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A Collaborative Endeavor.
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-29 DOI: 10.4088/JCP.24ed15761
Marlene P Freeman
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引用次数: 0
Relationship Between Trauma, PTSD, and Schizophrenia: Relevance for Outcomes, Screening, and Interventions.
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-29 DOI: 10.4088/JCP.24ac15773
Julieta Ramirez, Christoph U Correll
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引用次数: 0
Esketamine Nasal Spray vs Quetiapine Extended-Release: Examining Work Productivity Loss and Related Costs in Patients With Treatment-Resistant Depression.
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-27 DOI: 10.4088/JCP.24m15425
Kristin Clemens, Amanda Teeple, Maryia Zhdanava, Aditi Shah, Kruti Joshi, Jozefien Buyze, Dominic Pilon, Hannah E Bowrey, Yordan Godinov

Objective: This post hoc analysis of the ESCAPE-TRD trial compared work productivity loss (WPL) and related costs among patients with treatment-resistant depression (TRD) receiving esketamine nasal spray or quetiapine extended release in combination with an oral antidepressant.

Methods: Adults with TRD randomized to receive esketamine (56/84 mg) or quetiapine (150-300 mg) combined with ongoing antidepressant therapy were included. WPL was assessed using the Work Productivity and Activity Impairment questionnaire. Least squares (LS) mean WPL change versus baseline (treatment initiation date), and LS mean differences (MDs) between esketamine and quetiapine cohorts were reported at weeks 8-32 of treatment using mixed models for repeated measurements. Per patient productivity cost savings were estimated using mean 2021 weekly wages from US Bureau of Labor Statistics.

Results: The esketamine cohort included 165 patients, and quetiapine cohort included 156 patients. At baseline, total WPL was 77.0% and 72.5% in the esketamine and quetiapine cohorts, respectively. By week 8, total WPL decreased from baseline by 30.3 and 17.3 percentage points (pp) in the esketamine and quetiapine cohorts (MD = 13.0 pp; 95% confidence interval [CI], 6.3-19.8 pp), resulting in weekly cost savings of $363 and $207 (MD = $156; 95% CI, $76-$237), respectively. By week 32, total WPL decreased from baseline by 45.3 pp and 32.5 pp in the esketamine and quetiapine cohorts (MD = 12.7 pp; 95% CI, 4.7-20.7 pp), with weekly cost savings of $543 and $390 (MD = $153; 95% CI, $57-$250), respectively.

Conclusion: Among employed adults with TRD, esketamine treatment was associated with significantly larger improvements in WPL and related costs compared to quetiapine, suggesting greater benefits from patient well-being and employer perspectives.

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引用次数: 0
Ketamine vs Electroconvulsive Therapy in the Management of Treatment-Resistant Depression: Do We Need More Data?
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-27 DOI: 10.4088/JCP.24br15655
Taeho Greg Rhee, Sung Ryul Shim, Pasha A Davoudian, Randall T Espinoza, Roger S McIntyre
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引用次数: 0
Psychological Challenges of Adults With Severe Mental Illness During the COVID-19 Pandemic. COVID-19大流行期间严重精神疾病成年人的心理挑战
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-22 DOI: 10.4088/JCP.24m15448
Kadiatou Diallo-Montford, Jessica S Schwind, Stacy W Smallwood, Amenah Qotineh, Kelly L Sullivan

Background: The COVID-19 pandemic was an unprecedented global health crisis. Vulnerable populations with preexisting mental illness have been disproportionately burdened and may experience adverse mental health outcomes related to the COVID-19 pandemic.

Objectives: Our objective was to evaluate the association between COVID-19 diagnosis, known exposure to COVID-19, sheltering in place, symptom severity, psychological distress, and depression severity among adults with severe mental illness (SMI).

Methods: In a cross-sectional study, participants were recruited among patients with SMI who visited an urban community health center in Georgia between February 1, 2019, and March 11, 2021. Measures included COVID-19 impacts on the symptoms of schizophrenia and other psychotic disorders, and severe mood disorders with psychotic features, depression symptoms, self-reported psychological distress, and social connectedness.

Results: Adults diagnosed with COVID-19 experienced more severe psychological distress (odds ratio [OR] = 2.48, 95% CI, 1.02-6.28) compared to those not diagnosed with COVID-19. After adjusting for sex and age, adults with SMI who sheltered in place during the lockdown experienced higher psychological distress than those who did not (adjusted odds ratio [aOR] = 2.52, 95% CI, 1.02-6.48). Women experienced significantly higher SMI severity (Brief Psychiatric Rating Scale scores [.

