Psychiatry

RUL ECT outperforms algorithm-based pharmacotherapy acutely in treatment-resistant bipolar depression, with similar 6‑month outcomes

Inpatients with treatment-resistant bipolar depression were randomized to 6 weeks of right unilateral ECT or algorithm-based pharmacologic treatment (APT). Posttreatment, ECT patients improved in seven of eight RAND-36 domains, versus three domains with APT, indicating broader functional gains. PGI-I ratings and MADRS scores favored ECT over APT after 6 weeks, while everyday memory complaints did not differ between groups. By 6 months, there were no significant group differences in any patient-reported or clinician-rated outcomes under pharmacologic maintenance. Everyday memory scores improved from baseline to 6 months only in the ECT group, arguing against persistent subjective cognitive harm. 1

Digital CBT-based interventions modestly improve AOD use and psychosocial outcomes, mainly versus minimal treatment or as adjuncts

This meta-analysis synthesized 65 randomized trials of digitally delivered CBT-based interventions for adult alcohol and other drug use. As stand-alone treatments versus minimal controls, digital CBT produced small, significant benefits on consumption and psychosocial outcomes. When added to usual care, digital CBT improved substance consumption but not psychosocial functioning versus usual care alone. Digital CBT did not outperform other active digital or in-person interventions or therapist-delivered CBT. Within digital CBT arms, 60%–80% of participants improved from baseline, though effect sizes and heterogeneity varied by outcome domain. 2

Higher baseline LDL predicts greater relapse risk during antipsychotic tapering in schizophrenia

This study followed 83 patients with schizophrenia during a 6‑month antipsychotic taper and re-examined them 12 months after baseline. Twenty-nine patients (35%) relapsed, and relapsers had higher baseline LDL than stable patients. Mean LDL was 3.16 mmol/L (about 122 mg/dL) in relapsers versus 2.56 mmol/L (about 99 mg/dL) in non-relapsers, with p = 0.001. Higher LDL independently predicted relapse during tapering, with an adjusted odds ratio of 2.09 (95% CI 1.11–3.93). Although mechanisms are unclear, baseline LDL may help identify higher-risk taper candidates and justify slower tapering and closer follow-up. 3

Depression and anxiety markedly increase dementia risk in schizophrenia, independent of antipsychotic modality

This Taiwanese nationwide cohort included 8480 patients with schizophrenia followed for a mean of 9.5 years. Cumulative dementia prevalence was 12.98%, with advanced age as the strongest risk factor. Comorbid anxiety (aHR 2.77) and depression (aHR 2.42) independently doubled or more than doubled dementia risk. Dementia incidence did not differ significantly between patients on long-acting injectables and those on oral antipsychotics. Findings support age-stratified cognitive surveillance and aggressive management of anxiety and depression in older patients with schizophrenia. 4