International Review of Psychiatry最新文献

Management of patients with schizophrenia is a useful case study of future trends within wider clinical psychiatry. Recent scientific advances in the understanding of schizophrenia neuropathology, combined with work across pharmacology, psychology and biomarker discovery provide fertile ground for change. Future psychosis researchers and clinicians can transform the schizophrenia care model into one which delivers for patients and allows healthcare professionals to manage increasing workloads. In this article, the author highlights the most significant recent developments in the study of schizophrenia and suggests areas in which early-career psychiatrists can contribute to generational change in psychosis management.

There is a worldwide mental health crisis. The WHO estimates that 1 in 7 children suffers from and is impaired by mental problems and disorders. There are epidemics of neurodevelopmental disorders, eating disorders, substance and behavioural addictions in youth. The suicide figures worldwide are shifting. A decrease of suicides in elder people especially men and increase in suicide in young people especially women. Social media have an enormous impact on youngsters, with obvious benefits but big backlashes too: screen- fear of missing out-addictions and a worry impact of cyber bullying! In this paper the necessity of mental health services adapting in a flexible way to the increasing demand and possibilities are highlighted including peer support by Emphasis is put on the appeal to (mental) healthcare workers to speak up and address the causes. Mental health should be a responsibility of all, especially politicians and decision makers.

After musing over the possible reasons for our persistent preoccupation with the 'future of psychiatry', I formulate twelve arbitrary questions on this topic, and venture into their possible answers in two ways: first, what I would like to see happening thirty years hence (a playful fantasy); and second, what I think might actually happen thirty years hence (a putative projection). These questions range from: will psychiatry survive, as psychiatry, to: What about Low-and Middle-Income Countries? While gazing into this crystal ball armed with the current state of knowledge, attitude and practices, in the end it becomes clearer to me that, whatever psychiatry will experience over the ensuing decades, it should be imperative to sustain the essential core of psychiatry, both as a science and as an art of therapy: socioecological and political-commercial determinants of mental health along with its burgeoning biological determinants; the need for effective communication and relation at every level; and that precious thing called therapeutic alliance or bonding. The value of these will continue to exist, and perhaps increase, over the years and decades, provided we value these values and nurture these as essential components of psychiatric training.

Recently, resurgent personalist regimes and geopolitical instabilities have amplified concerns about psychopathic personality traits in high office. Yet, psychopathic traits and their associated correlates remain explicitly underexamined within the dynamics of international conflict, particularly nuclear flashpoints, where individual decision-making could entail disproportionate consequences. As part of a cumulative project on functional and psychological factors in Cold War leadership, preliminary psychopathic trait estimates were generated for 13 leaders central to the Suez Crisis (1956), the Cuban Missile Crisis (1962), and the Yom Kippur War (1973). Subject-matter experts (n = 149) rated leaders at-a-distance using an adapted 33-item Comprehensive Assessment of Psychopathic Personality-Lexical Rating Scale, a dimensional, non-diagnostic inventory suitable for non-clinicians. Inferred from over 5,000 item-level responses (155 total ratings; M = 11.9/leader), trait profiles revealed domain-specific and between-leader accentuations, many of which converged with historical and behavioural evidence. Representing disparate political systems, higher-scoring leaders exhibited pronounced "Dominance", "Self", and "Behavioural" dimensions (M ≈ 2.04-3.00; 1-4 scale), suggesting recurring tendencies and transideological psychopathic trait manifestations. Strong average-measure interrater reliability supported the robustness of these exploratory estimates, notwithstanding possible respondent artefacts. Accordingly, this study further demonstrates the methodological feasibility of retrospective psychopathic trait evaluations, underpinning future triangulation and potential investigations into their conflict-relevant intersections.

Neuropsychiatric symptoms are common in Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD), yet their genetic underpinnings remain unclear. To gain insight into biological processes related to neuropsychiatric symptoms in dementia, we investigated whether polygenic risk scores (PRS) for psychiatric disorders - major depressive disorder (MDD), schizophrenia (SCZ), bipolar disorder (BD), and autism spectrum disorder (ASD) - are associated with neuropsychiatric symptoms in dementia. Data included genetic and neuropsychiatric data of 6240 AD patients, 428 FTD patients and 390 DLB patients from five European cohorts (ADC, GR@ACE, DELCODE, AgeCoDe, and DCN). PRS for MDD, BD, SCZ, and ASD were calculated using LDpred2. Neuropsychiatric symptoms were assessed using total scores from the Neuropsychiatric Inventory (NPI) (NPI-12 and NPI-Q) and Geriatric Depression scale (GDS). Associations between PRS and symptoms were examined using linear regression models, followed by meta-analyses. In FTD, higher SCZ-PRS associated with lower NPI scores in the meta-analysis (β = -0.12, p = .001). No associations were found in AD and DLB. This is the first study to show that genetic liability for SCZ associates with lower NPI in FTD, warranting further investigation.

