Lancet Psychiatry最新文献

{"title":"Prevalence, correlates, tolerability-related outcomes, and efficacy-related outcomes of antipsychotic polypharmacy: a systematic review and meta-analysis","authors":"Mikkel Højlund, Ole Köhler-Forsberg, Anton T Gregersen, Christopher Rohde, Angelina I Mellentin, Simon J Anhøj, Adam F Kemp, Nina B Fuglsang, Anne Christine Wiuff, Louise Nissen, Marc A Sørensen, Nanna M Madsen, Christina B Wagner, Armaghan Agharazi, Cecilie Søndergaard, Marie Sandmark, Jana Reinhart, Christoph U Correll","doi":"10.1016/s2215-0366(24)00314-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00314-6","url":null,"abstract":"<h3>Background</h3>Antipsychotic polypharmacy remains a clinical reality, despite an increased risk of adverse events and little evidence of additional efficacy compared with antipsychotic monotherapy. In this systematic review and meta-analysis, we aimed to provide a comprehensive assessment of antipsychotic polypharmacy prevalence, trends, and correlates across mental disorders.<h3>Methods</h3>We searched MEDLINE and Embase from Jan 1, 2009 to April 30, 2024, for any original study (observational and interventional) reporting antipsychotic polypharmacy prevalence in populations with mental disorders or use of antipsychotics, regardless of age or diagnosis. Relevant studies before May 1, 2009, were identified from two previous systematic reviews of antipsychotic polypharmacy prevalence. Pooled antipsychotic polypharmacy prevalence was estimated using random-effects meta-analysis. Using subgroup and mixed-effects meta-regression analyses, we sought to identify relevant correlates of antipsychotic polypharmacy. People with lived experience were not involved in the project. This review is registered with PROSPERO (CRD42022329953).<h3>Findings</h3>We analysed 517 studies with 599 individual timepoints reporting on 4 459 149 individuals (mean age 39·5 years [range 6·4–86·3]; data on sex and ethnicity were infrequently reported). Most studies included patients with schizophrenia spectrum disorders (SSDs; k=270, 52%). Overall, 24·8% (95% CI 22·9–26·7) of the populations received antipsychotic polypharmacy, ranging from 33·2% (30·6–36·0) in people with SSDs to 5·2% (4·0–6·8) in people with dementia. Antipsychotic polypharmacy prevalence varied by region from 15·4% (95% CI 12·9–18·2) in North America to 38·6% (27·7–50·6) in Africa. Overall antipsychotic polypharmacy prevalence increased significantly from 1970 to 2023 (β=0·019, 95% CI 0·009–0·029; p=0·0002) and was higher in adults than in children and adolescents (27·4%, 95% CI 25·2–29·8 <em>vs</em> 7·0%, 4·7–10·3; p<0·0001) and among inpatients than among outpatients (31·4%, 27·9–35·2 <em>vs</em> 19·9%, 16·8–23·3; p<0·0001). Compared with antipsychotic monotherapy, antipsychotic polypharmacy was associated with an increased risk of relapse (relative risk [RR] 1·42, 95% CI 1·04–1·93; p=0·028), psychiatric hospitalisation (1·24, 1·12–1·38; p<0·0001), worse global functioning (standardised mean difference [SMD] –0·31, 95% CI –0·44 to –0·19; p<0·0001), and more adverse events, including extrapyramidal symptoms (RR 1·63, 95% CI 1·13–2·36; p=0·0098), dystonia (5·91, 1·20–29·17; p=0·029), anticholinergic use (1·91, 1·55–2·35; p<0·0001), higher side-effect scores (SMD 0·33, 95% CI 0·24–0·42; p<0·0001), longer corrected QT interval (0·24, 0·23–0·26; p<0·0001), and greater all-cause mortality risk (RR 1·19, 95% CI 1·00–1·41; p=0·047).<h3>Interpretation</h3>The prevalence of antipsychotic polypharmacy has increased globally over the past 50 years and is particularly high in patients with SSDs","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"72 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601163","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 challenges of antipsychotic polypharmacy","authors":"Jari Tiihonen, Heidi Taipale","doi":"10.1016/s2215-0366(24)00367-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00367-5","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"39 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601398","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":"Youth mental health in Tunisia: challenges and resources","authors":"Uta Ouali, Amina Aissa, Amine Larnaout, Zeineb Abbes, Fatma Charfi, Asma Bouden, Joseph Ventura","doi":"10.1016/s2215-0366(24)00329-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00329-8","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"8 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594294","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":"Reimagining community mental health: adapting interventions for culturally rich, low-resource settings","authors":"Naeem Dalal, Chikumbi Chambwe, Brian Maila, Roma Chilengi","doi":"10.1016/s2215-0366(24)00355-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00355-9","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"242 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142588368","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":"Feasibility and acceptability of the Problem Management for Moms programme for improving maternal mental health in Zambia: an open-label trial","authors":"Günther Fink, Maria Melero-Dominguez, Mpela Chembe, Daniela de Vernisy-Romero, Thandiwe Tembo, Tamara Billima, Ravi Paul, Margarita Alegria, Doug Parkerson, Peter C Rockers, Zaliwe Banda, Gabriel Lungu, Dorothy Sikazwe, Irene Falgas-Bague","doi":"10.1016/s2215-0366(24)00256-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00256-6","url":null,"abstract":"<h3>Background</h3>Psychological distress is common among mothers in low-income and middle-income countries, limiting their capacity to care for themselves and their children. This study aimed to test the feasibility and acceptability of an adapted psychosocial intervention for distressed mothers in low-resource settings.