The Journal Of Clinical Psychiatry[JOURNAL]
Sun
200 papers
Delirium as a Precursor to Dementia in Elderly Type 2 Diabetes Mellitus Patients.
Sun M, Wang X, Lu Z … +6 more , Yang Y, Lv S, Miao M, Chen WM, Wu SY, Zhang J
J Clin Psychiatry · 2025 May · PMID 40767775 · Publisher ↗
This study aimed to investigate the association between delirium and incident dementia in elderly (≥65 years) type 2 diabetes mellitus (T2DM) patients, addressing the heightened dementia risk in this population. We cond...
This study aimed to investigate the association between delirium and incident dementia in elderly (≥65 years) type 2 diabetes mellitus (T2DM) patients, addressing the heightened dementia risk in this population. We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) spanning January 1, 2005, to December 31, 2022. The study included elderly (≥65 years) T2DM patient newly diagnosed between January 1, 2005, and December 31, 2007. Patients were categorized into delirium and no delirium groups. A rigorous propensity score matching algorithm was applied to ensure optimal balance of baseline covariates, thereby minimizing selection bias and confounding, and Cox regression models along with competing risk analyses assessed the risk of incident dementia. The study included 5,128 elderly (≥65 years) T2DM patients, with 2,564 patients in both the delirium and no delirium groups. Baseline covariates achieved balance, including age, sex, income levels, urbanization, duration of diabetes, types of antidiabetic medications, and comorbidities. The incidence of dementia was significantly higher in the delirium group (42.75%) compared to the no delirium group (22.66%), with a value <.0001. The data reveal a clear dose-response pattern, wherein each additional delirium episode substantially amplifies dementia risk, underscoring the cumulative impact of repeated episodes on cognitive deterioration: no episodes (4.40 per 100 person-years), 1 episode (7.62 per 100 person-years), and 2 or more episodes (8.41 per 100 person-years). Our findings confirm a strong association between delirium and an increased risk of dementia in elderly (≥65 years) T2DM patients, suggesting a potential causal link. Effective delirium management in elderly T2DM patients is imperative to mitigate dementia risk. These findings advocate for targeted interventions to alleviate the substantial cognitive burden in this vulnerable population.
Postpartum Distress Among Women With and Without Attention-Deficit/Hyperactivity Disorder.
Babinski DE, Riggle K, Tuan WJ
J Clin Psychiatry · 2025 May · PMID 40767774 · Publisher ↗
The goal of this study was to examine the prevalence of postpartum distress among women with attention deficit/hyperactivity disorder (ADHD). Using a large electronic health records registry, a sample of 13,588 women wi...
The goal of this study was to examine the prevalence of postpartum distress among women with attention deficit/hyperactivity disorder (ADHD). Using a large electronic health records registry, a sample of 13,588 women with and 474,789 women without ADHD (18-45 years old) who had birth delivery records between 2010 and 2022 was identified. The prevalence of distress, including depression, anxiety, obsessive-compulsive disorder (OCD), and stress-related disorders at 6 weeks and 12 months following delivery, was compared between groups. Analyses also considered the effects of other factors associated with postpartum distress, including age, race, and ethnicity, as well as preexisting physical and mental health concerns. Relative to women without ADHD, women with ADHD reported higher rates of depression, OCD, and stress-related disorders at 6 weeks and 12 months following delivery. Compared to women without ADHD, and considering the effects of race, ethnicity, age, and preexisting mental and physical health conditions, women with ADHD were 1.14 times more likely to be diagnosed with mood disorder at 6 weeks postpartum and 1.21-1.24 times more likely to be diagnosed with a mood, anxiety, or stress-related disorder at 12 months postpartum. Women with ADHD face adversity in the acute and long-term postpartum periods. Future research examining mechanisms of postpartum risk and resilience is needed to guide the development of treatments to support women with ADHD during this sensitive developmental period.
Early Response to Ketamine for Suicidal Crisis Reduces Suicidal Events at 3 Months.
Pastre M, Chancel R, Malestroit M … +2 more , Courtet P, Olié E
J Clin Psychiatry · 2025 Jul · PMID 40767760 · Publisher ↗
Intravenous (IV) ketamine has demonstrated rapid reduction of suicidal ideation (SI), but its impact on suicidal attempts remains unclear. This study investigates the effect of IV ketamine on SI at 7 days and suicidal ev...
