Journal of Clinical Psychiatry最新文献

{"title":"The Prescriber's Guide to Oral Ketamine for Patients With Major Depressive Illness: Principles and Practice.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.26f16110","DOIUrl":"https://doi.org/10.4088/JCP.26f16110","url":null,"abstract":"<p><p>Ketamine can be administered in more than a dozen different ways for on-label and off-label indications. Oral ketamine, administered as a liquid repurposed from ketamine for injection, is one way in which ketamine is used to treat depression and chronic pain. Such repurposing may seem unorthodox but has been reported for at least the past 3 decades from many countries, including Canada, England, India, Israel, Japan, New Zealand, and the United States. Oral ketamine, thus administered, is noninvasive, and a safe and inexpensive option for medical practitioners who treat severe, suicidal, and/or treatment-resistant depression. It is safe because, when administered as a liquid in a glass of water or fruit juice, it can be sipped across 20-30 min; treatment-emergent dissociative, neurological, and other psychophysiological effects are thereby minimized. It is inexpensive because there are no costs associated with patented formulations, hospitalization, monitoring facilities, and additional personnel. Because of its simplicity, safety, and inexpensiveness, oral ketamine represents an opportunity for low-resource settings, especially in low- and middle-income countries. This article is intended to be a teaching article. It presents a brief theoretical background to the use of ketamine in the treatment of depression, justifies oral ketamine as an alternative to intranasal and intravenous routes of administration, explains clinical contexts in which the intervention can be used, and presents a detailed protocol for the use of oral ketamine. Matters considered are fitness for oral ketamine, consenting, facilities required, instructions on how to conduct the session, dosing, monitoring, ending the session, scheduling future sessions, continuation and maintenance therapy, domiciliary use, and many others. Drug interactions and concurrent medications are also discussed. This article is therefore a prescriber's guide to the use of oral racemic ketamine that could, it is hoped, make ketamine available in settings in which it is currently unavailable but needed.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867687","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":"Life's Essential 8 Cardiovascular Health and Suicide Mortality: Findings From a Nationally Representative Cohort in South Korea.","authors":"Seong-Uk Baek, Jin-Ha Yoon","doi":"10.4088/JCP.26m16353","DOIUrl":"https://doi.org/10.4088/JCP.26m16353","url":null,"abstract":"<p><p><b>Objective:</b> Although the \"Life's Essential 8\" (LE8) proposed by the American Heart Association is a useful tool for assessing individuals' lifestyles and cardiovascular health, its relationship with suicidal behavior remains poorly understood. This study analyzed the relationship between LE8 levels and suicide mortality.</p><p><p><b>Methods:</b> This cohort study included 54,382 adults in South Korea who were matched to the National Death Registry between 2007 and 2022. The LE8 score, which ranges from 0 to 100, was calculated using 4 health behaviors and 4 biometric health factors. LE8 levels were classified into poor (0-49), intermediate (50-79), and ideal (80-100). Suicide mortality was defined as death due to intentional self-harm (<i>ICD</i> codes: X60-X84). Cox regressions were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).</p><p><p><b>Results:</b> Among participants, 19.7% (n=10,703), 68.7% (n=37,346), and 11.6% (n=6,333) had ideal, intermediate, and poor LE8 scores, respectively. The median follow-up was 9.67 years, and the suicide mortality rate was 0.28 per 1,000 person-years. Compared with participants with an ideal LE8 score, those with a poor LE8 score had a higher risk of suicide mortality (HR: 2.49, 95% CI: 1.06-5.82), while the association for the intermediate LE8 score was not clear (HR: 1.83, 95% CI: 0.91-3.72). Additionally, among the subdimensions of the LE8 construct, the score for health behaviors had a stronger association with suicide mortality than did the score for biometric health factors.</p><p><p><b>Conclusion:</b> This cohort study found that poor LE8 scores were associated with a higher suicide risk among Korean adults.