Pub Date : 2026-01-21DOI: 10.1016/s2215-0366(25)00358-x
Etheldreda Nakimuli-Mpungu, Celso Arango, Rakhi Dandona, Tamsin Ford, Ann John, Ayana Jordan, Rebecca Cherop, Lola Kola, Carlos López-Jaramillo, Alexandra M Schuster, Martin Knapp, Magdalena Walbaum, Kelvin Opiepie, Fabian Musoro, Lawrence A White, Dmytro Martsenkovskyi, Benedict Daniel Michael, Rory O'Connor, Peter B Jones
{"title":"Policy and public health implications for mental health after the COVID-19 pandemic","authors":"Etheldreda Nakimuli-Mpungu, Celso Arango, Rakhi Dandona, Tamsin Ford, Ann John, Ayana Jordan, Rebecca Cherop, Lola Kola, Carlos López-Jaramillo, Alexandra M Schuster, Martin Knapp, Magdalena Walbaum, Kelvin Opiepie, Fabian Musoro, Lawrence A White, Dmytro Martsenkovskyi, Benedict Daniel Michael, Rory O'Connor, Peter B Jones","doi":"10.1016/s2215-0366(25)00358-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00358-x","url":null,"abstract":"","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"65 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014334","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 : 2026-01-21DOI: 10.1016/s2215-0366(25)00247-0
Alexandra M Schuster, Nisreen A Alwan, Felicity Callard, Eric Yu Hai Chen, Simon Gilbody, Bronwyn M Graham, Stephani L Hatch, Edgar Jones, Ayana Jordan, Martin Knapp, Carlos López-Jaramillo, Ethel Nakimuli-Mpungu, Soumitra Pathare, Kerry J Ressler, Simon Wessely, Lawrence A White, Peter B Jones
{"title":"The implications of the COVID-19 pandemic for clinical mental health care","authors":"Alexandra M Schuster, Nisreen A Alwan, Felicity Callard, Eric Yu Hai Chen, Simon Gilbody, Bronwyn M Graham, Stephani L Hatch, Edgar Jones, Ayana Jordan, Martin Knapp, Carlos López-Jaramillo, Ethel Nakimuli-Mpungu, Soumitra Pathare, Kerry J Ressler, Simon Wessely, Lawrence A White, Peter B Jones","doi":"10.1016/s2215-0366(25)00247-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00247-0","url":null,"abstract":"","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014335","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 : 2026-01-14DOI: 10.1016/s2215-0366(25)00338-4
Sasson Zemach,Joseph Zohar,Christoph U Correll,Stephen M Stahl,Filippo Drago,Guy M Goodwin,Hans-Jurgen Moller,Hiroyuki Uchida,Spyridon Siafis,Marlene Santos,Pierre Blier
In this Personal View, we introduce the concept of different dosage different pharmacology (DDDP), which describes how certain psychotropic medications have distinct therapeutic effects at low and high doses due to differing neurobiological mechanisms. Using the Neuroscience-based Nomenclature (NbN) framework, which classifies drugs by pharmacology and modes of action, we identified ten agents demonstrating DDDP in a comprehensive expert-based consensus process: amisulpride, amitriptyline, aripiprazole, brexpiprazole, cariprazine, doxepin, mirtazapine, quetiapine, risperidone, and trazodone. These medications show clearly demarcated dose-dependent effects, with changes in pharmacological action. For example, some drugs show anxiolytic or hypnotic effects at low doses (via histamine H1 or noradrenergic α1 antagonism) and antidepressant effects at high doses (via reuptake inhibition of serotonin or norepinephrine). Understanding these differences supports more rational prescribing (eg, increasing dopamine partial agonist doses beyond the optimal range might reduce efficacy). DDDP, within the NbN framework, offers a neuroscience-based approach to more precise psychopharmacology.
{"title":"Dose-dependent pharmacological mechanisms within the Neuroscience-based Nomenclature: a new concept to facilitate neuroscience-based prescribing.","authors":"Sasson Zemach,Joseph Zohar,Christoph U Correll,Stephen M Stahl,Filippo Drago,Guy M Goodwin,Hans-Jurgen Moller,Hiroyuki Uchida,Spyridon Siafis,Marlene Santos,Pierre Blier","doi":"10.1016/s2215-0366(25)00338-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00338-4","url":null,"abstract":"In this Personal View, we introduce the concept of different dosage different pharmacology (DDDP), which describes how certain psychotropic medications have distinct therapeutic effects at low and high doses due to differing neurobiological mechanisms. Using the Neuroscience-based Nomenclature (NbN) framework, which classifies drugs by pharmacology and modes of action, we identified ten agents demonstrating DDDP in a comprehensive expert-based consensus process: amisulpride, amitriptyline, aripiprazole, brexpiprazole, cariprazine, doxepin, mirtazapine, quetiapine, risperidone, and trazodone. These medications show clearly demarcated dose-dependent effects, with changes in pharmacological action. For example, some drugs show anxiolytic or hypnotic effects at low doses (via histamine H1 or noradrenergic α1 antagonism) and antidepressant effects at high doses (via reuptake inhibition of serotonin or norepinephrine). Understanding these differences supports more rational prescribing (eg, increasing dopamine partial agonist doses beyond the optimal range might reduce efficacy). DDDP, within the NbN framework, offers a neuroscience-based approach to more precise psychopharmacology.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"36 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993044","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 : 2026-01-12DOI: 10.1016/s2215-0366(25)00341-4
Rosa Ritunnano, Jeannette Littlemore, Barnaby Nelson, Clara S Humpston, Matthew R Broome
