Journal of Clinical Psychiatry最新文献

{"title":"Bright Light Therapy in the Morning or Midday for the Treatment of Nonseasonal Depression in Bipolar Disorder (LuBi): A Dose-Escalation Phase 1/2 Randomized Double-Blind Trial.","authors":"Pierre A Geoffroy, Sylvie Chevret, Sibylle Mauries, Cendrine Chaffaut, Ali Amad, Frank Bellivier, Victoire Benard, Philippe Courtet, Caroline Dubertret, Philip Gorwood, Nicolas Mazer, Lila Mekaoui, Emilie Olié, Guillaume Pataud, Guillaume Vaiva, Michel Lejoyeux, Dorothy Sit, Julia Maruani","doi":"10.4088/JCP.25m15826","DOIUrl":"https://doi.org/10.4088/JCP.25m15826","url":null,"abstract":"<p><p><b>Objective:</b> This dose-escalation study aimed to evaluate the tolerance (hypomanic symptoms) and efficacy of bright light therapy (BLT) in depressed patients with bipolar disorder (BD) with mood stabilizers, using different schedules (duration and escalation), applied in morning or midday.</p><p><p><b>Methods:</b> Patients with BD I or II (<i>DSM-IV TR</i>) followed a 1-week placebo phase and were randomized to morning or midday BLT with dose escalation from 7.5 to 45 minutes/d, until September 2023. Inter- and intrasubject escalation were performed, with dose adjustments based on dose-limiting toxicities (DLTs) to determine the maximum tolerated dose (MTD) and target ceiling dose (TCD) of BLT exposure. The primary outcome measure, DLT, was assessed weekly after each dose initiation or increase and defined as a hypomanic switch (Young Mania Rating Scale [YMRS] score ≥12/60) or subsyndromic hypomanic symptoms (YMRS score 8-12).</p><p><p><b>Results:</b> Both groups reached the starting dose of 45 minutes without reaching the MTD or TCD, enrolling 38 patients (morning = 18 and midday = 16) and demonstrating good tolerance and acceptability. Two patients (6%) experienced a hypomanic switch at 45 minutes: 1 in the morning group (week 1) and 1 in the midday group (week 4). Five patients had subsyndromic hypomania. All symptoms improved within 3 days after dose reduction. Depressive symptoms (Montgomery Asberg Depression Rating Scale, <i>P</i> = .007) and Clinical Global Impression (CGI) scores (<i>P</i> < .001 for severity, <i>P</i> = .01 for improvement) significantly improved over time. A cumulative exposure effect was observed on CGI improvement (<i>P</i> = .038), alongside a starting dose effect over the weeks on CGI severity (<i>P</i> < .001) and the Flexibility Circadian Type Inventory (<i>P</i> = .042). The comparison between groups shows a higher CGI improvement score in the morning group (<i>P</i> = .035).</p><p><p><b>Conclusions:</b> BLT is a viable antidepressant strategy for BD, safely starting at 45 minutes regardless of timing. Occurring hypomanic symptoms, if any, resolve quickly after dose reduction, provided there is careful monitoring.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03396744.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561814","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":"Differentiating Subtypes of Major Depressive Disorder Using Serum Biomarkers.","authors":"Jae-Min Kim, Hee-Ju Kang, Ju-Yeon Lee, Ju-Wan Kim, Honey Kim, Min Jhon, Sung-Wan Kim, Il-Seon Shin","doi":"10.4088/JCP.25m15828","DOIUrl":"10.4088/JCP.25m15828","url":null,"abstract":"<p><p><b>Objective:</b> This study aimed to differentiate subtypes of major depressive disorder (MDD) using 14 serum biomarkers across 6 functional systems.</p><p><p><b>Methods:</b> We analyzed serum biomarkers in 993 MDD patients, categorized into melancholic (N = 157; 16.8%), atypical (N = 56; 6.0%), and unspecified (N = 720; 77.2%) subtypes according to <i>DSM-IV</i> criteria. Biomarkers included high sensitivity C-reactive protein, tumor necrosis factor-α, interleukins (IL-1β, IL-6, IL-4, IL-10), cortisol, brain-derived neurotrophic factor, serotonin, leptin, total ghrelin, total cholesterol, folate, and homocysteine. Quantile regression analyses adjusted for relevant covariates were used to estimate associations between biomarkers and MDD subtypes.</p><p><p><b>Results:</b> Significant differences in biomarker profiles were observed across MDD subtypes: the melancholic subtype showed higher cortisol levels compared to the unspecified subtype (<i>P</i> = .009) and lower serotonin levels compared to both the unspecified (<i>P</i> = .045) and atypical (<i>P</i> = .006) subtypes. Meanwhile, the atypical subtype exhibited elevated levels of IL-1β compared to the unspecified subtype (<i>P</i> = .036) and higher IL-4 levels than both melancholic and unspecified subtypes (all <i>P</i> < .001). These associations remained significant even after adjusting for covariates.