Objective: To examine the sociodemographic and clinical profiles of veterans who primarily rely on the US Department of Veterans Affairs (VA) health care system for their care. Methods: Data were analyzed from a nationally representative sample of 4,069 US military veterans who participated in the National Health and Resilience in Veterans Study in 2019-2020. Results: Overall, 20.5% of veterans reported using the VA as their primary source of health care. Compared to non-VA users, these veterans were more likely to be younger, unmarried or unpartnered, and black/African American and to have lower household incomes (≤$60,000 annually). They also reported greater cumulative trauma exposure and were more likely to have a history of depression, posttraumatic stress disorder, and chronic medical conditions such as chronic pain, sleep disorders, and respiratory illnesses. Conclusion: VA health care serves a distinct and vulnerable subgroup of veterans who experience more complex psychiatric and medical needs, as well as greater financial insecurity, compared to non-VA users. These findings underscore the importance of expanding comprehensive, integrated services that address both physical and mental health conditions while accounting for socioeconomic factors to better meet the needs of veterans who rely on VA health care. Prim Care Companion CNS Disord 2026;28(3):25m04176. Author affiliations are listed at the end of this article.
Importance: At present, the diagnoses of many psychiatric and neurological disorders are based on clinical symptoms and behaviors, neglecting the laboratory test indicators. This narrative review assessed the existing published literature on the role of microRNAs (miRNAs) in psychiatric and neurological disorders. Observations: The miRNAs are involved in numerous biological processes, and their dysregulation can lead to neuropsychiatric disorders. They also play a prominent role in neurotransmitter signaling pathways, and their impairment can lead to psychiatric disorders. The miRNAs act as key regulators of neuronal functions such as neuroplasticity, differentiation, and protection of neurons and also play a role in establishing memory and cognition. Neurodegenerative processes therefore involve miRNAs as potential targets for treatment and early detection. The functional regulation of miRNAs of several genes has made miRNAs potent targets for therapeutic development. Conclusions and Relevance: miRNAs have the potential to be used as biomarkers for diagnosis and treatment response in psychiatric and neurological disorders. Prim Care Companion CNS Disord 2026;28(2):25nr04069. Author affiliations are listed at the end of this article.
Background: The attitudes of clinical staff toward aggression have been shown to influence the way they manage this behavior. The purpose of this study was to examine the attitudes of nursing staff toward the causes and management of aggression in an emergency department (ED) setting of a tertiary care multispecialty hospital. Methods: A convenience sample of 35 staff nurses was recruited from the emergency department of a tertiary care hospital in South India. Participants completed the Management of Aggression and Violence Scale (MAVAS), which assessed attitudes toward the causes and management of aggression in psychiatric settings. The study was conducted between August 2017 and December 2017. Results: A total of 35 clinical staff were invited to take part in the study, and of these, 33 completed the questionnaire. 51.5% of the respondents were male. 87.9% were BSc educated, and 57.6% had 1-3 years of experience in psychiatry. The MAVAS total score showed that 18 (54.5%) respondents had a positive attitude, and the rest of the respondents had a neutral attitude. The respondents had a tendency to disagree that factors directly related to the patient or external and situational factors, such as the environment and other people, contributed to aggressive behaviors. They also disagreed with the statement that patients from certain cultural groups were prone to these behaviors. Respondents had mixed views regarding the prevention and management of aggressive behavior. There was agreement that negotiation and de-escalation could be used more effectively and that seclusion and physical restraint sometimes may be required and should not be discontinued. Conclusions: Aggression in ED units of multispecialty hospitals occurs occasionally and is problematic. Attitudes of staff nurses toward the causes and management of aggression can affect the way staff manage this behavior. Hence, educational and training initiatives are needed to change the complex and contradictory attitudes of the nursing staff toward aggression for better management of this challenging clinical situation. Prim Care Companion CNS Disord 2026;28(2):25m04081. Author affiliations are listed at the end of this article.