Intravenous (IV) ketamine has demonstrated rapid reduction of suicidal ideation (SI), but its impact on suicidal attempts remains unclear. This study investigates the effect of IV ketamine on SI at 7 days and suicidal events (suicide attempt or hospitalizations for SI) at 3 months in a real-world clinical setting. We conducted an observational retrospective study including 100 adult French patients who received 1 or 2 IV ketamine infusions (0.5 mg/kg) within 1 week for a suicidal crisis between June 2022 and June 2024. Depressive symptoms (Montgomery-Asberg Depression Rating Scale) and SI severity (Columbia-Suicide Severity Rating Scale [C-SSRS]) were assessed at baseline and 7 days postinfusion. Suicidal events were collected from clinical records at 3 months. Ketamine significantly reduced depressive symptoms (β = -11; < .001) and SI severity (β = -2.0; < .001) at 7 days after controlling for age, sex, and number of infusions. A direct (β = -0.78; < .001) and indirect effect (β = -0.29; = .007) on SI through depression reduction was observed. Sixty-one percent of patients were SI responders (≥50% reduction in C-SSRS severity). SI responders at 7 days had 75% lower odds of experiencing suicidal events at 3 months (OR =0.25; = .009). This is the first study demonstrating that early SI response to IV ketamine is associated with a reduced risk of suicidal events at 3 months. These findings support ketamine's unique antisuicidal properties beyond its antidepressant effects, highlighting its potential role in suicide prevention. ClinicalTrials.gov identifier: NCT06806475.
Prognostic and Prescriptive Predictors of Treatment Response to Adjunctive VNS Therapy in Major Depressive Disorder: A RECOVER Trial Report.
Aaronson ST, Conway CR, Gordon C … +16 more , Lee YL, George MS, Zajecka J, Riva-Posse P, Dunner DL, Macaluso M, Rosenquist PB, Mickey BJ, Sheline YI, Hristidis VC, Brown H, Kriedt CL, Tran Q, Bunker MT, Sackeim HA, Rush AJ
J Clin Psychiatry · 2025 Jul · PMID 40673907 · Publisher ↗
Vagus nerve stimulation (VNS) therapy is a long-term intervention for treatment-resistant major depression (TRD) adjunctive to treatment as usual (TAU). To enhance clinical decision- making, we identified subgroups that...
Vagus nerve stimulation (VNS) therapy is a long-term intervention for treatment-resistant major depression (TRD) adjunctive to treatment as usual (TAU). To enhance clinical decision- making, we identified subgroups that respond especially well or poorly with active VNS vs no stimulation sham VNS (prognostic predictors) and subgroups that specifically benefit from active VNS vs sham VNS (prescriptive predictors). In the RECOVER trial, patients with marked TRD (N=493) were randomized to either active VNS (N=249) or sham VNS (N=244); both groups continued TAU. Baseline demographic, clinical, and treatment history characteristics were evaluated as potential prognostic and/or prescriptive outcome predictors. Outcome assessment was based on a tripartite measure that combined depressive symptoms (Quick Inventory of Depressive Symptomatology-Clinician), psychosocial function (Work Productivity and Activity Impairment Questionnaire item 6), and quality of life (Mini-Quality of Life Enjoyment and Satisfaction Questionnaire). Generalized linear mixed models were employed to identify both prognostic and prescriptive predictors of tripartite outcomes. Several baseline features predicted outcomes across the entire sample and within the sham VNS group (prognostic prediction). History of treatment with electroconvulsive therapy (ECT; lifetime and current episode) or transcranial magnetic stimulation (TMS; current episode) was associated with poorer prognosis. However, these same features were associated with greater benefit from active VNS vs sham VNS. The presence of comorbid anxiety disorders was predictive of a better prognosis overall, but smaller benefit from active VNS vs sham VNS. Marked TRD patients with a history of ECT or TMS had especially poorer outcomes when receiving sham VNS plus TAU for 1 year than those without this history. These same subgroups showed significant differential benefit with active VNS than with sham VNS (positive prescriptive effect). The absence of a comorbid anxiety disorder was linked to superior benefit from active VNS vs sham VNS. These predictors may inform clinical decision-making when considering VNS. ClinicalTrials.gov identifier: NCT03887715.
Actigraphy-Measured Sleep/Wake Characteristics Associated With Suicidal Ideation in Older Adults Who Have Depression and High Suicide Risk.
Smagula SF, Zhang G, Albert S … +7 more , Lim S, Harvey AG, Irwin MR, McCall WV, Reynolds CF, Buysse DJ, Krafty RT
J Clin Psychiatry · 2025 Jul · PMID 40673906 · Publisher ↗
The aim of this study was to identify sleep/wake characteristics associated with suicidal ideation (SI) severity among older adults who are at risk for suicide. This 6-week observational study examined associations betw...
