Journal of Clinical Psychiatry最新文献

{"title":"Cognitive Behavioral Therapy Following Esketamine for Major Depression and Suicidal Ideation for Relapse Prevention: The CBT-ENDURE Randomized Trial.","authors":"Samuel T Wilkinson, Brandon M Kitay, Matthew Macaluso, Mia C Santucci, Kristina Kumpf, Cindy Voghell, Lauren Astorino, Rachel Hershenberg, Valeria Martinez-Kaigi, Tiffany Nowell, Michael E Thase, Gerard Sanacora, T Greg Rhee","doi":"10.4088/JCP.25m16285","DOIUrl":"https://doi.org/10.4088/JCP.25m16285","url":null,"abstract":"<p><p><b>Background:</b> Suicide is a public health crisis in the US, with limited evidence demonstrating efficacy of treatments for high-risk patients due in part to their exclusion from most clinical trials. This clinical trial evaluates the feasibility and efficacy of adjunctive cognitive behavioral therapy (CBT) with esketamine in patients with major depression and suicidal ideation (MDSI).</p><p><p><b>Methods:</b> Treatment-seeking patients (57 inpatients; 36 outpatients) with major depressive disorder (<i>DSM-5</i> criteria) and suicidal ideation were randomized (1:1) to receive esketamine plus a 16-week course of CBT or esketamine plus treatment as usual (TAU) alone. The starting dose of esketamine was 84 mg in both groups. The primary outcome was feasibility, with a key secondary outcome being improvement in suicidal ideation. CBT consisted of traditional one-on-one therapy sessions and a computer-assisted program to facilitate psychoeducation and attainment of skills. Enrollment occurred between March 2021 and May 2025.</p><p><p><b>Outcomes:</b> Ninety-three subjects were randomized with a 72% study completion rate, demonstrating feasibility (primary outcome) by meeting recruitment goals of 80% of the targeted enrollment and 70% of retention through study end point. Change in suicidal ideation from baseline through week 18 (a key secondary outcome), based on the Beck Scale for Suicidal Ideation (BSSI), Clinician Global Improvement Scale for Suicide Severity (CGI-S), and Montgomery-Åsberg Depression Rating Scale (MADRS), favored the CBT group over the TAU group (BSSI mean difference of -1.91, 95% CI -3.57 to -0.24, <i>P</i>=.025; CGI-S mean difference of -0.33, 95% CI -0.58 to -0.08, <i>P</i>=.011; MADRS mean difference of -3.77, 95% CI -6.62 to -0.93, <i>P</i>=.009). No difference between groups was observed in the Columbia-Suicide Severity Rating Scale score, MADRS-SI score, or suicide-related events.</p><p><p><b>Interpretation:</b> This study demonstrates the feasibility and the effectiveness of combining CBT with esketamine to reduce SI and prevent relapse in patients with MDSI.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT04760652.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845589","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 Patient Perspective on Tardive Dyskinesia.","authors":"Nina R Schooler","doi":"10.4088/JCP.26com16440","DOIUrl":"https://doi.org/10.4088/JCP.26com16440","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845643","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":"Measuring What Matters: Further Validation for the Tardive Dyskinesia Impact Scale, a Novel Patient-Reported Outcome Measure in Valbenazine Clinical Trials.","authors":"Morgan Bron, Susan D Mathias, Donald E Stull, Hui Zhang, Michelle Turner, Eduardo Dunayevich, Ashok Parameswaran, Dawn Vanderhoef, M Mercedes Perez-Rodriguez, Christoph U Correll","doi":"10.4088/JCP.25nr16047","DOIUrl":"https://doi.org/10.4088/JCP.25nr16047","url":null,"abstract":"<p><p><b>Importance:</b> Tardive dyskinesia (TD) is a persistent, potentially disabling, medication-induced movement disorder that has been underrecognized. Involuntary movements in TD have a substantial impact beyond movement on individuals with TD. To quantify TD impact and burden, the Tardive Dyskinesia Impact Scale (TDIS), a new, TD-specific, fit-for-purpose patient-reported outcome (PRO) measure, was developed. Objectives were to examine how TDIS contributes to understanding of TD burden and use of clinician-reported outcomes (ClinROs) and other PROs in clinical trials assessing effects of vesicular monoamine transporter 2 inhibitors on TD. TDIS analyses included assessment of correlations between TDIS and other clinical outcome assessments (PROs and ClinROs), estimation of the minimal clinically importance difference (MCID), and description of the change in TDIS individual items longitudinally and via item response theory.