Current Opinion in Psychiatry最新文献

Purpose of review: The review synthesizes existing literature on the prevalence, assessment, and treatment of dissociation, focusing on its manifestation in eating disorders. The review explores various conceptualizations of dissociation, its relationship with trauma, and its role in emotion regulation.

Recent findings: Dissociation is a complex psychological process ranging from mild detachment to severe identity fragmentation. Everyday experiences like daydreaming or losing track of time are common examples of dissociation. More severe dissociative experiences are present in dissociative disorders, trauma-related stress disorders, and borderline personality disorder. In eating disorders, dissociation serves as a coping mechanism for managing intense emotions that can originate from traumatic and nontraumatic events. Recent studies highlight the role of dissociative experiences in emotion regulation, its association with functional seizures, and its link to night eating. Psychoeducation offers a promising way to address trauma-related dissociation and challenges with emotion regulation. Incorporating eye movement desensitization and reprocessing (EMDR) and other trauma-focused therapies into eating disorder treatment can also help reduce trauma-related dissociative symptoms in individuals with eating disorders.

Summary: This review underscores the multifaceted nature of dissociation and its role in eating disorders. It highlights the need for further research into effective treatments for people with eating disorders.

Purpose of review: This review summarizes recent research on the epidemiology of avoidant/restrictive food intake disorder (ARFID), including prevalence, diagnostic criteria, drivers of food avoidance, comorbidities, and illness course. It focuses on studies published in 2024 and the first half of 2025, with selected key studies from 2021 to 2023.

Recent findings: ARFID is as prevalent as other eating disorders, with estimates of 12.0% in clinical and 2.84% in nonclinical populations. It affects individuals across all age groups, confirming it as an age-independent condition. Most individuals with ARFID present with sensory sensitivity and/or low appetite, and restricted intake often results in weight loss and psychosocial impairment. Comorbidities are common and span medical, psychiatric and neurodevelopmental conditions. Several studies highlight issues with the current diagnostic criteria - particularly the exclusion of ARFID alongside other eating disorders - prompting discussions about potential revisions. Research on illness course is scarce and robust longitudinal (cohort) studies are lacking.

Summary: ARFID is marked by considerable heterogeneity affecting prevalence estimates and distribution of clinical presentation characteristics. To ensure accurate diagnosis and optimal outcomes, further research is needed - particularly to clarify diagnostic boundaries, overlap with other eating disorders, and long-term course and its predictors.

Purpose of review: To review whether sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists decrease the risk of depression, suicidal ideation and cognitive impairment in later life.

Recent findings: The results of studies using information derived from large registries and administrative health datasets suggest that GLP-1 receptor agonists (RAs) increase the risk of suicidality, although findings have been inconsistent. One nested-case control study reported that SGLT2i decreases the risk of depression among adults with diabetes, and findings from a small trial of the SGLT2i empagliflozin provided supportive evidence. Several observational studies reported that SGLT2i and GLP-1 RAs decrease dementia risk, with a target trial finding greater cognitive benefit associated with the use of GLP-1 RAs compared with other medicines commonly used to manage diabetes.

Summary: Recent results from large observational studies suggest that SGLT2i and GLP-1 RA may decrease the risk of cognitive impairment in later life. The effects of these medicines on mood have not been as well explored, but there are concerns about the potential increased risk of suicidality among GLP-1 RA users. Prescription bias could explain some of these associations, so that robust trial evidence is now needed to confirm or dismiss the reported findings.

Purpose of review: While rTMS is a safe therapeutic option, its efficacy remains to be improved. Patients with treatment-resistant depression show 50-60% response rates and 30-40% remission rates to standard 10 Hz rTMS protocols. Response prediction is a promising option to improve rTMS efficacy.

