ImportanceThe brain enters distinct activation states to support differential cognitive and emotional processes, but little is known about how brain activation states differ in youths with clinical anxiety.ObjectiveTo characterize brain activation states during socioemotional processing (movie stimuli) and assess associations between state characteristics and movie features and anxiety symptoms.Design

ImportanceNew pharmacotherapy options are needed for posttraumatic stress disorder (PTSD).ObjectiveTo investigate the efficacy, safety, and tolerability of brexpiprazole and sertraline combination treatment (brexpiprazole + sertraline) compared with sertraline + placebo for PTSD.Design, Setting, and ParticipantsThis was a parallel-design, double-blind, randomized clinical trial conducted from October

Importance Neurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear. Objective To conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback

ImportanceLarge-scale genome-wide association studies (GWAS) should ideally inform the development of pharmacological treatments, but whether GWAS-identified mechanisms of disease liability correspond to the pathophysiological processes targeted by current pharmacological treatments is unclear.ObjectiveTo investigate whether functional information from a range of open bioinformatics datasets can elucidate

This randomized controlled trial secondary analysis examines the association between treatment expectancies and the relative efficacy of psilocybin compared with escitalopram for major depressive disorder.

ImportancePediatric posttraumatic stress disorder (PTSD) is a common and debilitating mental disorder, yet a comprehensive network meta-analysis examining psychological interventions is lacking.ObjectiveTo synthesize all available evidence on psychological interventions for pediatric PTSD in a comprehensive systematic review and network meta-analysis.Data SourcesPsycINFO, MEDLINE, Web of Science, and

ImportanceWhile access to psychotherapy has recently increased in the US, concern exists that recent gains may be unevenly distributed despite teletherapy expansion.ObjectiveTo characterize recent trends and patterns in outpatient psychotherapy by US adults.Design, Setting, and ParticipantsThis is a repeated cross-sectional study of psychotherapy use among adults (ages ≥18 years) in the 2018 to 2021

ImportanceReliance on abstinence-based treatment success rules may fail to capture the full continuum of treatment response to buprenorphine plus medical counseling (BUP+MC) for opioid use disorder (OUD).ObjectiveTo describe patterns of reduction in illicit opioid use of patients both labeled as a success and nonsuccess based on an abstinent-based treatment outcome rule.Design, Setting, and ParticipantsThis

This cross-sectional study examines demographic characteristics of adults treated at outpatient mental health treatment centers using data from the 2022 US National Survey of Drug Use and Health.

ImportanceResearch suggests an increase in mental disorder incidence in recent years, but this trend remains unexplained, and there is a lack of large studies based on a representative sample that investigate mental disorders over the full spectrum.ObjectiveTo explore sex- and age-specific incidence of any mental disorder and 19 specific disorders according to birth cohort and calendar period.Design

This Viewpoint proposes applying a systematic curriculum for early management of traumatically injured patients as a framework for suicide risk screening after overdose.

ImportanceExposure to war is associated with poor mental health outcomes. Adverse and traumatic experiences can lead to long-lasting DNA methylation changes, potentially mediating the link between adversity and mental health. To date, limited studies have investigated the impact of war on DNA methylation in children or adolescents, hampering our understanding of the biological impact of war exposure

This Viewpoint discusses the “Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All” report, which emphasizes that health inequities lead to poor mental health for all people, not only minoritized populations, and a diverse workforce is needed to achieve mental health equity.

ImportancePreliminary studies suggest that glucagon-like peptide-1 receptor (GLP-1) agonists, used to treat type 2 diabetes and obesity, may decrease alcohol consumption.ObjectiveTo test whether the risk of hospitalization due to alcohol use disorder (AUD) is decreased during the use of GLP-1 agonists compared with periods of nonuse for the same individual.Design, Setting, and ParticipantsThis cohort

ImportanceInterest in and use of hallucinogens has been increasing rapidly. While a frequently raised concern is that hallucinogens may be associated with an increased risk of psychosis, there are limited data on this association.ObjectivesTo examine whether individuals with an emergency department (ED) visit involving hallucinogen use have an increased risk of developing a schizophrenia spectrum disorder

ImportanceProlonged grief disorder (PGD) is included as a new diagnosis in international classification systems. Treatments following a cognitive behavioral model are most effective, but comparisons with active control treatments are scarce.ObjectiveTo examine whether integrative cognitive behavioral therapy for prolonged grief (PG-CBT) is superior to present-centered therapy (PCT).Design, Setting

