Lancet Psychiatry最新文献_第4页

Quality improvement for suicide prevention and self-harm intervention: addressing the implementation gap and saving lives

IF 64.3 1区医学

Lancet Psychiatry Pub Date : 2025-02-10 DOI: 10.1016/s2215-0366(24)00442-5

Nav Kapur, Su-Gwan Tham, Pauline Turnbull, Nicola Richards, Cathryn Rodway, Caroline Clements, Saied Ibrahim, Roger T Webb, Tom Ayers, Emily Cannon, Louis Appleby, Leah Quinlivan

{"title":"Quality improvement for suicide prevention and self-harm intervention: addressing the implementation gap and saving lives","authors":"Nav Kapur, Su-Gwan Tham, Pauline Turnbull, Nicola Richards, Cathryn Rodway, Caroline Clements, Saied Ibrahim, Roger T Webb, Tom Ayers, Emily Cannon, Louis Appleby, Leah Quinlivan","doi":"10.1016/s2215-0366(24)00442-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00442-5","url":null,"abstract":"The prevention of suicide is an international priority. Self-harm is one of the most important antecedents to suicide and an important health and societal issue in its own right. Health care services have an important role to play in providing care and intervention after self-harm. As researchers, we often call for more research but there is already a substantial evidence base for the prevention of suicide and self-harm that has built up over the years. Perhaps the most pressing concern currently is the failure to implement what we know. In this Personal View, we summarise three recent national quality improvement programmes in England—one focused on suicide prevention, and two on self-harm. Aggregate observational data suggest that the initiatives might have been associated with positive outcomes in terms of reductions in the incidence of suicide and self-harm; but possibly more striking was the activity and innovation that the programmes generated. We argue that quality improvement approaches focused on suicide prevention and self-harm intervention have the potential to address the implementation gap in service provision and save lives.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"160 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385515","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}

引用次数: 0

Lithium for depression-related hospitalisation in bipolar disorder

IF 64.3 1区医学

Lancet Psychiatry Pub Date : 2025-02-05 DOI: 10.1016/s2215-0366(25)00026-4

Balwinder Singh

引用次数: 0

Trump 2.0: a better way to show leadership

IF 64.3 1区医学

Lancet Psychiatry Pub Date : 2025-02-05 DOI: 10.1016/s2215-0366(25)00038-0

引用次数: 0

Real-world effectiveness of pharmacological maintenance treatment of bipolar depression: a within-subject analysis in a Swedish nationwide cohort

IF 64.3 1区医学

Lancet Psychiatry Pub Date : 2025-02-05 DOI: 10.1016/s2215-0366(24)00411-5

Cagatay Ermis, Heidi Taipale, Antti Tanskanen, Eduard Vieta, Christoph U Correll, Ellenor Mittendorfer-Rutz, Jari Tiihonen

{"title":"Real-world effectiveness of pharmacological maintenance treatment of bipolar depression: a within-subject analysis in a Swedish nationwide cohort","authors":"Cagatay Ermis, Heidi Taipale, Antti Tanskanen, Eduard Vieta, Christoph U Correll, Ellenor Mittendorfer-Rutz, Jari Tiihonen","doi":"10.1016/s2215-0366(24)00411-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00411-5","url":null,"abstract":"<h3>Background</h3>Long-term add-on antidepressant use for bipolar depression remains controversial. This study aimed to investigate primarily the association between psychopharmacological treatments and hospitalisation (ie, hospital admission) for bipolar depression, and secondarily the association between psychopharmacological treatments and hospitalisation for bipolar mania and somatic reasons in a registry-based national Swedish cohort.<h3>Methods</h3>In this within-subject analysis, people diagnosed with bipolar disorder were identified from Swedish nationwide registers of inpatient and specialised outpatient care, sickness absence, and disability pension between Jan 1, 2006, and Dec 31, 2021. Data for hospitalisations, and antidepressant, antipsychotic, and mood stabiliser medication use were also retrieved from national databases. Treatment periods were modelled using the PRE2DUP method. Data were analysed with a within-individual design with stratified Cox Regression models, to eliminate selection bias when calculating adjusted hazard ratios (aHRs) and 95% CIs. The main outcome was hospitalisation due to depression and secondary outcomes were mania-related and somatic hospitalisations to address the risk–benefit ratio of antidepressant treatment. The reference was non-use of antidepressant, antipsychotic, and mood stabiliser medications. We also did head-to-head comparisons (ie, comparing different drug use periods within the same individual against each other) between medications to obtain results on comparative effectiveness while minimising confounding by indication. Ethnicity data were not available. People with related lived experience were involved in the research and writing process.<h3>Findings</h3>The study cohort included 105 495 individuals (mean age 44·2 years, SD 18·8; 65 607 [62·2%] women and 39 888 [37·8%] men). In medication class-based analyses, a higher risk of depression-related hospitalisation was associated with the use of antidepressant only (aHR 1·25, 95% CI 1·16–1·34), antipsychotic only (1·39, 1·24–1·55), antidepressant–antipsychotic combination (1·28, 1·18–1·39), and antipsychotic–mood stabiliser combination treatment (1·13, 1·03–1·24). By contrast, use of mood stabilisers only (0·89, 0·81–0·98) was associated with lower risk. For specific monotherapies, only lithium was associated with lower depression-related hospitalisation risk (0·75, 0·67–0·85). No specific antidepressant monotherapy was associated with reduced depression-related hospitalisation, while several antidepressants and antipsychotics were related to an increased risk. In head-to-head comparisons, lithium monotherapy was associated with a superior outcome compared with antidepressant monotherapy (0·59, 0·51–0·68), antipsychotic monotherapy (0·54, 0·44–0·66), lamotrigine monotherapy (0·69, 0·53–0·91), and quetiapine monotherapy (0·54, 0·41–0·71). Lithium was associated with the lowest risk of somatic hospitalisation (0·86, 0·80–0·93) when compared w","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"9 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192506","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}

引用次数: 0

Suicidality should be considered for inclusion in the diagnostic criteria for PMDD. 应考虑将自杀纳入 PMDD 的诊断标准。

IF 30.8 1区医学

Lancet Psychiatry Pub Date : 2025-02-01 Epub Date: 2024-09-19 DOI: 10.1016/S2215-0366(24)00288-8

Jennifer L Gordon, Sneha Chenji, Arianna Di Florio, Liisa Hantsoo, Sandi MacDonald, Jessica R Peters, Jaclyn M Ross, Katja Schmalenberger, Tory A Eisenlohr-Moul