American Journal of Psychiatry最新文献

{"title":"The Impact of Xanomeline and Trospium Chloride on Cognitive Impairment in Acute Schizophrenia: Replication in Pooled Data From Two Phase 3 Trials.","authors":"William P Horan, Colin Sauder, Philip D Harvey, Ian S Ramsay, Samantha E Yohn, Richard S E Keefe, Vicki G Davis, Steven M Paul, Stephen K Brannan","doi":"10.1176/appi.ajp.20240076","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240076","url":null,"abstract":"<p><strong>Objective: </strong>Xanomeline and trospium chloride (formerly known as KarXT), a novel M₁/M₄ muscarinic receptor agonist, demonstrated efficacy across phase 2 and 3 trials as monotherapy for the treatment of inpatients with acute schizophrenia on the Positive and Negative Syndrome Scale total score primary endpoint. In the phase 2 trial, xanomeline/trospium improved performance on a cognitive outcome measure in the subgroup of participants with clinically significant baseline cognitive impairment. The authors sought to confirm this finding using data from two phase 3 trials.</p><p><strong>Methods: </strong>Data were pooled from two 5-week inpatient trials of xanomeline/trospium monotherapy in patients with acute schizophrenia. The statistical analysis plan prespecified comparisons of cognitive composite score changes between xanomeline/trospium and placebo in the full sample and the cognitively impaired (≤1 SD below norms at baseline) subgroup.</p><p><strong>Results: </strong>There was no significant xanomeline/trospium effect in the full sample (N=357); however, in the impaired subgroup, xanomeline/trospium (N=71) had a significantly greater benefit for cognition compared with placebo (N=66; least squares mean difference=0.31, SE=0.10; d=0.54). The xanomeline/trospium effect size increased significantly with a more stringent baseline impairment threshold (≤-1.5 SD; d=0.80). Improvements in cognition were minimally correlated with concurrent changes in total, positive, and negative symptoms in both treatment groups.</p><p><strong>Conclusions: </strong>Participants with acute schizophrenia with prespecified impairments demonstrated significant cognitive improvement with xanomeline/trospium compared with placebo. This result directly confirms earlier findings. This benefit is not attributable to changes in symptoms, despite substantial evidence of efficacy for psychosis. Evaluation of xanomeline/trospium's potential for cognitive enhancement in a well-controlled trial of stable patients with cognitive impairment is warranted.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Behavioral Therapy and Lisdexamfetamine, Alone and Combined, for Binge-Eating Disorder With Obesity: A Randomized Controlled Trial.","authors":"Carlos M Grilo, Valentina Ivezaj, Cenk Tek, Sydney Yurkow, Ashley A Wiedemann, Ralitza Gueorguieva","doi":"10.1176/appi.ajp.20230982","DOIUrl":"https://doi.org/10.1176/appi.ajp.20230982","url":null,"abstract":"<p><strong>Objective: </strong>Binge-eating disorder (BED) is a prevalent, costly public health problem associated with serious functional impairments and heightened rates of psychiatric and medical comorbidities. Few evidence-based treatments are currently available for BED. We tested the effectiveness of cognitive-behavioral therapy (CBT), lisdexamfetamine (LDX), and combined CBT+LDX, for BED comorbid with obesity.</p><p><strong>Methods: </strong>Randomized controlled trial was conducted March 2019 to September 2023 at a single site. N=141 patients with BED (83.7% women, mean age 43.6, mean BMI 38.6 kg/m²) were randomized to one of three 12-week treatments: CBT (N=47), LDX (N=47), or CBT+LDX (N=47); 87.2% completed independent posttreatment assessments.</p><p><strong>Results: </strong>Mixed models revealed binge-eating frequency decreased significantly in all treatments, with CBT+LDX having the largest reduction and significantly outperforming CBT and LDX, which did not differ. Intention-to-treat binge-eating remission rates differed significantly between treatments, with CBT+LDX having the highest remission rate (70.2%) followed by CBT (44.7%) and LDX (40.4%). Mixed models revealed percent weight loss increased significantly throughout treatment with LDX and CBT+LDX but remained unchanged in CBT. LDX and CBT+LDX had significantly greater percent weight loss than CBT starting after one month and through posttreatment. Intention-to-treat rates of attaining ≥5% weight loss differed across treatments, with LDX having the highest (53.2%), followed by CBT+LDX (42.6%) and CBT (4.3%). Analyses revealed significant reductions in eating-disorder psychopathology; CBT+LDX had largest reductions and significantly outperformed CBT and LDX.