Lancet PsychiatryPub Date : 2024-12-01Epub Date: 2024-06-18DOI: 10.1016/S2215-0366(24)00115-9
Hael Abdulrazeq, Alexander P Philips, Rahul Sastry, Peter M Lauro, Nicole C R McLaughlin, Wael F Asaad
{"title":"The persistent value of lesions in psychiatric neurosurgery.","authors":"Hael Abdulrazeq, Alexander P Philips, Rahul Sastry, Peter M Lauro, Nicole C R McLaughlin, Wael F Asaad","doi":"10.1016/S2215-0366(24)00115-9","DOIUrl":"10.1016/S2215-0366(24)00115-9","url":null,"abstract":"<p><p>Neurosurgery for intractable psychiatric conditions has seen a resurgence with the increasing use of deep brain stimulation (DBS). Although DBS promises reversible neuromodulation and has become more popular than older lesioning methods, lesioning might still be preferred in specific cases. Here, we review the evidence for DBS and lesions in the treatment of intractable neuropsychiatric conditions and consider the factors that favour the continued use of lesioning procedures in appropriately selected cases. Broadly, systemic factors including comparative effectiveness, cost, and ethical arguments support an ongoing role for lesioning. Such a role is also supported by practical considerations including patient experiences of this type of therapy, the relative intensity of follow-up care, access to sparse or specialised follow-up care, and relative infection risk. Overall, we argue that neurosurgical lesion procedures remain an important alternative to DBS and their continued availability is necessary to fulfil the imperatives of mental health parity and enhance access to effective mental health treatments. Nonetheless, the efficacy of DBS and recent advances in closed-loop stimulation and remote programming might provide solutions to some of the challenges associated with wider use of electrical neuromodulation. Concerns about the scarcity of high-level evidence for the efficacy of lesioning procedures as well as the potential irreversible adverse effects of lesioning remain to be addressed.</p>","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":" ","pages":"1022-1029"},"PeriodicalIF":30.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437623","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 : 2024-12-01Epub Date: 2024-08-15DOI: 10.1016/S2215-0366(24)00186-X
Johanna Keller, Moritz Herle, William Mandy, Virginia Carter Leno
{"title":"The overlap of disordered eating, autism and ADHD: future research priorities as identified by adults with lived experience.","authors":"Johanna Keller, Moritz Herle, William Mandy, Virginia Carter Leno","doi":"10.1016/S2215-0366(24)00186-X","DOIUrl":"10.1016/S2215-0366(24)00186-X","url":null,"abstract":"<p><p>The focus of mental health research in emerging fields should be driven by the priorities of people with relevant lived experience. Autism and ADHD are childhood-onset neurodevelopmental conditions that are associated with a range of health inequalities, including increased risk for eating disorders. The evidence base for how best to support neurodivergent individuals who experience disordered eating is still in its infancy, but research suggests that existing clinical approaches are not currently fit for purpose. In this Personal View, through community consultation with autistic people and people with ADHD who have experienced disordered eating, we present a comprehensive ranked list of research topics that people with lived experience prioritise. These priorities could be clustered into two areas: improving outcomes and identifying causal mechanisms. Within the theme of improving disordered eating outcomes, priorities are the improvement of treatment, the need for neurodiversity training in clinical services, and the identification and minimisation of unintended adverse effects of psychological intervention. Within the theme of identifying causal mechanisms, priorities are the identification of risk factors and a better understanding of the effect of autistic or ADHD neurocognitive profiles as potential contributors to eating disorder vulnerability. The final top ten research priorities are contextualised in terms of how they compare to the existing literature on the overlap between autism or ADHD and eating disorders, and concrete suggestions are made for how to implement these research priorities as testable hypotheses. Research informed by these priorities will build necessary understanding of the reasons behind the increased risk for eating disorders in neurodivergent people, and how to best support people who are affected by disordered eating to live positive and fulfilling lives.</p>","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":" ","pages":"1030-1036"},"PeriodicalIF":30.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001035","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 : 2024-11-26DOI: 10.1016/s2215-0366(24)00356-0
Michaela Ladmanová, Tomáš Řiháček, Ladislav Timulak, Klára Jonášová, Barbora Kubantová, Petr Mikoška, Lucia Polakovská, Robert Elliott
