Pub Date : 2025-08-12DOI: 10.1016/s2215-0366(25)00162-2
Sean Halstead, Chloe X Yap, Nicola Warren, Sri Mahavir Agarwal, Bodyl A Brand, Sherry Kit Wa Chan, Andrea Cipriani, Christoph U Correll, Nicolas Crossley, Enrico D’Ambrosio, Robin Emsley, Joseph Firth, Fiona Gaughran, Siobhan Gee, Margaret Hahn, Joseph F Hayes, Adrian Heald, Oliver D Howes, John M Kane, Maria Kapi, Toby Pillinger
<h2>Section snippets</h2><section><section><section><h2>Background</h2>To counter modern medicine's tendency to fragment health care into silos, people with mental illness should have access to holistic care that protects both physical and mental health. Antipsychotics, mood stabilisers, and antidepressants are an integral component of evidenced-based treatment for mental disorders, and reduce morbidity and mortality at a population level. However, the various medications within these classes of psychotropic drugs lead to a range of important side-effects across</section></section></section><section><section><section><h2>Background</h2>Psychotropic medications are one of the fundamental components of evidence-based treatment for a range of psychiatric disorders.<sup>1</sup> The foundational ethical principle of primum non nocere (first, do no harm) signals the importance of balancing risks and benefits when prescribing psychotropic medication.2, 3 The benefits of antipsychotics, mood stabilisers, and antidepressants are clear: they are effective tools and their use is often associated with reduced mortality rates from both suicide and</section></section></section><section><section><section><h2>Cardiometabolic risk profile</h2>The cardiometabolic adverse reactions of psychotropic medications are recognised as a key contributor to the mortality and morbidity burden of people with severe mental illness.1, 23 The differences in cardiometabolic risk profiles between and within the three classes of antipsychotics, mood stabilisers, and antidepressants are outlined in the following sections.</section></section></section><section><section><section><h2>Cardiac conduction risk profile</h2>Some psychotropic agents are associated with prolongation of the corrected QT (QTc) interval and cardiac arrhythmia, including potentially fatal torsades de pointes. The relative risk of QTc prolongation associated with antipsychotics and antidepressants is presented in figure 2, and is generally considered to be dose related.35, 40 For mood stabilisers, lithium is purported to be associated with a low risk of QTc prolongation, whereas the effects of valproate, carbamazepine, and lamotrigine on</section></section></section><section><section><section><h2>Neurological risk profile</h2>Psychotropic medications are associated with a variety of neurological adverse reactions. Most prominent are the neuromotor adverse reactions of antipsychotics, namely akathisia, dystonia, parkinsonism, and tardive dyskinesia (figure 2A).24, 27, 89Rare but severe neurological reactions associated with psychotropic medications include seizures, neuroleptic malignant syndrome, and serotonin syndrome. For seizures, high-risk medications are outlined in figure 2 for antipsychotics and</section></section></section><section><section><section><h2>Sexual and reproductive risk profile</h2>Psychotropic medications can cause a range of sexual and reproductive side-effects that affect libido, pleasure, ar
{"title":"Holistic prevention and management of physical health side-effects of psychotropic medication: second report of the Lancet Psychiatry Physical Health Commission","authors":"Sean Halstead, Chloe X Yap, Nicola Warren, Sri Mahavir Agarwal, Bodyl A Brand, Sherry Kit Wa Chan, Andrea Cipriani, Christoph U Correll, Nicolas Crossley, Enrico D’Ambrosio, Robin Emsley, Joseph Firth, Fiona Gaughran, Siobhan Gee, Margaret Hahn, Joseph F Hayes, Adrian Heald, Oliver D Howes, John M Kane, Maria Kapi, Toby Pillinger","doi":"10.1016/s2215-0366(25)00162-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00162-2","url":null,"abstract":"<h2>Section snippets</h2><section><section><section><h2>Background</h2>To counter modern medicine's tendency to fragment health care into silos, people with mental illness should have access to holistic care that protects both physical and mental health. Antipsychotics, mood stabilisers, and antidepressants are an integral component of evidenced-based treatment for mental disorders, and reduce morbidity and mortality at a population level. However, the various medications within these classes of psychotropic drugs lead to a range of important side-effects across</section></section></section><section><section><section><h2>Background</h2>Psychotropic medications are one of the fundamental components of evidence-based treatment for a range of psychiatric disorders.