The aim of this study was to identify sleep/wake characteristics associated with suicidal ideation (SI) severity among older adults who are at risk for suicide. This 6-week observational study examined associations between weekly actigraphy-derived sleep/wake measures and SI severity (Beck Scale for Suicidal Ideation [SSI]). The sample (n = 30; 83% female; average age = 62 years), enrolled April 2021 through March 2023, self reported a physician diagnosis of major depressive disorder with an episode in the last 6 months and also had either recent active SI or a past suicide attempt. Weekly sleep/wake measures included sleep duration, fragmentation, and 2 rhythm variables (interdaily stability and relative amplitude). Primary analyses used age- and sex-adjusted repeated-measure linear mixed models, 1 model per sleep/wake variable, to assess associations between weekly sleep/ wake and SI reported at week's end. We examined if associations of sleep/wake factors with SI were independent of depression severity (Patient Health Questionnaire-8 scores). Longer sleep duration, greater interdaily stability, and higher relative amplitude were associated with lower SI (eg, for each standard deviation higher interdaily stability, SSI scores were an estimated 1.4 points lower [ = .005]). After adjusting for depression severity, both sleep/wake rhythm variables remained significantly associated with SI, whereas the association between sleep duration and SI severity was attenuated by >80%. In this sample, sleep/wake rhythm disruption (but not sleep duration or fragmentation) related to SI independent of depression severity. Targeting disruptions in sleep/wake rhythms may be an important avenue for future trials of sleep medicine approaches to reduce SI in older adults.
Klotho and Matrix Metalloproteinase-9 Levels and Their Association With Inhibitory Dyscontrol in Adolescents With First-Episode Major Affective Disorders.
Chen LC, Bai YM, Tsai SJ … +2 more , Hsu JW, Chen MH
J Clin Psychiatry · 2025 Jul · PMID 40673899 · Publisher ↗
The roles of Klotho and matrix metalloproteinase (MMP)-9 in the pathomechanisms underlying first episode major affective disorders as well as their impact on related inhibitory control function remain unclear. This stud...
The roles of Klotho and matrix metalloproteinase (MMP)-9 in the pathomechanisms underlying first episode major affective disorders as well as their impact on related inhibitory control function remain unclear. This study included 44 adolescents with first-episode bipolar disorder, 60 with first-episode major depressive disorder, and 46 age matched healthy controls between January 1, 2021, and August 31, 2024. criteria were used to make the diagnoses of 2 major affective disorders. All the participants were assessed for levels of Klotho and MMP-9 and completed the go/no-go task. Generalized linear models (GLMs) were employed to compare Klotho and MMP 9 levels, along with inhibitory control function, between groups. After adjustments for demographic characteristics, clinical symptoms, and psychotropic medication use, the GLMs indicated that adolescents with bipolar disorder and those with major depressive disorder exhibited significantly lower Klotho levels compared with the control group ( = .007). Additionally, adolescents with bipolar disorder had the highest MMP-9 levels ( = .002), followed by those with major depressive disorder ( = .031), compared with healthy controls. Furthermore, lower Klotho levels and higher MMP-9 levels were associated with inhibitory control deficits. Adolescents experiencing first-episode bipolar disorder and major depressive disorder exhibited decreased Klotho levels and increased MMP-9 levels, both of which were associated with deficits in inhibitory control function. Additional studies are warranted to clarify the specific pathomechanisms underlying the complex associations between major affective disorders, Klotho and MMP-9 dysregulation, and deficits in inhibitory control function.
How Do We Get Ketamine Safety Right? Three Questions From a Clinical Service.
Brody BD, Popeo DM, Smetana RW … +1 more , Kanellopoulos D
J Clin Psychiatry · 2025 Jul · PMID 40673898 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Global Population-Based Study on the Association Between Ketamine and Esketamine With Suicidality Using WHO VigiBase.
Kwan ATH, Lakhani M, Rosenblat JD … +8 more , Mansur RB, Rhee TG, Teopiz KM, Cao B, Ho R, Wong S, Le GH, McIntyre RS
J Clin Psychiatry · 2025 Jul · PMID 40637548 · Publisher ↗
Ketamine and esketamine have been reported to rapidly alleviate various parameters of suicidality, with antisuicidal effects that may be independent of their rapid-acting antidepressant effects. However, it remains uncle...
