Current Psychiatry Reports最新文献

Purpose of review: We review the literature on mHealth applications for childhood anxiety disorders, highlighting current use, limitations, and future directions.

Recent findings: Although mHealth apps targeting childhood anxiety disorders have recently increased, most have not been evaluated for clinical effectiveness, data security, or quality standards. Many apps do not contain scientifically based content and do not adequately incorporate the principles of exposure-based cognitive behavioral therapy. In addition, many apps have significant deficiencies in age-appropriateness, data security, privacy, cultural sensitivity, and accessibility. Limitations remain in terms of the standards for evaluating apps in pediatric populations. While interest in mHealth applications for childhood anxiety disorders is increasing, more research is needed to develop effective, safe, and age-appropriate digital interventions. Priorities include scientific grounding, privacy, equitable access, gamification, and parental involvement. Studies in this direction will increase the quality of applications and strengthen equality in access to mental health services.

Purpose of review: Evidence suggests that mindfulness training (MT) may protect and strengthen military service members' attentional control functions, improving their performance and holistic fitness as they face the modern-day battlefield. Yet, implementation challenges must be addressed to realize MT's benefits consistently and at scale.

Recent findings: Despite heterogeneity in MT program content, evaluation metrics, and participants' military career stages across studies, recent findings suggest that MT may bolster performance, cognitive functions, psychological well-being, and social relationships. Additionally, implementation factors such as daily practice, trainers' familiarity with the military, and course content influence the extent of benefits. Attentional control is critical for effective performance, yet vulnerable to compromise in high-demand cohorts, such as military service members. MT not only targets and strengthens military service members' attentional control but also enhances other aspects of their functioning. Despite recognized hurdles, best practice guidance is emerging and continued research and efforts to implement MT in military settings are warranted.

Purpose of review: Hybrid work is common in mental health care following the COVID-19 pandemic. Although widespread, little is known about how to optimize it. We review relevant literature for patients, employees and mental health systems, and offer guidance on navigating tradeoffs in the application of hybrid work.

Recent findings: Patients often prefer telehealth visits due to convenience, but in-person visits are sometimes clinically indicated or preferred. The mental health workforce appreciates reduced commutes and flexibility, though may risk increased isolation and work fatigue. Mental health systems may realize cost savings, although these may create challenges for accommodating patient in-person needs or employee preferences. Hybrid work in mental health care presents a promising path forward but requires thoughtful tradeoff management. It is unlikely that all benefits of hybrid work can be realized at once. Settings may benefit from identifying top priorities and designing hybrid work arrangements accordingly.

Purpose of review: This review critically examines the clinical utility, efficacy, and tolerability of fluphenazine long-acting injectable (LAI) relative to contemporary alternatives. It further evaluates whether fluphenazine LAI confers substantive advantages over other available formulations for the management of schizophrenia, particularly in light of its long-standing use.

Recent findings: The extant literature demonstrates that the tolerability and side effect profile of fluphenazine LAI are comparable to other FGA LAIs but likely less favorable than available second-generation antipsychotic (SGA) LAIs. Although fluphenazine trends towards the higher end of the efficacy scale in meta-analyses, there is a lack of robust evidence showing a true statistical superiority for relapse prevention in schizophrenia. Social determinants of health (SDoH), such as race and economic factors, significantly influence its prescribing patterns. Fluphenazine LAI continues to be utilized primarily due to its low cost and widespread clinical familiarity rather than evidence-based superiority in efficacy or tolerability. Its prescribing is disproportionately influenced by healthcare inequities and resource limitations. Clinicians should employ a rigorous, individualized approach to antipsychotic selection, incorporating shared decision-making and patient education to ensure optimal therapeutic outcomes.

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: There is limited information available regarding delirium that may occur during the course of electroconvulsive therapy (ECT) in pediatric patients (< 18 years). The aim of this paper is to describe ECT-associated delirium, suspected risk factors, and screening tools that may help in its identification and management. We present a case involving a 15 y.o. African American male who developed ECT-associated delirium during the treatment of catatonia.

Recent findings: Three subtypes of delirium associated with ECT have been described. First, postictal delirium which occurs immediately following ECT and may last up to 1 h; second, post ECT or agitated delirium occurring upon emergence from anesthesia, and interictal delirium which is a prolonged period of disorientation following ECT or it may appear de novo separately from the postictal disorientation period. ECT-associated delirium as a side effect of ECT has been described exclusively in adults. Limited evidence in published literature suggests that predisposing factors may include catatonia, developmental disorders, cerebral vascular disease, parkinson's disease, dementia, bi-temporal electrode placement, high stimulus intensity, and/or prolonged seizures. Patients receiving ECT should be routinely screened for delirium, and if present, for worsening of catatonia with/without NMS throughout their treatment. Patients who develop delirium during ECT should be evaluated for potential underlying etiologies including contributing pharmacological strategies. Clear and consistent definitions of ECT-associated delirium are necessary to improve outcomes.

Purpose of review: The pain-suicide relationship is one of the most debated in recent literature, but theories and clinical evidence have often reached contrasting conclusions. Through a critical overview of theoretical, meta-analytical and empirical contributions, we aimed at advancing the conversation on the pain-suicide relationship by integrating research on related concepts, specifically inflammation and dissociation, and their effects on interoceptive processes and pain perception.

