American Journal of Psychiatry最新文献

{"title":"The Importance and Limitations of Null Findings.","authors":"Dan J Stein, Jack van Honk, Paul M Thompson","doi":"10.1176/appi.ajp.20240957","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240957","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1033-1035"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765620","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":"An Honest Reckoning With the Amygdala and Mental Illness.","authors":"Andrew S Fox, Alexander J Shackman","doi":"10.1176/appi.ajp.20240941","DOIUrl":"10.1176/appi.ajp.20240941","url":null,"abstract":"<p><p>Anxiety disorders are a leading source of human misery, morbidity, and premature mortality. Existing treatments are far from curative for many, underscoring the need to clarify the underlying neural mechanisms. Although many brain regions contribute, the amygdala has received the most intense scientific attention. Over the past several decades, this scrutiny has yielded a detailed understanding of amygdala function, but it has failed to produce new clinical assays, biomarkers, or cures. Rising to this urgent public health challenge demands an honest reckoning with the functional-neuroanatomical complexity of the amygdala and a shift from theories anchored on \"the amygdala\" to models centered on specific amygdala nuclei and cell types. This review begins by examining evidence from studies of rodents, monkeys, and humans for the \"canonical model,\" the idea that the amygdala plays a central role in fear- and anxiety-related states, traits, and disorders. Next, the authors selectively highlight work indicating that the canonical model, while true, is overly simplistic and fails to adequately capture the actual state of the evidentiary record, the breadth of amygdala-associated functions and illnesses, or the complexity of the amygdala's functional architecture. The authors describe the implications of these facts for basic and clinical neuroimaging research. The review concludes with some general recommendations for grappling with the complexity of the amygdala and accelerating efforts to understand and more effectively treat amygdala-related psychopathology.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1059-1075"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765569","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":"Resting-State Functional Connectivity of the Amygdala in Autism: A Preregistered Large-Scale Study.","authors":"Dorit Kliemann, Paola Galdi, Avery L Van De Water, Brandon Egger, Dorota Jarecka, Ralph Adolphs, Satrajit S Ghosh","doi":"10.1176/appi.ajp.20230249","DOIUrl":"10.1176/appi.ajp.20230249","url":null,"abstract":"<p><strong>Objective: </strong>Three leading neurobiological hypotheses about autism spectrum disorder (ASD) propose underconnectivity between brain regions, atypical function of the amygdala, and generally higher variability between individuals with ASD than between neurotypical individuals. Past work has often failed to generalize, because of small sample sizes, unquantified data quality, and analytic flexibility. This study addressed these limitations while testing the above three hypotheses, applied to amygdala functional connectivity.</p><p><strong>Methods: </strong>In a comprehensive preregistered study, the three hypotheses were tested in a subset (N=488 after exclusions; N=212 with ASD) of the Autism Brain Imaging Data Exchange data sets. The authors analyzed resting-state functional connectivity (FC) from functional MRI data from two anatomically defined amygdala subdivisions, in three hypotheses with respect to magnitude, pattern similarity, and variability, across different anatomical scales ranging from whole brain to specific regions and networks.</p><p><strong>Results: </strong>A Bayesian approach to hypothesis evaluation produced inconsistent evidence in ASD for atypical amygdala FC magnitude, strong evidence that the multivariate pattern of FC was typical, and no consistent evidence of increased interindividual variability in FC. The results strongly depended on analytic choices, including preprocessing pipeline for the neuroimaging data, anatomical specificity, and subject exclusions.</p><p><strong>Conclusions: </strong>A preregistered set of analyses found no reliable evidence for atypical functional connectivity of the amygdala in autism, contrary to leading hypotheses. Future studies should test an expanded set of hypotheses across multiple processing pipelines, collect deeper data per individual, and include a greater diversity of participants to ensure robust generalizability of findings on amygdala FC in ASD.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"1076-1085"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103555","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":"Homelessness, Discrimination, PTSD, Autism, and the Amygdala.","authors":"Ned H Kalin","doi":"10.1176/appi.ajp.20240975","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240975","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1029-1032"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765588","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":"Translational Insights From Cell Type Variation Across Amygdala Subnuclei in Rhesus Monkeys and Humans.","authors":"Shawn Kamboj, Erin L Carlson, Bradley P Ander, Kari L Hanson, Karl D Murray, Julie L Fudge, Melissa D Bauman, Cynthia M Schumann, Andrew S Fox","doi":"10.1176/appi.ajp.20230602","DOIUrl":"10.1176/appi.ajp.20230602","url":null,"abstract":"<p><strong>Objective: </strong>Theories of amygdala function are central to our understanding of psychiatric and neurodevelopmental disorders. However, limited knowledge of the molecular and cellular composition of the amygdala impedes translational research aimed at developing new treatments and interventions. The aim of this study was to characterize and compare the composition of amygdala cells to help bridge the gap between preclinical models and human psychiatric and neurodevelopmental disorders.</p><p><strong>Methods: </strong>Tissue was dissected from multiple amygdala subnuclei in both humans (N=3, male) and rhesus macaques (N=3, male). Single-nucleus RNA sequencing was performed to characterize the transcriptomes of individual nuclei.