American Journal of Psychiatry最新文献

{"title":"20 Years of Aberrant Salience in Psychosis: What Have We Learned?","authors":"Philip R Corlett, Kurt M Fraser","doi":"10.1176/appi.ajp.20240556","DOIUrl":"10.1176/appi.ajp.20240556","url":null,"abstract":"<p><p>Twenty years ago Shitij Kapur's \"<b><i>Psychosis as a state of aberrant salience</i></b>\" captured the attention of clinicians and cognitive and behavioral neuroscientists. It has become the de facto way of talking about delusion formation in labs and clinics. Here, evidence for this theory is critically evaluated in consideration of evolving data since its publication. A particular focus is placed on its specific predictions regarding the neural and behavioral loci of dopamine dysfunction in psychosis and finds them lacking. This examination is informed by recent advances in the understanding of the function of the dopamine system and its impacts on behavior following the explosion of new tools and probes for precise measurement and manipulation of dopaminergic circuits. Contemporary theories that have developed since Kapur-which suggest a role for dopamine in belief formation, belief updating under uncertainty, and abductive inference to the best explanation for some set of circumstances-are argued to form a more cogent theory that fits better with the work in patients with delusions and hallucinations, how they behave, and what is known about the function of their dopamine system. The original salience hypothesis has been influential as it attempted to unite neurochemical dysfunction with clinical phenomenology through computational cognitive neuroscience, which has led to the development of novel predictions that the authors highlight as future directions for the field.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"819-829"},"PeriodicalIF":14.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scientific Advances Relevant to Schizophrenia, Psychosis, and the Treatment of Methamphetamine Use Disorder.","authors":"Ned H Kalin","doi":"10.1176/appi.ajp.20250758","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250758","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"43 1","pages":"797-800"},"PeriodicalIF":17.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959914","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":"Reduced Brain Iron and Striatal Hyperdopaminergia in Schizophrenia: A Quantitative Susceptibility Mapping MRI and PET Study.","authors":"Luke James Vano,Robert Ali McCutcheon,Jan Sedlacik,Stephen John Kaar,Grazia Rutigliano,Giovanna Nordio,Valeria Finelli,Leigh Townsend,Alaine Berry,Ben Statton,Amir Fazlollahi,Mattia Veronese,Seth Cabot Hopkins,Kenneth Stephen Koblan,Ian Paul Everall,Oliver David Howes","doi":"10.1176/appi.ajp.20240512","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240512","url":null,"abstract":"OBJECTIVENeuroimaging studies have independently associated schizophrenia with low iron and elevated dopamine synthesis. While preclinical research demonstrates that midbrain iron deficiency leads to striatal hyperdopaminergia, this relationship has not been studied in schizophrenia. The authors conducted a case-control study to examine differences in tissue magnetic susceptibility, a marker of brain iron, and correlated these with striatal dopamine synthesis capacity.METHODSMagnetic susceptibility in the substantia nigra and ventral tegmental area (SN-VTA) was measured using quantitative susceptibility mapping (QSM) MRI in 159 participants (control subjects, N=80; early-course schizophrenia, N=79, including patients who were antipsychotic-naïve or antipsychotic-free). Because magnetic susceptibility is increased by neuromelanin and reduced by myelin, neuromelanin-sensitive MRI (NM-MRI) and diffusion tensor imaging (DTI) were employed to investigate the influence of neuromelanin and myelin on the QSM findings in 99 participants (control subjects, N=38; schizophrenia patients, N=61). Dopamine synthesis capacity (Ki cer) was then assessed with [18F]-DOPA positron emission tomography in 40 people from the schizophrenia group to test whether low SN-VTA magnetic susceptibility was related to high striatal Ki cer.RESULTSSN-VTA magnetic susceptibility was lower in patients with schizophrenia than in control subjects (d=-0.66, 95% CI=-0.98, -0.34). This difference remained significant in analyses controlling for mean diffusivity (a DTI measure inversely correlating with myelin concentration) and NM-MRI contrast-to-noise ratios. SN-VTA magnetic susceptibility was significantly inversely correlated with striatal Ki cer, independent of mean diffusivity and NM-MRI contrast-to-noise ratios (r=-0.44). In both analyses, the strongest effects were observed in the ventral SN-VTA.CONCLUSIONSThese findings suggest that lower levels of non-neuromelanin-bound iron in the SN-VTA contribute to striatal hyperdopaminergia in schizophrenia. Further investigation is warranted to understand the role of low iron in schizophrenia and its potential as a treatment target.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"14 1","pages":"830-839"},"PeriodicalIF":17.