Alzheimer's disease (AD) is a common neurodegenerative illness affecting nearly 7 million people in the United States. Until 2023, no disease-targeting pharmacotherapeutics were widely available outside of research studi...Alzheimer's disease (AD) is a common neurodegenerative illness affecting nearly 7 million people in the United States. Until 2023, no disease-targeting pharmacotherapeutics were widely available outside of research studies. With relatively recent regulatory approval and increasing availability of antiamyloid therapies (AATs) in the United States, management of AD is rapidly shifting from symptomatic and supportive care alone to treatments aimed at disease modification. Appropriate selection of patients for AATs can be challenging and varies among health care settings and systems despite published appropriate-use recommendations. The first of this two-part Treatment in Behavioral Neurology & Neuropsychiatry series from the American Neuropsychiatric Association Dementia Special Interest Group addresses the challenges with patient selection. In this second part, the authors offer dementia-focused health care vignettes to illustrate challenges with AAT delivery encountered in different settings and discuss emerging logistical issues associated with delivery of dementia-focused care based on AAT protocols.
Arora J, Ossowski A, Patchell A
… +16 more, Jamison KW, Kuceyeski A, Singh J, Garetti J, Cappillo M, Hamill L, Blunt E, Kaunzner UW, Winchell R, Yee-Oleksy S, Khedr S, Dams-O'Connor K, Schiff ND, Liston C, Shah S, Jaywant A
J Neuropsychiatry Clin Neurosci
· 2026 · PMID 40509793
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OBJECTIVE: Depression is known to be highly heterogeneous, with distinct clusters of symptoms. Whether this heterogeneity exists after traumatic brain injury (TBI) and how clusters of depression symptoms after TBI may re...OBJECTIVE: Depression is known to be highly heterogeneous, with distinct clusters of symptoms. Whether this heterogeneity exists after traumatic brain injury (TBI) and how clusters of depression symptoms after TBI may relate to clinical symptoms, functional outcomes, and underlying neurobiology are largely unknown. METHODS: The authors investigated depression symptom clusters after subacute TBI and evaluated their clinical, functional, and neural correlates. Community-dwelling participants with complicated mild, moderate, or severe TBI (N=53) were evaluated on average 5 months postinjury. Participants were administered the 17-item Hamilton Depression Rating Scale (HDRS), the Rivermead Post-Concussion Symptom Questionnaire, the Glasgow Outcome Scale-Extended, and a neuropsychological test battery. A subset of participants completed a resting-state functional MRI scan. RESULTS: Principal component analysis on the HDRS items yielded a two-component solution that accounted for 40% of the variance. Component 1 encompassed mood and affective symptoms as well as agitation and loss of libido, and component 2 encompassed anxiety, insomnia, and most somatic symptoms of the HDRS. Component 2 was associated with greater TBI symptom burden and disability and worse executive functions but not resting-state functional connectivity. Component 1 was not related to TBI symptom burden, neuropsychological function, or disability, but there was a trend-level association between higher negative affect scores and greater functional connectivity between the dorsal attention and default mode networks. CONCLUSIONS: The findings suggest that depression after TBI may not be a unitary syndrome but rather may be composed of clusters of symptoms that have different associations with TBI symptom burden, disability, and brain connectivity.
