Current Opinion in Psychiatry最新文献

Purpose of review: This review summarizes current research on resilience in individuals with borderline personality disorder (BPD), its role in the development of BPD, and its impact on symptoms and recovery. Low resilience is considered a key factor contributing to emotional dysregulation and difficulty coping with adversity in BPD.

Recent findings: A scoping literature search identified 177 records, of which 12 studies met the inclusion criteria. Patients with BPD consistently exhibit lower resilience scores compared to mentally healthy control groups, with higher BPD features linked to reduced resilience. When compared to other mental disorders, such as major depressive disorder, persistent depressive disorder, and posttraumatic stress disorder, individuals with BPD tend to show the lowest resilience levels. Additionally, resilience has been identified as a mediator between childhood maltreatment and BPD features. Treatment interventions like dialectical behavior therapy have been found to significantly improve resilience in patients with BPD.

Summary: The findings underline the importance of resilience regarding the development, symptoms, and treatment of BPD, with lower resilience linked to higher BPD features and a history of childhood adversity. Results also suggest that enhancing resilience, particularly through interventions such as dialectical behavior therapy, could be a valuable therapeutic target.

Purpose of review: To review the association between Alzheimer pathology and dementia and the role of mAbs targeting amyloid in the treatment of people with dementia and mild cognitive impairment.

Recent findings: There is an association, but Alzheimer pathology explains less than 40% of the attributable risk of dementia when other pathologies such as vascular, Lewy Body and TDP-43 are accounted. Recent trials of passive immunization with MABs, including Aducanumab Lecanemab and Donanemab, have demonstrated some benefits but the effects are small in size and may be due to bias. The side effect of amyloid-related imaging abnormalities (ARIA) is common and potentially serious. The costs of assessments for treatment and actual treatment costs are large compared with potentially modest benefits.

Summary: It is still uncertain about the place of MABs in the treatment of Alzheimer's dementia. Further research is required regarding the long-term benefits and risks.

Purpose of review: Gut microbiota and its alterations have been increasingly implicated in the pathophysiology of major psychiatric disorders via the microbiota-gut-brain axis. This narrative review aims to highlight current findings from recent systematic reviews and meta-analyses (published between September 2023 and March 2025), addressing the role of gut microbiota in major depressive disorder (MDD) and schizophrenia, with particular attention to the effects of psychotropic medications and microbiota-targeted interventions.

Recent findings: In MDD, consistent changes in gut microbiota composition, such as depletion of Faecalibacterium and enrichment of Bifidobacterium, have been reported, although alpha diversity findings remain inconsistent. Antidepressants may modulate microbiota in both humans and animal models, while probiotic and synbiotic interventions yield modest reductions in depressive symptoms and inflammatory markers. In schizophrenia, observational studies showed stable alpha diversity, but altered beta diversity, with taxa like Bifidobacterium , Lactobacillus , and Roseburia linked to symptom severity, cognition, and antipsychotic exposure. Interventional studies, though limited, suggest small-to-moderate clinical improvements with probiotic supplementation, and emerging evidence supports potential benefits for both cognition and reducing metabolic side effects of psychotropic medications.

Summary: Across depressive and psychotic disorders, growing evidence supports a multifaceted and indispensable role of gut microbiota in clinical symptomatology, treatment response, and cognition of patients. However, substantial variability of methodological frame, limited sample sizes, lack of mechanistic precision, and heterogeneity between published studies result in unequivocal conclusions on the exact effect of microbiota on mental health in general, and on major psychiatric disorders. While microbiota-targeted therapies remain adjunctive and exploratory, recent findings reinforce them as a promising target for more successful treatment of mental health disorders in the near future. In order to reach that goal, we need more rigorous, longitudinal, and integrative studies to guide the clinical implementation.

Purpose of review: Wastewater-based epidemiology (WBE) of substances can serve as a valuable tool to supplement traditional surveillance techniques, providing information rapidly on community use. Despite ongoing WBE-opioid programs occurring throughout the world, few have integrated such data into public health decision-making to drive meaningful interventions. This gap could be due to several factors and concerns that vary across diverse communities. This perspective examines multiple levels of stakeholders involved in the implementation of WBE for substance use, their roles, and the challenges facing each.

Recent findings: Challenges have been identified by our team while conducting a multiyear project focused on integrating WBE in several communities across the United States. We also highlight communities that have successfully implemented such programs and the benefits they have seen from this approach. Based on our experience and the current state of the literature, we identify current priority needs to increase the utility and impact of using WBE for monitoring substance use across communities.

Summary: There is great promise for the utility of WBE as a tool for strengthening public health systems to address substance use. Understanding the roles and perspectives of stakeholders broadly will help to move this concept into an effective and trusted approach.

Purpose of review: The personal and social harms from unmanaged substance use disorders (SUD) are substantial. Too few people with SUD are engaged in treatment, partly due to the acceptability and accessibility of services. Co-production - sharing power and decision-making between professionals and people with lived experience (PWLE) - could address barriers to improve uptake and outcomes of SUD treatment. This scoping review examined recent (01/09/2023-08/03/2025) literature on co-production in community SUD treatment services.

Recent findings: Co-production has been used to address barriers to care and co-design new interventions and services, especially for marginalised populations and groups with complex needs. Methods, processes, and the degree of meaningful involvement of PWLE varied across projects. Most work occurred in higher income countries and the impacts on PWLE were rarely explored.

Summary: Co-production is feasible and can inform the development of more patient-centred SUD treatment services. Projects should be grounded in theory and power differentials in decision-making addressed to ensure equitable and meaningful participation throughout the process. There is a need to explore co-production in the design and evaluation of general SUD treatment, sustainability, impacts on participants, and evaluation of long-term outcomes.