Ketamine and esketamine have been reported to rapidly alleviate various parameters of suicidality, with antisuicidal effects that may be independent of their rapid-acting antidepressant effects. However, it remains unclear whether ketamine and/or esketamine are associated with the emergence or worsening of suicidality. In this global observational pharmacovigilance cohort study, we analyzed suicidality reports associated with ketamine and esketamine using data from the World Health Organization's VigiBase, accessed from its inception through January 2024. Disproportionality was assessed using the reporting odds ratio (ROR), with significance defined as < .05. Compared to lithium, esketamine exhibited higher disproportionality for suicidal ideation (ROR = 5.13, 95% CI, 4.48-5.87, < .0001), while ketamine showed lower disproportionality for suicidal ideation (ROR = 0.76, 95% CI, 0.58-0.99, = .043), suicide attempt (ROR =0.17, 95% CI, 0.12-0.24, < .0001), and completed suicide (ROR =0.30, 95% CI, 0.22-0.40, < .0001). Esketamine also had lower RORs for suicide attempt (ROR = 0.46, 95% CI, 0.39-0.54, < .0001) and completed suicide (ROR =0.36, 95% CI, 0.30-0.43, < .0001). When fluoxetine was used as the reference, esketamine showed higher disproportionality for suicidal ideation (ROR = 3.34, 95% CI, 3.06-3.65, < .0001), while ketamine had a lower ROR (ROR =0.49, 95% CI, 0.39-0.63, < .0001). For suicidal behavior, esketamine had a lower ROR (ROR =0.37, 95% CI, 0.17-0.81, = .012), and both ketamine (ROR =0.15, 95% CI, 0.10-0.21, < .0001) and esketamine (ROR = 0.39, 95% CI, 0.34-0.45, < .0001) had lower RORs for suicide attempt. Both agents also had lower RORs for completed suicides (ketamine: ROR = 0.24, 95% CI, 0.18-0.32, < .0001; esketamine: ROR= 0.29, 95% CI, 0.25-0.35, < .0001). Both increased and decreased RORs for suicidality parameters were observed with ketamine and esketamine, with similar results regardless of whether lithium or fluoxetine was used as the reference. However, causality between ketamine/esketamine use and changes in suicidality cannot be determined.
A Primer on Individual Participant Data Meta-Analysis and Its Strengths and Limitations.
Andrade C
J Clin Psychiatry · 2025 Jul · PMID 40637547 · Publisher ↗
In conventional (aggregate data) meta-analysis, the results of many similar studies are statistically combined to yield a single pooled result. Conventional meta-analyses have many limitations. They cannot examine resear...
In conventional (aggregate data) meta-analysis, the results of many similar studies are statistically combined to yield a single pooled result. Conventional meta-analyses have many limitations. They cannot examine research questions that were not examined in the source studies, interactions between variables cannot be studied, granular analyses cannot be performed, and systematic biases in the source study data will be retained in the pooled results. Individual participant data meta-analysis (IPD-MA) differs from conventional meta-analyses in that, instead of pooling the results of already completed analyses from source studies, the statistical team obtains and processes individual participant data from the source studies. This allows the specification of a new study protocol that can be uniformly applied, across source studies, to the individual participant data. Matters that can thus be harmonized across the source studies include participant eligibility criteria, choice of exposures and outcomes, operational definitions of exposures and outcomes, time points for data examination, and the method of data analysis. IPD-MA can be performed as a 1-stage or 2-stage procedure; the latter is simpler. Whereas IPD-MA overcomes some of the limitations of conventional meta-analysis, it has its own limitations. Obtaining individual participant data can be difficult and time-consuming, reprocessing and reanalyzing source study data requires time and effort, and new biases may be introduced. The new biases arise from lack of availability of individual participant data from all source studies, limitation of the generalizability of findings when harmonization of the study protocol excludes subjects from analysis, loss of randomization structure when participant eligibility restrictions are applied in IPD-MAs of randomized controlled trials, and failure to adequately adjust for necessary covariates. Readers need to be aware of these biases, and authors of IPD-MAs need to report on the potential impact of these biases on their results.
A Case Series of Intimate Partner Violence in Older Adults Within an Older Persons' Mental Health Service.
Sharma A, Reutens S, Wand APF
J Clin Psychiatry · 2025 Jul · PMID 40637543 · Publisher ↗
The aim of this case series is to explore the range of considerations (ethical, practical, and legal) for mental health clinical assessment and management of older adults experiencing intimate partner violence (IPV). Th...
The aim of this case series is to explore the range of considerations (ethical, practical, and legal) for mental health clinical assessment and management of older adults experiencing intimate partner violence (IPV). Three case reports are described. Participants were older adults presenting to an Older Persons Mental Health service in a metropolitan area who reported experiencing recent IPV (either as a survivor or perpetrator). Each case illustrates aspects of the complex issues to be considered in the assessment and management of IPV in older adults, including clinical factors (eg, cognition, interpersonal relationships, mental illness), ethical dilemmas, and legal, sociocultural, and practical considerations. This case series highlights the complexity in assessing and managing IPV in both members of the older adult dyad within a mental health service. Specific approaches to IPV are required given the physical, emotional, and cognitive interdependency often present in older adults.
Exploring Vascular Endothelial Growth Factor and Other Blood-Brain Barrier Biomarkers in Cognition of First-Episode Psychosis: An Observational Study.
Ballesteros A, Flores-Lopez M, Sánchez-Torres AM … +6 more , Gil-Berrozpe GJ, Moreno-Izco L, Gavito A, Serrano A, Rodríguez de Fonseca F, Cuesta MJ
J Clin Psychiatry · 2025 Jul · PMID 40637542 · Publisher ↗
Cognitive deficits are a core feature of early stages of schizophrenia. However, according to neurodevelopmental models, the extent to which chemokines and growth factors are involved in cognitive function remains debata...
