Childhood anxiety disorders are prevalent and impair children's socioemotional functioning. Abnormalities in sensory processing may play a role in the presentation of anxiety disorders. One important domain of sensory processing is sensory sensitivity, referring to heightened or diminished responses to sensory stimuli. While anxiety and sensory sensitivity frequently co-occur, research thus far has primarily focused on associations among autistic children, with limited investigation in anxious children. This study examined the associations between sensory sensitivity and anxiety symptom severity, externalizing problems, emotion dysregulation, and quality of peer and family relationships in children with elevated anxiety symptoms without neurodevelopmental disorders. Ninety-four children aged 8 to 17 years (mean age=12.41, SD=2.55y) with elevated anxiety symptoms but without neurodevelopmental disorders completed self-report assessments of sensory sensitivity, anxiety symptom severity, externalizing behaviors, emotion dysregulation, and quality of peer and family relationships. Participants' parents completed a parent-report assessment of children's externalizing behaviors. Sensory sensitivity and anxiety symptom severity were not statistically significantly associated. Controlling for anxiety symptom severity and relevant sociodemographic covariates, sensory sensitivity explained a statistically significant amount of variance in youth-reported (but not parent-reported) externalizing symptoms, emotion dysregulation, and quality of family but not peer relationships. Anxious youth with sensory sensitivity may experience externalizing symptoms, emotion dysregulation, and difficulties with family relationships. Study limitations included a racially/ethnically homogeneous sample and a cross-sectional design. Further research is necessary to better understand the causal impact of sensory sensitivity on behavioral difficulties and quality of life, identify potential protective factors, and test intervention strategies for this population.

A boxed warning, or "black box" warning, represents the US Food and Drug Administration's most serious cautionary statement for prescription drugs. These warnings communicate clinically significant risks that may alter prescribing decisions, patient consent, and medicolegal responsibility. This narrative review explores the regulatory history, creation, and modification of boxed warnings, emphasizing their role in psychopharmacology. Using the case of varenicline (Chantix) as a focal example, we trace how emerging postmarketing data led to the implementation and subsequent removal of its boxed warning. We then summarize major boxed warnings across psychotropic classes, highlighting practical implications for prescribing, documentation, and informed consent. Finally, we discuss strategies for integrating boxed warning awareness into clinical decision-making and patient communication. Boxed warnings serve not merely as restrictions but as instruments of safety, vigilance, and shared decision-making that enhance the quality of psychiatric care.

This column describes 3 mechanisms of therapeutic action in the treatment of mental and substance use disorders. These mechanisms include biomedical interventions, dyadic interventions, and interventions involving transdyadic social learning. Combining mechanisms of action offers the potential to augment treatment response. Intermediate levels of care (Intensive Outpatient Programs, Partial Hospital Programs, and Residential Treatment Centers) are generally designed to provide treatment combining all 3 mechanisms of therapeutic action in the service of helping patients better use outpatient treatment to pursue recovery.

Later this year, Dr. Preskorn will be stepping down from his position as Psychopharmacology Columnist for the Journal of Psychiatric Practice after over 30 years in that role. This column is intended to provide readers who have read or will read Dr Preskorn's articles on psychopharmacology in the Journal of Psychiatric Practice and other journals with a perspective on the author. Over his 50+ year career, the author has been and continues to be passionate about bringing science to the practice of psychiatry. The column describes the author's contributions in the following areas: (1) direct impact on psychiatric drug development and approval, (2) publication of peer-reviewed publications that have influenced both researchers and practitioners, (3) influence on psychiatrists and other prescribers to improve the prescribing of psychiatric medications for patients, and (4) regulatory, translational, and mechanistic contributions to the understanding of the science of psychiatry and clinical psychopharmacology.

Motivational interviewing (MI) is an evidence-based clinical approach that aims to assist patients in navigating ambivalence and in building motivation and commitment for behavior change. MI may be an especially helpful approach in lethal means safety (LMS) counseling, given the challenges in encouraging patients to adopt new firearm storage practices. The purpose of this 2-part series is to demonstrate how MI strategies might be applied to evoke motivation to change firearm storage practices. This column builds on part 1 of this series, in which we provided a rationale for considering an MI-based approach and discussed how the relational foundation of MI may help facilitate LMS counseling. In part 2, we focus on the technical strategies we use to evoke motivation to change behavior (eg, language and tools), including the use of "ask-offer-ask," recognizing and reflecting change talk, and using importance rulers.

Bipolar disorder is a severe mental illness, and rates of diagnosis have risen in recent years. Accurately diagnosing bipolar disorder can be difficult when a patient is not actively manic, as screening questionnaires are not reliable diagnostic tools, patient self-report can be unreliable, and bipolar symptoms overlap with other psychiatric conditions. Much has been written about the overlap between bipolar disorder and borderline personality disorder, but many other disorders present with similar symptoms, including unipolar depression. Accurate diagnosis is important to ensure optimal treatment and patient outcomes. The goal of this article is to provide an evidence-based approach to diagnosing bipolar disorder and distinguishing it from other psychiatric disorders in clinical settings. Using the mnemonic "DIGFAST" (distractibility, impulsivity, grandiosity, flight of ideas, activity increase, sleeplessness, talkativeness), we review the DSM-5-TR diagnostic criteria for mania. Distinguishing features include the episodic nature of elevated/irritable moods, severity of symptoms, and the simultaneous occurrence of multiple manic symptoms. Insight is typically impaired in bipolar disorder, and collateral information can help improve diagnostic clarity. Hypomanic symptoms can be distinguished from other conditions by their duration and accompanying changes in functioning. A thorough clinical interview is the most important asset in making an accurate diagnosis of bipolar disorder.

Encouraging changes in firearm-related storage practices through lethal means safety (LMS) counseling can be challenging. Motivational interviewing (MI) may be a useful clinical approach for clinicians who deliver LMS counseling. The aim of this 2-part series is to provide clinicians with guidance on applying MI strategies to evoke motivation for changing firearm storage practices. In part 1 of this series, we provide a rationale for considering an MI-based approach to facilitate secure firearm storage practices and briefly review the relational foundations of MI that are critical to successful MI-based interventions (ie, how we approach our patients). In part 2 of this work, we will discuss how MI technical strategies may be applied to LMS counseling to facilitate secure firearm storage practices.

Based on survey feedback, ~5% of prescribers do not understand the importance of the prescribing information (PI) provided by the U.S. Food and Drug Administration (FDA) and the specific manufacturer of the drug, even though it is provided every time the drug is dispensed. This column addresses 3 representative comments from this subset of prescribers about whether it is an appropriate expectation that the prescriber be familiar with the PI, whether by reading it in its entirety or the first page summary and any additional sections that they wish to know. It also discusses that many, if not all, prescribing "guides" are in fact the PI reformatted for the guide. This column refers the reader back to earlier columns that discuss some of these matters in more detail. This column also addresses comments by 8% of surveyed prescribers about the need for training programs to cover this information for the benefit of prescribers in training and their eventual patients.