CNS Spectrums最新文献

Objective: Adult major depression (MDD) studies implicate reward- and control-network dysconnectivity in suicidality, but it is unclear whether analogous alterations characterize adolescents, whose neural systems are still maturing.

Methods: Resting-state fMRI was obtained from 102 adolescents (12-17 years): 21 MDD with suicidal ideation (SI), 33 MDD without SI, and 48 matched healthy controls. Seed-based analyses targeted bilateral nucleus accumbens (NAc), ventral tegmental area (VTA), and bilateral dorsolateral prefrontal cortex (DLPFC).

Results: Between-group effects were specific to NAc circuitry. Adolescents with SI showed reduced coupling of the left NAc with the left superior parietal lobule (BA7) versus controls, and diminished connectivity between the right NAc and right frontal pole (BA47) versus depressed peers without SI. No significant differences emerged for DLPFC- or VTA-seeded connectivity.

Conclusions: The identified functional dysconnectivities in reward-related circuits, particularly the FCs between the NAc and both the frontal pole and superior parietal lobule, may be implicated in the manifestation of suicidality among adolescents with MD. However, the lack of significant associations for DLPFC- and VTA-seeded FC in adolescent MDSI requires further elucidation.

Objective: A longer duration of untreated illness (DUI) has been associated with poorer outcomes across several mental disorders; however, few studies have investigated DUI in anxiety disorders, particularly in generalized anxiety disorder (GAD). This study aimed to identify sociodemographic and clinical factors associated with a longer DUI in GAD.

Methods: We conducted a cross-sectional, multicenter study, retrospectively reviewing the medical records of GAD patients from three mental health services. Sociodemographic and clinical variables were extracted for analysis. One-way analyses of variance and Pearson's correlations were used to examine the relationship between DUI and categorical and quantitative variables, respectively. A multivariate linear regression model was then conducted to identify variables independently associated with DUI.

Results: The total sample included 243 patients; the mean DUI was 30.92 (±65.25) months. In the final model, a longer DUI was associated with an earlier age at onset (B = -0.428; p = 0.023), a longer duration of illness (B = -0.431; p < 0.001), and the presence of multiple side effects (B = 55.778; p < 0.001). There was a trend toward statistical significance for the association between a longer DUI and multiple medical comorbidities (B = 13.122; p = 0.076).

Conclusions: Our findings suggest that reducing the time between the onset of GAD and the initiation of appropriate pharmacological treatment may improve clinical outcomes, mitigating the risk of a chronic course of illness. Further studies are needed to elucidate the role of DUI as a prognostic factor in GAD.

Long-acting injectable (LAI) antipsychotics are not routinely offered and, thus, are underutilized despite their many advantages over oral formulations. In this special collection of articles, the reader will find overviews of the art and science of prescribing this important treatment option. Guidance is offered regarding incorporating LAIs in treatment planning, including inpatient, outpatient, and jail settings. Reviewed is the evidence surrounding the use of LAIs for patients in their first episode of schizophrenia, as well as switching from oral agents and other common issues that come up in day-to-day practice. Also provided is a comprehensive summary of each of the currently available formulations of LAIs, and some pragmatic reasons why one would be considered over another. In the end, the reader will come away with the notion that LAIs are not a "last resort" but an important and useful treatment modality that ought to be considered more often.