<sup>1</sup> The foundational ethical principle of primum non nocere (first, do no harm) signals the importance of balancing risks and benefits when prescribing psychotropic medication.2, 3 The benefits of antipsychotics, mood stabilisers, and antidepressants are clear: they are effective tools and their use is often associated with reduced mortality rates from both suicide and</section></section></section><section><section><section><h2>Cardiometabolic risk profile</h2>The cardiometabolic adverse reactions of psychotropic medications are recognised as a key contributor to the mortality and morbidity burden of people with severe mental illness.1, 23 The differences in cardiometabolic risk profiles between and within the three classes of antipsychotics, mood stabilisers, and antidepressants are outlined in the following sections.</section></section></section><section><section><section><h2>Cardiac conduction risk profile</h2>Some psychotropic agents are associated with prolongation of the corrected QT (QTc) interval and cardiac arrhythmia, including potentially fatal torsades de pointes. The relative risk of QTc prolongation associated with antipsychotics and antidepressants is presented in figure 2, and is generally considered to be dose related.35, 40 For mood stabilisers, lithium is purported to be associated with a low risk of QTc prolongation, whereas the effects of valproate, carbamazepine, and lamotrigine on</section></section></section><section><section><section><h2>Neurological risk profile</h2>Psychotropic medications are associated with a variety of neurological adverse reactions. Most prominent are the neuromotor adverse reactions of antipsychotics, namely akathisia, dystonia, parkinsonism, and tardive dyskinesia (figure 2A).24, 27, 89Rare but severe neurological reactions associated with psychotropic medications include seizures, neuroleptic malignant syndrome, and serotonin syndrome. For seizures, high-risk medications are outlined in figure 2 for antipsychotics and</section></section></section><section><section><section><h2>Sexual and reproductive risk profile</h2>Psychotropic medications can cause a range of sexual and reproductive side-effects that affect libido, pleasure, ar","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"12 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825213","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}
Pub Date : 2025-08-12DOI: 10.1016/s2215-0366(25)00217-2
Nicole G Hammond, Seana N Semchishen, Marie-Claude Geoffroy, Lindsey Sikora, Gamal Wafy, Lia Hsueh, Hassan Khan, Jordan Edwards, Christopher Gravel, Mark A Ferro, Ian Colman
<h3>Background</h3>Family dynamics are implicated in self-harm and suicidality among children and adolescents. However, whether negative family dynamics confer a prospective risk and positive family dynamics confer a protective effect is not understood. To address this research gap, we aimed to summarise the prospective, longitudinal evidence examining the relationship between family dynamics, self-harm, and suicidality (ie, suicidal thoughts and behaviours) during childhood and adolescence.<h3>Methods</h3>In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, and ERIC, as well as CINAHL, without language restrictions, from the date of database inception to May 20, 2025. Observational studies were eligible if they prospectively followed up a cohort of children and adolescents (age <20 years) from a general population, community, or school showing either no elevated risk or typical development of self-harm and suicidality for a minimum of 12 months. Eligible studies had to have included prospectively measured family dynamics, including positive (eg, emotionally supportive) and negative (eg, harsh, aversive, or punitive) parenting behaviours and family functioning (eg, family cohesion) or dysfunction (eg, discord or conflict) in childhood or adolescence. Extracted data consisted of study-level information and characteristics, participant characteristics, descriptions of study measures, and study results. Extracted data were entered into Covidence for consensus. The primary outcomes were self-harm (ie, thoughts of non-suicidal self-harm or self-injury, and non-suicidal self-harm or self-injury) and suicidality (ie, suicidal ideation and suicide attempt) over any reporting period. We examined individual and combined outcomes using a random-effects model. We assessed study quality using a modified Newcastle–Ottawa scale. This study is registered with PROSPERO (CRD42023434804).