Journal of Clinical Psychiatry最新文献

{"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}

{"title":"Correction. Long-Term Safety and Efficacy of Esmethadone in Patients With Major Depressive Disorder: Findings From a 12-Month Open-Label Study.","authors":"","doi":"10.4088/JCP.25lcx15938","DOIUrl":"https://doi.org/10.4088/JCP.25lcx15938","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042258","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":"Erecting Barriers to Suicide by Removing Barriers to Science.","authors":"Gin S Malhi, Kinga Szymaniak, Gurubhaskar Shivakumar, Erica Bell","doi":"10.4088/JCP.25l15883","DOIUrl":"https://doi.org/10.4088/JCP.25l15883","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051117","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":"Efficacy of Adjunctive Cariprazine on Anxiety Symptoms in Patients With Major Depressive Disorder: Post Hoc Analysis of a Randomized Placebo-Controlled Trial.","authors":"Maurizio Fava, Prakash S Masand, Vladimir Maletic, Chen Chen, Julie L Adams, Majid Kerolous","doi":"10.4088/JCP.24m15506","DOIUrl":"https://doi.org/10.4088/JCP.24m15506","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the effects of adjunctive cariprazine on anxiety symptoms in adults with a <i>DSM-5</i> diagnosis of major depressive disorder (MDD) and inadequate response to antidepressant therapy (ADT).</p><p><p><b>Methods:</b> In this post hoc analysis of a phase 3 study (NCT03738215), we assessed the effects of adjunctive cariprazine 1.5 and 3.0 mg/d on depressive and anxiety symptoms. The modified intent-to-treat (mITT) population was evaluated, as well as subgroups with varying degrees of baseline anxiety, defined by Hamilton Rating Scale for Depression (HAM-D) Anxiety/Somatization factor scores and Hamilton Anxiety Rating Scale (HAM-A) total scores. Least squares mean differences (LSMD) in change from baseline to week 6 in Montgomery Asberg Depression Rating Scale and HAM-A total scores and in HAM-D Anxiety/Somatization factor scores were reported.</p><p><p><b>Results:</b> The mITT population included 751 patients. At week 6, cariprazine 1.5 mg/d +ADT resulted in significantly greater changes in depressive symptoms versus placebo in patients with elevated baseline anxiety (HAM-D Anxiety/Somatization factor subgroup: LSMD [95% CI], -2.4 [-4.2 to -0.7]); HAM A total score subgroup: -2.8 [-4.6 to -1.0]). Adjunctive cariprazine also significantly reduced anxiety symptoms in the overall mITT population, as measured by mean reductions in HAM-D Anxiety/Somatization factor (1.5 mg/d: -0.8 [-1.2 to -0.3]; 3.0 mg/d: -0.5 [-1.0 to -0.1]) and HAM-A total scores (1.5 mg/d: -1.3 [-2.5 to -0.1]). Similar trends were observed for adjunctive cariprazine 1.5 mg/d in subgroups of patients with elevated anxiety symptoms.</p><p><p><b>Conclusions:</b> In addition to reducing depressive symptoms, adjunctive cariprazine may also reduce anxiety symptoms in patients with MDD, regardless of the level of baseline anxiety.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992923","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":"Public Health Nurse-Delivered 1-Day Cognitive Behavioral Therapy-Based Workshops for Treating Postpartum Depression: A Pilot Randomized Controlled Trial.","authors":"Haley Layton, Madisyn Campbell, Kathryn Huh, Arooba Mansoor, Jesus Serrano-Lomelin, June S L Brown, Peter J Bieling, Ryan J Van Lieshout","doi":"10.4088/JCP.24m15712","DOIUrl":"https://doi.org/10.4088/JCP.24m15712","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> This pilot randomized controlled trial (RCT) examined the feasibility of study procedures and acceptability of 1-day cognitive behavioral therapy (CBT)-based workshops for postpartum depression (PPD) delivered by nonspecialist public health nurses (PHNs) and explored the potential effects of the intervention on PPD and anxiety to inform a future, full-scale RCT.