Current Opinion in Psychiatry最新文献

Purpose of review: Early autism diagnosis is especially difficult when developmental history or caregiver input is unavailable (e.g., displaced, institutionalized, or orphaned children). We synthesize observation-first, clinician-led approaches and regulated, technology-enabled aids that minimize reliance on collateral history.

Recent findings: Standardized direct observation (e.g., ADOS-2 modules that do not require a caregiver) can support diagnosis when history is limited, but feasibility hinges on training, cultural adaptation, and service capacity. Many legacy instruments predate DSM-5/DSM-5-TR, creating construct gaps. Recently cleared aids, an eye-tracking system for toddlers, and a software tool combining short videos, caregiver input, and clinician ratings, function as decision support rather than stand-alone diagnostics. Mobile and remote screening paradigms show promise but require independent, cross-cultural validation.

Summary: Diagnostic equity necessitates pathways that are effective when medical histories are incomplete. We outline a minimum dataset and a pragmatic workflow that replace caregiver reports with structured observations, school/residential collateral, and carefully integrated objective measures, under clinician synthesis. Priorities include updating legacy instruments, publishing brief observational batteries with known accuracy bounds, and validating tools across languages and contexts.

Purpose of review: Apathy is one of the most prevalent and disabling symptoms of neurodegenerative disorders, yet targeted treatments remain poorly defined. In recent years, growing interest in its conceptualization and management has led to an increasing number of randomized controlled trials (RCTs) and meta-analyses addressing both pharmacological and nonpharmacological interventions.

Recent findings: Among pharmacological approaches, methylphenidate presented with early reductions in apathy with an acceptable safety profile in multiple RCTs, including a large 6-month trial. However, the sustainability of effect has not been fully achieved. Other stimulants, bupropion, and conventional Alzheimer's medications such as cholinesterase inhibitors and memantine show inconsistent or limited effects. Antidepressants and antipsychotics are not recommended for apathy, although selected agents may benefit comorbid conditions. As for the nonpharmacological interventions, evidence supports the benefits of physical exercise and the emerging promise of neuromodulation. Technology-based interventions are feasible but show variable efficacy.

Summary: Methylphenidate currently represents the most studied pharmacological agent for apathy in Alzheimer's disease (AD). However, optimal management is likely to combine pharmacological and psychosocial strategies tailored to the patient context. Future studies should include pragmatic trials with apathy as a primary endpoint, long-term follow-up, and expansion beyond AD.

Purpose of review: To synthesize recent evidence on neurodevelopmental disorders (NDDs) among children and adolescents in low- and middle-income countries (LMICs) and outline practical priorities for services, policy, and research.

Recent findings: Latest research suggests that NDDs are very common in LMICs. The population estimates of NDDs are 10-20% in children depending on subtype and setting. Yet, the diagnosis and treatment interventions remain inadequate. Current evidence suggests that implementation of targeted strategies for NDDs can be helpful. These include caregiver mediated interventions, task shifting approaches integrating community health workers and inclusive education interventions. There are also promising opportunities available in tele-health and emerging applications of artificial intelligence. But disparities continue to persist due to stigma, limited data, lack of adult diagnostic tools, and weak policy frameworks.

Summary: To enhance developmental outcomes, it is important integrate NDD care into existing health and education systems. In current times, this includes ability to utilize artificial intelligence and digital technologies. In addition, it is essential to develop policy frameworks, invest in research, and foster collaboration between various sectors.

Purpose of review: This review synthesizes recent advancements in understanding global dementia incidence while recognizing research inequities that hinder accurate estimates, especially among low- and middle-income countries (LMICs) and ethnoracial minorities. We highlight data gaps and outline opportunities to address these inequities, emphasizing the importance of diversity to achieve more reliable estimates.

Recent findings: Dementia incidence varies geographically; however, global estimates remain skewed due to under-representation and underdiagnosis in LMICs and minorities. While evidence from Europe and the USA show declining incidence, this trend is not universal with increases in Japan, Taiwan, and South Korea. Therefore, forecasted estimates assuming stable incidence, leave health systems underprepared. Risk factors like apolipoprotein Eε4 status show population-specific effects with a strong link to dementia incidence in Western but attenuated effects in African populations. Hence, variation in modifiable and protective factors call for country-specific estimates and interventions, based on diverse representative samples.

