Current Opinion in Psychiatry最新文献

Purpose of review: This narrative review synthesizes advances from the past 18 months on the etiology of autism spectrum disorder (ASD), integrating findings from genetics, neurobiology, environmental epidemiology, and developmental psychiatry. Given the profound clinical heterogeneity of ASD, improved etiologic clarity is essential for risk stratification, early identification, and targeted intervention.

Recent findings: Extensive genomic and multiancestry studies are now further clarifying how both common polygenic and rare high-impact variants contribute to ASD. These studies reveal different patterns of genetic liability that underlie distinct ASD subgroups. In parallel, functional and multiomic research is highlighting shared pathways involving synaptic signaling, gene regulation, immune processes, and the balance between excitatory and inhibitory signals. Environmental research, especially on maternal immune activation and maternal metabolic factors, uses causal inference methods to clarify modest but plausible causal effects, tempering earlier claims. Longitudinal imaging and infant cohort studies continue to show that atypical connectivity and social-brain differences occur before behavioral diagnosis. Sex differences and global diversity underscore the need for etiology models to incorporate sex-specific genetic architecture and address significant gaps in ancestral representation.

Summary: ASD arises from a dynamic interplay of genetic liability, early neurodevelopmental processes, and environmental exposures. Etiologic progress now depends on integrating multilevel and multiomic data - including genomic, transcriptomic, epigenetic, imaging, and epidemiologic information - toward stratified developmental models and better-tailored interventions.

Purpose of review: Climate change has emerged as a critical global health challenge, which poses significant risks to brain health and well being among older adults. This review summarized the evidence from the past 2 years on how climate change shapes cognitive health and further explored how social inequities amplify the climate-related exposures and the burden of dementia and its consequence.

Recent findings: Emerging evidence have linked climate-related exposures to the dementia continuum, from accelerating cognitive decline to increase acute hospitalization and mortality, through direct biological processes and indirect behavioral or social influences. These impacts were unequally distributed, with the greatest in low-income and middle-income countries and other socially disadvantaged groups. The socio-ecological framework provided a structured lens for understanding these dynamics, emphasizing public policy as a key lever for equitable adaptation and mitigation, such as climate-resilient infrastructure and specialized disaster protocols.

Summary: This review underscored the need to integrate climate considerations across the spectrum of cognitive health and to recognize the amplifying role of social inequities. Further research is required to close evidence gaps in resource-poor settings, implement advanced exposure measurements, and integrate social determinants and biomarkers for mechanisms exploration. Public policy should mitigate these inequities through targeted, equity-focused interventions and intersectoral collaboration.

Purpose of this review: This narrative review provides an overview of functional cognitive disorder (FCD) as a cognitive subtype within the functional neurological disorder (FND) spectrum. It addresses the conceptual challenges, diagnostic criteria, and epidemiology of FCD, emphasizing the need for standardization of internal inconsistency and clearer diagnostic boundaries to improve clinical assessment and research.

Recent findings: FCD is characterized by persistent cognitive complaints disproportionate to objective performance, underpinned by metacognitive, attentional, and cognitive-behavioural dysfunction. Emerging evidence supports a predictive processing framework in which maladaptive top-down priors and attentional dysregulation perpetuate subjective cognitive deficits despite preserved or inconsistent objective cognitive performance. Diagnostic criteria and FCD checklists show promise, although challenges remain in standardizing neuropsychological assessments and integrating patient-reported experiences. Epidemiological data highlight the stability of FCD and its distinctiveness from neurodegenerative conditions, with a nonprogressive trajectory in most cases.

Summary statement: Defining and refining FCD through standardized criteria and mechanistic models is crucial for enhancing diagnostic accuracy, patient care, and research validity. Advancing our understanding of the pathophysiology of FCD within the FND framework will facilitate targeted interventions and improve trial cohort purity in neurodegenerative disease research. Future studies should focus on objective biomarkers and therapeutic strategies that address attentional and metacognitive dysfunction in FCD.

Purpose of review: Artificial intelligence is increasingly advancing both fundamental research and clinical applications in schizophrenia. This review surveys recent literature on artificial intelligence driven approaches for schizophrenia diagnosis, treatment, management, and characterization, using multiple data modalities such as neuroimaging, electrophysiology, electronic health records, and genomic data.

Recent findings: Recent work shows substantial progress in leveraging machine learning and deep learning for diagnostic label prediction, treatment response modeling, and brain network characterization. While many studies continue to improve feature extraction and classification methods within single modalities, there is a growing trend to utilize multiple data sources to capture the complexity of schizophrenia from a comprehensive perspective. Emerging themes include multimodal fusion methodologies to identify linked correlates of schizophrenia, as well as data-driven approaches to learn subgroups, brain networks, and psychosis continua. The rise of large-scale multimodal datasets, foundation models, and mechanistic interpretability methods holds promise for scalable symptom assessment and biomarker identification, thereby better supporting early intervention and personalized treatment.

Summary: Current literature highlights a shift from unimodal prediction to holistic, multimodal characterization of schizophrenia. Transforming these artificial intelligence models into clinical tools, however, requires careful attention to patient privacy and data bias, alongside rigorous validation across diverse populations and settings.

Purpose of review: This systematic review and meta-analysis evaluated mental and oral health outcomes among left-behind children (LBC) affected by urbanization-driven rural-urban labour migration. Although mental health impacts of parental migration are increasingly recognized, oral health outcomes remain underexplored. This review synthesizes available evidence, quantifies disparities, and identifies shared social and structural determinants.

