Journal of Clinical Psychiatry最新文献

Objective: Evaluate long-term safety, tolerability, and durability of the effect of olanzapine/samidorphan (OLZ/SAM) for up to 4 years in patients with schizophrenia, schizophreniform disorder, or bipolar I disorder (BD-I).

Methods: This phase 3, multicenter, open-label, long-term extension (conducted June 2017-September 2023) assessed OLZ/SAM in patients completing the ENLIGHTEN clinical program. Patients received ≥2-4 years of additional treatment. Safety assessments included adverse event (AE) incidences and changes from baseline in body weight, waist circumference, and lipid/glycemic parameters. The durability of the effect was assessed using the Clinical Global Impressions-Severity (CGI-S) scale.

Results: Of 524 patients enrolled, 523 received ≥1 dose of OLZ/SAM. Of these, 460 (88%) patients had schizophrenia, 15 (3%) had schizophreniform disorder, and 48 (9%) had BD-I. Mean (SD) age was 35.1 (12.2) years. Mean (SD) OLZ/SAM exposure was 652.4 (454.8) days. Of 451 patients eligible for 2 years of treatment, 242 (53.7%) received it; of 335 patients eligible for 4 years, 109 (32.5%) received it. The most common AEs were weight increased (9.8%), headache (7.1%), anxiety (6.1%), insomnia (5.9%), somnolence (5.9%), nausea (5.7%), and weight decreased (5.7%). At 2 years, mean (SD) body weight change was 0.84 (6.84) kg; waist circumference change was -0.56 (6.24) cm. At 4 years, mean (SD) body weight change was 2.65 (8.12) kg; waist circumference change was 1.37 (8.65) cm. Changes in lipid/glycemic parameters were minimal. CGI-S scores remained stable.

Conclusion: OLZ/SAM maintained symptom control with a long-term safety profile over 4 years consistent with that of prior studies.

Trials Registration: ClinicalTrials.gov identifier: NCT03201757.

Objective: The prevalence of depressive and anxiety disorders is higher in women than in men. In contrast, there is still no clear consensus on the existence of sex-related differences in the effectiveness of antidepressant treatments for these disorders. This real-world study used filled prescription sequences to compare antidepressant medications between women and men at a medication level according to their acceptability (ie, combination of efficacy and tolerability).

Methods: In a nationwide cohort from the French national health data system (Système National des Données de Santé [SNDS]), 1.2 million people were identified as new antidepressant users for any condition in 2011. The outcome was clinical acceptability as measured by the continuation/change ratio over the 6- month period following the introduction of the first-line treatment. Continuation was defined as at least 2 refills of the same treatment. Change was defined as at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood stabilizer. Adjusted odds ratios (aORs) were computed through multivariable binary logistic regressions.

Results: Overall, after the first prescription of an antidepressant, the continuation/ change ratio was slightly higher for women than men (aOR [95% CI], 1.06 [1.05-1.08]), with escitalopram ranking first in both. Sex-by-medication interactions were significant for paroxetine (0.91 [0.88-0.95]) and fluoxetine (1.19 [1.12-1.26]) only. Specifically, fluoxetine was significantly more acceptable in female than in male participants (0.73 [0.70-0.75] vs 0.63 [0.60-0.67]), whereas paroxetine was more acceptable in male than in female participants (0.75 [0.72-0.78] vs 0.68 [0.66-0.70]).

Conclusion: These real-world data may help practitioners and policymakers prioritize choice of antidepressant medications in women and men.

Objective: The specific role of posttraumatic stress disorder (PTSD) in individuals who have attempted suicide, along with the influence of comorbid psychiatric conditions on the risk of suicide reattempt, remains unexplored. This study aims to assess the association between PTSD and suicide reattempt at 6 months among suicide attempt (SA) survivors, while controlling for prevalent psychiatric disorders.

Method: We analyzed data from a cohort of 972 participants enrolled in the ALGOS study between January 2010 and February 2013. We assessed the risk of suicide reattempt at 6 months and rehospitalization in both psychiatric and nonpsychiatric settings. A multivariable logistic regression model was performed, controlling for depression, generalized anxiety disorder, and alcohol use disorder.

Results: Among all participants, 79 had a lifetime diagnosis of PTSD. At 6 months, 117 participants (13.3%) had reattempted suicide. After controlling for randomization group, age, sex, and comorbid psychiatric conditions, PTSD was statistically associated with suicide reattempt at 6 months (odds ratio [OR] with 95% CI, 2.33 [1.39-3.89], P < .01), rehospitalization in psychiatric settings (OR = 2.24 [1.39-3.61], P < .01), and nonpsychiatric settings (OR = 3.06 [1.90-4.93], P < .01).

