The Journal of Clinical Psychiatry最新文献

{"title":"Nocturnal Wakefulness and Suicide Risk in the Australian Population.","authors":"Darren R Mansfield,&nbsp;Sanjiwika Wasgewatta,&nbsp;Amy Reynolds,&nbsp;Michael A Grandner,&nbsp;Andrew S Tubbs,&nbsp;Kylie King,&nbsp;Michael Johnson,&nbsp;Luis Mascaro,&nbsp;Melodi Durukan,&nbsp;Eldho Paul,&nbsp;Sean P A Drummond,&nbsp;Michael L Perlis","doi":"10.4088/JCP.21m14275","DOIUrl":"https://doi.org/10.4088/JCP.21m14275","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Temporal patterns for suicide over a 24-hour period have shown mixed results among prior studies. However, analyses of 24-hour temporal patterns for wakeful actions including suicidal behavior should adjust for expected sleep requirements that inherently skew such activities to conventional wakeful times. This study analyzed the time-of-day for suicide cases from the Australian population for the year 2017, adjusting for expected sleep patterns. Identification of time-of-day trends using this methodology may reveal risk factors for suicide and potentially modifiable contributors.</p><p><p><b><i>Methods:</i></b> The Australian National Coronial Information System database was accessed, and data for completed suicide were extracted for the most recent completed year (2017). Time of suicide was allocated to one of four 6-hourly time bins across 24 hours, determined from time last seen alive and time found subsequently. Prevalence of suicide for each time bin was adjusted for the likelihood of being awake for each bin according to sleep-wake norms published from a large Australian community survey. Observed prevalence of suicide was compared to expected values predicted from likelihood of being awake across each time bin calculated as a standardized incidence ratio (SIR).</p><p><p><b><i>Results:</i></b> For the year 2017, there were 2,808 suicides, of which 1,417 were able to be allocated into one of four 6-hourly time bins. When compared to expected values, suicides were significantly more likely to occur in the overnight bin (2301-0500; SIR = 3.93, <i>P</i> < .001).</p><p><p><b><i>Conclusions:</i></b> Higher-than-expected rates of suicide overnight associated with nocturnal wakefulness may represent a modifiable risk factor for triggering suicide events.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405349","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":"Early Antidepressant Resistance in Late-Onset Major Depressive Disorder: A Nationwide Population-Based Cohort Study.","authors":"Po-Chun Lin,&nbsp;Ta-Chuan Yeh,&nbsp;Ya-Mei Bai,&nbsp;Ju-Wei Hsu,&nbsp;Kai-Lin Huang,&nbsp;Nai-Ying Ko,&nbsp;Che-Sheng Chu,&nbsp;Hsuan-Te Chu,&nbsp;Shih-Jen Tsai,&nbsp;Tzeng-Ji Chen,&nbsp;Chih-Sung Liang,&nbsp;Mu-Hong Chen","doi":"10.4088/JCP.21m14073","DOIUrl":"https://doi.org/10.4088/JCP.21m14073","url":null,"abstract":"<p><p><b><i>Background:</i></b> The association of treatment resistance with physical and psychiatric comorbidities remains unclear in elderly patients with late-onset major depressive disorder (MDD).</p><p><p><b><i>Methods:</i></b> Participants were selected from the Taiwan National Health Insurance Research Database. We included patients aged ≥ 65 years with first-episode MDD (<i>ICD-9-CM</i> codes: 296.2X and 296.3X) between January 1, 2001, and December 31, 2010. All participants were followed for 1 year to investigate the incidence of treatment resistance. Treatment-resistant depression (TRD) was defined as unresponsiveness to at least 2 antidepressants, and treatment-resistant tendency (TRT) was defined as unresponsiveness to the first antidepressant. Physical comorbidities were assessed with the Charlson Comorbidity Index (CCI).</p><p><p><b><i>Results:</i></b> 27,189 patients with late-onset MDD were included, among whom 16.6% had the diagnosis of anxiety disorders, 1.5% had alcohol use disorders, and 1.6% had substance use disorder. For physical comorbidities, only 16.6% of patients had a CCI score of 0. During the first year of treatment, 22.1% of patients met TRT criteria, and 1.6% developed TRD. Anxiety disorders (odds ratio: 2.06; 95% confidence interval [CI], 1.67-2.53), substance use disorders (2.11; 95% CI, 1.26-3.53), and higher CCI scores (1.06; 95% CI, 1.01-1.10) were significantly associated with TRD, while anxiety disorders (1.44; 95% CI, 1.34-1.55) and higher CCI scores (1.06; 95% CI, 1.05-1.08) were significantly associated with TRT.