Journal of Clinical Psychiatry最新文献

{"title":"Worth the Weight? The Challenges of Administering the Glucagon-Like Peptide 1 Receptor Agonist Semaglutide With Long-Term Olanzapine Use in a Patient With Schizophrenia.","authors":"Francesca L Ricciardi, Jayda L Melnitsky, Shannon B Peleg, Preetika Govil, Joshua T Kantrowitz","doi":"10.4088/JCP.25cr15857","DOIUrl":"https://doi.org/10.4088/JCP.25cr15857","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250627","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":"What Clinicians Should Know About the Pragmatic Use of Xanomeline-Trospium Combination.","authors":"Joseph F Goldberg, Peter J Weiden","doi":"10.4088/JCP.25ac15945","DOIUrl":"https://doi.org/10.4088/JCP.25ac15945","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250626","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":"Cognitive Behavioral Therapy for Insomnia With Prolonged Exposure Compared to Sleep Hygiene and Prolonged Exposure: A Randomized Controlled Trial.","authors":"Peter J Colvonen, Christopher Hunt, Jane Park, Abigail C Angkaw, Philip Gehrman, Kira Clare, Sonya B Norman","doi":"10.4088/JCP.24m15584","DOIUrl":"https://doi.org/10.4088/JCP.24m15584","url":null,"abstract":"<p><p></p><p><p></p><p><p></p><p><p><b>Objective:</b> Co-occurrence of posttraumatic stress disorder (PTSD) and insomnia disorder is common and associated with greater psychiatric and functional problems than either condition alone. Evidence-based PTSD treatment often does not effectively decrease insomnia, and insomnia may interfere with the mechanisms underlying PTSD treatment. This study compared the efficacy of integrated cognitive behavioral therapy for insomnia (CBT-I) and prolonged exposure (PE; CBTI-PE) therapy to sleep hygiene and PE (hygiene-PE) in reducing insomnia and PTSD symptoms.</p><p><p><b>Methods:</b> Ninety-four veterans with insomnia disorder (Insomnia Severity Index [ISI] ≥11) and PTSD (Clinician Administered PTSD Scale for <i>DSM-5</i> [CAPS-5] diagnosis) were randomized to CBTI-PE or hygiene-PE therapy for 12 weeks of treatment. Recruitment ran from January 2017 to March 2023. Planned outcomes were PTSD symptoms (CAPS-5; PTSD Checklist for <i>DSM-5</i>), quality of life (World Health Organization Quality of Life-BREF [WHOQOL]), and insomnia severity (ISI, subjective sleep efficiency [SE], total sleep time [TST]) between baseline, week 5, posttreatment, and 3-month follow-up.</p><p><p><b>Results:</b> Randomized participants were 76.6% male, 52.1% white, and mean age was 40.0 years (SD = 11.6). Linear modeling showed PTSD symptoms significantly decreased for most participants, but there were no differences by treatment group (<i>P</i> = .844). While, on average, WHOQOL increased for all participants, there was greater improvement in perceived quality of life (QOL) in CBTI-PE relative to hygiene-PE. ISI decreased, and SE and TST increased for most participants but had statistically and clinically larger changes in CBTI-PE, compared to hygiene-PE (<i>P</i> < .001).</p><p><p><b>Conclusions:</b> On average, participants had reductions in PTSD symptoms, with no differences between the groups. CBTI-PE produced greater reductions in insomnia symptoms and larger increases in QOL, SE, and TST than hygiene-PE. Together, CBT-I PE is an effective intervention for treating 2 highly co-occurring disorders, insomnia and PTSD.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT02774642.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250621","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":"Risk of Alzheimer Disease and Vascular Dementia in Patients With Peripheral Vestibular Disorders: A Longitudinal Study of 140,726 Participants.","authors":"Yun-Hsuan Lin, Mu-Hong Chen, Shun-Chieh Yu, Ya-Mei Bai, Tung-Ping Su, Tzeng-Ji Chen, Shih-Jen Tsai","doi":"10.4088/JCP.24m15699","DOIUrl":"https://doi.org/10.4088/JCP.24m15699","url":null,"abstract":"<p><p><b>Objective:</b> The associations between peripheral vestibular disorders (PVDs)-specifically Meniere's disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and unspecified PVD-and dementia risk are unclear.</p><p><p><b>Methods:</b> By using data from the Taiwan National Health Insurance Research Database, this study included 70,363 patients aged ≥45 years with PVD between 1998 and 2011. An age-matched control group of 70,363 individuals without PVD was also established. All the included participants were followed up from the time of enrollment until the end of 2013 to assess the risk of dementia-related conditions, including Alzheimer's disease (AD), vascular dementia, and unspecified dementia.