<h3>Background</h3>Delusions in psychosis involve complex and dynamic experiential, affective, cognitive, behavioural, and interpersonal alterations. Their pattern of emergence during the early stages of illness remains poorly understood and the origin of their thematic content unclear. Phenomenological accounts have emphasised alterations of selfhood and reality experience in delusion formation but have not considered the role of life events and other contextual factors in the development of these disturbances. This study aimed to investigate the relationship between self-experience and the lived world in first-episode psychosis by situating the phenomenological analysis of delusions in the context of the person's life narrative.<h3>Methods</h3>In this qualitatively driven study, we recruited individuals with lived experience of delusions receiving care from three Early Intervention in Psychosis (EIP) teams in the UK. People with lived experience were involved in the development of the study design and protocol. Inclusion criteria were that the individual was being treated within an EIP service; past or current experience of clinically significant delusions, assessed by the attending psychiatrist to be at least of moderate severity; aged between 18 and 65 years; and willing and able to give informed consent and able to undertake interviews in English. Exclusion criteria included presence of a psychotic disorder solely related to substance intoxication or withdrawal. We used a novel multi-perspectival design to investigate delusions across three analytical standpoints: standard clinical psychopathology (third person), phenomenological psychopathology (a top-down approach to eliciting first-person data), and narrative inquiry (a bottom-up approach to eliciting first-person data). Delusion content was classified based on the definitions provided by the Scale for the Assessment of Positive Symptoms. Participants completed standardised psychometric scales, a narrative interview (ad-hoc Life Story Interview), and a phenomenological (Examination of Anomalous World Experience [EAWE]) interview. Findings were integrated through meta-inference across analytical frameworks.<h3>Findings</h3>Between Jan 4, 2023, and June 14, 2023, 33 interview sessions were completed with ten adults with first-episode psychosis and lived experience of delusions (three men, six women, and one person who was non-binary; median age 24·5 years [IQR 14·8]; eight White, two White and Black Caribbean). The three most common delusion themes were: persecutory (ten [100%]), reference (nine [90%]), and grandiose or religious (nine [90%]). No theme occurred in isolation. The phenomenological component of the analysis revealed a global, qualitative shift in the subjective experience of the lived world, with total EAWE scores ranging from 13 to 48 (mean 26·5 [SD 10·85]). The first narrative theme highlighted the role of early and repeated negative interpersonal emotions (especially shame)
{"title":"Delusion as embodied emotion: a qualitatively driven, multimethod study of first-episode psychosis in the UK","authors":"Rosa Ritunnano, Jeannette Littlemore, Barnaby Nelson, Clara S Humpston, Matthew R Broome","doi":"10.1016/s2215-0366(25)00341-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00341-4","url":null,"abstract":"<h3>Background</h3>Delusions in psychosis involve complex and dynamic experiential, affective, cognitive, behavioural, and interpersonal alterations. Their pattern of emergence during the early stages of illness remains poorly understood and the origin of their thematic content unclear. Phenomenological accounts have emphasised alterations of selfhood and reality experience in delusion formation but have not considered the role of life events and other contextual factors in the development of these disturbances. This study aimed to investigate the relationship between self-experience and the lived world in first-episode psychosis by situating the phenomenological analysis of delusions in the context of the person's life narrative.<h3>Methods</h3>In this qualitatively driven study, we recruited individuals with lived experience of delusions receiving care from three Early Intervention in Psychosis (EIP) teams in the UK. People with lived experience were involved in the development of the study design and protocol. Inclusion criteria were that the individual was being treated within an EIP service; past or current experience of clinically significant delusions, assessed by the attending psychiatrist to be at least of moderate severity; aged between 18 and 65 years; and willing and able to give informed consent and able to undertake interviews in English. Exclusion criteria included presence of a psychotic disorder solely related to substance intoxication or withdrawal. We used a novel multi-perspectival design to investigate delusions across three analytical standpoints: standard clinical psychopathology (third person), phenomenological psychopathology (a top-down approach to eliciting first-person data), and narrative inquiry (a bottom-up approach to eliciting first-person data). Delusion content was classified based on the definitions provided by the Scale for the Assessment of Positive Symptoms. Participants completed standardised psychometric scales, a narrative interview (ad-hoc Life Story Interview), and a phenomenological (Examination of Anomalous World Experience [EAWE]) interview. Findings were integrated through meta-inference across analytical frameworks.<h3>Findings</h3>Between Jan 4, 2023, and June 14, 2023, 33 interview sessions were completed with ten adults with first-episode psychosis and lived experience of delusions (three men, six women, and one person who was non-binary; median age 24·5 years [IQR 14·8]; eight White, two White and Black Caribbean). The three most common delusion themes were: persecutory (ten [100%]), reference (nine [90%]), and grandiose or religious (nine [90%]). No theme occurred in isolation. The phenomenological component of the analysis revealed a global, qualitative shift in the subjective experience of the lived world, with total EAWE scores ranging from 13 to 48 (mean 26·5 [SD 10·85]). The first narrative theme highlighted the role of early and repeated negative interpersonal emotions (especially shame)","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"120 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145955017","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 : 2026-01-06DOI: 10.1016/s2215-0366(25)00393-1
Jennifer Hall,Ledia Lazeri,Joao Breda,Natasha Azzopardi-Muscat
{"title":"Applying a quality lens to strengthening WHO European region child and youth mental health services.","authors":"Jennifer Hall,Ledia Lazeri,Joao Breda,Natasha Azzopardi-Muscat","doi":"10.1016/s2215-0366(25)00393-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00393-1","url":null,"abstract":"","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"3 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937683","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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