Lancet Psychiatry最新文献

{"title":"Clozapine and treatment-resistant schizophrenia: efficacy versus effectiveness","authors":"Dan Siskind, Korinne Northwood, Robert A McCutcheon","doi":"10.1016/s2215-0366(25)00032-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00032-x","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"28 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143507234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of clozapine versus second-generation antipsychotics in people with treatment-resistant schizophrenia: a systematic review and individual patient data meta-analysis","authors":"Johannes Schneider-Thoma, Tasnim Hamza, Konstantina Chalkou, Spyridon Siafis, Shimeng Dong, Irene Bighelli, Wulf-Peter Hansen, Elfriede Scheuring, John M Davis, Josef Priller, Pierre Baumann, Robert Conley, Joachim Cordes, Deanna Kelly, Michael Kluge, Sanjiv Kumra, Shôn Lewis, Herbert Y Meltzer, Dieter Naber, Nina Schooler, Stefan Leucht","doi":"10.1016/s2215-0366(25)00001-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00001-x","url":null,"abstract":"<h3>Background</h3>Clozapine is recommended by national and international guidelines for people with treatment-resistant schizophrenia. However, available meta-analyses of randomised controlled trials have not shown superior efficacy of clozapine when compared with other second-generation antipsychotics, with heterogeneity identified between the original studies. We aimed to use individual patient data (IPD) to account for potential reasons of variability and to synthesise an adjusted estimate for the difference in efficacy between clozapine and other second-generation antipsychotics for treatment-resistant schizophrenia.<h3>Methods</h3>In this systematic review and IPD meta-analysis, we searched the Cochrane Schizophrenia Group's Study-Based Register from inception to Jan 24, 2024, and previous reviews for blinded randomised controlled trials comparing clozapine with other second-generation antipsychotics in participants with treatment-resistant schizophrenia. Trials were eligible if they included patients with treatment-resistant schizophrenia and had a duration of at least 6 weeks. IPD were requested from trial investigators. The primary outcome was change in overall schizophrenia symptoms as measured by the Positive and Negative Syndrome Scale (PANSS) between clozapine and other second-generation antipsychotics after 6–8 weeks of treatment. The effect size measure for the primary outcome was mean difference with 95% credible interval (CrI). We fitted a Bayesian random-effects IPD meta-regression model that included duration of illness, baseline severity, and sex as potential prognostic factors or treatment effect modifiers. Confidence in the evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). People with lived experience of mental illness were involved in this study. This study is registered with PROSPERO, CRD42021254986.<h3>Findings</h3>We screened 13 876 references and included 19 studies with data for 1599 participants; IPD were available for 12 of 19 trials (n=1052; mean age 37·67 years [SD 11·24; range 10–66]; 348 [33·08%] women and 704 [66·92%] men). Data on ethnicity were not available. The estimated mean difference in change from baseline PANSS total score was –0·64 points (95% CrI –3·97 to 2·63; τ=2·68) in favour of other second-generation antipsychotics. Shorter duration of illness and higher baseline severity were prognostic factors associated with a larger reduction in symptoms, but neither those factors nor sex were found to modify the relative effect between clozapine and other second-generation antipsychotics. The confidence in the evidence was graded as very low.<h3>Interpretation</h3>This IPD meta-analysis found a small and uncertain advantage of other second-generation antipsychotics, mainly olanzapine and risperidone, and so did not provide evidence for superior efficacy of clozapine compared with other second-generation antipsychotics in treatment-resistant schizophrenia","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143507235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embracing dissensus in lived experience research: the power of conflicting experiential knowledge","authors":"Helene Speyer, Marte Ustrup","doi":"10.1016/s2215-0366(25)00003-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00003-3","url":null,"abstract":"Lived experience is a crucial component in the development of innovative interventions and services in mental health care. To unlock the full potential of this valuable source of knowledge, it is essential to actively cultivate and understand it. A common concern, however, is the variability of perspectives, as individuals with lived experience might express opposing views on some issues. Building on our own journey as researchers with a combination of academic training and lived experience, we have developed an approach that treats dissensus not necessarily as a challenge to be resolved through consensus, but rather as a source of innovation. Our approach involves a two-step model. First, we identify the genuine points of disagreement or true negations between us. Next, we clarify the epistemic goal of the inquiry at hand. Based on this process, we determine whether the dissensus—often a rich, complex expression of variation—offers deeper insights, or if a more generalised, consensus-based message would be the most effective way to answer the inquiry. With this Personal View, we hope to inspire collaborators, both with and without lived experience, to engage rigorously and enthusiastically with dissensus, recognising its potential as a driver of innovation.