Current Opinion in Psychiatry最新文献

Purpose of review: Conspiracy theories are not a recent phenomenon, but their dissemination has been facilitated by the internet and modern means of communication such as social media. This article reviews personality-based factors that increase the likelihood of endorsing conspiracy theories.

Recent findings: Most studies used a correlational approach and examined personality traits and dimensions rather than personality disorders. The strongest and most consistent relationships were found between endorsement of conspiracy theories and suspiciousness and paranoid ideation, pseudoscientific tendencies and beliefs, schizotypal personality traits and narcissism. Similar personality characteristics were identified as correlates of the endorsement of the specific COVID-19 conspiracy theories, but antisocial personality traits have also been reported in this context. Epistemic mistrust has emerged as arguably the key factor that facilitates endorsement of conspiracy theories. Schizotypal, paranoid, antisocial, borderline, and narcissistic personality disorders were more likely to accompany endorsement of conspiracy theories than other types of personality disorders.

Summary: Although correlation does not imply causation, recent work has identified personality-related characteristics that confer an increased risk of espousing conspiracy theories. Further research is necessary to ascertain how this vulnerability could be decreased, thus minimizing the harms of conspiracy theories that are inflicted on their adherents and broader society.

Purpose of the narrative review: Response and remission rates in patients with major depressive disorder (MDD) treated with antidepressants are frequently not satisfying. Therapeutic drug monitoring (TDM), i.e. the quantification of antidepressant drug levels in blood and dose adjustment, is a modern and useful tool of personalized pharmacological treatment of MDD.

Recent findings: Emerging evidence suggests that the use of TDM for antidepressants can be helpful in numerous clinical scenarios. Such scenarios include lack of treatment response, relapse, or adverse drug reactions related to antidepressants. The use of TDM is also indicated in specific patient subgroups, such as children, adolescents, pregnant women, elderly patients and patients with intellectual disabilities. Patients with polypharmacy and/or physical comorbidities may also benefit from TDM-guided antidepressant treatment. We critically reviewed TDM literature on antidepressants, summarizing therapeutic reference ranges and laboratory alert levels for antidepressants, although TDM is not equally recommended/supported for all antidepressants.

Summary: The utilization of TDM as a tool for treatment optimization in clinical routine with antidepressants for patients with MDD offers a valuable method to improve safety and effectiveness. This work summarizes essential TDM knowledge for antidepressants and encourages the application of TDM as part of the clinical decision-making process.

Purpose of review: A paradigm shift in the assessment of personality pathology is underway, as diagnosticians move beyond traditional personality disorder categories and assess personality dysfunction using contemporary dimensional frameworks. This article describes the assessment of personality pathology in ICD-11 and the DSM-5 Alternative Model for Personality Disorders (AMPD).

Recent findings: Recent findings in this area can be grouped into three domains: reliability, factor structure, and temporal stability of ICD-11 and AMPD constructs, convergence of personality pathology ratings with external indices of psychopathology and adjustment, and clinical utility (e.g., usefulness in rendering clinical decisions, prediction of treatment outcome).

Summary: Research in this area confirms that level of personality functioning and the presence of one or more pathological personality traits predict an array of clinical outcomes, including symptom disorders (e.g., anxiety, depression), suicide risk, and psychotherapy effectiveness. Findings support the cross-cultural generalizability of these patterns, and the clinical utility of assessing personality functioning and traits in adolescents and adults.

Purpose of review: Modern-type depression (MTD) has emerged as a distinct psychopathological construct in the context of 21st-century societal, technological, and cultural transformations in Japan. First described by Tarumi and then refined by Kato et al. , it has since been recognized internationally. MTD diverges from classical melancholic depression in aetiology, phenomenology, and therapeutic response.

Recent findings: It is especially prevalent among adolescents and young adults exposed to accelerated social rhythms, digital hyperconnectivity, and precarious work and relational structures. Clinically, MTD is characterized by avoidance of social roles, heightened sensitivity to interpersonal conflict, externalized complaints, emotional withdrawal, and tension between authentic and idealized selves. Unlike traditional depression, pharmacological treatments often yield limited benefit or worsen symptoms, underscoring the need for psychosocial and community-based interventions. Promising approaches include interpersonal counselling, psychoeducation, stress management, cognitive-behavioural therapy, physical activity, and neuromodulation techniques such as transcranial direct current stimulation.

Summary: The advent of MTD highlights how socio-cultural acceleration and technological mediation shape mental health, exposing the limitations of conventional diagnostic frameworks. It also provides a valuable opportunity to investigate how social change influences psychopathology and to design culturally sensitive, developmentally informed strategies for prevention and treatment in younger populations.

Purpose of review: This review examines the relationship between borderline personality disorder (BPD) and complex posttraumatic stress disorder (CPTSD) in light of recent claims that the former might be replaced by the latter.

Recent findings: The stigma associated with BPD is not a convincing reason to suggest that CPTSD is more adequate than BPD, despite the fact that there is currently less stigma attached to it. BPD and CPTSD share some core symptoms, such as affective dysregulation and interpersonal difficulties. However, several features, including impulsivity, identity disturbance, and fear of abandonment, are relatively specific for BPD and may distinguish it from CPTSD. While trauma is a major risk factor for both conditions, it is neither necessary nor sufficient for the development of BPD because it can occur in the absence of trauma. In contrast, trauma is indispensable in the development of CPTSD. Research using latent class analysis and structural equation modeling has produced mixed results, with most studies identifying overlapping symptom clusters of BPD and CPTSD and suggesting that the boundaries between the two conditions are not clear.

Summary: While there are many similarities between BPD and CPTSD, they can be distinguished clinically, although the boundaries between them are not clear-cut. Current evidence strongly suggests that BPD cannot be reduced to a trauma-related condition and that it would therefore be erroneous to replace it with CPTSD.

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: 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.