Cognitive deficits are a core feature of early stages of schizophrenia. However, according to neurodevelopmental models, the extent to which chemokines and growth factors are involved in cognitive function remains debatable. We aimed to investigate whether homeostatic/inflammatory chemokines and growth factors are associated with cognitive impairment in patients with first-episode psychosis (FEP) in remission. Fifty patients, 21 healthy siblings, and 24 controls participated in the study. The primary outcomes were associations between cognition and growth factors (brain-derived neurotrophic factor [BDNF] and vascular endothelial growth factor [VEGF]), homeostatic markers (CXCL12), and inflammatory chemokines (CCL2, CCL3, CX3CL1, and CCL11) using a whole-blood immunoassay procedure. Differences between the FEP group, siblings, and controls were also examined to understand distinct group profiles. The VEGF levels were significantly higher in the FEP group than in the control group. High VEGF levels are significantly associated with lower social cognition scores. Moreover, a post hoc hierarchical regression model explained 34.5% of the variance in social cognition (=1.533, =.168), with inflammatory variables explaining 13.5% and VEGF showing statistical significance (β=-1.936, =.022). No additional significant results were found for the other inflammatory biomarkers. Our preliminary results suggest that an increase in VEGF might help preserve social cognition after first- episode psychosis. These findings might suggest that a compensatory mechanism could outweigh other VEGF- related hypotheses, such as blood-brain barrier opening and chronic neuroinflammation. However, this hypothesis requires further investigation to address the methodological challenges of determining chemokine levels and controlling for confounding variables.
Using GenAI to Train Mental Health Professionals in Suicide Risk Assessment: Preliminary Findings.
Elyoseph Z, Levkovitch I, Haber Y … +1 more , Levi-Belz Y
J Clin Psychiatry · 2025 Jun · PMID 40608482 · Publisher ↗
Suicide risk assessment is a critical skill for mental health professionals (MHPs), yet traditional training in this area is often limited. This study examined the potential of generative artificial intelligence (GenAI)-...
Suicide risk assessment is a critical skill for mental health professionals (MHPs), yet traditional training in this area is often limited. This study examined the potential of generative artificial intelligence (GenAI)- based simulator to enhance self-efficacy in suicide risk assessment among MHPs. A quasiexperimental mixed methods study was conducted. Participants interacted with an AI-based simulator (AIBS) that embodied the role of a patient seeking suicide risk assessment. Each participant conducted a real-time risk assessment interview with the virtual patient and received comprehensive feedback on their assessment approach and performance. Quantitative data were collected through pre- and postintervention questionnaires measuring suicide risk assessment self efficacy and willingness to treat suicidal patients (using 11-point Likert scales). Qualitative data were gathered through open-ended questions analyzing participants' experiences, perceived benefits, and concerns regarding the AI simulator. Among the 43 participating MHPs, we found a significant increase in self efficacy scores from preintervention (mean = 6.0, SD = 2.4) to postintervention (mean = 6.4, SD = 2.1, < .05). Willingness to treat patients presenting suicide risk increased slightly from (mean = 4.76, SD =2.64) to (mean = 5.00, SD = 2.50) but did not reach significance. Participants reported positive experiences with the simulator, with high likelihood to recommend to colleagues (mean = 7.63, SD =2.27). Qualitative feedback indicated that participants found the simulator engaging and valuable for professional development. However, participants raised concerns about overreliance on AI and the need for human supervision during training. This preliminary study suggests that AIBSs show promise for improving MHPs' self-efficacy in suicide risk assessment. However, further research with larger samples and control groups is needed to confirm these findings and address ethical considerations surrounding AI use in suicide risk assessment training. AI powered simulation tools may have potential to increase access to training in mental health, potentially contributing to global suicide prevention efforts. However, their implementation should be carefully considered to ensure they complement rather than replace human expertise.
Zuranolone for Postpartum Depression in Real-World Clinical Practice.
Price MZ, Price RL
J Clin Psychiatry · 2025 Jul · PMID 40608478 · Publisher ↗
Abstract loading — click title to view on PubMed.
Bright Light Therapy in the Morning or Midday for the Treatment of Nonseasonal Depression in Bipolar Disorder (LuBi): A Dose-Escalation Phase 1/2 Randomized Double-Blind Trial.
Geoffroy PA, Chevret S, Mauries S … +15 more , Chaffaut C, Amad A, Bellivier F, Benard V, Courtet P, Dubertret C, Gorwood P, Mazer N, Mekaoui L, Olié E, Pataud G, Vaiva G, Lejoyeux M, Sit D, Maruani J
J Clin Psychiatry · 2025 Jun · PMID 40608475 · Publisher ↗
This dose-escalation study aimed to evaluate the tolerance (hypomanic symptoms) and efficacy of bright light therapy (BLT) in depressed patients with bipolar disorder (BD) with mood stabilizers, using different schedules...