ImportanceSynaptic dysfunction is involved in schizophrenia pathophysiology. However, whether in vivo synaptic density is reduced in early stages of psychosis, including its high-risk states, remains unclear.ObjectiveTo investigate whether synaptic density (synaptic vesicle glycoprotein 2A [SV2A] binding potential) is reduced in first-episode psychosis (FEP) and in clinical high risk (CHR) and investigate

ImportanceBrain translocator protein 18k Da (TSPO) binding, a putative marker of neuroinflammatory processes (eg, gliosis), is associated with stress and elevated in depressed and suicidal populations. However, it is unclear whether neuroinflammation moderates the impact of daily life stress on suicidal ideation and negative affect, thereby increasing risk for suicidal behavior.ObjectiveTo examine

ImportanceAdolescent cannabis use has been consistently posited to contribute to the onset and progression of psychosis. However, alternative causal models may account for observed associations between cannabis use and psychosis risk, including shared vulnerability for both cannabis use and psychosis or efforts to self-medicate distress from psychosis spectrum symptomology.ObjectiveTo test 3 hypotheses

This cross-sectional study describes US overdose death patterns for fentanyl and fentanyl combined with opioids, heroin, cocaine, methamphetamine, or benzodiazepines by race and ethnicity from 2010 to 2022.

This Viewpoint discusses injuries among US children that are attributable to TikTok challenges, addresses the challenge of distinguishing between unintentional injuries and suicide attempts, and explores potential methods of prevention, treatment, and clinical disposition for such injuries.

Importance Older adults with major depressive disorder (MDD) or mild cognitive impairment (MCI) are at high risk for cognitive decline. Objective To assess the efficacy of cognitive remediation (CR) plus transcranial direct current stimulation (tDCS) targeting the prefrontal cortex in slowing cognitive decline, acutely improving cognition, and reducing progression to MCI or dementia in older adults

ImportanceDepression is a leading contributor to mental health burdens globally and in India, the world’s most populous country. National-level evidence on health coverage for adults with depression in India is lacking.ObjectiveTo estimate proportions of middle-aged and older adults with depression in India who used health care services, were diagnosed with depression, received treatment, and were

ImportanceLeveraging real-world clinical biobanks to investigate the associations between genetic and environmental risk factors for mental illness may help direct clinical screening efforts and evaluate the portability of polygenic scores across environmental contexts.ObjectiveTo examine the associations between sexual trauma, polygenic liability to mental health outcomes, and clinical diagnoses of

This cross-sectional study uses data from 1135 male, European-American US military veterans to assess whether risk and protective factors influenced associations between posttraumatic stress disorder and epigenetic age.

ImportanceWhile adverse childhood experiences (ACEs) are known to impart significant risk for negative mental health and cognitive outcomes in youth, translation of ACE scores into clinical intervention is limited by poor specificity in predicting negative outcomes. This work expands on the ACE framework using a data-driven approach to identify 8 different forms of traumatic and adverse childhood experiences

This Viewpoint advocates for proactively addressing concerns related to the diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) in US adults to balance individual benefits with population-level risk.

Importance In the neurotypical brain, regions develop in coordinated patterns, providing a fundamental scaffold for brain function and behavior. Whether altered patterns contribute to clinical profiles in neurodevelopmental conditions, including autism, remains unclear. Objectives To examine if, in autism, brain regions develop differently in relation to each other and how these differences are associated

ImportanceThe field of public mental health is evolving to tackle the profound impact of global challenges such as climate change, migration, and health crises. These issues accentuate health and social inequities, necessitating a focus on how to achieve interventions that are equitable and enhance mental health across all societal strata.ObservationsPopulation-based interventions can inadvertently

ImportanceCognitive deficits are a substantial part of the symptoms of schizophrenia spectrum disorders (SSDs) and contribute heavily to the burden of disease. Antipsychotic drugs are not cognitive enhancers, but due to their different receptor-binding profiles, they could differ in their effects on cognition. No previous network meta-analysis compared antipsychotics to placebo, which is important

This Viewpoint describes both the current barriers patients face when filling their prescriptions for buprenorphine at pharmacies and a list of proposed fixes requiring changes at the federal, state, insurance, and clinician level.

