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Over the past 20 years, there has been increasing recognition that certain psychiatric diagnoses increase violence risk. This increase is nuanced, multifactorial, and variable. The risk attributable to serious mental illness accounts for only a small fraction of violent acts. There is much more impact from other risk factors, such as substance misuse. Many such factors increase risk, regardless of psychiatric diagnosis. Some factors are uniquely associated with psychiatric populations, such as a history of suicide attempts, antipsychotic medication nonadherence, and past hospitalizations. This article details recent data on violence risk factors and protective factors for psychiatric populations.
Gender-affirming care (GAC) improves the mental health and well-being of transgender and gender-diverse people. In January 2025, the Trump administration announced major National Institutes of Health (NIH) grant terminations, specifically aimed at defunding research related to transgender populations. To examine the scope, timing, and financial impact of NIH GAC grant terminations. This was a cross-sectional study of terminated and active federal research grants administered by the NIH, identified through the Grant Witness and NIH RePORTER databases. Inclusion criteria required that grants involve GAC outcomes or research related to its access or provision. Data were collected on May 12, 2025, and included funding status, dates of termination, and grant characteristics. Termination of NIH grants related to GAC. Primary outcomes included the number and proportion of terminated grants, total funding lost, date of termination, and study focus. Of 64 identified NIH grants related to GAC, 41 (64.1%) were terminated within a 3-week span ranging from March 3 to March 21, 2025. Among these terminated grants, 46.9% of their combined funding remained unspent at the time of cancellation, amounting to nearly $22 million lost in research dollars. Of the research topics that were terminated, the largest proportion focused on the interaction of GAC with physical health conditions (eg, breast cancer, HIV, cardiovascular outcomes). Findings of this study illustrate the scope and depth of a targeted disruption to a vital area of scientific inquiry and health equity, emphasizing the need for insulated funding streams to preserve ongoing GAC research.
Psilocybin, lysergic acid diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA) have remerged as agents of psychiatric and cultural relevance. However, public discourse has outpaced empirical understanding of their effects. Although hallucinogens have demonstrated a potential to treat certain mental disorders, their effect on aggression and violence risk remains inconclusive. This article reviews the historical, medical, legal, and cultural contexts of these popular psychedelic and entactogenic compounds. The impact of substance type, dose, set and setting, psychiatric comorbidity, and environmental factors on violence is reviewed. Prevention and response strategies relevant to hallucinogenic compounds are discussed, including harm reduction, risk assessment, and treatment. Individual risk factors that mediate violence risk for people who consume psilocybin, LSD, and MDMA remain an area for further research.
Mothers and fathers kill their children at similar rates, making filicides (child murders by parents) unique among homicides. In this article, the authors focus on maternal mental illness, child maltreatment, and homicide. Nearly all neonaticides (murder in the first day of life) are committed by young women acting alone. Most filicides in the general population are due to fatal child maltreatment; however, among perpetrators who are found legally insane, altruistic motives predominate. Mental illness intersects with the phenomena of neonaticide and filicide. Personality disorders, untreated mental illness, poor attachment, and substance use disorders may elevate risk. Filicide and child maltreatment are relevant to psychiatrists because they may coexist with mental illnesses. Psychiatrists, both in reproductive psychiatry and general psychiatry, should carefully consider risks and resources for their patients who are parents.
As social media becomes increasingly intertwined with everyday life, psychiatrists face new ethical challenges when navigating patients' online presence. Although patients' social media can offer valuable collateral information for psychiatrists, especially in high-risk or unclear clinical situations, accessing this content without consent risks undermining trust, breaching boundaries, and introducing bias. To preserve the therapeutic alliance in an evolving digital age, the field of psychiatry must establish clear, ethically grounded guidelines for when and how to engage with patients' social media. The objectives of this article are to explore the ethical, clinical, and legal implications for psychiatrists when accessing patients' social media, and to propose strategies for integrating digital boundaries into psychiatric practice.
