Current Psychiatry Reports最新文献

Purpose of review: Cancer-related lymphedema (CRL) places an already vulnerable patient population at risk for the development and worsening of psychological distress. The purpose of this review is to highlight factors contributing to distress in lymphedema secondary to breast, head and neck, genitourinary cancers, and melanoma and discuss pertinent treatment considerations.

Recent findings: Multiple factors contribute to distress in CRL, including changes in body image, sleep, sexuality, functional capacity, and social interaction. There is limited literature describing psychopharmacological considerations in CRL, though exercise, which may be used for the treatment of depression and anxiety, may also improve CRL. Psychiatrists, oncologists, physiatrists, palliative medicine physicians, and physical and occupational therapists should have an awareness and understanding of CRL. To effectively manage distress in these patients, it is crucial to be mindful of psychotropic side-effect profiles, emphasize non-pharmacologic modalities including psychotherapy and exercise, and ensure patients receive evidence-based treatments for CRL.

Purpose of review: We summarized studies investigating measures related to the Alternative Model for Personality Disorders (AMPD) of the DSM-5 and the personality model in ICD-11 in offenders in forensic-psychiatric treatment or prison to evaluate its forensic utility.

Recent findings: The reformation of the DSM and ICD with regards to the introduction of dimensional assessments of personality disorders holds many advantages over categorical models concerning clinical utility. With regards to DSM-5 AMPD Criterion A, a limited number of studies (k = 4) report impairments in interpersonal functioning in offenders. Studies assessing Criterion B (k = 13) predominantly report higher personality impairment measures for offenders, especially for antagonism and disinhibition. Due to the heterogeneity of the selected studies, this review cannot draw conclusions with regard to the predictive value of dimensional models for offenders in forensic-psychiatric treatment or prison, but provides initial evidence for the validity and utility of DSM-5 AMPD and ICD-11 in these settings.

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.

Purpose of review: Members of a technical panel representing Australia, Canada, New Zealand, the UK, and the US collaborated to develop surveys designed to provide military leaders with information to guide decisions early in the COVID-19 pandemic. The goal of this paper is to provide an overview of this collaboration and a review of findings from the resulting body of work.

Recent findings: While surveys pointed to relatively favorable mental health and perceptions of leadership among military personnel early in the pandemic, these observations did not reflect the experiences of personnel deployed in COVID-19 response operations, nor were these observations reflective of later stages of the pandemic. Establishing and leveraging networks that enable the rapid development of employee surveys and sharing of results can serve as a pathway for empowering military leaders in times of crisis. Organizational support and leadership decisions are especially critical for maintaining well-being among personnel during crises.

Purpose of review: We reviewed recent evidence regarding the impact of climate change (specifically, high ambient temperatures, heatwaves, weather-related disasters, and air pollution) on older adults' mental health. We also summarized evidence regarding other medical problems that can occur in aging adults in connection with climate change, resulting in psychiatric manifestations or influencing psychopharmacological management.

Recent findings: Older adults can experience anxiety, depressive, and/or posttraumatic stress symptoms, as well as sleep disturbances in the aftermath of climate disasters. Cognitive deficits may occur with exposure to air pollutants, heatwaves, or post-disaster. Individuals with major neurocognitive disorders and/or preexisting psychiatric illness have a higher risk of psychiatric hospitalizations after exposure to high temperatures and air pollution. There is a growing body of research regarding psychiatric clinical presentations associated with climate change in older adults. However, there is a paucity of evidence on management strategies. Future research should investigate culturally appropriate, cost-effective psychosocial and pharmacological interventions.

Purpose of review: Antisocial personality disorder (ASPD) is a characterized by lifelong or recurrent behavioral problems that begin in childhood or early adolescence. This communication provides an overview on ASPD including findings from recent reviews and new research.

