Journal of Clinical Psychiatry最新文献

Background: Distinguishing between primary and secondary mood disorders (illness-or substance-induced) is important for appropriate treatment, yet their prevalence and outcomes in the general population remain understudied.

Aim: To compare psychiatric and mental health outcomes between primary and secondary mood disorders over a 3-year follow-up.

Methods: We used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of the US adult population (Wave 1, 2001-2002; Wave 2, 2004-2005). Primary and secondary mood disorders were assessed following DSM-IV criteria. Outcomes assessed 3 years later included recurrence and persistence of mood disorders, suicide attempt, mental and physical health-related quality of life, and mental health help-seeking behavior. All analyses were adjusted for a wide range of sociodemographic and clinical characteristics.

Results: Among 3,602 participants with mood disorders during the 12 months before Wave 1, 298 (8.3%) had secondary and 3,304 (91.7%) primary mood diagnoses. Following adjustments, secondary mood disorders were associated with significantly poorer physical health-related quality of life (β=-2.75; 95% CI, -4.27 to -1.23) and lower 3-year recurrence (adjusted odds ratio [AOR]=0.51; 95% CI, 0.36 to 0.72) and persistence rates (AOR=0.49; 95% CI, 0.31 to 0.79) compared to primary mood disorders. Other outcomes showed no significant differences (all P>.05).

Conclusion: Secondary mood disorders were not rare and associated with poorer physical health-related quality of life than primary mood disorders. However, both groups showed similar risks of suicide attempts, impaired mental health-related quality of life, and rates of mental health help-seeking behavior. The findings for adults with secondary mood disorders align with efforts to integrate physical and mental health care.

The US Administration has moved to declare gestational exposure to acetaminophen (paracetamol) a risk factor for autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. This article examines the science on the subject. Studies suggest that about half of women use acetaminophen during pregnancy; nevertheless, there is no epidemic of neurodevelopmental disorders (NDDs) in offspring. Two large population-based studies, one Swedish and the other Japanese, found that maternal use of acetaminophen during pregnancy was associated with an increased risk of ASD, ADHD, and intellectual disability (ID) in children. However, the risks were very small in fully adjusted analyses; hazard ratios (HRs) were mostly in the 1.05-1.07 range. Importantly, maternal use of aspirin, other NSAIDs, opioids, or antimigraine drugs during pregnancy was also associated with an increased risk of ASD and ADHD (but not ID). Most importantly, in sibling analyses, gestational exposure to acetaminophen, aspirin, and other analgesic drug categories was not associated with an increased risk of NDDs. There are many key points. Acetaminophen has a safety profile that is better than that of alternative treatments. The magnitude of increase in absolute risk for NDDs is very small (eg, by 0.09% at age 10, for ASD). There are many unmeasured confounds that, evenif weak, could nullify the relationship between acetaminophen and NDDs. Sibling analyses suggest that shared genetic and shared environment risk factors (rather than acetaminophen exposure) may explain the NDD risk. Analyses of other analgesic drug groups suggest that pain and inflammation, rather than drug exposure, may also explain the NDD risk. Finally, for reasons that are explained, making acetaminophen unavailable during pregnancy does not mean that the NDD risk will reduce. These points need to be discussed with women in a shared decision-making process that is both equitable and free from guilting.

Xanomeline-trospium (XT) is the first muscarinic-based therapy approved for schizophrenia. It combines M1 and M4 receptor agonism with peripheral antagonism to limit cholinergic side effects. By modulating circuits upstream of dopamine release, XT offers a mechanism that differs from traditional antipsychotics and may address positive, negative, and cognitive symptoms. In July 2025, a consensus panel of clinicians with expertise in treating schizophrenia and real-world experience using XT convened to discuss practical strategies for its use across treatment settings. The panel concluded that XT should be considered early in the course of illness, particularly in first-episode psychosis, because it may alter long-term outcomes while reducing reliance on high-dose dopamine antagonists. Outpatient strategies emphasize individualized titration and proactive management of gastrointestinal side effects to support adherence. Inpatient use allows for more rapid titration and has shown rapid benefits in both positive and negative symptoms, facilitating earlier stabilization and discharge. Cross-titration experience suggests that XT can be dose-sparing when combined with dopamine blockers, reducing the burden of metabolic and motor side effects. These real-world insights highlight XT as a versatile treatment option that expands the therapeutic possibilities for schizophrenia.

Objective: Postpartum anxiety is common, often underrecognized, and associated with numerous negative outcomes for both the perinatal individual and their infant. Despite its high prevalence and burden, research focused on preventative strategies for postpartum anxiety remains very limited. This study investigated whether a 6-week cognitive behavioral therapy protocol targeting intolerance of uncertainty (CBT-IU) during pregnancy could reduce risk for postpartum anxiety disorders among individuals with heightened intolerance of uncertainty (IU).

Methods: In this investigator-initiated, single-site, proof-of-concept, randomized controlled trial (RCT), eligible participants (n=37), between 14 and 32 weeks' gestation, with heightened IU (baseline score of ≥64 on the 27-item Intolerance of Uncertainty Scale) were randomized to a 6-session individual CBT-IU or care as usual (CAU), of whom 35 completed measures and were included in analyses. The primary objective of this study was to evaluate whether CBT-IU for pregnant individuals with elevated IU could reduce the risk of postpartum anxiety disorder compared to CAU. Secondary outcomes included changes in worry, depression, and emotion regulation.

Results: CBT-IU significantly reduced the risk of postpartum anxiety disorder onset compared to CAU (P<.001), with none of the participants in the CBT-IU group meeting diagnostic (or provisional) criteria for an anxiety or related disorder, compared to 31.6% of participants in the CAU group. CBT-IU participants showed clinically significantly reductions in IU (P=.003), worry symptoms (P<.001), emotion dysregulation (P=.018), and interviewer-rated anxiety symptoms (P<.001) compared to CAU. Treatment satisfaction among CBT-IU participants was high.

Conclusion: These findings suggest that targeting IU during pregnancy may be an effective preventive strategy for reducing the risk of postpartum anxiety disorder onset. This proof-of-concept RCT supports a large-scale RCT to ultimately test CBT-IU as an effective intervention for prevention of postpartum anxiety disorders.

Trial Registration: ClinicalTrials.gov identifier: NCT05691140.