Nature mental health最新文献

{"title":"Evolving OCD treatment: breaking the loop","authors":"","doi":"10.1038/s44220-026-00643-3","DOIUrl":"10.1038/s44220-026-00643-3","url":null,"abstract":"Despite obsessive–compulsive disorder (OCD) being recognized as a global diagnosis with similar rates across countries, there is still a severe lack of trained specialists and high levels of underdiagnosis. This ‘treatment gap,’ together with high treatment resistance in OCD, poses a major challenge to healthcare systems and patients. To overcome barriers to access, there is an urgent need to expand the workforce via specialized training and to provide personalized treatment via digital tools, home-based scalable interventions and alternative treatment modalities.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"469-470"},"PeriodicalIF":8.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s44220-026-00643-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromodulation for treatment-resistant obsessive–compulsive disorder: a systematic review, meta-analysis and network analysis","authors":"Flavia Venetucci Gouveia, Gavin J. B. Elias, Emily H. Y. Wong, Andrew Yang, Michelle Beyn, Amelia Mesich, Uyiosa Omere, Sarah A. Iskin, Yutong Bai, Chao-Kai Hu, Alexandre Boutet, Andres M. Lozano, Jürgen Germann","doi":"10.1038/s44220-026-00586-9","DOIUrl":"10.1038/s44220-026-00586-9","url":null,"abstract":"Obsessive–compulsive disorder (OCD) is a chronic and disabling condition for which neuromodulation has emerged as a key therapeutic strategy for severe cases. This systematic review and meta-analysis evaluated invasive and non-invasive neuromodulation for OCD using studies identified from PubMed, Embase and Cochrane (inception to December 2024) that reported pre- and post-treatment severity scores in at least two patients. We assessed risk of bias, estimated pooled mean differences (MD) using random-effects models and investigated stimulation targets using network analysis. Across 142 studies (n = 2,960), neuromodulation reduced symptoms by 35.3% (95% confidence interval (CI) 32.6–38.0). Invasive interventions showed the largest effects (MD 39.7–45.1), whereas non-invasive modalities yielded more modest benefits (MD 26.4–28.8). Sham-controlled (MD 15.4, 95% CI 10.9–20.0) and low-bias analyses (MD 10.7, 95% CI 5.5–16.0) confirmed efficacy beyond placebo. These findings demonstrate robust symptom improvement with neuromodulation, with invasive approaches yielding the greatest benefit. In this study, the authors analyze data from 143 studies involving 2,743 patients to compare the efficacy of neuromodulatory invasive and non-invasive interventions in the treatment of obsessive–compulsive disorder.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"615-633"},"PeriodicalIF":8.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Publisher Correction: Revamping neuroimaging analysis to reveal biomarkers of adolescent mental health","authors":"Erica L. Busch, Nicholas B. Turk-Browne, Arielle Baskin-Sommers","doi":"10.1038/s44220-026-00646-0","DOIUrl":"10.1038/s44220-026-00646-0","url":null,"abstract":"","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"688-688"},"PeriodicalIF":8.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s44220-026-00646-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychostimulant use in Canada requires enhanced intervention strategies to reduce harm","authors":"Benedikt Fischer, Simon Dubreucq, Bernard Le Foll, Didier Jutras-Aswad","doi":"10.1038/s44220-026-00612-w","DOIUrl":"10.1038/s44220-026-00612-w","url":null,"abstract":"Canada is home to a prolonged public health crisis of overdose deaths, which increasingly involves psychostimulant drugs that are neglected in the intervention response. In this Comment, we examine the risks and harms of psychostimulant use, available interventions, and gaps for improved prevention and treatment.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"473-475"},"PeriodicalIF":8.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of mental disorders in homeless children, adolescents and youths","authors":"Lingxue Luo, Kangpeng Li, Xinyu Zhou, Yanping Bao, Lin Lu, Suhua Chang","doi":"10.1038/s44220-026-00616-6","DOIUrl":"10.1038/s44220-026-00616-6","url":null,"abstract":"Global homelessness is a rapidly increasing humanitarian crisis, affecting 120 million individuals worldwide. However, the prevalence of mental disorders in homeless young people globally is unknown; our study aimed to address this gap. In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus and Web of Science from January 1990 to 16 October 2024 for research articles in any language that reported any mental disorders for the homeless under the mean age of 24 years by reliable diagnostic methods. Studies with a response rate <50%, a sample size <50 and those that did not report the original data were excluded. Subgroup analyses and meta-regression were conducted to examine the potential factors influencing heterogeneity of prevalence. The study was registered with PROSPERO (CRD42024570399). Of the 33,600 reports identified, 45 from nine countries (73.3% from the USA) were included in this systematic review and meta-analyses. The studies encompassed 25,320 participants: 50.5% male and 48.3% female. The random-effects meta-analysis of mental disorders indicated that substance use disorders had the highest pooled point prevalence among homeless children, adolescents and youth (29.2% (95% CI 17.7–42.3%)), followed by conduct disorder (24.4% (95% CI 8.3–45.4%)), depressive disorders (21.3% (95% CI 16.7–26.4%)), anxiety disorders (16.3% (95% CI 9.9–23.9%)), posttraumatic stress disorder (14.8% (95% CI 10.8–19.3%)), bipolar and related disorders (13.0% (95% CI 4.8–24.2%)), ADHD (12.9% (95% CI 7.5–19.5%)) and schizophrenia spectrum disorders (5.4% (95% CI 1.8–10.6%)). The lifetime prevalence ranged from 12.5% (anxiety disorders) to 71.5% (conduct disorder). Subgroup and meta-regression analyses revealed key gaps: small samples, few post 2020 studies and major underrepresentation of Asian and African populations. Individuals aged 18–24 were at higher clinical risk. Conduct, anxiety and substance use disorders were more common in males; depressive disorders were more common in females. Overall, homeless children, adolescents and youth face markedly elevated risks for mental disorders, especially substance use and conduct disorders. Urgent, integrative tertiary prevention interventions and further research are needed to support this vulnerable group. This meta-analysis by Luo et al. shows high rates of mental disorders among homeless children and youth—especially substance use and conduct disorders—revealing major global data gaps and an urgent need for targeted mental health support.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"675-685"},"PeriodicalIF":8.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights, challenges and new frontiers for cognitive function in bipolar disorder","authors":"Kamilla Woznica Miskowiak, Hanne Lie Kjærstad, Eduard Vieta, Lakshmi N. Yatham","doi":"10.1038/s44220-026-00615-7","DOIUrl":"10.1038/s44220-026-00615-7","url":null,"abstract":"Cognitive impairment in various domains—including attention, memory and executive function—is a common feature of bipolar disorder (BD) that persists beyond mood episodes and greatly impacts daily functioning, prognosis and treatment outcomes. Yet, the mechanisms and clinical implications of this cognitive impairment remain insufficiently understood. In this narrative Review, we synthesize cutting-edge findings from multidisciplinary research on cognitive function in people with BD that provide the foundation for a paradigm shift in recognizing cognitive impairment as an independent treatment target in BD. Furthermore, we discuss cognition as a moderator of illness trajectory in BD, with implications extending beyond BD to other psychiatric disorders, highlighting the transdiagnostic relevance for improving cognition across psychiatric disorders. Finally, we provide recommendations for clinicians to screen for cognitive impairments and suggest perspectives for strategies to target cognition and improve cognitive functioning in BD. In this Review, the authors examine the evidence for cognitive impairment in individuals with bipolar disorder, explore underlying mechanisms and potential treatments, and advocate for incorporating cognitive screening into routine clinical practice.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"521-539"},"PeriodicalIF":8.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revamping neuroimaging analysis to reveal biomarkers of adolescent mental health","authors":"Erica L. Busch, Nicholas B. Turk-Browne, Arielle Baskin-Sommers","doi":"10.1038/s44220-026-00610-y","DOIUrl":"10.1038/s44220-026-00610-y","url":null,"abstract":"Advances in neuroscience research provide an unprecedented opportunity to identify the etiopathogenesis of mental health disorders. Yet it has proven difficult to find reliable associations between neurobiological phenotypes and real-world mental health experiences, particularly among youth. This Perspective addresses two pervasive assumptions inherent to many functional neuroimaging studies that diminish the predictivity of the data. First, studies assume that aligning data across individuals on the basis of the anatomy of the brain is sufficient to align their brain function. Individual brains vary meaningfully in the localization of functions, particularly across development and in clinical populations; neglecting this variability in functional neuroanatomy risks washing out rich and reliable patterns of individual-specific information. Second, studies assume that the underlying signal embedded in brain measurements over space and time can be modeled with simple transformations from high dimensions (that is, voxels) to low or single dimensions (that is, regional averages). However, the latent structure of brain activity and behavior is often complex and nonlinear. To overcome these assumptions, we suggest alternative methodological approaches that have yielded novel insights into the neurobiology of cognition and mental health symptoms in adolescence. Building robust predictive models of psychiatric problems requires methodology that can capture the richness and complexity of the brain and behavior. Neuroscience research struggles to link neurobiological phenotypes with real-world mental health experiences, especially in youth. Here the authors challenge assumptions in functional neuroimaging studies, proposing alternative methods that reveal complex, individual-specific brain patterns, enhancing predictive models of psychiatric issues and advancing the understanding of adolescent mental health.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"486-498"},"PeriodicalIF":8.