Luccarelli J, Smith JR, Turley N
… +5 more, Rogers JP, Sun H, Kohrman SI, Fricchione G, Westover MB
J Neuropsychiatry Clin Neurosci
· 2026 · PMID 40509792
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OBJECTIVE: Catatonia is an underdiagnosed disorder characterized by speech and motor abnormalities. EEG examinations may improve the accuracy of a catatonia diagnosis, but clinical and electrographic correlations have no...OBJECTIVE: Catatonia is an underdiagnosed disorder characterized by speech and motor abnormalities. EEG examinations may improve the accuracy of a catatonia diagnosis, but clinical and electrographic correlations have not been established. The authors describe catatonic features and EEG findings in a large multisite retrospective cohort. METHODS: The clinical records in two health care systems were searched for patients with an EEG recording and a catatonia assessment with the Bush-Francis Catatonia Rating Scale conducted within 24 hours of each other. Included patients were retrospectively screened for delirium through a chart-based assessment. Augmented inverse propensity weighting (AIPW) was used to estimate the causal effects of delirium and catatonia on the presence of an abnormal EEG finding. RESULTS: Overall, 178 patients met inclusion criteria, 144 (81%) of whom had catatonia. Among the patients with catatonia, 43% also had delirium. EEG abnormalities were present among 43% of patients with catatonia, including 28% of patients with catatonia without delirium and 69% of the patients with co-occurring catatonia and delirium. Individual catatonic signs and EEG abnormalities showed only a weak correlation. In AIPW models, a delirium diagnosis was associated with significantly higher odds for an abnormal EEG finding (OR=6.75; 95% CI=2.83-16.14), whereas a diagnosis of catatonia was not (OR=1.83, 95% CI=0.79-4.24). CONCLUSIONS: EEG abnormalities are common among individuals with catatonia, but these are difficult to disentangle from abnormalities resulting from co-occurring delirium. Further research is needed to define the role of EEG examinations in the assessments of catatonia and delirium.
González Rosas Z, Martínez-Jiménez HS, Arroyo-Landín M
… +7 more, Fragoso G, Chávez-Canales M, Hernández M, Rosetti MF, López-Alvarenga JC, Sciutto E, Cárdenas G
OBJECTIVE: COVID-19 has been associated with a wide range of systemic and neurological complications, known as long COVID or postacute sequelae of COVID-19 (PASC). Such sequelae can be observed among all infected individ...OBJECTIVE: COVID-19 has been associated with a wide range of systemic and neurological complications, known as long COVID or postacute sequelae of COVID-19 (PASC). Such sequelae can be observed among all infected individuals, even among those with a mild disease course. Dysbiosis, a common condition associated with low-grade inflammation, has been proposed as a potential mechanism of PASC by altering levels of circulating lipopolysaccharide (LPS) and the tryptophan pathway metabolites kynurenine and quinolinic acid, known to affect neurocognitive function. The authors evaluated the evolution of neurological, neurocognitive, and neuropsychiatric COVID-19 sequelae and their relationship with circulating LPS and kynurenine and quinolinic acid levels. METHODS: A prospective, longitudinal, and analytical study was conducted. Neurological, neurocognitive, and neuropsychiatric assessments of participants who had recovered from COVID-19 and did not require hospitalization during the acute stages of the infection were performed. Peripheral levels of LPS and tryptophan metabolites were measured 1, 3, 6, and 12 months after infection. RESULTS: Of 95 participants recruited, 67 COVID-19-convalescent individuals and 20 COVID-19-free individuals were included. Significantly higher occurrences of asthenia, olfaction and taste alterations, headache, memory dysfunction, and systemic symptoms such as dyspnea, cough, and periodontal diseases were found among participants in the COVID-19-convalescent group compared with participants in the comparison group. A significant decrease in kynurenine levels, which correlated with cognitive impairment, was observed among PASC convalescents. CONCLUSIONS: Significant neurocognitive and neuropsychiatric impairments were observed among COVID-19-convalescent individuals, along with decreased kynurenine levels, which recovered during a 12-month follow-up period.
