American Journal of Psychiatry最新文献

{"title":"Six Years After Approval of Esketamine Nasal Spray for Serious Depression: Clinical Conundrums and Unanswered Questions.","authors":"Sanjay J Mathew, Nicholas Murphy","doi":"10.1176/appi.ajp.20241177","DOIUrl":"https://doi.org/10.1176/appi.ajp.20241177","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"182 3","pages":"227-230"},"PeriodicalIF":15.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531169","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":"A Fresh Look at the Allostasis Theory of Addiction.","authors":"Markus Heilig","doi":"10.1176/appi.ajp.20241106","DOIUrl":"https://doi.org/10.1176/appi.ajp.20241106","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"182 2","pages":"142-144"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073342","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":"Real-Time Assessment of Alcohol Reward, Stimulation, and Negative Affect in Individuals With and Without Alcohol Use Disorder and Depressive Disorders.","authors":"Andrea C King, Andrew M Fischer, John F Cursio, Nathan A Didier, Zoe Lee, Daniel J Fridberg","doi":"10.1176/appi.ajp.20240069","DOIUrl":"10.1176/appi.ajp.20240069","url":null,"abstract":"<p><strong>Objective: </strong>The allostasis theory states that, as addiction develops, alcohol is consumed to relieve negative affect rather than to produce positive effects. This study aimed to investigate the real-time subjective effects of alcohol in individuals with alcohol use disorder (AUD) and those prone to negative affect by virtue of having comorbid depressive disorder (DEP).</p><p><strong>Methods: </strong>Participants (N=221) completed high-resolution ecological momentary assessments during 3-hour monitoring of one alcohol drinking episode and one non-alcohol drinking episode in their natural environment. Participants also completed daily mood surveys and next-day surveys. Linear mixed-effect models were used to compare drinking behavior and subjective responses (stimulation, sedation, liking, wanting, negative affect) among 120 participants with AUD (AUD+; with depression [DEP+]: N=64, without depression [DEP-]: N=56) and 101 participants without AUD (AUD-; DEP+: N=45, DEP-: N=56).</p><p><strong>Results: </strong>During the monitoring period, participants with AUD consumed an average of 8.5 standard alcohol drinks (estimated blood alcohol concentration [eBAC]=0.115 g/dl) versus 3.7 drinks (eBAC=0.040 g/dl) for non-AUD participants. The AUD group, regardless of comorbid DEP, reported increases in stimulation and rewarding effects that persisted throughout most of the alcohol episode relative to the non-alcohol episode. To a lesser extent, alcohol relieved negative affect but this was not specific to AUD or DEP groups.</p><p><strong>Conclusions: </strong>Contrary to the allostasis model of addiction's emphasis on negative reinforcement drinking, findings demonstrated that people with AUD prone to negative affect displayed positive alcohol reinforcement with pronounced and prolonged sensitivity to alcohol's pleasurable effects, akin to their noncomorbid counterparts. The findings provided critical testing of addiction theories in the natural environment to enhance external validity.</p>","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"182 2","pages":"187-197"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073469","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":"Understanding the Effects of Combined Lisdexamfetamine and Cognitive Behavior Therapy for Adults With Binge Eating Disorder.","authors":"Tom Hildebrandt, Elizabeth Martin","doi":"10.1176/appi.ajp.20241070","DOIUrl":"https://doi.org/10.1176/appi.ajp.20241070","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"182 2","pages":"149-150"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073474","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":"Using Genetically Diverse Rats to Identify Individual Differences in Addiction-Related Behaviors and Brain Activity.","authors":"Ginevra D'Ottavio, Kenichiro Negishi, Yavin Shaham","doi":"10.1176/appi.ajp.20241030","DOIUrl":"https://doi.org/10.1176/appi.ajp.20241030","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"182 2","pages":"145-148"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073477","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":"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":"209-218"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786997/pdf/","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":"OA","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":"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":"155-163"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","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":"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":"174-186"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","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":"Correcting Overestimations in Self-Harm Visit Data.","authors":"Abid Rizvi","doi":"10.1176/appi.ajp.20240577","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240577","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"182 2","pages":"219"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073343","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":"Tobacco Use Is Associated With Mental Illness and Substance Use Problems-Now What?","authors":"Judith J Prochaska","doi":"10.1176/appi.ajp.20241089","DOIUrl":"https://doi.org/10.1176/appi.ajp.20241089","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"182 2","pages":"137-138"},"PeriodicalIF":15.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073471","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}