Recent findings: Most studies test response prediction in patients with depression, schizophrenia, and OCD. Clinical data and structural MRI are primarily used for patient stratification, fMRI is employed to determine the optimal localization, and EEG is utilized for fine-tuning rTMS parameters to achieve the best efficacy. Employing magnetic resonance spectroscopy, PET, and measuring cortical excitability may also be helpful. However, only a few studies tested these methods. Furthermore, a crucial new task is to connect theta-burst accelerated protocols with response prediction, an approach applied in some recent studies.

Summary: We propose planning and carrying out multicentre studies to confirm existing results and provide a definitive conclusion for clinicians. Primarily, individual alpha peak (IAPF)-based response prediction results should be replicated in large-sample, multicentre trials, as this approach is the most robust and has the best chance of being implemented in clinical practice. Structural MRI-based patient stratification and fMRI-guided stimulation are possible add-ons.

Purpose of review: The 2024 Lancet Commission estimates 45% of dementias worldwide are preventable if 14 potentially modifiable risk factors for dementia were eliminated. While this is unlikely, there is evidence that even modest risk factor reduction will have significant benefits. Whether this is best achieved at the level of the individual or broader population level approaches is the purpose of this review.

Recent findings: To date, evidence for the efficacy of individual-level interventions in preventing cognitive decline or dementia is modest at best. Reasons for this include the sociodemographic and risk profile of study participants and complex disease causes, while overlooking the underlying social and commercial determinants of health influencing risk exposure. There is, however, growing evidence supporting population-level approaches to dementia risk reduction. Trend studies from high-income countries showing declines in dementia incidence over recent decades suggest their effectiveness.

Summary: The limited evidence for the efficacy, let alone effectiveness, of individual-level interventions is in part because they operate within the influence of social and commercial determinants of health. For significant and sustained risk factor reduction, population-level interventions targeting the underlying determinants of risk factor exposure across the life course, with sensitivity to diverse contexts, are required.

Purpose of review: Depression and physical illnesses have long been recognized as risk factors for suicidal behaviour in late life. Qualitative studies have previously identified frailty as being an issue in late life suicidal behaviour, but quantitative studies have been lacking. Establishing the role frailty plays in suicidal behaviour in late life has implications for suicide prevention.

Recent findings: Depression and frailty are closely linked in late life, with genetic and social factors suggesting bidirectional causality. Frailty is associated with an increased risk of suicidal ideation and suicide attempts that is likely enhanced by chronicity, depression, and social factors, such as living and eating alone. In contrast, suicide is associated with lower levels of frailty.

Summary: Suicide rates peak in late life with depression a consistently identified risk factor along with numerous diverse factors that include physical health and social issues. In investigating the relationship between physical health and suicidal behaviour, frailty has been neglected until recently. Interventions that reduce or prevent frailty and associated depression, such as physical training and nutritional management interventions, might have a role in preventing suicidal behaviour. Further research is required to elucidate the different associations reported between frailty and suicidal ideation/attempts and frailty and suicide.

Purpose of review: Since the term limbic-predominant age-related TDP-43 encephalopathy (LATE) was coined in 2019, more than 200 articles addressing the subject were published. This review aims to provide an updated synthesis of knowledge regarding LATE-NC as a cause of age-related neurodegeneration and cognitive decline while addressing the challenges posed by overlapping neuropathologies in aging populations.

Recent findings: LATE-NC is marked by TDP-43 deposition in limbic structures, such as the amygdala and hippocampus, and is often associated with cognitive decline resembling Alzheimer's disease, though with a slower progression in isolated cases. The frequent coexistence of LATE-NC with other neuropathologies, particularly Alzheimer's disease neuropathologic changes (ADNC) and Lewy body dementia (LBD), exacerbates dementia severity and complicates diagnosis and treatment. Recent efforts have established clinical criteria for in-vivo diagnosis, including neuroimaging markers like hippocampal atrophy and limbic hypometabolism. Genetic studies have identified key risk genes, including GRN , TMEM106B , SORL1 , and APOE , while biomarker development in cerebrospinal fluid (CSF) and blood remains in its early stages.