This Viewpoint describes efforts to provide timely, comprehensive, and high-quality mental health care to a large population-representative subset of children within a single health system and demonstrate its potential impact and true cost.

ImportanceCognitive functioning is associated with various factors, such as age, sex, education, and childhood adversity, and is impaired in people with psychosis. In addition to specific effects of the disorder, cognitive impairments may reflect a greater exposure to general risk factors for poor cognition.ObjectiveTo determine the extent that impairments in cognition in psychosis reflect risk factor

This Viewpoint discusses the critical yet overlooked role of the psychotherapy component in assessing the validity of the trials of midomafetamine/3,4-methylenedioxymethamphetamine (MDMA)–assisted psychotherapy for posttraumatic stress disorder.

ImportanceMale postpartum depression is prevalent across populations; however, there is limited evidence on strategies to address it, particularly in low-income settings.ObjectiveTo evaluate the effectiveness of Learning Through Play Plus Dads (LTP + Dads), a nonspecialist–delivered psychosocial intervention, in improving symptoms of male postpartum depression compared to treatment as usual.Design

ImportanceSeasonal humor disorders are prone to have a link with daylight exposure. However, the effect of external light on nonseasonal disorders remains unclear. Evidence is lacking for the validity of bright light therapy (BLT) as an adjunctive treatment for these patients.ObjectiveTo assess BLT effectiveness as an adjunctive treatment for nonseasonal depressive disorders.Data SourcesIn March 2024

ImportanceSuicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published

ImportanceThe suicide rate of military servicemembers increases sharply after returning to civilian life. Identifying high-risk servicemembers before they leave service could help target preventive interventions.ObjectiveTo develop a model based on administrative data for regular US Army soldiers that can predict suicides 1 to 120 months after leaving active service.Design, Setting, and ParticipantsIn

ImportanceDirect-to-patient interventions enabling transitions from long-term benzodiazepine receptor agonist (BZRA) use to cognitive behavioral therapy for insomnia (CBTI) by older adults has the potential to reduce BZRA use and related harms while improving sleep outcomes without requiring prearranged clinician involvement.ObjectiveTo compare 2 direct-to-patient behavior change interventions with

ImportanceChanges in suicide rates after a nationwide trauma may be different from changes in psychiatric symptoms or general distress after such events. However, very few studies have examined short-term suicide-related reactions after such an event.ObjectiveTo evaluate the short-term outcome of the events in Israel on October 7, 2023, a large-scale terror attack and unfolding war, on changes in suicidality

ImportanceLarge-scale evidence for the efficacy of continuation and maintenance electroconvulsive therapy (c/mECT) is lacking.ObjectiveTo provide an exhaustive and naturalistic insight into the real-world outcomes and the cost-effectiveness of c/mECT in a large dataset.Design, Setting, and ParticipantsThis cohort study included all patients in the Danish National Patient Registry who initiated treatment

ImportanceSuicide risk is elevated after discharge from inpatient level of care. Empirically supported inpatient suicide prevention treatments are needed.ObjectiveTo determine whether adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduces postdischarge suicide attempts, suicidal ideation, and psychiatric readmissions and to determine whether

ImportanceAntidepressant discontinuation substantially increases the risk of a depression relapse, but the neurobiological mechanisms through which this happens are not known. Amygdala reactivity to negative information is a marker of negative affective processes in depression that is reduced by antidepressant medication, but it is unknown whether amygdala reactivity is sensitive to antidepressant

This Viewpoint describes the importance of understanding the neurocomputational mechanisms by which individuals with anorexia nervosa assign value to food.

ImportancePsychiatry mainly deals with conditions that are mediated by brain function but are not directly attributable to specific brain abnormalities. Given the lack of concrete biological markers, such as laboratory tests or imaging results, the development of diagnostic systems is difficult.ObservationsThis narrative review evaluated 9 diagnostic approaches. The validity of the DSM and the International

ImportanceAdvancing precision psychiatry, where treatments are based on an individual’s biology rather than solely their clinical presentation, requires attention to several key attributes for any candidate biomarker. These include test-retest reliability, sensitivity to relevant neurophysiology, cost-effectiveness, and scalability. Unfortunately, these issues have not been systematically addressed

ImportanceAccording to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.ObjectiveTo (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response–like relationship at play (ie, the higher