The Journal of Clinical Psychiatry最新文献

{"title":"A Comprehensive Model of Predictors of Recurrence or Persistence in Individuals With Panic Disorder: Results From a National 3-Year Prospective Study.","authors":"Valentin Scheer,&nbsp;Frédéric Limosin,&nbsp;Carlos Blanco,&nbsp;Marina Sánchez-Rico,&nbsp;Cédric Lemogne,&nbsp;Caroline Dubertret,&nbsp;Nicolas Hoertel","doi":"10.4088/JCP.20m13778","DOIUrl":"https://doi.org/10.4088/JCP.20m13778","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Multiple factors may influence the risk of recurrence or persistence of panic disorder, suggesting the need to combine them into an integrative model to develop more effective prevention strategies. In this report, we sought to build a comprehensive model of the 3-year risk of recurrence or persistence in individuals with panic disorder using a longitudinal, nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001-2002; Wave 2, 2004-2005).</p><p><p><b><i>Methods:</i></b> We used structural equation modeling to simultaneously examine the effects of 5 broad groups of clinical factors previously identified as potential predictors of recurrence or persistence in adults with a past-year <i>DSM-IV</i> diagnosis of panic disorder (n = 775): (1) severity of panic disorder, (2) severity of comorbidity, (3) family history of psychiatric disorders, (4) sociodemographic characteristics, and (5) treatment-seeking behavior.</p><p><p><b><i>Results:</i></b> The 3-year rates of persistence and recurrence were 13.0% and 27.6%, respectively. A general psychopathology factor, representing the shared effect of all comorbid psychiatric disorders, panic disorder liability, a lower physical health-related quality of life, a greater number of stressful life events, and the absence of treatment-seeking behavior at baseline, significantly and independently predicted recurrence or persistence of symptoms between the two waves (all <i>P</i> < .05).</p><p><p><b><i>Conclusions:</i></b> This integrative model could help clinicians to identify individuals at high risk of recurrence or persistence of panic disorder and provide content for future research.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40555115","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":"Randomized, Double-Blind, Placebo-Controlled, Fixed-Dose Study to Evaluate the Efficacy and Safety of Amphetamine Extended-Release Tablets in Adults With Attention-Deficit/Hyperactivity Disorder.","authors":"Andrew J Cutler,&nbsp;Ann C Childress,&nbsp;Antonio Pardo,&nbsp;Stéphanie Duhoux,&nbsp;Roberto Gomeni,&nbsp;Eman Rafla,&nbsp;Thomas R King,&nbsp;Judith C Kando","doi":"10.4088/JCP.22m14438","DOIUrl":"https://doi.org/10.4088/JCP.22m14438","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To evaluate the efficacy and safety of amphetamine extended-release tablets (AMPH ER TAB) in adults with attention-deficit/hyperactivity disorder (ADHD).</p><p><p><b><i>Methods:</i></b> In a 5-week forced-dose titration phase, subjects were randomized to either oral double-blind AMPH ER TAB 5-mg starting dose or matching placebo, once daily in the morning. Safety and efficacy assessments were completed weekly. After visit 3, subjects received 20 mg for 14 ± 3 days before visit 5. At visit 5, efficacy assessments included the administration of serial Permanent Product Measure of Performance (PERMP) tests predose and at 0.5, 1, 2, 4, 8, 10, 12, 13, and 14 hours postdose. The primary efficacy endpoint was the mean PERMP Total score (PERMP-T) across postdose time points during the visit 5 serial PERMPs. Safety was monitored by adverse events (AEs) assessed at each visit, Columbia Suicide Severity Rating Scale (C-SSRS), vital signs, weight, physical examination, and assessment of sleep, appetite, mood, and psychotic AEs. The study was conducted from February 2019 to October 2019.</p><p><p><b><i>Results:</i></b> Of 130 randomized subjects, 127 were in the intent-to-treat (ITT) population and 91 completed the study. The mean PERMP-T across all postdose time points at visit 5 was statistically significantly higher in the AMPH ER TAB group than in the placebo group (302.8 vs 279.6; <i>P</i> = .0043). Numerical differences favoring AMPH ER TAB were seen at all time points, with statistically significant improvements in the AMPH ER TAB group at 30 minutes and 1, 2, 4, 8, and 13 hours postdose, although the 10-, 12-, and 14-hour time points were not significant. Common AEs included decreased appetite, insomnia, and dry mouth. The majority of treatment-emergent AEs were mild to moderate in severity, and no serious AEs, as defined by the US Food and Drug Administration, were reported.</p><p><p><b><i>Conclusions:</i></b> AMPH ER TAB demonstrated efficacy in treatment of symptoms of ADHD in adults, with an anticipated safety profile.</p><p><p><b><i>Trial Registration:</i></b> ClinicalTrials.gov identifier: NCT03834766.