Focus (American Psychiatric Publishing)最新文献

Cannabis and Cannabinoids in Mood and Anxiety Disorders: Impact on Illness Onset and Course, and Assessment of Therapeutic Potential. 大麻和大麻素在情绪和焦虑障碍：对疾病发病和病程的影响，以及治疗潜力的评估。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.25023010

Sabrina L Botsford, Sharon Yang, Tony P George

{"title":"Cannabis and Cannabinoids in Mood and Anxiety Disorders: Impact on Illness Onset and Course, and Assessment of Therapeutic Potential.","authors":"Sabrina L Botsford, Sharon Yang, Tony P George","doi":"10.1176/appi.focus.25023010","DOIUrl":"https://doi.org/10.1176/appi.focus.25023010","url":null,"abstract":"Background and objectives: Cannabis use is common in people with and mood and anxiety disorders (ADs), and rates of problematic use are higher than in the general population. Given recent policy changes in favor of cannabis legalization, it is important to understand how cannabis and cannabinoids may impact people with these disorders. We aimed to assess the effects of cannabis on the onset and course of depression, bipolar disorder, ADs, and post-traumatic stress disorder (PTSD), and also to explore the therapeutic potential of cannabis and cannabinoids for these disorders.Methods: A systematic review of the literature was completed. The PubMed® database from January 1990 to May 2018 was searched. We included longitudinal cohort studies, and also all studies using cannabis or a cannabinoid as an active intervention, regardless of the study design.Results: Forty-seven studies were included: 32 reported on illness onset, nine on illness course, and six on cannabinoid therapeutics. Cohort studies varied significantly in design and quality. The literature suggests that cannabis use is linked to the onset and poorer clinical course in bipolar disorder and PTSD, but this finding is not as clear in depression and anxiety disorders (ADs). There have been few high-quality studies of cannabinoid pharmaceuticals in clinical settings.Conclusions and scientific significance: These conclusions are limited by a lack of well-controlled longitudinal studies. We suggest that future research be directed toward high-quality, prospective studies of cannabis in clinical populations with mood and ADs, in addition to controlled studies of cannabinoid constituents and pharmaceuticals in these populations.Reprinted from Am J Addict 2020; 29:9-26, with permission from American Academy of Addiction Psychiatry. Copyright © 2019.","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 2","pages":"239-256"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051861","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

Patient Self-Diagnosis: Physician Engagement Tools to Compete With TikTok. 患者自我诊断：与TikTok竞争的医生参与工具。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.20250004

Dorothy E Stubbe

引用次数: 0

Ketamine Versus Electroconvulsive Therapy for the Treatment of Depression: A Guide for Clinicians. 氯胺酮与电惊厥治疗抑郁症：临床医生指南。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.20240040

Sophie I Elliott, Rachel B Katz, Robert B Ostroff, Mina Ansari, Sophie E Holmes, Gerard Sanacora

{"title":"Ketamine Versus Electroconvulsive Therapy for the Treatment of Depression: A Guide for Clinicians.","authors":"Sophie I Elliott, Rachel B Katz, Robert B Ostroff, Mina Ansari, Sophie E Holmes, Gerard Sanacora","doi":"10.1176/appi.focus.20240040","DOIUrl":"https://doi.org/10.1176/appi.focus.20240040","url":null,"abstract":"The effective treatment of major depressive disorder remains one of the biggest public health challenges globally. For moderate to severe cases, pharmacotherapy often falls short, leading to treatment-resistant depression. Electroconvulsive therapy (ECT) has generally been considered the gold standard for severe cases of treatment-resistant depression. However, emerging evidence suggests that ketamine may serve as a promising alternative. Two relatively large noninferiority trials and three meta-analyses support the efficacy of both treatments but report contradictory findings regarding superiority. The authors discuss possible reasons underlying these discrepant findings, including variations in patient selection criteria, study outcome measures, treatment delivery, and site experience. Additionally, the authors examine the unique risk and benefit profiles of each treatment, highlighting patient-specific considerations. By evaluating the most recent evidence for the efficacy of ketamine versus ECT alongside key patient-specific factors, the authors aimed to guide clinicians in recommending the optimal treatment choice for each patient.","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 2","pages":"195-205"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063365","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

Anhedonia as a Transdiagnostic Symptom Across Psychological Disorders: A Network Approach. 快感缺乏作为跨心理障碍的跨诊断症状：网络方法。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.25023012

Melissa G Guineau, N Ikani, M Rinck, R M Collard, P van Eijndhoven, I Tendolkar, A H Schene, E S Becker, J N Vrijsen