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"32 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143496027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing appropriate mental health research for LGBTQ+ people in southeast Asia","authors":"Rowalt Alibudbud","doi":"10.1016/s2215-0366(25)00041-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00041-0","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"11 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of local realities to address mental health in Africa","authors":"Natalie E Johnson, Makamohelo Malimabe, Grace H Yoon, Tom L Osborn, Irene Falgas-Bague, Monica H Swahn","doi":"10.1016/s2215-0366(25)00005-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00005-7","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"14 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sanju George: the rising costs of problem gambling in India","authors":"Ray Cavanaugh","doi":"10.1016/s2215-0366(25)00037-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00037-9","url":null,"abstract":"<span><figure><span><img alt=\"\" height=\"242\" src=\"https://ars.els-cdn.com/content/image/1-s2.0-S2215036625000379-fx1.jpg\"/><ol><li><span><span>Download: <span>Download high-res image (94KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span></figure></span>","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"49 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thanks to our peer reviewers for 2024","authors":"","doi":"10.1016/s2215-0366(25)00029-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00029-x","url":null,"abstract":"Every year, the editorial team at <em>The Lancet Psychiatry</em> relies on expert advice from hundreds of peer reviewers, for which we are always grateful. Our reviewers provide constructive, helpful guidance, for us as editors and for our authors. Several of our reviewers also bring their expertise as people with lived experience of a mental disorder and we are especially grateful for the insight they offer.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"11 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The most important aims of psychotherapy: to love, to work, and to find meaning","authors":"Orestis Zavlis, Peter Fonagy, Patrick Luyten","doi":"10.1016/s2215-0366(25)00006-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00006-9","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"12 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"India needs a national social media policy for children, adolescents, and young adults","authors":"Satish Suhas","doi":"10.1016/s2215-0366(25)00027-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00027-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mentalisation-based treatment for antisocial personality disorder in males convicted of an offence on community probation in England and Wales (Mentalization for Offending Adult Males, MOAM): a multicentre, assessor-blinded, randomised controlled trial","authors":"Peter Fonagy, Elizabeth Simes, Karen Yirmiya, James Wason, Barbara Barrett, Alison Frater, Angus Cameron, Stephen Butler, Zoe Hoare, Mary McMurran, Paul Moran, Mike Crawford, Stephen Pilling, Elizabeth Allison, Jessica Yakeley, Anthony Bateman","doi":"10.1016/s2215-0366(24)00445-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00445-0","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Antisocial personality disorder is a major health and social problem, but scepticism about its treatability has restricted development of the evidence base for psychological treatments. Mentalisation-based treatment (MBT) tailored for antisocial personality disorder (MBT-ASPD) can address problematic behaviours by improving the ability to understand and regulate the negative effects of thoughts and feelings. This study aimed to evaluate the clinical and cost-effectiveness of MBT-ASPD compared with probation as usual in reducing aggressive behaviours from baseline to 12 months of follow-up.&lt;h3&gt;Methods&lt;/h3&gt;The Mentaliziation for Offending Adult Males (MOAM) trial was a multicentre, two-group, pragmatic, assessor-masked, randomised controlled superiority trial in England and Wales. Eligible participants were male, aged 21 years or older, convicted of an offence and under National Probation Service supervision at one of 13 sites, identified through the Community Personality Disorder Pathways Service, met DSM-5 criteria for antisocial personality disorder, and scored at least 15 on the Overt Aggression Scale-Modified (OAS-M). After a three-stage screening process, consenting participants were randomly allocated (1:1), stratified by site, age, probation order type, and remaining probation duration, to either MBT-ASPD plus probation as usual, or probation as usual alone. Participants in the MBT-ASPD group were offered 12 months of weekly 75-min group therapy sessions and monthly 50 min individual sessions. Probation as usual lasted up to 12 months, after which participants continued under National Probation Service supervision for the remainder of their term. Investigators and data collectors were masked to treatment allocation. The primary outcome was aggression measured by the OAS-M at 12 months after random allocation. Data were collected by a hybrid team of traditional researchers and researchers with lived experience of the criminal justice system. The primary analysis was conducted in the intention-to-treat population using a linear mixed-effects model, adjusted for baseline at each follow-up timepoint (months 3, 6, 9, 12, 15, 18, 21, and 24). This trial is registered with ISRCTN (ISRCTN 32309003), and all pre-planned follow-ups are complete.&lt;h3&gt;Findings&lt;/h3&gt;Between Jan 2, 2016, and Aug 31, 2018, 1946 individuals were referred to the study; after the screening process, 313 participants were randomly allocated (156 [50%] to probation as usual and 157 [50%] to MBT-ASPD plus probation as usual). Participants had a mean age of 34·2 years (SD 9·3); the majority of participants (247 [79%]) identified as White British, Irish, or White Other; followed by Black British (Caribbean, African, or Other; 30 [10%]) or Mixed (29 [9%]). At 12 months after random allocation, mean OAS-M scores were significantly higher in the probation as usual group (mean score 186 [SD 153]) than in the MBT-ASPD group (90 [126]), with an adjusted mean difference ","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"5 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}