American Journal of Psychiatry最新文献

{"title":"Reduced Brain Responsiveness to Emotional Stimuli With Escitalopram But Not Psilocybin Therapy for Depression.","authors":"Matthew B Wall, Lysia Demetriou, Bruna Giribaldi, Leor Roseman, Natalie Ertl, David Erritzoe, David J Nutt, Robin L Carhart-Harris","doi":"10.1176/appi.ajp.20230751","DOIUrl":"10.1176/appi.ajp.20230751","url":null,"abstract":"<p><strong>Objective: </strong>Psilocybin is an emerging intervention for depression that may be at least as effective as selective serotonin reuptake inhibitors (SSRIs), but effects of the two treatments on the neural correlates of emotional processing have never been directly compared.</p><p><strong>Methods: </strong>The authors assessed neural responses to emotional faces using blood-oxygen-level-dependent (BOLD) functional MRI (fMRI) in two groups with major depression. One group (N=25; 9 women and 16 men) received two dosing sessions with 25 mg psilocybin plus 6 weeks of daily inert placebo, and the second group (N=21; 6 women and 15 men) received 6 weeks of escitalopram plus two dosing sessions with a nonpsychoactive (placebo) dose of 1 mg psilocybin. Both groups had equal psychological support throughout: 3 hours of preparation, one in-person integration session following the psilocybin dosing sessions, and two further integration sessions conducted via video call or telephone. An emotional face fMRI paradigm was completed before treatment and at the 6-week posttreatment primary end point (3 weeks following psilocybin dosing sessions).</p><p><strong>Results: </strong>Patient group (psilocybin versus escitalopram) interacted with time point (before versus after treatment) on a distributed set of cortical regions. Post hoc within-condition analyses showed that posttreatment BOLD responses to emotional faces of all types were significantly reduced in the escitalopram group, with no change or a slight increase in the psilocybin group. Analyses of amygdala responsivity showed a reduction of response to fearful faces in the escitalopram group, but lesser effects for the psilocybin group.</p><p><strong>Conclusions: </strong>Despite large improvements in depressive symptoms in the psilocybin group, psilocybin therapy had only a minor effect on brain responsiveness to emotional stimuli. These results are consistent with prior findings that the antidepressant action of SSRIs is often accompanied by a reduction in emotional responsiveness, but this effect may not occur in psychedelic therapy.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"569-582"},"PeriodicalIF":15.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958128","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":"Relationship Between Problematic Alcohol Use and Various Psychiatric Disorders: A Genetically Informed Study.","authors":"Yeeun Ahn,Jaehyun Kim,Kyeongmin Jung,Dong June Lee,Jin Young Jung,Yewon Eom,Sanghyeon Park,Jaeyoung Kim,Hyejin Kim,Hyeonbin Jo,Sanghoon Hong,Kevin S O'Connell,Ole A Andreassen,Woojae Myung,Hong-Hee Won","doi":"10.1176/appi.ajp.20240095","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240095","url":null,"abstract":"OBJECTIVEProblematic alcohol use (PAU) adversely affects the clinical course of psychiatric disorders. Genetic studies have suggested that genetic factors underlie the co-occurrence of PAU with psychiatric disorders. This study aimed to elucidate shared genetic architectures, prioritizing genes that disorders may have in common.METHODSUsing genome-wide association data of PAU including 435,563 samples from people of European ancestry, this study investigated the genetic relationship between PAU and 11 psychiatric disorders using a bivariate causal mixture model (MiXeR). Local genetic correlation and colocalization analyses were conducted to identify the genomic regions significantly associated with PAU and each psychiatric disorder. Postanalysis included the false discovery rate (FDR) and transcriptome-wide association studies (TWASs), as well as summary-data-based Mendelian randomization to prioritize shared genes by integrating brain transcriptome data.RESULTSMiXeR analysis revealed a substantial polygenic overlap (39%-73%) between PAU and psychiatric disorders. Four bivariate genomic regions with high correlations suggest shared causal variants of PAU with major depression and schizophrenia. Within these regions, four and six genes for the PAU-major depression and PAU-schizophrenia pairs, respectively, were mapped by conjunctional FDR analysis. Furthermore, TTC12 and ANKK1 were identified as potential causal genes for PAU and these disorders. The findings were replicated in multi-ancestry analyses of colocalization and TWASs.CONCLUSIONSDespite the varying degrees of genetic overlap and directions of shared genetic effect correlations, these results imply the presence of shared genetic factors influencing the comorbidity of PAU and psychiatric disorders. Additionally, TTC12 and ANKK1, located near DRD2, may be causally associated with comorbid conditions.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"282 1","pages":"appiajp20240095"},"PeriodicalIF":17.