</p><p><p><b>Conclusion:</b> Distinct serum biomarker profiles among MDD subtypes highlight their unique biological underpinnings. These findings enhance current understanding of the pathophysiology of different depressive subtypes and suggest targeted therapeutic approaches. Future research should focus on longitudinal studies to monitor these biomarkers over time and explore new biomarkers from genomics and proteomics to advance precision medicine in psychiatry.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561815","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":"Schizophrenia, Antipsychotic Drugs, and Risk of Breast Cancer.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25f15960","DOIUrl":"10.4088/JCP.25f15960","url":null,"abstract":"<p><p>Breast cancer is the commonest form of cancer among women. Literature suggests that women with schizophrenia are less likely to be screened for breast cancer and that, among women with schizophrenia who develop breast cancer, mortality rates are higher. This article examines recent meta-analyses and recent observational studies on the risk of breast cancer in women with schizophrenia, especially in the context of treatment with first generation and second generation antipsychotic (FGA, SGA) drugs. This article also examines the most recent observational study in detail to help readers better understand how to critically appraise this and, by extension, other studies in the field. In summary, studies in the field suggest that there is a small but statistically significant increase in the risk of breast cancer in women with schizophrenia relative to women without psychiatric disorders as well as relative to women with other psychiatric disorders. Women who appear to be most at risk are those in the perimenopausal age range and those with several years of exposure to FGA or prolactin raising antipsychotics. Whereas the possibility of residual confounding in observational studies precludes ascribing a causal role for antipsychotics, given that FGA and prolactin-raising SGA are associated with other adverse effects, it seems reasonable, wherever possible, to prefer SGA over FGA, and prolactin-sparing over prolactin-raising antipsychotics. Women with schizophrenia, and especially those who use prolactin raising antipsychotics for long periods, should be monitored for the risk of breast cancer as a special part of monitoring general health; and modifiable risk factors for breast cancer should be addressed through appropriate behavioral and pharmacological interventions. Women with schizophrenia comprise a vulnerable population, and their medical health should not be neglected even when caring for their mental health absorbs attention and time. Suggestions are provided for directions for future research.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303491","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":"Association Between Adult Sexual Assault and Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.","authors":"Domitille Tisseau, Elodie-Gaëlle Ngameni, Caroline Dubertret, Yann Le Strat, Sarah Tebeka","doi":"10.4088/JCP.24m15631","DOIUrl":"https://doi.org/10.4088/JCP.24m15631","url":null,"abstract":"<p><p><b>Background:</b> Sexual assault is a significant public health issue with high prevalence rates, particularly among women. Previous research suggests strong associations between sexual assault and psychiatric disorders, but studies focusing on adult sexual assault (ASA) and its sex specific consequences are limited.</p><p><p><b>Objective:</b> To estimate the prevalence of ASA in the US and assess its associations with psychiatric disorders and quality of life, focusing on sex differences.</p><p><p><b>Methods:</b> We analyzed cross-sectional data from the National Epidemiologic Study of Alcohol and Related Conditions III (NESARC-III), a nationally representative survey of US adults (N = 36,309). The study included assessments of self-reported ASA and lifetime psychiatric disorders (Alcohol Use Disorder and Associated Disabilities Interview Schedule 5) and quality of life (Short-Form 12-Item Survey version 2).