Summary: The review underscores the need for multidisciplinary research and clinical approaches to address the complexities of neurodegenerative diseases involving TDP-43 proteinopathy, improve diagnostic accuracy, and develop effective treatments tailored to individual patient profiles.

Purpose of review: Late-life depression (LLD) is a prevalent condition and frequently complicated by higher rates of medical comorbidities and cognitive decline. We review the current evidence implicating inflammation in the pathophysiology of LLD and the potential of related molecules and pathways to be used as biomarkers or pharmacological targets.

Recent findings: A growing body of evidence implicates chronic low-grade inflammation in the pathophysiology and progression of LLD. Inflammatory cytokines, stress-related neuroendocrine pathways, oxidative stress, mitochondrial dysfunction, and blood-brain barrier permeability all synergize with aging to worsen depressive symptoms. Moreover, LLD presents marked biological heterogeneity, with inflammation-related subtypes exhibiting worse clinical outcomes. Several biomarkers and novel therapeutic targets, including cytokines, gut microbiota, and mitochondrial DNA, are identified.

Summary: Inflammation is a key modifiable contributor to LLD and may serve as both a biomarker and therapeutic target. Although current clinical trials of anti-inflammatory treatments show promise, findings remain inconsistent. Future research should focus on identifying inflammatory subtypes of LLD and validating personalized, mechanism-based interventions to improve treatment outcomes in aging populations.

Purpose of review: Late-life depression (LLD) is a prevalent and often underdiagnosed condition in older adults, associated with significant cognitive, functional, and medical burdens. Conventional treatments frequently present limitations in this population, underscoring the need for safer, more effective alternatives. This review evaluates the growing body of evidence supporting transcranial magnetic stimulation (TMS) as a promising nonpharmacological treatment for LLD.

Recent findings: Recent meta-analyses and randomized controlled trials suggest that TMS is effective and well tolerated in older adults, even in cases of treatment resistance. Protocol adaptations, such as increased stimulation intensity and the use of theta burst or deep TMS, have demonstrated improved outcomes in this population. TMS also shows potential cognitive benefits and fewer systemic side effects compared to pharmacotherapy. However, barriers such as limited accessibility, insurance restrictions, and logistical challenges persist.

Summary: TMS represents a valuable therapeutic option for managing LLD, particularly in patients who are medication-intolerant or at high risk for adverse effects. While evidence supports its efficacy and safety, further research is needed to optimize protocols, identify predictors of response, and assess long-term outcomes. Addressing implementation challenges will be essential for translating these advances into routine clinical practice.

Purpose of review: As the term limbic-predominant age-related transactive response DNA-binding protein 43 (TDP-43) encephalopathy (LATE) was coined in 2019, more than 200 articles addressing the subject were published. This review aims to provide an updated synthesis of knowledge regarding LATE-NC as a cause of age-related neurodegeneration and cognitive decline while addressing the challenges posed by overlapping neuropathologies in aging populations.

Recent findings: LATE-NC is marked by TDP-43 deposition in limbic structures, such as the amygdala and hippocampus, and is often associated with cognitive decline resembling Alzheimer's disease, though with a slower progression in isolated cases. The frequent coexistence of LATE-NC with other neuropathologies, particularly Alzheimer's disease neuropathologic changes (ADNC) and Lewy body dementia (LBD), exacerbates dementia severity and complicates diagnosis and treatment. Recent efforts have established clinical criteria for in-vivo diagnosis, including neuroimaging markers like hippocampal atrophy and limbic hypometabolism. Genetic studies have identified key risk genes, including GRN, TMEM106B, SORL1, and APOE, while biomarker development in cerebrospinal fluid (CSF) and blood remains in its early stages.

Summary: The review highlights the importance of multidisciplinary research and clinical approaches in addressing the complexities of neurodegenerative diseases involving TDP-43 proteinopathy, enhancing diagnostic accuracy, and developing effective treatments tailored to individual patient profiles.