Lancet Psychiatry最新文献

{"title":"Mindfulness-based cognitive therapy versus treatment as usual after non-remission with NHS Talking Therapies high-intensity psychological therapy for depression: a UK-based clinical effectiveness and cost-effectiveness randomised, controlled, superiority trial","authors":"Thorsten Barnhofer, Barnaby D Dunn, Clara Strauss, Florian A Ruths, Barbara Barrett, Mary Ryan, Asha Ladwa, Frances Stafford, Roberta Fichera, Hannah Baber, Ailis McGuinness, Isabella Metcalfe, Daniel K Y Kan, Joanna Pooley, Delilah Harding, Emma Tassie, James Carson, Shelley Rhodes, Allan H Young, James Connors, Fiona C Warren","doi":"10.1016/s2215-0366(25)00105-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00105-1","url":null,"abstract":"<h3>Background</h3>Non-remission after psychological therapy for major depressive disorder is common, yet there are no established further-line treatments. In the UK National Health Service (NHS) Talking Therapies programme, about 50% of patients with depression who come to the end of the stepped care pathway do not show remission of symptoms. We aimed to investigate whether mindfulness-based cognitive therapy (MBCT) can improve clinical outcomes and whether the additional financial cost is worthwhile.<h3>Methods</h3>We conducted a parallel, randomised, controlled, superiority trial in three sites in the UK (Devon, London, and Sussex). Patients with current major depressive disorder whose symptoms had not reached remission (assessed as Patient Health Questionnaire-9 [PHQ-9] score ≥10) after an adequate dose of NHS Talking Therapies high-intensity therapy (≥12 sessions) were recruited from 20 NHS Talking Therapies services. Participants were allocated through remote random assignment (1:1) to MBCT plus treatment as usual or treatment as usual alone at the UK Clinical Research Collaboration-registered Exeter Clinical Trials Unit with minimisation on depression severity (PHQ-9 score <19 <em>vs</em> ≥19), antidepressant use at baseline (yes <em>vs</em> no), and recruitment site (Devon <em>vs</em> London <em>vs</em> Sussex). MBCT was delivered via videoconference and comprised an individual orientation session and eight weekly group sessions. The primary clinical outcome was reduction in depression symptomatology at 34 weeks after randomisation, using the PHQ-9. Cost-effectiveness was evaluated in terms of costs to primary, secondary, and tertiary health and social care services collected using the Adult Service Use Schedule and quality-adjusted life-years (QALYs) via health utilities derived from the EQ-5D. Primary outcome analyses were masked in the intention-to-treat population using observed data only. Lived experience experts were integral to all stages of this research. The trial was prospectively registered with ISRCTN, ISRCTN17755571.<h3>Findings</h3>Between April 20, 2021, and Jan 24, 2023, we enrolled 234 eligible participants, 166 (71%) of whom identified as women, 65 (28%) as men, one (<1%) as other, and two (1%) preferred not to say. The mean age was 42·5 years (SD 13·9). 201 (86%) of 234 participants were White. 118 participants were assigned to MBCT plus treatment as usual and 116 to treatment as usual alone, 101 and 102 of whom completed the final follow-up, respectively. At 34 weeks after randomisation, the MBCT plus treatment as usual group had significantly lower levels of depression symptomatology than the treatment as usual alone group (adjusted between-group difference –2·49, 95% CI –3·89 to –1·09; p=0·0006; Cohen's d –0·41, 95% CI –0·67 to –0·15). Utility scores were higher and costs were lower in the MBCT group (adjusted mean cost difference –£245·23, 95% CI –581·92 to 91·46; p=0·15) over the course of the study. The MBCT","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"4 1","pages":"433-446"},"PeriodicalIF":64.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979440","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":"Pharmacological treatment of anxiety in older adults: a systematic review and meta-analysis","authors":"Sarah E Neil-Sztramko, AnneMarie Levy, Alastair J Flint, Zahra Goodarzi, Amy Gough, Shanna C Trenaman, Michael Van Ameringen, Erica Weir, Anthony Yeung, Mahnoor R Akram, Titus A Chan, Sébastien Grenier, Heli Juola, Juliette Mojgani, Kristin Reynolds, Carly Whitmore, Andrea Iaboni","doi":"10.1016/s2215-0366(25)00100-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00100-2","url":null,"abstract":"<h3>Background</h3>Anxiety and its disorders are common in later life. Given the known risks of psychopharmacological treatments in older adults, clinical decision making for anxiety management should be guided by the strongest available evidence. This study aimed to comprehensively synthesise evidence on the pharmacological treatment of anxiety in older adults.<h3>Methods</h3>In this systematic review and meta-analysis, we searched MEDLINE, Cochrane Central, Embase, PsycINFO, and CINAHL from database inception to April 23, 2024, for randomised controlled trials on pharmacological treatments for anxiety in older adults (aged 60 years or older, mean age 65 years or older, or subgroup analyses meeting these criteria). Primary outcomes included reduction in anxiety symptoms, or treatment response, or remission. Standardised mean differences (SMD) were calculated for continuous variables and absolute difference and risk ratio (RR) for dichotomous variables. The risk of bias was assessed using the Cochrane Risk of Bias tool, and the certainty of evidence rated using GRADE. People with lived experience were involved in conducting this research. This trial is registered with PROSPERO (CRD42023407837).