Sexual violence among adolescents and adults is a significant health and safety issue. Identifying and mitigating risk factors for sexual violence perpetration is central to preventing these acts before they occur. Substantial work has examined the risk for recidivism among known sexual offenders. To complement that work, this literature synthesis focuses on risk indicators among nonadjudicated and first-time adolescent and adult perpetrators. This synthesis is intended to support clinical practice by providing an overview of the magnitude, burden, and developmental course of sexual violence victimization and perpetration. Across rigorous studies, strong support suggests that adversity or abuse during childhood, perpetration during adolescence, fraternity membership, unhealthy peer norms, and peer approval for sexual violence during college-paired with impulsivity and/or a hostile view of women-are associated with a higher likelihood of sexual violence perpetration. Risk for perpetration can be offset by providing social support and parental monitoring and by increasing empathy during adolescence. In addition, variation in perpetration patterns over time exists, suggesting the need for developmentally focused prevention approaches.
The nexus between mental disorder and terrorism has long confounded both clinicians and researchers. Data indicate that approximately one-third of lone-actor terrorists will be diagnosed as having a mental disorder on clinical interview, but members of a terrorist group typically have neither more nor less mental disorder diagnoses than the general population. Other notable problems for the psychiatrist are distinguishing between symptoms of mental disorder and extremist beliefs, discerning radicalization and a pathway to violence in a psychiatric patient, and identifying the proximal warning behaviors that suggest a heightened probability of violence toward a targeted individual or group. Steps toward clarification of these various issues through measurement and mitigation of risk are offered.
This review provides an overview and update of empirical evidence for psychologically meaningful dynamic risk factors and protective factors for sexual offending. Using the review by Mann et al. (2010) as a starting point, we reviewed relevant literature that has appeared since this publication, focusing on meta-analyses, systematic and scoping reviews of dynamic risk factors, recent evaluations of commonly used dynamic assessment tools, and studies of dynamic risk and protective factors in community samples in addition to clinical or forensic samples. Two risk factors previously deemed promising by Mann et al. (2010), hostility towards women and dysfunctional coping (conceptualized as hostile masculinity and emotional regulation deficits, respectively, in this review), could now be considered supported using this review's criteria of three or more studies demonstrating an effect size of 0.15 or greater. No new risk factors were identified. We conducted a broader search of protective factors in recognition of the relative newness of this literature: Positive social support was the only protective factor identified as empirically supported. We also discuss situational risk and protective factors. Reprinted from Clin Psychol Rev 2023; 106:102355, with permission from Elsevier. Copyright © 2023.
Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.
Obsessive-compulsive disorder (OCD) is a chronic and disabling condition, often leading to significant functional impairments. Despite its early onset, there is an average delay of 17 years from symptom onset to diagnosis and treatment, resulting in poorer outcomes. This systematic review aims to synthesize current findings on the application of AI in OCD, highlighting opportunities for early symptom detection, scalable therapy training, clinical decision support, novel therapeutics, computer vision-based approaches, and multimodal biomarker discovery. While previous reviews focused on biomarker-based OCD detection and treatment using machine learning (ML), the findings of the current review add information about novel applications of deep learning technology, specifically generative artificial intelligence (GenAI) and natural language processing (NLP). Among the included 13 articles, most studies (84.6%) utilized secondary data analyses, primarily through GenAI/NLP. Nearly 77% of these studies were published in the past two years, with high quality of evidence. The primary focus areas were enhancing treatment and management, and timely OCD detection (both 38.5%); followed by AI tool development for broader mental health applications. AI technologies offer transformative potential for improvements related to OCD if diagnosis occurs earlier after onset; thereby lessening the consequential economic burden. Prioritizing investment in ethically sound AI research could significantly improve OCD outcomes in mental health care. The online version contains supplementary material available at 10.1007/s40501-025-00359-8.
Although the recommended first-line treatment for attention-deficit hyperactivity disorder (ADHD) is medication, poor adherence is still common, particularly in adolescents and young adults (AYAs). This study aimed to adapt Customized Adherence Enhancement (CAE), a psychosocial intervention developed to improve medication adherence in bipolar disorder, to target AYAs with ADHD. Phase 1 included focus groups with AYAs, caregivers, and health care providers who treat AYAs with ADHD (N = 19). Prompts included barriers and facilitators of medication adherence, impact of ADHD, and reasons treatment regimens may be difficult to maintain. Focus groups were recorded, transcribed, and thematically coded. Phase 2 included cognitive interviews with AYAs with ADHD to assess acceptability and usability of the intervention (N = 6). Main themes were AYAs' perception of ADHD and its negative impact on work, sports performance, and interpersonal relationships. Barriers of adhering to medication were limited access, physiological side effects, difficulty following medication routines, and having comorbidities. Facilitators to medication adherence were having more knowledge about ADHD, benefits from medication adherence, and using external prompts. As untreated or undertreated ADHD negatively affects morbidity and functioning, intervening early and at a critical stage of development has the potential to change the long-term outcomes of AYAs with ADHD. Results informed the adaptation of an existing intervention (CAE) to target AYAs with ADHD and can be applied to adherence interventions more broadly.
