Pub Date : 2022-11-01DOI: 10.1016/S2215-0366(22)00317-0
Sanne Y Smith-Apeldoorn, Jolien Ke Veraart, Jan Spijker, Jeanine Kamphuis, Robert A Schoevers
Ketamine has rapid yet often transient antidepressant effects in patients with treatment-resistant depression. Different strategies have been proposed to prolong these effects. Maintenance ketamine treatment appears promising, but little is known about its efficacy, safety, and tolerability in depression. We searched Pubmed, Embase, and the Cochrane Library and identified three randomised controlled trials, eight open-label trials, and 30 case series and reports on maintenance ketamine treatment. We found intravenous, intranasal, oral, and possibly intramuscular and subcutaneous maintenance ketamine treatment to be effective in sustaining antidepressant effect in treatment-resistant depression. Tachyphylaxis, cognitive impairment, addiction, and serious renal and urinary problems seem uncommon. Despite the methodological limitations, we conclude that from a clinical view, maintenance ketamine treatment seems to be of therapeutic potential. We recommend both controlled and naturalistic studies with long-term follow-up and sufficient power to determine the position of maintenance ketamine treatment within routine clinical practice.
{"title":"Maintenance ketamine treatment for depression: a systematic review of efficacy, safety, and tolerability.","authors":"Sanne Y Smith-Apeldoorn, Jolien Ke Veraart, Jan Spijker, Jeanine Kamphuis, Robert A Schoevers","doi":"10.1016/S2215-0366(22)00317-0","DOIUrl":"10.1016/S2215-0366(22)00317-0","url":null,"abstract":"<p><p>Ketamine has rapid yet often transient antidepressant effects in patients with treatment-resistant depression. Different strategies have been proposed to prolong these effects. Maintenance ketamine treatment appears promising, but little is known about its efficacy, safety, and tolerability in depression. We searched Pubmed, Embase, and the Cochrane Library and identified three randomised controlled trials, eight open-label trials, and 30 case series and reports on maintenance ketamine treatment. We found intravenous, intranasal, oral, and possibly intramuscular and subcutaneous maintenance ketamine treatment to be effective in sustaining antidepressant effect in treatment-resistant depression. Tachyphylaxis, cognitive impairment, addiction, and serious renal and urinary problems seem uncommon. Despite the methodological limitations, we conclude that from a clinical view, maintenance ketamine treatment seems to be of therapeutic potential. We recommend both controlled and naturalistic studies with long-term follow-up and sufficient power to determine the position of maintenance ketamine treatment within routine clinical practice.</p>","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"907-921"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512904","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}
Pub Date : 2022-11-01Epub Date: 2022-10-04DOI: 10.1016/S2215-0366(22)00311-X
Fiona Mensah, Stephanie Brown
{"title":"The impact of sexual violence in gendered adolescent mental health pathways.","authors":"Fiona Mensah, Stephanie Brown","doi":"10.1016/S2215-0366(22)00311-X","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00311-X","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"847-848"},"PeriodicalIF":64.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494320","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}
Pub Date : 2022-11-01Epub Date: 2022-10-10DOI: 10.1016/S2215-0366(22)00336-4
Akihiro Takamiya, Taishiro Kishimoto
{"title":"Is this the end of precision medicine? Or the beginning?","authors":"Akihiro Takamiya, Taishiro Kishimoto","doi":"10.1016/S2215-0366(22)00336-4","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00336-4","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"849-850"},"PeriodicalIF":64.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33503806","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}
Pub Date : 2022-11-01Epub Date: 2022-10-10DOI: 10.1016/S2215-0366(22)00304-2
Stefan Leucht, Anna Chaimani, Marc Krause, Johannes Schneider-Thoma, Dongfang Wang, Shimeng Dong, Myrto Samara, Natalie Peter, Maximilian Huhn, Josef Priller, John M Davis
<p><strong>Background: </strong>As comparatively few trials in subgroups of patients with schizophrenia have been done, clinicians need to know whether they can rely on the results of randomised controlled trials (RCTs) in the general population of patients with schizophrenia. We aimed to compare the efficacy and side-effects of antipsychotic drugs in different subgroups.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we searched reference lists of previous systematic reviews and meta-analyses, the Cochrane Schizophrenia Group's Study-Based Register (from database inception to April 27, 2020), and PubMed (from April 1, 2020 to June 14, 2021). We excluded studies in patients with stable schizophrenia (ie, relapse prevention studies), studies with a high risk of bias, and studies from mainland China due to quality concerns concerning allocation and masking methods. We included single-blind RCTs or better that assessed one or more of 16 second-generation and 18 first-generation antipsychotics in the general population of patients with schizophrenia or in one or more of the subgroups: children and adolescents (age range as defined in the original studies), patients with a first episode, patients with predominant or prominent negative symptoms, patients with comorbid substance use, patients with treatment-resistant schizophrenia, or older patients (age range as defined in the original studies). Two authors independently screened the results of the search, retrieved full-text articles, and checked the inclusion criteria. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline, all parameters were extracted in duplicate. The primary outcome was change in overall symptoms. We compared drug efficacy between subgroups, by sex, schizoaffective disorder versus schizophrenia, and study origin using random-effects, inverse variance meta-analyses and random-effects subgroup tests, and meta-regression.</p><p><strong>Findings: </strong>We included 537 RCTs with 76 382 participants, 26 627 (34·9%) women, 49 755 (65·1%) men, mean age 37·3 years (range of means 7·9-80·2; ethnicity data not available). 412 RCTs included patients in the general population of patients with schizophrenia, 42 included patients with treatment-resistant schizophrenia, 25 included children and adolescents, 20 included patients with their first episode, 20 included patients with predominant or prominent negative symptoms, 13 included patients with comorbid substance use, and 11 included older patients. Of 507 random-effects subgroup tests done, 46 (9%) showed a significant difference (p<0·05) between subgroups, but there was no clear indication as to which drug should be used in which subgroup.</p><p><strong>Interpretation: </strong>The effects of antipsychotics in various patient subgroups were usually similar to those in the general population of patients with schizophrenia, but comparably few studies contributed to the subgroups
