Long-term remission following esketamine nasal spray sessions in a patient with severe and highly treatment-resistant depression: a single-case report

Transdiagnostic Effects of Schizophrenia Polygenic Scores on Treatment Outcomes in Major Psychiatric Disorders

Schizophrenia polygenic risk scores (SCZ PRS) have emerged as important tools for modulating factors not only in schizophrenia but also in major psychiatric disorders, such as major depression (MDD) and bipolar disorder (BD). Initially developed to capture the common variant risk for SCZ, accumulating evidence highlights the transdiagnostic impact of SCZ PRS on clinical severity, treatment response, and functional outcomes. This review synthesizes recent findings on the relationship between SCZ PRS and treatment outcomes across SCZ, BD, and MDD. A higher SCZ PRS is associated with poorer treatment outcomes, including treatment resistance or non-remission to antidepressants in MDD, reduced antipsychotic response in SCZ, and diminished lithium efficacy in BD. SCZ PRS is also linked to persistent negative symptoms, cognitive impairments, and long-term illness severity in SCZ. While the effect sizes are generally modest, integration of SCZ PRS with environmental factors, multiomics, and neuroimaging may enhance predictive accuracy. Despite variability in reported associations, the overarching evidence supports a transdiagnostic influence of SCZ PRS on disease trajectories and treatment responses. As a promising component of precision psychiatry, SCZ PRS holds potential for guiding more targeted and effective interventions. Future research should focus on combining SCZ PRS with multimodal approaches to fully realize its clinical utility.

Anhedonia: Current and future treatments

Anhedonia is a transdiagnostic domain that leads to poor disorder outcome and low remission rates. This narrative review describes a broad range of interventions targeting anhedonia, including pharmacological, neuromodulatory, behavioral, and lifestyle-based approaches. Drugs such as vortioxetine, agomelatine, bupropion, ketamine, and brexpiprazole show promising anti-anhedonic effects, while traditional antidepressants, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and, even more so, selective serotonin reuptake inhibitors (SSRIs), are less effective. Neuromodulation techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous auricular vagus nerve stimulation, proved effective at improving anhedonia, particularly when used in targeted areas. Psychotherapeutic interventions, including behavioral activation, mindfulness-based strategies, and savoring techniques, also help re-engage patients with pleasurable activities and enhance positive affect. Innovative treatments, such as aticaprant and psilocybin, showed promising results. Substantial evidence suggests that improving anhedonia leads to better psychosocial functioning, quality of life, and sustained remission. Although most data come from short-term studies, several long-term analyses suggest that maintaining hedonic improvements is feasible and beneficial. The reviewed evidence underscores the importance of routine assessment of anhedonia and the integration of symptom-specific strategies. Tailoring interventions to address individual patterns of reward disruption may optimize outcomes for patients with anhedonia.