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A central goal of neuroscience is to advance knowledge of the molecular basis of human brain function. Most molecular studies of the human brain have been performed using tissue from postmortem brain donors rather than living people. The assumption underlying this practice – which had never been rigorously tested prior to this report – is that the postmortem human brain is an appropriate proxy for the living human brain at the molecular level. Here, this assumption is thoroughly challenged for the first time by comparing human prefrontal cortex gene expression between 275 living samples and 243 postmortem samples. Vast differences in gene expression were found between the living and postmortem human brain. Expression levels differed significantly for nearly 80% of genes, and this finding was not a consequence of any potential technical or biological confounders of the gene expression data. Postmortem brain gene expression signatures of Alzheimer’s disease, schizophrenia, Parkinson’s disease, bipolar disorder, and autism spectrum disorder were shown to be inaccurate representations of disease processes occurring in the living brain. In light of these findings, the use of postmortem tissue as a proxy for living tissue in human brain research should be reconsidered. To advance knowledge of the molecular basis of human brain function, the study of tissue from living people should be prioritized.

Clinicians’ emotional responses to suicidal patients can be a clinically useful source of information when determining a patient’s level of suicide risk. Although clinicians’ emotional responses to suicidal patients have been largely overlooked in research and practice, a growing body of evidence suggests that clinicians exhibit unique patterns of emotional reactions to suicidal patients that are linked to clinician decision-making and prospective suicidal outcomes. This chapter reviews the extant literature on the association between clinicians’ emotional responses in interaction with suicidal patients and patients’ future suicidal behavior. Underlying mechanisms of clinicians’ emotional responses, common defense mechanisms in psychotherapy with suicidal patients, and the meaning of different patterns of clinician emotional responses are discussed and illustrated by clinical cases. Additionally, the use of clinicians’ emotions as diagnostic tools for assessing imminent suicide risk is described. The chapter outlines a self-assessment framework, which includes guidelines for appraising one’s subjective emotional response and incorporating it into formulating a patient’s suicide risk. A practical method for assessing one’s emotional response is provided with relevant clinical cases illustrating its implementation in clinical assessment.

Stressful life events are critical precipitants of suicidal thoughts and behaviors and play a central role in triggering the onset of acute suicidal states. This chapter reviews the evidence to date for various types of stressors that have been linked to suicidal thoughts and behaviors. Six broad categories of stressful life events are examined: work and financial hardship, relationship conflict, serious medical illness, serious mental illness, recent substance misuse, Internet and social media use, and the COVID-19 pandemic. While the literature discussed in the chapter largely includes adult samples, stressful life events shown to be uniquely related to suicide in adolescents, such as conflict with parents, ongoing childhood neglect, and bullying, are also examined throughout the text. Case examples are provided throughout the chapter to illustrate the role of stressful life events in conferring increased suicide risk.

The COVID-19 pandemic has and continues to have an impact on all areas of society, daily life, and health care, and it will have a major impact on the way health care will function beyond this public health crisis. For psychiatry, it also raises the fundamental question of how it could contribute to the response and redefine its role in medicine during changing conditions. Psychosocial care not only may help people cope with stressors such as loss and violence but also can help communicate public health measures to vulnerable populations in a way that is more easily accessible and comprehensible. Psychosocial care is of great importance in the field of prevention, protecting the most vulnerable and strengthening resilience.

Purpose of the review To assess the current state of the opioid overdose crisis along three major axes: drug markets and patterns of use, the effectiveness of systems of care, and international developments. Recent findings Overdose is a major contributor to mortality and disability among people who use drugs. The increasing number of opioid overdoses in North America especially is an indication of changing drug markets and failing regional systems of care. Globally, we see three clusters of overdose prevalence: (1) a group of countries led by the United States with historically high rates of opioid overdose, (2) a group of countries with increasing rates within a concerning range, (3) a group with very low rates. The contamination of street drugs, the quality and accessibility of treatment, and the overall system of care all contribute to the prevalence of overdose. Summary Drug markets and pattern of consumption in parts of the world are shifting towards contamination and opioids like fentanyl as the drug of choice, which dismantles insufficient and largely ineffective systems of care. Furthermore, outside of North America, more countries like Estonia, Lithuania, Sweden, Finland, and Norway show very concerning numbers. Without a consistent system response, effects will be devastating.