</p><p><strong>Results: </strong>The results reveal substantial heterogeneity between regions, even when restricted to inhibitory or excitatory neurons. Consistent with previous work, the data highlight the complexities of individual marker genes for uniquely targeting specific cell types. Cross-species analyses suggest that the rhesus monkey model is well-suited to understanding the human amygdala, but also identify limitations. For example, a cell cluster in the ventral lateral nucleus of the amygdala (vLa) is enriched in humans relative to rhesus macaques. Additionally, the data describe specific cell clusters with relative enrichment of disorder-related genes. These analyses point to the human-enriched vLa cell cluster as relevant to autism spectrum disorder, potentially highlighting a vulnerability to neurodevelopmental disorders that has emerged in recent primate evolution. Further, a cluster of cells expressing markers for intercalated cells is enriched for genes reported in human genome-wide association studies of neuroticism, anxiety disorders, and depressive disorders.</p><p><strong>Conclusions: </strong>Together, these findings shed light on the composition of the amygdala and identify specific cell types that can be prioritized in basic science research to better understand human psychopathology and guide the development of potential treatments.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":" ","pages":"1086-1102"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543058","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":"Charting the Neural Pathways From Discrimination to Mental Health Disparities.","authors":"Erika E Forbes","doi":"10.1176/appi.ajp.20240968","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240968","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1042-1044"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765582","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 Baum et al.","authors":"","doi":"10.1176/appi.ajp.20230657correction","DOIUrl":"https://doi.org/10.1176/appi.ajp.20230657correction","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":"142765584","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":"With Apologies to Monty Python: Is Every Cell Sacred?","authors":"Michaela E Price, Zoé A McElligott","doi":"10.1176/appi.ajp.20240969","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240969","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1036-1038"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765625","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":"Novel Pharmacologic and Other Somatic Treatment Approaches for Posttraumatic Stress Disorder in Adults: State of the Evidence.","authors":"Lauren M Sippel, Jessica L Hamblen, Benjamin Kelmendi, Jonathan E Alpert, Linda L Carpenter, Adrienne Grzenda, Nina Kraguljac, William M McDonald, Carolyn I Rodriguez, Alik S Widge, Charles B Nemeroff, Paula P Schnurr, Paul E Holtzheimer","doi":"10.1176/appi.ajp.20230950","DOIUrl":"10.1176/appi.ajp.20230950","url":null,"abstract":"<p><p>Posttraumatic stress disorder (PTSD) is a highly prevalent psychiatric disorder that can become chronic and debilitating when left untreated. The most commonly recommended first-line treatments for PTSD among adults are individual trauma-focused psychotherapies. Other evidence-based treatments include specific antidepressant medications and non-trauma-focused psychotherapies. Despite the effectiveness of these available treatments, many patients' symptoms do not remit. This has led to the search for novel treatments for PTSD. In this review, the authors critically evaluate the data supporting several emerging pharmacological and other somatic interventions in the categories of medication-assisted psychotherapy, novel medication monotherapy strategies, and neuromodulation, selected because of the salience of their mechanisms of action to the pathophysiology of PTSD (e.g., MDMA-assisted psychotherapy, ketamine, cannabidiol, transcranial magnetic stimulation). The authors also evaluate the evidence for treatments that are the focus of increasing scientific or public interest (i.e., hyperbaric oxygen therapy, stellate ganglion block, neurofeedback). To date, the evidence supporting most novel pharmacological and somatic treatments for PTSD is preliminary and highly variable; however, the data for several specific treatments, such as transcranial magnetic stimulation, are encouraging.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1045-1058"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765591","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":"Pathways to Homelessness: Childhood Maltreatment and Psychiatric Symptoms Increase Risk of Homelessness.","authors":"Cathy Spatz Widom, Kellie Courtney, Hang Heather Do","doi":"10.1176/appi.ajp.20230649","DOIUrl":"https://doi.org/10.1176/appi.ajp.20230649","url":null,"abstract":"<p><strong>Objective: </strong>Homelessness is a serious and increasing public health concern. Childhood maltreatment and psychiatric problems have been associated with homelessness as risk factors; however, reliance on cross-sectional studies introduces ambiguity into interpreting previous findings. This study seeks to understand whether psychiatric symptoms in part explain the relationship between childhood maltreatment and homelessness.</p><p><strong>Methods: </strong>The authors used data from a prospective cohort design study in which individuals with documented histories of childhood maltreatment (ages 0-11 years) and a demographically matched group of children without those histories (N=1,196) were followed up into middle adulthood and interviewed. Psychiatric symptoms (anxiety, depression, post-traumatic stress disorder [PTSD], antisocial personality disorder [ASPD], and alcohol and drug use) were assessed at mean age 29. Homelessness was assessed at mean ages 29, 39, 41, and 47 years. Structural equation modeling was used to test mediation.</p><p><strong>Results: </strong>Twice as many individuals with histories of childhood maltreatment reported ever being homeless (25.6% vs. 12.3%, AOR=2.54, 95% CI= 1.86-3.50) and past year homelessness (5.5% vs. 2.5%, AOR=2.09, 95% CI=1.31-3.43) at age 29, compared to controls. Controlling for past homelessness, psychiatric symptoms predicted future homelessness at mean ages 41 and 47. Three significant paths from childhood maltreatment to future homelessness were identified through depression, PTSD, and ASPD.</p><p><strong>Conclusions: </strong>This longitudinal study with documented cases of childhood maltreatment found that psychiatric symptoms earlier in life predict homelessness. Depression, PTSD, and ASPD represent pathways through which childhood maltreatment increases homelessness risk and warrant greater attention.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"181 12","pages":"1103-1111"},"PeriodicalIF":15.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765593","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}