± SD] for women =56.7 ±24.4 vs men = 48.5± 19.1; [P= .039]) and higher odds of depression (OR = 2.74, 95% CI, 1.22-6.13) during the pandemic than men. Furthermore, adults with SMI with high social support experienced higher psychological distress than those with low social support (aOR = 4.60, 95% CI, 1.82-11.8).

Conclusions: The findings of this study emphasized the need to incorporate infectious disease responses with mental health interventions during a public health crisis.

背景:2019冠状病毒病大流行是一场前所未有的全球卫生危机。先前存在精神疾病的弱势群体承受了不成比例的负担,并可能经历与COVID-19大流行相关的不良心理健康结果。目的:我们的目的是评估患有严重精神疾病(SMI)的成年人中COVID-19诊断、已知的COVID-19暴露、适当的庇护、症状严重程度、心理困扰和抑郁严重程度之间的关系。方法:在一项横断面研究中,参与者从2019年2月1日至2021年3月11日期间访问佐治亚州城市社区卫生中心的重度精神障碍患者中招募。测量包括COVID-19对精神分裂症和其他精神障碍症状的影响,以及具有精神病特征、抑郁症状、自我报告的心理困扰和社会联系的严重情绪障碍。结果:与未诊断为COVID-19的成年人相比,被诊断为COVID-19的成年人经历了更严重的心理困扰(优势比[OR] = 2.48, 95% CI, 1.02-6.28)。在对性别和年龄进行调整后,在封锁期间庇护的重度精神障碍成年人比没有庇护的人经历了更高的心理困扰(调整优势比[aOR] = 2.52, 95% CI, 1.02-6.48)。女性的重度精神分裂症严重程度明显更高(简短精神病学评定量表得分[x’;女性=56.7±24.4,男性= 48.5±19.1;[P= .039]),在大流行期间抑郁的几率高于男性(OR = 2.74, 95% CI, 1.22-6.13)。此外,高社会支持的重度精神障碍成人比低社会支持的重度精神障碍成人有更高的心理困扰(aOR = 4.60, 95% CI, 1.82-11.8)。结论:本研究的结果强调了在公共卫生危机期间将传染病应对与心理健康干预相结合的必要性。
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引用次数: 0
Suicides by Sodium Nitrite Reported to America's Poison Centers: 2020-2023. 向美国中毒中心报告的亚硝酸钠自杀:2020-2023。
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-22 DOI: 10.4088/JCP.24br15678
Anita Mudan, Jacob A Lebin
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引用次数: 0
Efficacy and Safety of Sulforaphane Added to Antipsychotics for the Treatment of Negative Symptoms of Schizophrenia: A Randomized Controlled Trial. 抗精神病药物中添加萝卜硫素治疗精神分裂症阴性症状的有效性和安全性:一项随机对照试验
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-20 DOI: 10.4088/JCP.24m15272
Jing Huang, AnMei Chen, Hua Jin, Fangkun Liu, Gangrui Hei, Ziwei Teng, Jingmei Xiao, Renrong Wu, Jingping Zhao, John M Davis, Ping Shao, Robert C Smith

Objective: There are few established treatments for negative symptoms in schizophrenia, which persist in many patients after positive symptoms are reduced. Oxidative stress, inflammation, and epigenetic modifications involving histone deacetylase (HDAC) have been implicated in the pathophysiology of schizophrenia. Sulforaphane has antioxidant properties and is an HDAC inhibitor. We conducted a 24-week, double-blind, placebo-controlled study, in Hunan, China, to assess the effect of high-dose sulforaphane (Nutramax extra strength sulforaphane tablets glucoraphanin content 30 mg/ tablet) on reducing negative symptoms in antipsychotic-treated patients with schizophrenia.

Methods: Participants were recruited from August 2020 to August 2022 and met DSM-5 criteria for schizophrenia. Participants were randomly assigned (2:1) to receive antipsychotics plus sulforaphane (1,700 mg Avmacol Extra Strength sulforaphane daily) or antipsychotics plus placebo for 24 weeks. Fifty-three patients treated with sulforaphane and 24 patients treated with placebo who had at least 1 postintervention clinical scale evaluation were analyzed. The primary outcome measure was change in the Positive and Negative Syndrome Scale (PANSS) negative symptoms.