{"title":"The response of subgroups of patients with schizophrenia to different antipsychotic drugs: a systematic review and meta-analysis.","authors":"Stefan Leucht, Anna Chaimani, Marc Krause, Johannes Schneider-Thoma, Dongfang Wang, Shimeng Dong, Myrto Samara, Natalie Peter, Maximilian Huhn, Josef Priller, John M Davis","doi":"10.1016/S2215-0366(22)00304-2","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00304-2","url":null,"abstract":"<p><strong>Background: </strong>As comparatively few trials in subgroups of patients with schizophrenia have been done, clinicians need to know whether they can rely on the results of randomised controlled trials (RCTs) in the general population of patients with schizophrenia. We aimed to compare the efficacy and side-effects of antipsychotic drugs in different subgroups.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we searched reference lists of previous systematic reviews and meta-analyses, the Cochrane Schizophrenia Group's Study-Based Register (from database inception to April 27, 2020), and PubMed (from April 1, 2020 to June 14, 2021). We excluded studies in patients with stable schizophrenia (ie, relapse prevention studies), studies with a high risk of bias, and studies from mainland China due to quality concerns concerning allocation and masking methods. We included single-blind RCTs or better that assessed one or more of 16 second-generation and 18 first-generation antipsychotics in the general population of patients with schizophrenia or in one or more of the subgroups: children and adolescents (age range as defined in the original studies), patients with a first episode, patients with predominant or prominent negative symptoms, patients with comorbid substance use, patients with treatment-resistant schizophrenia, or older patients (age range as defined in the original studies). Two authors independently screened the results of the search, retrieved full-text articles, and checked the inclusion criteria. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline, all parameters were extracted in duplicate. The primary outcome was change in overall symptoms. We compared drug efficacy between subgroups, by sex, schizoaffective disorder versus schizophrenia, and study origin using random-effects, inverse variance meta-analyses and random-effects subgroup tests, and meta-regression.</p><p><strong>Findings: </strong>We included 537 RCTs with 76 382 participants, 26 627 (34·9%) women, 49 755 (65·1%) men, mean age 37·3 years (range of means 7·9-80·2; ethnicity data not available). 412 RCTs included patients in the general population of patients with schizophrenia, 42 included patients with treatment-resistant schizophrenia, 25 included children and adolescents, 20 included patients with their first episode, 20 included patients with predominant or prominent negative symptoms, 13 included patients with comorbid substance use, and 11 included older patients. Of 507 random-effects subgroup tests done, 46 (9%) showed a significant difference (p<0·05) between subgroups, but there was no clear indication as to which drug should be used in which subgroup.</p><p><strong>Interpretation: </strong>The effects of antipsychotics in various patient subgroups were usually similar to those in the general population of patients with schizophrenia, but comparably few studies contributed to the subgroups","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"884-893"},"PeriodicalIF":64.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33503807","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}
Pub Date : 2022-11-01DOI: 10.1016/S2215-0366(22)00345-5
Priya Venkatesan
{"title":"Irina Pinchuk: independence and sovereignty of Ukraine are everything.","authors":"Priya Venkatesan","doi":"10.1016/S2215-0366(22)00345-5","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00345-5","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"857"},"PeriodicalIF":64.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512901","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}
Pub Date : 2022-11-01Epub Date: 2022-10-09DOI: 10.1016/S2215-0366(22)00344-3
The Lancet Psychiatry
{"title":"Recognising the right to be different.","authors":"The Lancet Psychiatry","doi":"10.1016/S2215-0366(22)00344-3","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00344-3","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"845"},"PeriodicalIF":64.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33501394","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}
Pub Date : 2022-11-01DOI: 10.1016/S2215-0366(22)00342-X
Marie-Claude Geoffroy, Bassam Khoury, Elise Chartrand, Ian Colman, Massimiliano Orri
{"title":"Suicidal ideation and self-harm behaviours in children aged 12 years or younger - Authors' reply.","authors":"Marie-Claude Geoffroy, Bassam Khoury, Elise Chartrand, Ian Colman, Massimiliano Orri","doi":"10.1016/S2215-0366(22)00342-X","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00342-X","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"855"},"PeriodicalIF":64.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512900","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}
Pub Date : 2022-11-01Epub Date: 2022-10-04DOI: 10.1016/S2215-0366(22)00271-1
Francesca Bentivegna, Praveetha Patalay
Background: A large gender gap appears in internalising mental health conditions during adolescence, with higher rates in girls than boys. There is little high-quality longitudinal population-based research investigating the role of sexual violence experiences, which are disproportionately experienced by girls. We aimed to estimate the effects of sexual violence experienced in mid-adolescence on mental health outcomes.
