World Psychiatry最新文献

{"title":"Real-world comprehensive care of people living with schizophrenia: recommendations across different settings and clinical stages.","authors":"Paolo Fusar-Poli, Toby Pillinger, Robert A McCutcheon, Thara Rangaswamy, Laila Asmal, Swaran P Singh, Dominic Oliver, Riccardo Stefanelli, Nicolas A Crossley, Ary Gadelha, Carlos Lopez-Jaramillo, Byamah B Mutamba, Majda Cheour, Marcelo Valencia, Laura Asher, Claudia Aymerich, Ana Catalan, Dong Keon Yon, Jae Il Shin, Marco Solmi, Stephen M Lawrie, Kazione Kulisewa, Olga Karpenko, Dror Ben-Zeev, Samuele Cortese, Crick Lund, Oliver Howes, Peter Kéri, Charlene Sunkel, Ilaria Bonoldi, Stefano Damiani, Laura Fusar-Poli, Patrick D McGorry, John M Kane, Christoph U Correll","doi":"10.1002/wps.70066","DOIUrl":"10.1002/wps.70066","url":null,"abstract":"<p><p>The clinical management of a complex disorder such as schizophrenia remains a significant challenge worldwide. This disorder requires a comprehensive, integrated and personalized care that blends multiple approaches, and the real-world availability of multiple resources. We present here the first recommendations addressing the real-world comprehensive care for people with schizophrenia-spectrum psychoses across different approaches, clinical stages, and levels of available resources. The recommendations are based on a critical review of the scientific literature and a collaborative appraisal by numerous clinical academics actively treating people with schizophrenia worldwide, representing various countries and clinical settings, including those in the Global South. Experts by experience were also involved. Our recommendations indicate that the comprehensive care of schizophrenia should involve: a) early detection; b) measurement-based monitoring; c) pharmacological treatments; d) psychological interventions; e) psychosocial interventions (including supported employment, housing and education); f) management of somatic conditions; g) community care; h) inpatient care; i) peer support, self-help, and alternative healing methods; j) population-level prevention, and l) societal-level support. The overarching core recommendation is to implement evidence-based care that addresses disparities across high- to middle/low-resource settings, emphasizing early intervention (and prevention when possible), culturally-sensitive paradigms that leverage the local existing resources, and task-sharing models that involve non-professional health care workers and, if possible, traditional healers. In the future, we expect that scalable and resource-saving, evidence-based digital solutions will help extend and improve care quality and efficiency across all resource settings. However, none of this can be achieved without adequately focusing on and strengthening mental health funding, improving access to care, addressing social determinants of health, and recognizing that care for people at risk for or living with schizophrenia is uneven and in need of improvement across all settings.</p>","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"231-264"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neurodiversity movement vs. the medical model of autism.","authors":"Steven K Kapp","doi":"10.1002/wps.70076","DOIUrl":"10.1002/wps.70076","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"322-323"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive care for schizophrenia: smart choices by clinicians can make a huge difference, even when resources are limited.","authors":"Robin Emsley","doi":"10.1002/wps.70051","DOIUrl":"10.1002/wps.70051","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"269-270"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The problem of recognition of clinical high-risk states is hampering the prevention of schizophrenia.","authors":"Scott W Woods","doi":"10.1002/wps.70055","DOIUrl":"10.1002/wps.70055","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"274-275"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multilevel systems approach to resilience after childhood adversity.","authors":"Anne-Laura van Harmelen","doi":"10.1002/wps.70070","DOIUrl":"10.1002/wps.70070","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"325-326"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatic symptoms and sensory dysregulation are central to the clinical presentation of PTSD.","authors":"Bessel A van der Kolk, Alexander C McFarlane","doi":"10.1002/wps.70039","DOIUrl":"10.1002/wps.70039","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"227-229"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic pain and mental disorders: a frequent comorbidity requiring a new comprehensive approach.","authors":"Brendon Stubbs, Davy Vancampfort","doi":"10.1002/wps.70062","DOIUrl":"10.1002/wps.70062","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"323-325"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The causality problem in climate anxiety research.","authors":"Francis Vergunst","doi":"10.1002/wps.70069","DOIUrl":"10.1002/wps.70069","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"334-335"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child and adolescent psychiatry: challenges, solutions, opportunities, and future directions.","authors":"Samuele Cortese, Celso Arango, Claudia Aymerich, Ana Catalan, Mohamed Chetouani, David Cohen, David Coghill, Alessandra Gabellone, Raquel Iniesta, Anoop Kadan, Hala Kerbage, Lars Vedel Kessing, Lucia Margari, Emilia Matera, Lucia Marzulli, Signe Mezinska, Melissa Mulraney, Peter Nagy, Dominic Oliver, Anne Katrine Pagsberg, Maria Giuseppina Petruzzelli, Veit Roessner, Gonzalo Salazar de Pablo, Paramala Santosh, Dejan Stevanovic, Gisela Sugranyes, Eduard Vieta, Christoph U Correll, Gil Zalsman, Diane Purper-Ouakil, Carmen Moreno, Paolo Fusar-Poli","doi":"10.1002/wps.70044","DOIUrl":"10.1002/wps.70044","url":null,"abstract":"<p><p>It is estimated that, globally, the mean point prevalence of diagnosable mental disorders in children and adolescents is higher than 11%, and around half of