<h3>Findings</h3>We identified 19 eligible studies, including 2336 participants, 1592 (68·15%) of whom were women and 722 (30·91%) men, and sex was not reported for the other 22 (0·94%) participants. Only eight of 19 studies reported on race or ethnicity, and study participants were predominantly White (1309 [91·6%] of 1428), and no studies reported outcomes related to gender. Antidepressants were more effective than placebo or waitlist control in reducing anxiety symptoms (SMD –1·19 [95% CI –1·80 to –0·58), with moderate certainty of evidence and substantial heterogeneity (<em>I</em>² 92·34%; p&lt;0·0001). Antidepressants were also more effective than placebo or waitlist control in response or remission (RR 1·52 [95% CI 1·21 to 1·90]; absolute difference 146 per 1000 [95% CI 59 to 252]); with a low certainty of evidence and low heterogeneity (<em>I</em>² 8·09%; p=0·36). Planned subgroup analysis indicated selective serotonin reuptake inhibitors led to a greater reduction in anxiety symptoms (SMD –1·84 [95% CI –2·52 to –1·17]) compared with serotonin–norepinephrine reuptake inhibitors (SMD –0·46 [95% CI –0·65 to –0·27]), and there was no difference in response or remission. Benzodiazepines might reduce anxiety symptoms compared with placebo, but the evidence is very uncertain with high risk of bias. Meta-analyses for other drug classes for primary outcomes were not possible.<h3>Interpretation</h3>Antidepressants are more effective than placebo or waitlist for reducing anxiety symptoms, with evidence supporting their safety and tolerability in older adults. Evidence for the efficacy and safety of benzodiazepines is weak. These findings can guide evidence-based practice.<h3>Funding</h3>Public Health Agency of Canada.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"10 1","pages":"421-432"},"PeriodicalIF":64.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979525","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":"Correction to Lancet Psychiatry 2025; 12: 266–75","authors":"","doi":"10.1016/s2215-0366(25)00159-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00159-2","url":null,"abstract":"<em>Nomura N, Siafis S, Schneider-Thoma J, et al. The trajectory of sedative adverse events caused by antipsychotics: a meta-analysis of individual participant data from randomised, placebo-controlled, clinical trials inacute phase schizophrenia.</em> Lancet Psychiatry <em>2025; <strong>12:</strong> 266–75</em>—The appendix of this Article has been corrected as of May 8, 2025.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"19 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926345","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":"Reproductive rights of women with severe mental disability and rights of their children in China","authors":"Yang Zhang, Xingbo Suo, Jin Gao","doi":"10.1016/s2215-0366(25)00040-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00040-9","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920375","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":"Recovery-oriented psychiatry: oxymoron or catalyst for change?","authors":"Helene Speyer, David Roe, Mike Slade","doi":"10.1016/s2215-0366(25)00092-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00092-6","url":null,"abstract":"This Personal View provides a normative and conceptual analysis of the intersection between the recovery movement and psychiatry. Although recovery emerged as a grassroots social justice movement emphasising empowerment and systemic change, psychiatry remains rooted in the medical paradigm. We aim to develop a nuanced conceptual framework that fosters academic debate and meaningful implementation, while avoiding superficial or tokenistic adoption of recovery principles. Our analysis explores the contrasting values, ontologies, and epistemologies of these perspectives, identifying points of tension and areas of compatibility. We examine and discuss integrative and non-integrative pluralistic approaches, and we conclude with actionable recommendations for transformation at different organisational levels.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"7 15 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915565","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":"Association between genetic liability to physical health conditions and comorbidities in individuals with severe mental illness: an analysis of two cross-sectional observational studies in the UK","authors":"Djenifer B Kappel, Sophie E Smart, Michael J Owen, Michael C O'Donovan, Antonio F Pardiñas, James T R Walters","doi":"10.1016/s2215-0366(25)00123-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00123-3","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Individuals with severe mental illness, including schizophrenia and bipolar disorder, have elevated rates of physical health conditions, contributing to increased morbidity and mortality. While environmental factors such as adverse effects from medication and lifestyle changes play a role, the contribution of genetic liability to physical health comorbidities remains underexplored. We investigated whether genetic risk for physical health conditions influences comorbidities in people with severe mental illness and compared these effects with those in the general population. Additionally, we explored the effects of psychiatric genetic liabilities and the occurrence of physical health problems in those with severe mental illness.