Journal of Clinical Psychiatry最新文献

{"title":"GLP-1 Receptor Agonists and All-Cause Overdose Risk in Veterans With Type 2 Diabetes and Opioid Use Disorder.","authors":"Kevin P Kennedy, Ryan Bremseth-Vining, Kevin G Lynch, Nicholas Reville, Jonathan Zhang, Jasmin Moshfegh, David W Oslin","doi":"10.4088/JCP.25m16212","DOIUrl":"10.4088/JCP.25m16212","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> Overdoses remain a major public health challenge. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been proposed as a treatment for opioid use disorder (OUD) based on preclinical research. Early observational research suggests that GLP-1RAs are associated with reduced opioid overdoses but warrants replication in different patient populations.</p><p><p><b>Methods:</b> This target trial emulation study used Veterans Health Administration (VA) data to include Veterans with a diagnosis of type 2 diabetes mellitus and OUD who initiated semaglutide and tirzepatide or a comparison diabetes medication (insulin, metformin, a sulfonylurea, a sodium-glucose transport 2 (SGLT2) inhibitor, or a dipeptidyl-peptidase 4 [DPP4] inhibitor) between January 1, 2020, and December 31, 2024. Each set of comparison groups was propensity score matched on relevant variables. Cox proportional hazards regression models were used to compare the time to all-cause overdose events in the 12 months after medication initiation.</p><p><p><b>Results:</b> After propensity score matching, semaglutide and tirzepatide were associated with significantly lower risk of all-cause overdose compared to insulin (hazard ratio [HR]=0.32; 95% CI=0.14-0.71; <i>P</i>=.006; n=630) and SGLT2 inhibitors (HR=0.25; 95% CI=0.09-0.68; <i>P</i>=.006; n=432). Semaglutide and tirzepatide were not associated with significantly lower risks than metformin (HR=0.75; 95% CI=0.38-1.45; n=1,016), sulfonylureas (HR=0.82; 95% CI=0.33-1.96; n=710), or DPP4 inhibitors (HR=1.20; 95% CI=0.52-2.78; n=858).</p><p><p><b>Conclusion:</b> Collectively, semaglutide and tirzepatide were associated with lower risk of all-cause overdose compared to insulin and SGLT2 inhibitors, but not metformin, sulfonylureas, or DPP4 inhibitors. These results suggest the possible role of GLP-1RAs in OUD but underscore the need for randomized controlled trials.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Vagus Nerve Stimulation on Suicidal Ideation in Markedly Treatment-Resistant Major Depression: A RECOVER Study Report.","authors":"Vasilis C Hristidis, Victoria De Leon, Andrew D Van Der Vaart, Harold A Sackeim, A John Rush, Scott T Aaronson, Mark T Bunker, Rebecca M Allen, Yvette Sheline, Ziad Nahas, David L Dunner, Britt M Gott, Ying-Chieh Lee, Charles Gordon, Quyen Tran, Olivia Shy, João Quevedo, Patricio Riva-Posse, John Zajecka, Brian J Mickey, Walter Duffy, Christopher L Kriedt, Maria A Oquendo, Charles R Conway","doi":"10.4088/JCP.25m16296","DOIUrl":"10.4088/JCP.25m16296","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> To compare effects of adjunctive active versus sham vagus nerve stimulation (VNS) on suicidal ideation (SI) in markedly treatment-resistant depression (TRD).</p><p><p><b>Methods:</b> RECOVER trial participants with nonpsychotic major depressive disorder and insufficient benefit from ≥4 adequate antidepressant trials in the current episode were randomized to adjunctive active or sham VNS plus treatment as usual over 12 months. SI was assessed at baseline and monthly (months 3-12) following VNS parameter titration/ pseudotitration. A composite suicidal ideation (CSI) score (range, 0-9) used SI items from 3 depressive symptom ratings to assess VNS effects on SI for those with (CSI ≥3) and without (CSI ≤2) significant baseline SI.</p><p><p><b>Results:</b> This exploratory study involved a sample (N = 463) who averaged 13.3 failed lifetime antidepressant treatments, with 17.7 years in the current depressive episode; 40.4% had previously attempted suicide. Among individuals with baseline SI, the likelihood of meaningful improvement (CSI score change ≥3) was greater with active than sham VNS (odds ratio [OR] = 1.43; 95% CI, 1.004-2.021; <i>P</i> < .05) over 10 months of evaluation. Additionally, active VNS was superior to sham VNS for SI remission (CSI ≤2) in months 10-12 (OR = 1.67; 95% CI, 1.007-2.763; <i>P</i> < .05). VNS did not significantly worsen SI in participants.</p><p><p><b>Conclusions:</b> This study suggests that, compared to sham VNS, active VNS reduces SI and potentially induces SI remission among participants with chronic TRD and baseline SI. Furthermore, VNS does not appear to worsen or induce SI in participants, regardless of their baseline SI status. Further research is warranted.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03887715.