<h3>Findings</h3>We screened 3860 articles and retained 38 studies, of which all 38 contributed to the narrative synthesis and 24 to the quantitative analyses. Altogether, the studies comprised 101 879 children and adolescents. Most study samples were from the USA (12 [32%]) or China (11 [29%]), with exposure and outcome ascertainment 12 months apart (25 [66%] studies) from age 10 years to 19 years (36 [95%]). Data stratified by sex, gender, race, or ethnicity were not consistently available. Female participants constituted a larger proportion of the samples than did male participants (ranges 42–100% <em>vs</em> 28–58%). Exposure to negative parenting was associated with an increased likelihood of combined self-harm and suicidal ideation (OR 1·29 [95% CI 1·15–1·46]) and non-suicidal self-harm or self-injury (1·46 [1·25–1·71]), but not suicidal ideation (1·07 [0·92–1·24]). Negative parenting practices and continuously measured self-harm and suicidality were not significantly associated. Positive parenting practices were not associated with suicidal
{"title":"Family dynamics and self-harm and suicidality in children and adolescents: a systematic review and meta-analysis","authors":"Nicole G Hammond, Seana N Semchishen, Marie-Claude Geoffroy, Lindsey Sikora, Gamal Wafy, Lia Hsueh, Hassan Khan, Jordan Edwards, Christopher Gravel, Mark A Ferro, Ian Colman","doi":"10.1016/s2215-0366(25)00217-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00217-2","url":null,"abstract":"<h3>Background</h3>Family dynamics are implicated in self-harm and suicidality among children and adolescents. However, whether negative family dynamics confer a prospective risk and positive family dynamics confer a protective effect is not understood. To address this research gap, we aimed to summarise the prospective, longitudinal evidence examining the relationship between family dynamics, self-harm, and suicidality (ie, suicidal thoughts and behaviours) during childhood and adolescence.<h3>Methods</h3>In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, and ERIC, as well as CINAHL, without language restrictions, from the date of database inception to May 20, 2025. Observational studies were eligible if they prospectively followed up a cohort of children and adolescents (age <20 years) from a general population, community, or school showing either no elevated risk or typical development of self-harm and suicidality for a minimum of 12 months. Eligible studies had to have included prospectively measured family dynamics, including positive (eg, emotionally supportive) and negative (eg, harsh, aversive, or punitive) parenting behaviours and family functioning (eg, family cohesion) or dysfunction (eg, discord or conflict) in childhood or adolescence. Extracted data consisted of study-level information and characteristics, participant characteristics, descriptions of study measures, and study results. Extracted data were entered into Covidence for consensus. The primary outcomes were self-harm (ie, thoughts of non-suicidal self-harm or self-injury, and non-suicidal self-harm or self-injury) and suicidality (ie, suicidal ideation and suicide attempt) over any reporting period. We examined individual and combined outcomes using a random-effects model. We assessed study quality using a modified Newcastle–Ottawa scale. This study is registered with PROSPERO (CRD42023434804).