Summary: Recent findings bring into focus the urgent need for high-quality longitudinal representative datasets, especially among under-researched LMICs and diverse ethnoracial groups. Investment into locally led cohort studies, culturally sensitive assessments and harmonization procedures, equitable collaborations, and methodological transparency will improve incidence accuracy, guiding population-specific interventions and public health policy.

Purpose of review: Prevention research has largely concentrated on mid- and late-life modifiable risk factors, whereas early-life adversities have received less attention. Growing evidence shows that early adversities can influence brain health across biological systems and social environments, yet findings are fragmented and rarely address broader structural conditions. This review synthesizes recent evidence and introduces an exposome-informed conceptual model to guide future research and prevention.

Recent findings: Childhood adversities are linked to faster aging-related changes, including biological alterations, poorer cognition, subjective decline, functional impairment, and neuropsychiatric and mental health symptoms, as well as increased risk of mild cognitive impairment and dementia. Abuse, neglect, and socioeconomic deprivation show the most consistent associations. However, variation in how adversities are measured and the underrepresentation of global settings limit comparability. Few studies examine combined social and physical exposures, incorporate structural determinants such as segregation or conflict, or assess protective factors.

Summary: Findings highlight the need to move beyond single exposures, address structural and environmental influences, and broaden diversity in research populations. Identifying individuals exposed to early adversities may help tailor prevention efforts. An exposome-informed conceptual model links social and physical exposures with both vulnerability and resilience and can inform precision-prevention strategies to promote equitable brain health.

Purpose of review: The high comorbidity and complex clinical presentation of psychotic disorders in adults with intellectual developmental disorders (IDDs) and autism spectrum disorder with cognitive or major communication issues (ASD-CMCI) requires highly accurate assessment approaches. This targeted review examines the availability, validity, and clinical utility of existing instruments for this high-risk population, in whom diagnostic procedures are often hindered by communication deficits and diagnostic overshadowing.

Recent findings: There is a substantial lack of PD-specific assessment tools for this population. Adapted neurotypical scales, including the PANSS and PSYRATS, demonstrate limited validity because they rely heavily on introspective self-report. The primary methodological challenge is distinguishing chronic neurodevelopmental features from acute psychotic change, a process that requires careful observation of objective deviations from the individual's baseline functioning and behaviour.

Summary: This targeted review underscores the need for dedicated, informant-based instruments for PD in IDD/ASD-CMCI. Approaches grounded in behavioural equivalents and systematic evaluation of change from baseline appear essential for reducing diagnostic overshadowing and improving diagnostic accuracy, although further validation of these methods remains necessary.

Purpose of review: Adolescents with neurodevelopmental disorders (NDDs) often display challenging behaviors such as hypersexuality, severe irritability, and aggression. This review emphasizes current management strategies, focusing on the evaluation of problematic behaviors and considering both pharmacological and nonpharmacological options, as well as their level of evidence in the current literature.

Recent findings: Hypersexuality in adolescents with NDDs may result from conditions such as precocious puberty, polycystic ovary syndrome, neurologic disorders, trauma, or medication effects. Management should be etiology-based; limited evidence suggests selective serotonin reuptake inhibitors (SSRIs) and opioid antagonists may help in compulsive sexual behavior, though data in youth remain scarce. Irritability is most consistently improved with atypical antipsychotics, particularly risperidone and aripiprazole. Adjunctive options include NMDA modulators, stimulants, alpha-2 agonists, and anti-inflammatory or nutraceutical agents. Aggression management relies on antipsychotics, with clozapine considered for refractory cases; benzodiazepines, guanfacine, sertraline, and investigational agents such as vafidemstat show early promise. Psychotherapeutic and family-based interventions remain essential.

Summary: Effective care requires holistic evaluation, elimination of iatrogenic contributors, and individualized treatment. Combining behavioral therapies with judicious medication use can improve functioning and safety. Emerging pharmacologic and biologic strategies warrant further investigation in this vulnerable population.

