Lancet Psychiatry最新文献

{"title":"Antipsychotics and sedation: from clinical to shared decision making","authors":"Subho Chakrabarti","doi":"10.1016/s2215-0366(25)00065-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00065-3","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"17 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653661","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":"Cost-effectiveness of a group psychological intervention for postnatal depression in British south Asian women: an economic evaluation from the ROSHNI-2 trial","authors":"Akbar Ullah, Farah Lunat, Traolach Brugha, Matthias Pierce, Richard Morriss, Deepali Sharma, Atif Rahman, Kamaldeep Bhui, Peter Bower, Nusrat Husain","doi":"10.1016/s2215-0366(25)00039-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00039-2","url":null,"abstract":"<h3>Background</h3>Minority ethnic groups often face ethnocultural barriers in accessing mental health treatments. The ROSHNI-2 trial compared culturally adapted cognitive behavioural therapy (Positive Health Programme [PHP]) with treatment as usual for postnatal depression in British south Asian women. We aimed to assess the cost-effectiveness of the PHP intervention.<h3>Methods</h3>The ROSHNI-2 trial was a multicentre, two-arm, assessor-blinded, randomised controlled trial; we conducted an economic evaluation over a 12-month period to assess the cost-effectiveness of PHP plus treatment as usual versus treatment as usual alone from the perspective of the English National Health Service and personal social services. In the trial, British south Asian women aged 16 years or older with a child aged up to 12 months, and meeting DSM-5 criteria for depression, were recruited from northwest England, Yorkshire, the East Midlands, and London. The PHP intervention involved 12 group sessions delivered by two trained bilingual facilitators, held once per week for 2 months and once per fortnight thereafter, each lasting 60–90 min. Questionnaires on depression symptoms, quality of life, and resource use were completed at baseline, 4 months (end of intervention), and 12 months after random assignment. Quality-adjusted life-years (QALYs) were used for the cost-utility analysis, and recovery from depression at 4 months (the primary clinical outcome), assessed using the Hamilton Rating Scale for Depression, informed the cost-effectiveness analysis. After the onset of the COVID-19 pandemic, the intervention was adapted for online delivery for the remaining participants. A stratified analysis compared the cost-effectiveness of online versus in-person delivery. The trial involved researchers with lived experience, and all methods, including health economic measures, were developed in consultation with service users, community members, and faith leaders. This is a preplanned analysis of the ROSHNI-2 trial, registered with ISRCTN (ISRCTN10697380).<h3>Findings</h3>From Feb 8, 2017, to March 29, 2020, 732 eligible women were enrolled: 368 participants were randomly assigned to the PHP arm and 364 to the treatment as usual arm. The base-case intention-to-treat analysis showed that PHP significantly increased costs (£712, 95% CI 311 to 1113) and QALYs (0·036, 95% CI 0·006 to 0·067), with an incremental cost-effectiveness ratio of £19 601 (7622 to 83 772). Based on the UK National Institute for Health and Care Excellence (NICE) maximum willingness-to-pay threshold of £30 000 per QALY, the likelihood of PHP being cost-effective was 77% from a health and social care perspective. Cost per remission from depression at the 4-month follow-up was £5509 (2916 to 17 860). In a stratified analysis of 34 participants attending online sessions during the pandemic, incremental QALY effects were 0·125 (0·048 to 0·203), resulting in costs of £202 (–3906 to 10 918) per additional QALY gain","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"49 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640870","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":"Cultural practices within Indigenous Australian communities enhance mental health","authors":"William D R Smitha, Rebecca Defina, Caitlin Hitchcock","doi":"10.1016/s2215-0366(25)00064-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00064-1","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"92 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599649","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":"Clinical effectiveness of an online psychoeducational and psychotherapeutic programme for caregivers of children newly diagnosed as autistic: a parallel, assessor-masked, randomised controlled trial in the UK (REACH-ASD)","authors":"Kathy Leadbitter, Sophie Langhorne, Richard Smallman, Petrina Chu, Ceri Ellis, Louisa Harrison, Tessa Hutton, Charlotte Butter, Caitlin Goldie, Kirsty James, Latha Hackett, Alison Dunkerley, Penny Bee, Gemma Shields, Linda Davies, Richard Emsley, Jonathan Green","doi":"10.1016/s2215-0366(25)00036-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00036-7","url":null,"abstract":"<h3>Background</h3>Caregivers of autistic children experience particularly poor levels of mental health and increased caregiving complexities. Proactive post-diagnostic family support is recommended but is inconsistently implemented, largely not evidence based, and does not directly address caregiver mental health. This study aimed to test the clinical effectiveness of the Empower-Autism programme plus treatment as usual versus the usual local post-diagnostic psychoeducation offer plus treatment as usual on caregiver mental health at the 52-week follow-up.