Current Psychiatry Reports最新文献

Purpose of review: There is a mental health crisis affecting youth, and the utility of existing treatments is often limited by lack of effectiveness and tolerability. The aim of this review is to report on outcomes of clinical trials for psilocybin-assisted psychotherapy for adults with depression and MDMA-assisted psychotherapy for adults with post-traumatic stress disorder (PTSD) and discuss recommendations for exploring these treatments in adolescent populations.

Recent findings: There have been encouraging data supporting the use of psilocybin-assisted psychotherapy for depression, including previously treatment-resistant symptoms. MDMA-assisted psychotherapy is showing similar promise in treating PTSD, with excellent response and remission rates that appear durable. However, no studies have looked at the use of these treatments in younger patients. The safety and efficacy of psychedelic- and MDMA-assisted psychotherapies should be investigated in adolescents, especially considering the burden of untreated and undertreated psychiatric illness in youth, and the benefits of a potentially earlier, more effective, and more tolerable recovery process. Research and implementation should be tailored to the needs of this population, and equity and access should be considered at every stage. In this novel and rapidly evolving landscape, the psychiatric community is encouraged to advocate for safe, appropriate, and inclusive inquiry into, and application and scaling of these treatment models in adolescent patients.

Purpose of review: Through an overview of invasive lobular carcinoma (ILC), this review highlights the unique complexities the diagnosis and treatment of this disease represents, followed by psychological considerations for both patients and providers. Perspectives from members of the multidisciplinary treatment team are included.

Recent findings: A cancer diagnosis can be difficult for patients and their families and can also have a significant impact on the treatment team. Prior work related specifically to ILC is limited. Each member of the multidisciplinary team faces unique challenges when treating patients with ILC. This can manifest in a variety of ways and recognizing the complexities specific to this diagnosis can be helpful when considering strategies to mitigate provider burn out and secondary injury. ILC is a variant of breast cancer with a distinct set of diagnostic and treatment challenges. Recognition of patient and provider challenges specific to this diagnosis is important for future research considerations and stress mitigation management strategies.

Purposeof review: Old age bipolar disorder (OABD), increasingly common as the population ages, presents unique diagnostic and treatment challenges. This selective review focuses on issues especially relevant to outpatient management.

Recent findings: People with OABD may have similar frequency and severity of mood episodes compared to younger adults. Depression predominates, and mixed symptoms in both depressive and manic episodes are common. Comorbidity and excess mortality are high, with a particular bidirectional association with cerebrovascular disease. Lithium may outperform valproic acid and second-generation antipsychotics in efficacy. Tolerability and long-term safety can be improved with relatively lower target drug therapeutic levels. Outpatient clinicians treating OABD should take an active role in the recognition and management of medical comorbidities. A careful history and examination might reveal subtle signs of bipolar disorder or mixed features and change treatment. A primary target for treatment is to reduce polypharmacy when appropriate. Further trials are needed to make specific and clear recommendations in OABD.

Purpose of review: We evaluated the impact of digital mental health interventions (DMHIs) for college students. We organized findings using the RE-AIM framework to include reach, effectiveness, adoption, implementation, and maintenance.

Recent findings: We conducted a systematic literature review of recent findings from 2019-2024. Our search identified 2,701 articles, of which 95 met inclusion criteria. In the reach domain, student samples were overwhelmingly female and White. In the effectiveness domain, over 80% of DMHIs were effective or partially effective at reducing their primary outcome. In the adoption domain, studies reported modest uptake for DMHIs. In the implementation and maintenance domains, studies reported high adherence rates to DMHI content. While recruitment methods were commonly reported, adaptations and costs of implementation and maintenance were rarely reported. DMHIs for college students are effective for many psychological outcomes. Future work should address diversifying samples and considering implementation in a variety of college settings.

Purpose of review: We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring.

Recent findings: PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

Purpose of review: With the growing body of research examining the link between sleep disorders, including insomnia and obstructive sleep apnea (OSA), and the gut microbiome, this review seeks to offer a thorough overview of the most significant findings in this emerging field.

Recent findings: Current evidence suggests a complex association between imbalances in the gut microbiome, insomnia, and OSA, with potential reciprocal interactions that may influence each other. Notably, specific gut microbiome species, whether over- or under-abundant, have been associated with variation in both sleep and mood in patients diagnosed with, e.g., major depressive disorder or bipolar disorder. Further studies are needed to explore the potential of targeting the gut microbiome as a therapeutic approach for insomnia and its possible effects on mood. The variability in current scientific literature highlights the importance of establishing standardized research methodologies.