<h3>Findings</h3>We screened 3860 articles and retained 38 studies, of which all 38 contributed to the narrative synthesis and 24 to the quantitative analyses. Altogether, the studies comprised 101 879 children and adolescents. Most study samples were from the USA (12 [32%]) or China (11 [29%]), with exposure and outcome ascertainment 12 months apart (25 [66%] studies) from age 10 years to 19 years (36 [95%]). Data stratified by sex, gender, race, or ethnicity were not consistently available. Female participants constituted a larger proportion of the samples than did male participants (ranges 42–100% <em>vs</em> 28–58%). Exposure to negative parenting was associated with an increased likelihood of combined self-harm and suicidal ideation (OR 1·29 [95% CI 1·15–1·46]) and non-suicidal self-harm or self-injury (1·46 [1·25–1·71]), but not suicidal ideation (1·07 [0·92–1·24]). Negative parenting practices and continuously measured self-harm and suicidality were not significantly associated. Positive parenting practices were not associated with suicidal ","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"6 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825211","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}
Pub Date : 2025-08-12DOI: 10.1016/s2215-0366(25)00170-1
Scott B Teasdale, Katarzyna K Machaczek, Wolfgang Marx, Melissa Eaton, Justin Chapman, Alyssa Milton, Adawele L Oyeyemi, Dicky C Pelupessy, Felipe B Schuch, Grace Gatera, Helal Uddin Ahmed, Hervita Diatri, Ibrahim M Jidda, Miguel Gutiérrez-Peláez, Mohamed Elshazly, Muhammad Abba Fugu, Natalia Grinko, Pillaveetil Sathyadas Indu, San San Oo, Suhavana Balasubramanian, Simon Rosenbaum
Section snippets
Background
The physical health disparities experienced by people who live with mental illness are well documented. This population group has cardiometabolic risks and diseases at rates 1·4–2·0 times higher than people without mental illness, and physical health conditions are responsible for 70% of the deaths of people with severe mental illness. They are the major drivers of the 13–15 year reduction in life expectancy that is found in individuals with mental illness, compared with those without mental
Conclusion
Mental health services need to prioritise evidence-based lifestyle interventions to generate systemic health benefits for people living with mental illness. The growing recognition of the need for lifestyle interventions in mental health care in national and international guidelines and from leading organisations such as the World Psychiatric Association creates an opportune time for change. Our Commission report provides recommendations for the implementation and delivery of lifestyle
Declaration of interests
SBT is funded by a National Health and Medical Research Council (NHMRC) EL1 Investigator Fellowship (APP2017302). KKM is supported partially by National Institute for Health and Care Research (NIHR) grants NIHR201618 and NIHR206943. AM is supported partially by the Australian Government through the Australian Research Council's Centre of Excellence for Children and Families over the Life Course (Project ID CE200100025), the Medical Research Future Fund Clinician Researchers Applied Research in
Acknowledgments
We acknowledge the support of research assistants Oliver Ardill-Young and Lauren Wheatley. We also acknowledge the contribution of Carmel Denholm, David Sims, Marvin Williams, Stephen Lake, Timothy To, and additional participants of the consumer and carer consultation process. Payments for the consumer and carer consultation process were funded through SBT's NHMRC EL1 Investigator Fellowship (APP2017302). Payments to participants of the consumer and carer consultation process were made using
精神疾病患者所经历的身体健康差异是有据可查的。这一人群的心脏代谢风险和疾病发生率比无精神疾病的人高出1.4 - 0倍，身体健康状况导致70%的严重精神疾病患者死亡。与没有精神疾病的人相比，它们是导致精神疾病患者预期寿命缩短13-15年的主要因素。结论：精神卫生服务需要优先考虑基于证据的生活方式干预措施，为精神疾病患者带来系统性健康益处。国家和国际指导方针以及世界精神病学协会等主要组织日益认识到在精神卫生保健中需要进行生活方式干预，这为变革创造了时机。我们的委员会报告为生活方式的实施和交付提供建议。利益声明ssbt由国家卫生和医学研究委员会（NHMRC） EL1研究员奖学金（APP2017302）资助。KKM部分由国家卫生与保健研究所（NIHR）资助NIHR201618和NIHR206943。AM由澳大利亚政府通过澳大利亚研究委员会儿童和家庭终身卓越中心（项目ID CE200100025），医学研究未来基金临床研究人员应用研究提供部分支持。我们感谢研究助理Oliver Ardill-Young和Lauren Wheatley的支持。我们也感谢Carmel Denholm， David Sims, Marvin Williams, Stephen Lake， Timothy To以及其他参与消费者和护理咨询过程的参与者的贡献。消费者和护理人员咨询过程的费用由SBT的NHMRC EL1研究员奖学金（APP2017302）资助。支付给消费者和护理人员咨询过程的参与者使用
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Pub Date : 2025-08-11DOI: 10.1016/s2215-0366(25)00266-4
Sun J, Rose-Clarke K, Bao YP, Wang Z, Lu L. Child and adolescent mental health policy advancement in China. Lancet Psychiatry 2025; published online Aug 4. https://doi.org/10.1016/S2215-0366(25)00240-8—In this Comment, the email address for the corresponding author was incorrect. This correction has been made to the online version as of Aug 11, 2025, and will be made to the printed version.