Background: There is a knowledge gap in systematic reviews on the impact of opioid agonist treatments on mental health.Objectives: We compared mental health outcomes between different opioid agonis...

ObjectiveThere is a dearth of high-quality systematic evidence on the impact of opioid substitution medications on mental health. We compared mental health outcomes between opioid medications and placebo/waitlist, and between different opioids.MethodsThis systematic review and meta-analysis of randomized clinical trials (RCTs) was pre-registered at PROSPERO (CRD42018109375). Embase, MEDLINE, PsychInfo, CINAHL Complete, and Web of Science Core Collection were searched from inception to May 2020. RCTs were included if they compared opioid agonists with each other or with a placebo/waitlist in substitution treatment of patients with opioid use disorder, and reported at least one mental health outcome on a span of more than 1-month post baseline. Studies with psychiatric care, adjunct psychotropic medications, or unbalanced psychosocial services were excluded. Primary outcomes were comparison of depressive symptoms and overall mental health between opioids and placebo/waitlist. Random effects model was used for all the meta-analysis.ResultsNineteen studies were included in the narrative synthesis and 15 in the quantitative synthesis. Hydromorphone, diacetylmorphine (DAM), methadone, slow-release oral morphine, buprenorphine, and placebo/waitlist were among the included interventions. Based on network meta-analysis for primary outcomes, buprenorphine (SMD (CI95%)= −0.61 (−1.20, −0.11)), DAM (−1.40 (−2.70, −0.23)), and methadone (−1.20 (−2.30, −0.11)) were superior to waitlist/placebo on overall mental health. Further direct pairwise meta-analysis indicated that overall mental health improved more in DAM compared to methadone (−0.23 (−0.34, −0.13)).ConclusionsIt appears that opioid medications improve mental health independent of psychosocial services. Potential contribution of other factors needs to be further investigated.

Summary Early intervention approaches are built on the premise of preventing disability, burden, and cognitive sequelae caused by bipolar disorder. The objective of this systematic review was to characterise the effectiveness of all the available psychological and pharmacological treatments for early intervention in people at high risk of developing bipolar disorder. The study was registered with PROSPERO (CRD42019133420). We did a systematic search to identify studies published in ten databases up to March 27, 2020. Randomised controlled trials and cohort studies that assessed the effect of pharmacological or psychological interventions in people at high risk of developing bipolar disorder were included. Studies of first episodes of mania were excluded. Eligible papers were assessed for quality and data were extracted. The primary outcomes were change in manic and depressive symptoms from baseline to endpoint. Of the 2856 citations retrieved by our search, 16 studies were included; five evaluated pharmacotherapeutic strategies (three randomised controlled trials and two open-label studies), ten assessed psychotherapeutic strategies (four randomised controlled trials and six open-label studies), and one randomised controlled trial assessed combination therapy; these 16 trials included a total of 755 participants at high risk of developing bipolar disorder. Quality assessment indicated fair to good quality for open-label studies, and a high risk of bias in four randomised controlled trials. Among the pharmacotherapeutic interventions, there is preliminary support for the efficacy of aripiprazole in reducing mood symptoms in people at high risk of developing bipolar disorder. Psychological interventions were effective for various outcomes. There was substantial methodological heterogeneity across studies. This systematic review underscores the need for multicentre, prospective, methodologically homogeneous studies evaluating conversion to bipolar disorder as an outcome measure.

Supplemental material, Checklist for Vortioxetine as adjunctive therapy to risperidone for treatment of patients with chronic schizophrenia: A randomised, double-blind, placebo-controlled clinical trial by Ehsan Mozen-Zadeh, Samaneh Bayanati, Kimia Ziafat, Farzin Rezaei, Bita Mesgarpour and Shahin Akhondzadeh in Journal of Psychopharmacology