Journal of Clinical Psychiatry最新文献

{"title":"Aripiprazole or Bupropion Augmentation Versus Switching to Bupropion in Treatment-Resistant Depression: A Risk-Benefit Analysis.","authors":"William U Meyerson, Eric L Ross, Chris J Kennedy, Rick H Hoyle, Jagpreet Chhatwal, Philip S Wang, Jordan W Smoller","doi":"10.4088/JCP.25m15863","DOIUrl":"10.4088/JCP.25m15863","url":null,"abstract":"<p><p><b>Objective:</b> In treatment-resistant depression (TRD), augmentation with aripiprazole (A-ARI) or combination therapy by adding bupropion (C-BUP) has been reported as more effective than switching to bupropion (S-BUP), but C-BUP risks falls in older adults, and A-ARI risks weight gain and tardive dyskinesia (TD). The aim of this study was to clarify whether the enhanced effectiveness outweighs such risks.</p><p><p><b>Methods:</b> In this risk-benefit decision analysis, lifetime quality-adjusted life-years (QALYs) following 1 year of A-ARI or C-BUP vs S-BUP treatment were simulated in a health-state transition model tracking depression remission, falls, weight gain, and TD, in age and baseline body mass index (BMI) subgroups, using data from the VAST-D and OPTIMUM trials and other literature. QALYs were converted to depression-free day-equivalents (DFDs), the QALYs gained from 1 day of remitted versus active depression.</p><p><p><b>Results:</b> Simulated adults aged 18-64 years experienced a net benefit of C-BUP over S-BUP of 20.7 DFDs, equivalent to about 3 weeks of faster remission of depressive symptoms. In older adults, especially those aged 85+ years, this benefit over S-BUP was partially but not fully offset by a risk of falls. In adults aged 18-64 years, A-ARI was estimated to offer only 8.0 DFDs after subtracting the expected harms from TD, and this was further reduced to -22.8 DFDs once metabolic harms were considered, in those overweight at baseline. Overall, C-BUP was preferred over A-ARI in all subgroups except ages 85-89 years with BMI<25, in whom A-ARI was preferred.</p><p><p><b>Conclusion:</b> In our model, C-BUP better balanced efficacy and tolerability in TRD in adults under 85 years than did S-BUP or A-ARI. A-ARI was least-preferred in overweight adults. These results may inform shared decision-making and clinical guidelines.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151790","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":"Ketamine Reduces Suicidality-Associated Emergency Department Utilization in Patients With Treatment-Resistant Depression: A 6-Month Mirror-Image Study.","authors":"Liliana Patarroyo-Rodriguez, Vanessa K Pazdernik, Jennifer L Vande Voort, Simon Kung, Mark A Frye, Balwinder Singh","doi":"10.4088/JCP.25m15941","DOIUrl":"10.4088/JCP.25m15941","url":null,"abstract":"<p><p><b>Background:</b> Short-term studies have demonstrated antisuicidal effects of ketamine/esketamine for patients with treatment-resistant depression (TRD). However, long-term data and their impact in reducing suicidality-related health care utilization are limited. This 6-month mirror-image study compares suicidality-associated emergency department (ED) visits before and after acute treatment with ketamine/esketamine in a TRD cohort.</p><p><p><b>Method:</b> This study included adults with TRD evaluated at Mayo Clinic Depression Center (Rochester, Minnesota) from May 2018 to May 2024, who received an acute series of intravenous (IV) ketamine or intranasal (IN) esketamine treatments. The primary outcome measure was the number of suicidality-associated ED visits in the 6 months before and after treatment. Negative binomial mixed-effects model was utilized to analyze suicidality-associated ED visits per person, estimating incidence rate ratios (IRRs) and 95% confidence intervals for the change between pre-and posttreatment periods.</p><p><p><b>Results:</b> Of 124 eligible individuals, 27 were excluded due to unavailable data, leaving 97 for analysis. The cohort was 69% female, with a median age of 48.9 years; 97% had major depressive disorder, and most (75%) received IV ketamine. After the acute treatment phase, ED visits for suicidal ideation decreased by 84% (IRR=0.16, 95% CI, 0.06-0.46, <i>P</i>=.001), and total ED visits for suicidality decreased by 63% (IRR=0.37, 95% CI, 0.18-0.77, <i>P</i>=.007).