{"title":"Correction to Lancet Psychiatry 2025; published online Aug 4. https://doi.org/10.1016/S2215-0366(25)00240-8","authors":"","doi":"10.1016/s2215-0366(25)00266-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00266-4","url":null,"abstract":"Sun J, Rose-Clarke K, Bao YP, Wang Z, Lu L. Child and adolescent mental health policy advancement in China. <em>Lancet Psychiatry</em> 2025; published online Aug 4. https://doi.org/10.1016/S2215-0366(25)00240-8—In this Comment, the email address for the corresponding author was incorrect. This correction has been made to the online version as of Aug 11, 2025, and will be made to the printed version.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"143 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819502","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}
Pub Date : 2025-08-06DOI: 10.1016/s2215-0366(25)00207-x
Rob Saunders, Jae Won Suh, Joshua E J Buckman, Amber John, Céline El Baou, Stephen Pilling, Glyn Lewis, Joshua Stott, Georgina Krebs, Argyris Stringaris
<h3>Background</h3>The prevalence of depression and anxiety in young adults is rising, leading to an increasing need for evidence-based treatment. Psychological therapies are a first-line treatment for these conditions and are broadly preferred to pharmacotherapies, particularly by young adults. There is some evidence that younger people might have poorer outcomes from psychological therapies than adults over the age of 25 years, but research has been confined to smaller studies or has not considered the role of statistical confounding, as well as the potential interaction between age and gender. This study uses data from a national psychological treatment programme to investigate differences in outcomes between young adults (age 16–24 years) and working age adults (age 25–65 years).<h3>Methods</h3>We used data from all individuals who had an episode of treatment in any English National Health Service Talking Therapies for anxiety and depression (TTad) service between April 1, 2015, and March 31, 2019. We compared change in Patient Health Questionnaire 9-item (PHQ-9) score and Generalised Anxiety Disorder Scale 7-item (GAD-7) score pre-treatment to post-treatment between patients who were aged 16–24 years and those aged 25–65 years, as well as service-specific outcomes including recovery, reliable recovery, reliable improvement, and reliable deterioration. Age was also treated as a continuous variable in linear regression models examining change in depression and anxiety symptom severity scores. We examined geographical and temporal consistency as sensitivity analyses. People with lived experience were involved in the study design and interpretation.<h3>Findings</h3>The young adult cohort contained 309 758 patients aged 16–24 years (214 977 [69·4%] female and 93 728 [30·3%] male; 255 547 [82·5%] of White ethnicity; mean age 20·8 years [SD 2·3]). The working age adult group comprised 1 290 130 patients aged 25–65 years (840 631 [65·2%] female and 445 466 [34·5%] male; 1 078 985 [83·6%] of White ethnicity; mean age 41·5 years [SD 11·1]). We observed that improvements in PHQ-9 and GAD-7 scores were smaller for young adults compared to working age adults (PHQ-9: b –0·98 [95% CI –1·00 to –0·96]; GAD-7: b –0·77 [–0·80 to –0·75]). Young adults were less likely to meet criteria for reliable improvement (odds ratio 0·78 [95% CI 0·77–0·78]), recovery 0·73 (0·73–0·74), and reliable recovery (0·74 [0·73–0·74]), and more likely to meet criteria for reliable deterioration 1·19 (1·17–1·20). Sensitivity analyses revealed consistency of the age-related treatment effect when differences in temporal, geographical, and adults older than 65 years, were considered.<h3>Interpretation</h3>Outcomes following routinely delivered psychological treatments across all areas of England were poorer in young adults than working age adults. These effects, when scaled up to the population level, affect thousands of young adults annually. Future research should consider adaptions t