Objective: Collaborative care models (CoCMs) are modalities for treating mental health conditions in primary care. One such iteration of CoCM, antidepressant monitoring (ADM), is a pharmacologic treatment modality for the management of depression and anxiety. ADM programs have established efficacy, yet little is known about ideal patient selection or approaches related to program retention. The objective of this study was to address this need by examining predictors of referral from a CoCM ADM program to higher levels of psychiatric services. Methods: A retrospective cohort analysis was conducted on individuals enrolled in the Tampa Veterans' Affairs ADM program over 18 months (from June 4, 2018, through December 4, 2019). Data collected included information related to referral to a higher level of service, as well as baseline information and covariates of interest. Primary analysis was conducted utilizing a multivariable logistic regression model to evaluate whether baseline characteristics were associated with differences in referral rates to higher-level services. Results: A total of 757 veterans were included in the analyses, with 131 (17.31%) referred on to a higher level of service for specialty psychiatric care. Multivariable modeling showed the following covariates to be associated with higher rates of referral to specialty psychiatric services: baseline 9-item Patient Health Questionnaire scores, sleep issues at the time of enrollment, alcohol use disorder, and cannabis use disorder. Conclusions: Results show low rates of referral overall but identify a number of baseline characteristics associated with higher referral rates to specialty psychiatric services. Further research is needed, including prospective work and studies examining proactive interventions to limit required referrals to specialty mental health services. Prim Care Companion CNS Disord 2026;28(2):25m04149. Author affiliations are listed at the end of this article.
Objective: To evaluate the performance of the New Hampshire Hospital Screening and Referral Algorithm (NHHSRA) and describe the characteristics of inpatients aged 18-65 years, with serious mental illness (SMI) referred for substance use disorder (SUD) interventions. Methods: Two questions were evaluated: (1) the accuracy and utility of the NHHSRA in identifying patients appropriate for addiction-focused interventions and (2) associations between referral status and patient characteristics. Receiver operating characteristic (ROC) curve analysis evaluated diagnostic performance of the NHHSRA, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), precision, and F1 score assessed. Logistic regressions assessed associations between patient characteristics and referral outcomes. The reference standard ("need for SUD intervention") was defined as the addiction psychiatrist's clinical assessment following direct patient evaluation. The patients assessed in this study were admitted to New Hampshire Hospital between January 2023 and February 2025. Results: The cohort (n = 927) was predominantly male (66.7%), with a mean age of 36.5 years. Opioid use disorder (OUD) was the most prevalent primary SUD (37.9%), followed by alcohol (23.9%), cannabis (15.1%), and methamphetamine (13.7%). The NHHSRA demonstrated excellent performance-sensitivity: 96.6%, specificity: 93.6%, PPV: 98.5%, NPV: 86%, and F1 score: 97.5%. ROC analysis yielded an AUC of 0.82, indicating strong discriminative ability. Logistic regressions identified higher odds of a positive NHHSRA screen among patients with OUD and lower odds among those with cannabis use disorder, after adjusting for age, sex, and psychiatric diagnosis. Conclusions: The NHHSRA is an accurate, objective tool that enhances identification of SUD intervention needs among inpatients with SMI. By addressing limitations of subjective clinical judgment and patient self-report, its implementation may improve access to addiction services and optimize treatment delivery. Patient characteristics associated with referrals inform targeted strategies for integrated care in this population. Prim Care Companion CNS Disord 2026;28(2):25m04110. Author affiliations are listed at the end of this article.
Objective: Physicians inevitably face illness; yet, occupying the role of patient poses distinct psychological and professional challenges. To elucidate the unique challenges and strengths physicians may experience as patients, this study examines how popular media portrays physicians, highlighting common themes and their implications for clinical practice and medical education. Methods: Literature was reviewed on the unique experiences of physicians in the role of patient. Searches were conducted on Google and ChatGPT using the terms movies + physician as patients, television + physician as patients, and popular media + physician as patients. Additional examples were drawn from the authors' media knowledge base. Retrieved results were reviewed for depictions that exemplify the challenges and strengths unique to physician patients. Scenes from widely recognized films and television shows were discussed to illustrate key themes. Results: Six recurring themes emerged: (1) shame and loss of professional identity, (2) interference in one's own care through self-diagnosis, (3) fear of burdening colleagues, (4) difficulty relinquishing control, (5) curbside consultations with blurred boundaries, and (6) health literacy as a strength. These narratives reflect the physician health literature and offer resonant vignettes of the tensions physician patients face. Conclusion: Physicians who become patients balance vulnerability with unique strengths, yet their professional identity often complicates care. Clinicians should anticipate these dynamics, set clear boundaries, and normalize help-seeking to ensure safe and dignified treatment. Media-based narratives can serve as powerful teaching tools, fostering empathy and preparing clinicians to navigate the complexities of caring for or assuming the role of physician patients. Prim Care Companion CNS Disord 2026;28(3):26m04196. Author affiliations are listed at the end of this article.
