Current Opinion in Psychiatry最新文献

Purpose of review: This review explores the high co-occurrence between personality disorders (PDs) and anxiety disorders (ADs), focusing on clinical implications, the frequency of their association, and the challenges these comorbidities pose for diagnosis and treatment. In addition, this review highlights recent research findings and the need for better therapeutic strategies.

Recent findings: Contemporary studies have confirmed a strong association between PDs and ADs, particularly borderline personality disorder (BPD), which shows an 85% comorbidity with anxiety disorders. Gender differences are also observed, with women generally exhibiting higher rates of co-occurring psychiatric conditions. These comorbidities contribute to increased symptom severity, a higher suicide risk, and worse long-term outcomes. Recent clinical trials have shown positive results in managing these disorders. However, treatment approaches remain inconsistent, and further research is needed to refine these strategies.

Summary: The co-occurrence of PDs and ADs complicates diagnosis and treatment, leading to worse outcomes. Although promising therapies exist, the current lack of a standardized treatment approach for this comorbid population highlights the need for further research. Future studies should explore more targeted treatment options, causal mechanisms linking PDs and ADs, and potential benefits of personalized interventions to improve clinical outcomes.

Purpose of review: This review summarizes recent evidence on immune-driven depression, a subtype of major depressive disorder (MDD) characterized by low-grade inflammation, energy-related symptoms and metabolic disturbances. This subtype is associated with worse outcomes and distinct antidepressant responses. Considering inflammatory features may help clinicians tailor MDD management, particularly by informing lifestyle measures and targeted interventions. The review highlights studies describing features of immune-driven depression, discussing mechanistic pathways, and evaluating mechanism-based interventions.

Recent findings: Novel mechanistic evidence includes sex-specific associations between inflammatory markers and depressive symptoms, effects of inflammation on motivation and immuno-metabolic interactions. These findings have informed stratified and enriched trial designs preselecting patients with inflammatory profiles. International initiatives integrate clinical, biomarker, neuroimaging and genetic data to define reproducible signatures. Novel interventions include GLP-1 receptor agonists, more focus on dopaminergic agents and low-dose interleukin-2.

Summary: Current evidence supports immune-driven depression as a clinically relevant MDD subtype. Indicators such as hsCRP, comorbid metabolic or inflammatory conditions and motivational anhedonia may help clinicians recognize at-risk patients. Most intervention trials remain limited by small, heterogeneous samples and nonspecific outcome measures. Advances in biomarker-guided stratification represent important steps toward precision psychiatry, aiming to develop tailored, mechanism-based treatments for MDD.

Purpose of review: Mentalization-based therapy for adolescents (MBT-A) is a treatment approach that aligns well with dimensional models of personality disorders. This article reviews recent literature on mentalizing and MBT, proposing ways in which findings may inform future research and clinical innovations.

Recent findings: There have been few new treatment studies and meta-analyses, and the evidence generally does not support the superiority of MBT-A over other well structured treatments for personality disorder in adolescents. Long-term follow-up studies suggest heterotypic continuity of personality disorder (PD) and indicate that discrepancies between adolescent and parent reporting may point to important mentalizing problems. A pilot study of MBT-A for conduct disorder has been published and shows promising results, despite a high dropout rate.

Summary: MBT was originally developed for BPD in adults, but it is increasingly being recognized as a transdiagnostic common-factor model relevant to many conditions, such as those affecting adolescents who have experienced childhood adversity and juveniles with persistent aggressive behavior. For the field to progress further, there is a strong need for more research and clinical innovation, which should continue to move beyond categorical classification and approach disorder and alleviation of suffering from a developmental and social-ecological starting point.

Purpose of review: To summarize recent updates in the treatment of postpartum bipolar disorder (PBD).PBD requires timely and comprehensive management, as childbirth is a period of elevated relapse risk in women with preexisting illness and may also mark first-onset presentations. Episodes can manifest as depression, mixed states, mania, or psychosis, with severe consequences for maternal safety, infant well being, and early bonding. Sleep loss around labor and postpartum further increases vulnerability.

