Journal of Clinical Psychiatry最新文献

{"title":"Symptom Network Analysis of Attention-Deficit/Hyperactivity Disorder and Emotional Symptoms in Adults: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).","authors":"Christophe Gauld, Sarah Tebeka, Diane Purper-Ouakil, Pierre Fourneret, Hugo Peyre, Yann Le Strat","doi":"10.4088/JCP.24m15287","DOIUrl":"https://doi.org/10.4088/JCP.24m15287","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> The diagnosis of attention-deficit/hyperactivity disorder (ADHD) is based on a set of symptoms and 2 main dimensions (impulsive/hyperactive and attentional). While the relationships between ADHD symptoms and emotional dysregulation (ED) have been widely studied, the interactions between individual symptoms have rarely been examined. The purpose of this study was to assess which symptoms are most influential (central) and which symptoms connect (bridge) the 2 main dimensions of ADHD and ED.</p><p><p><b>Methods:</b> Data from wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II) were utilized, which included a large, nationally representative sample of the US population (N=33,546). Eighteen ADHD symptoms were examined based on <i>DSM-5-TR</i> criteria, along with 4 variables related to ED. Symptom network analyses were conducted to explore the relationships between ADHD and ED symptoms.</p><p><p><b>Results:</b> The prevalence of ADHD was found to be 10.12% (N=3,397). Among all ADHD and ED symptoms, ED symptoms had the lowest influence (centrality) values. In terms of bridging the 2 ADHD dimensions, 2 ED symptoms were among the 4 most influential.</p><p><p><b>Conclusions:</b> The low centrality of ED symptoms supports the traditional focus on the 2 main dimensions of ADHD. However, the significant role of ED symptoms in connecting the impulsive/ hyperactive and attentional dimensions highlights their importance within the ADHD framework. These findings have potential implications for the epidemiology, public health, research, and clinical understanding of ADHD.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Emory Treatment Resistance Interview for PTSD-Short Version (E-TRIP-S).","authors":"Boadie W Dunlop, Nathaniel L Phillips, Barbara O Rothbaum","doi":"10.4088/JCP.25m15956","DOIUrl":"https://doi.org/10.4088/JCP.25m15956","url":null,"abstract":"<p><p><b>Objective:</b> Failure to benefit from treatments for posttraumatic stress disorder (PTSD) is common. We previously developed the Emory Treatment Resistance Interview for PTSD (E-TRIP), the first tool to evaluate treatment resistance in PTSD. Here, we provide a simplified version of the scale, the E-TRIP-Short version (E-TRIP-S), that assesses prior responses to first-line evidence-based psychotherapies and medications for PTSD.</p><p><p><b>Methods:</b> US military personnel and veterans (N=102) being evaluated for treatment through a specialized academic medical center PTSD clinical program from May 2019 to February 2020 were interviewed by trained assessors. Descriptive statistics of the E-TRIP-S psychotherapy and medication scores were evaluated to provide preliminary evidence regarding the utility of the measure.</p><p><p><b>Results:</b> Among those seeking care in an intensive outpatient program for PTSD, the majority of those with prior exposure to evidence-based interventions showed elevated E-TRIP-S scores. Only 11/39 (28.2%) of psychotherapy-treated and 12/52 (23.2%) of medication-treated patients reported that a prior treatment \"definitely helped\" for their intrusion or avoidance symptoms, indicating limited benefit from previous treatments and providing proof of concept for the measure. One-quarter of those who failed to benefit from one modality (ie, an evidence-based psychotherapy or medication) reported being definitely helped when treated with the alternative modality.</p><p><p><b>Conclusion:</b> The E-TRIP-S offers a simplified method for assessing treatment resistance among PTSD patients. Preliminary results suggest that the E-TRIP-S may contribute to clinical care by informing treatment selection for individuals and may support research by identifying treatment-resistant patients for testing new interventions or for stratifying patients based on prior treatment outcomes in clinical trials.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Prevalence of Burnout in Psychiatric Doctors Before and After the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.","authors":"Kathryn L Johnson, Michael S Gordon, Hannah G Gordon","doi":"10.4088/JCP.24r15697","DOIUrl":"https://doi.org/10.4088/JCP.24r15697","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> To determine the prevalence of burnout among psychiatry residents, fellows, and attendings (\"psychiatry doctors\") prior to and following the COVID-19 pandemic.</p><p><p><b>Data sources:</b> A systematic search of MEDLINE, Embase, PsycINFO, and PubMed databases was performed to identify studies reporting the prevalence of burnout pre-COVID-19 (pre-March 2020) and post-COVID-19 (post March 2020). The search was limited to articles written in English and published in peer-reviewed journals from January 1, 2010, until June 27, 2024.