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915201","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":"Advancing an Inflammatory Subtype of Major Depression.","authors":"Andrew H Miller","doi":"10.1176/appi.ajp.20250289","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250289","url":null,"abstract":"Chronic inflammation plays a prominent role in multiple medical disorders, including psychiatric diseases such as major depression. Exposure to inflammatory stimuli leads to changes in neurotransmitter systems and neurocircuits in the brain that are associated with depressive symptoms. Blockade of inflammatory cytokines can reduce depressive symptoms in medically ill and medically healthy individuals with depression. Increased levels of biomarkers of inflammation are associated with an overrepresentation of neurovegetative symptoms, including anhedonia, fatigue, and psychomotor slowing, and can predict response to antidepressant treatments. Importantly, however, increased inflammatory biomarkers occur in only a subgroup of individuals with depression. Thus, there appears to be a subset of patients with depression with a unique symptom presentation and treatment response whose disease is primarily driven by inflammation. Further identifying and characterizing this inflammatory subtype of depression can foster the development of treatments targeting the immune system and its effects on the brain. Moreover, by using this mechanism-based approach to parsing the heterogeneity of depression, we can refine our diagnostic nosology and model a strategy for precision medicine and targeted therapeutics in psychiatry.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"74 1","pages":"appiajp20250289"},"PeriodicalIF":17.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915202","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":"Prospective Associations Between Structural Brain Development and Onset of Depressive Disorder During Adolescence and Emerging Adulthood.","authors":"Sarah Whittle,Divyangana Rakesh,Julian G Simmons,Orli Schwartz,Nandita Vijayakumar,Nicholas B Allen","doi":"10.1176/appi.ajp.20240588","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240588","url":null,"abstract":"OBJECTIVEBrain structural alterations are consistently reported in depressive disorders, yet it remains unclear whether these alterations exist prior to disorder onset and thus may reflect a preexisting vulnerability. The authors investigated prospective adolescent neurodevelopmental risk markers for depressive disorder onset, using data from a 15-year longitudinal study.METHODSA community sample of 161 adolescents participated in neuroimaging assessments conducted during early (age 12), mid (age 16), and late (age 19) adolescence. Onsets of depressive disorders were assessed for the period spanning early adolescence through emerging adulthood (ages 12-27). Forty-six participants (28 female) experienced a first episode of a depressive disorder during the follow-up period; 83 participants (36 female) received no mental disorder diagnosis. Joint modeling was used to investigate whether brain structure (subcortical volume, cortical thickness, and surface area) or age-related changes in brain structure were associated with the risk of depressive disorder onset.RESULTSAge-related increases in amygdala volume (hazard ratio=3.01), and more positive age-related changes (i.e., greater thickening or attenuated thinning) of temporal (parahippocampal gyrus, hazard ratio=3.73; fusiform gyrus, hazard ratio=4.14), insula (hazard ratio=4.49), and occipital (lingual gyrus, hazard ratio=4.19) regions were statistically significantly associated with the onset of depressive disorder.CONCLUSIONSRelative increases in amygdala volume and temporal, insula, and occipital cortical thickness across adolescence may reflect disturbances in brain development, contributing to depression onset. This raises the possibility that prior findings of reduced gray matter in clinically depressed individuals instead reflect alterations that are caused by disorder-related factors after onset.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"25 1","pages":"appiajp20240588"},"PeriodicalIF":17.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915200","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":"Randomized Controlled Trial of \"Bounce Back Now,\" a Mobile App to Reduce Post-Disaster Symptoms of Posttraumatic Stress, Depressed Mood, and Sleep Disturbance.","authors":"Kenneth J Ruggiero,Arthur Andrews,Tatiana M Davidson,Yulia Gavrilova,Brian E Bunnell,Jennifer Dahne,Matthew Price,Zoe M F Brier,Gregory Cohen,Dean Kilpatrick,Ron Acierno,Sandro Galea","doi":"10.1176/appi.ajp.20240232","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240232","url":null,"abstract":"OBJECTIVEThere is tremendous public health interest in cost-efficient, scalable interventions to improve post-disaster mental health. The authors examined the efficacy of Bounce Back Now (BBN), a mobile application, versus an enhanced usual care app (EUC).METHODSA population-based trial was conducted with a diverse sample of 1,357 adults affected by Hurricane Harvey, Irma, Maria, Florence, or Michael in 2017 and 2018. Participants were eligible if they were ≥18 years of age, had access to an Internet-accessible device, were English speaking, and lived in a hurricane-affected area. BBN is designed to address symptoms of posttraumatic stress, depression, and sleep disturbance using evidence-based techniques grounded in behavioral and cognitive principles. Depressive, posttraumatic stress, and sleep symptoms were measured.RESULTSParticipants' accessing of the BBN and EUC apps was similar. Active engagement was significantly greater among BBN users than EUC users (d=0.31), but BBN users engaged more actively in coping skills activities than in more time-intensive elements designed to promote behavior change. Moderate symptom reduction was observed in both conditions; Cohen's d values for the 3-month postbaseline assessment ranged from 0.49 to 0.60 in the BBN condition and from 0.36 to 0.41 in the EUC condition. Latent change models revealed that BBN users had significantly greater reductions in depression, sleep difficulty, and PTSD symptoms than EUC users, and these differences were maintained at the 6-month and 12-month postbaseline assessments.CONCLUSIONSPopulation impact is driven by reach and effectiveness. The potential reach of BBN is high, which heightens opportunity for population-level impact, but per-user symptom reduction was modest. Per-user impact may be improved by embedding digital health resources in the context of a broader health care strategy.