The primary care companion for CNS disorders最新文献

{"title":"Rectal Insertion of Foreign Bodies: Motivations, Complications, and Management.","authors":"Ann C Schwartz, Gregg Robbins-Welty, Caroline Stiles, Theodore A Stern","doi":"10.4088/PCC.26f04248","DOIUrl":"https://doi.org/10.4088/PCC.26f04248","url":null,"abstract":"<p><p>The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.</p><p><p><i>Prim Care Companion CNS Disord</i> <i>2026;28(5):26f04248</i>.</p><p><p>\u0000 <i>Author affiliations are listed at the end of this article.</i>\u0000 </p>","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Depression: A Clinical Alert for Obstructive Sleep Apnea Screening.","authors":"Ana Lourenço, Marta Ribeiro","doi":"10.4088/PCC.26cr04237","DOIUrl":"https://doi.org/10.4088/PCC.26cr04237","url":null,"abstract":"","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serotonin Syndrome After Kratom Use in a Patient on a Stable Psychotropic Regimen.","authors":"Talya Kapenstein, Alëna A Balasanova","doi":"10.4088/PCC.26cr04244","DOIUrl":"https://doi.org/10.4088/PCC.26cr04244","url":null,"abstract":"","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Perspectives on Long-Acting Injectable Medications During Psychiatric Hospitalization.","authors":"Tanya Alim, Allea Frazier, Michelle Brooks, Stephanie A Rolin","doi":"10.4088/PCC.26m04258","DOIUrl":"https://doi.org/10.4088/PCC.26m04258","url":null,"abstract":"<p><p><b>Objective:</b> To characterize patient perspectives on long-acting injectable (LAI) medications among adult psychiatric inpatients.</p><p><p><b>Methods:</b> We conducted a prospective, observational pilot study of adult inpatients on a voluntary psychiatric unit at an urban safety-net hospital in Washington, DC. Patients were approached during hospitalization and completed a brief, structured worksheet assessing prior LAI exposure, perceived experience, and current treatment preferences. Data were collected from February 2025 to April 2025 and analyzed descriptively.</p><p><p><b>Results:</b> A total of 30 patients participated (mean age of 46.8 years, 63% men, 87% Black). Most participants reported no prior LAI exposure (n=22, 73%). Among those with reported prior exposure (n=7, 23%), experiences were mixed: 2 reported that it was mostly helpful (29%), 2 reported that it was neutral (29%), and 2 reported that it was not helpful (29%). One person had not yet formed an opinion. Regarding current treatment preferences, a third stated that they preferred oral medications (n=10, 33%). Most reported that they would consider an LAI (n=10, 33%) or that they were unsure and wanted to discuss it further with their treatment team (n=8, 27%).</p><p><p><b>Conclusions:</b> In this pilot sample, patient perspectives on LAI medications during psychiatric hospitalization were heterogeneous and characterized by substantial openness and uncertainty rather than fixed resistance. These findings suggest that inpatient settings may represent an opportunity for patient-centered discussion and shared decision-making regarding LAI treatment.</p><p><p><i>Prim Care Companion CNS Disord</i> <i>2026;28(5):26m04258</i>.</p><p><p>\u0000 <i>Author affiliations are listed at the end of this article.</i>\u0000 </p>","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esketamine For the Treatment of Depression in a Patient With Multiple Sclerosis.","authors":"Meghna Mathews, Genesy Aickareth, Anjal Abraham, Rucha Kamat, Rahul Mathews, Brett Pontelandofo, Shreya Mathews, Kelly Golden","doi":"10.4088/PCC.26cr04246","DOIUrl":"https://doi.org/10.4088/PCC.26cr04246","url":null,"abstract":"","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Treatment of Agitation in Alzheimer's Dementia: Prioritizing Function and Safety Over Sedation and Other Serious Harms.","authors":"Pierre N Tariot, Leslie Citrome, Carolyn K Clevenger, W Clay Jackson, C Brendan Montano, Amita Patel, Anton P Porsteinsson, Marwan Sabbagh","doi":"10.4088/PCC.haadachi2603","DOIUrl":"10.4088/PCC.haadachi2603","url":null,"abstract":"<p><p>Agitation is a common and clinically significant neuropsychiatric condition in Alzheimer's dementia. Clinicians across the spectrum of care settings frequently encounter agitation but often lack practical clinical guidance. In April 2026, a consensus panel of clinical experts reviewed the literature and developed guidance for managing agitation in Alzheimer's dementia. The panel emphasized the critical role of primary care in agitation management and discussed different treatment approaches for optimizing patient and caregiver outcomes. Treatment should prioritize reduction of patient and caregiver distress and preservation of function rather than mere sedation. Discussion of neurobiology focused on the evolving models of frontal-limbic imbalance as the key driver of agitation in progressing Alzheimer's disease and implications for pharmacologic selection. The panel reviewed evidence on safety and efficacy of pharmacologic agents commonly used in agitation management and concluded that efficacy and safety profiles should guide clinical decision-making. The panel recommended conducting a behavioral assessment using validated tools, ruling out reversible causes, and using nonpharmacologic interventions as the first-line approach prior to starting pharmacologic treatment. Finally, setting-specific considerations were discussed. These recommendations complement prior guidance with a primary-care clinical decision pathway that matches treatment to the neurobiology of agitation and to comparative safety profiles, and that extends to the assessment, documentation, and coding clinicians need at the point of care. The goal is to help clinicians select evidence-based interventions for agitation in Alzheimer's dementia that prioritize safety, alertness, functional engagement, and caregiver well-being while minimizing the serious harms that have historically accompanied off-label management in this population, including excess mortality, cerebrovascular events, cognitive impairment, falls, and sedation.