The edition · Psychiatry
Anxious distress, and the subgroup that gained most from augmentation
A post hoc look at adjunctive lumateperone found the effect nearly twice as large in patients with anxious distress. Plus what a 12-year psychosis follow-up says about the first three years, trauma-focused therapy in low-income settings, and why half the mental health apps you recommend will be gone in two years.
The edition in brief
Today's psychiatry edition leads with an exploratory post hoc analysis of a phase 3 trial of adjunctive lumateperone 42 mg in major depressive disorder with inadequate response to one or two antidepressants. Of 481 patients, 43% met DSM-5 criteria for anxious distress. In that subgroup the difference from placebo on MADRS total at day 43 was -6.8 points (95% CI -9.00 to -4.51, effect size 0.85); in those without anxious distress it was -3.5 (-5.47 to -1.58, effect size 0.44). GAD-7 improved significantly only in the anxious distress group. This is a subgroup analysis of a positive trial, not a separate trial, but the specifier is easy to record and may help decide who to augment. A 12-year follow-up of a first-episode psychosis trial followed 148 patients, 106 to the endpoint. Latent growth mixture modelling of social-occupational functioning over the first three years produced four trajectories; more than a quarter fell into a persistently poor class, which predicted worse function at 12 years. Baseline negative symptoms distinguished it. A Bayesian meta-analysis of 55 randomised trials and 5,041 adults in low- and middle-income countries found large effects for psychosocial interventions on PTSD symptoms (between-group g = -1.31, 95% CrI -1.66 to -0.95), sustained at follow-up, largest when trauma-focused and delivered face to face. A mega-analysis of 1,189 participants links antipsychotic non-response to raised medial frontal glutamate, choline and myo-inositol. And a five-year survival analysis of 865 mental health apps found 53.6% were withdrawn.
Anxious distress marks out who gained most from adjunctive lumateperone
Apply the DSM-5 anxious distress specifier when deciding whether to augment, and expect a larger gain in those who meet it.
The first three years of function in psychosis still predict the twelfth
Score social-occupational function at set points in the first three years of psychosis, because that trajectory is what predicts the twelfth.
Trauma-focused therapy holds up in low- and middle-income settings
Where PTSD treatment capacity is limited, spend it on trauma-focused, face-to-face work rather than generic counselling.
Antipsychotic non-response tracks with raised medial frontal glutamate
Treat this as support for glutamate and inflammatory treatment targets in non-responsive psychosis, not as a reason to image anyone.
Check the app you recommend runs on both platforms
Before you name an app in clinic, confirm it exists on both platforms — single-platform apps are twice as likely to disappear.
Over half the mental health apps in a curated database were gone within five years
Recommend mental health apps from a maintained, cross-platform-checked list, and ask at follow-up whether it still exists.
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