Journal of Clinical Psychiatry最新文献

{"title":"Trajectories of Irritability Improvement in Depressed Adolescents Treated With 1 Hz and 10 Hz Transcranial Magnetic Stimulation.","authors":"Karina Delaney, Paul A Nakonezny, Dicle Buyuktaskin, Lucero Sangster Carrasco, Arjun P Athreya, Magdalena Romanowicz, Julia Shekunov, Jennifer L Vande Voort, Paul E Croarkin","doi":"10.4088/JCP.24m15684","DOIUrl":"https://doi.org/10.4088/JCP.24m15684","url":null,"abstract":"<p><p><b>Objective:</b> Irritability is a debilitating, transdiagnostic symptom in adolescents spanning internalizing and externalizing disorders, and early reduction in irritability with antidepressant treatments has been seen as a positive prognostic sign in depression recovery. There are substantial knowledge gaps regarding how transcranial magnetic stimulation (TMS) treatments impact irritability.</p><p><p><b>Methods:</b> This exploratory study sought to investigate the relationship between irritability and depressive symptoms in adolescents with a <i>DSM-5</i> diagnosis of major depressive disorder (MDD) undergoing treatment with 2 different doses of TMS. Participants aged 12-18 years (N = 41) underwent 6 weeks of treatment (30 sessions) in a double-blind, randomized trial of 1 Hz vs. 10 Hz TMS for the treatment of MDD. The clinical trial was conducted from September 24, 2018, through March 3, 2023. A linear mixed model was used to assess the change in irritability (assessed with item 8 on the Children's Depression Rating Scale Revised) throughout the treatment course, and a logistic regression was implemented to examine the relationship between early (week 4) irritability improvements and a posttreatment Clinical Global Impressions-Improvement (CGI-I) score.</p><p><p><b>Results:</b> Irritability significantly improved during the course of TMS treatments in conjunction with overall depression improvement across the 6 week trial for the 1 Hz TMS group (<i>P</i> = .0120, <i>d</i> =0.381) and for the 10 Hz TMS group (<i>P</i> = .0288, <i>d</i> = 0.331). There was a significant negative (inverse) relationship between the change in irritability symptoms and CGI-I response for the 10 Hz TMS group (δ log odds = -1.5474, SE = 0.7343, <i>P</i> = .0351) and for the 1 Hz TMS group (δ log odds = -1.2852, SE = 0.5656, <i>P</i> = .0231).</p><p><p><b>Conclusion:</b> These results suggest that irritability is an important correlate of disease severity and predictor of treatment response for MDD in adolescents, replicating similar results found in trials using antidepressant medications. Future research should focus on incorporating assessments of irritability into clinical decision-making and intervention discovery for transdiagnostic symptoms of irritability in youth and adolescents.</p><p><p><b>Clinical Trial Registration:</b> Data used in this secondary analysis came from ClinicalTrials.gov identifier: NCT03363919.</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":"143996579","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":"Older Adults Visiting Emergency Departments for Mental Health Issues: A CHIRPP Database Study.","authors":"Maïna Laforce, Valérie Boucher, Ann-Pier Gagnon, Pier-Alexandre Tardif, Axel Benhamed, Pierre-Gilles Blanchard, Marcel Emond, François Poirier, Eric Mercier","doi":"10.4088/JCP.24m15516","DOIUrl":"https://doi.org/10.4088/JCP.24m15516","url":null,"abstract":"<p><p><b>Objectives:</b> To describe the characteristics, clinical trajectories, and disposition of older adults consulting in the emergency department (ED) for mental health issues. The secondary objective was to explore the impact of age, sex, and living environment on those patients' clinical care and disposition.</p><p><p><b>Methods:</b> This registry study included data from 5 Canadian EDs. Patients were included if they were aged ≥65 years and consulting in the ED between March 1, 2020, and March 31, 2021, for mental health issues. Relative risks (RRs) were obtained using a modified Poisson regression model, and 95% confidence intervals (CIs) were estimated with a robust variance estimator.</p><p><p><b>Results:</b> 1,673 patients were included. The mean ±SD age was 75.2±8.1 years; 58.8% were female, and 87.4% had a prior history of mental health issues. Suicidal ideations (40.8%) and neurocognitive disorders (31.8%) were the most frequent diagnostic impressions. 