Journal of Clinical Psychiatry最新文献

{"title":"Public Health Nurse-Delivered 1-Day Cognitive Behavioral Therapy-Based Workshops for Treating Postpartum Depression: A Pilot Randomized Controlled Trial.","authors":"Haley Layton, Madisyn Campbell, Kathryn Huh, Arooba Mansoor, Jesus Serrano-Lomelin, June S L Brown, Peter J Bieling, Ryan J Van Lieshout","doi":"10.4088/JCP.24m15712","DOIUrl":"https://doi.org/10.4088/JCP.24m15712","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> This pilot randomized controlled trial (RCT) examined the feasibility of study procedures and acceptability of 1-day cognitive behavioral therapy (CBT)-based workshops for postpartum depression (PPD) delivered by nonspecialist public health nurses (PHNs) and explored the potential effects of the intervention on PPD and anxiety to inform a future, full-scale RCT.</p><p><p><b>Methods:</b> Birthing parents ≥18 years old with an infant <12 months old, living in Ontario, Canada, with an Edinburgh Postnatal Depression Scale (EPDS) score ≥10 were recruited between March 18 and May 25, 2022, and randomly assigned to receive the 1-day CBT-based workshop plus treatment as usual (TAU; experimental group) or TAU alone (control group). Feasibility objectives (recruitment, retention, intervention attendance) were described using descriptive statistics, and treatment effects were assessed at enrollment and 3 and 9 months post-intervention.</p><p><p><b>Results:</b> 119 participants were enrolled in under 3 months, 85% in the experimental group attended their workshop, and 84% of participants completed the study. While the study was not powered to detect differences between experimental and control groups, the experimental group reported larger reductions in depression at 3 (<i>P</i> = .11) and 9 months (<i>P</i> = .045) postworkshop. Experimental group participants also reported greater reductions in anxiety at 3 (<i>P</i> < .01) and 9 months (<i>P</i> = .14) postworkshop than control participants.</p><p><p><b>Conclusion:</b> Recruiting and retaining participants in an RCT of PHN-delivered 1-day CBT-based workshops is feasible. Pilot results suggest that workshops may lead to improvements in PPD up to 9 months postworkshop. As this pilot study was not powered to detect differences in clinical outcomes, these findings warrant exploration in a full scale RCT.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT05314361.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042710","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":"Prevalence and Association of Defense Mechanisms With Common Psychiatric Disorders: A National Study.","authors":"Carlos Blanco, Leonie Kampe, Melanie M Wall, Shuai Wang, Eve Caligor, Mark Olfson","doi":"10.4088/JCP.24m15582","DOIUrl":"https://doi.org/10.4088/JCP.24m15582","url":null,"abstract":"<p><p><b>Objective:</b> Although defense mechanisms are central concepts in psychiatry, whether individual disorders (or categories of disorders) are associated with a specific profile of defense mechanisms or whether defense mechanisms are general markers of severity of psychopathology is unknown.</p><p><p><b>Methods:</b> We drew on data from the National Epidemiological Survey on Alcohol and Related Conditions (N = 43,093) to investigate associations of 12 pathological defense mechanisms with mood, anxiety, and substance use disorders. Logistic regressions were fit with mental disorders as predictors, defense mechanisms as outcomes, and respondent age, sex, and race/ethnicity as covariates.</p><p><p><b>Results:</b> Compared to individuals with no disorders, those with mood, anxiety, or substance use disorders generally had a higher prevalence of defense mechanisms. Specifically, the prevalence of any pathological mechanism was 30.0% (95% CI, 29.4%-30.7%) for individuals with no disorders, 67.6% (95% CI, 65.9%-69.2%) for individuals with mood disorders, 62.8% (95% CI, 61.3%-64.2%) for individuals with anxiety disorders, and 49.8% (95% CI, 48.7%-51.0%) for individuals with substance use disorders. Broad diagnostic categories or individual psychiatric disorders were not associated with specific defense profiles.</p><p><p><b>Conclusion:</b> Our findings suggest that defense mechanisms and psychiatric disorders represent correlated but different dimensions of psychopathology, which may respond to different treatment approaches.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003969","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":"Developing a Treatment-Resistant Depression Consultation Program, Part I: Practical and Logistical Considerations.","authors":"Vitaliy L Voytenko, Susan K Conroy, Anna R Docherty, Diana K Burnett, Joao Quevedo, Michael J Flood, Patricio Riva Posse, Subhdeep Virk, Jesse H Wright, William V Bobo, Jay C Fournier, Sagar V Parikh","doi":"10.4088/JCP.24cs15335","DOIUrl":"https://doi.org/10.4088/JCP.24cs15335","url":null,"abstract":"<p><p><b>Objective:</b> To provide recommendations for creating and sustaining a treatment-resistant depression (TRD) consultation program at an academic health center. This is a complementary manuscript to Part II, which discusses critical elements of the assessment package for such subspecialized consultations.</p><p><p><b>Participants:</b> Participants were a working group of 12 clinicians, researchers, administrators, and patient advocates from the National Network of Depression Centers (NNDC) TRD Task Group.