Current Psychiatry Reports最新文献

Purpose of review: This review summarizes recent advances in research on the neurobiology of borderline personality disorder (BPD) according to structural brain imaging investigations and resting-state and task-based functional brain activation studies.

Recent findings: Extending established findings on differences in regional brain volumes and cortical thickness between BPD and healthy controls, recent research illuminates shared and distinct brain structural characteristics compared to other psychiatric diagnoses, and uncovers relations of these brain structures with transdiagnostic symptoms and clinical features. Resting-state functional brain imaging studies reveal disruptions among adolescents and adults with BPD in frontolimbic and default-mode networks, which primarily underlie affect regulation and self-referential processes, respectively. Recent task-based functional brain imaging research builds on existing neurobiological understanding of emotion and cognition in BPD by revealing novel intersections with interpersonal- and stress-related processes. Studies of psychological and pharmacological interventions suggest possible effects on neural regions underlying emotion processing and behavioral control. Recent advances in neurobiological research on BPD underscore the pathophysiology of affective, behavioral and self-interpersonal symptoms, with growing interest in adolescents with BPD and the impacts of psychological and biological interventions. Corresponding with the increased prominence of alternative dimensional models of personality disorder in recent years, there is a gradual rise in studies examining the relationships of brain structures and functional brain activation with BPD-relevant symptom dimensions, including within transdiagnostic samples.

Purposeof review: This review discusses the importance of abortion care and access for mental wellbeing for people seeking abortion, abortion providers, and trainees. The recent Dobbs v. Jackson case has jeopardized the physical and mental health of millions.

Recent findings: Much of the data regarding mental health impacts of abortion access comes from the Turnaway Study. This study supports that abortion does not cause negative mental health effects and being denied abortion is detrimental to mental health, physical health, and has negative socioeconomic impacts. Other recent studies support that the Dobbs decision continues to disproportionately harm historically marginalized groups. Additionally, there is more anxiety and depression reported in states with abortion restrictions. Many obstetrician gynecologists are moving away from restricted states and report moral distress due to restrictions. Many medical students are choosing not to apply to obstetrics and gynecology residency programs in states with abortion restrictions. Access to abortion care is important for mental and physical health, and socioeconomic well-being for people seeking abortion. Restrictive bans negatively affect people seeking abortion, as well as healthcare providers and trainees.

Purpose of review: Autistic individuals experience disproportionate stigma across the life course in interpersonal, healthcare, and educational contexts. These experiences contribute to negative health and healthcare outcomes for this population. This paper seeks to describe autistic individuals' experiences of stigma and marginalization; discuss frameworks such as Campinha-Bacote's innovative concept of cultural competemility and its relevance to autistic populations; offer recommendations to healthcare providers based on this framework; and apply theory to practice in a case study.

Recent findings: Autistic individuals increasingly understand autism as an important aspect of their identity. There are, however, few culturally informed healthcare efforts that reflect this understanding. As a result, efforts to address stigma-related health disparities for this population have limited effectiveness. In this manuscript, we highlight opportunities within clinical encounters, medical training, healthcare offices and systems, and research to provide higher quality culturally informed care to autistic populations and address stigma-related health disparities.

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.

Purpose of review: Newborns and infants in the neonatal intensive care unit (NICU) may be at uniquely high risk of developing delirium. Because there is a dearth of NICU-focused literature, providers must rely on evidence derived from older children and infants in other care settings to guide management. The literature was rigorously reviewed to highlight evidence specific to newborns and infants and is summarized here.

Recent findings: Delirium likely occurs in newborns and infants at similar or higher rates than what is seen in other care settings. Recent literature calls particular attention to the lack of assessment tools validated in a NICU setting. Evidence for the evaluation and management of delirium in the NICU is lacking. More study specific to the NICU is needed to build consensus toward best practice.

Background: As the war in the Middle East intensifies, the support and well-being of healthcare practitioners (HCPs) become paramount to sustaining an effective healthcare system capable of serving the diverse Israeli population.

Methods: In collaboration with the integrative medicine (IM) team, we initiated a treatment intervention with the goal to relieve war-related HCPs concerns.

Results: This trilogy of narratives highlights the multifaceted experiences of HCPs in Israel during times of conflict. The director of internal medicine ward with his conventional medical and leadership expertise, provides stability and order. The IM practitioner offers holistic healing and care. The nurse reflects on her experience of being cared for.

Conclusions: These narratives illustrate the adaptability and resilience of healthcare professionals who navigate their roles with dedication and compassion, ensuring that amidst the strife, the human spirit remains cared for and supported.

Purpose of the review: This narrative review examines the efficacy, mechanisms and safety of mind-body medicine (MBM) in the treatment of depression. We reviewed the potential effects of various MBM interventions such as yoga, tai chi, qigong, mindfulness-based interventions and nutrition on clinical and subthreshold depressive symptoms.

Recent findings: Current studies indicate a growing interest in the use of MBM for psychiatric disorders, including depression. MBM interventions demonstrate efficacy in reducing depressive symptoms with fewer adverse effects and costs compared to pharmacological treatments. MBM has significant potential to improve mental health outcomes for depression. These interventions encourage self-care and stress management through behavioural, exercise, relaxation and nutritional approaches. While existing data are promising, further, more rigorous studies are required to confirm long-term effectiveness and to determine the role of MBM in comprehensive depression treatment strategies.

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: We review recent studies published from 2019 to 2024 examining slow waves and sleep spindles abnormalities across neurodevelopmental, mood, trauma-related, and psychotic disorders using polysomnography and Electroencephalogram (EEG).

Recent findings: Individuals with attention-deficit/hyperactivity disorder (ADHD) showed higher slow-spindle activity, while findings on slow-wave activity were mixed. Individuals with autism spectrum disorder (ASD) showed inconsistent results with some evidence of lower spindle chirp and slow-wave amplitude. Individuals with depression displayed lower slow-wave and spindle parameters mostly in medicated patients. Individuals with post-traumatic stress disorder (PTSD) showed higher spindle frequency and activity, which were associated with their clinical symptoms. Psychotic disorders demonstrated the most consistent alterations, with lower spindle density, amplitude, and duration across illness stages that correlated with patients' symptom severity and cognitive deficits, whereas lower slow-wave measures were present in the early phases of the disorders. Sleep spindle and slow-wave abnormalities are present across psychiatric populations, with the most consistent alterations observed in psychotic disorders. Larger studies with standardized methodologies and longitudinal assessments are needed to establish the potential of these oscillations as neurophysiological biomarkers and/or treatment targets.