The American journal of psychiatry最新文献

{"title":"Circadian-Informed Digital Intervention to Prevent Mood Disorder Recurrence: Findings and Questions From a Randomized Controlled Trial.","authors":"Greg Murray, Rebecca Fitton, Ben Bullock","doi":"10.1176/appi.ajp.20260610","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260610","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":"183 9","pages":"608-611"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868959","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":"New Horizons in the Development of Treatments for Substance Use Disorders.","authors":"John J Mariani, Frances R Levin","doi":"10.1176/appi.ajp.20260362","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260362","url":null,"abstract":"<p><p>Substance use disorders (SUDs) are a major public health problem in the United States and cause substantial morbidity and mortality. There are meaningful gaps in the available SUD treatment options, and the development of new therapies is urgently needed. While medications with U.S. Food and Drug Administration approval are available for alcohol, nicotine, and opioid use disorders, there are no approved pharmacotherapies for cannabis, cocaine, or methamphetamine use disorders. Behavioral treatments for SUDs have significant limitations in effectiveness and accessibility, and there is a need for the development of both new behavioral treatment options and new models of treatment delivery. The next generation of treatments for SUDs will likely come from a diverse set of interventions, including new drug classes, new technologies, and new methods of delivery.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":"183 9","pages":"615-623"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868996","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":"New Data Relevant to Treating Substance Use Disorders, Bipolar Disorder, and Pediatric Anxiety Disorders.","authors":"Ned H Kalin","doi":"10.1176/appi.ajp.20260718","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260718","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":"183 9","pages":"599-601"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148869001","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":"Oral Semaglutide for Alcohol Use Disorder: A Randomized Clinical Trial.","authors":"Joseph P Schacht, Joseph T Sakai, Kristen Raymond, Robert Shelton","doi":"10.1176/appi.ajp.20260003","DOIUrl":"10.1176/appi.ajp.20260003","url":null,"abstract":"<p><strong>Objective: </strong>Accumulating preclinical and observational evidence suggests that glucagon-like peptide-1 receptor agonists, including semaglutide, reduce alcohol consumption. This phase 2 double-blind, randomized, parallel-arm trial evaluated the effects of oral semaglutide on alcohol craving and consumption among treatment-seeking adults with alcohol use disorder (AUD).</p><p><strong>Methods: </strong>Fifty individuals with moderate to severe AUD were randomized to receive semaglutide (3 mg/day for 4 weeks, then 7 mg/day for 4 weeks) or placebo for 8 weeks. The primary outcome was laboratory-based alcohol cue-elicited craving at week 6. Key preregistered secondary outcomes were heavy drinking days and drinks per day during the last 4 weeks of treatment. Effects on other alcohol consumption measures, naturalistic alcohol craving, alcohol-related negative consequences, World Health Organization risk drinking level, and cannabis use were also explored.</p><p><strong>Results: </strong>Semaglutide did not significantly reduce laboratory-assessed craving or drinks per day compared with placebo, but significantly reduced heavy drinking days (b=-0.580, 95% CI=-1.012, -0.148). Semaglutide also significantly reduced drinks per drinking day (b=-1.177, 95% CI=-2.307, -0.047), naturalistic alcohol craving (b=-2.195, 95% CI=-4.174, -0.216), and cannabis use days (b=-1.434, 95% CI=-2.568, -0.301). Semaglutide reduced alcohol-related consequences at a significantly greater rate than placebo (b=-4.618, 95% CI=-8.651, -0.585). Significantly more participants in the semaglutide group than the placebo group reduced their risk drinking level by one or more levels (Wald χ²=4.01).</p><p><strong>Conclusions: </strong>These findings confirm previous results among non-treatment seekers with less severe AUD and suggest that continued development of semaglutide for AUD is warranted.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"636-645"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13567346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating Causal Circuits Into Therapeutic Targets.","authors":"Jonathan Downar, Joshua C Brown","doi":"10.1176/appi.ajp.20260710","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260710","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":"183 9","pages":"605-607"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148869022","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":"GLP-1 Receptor Agonists as Potential Treatments for Alcohol Use Disorder.","authors":"Henry R Kranzler, Paige Morris, Leah R Zindel","doi":"10.1176/appi.ajp.20260651","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260651","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":"183 9","pages":"602-604"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868939","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":"Real World, Real Decisions: Treatment of Pediatric Anxiety Disorders.","authors":"Melissa A Brotman","doi":"10.1176/appi.ajp.20260662","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260662","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":"183 9","pages":"612-614"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148869004","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":"Determinants of Nonspecific Response to Treatment in Randomized Controlled Trials of Major Depressive Disorder: A Narrative Review.","authors":"Clotilde Guidetti, Riccardo De Giorgi, Nathan T M Huneke, Franco De Crescenzo, Chiara Zippi, George I Papakostas, Maurizio Fava","doi":"10.1176/appi.ajp.20251233","DOIUrl":"10.1176/appi.ajp.20251233","url":null,"abstract":"<p><p>The design, conduct, and interpretation of double-blind randomized placebo-controlled clinical trials in major depressive disorder (MDD) are complicated by determinants of nonspecific response to treatment (NSRT). This narrative review provides a comprehensive overview of the