Focus (American Psychiatric Publishing)最新文献

{"title":"Advances in Psychopharmacology: What Clinicians Need to Know.","authors":"","doi":"10.1176/appi.focus.26024109","DOIUrl":"10.1176/appi.focus.26024109","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"207-208"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649930","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":"The Evolving Role of Long-Acting Injectable Antipsychotics.","authors":"Jose M Rubio","doi":"10.1176/appi.focus.20250041","DOIUrl":"10.1176/appi.focus.20250041","url":null,"abstract":"<p><p>Continuous antipsychotic treatment is crucial for relapse prevention in schizophrenia. This article reviews the literature comparing long-acting injectable antipsychotics (LAIs) with oral formulations in various outcomes, including relapse prevention, recovery, and mortality reduction. LAIs ensure consistent medication delivery and are increasingly valued especially for patients in the early phase of schizophrenia, in which they help prevent the irreversible consequences of relapse. The reconceptualization of LAIs underscores their role as proactive rather than as last-resort interventions, which positions them as essential tools in early treatment stages. It is vital for clinicians to communicate effectively with patients and their families about the benefits and practicalities of LAIs. Conversations should begin early in treatment to normalize LAI use by addressing potential misconceptions and emphasizing the role of LAIs in maintaining psychiatric stability and reducing hospitalizations. Engaging family members in discussions enhances support networks, which can then aid the patient's adherence to treatment. Clinicians should provide detailed comparisons between available pharmacologic treatment options, including their dosing intervals, administration methods, and side-effect profiles, that are tailored to patient needs and health care settings. Practical considerations such as storage requirements, insurance coverage, and administration logistics must be addressed. By framing LAIs as valuable components of schizophrenia management, particularly in early phases, clinicians can optimize patient adherence and outcomes. This review highlights the growing recognition of the role of LAIs in contemporary mental health care and advocates for their strategic implementation to enhance patient quality of life.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"149-158"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649861","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":"Long-Term Safety and Maintenance of Response With Esketamine Nasal Spray in Participants With Treatment-Resistant Depression: Interim Results of the SUSTAIN-3 Study.","authors":"Naim Zaki, Li Nancy Chen, Rosanne Lane, Teodora Doherty, Wayne C Drevets, Randall L Morrison, Gerard Sanacora, Samuel T Wilkinson, Vanina Popova, Dong-Jing Fu","doi":"10.1176/appi.focus.26024111","DOIUrl":"10.1176/appi.focus.26024111","url":null,"abstract":"<p><p>Patients with treatment-resistant depression (TRD) have higher rates of relapse and pronounced decreases in daily functioning and health-related quality of life compared to patients with major depressive disorder who are not treatment-resistant, underscoring the need for treatment choices with sustained efficacy and long-term tolerability. Adults with TRD who participated in ≥1 of 6 phase 3 \"parent\" studies could continue esketamine treatment, combined with an oral antidepressant, by enrolling in phase 3, open-label, long-term extension study, SUSTAIN-3. Based on their status at parent-study end, eligible participants entered a 4-week induction phase followed by an optimization/maintenance phase, or directly entered the optimization/maintenance phase of SUSTAIN-3. Intranasal esketamine dosing was flexible, twice-weekly during induction and individualized to depression severity during optimization/maintenance. At the interim data cutoff (01 December 2020), 1148 participants were enrolled, 458 at induction and 690 at optimization/maintenance. Mean (median) cumulative duration of maintenance esketamine treatment was 31.5 (37.7) months (totaling 2769 cumulative patient-years). Common treatment-emergent adverse events (≥20%) were headache, dizziness, nausea, dissociation, somnolence, and nasopharyngitis. Mean Montgomery-Åsberg Depression Rating Scale (MADRS) total score decreased during induction, and this reduction persisted during optimization/maintenance (mean [SD] change from the baseline to the endpoint of each phase: induction -12.8 [9.73]; optimization/maintenance +1.1 [9.93]), with 35.6% and 46.1% of participants in remission (MADRS total score ≤12) at induction and optimization/maintenance endpoints, respectively. Improvement in depression ratings generally persisted among participants who remained in maintenance treatment, and no new safety signal was identified during long-term treatment (up to 4.5 years) using intermittent-dosed esketamine in conjunction with daily antidepressant. Appeared originally in <i>Neuropsychopharmacology</i> 2023; 48: 1225-1233.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"212-222"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649880","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":"Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults With Major Depressive Disorder: A Systematic Review and Network Meta-Analysis.","authors":"Andrea Cipriani, Toshi A Furukawa, Georgia Salanti, Anna Chaimani, Lauren Z Atkinson, Yusuke Ogawa, Stefan Leucht, Henricus G Ruhe, Erick H Turner, Julian P T Higgins, Matthias Egger, Nozomi Takeshima, Yu Hayasaka, Hissei Imai, Kiyomi Shinohara, Aran Tajika, John P A Ioannidis, John R Geddes","doi":"10.1176/appi.focus.26024115","DOIUrl":"10.1176/appi.focus.26024115","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double-blind, randomised controlled trials from their inception to Jan 8, 2016. We included placebo-controlled and head-to-head trials of 21 antidepressants used for the acute treatment of adults (≥18 years old and of both sexes) with major depressive disorder diagnosed according to standard operationalised criteria. We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data. We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause). We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with random effects. This study is registered with PROSPERO, number CRD42012002291.