{"title":"A new WHO roadmap for mental health policy reform.","authors":"Michelle Funk,Natalie Drew,Celline Cole,Peter McGovern,Maria Francesca Moro","doi":"10.1002/wps.21360","DOIUrl":"https://doi.org/10.1002/wps.21360","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"52 1","pages":"441-442"},"PeriodicalIF":73.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059177","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":"Rethinking the therapeutic alliance in digital mental health interventions.","authors":"Thomas Berger","doi":"10.1002/wps.21343","DOIUrl":"https://doi.org/10.1002/wps.21343","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"34 1","pages":"345-346"},"PeriodicalIF":73.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059183","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":"Understanding side effects of psychotherapies: implications for clinical practice and research trials.","authors":"Adrienne O'Neil,Susan L Rossell,Michael Berk","doi":"10.1002/wps.21304","DOIUrl":"https://doi.org/10.1002/wps.21304","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"68 1","pages":"194-195"},"PeriodicalIF":73.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992008","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":"Sociocultural context and intersectionality are vital to women's reproductive mental health.","authors":"Jane Fisher","doi":"10.1002/wps.21308","DOIUrl":"https://doi.org/10.1002/wps.21308","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"30 1","pages":"218-219"},"PeriodicalIF":73.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992009","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":"Antisocial personality disorder: current evidence and challenges.","authors":"Donald W Black","doi":"10.1002/wps.21321","DOIUrl":"https://doi.org/10.1002/wps.21321","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"53 1","pages":"271-272"},"PeriodicalIF":73.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992068","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}
Jari Tiihonen,Antti Tanskanen,Ellenor Mittendorfer-Rutz,Oliver D Howes,Christoph U Correll,Dan Siskind,Heidi Taipale
Although clozapine is the most effective medication for treatment-resistant schizophrenia, response is inadequate in over half of people with that condition. There is limited guidance available on effective clozapine augmentation strategies. We studied the comparative effectiveness of specific doses of oral olanzapine, quetiapine, risperidone and aripiprazole augmentation of clozapine treatment on the risk of hospitalization due to a psychotic episode, as a marker for severe relapse, among patients with schizophrenia or schizoaffective disorder. In this population-based study, patients with one of those diagnoses receiving clozapine were identified from Finnish (years 1995-2017, N=14,053) and Swedish (years 2006-2021, N=8,743) nationwide registers. The risk of hospitalization due to a psychotic episode associated with periods of antipsychotic augmentation of clozapine treatment vs. same-dose clozapine monotherapy was assessed by a within-individual design, using each individual as his/her own control to eliminate selection bias, and analyzed with stratified Cox models. The two national cohorts were first analyzed separately; then results were combined using a random-effect meta-analysis. Secondary outcomes were somatic hospitalization, and hospitalization for psychosis or a somatic cause. The only augmentation associated with a significantly decreased risk of hospitalization due to psychosis in both countries was medium-dose (9 to <16.5 mg/day) aripiprazole combined with high-dose (≥330 mg/day) clozapine, and this combination was associated with the best outcome in the meta-analysis (adjusted hazard ratio, aHR=0.68, 95% CI: 0.62-0.75, p<0.0001). Among patients using medium-dose (180 to <330 mg/day) clozapine, medium-dose aripiprazole augmentation was the only treatment more effective than clozapine monotherapy after Bonferroni correction (aHR=0.79, 95% CI: 0.70-0.91, p=0.0006). The use of all high-dose augmentations was associated with an increased risk of hospitalization due to psychosis. Only aripiprazole augmentations were associated with a decreased risk of hospitalization for psychosis or a somatic cause, and the lowest risk was observed for medium-dose aripiprazole plus high-dose clozapine (aHR=0.70, 95% CI: 0.58-0.84, p=0.0001). This meta-analysis of two nationwide cohorts, totaling almost 23,000 patients using clozapine, indicates that medium-dose aripiprazole augmentation of clozapine treatment is associated with a 20-30% decreased risk of severe relapse compared with clozapine monotherapy within the same individuals, while augmentation with higher doses of aripiprazole (as well as with high doses of all other antipsychotics) is associated with an increased relapse risk.
