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Threat Assessment: An Approach To Prevent Targeted Violence. 威胁评估：预防针对性暴力的一种方法。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.26024105
Robert A Fein, Bryan Vossekuil, Gwen A Holden
{"title":"Threat Assessment: An Approach To Prevent Targeted Violence.","authors":"Robert A Fein, Bryan Vossekuil, Gwen A Holden","doi":"10.1176/appi.focus.26024105","DOIUrl":"https://doi.org/10.1176/appi.focus.26024105","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640669","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}
引用次数: 0
Stalking: Unwanted Pursuit and Fear. 跟踪：不必要的追求和恐惧。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.20250025
James L Knoll
{"title":"Stalking: Unwanted Pursuit and Fear.","authors":"James L Knoll","doi":"10.1176/appi.focus.20250025","DOIUrl":"https://doi.org/10.1176/appi.focus.20250025","url":null,"abstract":"<p><p>De Clérambault Syndrome brought attention to the problem of erotomanic stalkers. Over 100 years later, research has delineated other types of stalkers besides the classic erotomanic type. Before the 1990s, stalking was not clearly recognized as a crime. In the mid-1990s, a surge of valuable research on stalking emerged, resulting in significant advances to the understanding of stalking behaviors and risk assessment. Currently, all 50 states have antistalking statutes. Antistalking laws typically consist of three components: a pattern of unwanted pursuit, an implicit or explicit threat, and an intent to induce fear in the victim. This review covers basic concepts in stalking risk assessment and risk management. The 2023 U.S. Supreme Court ruling in <i>Counterman v. Colorado</i> is discussed, along with its potential to alter many states' legal obligations for the burden of prosecution in stalking cases.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"35-44"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640689","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}
引用次数: 0
Virtual Virtues: Is it Ethical to Search Patients on Social Media? 虚拟美德：在社交媒体上搜索病人是否合乎道德？
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.20250026
Zoya Munsar, Chaden Noureddine, Jacob M Appel
{"title":"Virtual Virtues: Is it Ethical to Search Patients on Social Media?","authors":"Zoya Munsar, Chaden Noureddine, Jacob M Appel","doi":"10.1176/appi.focus.20250026","DOIUrl":"https://doi.org/10.1176/appi.focus.20250026","url":null,"abstract":"<p><p>As social media becomes increasingly intertwined with everyday life, psychiatrists face new ethical challenges when navigating patients' online presence. Although patients' social media can offer valuable collateral information for psychiatrists, especially in high-risk or unclear clinical situations, accessing this content without consent risks undermining trust, breaching boundaries, and introducing bias. To preserve the therapeutic alliance in an evolving digital age, the field of psychiatry must establish clear, ethically grounded guidelines for when and how to engage with patients' social media. The objectives of this article are to explore the ethical, clinical, and legal implications for psychiatrists when accessing patients' social media, and to propose strategies for integrating digital boundaries into psychiatric practice.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"62-64"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640716","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}
引用次数: 0
From Fear to Framework: Toward Understanding of Violence and Mental Illness. 从恐惧到框架：对暴力和精神疾病的理解。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.20250038
Tyler Durns
{"title":"From Fear to Framework: Toward Understanding of Violence and Mental Illness.","authors":"Tyler Durns","doi":"10.1176/appi.focus.20250038","DOIUrl":"https://doi.org/10.1176/appi.focus.20250038","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640764","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}
引用次数: 0
High Stakes: Forming Rapport for Risk Assessment of a Radicalized Individual. 高风险：为激进个体的风险评估形成融洽关系。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.20250039
Dorothy E Stubbe
{"title":"High Stakes: Forming Rapport for Risk Assessment of a Radicalized Individual.","authors":"Dorothy E Stubbe","doi":"10.1176/appi.focus.20250039","DOIUrl":"https://doi.org/10.1176/appi.focus.20250039","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"69-72"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640683","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}
引用次数: 0
Anabolic Androgenic Steroids: Emerging Use Disorder, Mechanisms of Action, and Clinical Considerations for Pharmacotherapy. 合成代谢雄激素类固醇：新出现的使用障碍、作用机制和药物治疗的临床考虑。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-04-04 DOI: 10.1176/appi.focus.20250045
Eric Kutscher, Elena Silverman, Keren Bachi
{"title":"Anabolic Androgenic Steroids: Emerging Use Disorder, Mechanisms of Action, and Clinical Considerations for Pharmacotherapy.","authors":"Eric Kutscher, Elena Silverman, Keren Bachi","doi":"10.1176/appi.focus.20250045","DOIUrl":"https://doi.org/10.1176/appi.focus.20250045","url":null,"abstract":"<p><p>Anabolic androgenic steroids (AAS) are synthetic versions of testosterone that are frequently used as performance-enhancing drugs. Over the past few decades, these drugs have become more popular and readily available through online clinics and retail outlets. At the same time, increasing evidence has demonstrated their addictive potential and the likely emergence of an AAS use disorder. In addition to their impact on reward pathways, which is similar to that of other addictive substances, AAS have an addiction-related unique mechanism involving hormonal dysregulations of the hypothalamic-pituitary-gonadal axis that frequently result in long-term post-use hypogonadism, prompting patients to develop tolerance and continue to use AAS despite harms. In caring for patients with a likely AAS use disorder, a multidisciplinary care team is needed, including professionals in the fields of psychiatry, addiction medicine, and endocrinology, to screen for and treat body or muscle dysmorphia (if present) and hypogonadism, and to mitigate unwanted consequences of AAS use by using primary care and harm-reduction methods.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"168-178"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790893","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}