</p><p><p><b>Observations:</b> In KINECT trials, TDIS followed a similar trajectory to Abnormal Involuntary Movement Scale. An MCID of 4 points in TDIS was considered clinically meaningful. Item-level analyses showed that TDIS is reliable and precise for individual items. Most improved items in longitudinal analyses were self-consciousness (mean change: -1.24), embarrassment (-1.19), unwanted attention (-1.00), and mouth noises (-1.05), which exceeded the empirically derived item-level threshold for meaningful change (≥0.8). TDIS showed moderate correlation with treatment response as measured by Patient's Global Impression of Change (<i>r</i>=0.30) and Clinician's Global Impression of Change (<i>r</i>=0.34) scores.</p><p><p><b>Conclusions and Relevance:</b> TDIS is the only disease-specific PRO that has been validated in individuals with TD and complements ClinROs and other PROs by providing a comprehensive picture of TD impact beyond movement symptoms and can measure potential benefit of TD treatments.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845597","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":"Concurrent SSRI, SNRI, or Other Antidepressant Use Not Associated With Differential Outcomes in Ketamine or Esketamine Treatment.","authors":"Erin Curran, Morgan Hardy, Rachel Katz, Taeho Greg Rhee, Samuel T Wilkinson","doi":"10.4088/JCP.25br16294","DOIUrl":"https://doi.org/10.4088/JCP.25br16294","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845622","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":"Catatonia as a Case Study in Psychiatric Decision-Making.","authors":"Rachel L MacLean, Joseph B Stoklosa","doi":"10.4088/JCP.26ac16389","DOIUrl":"10.4088/JCP.26ac16389","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724549","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":"A Phase 2b Multicenter Study to Evaluate Basmisanil as an Adjunctive Treatment in Patients With Cognitive Impairment Associated With Schizophrenia.","authors":"Daniel Umbricht, Markus Abt, Michael Derks, Maria-Clemencia Hernandez, Nikhat Parkar, Diana Negron, Annette Koerner, Stefan Holiga, Celia Goeldner","doi":"10.4088/JCP.25m16022","DOIUrl":"https://doi.org/10.4088/JCP.25m16022","url":null,"abstract":"<p><p><b>Objective:</b> Cognitive impairment associated with schizophrenia (CIAS) is a key driver of functional deficits in patients with this disorder. CIAS may involve deficient NMDA receptor-dependent neurotransmission. Negative allosteric modulators (NAMs) of γ-aminobutyric acid (GABA) type A (GABA_A) α5 receptors enhance their activity and improve cognition in rodents and nonhuman primates. We tested whether prolonged treatment with basmisanil-a selective GABA_Aα5 NAM-improved CIAS.</p><p><p><b>Methods:</b> This 24-week placebo-controlled phase 2b study in patients with CIAS diagnosed according to <i>DSM-5</i> was conducted between November 2016 and December 2019. Two hundred thirteen patients were randomized to 80 mg of basmisanil, 240 mg of basmisanil, or placebo twice a day. Recruitment into the 80 mg group was stopped after a planned futility analysis. The primary outcome was the MATRICS Consensus Cognitive Battery (MCCB) neurocognitive composite score evaluated in the efficacy analysis population (EAP) in the placebo (n=76) and basmisanil 240 mg arms only (n=77, total EAP n=153). Secondary outcome measures included specific hippocampal and prefrontal-dependent cognitive tasks, functional outcomes, and symptoms. Novel study design features addressing potential sources of heterogeneity in drug response and learning and practice effects included stratification by cognitive trajectories and age as well as repeated administration of the MCCB test battery during screening.</p><p><p><b>Results:</b> Twenty-four weeks of treatment with basmisanil was well tolerated without improving cognitive or functional measures overall or in any of the stratified subgroups. Practice and learning effects were not observed at week 12.</p><p><p><b>Conclusion:</b> Basmisanil did not improve cognitive deficits. Although unsuccessful, some results offer insight into important factors that should facilitate the design of more informative trials.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT02953639.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693116","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":"Proton Pump Inhibitors and the Risk of Dementia.