Importance: Lithium remains one of the most effective pharmacologic treatments for bipolar disorder, with well-established benefits in acute mania, long-term mood stabilization, and suicide prevention. Yet over recent decades, its clinical use has declined worldwide, often in favor of anticonvulsants and second-generation antipsychotics that are perceived as easier to prescribe and monitor. Understanding how lithium emerged, fell out of favor, and is now being re-examined may clarify its appropriate place in contemporary treatment algorithms. Observations: This narrative review traces lithium's trajectory from a 19th-century urate-lowering agent for gout to its rediscovery as a treatment for "psychotic excitement" and mania in the mid-20th century. Open and controlled trials established lithium as the first mood stabilizer and led to regulatory approval for acute mania and prophylaxis. For several decades, lithium was the dominant treatment for bipolar disorder, supported by randomized trials and meta-analyses demonstrating robust relapse prevention and a unique reduction in suicide risk. More recently, however, concerns about toxicity, the need for monitoring, and the availability of heavily marketed alternatives have contributed to declining use, despite guideline recommendations that still endorse lithium as a preferred long-term option for many patients. In parallel, advances in molecular neuroscience and neuroimaging have identified several convergent pathways that may underlie lithium's therapeutic actions. These include inhibition of inositol-related phosphomonoesterases and glycogen synthase kinase-3, modulation of neurotrophic and neuroprotective cascades, and normalization of frontolimbic circuitry involved in emotion regulation and impulsivity. Such mechanisms offer plausible links between lithium's cellular effects, mood-stabilizing properties, and antisuicidal benefits. Conclusions: Lithium's historical prominence, subsequent decline in routine practice, and renewed mechanistic interest together suggest that it is underutilized rather than obsolete. Reappraising lithium through both historical and mechanistic lenses may support its more systematic consideration as a first-line mood stabilizer-particularly in patients at elevated risk for suicide-while emphasizing the importance of careful monitoring and collaborative, informed decision-making. Prim Care Companion CNS Disord 2026;28(2):25nr04160. Author affiliations are listed at the end of this article.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(3):25f04133. Author affiliations are listed at the end of this article.
Abstract. Objective: Community psychiatry, recognized as the "third psychiatry revolution," plays a pivotal role in mental health care by offering deinstitutionalized, accessible, and recovery-based approaches that promote social inclusion. The objective of this study was to conduct a bibliometric analysis to evaluate global research in community psychiatry, aiming to examine publication trends and document types in the field; the most active authors, institutions, and journals; and the most-cited articles. Methods: A bibliometric analysis was conducted from 2015 to 2025 using data from the Scopus database. The search strategy included the keywords TITLE-ABS-KEY ("community psychiatry") for publications between 2015 and 2025 (specifically up to October 10, 2025), limited to English-language publications. VOSviewer was utilized for visualization and analysis. Results: The analysis included 447 articles, predominantly original research. Publication volume showed a peak in 2020, potentially linked to the COVID-19 pandemic, while 2018 recorded the lowest output. Thematic analysis revealed a focus on community psychiatry's response to COVID-19, technological innovations, recovery-oriented models, and community engagement strategies. A notable limitation was the underrepresentation of research from non-Western countries. Conclusion: The findings underscore the growing importance of community psychiatry and can guide future research priorities and the development of more effective mental health care strategies. Prim Care Companion CNS Disord 2026;28(3):25m04107. Author affiliations are listed at the end of this article.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(3):25f04146. Author affiliations are listed at the end of this article.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(3):25f04157. Author affiliations are listed at the end of this article.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(2):25f04094. Author affiliations are listed at the end of this article.