</p><p><p><b>Conclusions:</b> Ketamine and esketamine reduced long-term ED visits for suicidality in individuals with TRD. Further longer-term follow-up research is encouraged to ascertain if these benefits on suicidality reduction are mood state dependent or reflect an independent mechanism.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082319","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":"Identifying Factors Linked to a Higher Prevalence of Posttraumatic Stress Disorder Among Younger US Military Veterans.","authors":"Jordan R Hathorn, Ian C Fischer, Peter J Na, Robert H Pietrzak","doi":"10.4088/JCP.25m15939","DOIUrl":"https://doi.org/10.4088/JCP.25m15939","url":null,"abstract":"<p><p><b>Objectives:</b> Posttraumatic stress disorder is a significant public health concern in the US, with military veterans disproportionately affected. Although younger veterans exhibit a higher prevalence of posttraumatic stress disorder (PTSD) compared to their older counterparts, the mechanisms driving this age-related difference remain unclear. This study examined sociodemographic, trauma-specific, and psychosocial factors that may contribute to the elevated prevalence of PTSD in younger (age <50) vs older (age 50 and older) veterans.</p><p><p><b>Methods:</b> Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US military veterans (n=4,069).</p><p><p><b>Results:</b> Younger veterans were 3 times more likely to screen positive for PTSD compared to older veterans (weighted 14.7% vs 4.9%, <i>P</i><.001). Mediation analysis revealed that 90% of the association between younger age and PTSD was indirectly mediated by psychosocial and trauma-specific factors. Psychosocial difficulties contributed the most to accounting for this association (42.9%), followed by loneliness (23.6%), avoidance coping (9.7%), adverse childhood experiences (9.5%), and combat exposure severity (4.2%). Secondary analyses identified interpersonal relationship challenges, substance use and self-blame coping strategies, and childhood physical abuse as key mediators of this association.</p><p><p><b>Conclusion:</b> Psychosocial and trauma-specific factors may mediate the link between younger age and higher rates of PTSD among US military veterans. These findings underscore the importance of targeted interventions designed to address psychosocial challenges, strengthen social connections, and promote adaptive coping strategies among younger veterans who are at risk for or currently living with PTSD.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082329","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":"Relationships Between Body Composition and Mental Health During Pregnancy Are Moderated by Physical Activity and Diet.","authors":"Yali Huang, Chary Akmyradov, Matthew T Keene, Sabrina L Chambers, Trevor D Durey, Xiaoxu Na, Jayne Bellando, Xiawei Ou","doi":"10.4088/JCP.25m15822","DOIUrl":"https://doi.org/10.4088/JCP.25m15822","url":null,"abstract":"<p><p><b>Objective:</b> This study examined the relationships between body fat mass percentage and mental health (depression and anxiety symptoms) during pregnancy, while assessing the moderating effects of physical activity and diet quality.</p><p><p><b>Methods:</b> A prospective cohort of 219 pregnant women was recruited for a longitudinal study of maternal health during pregnancy and offspring outcomes. Pregnant participants were assessed at ∼12 and ∼36 weeks of pregnancy. Body composition was measured using air displacement plethysmography, physical activity was measured with ActiGraph wearables, and diet was measured using the National Institute of Health Diet History Questionnaire-III. Depression and anxiety symptoms were also evaluated using the Beck Depression Inventory-II and State-Trait Anxiety Inventory, respectively, at each study visits. Multivariable mixed linear models adjusted for demographic and socioeconomic factors were used to analyze relationships among these parameters. The study period is from October 2019 to August 2024.</p><p><p><b>Results:</b> Higher body fat mass percentage was significantly associated with increased depression (β= 0.246, <i>P</i>=.014) and anxiety scores (β= 0.241, <i>P</i>=.002). Physical activity moderated the effect of body fat on depression (interaction β=-0.001, <i>P</i>=.017), while diet quality moderated the effect of body fat on anxiety (interaction β=-0.002, <i>P</i>=.047).