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40607993","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":"Treatment-Resistant Mood Disorders in LGBTQ People: A Retrospective Study of Clinical Features and Response to Electroconvulsive Therapy.","authors":"Fumie Oka,&nbsp;Kamile Weischedel,&nbsp;Amanda Bakian,&nbsp;Brian J Mickey","doi":"10.4088/JCP.21m14321","DOIUrl":"https://doi.org/10.4088/JCP.21m14321","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) experience greater social exclusion and discrimination and higher rates of depression. Little is known about the clinical characteristics or treatment outcomes of LGBTQ people with severe mood disorders. We hypothesized that LGBTQ patients would present with distinct clinical features and that they might respond less favorably to electroconvulsive therapy (ECT).</p><p><p><b><i>Methods:</i></b> We performed a retrospective chart review (2018-2020) of 59 LGBTQ patients and 441 non-LGBTQ patients who received an acute ECT series for treatment-resistant illness (in 95%, a depressive episode by <i>DSM-5</i> criteria). Clinical response was evaluated with the Clinical Global Impression Improvement (CGI-I) scale, self-rated Quick Inventory of Depressive Symptomatology (QIDS-SR), and QIDS-SR suicide item. Inverse probability of treatment weights were applied to regression models to balance baseline confounders.</p><p><p><b><i>Results:</i></b> LGBTQ status was associated with younger age, current suicide ideation, past suicide attempt, self-injurious behavior, posttraumatic stress disorder, personality disorder, tobacco smoking, past substance use disorder, and history of sexual abuse (all <i>P</i> < .05). LGBTQ and non-LGBTQ groups showed no significant differences in CGI-I score (odds ratio = 0.82, 95% CI = 0.48-1.40, <i>P</i> = .47), change in QIDS-SR total score (least-squares mean = -9.2 vs -8.1; <i>F</i>_1,408 = 1.42; <i>P</i> = .24), or change in QIDS-SR suicide item (odds ratio = 1.83, 95% CI = 0.91-3.68, <i>P</i> = .09).</p><p><p><b><i>Conclusions:</i></b> LGBTQ people with treatment-resistant mood disorders presented with distinct clinical features, some of which have been previously linked with less favorable treatment outcomes. Nonetheless, LGBTQ and non-LGBTQ patients experienced similar clinically significant improvement with an acute ECT series. ECT should be considered for treatment-resistant depression regardless of an individual's sexual orientation or gender identity.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40620035","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":"Psychiatric Care Considerations for Sexually and Gender Diverse Populations.","authors":"Alex S Keuroghlian","doi":"10.4088/JCP.22com14579","DOIUrl":"https://doi.org/10.4088/JCP.22com14579","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40607991","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":"The Pursuit to Recognize Bipolar Disorder in Pregnant and Postpartum Women.","authors":"Marlene P Freeman,&nbsp;Joseph F Goldberg","doi":"10.4088/JCP.22ed14399","DOIUrl":"https://doi.org/10.4088/JCP.22ed14399","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40502257","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":"Treatment of Overthinking: A Multidisciplinary Approach to Rumination and Obsession Spectrum.","authors":"Alice Flaherty,&nbsp;Douglas Katz,&nbsp;Anne Chosak,&nbsp;Michael E Henry,&nbsp;Nhi-Ha Trinh,&nbsp;Robert J Waldinger,&nbsp;Jonah N Cohen","doi":"10.4088/JCP.21ct14543","DOIUrl":"https://doi.org/10.4088/JCP.21ct14543","url":null,"abstract":"<p><p>Classic psychiatry patients are rare; real-world patients tend to have overlapping features of multiple disorders. Striving for diagnostic certainty, and treatments aimed at tentative diagnoses, often fail these patients. In such cases, tolerating diagnostic ambiguity and \"treating the symptoms\" can sometimes be transformative. An important symptom, often undertreated in a diagnosis-based approach, is rumination. We present a case study of a woman who, after 20 years of treatment failure, achieved significant symptom relief when her primary complaint-\"labored thinking\"-was targeted specifically. However, because no seriously ill person has only 1 symptom, 6 clinicians from different subdisciplines will discuss the patient's other issues, ones that an overfocus on rumination might leave out.