背景：年轻人中抑郁和焦虑的患病率正在上升，导致对循证治疗的需求日益增加。心理治疗是治疗这些疾病的一线治疗方法，与药物治疗相比，心理治疗更受年轻人的青睐。有证据表明，年轻人接受心理治疗的效果可能不如25岁以上的成年人，但研究仅限于规模较小的研究，或者没有考虑到统计混杂的作用，以及年龄和性别之间潜在的相互作用。本研究使用来自国家心理治疗项目的数据来调查年轻人（16-24岁）和工作年龄成年人（25-65岁）之间结果的差异。方法：我们使用了2015年4月1日至2019年3月31日期间在任何英国国家卫生服务焦虑和抑郁谈话疗法（TTad）服务中接受过治疗的所有个体的数据。我们比较了16-24岁和25-65岁患者治疗前后患者健康问卷9项（PHQ-9）评分和广泛性焦虑障碍量表7项（GAD-7）评分的变化，以及服务特定结果，包括恢复、可靠恢复、可靠改善和可靠恶化。在检验抑郁和焦虑症状严重程度评分变化的线性回归模型中，年龄也被视为连续变量。我们检验了地理和时间的一致性作为敏感性分析。有生活经验的人参与了研究的设计和解释。青壮年队列包括309758例16-24岁的患者，其中女性21477例（69.4%），男性93728例（30.3%）；白人255,547例[82.5%]；平均年龄20.8岁[SD 2.3])。工作年龄成年组25 ~ 65岁患者1 290 130例，其中女性840 631例（65.2%），男性445 466例（34.5%）；白种人1 078 985例[83.6%]；平均年龄41.5岁[SD 11.1])。我们观察到，与工作年龄的成年人相比，年轻人的PHQ-9和GAD-7评分的改善较小(PHQ-9: b - 0.98 [95% CI - 1.00至- 0.96]；GAD-7: b - 0.77[- 0.80 ~ - 0.75])。年轻人不太可能达到可靠改善（比值比0.78 [95% CI 0.77 - 0.78]）、恢复（比值比0.73 - 0.74）和可靠恢复（比值比0.74[0.73 - 0.74]）的标准，而更可能达到可靠恶化(比值比1.19（比值比1.17 - 1.20）的标准。敏感性分析显示，当考虑到时间、地理和年龄大于65岁的成年人的差异时，与年龄相关的治疗效果是一致的。解释：在英格兰所有地区，年轻人接受常规心理治疗的结果比工作年龄的成年人要差。当这些影响扩大到人口水平时，每年影响成千上万的年轻人。未来的研究应该考虑适应适合年轻人的治疗，包括年轻人如何驾驭成人心理健康服务。资助英国国家健康和护理研究所。
{"title":"Effectiveness of psychological interventions for young adults versus working age adults: a retrospective cohort study in a national psychological treatment programme in England","authors":"Rob Saunders, Jae Won Suh, Joshua E J Buckman, Amber John, Céline El Baou, Stephen Pilling, Glyn Lewis, Joshua Stott, Georgina Krebs, Argyris Stringaris","doi":"10.1016/s2215-0366(25)00207-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00207-x","url":null,"abstract":"<h3>Background</h3>The prevalence of depression and anxiety in young adults is rising, leading to an increasing need for evidence-based treatment. Psychological therapies are a first-line treatment for these conditions and are broadly preferred to pharmacotherapies, particularly by young adults. There is some evidence that younger people might have poorer outcomes from psychological therapies than adults over the age of 25 years, but research has been confined to smaller studies or has not considered the role of statistical confounding, as well as the potential interaction between age and gender. This study uses data from a national psychological treatment programme to investigate differences in outcomes between young adults (age 16–24 years) and working age adults (age 25–65 years).<h3>Methods</h3>We used data from all individuals who had an episode of treatment in any English National Health Service Talking Therapies for anxiety and depression (TTad) service between April 1, 2015, and March 31, 2019. We compared change in Patient Health Questionnaire 9-item (PHQ-9) score and Generalised Anxiety Disorder Scale 7-item (GAD-7) score pre-treatment to post-treatment between patients who were aged 16–24 years and those aged 25–65 years, as well as service-specific outcomes including recovery, reliable recovery, reliable improvement, and reliable deterioration. Age was also treated as a continuous variable in linear regression models examining change in depression and anxiety symptom severity scores. We examined geographical and temporal consistency as sensitivity analyses. People with lived experience were involved in the study design and interpretation.<h3>Findings</h3>The young adult cohort contained 309 758 patients aged 16–24 years (214 977 [69·4%] female and 93 728 [30·3%] male; 255 547 [82·5%] of White ethnicity; mean age 20·8 years [SD 2·3]). The working age adult group comprised 1 290 130 patients aged 25–65 years (840 631 [65·2%] female and 445 466 [34·5%] male; 1 078 985 [83·6%] of White ethnicity; mean age 41·5 years [SD 11·1]). We observed that improvements in PHQ-9 and GAD-7 scores were smaller for young adults compared to working age adults (PHQ-9: b –0·98 [95% CI –1·00 to –0·96]; GAD-7: b –0·77 [–0·80 to –0·75]). Young adults were less likely to meet criteria for reliable improvement (odds ratio 0·78 [95% CI 0·77–0·78]), recovery 0·73 (0·73–0·74), and reliable recovery (0·74 [0·73–0·74]), and more likely to meet criteria for reliable deterioration 1·19 (1·17–1·20). Sensitivity analyses revealed consistency of the age-related treatment effect when differences in temporal, geographical, and adults older than 65 years, were considered.<h3>Interpretation</h3>Outcomes following routinely delivered psychological treatments across all areas of England were poorer in young adults than working age adults. These effects, when scaled up to the population level, affect thousands of young adults annually. Future research should consider adaptions t","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"3 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792631","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}