</p><p><p><i>Prim Care Companion CNS Disord</i> <i>2026;28(5):haadachi2603</i>.</p>","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practicing in Resource-Limited and Siloed Settings: The Impact of Isolation on Morale, Clinical Care, and Lifelong Learning.","authors":"Sofia E Matta, Julian J Raffoul, Lynne Boone, Andrea C DeSimone, Margarita Bobonis-Babilonia, Ann C Schwartz, Theodore A Stern","doi":"10.4088/PCC.26f04247","DOIUrl":"https://doi.org/10.4088/PCC.26f04247","url":null,"abstract":"<p><p>The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.</p><p><p><i>Prim Care Companion CNS Disord</i> <i>2026;28(5):26f04247</i>.</p><p><p>\u0000 <i>Author affiliations are listed at the end of this article.</i>\u0000 </p>","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olfactory Reference Syndrome Responding to Amisulpride.","authors":"João Revez Lopes, Carlos Siopa, Inês Simões","doi":"10.4088/PCC.26cr04191","DOIUrl":"https://doi.org/10.4088/PCC.26cr04191","url":null,"abstract":"","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Transcranial Direct-Current Stimulation Over the Dorsolateral Prefrontal Cortex Significantly Reduces Relief Craving During Alcohol Withdrawal: A Randomized Sham-Controlled Trial Among Inpatients With Alcohol Dependence Syndrome in Northern India.","authors":"Twinkle Sharma, Priya Ranjan Avinash, Robin Victor, Praveen Rikhari, Shobit Garg","doi":"10.4088/PCC.26m04219","DOIUrl":"10.4088/PCC.26m04219","url":null,"abstract":"<p><p><b>Objective:</b> Alcohol dependence syndrome (ADS) carries a heavy global disease burden. Relief craving, the compulsion to drink to escape withdrawal distress, is among its most treatment-resistant features and a frequent trigger for relapse. Given the limited effectiveness of conventional therapies, there is growing interest in targeted neuromodulation of prefrontal circuits as an adjunct approach. The objective of this study was to examine whether bilateral transcranial direct-current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (dlPFC) could attenuate relief craving in ADS in patients undergoing withdrawal and whether treatment gains varied with the severity of dependence.</p><p><p><b>Methods:</b> A single-blind (participant-blinded) study was conducted between March 2024 and March 2025 at a tertiary psychiatry center in Dehradun, Northern India. Fifty male inpatients meeting ICD-10 criteria for ADS were targeted; 48 completed the study and were included in the analysis. The participants had a mean age of 38.5 years and were allocated to either active tDCS (group A, n = 24; 2 mA for 20 min/session, left cathodal F3/right anodal F4) or sham tDCS (group B, n = 24) across 10 sessions over 5 days, initiated during the active withdrawal phase. Craving and dependence severity were rated with the Penn Alcohol Craving Scale (PACS) and Severity of Alcohol Dependence Questionnaire (SADQ) at baseline (day 1) and 24 hours postcompletion (day 6).</p><p><p><b>Results:</b> PACS scores fell in both arms, but the active group's reduction was nearly twice that of sham (14.17 vs. 7.08; <i>P</i> < .001). Repeated-measures analysis of covariance confirmed a group-by-time interaction independent of baseline dependence severity (F_1,45= 11.89, <i>P</i> = .001, ηp² = 0.209; SADQ covariate: F_1,45= 1.20, <i>P</i> = .279). The anticraving effect held across both mild-to-moderate and severe dependence subgroups.</p><p><p><b>Conclusion:</b> Bilateral dlPFC tDCS applied during the active withdrawal period produced a clinically meaningful and statistically robust reduction in relief craving that exceeded sham and was not modified by dependence severity. These findings position tDCS as an affordable, well-tolerated adjunct worthy of investigation in larger definitive trials.</p><p><p><b>Trial Registration:</b> ISRCTN identifier: ISRCTN88255964.</p><p><p><i>Prim Care Companion CNS Disord 2026;28(5):26m04219</i>.</p><p><p>\u0000 <i>Author affiliations are listed at the end of this article.</i>\u0000 </p>","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Aftermath of Risking Life and Limb: Acute Reactions and Subsequent Adaptation.","authors":"Daniel Powell, Tyler McGehee, David Wilkerson, Gregg Robbins-Welty, Brendan Appold, Jacob MacDonald, James K Rustad, Theodore A Stern","doi":"10.4088/PCC.26f04215","DOIUrl":"https://doi.org/10.4088/PCC.26f04215","url":null,"abstract":"","PeriodicalId":22814,"journal":{"name":"The primary care companion for CNS disorders","volume":"28 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}