determinants of NSRT in randomized controlled trials (RCTs) for MDD, including the placebo effect, factors related to measurement of the primary endpoint, the inclusion of misdiagnosed patients, the relapsing-remitting course of MDD, and factors related to functional unblinding. Potential strategies to reduce the impact of the determinants of NSRT and to improve the interpretation of RCT outcomes in MDD are also summarized. These strategies include use of centralized rating and standardized rater training, independent diagnostic confirmation, optimized site selection, minimizing financial incentives, exclusion of subjects participating in multiple clinical trials, exclusion of patients with unstable major depressive episode trajectories, and use of active placebo and alternative trial designs. Uniformity among experts in the definitions of determinants of NSRT and related concepts, as well as in strategies to address them, may facilitate progress in the development of novel treatments for MDD.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"624-635"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612456","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":"Convergence of TMS Sites and Lesion Locations Associated With Nicotine Addiction Improvement on a Common Brain Circuit.","authors":"Sanaz Khosravani, William Drew, Michael R Apostol, Timothy Jordan, Thuc Doan P Ngo, Nicholas Kearley, Edythe D London, Andrew Leuchter, Michael D Fox, Nicole Petersen","doi":"10.1176/appi.ajp.20250855","DOIUrl":"10.1176/appi.ajp.20250855","url":null,"abstract":"<p><strong>Objective: </strong>Transcranial magnetic stimulation (TMS) is cleared by the U.S. Food and Drug Administration for smoking cessation, yet the optimal neuroanatomical stimulation target remains unclear. Lesion locations causally linked to nicotine addiction remission have recently been used to identify a candidate brain circuit; however, this circuit has not yet been tested in relation to TMS outcomes. The authors evaluated whether TMS sites more connected to this lesion-derived brain circuit are associated with greater reductions in nicotine addiction.</p><p><strong>Methods: </strong>Seventy-two participants with tobacco use disorder abstained from smoking for ≥12 hours and received TMS targeting four neuroanatomical regions in the left hemisphere (the dorsolateral prefrontal cortex, superior frontal gyrus, posterior parietal cortex, and visual cortex) across separate sessions, yielding a total of 243 stimulation sites. Nicotine withdrawal was assessed before and after each session using the Shiffman-Jarvik Withdrawal Scale. Functional connectivity between each TMS site and the lesion-based addiction remission circuit was estimated using a normative connectome derived from 1,000 healthy individuals. The authors examined whether TMS site connectivity to this circuit predicted improvements in withdrawal symptoms.</p><p><strong>Results: </strong>TMS site connectivity to the lesion-based addiction remission circuit was significantly associated with percentage improvement in withdrawal symptoms. This relationship remained significant after adjusting for sex, baseline nicotine dependence scores, or both covariates simultaneously. A data-driven TMS circuit for withdrawal improvement closely matched the topography of the lesion-based remission circuit (Pearson's r=-0.74). Integration of lesion and TMS data identified neuroanatomical targets in the frontopolar cortex, posterior parietal cortex, lateral temporal lobe, and superior frontal gyrus.</p><p><strong>Conclusions: </strong>TMS sites and lesion locations associated with nicotine addiction improvement converge on a common brain circuit. This circuit offers a testable target that may enhance therapeutic outcomes in future TMS interventions for nicotine addiction.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"646-656"},"PeriodicalIF":14.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hippocampal Dentate Gyrus Plasticity and Its Association With Dimensional Clinical Improvement Across Four Depression Treatment Interventions.","authors":"Akihiro Takamiya, Ryo Ueda, Kei Kamiya, Miyuki Tajima, Yusuke Kyuragi, Taro Suwa, Takamasa Noda, Fumitoshi Kodaka, Toshiya Murai, Kazuyuki Nakagome, Jinichi Hirano, Masaru Mimura","doi":"10.1176/appi.ajp.20251330","DOIUrl":"https://doi.org/10.1176/appi.ajp.20251330","url":null,"abstract":"<p><strong>Objective: </strong>The hippocampal dentate gyrus (DG) has been proposed as a key site of neuroplasticity underlying antidepressant effects. This study examined longitudinal effects of four standard depression treatment interventions on DG volume and their relationships with dimensional clinical and cognitive outcomes.</p><p><strong>Methods: </strong>This prospective multisite nonrandomized study involved 450 participants: 181 healthy individuals and 269 patients with major depressive disorder who received cognitive-behavioral therapy (CBT, N=106), pharmacotherapy (N=83), repetitive transcranial magnetic stimulation (rTMS, N=39), or electroconvulsive therapy (ECT, N=41). Clinical assessments and structural MRI were obtained at baseline, after a course of treatment (16 weeks for CBT and pharmacotherapy; 6 weeks for rTMS and ECT), and 6 months later. DG volume was set as the primary outcome. Linear mixed-effects models were used to assess treatment effects on DG volume, its long-term trajectories, and its associations with changes in dimensional symptom scores and cognitive function.</p><p><strong>Results: </strong>Across all patients, treatment was associated with a significant increase in DG volume, which was mainly driven by a robust significant increase in the ECT group. Change in DG volume was significantly correlated specifically with improvement in the core depressive symptom dimension, with no associations observed for anxiety, somatic, or insomnia dimensions or any cognitive domains. Long-term analyses revealed a nonlinear increase-decrease DG trajectory that parallelled changes in core depressive symptoms.</p><p><strong>Conclusions: </strong>The results suggest that MRI-detectable DG plasticity is not a shared mechanism of depression treatment interventions but may reflect working mechanisms unique to ECT.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20251330"},"PeriodicalIF":14.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820968","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}