</p><p><p><b>Methods:</b> Birthing parents ≥18 years old with an infant <12 months old, living in Ontario, Canada, with an Edinburgh Postnatal Depression Scale (EPDS) score ≥10 were recruited between March 18 and May 25, 2022, and randomly assigned to receive the 1-day CBT-based workshop plus treatment as usual (TAU; experimental group) or TAU alone (control group). Feasibility objectives (recruitment, retention, intervention attendance) were described using descriptive statistics, and treatment effects were assessed at enrollment and 3 and 9 months post-intervention.</p><p><p><b>Results:</b> 119 participants were enrolled in under 3 months, 85% in the experimental group attended their workshop, and 84% of participants completed the study. While the study was not powered to detect differences between experimental and control groups, the experimental group reported larger reductions in depression at 3 (<i>P</i> = .11) and 9 months (<i>P</i> = .045) postworkshop. Experimental group participants also reported greater reductions in anxiety at 3 (<i>P</i> < .01) and 9 months (<i>P</i> = .14) postworkshop than control participants.</p><p><p><b>Conclusion:</b> Recruiting and retaining participants in an RCT of PHN-delivered 1-day CBT-based workshops is feasible. Pilot results suggest that workshops may lead to improvements in PPD up to 9 months postworkshop. As this pilot study was not powered to detect differences in clinical outcomes, these findings warrant exploration in a full scale RCT.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT05314361.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Association of Defense Mechanisms With Common Psychiatric Disorders: A National Study.","authors":"Carlos Blanco, Leonie Kampe, Melanie M Wall, Shuai Wang, Eve Caligor, Mark Olfson","doi":"10.4088/JCP.24m15582","DOIUrl":"https://doi.org/10.4088/JCP.24m15582","url":null,"abstract":"<p><p><b>Objective:</b> Although defense mechanisms are central concepts in psychiatry, whether individual disorders (or categories of disorders) are associated with a specific profile of defense mechanisms or whether defense mechanisms are general markers of severity of psychopathology is unknown.</p><p><p><b>Methods:</b> We drew on data from the National Epidemiological Survey on Alcohol and Related Conditions (N = 43,093) to investigate associations of 12 pathological defense mechanisms with mood, anxiety, and substance use disorders. Logistic regressions were fit with mental disorders as predictors, defense mechanisms as outcomes, and respondent age, sex, and race/ethnicity as covariates.</p><p><p><b>Results:</b> Compared to individuals with no disorders, those with mood, anxiety, or substance use disorders generally had a higher prevalence of defense mechanisms. Specifically, the prevalence of any pathological mechanism was 30.0% (95% CI, 29.4%-30.7%) for individuals with no disorders, 67.6% (95% CI, 65.9%-69.2%) for individuals with mood disorders, 62.8% (95% CI, 61.3%-64.2%) for individuals with anxiety disorders, and 49.8% (95% CI, 48.7%-51.0%) for individuals with substance use disorders. Broad diagnostic categories or individual psychiatric disorders were not associated with specific defense profiles.</p><p><p><b>Conclusion:</b> Our findings suggest that defense mechanisms and psychiatric disorders represent correlated but different dimensions of psychopathology, which may respond to different treatment approaches.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Treatment-Resistant Depression Consultation Program, Part I: Practical and Logistical Considerations.","authors":"Vitaliy L Voytenko, Susan K Conroy, Anna R Docherty, Diana K Burnett, Joao Quevedo, Michael J Flood, Patricio Riva Posse, Subhdeep Virk, Jesse H Wright, William V Bobo, Jay C Fournier, Sagar V Parikh","doi":"10.4088/JCP.24cs15335","DOIUrl":"https://doi.org/10.4088/JCP.24cs15335","url":null,"abstract":"<p><p><b>Objective:</b> To provide recommendations for creating and sustaining a treatment-resistant depression (TRD) consultation program at an academic health center. This is a complementary manuscript to Part II, which discusses critical elements of the assessment package for such subspecialized consultations.