Pub Date : 2025-08-04DOI: 10.1016/s2215-0366(25)00218-4
Iris E Sommer, Sanne Koops, Martijn van den Heuvel
No Abstract
没有抽象的
{"title":"rTMS treatment for refractory hallucinations: new insights from classic targets","authors":"Iris E Sommer, Sanne Koops, Martijn van den Heuvel","doi":"10.1016/s2215-0366(25)00218-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00218-4","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778467","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}
Pub Date : 2025-08-04DOI: 10.1016/s2215-0366(25)00202-0
Christian Plewnia, Bettina Brendel, Tobias Schwippel, Julia Becker-Sadzio, Ibrahim Hajiyev, Benjamin Pross, Wolfgang Strube, Alkomiet Hasan, Mattia Campana, Frank Padberg, Patrick Mayer, Milenko Kujovic, Sabrina Lorenz, Carlos Schönfeldt-Lecuona, Marie-Luise Otte, Robert Christian Wolf, Jacqueline Höppner-Buchmann, Lina Maria Serna-Higuita, Peter Martus, Andreas Jochen Fallgatter
<h3>Background</h3>Auditory verbal hallucinations are a major burden for patients with schizophrenia spectrum disorder and are often resistant to pharmacological and psychotherapeutic interventions. Repetitive transcranial magnetic stimulation (rTMS) of the temporo-parietal cortex has been proposed as a treatment for persistent auditory verbal hallucinations. We aimed to compare the efficacy and safety of bilateral continuous theta burst stimulation (cTBS), a brief and efficient form of rTMS, in adults with auditory verbal hallucinations versus sham cTBS.<h3>Methods</h3>This multicentre, randomised, sham-controlled, triple-blind phase 3 clinical trial was conducted at seven German psychiatric university hospitals and followed a planned two-stage adaptive design. Eligible patients were aged 18–65 years, had experienced persistent auditory verbal hallucinations at least once per week for a minimum of 3 months, and scored 3 points or higher on item P3 (hallucinatory behaviour) of the clinician-rated Positive Scale of the Positive and Negative Syndrome Scale (PANSS). 138 adults with treatment-persistent auditory verbal hallucinations and schizophrenia spectrum disorder were randomly assigned (1:1) to receive 15 sessions of active (n=70) or sham cTBS (n=68) administered sequentially as 600 pulses to the left and 600 pulses to the right temporo-parietal cortex over a 3-week period. The primary outcome was the change in the auditory hallucinations subscale of the Psychotic Symptom Rating Scales (PSYRATS-AH) from baseline to the end of treatment at 3 weeks, analysed in the intention-to-treat population, which included all randomly assigned patients who received at least one stimulation session. Safety was assessed in all patients who received at least one stimulation session. Follow-up assessments were performed at 1, 3, and 6 months after the end of treatment. People with lived experience were not involved in the study. This trial was registered at <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT02670291</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>.<h3>Findings</h3>Between Oct 24, 2015, and May 1, 2023, 2583 patients were screened for eligibility, of whom 138 patients were randomly assigned to active cTBS (n=70; 32 [46%] females and 38 [54%] males) or sham treatment (n=68; 24 [35%] females and 44 [65%] males). Race and ethnicity data were not collected. The primary intention-to-treat analysis (66 patients in the active cTBS group; 64 patients in the sham cTBS group), combining stages 1 and 2, showed patients in the active cTBS group had a significantly greater decrease in the PSYRAT