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40481755","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":"Best Practices for Starting Clozapine in Patients With Schizophrenia: How to Switch From the Prior Antipsychotic(s).","authors":"Georgios Schoretsanitis,&nbsp;Jose de Leon","doi":"10.4088/JCP.22ac14500","DOIUrl":"https://doi.org/10.4088/JCP.22ac14500","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40481756","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":"Moderation of Risks to Sexual Health by Substance Use in College Students With ADHD.","authors":"Ashley M Rohacek,&nbsp;Madison K Firkey,&nbsp;Sarah E Woolf-King,&nbsp;Kevin M Antshel","doi":"10.4088/JCP.21m14240","DOIUrl":"https://doi.org/10.4088/JCP.21m14240","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Poor sexual health is a public health concern for college students and individuals with attention-deficit/hyperactivity disorder (ADHD), yet limited information is available on the sexual health of college students with ADHD. Here, the sexual health of college students with and without ADHD was described and moderators of risk to sexual health were identified.</p><p><p><b><i>Methods:</i></b> A secondary data analysis of the National College Health Assessment III (Fall 2019, Spring 2020, and Fall 2020 administrations) was conducted using a sample of sexually active undergraduate students (N = 36,236). Logistic regressions were used to compare sexual behaviors and health outcomes of college students with and without self-reported ADHD and test for interactions between ADHD and substance use-related moderators of risk to sexual health (ie, alcohol use, binge drinking, and cannabis use).</p><p><p><b><i>Results:</i></b> Compared to non-ADHD peers, college students with ADHD reported more past-year sexual partners (adjusted odds ratio [aOR] = 1.27; <i>P</i> < .01), lower rates of condom use (aOR = 0.77; <i>P</i> < .001), and higher rates of condomless sex while drinking (aOR = 1.52; <i>P</i> < .001). College students with ADHD reported more sexually transmitted infection diagnoses (aOR = 1.29; <i>P</i> < .01), a greater number of unplanned pregnancies (aOR = 1.72; <i>P</i> < .001), and more emergency contraception use (aOR = 1.19; <i>P</i> < .001). Alcohol use, binge drinking, and cannabis use moderated the relationship between ADHD and sexual health.</p><p><p><b><i>Conclusions:</i></b> College students with ADHD represent a vulnerable population for poor sexual health and are differentially impacted by substance use. Indicated sexual health prevention strategies and treatment for college students with ADHD are warranted.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40460302","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":"Factors Associated With Remission of Suicidal Ideation During the COVID-19 Pandemic: A Population-Based, Longitudinal Study in US Military Veterans.","authors":"Sarah Herzog,&nbsp;Brandon Nichter,&nbsp;Melanie L Hill,&nbsp;Peter J Na,&nbsp;Sonya B Norman,&nbsp;Robert H Pietrzak","doi":"10.4088/JCP.21br14341","DOIUrl":"https://doi.org/10.4088/JCP.21br14341","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40460305","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":"Toward a Definition of \"No Meaningful Benefit\" From Antidepressant Treatment: An Equipercentile Analysis With Cross-Trial Validation Across Multiple Rating Scales.","authors":"Carl Zhang,&nbsp;Sanya Virani,&nbsp;Taryn Mayes,&nbsp;Thomas Carmody,&nbsp;Paul E Croarkin,&nbsp;Richard Weinshilboum,&nbsp;A John Rush,&nbsp;Madhukar Trivedi,&nbsp;Arjun P Athreya,&nbsp;William V Bobo","doi":"10.4088/JCP.21m14239","DOIUrl":"https://doi.org/10.4088/JCP.21m14239","url":null,"abstract":"<p><p><b><i>Background:</i></b> Many patients with major depressive disorder (MDD) who experience no meaningful benefit (NMB) from antidepressive treatment go undetected. However, there is a lack of consensus on the definition of NMB from antidepressants.</p><p><p><b><i>Methods:</i></b> Equipercentile linking was used to identify a threshold for percent change in 17-item Hamilton Depression Rating Scale (HDRS-17) scores that equated with a Clinical Global Impressions-Improvement (CGI-I) score of 3 (minimally improved), a proxy for NMB, after 4 and 8 weeks of citalopram or escitalopram treatment, using data from the Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS). The NMB threshold for the HDRS-17 was validated by equating a CGI-I rating of 3 with percent change values from the clinician- and patient-rated versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) using data from PGRN-AMPS and phase 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. This study was conducted between June 2021 and September 2021.</p><p><p><b><i>Results:</i></b> In PGRN-AMPS, a 30% improvement in HDRS-17 score corresponded to a CGI-I rating of 3 at 4 and 8 weeks. The 30% improvement threshold was also observed for QIDS-C and QIDS-SR scores in both PGRN-AMPS and STAR*D. Similar results were observed for percent change in HDRS-17 and QIDS-based measures in lower- and higher-severity groups based on a median split of baseline total scores.</p><p><p><b><i>Conclusions:</i></b> Improvement in depressive severity of ≤ 30%, as assessed using the HDRS-17, QIDS-C, and QIDS-SR, may validly define NMB from antidepressants during short-term treatment.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40460306","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}