Current Psychiatry Reports最新文献

Purpose of review: Sleep disturbances are prevalent among those with comorbid substance use disorders (SUD), significantly impacting the initiation, maintenance and relapse of these conditions.

Recent findings: This review explores the latest research on the reciprocal relationship between sleep and substance misuse, the effects of treating sleep on substance use outcomes, and the potential therapeutic uses of cannabis for sleep disorders in people with and without SUDs. Understanding these interactions may be critical for augmenting current treatment strategies aimed at improving sleep disturbances and recovery outcomes in individuals with SUDs.

Purpose of the review: This narrative review examines the newest findings from clinical trials of chronotherapeutics for psychiatric disorders. We reviewed the potential effects of the most commonly-studied chronotherapeutics such as bright light therapy, dark therapy, melatonin, and chronotherapy on the psychiatric disorders of depression, bipolar disorder, and anxiety disorders.

Recent findings: The preponderance of recent clinical trials in chronotherapeutics has focused on bright light therapy in depression. However, there is an emerging body of preliminary studies testing chronotherapeutics in other psychiatric disorders, including bipolar disorder and post-traumatic stress disorder. Chronotherapeutics hold potential to improve sleep in adults with psychiatric conditions as well as psychiatric symptoms. Although the most recent literature demonstrates the promise of these interventions, the current body of work is limited by small sample sizes and relatively few studies outside of depression. Larger-scale trials are needed to refine treatment protocols, develop personalized treatment approaches, and inform dissemination. Studies in psychiatric conditions besides depression are particularly needed.

Purpose of review: We aimed to investigate the recent understanding of the frequent coexistence of obsessive-compulsive disorder (OCD) and major depression (MDD), exploring both clinical and mechanistic perspectives. Our focus was on deriving conclusions with therapeutic implications.

Recent findings: While biological factors contribute to the development of OCD-MDD, the comorbidity seems to be primarily induced by the convergence of symptoms that complicate the course of OCD. Tailored cognitive-behavioral therapy programs, specifically addressing MDD, alongside SSRI medication, may prove beneficial for patients experiencing moderate to severe forms of this comorbidity. The review underscores the significance of comorbidity from both diagnostic and therapeutic perspectives. However, existing research has yet to offer a clear understanding of the underlying mechanisms. Further research in the field, notably coming from network studies, could enrich our practice by helping to target specific dimensions that underly OCD-MDD comorbidity.

Purpose of review: Systematic review to identify the most promising experimental approaches to modify prenatal alcohol and cigarette use published since 2019.

Recent findings: 20 studies met review criteria. Among the five approaches to prenatal alcohol use, a study comparing brief intervention or brief advice to treatment as usual in Argentina, and a practice change intervention to include evidence-based assessment and intervention of prenatal alcohol use in Australia were noteworthy. Five different strategies to modify cigarette use included diverse samples and settings. An innovative approach that was rigorously evaluated was conducted in Hong Kong where an intervention with brief advice, a nicotine sample, and active referral to smoking cessation service resulted in doubling the odds of biochemically validated abstinence from nicotine in expectant fathers when compared to an attention control condition. Prenatal alcohol and cigarette smoking are common in the US and pending effective intervention strategies that may be informed by international research.

Purpose of review: Habits, characterized by automaticity and insensitivity to outcomes, may be key to the persistence of maladaptive behaviors in anorexia nervosa (AN). This review examines the status of habit research in AN, focusing on insights from task-based assessments.

Recent findings: Findings indicate dysfunction in the frontostriatal circuits associated with habitual and goal-directed behaviors, with some studies linking neural disturbances to habit measures or clinically relevant behaviors. Heightened habitual tendencies in AN have consistently been reported using self-reports, while research utilizing experimental paradigms has yielded mixed results and efforts to capture real-world habits in AN remain limited. Some experimental paradigms appear more sensitive than others, but all face challenges associated with studying habits in the lab. Promising new approaches will need to be adopted and efforts made to capture real-world habits. Understanding which habits are problematic, when in illness and for whom they dominate, could make good on the promise of habit-focused treatments for AN.

Purpose of review: We examine the deleterious effects on emotional development and mental health of college students wrought by the COVID-19 pandemic. In the era of climate change, political polarization, and global pandemics, some students are likely exposed to public disasters either on campus or at home at any given time.

Recent findings: The worsening incidence and severity of mental health symptoms foreshadowed a youth mental health crisis of unanticipated proportions. Post disaster, the treatment of physical illness typically takes precedence to the exclusion of preventive mental health measures. Even though the mental health effects of mass trauma are more pervasive and last longer than physical symptoms, mental health experts did not have a prominent place at the table of the COVID-19 response teams beyond their traditional role in the care of individual students. We conclude with a review of best practices for psychological first aid, and highlight the need for disaster response training for psychiatrists.