{"title":"Theta burst stimulation of temporo-parietal cortex regions for the treatment of persistent auditory hallucinations: a multicentre, randomised, sham-controlled, triple-blind phase 3 trial in Germany","authors":"Christian Plewnia, Bettina Brendel, Tobias Schwippel, Julia Becker-Sadzio, Ibrahim Hajiyev, Benjamin Pross, Wolfgang Strube, Alkomiet Hasan, Mattia Campana, Frank Padberg, Patrick Mayer, Milenko Kujovic, Sabrina Lorenz, Carlos Schönfeldt-Lecuona, Marie-Luise Otte, Robert Christian Wolf, Jacqueline Höppner-Buchmann, Lina Maria Serna-Higuita, Peter Martus, Andreas Jochen Fallgatter","doi":"10.1016/s2215-0366(25)00202-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00202-0","url":null,"abstract":"<h3>Background</h3>Auditory verbal hallucinations are a major burden for patients with schizophrenia spectrum disorder and are often resistant to pharmacological and psychotherapeutic interventions. Repetitive transcranial magnetic stimulation (rTMS) of the temporo-parietal cortex has been proposed as a treatment for persistent auditory verbal hallucinations. We aimed to compare the efficacy and safety of bilateral continuous theta burst stimulation (cTBS), a brief and efficient form of rTMS, in adults with auditory verbal hallucinations versus sham cTBS.<h3>Methods</h3>This multicentre, randomised, sham-controlled, triple-blind phase 3 clinical trial was conducted at seven German psychiatric university hospitals and followed a planned two-stage adaptive design. Eligible patients were aged 18–65 years, had experienced persistent auditory verbal hallucinations at least once per week for a minimum of 3 months, and scored 3 points or higher on item P3 (hallucinatory behaviour) of the clinician-rated Positive Scale of the Positive and Negative Syndrome Scale (PANSS). 138 adults with treatment-persistent auditory verbal hallucinations and schizophrenia spectrum disorder were randomly assigned (1:1) to receive 15 sessions of active (n=70) or sham cTBS (n=68) administered sequentially as 600 pulses to the left and 600 pulses to the right temporo-parietal cortex over a 3-week period. The primary outcome was the change in the auditory hallucinations subscale of the Psychotic Symptom Rating Scales (PSYRATS-AH) from baseline to the end of treatment at 3 weeks, analysed in the intention-to-treat population, which included all randomly assigned patients who received at least one stimulation session. Safety was assessed in all patients who received at least one stimulation session. Follow-up assessments were performed at 1, 3, and 6 months after the end of treatment. People with lived experience were not involved in the study. This trial was registered at <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT02670291</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>.<h3>Findings</h3>Between Oct 24, 2015, and May 1, 2023, 2583 patients were screened for eligibility, of whom 138 patients were randomly assigned to active cTBS (n=70; 32 [46%] females and 38 [54%] males) or sham treatment (n=68; 24 [35%] females and 44 [65%] males). Race and ethnicity data were not collected. The primary intention-to-treat analysis (66 patients in the active cTBS group; 64 patients in the sham cTBS group), combining stages 1 and 2, showed patients in the active cTBS group had a significantly greater decrease in the PSYRAT","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778472","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}
Pub Date : 2025-08-04DOI: 10.1016/s2215-0366(25)00240-8
Jie Sun, Kelly Rose-Clarke, YanPing Bao, Zhe Wang, Lin Lu
No Abstract
没有抽象的
{"title":"Child and adolescent mental health policy advancement in China","authors":"Jie Sun, Kelly Rose-Clarke, YanPing Bao, Zhe Wang, Lin Lu","doi":"10.1016/s2215-0366(25)00240-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00240-8","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"8 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778524","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}
Pub Date : 2025-07-28DOI: 10.1016/s2215-0366(25)00237-8
Scott R Clark, Catharine Toben, Magdalene C Jawahar, Azmeraw T Amare, Lyle J Palmer, K Oliver Schubert
No Abstract
没有抽象的
{"title":"Infection, inflammation, and personalisation: time for an integrated approach to clozapine monitoring","authors":"Scott R Clark, Catharine Toben, Magdalene C Jawahar, Azmeraw T Amare, Lyle J Palmer, K Oliver Schubert","doi":"10.1016/s2215-0366(25)00237-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00237-8","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"97 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719616","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}
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