Psychiatric Annals

and treatable mental disorders presenting in general medical as well as specialty settings. There are a number of case-finding instruments for detecting depression in primary care, ranging from 2 to 28 items.1,2 Typically these can be scored as continuous measures of depression severity and also have established cutpoints above which the probability of major depression is substantially increased. Scores on these various measures tend to be highly correlated3, with little evidence that one measure is superior to any other.1,2,4

Positive psychiatry extends traditional psychiatric care by promoting resilience, wisdom, well-being, and human flourishing alongside prevention and treatment of mental illnesses. This article examines the role of positive social determinants of health (PSDoHs) as protective social, economic, and environmental conditions that support mental health across individual, community, and societal levels. Integration of PSDoHs within a biopsychosocial framework could strengthen clinical care, research, education, and policy by shifting the focus from deficits to strengths. Key domains include social connectedness, economic stability, neighborhood environments, faith and spirituality, health care access, immigration, and emerging technologies such as artificial intelligence. Advancing positive psychiatry through a strengths-based, person-centered approach offers opportunities to reduce disparities, improve well-being, and promote equitable mental health outcomes across diverse populations. Suggested priorities are specified for clinical, research, and policy considerations.

Symptom reduction is a critical goal for individuals with severe mental illness, but improving and treating symptoms does not always translate into personally defined recovery. Positive psychiatry offers a complementary approach to conventional psychiatric care and emphasizes strengths, protective factors, overall well-being, and personal recovery. This is accomplished through approaches such as whole-person history taking and formulation, values-oriented goal setting, understanding strengths and protective factors, and utilizing recovery-oriented community-based resources. Although the evidence base for positive psychiatry in severe mental illness is still emerging, this article provides a review of the existing literature and focuses on practical ways to implement these approaches into everyday clinical practice. Instead of asking only “What is wrong?” we can explore the question of “What is strong?” to help patients with severe mental illness move toward lives characterized by hope, empowerment, meaning, and social connectedness.

Positive psychiatry expands the goals of mental health care beyond diagnosis, treatment, and symptom reduction to emphasize meaning, purpose, resilience, and flourishing. Spirituality has long provided pathways for cultivating these dimensions of well-being, while emerging digital technologies, including artificial intelligence (AI), offer pathways for cultivating spiritual connection, reflection, and meaning. These technologies also introduce unique risks, including loss of human connection and challenges in measuring spiritual growth. We further explore the distinction between AI and artificial wisdom. While AI excels at information processing and pattern recognition, true wisdom requires compassion, self-reflection, emotional regulation, and sound judgment amid uncertainty. These are capacities that remain distinctly human. Drawing on frameworks from positive psychiatry, neurospirituality, and wisdom science, future AI applications may hold the greatest promise not as autonomous decision makers, but as tools supporting reflective processes, helping patients and clinicians identify values, navigate complex decisions, strengthen connection, and pursue flourishing across the lifespan.

Positive mental health and lifestyle psychiatry share a complementary framework focused on enhancing well-being, resilience, and flourishing, rather than solely treating disease. This focus provides a broader framework that incorporates biological, psychological, social, and environmental factors into a comprehensive model of care. Significantly, this approach aligns with health equity principles by highlighting how health behaviors are rooted in structural inequalities, such as socioeconomic position, environmental exposures, and access to resources, which contribute to both the development and persistence of mental illness, disproportionately affecting marginalized populations. The article reviews the core pillars of lifestyle psychiatry, including nutrition, physical activity, restorative sleep, stress management, connectedness, and avoidance of toxic exposures, situates them within a positive psychiatry lens, and ends with a lifestyle psychiatry assessment model.

Endogenous testosterone is a steroid hormone that contributes to a multitude of physiological functions in women. Androgen levels decline with age and subsequently affect libido, cognition, mood, and overall well-being. Testosterone replacement therapy (TRT) may improve female sexual dysfunction in postmenopausal women. There are currently no FDA-approved testosterone formulations for women. Consensus guidelines support the use of off-label TRT through specific formulations, such as testosterone gel, at one-tenth of the recommended dose for men. Obtaining total testosterone levels during treatment is recommended by clinical monitoring guidelines, and TRT should be avoided in women with clinical signs of androgen excess. Although TRT may improve overall sexual functioning in women, further research is needed to explore possible benefits with cognition and mood.

The menopausal transition is a period of reproductive changes linked to heightened risk for depressive symptoms, and in some cases, a major depressive episode. Understanding risk is critical to identifying patients experiencing distress from these affective disturbances. Once identified, both subsyndromal and major depressive episodes can be treated with pharmacological as well as non-pharmacological methods.

Perimenopause is associated with significant psychiatric morbidity, including depressive episodes, sleep disturbance, and cognitive symptoms. Despite this, perimenopause remains underrecognized in psychiatric settings, and many women do not receive timely or appropriate care. This article provides psychiatrists with a practical framework for identifying perimenopause in clinical practice, including how to take a reproductive history and apply validated screening tools. The article reviews mood disorders, sleep disturbance, and cognitive changes during perimenopause and the biological, psychological, and social factors that contribute to symptom burden. Evidence-based treatment options including antidepressants, cognitive-behavioral therapy, and hormone therapy are reviewed.