Opparounds

Electroencephalography Microstate Instability and Clinical Outcomes in Individuals at Clinical High Risk of Psychosis

Liebrand M, Hamilton HK, Roach BJ, et al. · JAMA Psychiatry · August 2026

Clinical high-risk (CHR) criteria for psychosis identify people worth watching, but they don't reliably predict who will convert, so this study tested resting-state EEG microstates — brief, sub-second patterns of scalp electrical activity — as a biomarker in the 8-site NAPLS-2 cohort.

Compared with 183 healthy controls, 460 individuals at CHR showed shorter, less stable microstate durations and more frequent switching between them, a signature of reduced temporal stability.

Among the CHR group, the 56 who went on to develop psychosis showed significantly more instability than the 70 who remitted, and greater instability tracked with earlier conversion and more severe positive symptoms.

Counterintuitively, more instability was also associated with better attention scores, suggesting it may partly reflect a compensatory response to cognitive deficits rather than pure pathology.

Read the paper →  doi:10.1001/jamapsychiatry.2026.1084

The Significance of Personality Disorder and Traits in Short-Term Psychodynamic and Cognitive Behavioral Therapy for Major Depression

Wilberg T, Ulberg R, Klungsøyr O, et al. · Frontiers in Psychiatry · April 2026

This Norwegian RCT randomized 100 outpatients with major depressive disorder to 16 weeks of CBT or 28 weeks of short-term psychodynamic psychotherapy (STPP), then asked whether a comorbid personality disorder (28 of 100 patients, by SCID-II) changed which treatment worked better.

It didn't: both treatments produced large, statistically indistinguishable reductions in depression (HDRS, BDI-II) regardless of PD status.

But a specific trait, not the categorical diagnosis, mattered — patients with paranoid traits showed a significant interaction favoring STPP across HDRS, BDI-II, and social-adjustment outcomes (p=.017 to .048).

Read the paper →  doi:10.3389/fpsyt.2026.1789466

Clozapine's deadliest side effect isn't the one you're screening for

Clozapine kills more patients through the gut than through the bone marrow. Gastrointestinal hypomotility — driven by clozapine's potent anticholinergic and antiserotonergic effects on the enteric nervous system — carries a mortality of 15 to 27.5 percent once it progresses to ileus or bowel obstruction, versus 2 to 4 percent for agranulocytosis.

For every 1,000 patients started on clozapine, 300 to 600 will develop constipation, at least four will have a serious complication (ileus, obstruction, ischemia, or perforation), and one will die of it. The trap is that clozapine blunts visceral pain perception along with peristalsis, so patients under-report symptoms until they present with silent, advanced obstruction.

Ask about bowel movements at every visit with the same reflex you use for ANC — no stool in three days should trigger the same urgency as a falling white count. Prophylactic laxative co-prescription at initiation, not after the first complaint, is now standard rather than optional.

Hypermentalizing is confident, articulate, and wrong

MBT names three ways mentalizing fails, and only two get taught well. Psychic equivalence collapses thought and reality; pretend mode floats free of it. The third, hypermentalizing, is easy to miss because it looks like the goal: a patient (or a therapist) produces a fluent, psychologically-sophisticated narrative about someone's motives — confident, detailed, unfalsifiable.

It is mentalizing in form but not in function, because genuine mentalizing tolerates not-knowing and hypermentalizing forecloses it. The technical response is not to argue with the content but to slow down and rewind — stop before the conclusion, and reconstruct the specific moment, expression, or word that supposedly proved it. The move is procedural, not interpretive: you are restoring the process of finding out, not correcting the finding.