Lancet PsychiatryPub Date : 2024-12-17DOI: 10.1016/s2215-0366(24)00360-2
Edoardo G Ostinelli, Marcel Schulze, Caroline Zangani, Luis C Farhat, Anneka Tomlinson, Cinzia Del Giovane, Samuel R Chamberlain, Alexandra Philipsen, Susan Young, Phil J Cowen, Andrea Bilbow, Andrea Cipriani, Samuele Cortese
{"title":"Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis","authors":"Edoardo G Ostinelli, Marcel Schulze, Caroline Zangani, Luis C Farhat, Anneka Tomlinson, Cinzia Del Giovane, Samuel R Chamberlain, Alexandra Philipsen, Susan Young, Phil J Cowen, Andrea Bilbow, Andrea Cipriani, Samuele Cortese","doi":"10.1016/s2215-0366(24)00360-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00360-2","url":null,"abstract":"<h3>Background</h3>The comparative benefits and harms of available interventions for ADHD in adults remain unclear. We aimed to address these important knowledge gaps.<h3>Methods</h3>In this systematic review and component network meta-analysis (NMA), we searched multiple databases for published and unpublished randomised controlled trials (RCTs) investigating pharmacological and non-pharmacological interventions for ADHD in adults from database inception to Sept 6, 2023. We included aggregate data from RCTs comparing interventions against controls or any other eligible active intervention for the treatment of symptoms in adults (ages ≥18 years) with a formal diagnosis of ADHD. Pharmacological therapies were included only if their maximum planned doses were considered eligible according to international guidelines. We included RCTs of at least 1-week duration for medications, of at least four sessions for psychological therapies, and of any length deemed appropriate for neurostimulation. For RCTs of medications, cognitive training, or neurostimulation alone, we included only double-blind RCTs. At least two authors independently screened the identified records and extracted data from eligible RCTs. Our primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). We estimated standardised mean differences (SMDs) and odds ratios (ORs) using random effects pairwise and component NMA, dismantling interventions into specific therapeutic components. This study was registered with PROSPERO (CRD42021265576). People with relevant lived experience were involved in the conduct of the research and writing process.<h3>Findings</h3>Of 32 416 records, 113 unique RCTs encompassing 14 887 participants were eligible for analysis (6787 [45·6%] females, 7638 [51·3%] males, 462 [3·1%] sex not reported). The RCTs encompassed pharmacological therapies (63 [55·8%] of 113 RCTs; 6875 participants), psychological therapies (28 [24·8%] of 113 RCTs; 1116 participants), neurostimulatory therapy and neurofeedback (ten [8·8%] of 113 RCTs; 194 participants), and control conditions (97 [85·8%] of 113 RCTs; 5770 participants). For reduction of ADHD core symptoms at 12 weeks on both self-reported and clinician-reported rating scales, atomoxetine (self-reported scale SMD –0·38, 95% CI –0·56 to –0·21; clinician-reported scale –0·51, –0·64 to –0·37) and stimulants (0·39, –0·52 to –0·26; –0·61, –0·71 to –0·51) had higher efficacy than placebo (Confidence in Network Meta-Analysis [CINeMA] ranging between very low and moderate). Cognitive behavioural therapy (–0·76, –1·26 to –0·26), cognitive remediation (–1·35, –2·42 to –0·27), mindfulness (–0·79, –1·29 to –0·29), psychoeducation (–0·77, –1·35 to –0·18), and transcranial direct current stimulation (–0·78; –1·13 to –0·43) were better than placebo only on clinician-reported measures. Regarding acceptability, al","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"114 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841234","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}
Lancet PsychiatryPub Date : 2024-12-09DOI: 10.1016/s2215-0366(24)00333-x
Carolina Seybert, Nina Schimmers, Lucio Silva, Joost J Breeksema, Jolien Veraart, Bárbara S Bessa, Dora d'Orsi, Robert A Schoevers, Albino J Oliveira-Maia
{"title":"Quality of reporting on psychological interventions in psychedelic treatments: a systematic review","authors":"Carolina Seybert, Nina Schimmers, Lucio Silva, Joost J Breeksema, Jolien Veraart, Bárbara S Bessa, Dora d'Orsi, Robert A Schoevers, Albino J Oliveira-Maia","doi":"10.1016/s2215-0366(24)00333-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00333-x","url":null,"abstract":"Although studies of psychedelic-assisted psychotherapy are accumulating, there is no consensus regarding best practice of the psychotherapeutic component. In this systematic review, we summarised the quality of reporting on psychological interventions in research about psychedelic treatments. The design followed PRISMA guidelines and was preregistered in PROSPERO (CRD42022319221). We searched MEDLINE, PsycINFO, and Embase for original studies on psychedelic-assisted psychotherapy and included 45 studies assessing psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (known as LSD), or ayahuasca, for the treatment of mental disorders. Psychological interventions were done heterogeneously across studies, and completeness of information reported about these interventions was mostly low, according to an adaptation of the Template for Intervention Description and Replication checklist. In studies including MDMA, psychotherapy was more homogeneous and more procedural details were provided. Improved reporting on psychological interventions of psychedelic treatments will support replicability, generalisability, and accurate interpretation of research, while enhancing feasibility and safety of future clinical research and real-world implementation of treatments.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"94 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796824","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}
Lancet PsychiatryPub Date : 2024-12-04DOI: 10.1016/s2215-0366(24)00410-3