{"title":"Client-identified outcomes of individual psychotherapy: a qualitative meta-analysis","authors":"Michaela Ladmanová, Tomáš Řiháček, Ladislav Timulak, Klára Jonášová, Barbora Kubantová, Petr Mikoška, Lucia Polakovská, Robert Elliott","doi":"10.1016/s2215-0366(24)00356-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00356-0","url":null,"abstract":"<h3>Background</h3>Psychotherapy outcomes are typically measured in terms of symptom relief. However, this method might overlook important changes from clients' perspectives when they are asked to report on them. A more client-centred approach might bring a deeper understanding of psychotherapy outcomes. We aimed to evaluate the outcomes identified by clients within qualitative psychotherapy research.<h3>Methods</h3>The PsycArticles, PsycInfo, and MEDLINE Complete databases were searched for English language studies published until Nov 11, 2023. Additional studies were identified through references in the primary studies and previous meta-analyses or systematic reviews. Search terms were related to psychotherapy and counselling, clients' or patients' experiences, psychotherapy outcomes and changes, post-treatment perspectives, and types of qualitative methods. Qualitative studies on client-identified outcomes of individual psychotherapy were included. Findings related to clients' perceptions of psychotherapy outcomes were extracted (by ML and checked by TR and LT) and analysed (by all authors) using the descriptive–interpretative meta-analytic approach. All authors have personally experienced psychotherapy as clients. This study was pre-registered with PROSPERO (CRD42021277330).<h3>Findings</h3>We included 177 studies in the qualitative meta-analysis, from 24 countries, including descriptions from 2908 clients. Most of the studies were of good quality; they covered a wide range of therapeutic approaches and diagnoses. The descriptions of psychotherapy outcomes were classified into 60 meta-categories and grouped into ten clusters. These clusters related to clients' relational and social functioning; their emotional functioning; self-awareness, self-understanding, and more adaptive cognitive processing; behavioural functioning; developing their own resources; clients' attitudes towards themselves; generally embracing life; symptom and problem change; and more general wellbeing. The tenth cluster was outcomes that could not be clearly attributed to psychotherapy, which was considered outside the scope of this study.<h3>Interpretation</h3>The meta-analysis showed that clients value outcome dimensions beyond symptom reduction, such as deeper self-understanding, enhanced self-agency, and greater social engagement. By examining psychotherapy outcomes across various diagnoses and therapeutic approaches, we highlight limitations in traditional outcome measures, showing the need for more comprehensive, client-centred assessment tools and the value of incorporating qualitative methods into understanding dimensions of change.<h3>Funding</h3>European Union.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"67 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718552","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 : 2024-11-26DOI: 10.1016/s2215-0366(24)00369-9
Christiane Steinert
{"title":"Putting opacity back into outcome","authors":"Christiane Steinert","doi":"10.1016/s2215-0366(24)00369-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00369-9","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"67 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718752","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 : 2024-11-25DOI: 10.1016/s2215-0366(24)00359-6
Blandine French, Camilla Babbage, Sarah Cassidy, Stefan Rennick-Egglestone
{"title":"Misrepresentation by online study participants—a threat to data integrity","authors":"Blandine French, Camilla Babbage, Sarah Cassidy, Stefan Rennick-Egglestone","doi":"10.1016/s2215-0366(24)00359-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00359-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"149 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142713237","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 : 2024-11-21DOI: 10.1016/s2215-0366(24)00365-1
Orestis Zavlis, Patrick Luyten, Steve Pilling, Peter Fonagy
{"title":"Pressing need for clinical trial research on dimensional personality disorder","authors":"Orestis Zavlis, Patrick Luyten, Steve Pilling, Peter Fonagy","doi":"10.1016/s2215-0366(24)00365-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00365-1","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"13 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684742","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 : 2024-11-19DOI: 10.1016/s2215-0366(24)00331-6
Jan Dirk Blom, Brian A Sharpless
{"title":"On the perceptual characteristics of auditory verbal hallucinations","authors":"Jan Dirk Blom, Brian A Sharpless","doi":"10.1016/s2215-0366(24)00331-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00331-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"22 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673002","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}