Circular RNA (circRNA) is a recently characterized species of RNA that is highly enriched in the human brain, differentially expressed in neuropsychiatric disorders, and readily detectable in the peripheral circulation....Circular RNA (circRNA) is a recently characterized species of RNA that is highly enriched in the human brain, differentially expressed in neuropsychiatric disorders, and readily detectable in the peripheral circulation. These characteristics make circRNA an attractive candidate biomarker for neuropsychiatric illness and suggest it as a potential missing link in the understanding of the specific biological underpinnings of neuropsychiatric illness. In this scoping review, the authors summarize the literature on circRNA in neuropsychiatric disorders and add clinical context. The authors searched PubMed, PsycInfo, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials for articles describing research on circRNA and mental disorders published in or after 2012. The authors included peer-reviewed studies with substantive discussions of circRNA and mental disorders that included human participants or cell lines. Only studies written in English or with English translations were considered. Seventy-eight studies met the authors' inclusion criteria. Common and serious neuropsychiatric illnesses were well represented among these studies, including schizophrenia, major depressive disorder, and major neurocognitive disorder. Many studies identified altered circRNA levels in peripheral blood and specific brain regions that were both sensitive to and specific for neuropsychiatric disorders. Few studies discussed the role that circRNA-based diagnostic tests might play in clinical practice, and research on prognostic, therapeutic, or monitoring biomarkers was limited. Although circRNAs have the potential to change the understanding and treatment of neuropsychiatric disorders, the research field would benefit from more clinician involvement in this area to identify and address urgent clinical needs.
OBJECTIVE: Cortical regions such as parietal area H (PH) and the fundus of the superior temporal sulcus (FST) are involved in higher visual function and may play a role in dementia with Lewy bodies (DLB), which is freque...OBJECTIVE: Cortical regions such as parietal area H (PH) and the fundus of the superior temporal sulcus (FST) are involved in higher visual function and may play a role in dementia with Lewy bodies (DLB), which is frequently associated with hallucinations. The authors evaluated functional connectivity between these two regions for distinguishing participants with DLB from those with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and from cognitively normal (CN) individuals to identify a functional connectivity MRI signature for DLB. METHODS: Eighteen DLB participants completed cognitive testing and functional MRI scans and were matched to AD or MCI and CN individuals whose data were obtained from the Alzheimer's Disease Neuroimaging Initiative database (https://adni.loni.usc.edu). Images were analyzed with data from Human Connectome Project (HCP) comparison individuals by using a machine learning-based subject-specific HCP atlas based on diffusion tractography. RESULTS: Bihemispheric functional connectivity of the PH to left FST regions was reduced in the DLB group compared with the AD and CN groups (mean±SD connectivity score=0.307±0.009 vs. 0.456±0.006 and 0.433±0.006, respectively). No significant differences were detected among the groups in connectivity within basal ganglia structures, and no significant correlations were observed between neuropsychological testing results and functional connectivity between the PH and FST regions. Performances on clock-drawing and number-cancelation tests were significantly and negatively correlated with connectivity between the right caudate nucleus and right substantia nigra for DLB participants but not for AD or CN participants. CONCLUSIONS: The functional connectivity between PH and FST regions is uniquely affected by DLB and may help distinguish this condition from AD.
Peppel L, Lai RY, Rummey C
… +26 more, Opal P, Schmahmann JD, Gomez CM, Paulson H, Zesiewicz TA, Perlman S, Wilmot G, Ying SH, Onyike CU, Bushara KO, Geschwind MD, Figueroa KP, Pulst SM, Subramony SH, Duquette A, Ashizawa T, Hamedani AG, Davis MY, Srinivasan SR, Burns MR, Amokrane N, Moore LR, Shakkottai VG, Rosenthal LS, Kuo SH, Lin CR
J Neuropsychiatry Clin Neurosci
· 2026 · PMID 40350965
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OBJECTIVE: Suicidal ideation has not been extensively studied in spinocerebellar ataxias (SCAs). The authors examined whether individuals with SCAs have increased suicidal ideation and related factors. METHODS: The autho...OBJECTIVE: Suicidal ideation has not been extensively studied in spinocerebellar ataxias (SCAs). The authors examined whether individuals with SCAs have increased suicidal ideation and related factors. METHODS: The authors studied patients with genetically confirmed SCAs enrolled in the Clinical Research Consortium for the Study of Cerebellar Ataxia cohort, examining the percentages of patients with SCA subtypes 1, 2, 3, and 6 who reported suicidal ideation and comparing findings with nationally representative data from the National Survey on Drug Use and Health (NSDUH). Clinical characteristics that may contribute to suicidal ideation in SCAs, including age, disease duration, sex, ataxia severity, depression, and SCA subtype, were also studied. RESULTS: Suicidal ideation was present among 12% of 769 patients with SCAs and 4.3% of individuals in the general population recorded in the NSDUH. Compared with individuals in the general population, SCA patients had higher odds of suicidal ideation (OR=2.72). Compared with patients with SCA without suicidal ideation, patients with SCA and suicidal ideation had a longer disease duration (mean±SD=13.1±8.2 years vs. 11.2±9.4 years), more severe ataxia (Scale for the Assessment and Rating of Ataxia mean score=15.9±8.6 vs. 12.9±7.6), and more severe depression. Having suicidal ideation at baseline significantly increased the odds of suicidality later in the disease course (OR=58.73, 95% CI=36.00-98.40). CONCLUSIONS: Suicidal ideation was more prevalent among patients with SCAs than in the general population. The findings of this study underscore the importance of continuous suicidal risk screening among individuals with SCAs and the need for effective depression management.