Recent findings: With regard to DSM-5's Section III Alternative Model of Personality Disorder criteria for ASPD, advocates point to the broader symptom coverage and harmonization with ICD-11; yet critics point to the lack of evidence for improved outcomes. A new report shows that antisocial individuals age faster than non-antisocial peers. ASPD has high heritability and newer molecular studies have found intriguing linkages to genes associated with crucial brain regions. A mentalization-based therapy model has been developed and early work shows promise. ASPD is common, widespread, and disruptive to individuals, families, and society. Chronic and lifelong, ASPD typically lessens in severity with advancing age. Assessment rests on the individual's history because there are no diagnostic tests. ASPD likely results from an interplay of genetic and environmental factors. Brain imaging studies have linked cortical dysfunction to antisocial behavior in crucial brain regions. Medication is sometimes targeted at the individual's aggression and irritability, but a more rational approach is to target co-occurring disorders. Cognitive-behavioral therapy and mentalization-based therapy models have been developed and are being studied.

Purpose of review: We evaluate available evidence for the role of inflammation in depression. We reappraise literature involving systemic inflammation, neuroinflammation and neurotransmission and their association with depression. We review the connection between depression, autoimmunity and infectious diseases. We revise anti-inflammatory treatments used in depression.

Recent findings: Peripheral inflammatory markers are present in a subset of patients with depression and can alter common neurotransmitters in this population but there is no clear causality between depression and systemic inflammation. Infectious conditions and autoimmune illnesses do not have a clear correlation with depression. Certain medications have positive evidence as adjunctive treatments in depression but studies are heterogenic, hence they are sparsely used in clinical settings. The current evidence does not fully support inflammation, infections or autoimmunity as possible etiologies of depression. The available studies have numerous confounders that obscure the findings. Anti-inflammatory agents may have potential for treatment of depression, but further research is needed to clarify their usefulness in routine clinical practice.

Purpose of review: To explore the relationship between early life trauma, hormonal sensitivity, and psychiatric disorders across female-reproductive life events, with a focus on the neurobiological mechanisms.

Recent findings: Childhood trauma significantly increases the risk of subsequent mood disorders during periods of intense hormonal fluctuation such as premenstrual, pregnancy, postpartum, and perimenopause. Neurobiological changes resulting from early trauma influence emotion regulation, which emerges as a key predisposing, exacerbating, and perpetuating factor to hormonal sensitivity and subsequent psychiatric symptoms. We identified altered stress response and allopregnanolone imbalance, bias in cognitive processing of emotions, neuroimage correlates and sleep disturbances as potential underlying neurobiological mechanisms. This review integrates cumulative findings supporting a theoretical framework linking early life trauma to hormonal sensitivity and mood disorders. We propose that some women might be more susceptible to such hormonal fluctuations because of emotion dysregulation following significant early life trauma.

Purpose of Review

We review the published literature on the relationship between race and ethnicity and suicidal thoughts and behaviors among students enrolled at institutions of higher education in the United States.

Recent Findings

College students with certain racial and ethnic identities have a higher prevalence of past-year suicidal ideation (Asian, Black or African American, multiracial, and Native Hawaiian or Other Pacific Islander) and past-year suicide attempts (Asian, Black or African American, multiracial, and Hispanic) than White students. There is a lack of evidence about racial and ethnic differences in suicide deaths.

Summary

More research is needed to understand factors that contribute to the racial and ethnic disparities in suicidal thoughts and behaviors among college students. Identifying modifiable risk factors that may be specific to college students will ultimately reduce suicide deaths and guide the development of more effective suicide prevention programs across diverse racial and ethnic groups of students.

Purpose of Review

This paper summarizes the prevalence, impact, and presentation of ageism across multiple mental health care settings including inpatient, outpatient, long-term care, and criminal justice. Strategies for combating ageism are described.

Recent Findings

Ageism is a common form of bias that has deleterious medical and psychosocial consequences for older adults. Ageism manifests in a variety of ways in mental health settings. Clinical, educational, and public policy strategies are recommended to combat ageism in mental health settings.

Summary

Ageism remains pervasive in society and in mental health care settings. Ageism impacts healthcare trainees, healthcare providers, healthcare systems, and older adults themselves. Age-friendly practices and strategies for combating ageism exist and need broader dissemination.