</p><p><p><b>Study selection:</b> There were 1,825 studies screened by 2 independent reviewers, with 36 eligible for inclusion. Observational studies and randomized controlled trials reporting the prevalence of burnout using validated tools were eligible for inclusion.</p><p><p><b>Data extraction:</b> Prevalence data were independently extracted by 2 authors and pooled using a random effects model. A subgroup analysis was performed, stratifying burnout by country income status.</p><p><p><b>Results:</b> The prevalence of burnout was 37.5% (95% confidence interval [CI], 28.2-47.3; 25 studies; 12,524 psychiatry doctors) prior to the COVID-19 pandemic and 32.0% (95% CI, 18.6-47.0; 12 studies; 7,458 psychiatry doctors) following the COVID-19 pandemic. Almost 1 in 2 psychiatry doctors from middle-income countries reported burnout pre-COVID-19 (49.8% [95% CI, 34.5-65.1]; 3 studies), with no studies reporting the prevalence of burnout in low-income countries. There was significant heterogeneity between studies.</p><p><p><b>Conclusions:</b> Burnout among psychiatry doctors is common, affecting 1 in 3 both prior to and following the COVID-19 pandemic. Additional studies are needed from psychiatrists in low- and middle-income countries to better characterize the prevalence of burnout in this cohort.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Interpersonal and Social Rhythm Therapy on Suicidal Ideation in Adults With Bipolar II Depression.","authors":"Bridget C Bailey, Theresa J Early, Kathryn E Williams-Sites, Bailey Dyson, Holly A Swartz","doi":"10.4088/JCP.24m15768","DOIUrl":"https://doi.org/10.4088/JCP.24m15768","url":null,"abstract":"<p><p><b>Objective:</b> Individuals with bipolar II disorder (BD II) have among the highest rates of suicide ideation (SI), attempts, and deaths. No studies to date have examined psychosocial treatment of SI in adults with BD II. The purpose of this study was to investigate whether patients with BD II depression receiving interpersonal and social rhythm therapy (IPSRT), an evidence-based psychotherapy for BD, experienced a decrease in SI, and whether this varied by use of adjunctive medication compared to IPSRT monotherapy.</p><p><p><b>Methods:</b> In a post hoc analysis of Swartz et al (2018), adults meeting <i>DSM-IV</i> criteria for BD II, currently depressed (n=92), were randomly assigned to receive IPSRT+placebo (IPSRT+P) or IPSRT+quetiapine (IPSRT+Q) and treated for 20 weeks. SI was assessed at baseline and weekly using the 17-item Hamilton Depression Rating Scale item 3. Multilevel logistic regression was used to model SI categorically.</p><p><p><b>Results:</b> The results demonstrate a decrease in odds of SI over time (OR=0.8719, 95% CI, 0.8166-0.9309, <i>P</i>≤.001), with a 13% decrease in the odds of having SI for each additional week of treatment. There was no significant difference between those receiving IPSRT+P vs IPSRT+Q.</p><p><p><b>Conclusions:</b> IPSRT has the potential to mitigate suicidal ideation in patients with BD II depression, regardless of whether they receive medication in addition to IPSRT. IPSRT alone may be a reasonable option to treat SI in an outpatient setting for some patients with BD II, especially those for whom medication is contraindicated or who prefer avoiding medication.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT01133821.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Getting Major Depression Right Matters-For Mothers, Babies, and All of Us.","authors":"Jennifer L Payne","doi":"10.4088/JCP.25com16092","DOIUrl":"https://doi.org/10.4088/JCP.25com16092","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritizing Mental Health to Optimize Perinatal, Fetal, and Neonatal Outcomes.","authors":"Kay Roussos-Ross, Tiffany A Moore Simas, M Camille Hoffman, Emily S Miller","doi":"10.4088/JCP.25com16100","DOIUrl":"https://doi.org/10.4088/JCP.25com16100","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effects of Repeated Ketamine Infusion Versus Intranasal Esketamine in Patients With Treatment-Resistant Depression: A Retrospective Chart Review.","authors":"Robert Meisner, Shuang Li, Brian Boyle, Violeta Valdivia, Amanda Sedgewick, Danika Dai, Courtney Miller, Paula Bolton, Steve Seiner","doi":"10.4088/JCP.25m15789","DOIUrl":"10.4088/JCP.25m15789","url":null,"abstract":"<p><p><b>Objective:</b> Both intravenous (IV) racemic ketamine and intranasal (IN) esketamine have emerged as rapid-acting antidepressants for treatment-resistant depression (TRD) and are increasingly used in clinical settings. Relatively few studies, however, have compared these interventions in larger, naturalistic cohorts. This study was conducted to assess the comparative efficacy and rapidity of response observed with repeated IV ketamine versus IN esketamine in a psychiatric neurotherapeutics specialty service. Through retrospective chart review, we conducted what is, to the best of our knowledge, among the larger such comparisons to date.