</p><p><p><b>Results:</b> The prevalence of self-reported ASA was 2.6% (n =922), with higher rates in women (4.26%) compared to men (0.53%). ASA was associated with all lifetime psychiatric disorders and a poorer quality of life. Among participants who experienced ASA, 85.25% had at least one lifetime psychiatric disorder. Specifically, among women, 86.09% of victims had at least one lifetime psychiatric disorder (vs 54.43% in women control). The strongest associations were found with posttraumatic stress disorder (PTSD) (adjusted odds ratio [aOR] =5.96), borderline personality disorder (aOR= 4.06), and suicide attempts (aOR= 4.67). Among men, 78.27% of victims had at least one lifetime psychiatric disorder (vs 58.09% in men control). The strongest associations were with psychotic disorders (aOR=6.65), PTSD (aOR=6.62), and suicide attempts (aOR=5.01).</p><p><p><b>Conclusions:</b> ASA was associated with many psychiatric disorders and reduced quality of life, with significant sex differences. These findings highlight the need for targeted interventions and support for sexual assault survivors, emphasizing the importance of routine screening and sex-specific prevention strategies.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303490","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":"Optimizing Treatment With Aripiprazole Monohydrate: Pharmacokinetic Advantages of Long-Acting Injectable Formulations, A Consensus Panel Report.","authors":"Joseph F Goldberg, Eric D Achtyes, Christoph U Correll, Martha Sajatovic, Stephen R Saklad","doi":"10.4088/JCP.plunlai2424ah1","DOIUrl":"10.4088/JCP.plunlai2424ah1","url":null,"abstract":"<p><p>Schizophrenia and bipolar I disorder (BP-I) are chronic, disabling psychiatric illnesses marked by high morbidity, elevated mortality, and functional deterioration, often exacerbated by poor adherence to oral antipsychotic medications. Long-acting injectable (LAI) antipsychotics were developed to address adherence challenges and have demonstrated clinical benefits including reduced non-adherence and relapse rates, fewer hospitalizations, and improved functioning and quality of life, and reduced mortality risk. Among available LAIs, aripiprazole offers a unique pharmacologic profile as the only partial dopamine agonist available in an LAI formulation. Aripiprazole monohydrate LAI is available as a once monthly and a once-every-two-month formulation. In this consensus panel report, five psychiatric experts convened to evaluate the pharmacokinetic properties, safety, efficacy, and clinical utility of aripiprazole monohydrate LAIs in the treatment of schizophrenia and BP-I. The panel focused particularly on the more recently approved once-every-2-month ready-to-use formulation. This article summarizes the evidence reviewed by the panel and highlights key considerations for optimizing the use of aripiprazole monohydrate LAIs in clinical practice to enhance treatment outcomes in patients with schizophrenia and BP-I.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289740","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":"Worth the Weight? The Challenges of Administering the Glucagon-Like Peptide 1 Receptor Agonist Semaglutide With Long-Term Olanzapine Use in a Patient With Schizophrenia.","authors":"Francesca L Ricciardi, Jayda L Melnitsky, Shannon B Peleg, Preetika Govil, Joshua T Kantrowitz","doi":"10.4088/JCP.25cr15857","DOIUrl":"https://doi.org/10.4088/JCP.25cr15857","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250627","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":"What Clinicians Should Know About the Pragmatic Use of Xanomeline-Trospium Combination.","authors":"Joseph F Goldberg, Peter J Weiden","doi":"10.4088/JCP.25ac15945","DOIUrl":"https://doi.org/10.4088/JCP.25ac15945","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250626","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":"Cognitive Behavioral Therapy for Insomnia With Prolonged Exposure Compared to Sleep Hygiene and Prolonged Exposure: A Randomized Controlled Trial.","authors":"Peter J Colvonen, Christopher Hunt, Jane Park, Abigail C Angkaw, Philip Gehrman, Kira Clare, Sonya B Norman","doi":"10.4088/JCP.24m15584","DOIUrl":"10.4088/JCP.24m15584","url":null,"abstract":"<p><p></p><p><p></p><p><p></p><p><p><b>Objective:</b> Co-occurrence of posttraumatic stress disorder (PTSD) and insomnia disorder is common and associated with greater psychiatric and functional problems than either condition alone. Evidence-based PTSD treatment often does not effectively decrease insomnia, and insomnia may interfere with the mechanisms underlying PTSD treatment. This study compared the efficacy of integrated cognitive behavioral therapy for insomnia (CBT-I) and prolonged exposure (PE; CBTI-PE) therapy to sleep hygiene and PE (hygiene-PE) in reducing insomnia and PTSD symptoms.