</p><p><p><b>Participants:</b> Participants were a working group of 12 clinicians, researchers, administrators, and patient advocates from the National Network of Depression Centers (NNDC) TRD Task Group.</p><p><p><b>Evidence:</b> The recommendations are based on expert opinion. TRD consultation programs can offer an individualized treatment roadmap to be implemented by the patient and their providers with the goal of maximizing the likelihood of response or full remission of symptoms. However, there is currently no published work addressing the practical and logistical considerations for establishing such programs. This consensus statement puts forth a set of recommendations that could serve as a basis for future empirical work.</p><p><p><b>Consensus Process:</b> Members of the working group provided written descriptions of relevant procedures used at their institutions, which were used during a day-long in-person forum to achieve consensus on recommendations for each major aspect of a TRD consultation program. Subgroups were formed to draft recommendations, and points of disagreement were resolved at subsequent meetings of the full working group.</p><p><p><b>Conclusions:</b> We describe key practical considerations, including systems-level and financial issues; equity and access to TRD care for a diverse patient population; selecting a target population and facilitating the referral process; the product of the consultation; communication between the program, patient, and community providers; and postconsultation care and contact.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvements Over Time with Valbenazine in Elderly Adults (≥65 Years) with Tardive Dyskinesia: Post Hoc Analyses of 2 Long-Term Studies.","authors":"Martha Sajatovic, George S Alexopoulos, Eric Jen, Khody Farahmand, Celia Zinger","doi":"10.4088/JCP.24m15550","DOIUrl":"10.4088/JCP.24m15550","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the long-term effects of once-daily valbenazine (40 or 80 mg) on tardive dyskinesia (TD) in elderly adults (age ≥65 years).</p><p><p><b>Methods:</b> Data were pooled from two 48-week studies, KINECT 3 extension (NCT02274558) and KINECT 4 (NCT02405091), with analyses performed over time in elderly participants (≥65 years) and at Week 48 by age group (<65 and ≥65 years). Outcomes included mean change in Abnormal Involuntary Movement Scale (AIMS) total score, AIMS response thresholds (≥30% and ≥50% improvement from baseline), and response threshold for Clinical Global Impression of Change-TD (CGI-TD) and Patient Global Impression of Change (PGIC), defined as a score ≤2 (\"much improved\" or \"very much improved\"). Safety assessments included treatment-emergent adverse events (TEAEs) and psychiatric symptom scales (eg, Positive and Negative Syndrome Scale).</p><p><p><b>Results:</b> Of the pooled analysis population (N = 304), 55 (18.1%) were ≥65 years of age. The mean change from baseline in AIMS total score (±standard error) in the ≥65-year age group increased from Week 8 (-4.5 ± 0.7; first visit after dose escalation in KINECT 4) through Week 48 (-8.8 ± 0.9). These robust and sustained improvements were consistent with the percentage who met response thresholds at Weeks 8, 24, and 48: AIMS ≥30% improvement (58.0%, 88.5%, and 89.3%); AIMS ≥50% improvement (40.0%, 65.4%, and 82.1%); CGI-TD score ≤2 (33.3%, 88.5%, and 92.9%); and PGIC score ≤2 (43.1%, 84.6%, and 85.7%). The most common TEAEs among elderly participants were urinary tract infections (10.9%) and somnolence (10.9%). Psychiatric status remained stable during the studies.</p><p><p><b>Conclusion:</b> Valbenazine was safe and effective in elderly adults who received up to 48 weeks of treatment. Long-term treatment led to substantial and sustained TD improvements per clinician assessment (AIMS, CGI-TD) and patient report (PGIC), with no impact on psychiatric stability.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}