引用次数: 0
Extremism, Terrorism, and Mental Disorder. 极端主义、恐怖主义和精神障碍。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.20250033
J Reid Meloy
{"title":"Extremism, Terrorism, and Mental Disorder.","authors":"J Reid Meloy","doi":"10.1176/appi.focus.20250033","DOIUrl":"https://doi.org/10.1176/appi.focus.20250033","url":null,"abstract":"<p><p>The nexus between mental disorder and terrorism has long confounded both clinicians and researchers. Data indicate that approximately one-third of lone-actor terrorists will be diagnosed as having a mental disorder on clinical interview, but members of a terrorist group typically have neither more nor less mental disorder diagnoses than the general population. Other notable problems for the psychiatrist are distinguishing between symptoms of mental disorder and extremist beliefs, discerning radicalization and a pathway to violence in a psychiatric patient, and identifying the proximal warning behaviors that suggest a heightened probability of violence toward a targeted individual or group. Steps toward clarification of these various issues through measurement and mitigation of risk are offered.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"53-58"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640675","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}
引用次数: 0
Violence Risk Factors in Psychiatric Populations. 精神科人群中的暴力危险因素。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.20250028
Ashley H VanDercar, Phillip J Resnick
{"title":"Violence Risk Factors in Psychiatric Populations.","authors":"Ashley H VanDercar, Phillip J Resnick","doi":"10.1176/appi.focus.20250028","DOIUrl":"https://doi.org/10.1176/appi.focus.20250028","url":null,"abstract":"<p><p>Over the past 20 years, there has been increasing recognition that certain psychiatric diagnoses increase violence risk. This increase is nuanced, multifactorial, and variable. The risk attributable to serious mental illness accounts for only a small fraction of violent acts. There is much more impact from other risk factors, such as substance misuse. Many such factors increase risk, regardless of psychiatric diagnosis. Some factors are uniquely associated with psychiatric populations, such as a history of suicide attempts, antipsychotic medication nonadherence, and past hospitalizations. This article details recent data on violence risk factors and protective factors for psychiatric populations.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"2-9"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640684","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}
引用次数: 0
Ethical and Legal Aspects of Forensic Psychiatry. 法医精神病学的伦理和法律方面。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.20250034
Jacob M Appel
{"title":"Ethical and Legal Aspects of Forensic Psychiatry.","authors":"Jacob M Appel","doi":"10.1176/appi.focus.20250034","DOIUrl":"https://doi.org/10.1176/appi.focus.20250034","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"65-68"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640706","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}
引用次数: 0
Use of Illicit Substances and Violent Behaviour in Psychotic Disorders: Two Nationwide Case-Control Studies and Meta-Analyses. 精神障碍患者使用非法药物和暴力行为：两项全国性病例对照研究和荟萃分析。
Focus (American Psychiatric Publishing) Pub Date : 2026-01-01 Epub Date: 2026-01-15 DOI: 10.1176/appi.focus.26024106
Jelle Lamsma, Wiepke Cahn, Seena Fazel
{"title":"Use of Illicit Substances and Violent Behaviour in Psychotic Disorders: Two Nationwide Case-Control Studies and Meta-Analyses.","authors":"Jelle Lamsma, Wiepke Cahn, Seena Fazel","doi":"10.1176/appi.focus.26024106","DOIUrl":"https://doi.org/10.1176/appi.focus.26024106","url":null,"abstract":"<p><strong>Background: </strong>Substance use disorder explains much of the excess risk of violent behaviour in psychotic disorders. However, it is unclear to what extent the pharmacological properties and subthreshold use of illicit substances are associated with violence.</p><p><strong>Methods: </strong>Individuals with psychotic disorders were recruited for two nationwide projects: GROUP (<i>N</i> = 871) in the Netherlands and NEDEN (<i>N</i> = 921) in the United Kingdom. Substance use and violent behaviour were assessed with standardized instruments and multiple sources of information. First, we used logistic regression models to estimate the associations of daily and nondaily use with violence for cannabis, stimulants, depressants and hallucinogens in the GROUP and NEDEN samples separately. Adjustments were made for age, sex and educational level. We then combined the results in random-effects meta-analyses.</p><p><strong>Results: </strong>Daily use, compared with nondaily or no use, and nondaily use, compared with no use, increased the pooled odds of violence in people with psychotic disorders for all substance categories. The increases were significant for daily use of cannabis [pooled odds ratio (pOR) 1.6, 95% confidence interval (CI) 1.2-2.0), stimulants (pOR 2.8, 95% CI 1.7-4.5) and depressants (pOR 2.2, 95% CI 1.1-4.5), and nondaily use of stimulants (pOR 1.6, 95% CI 1.2-2.0) and hallucinogens (pOR 1.5, 95% CI 1.1-2.1). Daily use of hallucinogens, which could only be analysed in the NEDEN sample, significantly increased the risk of violence (adjusted odds ratio 3.3, 95% CI 1.2-9.3).</p><p><strong>Conclusions: </strong>Strategies to prevent violent behaviour in psychotic disorders should target any substance use.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 1","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640676","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}
引用次数: 0
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