non-initiation or discontinuation, and continuing psychosocial care.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Neurofilament Light Chain as a Biomarker of Central Network Dysregulation in Methamphetamine Use Disorder: A Multi-Modal Investigation with Clinical Implications.","authors":"Shyh-Yuh Wei, Yu-Li Liu, Huai-Hsuan Tseng, Po See Chen, Yen Kuang Yang, Yihong Yang, Tzu-Yun Wang","doi":"10.1111/pcn.70122","DOIUrl":"https://doi.org/10.1111/pcn.70122","url":null,"abstract":"<p><strong>Aim: </strong>There is a critical need for objective biomarkers that can link peripheral assays to central neural network dysfunction. We investigated blood neurofilament light chain (NfL), a marker of axonal injury, and C-reactive protein (CRP), a marker of systemic inflammation, in relation to the brain network topology and microstructural integrity in methamphetamine use disorder (MUD), a paradigm of acquired neurotoxicity.</p><p><strong>Methods: </strong>Forty-two male MUD patients and 44 male controls received diffusion and resting-state functional magnetic resonance imaging and underwent analysis of blood NfL and CRP levels.</p><p><strong>Results: </strong>Compared to controls, MUD patients exhibited significantly elevated blood NfL and CRP levels, as well as salience-network dysfunction and microstructural abnormality. Furthermore, higher NfL levels were associated with lower local efficiency (segregation) in the right anterior insula and higher mean diffusivity in the right insula and supramarginal gyrus, supporting a link with axonal injury. By contrast, higher CRP levels were associated with integration-related graph measures in the bilateral supramarginal gyrus, suggesting that systemic inflammation may also be relevant to salience-network dysfunction in MUD. Crucially, the correlation involving NfL levels remained significant after controlling for the duration of methamphetamine use, and higher baseline NfL levels were significantly correlated with greater urine positivity rates during one-year follow-up.</p><p><strong>Conclusions: </strong>Blood NfL was associated with both functional and microstructural abnormalities of the salience network and potentially associated with relapse vulnerability in MUD.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain Network Convergence of Abnormal Gray Matter and Functional Activity of Pathological Dissociative Symptoms.","authors":"Xuhan Cui, Leyi Zhang, Yangpan Ou, Yong Liu, Bing Lang, Wenbin Guo","doi":"10.1111/pcn.70125","DOIUrl":"https://doi.org/10.1111/pcn.70125","url":null,"abstract":"<p><strong>Aim: </strong>Pathological dissociation is a complex clinical symptom widely observed across various psychiatric disorders. Dissociative symptoms prolong the duration of hospitalization and are associated with a poor clinical prognosis. Although several pathological models (e.g., the frontal-limbic overmodulation model and the defense cascade model) have been proposed to interpret dissociative symptoms, heterogeneous regional-level imaging findings impede our comprehension of the neural changes underlying dissociative symptoms across diagnoses.</p><p><strong>Methods: </strong>Using the functional connectivity network mapping method, this study systematically screened 45 cross-diagnostic reports of dissociation-related structural and functional brain changes. By integrating resting-state imaging data from healthy individuals (n = 872), we constructed dissociative task-induced activation, gray matter volume (GMV), and resting-state activity impairment networks. Additionally, we performed spatial correlation analyses between the damage networks and 19 neurotransmitter distribution maps.</p><p><strong>Results: </strong>The task-induced damage network showed the largest proportional overlap with the anterior salience network (SN, 12.25%), basal ganglia network (BGN, 13.57%), and dorsal default mode network (DMN, 17.74%). For the GMV damage network, the main overlap proportions were observed with the dorsal DMN (12.33%) and the anterior SN (7.67%). The resting-state activity damage network showed the greatest overlap with the anterior SN (5.17%), posterior SN (5.73%), auditory (5.47%), and sensorimotor network (4.50%). Spatial correlation analyses found associations between network changes and the distribution of N-methyl-D-aspartate receptors, vesicular acetylcholine transporter, cannabinoid receptor CB1, serotonin transporter, and mu-opioid receptor.</p><p><strong>Conclusion: </strong>This study further elucidated the neuroimaging changes underlying across-diagnostic dissociation and provided new insights for identifying network intervention targets to improve dissociative symptoms.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating social incentive deficits in treatment-resistant schizophrenia into rehabilitation targets.","authors":"Chungh-Hua Peng, Lien-Chung Wei","doi":"10.1111/pcn.70120","DOIUrl":"https://doi.org/10.1111/pcn.70120","url":null,"abstract":"<p><p>This article relates to Translating social incentive deficits in treatment-resistant schizophrenia into rehabilitation targets.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}