Lancet Psychiatry最新文献

{"title":"Factors that affect the resilience of young adults to depression: a systematic review","authors":"Linda Theron, Dov J Stekel, Jan Höltge, Olufunmilayo I Fawole, Diane T Levine, Zainab Mai-Bornu, Kassa Maksudi, Olanrewaju Olaniyan, Caradee Y Wright, Michael Ungar","doi":"10.1016/s2215-0366(25)00044-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00044-6","url":null,"abstract":"Depression among young people (aged 18–29 years) transitioning to adulthood is becoming more widespread. Knowing which factors in which systems co-enable resilience to depression is crucial, but there is no comprehensive synthesis of the physiological, psychological, social, economic, institutional, cultural, and environmental system factors associated with no or minimal emerging adult depression, or combinations of these factors. We have therefore conducted a preregistered systematic review (Prospero, CRD42023440153). We searched eight databases for observational studies reporting factors associated with depression symptomology that is mild, minimal, or absent among emerging adults with exposure to risk factors for depression; independently screened titles, abstracts, and full texts; extracted data; and assessed study quality. From 1824 unique citations, we included 139 papers (N=17721; in study populations that are majority female, cisgender, and in North America) and conducted a multisystemic resilience-informed narrative synthesis and quantitative summary. Personal (eg, psychological resilience and positive cognition) or social factors (eg, social support and family support) were frequently linked to reduced depression symptomology, followed by combinations of these. Economic, institutional, cultural, and environmental factors, or combinations of factors from three or more systems, were rarely reported. Low-income and middle-income countries, in which most young people live, were under-represented, which suggests inadequate understanding of emerging adult resilience to depression. Future studies should include more diverse populations and redress the tendency to reduce resilience to depression to a psychological or limited social phenomenon.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806248","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 and safety of brexpiprazole in adolescents with schizophrenia: a multicountry, randomised, double-blind, placebo-controlled, phase 3 trial with an active reference","authors":"Caroline Ward, Milica Pejović Milovančević, Eva Kohegyi, Nanco Hefting, Catherine Aurang, Dalei Chen, Klaus Groes Larsen, Mary Hobart, Christoph U Correll","doi":"10.1016/s2215-0366(25)00043-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00043-4","url":null,"abstract":"<h3>Background</h3>New treatment options are needed for adolescent schizophrenia, partly due to an unfavourable risk–benefit profile of current options. This trial aimed to evaluate the short-term efficacy and safety of brexpiprazole in adolescents with schizophrenia.<h3>Methods</h3>This multicountry, randomised, double-blind, parallel-arm, placebo-controlled, phase 3 trial with an active reference was done at 62 outpatient sites in ten countries. Eligible patients were aged 13–17 years with a primary DSM-5 diagnosis of schizophrenia and a Positive and Negative Syndrome Scale (PANSS) total score ≥80 at screening and baseline. Patients were randomly assigned (1:1:1) to oral brexpiprazole 2–4 mg/day, placebo, or aripiprazole 10–20 mg/day (active reference). Patients, investigators, and sponsor personnel were masked to treatment assignment. The primary efficacy endpoint was change from baseline to week 6 in PANSS total score (in randomly assigned patients who took at least one dose of study drug and had baseline and post-baseline PANSS evaluations). Safety was assessed in randomly assigned patients who took at least one dose of study drug. People with lived experience of schizophrenia were not involved in the research or writing process. The trial was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT03198078</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is complete.<h3>Findings</h3>Between June 29, 2017, and Feb 23, 2023, 376 patients were screened, and 316 patients were randomly assigned to brexpiprazole (n=110), placebo (n=104), or aripiprazole (n=102). The mean age of patients was 15·3 years (SD 1·5). 