Purpose of review: Provide an overview of the Alternative DSM-5 model of Personality Disorder (AMPD) and ICD-11's PD diagnostic model; review the models' assessment measures and construct validity; describe the models' current and ongoing status.

Recent findings: The models have many content similarities but differ significantly in that maladaptive-range traits are an AMPD requirement, but optional specifiers in ICD-11. An extensive literature using the Personality Inventory for DSM-5 (PID-5) has yielded comprehensive reviews of its clinical utility and construct validity. Structural meta-analyses found three core facets for each of the five domains, and correlations with non-FFM measures identified 13 traits with maladaptive content not assessed by the PID-5. Joint analyses of AMPD personality-functioning measures find a clear general factor, but have raised concerns about discriminant validity among measures and with Criterion B. For both criteria, the multimethod assessment literature is sparce. Regarding ICD-11, few measures assess the required personality functioning, but one has shown promising construct validity. Multiple measures assess the optional trait specifiers, the most noteworthy of which was developed by an international group, exists in 12 languages, and assesses all six domains of the DSM-5 and ICD-11.

Conclusion: The status of the ongoing revision process for the AMPD is described. It seems likely-but far from guaranteed-to result in a dimensional model in the main DSM-5 section. The next step for the ICD-11 is development of a version with Research Diagnostic Criteria, but the timeline is unknown.

Purpose of review: We review the published literature on common presentations, unique challenges, existing models of care, and best practices regarding college student psychiatric emergencies.

Recent findings: College students who are in psychiatric crisis experience a range of responses and support. The diversity of institutions of higher education (IHEs), geography, resources, and the demographics of college students themselves means that no two psychiatric emergency responses are alike. Population health approaches to these crises are generally lacking even though the literature is clear that some students have unique and elevated risk. New models of care have emerged at some IHEs but have not yet been sufficiently evaluated. There are diverse responses and models of care for college student psychiatric emergencies. Recent guidelines reflect novel approaches to care and support.

Purpose of review: Suicidal behaviour remains a critical public health issue, with limited progress in reducing suicide rates despite various prevention efforts. The introduction of precision psychiatry offers hope by tailoring treatments based on individual genetic, environmental, and lifestyle factors. This approach could enhance the effectiveness of interventions, as current strategies are insufficient-many individuals who die by suicide had recently seen a doctor, but interventions often fail due to rapid progression of suicidal behaviour, reluctance to seek treatment, and poor identification of suicidal ideation.

Recent findings: Precision medicine, particularly through the use of machine learning and 'omics' techniques, shows promise in improving suicide prevention by identifying high-risk individuals and developing personalised interventions. Machine learning models can predict suicidal risk more accurately than traditional methods, while genetic markers and environmental factors can create comprehensive risk profiles, allowing for targeted prevention strategies. Stratification in psychiatry, especially concerning depression, is crucial, as treating depression alone does not effectively reduce suicide risk. Pharmacogenomics and emerging research on inflammation, psychological pain, and anhedonia suggest that specific treatments could be more effective for certain subgroups. Ultimately, precision medicine in suicide prevention, though challenging to implement, could revolutionise care by offering more personalised, timely, and effective interventions, potentially reducing suicide rates and improving mental health outcomes. This new approach emphasizes the importance of suicide-specific strategies and research into stratification to better target interventions based on individual patient characteristics.

Purpose of review: Researchers and clinicians have increasingly recognized the importance of investigating and considering sex differences in obesity treatment. In this narrative review, we first summarized sex differences in select obesity-related conditions that have been the focus of studies of second-generation anti-obesity medications (i.e., semaglutide and tirzepatide) including type 2 diabetes, obstructive sleep apnea, knee osteoarthritis, and heart failure. We next described sex differences related to obesity treatments with a focus on the second-generation anti-obesity medications, semaglutide and tirzepatide.

Recent findings: Type 2 diabetes, obstructive sleep apnea, knee osteoarthritis, and heart failure demonstrated sex-specific pathways influenced by factors such as hormones and body composition. Lifestyle modification, on average, resulted in larger weight losses in males. In contrast, second-generation AOMs produced higher mean weight losses among females. Females reported more adverse events (e.g., nausea, vomiting) with second-generation anti-obesity medications. The few studies that have performed analyses of changes in obesity-related comorbidities stratified by sex have shown consistent improvements between males and females in heart failure and cardiovascular outcomes. Studies are needed to evaluate the effect of sex on the efficacy of anti-obesity medications including on mental health, investigate the mechanisms underlying these effects, and develop interventions to improve the availability and access of these medications.