</p><p><p><b><i>Conclusions:</i></b> Approximately one-fourth of elderly patients responded poorly to the first antidepressant treatment during the first year of late-onset MDD. Psychiatric comorbidities were more associated with the risk of early TRT than were physical comorbidities.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40318322","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, Placebo-Controlled Effectiveness Study of Quetiapine XR in Comorbid Depressive and Anxiety Disorders.","authors":"Nisha Ravindran,&nbsp;Martha McKay,&nbsp;Angela Paric,&nbsp;Sunny Johnson,&nbsp;Ranjith Chandrasena,&nbsp;Gaby Abraham,&nbsp;Arun V Ravindran","doi":"10.4088/JCP.21m14096","DOIUrl":"https://doi.org/10.4088/JCP.21m14096","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Quetiapine is approved as an adjunctive treatment for major depressive disorder (MDD) and as monotherapy for bipolar depression. It is often used off-label for treating anxiety conditions and as an augmentation agent for treatment-resistant depression. However, its benefit in depression with comorbid anxiety disorders has not been systematically evaluated. The current study evaluated the benefit and tolerability of quetiapine as augmentation to first-line antidepressants for MDD comorbid with anxiety disorders.</p><p><p><b><i>Methods:</i></b> In this multicenter trial (June 2008-June 2013), 76 adults (aged 18-65 years) with a primary diagnosis of unipolar depression comorbid with at least 1 anxiety disorder (per <i>DSM-IV-TR</i> criteria) received flexible-dose quetiapine extended-release (XR) 50-300 mg/d or placebo as add-on for 12 weeks in a 2:1 ratio. Depression, anxiety, life satisfaction, and adverse events were assessed.</p><p><p><b><i>Results:</i></b> Depression, anxiety, and function improved significantly in both groups. On primary outcome measures, quetiapine was superior to placebo in improving depression (17-item Hamilton Depression Rating Scale score: mean difference = -3.64; 95% CI, -7.01 to -0.27) and anxiety symptoms (Hamilton Anxiety Rating Scale score: mean difference = -4.02; 95% CI, -7.41 to -0.64), as well as Clinical Global Impressions-Severity of Illness scale score (mean difference = -0.64; 95% CI, -1.13 to -0.15). On secondary measures including the Montgomery-Asberg Depression Rating Scale, Beck Depression Inventory, Penn State Worry Questionnaire, and Quality of Life Satisfaction and Enjoyment Questionnaire, quetiapine produced a greater degree of improvement compared to placebo, but group differences were not statistically significant. Quetiapine was well tolerated, with mostly minor and no serious adverse effects.</p><p><p><b><i>Conclusions:</i></b> Quetiapine augmentation may be a useful intervention for MDD with comorbid anxiety.</p><p><p><b><i>Trial Registration:</i></b> ClinicalTrials.gov Identifier: NCT00688818.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40318323","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":"Antipsychotic Exposure in Clinical High Risk of Psychosis: Empirical Insights From a Large Cohort Study.","authors":"JiaHui Zeng, Andrea Raballo, RanPiao Gan, GuiSen Wu, YanYan Wei, LiHua Xu, XiaoChen Tang, YeGang Hu, YingYing Tang, Tao Chen, ChunBo Li, JiJun Wang, TianHong Zhang","doi":"10.4088/JCP.21m14092","DOIUrl":"10.4088/JCP.21m14092","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Current treatment guidelines for individuals at clinical high risk (CHR) for psychosis do not recommend the prescription of antipsychotics (not even second-generation ones) as the first treatment option for preventing psychosis. Yet, recent meta-analytic evidence indicates that antipsychotic exposure in CHR is relatively widespread and associated with a higher imminent risk of transition to psychosis. Therefore, we undertook this study to better delineate which clinical characteristics of CHR individuals may lead to the choice of antipsychotic prescription and whether it identifies a subgroup at higher risk for conversion to psychosis.