American Journal of Geriatric Psychiatry最新文献

{"title":"A Comparative Analysis of Fatal Outcomes in 5,370 Geriatric Versus 12,254 Nongeriatric Adult Patients: A Clozapine Study in VigiBase","authors":"Jose de Leon M.D. ,&nbsp;Can-Jun Ruan Ph.D. ,&nbsp;Georgios Schoretsanitis M.D., Ph.D. ,&nbsp;Hélène Verdoux M.D., Ph.D. ,&nbsp;Joseph Friedman M.D. ,&nbsp;Emilio J. Sanz M.D., Ph.D. ,&nbsp;Carlos De las Cuevas M.D.","doi":"10.1016/j.jagp.2025.08.010","DOIUrl":"10.1016/j.jagp.2025.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>Fatal outcomes associated with clozapine adverse drug reactions (ADRs) were studied for over/underrepresentation in geriatric patients.</div></div><div><h3>Design, Setting, Participants</h3><div>The worldwide pharmacovigilance database (VigiBase) was studied for fatal outcomes associated with clozapine ADRs from 1974 to January 15, 2023. They included 5,370 geriatric cases (≥65 years) versus 12,254 nongeriatric adult controls.</div></div><div><h3>Measurements</h3><div>Fatal outcomes of clozapine ADRs were ranked by frequency. Over/underrepresentation was determined by comparison with nongeriatric controls using univariate odds ratios (OR), their 95% confidence intervals (CIs) and adjusted ORs after adjusting for major confounders.</div></div><div><h3>Result</h3><div>Respiratory complications likely associated with swallowing impairment led to 1,042 fatal outcomes (19% of all geriatric fatal outcomes and 31% of those with specific information) and was the most overrepresented ADR among the geriatric cases (adjusted OR = 2.53; CI, 2.31–2.78). More than 99% of these 1,042 respiratory fatal outcomes were not explained by agranulocytosis. Agranulocytosis led to only 39 fatal outcomes (0.7% of the geriatric fatal outcomes) and was underrepresented in the geriatric cases (adjusted OR = 0.59; CI, 0.41–0.85). Other underrepresented fatal outcomes were acute cardiac fatal outcomes (adjusted OR = 0.62, CI, 0.59–0.69), myocarditis (adjusted OR = 0.08, CI, 0.03–0.25), completed suicide (adjusted OR=0.14, CI 0.09–0.14) and pulmonary embolism (adjusted OR = 0.37, CI, 0.28–0.49).</div></div><div><h3>Conclusion</h3><div>As hematological monitoring is used in most countries for clozapine, agranulocytosis is very rarely fatal. According to VigiBase, in order to prevent the largest number of deaths in clozapine-treated patients, psychiatrists need to focus on respiratory complications likely associated with swallowing impairment; this is most evident in geriatric patients.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 591-601"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322739","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":"Allostatic Load and Physical Frailty Increase the Risk of Depression Recurrence in Middle-Aged and Older Adults: A Prospective Cohort Study","authors":"Boyue Zhao ,&nbsp;Xin Qi ,&nbsp;Jinyu Xia ,&nbsp;Xinyang Li ,&nbsp;Jingni Hui ,&nbsp;Yifan Gou ,&nbsp;Wenming Wei ,&nbsp;Chuyu Pan ,&nbsp;Dan He ,&nbsp;Jin Feng ,&nbsp;Xuena Yang ,&nbsp;Shiqiang Cheng ,&nbsp;Feng Zhang","doi":"10.1016/j.jagp.2025.07.009","DOIUrl":"10.1016/j.jagp.2025.07.009","url":null,"abstract":"<div><h3>Aims</h3><div>Individuals with prior depressive episodes have a more fragile homeostasis, but the exploration of depression recurrence remains limited. Our study aimed to explore the associations of allostatic load (AL) and frailty with the risk of depression recurrence.</div></div><div><h3>Methods</h3><div>This study included 9,936 individuals from the UK Biobank who reported depression prior to recruitment. AL and frailty were estimated based on 10 biomarkers and 5 indicators, respectively. The outcome was recurrence of depression, determined by International Classification of Diseases (ICD-10) codes based on self-report, inpatient hospital data, primary care, and death records. Cox proportional hazards models were used to assess the prospective association of AL and frailty with the risk for recurrence of depression, and stratified analyses were conducted by gender, age, and Townsend deprivation index (TDI). Additionally, the mediating effect of either AL or frailty on the association of the other with the recurrence of depression was examined.