Purpose of review: This review highlights three of the most promising mouse models of vascular cognitive impairment and dementia (VCID) that recapitulate chronic cerebral hypoperfusion. It also discusses therapeutic candidates evaluated using these models.

Recent findings: The three mouse models of chronic cerebral hypoperfusion induced by carotid artery manipulations are bilateral common carotid artery stenosis (BCAS), asymmetric common carotid artery surgery (ACAS), and gradual common carotid artery stenosis (GCAS). Altogether, these models reproduce white matter lesions and executive dysfunction. Notably, ACAS and GCAS exhibit gradual cerebral blood flow (CBF) reduction and motor impairments, addressing key limitations of BCAS, which induces abrupt CBF decrease and no motor deficits. Furthermore, ACAS uniquely demonstrates subcortical small infarcts, a hallmark feature of clinical VCID. These models have greatly contributed to elucidating VCID pathophysiology, including abnormal oligodendrocyte maturation, astrocytic dysfunction, and neuroinflammation. Several therapeutic strategies developed using these models - such as adrenomedullin and SIRT1 activator - are currently under investigation in clinical trials.

Summary: The three models are robust and complementary tools for exploring the VCID mechanisms. They have been instrumental in advancing our understanding of VCID pathogenesis and in facilitating the development of novel therapeutic approaches.

Purpose of review: High comorbidity rates across neurodevelopmental disorders (NDDs) may suggest shared pathogenic mechanisms rather than independent disease processes. This review synthesizes recent neuroimaging evidence (2024-2025) examining how comorbidity patterns reveal circuit-level convergence across traditional diagnostic boundaries.

Recent findings: Studies of brain connectivity demonstrate that four core transdiagnostic dimensions of cognitive rigidity, sensory processing, repetitive behaviours, and social-emotional regulation show both circuit convergence and disorder-specific patterns across autism spectrum disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, Tourette syndrome and anxiety disorders. Analyses of how brain networks change over time clarify inconsistencies in earlier static studies, revealing that temporal network inflexibility predicts symptom severity better than anatomical connectivity alone. Developmental studies suggest circuit dysfunction emerges early (as early as 18 months for sensory processing) and creates cascade effects throughout maturation. Interventions targeting specific brain circuits produce transdiagnostic improvements, validating circuit-based approaches over disorder-specific supports.

Summary: Comorbidity patterns provide critical clues to shared pathogenesis, with circuit-level evidence supporting dimensional models over categorical diagnoses. The timing and of circuit dysfunction inform whether patterns reflect shared vulnerabilities, developmental cascades, or independent processes converging on similar phenotypes. These findings suggest that assessments and interventions targeting underlying brain mechanisms may be more effective than traditional categorical diagnosis-based interventions.

Purpose of review: Accurate dementia risk prediction is critical for prevention, yet it remains unclear which predictors add meaningful value beyond chronological age. This review evaluates the extent to which multivariable dementia risk models identify modifiable risk factors that enhance prediction value.

Recent findings: We systematically reviewed cohort studies reporting both age-only and multivariable dementia prediction models in the same population. Six age-only models across five cohorts were included. Age-only models achieved poor to good discrimination (C-statistics 0.66-0.84). Adding modifiable cardiovascular and lifestyle factors provided consistent, modest improvements of 0.02-0.05 in the UK Biobank, Atherosclerosis Risk in Communities (ARIC), and Rotterdam cohorts. Larger improvements of 0.07-0.12 were observed in models including cognitive testing or genetic factors [e.g., UK Biobank Dementia Risk Score (UKBDRS-APOE)] with the Hanley-McNeil z-test confirming the improvements were significant, indicating genuine improvement rather than random variation.

Summary: While age is a significant risk factor for dementia, modifiable cardiovascular and lifestyle factors provide incremental predictive value beyond age and represent actionable targets for prevention. Despite modest statistical improvements, these factors offer the most clinically relevant targets for prevention strategies. Future efforts should prioritise interventions addressing these modifiable determinants to reduce dementia risk across populations.