Journal of Clinical Psychiatry最新文献

{"title":"Rates of Major Depressive Disorder and Bipolar Disorder in Black and White Postpartum Women.","authors":"Taylor N Burchfield, Amy Yang, Katherine L Wisner, Crystal T Clark","doi":"10.4088/JCP.23m15023","DOIUrl":"https://doi.org/10.4088/JCP.23m15023","url":null,"abstract":"<p><p></p><p><p><b>Importance:</b> Little is known about differences between Black and White women with respect to the prevalence of postpartum mood disorders or symptom presentations.</p><p><p><b>Objective:</b> To determine the prevalence and characteristics of postpartum major mood disorders in Black and White women at 4-6 weeks after birth.</p><p><p><b>Methods:</b> This is a secondary analysis of a large-scale study designed to screen women for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS) and collect symptom data. Data were collected at an urban maternity hospital in an academic setting in Pittsburgh, Pennsylvania. Of the 2,019 women who screened positive and accepted a psychiatric diagnostic interview, 163 and 85 Black women had major depressive and bipolar disorders, respectively, and 508 and 177 White women had major depressive and bipolar disorders, respectively. Those with an EPDS score greater than or equal to 10 were offered a psychiatric assessment (in-person at home or by telephone) with the Structured Clinical Interview for <i>DSM IV</i> using the Structured Interview Guide for the Hamilton Rating Scale for Depression, Atypical Depression Version symptom inventory, a questionnaire related to childhood and adulthood physical and sexual abuse, and the Short Form Survey 12. Participants who self-identified as Black or White were included in this analysis.</p><p><p><b>Results:</b> Among screen-positive participants, no significant difference in the rate of major depressive disorder (40% Black and 35% White) was observed. However, bipolar disorder significantly differed between Black (19.2%) and White (11.5%) women. Additionally, symptom profiles differed between Black and White participants with major depressive disorder, and a high rate of traumatic experiences was reported by participants with major depression and bipolar disorder in both racial groups.</p><p><p><b>Conclusion:</b> An understanding of the different presentations of postpartum mood disorders between Black and White women, as well as trauma-informed care, can optimize postpartum health care through supporting advocacy efforts for resource allocation and health care delivery.</p><p><p><b>Trial Registration:</b> Dataset from study at ClinicalTrials.gov identifier: NCT00282776.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683419","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":"Towards a Further Understanding of Meta-Analysis Using Gestational Exposure to Cannabis and Birth Defects as a Case in Point.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.24f15673","DOIUrl":"https://doi.org/10.4088/JCP.24f15673","url":null,"abstract":"<p><p>About 5%-10% of pregnancies in the US are exposed to cannabis with highest use reported during the first trimester. Two recent meta-analyses presented estimates of the risk of birth defects associated with prenatal exposure to cannabis; the larger and more recent meta-analysis pooled data from 18 cohort and 18 case-control studies with a total sample size of >19 million subjects. The meta-analyses found that prenatal exposure to cannabis was associated with a small but statistically significant increased risk of any birth defect (pooled odds ratios [ORs], 1.25-1.33); ORs were also significantly elevated for cardiovascular, gastrointestinal, nervous system, genitourinary, and musculoskeletal but not orofacial birth defects. The ORs were smaller and less likely to be statistically significant in adjusted analyses. These meta-analyses had strengths but also shortcomings. The strengths and shortcomings are explained in detail so that readers obtain a better understanding of how to critically assess findings in meta-analyses. One strength was the presentation of both unadjusted and adjusted pooled estimates; the former allow an understanding of risks in the average real world patient and the latter allow an understanding of the unique contribution of the exposure to the outcomes. Another strength was the presentation of cumulative meta-analyses which demonstrated from which calendar year onwards a finding became consistently statistically significant in the scientific literature. One shortcoming, in analyses of subcategories of birth defects, was the repeated representation of the same sample in the same forest plot; the many reasons why this is problematic are explained. Another shortcoming was the pooling of ORs obtained from cohort studies with those obtained from case control studies; conceptual and numerical reasons why this is problematic are also explained.