52.0% were assessed by a psychiatrist, and 49.9% were discharged from the ED. Males were at higher risk of neurocognitive (RR: 1.16 [95% CI, 1.01-1.32]) and substance use disorders (RR: 1.54 [95% CI, 1.19-1.99]). Patients aged ≥85 were more likely to be physically/chemically restrained and less likely to be assessed by psychiatry and hospitalized (RR: 1.69 [95% CI, 1.14-2.50], RR: 0.62 [95% CI, 0.52-0.74], RR: 0.73 [95% CI, 0.57-0.95]).</p><p><p><b>Conclusion:</b> This study highlights that most older ED patients consulting for mental health issues had a prior history of such issues. A psychiatrist assessed most patients, but those aged ≥85 were less likely to be assessed or hospitalized, yet more likely to be restrained. These results should be considered when designing targeted investigations to meet the complex needs of this population.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057071","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":"Combining Ketamine Infusions and Written Exposure Therapy for Chronic PTSD: An Open-Label Trial.","authors":"Adriana Feder, Oneysha Brown, Sarah B Rutter, Leah Cahn, Jessica R Overbey, Saren H Seeley, Alex Yu, Philip A Bonanno, Rachel A Fremont, Andrew A Delgado, Manish K Jha, Sara Costi, Rachel Yehuda, Daniela Schiller, Robert H Pietrzak, Dennis S Charney, Denise M Sloan, James W Murrough","doi":"10.4088/JCP.24m15622","DOIUrl":"https://doi.org/10.4088/JCP.24m15622","url":null,"abstract":"<p><p><b>Objective:</b> This open-label clinical trial examined the preliminary efficacy of combining a course of 6 ketamine infusions with a brief, evidence-based exposure-based psychotherapy-written exposure therapy (WET)-in patients with chronic posttraumatic stress disorder (PTSD).</p><p><p><b>Methods:</b> The trial was conducted between June 2021 and October 2023. Patients with chronic PTSD and high-moderate to severe symptom levels received 6 intravenous ketamine infusions (0.5 mg/kg), 3 times a week for 2 consecutive weeks, plus 5 WET sessions over 2 weeks, beginning after the first 4 infusions and administered on different days than infusion days. The primary outcome was change in the Clinician Administered PTSD Scale for <i>DSM-5</i> (CAPS-5) scores from baseline (before the first infusion) to 12 weeks from start of WET (\"Week 12\").</p><p><p><b>Results:</b> Fourteen eligible patients began treatment, and 13 completed all infusions and WET. The combined treatment was associated with large-magnitude improvement in PTSD symptom severity from baseline (mean CAPS 5 = 41.6 [SD = 6.2]) to Week 12 (CAPS 5 = 20.8 [14.8], Cohen <i>d</i> [95% CI] = 1.9 [1.0-2.8], <i>P</i> < .001). Nine (69%) patients were treatment responders (≥30% improvement on the CAPS-5). Response was rapid and also durable in 8 (61.5%) patients, assessed up to 6 months from baseline.</p><p><p><b>Conclusions:</b> Preliminary findings from this open-label clinical trial suggest that the combined treatment may yield large magnitude and durable reductions in PTSD symptoms for patients with more severe chronic PTSD. Large-scale randomized controlled trials are needed to determine the efficacy and potential synergistic effect of this promising combined treatment in this patient population.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT04889664.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030587","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 Parental Severe Mental Disorders on All-Cause and Suicide Mortalities in Adolescents and Young Adults With Major Depressive Disorder.","authors":"Shih-Jen Tsai, Chih-Ming Cheng, Wen-Han Chang, Ya-Mei Bai, Tung-Ping Su, Tzeng-Ji Chen, Mu-Hong Chen","doi":"10.4088/JCP.24m15476","DOIUrl":"https://doi.org/10.4088/JCP.24m15476","url":null,"abstract":"<p><p><b>Background:</b> Major depressive disorder (MDD) has been associated with both all cause and suicide mortality in young adults. However, the effects of parental severe mental disorders (SMDs), such as schizophrenia, bipolar disorder, MDD, alcohol use disorder (AUD), and substance use disorder, on the risks of all-cause and suicide mortality in adolescents and young adults with MDD remain unclear.</p><p><p><b>Methods:</b> We retrospectively evaluated the incidence of all-cause and suicide mortality (2001-2011) in 196,000 adolescents (age: 10-17 years) and young adults (age: 18-29 years) with MDD. We investigated associations between parental SMDs and all-cause and suicide mortality among patients with MDD using Cox regression analyses. In addition, we assessed the additive effects of paternal and maternal SMDs on the mortality risk of depressed offspring.