Opparounds

Convergence of TMS Sites and Lesion Locations Associated With Nicotine Addiction Improvement on a Common Brain Circuit

Khosravani S, Drew W, Apostol MR, et al. · American Journal of Psychiatry · September 2026

In 72 participants with tobacco use disorder, TMS was delivered to four different left-hemisphere targets (243 stimulation sites total) after at least 12 hours of abstinence, and withdrawal-symptom change was compared against each site's connectivity to a previously identified lesion-derived addiction remission circuit. Greater connectivity to that circuit predicted greater improvement, and a data-driven map of the best-performing TMS sites closely matched the lesion-based circuit (r=−0.74), converging on frontopolar cortex, posterior parietal cortex, lateral temporal lobe, and superior frontal gyrus.

Read the paper →  doi:10.1176/appi.ajp.20250855

Moderating Factors for the Effectiveness of Brief Psychological Intervention for People With Probable Personality Disorder: Secondary Analysis of Data From the SPS Trial

Williams R, Barnicot K, Sampson M, et al. · Personality and Mental Health · August 2026

This secondary analysis of a 336-patient, 7-site NHS trial of Structured Psychological Support (SPS) — a brief individual intervention for probable personality disorder that showed no overall benefit in the main trial — tested whether baseline personality-dysfunction severity, duration of prior mental-health contact, or which practitioner delivered treatment moderated 6-month outcomes. Practitioner sequence didn't matter, but exploratory findings suggested SPS may help emotional dysregulation more in patients with lower baseline severity, and social functioning more in those with shorter illness histories.

Read the paper →  doi:10.1002/pmh.70096

Bupropion's Seizure Risk Is a Per-Dose Problem, Not Just a Daily-Total Problem

Seizure incidence rises almost tenfold going from 450 mg/day to 600 mg/day of bupropion, but the daily ceiling isn't the whole story — the maximum single dose matters independently, because a supratherapeutic peak lowers the seizure threshold even when the day's total stays within labeling. That's why immediate-release dosing caps at 150 mg per dose, sustained-release doses must be spaced at least 8 hours apart, and extended-release at least 24 hours — the spacing exists to prevent stacking peaks, not just to divide a total. Risk compounds with eating disorders, abrupt alcohol or benzodiazepine withdrawal, and prior seizure history. A patient who doubles up a missed dose “to stay on schedule” has recreated exactly the pharmacokinetic pattern the labeling was written to prevent.

Grandiosity Is Load-Bearing, Not Just Obnoxious

Kernberg's technique for narcissistic pathology treats grandiosity in the transference not as a character flaw to confront directly, but as a structure defending against a split-off, unbearable sense of dependency and envy. A patient who dismisses an interpretation as obvious, or announces he's outgrown the treatment, is often managing the intolerable experience of needing someone he can't control. Confronting the grandiosity head-on — “you're being dismissive” — tends to provoke defensive escalation, because it attacks the defense without touching what it's defending against. The more useful move interprets the sequence: name the devaluation, then name what would be unbearable to feel if the devaluation weren't in place — usually envy of the therapist's capacity to help, or dread of needing something that could be withheld.