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683423","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":"Clarification Regarding the Psychiatrist's Role: Psychiatric Care Versus Psychosocial Support-Reply to Akerson et al.","authors":"Sindhura Vangala, Roy Williams Jr, Cara M Buskmiller, Jessian L Munoz","doi":"10.4088/JCP.24lr15579a","DOIUrl":"https://doi.org/10.4088/JCP.24lr15579a","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683413","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":"Mental Health Assessment and Psychosocial Intervention Are Already Happening for Maternal-Fetal Interventions.","authors":"Valerie M Akerson, Kara L Hansen, Kassie Merrill Olver, Judith L M McCoyd","doi":"10.4088/JCP.24lr15579","DOIUrl":"https://doi.org/10.4088/JCP.24lr15579","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683417","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":"Substance Use Disorder Treatment Programs for Transgender and Gender Diverse Patients.","authors":"Anshul V Puli, Alex S Keuroghlian","doi":"10.4088/JCP.24com15581","DOIUrl":"https://doi.org/10.4088/JCP.24com15581","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683422","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":"Hyperbaric Oxygen Therapy for Veterans With Combat-Associated Posttraumatic Stress Disorder: A Randomized, Sham-Controlled Clinical Trial.","authors":"Keren Doenyas-Barak, Ilan Kutz, Erez Lang, Amir Assouline, Amir Hadanny, Kristoffer C Aberg, Gabriela Levi, Ilia Beberashvili, Avi Mayo, Shai Efrati","doi":"10.4088/JCP.24m15464","DOIUrl":"https://doi.org/10.4088/JCP.24m15464","url":null,"abstract":"<p><p><b>Objective:</b> Cumulative data indicate that new protocols of hyperbaric oxygen therapy (HBOT) may induce neuroplasticity and improve clinical symptoms of patients suffering from posttraumatic stress disorder (PTSD). The aim of the current study was to evaluate the effects of HBOT on veterans with combat-associated PTSD (CA-PTSD) in a randomized, sham-controlled trial.</p><p><p><b>Methods:</b> Male veterans aged 25-60 years with CA-PTSD, with a Clinician-Administered PTSD Scale for <i>DSM-5</i> (CAPS-5) score above 20, were included. Exclusion criteria included a history of traumatic brain injury, other psychiatric diseases, or contraindication to HBOT. Participants were randomly assigned to HBOT or sham intervention. Both interventions involved 60 daily sessions, with 90 minutes of either 100% oxygen at 2 atmospheres absolute (ATA) (HBOT) or 21% oxygen at 1.02 ATA (sham) with 5-minute air breaks every 20 minutes. CAPS-5 score, Beck Depression Inventory-II (BDI-II), the Depression, Anxiety and Stress Scale 21 Items (DASS-21), and resting-state functional magnetic resonance imaging (rsfMRI) were assessed at baseline and posttreatment, with the primary end point defined as a 30% reduction in CAPS-5 score from baseline.</p><p><p><b>Results:</b> The study was conducted between February 2020 and July 2023. Of 63 veterans who underwent randomization, 56 completed the study protocol (28 in each group). The HBOT group showed a significant decrease in mean CAPS-5 total score, from 42.57 ±9.29 at baseline to 25.8±9.5 following HBOT (<i>P</i>< .001) and 25.08± 13.08 at follow-up (<i>P</i>< .001). The sham group demonstrated a significant increase in CAPS-5 total score from baseline to follow-up, from 45.11 ±8.99 to 47.75± 11.27 following HBOT (<i>P</i>= .069) and 49.22± 10.26 at follow-up (<i>P</i>= .011). Significant improvements in the depression domain of the DASS-21 questionnaire and BDI-II were demonstrated (<i>F</i>=4.55, <i>P</i>= .03 and <i>F</i>=4.2, <i>P</i>= .04, respectively). The stress and anxiety domains of DASS-21 did not reach statistically significant levels. Analysis of rsfMRI demonstrated improved connectivity within the 3 main networks (default-mode network, central-executive network, salience network) in HBOT vs sham groups.</p><p><p><b>Conclusions:</b> Dedicated HBOT protocol can improve PTSD symptoms of veterans with CA-PTSD. The clinical improvement was accompanied by enhanced functional connectivity demonstrated by rsMRI.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT04518007.