This dose-escalation study aimed to evaluate the tolerance (hypomanic symptoms) and efficacy of bright light therapy (BLT) in depressed patients with bipolar disorder (BD) with mood stabilizers, using different schedules (duration and escalation), applied in morning or midday. Patients with BD I or II () followed a 1-week placebo phase and were randomized to morning or midday BLT with dose escalation from 7.5 to 45 minutes/d, until September 2023. Inter- and intrasubject escalation were performed, with dose adjustments based on dose-limiting toxicities (DLTs) to determine the maximum tolerated dose (MTD) and target ceiling dose (TCD) of BLT exposure. The primary outcome measure, DLT, was assessed weekly after each dose initiation or increase and defined as a hypomanic switch (Young Mania Rating Scale [YMRS] score ≥12/60) or subsyndromic hypomanic symptoms (YMRS score 8-12). Both groups reached the starting dose of 45 minutes without reaching the MTD or TCD, enrolling 38 patients (morning = 18 and midday = 16) and demonstrating good tolerance and acceptability. Two patients (6%) experienced a hypomanic switch at 45 minutes: 1 in the morning group (week 1) and 1 in the midday group (week 4). Five patients had subsyndromic hypomania. All symptoms improved within 3 days after dose reduction. Depressive symptoms (Montgomery Asberg Depression Rating Scale, = .007) and Clinical Global Impression (CGI) scores ( < .001 for severity, = .01 for improvement) significantly improved over time. A cumulative exposure effect was observed on CGI improvement ( = .038), alongside a starting dose effect over the weeks on CGI severity ( < .001) and the Flexibility Circadian Type Inventory ( = .042). The comparison between groups shows a higher CGI improvement score in the morning group ( = .035). BLT is a viable antidepressant strategy for BD, safely starting at 45 minutes regardless of timing. Occurring hypomanic symptoms, if any, resolve quickly after dose reduction, provided there is careful monitoring. ClinicalTrials.gov identifier: NCT03396744.
Differentiating Subtypes of Major Depressive Disorder Using Serum Biomarkers.
Kim JM, Kang HJ, Lee JY … +5 more , Kim JW, Kim H, Jhon M, Kim SW, Shin IS
J Clin Psychiatry · 2025 Jun · PMID 40608474 · Publisher ↗
This study aimed to differentiate subtypes of major depressive disorder (MDD) using 14 serum biomarkers across 6 functional systems. We analyzed serum biomarkers in 993 MDD patients, categorized into melancholic (N = 15...
This study aimed to differentiate subtypes of major depressive disorder (MDD) using 14 serum biomarkers across 6 functional systems. We analyzed serum biomarkers in 993 MDD patients, categorized into melancholic (N = 157; 16.8%), atypical (N = 56; 6.0%), and unspecified (N = 720; 77.2%) subtypes according to criteria. Biomarkers included high sensitivity C-reactive protein, tumor necrosis factor-α, interleukins (IL-1β, IL-6, IL-4, IL-10), cortisol, brain-derived neurotrophic factor, serotonin, leptin, total ghrelin, total cholesterol, folate, and homocysteine. Quantile regression analyses adjusted for relevant covariates were used to estimate associations between biomarkers and MDD subtypes. Significant differences in biomarker profiles were observed across MDD subtypes: the melancholic subtype showed higher cortisol levels compared to the unspecified subtype ( = .009) and lower serotonin levels compared to both the unspecified ( = .045) and atypical ( = .006) subtypes. Meanwhile, the atypical subtype exhibited elevated levels of IL-1β compared to the unspecified subtype ( = .036) and higher IL-4 levels than both melancholic and unspecified subtypes (all < .001). These associations remained significant even after adjusting for covariates. Distinct serum biomarker profiles among MDD subtypes highlight their unique biological underpinnings. These findings enhance current understanding of the pathophysiology of different depressive subtypes and suggest targeted therapeutic approaches. Future research should focus on longitudinal studies to monitor these biomarkers over time and explore new biomarkers from genomics and proteomics to advance precision medicine in psychiatry.
Schizophrenia, Antipsychotic Drugs, and Risk of Breast Cancer.
Andrade C
J Clin Psychiatry · 2025 Jun · PMID 40521916 · Publisher ↗
Breast cancer is the commonest form of cancer among women. Literature suggests that women with schizophrenia are less likely to be screened for breast cancer and that, among women with schizophrenia who develop breast ca...
