Journal of Clinical Psychiatry最新文献

{"title":"Autism Spectrum Disorder, 2: Observations on the Imprecision of the Numerical Value of Risk when Examining Predictors of Risk in Regression.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25f15918","DOIUrl":"10.4088/JCP.25f15918","url":null,"abstract":"<p><p>Hundreds of genes and more than a hundred environmental exposures have been identified as potential causes, mediators, or markers of risk for autism spectrum disorder (ASD). The findings for the environmental exposures, almost all occurring during pregnancy, have emerged from regression analyses in observational studies. The risk estimates are most often presented as odds ratios (ORs), sometimes as hazard ratios (HRs), and rarely as relative risks. This article uses gestational exposure to antidepressant drugs and risk of ASD in offspring as a background to explain how estimates of ASD risk in observational studies are commonly interpreted and why and when the usual interpretations are wrong, often very wrong. The article provides discussions on crude and adjusted estimates, ORs and HRs, individual studies and meta-analyses, strategies that help address confounding by unmeasured and unknown variables, and a detailed discussion on the imprecision of the numerical value of the adjusted estimate. The article explains how the value of an OR is not set in stone; different procedures and approaches in analysis of the same data result in different OR values. The article also explains how to evaluate an individual patient's risk when multiple risk factors are present that may or may not be independent of each other. Finally, the article suggests the presence of an elephant in the room: risk factors that, though independent, may saturate mechanisms that mediate the outcome; so, when simultaneously present, their individual ORs may suggest falsely lower values of risk. This suggestion could explain why ASD is uncommon in the population although the risk factors for ASD are common and many. It is important to be aware of the issues considered in this article when attempting to understand the field, counsel patients, communicate research findings to peers and the public, and frame policy.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112335","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":"Is Posttraumatic Stress Disorder in a Class of Its Own? Longitudinal Comparison to Other Conditions Following Trauma and Life Stress Exposure.","authors":"Ashley L Greene, Holly F Levin-Aspenson, Scott Feltman, Stephen Long, Madeleine Moore, Camilo Ruggero, Sean A P Clouston, Evelyn J Bromet, Benjamin J Luft, Roman Kotov","doi":"10.4088/JCP.24m15591","DOIUrl":"10.4088/JCP.24m15591","url":null,"abstract":"<p><p><b>Objective:</b> Posttraumatic stress disorder (PTSD) is defined by the assumption that qualifying traumatic events lead to a syndrome distinct from other internalizing disorders, while stressful life events play a prominent role in etiologic theories of major depressive disorder (MDD). We examined whether the environmental etiology of PTSD and MDD are distinct by evaluating the relative contributions of traumatic and stressful life events to both conditions. Harmful alcohol use and physical limitations served as noninternalizing comparators expected to show weaker associations with environmental factors.</p><p><p><b>Methods:</b> Longitudinal cohort study of World Trade Center disaster responders who completed annual assessments of mental health and physical functioning from July 1, 2002, to December 31, 2020. Psychiatric diagnoses were ascertained in clinical interviews. Multivariate regression and multilevel modeling quantified the percentage of variance in psychopathology and physical limitations attributable to trauma versus life stress.</p><p><p><b>Results:</b> 11,153 responders (mean age on September 11, 2001: 37.5 years; 91% male) completed 61,244 visits. The combined environmental effect of 9/11-trauma and life stress on PTSD and MDD was nearly identical (14.3% and 14.8% of between person variability), but much weaker for alcohol use and physical limitations (0.8% and 9.1%). Life stress explained the most variance in all diagnoses and symptoms across longitudinal and cross-sectional analytic strategies.</p><p><p><b>Conclusions:</b> In the longest study to date coexamining the environmental etiology of PTSD and MDD, trauma and life stress contributed to both conditions. Considering a spectrum of exposures from stressful life events to trauma and integrating knowledge across internalizing conditions may advance understanding and treatment of stress related psychopathology.