</p><p><p><b>Results:</b> Our findings revealed that all cause mortality in offspring was associated with paternal AUD (hazard ratio [HR]: 1.66) as well as maternal schizophrenia (HR: 2.77), bipolar disorder (HR: 1.99), and MDD (HR: 1.25). Furthermore, suicide mortality in offspring was associated with maternal schizophrenia (HR: 4.36) and bipolar disorder (HR: 4.01). Notably, the risk of suicide mortality was the highest in offspring with paternal bipolar disorder and maternal MDD (HR: 7.31).</p><p><p><b>Conclusion:</b> Parental SMDs such as schizophrenia, bipolar disorder, MDD, and AUD are associated with all-cause and suicide mortality in adolescents and young adults with MDD. Optimizing support systems and prioritizing early interventions for parental mental health problems may help reduce the risks of suicide and premature death in young patients with MDD.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990582","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":"Xanomeline and Trospium Chloride for the Treatment of Agitation Associated With Schizophrenia: PANSS-Excited Component Results From 3 Randomized, Double-Blind, Placebo-Controlled EMERGENT Trials.","authors":"Paul P Yeung, Alan Breier, Haiyuan Zhu, Inder Kaul, Ronald N Marcus","doi":"10.4088/JCP.24m15668","DOIUrl":"https://doi.org/10.4088/JCP.24m15668","url":null,"abstract":"<p><p><b>Objective:</b> To further characterize the efficacy of oral xanomeline and trospium chloride in the treatment of agitation associated with schizophrenia.</p><p><p><b>Methods:</b> Analyses were performed on the change from baseline of the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC; composed of excitement, tension, hostility, uncooperativeness, and poor impulse control items) data from the 5-week, randomized, double-blind, placebo controlled, inpatient EMERGENT-1, EMERGENT-2, and EMERGENT-3 trials of xanomeline/trospium in adults with schizophrenia with a recent worsening of psychosis requiring hospitalization. The 3 trials met the primary endpoint of reduction from baseline to week 5 in PANSS total score. Data were analyzed from individual studies and were also pooled.</p><p><p><b>Results:</b> The population comprised 640 participants from the pivotal trials which were conducted from September 2018 to December 2022. PANSS-EC scores were significantly reduced with xanomeline/trospium vs placebo at week 5 across all 3 EMERGENT trials. In EMERGENT-1, xanomeline/trospium (n = 83) was statistically significantly superior (Cohen's <i>d</i> =0.62, <i>P</i> = .0002) to placebo (n = 87) in improvement (decrease) of PANSS-EC score at week 5. In EMERGENT-2, xanomeline/trospium (n = 117) was significantly superior (<i>d</i> = 0.43, <i>P</i> = .0026) to placebo (n = 119) at week 5. In EMERGENT-3, xanomeline/ trospium (n = 114) was significantly superior (<i>d</i> = 0.62, <i>P</i> < .0001) to placebo (n = 120) at week 5. Pooled results were consistent with the individual trials.</p><p><p><b>Conclusion:</b> Xanomeline/trospium showed improvement in agitation as measured by PANSS-EC in participants with acute exacerbations of schizophrenia. Xanomeline/trospium is the first in a new class of treatments for schizophrenia based on muscarinic receptor agonism.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifiers: NCT03697252, NCT04659161, NCT04738123.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030039","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":"Treating Posttraumatic Stress Disorder in Military Populations: A Meta-Analysis.","authors":"Jenny J W Liu, Anthony Nazarov, Natalie Ein, Bethany Easterbrook, Tri Le, Clara Baker, Julia Gervasio, Edouard Auger, Ken Balderson, Mathieu Bilodeau, Amer M Burhan, Murray W Enns, Fardous Hosseiny, Vicky Lavoie, Natalie Mota, Maya L Roth, Sonya G Wanklyn, J Don Richardson","doi":"10.4088/JCP.24r15571","DOIUrl":"https://doi.org/10.4088/JCP.24r15571","url":null,"abstract":"<p><p><b>Background:</b> Military and Veteran populations experience higher rates of posttraumatic stress disorder (PTSD) compared to civilians. While trauma focused psychotherapies are generally recommended as first-line treatments, the effectiveness of various treatments in military populations requires further investigation.</p><p><p><b>Objective:</b> This meta-analysis aims to synthesize the current literature regarding effectiveness of psychotherapies, pharmacotherapies, and combination treatments for PTSD in military populations.</p><p><p><b>Data Sources:</b> This preregistered review (PROSPERO: CRD42021245754) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses and Cochrane guidelines. A search was conducted using PsycINFO, MEDLINE, Embase, CINAHL, and ProQuest Dissertations and Theses.