Purpose of review: This is a critical review of English language literature (January 2023-June 2024) on psychological trauma amongst forcibly displaced migrant women. The Mental Health and Psychosocial Support (MHPSS) Framework was used to organize multi-layered mental health interventions.

Recent findings: Findings indicate many promising community-based interventions, often delivered by trained lay facilitators. Interventions address: upstream drivers of mental health such as empowerment and economic security, group-based care focused on social connection and well-being, and trauma focused treatment such as Mindfulness Based Interventions, Cognitive Processing Therapy, and Culturally Adapted Cognitive Behavioral Therapy. The variety of (primarily short-term) interventions must be complemented by longitudinal evaluation. Clinicians and care systems should partner with those delivering psychosocial interventions outside of clinical settings. Continued research on the impacts of cumulative and intergenerational trauma amongst refugee women, and intervention research that centers the experiences of marginalized groups (e.g., sexual and gender minority refugees) is needed.

Purpose of review: This review synthetizes findings reflecting the increasing racial and ethnic inequities in opioid overdose mortality and emphasizes the necessity for tailored interventions as well as other policy-level and structural strategies to stem this trend.

Recent findings: Factors contributing to inequities in overdose mortality include changes in drug supply, persistent social-structural vulnerabilities stemming from structural racism, and inequities in access to medication for opioid use disorder and harm reduction services. Key strategies to address these inequities include the cultural adaptation of evidence-based interventions within an equity-based framework, integrating social determinants of health into addiction treatment, centering anti-racism praxis in addiction research, diversifying the addiction workforce, and integrating structural competency as a tool to restructure education and inform practice. Structural racism must be recognized as a key driver of inequities in substance use outcomes, and this understanding must be integrated into existing models of substance use disorder prevention, treatment, and research.

Purpose of review: This review aims to provide an updated overview of trends in firearm- related deaths, the mental health impact on communities, and clinical and legislative interventions. We examine existing interventions and highlight lesser-known yet impactful strategies, such as incorporating appropriate training in medical education on firearm safety. Additionally, we explore the broader impacts of firearm violence on community mental health and address the disputed topic of whether mental illness is a driving factor behind mass shootings.

Recent findings: The rate of firearm suicides has continued to grow in the United States, even as firearm homicides have slightly declined. While the media often attributes mass shootings to the perpetrator having a mental illness, research indicates such symptoms only account for a small subset of shooters. Recent studies highlight the benefits of incorporating firearm safety into professional medical education, which can reduce barriers for healthcare providers when discussing safe storage practices with patients. While suicide risk is frequently assessed among individuals with mental illnesses due to their heightened risk, other factors should be considered by all clinicians, not just those in mental health. Similarly, certain mental health symptoms may play a role in a small fraction of gun violence, but other risk factors account for most violence risk. Despite the implementation of firearm restriction laws and increased access to mental health resources, gaps remain that must be addressed to reduce not only the rate of suicide by firearm, but also the mental burden the aftermath has on the community.

Purpose of review: We review recent research on interventions, services and supports for children on the autism spectrum, examining both advancements and setbacks.

Recent findings: Progress has included an increase in quantity and rigor of intervention science, as well as a broadening of disciplines and perspectives engaged in the examination of early interventions, including their effectiveness, social validity and the contextual determinants of implementation outcomes. Setbacks have included the decrease in research involving children on the autism spectrum who have co-occurring profound intellectual disability, minimal or no spoken language, and who require constant assistance with daily living activities. This trend is alarming because it contributes to the marginalization and unmet needs of children who need intervention the most. Additionally, access to early intervention services is unequal and complicated by the misalignment of policy with the evolving evidence base in the field. The recent growth in the depth and breadth of knowledge related to autism early intervention means that policies, practices, advocacy efforts and research directions can be grounded on a more comprehensive evidence base and societal appraisal of autism. Nevertheless, these indisputable markers of success co-exist with conflicting narratives that hinder the establishment of a cohesive agenda to tackle inequities experienced by marginalized subgroups. Reconciliation of conflicting narratives requires a nuanced and compassionate appraisal of sources of tensions and heterogeneity of needs within the autism spectrum.