Objective: To examine how health belief model constructs influence treatment adherence among patients with dissociative disorders and to explore how demographic variables influence the relationship. Methods: This cross-sectional study used stratified random sampling to assess 130 patients with dissociative disorders at Allied Hospital 2, Faisalabad, Pakistan. Data were collected over a 4- month period (July 1 to October 31, 2024) via a standardized health belief model questionnaire and analyzed in SPSS v25. Health belief model constructs served as exposure variables, with treatment adherence as he outcome; correlation and regression analyses were performed. Results: Of 130 dissociative patients, 65 were compliant and 65 were noncompliant. Perceived benefits correlated significantly with compliance (P=.003), with 61.6% of the compliant group reporting high benefits versus 38.3% of the noncompliant group. Perceived barriers were inversely related to adherence (P=.007). No significant associations were found for perceived severity (P=.104), susceptibility (P=.365), or cues to action (P=.588). The following demographic factors showed no significant correlations with adherence: age (P=.366), sex (P=.415), marital status (P=.514), education (P=.197), occupational status (P=.571), employment type (P=.437), and time since diagnosis (P=.189). Conclusion: The results showed that perceived benefits and barriers within the health belief model had considerable effects on treatment adherence among people with dissociative disorders. Demographic characteristics and other health belief model components did not significantly correlate with compliance. Targeted interventions to strengthen perceived benefits and reduce perceived barriers could enhance adherence in this population. Prim Care Companion CNS Disord 2026;28(2):25m04085. Author affiliations are listed at the end of this article.
Objective: To summarize current evidence on the use of buprenorphine for chronic pain management in individuals with sickle cell disease (SCD) and identify gaps for future research. Data Sources: PubMed, Embase, and Cochrane CENTRAL were systematically searched from database inception through August 2025 using keywords related to buprenorphine, SCD, chronic pain, and analgesia. Searches were limited to human studies published in English. Study Selection: Seven studies were included involving pediatric or adult patients with SCD treated with buprenorphine for chronic pain. Eligible studies reported at least 1 patient-centered outcome, including pain severity, opioid utilization, health care use, or quality of life. Included study designs were case reports, case series, observational studies, and qualitative studies. Abstract-only publications and studies not specific to SCD were excluded. Data Extraction: Two reviewers independently extracted data using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines, with discrepancies resolved by consensus. Data Synthesis: A descriptive synthesis was performed. Most studies evaluated buprenorphine initiation using microinduction strategies. Buprenorphine was generally well tolerated and associated with reduced full opioid agonist use, fewer emergency department visits and hospitalizations, and improvements in functional outcomes and patient-reported autonomy. Study heterogeneity and small sample sizes limited comparative analysis. Conclusions: Available evidence suggests that buprenorphine may be a safe and effective option for chronic pain management in SCD. Larger prospective studies with standardized induction protocols and validated outcome measures are needed to guide clinical practice. Prim Care Companion CNS Disord 2026;28(3):25r04126. Author affiliations are listed at the end of this article.
Objective: To identify the readability levels of measures used in assessing psychosis. Methods: Measures were identified through a literature search. Fourteen measures met the inclusion criteria (written in English, developed in the US between 1997 and 2024, and publicly available) and were analyzed using 4 validated formulas: Gunning Fog, Simple Measure of Gobbledygook, FORCAST, and Flesch Reading Ease Score. Measures with an average readability score exceeding 6.00 were above the recommended reading level. Results: All measures exhibited mean readability scores above the recommended sixth-grade level. The mean reading levels of the instruction and item sections were 9.08 (SD=1.44, range, 7.13-10.70) and 9.06 (SD=1.98, range, 7.08-13.79), respectively. Conclusion: The findings indicate that measures used in assessing psychosis are written above the recommended reading levels and do not conform to suggested standards. The study highlights a significant gap in the readability of psychosis assessment measures, emphasizing the need for improvements to ensure accurate symptom assessment and effective treatment monitoring for individuals with psychotic disorders. Prim Care Companion CNS Disord 2026;28(3):25m04077. Author affiliations are listed at the end of this article.
