Current Psychiatry Reports最新文献

Purpose of review: Medicine and specifically mental health have been affected by emerging technologies advancing mental health treatment while at the same time bringing new challenges and stressors to the battlefield, military systems, and the warfighter.

Recent findings: This article reviews the evolving positive and negative impacts of technology on combat mental health and treatment. A history of technology and military mental health concerns and services is followed by an overview of present benefits and risks. The conflict in Ukraine, the Russo-Ukraine War, is used to illustrate the current state-of-affairs with examples of the use, deployment, and consequence of technology on battlefield mental health. Models need to be developed that assess specific battlefield environments and then selected and appropriately paired with available resources, technology, infrastructure, and workforce for mental health services at the individual and systems level, while understanding the impact of the changing battlefield ton mental health.

Purpose of review: The goals of this analysis were to identify practice elements frequently used in child mass trauma interventions and to determine if these elements differed across interventions with respect to type of event addressed.

Recent findings: The most frequent elements used were psychoeducation for the child, affect modulation, relaxation, cognitive techniques, exposure, support networking, and narrative. The most frequently used elements were similar for political violence and natural disaster interventions but differed for COVID-19 interventions. Similarities in elements used in political violence and natural disaster interventions reflect the all-hazards approach to mass trauma response. Differences for COVID-19 interventions may address distinctions between the pandemic and these events and underscore the importance of considering an expanded set of elements in future research. The findings suggest that characteristics of the event as well as the population receiving the intervention and the context should guide the selection of interventions and intervention elements.

Purpose of review: Neurotheology is a nascent field of research and scholarship that seeks to understand the relationship between the brain and religious and spiritual phenomena. In the context of integrative psychiatry, neurotheology offers an intriguing intermediary between understanding how spirituality and religion affect brain function, and how this might be related to changes in mental health.

Recent findings: A number of research studies over the years have observed that religious and spiritual beliefs, practices, and experiences can have a profound impact on a person's psyche. Many times, the effects are positive leading to lower depression, anxiety and distress. However, there are times that religion and spirituality can lead to negative beliefs and behaviors. Neurotheology seeks to understand both the positive and negative effects of religion and spirituality on mental health from a brain perspective. In addition, neurotheology offers important philosophical insights into the nature of the human mind and how we perceive the reality around us. This review evaluates these many topics as it considers how neurotheology can have practical applications with regard to integrative psychiatry.

Purpose of review: This review critically evaluates literature on war-induced anxiety, highlighting findings from 2021 to 2024, especially during the Russia-Ukraine war.

Recent findings: Measures and prevalence estimates of anxiety and fear are updated. Populations affected by armed conflicts include residents of conflict zones and neighboring countries, internally displaced persons, refugees, combatants, and healthcare and humanitarian aid workers. Socioeconomic factors predict anxiety incidence and individuals differ in coping strategies. Anxiety could have long-term adverse effects over the life-course and across generations. Community and online interventions may reduce anxiety. The review underscores research directions in war-related anxiety's definition and assessment, risk and protective factors, health and societal consequences, and prevention and treatment approaches. The review provides an update for mental health researchers and practitioners working with the victims of war and other crises, often compounded by additional layers of stress of social inequalities, political divisions, and ethnic and racial tensions.

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: Recent scholarship has advocated the need for more detailed analysis of key components within sexual offender treatment programs that contribute to successful outcomes; and importantly to delineate 'what works best, for whom.' The present review interrogates recent scholarship on treatment duration and dosage, program composition and sequencing, to advance critical discussion on 'for whom' treatment works best.

Recent findings: Although we now know more about what key program components are associated with better outcomes overall, observed differences at an individual level reemphasize the importance of attending to specific responsivity factors in treatment. Elevating the specific responsivity principle demands more tailored methods to program design and implementation. However, implementing nuanced programming within 'real-world' correctional settings poses significant challenges. Therefore, we call to action the adoption of an implementation science lens in future research, to optimize translation of research knowledge on 'what works, and for whom' into practice.