Results: Sulforaphane-treated patients showed a significantly greater decrease in PANSS negative symptom total score (P = .01) and PANSS negative factor score (P = .02) than placebo-treated patients, with the most prominent difference occurring at 24 weeks (P ≤ .001) with a large effect size at this time point (d = 0.8). Sulforaphane's effect on decreasing negative symptoms was not mediated by changes in scores of depression or cognitive factors on the PANSS.

Conclusions: The results of this study suggest that add-on high-dose sulforaphane may reduce negative symptoms in patients with schizophrenia. The clinical significance of this reduction in negative symptoms needs further evaluation.

Trial Registration: ClinicalTrials.gov identifier: NCT04521868.

目的:精神分裂症阴性症状的治疗方法很少,许多患者在阳性症状减轻后仍存在阴性症状。氧化应激、炎症和涉及组蛋白去乙酰化酶(HDAC)的表观遗传修饰与精神分裂症的病理生理有关。萝卜硫素具有抗氧化性能,是一种HDAC抑制剂。我们在中国湖南进行了一项为期24周的双盲安慰剂对照研究,以评估高剂量萝卜硫素(Nutramax特强型萝卜硫素片,萝卜硫素含量30mg /片)对减轻抗精神病治疗的精神分裂症患者阴性症状的影响。方法:参与者于2020年8月至2022年8月招募,符合DSM-5精神分裂症标准。参与者被随机分配(2:1)接受抗精神病药物加萝卜硫素(每天1700mg Avmacol特强型萝卜硫素)或抗精神病药物加安慰剂,持续24周。对53例萝卜硫素组患者和24例安慰剂组患者进行干预后至少1次临床量表评估。主要结局指标为阳性和阴性症状量表(PANSS)阴性症状的改变。结果:萝卜硫素组患者的PANSS阴性症状总分(P = 0.01)和PANSS阴性因子评分(P = 0.02)均显著低于安慰剂组,且差异在24周时最为显著(P≤0.001),且该时点效应量较大(d = 0.8)。萝卜硫素对减少阴性症状的作用不受PANSS中抑郁评分或认知因素变化的影响。结论:本研究结果提示,添加高剂量萝卜硫素可减轻精神分裂症患者的阴性症状。阴性症状减少的临床意义有待进一步评估。试验注册:ClinicalTrials.gov标识符:NCT04521868。
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引用次数: 0
Efficacy and Safety of BI 1358894 in Patients With Borderline Personality Disorder: Results of a Phase 2 Randomized, Placebo-Controlled, Parallel Group Dose-Ranging Trial.
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-13 DOI: 10.4088/JCP.24m15523
Jennifer B Dwyer, Christian Schmahl, Manabu Makinodan, Sarah K Fineberg, Stephanie Sommer, Jan Wruck, Ante Jelaska, Abidemi Adeniji, Marianne Goodman

Objective: To provide proof-of-concept (PoC), dose-range finding, and safety data for BI 1358894, a TRPC4/5 ion channel inhibitor, in patients with borderline personality disorder (BPD).

Methods: This was a phase 2, multinational, randomized, double-blind, placebo controlled trial. Patients were randomized to oral placebo or BI 1358894 (5 mg, 25 mg, 75 mg, or 125 mg) once daily in a 2.5:1:1:1:2 ratio for 12 weeks. The primary end point was change from baseline in the Zanarini Rating Scale for BPD (ZAN BPD) total score at Week 10. Secondary end points included ≥30% ZAN-BPD reduction response from baseline at Week 10, change from baseline at Week 10 in the Difficulties in Emotion Regulation Scale-16 item total, State-Trait Anxiety Inventory-State Anxiety total, Patient Health Questionnaire-9 total, Clinical Global Impressions-Severity, and Patient Global Impression-Severity scores.

Results: Of 655 enrolled patients, 390 were randomized and 323 (82.8%) completed the trial. For primary and secondary end points, no differences were observed between treatment and placebo; therefore, PoC was not established. The proportion of patients with adverse events (AEs, BI 1358894 overall vs placebo: 77.9% vs 75.0%) and serious AEs (SAEs; 10.3% vs 8.6%) was comparable between treatments. The proportion of patients with an SAE of suicidal ideation was 4.2% (BI 1358894 overall) and 6.3% (placebo).