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112346","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":"Results of a Randomized Controlled Trial Examining the Efficacy of Intranasal Oxytocin to Enhance Alcohol Behavioral Couple Therapy.","authors":"Julianne C Flanagan, Paul J Nietert, Barbara S McCrady, Stacey Sellers, Anjinetta Yates-Johnson, Sarah T Giff, Shannon R Forkus","doi":"10.4088/JCP.24m15627","DOIUrl":"10.4088/JCP.24m15627","url":null,"abstract":"<p><p><b>Objective:</b> This study examined the efficacy of intranasal oxytocin (40 IU), compared to matching placebo (saline), when combined with Alcohol Behavioral Couple Therapy (ABCT) for the treatment of alcohol use disorder (AUD).</p><p><p><b>Methods:</b> This 12-week clinical trial (2018-2024) utilized a double-blind, randomized, placebo-controlled design. Enrollment occurred from May 2019 to April 2023. Participants were romantic couples (N = 96 dyads; n = 49 oxytocin, n = 47 placebo) consisting of an identified patient (IP) with current AUD per <i>DSM-5</i> and their partner. Dyads in which both partners had AUD were eligible, and both partners in each dyad were randomized to the same drug condition (ie, placebo or oxytocin). Participants were observed in their medication self-administration 30 minutes prior to ABCT therapy sessions. Primary outcome measures were alcohol consumption (percent days drinking and percent days heavy drinking; Time Line Follow-Back) and relationship functioning (Dyadic Adjustment Scale-Short Form).</p><p><p><b>Results:</b> All IPs and 50% of partners met diagnostic criteria for AUD; 62 IPs (64.5%) met criteria for severe AUD. Findings from the intent-to-treat analyses indicate that IPs and partners in both conditions evidenced substantial improvements in alcohol consumption and alcohol problem severity but not relationship functioning. No group differences emerged in alcohol consumption, alcohol problem severity, or relationship functioning at end of treatment. Participants completed an average of 10.2 ABCT sessions (SD = 3.5). There were no group differences in the number of medication doses administered or adverse events.</p><p><p><b>Conclusions:</b> Oxytocin was safe and tolerable but did not provide additional benefit beyond ABCT at the end of treatment. Alternative strategies are necessary to understand oxytocin's potential to facilitate different domains of AUD recovery.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03046836.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112351","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":"Lower Risk of First Onset of Many Cardiovascular Disorders in Antidepressant-Treated Women Veterans: Encouraging Findings but Concerns Remain.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25com15886","DOIUrl":"https://doi.org/10.4088/JCP.25com15886","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056884","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":"Preferences for Lisdexamfetamine vs Cognitive-Behavioral Therapy for Binge-Eating Disorder: Correlates and Outcomes.","authors":"Sydney Yurkow, Valentina Ivezaj, Brian Pittman, Carlos M Grilo","doi":"10.4088/JCP.24m15552","DOIUrl":"https://doi.org/10.4088/JCP.24m15552","url":null,"abstract":"<p><p><b>Background:</b> Efficacious treatments for binge-eating disorder (BED) have been identified, but research is lacking regarding patients' treatment preferences and their effects on outcomes. We investigated the frequency and correlates of patients' preferences for 2 distinct BED treatments-cognitive behavioral therapy (CBT) and lisdexamfetamine (LDX)-and whether preferences predicted and/or moderated outcomes.</p><p><p><b>Method:</b> In a randomized controlled trial (performed March 2019 to September 2023) testing CBT and LDX for <i>DSM-5</i>- defined BED, 102 participants indicated their preference after treatments were described and prior to beginning treatment. Treatment was randomly assigned (not influenced by preferences). Independent assessors, blinded to treatments and to patients' treatment preferences, performed outcome assessments.</p><p><p><b>Results:</b> 43.1% (44/102) preferred LDX, 23.5% (24/102) preferred CBT, and 33.3% (34/102) reported no preference. Treatment preference was not significantly associated with any sociodemographic or baseline clinical characteristics. Logistic regression models (for binge-eating remission and attaining ≥5% weight loss) and mixed models (for changes in binge-eating frequency, weight, eating disorder psychopathology, and depression) testing main effects of treatments, main effects of treatment preferences, and their interaction effects converged. No significant interaction effects between treatment and treatment preferences were observed.