Opparounds

Association of Lithium Use With Suicide and Self-Harm Among Chinese Adolescents and Adults With Bipolar Disorder: A Nationwide Multicenter Retrospective Cohort Study

Xu N, Lv X, Deng Y, et al. · Journal of Clinical Psychiatry · August 2026

This multicenter retrospective cohort study followed 585 adolescents and adults (ages 12-45) with DSM-IV bipolar disorder across 15 psychiatric centers in mainland China, comparing 290 patients who took lithium for at least 80% of the initial six months against 295 non-lithium controls.

At one-year follow-up using the Columbia-Suicide Severity Rating Scale, lithium use was associated with a 43% lower odds of suicidal ideation (aOR 0.57, 95% CI 0.38-0.86) and a 40% lower odds of suicidal behaviors, including preparations and attempts (aOR 0.60, 95% CI 0.39-0.90). Lithium users also scored lower on hostility measures, though nonsuicidal self-injury did not differ significantly between groups.

Read the paper →  doi:10.4088/JCP.25m16219

Anticholinergic Drug Burden and Incident Cardiovascular Events: A Population-Based Study

Zhu N, Eriksdotter M, Shahim B, et al. · BMC Medicine · February 2026

This population-based cohort followed 508,273 Stockholm residents aged 45 and older with no baseline cardiovascular disease for a median of 14 years, tracking cumulative anticholinergic drug exposure with the Anticholinergic Cognitive Burden scale and annual defined daily doses.

Cardiovascular events accrued in a clear dose-response pattern: the highest-exposure group had a 71% higher risk of an incident cardiovascular event than never-users, with the strongest signal for heart failure and arrhythmias. The authors propose the effect runs partly through unopposed parasympathetic withdrawal at the sinoatrial node and myocardium, not through weight or metabolic pathways alone.

Read the paper →  doi:10.1186/s12916-026-04751-w

Fluvoxamine turns clozapine dosing upside down

Fluvoxamine is the most potent CYP1A2 inhibitor in routine psychiatric use, and clozapine is cleared almost entirely by CYP1A2 at baseline. Add a therapeutic dose of fluvoxamine, even 25-50 mg, to a stable clozapine regimen and plasma levels can rise 3- to 10-fold within one to two weeks, because inhibition removes the enzyme handling the bulk of first-pass and systemic clearance.

This is exploited deliberately in patients who can't tolerate clozapine's usual 300-600 mg range: a small fluvoxamine dose lets the clozapine dose drop by roughly half to two-thirds while holding the same plasma level, cutting pill burden and cost. The trade is real, though. Because this is enzyme inhibition rather than induction, any change in fluvoxamine dose, or stopping it, moves clozapine levels within days, not the weeks a change in smoking status would take. Check a level before and about a week after any change to either drug, and keep in mind this interaction runs in the opposite direction from the smoking-cessation clozapine toxicity most residents learn to watch for first.

Splitting doesn't stay in the room — it recruits the whole team

In TFP terms, splitting isn't a psychological event confined to the patient's mind — it's an interpersonal operation that reliably reproduces itself across everyone treating the patient. One nurse experiences the patient as uniquely insightful and easy; another experiences the same patient, the same day, as manipulative and demanding. Neither is wrong about what they're seeing — the patient really is presenting differently to each of them, unconsciously assigning the 'good' and 'bad' halves of an unintegrated internal object to different people so neither half has to be held in mind at once.

The technical error is treating this as a staff disagreement to resolve by comparing notes and deciding who's right. The move is to read the split as data about the patient's internal structure, then bring both halves into the same room — in a team meeting, or verbally, by naming both experiences back to the patient in one session — so the contradiction has to be tolerated rather than distributed.