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.26f16420","DOIUrl":"https://doi.org/10.4088/JCP.26f16420","url":null,"abstract":"<p><p>Proton pump inhibitors (PPIs) are the most prescribed gastric acid suppressant drugs; the category includes omeprazole, esomeprazole, lansoprazole, dexlansoprazole, pantoprazole, and rabeprazole. In 2015, a study suggested that PPI use was associated with an increased risk of dementia. An early meta-analysis confirmed this concern, but the findings were inconsistent in subsequent meta-analyses. Also problematic is that these meta-analyses used questionable approaches, and their findings were characterized by very high heterogeneity. Notably, the high heterogeneity appeared to be driven by large studies with widely different outcomes. Nonetheless, one finding stands out in the body of research examined: older subjects who initiated and continued PPIs (implying chronic use) were at a significantly increased risk of dementia and mild cognitive impairment. Although there are causal and non-causal pathways that associate PPI use with dementia, for reasons that are explained in this article, a cause-effect relationship cannot at present be presumed; so, PPI use is best considered to be a marker of future dementia risk. However, because chronic use of PPIs has been associated with many adverse medical outcomes (eg, disturbances of the gut microbiome, orthopedic complications), and because some PPIs are associated with pharmacokinetic drug interactions (mainly inhibition of CYP2C19), it would be wise to limit the use of PPIs to the shortest duration necessary and to deprescribe PPIs when there does not appear to be need for their continuation.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693091","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":"Suicide Risk and Veterans Health Administration Utilization Among those With a Documented Suicide Attempt in the US Military.","authors":"Mark A Reger, Sybil W Morley, Kevin D Masters, Brady M Stephens","doi":"10.4088/JCP.25m16168","DOIUrl":"https://doi.org/10.4088/JCP.25m16168","url":null,"abstract":"<p><p><b>Objective:</b> To examine how Veterans Health Administration (VHA) utilization and suicide outcomes differ for those with and without a suicide attempt prior to separating from the military.</p><p><p><b>Background:</b> Suicide attempts are frequently described as an important risk factor for future suicide behaviors. Additionally, Veterans who have recently transitioned out of military service have been identified as an at-risk group. We evaluated whether a suicide attempt prior to transition out of military service is an important risk factor among US Veterans.</p><p><p><b>Methods:</b> This retrospective study included 1,030,599 service members who separated from the active US military from 2015 to 2020. VHA utilization, VHA documented suicide behaviors, suicide mortality, and all-cause mortality in the 2 years following separation were examined, comparing those with and without a documented suicide attempt in their last 2 years of active duty service.</p><p><p><b>Results:</b> Service members with a documented suicide attempt prior to military separation were significantly more likely to initiate VHA care (hazard ratio [HR]=1.91 [95% CI, 1.84-1.98]) and VHA mental health care (HR =2.20 [95% CI, 2.13-2.28]) compared with those without an attempt. Among those who initiated VHA care, 90% of those with a recent military suicide attempt accessed VHA mental health services. Still, 39% of those with a suicide attempt prior to separation did not utilize VHA care. Those with a history of suicide attempt prior to transition were also more likely to have a suicide attempt (relative risk=7.78 [95% CI, 7.10-8.52]) or die from suicide (standardized mortality ratio= 9.94 [95% CI, 7.37-13.10]) after separation than those without.</p><p><p><b>Conclusions:</b> Results indicate that most Veterans in this group receive VHA services after separation, but a significant minority of high-risk Veterans remain unengaged.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693157","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":"Nonsuicidal Self-Injury and Its Association With Suicidal Ideation and Negative Affect: A 12-Month Ecological Momentary Assessment.","authors":"Adrián Alacreu-Crespo, Ana Maria de Granda-Beltrán, Elena Abances-Utrilla, Sandra Grijalba, Laura Jiménez-Muñoz, Maria Luisa Barrigón, Philippe Courtet, Jorge López-Castromán, Alejandro Porras-Segovia, Enrique Baca-García","doi":"10.4088/JCP.25m16072","DOIUrl":"https://doi.org/10.4088/JCP.25m16072","url":null,"abstract":"<p><p><b>Objective:</b> The desire to self-harm (DSH) is a key predictor of nonsuicidal self-injury (NSSI), which is also linked to negative affect, suicidal ideation (SI), and interpersonal difficulties. However, studies on these relationships are scarce and often limited by short follow-up periods. The aim of this study was to explore the relationship between DSH and NSSI during a 12-month follow-up and to test whether SI, negative affect, and negative interpersonal experiences are risk factors for NSSI.