</p><p><p><b>Conclusion:</b> Higher body fat mass during pregnancy is associated with more symptoms of depression and anxiety. However, increased physical activity and adherence to high-quality diets can attenuate these effects, indicating that lifestyle interventions during pregnancy may improve mental health of pregnant women, particularly for those with obesity.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082269","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":"Practitioners Providing Care for Persons With Severe Mental Disorders Should Routinely Screen for Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Roger S McIntyre, Gia Han Le","doi":"10.4088/JCP.25com16021","DOIUrl":"https://doi.org/10.4088/JCP.25com16021","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082313","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":"New Onset Mental Health Diagnosis and Emergent Service Utilization Associated With Bariatric Surgery.","authors":"Mark M Halim, AnMarie Nguyen, Karen J Coleman, Hilary A Bennett","doi":"10.4088/JCP.25m15806","DOIUrl":"10.4088/JCP.25m15806","url":null,"abstract":"<p><p><b>Objective:</b> The objective of this study was to investigate potential associations between bariatric surgery and new onset mental health diagnoses and emergent psychiatric care utilization.</p><p><p><b>Methods:</b> This was an observational retrospective cohort study. Patients without a history of mental health diagnoses who underwent bariatric surgery between 2010-2016 were matched to patients who were eligible for but did not undergo bariatric surgery on demographic, body mass index (BMI), and comorbidity burden at baseline (date of surgery for cases and matching date for controls). Outcomes of new onset mental health diagnoses after baseline and emergent care utilization were measured in 2-year increments between baseline (ranged from 2010 to 2016) until the end of follow-up (December 31, 2021) to assess changes in risk over time.</p><p><p><b>Results:</b> The surgical group had lower risk of a new onset mental health diagnosis in the first 2 years (hazard ratio [HR]: 0.82, 95% CI, 0.76-0.88) and approximately 20% higher risk in years 4-8 of follow-up than the control group (years 4-6 HR: 1.22, 95% CI, 1.09-1.36; years 6-8 HR: 1.19, 95% CI, 1.03-1.39). However, emergent psychiatric service utilization did not differ between the groups during follow-up. Utilization was associated with a higher BMI (HR: 1.03, 95% CI, 1.02-1.04) and higher comorbidity burden (HR: 1.43, 95% CI, 1.37-1.49) at baseline.</p><p><p><b>Conclusions:</b> Bariatric surgery may have a delayed impact on new onset mental health diagnoses, with surgical patients having higher risk of diagnoses than their nonsurgical counterparts 4-8 years following surgery. Despite these increases, there was no change in emergent psychiatric service utilization.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082354","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":"Ketamine-Associated Uropathy During Therapeutic and Nontherapeutic Use: Prevalence, Clinical Features, Mechanisms, and Strategies for Risk Reduction.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25f16083","DOIUrl":"10.4088/JCP.25f16083","url":null,"abstract":"<p><p>Ketamine, introduced as an anesthetic drug, is now used for many indications beyond anesthesia; it is also increasingly a drug of abuse. Long-term recreational use and abuse of ketamine are associated with urological risks. This article discusses ketamine-associated uropathy from the perspective of prevalence, clinical features, mechanisms, and strategies for risk reduction in patients who require long term maintenance therapy with the drug for psychiatric indications. A systematic review and meta-analysis of 37 studies of uropathy in recreational (ab)users obtained prevalences of 44% to 77% for lower urinary tract symptoms and 8% to 30% for upper urinary tract disease; for reasons explained, these findings are potentially misleading and cannot be extrapolated to therapeutic contexts. More recent studies, using different methods of case ascertainment, present lower risks (2% to 27%). A systematic review of 27 studies of ketamine used to treat psychiatric disorders, mainly depression, found urological symptoms in 0% to 24% of patients; however, in 14 randomized controlled trials, urological symptom prevalences differed little between ketamine and comparison arms. The review presented