{"title":"Anhedonia as a Transdiagnostic Symptom Across Psychological Disorders: A Network Approach.","authors":"Melissa G Guineau, N Ikani, M Rinck, R M Collard, P van Eijndhoven, I Tendolkar, A H Schene, E S Becker, J N Vrijsen","doi":"10.1176/appi.focus.25023012","DOIUrl":"https://doi.org/10.1176/appi.focus.25023012","url":null,"abstract":"Background: Anhedonia is apparent in different mental disorders and is suggested to be related to dysfunctions in the reward system and/or affect regulation. It may hence be a common underlying feature associated with symptom severity of mental disorders.Methods: We constructed a cross-sectional graphical Least Absolute Shrinkage and Selection Operator (LASSO) network and a relative importance network to estimate the relationships between anhedonia severity and the severity of symptom clusters of major depressive disorder (MDD), anxiety sensitivity (AS), attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) in a sample of Dutch adult psychiatric patients (N = 557).Results: Both these networks revealed anhedonia severity and depression symptom severity as central to the network. Results suggest that anhedonia severity may be predictive of the severity of symptom clusters of MDD, AS, ADHD, and ASD. MDD symptom severity may be predictive of AS and ADHD symptom severity.Conclusions: The results suggest that anhedonia may serve as a common underlying transdiagnostic psychopathology feature, predictive of the severity of symptom clusters of depression, AS, ADHD, and ASD. Thus, anhedonia may be associated with the high comorbidity between these symptom clusters and disorders. If our results will be replicated in future studies, it is recommended for clinicians to be more vigilant about screening for anhedonia and/or depression severity in individuals diagnosed with an anxiety disorder, ADHD and/or ASD.Appeared originally in Psychol Med 2023; 53:3908-3919.","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 2","pages":"257-269"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054396","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

Cognitive Deficits in Late-Life Depression: From Symptoms and Assessment to Therapeutics. 老年抑郁症的认知缺陷：从症状、评估到治疗。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.20240046

Antonio L Teixeira, Allison Gregg, Melanie T Gentry, Swathi Gujral, Ellie Rapp, Lauren Oberlin, Olusola Ajilore, Sara Weisenbach, Regan Patrick

{"title":"Cognitive Deficits in Late-Life Depression: From Symptoms and Assessment to Therapeutics.","authors":"Antonio L Teixeira, Allison Gregg, Melanie T Gentry, Swathi Gujral, Ellie Rapp, Lauren Oberlin, Olusola Ajilore, Sara Weisenbach, Regan Patrick","doi":"10.1176/appi.focus.20240046","DOIUrl":"https://doi.org/10.1176/appi.focus.20240046","url":null,"abstract":"Cognitive symptoms and deficits are core features of late-life depression (LLD), with an estimated 20%-50% of affected individuals meeting diagnostic criteria for mild cognitive impairment (MCI). Cognitive deficits, especially executive dysfunction, have consistently been associated with poorer treatment outcomes among people with LLD. Furthermore, distinguishing depression with cognitive complaints or cognitive impairment from the early stages of Alzheimer's disease (AD) can be challenging. Cognitive concerns are often emphasized among those with LLD, although, paradoxically, their description of memory difficulty may include detailed recall of specific memory lapses. Conversely, people with AD often have limited insight into their progressive cognitive decline, minimizing and concealing their cognitive difficulties. Neuropsychological assessment is one of the most useful means of clarifying this differential diagnosis. A subcortical cognitive pattern is commonly observed among people with LLD, including psychomotor slowing, variable attention, and executive dysfunction, which can affect memory encoding and free recall. A broad range of therapeutic approaches have been applied to older adults experiencing LLD along with cognitive symptoms, MCI, or dementia. Most studies focus on treatments to address LLD or MCI, with relatively fewer examining treatments specifically at this intersection. Nonpharmacological strategies, including aerobic exercise, cognitive remediation, and neuromodulation, are highly recommended to improve both depression and cognition. Antidepressants may have benefits for elements of cognition among people with LLD, but they have less evidence for their efficacy for people with cognitive deficits and dementia. This review provides an updated conceptual and practical framework for clinicians evaluating and treating LLD.","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 2","pages":"183-194"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054535","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

Symptom Severity and Treatment Needs Among Racial Groups Seeking Treatment at a Mood Outcomes Program. 在一个情绪结果项目中寻求治疗的种族群体的症状严重程度和治疗需求。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.20240051

Jorge A Sanchez-Ruiz, Jason Straub, Peter P Zandi, Olusola Ajilore, Brandon J Coombes, Stephen M Strakowski, Mark A Frye, Monica J Taylor-Desir

{"title":"Symptom Severity and Treatment Needs Among Racial Groups Seeking Treatment at a Mood Outcomes Program.","authors":"Jorge A Sanchez-Ruiz, Jason Straub, Peter P Zandi, Olusola Ajilore, Brandon J Coombes, Stephen M Strakowski, Mark A Frye, Monica J Taylor-Desir","doi":"10.1176/appi.focus.20240051","DOIUrl":"https://doi.org/10.1176/appi.focus.20240051","url":null,"abstract":"Mood disorders are highly prevalent. Despite increased rates of treatment provision, treatment gaps are sustained by inadequate targeting of interventions and little emphasis on prevention. Here, the authors present an overview and analysis of the National Network of Depression Centers (NNDC) Mood Outcomes Program, which is both a measurement-based care program, with a standardized set of mood \"vital signs\" assessed as part of routine clinical care, and a learning health system. The authors analyzed all data collected since the program's inception in 2015 to assess whether baseline symptom severity, prior suicidal ideation or attempts, length of care, and longitudinal symptom severity differed across sociodemographic groups. The results show important treatment needs that are not being fulfilled. Most notably, the groups with the greatest symptom severity were not the groups with the most visits. Efforts to address systemic barriers that prevent access to mental health care are required. Given that the NNDC Mood Outcomes Program is integrated with clinical care, academic programs, and research at each site, the authors anticipate that the program is well suited to support efforts to dismantle systemic barriers to care.","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 2","pages":"156-162"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063373","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 Evaluating and Treating Mood Disorders. 评估和治疗情绪障碍的伦理和法律方面。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.20240041

Jacob M Appel

引用次数: 0

Evaluating the Machine Learning Literature: A Primer and User's Guide for Psychiatrists. 评估机器学习文献：精神病学家入门和用户指南。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.25023011

Adrienne Grzenda, Nina V Kraguljac, William M McDonald, Charles Nemeroff, John Torous, Jonathan E Alpert, Carolyn I Rodriguez, Alik S Widge

引用次数: 0

Targeted Research and Treatment Implications in Women With Depression. 女性抑郁症的针对性研究和治疗意义。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.20240052

Marie E Gaine, Kathleen M Jagodnik, Ritika Baweja, William V Bobo, Erin C McGlade, Sandra J Weiss, Marissa L Beal, Sharon Dekel, Aysegul Ozerdem

{"title":"Targeted Research and Treatment Implications in Women With Depression.","authors":"Marie E Gaine, Kathleen M Jagodnik, Ritika Baweja, William V Bobo, Erin C McGlade, Sandra J Weiss, Marissa L Beal, Sharon Dekel, Aysegul Ozerdem","doi":"10.1176/appi.focus.20240052","DOIUrl":"https://doi.org/10.1176/appi.focus.20240052","url":null,"abstract":"Women with a history of traumatic experience, particularly adversity encountered during childhood, have an increased risk of developing depression. The authors review the biological mechanisms associating trauma with depression, including the role of the hypothalamic-pituitary-adrenal axis. Additionally, the psychosocial and cultural considerations associating traumatic experience with depression are discussed, and current gaps in knowledge about biological mechanisms, psychosocial factors, and cultural aspects relating trauma to depression that remain to be addressed are described. Women with a history of trauma are also at increased risk for engaging in suicidal behaviors, including suicidal ideation and attempts. Increased suicidality in women with a history of trauma has been observed in various populations, including among victims of intimate partner violence, female veterans, refugees, and individuals who identify as lesbian, gay, bisexual, transgender, queer or questioning, or other. Although associations between trauma and suicidality have been well documented, limited research has examined the impact of age or reproductive stage, an important area for future research. A wide range of biological, psychosocial, and cultural factors that can increase the risk for suicidality across the lifespan in women are described, and how they may be included when completing clinical assessments for women is highlighted. Machine learning, and its use in risk and outcome prediction of depression in women across reproductive stages toward individualized psychiatric services, is introduced, with future directions reviewed.","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 2","pages":"141-155"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031875","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

Early Life Stress and Substance Use Disorders: Underlying Neurobiology and Pathways to Adverse Outcomes. 早期生活压力和物质使用障碍：潜在的神经生物学和不良后果的途径。

Focus (American Psychiatric Publishing) Pub Date : 2025-04-01 Epub Date: 2025-04-15 DOI: 10.1176/appi.focus.25023013

Dylan Kirsch, Charles M Nemeroff, Elizabeth T C Lippard

{"title":"Early Life Stress and Substance Use Disorders: Underlying Neurobiology and Pathways to Adverse Outcomes.","authors":"Dylan Kirsch, Charles M Nemeroff, Elizabeth T C Lippard","doi":"10.1176/appi.focus.25023013","DOIUrl":"https://doi.org/10.1176/appi.focus.25023013","url":null,"abstract":"Early life stress (ELS) has been established as a major risk factor for a multitude of psychiatric and medical disorders. ELS is highly prevalent in the general population and constitutes a major public health concern. The current review will focus on the clinical literature that suggests a link between adverse early life experiences and vulnerability for adolescent and adult substance use disorders. It will investigate the characteristics of ELS that appear to increase risk for disorder onset and a more severe disease course, characterized by earlier onset, greater risk of relapse, and treatment resistance. The authors explore how ELS may increase risk for adverse substance use outcomes through long-lasting changes in the HPA axis and development of stress, reward, and executive control brain systems. The review will also discuss potential pathways to substance use disorder following ELS, with a focus on the role of comorbid mood and anxiety disorders and other modifiable traits. Finally, the authors will discuss how the current body of work presents the potential for prevention and intervention strategies to reduce the psychosocial consequences following early life stress and minimize adverse substance use outcomes. Reprinted from Advers Resil Sci 2020; 1:29-47, with permission from Springer. Copyright © 2020.","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 2","pages":"221-238"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036862","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