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classic psychedelics in obsessive–compulsive disorder: a circuit-based framework","authors":"Saif S. Ali, Robin L. Carhart-Harris, Karl G. Sieg","doi":"10.1038/s44220-026-00626-4","DOIUrl":"10.1038/s44220-026-00626-4","url":null,"abstract":"Obsessive–compulsive disorder (OCD) is a psychiatric condition with high rates of treatment resistance. Emerging neuroimaging evidence implicates dysfunction in large-scale brain networks, particularly the cortico–striatal–thalamo–cortical (CSTC) circuit, default mode network (DMN) and salience network (SN). Lysergic acid diethylamide (LSD) and psilocybin induce acute dysregulation of the DMN and increase connectivity across normally segregated networks, potentially disrupting maladaptive rumination and self-referential loops. Furthermore, psychedelics may improve aberrant DMN–SN connectivity in OCD, improving functioning under the triple network model. Simultaneously, both LSD and psilocybin modulate CSTC function, particularly by modulating activity in the subthalamic nucleus and striatum, regions implicated in compulsive behavior. Beyond network disruption, psychedelics rapidly enhance neuroplasticity via 5-HT2A-receptor-mediated pathways, promoting dendritic spine formation (rodents). These dual mechanisms may ‘reset’ pathological patterns and support long-term restructuring of maladaptive circuits. Future clinical trials with specific neuroimaging endpoints are needed to validate the presented framework for psychedelic action in OCD. In this Review, the authors explore how psychedelics such as LSD and psilocybin may disrupt maladaptive circuits and enhance neuroplasticity in obsessive–compulsive disorder (OCD), potentially offering a therapeutic approach for OCD by resetting pathological patterns and improving network connectivity.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"540-550"},"PeriodicalIF":8.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of clozapine response rates in schizophrenia","authors":"Myrto Samara, Eleni Glarou, Elisavet Pinioti, Adriani Nikolakopoulou, Spyridon Siafis, Nikos Christodoulou, Stefan Leucht, Andreas S. Lappas","doi":"10.1038/s44220-026-00604-w","DOIUrl":"10.1038/s44220-026-00604-w","url":null,"abstract":"Clozapine is the gold standard for treatment-resistant schizophrenia (TRS) and demonstrates superior efficacy in non-TRS. Clozapine response rates have been quantified in TRS, but comparable data for non-TRS groups are sparse. Here we conducted a single-group meta-analysis of randomized controlled trials evaluating clozapine monotherapy efficacy across the schizophrenia spectrum, irrespective of treatment resistance. Primary outcomes included response rates (≥20% Positive and Negative Syndrome Scale (PANSS) reduction) and absolute/percentage PANSS score changes. Secondary analyses examined ≥50% PANSS reduction rates, author-defined remission criteria and imputed response rates across multiple thresholds (0–75% reduction). Meta-regression and subgroup analyses explored the impact of predefined variables. Sixty randomized controlled trials were included: 27 in non-TRS patients and 33 in TRS. In non-TRS, we found an 81% response rate (95% confidence interval (CI) 69% to 89%), with mean PANSS reductions of 31.1 points (95% CI −38.0 to −24.2), representing a 48.3% improvement (95% CI −57.9% to −38.7%). In TRS, we found a 63% response rate (95% CI 56% to 69%), with mean reductions of 22.4 PANSS points (95% CI −27.4 to −17.4) equating to 31.3% improvement (95% CI −37.1% to −25.6%). Studies with a longer illness duration showed a nonlinear association with worse outcomes. Response declined steeply in the first illness decade (odds ratio 0.80 per year, 95% CI 0.71 to 0.91), from >90% at illness onset to ~46% by year 10, before stabilizing with no further time-dependent effects. This meta-analysis provides robust evidence for clozapine’s efficacy across all stages of schizophrenia. The duration-of-illness effect underscores the importance of prompt treatment initiation. Clinicians and researchers should consider clozapine earlier in the treatment algorithm and maintain therapeutic optimism even in chronic cases, as substantial response rates persist. This single-group meta-analysis of randomized controlled trials examined clozapine monotherapy efficacy across the schizophrenia spectrum in both treatment-resistant and non-treatment-resistant populations. The study revealed higher clozapine response rates than previously reported, underscoring the importance of a timely initiation of clozapine therapy.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"664-674"},"PeriodicalIF":8.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rumination reconsidered: a dynamic interpersonal model","authors":"Laura Sels, Kristof Hoorelbeke, Ernst H. W. Koster","doi":"10.1038/s44220-026-00618-4","DOIUrl":"10.1038/s44220-026-00618-4","url":null,"abstract":"Rumination is a core transdiagnostic factor underlying mental health, traditionally conceptualized as a maladaptive intrapersonal habit. However, rumination is deeply embedded in people’s relationships. Here we propose the Dynamic Interpersonal Model of Rumination (DIM-Rum), repositioning rumination as a recursive interpersonal, dynamic process. We start by outlining the traditional approach to rumination, and then integrate findings from diverse research areas to show how rumination is continuously shaped by and shaping the interpersonal world. Next, we present DIM-Rum, which complements and extends existing intrapersonal models by explicitly incorporating dynamic interpersonal feedback loops. We suggest implications and future directions that require the expansion of current methods and collaborations. By considering rumination in its interpersonal context, DIM-Rum offers novel targets for research and intervention. In this Perspective, the authors present rumination as a dynamic interpersonal process through the Dynamic Interpersonal Model of Rumination (DIM-Rum), integrating diverse findings to highlight feedback loops, thereby suggesting new avenues for intervention and methodological expansion in mental health studies.","PeriodicalId":74247,"journal":{"name":"Nature mental health","volume":"4 4","pages":"499-507"},"PeriodicalIF":8.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}