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683415","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":"Dysregulation of Noradrenergic Activity: Its Role in Conceptualizing and Treating Major Depressive Disorder, Schizophrenia, Agitation in Alzheimer's Disease, and Posttraumatic Stress Disorder.","authors":"Rakesh Jain, Craig Chepke, Lori L Davis, Roger S McIntyre, Murray A Raskind","doi":"10.4088/JCP.plunaro2417ah","DOIUrl":"10.4088/JCP.plunaro2417ah","url":null,"abstract":"<p><p>When discussing neurotransmitters whose signaling plays an important role in psychiatric illnesses, serotonin and dopamine may be the first that come to mind. Although serotonin and dopamine have significant roles, the impact of norepinephrine signaling is often overlooked. A growing body of evidence suggests that hyperactivity of norepinephrine signaling is an underlying issue in psychiatric disorders; conversely, there is evidence to suggest that deficits in the noradrenergic system are just as significant. Hence, alterations in noradrenergic activity are better characterized as dysregulation rather than a reductive, outdated formulation of \"too much\" or \"too little\" activity. Therefore, symptoms such as agitation, irritability, hyperarousal, and insomnia could be treated by targeting the underlying pathophysiology related to noradrenergic dysregulation with targeted treatments. In a recent consensus panel meeting, 5 experts reviewed the available evidence of altered noradrenergic activity and its potential role in some of the most common psychiatric disorders. This Academic Highlights article summarizes their discussion and presents the panel's conclusions.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607061","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":"Mixed Features and Nonfatal Suicide Attempt Among Individuals With Major Depressive Episode: Insights From the French MHGP Survey.","authors":"Hugo Peyre, Nicolas Hoertel, Baptiste Pignon, Ali Amad, Jean-Luc Roelandt, Imane Benradia, Pierre Thomas, Guillaume Vaiva, Pierre-Alexis Geoffroy, Emilie Olié, Philippe Courtet","doi":"10.4088/JCP.24m15445","DOIUrl":"https://doi.org/10.4088/JCP.24m15445","url":null,"abstract":"<p><p></p><p><p><b>Background:</b> This study explores among individuals with a major depressive episode (MDE) the potential impact of mixed features on the risk of suicide attempt, suicidal thoughts, self-harm intentions, and thoughts of death.</p><p><p><b>Methods:</b> Data from the French Mental Health in General Population (MHGP) survey (1999-2003) were analyzed, including 128 participants meeting <i>DSM 5</i> criteria for MDE with mixed features (MDE with at least 3 manic symptoms) and 3,312 participants experiencing MDE without mixed features. Our primary analysis focused on suicide attempt, with additional examination of recent suicidal thoughts, self-harm intentions, and thoughts of death. Multivariable regression models were performed to adjust for potential confounding variables, including sociodemographics, previous suicide attempt, number of depressive symptoms, and psychiatric comorbidity.</p><p><p><b>Results:</b> MDE with mixed features was significantly associated with an increased risk of suicide attempt (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.26-2.25). This association did not significantly differ between men and women. Furthermore, the number of manic symptoms demonstrated a dose-dependent relationship with an increased risk of suicide attempt (AOR = 1.18; 95% CI, 1.07-1.30; <i>P</i> < .001). Mixed features were also associated with suicide attempt among individuals with MDE and without recent suicidal thoughts (AOR = 2.74; 95% CI, 1.36-5.54).</p><p><p><b>Conclusion:</b> This study underscores the importance of assessing mixed features when evaluating the risk of suicide attempt in individuals with MDE. Mechanisms underlying this association might be independent of progression from thoughts of death to suicidal thoughts, suicidal intention, and ultimately, suicide attempt.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607120","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":"History of Concussion and Risk of Severe Maternal Mental Illness: A Population-Based Cohort Study.","authors":"Samantha Krueger, Simone N Vigod, Vincy Chan, Tatyana Mollayeva, Rea Alonzo, Hannah Chung, Hilary K Brown","doi":"10.4088/JCP.24m15373","DOIUrl":"https://doi.org/10.4088/JCP.24m15373","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> To evaluate the relationship between a predelivery history of concussion and risk of severe maternal mental illness.