Current Opinion in Psychiatry最新文献

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: Clozapine is the most effective treatment for antipsychotic nonresponse, yet its use in the early stages of schizophrenia remains substantially delayed. Because the first several years after diagnosis represent a critical window for influencing long-term outcomes, clarifying the benefits, risks, and implementation challenges of earlier clozapine initiation is both timely and clinically relevant. This review synthesizes recent evidence on clozapine effectiveness, safety, and utilization within the first five years of illness.

Recent findings: Across cohort studies, registry analyses, and meta-analyses, clozapine demonstrates superior response and relapse-prevention outcomes when used following early treatment failure or relapse. Sequential treatment data show diminishing returns with repeated nonclozapine antipsychotic trials, whereas clozapine maintains comparatively higher response rates. Earlier initiation, particularly within three years of first episode, is associated with improved negative symptoms and functioning. Despite these advantages, clozapine remains markedly underutilized, with substantial delays. Safety profiles in first episode and early-phase samples mirror established risks, with serious adverse events uncommon in the short term.

Summary: Evidence supports considering clozapine earlier in the treatment sequence for early-stage schizophrenia, particularly after initial nonresponse or relapse. System-level interventions and emerging biomarker-guided strategies may reduce delays and improve long-term outcomes.

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.

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: 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: 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.