</div></div><div><h3>Results</h3><div>During a median follow-up of 13.19 years, 1,864 individuals with depression experienced recurrence of depression. Compared to those with low AL, individuals with medium (HR: 1.25; 95% CI: 1.11–1.41) and high AL (HR: 1.42; 95% CI: 1.26–1.60) had an increased risk of depression recurrence. Compared to nonfrail individuals, those with prefrailty (HR: 1.43; 95% CI: 1.28–1.59) and frailty (HR: 1.72; 95% CI: 1.48–1.99) had an increased risk of depression recurrence. The stronger effects were observed in women and middle-aged groups. Bidirectional mediation analyses revealed that frailty mediated 22.42% of allostatic load's effect on recurrence risk, while AL mediated 12.27% of frailty's effect.</div></div><div><h3>Conclusion</h3><div>Assessing AL and frailty may help identify individuals at high risk of depression recurrence, with their simultaneous management potentially mitigating this risk.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 462-473"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986920","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":"Agitation in Alzheimer’s Disease as a Qualifying Condition for Medical Cannabis in the United States: A Brief Report on Current Trends","authors":"Erin E. Bonar Ph.D. ,&nbsp;Chiu Yi Tan M.S.W. ,&nbsp;Adam Patyk B.A. ,&nbsp;Lianlian Lei Ph.D. ,&nbsp;Donovan T. Maust M.D., M.S.","doi":"10.1016/j.jagp.2025.06.003","DOIUrl":"10.1016/j.jagp.2025.06.003","url":null,"abstract":"<div><h3>Objectives</h3><div>We assessed state-level access to medical cannabis with Alzheimer’s Disease and related agitation (AD) as a qualifying condition.</div></div><div><h3>Methods</h3><div>In 2024–2025, we examined regulatory agencies’ publicly available online reports regarding medical cannabis, including use specifically for AD.</div></div><div><h3>Results</h3><div>Of 38 states that allow medical cannabis, 19 (50%) allow medical cannabis for AD. AD accounts for &lt;1% of medical cannabis certifications. Some data suggest that AD as a qualifying condition is declining in states that have legalized recreational cannabis use.</div></div><div><h3>Conclusions</h3><div>Despite limited evidence of efficacy supporting medical cannabis for AD, this remains a qualifying condition in 19 states, though it is invoked for a small minority of the population. With increasing medical and recreational cannabis access, there is a need for geriatric clinicians to assess and monitor cannabis use among the growing population of patients with AD across states with varied policies, particularly given decreases in medical program involvement.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 639-644"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546870","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":"Decline of Aging: Aesthetics and Ethics of Care","authors":"George S. Alexopoulos M.D.","doi":"10.1016/j.jagp.2026.01.005","DOIUrl":"10.1016/j.jagp.2026.01.005","url":null,"abstract":"<div><div>Drawing on contemporary phenomenology, existential philosophy, predictive processing models and care ethics, this paper argues that finitude reorganizes both clinical attention and moral salience. Across philosophical traditions from Heidegger, Levinas, Carel, and Butler, beauty and ethics are intensified by transience. What is fragile, passing, and irreplaceable receives heightened attention because it cannot be secured. The paper challenges heroic existential models that consider awareness of death as a stimulus for authenticity, radical freedom, or rebellion. Such models assume a reliable body, an unconstrained agency, and an open future, assumptions undermined by aging. In phenomenology of aging and illness, agency is reconceptualized as dependent on both bodily abilities and external supports rather than the individual’s free choice among stable options. In clinical encounters, attention functions as a mechanism of precision-weighting that shapes the interpretation of clinical information and drives treatment choices. Predictive processing illustrates how diagnostic formulations can act as top-down constraints conferring salience to certain symptoms and undervaluing aspects of the patient’s narrative. Ethics of attention invites clinicians to examine the parts of a clinical encounter to which they allocate salience and remain responsive to patients’ vulnerability, partial persistence, and meaning of relationships. The paper proposes care ethics as a framework that locates moral value not in decisive interventions for restoring autonomy, but in sustained presence and responsiveness. Vulnerability and decline are not failures but conditions that generate shared responsibility. Recognizing temporality as central to aesthetic and moral experience supports an ethics of care attuned to what is transient and human.