Opparounds

Psychological and Psychosocial Interventions for People With Schizophrenia and Co-Occurring Substance Use Disorders: A Systematic Review and Meta-Analysis

Nurul Husna Salahuddin, Emilia Herlitzius, Alexandra Schütz, Spyridon Siafis, Josef Priller, Stefan Leucht, Irene Bighelli · JAMA Psychiatry · February 2026

This systematic review and random-effects meta-analysis pooled 35 randomized trials (4,136 participants) testing psychological and psychosocial interventions against control conditions in adults with schizophrenia and a co-occurring substance use disorder; 29 trials with 3,831 participants contributed to the pairwise meta-analyses.

Across the pooled trials, these interventions produced only a very small effect on overall psychiatric symptoms and did not significantly reduce substance use overall. The one consistent exception was nicotine, where adjunctive psychosocial treatment showed a small but real benefit; alcohol, cannabis, amphetamine, and other stimulant use showed no significant effect.

Read the paper →  doi:10.1001/jamapsychiatry.2025.4390

Patients' Perspective on an Optimal Therapeutic Alliance; Facilitating Engagement in Treatment of Antisocial Personality Disorder

Janneke E.M. Aerts, Madeleine J.N. Rijckmans, Stefan Bogaerts, Arno Van Dam · Psychotherapy Research · March 2026

This qualitative study conducted in-depth interviews with 15 patients diagnosed with antisocial personality disorder in forensic and clinical mental-health settings, asking them directly what helped and hindered them in forming a working alliance with a therapist. Reflexive thematic analysis produced seven themes across two categories: "facilitators," reflecting therapist attitudes that matched what these patients said they actually needed, and "barriers to engage," describing what got in the way.

Patients consistently favored a client-centered, genuine, non-judgmental therapist who could convey warmth while still holding a firm, clear structure — not a permissive stance, and not a purely confrontational one. The study is a direct patient-perspective counterpart to the same research group's 2023 study of therapists' views on the identical question.

Read the paper →  doi:10.1080/10503307.2026.2634080

Tardive dyskinesia treatment has its own CYP2D6 problem

The two VMAT2 inhibitors approved for tardive dyskinesia, valbenazine and deutetrabenazine, both depend heavily on CYP2D6 for their active-metabolite handling, and that dependency changes dosing in ways that aren't obvious at a glance.

Valbenazine's active metabolite is a CYP2D6 substrate: in poor metabolizers, exposure rises enough that the maximum recommended dose is capped lower than for normal metabolizers, and a strong CYP2D6 inhibitor — bupropion, fluoxetine, paroxetine — does the same thing pharmacologically, phenocopying a poor metabolizer even in a patient whose own genotype is normal. Deutetrabenazine is handled differently: deuterium substitution slows CYP2D6-mediated clearance of its active metabolites just enough to allow twice-daily instead of three-times-daily dosing, but it still needs its own, different dose ceiling when combined with a strong CYP2D6 inhibitor. The practical implication is that these two drugs do not share a dosing ceiling with each other — before titrating either one in a patient already on a strong CYP2D6 inhibitor for depression, check the interaction table for that specific drug rather than assuming the two behave alike.

The downward arrow finds the belief the thought record can't touch

A thought record that stays at the level of the automatic thought — "I'll fail the exam," "she thinks I'm incompetent" — can produce a technically correct, well-evidenced disputation that still doesn't move the patient, because the automatic thought was never the thing doing the work. A core belief underneath it was.

The downward arrow technique asks, of any automatic thought, "if that were true, what would it mean about you?" — then asks the same question of the answer, repeatedly, until the patient reaches a global, trait-level statement about self, others, or the world that no longer sounds situation-specific. That statement is the actual treatment target. Restructuring the surface thought without reaching it produces symptom relief that plateaus and often relapses under the next stressor that touches the same underlying belief.