Breast cancer is the commonest form of cancer among women. Literature suggests that women with schizophrenia are less likely to be screened for breast cancer and that, among women with schizophrenia who develop breast cancer, mortality rates are higher. This article examines recent meta-analyses and recent observational studies on the risk of breast cancer in women with schizophrenia, especially in the context of treatment with first generation and second generation antipsychotic (FGA, SGA) drugs. This article also examines the most recent observational study in detail to help readers better understand how to critically appraise this and, by extension, other studies in the field. In summary, studies in the field suggest that there is a small but statistically significant increase in the risk of breast cancer in women with schizophrenia relative to women without psychiatric disorders as well as relative to women with other psychiatric disorders. Women who appear to be most at risk are those in the perimenopausal age range and those with several years of exposure to FGA or prolactin raising antipsychotics. Whereas the possibility of residual confounding in observational studies precludes ascribing a causal role for antipsychotics, given that FGA and prolactin-raising SGA are associated with other adverse effects, it seems reasonable, wherever possible, to prefer SGA over FGA, and prolactin-sparing over prolactin-raising antipsychotics. Women with schizophrenia, and especially those who use prolactin raising antipsychotics for long periods, should be monitored for the risk of breast cancer as a special part of monitoring general health; and modifiable risk factors for breast cancer should be addressed through appropriate behavioral and pharmacological interventions. Women with schizophrenia comprise a vulnerable population, and their medical health should not be neglected even when caring for their mental health absorbs attention and time. Suggestions are provided for directions for future research.
Association Between Adult Sexual Assault and Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.
Tisseau D, Ngameni EG, Dubertret C … +2 more , Le Strat Y, Tebeka S
J Clin Psychiatry · 2025 Jun · PMID 40521915 · Publisher ↗
Sexual assault is a significant public health issue with high prevalence rates, particularly among women. Previous research suggests strong associations between sexual assault and psychiatric disorders, but studies focus...
Sexual assault is a significant public health issue with high prevalence rates, particularly among women. Previous research suggests strong associations between sexual assault and psychiatric disorders, but studies focusing on adult sexual assault (ASA) and its sex specific consequences are limited. To estimate the prevalence of ASA in the US and assess its associations with psychiatric disorders and quality of life, focusing on sex differences. We analyzed cross-sectional data from the National Epidemiologic Study of Alcohol and Related Conditions III (NESARC-III), a nationally representative survey of US adults (N = 36,309). The study included assessments of self-reported ASA and lifetime psychiatric disorders (Alcohol Use Disorder and Associated Disabilities Interview Schedule 5) and quality of life (Short-Form 12-Item Survey version 2). The prevalence of self-reported ASA was 2.6% (n =922), with higher rates in women (4.26%) compared to men (0.53%). ASA was associated with all lifetime psychiatric disorders and a poorer quality of life. Among participants who experienced ASA, 85.25% had at least one lifetime psychiatric disorder. Specifically, among women, 86.09% of victims had at least one lifetime psychiatric disorder (vs 54.43% in women control). The strongest associations were found with posttraumatic stress disorder (PTSD) (adjusted odds ratio [aOR] =5.96), borderline personality disorder (aOR= 4.06), and suicide attempts (aOR= 4.67). Among men, 78.27% of victims had at least one lifetime psychiatric disorder (vs 58.09% in men control). The strongest associations were with psychotic disorders (aOR=6.65), PTSD (aOR=6.62), and suicide attempts (aOR=5.01). ASA was associated with many psychiatric disorders and reduced quality of life, with significant sex differences. These findings highlight the need for targeted interventions and support for sexual assault survivors, emphasizing the importance of routine screening and sex-specific prevention strategies.
Optimizing Treatment With Aripiprazole Monohydrate: Pharmacokinetic Advantages of Long-Acting Injectable Formulations, A Consensus Panel Report.
Goldberg JF, Achtyes ED, Correll CU … +2 more , Sajatovic M, Saklad SR
J Clin Psychiatry · 2025 Jun · PMID 40512701 · Publisher ↗
Schizophrenia and bipolar I disorder (BP-I) are chronic, disabling psychiatric illnesses marked by high morbidity, elevated mortality, and functional deterioration, often exacerbated by poor adherence to oral antipsychot...
Schizophrenia and bipolar I disorder (BP-I) are chronic, disabling psychiatric illnesses marked by high morbidity, elevated mortality, and functional deterioration, often exacerbated by poor adherence to oral antipsychotic medications. Long-acting injectable (LAI) antipsychotics were developed to address adherence challenges and have demonstrated clinical benefits including reduced non-adherence and relapse rates, fewer hospitalizations, and improved functioning and quality of life, and reduced mortality risk. Among available LAIs, aripiprazole offers a unique pharmacologic profile as the only partial dopamine agonist available in an LAI formulation. Aripiprazole monohydrate LAI is available as a once monthly and a once-every-two-month formulation. In this consensus panel report, five psychiatric experts convened to evaluate the pharmacokinetic properties, safety, efficacy, and clinical utility of aripiprazole monohydrate LAIs in the treatment of schizophrenia and BP-I. The panel focused particularly on the more recently approved once-every-2-month ready-to-use formulation. This article summarizes the evidence reviewed by the panel and highlights key considerations for optimizing the use of aripiprazole monohydrate LAIs in clinical practice to enhance treatment outcomes in patients with schizophrenia and BP-I.
