Opparounds

Cognitive, Electrophysiological, and Behavioral Presentation of First-Episode Psychosis With or Without Cannabis Exposure

D'Souza DC, Cortes-Briones J, Raj J, et al. · American Journal of Psychiatry · June 2026

This prospective study compared 66 hospitalized men with new-onset, cannabis-associated psychosis (CAP) to 53 with non-cannabis-associated psychosis (NCAP), assessing cognition, EEG, and mood/psychosis symptoms at admission and after four weeks of standardized inpatient treatment. The two groups had equivalent cognitive scores at baseline, but the CAP group went on to show significantly greater cognitive improvement over four weeks despite starting from the same point. CAP patients also presented with fewer negative symptoms but more depressive and manic symptoms than NCAP patients, and their EEG showed a distinctly higher power-spectral-density exponent, a proxy for cortical excitatory/inhibitory balance.

In a small follow-up subgroup, relapse tracked tightly with cannabis resumption and was rare among those who stayed abstinent.

Read the paper →  doi:10.1176/appi.ajp.20250726

Implications of the 2026 Dyslipidemia Guideline for Primary Prevention Statin Therapy

Anderson TS, Wilson LM, Sussman JB · JAMA · July 2026

Using NHANES data on 4,366 adults aged 30-79 without known cardiovascular disease, this cross-sectional analysis modeled how the 2026 ACC/AHA multisociety dyslipidemia guideline changes statin eligibility compared with the 2018 guideline. By broadening risk assessment from ages 40-75 to 30-79 and extending the risk window beyond ten years, the new guideline makes an estimated 87.5 million adults (56.6%) eligible for statin therapy, including 21.5 million newly eligible patients who are, on average, younger and lower-risk (mean 10-year ASCVD risk 3.1%) than those already eligible under the old criteria.

Read the paper →  doi:10.1001/jama.2026.11246

Your ECT anesthetic choice is titrating the seizure, not just the sleep

Methohexital is the default ECT anesthetic because it is nearly seizure-neutral, but the alternatives are a real clinical lever, not just an anesthesia-team preference. Propofol raises seizure threshold and shortens seizure duration and quality through its GABAergic, anticonvulsant action — useful for hemodynamic stability or postictal agitation, costly when you're already fighting a high threshold (elderly patients, right unilateral placement, benzodiazepines on board). Etomidate does the opposite: it lowers seizure threshold and prolongs seizures, which is why it's the rescue anesthetic when methohexital or propofol keeps producing subtherapeutic seizures despite maximal stimulus dosing.

The tradeoff is real — etomidate causes more myoclonus, longer emergence, injection pain, and transient adrenocortical suppression with repeated exposure, so it functions as a bridge, not a default. In practice: if seizure adequacy is marginal on methohexital, switching anesthetics before escalating stimulus intensity is often the more elegant fix — and it's worth naming to the anesthesiologist explicitly, since the anesthetic is a variable you control, not a fixed input.

Guilt replacing blame is the signal, not a symptom to fix

Klein's shift from the paranoid-schizoid to the depressive position isn't textbook trivia — it's a marker you can track session to session in an advanced patient's material. Early in treatment, a bad object is simply bad: the mother was cold, the partner is selfish, the pain came entirely from outside. Movement toward the depressive position shows up as guilt replacing blame — the patient starts to notice their own contribution and worry about damage done to someone they also love.

This guilt is not the same as persecutory shame; it's concern-based, and it's evidence the patient can now hold a whole object — good and disappointing in the same person — instead of splitting them apart. The technical trap is treating that guilt as distress to soothe. Premature reassurance collapses the achievement back into denial before the patient has had a chance to metabolize it.