Conclusions: Although the primary end point was not met, BI 1358894 was well tolerated with no increase in self harm or suicidality. More targeted populations, alternative outcome assessments, and additional measures to minimize placebo effects should be considered for future trials.

Trial Registration: ClinicalTrials.gov identifier: NCT04566601.

{"title":"Efficacy and Safety of BI 1358894 in Patients With Borderline Personality Disorder: Results of a Phase 2 Randomized, Placebo-Controlled, Parallel Group Dose-Ranging Trial.","authors":"Jennifer B Dwyer, Christian Schmahl, Manabu Makinodan, Sarah K Fineberg, Stephanie Sommer, Jan Wruck, Ante Jelaska, Abidemi Adeniji, Marianne Goodman","doi":"10.4088/JCP.24m15523","DOIUrl":"https://doi.org/10.4088/JCP.24m15523","url":null,"abstract":"<p><p><b>Objective:</b> To provide proof-of-concept (PoC), dose-range finding, and safety data for BI 1358894, a TRPC4/5 ion channel inhibitor, in patients with borderline personality disorder (BPD).</p><p><p><b>Methods:</b> This was a phase 2, multinational, randomized, double-blind, placebo controlled trial. Patients were randomized to oral placebo or BI 1358894 (5 mg, 25 mg, 75 mg, or 125 mg) once daily in a 2.5:1:1:1:2 ratio for 12 weeks. The primary end point was change from baseline in the Zanarini Rating Scale for BPD (ZAN BPD) total score at Week 10. Secondary end points included ≥30% ZAN-BPD reduction response from baseline at Week 10, change from baseline at Week 10 in the Difficulties in Emotion Regulation Scale-16 item total, State-Trait Anxiety Inventory-State Anxiety total, Patient Health Questionnaire-9 total, Clinical Global Impressions-Severity, and Patient Global Impression-Severity scores.</p><p><p><b>Results:</b> Of 655 enrolled patients, 390 were randomized and 323 (82.8%) completed the trial. For primary and secondary end points, no differences were observed between treatment and placebo; therefore, PoC was not established. The proportion of patients with adverse events (AEs, BI 1358894 overall vs placebo: 77.9% vs 75.0%) and serious AEs (SAEs; 10.3% vs 8.6%) was comparable between treatments. The proportion of patients with an SAE of suicidal ideation was 4.2% (BI 1358894 overall) and 6.3% (placebo).</p><p><p><b>Conclusions:</b> Although the primary end point was not met, BI 1358894 was well tolerated with no increase in self harm or suicidality. More targeted populations, alternative outcome assessments, and additional measures to minimize placebo effects should be considered for future trials.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT04566601.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Synopsis of the 2023 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline for the Management of Bipolar Disorder. 2023年美国退伍军人事务部和美国国防部双相情感障碍管理临床实践指南摘要。
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-13 DOI: 10.4088/JCP.24cs15546
Michael J Ostacher, Christopher J Miller, Amanda Edwards-Stewart, Paulette T Cazares, Richard R Owen, Matthew A Fuller, David Osser, Thad E Abrams, Jed P Mangal, Ira Katz, Jennifer M Ballard-Hernandez, Sarah D Davis-Arnold, Isabella Alvarez, James L Sall

Objective: The US Department of Veterans Affairs (VA) and Department of Defense (DOD) Work Group revised the 2013 VA/DOD Clinical Practice Guideline (CPG) for the Management of Bipolar Disorder (BD). This paper reviews the 2023 CPG and its development process, including how recommendations were made for evidence-based treatment in BD.

Methods: Subject experts and key stakeholders developed 20 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Recommendations were based on quality and strength of evidence and informed by other factors, including feasibility, patient perspectives, and the unique needs of people with BD. Peer review by an external group of experts then resulted in completion of the CPG.

Recommendations: While the scope of the CPG is broad, this synopsis focuses on clinically relevant recommendations related to the identification and management of BD, including the acute and maintenance phases of illness.