Recent findings: PBD demands a multifaceted therapeutic approach, with pharmacotherapy as the cornerstone. Lithium, lamotrigine, and selected second-generation antipsychotics remain key options, guided by efficacy, lactation safety, and individualized risk-benefit assessment. Structured relapse-prevention planning, sleep protection, and support for mother-infant bonding are crucial nonpharmacological elements. Early, targeted intervention reduces relapse and suicide risk while supporting maternal functioning and family stability.

Summary: Beyond optimized pharmacological care, recent research highlights a treatment continuum spanning pregnancy and postpartum. Multidisciplinary collaboration across psychiatry, obstetrics, and neonatal care is crucial to ensure maternal safety, optimize infant outcomes, and support families. Integrating lived experience and patient collaboration enhances relevance. A life-course perspective across reproduction, combining biological and psychosocial insights, signals a shift toward holistic, personalized, precision-based strategies in managing PBD.

Purpose of review: The rapidly growing environment of artificial intelligence (AI) has accelerated interest in its potential use for improving the efficiency and efficacy of the healthcare industry. Specifically, there has been a growing interest in AI role mental healthcare for common disorders like anxiety and depression. However, it remains unclear whether current evidence is sufficient to determine efficacy and safety of AI chatbots in clinical practice.

Recent findings: Most studies reported symptom reductions on validated anxiety and depression measures; however, the majority lacked appropriate active control conditions, featured small and demographically narrow samples, and used inconsistent outcome metrics, limiting generalizability and replication. Reporting of adverse events was rare, and potential risks such as emotional dependence and parasocial relationships were largely unexamined.

Summary: This paper offers a review of the recent literature (February 2024 and July 2025) regarding AI effectiveness in treating anxiety and depression. While findings suggest that AI chatbots are feasible and acceptable to users, current evidence is insufficient to determine their efficacy or safety in clinical practice.

Purpose of review: Conspiracy theories are not a recent phenomenon, but their dissemination has been facilitated by the internet and modern means of communication such as social media. This article reviews personality-based factors that increase the likelihood of endorsing conspiracy theories.

Recent findings: Most studies used a correlational approach and examined personality traits and dimensions rather than personality disorders. The strongest and most consistent relationships were found between endorsement of conspiracy theories and suspiciousness and paranoid ideation, pseudoscientific tendencies and beliefs, schizotypal personality traits and narcissism. Similar personality characteristics were identified as correlates of the endorsement of the specific COVID-19 conspiracy theories, but antisocial personality traits have also been reported in this context. Epistemic mistrust has emerged as arguably the key factor that facilitates endorsement of conspiracy theories. Schizotypal, paranoid, antisocial, borderline, and narcissistic personality disorders were more likely to accompany endorsement of conspiracy theories than other types of personality disorders.

Summary: Although correlation does not imply causation, recent work has identified personality-related characteristics that confer an increased risk of espousing conspiracy theories. Further research is necessary to ascertain how this vulnerability could be decreased, thus minimizing the harms of conspiracy theories that are inflicted on their adherents and broader society.

Purpose of the narrative review: Response and remission rates in patients with major depressive disorder (MDD) treated with antidepressants are frequently not satisfying. Therapeutic drug monitoring (TDM), i.e. the quantification of antidepressant drug levels in blood and dose adjustment, is a modern and useful tool of personalized pharmacological treatment of MDD.

Recent findings: Emerging evidence suggests that the use of TDM for antidepressants can be helpful in numerous clinical scenarios. Such scenarios include lack of treatment response, relapse, or adverse drug reactions related to antidepressants. The use of TDM is also indicated in specific patient subgroups, such as children, adolescents, pregnant women, elderly patients and patients with intellectual disabilities. Patients with polypharmacy and/or physical comorbidities may also benefit from TDM-guided antidepressant treatment. We critically reviewed TDM literature on antidepressants, summarizing therapeutic reference ranges and laboratory alert levels for antidepressants, although TDM is not equally recommended/supported for all antidepressants.

