<![CDATA[Psilocybin therapy shows fast, lasting relief for depression; clinicians discuss trial hurdles and emerging promise for PTSD and addiction in this podcast.]]>
Computer-based tree drawing test in adolescents and adults with depression
ObjectiveTo evaluate the value of the computer-based Tree Drawing Test in the auxiliary diagnosis of depressive disorders and to analyze the differences in the performance of adolescent and adult depression patients in the Tree Drawing Projection Test.MethodsThis study was conducted at Guo Yang County People’s Hospital in Anhui, China, and involved a total of 184 participants: 43 adults with depression, 82 adolescents with depression, and 59 healthy controls. The Tree Drawing Test and scale assessments were administered to patients with depressive disorders (adult group and adolescent group) and a control group. Computer image recognition and calculation techniques were used to analyze the results statistically.ResultsSignificant differences were observed between the adult depression group and the control group in terms of crown area, trunk area, total area, and HDRS scores (p < 0.001). Statistically significant differences were also found between the adult depression group and the adolescent depression group in terms of trunk area (p < 0.01), total area (p < 0.001), HDRS scores (p < 0.001), and HAMA scores (p < 0.01). The crown area (r = -0.261, p < 0.001), trunk area (r = -0.154, p = 0.037), total area (r = -0.285, p < 0.001), and HDRS scores in the Tree Drawing Test were significantly correlated.ConclusionThe computer-based Tree Drawing Test has certain value in the auxiliary diagnosis of depression. Future research should include larger sample sizes and participants from different regions and cultural backgrounds to further validate the generalizability and cultural adaptability of the Tree Drawing Test for depression assessment.
Adaptation of behavioural activation for adolescents with mild to moderate intellectual disabilities and depression
IntroductionAdolescents with intellectual disabilities are at increased risk for mental health problems and depression. Despite this, there is currently no evidence for effective psychological interventions for treating low mood and depression in this population. Behavioural activation has been identified as an effective intervention for treating depression in autistic adolescents and for adults with intellectual disabilities and may therefore also be suitable for use with adolescents with intellectual disabilities.MethodThe current paper describes an approach taken to adapting an existing behavioural activation intervention used with adults with intellectual disabilities (Beat-It) to be suitable for adolescents, named Beat-Depression (Beat-D). An iterative, three-phase approach was adopted for the adaptation process. The first phase involved review of the Beat-It manual and proposed adaptations by the project team, followed by a second phase consisting of consultations with parents of adolescents with intellectual disabilities and professionals with experience in the field.ResultsThe outcomes from phases one and two were incorporated into a final adapted manual for the Beat-D intervention. The intervention is described following the principles of the Template for Intervention Description and Replication (TIDieR) checklist.DiscussionImplications for using this adaptation approach more broadly to ensure psychological interventions used with adolescents with intellectual disabilities are suitable and accessible are discussed along with future plans for the evaluation of Beat-D.
Barriers and Facilitators in the Implementation of the Systematic Medical Appraisal, Referral, and Treatment (SMART) Mental Health Digital Intervention in Rural India: Mixed Methods Process Evaluation Study
<strong>Background:</strong> An estimated 150 million people have mental health care needs in India, but only 15% are able to access care. Depression and anxiety contribute to a large proportion of mental morbidity. The Systematic Medical Appraisal, Referral, and Treatment (SMART) Mental Health trial used a mobile-based clinical decision support system for primary care doctors and community health workers (CHWs) to identify and treat people at risk of depression, anxiety disorders, and self-harm. A community-based antistigma campaign was also delivered. The intervention led to improved remission rates for depression and anxiety and lower stigma scores. <strong>Objective:</strong> A process evaluation assessed (1) implementation fidelity, barriers, and facilitators; (2) perceptions of doctors and CHWs on the use of SMART Mental Health; and (3) the causal pathways that led to trial outcomes. <strong>Methods:</strong> A mixed methods evaluation combining backend program data and qualitative data was conducted. A total of 38 focus group discussions and 37 key informant interviews were conducted with primary doctors, CHWs, government officials, local community leaders, and research project staff. The data were coded and analyzed using a framework analysis approach based on the UK Medical Research Council guidance on process evaluations and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. <strong>Results:</strong> The intervention had high implementation fidelity. Across clusters, the median proportion of participants with at least 1 CHW follow-up was 98% (IQR 96.6%-100%). The referral rate for a psychiatrist was low (224/1697, 13.2%), and only 23.6% (53/224) of those referred visited the psychiatrist. The median exposure to antistigma audiovisual content was 84% (IQR 65.7%-95.9%). At the community level, key implementation barriers included cultural inhibitions in seeking mental health care and the unavailability of patients due to competing demands. Proximity and tight social connections between CHWs and their communities were important facilitators in seeking medical help. Doctor and CHW training, mentoring, and feedback provided by program staff were important facilitators to support the use of the digital health components by the health workforce. <strong>Conclusions:</strong> A complex intervention that included both community-based antistigma and clinical digital health interventions achieved high implementation fidelity. Key areas to consider for maintenance of such interventions include (1) the need for sustained community-based strategies to address stigma and other cultural barriers; (2) health workforce strengthening policies, including supportive supervision for CHWs and doctors to increase capability in the use of mental health digital health tools; and (3) strategies to improve access to specialist care for those with more complex care needs. <strong>Trial Registration:</strong> Clinical Trial Registry India CTRI/2018/08/015355; https://tinyurl.com/5r63suxp