目的:美国退伍军人事务部(VA)和国防部(DOD)工作组修订了2013年VA/DOD双相情感障碍(BD)管理临床实践指南(CPG)。本文回顾了2023年CPG及其发展过程,包括如何为bd的循证治疗提出建议。方法:学科专家和关键利益相关者在使用PICOTS(人群、干预、比较者、结果、结果测量时间和设置)方法进行系统搜索后,制定了20个关键问题并回顾了已发表的文献。然后使用建议分级评估、发展和评价(GRADE)方法对证据进行评估。建议以证据的质量和强度为基础,并考虑其他因素,包括可行性、患者观点和双相障碍患者的独特需求。外部专家组的同行评议最终完成CPG。建议:虽然CPG的范围很广,但本摘要侧重于与BD的识别和管理相关的临床相关建议,包括疾病的急性期和维持期。
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引用次数: 0
Inpatient Treatment of Suicidality: A Systematic Review of Clinical Trials. 自杀的住院治疗:临床试验的系统回顾。
IF 4.5 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-01-08 DOI: 10.4088/JCP.24r15382
Ali Abdolizadeh, Brett D M Jones, Maryam Hosseini Kupaei, Amal Shah, Terri Rodak, Salman Farooqui, Mohammed Omair Husain, Cory R Weissman, Juveria Zaheer, David Gratzer, Daniel M Blumberger, Muhammad Ishrat Husain

Objective: Psychiatric inpatients represent an acutely vulnerable population with high rates of suicidality (ie, suicidal ideation, attempts, and completed suicide). This systematic review aimed to evaluate treatments for suicidality delivered within inpatient settings.

Data Sources: MEDLINE, Embase, APA PsycInfo, CINAHL, and The Cochrane Library were systematically searched using 3 concepts: suicidality, inpatient population/setting, and treatment/ interventions. Searches were limited to years 2001-2024, with no language restrictions.

Study Selection: Of 19,921 articles identified, 11,519 were screened, and 179 underwent full-text review. We included clinical trials on pharmacologic and nonpharmacologic interventions for suicidality in psychiatric inpatients aged 18-65 with moderate to high levels of suicidality that measured changes in suicidality.

Data Extraction and Synthesis: Studies were organized into tables by study design, treatments, participants, suicide measure, outcomes, and key findings. Due to heterogeneity, a meta-analysis was not conducted; instead, a narrative synthesis was used for qualitative analysis.

Results: Forty-nine studies were included. Of 14 pharmacologic trials, intravenous ketamine showed most consistent rapid reduction in suicidality. Thirty-five nonpharmacologic trials, covering a broad spectrum of treatments including chronotherapy, neurostimulations, and psychotherapies, were reviewed. The results were mixed, with some interventions showing potential in reducing suicidality, particularly in the mood, personality, and trauma-related disorders. Many studies had methodological concerns including nonrandomized designs, lack of control arms, and retrospective assessments.

Conclusion: A range of interventions for treating suicidality in inpatient settings have been evaluated, with mixed results. The current review underscores the need for larger, well-designed trials to assess the effectiveness of these treatments in inpatient settings.

目的:精神科住院患者是自杀率高的急性脆弱人群(即自杀意念、自杀企图和自杀完成)。本系统综述旨在评估在住院患者环境中提供的自杀治疗。数据来源:MEDLINE, Embase, APA PsycInfo, CINAHL和Cochrane图书馆使用3个概念进行系统检索:自杀,住院患者人数/环境和治疗/干预。搜索仅限于2001年至2024年,没有语言限制。研究选择:在19921篇文章中,筛选了11519篇,其中179篇进行了全文综述。我们纳入了18-65岁中高自杀率精神病住院患者自杀的药物和非药物干预的临床试验,测量了自杀率的变化。数据提取和综合:研究按研究设计、治疗方法、参与者、自杀测量、结果和主要发现整理成表格。由于存在异质性,未进行meta分析;相反,定性分析采用叙事综合法。结果:纳入49项研究。在14项药理学试验中,静脉注射氯胺酮显示出最一致的快速降低自杀率。本文回顾了35项非药物试验,涵盖了广泛的治疗方法,包括时间疗法、神经刺激和心理疗法。结果好坏参半,一些干预措施显示出减少自杀的潜力,特别是在情绪、人格和创伤相关障碍方面。许多研究在方法学上存在问题,包括非随机设计、缺乏对照组和回顾性评估。结论:一系列治疗住院患者自杀的干预措施已被评估,结果好坏参半。目前的综述强调需要更大规模的、设计良好的试验来评估这些治疗在住院环境中的有效性。
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引用次数: 0
期刊
Journal of Clinical Psychiatry
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