Long-acting injectable (LAI) antipsychotics are highly effective tools for managing serious mental illness, yet their clinical utility is often compromised by logistical and pharmacological complexities. This review serves as a practical guide to optimizing LAI therapy by addressing common clinical hurdles. Maintaining a consistent injection schedule is essential to successful treatment. To improve adherence, clinicians should implement proactive reminder systems-such as phone calls or text messages-and involve family or caregivers in the care plan. When injections are delayed, management strategies must be tailored to the specific medication and the length of the "dosing window". For example, aripiprazole monohydrate (Abilify Maintena) allows a ±7 day window, whereas paliperidone palmitate (Invega Sustenna) provides a +14 day window. If these windows are exceeded, catch-up protocols may involve administering the next dose as soon as possible, utilizing supplemental oral antipsychotics for a bridge period (e.g., 14 days for aripiprazole or 21 days for risperidone), or restarting initiation loading regimens entirely. Clinically significant drug interactions, such as the reduction of aripiprazole or risperidone levels by carbamazepine, can lead to symptom breakthrough. Conversely, CYP450 inhibitors like fluvoxamine or fluoxetine may increase antipsychotic concentrations, necessitating dose reductions. Adverse effects, including drug-induced Parkinsonism and akathisia, should be managed by reducing the LAI dose or switching to agents with lower risk profiles, such as aripiprazole-based products. For akathisia, short-term adjunctive treatments like vitamin B6 or mirtazapine may be utilized until dose adjustments reach steady state. Patient-centered care requires a collaborative approach to substance use, which can exacerbate symptoms or interfere with LAI effectiveness. Clinicians must also engage in nonjudgmental discussions when patients request a return to oral therapy, carefully considering the pharmacokinetic properties of the LAI to time the transition safely. Ultimately, a proactive management plan that addresses these clinical variables is essential for reducing relapse risk and improving long-term quality of life.

Long-acting injectable antipsychotics (LAIs) can lead to improved outcomes for people with schizophrenia, schizoaffective disorder, and bipolar disorder, as they guarantee medication delivery during the injection interval. Contemporary guidance on the use of LAIs includes considering not only patients with poor or uncertain adherence but also patients who would prefer monthly administration (or longer) of their maintenance medication, including those in their first episode of illness. This narrative review discusses the incorporation of LAIs in treatment planning across different settings: acute inpatient units, community mental health outpatient clinics, and jails. Implementing this treatment modality requires the recognition of eligible patients, providing information to patients and their families about the benefits and drawbacks of LAIs, and educating all members of the treatment team.

The failure to make LAI the default route over the same oral when both are available is a lost opportunity to improve outcomes for people with schizophrenia. A striking example is the lost opportunity to improve life expectancy. A sophisticated pharmacoepidemiologic study from Sweden matched antipsychotic prescriptions with mortality rates and found that receiving an LAI version improved longevity by about 30% compared to its equivalent oral counterpart. Published a decade ago, it seems to have had little impact within US mental health services. This paper attempts to explain some of the reasons for complacency in adapting LAIs as a preferred approach for oral that have an LAI option available. Hypotheses include (1) not appreciating the importance of accurate information to guide present and future treatment recommendations, (2) considering LAIs primarily for adherence interventions rather than their more general benefit as a superior information platform, (3) how fear of disclosing nonadherence is a primary cause of misinformation, and (4) complacency with status quo acceptance of misinformation without fully appreciating how it harms future outcomes. The outcome benefits that come from changing from the oral to the LAI, if available, will continue. Advances in formulation technology have greatly improved the safety and flexibility of recent LAIs compared to earlier formulations, and formulation advances will allow for additional antipsychotics currently limited to oral formulation to expand to having an LAI version readily available.

Cognitive problems represent one of the most common symptom dimensions in functional neurological disorder (FND; >80% of patients) and are frequently associated with distress, disability, and difficulties engaging in evidence-based treatments such as psychotherapy. Cognitive difficulties occur across the FND subtypes (eg, seizures, movement disorders, dizziness) but are largely underrecognized and undertreated by healthcare providers. That is, although a variety of interventions are available for primary functional symptoms and mental health comorbidities, there have not been any systematic efforts to date to specifically target cognitive functioning in FND, leaving an important gap in the literature.Cognitive rehabilitation is a flexible approach utilizing diverse techniques aimed at improving cognition and enhancing functional independence in people with neuropsychiatric disorders. Cognitive rehabilitation can have positive impacts (moderate effect sizes) on cognition and everyday functioning across a variety of conditions, including traumatic brain injury, mild cognitive impairment, long COVID, PTSD, and others. Given the transdiagnostic clinical utility of cognitive rehabilitation, it has potential for benefit in many patients with FND if adapted and applied appropriately.In this review, we highlight the utility of cognitive rehabilitation for FND, with a focus on clinically actionable advice and guidance. We describe fundamental principles of cognitive rehabilitation, evidence for its efficacy and effectiveness across neuropsychiatric disorders, and methods for avoiding potential pitfalls when applying it in FND. We then discuss a Case Vignette in order to emphasize the application of cognitive rehabilitation principles in an individual patient. We conclude with future directions for research and clinical care.