&lt;h3&gt;Methods&lt;/h3&gt;We analysed two UK cross-sectional cohorts of people with severe mental illness—the Cardiff Cognition in Schizophrenia study (CardiffCOGS) cohort and the National Centre for Mental Health (NCMH) cohort. Individuals were selected for analyses if they responded to a validated self-report questionnaire of physical health problems and if their genetic data passed quality control. These subsets of individuals were used to test associations between polygenic risk scores for six physical health conditions (high cholesterol, type 2 diabetes, hypertension, asthma, heart disease, and rheumatoid arthritis) and corresponding physical health conditions in this population. Models were further adjusted for demographic and clinical covariates (sex, age, smoking, and clozapine use). Effect sizes from these analyses were compared in magnitude to those reported in studies conducted in the general population. We also evaluated associations between psychiatric polygenic risk scores (schizophrenia, bipolar disorder, major depressive disorder, and ADHD) and physical comorbidities. People with lived experience were involved in the analysis planning and guided the choices of outcomes analysed.&lt;h3&gt;Findings&lt;/h3&gt;Following exclusions due to missing phenotypic or genetic data (403 individuals in CardiffCOGS; 1704 individuals in NCMH), our analyses included 721 individuals from the CardiffCOGS cohort (mean age 43·7 years [SD 12·1], 267 [37·0%] females, 454 [63·0%] males, and 703 [97·5%] with self-reported White ethnicity) and 1011 from the NCMH cohort (mean age 47·6 years [SD 13·7], 553 [54·7%] females, 458 (45·3%) males, and 928 [91·8%] with self-reported White ethnicity). Polygenic risk scores for physical health conditions were associated with corresponding conditions in one or both of these cohorts, explaining between 1·4% and 6·5% of the variability in these comorbidities. Polygenic risk score effect sizes for at least one of the cohorts overlapped with the reported effects (within 84% CIs) in the general population. Adjustments for clinical and demographic factors had minimal impact on these associations. Psychiatric polygenic risk scores showed weaker and less consistent associations with physical comorbidities.&lt;h","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"59 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910036","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":"Correction to Lancet Psychiatry 2025; 12: 276–88","authors":"","doi":"10.1016/s2215-0366(25)00133-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00133-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"43 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889450","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":"Correction to Lancet Psychiatry 2025; published online April 23. https://doi.org/10.1016/S2215-0366(25)00096-3","authors":"","doi":"10.1016/s2215-0366(25)00134-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00134-8","url":null,"abstract":"<em>Mimiaga MJ, Yonko EA. LGBTQ+ mental health in the wake of USA politics.</em> Lancet Psychiatry <em>2025; published online April 23. https://doi.org/10.1016/S2215-0366(25)00096-3</em>—The fourth sentence of paragraph 2 should read, “data from the 2015 US transgender survey found that 7% had attempted suicide in the past year,⁴ almost 12 times the rate in the USA population (0·6%) as reported by the Substance Abuse and Mental Health Services Administration.”. This correction has been made to the online version as of April 29, 2025, and will be made to the printed version.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"34 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889451","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":"Correction to Lancet Psychiatry 2025; 12: 384–94","authors":"","doi":"10.1016/s2215-0366(25)00131-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00131-2","url":null,"abstract":"<em>McCutcheon RA, Pillinger T, Varvari I, et al. INTEGRATE: international guidelines for the algorithmic treatment of schizophrenia.</em> Lancet Psychiatry <em>2025;</em> 12: <em>384–94—</em>In this Health Policy, an arrow in the figure erroneously pointed from the Assess Adherence box to Effective?. This correction has been made to the online version as of MMM DD, YYYY","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884627","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":"Improving mental health care in Iran","authors":"Rahim Badrfam, Atefeh Zandifar","doi":"10.1016/s2215-0366(25)00104-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00104-x","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"8 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872855","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}