Journal of Clinical Psychiatry最新文献

{"title":"GLP-1 Receptor Agonists and Risk of Kidney Replacement Therapy and Health Care Utilization in Bipolar Disorder With Chronic Kidney Disease.","authors":"Balwinder Singh, Maria L Gonzalez Suarez, Hossam M Ali, Raman Baweja","doi":"10.4088/JCP.26m16392","DOIUrl":"10.4088/JCP.26m16392","url":null,"abstract":"<p><p><b>Objective:</b> To examine whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is associated with reduced risk of kidney replacement therapy (KRT) and health care utilization (HCU) compared with active comparators in adults with bipolar disorder (BD) and chronic kidney disease (CKD; stage ≤3).</p><p><p><b>Methods:</b> Using TriNetX, we conducted a real-world, new-user active-comparator cohort study among adults with BD+CKD initiating GLP-1 RA or dipeptidyl peptidase-4 (DPP-4) inhibitor therapy (primary comparator), with a secondary analysis versus renin-angiotensin-aldosterone system (RAAS) inhibitor users. Propensity score matching (PSM) balanced baseline characteristics. Cox proportional hazards regression estimated adjusted hazard ratios (aHR) for KRT and HCU over 5-year follow-up. Subgroup analyses examined effect modification by sex, race, ethnicity, obesity, and psychotropic medication use.</p><p><p><b>Results:</b> Compared with DPP-4 inhibitor use, GLP-1 RA use was associated with lower observed risk of KRT (aHR 0.56, 95% CI 0.50-0.64) and HCU (aHR 0.74, 95% CI 0.71-0.78). Following PSM (n=3,908 per group), 5-year KRT-free survival was 87.93% versus 84.63% (<i>P</i><.001); HCU-free survival did not differ significantly (<i>P</i>=.89). Versus RAAS inhibitors, GLP-1 RA use was similarly associated with lower observed risk of KRT (aHR 0.66) and HCU (aHR 0.62); after PSM (n=2,539 per group), KRT-free survival was higher (94.68% vs. 89.77%; <i>P</i><.001), while HCU-free survival did not differ significantly (<i>P</i>=.15). Benefits were consistent across sex, race, and obesity status and across psychotropic subgroups, including lithium.</p><p><p><b>Conclusions:</b> GLP-1 RA use was associated with lower observed risk of KRT and HCU compared with DPP-4 inhibitors, corroborated for KRT in a secondary comparison against RAAS inhibitors. These exploratory findings warrant further investigation, including prospective studies, to evaluate whether this association reflects a causal effect.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139171","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":"Worsening of Depression and Anxiety With Psilocybin: A Case Report in Cyclothymia.","authors":"S Nassir Ghaemi","doi":"10.4088/JCP.26cr16608","DOIUrl":"https://doi.org/10.4088/JCP.26cr16608","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117845","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":"On the Use of Artificial Intelligence in Medical Publishing.","authors":"Joseph F Goldberg, Marlene P Freeman, John C Markowitz, Ann K Shinn, Jordan F Karp, Leslie Citrome, Karen D Wagner, Samuel T Wilkinson, Rachel Vanderkruik","doi":"10.4088/JCP.26ed16673","DOIUrl":"https://doi.org/10.4088/JCP.26ed16673","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117868","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":"Psychotherapy Must Remain an Integral Part of Psychiatry.","authors":"John C Markowitz","doi":"10.4088/JCP.26com16688","DOIUrl":"https://doi.org/10.4088/JCP.26com16688","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117885","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":"Impact of Cannabis Use on Time to Psychiatric Rehospitalization in Young Adults With Bipolar and Psychotic Disorders: A Survival Analysis.","authors":"Justine Perino, Amélie Daveluy, Anna Truong-Bastos, Flora Miremont, Mélina Fatseas, Marie Tournier","doi":"10.4088/JCP.25m16257","DOIUrl":"https://doi.org/10.4088/JCP.25m16257","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> Psychiatric disorders are frequently associated with drug use and substance use disorders (SUDs). This study aimed to (1) assess the risk of psychiatric readmission associated with cannabis use in young adults (18-29 years) with bipolar or psychotic disorders and (2) describe drug use and SUD recorded in their medical files.</p><p><p><b>Methods:</b> This historical cohort included 200 adults aged 18-29 years hospitalized full time for psychotic or bipolar disorders in 2017 (index hospitalization) and followed until May 31, 2023. Data were extracted from medical records. Cox regression models assessed the association between cannabis use at admission and psychiatric readmission during the year after discharge.</p><p><p><b>Results:</b> Among the 200 patients (mean age 24 years; 47% male), 58% reported lifetime drug use and 44% current drug use at admission, excluding alcohol and tobacco. Multiple drug users represented 13%, and 37% had SUD. Cannabis was the most commonly used drug (lifetime 58%, current 43%), followed by cocaine (17% and 6%) and ecstasy (15% and 5%). Cannabis use at the index hospitalization was associated with an increased risk of readmission within the first month postdischarge (hazard ratio [HR]=2.8; 95% CI 1.3-5.9), decreasing by 3 months (HR=1.9; 95% CI 1.1-3.3), and becoming nonsignificant at 6 months.