{"title":"Effectiveness of clozapine augmentation with specific doses of other antipsychotics in schizophrenia: a meta-analysis from two nationwide cohorts.","authors":"Jari Tiihonen,Antti Tanskanen,Ellenor Mittendorfer-Rutz,Oliver D Howes,Christoph U Correll,Dan Siskind,Heidi Taipale","doi":"10.1002/wps.21316","DOIUrl":"https://doi.org/10.1002/wps.21316","url":null,"abstract":"Although clozapine is the most effective medication for treatment-resistant schizophrenia, response is inadequate in over half of people with that condition. There is limited guidance available on effective clozapine augmentation strategies. We studied the comparative effectiveness of specific doses of oral olanzapine, quetiapine, risperidone and aripiprazole augmentation of clozapine treatment on the risk of hospitalization due to a psychotic episode, as a marker for severe relapse, among patients with schizophrenia or schizoaffective disorder. In this population-based study, patients with one of those diagnoses receiving clozapine were identified from Finnish (years 1995-2017, N=14,053) and Swedish (years 2006-2021, N=8,743) nationwide registers. The risk of hospitalization due to a psychotic episode associated with periods of antipsychotic augmentation of clozapine treatment vs. same-dose clozapine monotherapy was assessed by a within-individual design, using each individual as his/her own control to eliminate selection bias, and analyzed with stratified Cox models. The two national cohorts were first analyzed separately; then results were combined using a random-effect meta-analysis. Secondary outcomes were somatic hospitalization, and hospitalization for psychosis or a somatic cause. The only augmentation associated with a significantly decreased risk of hospitalization due to psychosis in both countries was medium-dose (9 to <16.5 mg/day) aripiprazole combined with high-dose (≥330 mg/day) clozapine, and this combination was associated with the best outcome in the meta-analysis (adjusted hazard ratio, aHR=0.68, 95% CI: 0.62-0.75, p<0.0001). Among patients using medium-dose (180 to <330 mg/day) clozapine, medium-dose aripiprazole augmentation was the only treatment more effective than clozapine monotherapy after Bonferroni correction (aHR=0.79, 95% CI: 0.70-0.91, p=0.0006). The use of all high-dose augmentations was associated with an increased risk of hospitalization due to psychosis. Only aripiprazole augmentations were associated with a decreased risk of hospitalization for psychosis or a somatic cause, and the lowest risk was observed for medium-dose aripiprazole plus high-dose clozapine (aHR=0.70, 95% CI: 0.58-0.84, p=0.0001). This meta-analysis of two nationwide cohorts, totaling almost 23,000 patients using clozapine, indicates that medium-dose aripiprazole augmentation of clozapine treatment is associated with a 20-30% decreased risk of severe relapse compared with clozapine monotherapy within the same individuals, while augmentation with higher doses of aripiprazole (as well as with high doses of all other antipsychotics) is associated with an increased relapse risk.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"129 1","pages":"250-259"},"PeriodicalIF":73.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992069","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":"Shaping the future of autism care: the need for a precision medicine approach.","authors":"Mirko Uljarević,Lacey Chetcuti,Eva Loth,Andrew Whitehouse,Robert Krueger","doi":"10.1002/wps.21327","DOIUrl":"https://doi.org/10.1002/wps.21327","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"23 1","pages":"280-282"},"PeriodicalIF":73.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992071","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}
Michael Berk,Asier Corrales,Roth Trisno,Seetal Dodd,Lakshmi N Yatham,Eduard Vieta,Roger S McIntyre,Trisha Suppes,Bruno Agustini
Bipolar II disorder (BD-II) is currently identified by both the DSM-5 and ICD-11 as a distinct subtype of bipolar disorder, defined by at least one depressive episode and at least one hypomanic episode, with no history of mania. Despite its prevalence and impact, the literature on BD-II remains relatively sparse. This paper provides a comprehensive overview of the available research and current debate on the disorder, including its diagnostic criteria, clinical presentations, comorbidities, epidemiology, risk factors, and treatment strategies. Patients with BD-II often present with recurrent depressive episodes, which outnumber hypomanic episodes by a ratio of 39:1. The condition is therefore often misdiagnosed as major depressive