International Clinical Psychopharmacology最新文献

Transcranial direct current stimulation (tDCS) holds promise as a treatment for obsessive-compulsive disorder (OCD). Patients with OCD show impairment in specific domains of cognitive flexibility and response inhibition. We previously reported that tDCS produced a positive clinical effect on OCD symptoms. Here, we report a secondary analysis of neurocognitive data. In this randomized, double-blind, sham-controlled, crossover, multicenter feasibility study, adults with a diagnosis of OCD according to the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) received three courses of clinic-based tDCS, targeting the left orbitofrontal cortex (L-OFC), bilateral supplementary motor area (SMA), and sham, randomly allocated and delivered in counterbalanced order. Cognitive assessments were conducted before and 2-h after the first stimulation in each arm. Nineteen adults were recruited. tDCS of both the L-OFC and SMA significantly improved cognitive inflexibility, while sham treatment did not (paired-sample t test, baseline vs. 2-h after stimulation). No significant effect of tDCS was found for motor impulsivity (stop-signal reaction time) in any of the three arms. In a small sample of patients with OCD, a single administration of tDCS to the L-OFC and SMA produced a rapid improvement in cognitive inflexibility but not in motor impulsivity. A definitive randomized, controlled trial of tDCS targeting both the OFC and SMA, including cognitive markers, is indicated.

The aim of this study is to evaluate the therapeutic outcomes, tolerability, and adherence to immediate-release (IR) and prolonged-release (PR) lithium formulations in patients with bipolar disorder (BD) over a 2-year follow-up. This naturalistic study included 143 BD patients who initiated IR (48%) or PR (52%) lithium treatment at the inpatient and outpatient services of the University Hospital of Pisa. During follow-up, data were collected on side effects, treatment adherence, blood lithium levels, and creatinine and thyroid stimulating hormone concentrations. Clinical efficacy and functioning were assessed using the Clinical Global Impressions for Bipolar Disorder and Functioning Assessment Short Test scales. Approximately 50% of patients completed the 2-year follow-up, with similar dropout rates between the two groups. Both groups showed significant clinical improvement with comparable efficacy. PR lithium, however, was associated with fewer side effects, particularly tremors and gastrointestinal issues, leading to better adherence. Additionally, PR lithium administration resulted in more stable blood lithium levels. Despite its limitations, including the observational design, potential confounders such as concomitant medications, and a high dropout rate, these findings suggest that PR lithium formulations provide similar clinical efficacy to IR formulations but offer superior tolerability. Therefore, PR lithium represents a favorable option for improving adherence, particularly in patients at risk of treatment discontinuation.

This study aimed to investigate the effects of lumateperone as a combination therapy with sertraline in major depressive disorder (MDD). The 8-week, double-blind, placebo-controlled trial was registered with the Iranian Registry of Clinical Trials (registration date: 2022-03-01, registration number: IRCT20090117001556N141). Patients with MDD were randomized to receive either sertraline (100 mg/day) combined with lumateperone (42 mg/day) or sertraline (100 mg/day) with placebo. The Hamilton Depression Rating Scale (HDRS) was used to assess treatment efficacy. Fifty-eight patients with MDD were analyzed (age: 36.91 ± 9.81 and male: 69.0%). The two groups were comparable across baseline sociodemographic and clinical characteristics except for marital status. There was a significant time × treatment interaction on HDRS ( P  = 0.027), suggesting greater improvement in depressive symptoms following the lumateperone adjuvant therapy. Compared with the placebo group, a significantly larger proportion of individuals receiving lumateperone experienced an HDRS reduction rate greater than or equal to 50% at weeks 4 (90.0 vs. 60.7%, P  = 0.014) and 8 (100 vs. 82.1, P  = 0.021). However, the remission rate was not different. No serious adverse events were reported. This study suggests that lumateperone can be considered an effective and safe adjuvant treatment for MDD. Future larger clinical trials with extended follow-up periods are needed to confirm its efficacy for clinical use.

Major depressive disorder (MDD) is a severe and debilitating illness. Despite the available treatments, clinical outcomes remain suboptimal, and hence, it is crucial to identify predictive factors for response. This is a secondary analysis investigating the relationship between treatment preference and response to treatment in the antidepressant incomplete and non-responders with treatment resistant depression (ASCERTAIN-TRD) trial (NCT02977299) comparing three treatment arms [aripiprazole augmentation, repetitive transcranial magnetic stimulation (rTMS) augmentation, switching to venlafaxine XR or duloxetine] in MDD patients with treatment-resistant depression (TRD) who are currently on ongoing, stable, and adequate antidepressant therapy. Patient treatment preferences were recorded in the study entry. In total, 278 subjects were randomly assigned to one of three treatment groups: aripiprazole (n = 92), rTMS (n = 70), or venlafaxine/duloxetine (n = 98). Of these 278 subjects, 256 (92.1%) had at least one postbaseline Montgomery-Asberg Depression Rating Scale (MADRS) score and a recorded treatment preference and were included in this secondary analysis. In the total population, participants' preferences did not affect their response to treatment, and the change in MADRS score was similar among patients who received their preferred treatment, had no preference, or received treatment against their preference (P = 0.49). These results indicate that patient preference is not a significant factor that predisposes to optimal treatment outcomes.

Despite increasing attention to patient-centered care, the treatment of schizophrenia remains predominantly clinician-driven, with limited integration of patients' subjective needs. This paper critically examines the concept of unmet needs in schizophrenia. While structured tools exist, they are rarely used in routine care, and even less frequently from the patient's perspective. Drawing on international literature and Italian service data, this paper examines the systemic, clinical, and ethical implications of unmet needs, highlighting neglected domains including family support, physical health, and sexual well-being. Comparing mental health systems in Italy, Northern Europe, and the UK reveals systemic differences in the inclusion of patient voice in care planning. Finally, we address the issue of clinician training, proposing a reframing of professional competencies to include active listening, shared decision-making, and coproduction. Integrating patients' voices into need assessment is not optional; it is a prerequisite for meaningful, effective, and equitable care in schizophrenia.