Background: Skin picking disorder is characterized by repetitive excoriation of one's skin. Although skin picking disorder is associated with substance use problems, no previous research has examined the associations of alcohol use on skin picking symptomatology.

Methods: Adults with skin picking disorder (n = 182) were recruited from the general community via an online survey. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) to measure alcohol use and various self-report measures to assess clinical profiles and associated characteristics. We compared variables of interest between those with hazardous alcohol use in the past year (AUDIT ≥8) compared to those with low-risk or no alcohol use in the past year. We also examined the extent to which skin picking disorder symptoms were dimensionally related to AUDIT scores while controlling for confounders.

Results: Of the 182 adults with skin picking disorder, 62 (34.1%) met criteria for hazardous alcohol use. Hazardous drinking was associated with less frequent skin picking but higher overall picking-related severity and impairment, aggression, and rates of comorbid borderline personality disorder, gambling disorder, and compulsive sexual behavior disorder. Skin picking-related impairment predicted the degree of hazardous drinking while controlling for sex.

Conclusions: This study highlights the importance of screening for hazardous alcohol use in people with skin picking disorder. More research is needed to explore the relationship between aggression, hazardous alcohol use, and skin picking, as well as how treatments might best be adapted to treat individuals with this cluster of symptoms.

Background: The link between problematic usage of the internet (PUI) and eating disorder symptoms is well-established. However, less is known about this association in the context of orthorexia nervosa (ON), an excessive preoccupation with healthy eating. This study aimed to investigate the relationship between PUI, including various problematic online behaviors, and ON tendency in a sample of US adults.

Methods: Three hundred adults completed an online survey via prolific (mean age = 37.40, 54.6% female). The survey included demographic questions, the ORTO-R to measure ON symptoms, and the Internet Severity and Activities Addiction Questionnaire (ISAAQ-10) to assess PUI and the extent of engagement in several online activities, such as gaming, shopping, social networking, cyberchondria, pornography, and cyberbullying.

Results: Women had higher ORTO-R scores than men (p < .05). ISAAQ-10 scores predicted ORTO-R scores in a regression model (β = .375, p < .001) even after controlling for age, gender, and an eating disorder diagnosis. ON risk was associated with a high engagement in cyberchondria, researching healthy food choices on the internet, cyberbullying perpetration, and online shopping.

Conclusions: Results indicate that PUI is associated with ON symptoms even after considering other predictors. Maladaptive use of nutrition and medical-related resources may play a significant role in this association. However, it remains unclear whether exposure to this content increases ON risk or if people with ON symptoms seek this information online. The directionality of this relationship is an important area for future research.

Psychoactive substances, known for their acute impact on perception and cognition, are gaining attention for their potential therapeutic applications. Many of these substances are plant-derived with deep-rooted histories of use in non-medical contexts, where they have been viewed as either tools for social cohesion or sources of discord, depending on cultural and societal contexts. This review explores psychoactive substances; psychedelics, cannabis, and stimulants, in a legitimized medical context, focusing on the ethical considerations shaping research and the regulatory and prescribing challenges involved in translating these compounds into viable clinical treatments. It highlights the diverse voices; Indigenous, philosophical, psychiatric, and using communities advocating for careful consideration of their broader implications. Key issues include navigating the blurred boundaries between therapeutic benefit and potential misuse, ensuring rigorous scientific methodologies, and addressing the sociopolitical factors shaping public perception and policy. The article emphasizes the need for evidence-based frameworks that balance innovation with patient safety and calls for approaches that recognize the social and commercial determinants of health, extending ethical considerations beyond merely prescribing. By critically assessing the promise and limitations of repurposing these substances, the article contributes to the ongoing discourse on their role in contemporary psychiatric practice.