</p><p><strong>Conclusions: </strong>CBT, LDX, and CBT+LDX showed significant improvements in BED, with a consistent pattern of the combined CBT+LDX being superior to the two individual treatments, which differed little.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Advances in Behavioral Addictions: From Fundamental Research to Clinical Practice.","authors":"Matthias Brand, Stephanie Antons, Beata Bőthe, Zsolt Demetrovics, Naomi A Fineberg, Susana Jimenez-Murcia, Daniel L King, Gemma Mestre-Bach, Tania Moretta, Astrid Müller, Elisa Wegmann, Marc N Potenza","doi":"10.1176/appi.ajp.20240092","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240092","url":null,"abstract":"<p><p>Gambling disorder is the only behavioral addiction recognized as a clinical disorder in DSM-5, and Internet gaming disorder is included as a condition requiring further research. ICD-11 categorizes gambling and gaming disorders as disorders due to addictive behaviors. Additional behavioral addictions may include compulsive sexual behavior disorder, compulsive buying-shopping disorder, and problematic use of social media. This narrative review summarizes the current state of knowledge regarding these five (potential) disorders due to addictive behaviors. All five (potential) disorders are clinically relevant and prevalent. Behavioral addictions frequently co-occur with other mental and behavioral problems, such as depression, anxiety, and attention deficit hyperactivity disorder. Validated diagnostic instruments exist, with empirical support varying across conditions. No medications have approved indications from regulatory bodies for behavioral addictions, and cognitive-behavioral therapy has the most empirical support for efficacious treatment. Given that behavioral addictions are prevalent, frequently co-occur with psychiatric disorders, may often go undiagnosed and untreated, and have been linked to poorer treatment outcomes, active screening and treatment are indicated. Public health considerations should be expanded, and impacts of modern technologies should be investigated more intensively. Treatment optimization involving pharmacotherapy, psychotherapy, neuromodulation, and their combination warrants additional investigation.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Varenicline, Bupropion, Nicotine Patch, and Placebo on Treating Smoking Among Persons With Current or Past Major Depressive Disorder: Secondary Analysis of a Double-Blind, Randomized, Placebo-Controlled Trial.","authors":"George Kypriotakis, Paul M Cinciripini, Charles E Green, David Lawrence, Robert M Anthenelli, Jennifer A Minnix, Diane Beneventi, Chad Morris, Maher Karam-Hage, Janice A Blalock","doi":"10.1176/appi.ajp.20230855","DOIUrl":"https://doi.org/10.1176/appi.ajp.20230855","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the safety and efficacy of the leading smoking cessation medications among individuals with current versus past major depressive disorder (MDD).</p><p><strong>Methods: </strong>This was a secondary analysis of a randomized, double-blind trial over 12 weeks with varenicline or bupropion, followed by a 12-week assessment, in participants ages 18-75 with past (N=2,174) or current (N=451) MDD or without psychiatric disorders (N=4,028). Interventions included 12 weeks of pharmacotherapy with placebo, nicotine replacement therapy (NRT; nicotine patch), bupropion, or varenicline, and brief counseling. The primary safety outcome was occurrence of one or more moderate to severe neuropsychiatric adverse events. Efficacy was assessed as biochemically verified continuous abstinence during weeks 9-12.</p><p><strong>Results: </strong>Among all 6,653 participants, the risk of neuropsychiatric adverse events did not differ by medication within the past-MDD, current-MDD, or nonpsychiatric cohorts. The MDD cohorts had higher risk difference (p<0.001) for neuropsychiatric adverse events compared with the nonpsychiatric cohort (past-MDD cohort, risk difference=-0.03, 95% CI=-0.05, -0.02; current-MDD cohort, risk difference=-0.02, 95% CI=-0.05, 0.00). Within the past-MDD cohort, the odds ratios compared with placebo were 3.0 (95% CI=2.0, 4.5) for varenicline, 2.1 (95% CI=1.6, 2.7) for bupropion, and 2.1 (95% CI=1.4, 3.2) for NRT. Within the current-MDD cohort, varenicline differed from placebo (odds ratio=2.67, 95% CI=1.2, 6.15) and NRT (odds ratio=2.93, 95% CI=1.2, 7.2).