Purpose of the review: The purpose of this review is to report on prevalence of co-occurrence, possible etiologic mechanisms, and course and treatment implications of each of these challenging clinical disorders (Autism Spectrum Disorder, Eating Disorders, Posttraumatic Stress Disorder) comorbid with Personality Disorders.

Recent findings: These comorbidities often increase the symptom severity, worsen the course and outcome, and increase the risk of self-harm and suicidal behavior. For EDs and PTSD, existing therapies may prove somewhat helpful but novel approaches are needed and under investigation in the context of comorbid PDs and ASD, EDs and PTSD to address common underlying diatheses. Treatments for these comorbid disorders need to incorporate interventions addressing suicide risk, emotion dysregulation, be trauma-informed and attend to patient engagement. Future research should prioritize studying the course and outcome of ASD comorbid with PDs, novel therapies for EDs comorbid with PDs; refining the concept of Complex PTSD and commencing study of SSD comorbid with PDs.

PURPOSE OF REVIEW: Patients with Serious Mental Illness (SMI) are reported to be at higher risk for somatic disorders (e.g. cardiovascular and metabolic diseases) and higher mortality, compared to the general population, because of the consequences of SMI including psychotropic medication side effects, sedentary and unhealthy lifestyle, difficult access to physical health care. The aim of this review was to examine the current evidence regarding oncology, focusing on the problem of cancer among patients with SMI. RECENT FINDINGS: Compared to the general population, individuals with SMI showed a lower rate of screening for cancer, suboptimal standard cancer treatment, delayed treatment, and higher mortality from cancer. Several factors, including those related to the patient, the health-care system, and the social context, are involved in these negative outcomes. It is therefore necessary to raise awareness and alert clinicians in oncology settings to the challenging problem of cancer among patients with SMI, a marginalized and vulnerable segment of the population that can be at risk for not receiving proper cancer prevention and care. Evidence supports the mandatory need for an interdisciplinary approach involving psychiatry and mental health services.

Purpose of review: Conflict-related sexual violence (CRSV) is a frequent but not ubiquitous part of warfare, affecting not only survivors but also their families and wider communities. This thematic review describes advances in research on CRSV, reviews new developments in the literature, and proposes recommendations for future study.

Recent findings: An increasing number of studies consider how to address methodological and ethical research challenges, how understudied victim/survivor groups as well as families and communities are affected by CRSV, how survivor-centered justice mechanisms can be developed to reduce impunity, and how CRSV is perceived by different actors. Research is expanding to deepen and nuance knowledge on CRSV, particularly on CRSV by rebel groups and the experiences of diverse victims. The research community is also growing more diverse. Remaining challenges exist, in particular regarding data and measurement, justice and accountability, and violations by state-affiliated actors.

Purpose of review: This systematic review explores the relationship between personality disorders (PDs) and lethal suicide behavior. Following PRISMA guidelines, the study examines psychological autopsy studies with suicide deaths and identified PDs. Inclusion criteria encompass studies using the psychological autopsy method, reporting PD diagnosis and suicide deaths, in English language and with no temporal restrictions. The search strategy, conducted in PubMed and Embase until December 2nd, 2023, utilized specific terms related to suicide, PD, and psychological autopsy. Quality assessment using the Newcastle Ottawa-Scale for case-control studies was employed.

Recent findings: 56 psychological autopsy studies were included in the systematic review, revealing a prevalence of PDs among suicide deaths, and emphasizing their role as significant suicide risk factors. The review underscores the impact of comorbid PDs and Axis I disorders on suicide risk, particularly if additional stressors are present. Gender differences in PD prevalence are noted, with impulsivity and alcohol abuse identified as universal risk factors. Despite extensive global data collection, limitations include potential methodological variations and biases inherent in psychological autopsy studies. This study, registered in PROSPERO (CRD42022322359), contributes essential insights into the prevalence, characteristics, and risk factors of PDs among suicide deaths.