</p><p><p><b><i>Methods:</i></b> Consecutively referred CHR individuals (N = 717) were assessed for demographic and clinical characteristics and followed up for 3 years (200 did not reach the end of the follow-up time) from 2016 to 2021. The sample was then dichotomized, on the basis of antipsychotic prescription, to prescribed (CHRAP+, n = 492) or not-prescribed (CHRAP-, n = 225) groups, which were subsequently compared for sociodemographic and clinical characteristics. The risks of conversion to psychosis in CHRAP+ versus CHRAP- groups were tested via survival analysis.</p><p><p><b><i>Results:</i></b> Of the 717 CHR individuals, 492 (68.62%) were prescribed antipsychotics; among these antipsychotics, the highest proportion used was for aripiprazole (n = 152), followed by olanzapine (n = 106), amisulpride (n = 76), and risperidone (n = 64). The CHRAP+ group had younger age (<i>t</i> = 2.138, <i>P</i> = .033), higher proportion of female individuals (<i>χ</i>² = 5.084, <i>P</i> = .024), psychotic symptoms of greater severity (<i>t</i> = 7.910, <i>P</i> < .001), and more impaired general function (<i>t</i> = 5.846, <i>P</i> < .001) than the CHRAP- group. The CHRAP+ group had greater risk for conversion to psychosis (27.0% in the CHRAP+ group vs 10.9% in the CHRAP- group, <i>P</i> < .001). Factors related to positive symptoms were the most likely to influence doctors' decision-making regarding prescripton of antipsychotics, without influence of age, sex, and education levels.</p><p><p><b><i>Conclusions:</i></b> Clinicians may prescribe antipsychotics mainly based on the severity of positive and disorganization symptoms of CHR individuals. The CHRAP+ group was associated with a higher risk of conversion to psychosis. In pragmatic terms, this finding indicates that baseline antipsychotic prescription in CHR cohorts is a warning flag for higher incipient risk of psychosis and designates as hyper-CHR subgroup as compared to antipsychotic-naive CHR.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT04010864.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40318785","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":"Prevalence, Clinical Correlates, Cognitive Trajectories, and Dementia Risk Associated With Mild Behavioral Impairment in Asians.","authors":"Cheuk Ni Kan,&nbsp;Jemellee Cano,&nbsp;Xuhao Zhao,&nbsp;Zahinoor Ismail,&nbsp;Christopher Li-Hsian Chen,&nbsp;Xin Xu","doi":"10.4088/JCP.21m14105","DOIUrl":"https://doi.org/10.4088/JCP.21m14105","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Mild behavioral impairment (MBI) is characterized as later-life-emergent and persistent neuropsychiatric symptoms (NPS). The symptom persistence criterion of MBI has shown to increase the signal-to-noise ratio of the syndrome, decreasing the likelihood of false-positive NPS. However, the long-term cognitive and prognostic impact of MBI remains to be evaluated against the traditional framework of NPS, especially in Asian cohorts. This study investigated the epidemiologic characteristics of MBI in a prospective clinical cohort of Singaporean elderly.</p><p><p><b><i>Methods:</i></b> A total of 304 dementia-free individuals (mean [SD] age = 72.2 [8.0] years, 51.6% female) were recruited between August 2010 and October 2019. All participants underwent annual neuropsychological, neuropsychiatric, and clinical assessments for 4 consecutive years and were diagnosed as having no cognitive impairment (NCI) or cognitive impairment-no dementia (CIND). MBI was ascertained using both baseline and year-1 Neuropsychiatric Inventory assessments. Cognitive <i>Z</i>-scores and Clinical Dementia Rating Sum-of-Boxes (CDR-SoB) scores were calculated.</p><p><p><b><i>Results:</i></b> The prevalence of MBI was 14.5% (7.1% of NCI, 12.9% of CIND-mild, and 24.7% of CIND-moderate patients). MBI patients showed poorer cognitive function at baseline (<i>F</i>_1,295 = 8.13 [SE = 0.47], <i>P</i> = .005), primarily in memory and executive function domains. MBI was associated with accelerated decline in global cognition (<i>β</i> = -0.15; 95% CI, -0.23 to -0.07) along with faster increase in CDR-SoB (<i>β</i> = 0.92; 95% CI, 0.62 to 1.21) as compared to individuals without symptoms or transient NPS. A total of 38.6% of MBI patients developed dementia as compared to 12.3% of non-MBI elderly (χ² = 19.29, <i>P</i> < .001). MBI increased risk of incident dementia by 2.56-fold as compared to no symptoms or transient NPS, regardless of cognitive impairment.