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450355","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":"GLP-1 Receptor Agonists for Non-obese Asian Patients With Schizophrenia: Beyond the Body Mass Index Paradigm.","authors":"Takahiko Nagamine","doi":"10.4088/JCP.26lr16549","DOIUrl":"https://doi.org/10.4088/JCP.26lr16549","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450377","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":"Psychiatrists and Medical Aid in Dying: Entering Uncharted Waters.","authors":"Jacob M Appel","doi":"10.4088/JCP.26com16382","DOIUrl":"10.4088/JCP.26com16382","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363629","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":"Generative AI for the Clinical Psychopharmacologist: Is It Ready for Prime Time?","authors":"Ritvij Satodiya","doi":"10.4088/JCP.26ac16486","DOIUrl":"10.4088/JCP.26ac16486","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363658","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":"Mind and Metabolism in Crisis: US Mortality Involving Obesity and Psychiatric Disorders-Trends, Disparities, and ARIMA Projections.","authors":"Ali Imam Awan, Eslam Elhossieny, Ali Zubair, Muhammad Arham, Nida Waheed, Elizabeth Zharovsky, Haitham Salem","doi":"10.4088/JCP.26m16430","DOIUrl":"10.4088/JCP.26m16430","url":null,"abstract":"<p><p></p><p><p><b>Background:</b> Obesity and psychiatric disorders are major contributors to morbidity and premature mortality in the US and frequently co-occur, yet their joint mortality burden has not been systematically quantified nationally.</p><p><p><b>Methods:</b> We conducted a retrospective population-based study of adults aged ≥25 years using the CDC WONDER Multiple Cause of Death database (1999-2023). Deaths were identified using <i>ICD-10</i> codes for obesity (E66) and psychiatric disorders (F01-F99). Age-adjusted mortality rates (AAMRs) were calculated, and trends were assessed using joinpoint regression to estimate annual percent change (APC). Future trends through 2030 were forecasted using autoregressive integrated moving average (ARIMA) modeling. Sociodemographic and geographic disparities were examined using multivariable Poisson regression, reporting incidence rate ratios (IRRs).</p><p><p><b>Results:</b> A total of 195,180 deaths were identified. AAMRs increased from 6.0 to 82.2 per million between 1999-2021, then declined to 66.6 per million in 2023. The steepest increases occurred in 1999-2005 (APC=+19.2%) and 2018-2021 (APC=+20.6%). Substance use disorders showed the highest burden (AAMR=29.8), followed by mood (2.6), organic (2.2), and psychotic (1.0) disorders. Mortality was higher in males (IRR=1.41) and adults aged 65-74 years (IRR=8.34). Per-capita mortality was highest among American Indian/Alaska Native populations and lowest among Asian individuals (IRR=0.09). ARIMA projected a rebound to 74.2 per million by 2030.</p><p><p><b>Conclusion:</b> Co-occurring obesity and psychiatric disorders are associated with rising and inequitable mortality in the US, underscoring the need for integrated obesity care, metabolic monitoring, and targeted substance use interventions.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363627","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":"Major Depressive Disorder and PTSD Treatment Outcome in Interpersonal Psychotherapy and Prolonged Exposure.","authors":"M Tracie Shea, Mihriye Mete, Bonnie L Green, Janice L Krupnick","doi":"10.4088/JCP.25m16236","DOIUrl":"10.4088/JCP.25m16236","url":null,"abstract":"<p><p><b>Objective:</b> Trauma-focused psychotherapies are first-line treatments for posttraumatic stress disorder (PTSD). For veterans, however, response rates are low, and dropout tends to be high. Some evidence suggests that those with comorbid depression are less likely to complete treatment and improve less in trauma-focused treatments. This study examined treatment noncompletion and PTSD symptom outcomes among veterans with and without comorbid major depressive disorder (MDD) treated for PTSD with either a trauma-focused psychotherapy (prolonged exposure [PE]) or a non-trauma-focused psychotherapy (interpersonal psychotherapy [IPT]). We also examined depressive symptoms as an outcome.</p><p><p><b>Methods:</b> We conducted a secondary analysis of data from a randomized controlled trial comparing PE and IPT for the treatment of PTSD in veterans. Among 109 veterans starting treatment, 30 (52%) of 58 IPT patients and 21 (41%) of 51 PE patients were diagnosed with MDD. Those completing fewer than 8 sessions were considered noncompleters. Outcomes within each treatment and between treatments were compared by MDD status.</p><p><p><b>Results:</b> There were no differences in noncompletion by MDD status in IPT. In PE, failure to complete was numerically but nonsignificantly higher in those without MDD. MDD was associated with significantly less PTSD symptom improvement in PE (<i>P</i>=.04) but not in IPT at the end of treatment. Findings from a linear model incorporating posttreatment follow-up data, although not statistically significant, were consistent with the end-of-treatment findings. Comparisons between treatments among those with MDD showed partial support for an advantage of IPT for PTSD symptom improvement. There were no differences between the treatments in change in symptoms of depression.</p><p><p><b>Conclusions:</b> Findings are consistent with prior research showing that depression is associated with less PTSD symptom improvement in PE, a trauma-focused psychotherapy, but does not affect PTSD outcome in IPT. Although in need of replication in studies designed and statistically powered to test the role of MDD in PTSD treatment outcome, findings suggest a possible advantage for IPT relative to trauma-focused treatment for PTSD for those with comorbid MDD.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCTO2586064.