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867787","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":"Genetically Informed Triangulation Can Strengthen Counseling About Gestational Antidepressant Exposure.","authors":"Zihan Ye, Yibing Ye, Yusheng Zhu","doi":"10.4088/JCP.26lr16590","DOIUrl":"https://doi.org/10.4088/JCP.26lr16590","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867666","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":"Psychotherapy, Pharmacotherapy, and Neuromodulatory Interventions in Operational Definitions of Treatment-Resistant Depression: Reply to De Oliveira Reis et al.","authors":"Matheus G Marques, Mark A Frye, Balwinder Singh","doi":"10.4088/JCP.26lr16517a","DOIUrl":"https://doi.org/10.4088/JCP.26lr16517a","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867748","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":"Psychotherapy and the Operational Definition of Treatment-Resistant Depression.","authors":"Verônica de Oliveira Reis, Antonio E Nardi, Stephanie Zakhour","doi":"10.4088/JCP.26lr16517","DOIUrl":"https://doi.org/10.4088/JCP.26lr16517","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867732","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":"Time Trends in Maternal Attention-Deficit/Hyperactivity Disorder and Medication Use in Pregnancy.","authors":"Sofie Egsgaard, Hilary K Brown, Jonathan Zipursky, Trine Munk-Olsen, Amreen Babujee, Aditi Patrikar, Mindy Lu, Simone N Vigod","doi":"10.4088/JCP.26m16321","DOIUrl":"https://doi.org/10.4088/JCP.26m16321","url":null,"abstract":"<p><p><b>Background:</b> Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized among women of reproductive age. Little is known about time trends in maternal ADHD, and treatment utilization in this group.</p><p><p><b>Methods:</b> We conducted a cross-sectional time series analysis of all obstetrical deliveries in Ontario, Canada, from 2002-2023 (medication data available from 2014). Maternal ADHD was defined by inpatient or outpatient diagnosis within 10 years preconception. Stimulant medication use (amphetamine, dextroamphetamine, lisdexamfetamine, methylphenidate) was assessed via prescription fills in the year before pregnancy, during pregnancy, and stratified by trimester. We described the annual proportions of pregnancies with preconception maternal ADHD diagnoses and stimulant use patterns in this group.</p><p><p><b>Results:</b> Of 2,327,110 included pregnancies, the proportion of pregnancies with maternal ADHD rose from 0.5% to 2.5% from 2002 to 2023. Between 2014 and 2023, stimulant use increased from 21.8% to 39.8% in the year prior to pregnancy and from 10.1% to 20.9% during pregnancy among those with ADHD. Methylphenidate predominated early in the study period, but increases over time were largely driven by lisdexamfetamine. Approximately 75% of those prescribed a stimulant in the year prior to conception discontinued it prior to, or in, the first trimester of pregnancy, with stable time trends.</p><p><p><b>Conclusions:</b> The 4-fold increase in maternal ADHD in pregnancy over a 20-year period and 2-fold increase in the use of stimulant medication before and during pregnancy in this group underline the need for clinical guidance on managing ADHD in pregnancy.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867860","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":"Decades After the NIH Revitalization Act: Persistent Gaps in Diversity of US Antidepressant Trials.","authors":"Mathews Sajan, Ria R Trivedi, Sohail R Daulat, Saren Sall, Francisco A Moreno","doi":"10.4088/JCP.26m16436","DOIUrl":"10.4088/JCP.26m16436","url":null,"abstract":"<p><p></p><p><p><b>Background:</b> Clinical trials for antidepressants inform prescribing practices and clinical guidelines, but the demographic composition of the trial participants affects the generalizability. For this reason, the sex, race, and ethnicity reporting and participant composition in US antidepressant trials must be investigated.</p><p><p><b>Methods:</b> We searched ClinicalTrials.gov for completed US antidepressant trials conducted between January 1, 1993, and September 1, 2025. Data on trial characteristics and the reporting of sex, race, and ethnicity were extracted (n=166 trials). Normality of the observed trial-level sex distributions was assessed using the Shapiro-Wilk test. Paired <i>t</i> tests or Wilcoxon signed-rank tests were conducted to assess representation adequacy compared to annual state census data.</p><p><p><b>Results:</b> Sex was reported by 90.36% of trials, race by 39.16%, and ethnicity by 33.13%. Across trials reporting race or ethnicity, pooled participant proportions showed underrepresentation of Asian (4.13% vs 5.67% census, <i>P</i><.001), American Indian/Alaska Native (AIAN, 0.44% vs 0.89%, <i>P</i><.001), multiracial (1.90% vs 2.26%, <i>P</i>=.031), and Hispanic/Latino participants (12.42% vs 17.20%, <i>P</i><.001). Across trials, female participants accounted for 58.27% of participants, which was significantly higher than the state-level benchmark but significantly lower than the benchmark female proportion among antidepressant users (<i>P</i><.001).</p><p><p><b>Conclusions:</b> Reporting gaps persist and multiple minority racial/ethnic groups remain underrepresented in US antidepressant trials, limiting generalizability. Clearer reporting standards and targeted recruitment strategies are needed.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867580","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 Relative Infant Dose for Maternal Use of Drugs During Breastfeeding: Nuances in Derivation, Interpretation, and Application.