Recent findings: Ideation-to-action theories consider increased pain tolerance a key risk factor for the transition from suicidal ideation to attempt. However, several meta-analytical findings suggest that suicidal thoughts and behaviors are associated with inflammation-induced pain sensitization. On the one hand, inflammation contributes to the development and maintenance of chronic pain conditions and mood disorders, and is associated with interoceptive hypervigilance and pain hypersensitivity. Moreover, a trait of increased pain tolerance does not seem to distinguish the individuals attempting suicide among those living with suicidal thoughts. On the other, temporary hypoalgesia is often activated by dissociative experiences. Highly dissociative individuals can indeed be exposed to frequent disintegration of interoceptive processes and transitory hyposensitivity to pain. In light of this, two different patterns of responses to stress (i.e. inflammation vs. dissociation) may characterize different kinds of patients at risk of suicide, associated with specific patterns of interoceptive functioning, pain sensitivity and possibly suicidal ideation. This proposition is partially supported by neuroimaging studies on post-traumatic stress disorder and psychodynamic perspectives on neurodevelopment, as well as alternative clustering models of suicidal behavior. Theoretical, meta-analytical and neurobiological evidence highlight two opposite directions in the pain-suicide relationship: hyper- vs. hyposensitivity. Such contrasts may be explained by the existence of two tendencies in stress-response, namely inflammation and dissociation, defining two different subtypes of patients at risk of suicide. We thus propose the existence of a hypersensitive subtype, defined by underlying neuroinflammatory processes, increased vulnerability to chronic pain and mood disorders, interoceptive hypervigilance, pain hypersensitivity and potentially more persistent suicidal ideation. We further hypothesize a dissociative subtype, characterized by greater trait dissociation, vulnerability to depersonalization and derealization, frequent disintegration of interoceptive processes, transient pain hyposensitivity and abrupt peaks in suicidal ideation.

Bipolar Disorder (BD) is a chronic mental health condition characterized by significant mood swings, including periods of mania or hypomania and depression. Affecting approximately 1-2% of the global population, BD is associated with impaired social functioning, decreased quality of life, and an increased risk of suicide. The disorder presents a substantial burden on healthcare systems and imposes significant economic costs due to lost productivity and the need for extensive treatment and support services. This comprehensive review synthesizes global trends in BD pharmacotherapy over the past 1 to 3 years, focusing on emerging medications, novel treatment protocols, and ongoing debates within the field. Additionally, the review explores differences in prescribing patterns across developed and developing countries, introduces the impact of pharmacogenomics and personalized medicine on treatment outcomes. PURPOSE OF REVIEW: The primary purpose of this review is to provide a comprehensive and up-to-date synthesis of the global trends in the use of medications for the treatment of BD over the past 1 to 3 years. This review aims to outline the latest studies, clinical trials, and meta-analyses relevant to BD pharmacotherapy, highlighting new discoveries and advancements. Furthermore, this review will address ongoing debates and controversies in the field, such as the role of antidepressants in BD treatment and the long-term use of antipsychotics, aiming to bridge knowledge gaps and guide future research directions. RECENT FINDINGS: Studies continue to reinforce the efficacy of lithium in mood stabilization and reduction of suicidal behavior, despite its declining use due to safety concerns. Mood stabilizing anticonvulsants like valproate and carbamazepine continue to be vital alternatives, each with distinct side effect profiles necessitating careful patient monitoring. The approval and increasing use of novel atypical antipsychotics, such as lurasidone (2013) and cariprazine (2015), has expanded treatment options, offering efficacy in different phases of BD with relatively favorable side effect profiles. Antidepressants remain contentious, with evidence suggesting their benefits primarily when used in combination with mood stabilizers. Emerging agents like lumateperone (Dec 2021) and esketamine show promise, while pharmacogenomic research is paving the way for more personalized treatments. The landscape of BD pharmacotherapy is marked by significant advancements and ongoing challenges. Lithium and mood stabilizing anticonvulsants remain foundational treatments, albeit with adherence challenges and side effect concerns. The advent of new atypical antipsychotics and novel agents offers promising therapeutic options, while antidepressants continue to be debated. Personalized medicine and pharmacogenomics could emerge as transformative approaches, allowing for more tailored and effective treatments. However, disparities in medication accessibility

Purpose of review: This review of the recent literature highlights the need to better define the role of faculty in supporting student mental health in higher education institutions in the United States.

Recent findings: The last several decades, and especially since the COVID-19 pandemic, has seen an emphasis on college student mental health. While students are seeking knowledge, connectedness, and career options, faculty are focused on teaching, mentorship but also on how to best support student mental health. With this rise of concentration on mental health in higher education, a major question has arisen-what is the role of faculty in supporting student mental health? The literature is vast in terms of college student mental health and students' stressors and concerns. More and more literature is available regarding interventions used to identify, manage and treat students, and even studies on staff and faculty and their own mental health. Much of the data from faculty has recently been about burnout and their own mental health. There is, however, much less research and literature on either guidelines or guideposts regarding the specific roles that faculty have towards supporting student mental health. This brief paper highlights the potential opportunities and barriers and suggests model strategies for higher education leaders, administrators and faculty to better define the faculty role in supporting student mental health.