</p><p><p><b>Study Selection:</b> The final sample included data from 414 studies.</p><p><p><b>Data Extraction:</b> Full study methodologies can be found in the published protocol (Liu et al, 2021).</p><p><p><b>Results:</b> The pooled random-effects model found effect size across all PTSD treatments (<i>k</i> = 712) was <i>g</i>=0.96, compared to <i>g</i>=0.45 for control conditions (<i>k</i> = 122). Clinician administered measures indicated larger treatment effects (<i>g</i>= 1.02) than self reported measures (<i>g</i> =0.82). Combination therapies yielded the largest effects (<i>g</i> =2.17), outperforming both psychotherapies and pharmacotherapies alone. No significant differences were found across control conditions.</p><p><p><b>Conclusion:</b> Findings suggest that integrating psychotherapies and pharmacotherapies may address multiple dimensions of PTSD more effectively than monotherapies. However, these results contrast with the prioritization of trauma-informed psychotherapies over pharmacotherapies, as recommended by the 2023 US Department of Veterans Affairs/Department of Defense guidelines. Future research should focus on subclass analyses and long-term outcomes to refine treatment strategies for PTSD in military populations. Tailoring treatment plans to individual needs remains crucial for optimizing recovery and long-term symptom management.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046001","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":"A Single-Dose, Randomized, Open-Label, Parallel Design Study to Characterize the Pharmacokinetics of an Investigational Olanzapine Intranasal Spray Compared to a Reference Dose of Olanzapine Intramuscular Injection in Healthy Adult Males.","authors":"Stuart Madden, Leslie Citrome, Christoph U Correll, Evelyn K Shih, Miguel Lopez-Toledano, Adrian L Rabinowicz, Enrique Carrazana","doi":"10.4088/JCP.24m15665","DOIUrl":"10.4088/JCP.24m15665","url":null,"abstract":"<p><p><b>Objective:</b> Injectable olanzapine for acute agitation in psychiatric disorders is limited to delivery by health care professionals in supervised settings. Intranasal (IN) administration offers a potential needle free route of delivery with favorable pharmacokinetics and patient experience, including the possibility of self-administration in community settings. Two IN formulations of olanzapine containing the permeation enhancer dodecyl maltoside (DDM) were assessed, with intramuscular (IM) olanzapine as a reference.</p><p><p><b>Methods:</b> In this randomized phase 1 trial (conducted October 2023), healthy volunteers (N =24) were randomized 1:1: 1 to receive 1 dose of IN olanzapine 7.5 mg+0.25% DDM, IN olanzapine 7.5 mg+0.50% DDM, or olanzapine 7.5 mg IM. Plasma olanzapine concentrations were measured over time, and safety and tolerability were assessed.</p><p><p><b>Results:</b> Mean peak plasma olanzapine concentrations were 31.5, 32.3, and 20.5 ng/mL for 0.25% and 0.50% DDM sprays and IM dosing, respectively. Median times to peak plasma concentration were 4.8, 10.2, and 37.8 minutes. After a single dose of the 0.25% and 0.50% DDM formulations, bioavailability was 88.8% and 83.3% of a single IM dose. All reported treatment emergent adverse events were mild, transient, and deemed possibly related to the study drug, with the most frequent being sedation (n = 24) and nasal discomfort lasting seconds (n = 16, IN treatments). Nasal irritation scores were grade 0 (no sign of nasal irritation or mucosal erosion), and suicide risk assessment was negative for all time points.</p><p><p><b>Conclusion:</b> Two novel investigational IN formulations of olanzapine containing the permeation enhancer DDM showed favorable pharmacokinetics and an acceptable safety profile presenting no unexpected signals in healthy adults. Continued study is warranted.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06600477.