Detecting Tardive Dyskinesia Using Video-Based Artificial Intelligence.
Sterns AA, Hughes JW, Grimm B … +7 more , Larsen L, Ma F, Ranjan R, MacMillan C, Talbot BH, Friedman JH, Muir OS
J Clin Psychiatry · 2025 May · PMID 40488727 · Publisher ↗
Tardive dyskinesia (TD) is a late-onset adverse effect of dopamine receptor-blocking medications, characterized by involuntary movements primarily affecting the mouth, though other body parts may be involved. Severity of...
Tardive dyskinesia (TD) is a late-onset adverse effect of dopamine receptor-blocking medications, characterized by involuntary movements primarily affecting the mouth, though other body parts may be involved. Severity of TD varies from mild to debilitating and is usually irreversible. Despite the existence of treatments such as VMAT2 inhibitors, TD remains underdiagnosed, with 40,000 patients treated of an estimated 2.6 million affected US individuals. This study demonstrates a novel, efficient, and reliable method to detect and bring TD to psychiatrists' attention using video-based artificial intelligence. Individuals taking antipsychotic medications were enrolled in Study 1 (n = 46) between March and November 2018, in Study 2 (n = 136) between May 2023 and May 2024, and in Study 3 (n = 174) between July 2023 and May 2024. Participants completed video assessments. A vision transformer machine-learning architecture was evaluated by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity compared with a reference standard of the trained raters' evaluation of TD on the Abnormal Involuntary Movement Scale. The algorithm reached an AUC of 0.89 in the combined validation cohort across Studies 1, 2, and 3. The model demonstrated strong and reliable levels of agreement, outperforming human raters. Our algorithm reliably detected suspected TD, reaching higher sensitivity and specificity than trained raters using the standard assessment. The algorithm can be used to monitor patients taking antipsychotic medications, allowing scarce resources to assess identified patients for a conclusive diagnosis by psychiatrists.
Cognitive Behavioral Therapy for Insomnia With Prolonged Exposure Compared to Sleep Hygiene and Prolonged Exposure: A Randomized Controlled Trial.
Colvonen PJ, Hunt C, Park J … +4 more , Angkaw AC, Gehrman P, Clare K, Norman SB
J Clin Psychiatry · 2025 Jun · PMID 40488726 · Publisher ↗
Co-occurrence of posttraumatic stress disorder (PTSD) and insomnia disorder is common and associated with greater psychiatric and functional problems than either condition alone. Evidence-based PTSD treatment often does...
Co-occurrence of posttraumatic stress disorder (PTSD) and insomnia disorder is common and associated with greater psychiatric and functional problems than either condition alone. Evidence-based PTSD treatment often does not effectively decrease insomnia, and insomnia may interfere with the mechanisms underlying PTSD treatment. This study compared the efficacy of integrated cognitive behavioral therapy for insomnia (CBT-I) and prolonged exposure (PE; CBTI-PE) therapy to sleep hygiene and PE (hygiene-PE) in reducing insomnia and PTSD symptoms. Ninety-four veterans with insomnia disorder (Insomnia Severity Index [ISI] ≥11) and PTSD (Clinician Administered PTSD Scale for [CAPS-5] diagnosis) were randomized to CBTI-PE or hygiene-PE therapy for 12 weeks of treatment. Recruitment ran from January 2017 to March 2023. Planned outcomes were PTSD symptoms (CAPS-5; PTSD Checklist for ), quality of life (World Health Organization Quality of Life-BREF [WHOQOL]), and insomnia severity (ISI, subjective sleep efficiency [SE], total sleep time [TST]) between baseline, week 5, posttreatment, and 3-month follow-up. Randomized participants were 76.6% male, 52.1% white, and mean age was 40.0 years (SD = 11.6). Linear modeling showed PTSD symptoms significantly decreased for most participants, but there were no differences by treatment group ( = .844). While, on average, WHOQOL increased for all participants, there was greater improvement in perceived quality of life (QOL) in CBTI-PE relative to hygiene-PE. ISI decreased, and SE and TST increased for most participants but had statistically and clinically larger changes in CBTI-PE, compared to hygiene-PE ( < .001). On average, participants had reductions in PTSD symptoms, with no differences between the groups. CBTI-PE produced greater reductions in insomnia symptoms and larger increases in QOL, SE, and TST than hygiene-PE. Together, CBT-I PE is an effective intervention for treating 2 highly co-occurring disorders, insomnia and PTSD. ClinicalTrials.gov identifier: NCT02774642.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe