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: This review examines the evolving role of telemedicine and digital mental health (DMH) in Hong Kong's urban healthcare landscape, focusing on accessibility, equity, and user engagement across diverse populations.

Recent findings: Telemedicine platforms such as HA Go have improved continuity of care and reduced stigma in mental health services. The pandemic accelerated the use of remote tools, revealing both strong public receptivity and persistent challenges related to regulation, usability, and clinical confidence. DMH interventions have expanded across age groups, including chatbot-based mindfulness programs for university students and digital games for primary school children. These studies highlight the importance of digital health literacy, cultural adaptation, and tailored approaches that address disparities in access and engagement shaped by socioeconomic status, age, and regional differences.

Summary: Hong Kong's digital health ecosystem is at a critical juncture. While infrastructure and public receptivity are strong, sustained progress requires inclusive design, clearer legal frameworks, and cross-sector collaboration. Telemedicine and DMH must evolve beyond crisis-driven adoption to deliver personalized, equitable, and trustworthy care across age, socioeconomic status, and regional divides.

Purpose of review: Rapid urbanization and the algorithmically mediated digital environment have been linked to a "digital pandemic" in youth mental health. As Generation Z transitions from play-based to phone-based childhoods, understanding how digital architecture interacts with urban stressors is critical. This review delineates the socio-neurobiological mechanisms underlying this crisis and proposes a comprehensive multi-tiered public health framework for technology-led intervention.

Recent findings: Emerging evidence suggests that attention-optimizing algorithms exploit neurodevelopmental vulnerabilities, intensifying negative affect and maladaptive social comparison. Recent studies link digital immersion to circadian disruption, hypothalamic-pituitary-adrenal axis dysregulation, and systemic low-grade inflammation. Urban stressors - including sensory overload and reduced green space - further sensitize the "social brain," creating an evolutionary mismatch that amplifies algorithmic influence and psychological distress.

Summary: We define the "digital pandemic" as a population-level phenomenon associated with algorithmic pathogenesis, and propose a "Digital Precision Psychiatry" framework that shifts the clinical paradigm from episodic, subjective observation to continuous, objective management. By utilizing digital phenotyping and Just-in-Time Adaptive Interventions (JITAI), this vertically integrated strategy aims to restore bio-psycho-social resilience in youth, turning the digital environment from a source of pathology into a tool for neuroprotection.

Purpose of review: Hikikomori (prolonged social withdrawal) was first described in Japan and was initially regarded as culture-bound. It is now recognized as a global mental health concern, more prevalent in urban settings and frequently comorbid with psychiatric disorders. In the post-COVID-19 era, home-centered lifestyles have become increasingly normative, prompting a reconceptualization of hikikomori beyond reduced outing frequency. Drawing on over two decades of clinical and research experience, we propose a psychodynamic (developmental and attachment-informed), transdiagnostic, and multidimensional framework and outline assessment and intervention strategies for urban digital societies.

Recent findings: International frameworks distinguish pathological from non-pathological hikikomori based on psychological distress and functional impairment. Emerging evidence implicates attachment insecurity, early adversity, and transdiagnostic biological pathways involving inflammation, and neurodevelopmental mechanisms. Early-phase pathological hikikomori is associated with increased risk of depression and gaming disorder, with possible relevance of modern-type depression. Digital tools, including online engagement and virtual reality based interventions, may provide low-threshold gateways to reach otherwise hard-to-reach individuals.

Summary: In contemporary urban life, physical isolation per se is not necessarily pathological. Translating a biopsychosocial-cultural model integrating psychopathology and attachment into structured assessment, family-based approaches, clinical care, and digital interventions is essential to prevent long-term pathological hikikomori.

Purpose of review: To review the association between bipolar disorder in later life, lifestyle measures and physical health.

Recent findings: Unhealthy lifestyle behaviours are more frequent among individuals with than without bipolar disorder, and recent retrospective cohort studies using the UK Biobank and Primary Care Clinical Practice Research Datalink have produced results suggesting that hazardous lifestyles may individually and together increase the risk of incident bipolar disorder, including later in life. In addition, new investigations using data from the GAGE-BD consortium and the Australian Pharmaceutical Benefits Scheme suggest that physical health morbidities are generally more prevalent among older women than men with bipolar disorder.

Summary: The findings of recent studies indicate that bipolar disorder is associated with unhealthy or hazardous lifestyles and that the association between them may be reciprocal. Lifestyle behaviours seem to have additive effects on physical morbidity, and this may help guide the introduction of harm-minimisation interventions. Bipolar disorder is also associated with high physical health burden, which seems to be more pronounced in women than men. The reasons behind such sex-discrepancy are unclear.

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.