Recent findings: Thirty-three studies met inclusion criteria. Pooled analyses revealed significantly higher depressive symptoms among LBC compared to non-LBC peers [standardized mean difference (SMD) = 0.16, 95% confidence interval (CI): 0.03-0.29], with increased risk of elevated depressive symptoms [odds ratio (OR) = 1.36, 95% CI: 1.01-1.83]. LBC also experienced higher rates of permanent tooth caries (SMD = 0.15, 95% CI: 0.05-0.25) and were less likely to attend dental care in the past year (OR = 0.80, 95% CI: 0.67-0.94). Greater distress was observed in cases of shorter parental separation and when both parents had migrated. Factors such as caregiver education, quality of parent-child communication, and school climate consistently influenced outcomes across both mental and oral health domains.

Summary: LBC experience a dual burden of psychological distress and unmet dental need, reflecting the effects of urbanization-related parental migration. These disparities are shaped by caregiving discontinuity, reduced access to preventive services, and socio-environmental stressors. Findings highlight the need for integrated responses, including caregiver training, school-based prevention, and equitable health entitlements. Addressing shared determinants across mental and oral health domains offers a feasible path toward improved outcomes and greater equity.

Trial registration: PROSPERO ID: CRD420251152265.

Purpose of review: The rapid urbanization in China has profoundly transformed social structures, environmental conditions, and public health landscapes within a relatively brief period. While driving economic growth, it has also generated complex mental health challenges. We explored the multifaceted relationships between urbanization and mental health in China, highlighting spatial and demographic disparities, impact pathways, and intervention strategies.

Key findings: Mental health outcomes are shaped not by a simple urban-rural divide but by many determinants such as age, gender, chronic illness, socioeconomic status, and stage of life. Vulnerable groups, including rural older adults, migrant workers, left-behind or migrant children, and urban youth, face elevated psychological risks from environmental stressors, social exclusion and institutional barriers. Key influences are likely to involve the physical environment, social system, economic factors and policy frameworks. In addition, intervention strategies emphasize both individual and structural approaches, such as community-based psychosocial support, urban greening, inclusive policy design, and integrated mental health governance. However, current research on their impacts remains constrained by methodological limitations.

Summary: This review underscores the need for equity-oriented approaches, interdisciplinary research and policy innovations to support community mental health within China's urbanization trajectory. Aligning public mental health strategies with national initiatives like "Healthy China 2030" and dual carbon goals is imperative to building inclusive and healthy urban environments for population mental well being and resilience.

Purpose of review: This review synthesizes emerging research on loneliness in psychosis, integrating neurocognitive, social, developmental, and phenomenological perspectives. We highlight how loneliness operates as both a precipitant and consequence of psychosis symptoms, discuss its manifestations across the psychosis spectrum, and outline conceptual and clinical priorities for advancing person-centered research and clinical care.

Recent findings: Loneliness is highly prevalent in psychotic disorders and strongly associated with psychiatric symptom severity, instability of self-concept, and overall reduced wellbeing. Neurocognitive models demonstrate that chronic loneliness heightens social threat sensitivity and alters brain networks supporting social cognition and emotion regulation in individuals with psychosis. Longitudinal data show bidirectional relationships between loneliness and paranoia, psychotic-like experiences, and social-cognitive biases. Qualitative work emphasizes loneliness as a profound barrier to recovery across stages of illness. Understudied contributors, including attachment disruptions, social defeat, context, solitude, and disturbances in self and identity, shape subjective experiences of loneliness beyond objective isolation.

Summary: Loneliness in psychosis is multidimensional, driven by interacting cognitive, interpersonal, developmental, and contextual processes. Future research should refine definitional distinctions of loneliness in psychosis phenomenology, incorporate dynamic and mixed-methods paradigms, and examine individual-specific and interpersonal mechanisms. Clinically, evidence supports treatments that prioritize meaning making, improving existing relationships, and addressing social biases, integrating cognitive, meta-cognitive, and narrative approaches.

Purpose of review: Recent evidence has expanded understanding of how urbanization influences bipolar disorder, yet findings remain inconsistent due in part to heterogeneous definitions of urbanicity. This review synthesizes recent studies using a structured framework encompassing interconnected constructs, timing of exposure, and community-level mechanisms. The aim is to clarify potential mediating factors underlying the relationship between urban environments and bipolar disorder.

Recent findings: Few recent studies focus specifically on bipolar disorder, but most report a positive association between urbanicity and bipolar disorder risk or clinical encounters. Conventional urbanicity measures show limited associations with bipolar disorder related outcomes. In contrast, timing effects such as the interaction between urban birth and longest rural residence appear relevant. Community-level mechanisms constitute the most active domain of new research. Air pollution, high ambient temperatures, limited greenspace, and high walkability are associated with increased bipolar disorder risk or service use, while virtual exposure to nature appears beneficial.

Summary: Environmental and community-level characteristics may play a more significant role in bipolar disorder than traditional geographic definitions of urbanicity. However, findings remain fragmented due to variable operationalization, small study numbers, and limited replication. Future work requires clearer differentiation between urbanization constructs, adoption of standardized or context-specific measures, investigation of macro- and micro-environmental mechanisms, and comparative analyses across bipolar disorder subtypes and related disorders.