Purpose of review: Nonadherence to medication is prevalent in patients with mental illness. Various factors responsible for it. As a result, there are more hospitalizations, increased risk of suicide and increased cost of care. Thus, there is a need for effective interventions to improve adherence in mentally ill patients.

Recent findings: Adherence to medication includes participation of patient in decision making. Interventions in the recent years help patients through techniques like psychoeducation, motivational interviewing and cognitive behaviour therapy. Interventions involve both patients and caregivers. There is a growing body of research about use of technology -based interventions using smart phones, various applications, digital platforms and artificial intelligence. Recent findings of research indicate that a combination of methods of intervention may be more useful in improving adherence. Some conventional interventions yield good results. Robust research is needed in the field of technology- based interventions.

Summary: Non adherence to medication leads to poorer health outcomes and hampers integration of the patient in the society. A collaborative effort of the team of healthcare providers, the patient and caregivers is the way ahead for better adherence and good quality of life.

Purpose of review: People experiencing homelessness (PEH) are at increased risk of adverse consequences from opioid use disorder and other health conditions yet face multiple structural and personal barriers to accessing care. The expansion of digitized health and social care services may have improved access and efficiency of services to many in the general population but at the cost of further marginalizing PEH. Current digital exclusion mitigation strategies may not be sufficiently nuanced to address the deeply complex and challenging circumstances of PEH lives.

Recent findings: Providing devices, data and skills to PEH is no guarantee of increased use and benefit from digitally enabled services. Precarious and constantly mobile lives mean that maintaining sustained digital access is problematic and not always desirable. Even where digital access is secured, PEH are constrained in the range of activities they can engage with online due to privacy and other structural constraints. Justifiable distrust of institutions including healthcare colors the acceptability of digitized services for PEH. This distrust is magnified due to new inequities and vulnerabilities introduced by digitized services including the need for a digital persona, adverse outcomes from adverse digital inclusion and a widening of power imbalances. These more nuanced understandings of digital exclusion are increasingly incorporated into mitigation strategies, premised on co-production and engagement with PEH.

Summary: Improved engagement with digitally enabled OUD care for PEH must be prefaced by improved access to technology, optimized physical environments to maintain and use technology, and collaborative cross-sectoral efforts to build trust and engage this group through co-production and rebalanced power dynamics.

Purpose of review: Sentinel surveillance networks have been developed in different countries to monitor changes in patterns of addiction. The aim of this study was to ascertain fundamental aspects required for the design and implementation of a sentinel network for the surveillance of illicit drugs use in Spain.

Recent findings: Internationally, sentinel networks vary in organization, collaboration, and informants. Some rely on hospital emergency departments, such as Euro-DEN Plus and SISVEA; others include community pharmacists (Addictovigilance, Catalan Sentinel Pharmacies) or drug users themselves (IDRS, EDRS). Networks like N-DEWS and CCENDU combine real-time community data with epidemiological analysis. The challenges identified in the literature include the inclusion of drug users as informants due to reliability concerns, inconsistencies in data collection across health services, and professional fatigue. While focused on Spain, these findings may also be relevant for other countries with comparable public health challenges.

Summary: This qualitative study, based on focus groups with key informants, offers recommendations for the creation of a multidisciplinary, flexible sentinel network adapted to the Spanish context. Integration of professionals from diverse sectors, training in toxicology and digital tools, and mechanisms for feedback and motivation are critical. These insights can support clinical early detection, improve alert dissemination, and serve as a foundation for future research on surveillance systems for substance use.

Purpose of review: Despite growing recognition of the impact of Gaming Disorder in individuals with psychotic disorders, little is known about the clinical and personal implications of this dual diagnosis. Preliminary data suggest that Gaming Disorder may be associated with increased psychotic symptoms and reduced occupational and social functioning. However, insight from lived experience remain largely absent, despite their importance.

Recent findings: This review synthesizes recent literature on the comorbidity between Gaming Disorder and psychotic disorders, highlighting the scarcity of research in this emerging field. It also presents preliminary findings from an ongoing qualitative study focussing on the lived experiences of individuals receiving early psychosis intervention. These data focus on participants' motivations for gaming and their perceptions of both positive and negative effects gaming has on their life.

Summary: This review underscores the significant lack of data on the dual diagnosis of Gaming Disorder and psychosis. Early qualitative insights reveal diverse gaming motivations, including symptom regulation, anxiety management, cognitive stimulation, and social connection. These first-person accounts emphasize the functional role of gaming and the need for recovery-oriented care. Integrating lived experience into research and clinical practice can improve relevance, support nuanced interventions, and advance our understanding of behavioral addictions in early psychosis.

Purpose of review: Preclinical (nonhuman) research on neurobehavioral underpinnings of addiction often focuses on one addictive drug studied in isolation, however, this does not reflect real-world substance use patterns of polysubstance use (PSU). Here we make a case against purity, incorporating patterns of clinically relevant PSU into preclinical models. We argue that the meaningful inclusion of people with living experience as integral collaborators in translational addiction models is critical to advance the identification of novel efficacious therapeutics to reduce the harms associated with PSU.

Recent findings: Substance use disorders are complex as clinically defined and diagnosed. Further, PSU is highly prevalent and individuals may use multiple substances within the illicit drug supply which continually evolves and is tracked via surveillance efforts (e.g., the National Drug Early Warning System). Preclinical models often model monosubstance use patterns which do not reflect real world drug use and omits expertise from people who use drugs in driving preclinical addiction science.

Summary: Here, we argue a case against purity in the development, design, and implementation of preclinical translational studies of addictive drugs, a need for inclusion of individuals with living experience, and highlight the need for additional research on PSU across the translational spectrum.