The Journal of Clinical Psychiatry最新文献

{"title":"A Randomized, Double-Blind, Placebo-Controlled Pilot Trial of the Acute Antisuicidal and Antidepressant Effects of Intranasal (R,S)-Ketamine in Severe Unipolar and Bipolar Depression With and Without Comorbid Alcohol Use Disorder.","authors":"Gregory H Jones, Courtney M Vecera, Ana C Ruiz, Hanjing E Wu, Sophia I McInturff, Maria J Orejarena, Kacy A Smith, Jair C Soares, Carlos A Zarate, Scott D Lane, Rodrigo Machado-Vieira","doi":"10.4088/jcp.23m14974","DOIUrl":"https://doi.org/10.4088/jcp.23m14974","url":null,"abstract":"<b>Objective:</b> Although individuals with a family history of alcohol use disorder (AUD) have a superior antidepressant response to ketamine, outcomes in patients with current AUD remain unclear. This study sought to investigate whether intranasal (IN) racemic (<i>R,S</i>)-ketamine had antisuicidal and antidepressant effects in unipolar and bipolar depression and whether comorbid AUD conferred superior antisuicidal outcomes for patients. <b>Methods:</b> This was a double-blind, randomized, placebo-controlled trial (May 2018 to January 2022) of single administration, fixed-dose (50 mg) IN (<i>R,S</i>)-ketamine (or saline comparator) in unmedicated inpatients meeting <i>Diagnostic and Statistical Manual of Mental Disorders</i>, Fourth Edition, Text Revision, criteria for a current major depressive episode (bipolar or unipolar), with current suicidal ideation (SI) and past attempt. Patients with and without comorbid AUD were enrolled. Change in Scale for Suicide Ideation score was the primary outcome measure, and change in Montgomery-Åsberg Depression Rating Scale score was the secondary outcome measure. <b>Results:</b> No significant group × time effect was noted for SI (<i>F</i> = 1.1, <i>P</i> = .36). A statistical trend toward superior improvement in suicidality was observed in participants with comorbid AUD. The group × time interaction was significant for improvements in depression (<i>F</i> = 3.06, <i>P</i> = .03) and largely unaffected by comorbid AUD or primary mood disorder type. Within the ketamine group, a significant correlation was observed between improvement in depressive symptoms and SI for patients without comorbid AUD (<i>r</i> =0.927, <i>P</i> = .023) that was absent in patients with AUD (<i>r</i> = 0.39, <i>P</i> = .44). <b>Conclusion:</b> IN ketamine induced rapid antidepressant effects compared to placebo but did not significantly alter SI scores. The treatment was well tolerated. Continued investigation with IN ketamine as a practical alternative to current formulations is warranted. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03539887.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140828931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Fully Remote Randomized Trial of Transcranial Alternating Current Stimulation for the Acute Treatment of Major Depressive Disorder","authors":"Philip R. Gehrman, Eric J. Bartky, Curtis Travers, Kyle Lapidus","doi":"10.4088/jcp.23m15078","DOIUrl":"https://doi.org/10.4088/jcp.23m15078","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"89 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of Antipsychotic-Induced Cervical Dystonia Assessed by the Algorithm-Based Rating System.","authors":"Toshiya Inada, Yuta Tanabe, Yuji Fukaya, Kazuyoshi Ogasawara, Nobutomo Yamamoto","doi":"10.4088/jcp.23m14929","DOIUrl":"https://doi.org/10.4088/jcp.23m14929","url":null,"abstract":"Background: The severity of antipsychotic-induced cervical dystonia has traditionally been evaluated visually. However, recent advances in information technology made quantification possible in this field through the introduction of engineering methodologies like machine learning.\u0000Methods: This study was conducted from June 2021 to March 2023. Psychiatrists rated the severity of cervical dystonia into 4 levels (0: none, 1: minimal, 2: mild, and 3: moderate) for 101 videoclips, recorded from 87 psychiatric patients receiving antipsychotics. The Face Mesh function of the open-source framework MediaPipe was employed to calculate the tilt angles of anterocollis or retrocollis, laterocollis, and torticollis. These were calculated to examine the range of tilt angles for the 4 levels of severity of the different types of cervical dystonia.\u0000Results: The tilt angles calculated using Face Mesh for each level of dystonia were 0° ≤ θ < 6° for none, 6° ≤ θ < 11° for minimal, 11° ≤ θ < 25° for mild, and 25° ≤ θ for moderate laterocollis; 0° ≤ θ < 11° for none, 11° ≤ θ < 18° for minimal, 18° ≤ θ <25° for mild, and 25° ≤ θ for moderate anterocollis or retrocollis; and 0° ≤ θ < 9° for none, 9° ≤ θ < 17° for minimal, 17° ≤ θ < 32° for mild, and 32° ≤ θ for moderate torticollis.\u0000Conclusion: While further validation with new cases is needed, the range of tilt angles in this study could provide a standard for future artificial intelligence devices for cervical dystonia.