</p><p><p><b>Conclusion:</b> In young adults with psychotic or bipolar disorders, cannabis use at admission is a significant predictor of early psychiatric readmission. The first 3 months postdischarge represents a critical period for targeted follow-up and intervention.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117905","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":"An Open-Label, Dose-Escalation Trial of Psilocybin-Assisted Therapy for Bipolar II Depression.","authors":"Amanda E Downey, Balázs Szigeti, Ellen R Bradley, Gisele Fernandes-Osterhold, Kimberly Sakai, Katiah Llerena, Lisa Fredenburg, Jerusalem Nerayo, Lilly Evans-Riera, Brittany Nielsen, Andrew D Krystal, Aoife O'Donovan, David E Gard, Josh D Woolley","doi":"10.4088/JCP.25m16227","DOIUrl":"10.4088/JCP.25m16227","url":null,"abstract":"<p><p><b>Objective:</b> Individuals with bipolar II disorder (BD-II) and depression face limited treatment options and are often excluded from psilocybin therapy trials due to concerns about precipitating mania or psychosis. The objective of this study was to evaluate the safety, tolerability, and preliminary efficacy of psilocybin therapy in individuals with BD-II and depression.</p><p><p><b>Methods:</b> We conducted an open-label, single-arm pilot trial from 2022-2025 in which 14 participants with BD-II depression, diagnosed using adapted criteria requiring ≥2 consecutive days of hypomanic symptoms, received 10 mg of psilocybin, followed by 25 mg if symptoms persisted. Participants completed psychotherapy before, during, and after psilocybin sessions and were proactively monitored for adverse events. Depression and quality of life were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS; primary end point 21 days after each participant's final administration session) and the Quality of Life in Bipolar Disorder Questionnaire (QoL-BD), alongside exploratory measures.</p><p><p><b>Results:</b> Psilocybin was well tolerated, with only transient increases in heart rate and blood pressure and no serious adverse events. Common side effects included mild-to-moderate anxiety, nausea, and headache. Three participants experienced notable psychiatric events (suicidal ideation or hypomania), which resolved with support. Following the 10 mg session, MADRS scores improved significantly (-12.7 [2.7], <i>P</i><.001), with 4 participants (28.5%) meeting remission criteria and therefore not proceeding to the 25 mg session; 9 participants received the 25 mg dose. Among those who received the 25 mg dose, MADRS scores improved significantly 21 days following 25 mg (-18.6 [3.1], <i>P</i><.001). QoL-BD scores also improved at 90 days following the final dose (31.2 [10.2], <i>P</i>=.004).</p><p><p><b>Conclusion:</b> These findings suggest that psilocybin therapy may be safe, tolerable, and preliminarily efficacious for treating depression in BD-II, but randomized controlled trials are needed to confirm efficacy and optimize protocols.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT05065294.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013084","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 Role of Chronic Anhedonia in the Relationship Between Treatment-Resistant Depression and Suicidality.","authors":"Tia Sternat, Irvin Epstein, Kathryn Fotinos, Sachinthya Lokuge, Alexandria Greifenberger, Elssa Toumeh, Martin A Katzman","doi":"10.4088/JCP.25m16189","DOIUrl":"https://doi.org/10.4088/JCP.25m16189","url":null,"abstract":"<p><p><b>Objective:</b> Treatment-resistant depression (TRD) is a severe form of major depressive disorder (MDD) associated with increased suicidality. Anhedonia, the reduced ability to experience pleasure, is recognized across various psychiatric conditions, including TRD. This study aims to investigate the relationship between chronic anhedonia, or low hedonic tone, and suicidal behavior in patients with TRD.</p><p><p><b>Methods:</b> A cohort of 160 participants from the START Clinic for Mood and Anxiety Disorders in Toronto, Canada, was assessed. Diagnosis of TRD followed criteria established by McIntyre et al (2014) and used the Mini International Neuropsychiatric Interview (MINI) 6.0.0 diagnostic evaluation. Chronic anhedonia was classified using the MINI module A, and suicidality was assessed using the MINI Suicide Module.</p><p><p><b>Results:</b> Of the 160 participants, 97 met the criteria for TRD. Within the TRD group, 58% reported chronic anhedonia. Participants with TRD and chronic anhedonia were 2.4-fold more likely to report suicidal ideation (<i>P</i>=.049) and 3.9-fold more likely to report a suicide attempt (<i>P</i>=.035) in the preceding month than those without chronic anhedonia.</p><p><p><b>Conclusion:</b> Chronic anhedonia is significantly associated with an increased risk of suicidal ideation and attempts in patients with TRD. Clinicians should consider chronic anhedonia as a key risk factor for suicidality in this population and prioritize its assessment and management.