</p><p><p><b>Conclusions:</b> In this study comparing CBT and LDX treatments for BED in patients with obesity, participants' preferences for treatments were not associated with their sociodemographic or clinical characteristics and did not moderate treatment outcomes of these 2 effective interventions. Implications for clinical practice and future research are discussed.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03924193.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025172","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":"Antidepressant Medication Prescription and Incident Cardiovascular Disease in Women Veterans.","authors":"Jennifer A Sumner, Paul A Dennis, Carlos A Alvarez, Aaron Perkins, Jean C Beckham, Ramin Ebrahimi","doi":"10.4088/JCP.24m15647","DOIUrl":"https://doi.org/10.4088/JCP.24m15647","url":null,"abstract":"<p><p><b>Objective:</b> Antidepressants are commonly prescribed, yet understanding of consequences for cardiovascular disease (CVD) risk is less well-developed. We examined associations of antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], other antidepressants) with incident CVD in women Veterans, a population with a high psychiatric and CVD risk burden.</p><p><p><b>Methods:</b> Using Veterans Health Administration (VHA) electronic health records, we identified women Veterans who were VHA patients from January 1, 2000, to December 31, 2019. Exclusion criteria included <12 months of baseline data before index visit, prior CVD or antidepressant prescription, and no encounters after index visit. Antidepressant prescriptions were documented in pharmacy data. Our primary outcome was an incident CVD composite, comprising first-onset ischemic heart disease, stroke, atrial fibrillation/flutter, heart failure/ cardiomyopathy, and pulmonary hypertension based on diagnostic codes.</p><p><p><b>Results:</b> Women Veterans (N = 609,546) had a mean age of 41.3 years. During mean follow-up of 8.8 years, 40.1% of women were prescribed SSRIs, 18.2% SNRIs, and 38.6% other antidepressants; 9.2% developed CVD. Marginal structural modeling was used to de-confound associations of antidepressants with incident CVD, accounting for demographics, VHA engagement, traditional CVD risk factors, and psychiatric disorders. SSRIs, SNRIs, and other antidepressants (vs no antidepressants) were associated with lower incidence of the CVD composite, as well as ischemic heart disease and stroke (relative risk: 0.27-0.76). Additionally, the inverse association between antidepressants and CVD was larger for women with major depressive disorder, posttraumatic stress disorder, and anxiety disorders.</p><p><p><b>Conclusion:</b> As antidepressants are widely prescribed in the VHA and beyond, these results are encouraging for patients receiving this care.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990575","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 II: Assessment.","authors":"Jay C Fournier, Vitaliy L Voytenko, Anna R Docherty, Jesse H Wright, Subhdeep Virk, Patricio Riva Posse, Michael J Flood, Joao Quevedo, Diana K Burnett, William V Bobo, Susan K Conroy, Sagar V Parikh","doi":"10.4088/JCP.24cs15336","DOIUrl":"https://doi.org/10.4088/JCP.24cs15336","url":null,"abstract":"<p><p><b>Objective:</b> To provide recommendations regarding the critical elements of the assessment package in treatment-resistant depression (TRD) consultation programs. This is a complementary manuscript to Part I, which discusses practical and logistical considerations for developing and sustaining a subspecialized TRD consultation program.</p><p><p><b>Participants:</b> A 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. This consensus statement reflects the effort of the NNDC's TRD Task Group to reach agreement on a set of principles that those interested in establishing new consultation programs could use to guide their effort and a set of recommendations that could serve as a basis for future empirical work.</p><p><p><b>Consensus Process:</b> Each member of the NNDC TRD Task Group provided a written description of the procedures used at their home institution, which were used during a day-long forum to achieve consensus on recommendations for each component of a TRD consultation program. Subgroups were formed to draft recommendations, and points of disagreement were resolved at subsequent meetings of the full task group.</p><p><p><b>Conclusions:</b> We describe consensus recommendations regarding the goals of a TRD consultation, which include establishing the primary diagnosis and comorbidities, clarifying medical and psychiatric symptoms, identifying goals, documenting treatment history, identifying treatment barriers, and developing actionable treatment recommendations. We detail important components of the consultation evaluation process, the assessment tools to consider in establishing a TRD consultation program, and the qualifications of providers.