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"51 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140701444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Pain as a Risk Factor for Suicidal Ideation: An Ecological Momentary Assessment Study on Inpatients With Depression With and Without Comorbid Borderline Personality Disorder.","authors":"Ilya Baryshnikov, Tom H Rosenström, Erkki T Isometsä","doi":"10.4088/jcp.23m14926","DOIUrl":"https://doi.org/10.4088/jcp.23m14926","url":null,"abstract":"<b>Objective:</b> Psychological pain (PP) is a potentially important risk factor for suicide. However, its temporal stability and association with suicidal ideation (SI) remain obscure. Whether PP represents a risk factor for SI independently of depression, anxiety, and hopelessness or is more prominent and temporally unstable in patients with depression and borderline personality disorder (BPD) is also unclear. <b>Methods:</b> From November 2020 to December 2022, psychiatric inpatients with depression without (N = 37) and with (N = 30) BPD were recruited to an ecological momentary assessment (EMA) study, wherein their PP, severity of depression, SI, and hopelessness were assessed 3 times daily using visual analog scales. Multilevel regression models were estimated. <b>Results:</b> Altogether, 4,320 EMA observations were collected. PP correlated with hopelessness (<i>r</i> = 0.417), depression (<i>r</i> = 0.339), and anxiety (<i>r</i> = 0.496), but the between-patient variance of PP remained at 1.26 (95% CI, 1.025-1.533) after controlling for these variables. The within-patient variance of PP was associated with SI (β = 0.17 [95% CI, 0.12-0.22]) with a magnitude comparable to hopelessness (β = 0.1 [95% CI, 0.05-0.15]) and depression (β = 0.12 [95% CI, 0.08-0.17]). Patients with depression and BPD reported higher daily PP and SI (<i>P</i> &lt; .001) and a more prominent within-patient variation in PP. <b>Conclusions:</b> In psychiatric inpatients with depression, besides depression and hopelessness, PP represents an independent risk factor for SI, varying within a timescale of days. Depressive patients with BPD may experience more prominent and temporally unstable PP, likely underlying their higher vulnerability to SI.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140587710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serotonin Syndrome and Dextromethorphan Toxicity Caused by Drug-Drug Interaction Between Fluoxetine and Bupropion-Dextromethorphan: A Case Report.","authors":"Michelle Anjali Singh, Devon Johnson","doi":"10.4088/JCP.23cr15139","DOIUrl":"https://doi.org/10.4088/JCP.23cr15139","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"613 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140749632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SSRI Behavioral Activation, the Boxed Bolded Warning, and Neurodevelopmental Disorders.","authors":"Mayank Gupta","doi":"10.4088/JCP.24ac15280","DOIUrl":"https://doi.org/10.4088/JCP.24ac15280","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"240 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure of Pregnancy to Pregestational Diabetes, Gestational Diabetes, and Antidiabetic Medications With Especial Focus on Major Congenital and Cardiac Malformations in Offspring","authors":"Chittaranjan Andrade","doi":"10.4088/jcp.24f15318","DOIUrl":"https://doi.org/10.4088/jcp.24f15318","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140253118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Lurasidone on Social Functioning in Schizophrenia: Post Hoc Analysis of the JEWEL Study.","authors":"Itaru Miura, Fumiya Sano, Reiko Sakaguchi, Keisuke Okamoto, Hidenori Maruyama","doi":"10.4088/jcp.23m14881","DOIUrl":"https://doi.org/10.4088/jcp.23m14881","url":null,"abstract":"<b><i>Objective:</i></b> To evaluate the effects of lurasidone on social functioning in schizophrenia over the course of a 6-week, double-blind, placebo-controlled study and a subsequent 12-week open-label extension study. <b><i>Methods:</i></b> A total of 478 patients with schizophrenia (per <i>DSM-IV-TR</i> criteria) randomized to either lurasidone 40 mg/d (n = 245) or placebo (n = 233) in the initial 6-week double-blind study (initiated May 2016, completed November 2018) were included in the analysis. Longer-term changes were examined in a sample of 146 patients who received lurasidone, and 141 who received placebo, during the 6-week study and received flexibly dosed (40-80 mg/d) lurasidone during the 12-week extension phase. The 4-item Positive and Negative Syndrome Scale (PANSS) prosocial subscale was used to examine changes in social functioning. <b><i>Results:</i></b> At week 6 of the double-blind phase, lurasidone-treated patients had significantly greater improvement on the PANSS prosocial subscale compared to placebo-treated patients (<i>P</i> &lt; .01, effect size at week 6 = 0.33). Significant differences from placebo were also evident at week 2 (<i>P</i> &lt; .05), week 4 (<i>P</i> &lt; .001), and week 5 (<i>P</i> &lt; .01). Across the 12-week extension phase, patients who received lurasidone during both the 6-week double-blind phase and the 12-week open-label phase continued to show successive decreases in scores on the 4-item PANSS prosocial subscale (score change of -3.0 from double-blind baseline to week 6; mean score change of -4.2 from double-blind baseline to week 12 of the extension phase). <b><i>Conclusions:</i></b> In patients with schizophrenia treated with lurasidone, social functioning improved relative to placebo during a 6-week double-blind study and continued to improve over the course of 12 weeks of extension treatment with lurasidone. Effects of lurasidone on social functioning appear to be comparable to what has been reported for other atypical antipsychotics. <b><i>Trial Registration:</i></b> EudraCT Numbers: 2016-000060-42 and 2016-000061-23.