<![CDATA[Online tool personalizes antidepressant choice in primary care, cutting dropouts and improving 24-week depression and anxiety scores.]]>
<![CDATA[New psychiatry drugs target dementia agitation, ADHD, depression, TRD, and schizophrenia—see which novel mechanisms may reach the FDA next.]]>
PMAT enhances sexual dimorphism of fear behaviors and facilitates female mice’s generalized contextual fear extinction
Enhanced signaling of dopamine and/or serotonin during highly arousing situations can be reduced in part by monoamine transporters, such as plasma membrane monoamine transporter (PMAT, Slc29a4). An absence of selective pharmacological inhibitors means genetically modified mice constitutively deficient in PMAT remain the best tool for studying PMAT’s organism-level functional effects. Fear conditioning is a high arousal process. Generalization of fear is evolutionarily advantageous, whereby information learned from one experience is applied to other new but similar encounters. Pathological fear generalization, in contrast, is a core feature of most anxiety disorders. Given our previous findings indicating PMAT function reduces male mice’s context fear and enhances extinction of female mice’s cued fear, we hypothesized PMAT would similarly reduce generalization (i.e., enhance discrimination) of context and cued fear in male and female mice, respectively. Our context and cued fear conditioning experiments in adult PMAT wildtype (+/+) and heterozygous (+/−) male and female mice partially supported our hypotheses. We discovered PMAT facilitates extinction of contextually generalized fear, plus subsequent extinction of context-specific fear, selectively in females. Moreover, when specific fear cues or contexts were temporally presented before cues or contexts that were similar enough to make generalization possible, PMAT enhanced biological sex differences. Growing evidence reports common PMAT polymorphisms elicit measurable effects when PMAT function is reduced. Thus, we suspect future experiments may reveal positive associations between PMAT polymorphisms and risk for anxiety disorder symptoms, particularly in people assigned female at birth. Inclusion of these genetic variations in pharmacogenomic analyses may prove therapeutically beneficial.
Beyond distress relief: the Anhedonic Subtype of nonsuicidal self-injury and the imperative for Positive Affect Treatment
This perspective article argues that the theoretical landscape of nonsuicidal self-injury (NSSI) has long been stabilized by the “hydraulic” model of Automatic Negative Reinforcement, which conceptualizes self-harm primarily as a mechanism to down-regulate aversive hyper-arousal. While this framework successfully elucidates the etiology of self-injury driven by high-intensity negative affect, it fails to account for a substantial, treatment-resistant phenotype: adolescents driven by profound anhedonia and ventral striatal hypofunction. This perspective article argues for the formal recognition of an “Anhedonic Subtype” of NSSI. Synthesizing recent epidemiological data identifying “emptiness” as a central symptom network bridge, alongside neurobiological evidence of reward blunting, we posit that for this subtype, NSSI functions not as a sedative, but as a mechanism of “forced activation.” We propose a preliminary differential diagnostic framework distinguishing defensive dissociation from anhedonic deficit and outline the theoretical rationale for exploring a shift in clinical intervention from distress tolerance toward positive affect up-regulation. The clinical utility of this framework remains to be evaluated in future empirical research.
Identifying clinical features associated with electroconvulsive therapy response in adolescents with major depressive disorder using machine learning
BackgroundElectroconvulsive therapy (ECT) is an effective treatment for adolescent major depressive disorder (MDD), but its efficacy varies. This study utilized machine learning (ML) to identify baseline clinical factors associated with poor ECT response.MethodsWe retrospectively enrolled 503 adolescent MDD patients. A poor response was defined as a <50% reduction on the Hamilton Depression Scale (HAMD-24). The optimal ML algorithm (Random Forest, RF) was selected from nine candidates and then simplified using recursive feature elimination (RFE) and interpreted via Shapley Additive Explanations (SHAP).ResultsA simplified model using two baseline features—the neutrophil-to-platelet ratio (NPR) and pre-treatment HAMD score—achieved an AUC of 0.731 on the testing set, comparable to the full-feature model (AUC: 0.751). SHAP analysis revealed that a lower baseline NPR and a lower pre-treatment HAMD score were associated with a poor response. Furthermore, retrospective statistical comparisons revealed that patients in the poor response group completed significantly fewer ECT sessions than those in the good response group.ConclusionsWe developed a concise explanatory model demonstrating that routine clinical data available at admission (blood NPR and HAMD score) can effectively stratify the risk of poor ECT efficacy. Crucially, identifying these high-risk patients early empowers clinicians to implement targeted management, ensuring they complete a full and adequate course of ECT to maximize therapeutic benefits and prevent premature termination.
[Articles] Who receives psychiatry-focused pharmacogenomic testing, and is it associated with prescribing patterns and acute care utilisation in depression? Real-world evidence from a large health system
In routine clinical practice, PGx testing is preferentially used in youth and adults with clinically complex histories and is associated with shifts in antidepressant prescribing patterns. Exploratory findings suggest hypothesis-generating signals of reduced psychiatric ED utilisation among patients with higher psychiatric complexity, which requires further confirmation. Observed racial disparities highlight the need for earlier and more equitable implementation. Prospective studies incorporating symptom-level and safety outcomes are needed to determine whether PGx-guided prescribing translates into meaningful clinical benefit.