The AI Psych Brief

Incidence of systemic physical multimorbidity among people with schizophrenia-spectrum or bipolar-spectrum disorders compared with age-matched and sex-matched individuals in Queensland, Australia: a statewide, hospital cohort study

Halstead S, Warren N, Kisely S, Arnautovska U, Trott M, Correll CU, Ebdrup BH, Heffernan E, Mohr GH, McCutcheon RA, Morley KI, O'Donoghue B, Pillinger T, Sara G, Taipale H, Siskind D · The Lancet Psychiatry · September 2026

Using statewide hospital registries in Queensland from 2000 to 2023, the authors matched 30,189 people with schizophrenia-spectrum or bipolar disorder (median age 32) 1:4 by age and sex with 148,476 hospital comparators, then tracked how many organ systems accumulated chronic physical disease. Rather than counting single diagnoses, the outcome was systemic multimorbidity — the number of distinct body systems affected.

The gap widened as the bar rose: the adjusted subdistribution hazard ratio was 1.85 for at least one affected system but 3.16 for five or more. In absolute terms, by 20 years there were about 18 extra cases per 100 people of multimorbidity spanning two or three systems. The relative excess was steepest in the youngest patients — women under 25 had a hazard ratio of 9.24 for five or more affected systems.

Read the paper →  doi:10.1016/S2215-0366(26)00196-3

Clinical Characteristics, Neuroimaging Findings, and Mortality in Korsakoff Syndrome

Coffi I, Lecœur E, Zarca K, Kardas-Sloma L, Durand-Zaleski I, Treluyer JM, Mouthon L, Chaigne B · JAMA Neurology · September 2026

This cohort drew on electronic health records from the 39 hospitals of the Greater Paris University Hospitals system, identifying 1,320 adults diagnosed with Korsakoff syndrome between 2017 and 2022 (mean age 63; 73% men). In a well-documented subgroup of 114 patients, anterograde amnesia was the most common presentation, but only 19% had a recorded history of Wernicke encephalopathy — consistent with the long-recognized problem that the acute stage is frequently missed.

Among those imaged, 44% showed Papez-circuit abnormalities and 44% showed vascular leukoencephalopathy. Over a median 3.1 years of follow-up, 30% of patients died. Malnutrition (HR 1.54), alcoholic liver disease (HR 1.45), male sex, and age 80–89 independently predicted death.

Read the paper →  doi:10.1001/jamaneurol.2026.3114

In alcohol use disorder with organ damage, choose the medication by the organ that clears it

The reflex to avoid naltrexone in anyone with abnormal liver enzymes outlived its evidence: the FDA removed naltrexone's hepatotoxicity boxed warning in 2013, and the hepatotoxicity signal came from doses several-fold above the 50 mg used for alcohol. Mildly elevated transaminases from ongoing drinking are an indication, not a contraindication — continued drinking is the bigger hepatic risk. Guidelines still advise against it in acute hepatitis and decompensated cirrhosis, which is where you step aside.

Acamprosate is the mirror image: it is not hepatically metabolized at all and is cleared unchanged by the kidney. That makes it a natural choice in liver disease, but it means renal function sets the dose — 333 mg three times daily for CrCl 30–50, and it is contraindicated at 30 or below. Disulfiram is the one to avoid when the liver is already damaged. The practical move: check LFTs and creatinine together before choosing, then let the organ that is failing pick the drug.

Working through: an interpretation that lands once has to be found again

Residents often expect a well-timed interpretation to be curative — the patient sees the pattern, says so, and it should be over. Freud's point in introducing working through was that insight reached once is fragile; the same conflict reappears in new settings, often in disguised forms, and the patient has to recognize it again each time before it loosens. The repetition is not evidence that the interpretation failed. It is the work itself. The technical error is impatience: either re-delivering the original interpretation verbatim, which turns it into a slogan the patient can agree with without feeling anything, or abandoning it for a new formulation because the first one 'didn't stick.' The better move is to let the patient discover the old pattern in the new material, adding only what is specific to this instance — so insight is rebuilt from fresh affect rather than recited.