</p><p><p><b>Results:</b> Cox proportional hazards regression models, adjusted for demographic characteristics and psychiatric comorbidities, revealed that patients with PVD exhibited a significantly elevated risk of any form of dementia during the follow-up period (hazard ratio [HR] = 1.83, 95% CI, 1.69-1.97) compared with the control group. Notably, patients with BPPV exhibited the highest risk of AD (HR = 3.14, 95% CI, 2.35-4.19), followed by Meniere's disease (HR= 2.79, 95% CI, 2.17-3.59) and vestibular neuritis (HR = 2.66, 95% CI, 2.11-3.35).</p><p><p><b>Conclusions:</b> PVDs are a risk factor for dementia, regardless of psychiatric comorbidities. Further research is warranted to elucidate the pathophysiological mechanisms underlying the association between PVDs and dementia.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250625","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":"Idiopathic Hypersomnia: Recognition and Management in Psychiatric Practice.","authors":"Craig Chepke, Ruth M Benca, Andrew J Cutler, Andrew D Krystal, Nathaniel F Watson","doi":"10.4088/JCP.24nr15718","DOIUrl":"https://doi.org/10.4088/JCP.24nr15718","url":null,"abstract":"<p><p><b>Objective:</b> This review of the relationship between idiopathic hypersomnia and psychiatric disorders describes considerations in recognizing and managing complaints of excessive daytime sleepiness (EDS) in patients in psychiatric clinical practice.</p><p><p><b>Data Sources:</b> Terms including \"idiopathic hypersomnia\" and \"psychiatric\" were used to search PubMed and Embase for English-language publications of human studies from inception to July 2024.</p><p><p><b>Study Selection:</b> Articles were manually screened for relevance to idiopathic hypersomnia pathophysiology, diagnosis, and treatment and EDS in psychiatric populations. Reference lists of identified articles were manually searched for additional relevant publications.</p><p><p><b>Data Extraction:</b> Formal data charting was not performed.</p><p><p><b>Results:</b> A total of 119 articles were included. Idiopathic hypersomnia is a central sleep disorder with the primary complaint of EDS, diagnosed prevalence of 0.037%, and estimated population prevalence up to 1.5%. Other prominent symptoms include sleep inertia, long sleep time, autonomic nervous system dysfunction, brain fog, and cognitive complaints. A high proportion of patients with idiopathic hypersomnia experience psychiatric comorbidities, including mood disorders and attention-deficit/hyperactivity disorder. Assessing individuals with psychiatric disorders and complaints of hypersomnolence can pose diagnostic challenges. Diagnosis and treatment may be complicated by possible exacerbation of EDS by psychiatric medications and, conversely, exacerbation of psychiatric symptoms by idiopathic hypersomnia treatments.</p><p><p><b>Conclusions:</b> Psychiatric clinicians are more likely to encounter patients with idiopathic hypersomnia than would be expected given its overall prevalence due to increased rate of psychiatric symptom comorbidity in this population. Recognizing and managing idiopathic hypersomnia for individuals with psychiatric conditions may lead to improvements in treatment outcome for patients.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250623","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":"What Is Meant by the Term \"Deprescribing,\" and Does It Belong in Our Lexicon?","authors":"Joseph F Goldberg, Holly A Swartz, Rajnish Mago, Roger S McIntyre, Gin S Malhi, Joshua D Rosenblat, Marlene P Freeman, Eduard Vieta, Michael E Thase, Mauricio Tohen, Leslie Citrome","doi":"10.4088/JCP.25ac15936","DOIUrl":"https://doi.org/10.4088/JCP.25ac15936","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250628","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":"Detecting Tardive Dyskinesia Using Video-Based Artificial Intelligence.","authors":"Anthony A Sterns, Joel W Hughes, Bradley Grimm, Loren Larsen, Fred Ma, Rakesh Ranjan, Carlene MacMillan, Bretton H Talbot, Joseph H Friedman, Owen S Muir","doi":"10.4088/JCP.25m15792","DOIUrl":"https://doi.org/10.4088/JCP.25m15792","url":null,"abstract":"<p><p><b>Objective:</b> Tardive dyskinesia (TD) is a late-onset adverse effect of dopamine receptor-blocking medications, characterized by involuntary movements primarily affecting the mouth, though other body parts may be involved. Severity of TD varies from mild to debilitating and is usually irreversible. Despite the existence of treatments such as VMAT2 inhibitors, TD remains underdiagnosed, with 40,000 patients treated of an estimated 2.6 million affected US individuals. This study demonstrates a novel, efficient, and reliable method to detect and bring TD to psychiatrists' attention using video-based artificial intelligence.