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.26f16563","DOIUrl":"10.4088/JCP.26f16563","url":null,"abstract":"<p><p>Medications used by lactating mothers appear in breast milk to varying extents and are ingested by the breastfed infant. The degree of exposure of infants to maternal medication is therefore a matter of concern. Key clinical considerations are the absolute exposure of the infant to the drug, the infant's age and capacity to metabolize the drug, and the possible effects of drug exposure in the infant. In this context, the relative infant dose (RID) is a useful construct that helps predict infant exposure without requiring infant blood sampling. By definition, the RID estimates the dose of drug that a breastfed infant ingests per day relative to the dose that the mother receives per day; dosing is standardized per kg body weight, and breast milk intake is standardized at 150 mL/kg/d. A drug with an RID that is <10% is conventionally considered to be compatible with breastfeeding; however, this interpretation is nuanced. This article explains the RID using a worked example. Clinically important issues in the derivation, interpretation, and application of the RID are discussed. Matters considered include how maternal weight and infant weight influence the estimated RID, the need to consider active metabolites, and study-related issues such as sample size and breast milk sampling. Special situations examined include intermittent drug dosing and rescue dosing, dosing with drugs that have long half-lives, use of prodrugs or long-acting injections, and use of drugs that may be problematic regardless of dose. Examples of the RID are provided for ketamine and its active metabolite norketamine, lurasidone, and viloxazine. Readers need to be aware that there is more to the RID than just the arbitrary 10% cutoff.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867823","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 of Lithium Use With Suicide and Self-Harm Among Chinese Adolescents and Adults With Bipolar Disorder: A Nationwide Multicenter Retrospective Cohort Study.","authors":"Ni Xu, Xiaozhen Lv, Yutong Deng, Sicheng Huang, Xingchen Hu, Zijia Cui, Yichen Li, Lina Wang, Yanchi Zhang, Ping Sun, Zhonghua Su, Zhijian Yao, Cuixia An, Yanbin Jia, Zuowei Wang, Han Rong, Kangguang Lin, Zongling He, Shaohua Hu, Chuansheng Wang, Jiaqi Bao, Xiangyang Xu, Xin Yu","doi":"10.4088/JCP.25m16219","DOIUrl":"10.4088/JCP.25m16219","url":null,"abstract":"<p><p><b>Objective:</b> Bipolar disorder (BD) greatly increases the risk of suicide. While lithium is recognized for reducing suicide and suicidal behaviors, evidence regarding its association with suicidal ideation remains limited. This study evaluated lithium's association with reduced suicidal ideation and behaviors among adolescents and adults with BD in China.</p><p><p><b>Method:</b> This multicenter, retrospective cohort study included participants aged 12-45 years from 15 psychiatric centers across mainland China who met <i>DSM-IV</i> criteria for BD, recruited between April 19, 2024, and November 30, 2024. Patients receiving lithium for ≥80% of the first 6 months in the preceding year formed the lithium group; those without lithium exposure served as controls. The primary outcome was suicidal ideation assessed by the Columbia-Suicide Severity Rating Scale; secondary outcomes included suicidal behaviors, nonsuicidal self-injury (NSSI), and aggression.</p><p><p><b>Results:</b> Of 603 screened patients, 585 (290 lithium; 295 controls) met inclusion criteria. At 1-year follow-up, lithium use was significantly associated with a lower likelihood of suicidal ideation (adjusted odds ratio [aOR] = 0.57, 95% CI = 0.38-0.86, <i>P</i> = .008) and suicidal behaviors (aOR= 0.60, 95% CI = 0.39-0.90, <i>P</i> = .02). No difference was observed in NSSI, while lithium users reported lower hostility scores (<i>P</i> = .01). Subgroup analyses indicated more pronounced protective associations among females, adults, higher-income individuals, and those without comorbid anxiety, rapid cycling, or predominantly depressive episodes, regardless of psychotic symptoms.</p><p><p><b>Conclusions:</b> Lithium was associated with a 40% lower risk of suicidal ideation and reduced suicidal behaviors in BD. These findings reinforce lithium as a first-line treatment for suicide prevention and highlight its comprehensive antisuicidal role-from lower rates of ideation to fewer behaviors-supporting confident, evidence-based clinical use.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867568","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":"When Do Physical Symptoms After Antidepressant Cessation Reflect Pharmacodynamic versus Non-pharmacodynamic Clinical Phenomena?","authors":"Joseph F Goldberg, M Lynn Crismon, David W Goodman, Manish K Jha, Michael Berk, Leslie Citrome, Rajnish Mago, Roger S McIntyre, A John Rush, Lawrence J Cohen, Anita H Clayton, Mauricio Tohen, Sheldon Preskorn, Michael E Thase, Holly A Swartz, Dan V Iosifescu, Kay Roussos-Ross, Carrie L Ernst, Mark H Rapaport","doi":"10.4088/JCP.26ac16648","DOIUrl":"https://doi.org/10.4088/JCP.26ac16648","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686235","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}