Current Opinion in Psychiatry最新文献

Purpose of review: Negative symptoms in schizophrenia remain an unmet treatment need. Recent guidelines and meta-analyses suggest that some pharmacological and psychosocial interventions show modest efficacy. Adding to this evidence, this review summarizes randomized clinical trials (RCTs) published between January 2024 and October 2025 on pharmacological, psychosocial, physical, digital, and neuromodulatory interventions targeting negative symptoms.

Recent findings: Most recent RCTs were small and methodologically heterogeneous, and effects on negative symptoms were generally modest. Exercise-based and body-oriented interventions, CBT-based interventions, psychosocial programmes, and digital tools were feasible and often associated with within-group improvement, but rarely superior to active controls or treatment as usual; only a larger yoga trial showed clear added benefit. Cognitive remediation did not directly reduce negative symptoms, but recent work indicates that negative symptoms moderate the translation of cognitive gains into functional improvement. Pharmacological trials yielded mixed results, with signals for muscarinic agonist-antagonist treatment, selected repurposed agents, and sulforaphane. Neuromodulation studies, particularly intermittent theta burst stimulation and transcutaneous auricular vagus nerve stimulation, suggested small to moderate improvements that depended on stimulation parameters and treatment duration.

Summary: Current evidence confirms that negative symptoms are modifiable and underscores the need for adequately powered, mechanism-informed, multimodal trials with long-term follow-up.

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: 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: 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 populations. 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.

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 LMCs 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: This review synthesizes recent findings on recent developments in the understanding and treatment of longstanding eating disorders (L-ED).

Recent findings: Following a systematic search 42 papers were identified that included 5 scoping or systematic reviews. The majority were about phenomenology and treatment. Co-design and perspectives of people with lived experience expertise were common. Research on conceptualization suggests some consistency that duration is a necessary but insufficient defining feature, and to broaden from a symptom focus to the inter- and intra-personal experience of L-ED. There has been little progress however on a consensus for the defining features or the aetiological understanding of L-ED or longstanding anorexia nervosa (L-AN). There are several new collaborative and person-centred models of care and therapeutic approaches, alongside developments in treatments, mostly biological however, and most of L-AN, e.g. ketamine, repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS). There remains an acute need to test these in controlled trials.

Summary: L-EDs continue to present unique challenges. The involvement of people with lived experience expertise in research has supported the increasing emphasis on exploring improved longer-term outcomes and meaningful trajectories of recovery, with personalized and integrated approaches to care being the new holy grail.

Purpose of review: Only one in five people with eating disorders ever receive care, making effective prevention critical. This review synthesizes prevention trials from the past 2 years - highlighting new interventions and implementation strategies.

Recent findings: A dissonance-based program for Brazilian men reduced muscle dysmorphia and body dissatisfaction, but not eating-disorder symptoms. The Body Advocacy Movement , designed to lessen fatphobia, produced medium declines in weight bias but only small symptom reductions, performing no better than the Body Project . Eat Breathe Thrive, a yoga-based program for female athletes, improved anxiety and interoceptive body trusting but did not reduce eating pathology. Two studies testing the Diabetes Body Project for young women with type 1 diabetes - an open pilot and a multinational randomized trial - produced large, durable reductions in general and diabetes specific symptoms but did not improve glycemic control. An implementation experiment across 63 colleges showed that pairing train-the-trainer workshops with technical assistance and ongoing quality assurance supervision maximized clinical benefit per dollar.

Summary: Recent work demonstrates promising population-specific adaptations of dissonance-based programs and underscores that comprehensive implementation support enhances effectiveness. Future work should optimize high-school delivery, boost effect sizes, and verify long-term reductions in future eating disorder onset.

Purpose of review: Adolescence is a sensitive period for the onset of mood disorders. Many adolescents experience mood symptoms, which for some are transient and pass over time and for others lead to a mood disorder diagnosis. Mood disorders are substantially heritable and those at highest genetic risk tend to have an earlier onset. The present review summarizes recent advances in our understanding of genetic factors contributing to mood disorders in adolescents.