<h3>Methods</h3>We did a prospective, multicentre, two-parallel-group, randomised controlled superiority trial of the Empower-Autism programme. Empower-Autism is a group-based, manualised, post-diagnostic programme designed to improve the mental health of caregivers of newly diagnosed autistic children. The programme combines autism psychoeducation and psychotherapeutic components based on Acceptance and Commitment Therapy and was delivered online via videoconferencing. Participants were recruited from 11 North-West England autism diagnostic or intervention centres and were parents or primary caregivers of children aged 2–15 years given an autism diagnosis within the past 12 months. Exclusion criteria were insufficient English language skills, significant learning disability, hearing or visual impairment, or psychiatric condition in caregiver and significant current family safeguarding concerns. Participants were randomly assigned to the intervention or treatment as usual (2:1), stratified by centre. Assessors were masked to group assignment but participants were not. The primary outcome was caregiver mental health assessed by the General Health Questionnaire-30 at 52 weeks. All outcomes were analysed following an intention-to-treat approach using linear mixed models on available cases in the first instance, which resulted in a modified intention-to-treat set due to missing data. Sensitivity analyses on multiply imputed data reflected the full intention-to-treat set. People with lived experience were involved in the trial across all stages. The trial was prospectively registered (ISRCTN 45412843) on Sept 11, 2019, and is complete.<h3>Findings</h3>Between Sept 16, 2020 and April 14, 2022, 835 potential participants were referred and screened, 384 provided consent, and 379 caregivers were recruited, 255 of whom were randomly assigned to the intervention group and 124 to the treatment as usual group. 333 (88%) participants were female and 46 (12%) were male, with a mean age of 40·6 years (SD 7·3; range 23–69). 294 (78%) of the 379 caregivers were White British, 18 (5%) were White Other, 12 (3%) were Mixed or of multiple ethnicity, 32 (8%) were Asian or Asian British, 16 (4%) were Black or Black British, six (2%) were from any other ethnic group, and one (<1%) had missing ethnicity data. 267 (70%) index children were male, 111 (29%) were female, and one (<1%) was non-binary or other, with a me","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599502","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":"Sarah Kline: Better mental health everywhere, for everyone","authors":"Jules Morgan","doi":"10.1016/s2215-0366(25)00033-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00033-1","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"17 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575186","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":"Balancing collective forgetting, remembrance, and change to secure Syria's future","authors":"Kinda Alsamara, Alexander C McFarlane","doi":"10.1016/s2215-0366(25)00059-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00059-8","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"37 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546436","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 Feb 19. https://doi.org/10.1016/S2215-0366(25)00005-7","authors":"","doi":"10.1016/s2215-0366(25)00068-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00068-9","url":null,"abstract":"<em>Johnson N E, Malimabe M, Yoon G H, et al. Integration of local realities to address mental health in Africa. Lancet Psychiatry 2025; published online Feb 19. https://doi.org/10.1016/S2215-0366(25)00005-7</em>—In this Comment, the first two institutions in the affiliations section should be listed as: Division of Clinical Epidemiology, Department of Clinical Research, University Hospital of Basel, Basel, 4051 Switzerland and University of Basel, Basel, Switzerland. This correction has been made to the online version as of March 3, 2025.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"35 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538454","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":"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":"&lt;h3&gt;Background&lt;/h3&gt;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.&lt;h3&gt;Methods&lt;/h3&gt;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.&lt;h3&gt;Findings&lt;/h3&gt;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.&lt;h3&gt;Interpretation&lt;/h3&gt;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}