cases of major mental disorders have their onset before the age of 18. Mental disorders with onset in childhood or adolescence have an enormous impact on the developing brain, body and personal identity, as well as on the short- and long-term social, educational and functional capacity of individuals. Child and adolescent psychiatry - as a discipline, profession, academic field, and network of clinical services - is still relatively young, with its formal evolution beginning in the 20th century. Therefore, it is not surprising that there are currently many challenges, but also opportunities and expected future developments, in this area. In this paper, we identify and address the core challenges, possible solutions, opportunities, and future directions of child and adolescent psychiatry. In the first part of the paper, challenges and possible solutions are discussed regarding diagnostic issues, stigma, access to care, shortage of mental health professionals, evidence-based treatments, treatment adherence, parental participation/engagement, integration with schools, digital influences and cyberbullying, and war/forced displacement. In the second part, opportunities and developments are addressed that relate to early identification and intervention, resilience, interdisciplinary collaborations, integration with primary care, community-based approaches, use of digital technologies, precision child and adolescent psychiatry, artificial intelligence and related ethical issues, and cultural diversity and competences. Despite the significance and impact of mental disorders in children and adolescents, clinical delivery and research on these conditions remain underfunded and underprioritized, even in high-income countries, with clinical services and prevention/early intervention research receiving minimal investment. Addressing mental health in children and young people requires multi-level strategies beyond individual treatment, including tackling structural and socioeconomic barriers and creating opportunities for strengthening resilience and well-being. A well-trained workforce, adequate policies, and increased public awareness are crucial. Overall, the current gaps demand urgent action and global funding rebalancing to more adequately meet the critical needs of children and young people challenged by mental illness.</p>","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"190-224"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting long-term poor outcomes in individuals at clinical high risk for psychosis using real-world clinical data: the OASIS1000 prospective study.","authors":"Yanakan Logeswaran, Andrea De Micheli, Ilaria Toniol, Tiexin Chen, Antonio Melillo, Maite Arribas, Nicholas R Livingston, Kamil Krakowski, Dominic Oliver, Daniel Stahl, Paolo Fusar-Poli","doi":"10.1002/wps.70063","DOIUrl":"10.1002/wps.70063","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Most research into the clinical high risk for psychosis (CHR-P) state has focused on predicting transition to psychosis in the short term, and largely in research samples that are not representative of real-world preventive care. However, CHR-P individuals experience a broad range of poor long-term clinical outcomes in real-world settings, such as hospitalization for psychiatric reasons, initiation of a new antipsychotic treatment, or suicide. Improving the detection of individuals at greater risk of these long-term poor outcomes is critical to advance preventive care in real-world clinical settings. This study aims to develop and internally validate a personalized clinical prediction model for real-world, long-term poor outcomes beyond transition risk in CHR-P individuals. This RECORD-compliant, real-world, long-term prospective cohort study included electronic health records (EHR) data from all CHR-P individuals receiving preventive care from the Outreach and Support in South London (OASIS) service in South London and Maudsley National Health Service Foundation Trust in the UK from 2001 to 2024. The primary outcome was the long-term cumulative risk of first real-world poor outcome, operationalized by pragmatic parameters informing clinical practice: transition to psychosis, receiving a first antipsychotic treatment at a dosage necessary to treat first-episode psychosis, receiving a first voluntary or compulsory hospitalization for psychiatric reasons, or dying by suicide. A clinical prediction model (regularized Cox regression) was developed and validated using internal-external cross-validation to predict long-term poor outcomes, utilizing real-world predictors available in routine care. Model performance was indexed by discrimination (Harrell's C), calibration (slope, intercept), overall performance (Brier score), and potential clinical utility (decision curve analysis). One thousand CHR-P OASIS patients were included (mean age: 22.51±4.99 years; 53.60% males, 44.73% White) and followed up to a maximum of 21 years. The cumulative risk of real-world poor outcome was 0.644 (95% CI: 0.547-0.742) at 14-18 years. The validated clinical prediction model showed statistically significant discrimination (C=0.69; 95% CI: 0.63-0.74), calibration (slope = 1.61, 95% CI: 0.74-2.48; intercept = -0.03, 95% CI: -0.62 to 0.55) and overall performance (Brier score = 0.18; 95% CI: 0.13-0.22). Decision curve analysis demonstrated that the model was associated with greater net benefit than the clinical alternatives at risk thresholds from 0% to 50%. These data suggest that most CHR-P individuals have long-term poor outcomes, beyond transition to psychosis, in real-world care, which should become the focus of a new generation of research. The clinical prediction model presented here can identify these individuals and facilitate the personalized provision of preventive care, thereby improving outcomes in this population. CHR-P services should extend their dura","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"25 2","pages":"295-306"},"PeriodicalIF":79.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}