Journal of Clinical Psychiatry最新文献

{"title":"Diagnosis of the Suicide Crisis Syndrome in the Emergency Department Associated With Significant Reduction in 3-Month Readmission Rates.","authors":"Lisa J Cohen, Betsy J White, Fred E Miller, Ethan F Karsen, Igor I Galynker","doi":"10.4088/JCP.24m15320","DOIUrl":"10.4088/JCP.24m15320","url":null,"abstract":"<p><p><b>Objective:</b> The suicide crisis syndrome (SCS), an acute negative affect state predictive of near-term suicidal behavior, is currently under review for inclusion as a suicide-specific diagnosis in the <i>Diagnostic and Statistical Manual of Mental Disorders</i> (<i>DSM</i>). While the SCS has ample psychometric validation, it is critical to test its utility as a clinical tool within a real-world clinical setting. The present study investigates patterns of emergency department (ED) readmissions following implementation of an SCS-based risk assessment tool into the ED of a large, urban hospital system.</p><p><p><b>Methods:</b> Patterns of readmission rates to the ED in the 3 months following initial ED visit were evaluated for patients diagnosed with the SCS, after controlling for suicidal ideation (SI), self-harm behavior (SHB), and psychosis in the initial ED visit. All diagnoses were extracted from the electronic medical record. SCS diagnosis was based on the Abbreviated SCS Checklist (A-SCS-C), a clinician administered rating scale.</p><p><p><b>Results:</b> Analysis of the SCS was performed on 213 patients consecutively admitted to the ED 9 months post-implementation of the A-SCS-C. Over one third (79; 37%) of patients were diagnosed with the SCS, over half 111 (52.1%) presented with SI and 8 (3.8%) with suicide attempt. After controlling for covariates, SCS diagnosis reduced readmission risk by approximately 72% (AOR = 0.281) for any reason and almost 75% (AOR = 0.257) for suicidal presentations, while SI and SHB upon initial ED visit either increased readmission risk or were noncontributory. The protective effect of the SCS was consistent across levels of severity of both SI and SHB.</p><p><p><b>Conclusion:</b> Use of the SCS appears to improve clinical outcome with suicidal patients presenting to the ED.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548672","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 Gepirone-ER on Sexual Function in Patients With Major Depressive Disorder.","authors":"Tierney K Lorenz, Mary F Johnson, Anita H Clayton","doi":"10.4088/JCP.24m15357","DOIUrl":"10.4088/JCP.24m15357","url":null,"abstract":"<p><p><b>Objective:</b> To describe effects of gepirone extended-release (ER), an azapirone, on sexual function in patients receiving treatment for major depressive disorder (MDD).</p><p><p><b>Methods:</b> Sexual function was assessed in 1,767 patients (67% women) across five Phase 3 randomized controlled clinical trials comparing gepirone-ER against placebo or active treatment with selective serotonin reuptake inhibitors (SSRIs) for treatment of MDD. All five trials assessed sexual functioning in the short term (8 weeks), with three including long-term extensions of 16, 20, or 44 weeks. Sexual function was assessed prospectively and throughout trials via clinical interview and well-validated survey measures.</p><p><p><b>Results:</b> Across studies, gepirone-ER was equivalent to placebo on sexual side effects and treatment-emergent sexual dysfunction. Relative to SSRIs, gepirone-ER was associated with significantly better effect on sexual function across time points studied. Evidence from patients without sexual dysfunction at baseline demonstrates superiority of gepirone-ER over SSRIs in the first few weeks of treatment, when patients are most vulnerable to the negative effects of sexual side effects on medication nonadherence/ discontinuation. Importantly, these benefits were maintained across treatment.</p><p><p><b>Conclusions:</b> Gepirone-ER was not associated with sexual dysfunction in patients with MDD. Rates of sexual side effects and treatment-emergent sexual dysfunction with gepirone-ER were comparable to those reported for placebo and lower than sexual side effects reported for active treatment with SSRIs.