Antisocial and criminal behavior is an underrecognized aspect of neurodegenerative diseases. These behaviors are defined as behaviors and actions that violate the basic rights of others. Antisocial behaviors are seen in relatively high rates in behavioral variant frontotemporal dementia, but can be seen in other conditions. Several recent tools have been developed in attempt to quantify antisocial behaviors and neuroimaging studies have helped identify likely brain regions and networks involved in the genesis of antisocial behaviors. These regions include the anterior insula, ventral striatum, orbitofrontal cortex, and prefrontal cortices. The management of such symptoms is challenging with limited high quality studies available at this time. The recognition of antisocial behaviors can help limit complications. Further work is needed to more clearly delineate the pathophysiology of antisocial behavior.

Agitation and abnormal motor behaviors are common, distressing symptoms of Frontotemporal Dementia (FTD). While these symptoms currently lack efficacious and safe pharmacological treatments, case reports in FTD and a clinical trial in Alzheimer's disease suggest that patients may benefit from lithium treatment. We designed a randomized, double-blind, placebo-controlled, 12-week clinical trial to evaluate low-dose lithium for the treatment of agitation and abnormal motor behaviors in FTD. However, the trial did not meet its recruitment target (n = 60). This report assesses the trial's feasibility and tolerability using recruitment, study completion, and safety metrics. Sixteen adults with FTD (median age 59.5 years; 69% female) were enrolled from 2017 to 2021. Fourteen participants (88%) completed the trial. The majority of participants on lithium were taking the maximum daily dose by Week 12 (600 mg), had median (interquartile range) final serum lithium levels of 0.42 (0.37-0.57), and reported minimal side effects, including drowsiness, diarrhea, constipation and insomnia. Preliminary data from intended efficacy outcomes showed no median pre-post changes between treatment groups. Low-dose lithium is feasible and well-tolerated in an FTD population. Further systematic study of lithium and its efficacy to treat agitation and abnormal motor behaviors in FTD is warranted.

Frontotemporal dementia (FTD) is one of the most frequent forms of early-onset neurocognitive disorders worldwide. Behavioral variant FTD (bvFTD), the most common FTD phenotype, is frequently associated with neuropsychiatric symptoms (NPS) such as apathy, depression, impulsivity, and repetitive behaviors that lead to diminished quality of life for patients and their loved ones. Common NPS in bvFTD are also similar to symptoms that can be present in psychiatric disorders, complicating diagnosis. The present review describes the clinical significance of NPS in bvFTD, provides guidance to psychiatrists with differentiating NPS due to bvFTD from psychiatric disorders along with an overview of tools that may aid clinical evaluations, and presents direction on future avenues of research into improving the care of patients with NPS due to bvFTD.

Frontotemporal dementia (FTD) often presents with complex behavioural and communication changes that are frequently misinterpreted as primary psychiatric disorders, contributing to delayed diagnoses, inappropriate interventions, and caregiver distress. This commentary explores overlapping clinical features of psychiatric and language symptoms in FTD and highlights the important role that speech-language pathologists (SLPs) can play in early identification, care planning, and psychosocial support. Drawing on two illustrative vignettes, an individual living with behavioural variant frontotemporal dementia (bvFTD) and another living with semantic variant primary progressive aphasia (svPPA), this paper examines how communication impairments overlap psychiatric conditions and how SLP-led interventions can clarify diagnoses, reframe behaviours, and foster functional participation. These cases emphasise the importance of SLP involvement in interdisciplinary teams, not only for language rehabilitation but also for caregiver education and relational scaffolding. Despite a growing understanding of FTD, clinical frameworks often fail to integrate speech-language assessment early into pathways, particularly in younger individuals. This paper advocates for earlier SLP referral, structured caregiver supports, and formal recognition of communication disorders as diagnostic and therapeutic entry points for neurodegenerative disease. Enhanced awareness of the communicative dimensions of FTD may improve diagnostic accuracy, reduce stigma, and promote more holistic and relationship-centred models of care.