</p><p><p><b>Evidence:</b> The recommendations are based on expert opinion. TRD consultation programs can offer an individualized treatment roadmap to be implemented by the patient and their providers with the goal of maximizing the likelihood of response or full remission of symptoms. However, there is currently no published work addressing the practical and logistical considerations for establishing such programs. This consensus statement puts forth a set of recommendations that could serve as a basis for future empirical work.</p><p><p><b>Consensus Process:</b> Members of the working group provided written descriptions of relevant procedures used at their institutions, which were used during a day-long in-person forum to achieve consensus on recommendations for each major aspect of a TRD consultation program. Subgroups were formed to draft recommendations, and points of disagreement were resolved at subsequent meetings of the full working group.</p><p><p><b>Conclusions:</b> We describe key practical considerations, including systems-level and financial issues; equity and access to TRD care for a diverse patient population; selecting a target population and facilitating the referral process; the product of the consultation; communication between the program, patient, and community providers; and postconsultation care and contact.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057394","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":"Improvements Over Time with Valbenazine in Elderly Adults (≥65 Years) with Tardive Dyskinesia: Post Hoc Analyses of 2 Long-Term Studies.","authors":"Martha Sajatovic, George S Alexopoulos, Eric Jen, Khody Farahmand, Celia Zinger","doi":"10.4088/JCP.24m15550","DOIUrl":"https://doi.org/10.4088/JCP.24m15550","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the long-term effects of once-daily valbenazine (40 or 80 mg) on tardive dyskinesia (TD) in elderly adults (age ≥65 years).</p><p><p><b>Methods:</b> Data were pooled from two 48-week studies, KINECT 3 extension (NCT02274558) and KINECT 4 (NCT02405091), with analyses performed over time in elderly participants (≥65 years) and at Week 48 by age group (<65 and ≥65 years). Outcomes included mean change in Abnormal Involuntary Movement Scale (AIMS) total score, AIMS response thresholds (≥30% and ≥50% improvement from baseline), and response threshold for Clinical Global Impression of Change-TD (CGI-TD) and Patient Global Impression of Change (PGIC), defined as a score ≤2 (\"much improved\" or \"very much improved\"). Safety assessments included treatment-emergent adverse events (TEAEs) and psychiatric symptom scales (eg, Positive and Negative Syndrome Scale).</p><p><p><b>Results:</b> Of the pooled analysis population (N = 304), 55 (18.1%) were ≥65 years of age. The mean change from baseline in AIMS total score (±standard error) in the ≥65-year age group increased from Week 8 (-4.5 ± 0.7; first visit after dose escalation in KINECT 4) through Week 48 (-8.8 ± 0.9). These robust and sustained improvements were consistent with the percentage who met response thresholds at Weeks 8, 24, and 48: AIMS ≥30% improvement (58.0%, 88.5%, and 89.3%); AIMS ≥50% improvement (40.0%, 65.4%, and 82.1%); CGI-TD score ≤2 (33.3%, 88.5%, and 92.9%); and PGIC score ≤2 (43.1%, 84.6%, and 85.7%). The most common TEAEs among elderly participants were urinary tract infections (10.9%) and somnolence (10.9%). Psychiatric status remained stable during the studies.</p><p><p><b>Conclusion:</b> Valbenazine was safe and effective in elderly adults who received up to 48 weeks of treatment. Long-term treatment led to substantial and sustained TD improvements per clinician assessment (AIMS, CGI-TD) and patient report (PGIC), with no impact on psychiatric stability.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045999","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":"Psychosocial Correlates of Optimism Among US Military Veterans.","authors":"Rick Yang, Ian C Fischer, Peter J Na, Robert H Pietrzak","doi":"10.4088/JCP.25br15791","DOIUrl":"https://doi.org/10.4088/JCP.25br15791","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059770","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":"One-Day Online Cognitive Behavioral Therapy-Based Workshops for the Prevention of Postpartum Depression: A Randomized Controlled Trial.","authors":"Zoe Boland, Nancy Lloyd, Jaslyn Drage, Jesus Serrano-Lomelin, Peter Bieling, David Streiner, Ryan J Van Lieshout","doi":"10.4088/JCP.24m15674","DOIUrl":"https://doi.org/10.4088/JCP.24m15674","url":null,"abstract":"<p><p></p><p><p><b>Background:</b> Postpartum depression (PPD) affects up to 1 in 5 birthing parents and is associated with more future depressive episodes. We aimed to determine if PPD could be prevented with online 1-day cognitive behavioral therapy (CBT)-based workshops.</p><p><p><b>Methods:</b> This randomized controlled trial enrolled pregnant persons at 28-38 weeks gestation at increased risk for PPD, living in Ontario and free of current <i>DSM-5</i> major depressive disorder (MDD). Participants received the workshop plus treatment as usual (TAU; experimental group) or TAU alone (control group). We assessed MDD diagnosis, levels of PPD symptoms, anxiety, social support, mother-infant relationship, and infant temperament at 1, 2, and 3 months postpartum. The primary outcome was MDD at 3 months postpartum assessed using the Mini-International Neuropsychiatric Interview.</p><p><p><b>Results:</b> Since <10% of participants developed MDD, trial recruitment was stopped early. Data were collected up to 2 months postpartum in those already enrolled. Among these participants (n = 124), reductions in Edinburgh Postnatal Depression Scale (EPDS) scores were seen in the experimental group at 2 months but were not statistically significant (<i>P</i> = .06). Higher risk participants (baseline EPDS ≥7) in the experimental group showed larger, statistically significant reductions (<i>P</i><.05) in PPD and anxiety at 2 months postpartum.