Methods: In this study, we used data from the longitudinal UK Millennium Cohort Study, a large nationally representative cohort of children born in the UK in 2000-02, for participants with information available at age 17 years on sexual violence in the past year (eg, sexual assault or unwelcome sexual approach), mental health outcomes (eg, completion of the Kessler Psychological Distress K6 scale in the past 30 days, self-harm in the past year, and lifetime attempted suicide). Multivariable confounder adjusted regressions and propensity matching approaches were used, and population attributable fractions (PAFs) were calculated.
Findings: We included 5119 girls and 4852 boys (8063 [80·8%] of whom were White) in the full analysis sample. In the fully adjusted model, compared with no sexual violence, sexual violence was associated with greater mean psychological distress in girls (mean difference 2·09 [95% CI 1·51-2·68]) and boys (2·56 [1·59-3·53]), higher risk of high psychological distress in girls (risk ratio [RR] 1·65 [95% CI 1·37-2·00]) and boys (1·55 [1·00-2·40]), higher risk of self-harm in girls (RR 1·79 [1·52-2·10]) and boys (RR 2·16 [1·63-2·84]), and higher risk of attempted suicide in girls (RR 1·75 [1·26-2·41]) and boys (RR 2·73 [1·59-4·67]). PAF estimates suggest that, in a hypothetical scenario with no sexual violence, the prevalence of adverse mental health outcomes at age 17 years would be 3·7-10·5% lower in boys and 14·0-18·7% lower in girls than the prevalence in this cohort.
Interpretation: Reductions in sexual violence via policy and societal changes would benefit the mental health of adolescents and might contribute to narrowing the gender gap in internalising mental ill health. Clinicians and others working to support adolescents should be aware that sexual violence has a widespread, gendered nature and an impact on mental health.
{"title":"The impact of sexual violence in mid-adolescence on mental health: a UK population-based longitudinal study.","authors":"Francesca Bentivegna, Praveetha Patalay","doi":"10.1016/S2215-0366(22)00271-1","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00271-1","url":null,"abstract":"<p><strong>Background: </strong>A large gender gap appears in internalising mental health conditions during adolescence, with higher rates in girls than boys. There is little high-quality longitudinal population-based research investigating the role of sexual violence experiences, which are disproportionately experienced by girls. We aimed to estimate the effects of sexual violence experienced in mid-adolescence on mental health outcomes.</p><p><strong>Methods: </strong>In this study, we used data from the longitudinal UK Millennium Cohort Study, a large nationally representative cohort of children born in the UK in 2000-02, for participants with information available at age 17 years on sexual violence in the past year (eg, sexual assault or unwelcome sexual approach), mental health outcomes (eg, completion of the Kessler Psychological Distress K6 scale in the past 30 days, self-harm in the past year, and lifetime attempted suicide). Multivariable confounder adjusted regressions and propensity matching approaches were used, and population attributable fractions (PAFs) were calculated.</p><p><strong>Findings: </strong>We included 5119 girls and 4852 boys (8063 [80·8%] of whom were White) in the full analysis sample. In the fully adjusted model, compared with no sexual violence, sexual violence was associated with greater mean psychological distress in girls (mean difference 2·09 [95% CI 1·51-2·68]) and boys (2·56 [1·59-3·53]), higher risk of high psychological distress in girls (risk ratio [RR] 1·65 [95% CI 1·37-2·00]) and boys (1·55 [1·00-2·40]), higher risk of self-harm in girls (RR 1·79 [1·52-2·10]) and boys (RR 2·16 [1·63-2·84]), and higher risk of attempted suicide in girls (RR 1·75 [1·26-2·41]) and boys (RR 2·73 [1·59-4·67]). PAF estimates suggest that, in a hypothetical scenario with no sexual violence, the prevalence of adverse mental health outcomes at age 17 years would be 3·7-10·5% lower in boys and 14·0-18·7% lower in girls than the prevalence in this cohort.</p><p><strong>Interpretation: </strong>Reductions in sexual violence via policy and societal changes would benefit the mental health of adolescents and might contribute to narrowing the gender gap in internalising mental ill health. Clinicians and others working to support adolescents should be aware that sexual violence has a widespread, gendered nature and an impact on mental health.</p><p><strong>Funding: </strong>UK Medical Research Council.</p>","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"874-883"},"PeriodicalIF":64.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9630148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494322","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号