</p><p><p><b><i>Conclusions:</i></b> MBI is a neurobehavioral risk factor for dementia, representing a potential target for dementia risk modeling, preventive intervention, and disease management.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33445114","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":"Influence of Care Delivery Models on Quality of Diabetes Care Among Individuals With Schizophrenia.","authors":"Nicole Huang,&nbsp;Po-Sen Wang,&nbsp;Chuan-Yu Chen,&nbsp;Ya-Mei Bai,&nbsp;Yiing-Jenq Chou","doi":"10.4088/JCP.21m13880","DOIUrl":"https://doi.org/10.4088/JCP.21m13880","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Managing chronic conditions in individuals with severe mental illnesses is critical for amending health disparities in this vulnerable group. The study aimed to compare the management and outcomes of diabetes care under different care models in individuals with schizophrenia in Taiwan.</p><p><p><b><i>Methods:</i></b> A population-based retrospective cohort comprising incident cases of diabetes in individuals (N = 9,109) with schizophrenia (<i>ICD-9-CM</i> code 295) in Taiwan between 2008 and 2015 was selected using the National Health Insurance Research Database. Generalized estimating equation (GEE) modeling was used to compare 3 care models: the sole-physician model, the colocation model, and the different-facilities model. Each individual was followed up for 3 years. Propensity score matching was used to address potential selection bias.</p><p><p><b><i>Results:</i></b> Patients in the sole-physician model had the highest number of recommended routine examinations (incident rate ratio [IRR] = 1.2; 95% CI, 1.1-1.2) and the highest likelihood of having regular diabetes-related visits as recommended (odds ratio [OR] = 2.6; 95% CI, 2.1-3.2), followed by those in the colocation model (number of recommended routine examinations: IRR = 1.1; 95% CI, 1.1-1.2; likelihood of regular visits: OR = 1.6; 95% CI, 1.3-1.9) and those in the different-facilities model. However, the sole-physician group had a significantly higher likelihood of admission for diabetes-related ambulatory care sensitive conditions within 1 year (OR = 1.9; 95% CI, 1.3-2.8) and 3 years (OR = 1.6; 95% CI, 1.2-2.1) than its counterparts. Within the sole-physician group, patients of psychiatrists had more favorable disease outcomes than those of non-psychiatrists.</p><p><p><b><i>Conclusions:</i></b> The sole-physician and colocation models may significantly improve the process quality of diabetes care; however, such models alone are not sufficient to improve diabetes outcomes.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33445137","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":"Deimplementation of Benzodiazepine Prescribing in Posttraumatic Stress Disorder in the Veterans Health Administration.","authors":"Nancy C Bernardy,&nbsp;Matthew J Friedman,&nbsp;Brian C Lund","doi":"10.4088/JCP.21m14128","DOIUrl":"https://doi.org/10.4088/JCP.21m14128","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Our objective was to characterize benzodiazepine prescribing changes among veterans with posttraumatic stress disorder (PTSD) and inform efforts to deimplement low-value prescribing practices.</p><p><p><b><i>Methods:</i></b> This retrospective observational study used national Veterans Health Administration (VHA) administrative databases to examine annual period prevalence and incidence of benzodiazepine prescribing from 2009 through 2019 in veterans with PTSD. <i>International Classification of Diseases</i> (<i>ICD-9/10</i>) codes were used to identify PTSD. Temporal trends in discontinuation rates, incidence rates, and prevalent prescribing among patients newly engaged in PTSD care were measured.