</p><p><p><b>Methods:</b> Adult outpatients were recruited in hospitals in Spain for presenting SI and/or a suicide attempt. The variables were registered by ecological momentary assessment (EMA) through a mobile application during a 12-month follow-up. Mixed models were used to test the association between variables.</p><p><p><b>Results:</b> A total of 106 patients were analyzed. We found a statistically significant positive relationship between mean DSH and the occurrence of NSSI episodes (OR=1.026, 95% CI=1.005-1.046). Furthermore, higher negative affect (<i>P</i>=.009) and negative interpersonal experience (<i>P</i><.001) were related with NSSI but showed a negative slope. Thus, NSSI patients had higher negative affect and negative interpersonal experience that decreased across the follow-up. With regard to specific emotions, restlessness, sadness, and hopelessness behaved similarly to the general variable of negative affect. By contrast, passive SI and anxiety showed a positive slope across the follow-up. Finally, intraindividual variability of SI was positively related with intraindividual mean of DSH (<i>P</i><.001).</p><p><p><b>Conclusion:</b> These results highlight the relevance of DSH in understanding NSSI. They also show the variation in the levels of SI, negative affect, and negative interpersonal experiences and their associations with NSSI. Future research should explore how to translate EMA-based monitoring into actionable suicide prevention programs implemented in routine care.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693043","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":"Using Natural Language Processing to Evaluate Differences in Psychotherapeutic Services for Posttraumatic Stress Disorder in a Suicide-Risk-Stratified Veteran Sample.","authors":"Maxwell Levis, Monica Dimambro, Joshua Levy, Natalie Riblet, Brian Shiner","doi":"10.4088/JCP.25m15904","DOIUrl":"10.4088/JCP.25m15904","url":null,"abstract":"<p><p><b>Objective:</b> Posttraumatic stress disorder (PTSD) is a common psychiatric condition, especially among US Veterans. Individuals diagnosed with PTSD have higher likelihoods of experiencing suicidal thoughts, attempting suicide, and dying by suicide compared to those without PTSD diagnoses. Although the US Department of Veterans Affairs (VA) emphasizes psychotherapy as a leading treatment for PTSD and associated suicide risk, there is limited understanding about how these treatments are used by VA patients who did and did not die by suicide. To better assess these patients' psychotherapy usage differences, we used Latent Dirichlet Allocation, a natural language processing topic modeling methodology, to study patients' unstructured electronic health record (EHR) note corpus.</p><p><p><b>Methods:</b> We evaluated VA suicide-risk-stratified patients (high-, moderate-, and low-suicide-risk) who died by suicide in 2017-2018 (cases) and suicide-risk-matched patients with similar demographics, diagnoses, and care who did not die by suicide (controls). After collecting all psychotherapy EHR notes within 1 year of case death and completing corpus preprocessing, we derived topics and used a binomial logistic regression model to evaluate topic differences, calculate odds ratios and <i>P</i> values, and examine topic clinical relevance.</p><p><p><b>Results:</b> We identified 5 topics: Risk, Treatment Planning, Evaluation, Psychosocial, and Medication. Cases and controls had several significantly different topic patterns, including Risk differences for moderate-risk patients, Treatment Planning differences for moderate- and high-risk patients, Evaluation differences for high-risk patients, Psychosocial differences for low- and moderate-risk patients, and Medication differences for all patient subgroups.</p><p><p><b>Conclusion:</b> Topic differences help distinguish closely matched cases and controls, aiding understanding of psychotherapy utilization and risk monitoring. Our findings suggest divergent care priorities, such that evaluation and risk monitoring are more central for high-risk cases while collaborative treatment planning and medication management are more central for high-risk controls.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693200","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}