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 694-700"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145568","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 Independent Effect of Depression on Financial Decision-Making in Older Adults—Commentary","authors":"Dora Kanellopoulos Ph.D. ,&nbsp;Dimitris N. Kiosses Ph.D.","doi":"10.1016/j.jagp.2026.01.008","DOIUrl":"10.1016/j.jagp.2026.01.008","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 447-449"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198326","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":"Electroconvulsive Therapy for Aggression and Agitation in Dementia: A Systematic Review With Exploratory Meta-analytic and Ethical Perspectives","authors":"Sarah Kayser M.D., M.Sc. ,&nbsp;Andreas Fallgatter M.D. ,&nbsp;Florian Funer M.D., M.A.","doi":"10.1016/j.jagp.2026.01.004","DOIUrl":"10.1016/j.jagp.2026.01.004","url":null,"abstract":"<div><div>Aggression and agitation are among the most distressing and treatment-resistant behavioral and psychological symptoms of dementia (BPSD), and conventional pharmacological or behavioral interventions often provide limited benefit and carry substantial risks in frail older adults. We conducted a systematic review in accordance with PRISMA guidelines, searching PubMed, EMBASE and the Cochrane Library through September 24, 2025 for clinical studies of electroconvulsive therapy (ECT) for agitation and/or aggression in dementia, including case reports, case series, observational cohorts, chart reviews and randomized trial protocols. Data on patient characteristics, ECT parameters, outcomes, adverse events and consent procedures were extracted, and exploratory random-effects pooling of clinical response rates was performed. Thirteen studies including 206 patients met inclusion criteria. Across studies, most patients showed clinically relevant improvement, with reported response rates typically between 70% and 90%; exploratory meta-analytic pooling yielded a clinical response proportion of 77.7% confidence interval CI (95% CI 71.0%–83.3%), which remained stable in sensitivity analyses (<em>n</em> ≥ 5: 81.2%, 95% CI 71.7%–88.0%). Improvement usually emerged within 2–4 treatments (median = 3 sessions), and reductions in agitation and aggression were supported by validated instruments such as the Cohen–Mansfield Agitation Inventory (CMAI) and Pittsburgh Agitation Scale (PAS). ECT was generally well tolerated, with mostly mild and transient adverse effects and no reported treatment-related deaths or persistent severe complications. Available evidence suggests that ECT may provide a rapid, effective and relatively safe last-resort option for otherwise refractory aggression and agitation in dementia, but confirmatory prospective and ethically informed controlled studies are needed.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 624-638"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198350","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":"From Cultural Context to System Resilience: Advancing Global Mental Health for Older Adults","authors":"Jie Chen Ph.D.","doi":"10.1016/j.jagp.2025.11.013","DOIUrl":"10.1016/j.jagp.2025.11.013","url":null,"abstract":"<div><div>Population aging worldwide has intensified the need to understand how mental health in later life is shaped by both cultural norms and structural systems. The book <em>Mental Health in Older People Across Cultures</em> underscores the central role of culture in shaping expectations about independence, emotional expression, and family roles, particularly in the context of depression. In this commentary, we build on that foundation by emphasizing system-level resilience as a necessary complement to cultural understanding. Drawing on the SUNSHINE framework, Seniors Uniting Nationwide to Support Health, INtegrated Care, and Evolution, we argue that mental health outcomes emerge from interactions among cultural beliefs, healthcare