</p><p><p><b>Limitations:</b> Eligibility criteria resulted in a sample that did not develop MDD at rates high enough to continue the trial and limited study statistical power.</p><p><p><b>Conclusions:</b> Definitive conclusions regarding the effectiveness of online 1-day workshops for preventing PPD are not possible, but these results may warrant future testing with a higher risk sample.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT05753176.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024783","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":"Autism Spectrum Disorder, 1: Genetic and Environmental Risk Factors.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25f15878","DOIUrl":"https://doi.org/10.4088/JCP.25f15878","url":null,"abstract":"<p><p>The global prevalence of autism spectrum disorder (ASD) has quadrupled during the past 3 decades; the reasons for this are many and include broadening of the diagnostic concept, increased awareness of the disorder, increased screening (including of adults and of girl children), and, possibly, increased exposure to environmental risk factors. This article examines genetic and especially environmental risk factors for ASD. Unsurprisingly, hundreds of potential genes have been identified, many of which overlap between ASD, schizophrenia, depression, and cardiometabolic disorders. Likewise, over a hundred environmental exposures have been associated with ASD risk. These include exposure to parental and family characteristics, exposure to maternal disorders arising during pregnancy, exposure to chronic maternal disorders present during pregnancy, exposure to fetal and other pregnancy-related problems/events, exposure to neonatal problems/events, exposure to maternal nutritional deficiencies during pregnancy, maternal exposure to substances during pregnancy, maternal exposure to pharmacological agents during pregnancy, in utero exposure to toxic substances, and early life exposure to toxic substances. Some of the risk factors identified may be causal, some may be markers of intermediary mechanisms, and some may be unrelated markers. About 40 of these risk factors have been confirmed in meta-analysis for association with ASD. Nearly 70 maternal diagnoses have also been associated with ASD, but, after correcting for false discovery error and shared risk, only 30 remain; and, of these 30, almost all may be explained by genetic and environmental risk factors shared between mother and child, judging from findings in discordant sibling pair and paternal negative control analyses. Caveats and nuances in the interpretation of risks are briefly discussed.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051116","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":"Benefits and Risks of New Tests for Alzheimer's Disease.","authors":"Maxwell Z Price, Gary W Small","doi":"10.4088/JCP.25com15837","DOIUrl":"https://doi.org/10.4088/JCP.25com15837","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006459","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":"Appetite Hormone Regulation Biotypes of Major Affective Disorders in Proinflammatory Cytokines and Executive Function.","authors":"Ju-Wei Hsu, Wei-Chen Lin, Ya-Mei Bai, Shih-Jen Tsai, Mu-Hong Chen","doi":"10.4088/JCP.24m15561","DOIUrl":"https://doi.org/10.4088/JCP.24m15561","url":null,"abstract":"<p><p><b>Backgrounds:</b> Evidence indicates that appetite hormones, namely, insulin, leptin, and adiponectin, play crucial roles in the pathophysiology of major affective disorders. However, whether appetite hormone regulation biotypes differ among patients with major affective disorders remains unclear.</p><p><p><b>Methods:</b> A total of 501 patients with major affective disorders (278 with bipolar disorder and 223 with major depressive disorder) were enrolled between 2018 and 2022 and clustered into biotype groups on the basis of fasting insulin, leptin, and adiponectin levels. Major affective disorder diagnoses were based on the criteria of the <i>Diagnostic and Statistical Manual of Mental Disorders,</i> Fifth Edition. All participants underwent the Wisconsin Card Sorting Test and proinflammatory cytokine assessment.</p><p><p><b>Results:</b> A k-means cluster analysis identified 3 biotype groups based on appetite hormone levels: a high insulin/ leptin and low adiponectin group, a low insulin/leptin and high adiponectin group, and an intermediate group. The high insulin/leptin and low adiponectin group exhibited poorer performance on the Wisconsin Card Sorting Test and had higher C-reactive protein and tumor necrosis factor-α levels than did the other biotype groups after adjusting for diagnosis, body mass index, clinical symptoms, and psychotropic medication use.</p><p><p><b>Discussion:</b> This study identified 3 appetite hormone regulation biotypes among patients with major affective disorders. These biotypes were associated with proinflammatory cytokine profiles and executive function.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990577","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":"Investigation of Appetite Hormones and Their Association With Mood Disorders Illustrates the Current Limitations of Psychiatric Diagnosis.","authors":"David Mischoulon","doi":"10.4088/JCP.25com15802","DOIUrl":"https://doi.org/10.4088/JCP.25com15802","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056409","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}