The primary care companion for CNS disorders最新文献

Importance: Major depressive disorder is a heterogeneous disorder affecting over 280 million people globally. Despite multiple treatment options, individual response to drugs varies significantly, and most patients go through a trial-and-error approach, resulting in multiple drug iterations before alleviation of symptoms is achieved. Treatment optimization is further complicated by lack of full elucidation of the neurobiology of depression. The high prevalence of nonresponse, coupled with the detrimental effects of prolonged disease on patient welfare, economic burden, and increased likelihood of recurrence, substantiates the critical need for robust tools capable of precisely matching patients with their most effective and safe treatment options in a time-sensitive manner.

Observations: Research into technologies that tailor treatments to individual patients based on their unique molecular and cellular characteristics has led to the development of precision medicine tools ranging from pharmacogenetics through peripheral biomarkers and neuroimaging to a platform that uses patient-derived neurons as a substrate for in vitro patient-specific functional readouts.

Conclusions and relevance: Novel precision medicine tools in depression are being introduced that aim to identify the optimal treatment for each patient. Such tools have the potential to significantly improve depression management by guiding treatment selection for prescribers and people with lived experience.

Prim Care Companion CNS Disord 2025;27(5):25nr03970.

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Context: Antipsychotic medications are associated with significant metabolic risks including weight gain, lipid abnormalities, and glucose intolerance. Incretin therapies could have massive potential to benefit patients affected by antipsychotic-induced weight gain. However, patients with psychiatric disorders were often excluded from clinical trials, leaving safety and efficacy in this population largely unexplored.

Evidence Acquisition: A narrative review was conducted to evaluate the data surrounding use of incretin therapies to mitigate metabolic consequences of antipsychotics and to review general safety and efficacy data relevant to prescribing of these agents to be distilled for the psychiatric provider. Package inserts, relevant clinical guidelines, and cardiometabolic outcomes trials were reviewed in developing the prescribing guide.

Results: Limited data suggest that incretin therapies may be effectively utilized in patients with psychiatric conditions. A prescribing guide and algorithm were developed and include information on selecting an agent based on comorbidities, dosing and prescribing, contraindications, and clinical pearls that may be of use to providers who wish to utilize incretin therapies in patients with psychiatric comorbidities.

Conclusion: Incretin therapies are highly effective medications for diabetes and weight management in the general population. While additional monitoring may be warranted in patients with psychiatric conditions, these agents are potentially effective and safe for use in treating obesity or overweight and diabetes in this population.

Prim Care Companion CNS Disord 2025;27(5):25nr03924.

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Objective: To assess depression response and remission rates with electroconvulsive therapy (ECT) in a community clinic and to identify factors predicting success in treatment.

Methods: Thirty-five patients were identified by a retrospective chart review with a diagnosis of major depressive disorder or depressive disorder not otherwise specified (according to the DSM-IV-TR) who were treated with an acute series of ECT at a community ECT clinic from March 1, 2014, to March 9, 2015. Logistic regression examined associations between clinical variables and depression response (defined as ≥50% reduction in score on the Patient Health Questionnaire-9 [PHQ-9]) and remission (final PHQ-9 score <5) rates and anxiety response rates (based on the Generalized Anxiety Disorder 7 item).

Results: Depression response and remission rates were 54.3% and 31.4%, respectively. This was a highly treatment-resistant sample, with an average of 5.3 antidepressant trials prior to initiating ECT. Improvement in anxiety symptoms was associated with depression response (odds ratio: 1.41, 95% CI, 1.11-1.78). Additionally, patients with initial severe anxiety scores were less likely than other patients to exhibit a response in depression (P=.027).

Conclusion: Almost half of this sample of patients with treatment-resistant depression did not respond to ECT in this community-based clinic, highlighting the challenges of treating this condition. Comorbid anxiety symptoms may reduce the likelihood of depression response, as patients with severe anxiety were less likely to respond.

Prim Care Companion CNS Disord 2025;27(4):25m03939.

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The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Prim Care Companion CNS Disord 2025;27(4):25f03975.

Author affiliations are listed at the end of this article.