no convincing evidence of ketamine-associated uropathy arising in therapeutic contexts. The literature on ketamine-associated uropathy is critically examined; reasons for false positive uropathy findings are considered. Ketamine pharmacokinetics are described to assist the understanding of how ketamine and its metabolites may predispose to uropathy. Mechanisms of uropathy, arising from exposure to ketamine and its metabolites in urine (rather than in circulation), are summarized. A reasonable conclusion is that higher doses of ketamine, more frequent dosing with ketamine, longer duration of treatment with ketamine, and oral administration of ketamine are all potential risk factors for ketamine-associated uropathy during maintenance therapy. High hydration and frequent voiding of urine on treatment days can reduce exposure of the bladder to ketamine and its metabolites, reducing urological risks. Fortnightly or monthly urine testing is also advisable.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082338","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":"Misleading Labeling of S-Methadone as a Novel N-Methyl-D-Aspartate Receptor Antagonist.","authors":"Sergi Ferré, Michael Michaelides","doi":"10.4088/JCP.25lr15973","DOIUrl":"https://doi.org/10.4088/JCP.25lr15973","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082297","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":"Reasons for Maintaining the Classification of Esmethadone as an Investigational Uncompetitive NMDAR Antagonist Rapid Antidepressant: Reply to Ferré and Michaelides.","authors":"Sara De Martin, Stefano Comai, Andrea Mattarei, Thomas R Kosten, Frank J Vocci, Charles W Gorodetzky, Marco Pappagallo, Paolo L Manfredi","doi":"10.4088/JCP.25lr15973a","DOIUrl":"https://doi.org/10.4088/JCP.25lr15973a","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082266","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":"Validity of an Online Assessment of Attention-Deficit/Hyperactivity Disorder Among a Real-World Sample of Adults Seeking Web-Based Mental Health Care.","authors":"Barry K Herman, Stephen V Faraone, Andrew J Cutler, Jeffrey H Newcorn, Emily M LaFrance, Michelle Ripper Lewis, Charles Ruetsch","doi":"10.4088/JCP.25m15846","DOIUrl":"https://doi.org/10.4088/JCP.25m15846","url":null,"abstract":"<p><p><b>Objective:</b> To compare the results of a proprietary online assessment of adult attention-deficit/hyperactivity disorder (ADHD) with the current standard of care, a clinical interview, among a real-world population of adults seeking online ADHD assessment.</p><p><p><b>Methods:</b> Participants recruited from a population of adults seeking online ADHD assessment completed a virtual clinical interview followed by the online self-report assessment between July and November 2024. Agreement was calculated using a 2×2 matrix, and disagreement was further examined: first, a licensed clinician reviewed both assessments and rendered a \"full data\" diagnosis using all available results, and then, factors associated with disagreement (eg, psychiatric comorbidities, ADHD presentation) were explored.</p><p><p><b>Results:</b> The sample (N = 345) was predominantly female, with an approximate age of 35 years. The most common ADHD presentations were combined and inattentive. The agreement between assessments was 78% (positive predictive value: 94.9%, negative predictive value: 15.1%, sensitivity: 80.6%, specificity: 44.0%, and κ: 0.13). Over 80% of cases in which there was disagreement between the assessments were found to have ADHD on clinical interview, whereas the initial online assessment did not confirm a diagnosis of ADHD and recommended further assessment.</p><p><p><b>Conclusions:</b> This is the first study to validate an online asynchronous ADHD assessment relative to the current standard of care among individuals seeking online behavioral health care. The online assessment correctly identified over 80% of ADHD-positive cases. Compared with the clinical interview, the online assessment was more conservative in rendering ADHD-positive diagnoses, allaying possible concerns about overdiagnosis. Due to the high prevalence of ADHD in the study sample, these results are not yet generalized to a broader clinical setting.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082325","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}