disorder and treated with antidepressant monotherapy, which may worsen its prognosis. The recognition of BD-II is further complicated by the overlap of its symptoms with other disorders, in particular borderline personality disorder. Although BD-II is often perceived as a less severe form of bipolar disorder, evidence suggests significant functional and cognitive impairment, accompanied by an elevated risk of suicidal behavior, including a rate of completed suicide at least equivalent to that observed in bipolar I disorder (BD-I). Psychiatric comorbidities, in particular anxiety and substance use disorders, are common. The disorder is associated with a high prevalence of numerous physical comorbidities, with a particularly high risk of comorbid cardiovascular diseases. Various genetic and environmental risk factors have been identified. Inflammation, circadian rhythm dysregulation and mitochondrial dysfunction are being studied as potential pathophysiological mechanisms. Current treatment guidelines, often extrapolated from BD-I and depression research, may not fully address the unique aspects of BD-II. Nevertheless, substantial evidence supports the value of some pharmacological treatments - primarily mood stabilizers and atypical antipsychotics - augmented by psychoeducation, cognitive behavioral or interpersonal and social rhythm therapy, and lifestyle interventions. Further research on BD-II should be a priority, in order to refine diagnostic criteria, identify potentially modifiable risk factors, and develop targeted interventions.
{"title":"Bipolar II disorder: a state-of-the-art review.","authors":"Michael Berk,Asier Corrales,Roth Trisno,Seetal Dodd,Lakshmi N Yatham,Eduard Vieta,Roger S McIntyre,Trisha Suppes,Bruno Agustini","doi":"10.1002/wps.21300","DOIUrl":"https://doi.org/10.1002/wps.21300","url":null,"abstract":"Bipolar II disorder (BD-II) is currently identified by both the DSM-5 and ICD-11 as a distinct subtype of bipolar disorder, defined by at least one depressive episode and at least one hypomanic episode, with no history of mania. Despite its prevalence and impact, the literature on BD-II remains relatively sparse. This paper provides a comprehensive overview of the available research and current debate on the disorder, including its diagnostic criteria, clinical presentations, comorbidities, epidemiology, risk factors, and treatment strategies. Patients with BD-II often present with recurrent depressive episodes, which outnumber hypomanic episodes by a ratio of 39:1. The condition is therefore often misdiagnosed as major depressive disorder and treated with antidepressant monotherapy, which may worsen its prognosis. The recognition of BD-II is further complicated by the overlap of its symptoms with other disorders, in particular borderline personality disorder. Although BD-II is often perceived as a less severe form of bipolar disorder, evidence suggests significant functional and cognitive impairment, accompanied by an elevated risk of suicidal behavior, including a rate of completed suicide at least equivalent to that observed in bipolar I disorder (BD-I). Psychiatric comorbidities, in particular anxiety and substance use disorders, are common. The disorder is associated with a high prevalence of numerous physical comorbidities, with a particularly high risk of comorbid cardiovascular diseases. Various genetic and environmental risk factors have been identified. Inflammation, circadian rhythm dysregulation and mitochondrial dysfunction are being studied as potential pathophysiological mechanisms. Current treatment guidelines, often extrapolated from BD-I and depression research, may not fully address the unique aspects of BD-II. Nevertheless, substantial evidence supports the value of some pharmacological treatments - primarily mood stabilizers and atypical antipsychotics - augmented by psychoeducation, cognitive behavioral or interpersonal and social rhythm therapy, and lifestyle interventions. Further research on BD-II should be a priority, in order to refine diagnostic criteria, identify potentially modifiable risk factors, and develop targeted interventions.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"96 1","pages":"175-189"},"PeriodicalIF":73.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992090","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}
John Torous,Jake Linardon,Simon B Goldberg,Shufang Sun,Imogen Bell,Jennifer Nicholas,Lamiece Hassan,Yining Hua,Alyssa Milton,Joseph Firth
