Focus (American Psychiatric Publishing)最新文献

{"title":"Smartphone Apps and Digital Tools for Managing Schizophrenia and Psychotic Disorders: A Clinical Review.","authors":"Winna Xia, Christine Hau, Joseph Firth, David Kimhy, John Torous","doi":"10.1176/appi.focus.20250014","DOIUrl":"10.1176/appi.focus.20250014","url":null,"abstract":"<p><p>There is increasing interest in smartphone digital mental health interventions (DMHIs) for managing schizophrenia. Currently, numerous applications (or, apps) that target different specific domains (e.g., medication adherence, social functioning, relapse prediction, and general mental well-being) have been developed and evaluated in research studies; however, few are commercially available to patients. The emergence of DMHIs has also highlighted the critical role of app engagement and the therapeutic alliance in effective treatments. This has driven the adoption of hybrid care models that integrate traditional psychotherapy with smartphone-based tools for symptom monitoring and intervention delivery, such as psychoeducation, cognitive-behavioral therapy for psychosis modules, and other targeted supports. This clinical review examines the current landscape of DMHIs for managing schizophrenia, including research evaluating outcomes related to effectiveness and implementation.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"419-428"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088284","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":"Switching Between Long-Acting Injectable Antipsychotic Medications.","authors":"Megan J Ehret","doi":"10.1176/appi.focus.20250021","DOIUrl":"10.1176/appi.focus.20250021","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"439-441"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088260","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":"Why Not Rock the Boat? Deprescribing Anticholinergic Medications That Are No Longer Needed in Persons With Schizophrenia.","authors":"Jessica M Gannon, Kadiamada N Roy Chengappa, Ana M Lupu, Jaspreet S Brar","doi":"10.1176/appi.focus.20250010","DOIUrl":"10.1176/appi.focus.20250010","url":null,"abstract":"<p><p>Anticholinergic medications (ACMs) prescribed for the treatment of antipsychotic-associated extrapyramidal symptoms (EPSs) are frequently prescribed for durations that exceed expert guidelines and are associated with significant side-effect burden. Evidence suggests that education with regard to the risks of long-term prescribing of ACMs for resolved EPSs may be lacking in the health care community, and no best practices exist for deprescribing ACMs. This review discusses EPSs and their treatment with two ACMs, benztropine and trihexyphenidyl, and it presents evidence of the risks of chronic ACM prescribing, including serious side effects such as cognitive impairment, dry mouth, blurred vision, and risk for delirium, as well as sequelae of severe constipation and urinary retention. It is pertinent to remember that many psychotropic agents, including several antipsychotics, as well as other commonly prescribed medications have moderate to strong anticholinergic properties. Each ACM, when prescribed with other medications concomitantly, compounds ACM burden and associated side effects. Informed by the authors' extensive experience with quality improvement projects on deprescribing ACMs, this review examines both the benefits and risks of ACM deprescribing, with an emphasis on choosing appropriate patients and engaging in shared decision making while utilizing patient-facing assessments and decision-support tools. ACM tapering schedules are suggested, along with recommendations for closer patient monitoring during the deprescription process. Barriers to deprescription at the patient, prescribing clinician, and system level are then reviewed, along with relevant ethical considerations inherent to any medication changes, including ACM deprescribing.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"399-406"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088200","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":"Xanomeline-Trospium for the Treatment of Schizophrenia.","authors":"Megan J Ehret, Jonathan M Meyer","doi":"10.1176/appi.focus.20250022","DOIUrl":"10.1176/appi.focus.20250022","url":null,"abstract":"<p><p>The objective of this review is to examine the pharmacology, pharmacokinetics, clinical efficacy, and safety profile of the combination of xanomeline and trospium (XT) for the treatment of schizophrenia. A search was conducted of all publicly available information (including press releases) and specifically within the databases MEDLINE, Embase, and PsycINFO, from their inception to May 1, 2025, noting the keywords \"muscarinic,\" \"schizophrenia,\" \"xanomeline,\" and \"emraclidine.