</p><p><p><b>Methods:</b> Individuals taking antipsychotic medications were enrolled in Study 1 (n = 46) between March and November 2018, in Study 2 (n = 136) between May 2023 and May 2024, and in Study 3 (n = 174) between July 2023 and May 2024. Participants completed video assessments. A vision transformer machine-learning architecture was evaluated by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity compared with a reference standard of the trained raters' evaluation of TD on the Abnormal Involuntary Movement Scale.</p><p><p><b>Results:</b> The algorithm reached an AUC of 0.89 in the combined validation cohort across Studies 1, 2, and 3. The model demonstrated strong and reliable levels of agreement, outperforming human raters.</p><p><p><b>Conclusion:</b> Our algorithm reliably detected suspected TD, reaching higher sensitivity and specificity than trained raters using the standard assessment. The algorithm can be used to monitor patients taking antipsychotic medications, allowing scarce resources to assess identified patients for a conclusive diagnosis by psychiatrists.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250622","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":"Outpatient Ketamine Prescribing Practices in Psychiatry in the United States: A Nationwide Survey Study.","authors":"Rachel M Pacilio, Sagar V Parikh, Jamarie Geller","doi":"10.4088/JCP.25m15809","DOIUrl":"https://doi.org/10.4088/JCP.25m15809","url":null,"abstract":"<p><p><b>Background:</b> Ketamine is an increasingly popular tool for the treatment of psychiatric disorders. Initially available in controlled studies at academic institutions, it is now being offered widely in the community, but little is known about how treatment is actually being delivered and if there are undetermined safety concerns. The aim of this study is to assess ketamine prescribing practices among clinics across the United States.</p><p><p><b>Methods:</b> An online survey was sent to all community-based ketamine clinics with publicly available email addresses collected from 4 ketamine clinic databases (n = 484) between September and November 2023. Public ketamine clinic websites (n = 473) were also reviewed for information regarding the credentials of prescribers in June 2024.</p><p><p><b>Results:</b> A total of 126 (26% response rate) of the clinics responded to the survey request, and 119 were included in analyses. All included respondents (100%) report utilizing ketamine for treatment-resistant depression, with many also prescribing ketamine for treatment naive (72.3%), bipolar (78.9%), and subclinical depression (59.7%) in addition to nondepressive conditions at significant rates. Over 80% of clinics utilize maintenance ketamine treatment, with a substantial portion doing so for prolonged periods. A variety of ketamine formulations are regularly prescribed, and over 40% of clinics provide ketamine for at-home use. Based on website review, fewer than 30% of ketamine clinics reviewed are run by psychiatric physicians and over 25% are run by nonphysician providers.</p><p><p><b>Conclusions:</b> There is significant variability in ketamine treatment in the community including indications for therapy, duration of treatment courses, formulation of ketamine prescribed, and setting of use. There is a need for increased oversight and more specific practice guidelines to ensure ketamine is being used safely, appropriately, and effectively.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250624","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":"Prediction of Adolescent Suicidal Events by Residual Depressive Symptoms After Intensive Treatment.","authors":"Muruga A Loganathan, Stephen Buerkert, Gabriela Lange Valenga, Graham J Emslie, Sunita M Stewart","doi":"10.4088/JCP.24m15462","DOIUrl":"10.4088/JCP.24m15462","url":null,"abstract":"<p><p><b>Objective:</b> Adolescents with a history of depression are at a high risk of recurrent suicidal ideation (SI) and attempts. To enhance risk prediction, we examined the association of individual residual symptoms of depression to suicidal events (suicide attempts, emergency room visits, and inpatient hospitalization) 6 months after discharge from treatment.