<h3>Methods</h3>In this open-label trial, we enrolled women living in Lusaka, Zambia, with high mental distress (>7 score on the 20-item Self-Reporting Questionnaire [SRQ-20]) and children younger than 2 years, who had previously enrolled in the ZamCharts early childhood nutrition trial. We randomly assigned participants (1:1) to the intervention or control group using a random number draw. The intervention was a newly developed Problem Management for Moms (PM4M) programme: a ten-session treatment adapted from Problem Management Plus, which was offered by phone or in person. After randomisation, participants in the intervention group underwent pre-intervention screening, a post-intervention assessment, and a final follow-up assessment 9 months after treatment initiation (ie, final follow-up visit). The control group was assessed at the baseline of ZamCharts and at the final follow-up assessment, and these participants did not receive any intervention. The primary study outcomes were feasibility, acceptability, and participant mental distress measured using the SRQ-20. All primary and secondary outcomes were estimated in the intention-to-treat population, which included all participants who were randomised to the intervention group and attended the final follow-up assessment. Data on ethnicity were not collected. The trial is registered at <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>NCT05627206</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 has been completed. Women with lived experience of mental health symptoms were involved in this study.<h3>Findings</h3>Between April 26, and July 14, 2021, 790 women were interviewed in the ZamCharts trial, of whom 265 had high mental distress and were randomly assigned to treatment groups in this trial (134 to the intervention group and 131 to the control group). Of the 134 women in the intervention group, 61 (46%) received the PM4M intervention and 73 (55%) were excluded; 103 in the intervention group and 106 in the control group were successfully interviewed at the final follow-up assessment. The mean age of participants was 27·6 years (SD 7·6) at ZamCharts baseline. PM4M sessions were conducted between Dec 16, 2022, and May 6, 2023. The 61 participants deemed eligible after pre-intervention screening who started ","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"96 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142588367","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 2024; 11: 910–33","authors":"","doi":"10.1016/s2215-0366(24)00371-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00371-7","url":null,"abstract":"<em>Pinchuk I, Leventhal B L, Ladyk-Bryzghalova A, et al. The</em> Lancet Psychiatry <em>Commission on mental health in Ukraine. Lancet Psychiatry 2024;</em> <strong>11</strong>: <em>910–33</em>—In this Commission, the affiliation for author Marisa Casanova Dias MD MSc is incorrect. The correct affiliation is National Centre for Mental Health, Cardiff University, Cardiff, UK. This correction has been made to the online version as of Nov 4.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142579935","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":"Promoting academic forensic psychiatry in low-income and middle-income countries.","authors":"Yasin Hasan Balcioglu","doi":"10.1016/S2215-0366(24)00175-5","DOIUrl":"10.1016/S2215-0366(24)00175-5","url":null,"abstract":"","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":" ","pages":"872-874"},"PeriodicalIF":30.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471761","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":"Forensic mental health: envisioning a more empirical future.","authors":"John Tully, Jonathan Hafferty, Daniel Whiting, Kimberlie Dean, Seena Fazel","doi":"10.1016/S2215-0366(24)00164-0","DOIUrl":"10.1016/S2215-0366(24)00164-0","url":null,"abstract":"<p><p>Forensic mental health services provide crucial interventions for society. Such services provide care for people with mental disorders who commit violent and other serious crimes, and they have a key role in the protection of the public. To achieve these goals, these services are necessarily expensive, but they have been criticised for a high-cost, low-volume approach, for lacking consistent standards of care, and for neglecting human rights and other ethical considerations. A key concern is an insufficient evidence base to justify common practices, such as restricting leave from hospital and detaining patients for long periods. There is also insufficient quality evidence for core interventions, including psychological therapies, pharmacotherapy, and seclusion and restraint. The causes for this evidence deficit are complex but include insufficient investment in research infrastructure and fragmentation and isolationism of services, both nationally and internationally. In this Personal View, we highlight some of the major gaps in the forensic mental health evidence base and the challenges in addressing these gaps. We suggest solutions with implications at clinical, societal, and public health policy levels.</p>","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":" ","pages":"934-942"},"PeriodicalIF":30.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471760","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":"Sex-sensitive and gender-sensitive care for patients with mental disorders","authors":"Bernd Lenz, Birgit Derntl","doi":"10.1016/s2215-0366(24)00330-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00330-4","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"67 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489174","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":"Priority setting for mental health in Gaza","authors":"Yasser Abu Jamei, Corrado Barbui","doi":"10.1016/s2215-0366(24)00335-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00335-3","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487062","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}