{"title":"Correction to Lancet Psychiatry 2024; published online Nov 21. https://doi.org/10.1016/S2215-0366(24)00365-1","authors":"","doi":"10.1016/s2215-0366(24)00410-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00410-3","url":null,"abstract":"<em>Zavlis O, Luyten P, Pilling S, Fonagy P. Pressing need for clinical trial research on dimensional personality disorder. Lancet Psychiatry 2024; published online Nov 21. https://doi.org/10.1016/s2215-0366(24)00365-1</em>. In this Correspondence, the second sentence of the first paragraph should read, “However, national health guidelines (such as those from the UK's National Institute of Clinical Excellence) have not been updated to reflect changes from the previous categorical model of personality disorders”. The third sentence of the fifth paragraph should read “Recent work also supports the predictive superiority of dimensional personality disorder over categorical personality disorders by revealing that dimensional personality difficulties (such as personality disorder severity and traits) are stronger predictors of various clinical outcomes (including general psychiatric severity, psychosocial functioning, and quality of life), compared to categorical personality diagnoses.” These corrections have been made to the online version as of Dec 4, and will be made to the printed version.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"10 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776644","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}
Lancet PsychiatryPub Date : 2024-12-04DOI: 10.1016/s2215-0366(24)00361-4
Ellie May Robson, Hanafi M Husin, Seydeh Ghazaleh Dashti, Nandita Vijayakumar, Margarita Moreno-Betancur, Paul Moran, George C Patton, Susan M Sawyer
{"title":"Tracking the course of depressive and anxiety symptoms across adolescence (the CATS study): a population-based cohort study in Australia","authors":"Ellie May Robson, Hanafi M Husin, Seydeh Ghazaleh Dashti, Nandita Vijayakumar, Margarita Moreno-Betancur, Paul Moran, George C Patton, Susan M Sawyer","doi":"10.1016/s2215-0366(24)00361-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00361-4","url":null,"abstract":"<h3>Background</h3>Adolescent mental health appears to be in crisis, yet few studies have comprehensively charted the course of common mental disorders (CMDs; depression and anxiety) across this key life stage. We aimed to describe the course of CMD symptoms in adolescence by summarising annual prevalence, cumulative incidence, and course for depression and anxiety, both separately and as comorbid CMDs, by sex assigned at birth in a contemporary Australian cohort.<h3>Methods</h3>The Child to Adult Transition Study (CATS) was established in 2012 to form a representative cohort of adolescents in Melbourne, VIC, Australia. 43 schools were recruited using a stratified sampling approach, and all 2289 students aged 8–9 years were invited to participate. 1239 (54·1%) students obtained parental written informed consent and were followed up annually from 2012 to 2019 for a total of ten waves. Data from waves 3–10 (ages 10 to 18 years) were used for the current study and analysed to describe the course of symptoms of CMDs across adolescence. Primary measures of interest were clinically relevant depressive symptoms, clinically relevant anxiety symptoms, and any CMD (clinically relevant depressive or anxiety symptoms) at waves 3–10. A secondary measure of interest was comorbid CMDs (concurrent reporting of clinically significant anxiety and depressive symptoms) at waves 3–10. Depressive symptoms in the past 2 weeks were self-reported using the 13-item validated Short Mood and Feelings Questionnaire (SMFQ) at each wave, with a threshold score of 12 or more indicating clinically relevant symptoms. Anxiety symptoms in the past two weeks were self-reported using an 8-item shortened version of the Spence Children's Anxiety Scale (SCAS) at each wave, with a threshold score of 11 or higher indicating clinically relevant symptoms. The course of CMDs was described using annual prevalence, cumulative incidence for depression and anxiety, separately and combined. Missing data were handled via multiple imputation. An author with lived experience was involved in the research and writing process.<h3>Findings</h3>Of the 1239 adolescents who participated in the study, 667 (53·8%) were female and 572 (46·2%) were male. 769 (62·1%) of 1239 were classified as socioeconomically advantaged, 675 (66·4%) of the 1016 with available data had a mother whose highest level of education was vocational or tertiary, and 579 (70·7%) of the 819 participants with ethnicity data identified as Anglo-Celtic or European. Overall, incidence of any clinically significant CMD symptoms during adolescence was 74% (95% CI 70–77; 84% [81–88] for females and 61% [55–66] for males). Independently, incidences of clinically significant depressive symptoms and anxiety symptoms were 65% (62–68) and 58% (55–62), respectively. Incidence of comorbid CMD was 48% (45–52). The estimated mean ages of first report in adolescence for both sexes were 14·1 years (95% CI 13·9–14·4) and 13·6 years (3·3–13·9) for depressi","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776645","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}
Lancet PsychiatryPub Date : 2024-12-04DOI: 10.1016/s2215-0366(24)00402-4
Karolin Rose Krause, Peter Szatmari
{"title":"Nuanced epidemiology for nuanced care: addressing the substantial mental health needs of adolescents","authors":"Karolin Rose Krause, Peter Szatmari","doi":"10.1016/s2215-0366(24)00402-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00402-4","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"46 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776646","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}