</p><p><p><b>Methods:</b> A retrospective post hoc analysis of patients aged 12-18 years examined depression symptoms at admission and discharge. Patients in an intensive treatment program (December 2013-September 2022) received psychosocial and medication management. The Quick Inventory of Depressive Symptomatology, Adolescent Version, assessed depressive symptoms at entry and discharge (n <i>=</i> 1,029), and suicidal events postdischarge were tracked (n <i>=</i> 736). Analysis of variance analyzed symptom severity changes, and logistic regression used residual symptoms and controls (age, sex, previous attempt, and nonsuicidal self-injury) to predict suicidal events.</p><p><p><b>Results:</b> Sad mood, view of self, and SI improved the most, while mood and sleep disturbance were most prevalent at discharge. Sleep disturbance (odds ratio [OR] = 2.09, 95% CI, 1.24-3.53, <i>P</i> < .01) and SI (OR = 2.22, 95% CI, 1.26-3.90, <i>P</i> < .01) were the strongest predictors of hospitalization, and, together with anhedonia (OR = 1.40, 95% CI, 1.02-1.93, <i>P</i> < .05), they consistently predicted suicidal events during follow-up.</p><p><p><b>Conclusion:</b> Residual sleep disturbance, SI, and anhedonia after treatment indicated risk post discharge and might inform continuity of care planning. These findings encourage further research about the relationships between specific residual symptoms and suicidal events.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112360","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":"Evidence-Based and Evidence-Informed Treatments: A Naturalistic Study of the Impact of Treatment Type on Engagement in Posttraumatic Stress Disorder.","authors":"Melanie Arenson, Baylee Crone, Ranon Cortell, Elisabeth Carlin","doi":"10.4088/JCP.24m15567","DOIUrl":"10.4088/JCP.24m15567","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> Evidence-based psychotherapies (EBPs) have revolutionized posttraumatic stress disorder (PTSD) treatment, but research suggests more limited engagement and effectiveness in naturalistic settings, relative to randomized controlled trials. Some clinics therefore offer additional evidence-informed options (eg, Skills Training in Affective and Interpersonal Regulation, Acceptance and Commitment Therapy, and Mindfulness Based Stress Reduction), but little research has compared outcomes within a naturalistic setting.</p><p><p><b>Methods:</b> We completed a retrospective chart review of 480 Veterans presenting to a trauma-focused clinic within a Veterans Affairs Medical Center during 2019. All variables were extracted from the VA medical record. We used logistic or linear regression models, χ², and analysis of variance to examine treatment outcomes differences.</p><p><p><b>Results:</b> In the year following intake, 71.87% (n = 345) engaged with treatment, and 45.42% (n = 218) received an adequate dose of at least 1 treatment; of those who engaged with treatment, 63.19% received an adequate dose of at least 1 treatment. Veterans attended an average of 8.40 sessions and 1.39 episodes of care. At the person level<i>,</i> rates of engagement and receipt of an adequate dose did not differ by treatment type (odds ratio [OR] = 1.52, <i>P =</i> .17; OR= 1.52, <i>P =</i> .17, respectively). However, those who planned to and/or received at least 1 EBP attended a significantly greater number of total sessions (11.82) relative to those that planned to and/or received evidence-informed psychotherapy (EIP; 7.31; <i>b =</i> 1.69, <i>P =</i> .04). Within episodes of care<i>,</i> rates of engagement did not differ by treatment type (OR = 1.39, <i>P</i> = .14). However, those who planned to and/or received EBP were more likely to receive an adequate dose of treatment (OR = 1.44, <i>P</i> = .04) and attended a significantly greater number of sessions per episode (7.60), relative to EIP (6.00).</p><p><p><b>Discussion:</b> These data highlight differences in treatment engagement and receipt of an adequate dose of treatment based on intervention-level factors within an active PTSD specialty clinic, which can aid decision-making for patients and providers. Future research is needed to investigate predictors of treatment engagement and outcomes.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112340","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}