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecting Misuse of Prescription Opioids: Easier Said Than Done?","authors":"Vania Modesto-Lowe, Alyssa Crispino, Michael Salley","doi":"10.4088/JCP.24lr15562","DOIUrl":"https://doi.org/10.4088/JCP.24lr15562","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479593","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":"Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study.","authors":"Margaret H Sibley, Traci M Kennedy, James M Swanson, L Eugene Arnold, Peter S Jensen, Lily T Hechtman, Brooke S G Molina, Andrea Howard, Laurence Greenhill, Andrea Chronis-Tuscano, John T Mitchell, Jeffrey H Newcorn, Luis A Rohde, Stephen P Hinshaw","doi":"10.4088/JCP.24m15395","DOIUrl":"10.4088/JCP.24m15395","url":null,"abstract":"<p><p><b>Objectives:</b> Recent studies report a fluctuating course of attention-deficit/ hyperactivity disorder (ADHD) across development characterized by intermittent periods of remission and recurrence. In the Multimodal Treatment of ADHD (MTA) study, we investigated fluctuating ADHD including clinical expression over time, childhood predictors, and between- and within-person associations with factors hypothesized as relevant to remission and recurrence.</p><p><p><b>Methods:</b> Children with <i>DSM-5</i> ADHD, combined type (N <i>=</i> 483), participating in the MTA adult follow-up were assessed 9 times from baseline (mean age = 8.46) to 16-year follow-up (mean age = 25.12). The fluctuating subgroup (63.8% of sample) was compared to other MTA subgroups on variables of interest over time.</p><p><p><b>Results:</b> The fluctuating subgroup experienced multiple fluctuations over 16 years (mean <i>=</i> 3.58<i>,</i> SD = 1.36) with a 6- to 7-symptom within-person difference between peaks and troughs. Remission periods typically first occurred in adolescence and were associated with higher environmental demands (both between- and within-person), particularly at younger ages. Compared to other groups, the fluctuating subgroup demonstrated moderate clinical severity. In contrast, the stable persistent group (10.8%) was specifically associated with early and lasting risk for mood disorders, substance use problems in adolescence/ young adulthood, low medication utilization, and poorer response to childhood treatment. Protective factors were detected in the recovery group (9.1%; very low parental psychopathology) and the partial remission group (15.6%; higher rates of comorbid anxiety).</p><p><p><b>Conclusions:</b> In the absence of specific risk or protective factors, individuals with ADHD demonstrated meaningful within-individual fluctuations across development. Clinicians should communicate this expectation and monitor fluctuations to trigger as-needed return to care. During remission periods, individuals with ADHD successfully manage increased demands and responsibilities.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT00000388.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479582","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":"Cannabis Use and Attention-Deficit/Hyperactivity Disorder in Community Mental Health: Considering Comorbidity and Accurate Documentation.","authors":"Fawaz Stipho, Kai Glahn, Erica A Rodriguez, Jordan F Karp","doi":"10.4088/JCP.24l15496","DOIUrl":"https://doi.org/10.4088/JCP.24l15496","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479581","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":"Clinical Implications of Attention-Deficit/Hyperactivity Disorder in Adults: What New Data on Diagnostic Trends, Treatment Barriers, and Telehealth Utilization Tell Us.","authors":"Gregory Mattingly, Ann Childress","doi":"10.4088/JCP.24com15592","DOIUrl":"https://doi.org/10.4088/JCP.24com15592","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479583","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":"Efficacy and Safety of Ketamine/Esketamine in Bipolar Depression in a Clinical Setting.","authors":"Mia C Santucci, Mina Ansari, Sina Nikayin, Rajiv Radhakrishnan, Taeho G Rhee, Samuel T Wilkinson","doi":"10.4088/JCP.24m15376","DOIUrl":"10.4088/JCP.24m15376","url":null,"abstract":"<p><p><b>Background:</b> Bipolar disorder represents a significant source of morbidity and elevated mortality risk. Ketamine has emerged as a powerful antidepressant; however, there have been few trials of ketamine in bipolar depression and no trials with esketamine in bipolar depression, and few data exist from real-world settings. Here, we report outcomes from a cohort of patients with bipolar depression treated with ketamine/ esketamine in a real-world setting.