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013057","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":"Correction. Evaluation of Sexual Function With Adjunctive Lumateperone in Patients With Major Depressive Disorder.","authors":"","doi":"10.4088/JCP.26lcx16709","DOIUrl":"https://doi.org/10.4088/JCP.26lcx16709","url":null,"abstract":"<p><p>This corrects the article DOI: 10.4088/JCP.26m16387.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013148","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":"Population Pharmacokinetics and Dosing Simulations for Paliperidone Palmitate 351 mg as Alternative Maintenance Doses in Patients With Schizophrenia or Schizoaffective Disorder.","authors":"Yonglin Chen, Leijun Hu, Jonathan M Meyer, Leslie Citrome, Hongtao Song, Siwen Wang, Pinglan Liu, John J Yang, Ying Dong","doi":"10.4088/JCP.26m16416","DOIUrl":"10.4088/JCP.26m16416","url":null,"abstract":"<p><p><b>Objective:</b> Once-monthly paliperidone palmitate (PP1M) extended-release injectable suspension is approved for the treatment of adults with schizophrenia or schizoaffective disorder. A 351 mg dose of PP1M (LY03010 [brand name Erzofri]) became available in the US in April 2025 and is approved as a single initiation injection followed by recommended monthly maintenance doses up to 234 mg. The objective of this study was to investigate steady-state paliperidone exposure following administration of 351 mg as a maintenance dose at different dosing intervals using population pharmacokinetic (popPK) analysis.</p><p><p><b>Methods:</b> A popPK model was developed using Nonlinear Mixed Effects Modeling (NONMEM) based on the paliperidone concentration data from 2 phase 1 studies for LY03010. Plasma paliperidone exposures based on model simulations were summarized.</p><p><p><b>Results:</b> Simulated plasma concentration-time profiles demonstrated that LY03010 351 mg every 4 weeks (Q4W) produced steady-state paliperidone exposure comparable to 234 mg every 3 weeks (Q3W) based on analysis of C_max,ssand C_trough,ss.Simulated data indicated that administration of LY03010 351 mg every 6 weeks (Q6W) provided similar paliperidone exposure to 234 mg PP1M Q4W at steady state. Simulation of LY03010 351 mg every 8 weeks (Q8W) showed that C_max,ssof paliperidone fell in-between that of 234 mg Q4W and 156 mg Q4W while C_trough,sswas comparable to that of 117 mg Q4W.</p><p><p><b>Conclusions:</b> PopPK simulations suggest that LY03010 351 mg may provide alternative treatment options as a maintenance dose at different dosing intervals. Currently, there are no clinical data to support the alternative dosing regimens.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifiers: NCT04572685 and NCT04922593.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992190","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":"Utilization of Long-Acting Injectable Antipsychotics and Clozapine in Coordinated Specialty Care: Data From EPINET.","authors":"John M Kane, Nina R Schooler, Patricia Marcy, C Hendricks Brown, Delbert G Robinson","doi":"10.4088/JCP.26m16461","DOIUrl":"https://doi.org/10.4088/JCP.26m16461","url":null,"abstract":"<p><p><b>Objective:</b> We utilized the Early Psychosis Intervention Network (EPINET) platform to examine variability in utilization rates of 2 evidence-based pharmacologic treatments, long-acting injectable (LAI) formulations of antipsychotics and clozapine.</p><p><p><b>Methods:</b> Data come from 8 EPINET clinic consortia, called \"hubs,\" comprising a total of 113 clinics delivering coordinated specialty care (CSC). Hub rates of LAI and clozapine use were calculated based upon the number of patients who were prescribed LAIs or clozapine at any point in a patient's treatment during EPINET participation. Potential effects of demographic differences, including biological sex, race, and ethnicity, across hubs and sites on utilization were examined.</p><p><p><b>Results:</b> Medication data, collected from September 2019 to June 2024, were available from 16,847 records with 5,324 participants. At the level of hubs, the proportion of patients receiving LAIs ranged from 5.0% to 37.5% and for clozapine 1.7% to 9.0%, and, at the clinic level, the proportion receiving LAIs ranged from 0.024 to 0.60 and for clozapine 0.005 to 0.33. We found very large standard deviations in both hub (0.61) and site (0.50) differences for LAIs, which remained large after adjustments for sex, ethnicity, and race. For clozapine prescribing, site differences were extremely large (0.92), while hub differences (0.37) were nonsignificant.</p><p><p><b>Conclusions:</b> Pharmacological treatment practices regarding LAIs and clozapine are highly variable in US-based CSC programs. Higher adoption and patient reach through implementation strategies of these evidence-based practices might decrease the all-too-frequent occurrences of persistent positive symptoms, psychotic relapse, and hospitalization in early phase psychotic disorders.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992203","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}