OBJECTIVE: Attention-deficit hyperactivity disorder, obsessive-compulsive disorder, depression, and anxiety are highly comorbid in Tourette's syndrome. Cutoff points of screening instruments for these conditions have bee...OBJECTIVE: Attention-deficit hyperactivity disorder, obsessive-compulsive disorder, depression, and anxiety are highly comorbid in Tourette's syndrome. Cutoff points of screening instruments for these conditions have been validated in the general population. The authors assessed whether established cutoff points on the General Anxiety Disorder-7 (GAD-7) scale; Patient Health Questionnaire-9 (PHQ-9); PHQ-2; Adult ADHD Self-Report Scale, version 1.1 (ASRS v1.1); and Obsessive-Compulsive Inventory (OCI) need to be adjusted for adults with Tourette's syndrome. METHODS: Thirty-six adults with Tourette's syndrome completed these instruments and a diagnostic psychiatric interview. Measures of diagnostic accuracy were calculated (area under the receiver operating characteristic curve [AUC], sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio) for each instrument at various cutoffs. Cutoffs for the sample of adults with Tourette's syndrome were suggested by the lowest value derived from a Euclidean distance method. RESULTS: In this sample of adults with Tourette's syndrome, the optimal cutoff points were a GAD-7 score ≥13 (sensitivity, 67%; specificity, 91%; and AUC, 79%), a PHQ-9 score ≥15 (sensitivity, 67%; specificity, 73%; and AUC, 70%), a PHQ-2 score ≥3 (sensitivity, 67%; specificity, 67%; and AUC, 67%), an ASRS v1.1 score ≥14 (sensitivity, 83%; specificity, 77%; and AUC, 80%), and an OCI score ≥63 (sensitivity, 70%; specificity, 89%; and AUC, 79%). The best-performing instrument was the ASRS v1.1, followed by the GAD-7 and OCI; the PHQ-9 and PHQ-2 performed least well in this population. CONCLUSIONS: Further research is needed to adapt screening instruments for the assessment of comorbid conditions among patients with Tourette's syndrome.
Neurodevelopmental disorders (NDDs) affect brain development, leading to diverse cognitive, social, behavioral, and affective impairments. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic st...Neurodevelopmental disorders (NDDs) affect brain development, leading to diverse cognitive, social, behavioral, and affective impairments. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial photobiomodulation (tPBM), have been investigated as potential treatments for NDDs. The authors of this systematic review evaluated the literature on NIBS in NDDs, including double-blind, sham-controlled, randomized controlled trials. Following PRISMA guidelines and a registered protocol, the authors conducted a comprehensive search in PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and Scopus, identifying 23 studies. TMS showed promise for addressing hyperactivity, inattention, and working memory deficits in attention-deficit hyperactivity disorder (ADHD), with outcomes influenced by coil type (H5 vs. H6) and stimulation site (right vs. left dorsolateral prefrontal cortex). tDCS showed potential for improving inattention and executive function in ADHD, with limited effects observed on reducing symptom severity in autism spectrum disorder (ASD) and dyslexia. tPBM offered specific therapeutic benefits in reducing irritability in ASD. Although NIBS generally showed mild, transient adverse effects, isolated seizure events, such as one during TMS in ADHD, highlight the importance of rigorous safety protocols, especially in NDDs with elevated epilepsy risk. This review identified potential benefits of certain NIBS protocols in NDDs; however, high variability in methodologies, sample size limitations, and bias concerns underscore the need for further research to clarify the therapeutic efficacy and safety of NIBS among patients with NDDs.