The expanding domain of digital mental health is transitioning beyond traditional telehealth to incorporate smartphone apps, virtual reality, and generative artificial intelligence, including large language models. While industry setbacks and methodological critiques have highlighted gaps in evidence and challenges in scaling these technologies, emerging solutions rooted in co-design, rigorous evaluation, and implementation science offer promising pathways forward. This paper underscores the dual necessity of advancing the scientific foundations of digital mental health and increasing its real-world applicability through five themes. First, we discuss recent technological advances in digital phenotyping, virtual reality, and generative artificial intelligence. Progress in this latter area, specifically designed to create new outputs such as conversations and images, holds unique potential for the mental health field. Given the spread of smartphone apps, we then evaluate the evidence supporting their utility across various mental health contexts, including well-being, depression, anxiety, schizophrenia, eating disorders, and substance use disorders. This broad view of the field highlights the need for a new generation of more rigorous, placebo-controlled, and real-world studies. We subsequently explore engagement challenges that hamper all digital mental health tools, and propose solutions, including human support, digital navigators, just-in-time adaptive interventions, and personalized approaches. We then analyze implementation issues, emphasizing clinician engagement, service integration, and scalable delivery models. We finally consider the need to ensure that innovations work for all people and thus can bridge digital health disparities, reviewing the evidence on tailoring digital tools for historically marginalized populations and low- and middle-income countries. Regarding digital mental health innovations as tools to augment and extend care, we conclude that smartphone apps, virtual reality, and large language models can positively impact mental health care if deployed correctly.
{"title":"The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality.","authors":"John Torous,Jake Linardon,Simon B Goldberg,Shufang Sun,Imogen Bell,Jennifer Nicholas,Lamiece Hassan,Yining Hua,Alyssa Milton,Joseph Firth","doi":"10.1002/wps.21299","DOIUrl":"https://doi.org/10.1002/wps.21299","url":null,"abstract":"The expanding domain of digital mental health is transitioning beyond traditional telehealth to incorporate smartphone apps, virtual reality, and generative artificial intelligence, including large language models. While industry setbacks and methodological critiques have highlighted gaps in evidence and challenges in scaling these technologies, emerging solutions rooted in co-design, rigorous evaluation, and implementation science offer promising pathways forward. This paper underscores the dual necessity of advancing the scientific foundations of digital mental health and increasing its real-world applicability through five themes. First, we discuss recent technological advances in digital phenotyping, virtual reality, and generative artificial intelligence. Progress in this latter area, specifically designed to create new outputs such as conversations and images, holds unique potential for the mental health field. Given the spread of smartphone apps, we then evaluate the evidence supporting their utility across various mental health contexts, including well-being, depression, anxiety, schizophrenia, eating disorders, and substance use disorders. This broad view of the field highlights the need for a new generation of more rigorous, placebo-controlled, and real-world studies. We subsequently explore engagement challenges that hamper all digital mental health tools, and propose solutions, including human support, digital navigators, just-in-time adaptive interventions, and personalized approaches. We then analyze implementation issues, emphasizing clinician engagement, service integration, and scalable delivery models. We finally consider the need to ensure that innovations work for all people and thus can bridge digital health disparities, reviewing the evidence on tailoring digital tools for historically marginalized populations and low- and middle-income countries. Regarding digital mental health innovations as tools to augment and extend care, we conclude that smartphone apps, virtual reality, and large language models can positively impact mental health care if deployed correctly.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"14 1","pages":"156-174"},"PeriodicalIF":73.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992094","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：