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003964","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":"Increased Risk of Suicide Attempt in Patients With Atopic Dermatitis: A Nationwide Population-Based Cohort Study.","authors":"Mu-Chun Lin, Sheng-Hsiang Ma, Ying-Hsuan Tai, Ying-Xiu Dai, Mu-Hong Chen, Chih-Chiang Chen","doi":"10.4088/JCP.24m15590","DOIUrl":"https://doi.org/10.4088/JCP.24m15590","url":null,"abstract":"<p><p><b>Introduction:</b> Atopic dermatitis (AD) is associated with an increased risk of mental illness. However, few studies have explored the association between AD and suicidal risk. This study aimed to investigate the risk of suicide attempts in patients with AD.</p><p><p><b>Methods:</b> Between 1997-2013, 5,169 patients with AD and 20,676 controls (1:4) matched according to age, sex, socioeconomic status, and selected comorbidities were enrolled from the Taiwan's National Health Insurance Research Database to analyze the risk of suicide attempt.</p><p><p><b>Results:</b> Individuals with AD were found to have an elevated risk of suicide attempts, with an adjusted hazard ratio of 3.44 (95% CI, 1.83-6.46), compared to the control group. In the stratification analysis, the risk of suicide remained significantly higher in patients with AD of younger age, female sex, and those with cumulative systemic corticosteroid use for <30 days.</p><p><p><b>Conclusions:</b> Dermatologists must recognize the potential increased suicidal risk in patients with AD, especially in vulnerable groups and those with certain comorbidities. Furthermore, patients with mild AD did not have a reduced suicidal risk.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042260","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":"Vortioxetine for Cognitive Impairment in Major Depressive Disorder During Post-COVID Syndrome: Real-World Evidence.","authors":"Hernan F Guillen-Burgos, Juan F Galvez-Florez, Sergio Moreno-López, Juan-Manuel Anaya, Angela T H Kwan, Roger S McIntyre","doi":"10.4088/JCP.24m15387","DOIUrl":"https://doi.org/10.4088/JCP.24m15387","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> To compare the effectiveness of vortioxetine versus escitalopram and sertraline as a treatment in individuals with major depressive disorder (MDD) and post-COVID syndrome (PCS).</p><p><p><b>Methods:</b> This is a prospective, open-label, comparative effectiveness study in individuals with new-onset MDD as PCS outcome. The study was carried out in 1 clinical site. Individuals who had a history of confirmed SARS-CoV 2 infection, who met World Health Organization-defined criteria for PCS, and who met new-onset of MDD criteria according to <i>DSM-5-TR</i> were included. Participants that were eligible were assigned to receive vortioxetine at 10-20 mg/d, escitalopram 10-20 mg/d, or sertraline 50-200 mg/d over 8 weeks. The primary and secondary outcomes were changes from baseline to end point in Digital Symbol Substitution Test (DSST) and Montgomery-Asberg Depression Rating Scale (MADRS) or Patient Reported Outcome Measurement Information System Fatigue Short Form 7a (PROMIS 7a), respectively. Data were collected during January 2022 and December 2023.</p><p><p><b>Results:</b> 140 participants were assigned to received vortioxetine (n = 70), escitalopram (n = 36), or sertraline (n = 34). Participants assigned to vortioxetine exhibited significant changes in DSST scores from baseline to end point compared to escitalopram or sertraline (least squares [LS] mean differences, 8.25; 95% CI, 6.25-10.25; <i>P</i> < .001; LS mean differences, 8.00; 95% CI, 5.95-10.06; <i>P</i> < .001, respectively). Participants in the vortioxetine treatment group reported significantly greater changes in total MADRS scores from baseline to end point compared to escitalopram or sertraline (LS mean differences, -4.06; 95% CI, -4.92 to -3.20; <i>P</i> < .001; LS mean differences, -3.94; 95% CI, -4.83 to -3.06; <i>P</i> < .001, respectively).</p><p><p><b>Conclusion:</b> Vortioxetine has a significant procognitive effect. Antidepressant effects and improvement in fatigue symptoms (PROMIS 7a) also were observed.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994078","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":"Clozapine Monitoring in the Post-REMS World: Some Guidance for Clinicians.","authors":"Jonathan M Meyer, Jose M Rubio","doi":"10.4088/JCP.25ac15898","DOIUrl":"https://doi.org/10.4088/JCP.25ac15898","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024766","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}