Bateman JR, Carlisle TC, Yang Y
… +12 more, Lachner C, Stockbridge MD, Flashman LA, Chemali Z, Alzbeidi N, Pressman PS, Osibajo AM, Bobrin BD, Martinez-Menendez CJ, Teixeira AL, Daffner KR, American Neuropsychiatric Association Dementia Special Interest Group
J Neuropsychiatry Clin Neurosci
· 2025 · PMID 40320852
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The availability of monoclonal antibodies directed against amyloid beta, for use as disease-modifying therapies for Alzheimer's disease (AD), represented a major shift in the field of AD research and treatment. U.S. Food...The availability of monoclonal antibodies directed against amyloid beta, for use as disease-modifying therapies for Alzheimer's disease (AD), represented a major shift in the field of AD research and treatment. U.S. Food and Drug Administration approvals for the monoclonal antibody-based medications lecanemab and, more recently, donanemab provide clinicians with two antiamyloid therapy (AAT) options for targeting early symptomatic AD. The emergence of AAT has made careful biomarker-informed diagnosis of AD paramount, which was once reserved for highly specialized centers and research settings. Patient selection is complex, and although appropriate-use recommendations have been published, clinicians caring for patients with AD across the United States face uncertainty when trying to align clinical trial criteria, appropriate-use recommendations, and real-world patients in the clinic. Practical issues in patient selection as well as health care and systemic challenges in the implementation of AAT are considered in part 1 and part 2, respectively, of this two-part Treatment in Behavioral Neurology & Neuropsychiatry commentary on these therapies from the American Neuropsychiatric Association Dementia Special Interest Group.
Ratajska AM, Rodriguez K, Appleton H
… +5 more, Schade RN, Gertler J, Kenney LE, Pontone GM, Bowers D
J Neuropsychiatry Clin Neurosci
· 2025 · PMID 40289592
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OBJECTIVE: Apathy is a prevalent neuropsychiatric feature of Parkinson's disease (PD), marked by reduced goal-directed behavior. Apathy is distinct from depression and significantly affects daily functioning and quality...OBJECTIVE: Apathy is a prevalent neuropsychiatric feature of Parkinson's disease (PD), marked by reduced goal-directed behavior. Apathy is distinct from depression and significantly affects daily functioning and quality of life. Despite this, the DSM-5 does not acknowledge apathy as its own diagnostic category. The authors sought to examine how individuals with PD who score high on a self-report apathy scale are diagnostically classified by psychiatrists within a clinical setting. METHODS: Fifty-five individuals with "pure apathy" were identified from a larger clinical convenience sample of 458 patients with PD. The pure-apathy group consisted of patients who scored above the clinical cutoff on a self-report measure of apathy but whose symptoms were below the cutoffs for depression and anxiety measures. These patients also received a standard clinical psychiatric evaluation using DSM-5 criteria. The authors examined the diagnoses provided by psychiatrists who were unaware of results of the mood scales. RESULTS: More than half (53%) of the pure-apathy group had received no psychiatric diagnosis. The remainder had received the following diagnoses: anxiety (27%), depression (5%), comorbid depression and anxiety (5%), and other psychiatric diagnoses (9%). The most common anxiety diagnoses were unspecified or other specified anxiety disorders and generalized anxiety disorder. The most common depression diagnoses were unspecified or other specified depressive disorders. CONCLUSIONS: This study highlights a gap in diagnosing psychiatric conditions in PD, specifically for individuals with primarily apathetic presentations. More than 50% of PD patients in the pure-apathy group had received no psychiatric diagnosis, possibly resulting in unmet clinical needs.