</p><p><p><b><i>Results:</i></b> Benzodiazepine prevalence in veterans with PTSD declined from 31.3% in 2009 to 10.7% in 2019, and incidence decreased from 11.4% to 2.9%, along with a 30% decrease in daily doses. Increasing discontinuation rates accounted for 21.0% of the decline in prevalence, while decreasing incidence among existing patients accounted for 36.8%, and decreased prevalence among new PTSD cohort entrants accounted for 42.2%. Women received benzodiazepines more commonly than men (odds ratio [OR] = 1.67; 95% CI, 1.64-1.70). The proportion of older adults increased over time among both existing (2009: 14.5%; 2019: 46.5%) and new (2009: 8.6%; 2019: 24.3%) benzodiazepine recipients.</p><p><p><b><i>Conclusions:</i></b> Benzodiazepine prescribing in VHA among veterans with PTSD showed changes driven by decreases in prevalence among new PTSD cohort entrants, with smaller changes in discontinuation and decreased incidence among existing patients. Educational initiatives may have curtailed benzodiazepine prescribing through promotion of effective alternative treatment options and supporting discontinuation through various tapering strategies. These initiatives offer resources and lessons to other health care systems to deimplement inappropriate benzodiazepine prescribing and other potentially harmful practices through patient-centered approaches that promote viable treatment alternatives.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33445238","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 Dimensions of Palliative Care Consultation: Approaches to Seriously Ill Patients at the End of Life.","authors":"Leah B Rosenberg,&nbsp;Anne K Fishel,&nbsp;Rebecca Harley,&nbsp;Theodore A Stern,&nbsp;Linda Emanuel,&nbsp;Jonah N Cohen","doi":"10.4088/JCP.22ct14391","DOIUrl":"https://doi.org/10.4088/JCP.22ct14391","url":null,"abstract":"<p><p>Mental health clinicians often hear seriously ill patients ask the unanswerable: Why did this happen? What is the meaning of my suffering? In the inpatient setting, general medical ward, or oncology unit, patients are confronted with their mortality in new, urgent ways. Palliative medicine, or the specialized, comprehensive care of patients facing a life-limiting illness, occupies a unique and liminal space. Although often practiced by clinicians with non-mental health training backgrounds, there exists ample psychological content to be explored in the palliative care encounter. In this article, we present the case of a husband and international businessperson who experienced terminal complications from an advanced stage lung cancer. His illness was not responsive to multiple cancer-directed treatments, and he developed respiratory failure requiring high levels of supplemental oxygen support, from which he was unable to wean. Palliative care consultation was sought with the multiple objectives of ameliorating his severe death anxiety and persistent dyspnea as well as assisting in the clarification of his end-of-life wishes. Our goal with this case presentation and related discussion is to introduce the psychological aspects of palliative medicine to psychiatrists and psychotherapists.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39805986","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":"Posttraumatic Stress Disorder in US Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study.","authors":"Blair E Wisco,&nbsp;Faith O Nomamiukor,&nbsp;Brian P Marx,&nbsp;John H Krystal,&nbsp;Steven M Southwick,&nbsp;Robert H Pietrzak","doi":"10.4088/JCP.20m14029","DOIUrl":"https://doi.org/10.4088/JCP.20m14029","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The US military veteran population is changing rapidly, and contemporary data on the prevalence of <i>DSM-5</i> posttraumatic stress disorder (PTSD) are lacking. The <i>DSM-5</i> clarified PTSD Criterion A to delineate direct and indirect trauma exposures, but effects on the conditional probability of PTSD and functional impairment remain unknown. The objectives of this study were to provide contemporary estimates of PTSD prevalence and conditional probabilities in the US military veteran population, determine the likelihood of developing PTSD following direct versus indirect exposures to potentially traumatic events (PTEs), and examine the effects of direct and indirect PTEs and PTSD on functional impairment.