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"93 1","pages":"463-472"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897361","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":"Problems With Noninferiority Designs in PTSD Treatment Research: Losing Signal to Noise.","authors":"Sheila A M Rauch,H Myra Kim,Ron Acierno,Peter W Tuerk,Barbara O Rothbaum","doi":"10.1176/appi.ajp.20240567","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240567","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"48 1","pages":"421-423"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897351","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":"Harnessing Technology to Reimagine and Scale Support for Individual and Community Mental Health After Disaster.","authors":"Shannon Wiltsey Stirman,Adrienne Heinz","doi":"10.1176/appi.ajp.20250138","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250138","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"12 1","pages":"412-413"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897353","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":"Neuropsychiatric Symptoms of Subacute and Chronic Long COVID.","authors":"Thida M Thant,Abhisek C Khandai,Aisha Gillan,Melissa Peace,Davin Quinn,John Levenson","doi":"10.1176/appi.ajp.25182003","DOIUrl":"https://doi.org/10.1176/appi.ajp.25182003","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"62 1","pages":"498-499"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897360","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":"Five-Year Outcomes of a School-Based Personality-Focused Prevention Program on Adolescent Substance Use Disorder: A Cluster Randomized Trial.","authors":"Patricia Conrod, Sherry H Stewart, Jean Seguin, Robert Pihl, Benoit Masse, Sean Spinney, Samantha Lynch","doi":"10.1176/appi.ajp.20240042","DOIUrl":"10.1176/appi.ajp.20240042","url":null,"abstract":"<p><strong>Objective: </strong>Rates of substance use disorders (SUDs) remain significantly above national targets for health promotion and disease prevention in Canada and the United States. This study investigated the 5-year SUD outcomes following a selective drug and alcohol prevention program targeting personality risk factors for adolescent substance misuse.</p><p><strong>Methods: </strong>The Co-Venture trial is a cluster randomized trial involving 31 high schools in the greater Montreal area that agreed to conduct annual health behavior surveys for 5 years on the entire 7th grade cohort of assenting students enrolled at the school in 2012 or 2013. Half of all schools were randomly assigned to be trained and assisted in the delivery of the personality-targeted PreVenture Program to all eligible 7th grade participants. The intervention consisted of a brief (two-session) group cognitive-behavioral intervention that is delivered in a personality-matched fashion to students who have elevated scores on one of four personality traits linked to early-onset substance misuse: impulsivity, sensation seeking, anxiety sensitivity, or hopelessness.</p><p><strong>Results: </strong>Mixed-effects multilevel Bayesian models were used to estimate the effect of the intervention on the year-by-year change in probability of SUD. When baseline differences were controlled for, a time-by-intervention interaction revealed positive growth in SUD rate for the control group (b=1.380, SE=0.143, odds ratio=3.97) and reduced growth for the intervention group (b=-0.423, SE=0.173, 95% CI=-0.771, -0.084, odds ratio=0.655), indicating a 35% reduction in the annual increase in SUD rate in the intervention condition relative to the control condition. Group differences in SUD rates were reliably nonzero (95% confidence) at the fourth and fifth year of assessment. Secondary analyses revealed no significant intervention effects on growth of anxiety, depression, or total mental health difficulties over the four follow-up periods.</p><p><strong>Conclusions: </strong>This study showed for the first time that personality-targeted interventions might protect against longer-term development of SUD.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"473-482"},"PeriodicalIF":15.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982399","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":"Telemental Health Care for Children and Adolescents in the United States: Challenges and Opportunities.","authors":"Barbara J Coffey","doi":"10.1176/appi.ajp.20250141","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250141","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"48 1","pages":"419-420"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897364","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}