Borderline personality disorder (BPD) is characterized by a long-term pattern of instability of interpersonal relationships, unstable self-image, marked impulsivity, and/or affective instability. In addition, these features can be evidenced by efforts to avoid real or feared abandonment, chronic feelings of emptiness, mood reactivity, recurrent self-injurious or suicidal behavior, other impulsive behaviors with potential for self-damaging effects, intense anger or difficulty with anger control, and transient paranoid ideation or stress-related dissociative symptoms. BPD is associated with substantial lifetime burdens and psychosocial impairments, including high rates of co-occurring psychiatric disorders; disruptions in interpersonal relationships, school, work, and housing; and suicide attempts and nonsuicidal self-injury. Consequently, early identification and treatment of BPD are crucial. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder aims to enhance knowledge and increase the appropriate use of interventions for BPD, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with BPD. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and ABPN Continuing Certification, Improvement in Medical Practice.
Early life adversity (ELA) disrupts default mode network (DMN) integrity subserving self-referential processes involved in emotional awareness and regulation. Mindfulness training (MT) reduces self-referential processing and down-regulates the DMN. We employed neurofeedback-augmented mindfulness training (NAMT), combining a core mindfulness strategy (focusing on breath) with real-time fMRI neurofeedback (rtfMRI-nf) to modulate DMN by targeting the posterior cingulate cortex (PCC). ELA-exposed (ELA; n = 43) and healthy control (HC; n = 40) adolescents completed a scan with three conditions: (a) Focus-on-breath (MT): rtfMRI-nf was presented as a variable-height bar, and adolescents attempted to lower the bar; (b) Describe: engaging self-referential processing; and (c) Rest. ELA were single-blind randomized to active PCC rtfMR-nf (NF; n = 22) or artificial feedback (SHAM; n = 21). Adolescents reported perceived stress, state mindfulness, and affect at baseline, post-training, and one-week follow-up. General linear models (GLMs) examined group differences (ELA vs. HC; NF vs. SHAM) on neural (MT vs. Describe) and self-report measures. ELA showed greater difficulty in PCC down-regulation relative to HC. For ELA, SHAM evidenced similar PCC down-regulation as active NF. All adolescents reported increased state mindfulness post-training. Relative to HC, ELA reported greater improvements in positive affect, negative affect and stress at follow-up. There was no difference in self-reported measures between active and SHAM. PCC responses in ELA confirm the region's utility as a potential treatment target. NAMT was feasible and acceptable for ELA-exposed adolescents, but may not enhance mindfulness training more than SHAM. Optimal strategies for enhancing PCC regulation in ELA may be elucidated with future research.
Appeared originally in NIJ Research in Action, NCJ 155000, Washington, DC, U.S. Department of Justice, Office of JusticePrograms, National Institute of Justice, 1995
Violence risk assessments are a common and important aspect of mental health professionals' work in a range of settings. Providers must be aware of important components of violence risk assessments, including emerging standards of assessing risk of future harm. This review summarizes generations of risk assessments, factors to consider when choosing a risk assessment instrument, and the use of structured violence risk assessments in different settings.
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De Clérambault Syndrome brought attention to the problem of erotomanic stalkers. Over 100 years later, research has delineated other types of stalkers besides the classic erotomanic type. Before the 1990s, stalking was not clearly recognized as a crime. In the mid-1990s, a surge of valuable research on stalking emerged, resulting in significant advances to the understanding of stalking behaviors and risk assessment. Currently, all 50 states have antistalking statutes. Antistalking laws typically consist of three components: a pattern of unwanted pursuit, an implicit or explicit threat, and an intent to induce fear in the victim. This review covers basic concepts in stalking risk assessment and risk management. The 2023 U.S. Supreme Court ruling in Counterman v. Colorado is discussed, along with its potential to alter many states' legal obligations for the burden of prosecution in stalking cases.