</p><p><p><b><i>Methods:</i></b> Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), an online survey of a nationally representative sample of US military veterans conducted from November 2019 to March 2020 (median completion date: November 21, 2019). Trauma exposures were assessed with the Life Events Checklist-5 and PTSD with the PTSD Checklist for <i>DSM-5</i>.</p><p><p><b><i>Results:</i></b> The weighted prevalence of lifetime PTSD was 9.4% (95% CI, 8.5%-10.3%) and of past-month PTSD was 5.0% (95% CI, 4.3%-5.7%). Direct PTEs were associated with increased odds of lifetime (odds ratio [OR] = 1.36; 95% CI, 1.30-1.42) and past-month PTSD (OR = 1.38; 95% CI, 1.31-1.46), but indirect PTEs were not (lifetime OR = 1.01; 95% CI, 1.00-1.03; past-month OR = 0.99; 95% CI, 0.97-1.00). Both PTSD (unstandardized B = 6.11, SE = 0.35) and direct PTEs (unstandardized B = 0.13, SE = 0.04), but not indirect PTEs, were significantly associated with functional impairment after adjustment for demographic and psychiatric variables.</p><p><p><b><i>Conclusions:</i></b> The prevalence of lifetime PTSD in US military veterans (9.4%) is slightly higher than 2016 estimates (6.9%-8.1%). Direct and indirect PTEs are prevalent in US military veterans, with only direct PTEs associated with higher conditional probability of past-month PTSD and greater functional impairment.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39805985","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":"Neuropsychiatric Manifestations of Autoimmune Encephalitis in a Tertiary Hospital: A Case Series and Current Perspectives.","authors":"Akriti Sinha,&nbsp;Trenton J Smolik,&nbsp;Kamalika Roy,&nbsp;Pradeep C Bollu","doi":"10.4088/JCP.21nr13920","DOIUrl":"https://doi.org/10.4088/JCP.21nr13920","url":null,"abstract":"<p><p><b><i>Importance:</i></b> <i>Autoimmune encephalitis</i> (AE) refers to a group of neuropsychiatric conditions associated with specific circulating autoantibodies directed against synaptic receptors, neuronal cell surface proteins, and intracellular targets. Increased recognition of these disorders is of value, as affected patients prominently display cognitive impairment, behavioral disturbances, and seizures requiring multidisciplinary teams, with early recognition often impacting prognosis.</p><p><p><b><i>Observations:</i></b> This case series is based on a retrospective record review of adult patients diagnosed with AE between January 1, 2010- January 1, 2020. Cases 1 and 2, demonstrating anti- <i>N</i>-methyl-d-aspartate receptor (NMDAR) encephalitis with initial manifestations of neurologic and psychiatric symptoms, correlate with the literature describing a higher prevalence of this condition in young women. Case 3, despite being seronegative, exhibited classic features of anti-NMDAR encephalitis. Case 4 demonstrates a classic presentation of anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis: a middle-aged male with psychosis, altered mentation, and epilepsy. Case 5 had a more indolent neuropsychiatric presentation with mild elevation of N-type voltage-gated potassium channel (VGKC) antibody. Case 6, with glutamic acid decarboxylase 65 (GAD65) antibody, was an elderly female with speech dysfunction and altered mentation, and case 7 was an elderly male with GAD65 antibody who had stiff-person syndrome, ataxia, cognitive decline, and thymoma.</p><p><p><b><i>Conclusions:</i></b> This retrospective case series describes the clinical details of 7 individuals with AE and overlapping neuropsychiatric symptoms. This series is limited in scope, with a small number of cases and observational findings, which prevents specific conclusions from being drawn. Despite this limitation, the present article explores the nuances of variable presentations of this disease to inform better interdisciplinary management and emphasize the gap areas that need rigorous research.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39804959","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}