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Real-world effectiveness of medication-assisted treatment and psychotherapy for opioid use disorder: a national multi–health care organization analysis

BackgroundHarm reduction strategies for opioid use disorder (OUD) emphasize pragmatic, evidence-based approaches that reduce overdose risk, relapse, and other adverse outcomes without requiring abstinence. Medication for opioid use disorder (MOUD) and structured psychotherapy represent core harm-reduction modalities, yet their real-world comparative effectiveness, alone and in combination, remains underexplored at scale.MethodsA retrospective cohort study was conducted using the TriNetX Research Network, comprising de-identified electronic health records from 112 U.S. health systems. 18,047 adults aged 18–45 were identified with a diagnosis of opioid dependence (ICD-10 F11.20) between 2016 and 2025. Subjects were assigned to eight mutually exclusive treatment cohorts: no treatment (Cohort 1); buprenorphine alone (Cohort 2); methadone alone (Cohort 3); psychotherapy alone (30 minutes (Cohort 4), 45 minutes (Cohort 5), or 60 minutes (Cohort 6)); buprenorphine + psychotherapy (Cohort 7); and methadone + psychotherapy (Cohort 8), with combination treatments defined within a ±30-day window. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for remission (F11.21, F11.11) within 12 months.ResultsBuprenorphine (aHR = 2.33; 95% CI: 1.85–2.94), methadone (aHR = 2.50; 95% CI: 2.05–3.04), and psychotherapy (30 min: aHR = 2.18; 45 min: aHR = 2.38) were each independently associated with significantly higher remission compared to no treatment. The combination of buprenorphine + psychotherapy yielded the strongest effect (aHR = 5.26; 95% CI: 2.68–10.32). Anxiety diagnoses and gabapentinoid prescriptions were positively associated with remission; benzodiazepine co-prescription was negatively associated.ConclusionsIn this first national-scale, multi–health-care-organization analysis, both pharmacologic and psychosocial harm-reduction interventions were independently associated with improved OUD remission, with additive benefit when integrated. These findings underscore the value of embedding comprehensive, multimodal harm-reduction services within routine care and support policies promoting equitable access to both MOUD and behavioral health supports across diverse health systems.
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A prospective cohort study on the incidence and influencing factors of subsyndromal delirium in ICU patients

BackgroundThis study aims to develop and validate a machine learning-based risk prediction model for subsyndromal delirium (SSD) in ICU patients, while identifying key risk factors.MethodThis study was a prospective study, selecting patients who were hospitalized in the ICU from October 2024 to May 2025. We compared seven machine learning algorithms: Random Forest (RF), Decision Tree (DT), K-Nearest Neighbor (KNN), Logistic Regression (LR), Elastic Network (EN), Extreme Gradient Enhancement (XGB), and Support Vector Machine (SVM).ResultIn our study, the prevalence rate of SSD was 37.158%. The comparative analysis shows that XGB is the best predictive model (AUC = 0.84). Feature importance analysis identified four significant predictive factors: Use of vasoactive drugs (0.412), Monthly household income (0.306), Undergone surgery (0.191) and Number of Medications (0.036).ConclusionThe prediction model based on XGB has a good effect in identifying the risk of SSD in ICU patients. These findings enable clinicians to stratify high-risk groups and implement timely and targeted intervention measures, effectively reducing the risk of adverse consequences. Future multicenter studies should validate these results in larger cohorts.
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Human Ventral Tegmental Local Field Potentials in Treatment-Resistant Depression and Obsessive-Compulsive Disorder

The ventral tegmental area (VTA) is a key node within the limbic circuitry. Through dense dopaminergic, glutamatergic, and GABAergic projections, the VTA forms reciprocal loops with prefrontal and limbic cortices that are consistently implicated in major depressive disorder (MDD) and obsessive–compulsive disorder (OCD) (1,2). Decades of animal research have established the VTA as a central hub for motivational drive and reward prediction error signaling (3,4). Despite its presumed critical role in mental disorders, direct electrophysiological recordings from the human VTA have so far remained absent.

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The Biological Psychiatry Family of Journals Is Rewarding Its Reviewers

The Biological Psychiatry family of Journals (Biological Psychiatry (BPS); Biological Psychiatry: Cognitive Neuroscience and Neuroimaging (BP:CNNI); Biological Psychiatry: Global Open Science (BP:GOS) is pleased to announce a new program that, beginning this year, will both recognize and reward our most productive reviewers. This reward system was developed in collaboration with the leaders of the Society of Biological Psychiatry (SOBP) and is underwritten by the Society. We are initiating this program with no changes to publication fees for authors who publish in our Journals and without increasing the cost of SOBP membership.