Mukwikwi ER, Jones SL, Manera AL
… +18 more, Salpeter R, Fumagalli GG, Eratne D, Kang MJY, Bertoux M, Didic M, Katisko K, Solje E, Santillo AF, Laforce RJ, Schroeter ML, Van den Stock J, Vandenbulcke M, Morin A, de Boer S, Pijnenburg Y, Ducharme S, Neuropsychiatric International Consortium for Frontotemporal Dementia
OBJECTIVE: Previous studies have reported misdiagnosis rates of nondegenerative primary psychiatric disorders of up to 50% among patients with behavioral variant frontotemporal dementia (bvFTD). The authors hypothesized...OBJECTIVE: Previous studies have reported misdiagnosis rates of nondegenerative primary psychiatric disorders of up to 50% among patients with behavioral variant frontotemporal dementia (bvFTD). The authors hypothesized that misdiagnosis rates have decreased over time because of an increased awareness and a better understanding of psychiatric prodromes of FTD. METHODS: Retrospective data on past psychiatric trajectories of individuals with probable or definite bvFTD (N=609) were acquired from 12 sites of the Neuropsychiatric International Consortium on FTD. Symptom profiles, primary psychiatric disorder diagnoses, and treatment information were collected from medical records. The authors used descriptive statistics to characterize past diagnostic trajectories, chi-square and t tests to compare groups, and logistic regressions to determine risk factors for diagnostic errors. RESULTS: Of 609 bvFTD patients, 33% received a primary psychiatric disorder diagnosis after the onset of bvFTD symptoms but before a formal bvFTD diagnosis. In 13% (N=80) of all bvFTD cases, the diagnosis was retrospectively considered erroneous. The most common misdiagnosis was major depressive disorder, followed by anxiety disorders and psychosis. The remaining cases were classified as psychiatric prodromes (N=68) and comorbid conditions (N=42). Patients with misdiagnoses were significantly younger, by about 5.5 years, than those without such diagnoses and had higher rates of depressed mood, dietary changes, stereotypy, somatization, and anxiety symptoms. Only younger age predicted erroneous diagnoses. CONCLUSIONS: The rate of patients who were misdiagnosed as having primary psychiatric disorders was much lower than in previous reports, suggesting improvements in the quality of diagnostic assessments. Misdiagnoses were more common among younger patients, with some psychiatric symptoms being overrepresented in such cases.
OBJECTIVE: The authors of this prospective cohort study sought to examine associations between mid- and late-life physical activities and incident clinical depression and anxiety among community-dwelling older adults. ME...OBJECTIVE: The authors of this prospective cohort study sought to examine associations between mid- and late-life physical activities and incident clinical depression and anxiety among community-dwelling older adults. METHODS: The sample included 2,630 adults to examine the outcome of clinical depression (median follow-up length=5.4 years) and 2,444 to examine clinical anxiety (median follow-up length=5.6 years). Participants were ages ≥70 years, were enrolled in the Mayo Clinic Study of Aging, and did not have dementia or the respective neuropsychiatric symptoms at baseline. Mid- and late-life physical activities were assessed as predictors with a validated questionnaire, and physical activity composite scores were calculated. Outcomes of interest were new onset of clinical depression and anxiety, measured with the Beck Depression Inventory (score >13) and Beck Anxiety Inventory (score >7), respectively. The authors used Cox proportional hazard models, adjusted for age (timescale), sex, education, apolipoprotein E ε4 genotype status, and comorbid medical conditions. RESULTS: Higher overall physical activity in late life was associated with a decreased risk for incident clinical depression (hazard ratio [HR]=0.85, 95% CI=0.74-0.98, p=0.025). Higher late-life overall physical activity (HR=0.79, 95% CI=0.71-0.89, p<0.001) and moderate-to-vigorous physical activity (MVPA; HR=0.86, 95% CI=0.77-0.95, p=0.003) were associated with a decreased risk for incident clinical anxiety. Higher midlife overall physical activity (HR=1.16, 95% CI=1.05-1.28, p=0.003) and MVPA (HR=1.12, 95% CI=1.02-1.23, p=0.019) were associated with an increased risk for new-onset clinical anxiety but not depression. CONCLUSIONS: Engagement in late-life physical activity was associated with reduced risk for new-onset depression and anxiety among community-dwelling older adults without dementia.