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89-2·41) for amitriptyline and 1·37 (1·16-1·63) for reboxetine. For acceptability, only agomelatine (OR 0·84, 95% CrI 0·72-0·97) and fluoxetine (0·88, 0·80-0·96) were associated with fewer dropouts than placebo, whereas clomipramine was worse than placebo (1·30, 1·01-1·68). When all trials were considered, differences in ORs between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability, with wide CrIs on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"252-262"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649943","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":"High Stakes, High Risk: Cannabis Use Among Adolescents With Bipolar Disorder.","authors":"Manpreet K Singh","doi":"10.1176/appi.focus.20260004","DOIUrl":"10.1176/appi.focus.20260004","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"188-190"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649900","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":"Use of Ketamine and Esketamine in the Pediatric Population: Current Evidence and Clinical Applications.","authors":"Thomas Kun Pak, Stephen Kimatian, Graham Emslie, Emine Rabia Ayvaci","doi":"10.1176/appi.focus.20250040","DOIUrl":"10.1176/appi.focus.20250040","url":null,"abstract":"<p><p>Ketamine is a well-established anesthetic agent that is gaining increasing recognition for its diverse therapeutic applications, including the management of chronic pain, refractory status epilepticus, major depressive disorder, and suicidality. Although it has been used clinically since the 1960s, multiple clinical trials with ketamine and esketamine in adults and pediatric populations are ongoing. There has been recent growing interest in ketamine and esketamine for psychiatric conditions in children and adolescents. The clinical use of ketamine is complex, in part because of the numerous available formulations and administration routes. Ketamine has different bioavailability depending on the route of administration: intravenous (100%), intramuscular (64%-93% in adults, 41% in pediatric populations), intranasal (43%-48% in adults, 50% in pediatric populations), sublingual (29%-32%), rectal (25%-30%), epidural (77%), and oral (17%-18%), which is due to extensive first-pass hepatic metabolism. Differences in dosing also produce distinct clinical effects. The challenges associated with ketamine use are further magnified in pediatric populations, for which developmental stage, pharmacokinetics, and neurodevelopmental factors play critical roles in guiding safe and effective treatment. In this review, the authors summarize the pharmacodynamics, pharmacokinetics, adverse effects and contraindications, and clinical applications of ketamine and esketamine among adult and pediatric populations.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"127-139"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650044","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":"The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence.","authors":"Joanna Moncrieff, Ruth E Cooper, Tom Stockmann, Simone Amendola, Michael P Hengartner, Mark A Horowitz","doi":"10.1176/appi.focus.26024112","DOIUrl":"10.1176/appi.focus.26024112","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The serotonin hypothesis of depression is still influential. We aimed to synthesise and evaluate evidence on whether depression is associated with lowered serotonin concentration or activity in a systematic umbrella review of the principal relevant areas of research. PubMed, EMBASE and PsycINFO were searched using terms appropriate to each area of research, from their inception until December 2020. Systematic reviews, meta-analyses and large data-set analyses in the following areas were identified: serotonin and serotonin metabolite, 5-HIAA, concentrations in body fluids; serotonin 5-HT&lt;sub&gt;1A&lt;/sub&gt; receptor binding; serotonin transporter (SERT) levels measured by imaging or at post-mortem; tryptophan depletion studies; SERT gene associations and SERT geneenvironment interactions. Studies of depression associated with physical conditions and specific subtypes of depression (e.g. bipolar depression) were excluded. Two independent reviewers extracted the data and assessed the quality of included studies using the AMSTAR-2, an adapted AMSTAR-2, or the STREGA for a large genetic study. The certainty of study results was assessed using a modified version of the GRADE. We did not synthesise results of individual meta-analyses because they included overlapping studies. The review was registered with PROSPERO (CRD42020207203). 17 studies were included: 12 systematic reviews and meta-analyses, 1 collaborative meta-analysis, 1 meta-analysis of large cohort studies, 1 systematic review and narrative synthesis, 1 genetic association study and 1 umbrella review. Quality of reviews was variable with some genetic studies of high quality. Two meta-analyses of overlapping studies examining the serotonin metabolite, 5-HIAA, showed no association with depression (largest &lt;i&gt;n&lt;/i&gt; = 1002). One meta-analysis of cohort studies of plasma serotonin showed no relationship with depression, and evidence that lowered serotonin concentration was associated with antidepressant use (&lt;i&gt;n&lt;/i&gt; = 1869). Two meta-analyses of overlapping studies examining the 5-HT&lt;sub&gt;1A&lt;/sub&gt; receptor (largest &lt;i&gt;n&lt;/i&gt; = 561), and three meta-analyses of overlapping studies examining SERT binding (largest &lt;i&gt;n&lt;/i&gt; = 1845) showed weak and inconsistent evidence of reduced binding in some areas, which would be consistent with increased synaptic availability of serotonin in people with depression, if this was the original, causal abnormaly. However, effects of prior antidepressant use were not reliably excluded. One meta-analysis of tryptophan depletion studies found no effect in most healthy volunteers (&lt;i&gt;n&lt;/i&gt; = 566), but weak evidence of an effect in those with a family history of depression (&lt;i&gt;n&lt;/i&gt; = 75). Another systematic review (&lt;i&gt;n&lt;/i&gt; = 342) and a sample of ten subsequent studies (&lt;i&gt;n&lt;/i&gt; = 407) found no effect in volunteers. No systematic review of tryptophan depletion studies has been performed since 2007. The two largest and highest quality studies of the SERT gene, one genetic a","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 2","pages":"236-251"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650006","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":"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}

{"title":"Stalking: Unwanted Pursuit and Fear.","authors":"James L Knoll","doi":"10.1176/appi.focus.20250025","DOIUrl":"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}

{"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":"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}