</p><p><strong>Conclusions: </strong>All medications were generally safe in both MDD cohorts. NRT and bupropion were not more effective than placebo for those with current MDD. Varenicline plus counseling may be the best treatment for individuals with past or current MDD, given its greater efficacy, similar risk of adverse events, and, for those with current depression, reductions in anxiety and depression while trying to quit smoking.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Deligiannidis et al.","authors":"","doi":"10.1176/appi.ajp.20220785correction","DOIUrl":"https://doi.org/10.1176/appi.ajp.20220785correction","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"appiajp20220785correction"},"PeriodicalIF":15.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewers for <i>The American Journal of Psychiatry</i>.","authors":"","doi":"10.1176/appi.ajp.24181012","DOIUrl":"https://doi.org/10.1176/appi.ajp.24181012","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1131-1134"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrimination Exposure, Neural Reactivity to Stress, and Psychological Distress.","authors":"Devon K Grey, Juliann B Purcell, Kristen N Buford, Mark A Schuster, Marc N Elliott, Susan Tortolero Emery, Sylvie Mrug, David C Knight","doi":"10.1176/appi.ajp.20220884","DOIUrl":"10.1176/appi.ajp.20220884","url":null,"abstract":"<p><strong>Objective: </strong>Discrimination exposure has a detrimental impact on mental health, increasing the risk of depression, anxiety, and posttraumatic stress. The impact discrimination exposure has on mental health is likely mediated by neural processes associated with emotion expression and regulation. However, the specific neural processes that mediate the relationship between discrimination exposure and mental health remain to be determined. The present study investigated the relationship adolescent discrimination exposure has with stress-elicited brain activity and mental health symptoms in young adulthood.</p><p><strong>Methods: </strong>A total of 301 participants completed the Montreal Imaging Stress Task while functional MRI data were collected. Discrimination exposure was measured four times from ages 11 to 19, and stress-elicited brain activity and psychological distress (depression, anxiety, posttraumatic stress) were assessed in young adulthood (age 20).</p><p><strong>Results: </strong>Stress-elicited dorsolateral and dorsomedial prefrontal cortex (PFC), inferior parietal lobule (IPL), and hippocampal activity varied with discrimination exposure. Activity within these brain regions varied with the cumulative amount and trajectory of discrimination exposure across adolescence (initial exposure, change in exposure, and acceleration of exposure). Depression, anxiety, and posttraumatic stress symptoms varied with discrimination exposure. Stress-elicited activity within the dorsolateral PFC and the IPL statistically mediated the relationship between discrimination exposure and psychological distress.</p><p><strong>Conclusions: </strong>The findings suggest that adolescent discrimination exposure may alter the neural response to future stressors (i.e., within regions associated with emotion expression and regulation), which may in turn modify susceptibility and resilience to psychological distress. Thus, differences in stress-elicited neural reactivity may represent an important neurobiological mechanism underlying discrimination-related mental health disparities.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"1112-1126"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Genetically Inferred Effects Linking Posttraumatic Stress Disorder to Women's Health, Lipid Disorders, and Malaria Medications.","authors":"Gita A Pathak, Frank R Wendt, Adam X Maihofer, Kerry J Ressler, Murray B Stein, Karestan C Koenen, Caroline M Nievergelt, Renato Polimanti","doi":"10.1176/appi.ajp.20230832","DOIUrl":"10.1176/appi.ajp.20230832","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"1127-1130"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centering Agency and Choice in Moving Toward Social Justice in Mental Health: Reflections on Childhood Maltreatment, Psychiatric Symptoms, and Homelessness.","authors":"Ana Carolina Florence, Ezra Susser","doi":"10.1176/appi.ajp.20240956","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240956","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1039-1041"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to McClure et al.","authors":"","doi":"10.1176/appi.ajp.20230508correction","DOIUrl":"https://doi.org/10.1176/appi.ajp.20230508correction","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1134"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}