</p><p><p><b>Methods:</b> Patients with treatment refractory bipolar depression were referred to Yale Psychiatric Hospital Interventional Services for treatment from October 2014 to November 2023. Appropriate patients were treated with intravenous (IV) ketamine (0.5 mg/kg over 40 minutes) or intranasal esketamine (56 or 84 mg). Diagnosis of bipolar depression was done by clinical evaluation by an attending psychiatrist, based on <i>DSM</i> criteria. Clinical outcomes were tabulated from medical records.</p><p><p><b>Results:</b> Overall, 45 patients with bipolar depression were treated with IV ketamine or intranasal (IN) esketamine during the time period specified. Depression severity outcomes were available for 38 patients that completed an acute series, defined as treatment twice weekly for up to 4 weeks. Overall, 15/38 (39%) achieved clinical response (≥50% improvement on the Montgomery-Asberg Depression Rating Scale [MADRS]) and 5/38 (13.2%) achieved remission (≤10 on MADRS) following the acute series. Mean MADRS scores decreased from 31.1 to 19.2 (38.3% mean improvement). Safety data (hypomania/manic symptoms) were available for all 45 patients (518 patient-months of follow-up). No patients experienced any mania/hypomania during the acute series phase (when treatments are given twice weekly). However, 13/45 (28.9%) patients experienced symptoms consistent with a hypomanic or manic episode at some point following the acute phase while continuing to receive ketamine or esketamine during a maintenance phase. There were 16 manic/hypomanic events, indicating 1 event for every 2.7 patient-years. Only 1 event was severe and resulted in hospitalization.</p><p><p><b>Conclusion:</b> In a small sample of patients with bipolar depression treated with ketamine/esketamine, no evidence of mania/hypomania was seen during the acute phase of treatment. Further research is needed to evaluate whether ketamine or esketamine confers heightened risk of affective switch during maintenance treatment.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367274","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":"Integrating Previous Suicide Attempts, Gender, and Age Into Suicide Risk Assessment Using Advanced Artificial Intelligence Models.","authors":"Shiri Shinan-Altman, Zohar Elyoseph, Inbar Levkovich","doi":"10.4088/JCP.24m15365","DOIUrl":"10.4088/JCP.24m15365","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> Suicide is a critical global health concern. Research indicates that generative artificial intelligence (GenAI) and large language models, such as generative pretrained transformer-3 (GPT-3) and GPT-4, can evaluate suicide risk comparably to experts, yet the criteria these models use are unclear. This study explores how variations in prompts, specifically regarding past suicide attempts, gender, and age, influence the risk assessments provided by ChatGPT-3 and ChatGPT-4.</p><p><p><b>Methods:</b> Using a controlled scenario based approach, 8 vignettes were created. Both ChatGPT-3.5 and ChatGPT 4 were used to predict the likelihood of serious suicide attempts, suicide attempts, and suicidal thoughts. A univariate 3-way analysis of variance was conducted to analyze the effects of the independent variables (previous suicide attempts, gender, and age) on the dependent variables (likelihood of serious suicide attempts, suicide attempts, and suicidal thoughts).</p><p><p><b>Results:</b> Both ChatGPT-3.5 and ChatGPT-4 recognized the importance of previous suicide attempts in predicting severe suicide risks and suicidal thoughts. ChatGPT-4 also identified gender differences, associating men with a higher risk, while both models disregarded age as a risk factor. Interaction analysis revealed that ChatGPT-3.5 associated past attempts with a higher likelihood of suicidal thoughts in men, whereas ChatGPT-4 showed an increased risk for women.</p><p><p><b>Conclusions:</b> The study highlights ChatGPT-3.5 and ChatGPT-4's potential in suicide risk evaluation, emphasizing the importance of prior attempts and gender, while noting differences in their handling of interactive effects and the negligible role of age. These findings reflect the complexity of GenAI decision-making. While promising for suicide risk assessment, these models require careful application due to limitations and real-world complexities.