166 (53%) of 316 patients were female and 150 (47%) were male. Of 316 patients, seven (2%) were American Indian or Alaskan Native, two (1%) were Asian, 21 (7%) were Black or African American, 204 (65%) were White, and 81 (26%) were other, as reported using US Census Bureau classifications. Mean doses of brexpiprazole and aripiprazole at last visit were 3·0 mg (SD 0·9) and 13·9 mg (4·7), respectively. Least squares mean change from baseline to week 6 in PANSS total score was –22·8 (SE 1·5) with brexpiprazole and –17·4 (1·6) with placebo (least squares mean difference –5·33 [95% CI –9·55 to –1·10]; p=0·014). The corresponding PANSS total score change at week 6 with aripiprazole was –24·0 (SE 1·6; least squares mean difference versus placebo –6·53 [95% CI –10·8 to –2·21]; p<sub>nominal</sub>=0·0032, not adjusted for multiple testing). Treatment-emergent adverse events were reported in 44 (40%) of 110 patients in the brexpiprazole group, 42 (40%) of 104 in the pla","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"23 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143798094","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":"Brexpiprazole for the treatment of adolescent schizophrenia","authors":"Maria Rogdaki","doi":"10.1016/s2215-0366(25)00094-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00094-x","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"74 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143798093","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":"Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis","authors":"Luis C Farhat, Alice Lannes, Cinzia Del Giovane, Valeria Parlatini, Miguel Garcia-Argibay, Edoardo G Ostinelli, Anneka Tomlison, Zheng Chang, Henrik Larsson, Cristiano Fava, François Montastruc, Andrea Cipriani, Alexis Revet, Samuele Cortese","doi":"10.1016/s2215-0366(25)00062-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00062-8","url":null,"abstract":"<h3>Background</h3>Concerns about the cardiovascular safety of medications used for the treatment of attention-deficit hyperactivity disorder (ADHD) remain. We aimed to compare the effects of pharmacological treatments for ADHD on haemodynamic values and electrocardiogram (ECG) parameters in children, adolescents, and adults.<h3>Methods</h3>For this systematic review and network meta-analysis, we searched 12 electronic databases, including Cochrane CENTRAL, Embase, PubMed, and the WHO International Clinical Trials Registry Platform, from database inception to Jan 18, 2024, for published and unpublished randomised controlled trials comparing amphetamines, atomoxetine, bupropion, clonidine, guanfacine, lisdexamfetamine, methylphenidate, modafinil, or viloxazine against each other or placebo. Primary outcomes were change in systolic blood pressure (SBP) and diastolic blood pressure (DBP), measured in mm Hg, and pulse, measured in beats per minute, at timepoints closest to 12 weeks, 26 weeks, and 52 weeks. Summary data were extracted and pooled in random-effects network meta-analyses. Certainty of evidence was assessed with the Confidence in Network Meta-Analysis (CINeMA) framework. This study was registered with PROSPERO, CRD42021295352. Before study initiation, we contacted representatives of a UK-based charity of people with lived experience of ADHD—the ADHD Foundation—regarding the relevance of the topic and the appropriateness of the outcomes chosen.<h3>Findings</h3>102 randomised controlled trials with short-term follow-up (median 7 weeks [IQR 5–9]) were included, encompassing 13 315 children and adolescents (aged ≥5 years and <18 years; mean age 11 years [SD 3]; of available data, 9635 [73%] were male and 3646 [27%] were female; of available data, 289 [2%] were Asian, 1719 [15%] were Black, and 8303 [71%] were White) and 9387 adults (≥18 years, mean age 35 years [11]; of available data, 5064 [57%] were male and 3809 [43%] were female; of available data, 488 [6%] were Asian, 457 [6%] were Black, and 6372 [79%] were White). Amphetamines, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine led to increments in haemodynamic values in children and adolescents, adults, or both. In children and adolescents, mean increase against placebo ranged from 1·07 (95% CI 0·36–1·79; moderate CINeMA confidence) with atomoxetine to 1·81 (1·05–2·57; moderate) with methylphenidate for SBP; from 1·93 (0·74–3·11; high) with amphetamines to 2·42 (1·69–3·15; low) with methylphenidate for DBP; and from 2·79 (1·05–4·53; moderate) with viloxazine to 5·58 (4·67–6·49; high) with atomoxetine for pulse. In adults, mean increase against placebo ranged from 1·66 (95% CI 0·38–2·93; very low) with methylphenidate to 2·3 (0·66–3·94; very low) with amphetamines for SBP; from 1·60 (0·29–2·91; very low) with methylphenidate to 3·07 (0·69–5·45; very low) with lisdexamfetamine for DBP; and from 4·37 (3·16–5·59; very low) with methylphenidate to 5·8 (2·3–9·3; very low) wit","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789690","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":"Cardiovascular effects of ADHD medications","authors":"Steven R Pliszka","doi":"10.1016/s2215-0366(25)00084-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00084-7","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"34 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789691","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":"INTEGRATE: international guidelines for the algorithmic treatment of schizophrenia","authors":"Robert A McCutcheon, Toby Pillinger, Ioana Varvari, Sean Halstead, Olatunde O Ayinde, Nicolás A Crossley, Christoph U Correll, Margaret Hahn, Oliver D Howes, John M Kane, Thomas Kabir, Åsa Konradsson-Geuken, Belinda Lennox, Christy Lai Ming Hui, Susan L Rossell, Marco Solmi, Iris E Sommer, Heidi Taipale, Hiroyuki Uchida, Ganesan Venkatasubramanian, Dan Siskind","doi":"10.1016/s2215-0366(25)00031-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00031-8","url":null,"abstract":"Schizophrenia is a mental illness involving multiple symptom domains and is often associated with substantial physical health comorbidities. Guidelines exist, but these tend to be country-specific and are often missing a concise yet comprehensive algorithmic approach. From May 1, 2023, to Jan 1, 2025, International Guidelines for Algorithmic Treatment (INTEGRATE) authors from all UN regions collaborated to develop a consensus guideline focused on the pharmacological treatment of schizophrenia. Following an umbrella review of the literature, input from expert workshops, a consensus survey, and lived experience focus groups, a consensus algorithmic guideline and associated digital tool were developed. Key recommendations include a focus on metabolic health from treatment initiation, timely assessment and management of non-response, symptom domain-specific interventions, mitigation of side-effects, and the prompt use of clozapine in cases of treatment resistance.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"8 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745203","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's mental health budget 2025 needs urgent reform","authors":"Sheikh Shoib, Ilham Zaidi, Miyuru Chandradasa, Sujita Kumar Kar, Fahimeh Saeed","doi":"10.1016/s2215-0366(25)00071-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00071-9","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"21 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723412","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":"Reevaluating the brain disease model of addiction","authors":"Chrysanthi Blithikioti, Eiko I Fried, Emiliano Albanese, Matt Field, Ioana A Cristea","doi":"10.1016/s2215-0366(25)00060-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00060-4","url":null,"abstract":"The brain disease model of addiction has dominated public and scientific discourse on addiction (termed substance use disorder [SUD] in the DSM-5) over the past 3 decades. The model framed addiction as a chronic and relapsing brain disease caused by structural and functional brain alterations. The purpose of this model was purportedly dual, as both an aetiological theory and a tool to reduce stigma. Weak empirical support and concerns about the model downplaying fundamental psychosocial causes of SUDs have led to stark disagreement as to whether addiction should be conceptualised as a brain disease. In this Personal View, we argue that the absence of an agreed, clear, and consistent definition of a brain disease—coupled with frequent recourse to concepts with divergent or shifting meaning—have obstructed productive debate and a coherent advance in knowledge and understanding of addiction. Borrowing from the philosophy of psychiatry, we show that both narrow and broad views of brain disease coexist and inform addiction research, though often implicitly and inconsistently. The narrow view of brain disease posits that a mental condition qualifies as a brain disease only if it manifests similarly to a paradigmatic brain disease, resulting from either known or unknown structural and functional damage. The broad view of brain disease suggests that brain disease status should be granted automatically to mental disorders, as all mental activity resides in the brain. We examine theoretical assumptions, empirical evidence, and treatment implications for each view and propose ways of moving beyond them.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"28 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143703289","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 value of many","authors":"","doi":"10.1016/s2215-0366(25)00070-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00070-7","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"56 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653660","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":"Colonialism, trauma, and mental health","authors":"Uma Devi Khemraj","doi":"10.1016/s2215-0366(25)00069-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00069-0","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"69 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653663","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}