\" A first-in-class medication approved for the treatment of schizophrenia in adults, XT possesses no direct action on dopamine D₂ receptors. It is dosed twice daily without food and has demonstrated efficacy and safety in three 5-week double-blind, placebo-controlled trials and in two 52-week open-label studies. The pooled effect size of 0.61 (0.56 using the meta-analysis method) is greater than that for other agents approved for schizophrenia since 1996, with no risk for movement disorders, weight gain, and hyperprolactinemia. Post hoc analyses from the acute schizophrenia trials also indicate an impact on cognition among individuals with more significant baseline levels of cognitive impairment. Preliminary results of the adjunctive trial for adults with schizophrenia who are partial responders to other antipsychotics were not statistically significant, but ongoing studies are exploring XT for dementia-related psychosis and pediatric indications.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"389-398"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088224","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":"Risk Factors and Management Strategies for Antipsychotic-Induced Weight Gain: A Prescriptive Review for Clinicians.","authors":"Nicolette Stogios, Akash PrasannaKumar, Kamna Mehra, Margaret K Hahn, Sri Mahavir Agarwal","doi":"10.1176/appi.focus.20250020","DOIUrl":"10.1176/appi.focus.20250020","url":null,"abstract":"<p><p>Antipsychotic-induced weight gain (AIWG) is a pervasive and concerning side effect of treatment with antipsychotic medications (APs) that has grave implications for morbidity and mortality rates in individuals with serious mental illness. As such, acknowledging, identifying, and addressing the metabolic side effects of these medications are critical to improve the overall health and quality of life of individuals treated with APs. This review summarizes the key risk factors and predictors of AIWG and provides a comprehensive and prescriptive overview of the best-researched and evidenced nonpharmacological and pharmacological therapies available to address this problem. Age, prior exposure to APs, and AP type are strong determinants of AIWG. Metabolic monitoring and lifestyle changes remain the methods of choice for addressing metabolic risk in this population. Clinical guidelines have recommended the off-label use of metformin when such interventions are not effective, and there is emerging evidence for the effectiveness of other novel weight loss agents in this population that may represent an opportunity for greater metabolic improvements. Most of the research and guidelines to date have focused on treating AIWG; however, prevention efforts may confer greater benefits given the challenges of reversing weight gain. To effectively mitigate the metabolic risks associated with these medications, substantial system-level reforms in both education and clinical service delivery are essential, with a focus on proactive monitoring and early intervention based on up-to-date evidence and best-practice recommendations.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"407-418"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088271","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":"Efficacy and Moderators of Cognitive Behavioural Therapy for Psychosis Versus Other Psychological Interventions: An Individual-Participant Data Meta-Analysis.","authors":"David T Turner, Mirjam Reijnders, Mark van der Gaag, Eirini Karyotaki, Lucia R Valmaggia, Steffen Moritz, Tania Lecomte, Douglas Turkington, Rafael Penadés, Helio Elkis, Corinne Cather, Frances Shawyer, Kieron O'Connor, Zhan-Jiang Li, Eliza Martha de Paiva Barretto, Pim Cuijpers","doi":"10.1176/appi.focus.25023026","DOIUrl":"10.1176/appi.focus.25023026","url":null,"abstract":"<p><strong>Background: </strong>Study-level meta-analyses have demonstrated the efficacy of cognitive-behavioural therapy for psychosis (CBTp). Limitations of conventional meta-analysis may be addressed using individual-participant-data (IPD). We aimed to determine a) whether results from IPD were consistent with study-level meta-analyses and b) whether demographic and clinical characteristics moderate treatment outcome.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, PsychInfo and CENTRAL. Authors of RCTs comparing CBTp with other psychological interventions were contacted to obtain original databases. Hierarchical mixed effects models were used to examine efficacy for psychotic symptoms. Patient characteristics were investigated as moderators of symptoms at post-treatment. Sensitivity analyses were conducted for risk of bias, treatment format and study characteristics.</p><p><strong>Results: </strong>We included 14 of 23 eligible RCTs in IPD meta-analyses including 898 patients. Ten RCTs minimised risk of bias. There was no significant difference in efficacy between RCTs providing IPD and those not (<i>p ></i>0.05). CBTp was superior vs. other interventions for total psychotic symptoms and PANSS general symptoms. No demographic or clinical characteristics were robustly demonstrated as moderators of positive, negative, general or total psychotic symptoms at post-treatment. Sensitivity analyses demonstrated that number of sessions moderated the impact of treatment assignment (CBTp or other therapies) on total psychotic symptoms (<i>p</i> = 0.02).</p><p><strong>Conclusions: </strong>IPD suggest that patient characteristics, including severity of psychotic symptoms, do not significantly influence treatment outcome in psychological interventions for psychosis while investing in sufficient dosage of CBTp is important. IPD provide roughly equivalent efficacy estimates to study-level data although significant benefit was not replicated for positive symptoms. We encourage authors to ensure IPD is accessible for future research.