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367275","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":"Long-Term Changes in Cognition Among Patients With Schizophrenia Spectrum Disorders and Different Durations of Illness: A Meta-Analysis.","authors":"Lars de Winter, Auke Jelsma, Jentien M Vermeulen, Mirjam van Tricht, Jaap van Weeghel, Ilanit Hasson-Ohayon, Cornelis L Mulder, Nynke Boonstra, Wim Veling, Lieuwe de Haan","doi":"10.4088/JCP.23r15134","DOIUrl":"10.4088/JCP.23r15134","url":null,"abstract":"<p><p><b>Objective:</b> In this meta-analysis, we evaluated changes in cognition for patients with schizophrenia spectrum disorders (SSD) with different durations of illness (DOIs).</p><p><p><b>Data Sources:</b> Records were identified through searches in PubMed, PsycINFO, CINAHL, and Cochrane until December 2021. We used terms related to SSDs, chronicity, course, and recovery.</p><p><p><b>Study Selection and Data Extraction:</b> We included 57 longitudinal studies, with a follow-up length of at least 1 year, investigating changes in 10 domains of cognition of patients who are all diagnosed with SSD. Changes in cognition were analyzed through effect sizes of change between baseline and follow-up assessments within each study. These changes were evaluated in different subgroups of studies including patients with a DOI <5 years, 5-10 years, or >10 years. We also investigated the influence of 19 potential moderators on these changes in cognition.</p><p><p><b>Results:</b> We found marginal improvements in overall cognition (<i>d</i> =0.13), small improvements in verbal memory (<i>d</i> = 0.21), processing speed (<i>d</i> = 0.32), marginal improvements in visual memory (<i>d</i> = 0.17), executive functioning (<i>d</i> = 0.19), and language skills (<i>d</i> = 0.13), and no significant improvements in the other cognitive domains. The largest improvements were achieved for patients with a DOI <10 years. Changes are more favorable for patients with a younger age, no schizophrenia diagnosis, female gender, higher education level, and low negative symptom severity.</p><p><p><b>Conclusions:</b> We observed only modest cognitive improvement in SSD almost exclusively in patients with early psychosis. Future research should focus on optimizing interventions targeting cognition in specific subgroups and the interrelationships with other life domains.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367276","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":"Regression: Understanding What Covariates and Confounds Do in Adjusted Analyses.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.24f15573","DOIUrl":"10.4088/JCP.24f15573","url":null,"abstract":"<p><p>The use of regression analysis is common in research. This article presents an introductory section that explains basic terms and concepts such as independent and dependent variables (IVs and DVs), covariates and confounds, zero-order correlations and multiple correlations, variance explained by variables and shared variance, bivariate and multivariable linear regression, line of least squares and residuals, unadjusted and adjusted analyses, unstandardized (<i>b</i>) and standardized (β) coefficients, adjusted <i>R</i>², interaction terms, and others. Next, this article presents a more advanced section with the help of 3 examples; the raw data files for these examples are included in supplementary materials, and readers are encouraged to download the data files and run the regressions on their own in order to better follow what is explained in the text (this, however, is not mandatory, and readers who do not do so can also follow the discussions in the text). The 3 examples illustrate many points. When important covariates are not included in regressions, the included IVs explain a smaller proportion of the variance in the DV, and the relationships between the included IVs and the DV may not be correctly understood. Including interaction terms between IVs can improve the explanatory value of the model whether the IVs are intercorrelated or not. When IVs are intercorrelated (such as when one is a confound), although their net effect in multivariable regression may explain a greater proportion of the variance in the DV, their individual <i>b</i> and β coefficients decrease in proportion to the shared variance that is removed. Thus, variables that were found statistically significant in unadjusted analyses may lose statistical significance in fully adjusted analyses. Readers may find it useful to keep these points in mind when running regressions on their data or when reading studies that present their results through regressions.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"85 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308985","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}