Importance: Daily fantasy sports (DFS) have rapidly become a major component of the global gambling industry, with platforms offering users the opportunity to draft fantasy teams and compete for real monetary rewards based on real-world sports performance. This article compares India's DFS expansion with current US trends, examining regulatory environments, market dynamics, and mental health implications. Emphasis is placed on vulnerable groups, including adolescents, individuals with preexisting psychiatric conditions, and populations with socioeconomic disadvantage. The analysis explores pathways linking DFS engagement to addiction risk and related psychological harms, with attention to contextual cultural factors. Observations: Evidence from India indicates that DFS participation can escalate involvement in additional betting activities and contribute to mental health problems such as compulsive gambling behaviors, anxiety, and stress-related disorders. These patterns offer insights for US policymakers and public health stakeholders as they respond to the rapid growth of online sports wagering. Cross-national differences in cultural attitudes, regulatory enforcement, and media integration are examined to identify strategies with potential for effective adaptation. Conclusions: The findings underscore the need for evidence-based regulatory approaches, targeted public health interventions, and culturally tailored awareness initiatives to mitigate gambling-related harms in both countries. Recommendations are provided to guide policymakers, clinicians, and industry stakeholders in protecting vulnerable populations amid the continued expansion of DFS and online sports betting. Prim Care Companion CNS Disord 2026;28(3):25nr04142. Author affiliations are listed at the end of this article.
Background: To compare the severity of alcohol craving between euthymic patients with unipolar and bipolar disorders and comorbid alcohol use disorder (AUD) and to explore associations between craving severity and clinical and biological markers, including carbohydrate-deficient transferrin (CDT) and homocysteine, to better characterize diagnostic-specific patterns of dual diagnosis. Methods: This cross-sectional study assessed 50 euthymic outpatients with comorbid AUD and either major depressive disorder (MDD) or bipolar disorder. Participants were evaluated using the Alcohol Use Disorder Identification Test (AUDIT), Visual Analog Scale (VAS) for craving, and blood biomarkers including homocysteine and CDT. Group differences and correlations between craving severity and clinical/biological variables were analyzed. Participants were consecutively recruited over a 12-month period, from June 2015 to May 2016. Results: Patients with AUD and MDD reported significantly higher alcohol craving (VAS), AUDIT scores, and CDT levels than those with AUD and bipolar disorder. In both groups, alcohol craving positively correlated with AUDIT scores, CDT levels, and plasma homocysteine concentrations. No significant associations were found with sociodemographic variables. Conclusions: Patients with AUD and MDD may represent a more severe clinical subtype of dual diagnosis. Elevated homocysteine may serve as a potential biomarker for craving intensity and mood instability. These findings support the need for integrated, personalized treatment approaches in dual-diagnosis populations. Prim Care Companion CNS Disord 2026;28(2):25m04123. Author affiliations are listed at the end of this article.
Objective: To determine the prevalence of generalized anxiety disorder (GAD) in patients (aged 18-86 years, not under treatment, and with no prior diagnosis of GAD) attending an underserved primary care outpatient clinic in Higuerote, Venezuela, between October and December 2023. Methods: A descriptive, cross-sectional, quantitative, population-based study was conducted. Data were collected via a 49-item closed-question survey that included the Hamilton Anxiety Rating Scale, Perceived Stress Scale, and 16 author-designed yes/no questions on GAD-related risk factors. Statistical analysis was performed using SPSS V26; P < .01 was considered statistically significant. Results: The study included 440 patients (mean age of 33.8± 15.3 years; 70.2% female); 50.0% of participants presented with mild anxiety, 6.0% with mild-to-moderate anxiety, and 44.0% with moderate-to-severe anxiety. Psychosocial stress, reported by 299 patients (67.9%), was strongly associated with anxiety severity (odds ratio [OR] =124.6; 99% CI, 29.3-529.6; P<.001). Among those with moderate-to-severe anxiety, 85.7% (n=192; OR= 641.0; 99% CI, 138.5-2,966.8; P<.001) reported anxiety episodes, and 90.0% (n= 180; OR= 74.9; 99% CI, 30.2-185.7; P<.001) reported panic attacks. Alcohol consumption (71.8%, n=316) was significantly associated with anxiety severity (P<.001). Family history of anxiety (60.0%, n=264) and depression (51.8%, n=228) were also significantly associated with anxiety severity (P<.01). While SARS-CoV-2 was infection was significantly associated with anxiety severity (OR=1.9; 99% CI, 1.2-3.1; P<.001), history of traumatic brain injury was not (P = .12). Conclusions: This study revealed a statistically significant high prevalence of GAD in the underserved population of Higuerote, Venezuela. These results show the need for updated mental health epidemiologic data, surveillance, and individualized community-based strategies in disadvantaged/marginalized populations, by empowering local psychiatric workforces through data-driven, context-specific care initiatives.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(2):25f04076. Author affiliations are listed at the end of this article.
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