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"464-474"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144965","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":"New and Developing Treatments in Schizophrenia.","authors":"","doi":"10.1176/appi.focus.25023022","DOIUrl":"10.1176/appi.focus.25023022","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"461-462"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088241","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":"Psychological Interventions to Reduce Positive Symptoms in Schizophrenia: Systematic Review and Network Meta-Analysis.","authors":"Irene Bighelli, Georgia Salanti, Maximilian Huhn, Johannes Schneider-Thoma, Marc Krause, Cornelia Reitmeir, Sofia Wallis, Felicitas Schwermann, Gabi Pitschel-Walz, Corrado Barbui, Toshi A Furukawa, Stefan Leucht","doi":"10.1176/appi.focus.25023024","DOIUrl":"10.1176/appi.focus.25023024","url":null,"abstract":"<p><p>Psychological treatments are increasingly regarded as useful interventions for schizophrenia. However, a comprehensive evaluation of the available evidence is lacking and the benefit of psychological interventions for patients with current positive symptoms is still debated. The present study aimed to evaluate the efficacy, acceptability and tolerability of psychological treatments for positive symptoms of schizophrenia by applying a network meta-analysis approach, that can integrate direct and indirect comparisons. We searched EMBASE, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Library, World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov for randomized controlled trials of psychological treatments for positive symptoms of schizophrenia, published up to January 10, 2018. We included studies on adults with a diagnosis of schizophrenia or a related disorder presenting positive symptoms. The primary outcome was change in positive symptoms measured with validated rating scales. We included 53 randomized controlled trials of seven psychological interventions, for a total of 4,068 participants receiving the psychological treatment as add-on to antipsychotics. On average, patients were moderately ill at baseline. The network meta-analysis showed that cognitive behavioural therapy (40 studies) reduced positive symptoms more than inactive control (standardized mean difference, SMD=-0.29; 95% CI: -0.55 to -0.03), treatment as usual (SMD=-0.30; 95% CI: -0.45 to -0.14) and supportive therapy (SMD=-0.47; 95% CI: -0.91 to -0.03). Cognitive behavioural therapy was associated with a higher dropout rate compared with treatment as usual (risk ratio, RR=0.74; 95% CI: 0.58 to 0.95). Confidence in the estimates ranged from moderate to very low. The other treatments contributed to the network with a lower number of studies. Results were overall consistent in sensitivity analyses controlling for several factors, including the role of researchers' allegiance and blinding of outcome assessor. Cognitive behavior therapy seems to be effective on positive symptoms in moderately ill patients with schizophrenia, with effect sizes in the lower to medium range, depending on the control condition. Reprinted from <i>World Psychiatry 2018; 17:316-329</i>, with permission from World Psychiatric Association. Copyright © 2018.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"475-488"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144372","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":"Do We Now Have the Tools to Meaningfully Improve Outcomes for People With Schizophrenia?","authors":"Robert O Cotes","doi":"10.1176/appi.focus.20250030","DOIUrl":"10.1176/appi.focus.20250030","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 4","pages":"373-374"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088215","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":"Interstate Mental Health and Substance Use Disorder Practice: Policies, Clinical Considerations, and Legal Implications.","authors":"Michelle Bedoya, Rachel Presskreischer","doi":"10.1176/appi.focus.20250002","DOIUrl":"10.1176/appi.focus.20250002","url":null,"abstract":"<p><p>In the United States, mental health and substance use disorder care is provided by a range of professionals, including psychiatrists, psychologists, and master's-level clinicians. These professionals are overseen and regulated at the state level by field-specific boards. Considerable variation between states in the educational and clinical supervision requirements for licensure creates challenges for license portability. To address these challenges, beginning in 2014, states have adopted practice compacts in medicine, psychology, counseling, and social work that allow clinicians licensed in a participating state to practice either via telehealth or in person in other participating states. This article discusses the nature of these compacts and provides legal and practice considerations for clinicians interested in joining a practice compact in their profession.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"323-329"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546443","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}