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674687","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":"The Association Between Infant Distress to Limitation and Postpartum Depression Treatment Response.","authors":"Kian Yousefi Kousha, John E Krzeczkowski, Ryan J Van Lieshout","doi":"10.4088/JCP.24br15503","DOIUrl":"https://doi.org/10.4088/JCP.24br15503","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674782","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":"Longitudinal Effects of Negative Ethnic-Racial Identity Affect on Internalizing Symptoms in Youth of Latiné Background Exposed to Interpersonal Trauma.","authors":"Sunita M Stewart, Nazan Aksan, Andrea Bancroft, Jeffrey D Shahidullah, Savannah M Krantz, Madelyn Guerra, Jessica Sandoval, Cynthia Garza, Andres G Viana, Myesha Morgan, Cecilia DeVargas, Justin F Rousseau, D Jeffrey Newport, Karen Dineen Wagner, Charles B Nemeroff","doi":"10.4088/JCP.24m15654","DOIUrl":"10.4088/JCP.24m15654","url":null,"abstract":"<p><p><b>Objectives:</b> Latiné youth in the US are at elevated risk for trauma exposure, but factors that contribute to their symptoms are not well studied. We examined the effects of interpersonal trauma (IPT) burden and negative affect about ethnic-racial identity (NERI-A) on internalizing symptoms following trauma exposure.</p><p><p><b>Method:</b> Participants were 1,006 US-born youth of Latiné background (mean age 15.4 years, 60% female at birth, and 70% identified as White) from the Childhood Trauma Research Network, a research consortium examining long-term outcomes of childhood trauma in Texas. Participants were enrolled between October 2020 and February 2024. Analyses controlled for sex, age, race, non-interpersonal trauma, whether parents were of the immigrant generation, and mental health treatment received.</p><p><p><b>Results:</b> Greater IPT burden and higher baseline NERI-A were associated with greater baseline anxiety (<i>P</i> < .001, <i>P</i> = .026) and depressive (<i>P</i> < .001, <i>P</i> = .040) symptoms. The effect of baseline IPT burden on direction and magnitude of longitudinal change in anxiety (0.038) and depression (0.002) differed for those with high NERI-A vs low NERI-A. In the context of low NERI-A, IPT burden showed steady or decreasing associations with symptoms over time. In contrast, for those reporting high NERI-A, IPT burden showed strengthening associations with both anxiety and depression over time.</p><p><p><b>Conclusion:</b> Our study highlights the vulnerability of youth who experience IPT and report NERI-A. Further research is needed to determine how NERI-A develops, changes, and is moderated in the diverse groups of individuals of Latiné descent.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674714","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":"Discordant Sibling Pair Comparisons in Observational Studies: A Research Design Simply Explained.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25f15843","DOIUrl":"10.4088/JCP.25f15843","url":null,"abstract":"<p><p>When studying how (eg) gestational exposure to antidepressant drugs influences the risk of (eg) autism spectrum disorder (ASD) in offspring, conventional observational studies adjust analyses for available covariates and confounds. In such analyses, a significant association between antidepressant exposure and ASD outcome can never be asserted to be causal because of the possibility of residual confounding arising from confounding by indication (or severity thereof), confounding by genetic risk factors, and confounding by environmental risk factors. Confounding by indication and severity thereof can sometimes be addressed through propensity score matching, but the adjustment can never be perfect. Additionally, adjustment for genetic and environmental risk factors is hard or impossible to do because these are inadequately measured, unmeasured, and/or unknown variables. Sibling comparison studies have recently emerged as an option to address the genetic and environmental risk factors. In such studies, sibs discordant for exposure are compared for risk of outcome (cohort design) or sibs discordant for outcome are compared for odds of exposure (case-control design). The assumption is that sibs share similar genetic and environmental risk factors and so, when sibs are compared, these risk factors cancel out whether they are measured or not, known or unknown. If antidepressant exposure remains significantly associated with ASD in sibling comparisons, a possible conclusion is that antidepressants and not genetic or environmental factors drive the ASD risk. If antidepressant exposure loses significance in the sibling comparisons, it suggests that shared genetic and/or environmental factors, rather than antidepressant exposure, explain the ASD risk. The interpretation, however, is nuanced. Strengths, limitations, and interpretations of sibling comparison studies are explained. To illustrate the usefulness of sibling comparisons, results are presented from a recent study of ASD risk after gestational or early infancy exposure to antibiotics.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674692","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}