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363684","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 Challenges of PTSD Prevention: Placing Benzodiazepine Use in Context.","authors":"Eric Bui, Naomi M Simon","doi":"10.4088/JCP.26com16516","DOIUrl":"https://doi.org/10.4088/JCP.26com16516","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320319","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":"Posttrauma Benzodiazepine Use and Subsequent PTSD: A Population-Wide Analysis Following Extreme Traumatic Exposure.","authors":"Ofer Rahamim, Aviv Segev, Dana Sinai","doi":"10.4088/JCP.25m16307","DOIUrl":"10.4088/JCP.25m16307","url":null,"abstract":"<p><p><b>Objective:</b> To examine whether benzodiazepine use within 30 days after mass trauma increases posttraumatic stress disorder (PTSD) risk and whether timing or persistence of use modifies this association.</p><p><p><b>Methods:</b> This retrospective cohort study leveraged 3 advantages: large-scale clinical dataset (∼4 million individuals), unprecedented collective exposure to trauma, and novel methodological approach addressing severity bias. Using data from Clalit Health Services (covering ∼54% of the population), we identified 15,570 benzodiazepine-naïve adults who received a new benzodiazepine prescription within 30 days of index date (October 7, 2023). Medication exposure was defined by prescription redemption (none, early ≤7 days, late 8-30 days) and by persistence based on refill behavior. Incident PTSD diagnoses (<i>ICD-10</i> F43.1) were identified over 12 months. Cox proportional hazards models estimated hazard ratios (HRs), adjusting for demographic characteristics and psychiatric history.</p><p><p><b>Results:</b> Overall PTSD incidence was 5.0% (773/15,570). Twelve-month risk was 5.2% for nonpurchasers, 4.7% for early purchasers, and 5.0% for late purchasers. Fully adjusted models showed no increased risk with early (HR=0.98, 95% CI=0.80-1.20) or late (HR=1.11, 95% CI=0.94-1.31) purchase. Persistent users had elevated risk (HR=1.60, 95% CI=1.14-2.25 and HR=2.07, 95% CI=1.60-2.68), whereas discontinued users did not. Among Gaza border residents (n=238), both early (HR=0.52, 95% CI=0.31-0.88) and late (HR=0.62, 95% CI=0.38-0.98) purchasers had lower PTSD risk than nonpurchasers.</p><p><p><b>Conclusions:</b> In this naturalistic setting of mass trauma, short-term benzodiazepine use during 30 days postexposure was not associated with increased 12 month PTSD risk. Among highly trauma-exposed individuals, it was linked to reduced risk at 12 months. These findings challenge current caution against early benzodiazepine use in the immediate aftermath of trauma.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320359","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":"Hallucinogen-Psychosis Associations Are Confounded by Baseline Psychiatric History.","authors":"Jacob T Steinle, Suraj Shankar, Joshua S Siegel, Leopoldo J Cabassa, Danielle R Adams, Patricia Cavazos-Rehg, Arpana Agrawal, Ginger E Nicol, Richard Grucza, Kevin Y Xu","doi":"10.4088/JCP.25m16034","DOIUrl":"10.4088/JCP.25m16034","url":null,"abstract":"<p><p><b>Background:</b> Current drug policy debates often center on whether hallucinogen-related hospital admissions indicate a causal relationship with psychosis. This study examines the extent to which observed associations between hallucinogen use and psychosis are mediated by preexisting psychiatric conditions, providing important evidence for psychedelic policy formulation.</p><p><p><b>Methods:</b> We conducted a retrospective analysis using MarketScan Medicaid and commercial claims databases from 2015-2019. The population-based sample included individuals receiving substance use disorder treatment with documented substance-related emergency admissions or hospitalizations. We compared psychosis-related admissions occurring 30 days to 6 months postindex event between individuals with hallucinogen-related admissions versus those with nonhallucinogen substance-related admissions. Cox regression models adjusted for demographics and clinical characteristics to determine whether prior psychiatric history explained observed associations.</p><p><p><b>Results:</b> Among 273,466 individuals with substance-related admissions, psychosis diagnoses were more prevalent following hallucinogen-related admissions (16.4%) compared to nonhallucinogen substance admissions (6.6%, <i>P</i><.001). While unadjusted models showed increased psychosis risk for hallucinogen-related admissions (hazard ratio [HR]=1.22, 95% CI=1.19-1.25), this association became nonsignificant after adjusting for clinical characteristics (HR=0.97, 95% CI=0.95-1.00).</p><p><p><b>Conclusions:</b> Apparent associations between hallucinogen use and psychosis appear largely attributable to baseline psychiatric comorbidities rather than direct causal effects. These findings carry implications for evidence-based policy development, suggesting that observed epidemiologic associations may reflect underlying vulnerability factors rather than hallucinogen-induced psychosis. Policymakers should consider these results when interpreting population-level data regarding hallucinogen safety profiles and regulatory frameworks.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13296641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}