</p><p><p><b>Methods:</b> Data from 153 patients with severe TRD were reviewed (111 patients received IV ketamine and 42 patients received IN esketamine). In accordance with consensus criteria for TRD and validated objective criteria for illness severity, included patients failed a minimum of 2 adequate antidepressant treatment trials and demonstrated a preketamine treatment score of 16 or higher on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR₁₆). Severity of depression was subsequently reassessed with the QIDS-SR₁₆prior to each ketamine and esketamine administration. A 2-way analysis of variance was used to compare changes in QIDS-SR₁₆scores between the IV ketamine and IN esketamine treatment groups.</p><p><p><b>Results:</b> With equivalent depression severity measured by QIDS-SR₁₆at pretreatment baseline, the IV ketamine treatment group showed significantly greater decreases in QIDS-SR₁₆scores compared to the IN esketamine group, as measured immediately before each treatment from the third to the eighth session (all <i>P</i> values < .05). Patients who received IV ketamine infusions demonstrated a 49.22% reduction in QIDS-SR₁₆scores by the eighth treatment, while patients who received IN esketamine over the same induction period showed a 39.55% reduction. As expected, both IV ketamine and IN esketamine treatments resulted in significant decreases in QIDS-SR₁₆scores. In the IV ketamine group, the decrease in QIDS-SR₁₆scores reached significance after 1 treatment, while in the IN esketamine treatment group, the decrease in QIDS-SR₁₆scores reached significance after the second treatment.</p><p><p><b>Conclusion:</b> In this naturalistic sample of patients with similarly severe TRD treated in a ketamine subspecialty service over a 4-5-week induction period, treatment with IV racemic ketamine was associated with a more rapid response and greater overall efficacy than treatment with IN esketamine.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine and Esketamine: Is There a Meaningful Clinical Difference?","authors":"Samuel T Wilkinson, Taeho Greg Rhee","doi":"10.4088/JCP.25com16003","DOIUrl":"https://doi.org/10.4088/JCP.25com16003","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failing Public Health Again? Analytical Review of Depression and Suicidality From Finasteride.","authors":"Mayer Brezis","doi":"10.4088/JCP.25nr15862","DOIUrl":"10.4088/JCP.25nr15862","url":null,"abstract":"<p><p><b>Background:</b> Finasteride, widely prescribed for androgenetic alopecia, has long been suspected of causing severe neuropsychiatric reactions, including depression, anxiety, and suicidality, even after the drug is discontinued. This study systematically reviews evidence that supports this suspicion and analyzes the reasons for this delayed recognition.</p><p><p><b>Observations:</b> Concerns about depression from finasteride were raised in several studies as early as 2002. Between the years 2017 and 2023, 4 independent analyses of adverse event reporting systems and 4 studies using data mining of healthcare records indicated a significant increase in the risk for depression, anxiety, and/or suicidal behavior with the use of finasteride. There has been, therefore, a two-decade delay in the realization of the incidences and the gravity of neuropsychiatric effects, allowing harm from a medicine prescribed for a cosmetic indication of hair loss.</p><p><p><b>Potential Harms and Implications:</b> Over 20 years worldwide, hundreds of thousands may have endured depression, and hundreds may have died by suicide. According to the precautionary principle, such a risk from a cosmetic medication suggests a benefit-to-harm balance that justifies action to protect the public, and the burden of proving that the intervention is <i>not</i> harmful falls on manufacturers.</p><p><p><b>Causes for Delayed Risk Recognition:</b> The long delay in recognizing the risks associated with finasteride exposure includes the manufacturer's failure to perform and publish simple pharmacovigilance studies using database analyses and regulators' failure to request such studies from the manufacturer or to perform them.</p><p><p><b>Conclusions and Relevance:</b> Current evidence shows that finasteride use can cause depression and suicidality. A historical literature review discloses gaps between research evidence and regulatory steps. The lesson is that before approving a medication for the market, regulators should require manufacturers to commit to performing and disclosing ongoing postapproval analytical studies, and this requirement needs to be enforced.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Emerging Science of Clinimetrics: Implications for Clinical Psychiatry.","authors":"Jenny Guidi","doi":"10.4088/JCP.25com16124","DOIUrl":"https://doi.org/10.4088/JCP.25com16124","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}