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139670383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth Collaborative Care Led by Clinical Pharmacists for People With Psychosis or Bipolar Disorder: A Propensity Weighted Comparison With Usual Psychiatric Care.","authors":"Esti Iturralde, Lisa Fazzolari, Natalie E Slama, Stacey E Alexeeff, Stacy A Sterling, Sameer Awsare, Maria T Koshy, Macy Shia","doi":"10.4088/jcp.23m14917","DOIUrl":"https://doi.org/10.4088/jcp.23m14917","url":null,"abstract":"<b><i>Objective:</i></b> People with psychosis or bipolar disorder (severe and persistent mental illness [SPMI]) are at high risk for poor psychiatric and chronic illness outcomes, which could be ameliorated through improved health care quality. This study assessed whether a telehealth, collaborative care program managed by psychiatric clinical pharmacists (SPMI Population Care) was associated with improved health care quality for adults with SPMI in a large California health system. <b><i>Methods:</i></b> This retrospective cohort study used electronic health record data to compare 968 program enrollees at 6 demonstration sites (Population Care) to 8,339 contemporaneous patients with SPMI at 6 non-program sites (Usual Care). SPMI diagnoses were based on <i>ICD-10-CM</i> diagnostic codes. Primary outcomes were optimal psychotropic medication adherence, guideline-recommended glycemic screening, annual psychiatrist visit, and emergency department use. Difference-in-difference analyses assessed change in outcomes from 12 months pre- to 12 months post-enrollment using overlap weighting with high dimensional propensity scores to balance participant characteristics across groups. Participant data were collected from January 1, 2020, to June 30, 2022. <b><i>Results:</i></b> From pre- to post-enrollment, Population Care was associated with greater achievement of psychotropic medication adherence and glycemic screening (+6 and +9 percentage points), but unexpectedly with a decrease in annual psychiatrist visits (-6 percentage points) and no significant change in emergency department use, relative to Usual Care. More than 75% of Population Care participants attended an intake and ≥ 1 follow-up visits. Participants with psychosis (26% of sample) had similar results as those with bipolar disorder. <b><i>Conclusions:</i></b> Clinical pharmacist-led telehealth collaborative care has potential to improve psychopharmacologic treatment adherence and recommended disease preventive screening for people with psychosis or bipolar disorder.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139670381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Exercise and Health, 5: Sedentary Time, Independent of Health-Related Physical Activity, as a Risk Factor for Adverse Physical Health and Mental Health Outcomes.","authors":"Chittaranjan Andrade","doi":"10.4088/jcp.24f15261","DOIUrl":"https://doi.org/10.4088/jcp.24f15261","url":null,"abstract":"Medical and neuropsychiatric benefits associated with physical exercise and activity are well recognized. It is less well known that time spent in sedentary behaviors, such as television-viewing or sitting at a desk, are associated with adverse health outcomes even after taking into consideration health-related physical activity. Although sedentary behaviors have become common in daily life, people tend to substantially underestimate how sedentary they actually are. The average person spends nearly 10 hours per day in a sedentary state, during leisure activities or work; sedentariness is even greater in persons with major mental illness such as psychosis. This article explains what sedentariness is, why sedentary behaviors are common in daily life, and how sedentariness is defined and assessed. Sedentariness is an important concept in its own right; it is not merely an absence of health-related physical activity. Sedentariness is associated with adverse outcomes in children and adolescents, adults, and older adults. Examples are provided of associations between sedentariness and adverse medical outcomes such as the metabolic syndrome, cardiovascular disease, stroke, and all cause mortality. Examples are also provided of associations between sedentariness and adverse mental health outcomes such as anxiety, depression, and dementia. Importantly, the adverse associations are independent of health-related physical activity; however, higher levels of physical activity may attenuate or offset the adverse effects of sedentariness. It is hoped that this article will encourage readers to reduce sedentary behaviors with a view to improve long-term physical and mental health.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139670382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}