</p><p><p><b>Methods:</b> Ninety-four veterans with insomnia disorder (Insomnia Severity Index [ISI] ≥11) and PTSD (Clinician Administered PTSD Scale for <i>DSM-5</i> [CAPS-5] diagnosis) were randomized to CBTI-PE or hygiene-PE therapy for 12 weeks of treatment. Recruitment ran from January 2017 to March 2023. Planned outcomes were PTSD symptoms (CAPS-5; PTSD Checklist for <i>DSM-5</i>), quality of life (World Health Organization Quality of Life-BREF [WHOQOL]), and insomnia severity (ISI, subjective sleep efficiency [SE], total sleep time [TST]) between baseline, week 5, posttreatment, and 3-month follow-up.</p><p><p><b>Results:</b> Randomized participants were 76.6% male, 52.1% white, and mean age was 40.0 years (SD = 11.6). Linear modeling showed PTSD symptoms significantly decreased for most participants, but there were no differences by treatment group (<i>P</i> = .844). While, on average, WHOQOL increased for all participants, there was greater improvement in perceived quality of life (QOL) in CBTI-PE relative to hygiene-PE. ISI decreased, and SE and TST increased for most participants but had statistically and clinically larger changes in CBTI-PE, compared to hygiene-PE (<i>P</i> < .001).</p><p><p><b>Conclusions:</b> On average, participants had reductions in PTSD symptoms, with no differences between the groups. CBTI-PE produced greater reductions in insomnia symptoms and larger increases in QOL, SE, and TST than hygiene-PE. Together, CBT-I PE is an effective intervention for treating 2 highly co-occurring disorders, insomnia and PTSD.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT02774642.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250621","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":"Risk of Alzheimer Disease and Vascular Dementia in Patients With Peripheral Vestibular Disorders: A Longitudinal Study of 140,726 Participants.","authors":"Yun-Hsuan Lin, Mu-Hong Chen, Shun-Chieh Yu, Ya-Mei Bai, Tung-Ping Su, Tzeng-Ji Chen, Shih-Jen Tsai","doi":"10.4088/JCP.24m15699","DOIUrl":"https://doi.org/10.4088/JCP.24m15699","url":null,"abstract":"<p><p><b>Objective:</b> The associations between peripheral vestibular disorders (PVDs)-specifically Meniere's disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and unspecified PVD-and dementia risk are unclear.</p><p><p><b>Methods:</b> By using data from the Taiwan National Health Insurance Research Database, this study included 70,363 patients aged ≥45 years with PVD between 1998 and 2011. An age-matched control group of 70,363 individuals without PVD was also established. All the included participants were followed up from the time of enrollment until the end of 2013 to assess the risk of dementia-related conditions, including Alzheimer's disease (AD), vascular dementia, and unspecified dementia.</p><p><p><b>Results:</b> Cox proportional hazards regression models, adjusted for demographic characteristics and psychiatric comorbidities, revealed that patients with PVD exhibited a significantly elevated risk of any form of dementia during the follow-up period (hazard ratio [HR] = 1.83, 95% CI, 1.69-1.97) compared with the control group. Notably, patients with BPPV exhibited the highest risk of AD (HR = 3.14, 95% CI, 2.35-4.19), followed by Meniere's disease (HR= 2.79, 95% CI, 2.17-3.59) and vestibular neuritis (HR = 2.66, 95% CI, 2.11-3.35).</p><p><p><b>Conclusions:</b> PVDs are a risk factor for dementia, regardless of psychiatric comorbidities. Further research is warranted to elucidate the pathophysiological mechanisms underlying the association between PVDs and dementia.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250625","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":"What Is Meant by the Term \"Deprescribing,\" and Does It Belong in Our Lexicon?","authors":"Joseph F Goldberg, Holly A Swartz, Rajnish Mago, Roger S McIntyre, Gin S Malhi, Joshua D Rosenblat, Marlene P Freeman, Eduard Vieta, Michael E Thase, Mauricio Tohen, Leslie Citrome","doi":"10.4088/JCP.25ac15936","DOIUrl":"https://doi.org/10.4088/JCP.25ac15936","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250628","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}