access, social infrastructure, and broader system capacity. Structural challenges, including fragmented care coordination, multimorbidity, polypharmacy, digital exclusion, and caregiver strain, often intensify cultural vulnerabilities. Depression also contributes to spending differences among older adults, reinforcing the need for whole-person and whole-system approaches. We discuss the potential of Health information technology (HIT) and artificial intelligence to strengthen system-level resilience by improving early identification, medication management, care coordination, and culturally grounded communication. We conclude by calling for system-level measures that reflect cultural variation, structural capacity, and caregiver context, and for applying SUNSHINE across cultures to guide the development of more adaptive and supportive mental health systems for older adults.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 664-668"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322749","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":"Closing the Gap: Telepsychology and Quality of Life in Parkinson’s Disease","authors":"Bhavana Patel D.O.,&nbsp;Gregory M. Pontone M.D., M.H.S.","doi":"10.1016/j.jagp.2025.12.019","DOIUrl":"10.1016/j.jagp.2025.12.019","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 434-436"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097759","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":"Social Cognition and Loneliness in Older Adults: A Population-based Study","authors":"Soyoung Lee M.D. ,&nbsp;Ruopu Song M.S. ,&nbsp;Tiffany F. Hughes Ph.D. ,&nbsp;Erin P. Jacobsen M.S. ,&nbsp;Chung-Chou H. Chang Ph.D. ,&nbsp;Nancy J. Donovan M.D. ,&nbsp;Mary Ganguli M.D., M.P.H.","doi":"10.1016/j.jagp.2025.11.019","DOIUrl":"10.1016/j.jagp.2025.11.019","url":null,"abstract":"<div><h3>Background</h3><div>Social isolation and loneliness represent objective and subjective aspects of low social connection. They are important psychosocial risk factors in late life, associated with poor physical health, cognitive decline, and psychiatric morbidities. Social cognition, the set of cognitive abilities essential for adaptive social interactions, could play a role in social isolation and loneliness, but has not been extensively investigated.</div></div><div><h3>Methods</h3><div>We investigated associations of social cognition with social isolation and loneliness in a large, prospective population-based cohort of older adults, followed for up to 5 years. Social cognition was measured by the Social Norms Questionnaire (SNQ22), measuring awareness of prevailing norms, and the Reading the Mind in the Eyes Test (RMET10), measuring cognitive empathy. Social connection was measured by composite measures of social isolation and loneliness. Cross-sectional linear regression and longitudinal linear mixed-effect models were performed to investigate the associations between social cognition, social isolation, and loneliness, adjusting for demographics, depression, anxiety, and general cognition.</div></div><div><h3>Findings</h3><div>The study included 792 older adults with mean age 74.9 years. Higher social norms awareness, but not cognitive empathy, was cross-sectionally associated with lesser loneliness, adjusting for all covariates, and it also predicted lesser loneliness over time. This association remained significant after adjusting for social isolation. Neither social cognition measure was associated with social isolation.</div></div><div><h3>Interpretation</h3><div>Better awareness of social norms, but not emotional perception and cognitive empathy, was associated with lesser loneliness concurrently and over time. These results warrant further investigation into the mechanisms linking social cognition and loneliness.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 407-418"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847065","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":"You Just Don’t Get It! Social Isolation, Loneliness, and Social Cognition","authors":"Dan G. Blazer M.D., Ph.D.","doi":"10.1016/j.jagp.2025.12.013","DOIUrl":"10.1016/j.jagp.2025.12.013","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 419-421"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097753","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}