Opparounds

Adolescent Peers' Diagnoses and Genetic Predispositions and Subsequent Risk of Mental Disorders

Jussi Alho, Mai Gutvilig, Ripsa Niemi, Kaarina Suokas, Kaisla Komulainen, Petri Böckerman, Marko Elovainio, Roger T. Webb, Christian Hakulinen · JAMA Psychiatry · September 2026

This Finnish nationwide register study followed 604,819 people from age 17 (no psychiatric diagnosis at baseline) for a median of nearly 12 years, using school, neighborhood, and small-area networks to define 'peers.' Two separate exposures were tested: a peer's own family-based genetic risk score for mental illness, and a peer's actual diagnosis.

Peer genetic risk predicted the same category of disorder later in the proband — strongest for externalizing disorders in upper secondary school (HR 1.34) — while peer diagnoses themselves predicted internalizing disorders most strongly in that same school context (HR 1.17). Cross-disorder spillover also showed up: peers' externalizing genetic risk raised a proband's odds of an internalizing diagnosis and vice versa, though peer internalizing diagnoses spread to both outcome types while peer externalizing diagnoses mostly stayed within their own lane.

Read the paper →  doi:10.1001/jamapsychiatry.2026.1752

Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial

Charles M. Morin, Colleen Colecchi, Jacques Stone, Rakesh Sood, Debra Brink · JAMA · March 1999

This randomized, placebo-controlled trial enrolled 78 older adults (mean age 65) with chronic primary insomnia and assigned them to 8 weeks of cognitive-behavioral therapy (stimulus control, sleep restriction, sleep hygiene, cognitive therapy), temazepam, both combined, or placebo.

All three active arms beat placebo at the end of treatment, with the combined arm producing the largest reduction in time awake after sleep onset (63.5%, versus 55% for CBT alone and 46.5% for medication alone). The difference that mattered was durability: patients who'd received behavioral treatment — alone or combined — held onto their gains at long-term follow-up, while those treated with temazepam alone did not, and behavioral treatment also scored higher on patient, informant, and clinician satisfaction ratings.

Read the paper →  doi:10.1001/jama.281.11.991

Rifampin Doesn't Just Clear TB — It Can Quietly Clear Your Antipsychotic Too

Rifampin is one of the most potent inducers of CYP3A4 in clinical use, and CYP3A4 handles the primary metabolism of quetiapine, aripiprazole, and — critically — buprenorphine. Induction isn't instant: it takes 1–2 weeks to fully ramp up as the liver synthesizes new enzyme, and just as long to wear off after rifampin stops, so the danger window extends well past the antibiotic course itself.

Quetiapine clearance can increase roughly 5-fold during concurrent rifampin, meaning a stable maintenance dose can become subtherapeutic without any change on the patient's end — the usual presentation is 'relapse' that's actually just an emptied receptor. The same mechanism is why rifampin is a documented cause of precipitated opioid withdrawal in patients on buprenorphine maintenance — not a drug interaction most prescribers think to check when TB treatment starts on someone else's service. Unlike carbamazepine's slower autoinduction, this is fast, potent, and often overlooked, because the inducing drug rarely comes from a psychiatric prescriber's own hand — it shows up on someone else's medication list.

Role Transition Grief Has to Be Mourned Before It Can Be Solved

IPT organizes interpersonal problems into four fixed categories, and role transition is the one clinicians most often rush. The model's own sequencing matters: before any skill-building for the new role, the therapy has to do grief work for the role that was lost — mourning what was good about the old role, and what's genuinely hard about giving it up, not just cheerleading toward the new one.

Skip that step and psychoeducation about the new role lands as minimization; the patient hears 'get over it' underneath the coping strategies. The interpersonal inventory is what locates the transition in the first place — mapping which relationships changed, improved, or disappeared around the transition point — since patients frequently present with mood symptoms and no idea the trigger was a role change at all.