OBJECTIVE: Persistent headache is the most common and debilitating chronic condition after traumatic brain injury (TBI), affecting mood and reducing quality of life. The investigators examined in a community-based settin...OBJECTIVE: Persistent headache is the most common and debilitating chronic condition after traumatic brain injury (TBI), affecting mood and reducing quality of life. The investigators examined in a community-based setting whether repetitive transcranial magnetic stimulation (rTMS) for management of major depression among outpatients with TBI histories was associated with improvement in the functional impact of headache (FH) and whether improvements were related to treatment at a specific site in the dorsolateral prefrontal cortex (DLPFC). METHODS: In the discovery phase (posttraumatic headache 1 [PTH-1] group, N=21), the association of rTMS treatment at DLPFC targets and improvement in headache and depression and anxiety were studied. Associations between functional connectivity of the patient-specific TMS treatment sites and changes in patients' FH were used to identify a target for simultaneous treatment of behavioral and headache symptoms. Patients in the translational phase (PTH-2 group, N=7) received TMS treatment at this target. RESULTS: The patients in the PTH-1 group had significant improvements in depression and anxiety but not FH, and more than half had a reduction in FH and reported an improvement in headache severity and duration. Increased functional connectivity between TMS sites and a subregion in the left DLPFC and bilateral precuneus was related to improved FH. Unlike the PTH-1 group, the PTH-2 group exhibited significant reductions in FH after 4 weeks of treatment and in anxiety and depression after 1-2 weeks of treatment. CONCLUSIONS: TMS treatment targeting the left DLPFC coordinate identified in this study may help improve treatment for both FH and anxiety and depression among PTH patients.
OBJECTIVE: The authors examined lived experience perspectives of suicidality and nonsuicidal self-injury (NSSI) after moderate-to-severe traumatic brain injury (TBI), risk and protective factors, and methods of coping. M...OBJECTIVE: The authors examined lived experience perspectives of suicidality and nonsuicidal self-injury (NSSI) after moderate-to-severe traumatic brain injury (TBI), risk and protective factors, and methods of coping. METHODS: A record review of suicide risk assessments was completed as part of routine clinical risk management for a research study. The authors used a semistructured interview approach developed from existing clinical tools and extracted data from assessment records by using content analysis to categorize common responses. RESULTS: Data were extracted from records of 68 participants (mean±SD age=45.9±14.4 years; 82% male) with a history of moderate-to-severe TBI (mean=10.7±9.1 years after TBI). Most participants (86%) were currently experiencing suicidal thoughts, and 50% had experienced NSSI thoughts in their lifetime. Fifteen participants (28%) reported a lifetime suicide attempt. The most common protective factors for suicidal ideation reported by participants were support from family (59%) and the personal attributes of openness and being optimistic (49%). The most common risk factors were emotional distress or presence of a psychiatric diagnosis (62%), TBI sequelae (such as fatigue; 49%), work-related stress (43%), and lack of family support (34%). Engaging with health professionals (62%) and seeking support from family (57%) were the most common healthy coping strategies, whereas substance use (38%) and social withdrawal (32%) were the most common unhealthy coping strategies. CONCLUSIONS: The findings of this study provide detailed insights into the lived experiences of suicidality and NSSI after moderate-to-severe TBI, how survivors conceptualize factors that may increase or attenuate risk, and common coping strategies.