Conclusion: Almost 1 in 10 SA survivors suffer from PTSD. These individuals are at a higher risk of suicide reattempt and appear more generally to be in poorer health, with a higher risk of hospitalization in psychiatric and nonpsychiatric settings. Recognizing and effectively managing PTSD among individuals admitted after an SA is thus imperative for reducing the risk of subsequent suicide reattempts.

The pandemic refocused interest on the burden of depression across the lifespan; the increased efforts to prevent and treat depression are now a priority of health care systems, insurers, patient advocates, digital therapeutic engineers, telemedicine platforms, and community health agencies. However, the challenges of treating depression to remission in adult patients who do not respond to first, second, or third levels of oral pharmacotherapy remain. The increased prevalence of these conditions is at odds with the shrinking psychiatric workforce. Since addressing difficult to treat depression is situated in a rapidly evolving treatment landscape, The University of Arizona College of Medicine-Tucson Department of Psychiatry organized and hosted the Southwest Forum on Difficult to Treat Depression: Focus on Approach, Algorithms, and Access in July 2024. The Forum convened 11 internationally renowned experts in the science and treatment of depression, in particular difficult to treat depression, for a day of teaching and discussion. Based on their expertise, participants were asked to address one of the following three themes: (1) Novel Mechanism Approaches for Difficult to Treat Depression, (2) What Do I Do Next? Evidence-Informed Algorithms to Get Patients Better Faster, and (3) Access: Providing Comprehensive Depression Care Across the Spectrum of Clinical Severity.

Importance: Little is known about differences between Black and White women with respect to the prevalence of postpartum mood disorders or symptom presentations.

Objective: To determine the prevalence and characteristics of postpartum major mood disorders in Black and White women at 4-6 weeks after birth.

Methods: This is a secondary analysis of a large-scale study designed to screen women for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS) and collect symptom data. Data were collected at an urban maternity hospital in an academic setting in Pittsburgh, Pennsylvania. Of the 2,019 women who screened positive and accepted a psychiatric diagnostic interview, 163 and 85 Black women had major depressive and bipolar disorders, respectively, and 508 and 177 White women had major depressive and bipolar disorders, respectively. Those with an EPDS score greater than or equal to 10 were offered a psychiatric assessment (in-person at home or by telephone) with the Structured Clinical Interview for DSM IV using the Structured Interview Guide for the Hamilton Rating Scale for Depression, Atypical Depression Version symptom inventory, a questionnaire related to childhood and adulthood physical and sexual abuse, and the Short Form Survey 12. Participants who self-identified as Black or White were included in this analysis.

Results: Among screen-positive participants, no significant difference in the rate of major depressive disorder (40% Black and 35% White) was observed. However, bipolar disorder significantly differed between Black (19.2%) and White (11.5%) women. Additionally, symptom profiles differed between Black and White participants with major depressive disorder, and a high rate of traumatic experiences was reported by participants with major depression and bipolar disorder in both racial groups.

Conclusion: An understanding of the different presentations of postpartum mood disorders between Black and White women, as well as trauma-informed care, can optimize postpartum health care through supporting advocacy efforts for resource allocation and health care delivery.

Trial Registration: Dataset from study at ClinicalTrials.gov identifier: NCT00282776.

About 5%-10% of pregnancies in the US are exposed to cannabis with highest use reported during the first trimester. Two recent meta-analyses presented estimates of the risk of birth defects associated with prenatal exposure to cannabis; the larger and more recent meta-analysis pooled data from 18 cohort and 18 case-control studies with a total sample size of >19 million subjects. The meta-analyses found that prenatal exposure to cannabis was associated with a small but statistically significant increased risk of any birth defect (pooled odds ratios [ORs], 1.25-1.33); ORs were also significantly elevated for cardiovascular, gastrointestinal, nervous system, genitourinary, and musculoskeletal but not orofacial birth defects. The ORs were smaller and less likely to be statistically significant in adjusted analyses. These meta-analyses had strengths but also shortcomings. The strengths and shortcomings are explained in detail so that readers obtain a better understanding of how to critically assess findings in meta-analyses. One strength was the presentation of both unadjusted and adjusted pooled estimates; the former allow an understanding of risks in the average real world patient and the latter allow an understanding of the unique contribution of the exposure to the outcomes. Another strength was the presentation of cumulative meta-analyses which demonstrated from which calendar year onwards a finding became consistently statistically significant in the scientific literature. One shortcoming, in analyses of subcategories of birth defects, was the repeated representation of the same sample in the same forest plot; the many reasons why this is problematic are explained. Another shortcoming was the pooling of ORs obtained from cohort studies with those obtained from case control studies; conceptual and numerical reasons why this is problematic are also explained.