Recent findings: Genetic predispositions play a critical part in the development of mood disorders, including major depression and bipolar disorder. Both cross-sectional and longitudinal studies have consistently found that individuals reporting mood symptoms during adolescence have higher polygenic risk for both mood disorders and other psychiatric disorders than those without symptoms. Polygenic Risk Scores (PRS) that aggregate the effects of thousands of genetic variants can improve individual risk prediction for bipolar disorder when combined with clinical and environmental factors. Genetically informative designs, either using observed genotypes summarized in PRS or the occurrence of the disorder in family members summarized in Family Genetic Risk Scores (FGRS) are also used to investigate mechanisms underlying associations with risk factors. Recent studies suggest that teens whose peers are genetically vulnerable to depression have an increased risk for depression compared to teens with the same genetic risk but whose peers are not genetically vulnerable. This indicates a direct environmental effect. These studies illustrate that both family-based and molecular-based genetic approaches can help in diagnosing and understanding the origins of mood disorders in adolescents.

Summary: Adolescent-onset mood disorders are associated with increased genetic risk relative to later-onset. Although not currently clinically applicable, genetic factors, with a focus on PRS and FGRS, can help to predict onset and course of mood disorders in adolescents. The use of PRS and FGRS, combined with environmental factors, improves prediction models for mood disorders in adolescents. Additionally, it also provides information on the etiology of these disorders, for example by examining parent-offspring and peer group associations in genetically informative study designs.

Purpose of review: Eating disorders, particularly anorexia nervosa and avoidant-restrictive food intake disorder, commonly co-occur with autism. Many autistic people with eating disorders face delays and challenges in assessment and treatment because their particular needs are not understood. The aim of this narrative review is to introduce the concept of neurodivergence-affirming eating disorder care and to review recent scientific research on this topic.

Recent findings: Some of the unique challenges that autistic individuals with eating disorders face include sensory processing differences, communication barriers, and unmet support needs. Neurodiversity-affirming care challenges structural ableism by emphasizing co-designing care with autistic experts by experience. Neurodiversity-affirming practitioners presume that their clients are autonomous and competent. When providing care, they respect different communication styles, tailor support to their client's individual needs and strengths, and seek to foster a positive autistic identity. This involves respecting autistic eating behaviours, providing timely assessment and support, individualized treatment goals, and carefully considering communication and sensory needs.

Summary: Eating disorder service providers often have a hard time understanding their autistic clients. This can contribute to poor eating disorder treatment outcomes. Neurodiversity-affirming practitioners seek insight from the autistic community and participatory research to improve eating disorder services for their clients.

Purpose of review: Over one billion people suffer from psychiatric and/or neurological disorders for which transcranial magnetic stimulation (TMS) has shown efficacy. Achieving widespread TMS access will require major improvements to cost and convenience. A key figure of merit for a given TMS protocol concerns not its remission rate or tolerability, but simply its treatment time per remission (TTPR).

Recent findings: Outcomes for conventional bilateral TMS protocols imply a TTPR of more than 100 h - incompatible with widespread access. However, briefer accelerated and/or theta-burst protocols may improve TTPR to less than 20 h. Personalization strategies that improve remission rates sometime improve TTPR, depending on associated cost-penalties of time or complexity. A potentially groundbreaking new strategy to improve TTPR involves pharmacological augmentation of neuroplasticity, using agents such as D -cycloserine. Plasticity-augmentation may improve TTPR by improving remission rates, and by reducing the number of required sessions. Recent literature suggests that TTPR values of under 5 h per remission may be achievable via neuroplasticity augmentation.

Summary: The most recent plasticity-augmented TMS protocols may approach or exceed cost-parity with pharmacotherapy, in terms of reducing the prevalence of depression. With the health economics of TMS improving steadily, a pathway to universal access may be within reach.