</p><p><p><b>Methods:</b> We conducted a population based cohort study of birthing people with a singleton livebirth accrued between 2007 and 2017 with follow-up to 2021 in Ontario, Canada. The primary outcome was severe maternal mental illness, defined as a psychiatric emergency department visit, psychiatric hospital admission, or self-harm or suicide in the 14 years after delivery. Cox proportional hazards regression generated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) comparing those with a history of a health care encounter for concussion between database inception and the index delivery date to those without a recorded health care encounter for concussion, adjusted for maternal age, parity, neighborhood income quintile, rural residence, immigration status, chronic conditions, history of interpersonal violence, and history of mental illness. Results were also stratified by history of mental illness.</p><p><p><b>Results:</b> There were n = 18,064 birthing people with a history of concussion and n = 736,689 without a history of concussion. Those with a history of concussion had an increased risk of severe maternal mental illness compared to those without this history (14.7 vs 7.9 per 1,000 person-years; aHR 1.25, 95% CI, 1.20-1.31). After stratification by predelivery history of mental illness, the association was strongest in individuals with no mental illness history (aHR 1.33, 95% CI, 1.23-1.44).</p><p><p><b>Conclusion:</b> These findings indicate the need for early identification and screening of birthing people with a history of concussion, as well as ongoing long-term supports using trauma informed approaches to prevent adverse psychiatric outcomes.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607118","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":"Opioid Use Disorder Treatment in Sexually and Gender Diverse Patients: A Retrospective Cohort Study.","authors":"Michal J McDowell, Amitai S Miller, Dana S King, Sy Gitin, Avery E Allen, Ellis J Yeo, Abigail W Batchelder, Alisa B Busch, Shelly F Greenfield, Haiden A Huskamp, Alex S Keuroghlian","doi":"10.4088/JCP.23m15185","DOIUrl":"10.4088/JCP.23m15185","url":null,"abstract":"<p><p><b>Objective:</b> This study assesses differences in opioid use disorder (OUD) treatment among sexually and gender diverse (SGD) vs non-SGD people.</p><p><p><b>Methods:</b> Using electronic health record data from a federally qualified health center, this retrospective cohort study explores OUD treatment for adults with an OUD diagnosis, as well as any clinic visit from January 2013 until June 2021 (N = 1,133), through review of medication prescriptions for OUD and OUD-related visits.</p><p><p><b>Results:</b> Patients identifying as lesbian/gay had the lowest prevalence of OUD, with 1% (n = 231) of lesbian/gay patients having an OUD diagnosis, as compared to 1.5% (n = 560) of straight/heterosexual patients, 1.7% (n = 108) of bisexual patients, 1.4% (n = 44) of patients who identified as \"something else,\" 1.6% (n = 26) of patients who \"don't know\" their sexual orientation, and 1.6% (n = 164) of patients who did not report their sexual orientation (<i>P</i> < .0001). There was not a statistically significant difference (<i>P</i> = .49) between OUD diagnosis in the transgender and gender diverse (TGD) cohort (1.5%, n = 117) and the cisgender cohort (1.4%, n = 1016). Straight/heterosexual patients were more likely than sexually diverse patients to be prescribed buprenorphine (44.3%, n = 248 vs 34.7%, n = 133, <i>P</i> = .003), methadone (13.8%, n = 77 vs 9.4%, n = 36, <i>P</i> = .04), and naloxone (47.0%, n = 263 vs 38.9%, n = 149, <i>P</i> = .01). Cisgender patients were more likely to be prescribed buprenorphine than TGD patients (40.9%, n = 416 vs 31.6%, n = 37, <i>P</i> = .05). TGD patients were more likely to be prescribed oral naltrexone than cisgender patients (19.7%, n = 23 vs 7.0%, n = 71, <i>P</i> < .001). The straight/ heterosexual cohort had the lowest proportion of pharmacotherapy (19.3%, n = 108), individual psychotherapy (35.9%, n = 201), addiction and group therapy (12.9%, n = 72), case management (8.4%, n = 47), and complementary care visits (3.9%, n = 22). Straight/heterosexual patients had the highest proportion of outpatient medical visits (68.4%, n = 383). Transgender men had the highest proportion of individual therapy visits (80.8%, n = 21), compared to 53.7% (n = 29) of genderqueer/nonbinary patients, 51.4% (n = 19) of transgender women, 40.7% (n = 300) of cisgender men, and 40.6% (n = 113) of cisgender women (<i>P</i> < .001).</p><p><p><b>Conclusion:</b> The disparities in buprenorphine prescriptions and in outpatient medical visit access between the SGD and non-SGD cohorts highlight important priorities for culturally responsive interventions at clinical, organizational, and systems levels.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548674","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}