OBJECTIVE: The authors aimed to characterize the long-term psychiatric outcomes and their predictors among survivors of autoimmune encephalitis (AE). METHODS: In this retrospective cohort study, patients diagnosed as hav...OBJECTIVE: The authors aimed to characterize the long-term psychiatric outcomes and their predictors among survivors of autoimmune encephalitis (AE). METHODS: In this retrospective cohort study, patients diagnosed as having AE between 2008 and 2023 at two academic medical centers (in New York City and Toronto) completed the Mini International Neuropsychiatric Interview 7.0.2 (MINI) and Profile of Mood States (POMS-2) to assess long-term psychiatric outcomes. Clinical characteristics were assessed for potential predictors of psychiatric outcomes. Bivariate analyses and univariate logistic regressions were conducted to assess the relationship between the predictors and the primary outcome. RESULTS: Overall, 42 participants (female, N=26, 62%; median age=37.5 years, interquartile range [IQR]=32.8 years) were assessed a median of 4 years (IQR=6 years) after an AE diagnosis. AE subtypes included anti--methyl-d-aspartate (33%), anti-leucine-rich-glioma-inactivated 1 (24%), anti-glutamic acid decarboxylase 65 (14%), and antibody-negative encephalitis (29%). In total, 71% of participants who completed the MINI met criteria for a DSM-5 diagnosis, and 56% were diagnosed as having a mood disorder. Thirteen participants (31%) reported above-average total mood disturbance on the POMS-2. Mann-Whitney U tests revealed that participants diagnosed as having a mood disorder self-reported significantly higher levels of confusion and bewilderment (z=-2.04, p=0.04) and depression and dejection (z=-2.24, p=0.03) and lower levels of vigor and activity (z=-2.62, p=0.01). CONCLUSIONS: AE survivors have a high prevalence of psychiatric comorbid conditions, with most being diagnosed as having a mood disorder and a significant proportion endorsing ongoing mood disturbance. Patients with a psychiatric history may benefit from closer psychiatric follow-up.
J Neuropsychiatry Clin Neurosci
· 2025 · PMID 40134271
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OBJECTIVE: Through the brain-gut-microbiome axis, myriad psychological functions that affect behavior share a dynamic, bidirectional relationship with the intestinal microbiome. Little is known about the relationship bet...OBJECTIVE: Through the brain-gut-microbiome axis, myriad psychological functions that affect behavior share a dynamic, bidirectional relationship with the intestinal microbiome. Little is known about the relationship between personality-a stable construct that influences social- and health-related behaviors-and the bacterial ecosystem. The authors of this exploratory study examined the relationship between general and maladaptive personality traits and the composition of the gut microbiome. METHODS: In total, 105 psychiatric inpatients provided clinical data and fecal samples. Personality traits were measured with the five-factor model of personality, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and the Personality Inventory for DSM-5; 16S ribosomal DNA sequencing and whole-genome shotgun sequencing methods were used on fecal samples. Machine learning (ML) was used to identify personality traits associated with bacterial variability and specific taxa. RESULTS: Supervised ML techniques were used to classify traits of social detachment (maximum area under the receiver operating characteristic curve [AUROC]=0.944, R>0.20), perceptual disturbance (maximum AUROC=0.763, R=0.301), and hoarding behaviors (maximum AUROC=0.722) by using limited sets of discriminant bacterial species or genera. Established bacterial genera associated with psychosis (e.g., and ) were associated with traits of perceptual disturbance. Hoarding behaviors were associated with a defined gut microbial composition that included , a known contributor to the development of pediatric autoimmune neuropsychiatric disorders. CONCLUSIONS: Observations from this study are consistent with recent findings demonstrating person-to-person interactions as a mode of gut microbiome transmission. This study adds to the emerging literature on the intricate connections between brain and gut function, expanding the interdisciplinary field of psychiatric microbiology.