Current Psychiatry Reports最新文献

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 aim to update readers on the latest evidence regarding the role of the gut microbiome in generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia, and social anxiety disorder (SAD). This review summarises the literature on microbiome composition and function in these conditions, provides insights about causality and mechanisms and evaluates current evidence for microbiome-based interventions in anxiety disorders.

Recent findings: Most studies exploring the microbiome in anxiety disorders are small, cross-sectional studies. Nevertheless, some consistent findings emerge. Bacterial taxa such as Eubacterium, Coprococcus and Faecalibacterium may be depleted in GAD. Studies in PD and SAD are scarce and, to our knowledge, there have been no studies conducted in agoraphobia. Probiotics may help reduce anxiety symptoms, although the majority of studies have been in non-clinical cohorts. Large, prospective studies are required to further elucidate the role of the microbiome-gut-brain axis in anxiety disorders. Microbiome-based interventions hold promise, but randomised controlled trials in clinical populations with relevant diagnoses are now warranted and urgently required.

Purpose of review: Over 500,000 college students compete in the three divisions of the National Collegiate Athletic Association (NCAA) each year. The rates of most mental health issues among collegiate student-athletes approximate the rates among non-athlete college students. In recent years, greater attention has been given to recognizing and treating the mental health concerns of student-athletes. This paper examines some of the specific mental health considerations that may arise when working with student-athletes.

Recent findings: Using a biopsychosocial-structural framework, we were able to identify several broad categories of factors that influence the mental health of student-athletes. Within those categories we identified specific diagnoses (such as physical injury), life events (such as early retirement from sport), ways of thinking (including stigma against mental health treatment), and external influences (such as racism and sexism) that impact the mental health of student-athletes. Mental health concerns among college students are common. When working with student-athletes, there are biopsychosocial-structural factors that affect the mental health of student-athletes in unique ways compared to their non-athlete college student counterparts.

Purpose of review: We review recent clinical developments in borderline personality disorder and personality disorders more broadly, as well as changes in national psychiatry residency training guidelines in an effort to establish a roadmap for psychiatry residency training directors to create curricula to prepare residents to manage these disorders.

Recent findings: Though no randomized controlled trials exist, small studies demonstrating positive effects of teaching specialized treatment models to residents in programs with resources in these areas. The ACGME's Milestones 2.0 and their relevance for personality disorder curriculum are discussed. Narcissistic Personality Disorder (NPD), its increasing importance in public and clinical consciousness, and recent developments in diagnosis, theory, and manualized treatments are noted, including a recent model of group psychoeducation. The current state of dimensional models for personality including the DSM 5 Section III (the Alternative Model for Personality Disorders) and ICD-11's version introduced in 2022 are reviewed. Given BPD's widespread prevalence, especially in the clinical setting, and the combination of the disorder's complexity, comorbidity, and treatment challenges, we argue that devoting curricular resources to teaching about BPD makes good educational sense. We present a model curriculum based on the generalist approach of Good Psychiatric Management (GPM). This, we argue, can allow programs without specialist faculty to provide "good enough" preparation of residents for treating BPD, while also allowing more resource rich programs to add specialized Evidence Based Treatment (EBT) training for interested residents. We also offer GPM's adapted approach to NPD as the basis for residency curricula for this important disorder. Finally, we propose ways to teach the use of the Alternative Model for Personality Disorders in the classroom setting, and in working with NPD patients.

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.

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: Recent research indicates that Dialectical Behavior Therapy (DBT) is feasible, acceptable, and effective for autistic adults. This review aims to provide conceptual arguments and empirical evidence to support DBT as a relevant therapeutic alternative for autistic individuals experiencing emotion dysregulation (ED).

Recent findings: ED is frequent in autism whereby it is associated with severe mental health challenges. However, appropriate therapeutic options are limited. Currently, DBT has amassed the most evidence for treatment of ED across a range of clinical conditions, although it was originally developed for borderline personality disorder (BPD). In the context of autism, there is evidence supporting the efficacy of DBT for ED, life-threatening behaviors and depression, but adaptations are likely to improve its dissemination and acceptability. While similar biosocial factors seem to be involved in ED in BPD and autism, alexithymia is prominent in autism and autistic features such as sensory sensitivity and social overload also contribute to ED in autistic adults.

Conclusion: Given the significant impact of ED on the well-being of autistic adults, there is an urgent need to enhance our understanding of the mechanisms involved in ED in autism and the adaptations likely to improve the acceptability and dissemination of DBT for autistic people.

Purpose of review: Findings from the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) project, including sociodemographic and clinical information from older age bipolar disorder (OABD) and healthy participants around the globe (approximately N = 5000) were reviewed. Data was collected in multiple waves to create a large integrated dataset.

Recent findings: BD does not seem to fade with age. BD subtype and early/late onset did not show significant differences in daily functioning. Physical comorbidities were more frequent in OABD compared with controls. Women with OABD had an earlier age at onset and more psychiatric hospitalizations. GAGE-BD is the largest OABD cohort. Dataset results offer a unique and comprehensive resource for understanding the long-term trajectory of BD and the specific needs of this population. Findings are vital for guiding future research and improving care strategies for aging individuals with BD.

Purpose of review: This review integrates recent findings from randomized controlled clinical trial (RCT) research examining the impacts of physical exercise activities on various aspects and areas of functioning for autistic individuals.

Recent findings: Recent meta-analytic and clinical trials research indicates physical exercise intervention programs improve social and communication skills for autistic children and adolescents, improve executive functioning skills for autistic children, improve sleep-related behavior for autistic children and adolescents, and may be helpful for improving physical health for autistic children. There is very limited RCT research evidence on exercise intervention approaches or impacts for autistic adults, for autistic girls or women, for autistic people with co-occurring intellectual disability, and for reducing negative emotional symptoms (e.g., anxiety, depression) for any autistic population. The extant clinical trials research provides convincing, consistent evidence for positive impacts of physical exercise programs on multiple areas of functioning for autistic children and adolescents. Additional research is needed to determine and ensure potential impacts of physical exercise activity programs for important autistic sub-populations, including adults.

Purpose of review: This paper explores Predominant Polarity (PP) in Bipolar Disorder (BD), defined as the predominance of either manic or depressive episodes over a patient's course of illness. We examine its clinical relevance, neurobiological foundations, and potential for guiding personalized treatment strategies. The review seeks to determine whether PP is a reliable course specifier and how it can be utilized to improve clinical outcomes.

Recent findings: PP has a significant impact on prognosis and treatment planning in BD. Manic and depressive PP are associated with distinct clinical and neurobiological profiles of BD, while individuals without a clear predominance of either episode type represent a more severe to-treat subgroup of patients. The development of the Polarity Index (PI) facilitates treatment decisions based on PP. PP offers a valuable framework for refining BD treatment and understanding its complexity. Future research should focus on refining PP definitions, validating neurobiological markers, and integrating these insights into comprehensive treatment models to improve patient outcomes.