Summary: The utilization of TDM as a tool for treatment optimization in clinical routine with antidepressants for patients with MDD offers a valuable method to improve safety and effectiveness. This work summarizes essential TDM knowledge for antidepressants and encourages the application of TDM as part of the clinical decision-making process.

Purpose of review: A paradigm shift in the assessment of personality pathology is underway, as diagnosticians move beyond traditional personality disorder categories and assess personality dysfunction using contemporary dimensional frameworks. This article describes the assessment of personality pathology in ICD-11 and the DSM-5 Alternative Model for Personality Disorders (AMPD).

Recent findings: Recent findings in this area can be grouped into three domains: reliability, factor structure, and temporal stability of ICD-11 and AMPD constructs, convergence of personality pathology ratings with external indices of psychopathology and adjustment, and clinical utility (e.g., usefulness in rendering clinical decisions, prediction of treatment outcome).

Summary: Research in this area confirms that level of personality functioning and the presence of one or more pathological personality traits predict an array of clinical outcomes, including symptom disorders (e.g., anxiety, depression), suicide risk, and psychotherapy effectiveness. Findings support the cross-cultural generalizability of these patterns, and the clinical utility of assessing personality functioning and traits in adolescents and adults.

Purpose of review: Modern-type depression (MTD) has emerged as a distinct psychopathological construct in the context of 21st-century societal, technological, and cultural transformations in Japan. First described by Tarumi and then refined by Kato et al. , it has since been recognized internationally. MTD diverges from classical melancholic depression in aetiology, phenomenology, and therapeutic response.

Recent findings: It is especially prevalent among adolescents and young adults exposed to accelerated social rhythms, digital hyperconnectivity, and precarious work and relational structures. Clinically, MTD is characterized by avoidance of social roles, heightened sensitivity to interpersonal conflict, externalized complaints, emotional withdrawal, and tension between authentic and idealized selves. Unlike traditional depression, pharmacological treatments often yield limited benefit or worsen symptoms, underscoring the need for psychosocial and community-based interventions. Promising approaches include interpersonal counselling, psychoeducation, stress management, cognitive-behavioural therapy, physical activity, and neuromodulation techniques such as transcranial direct current stimulation.

Summary: The advent of MTD highlights how socio-cultural acceleration and technological mediation shape mental health, exposing the limitations of conventional diagnostic frameworks. It also provides a valuable opportunity to investigate how social change influences psychopathology and to design culturally sensitive, developmentally informed strategies for prevention and treatment in younger populations.

Purpose of review: This review examines the relationship between borderline personality disorder (BPD) and complex posttraumatic stress disorder (CPTSD) in light of recent claims that the former might be replaced by the latter.

Recent findings: The stigma associated with BPD is not a convincing reason to suggest that CPTSD is more adequate than BPD, despite the fact that there is currently less stigma attached to it. BPD and CPTSD share some core symptoms, such as affective dysregulation and interpersonal difficulties. However, several features, including impulsivity, identity disturbance, and fear of abandonment, are relatively specific for BPD and may distinguish it from CPTSD. While trauma is a major risk factor for both conditions, it is neither necessary nor sufficient for the development of BPD because it can occur in the absence of trauma. In contrast, trauma is indispensable in the development of CPTSD. Research using latent class analysis and structural equation modeling has produced mixed results, with most studies identifying overlapping symptom clusters of BPD and CPTSD and suggesting that the boundaries between the two conditions are not clear.

Summary: While there are many similarities between BPD and CPTSD, they can be distinguished clinically, although the boundaries between them are not clear-cut. Current evidence strongly suggests that BPD cannot be reduced to a trauma-related condition and that it would therefore be erroneous to replace it with CPTSD.