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959915","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":"Buprenorphine and Methadone Discontinuation During Pregnancy and the Postpartum Period: A Nationwide Cohort Study.","authors":"Chih-Wan Grace Lin,Brian T Bateman,Loreen Straub,Sonia Hernández-Díaz,Seanna M Vine,Hendrée E Jones,Hilary S Connery,Jonathan M Davis,Kathryn J Gray,Barry Lester,Elizabeth A Suarez,Ayesha C Sujan,Mishka Terplan,Krista F Huybrechts","doi":"10.1176/appi.ajp.20241127","DOIUrl":"https://doi.org/10.1176/appi.ajp.20241127","url":null,"abstract":"OBJECTIVETreatment of pregnant patients with opioid use disorder with methadone or buprenorphine is crucial for maternal and neonatal safety. While several clinical trials have demonstrated higher treatment discontinuation rates for buprenorphine compared with methadone outside of pregnancy, evidence during pregnancy and the postpartum period is limited. The authors compared treatment discontinuation between buprenorphine and methadone during pregnancy and over follow-up through 1 year postpartum.METHODSThis was a cohort study, using nationwide Medicaid data, of pregnant patients who initiated methadone or transmucosal buprenorphine (with or without naloxone) for opioid use disorder during the first trimester. The primary outcome was treatment discontinuation, defined as a treatment gap ≥60 days; alternative definitions for discontinuation were explored in sensitivity analyses. Hazard ratios were estimated using Cox proportional hazards regression with propensity score overlap weighting to control for confounding. Subgroup analyses were conducted, stratified by buprenorphine alone versus the buprenorphine/naloxone combination, each compared to methadone.RESULTSOverall, 696 pregnant patients were identified who initiated methadone treatment and 1,538 who initiated buprenorphine treatment in the first trimester. Compared to methadone initiators, buprenorphine initiators were more likely to discontinue treatment during pregnancy (32.8% for buprenorphine vs. 25.6% for methadone; weighted hazard ratio=1.41, 95% CI=1.15, 1.72) and through 1 year postpartum (58.8% vs. 49.0%; hazard ratio=1.37, 95% CI=1.19, 1.57). For patients initiating the buprenorphine/naloxone combination, the hazard ratio was 1.73 (95% CI=1.36, 2.19) during pregnancy and 1.56 (95% CI=1.30, 1.86) through 1 year postpartum. For patients initiating buprenorphine alone, the hazard ratios were 1.14 (95% CI=0.90, 1.46) and 1.23 (95% CI=1.04, 1.46), respectively. Varying the treatment gap used to define discontinuation in sensitivity analyses yielded consistent results.CONCLUSIONPregnant patients initiating transmucosal buprenorphine during early pregnancy were more likely to discontinue treatment than those initiating methadone, but treatment discontinuation was high for both treatments. The study findings highlight the importance of identifying and addressing barriers to treatment retention among pregnant patients with opioid use disorder.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"16 1","pages":"appiajp20241127"},"PeriodicalIF":17.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959891","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":"From Crisis to Action: Psychiatry's Ethical Imperative to Defend Transgender People's Rights, Dignity, and Access to Care.","authors":"Aaron S Breslow,Arjee Restar,Elizabeth Cavic,Jonathan E Alpert,Benjamin Lê Cook","doi":"10.1176/appi.ajp.20250051","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250051","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"31 1","pages":"appiajp20250051"},"PeriodicalIF":17.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959890","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":"Glucagon-Like Peptide-1 Receptor Agonists and Suicidality: Association Versus Causation and the Need for Ongoing Surveillance.","authors":"Roger S McIntyre","doi":"10.1176/appi.ajp.20241087","DOIUrl":"https://doi.org/10.1176/appi.ajp.20241087","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"19 1","pages":"appiajp20241087"},"PeriodicalIF":17.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959892","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":"Psychiatric Genetics and Assessing Telehealth Prescribing of Controlled Substances.","authors":"Ned H Kalin","doi":"10.1176/appi.ajp.20250599","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250599","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"1 1","pages":"707-710"},"PeriodicalIF":17.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756127","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":"What Happened to the Antidepressants? Response to Marques and Singh.","authors":"Iris Dalhuisen,Martijn Arns,Jan Spijker,Indira Tendolkar,Philip van Eijndhoven","doi":"10.1176/appi.ajp.20240863r","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240863r","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"1 1","pages":"795-796"},"PeriodicalIF":17.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756242","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":"Anticholinergic Burden in Serious Mental Illness: Is This a Plague Hiding in Plain Sight?","authors":"Philip D Harvey,Tim B Bigdeli","doi":"10.1176/appi.ajp.20250521","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250521","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"27 1","pages":"711-713"},"PeriodicalIF":17.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756267","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":"Long-Read Genome Sequencing in Clinical Psychiatry: <i>RFX3</i> Haploinsufficiency in a Hospitalized Adolescent With Autism, Intellectual Disability, and Behavioral Decompensation.","authors":"Milad Mortazavi, Sergey Batalov, Jerica Lenberg, Corrine Blucher, Aisha Omorodion, Daniel Helbling, Lucita Van Der Kraan, Zaira Bezares-Orin, Arivudainambi Ramalingam, Matthew N Bainbridge, Jonathan Sebat, Aaron D Besterman","doi":"10.1176/appi.ajp.20240471","DOIUrl":"10.1176/appi.ajp.20240471","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"722-727"},"PeriodicalIF":14.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810262","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}