Pub Date : 2024-12-17DOI: 10.1016/s2215-0366(24)00360-2
Edoardo G Ostinelli, Marcel Schulze, Caroline Zangani, Luis C Farhat, Anneka Tomlinson, Cinzia Del Giovane, Samuel R Chamberlain, Alexandra Philipsen, Susan Young, Phil J Cowen, Andrea Bilbow, Andrea Cipriani, Samuele Cortese
<h3>Background</h3>The comparative benefits and harms of available interventions for ADHD in adults remain unclear. We aimed to address these important knowledge gaps.<h3>Methods</h3>In this systematic review and component network meta-analysis (NMA), we searched multiple databases for published and unpublished randomised controlled trials (RCTs) investigating pharmacological and non-pharmacological interventions for ADHD in adults from database inception to Sept 6, 2023. We included aggregate data from RCTs comparing interventions against controls or any other eligible active intervention for the treatment of symptoms in adults (ages ≥18 years) with a formal diagnosis of ADHD. Pharmacological therapies were included only if their maximum planned doses were considered eligible according to international guidelines. We included RCTs of at least 1-week duration for medications, of at least four sessions for psychological therapies, and of any length deemed appropriate for neurostimulation. For RCTs of medications, cognitive training, or neurostimulation alone, we included only double-blind RCTs. At least two authors independently screened the identified records and extracted data from eligible RCTs. Our primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). We estimated standardised mean differences (SMDs) and odds ratios (ORs) using random effects pairwise and component NMA, dismantling interventions into specific therapeutic components. This study was registered with PROSPERO (CRD42021265576). People with relevant lived experience were involved in the conduct of the research and writing process.<h3>Findings</h3>Of 32 416 records, 113 unique RCTs encompassing 14 887 participants were eligible for analysis (6787 [45·6%] females, 7638 [51·3%] males, 462 [3·1%] sex not reported). The RCTs encompassed pharmacological therapies (63 [55·8%] of 113 RCTs; 6875 participants), psychological therapies (28 [24·8%] of 113 RCTs; 1116 participants), neurostimulatory therapy and neurofeedback (ten [8·8%] of 113 RCTs; 194 participants), and control conditions (97 [85·8%] of 113 RCTs; 5770 participants). For reduction of ADHD core symptoms at 12 weeks on both self-reported and clinician-reported rating scales, atomoxetine (self-reported scale SMD –0·38, 95% CI –0·56 to –0·21; clinician-reported scale –0·51, –0·64 to –0·37) and stimulants (0·39, –0·52 to –0·26; –0·61, –0·71 to –0·51) had higher efficacy than placebo (Confidence in Network Meta-Analysis [CINeMA] ranging between very low and moderate). Cognitive behavioural therapy (–0·76, –1·26 to –0·26), cognitive remediation (–1·35, –2·42 to –0·27), mindfulness (–0·79, –1·29 to –0·29), psychoeducation (–0·77, –1·35 to –0·18), and transcranial direct current stimulation (–0·78; –1·13 to –0·43) were better than placebo only on clinician-reported measures. Regarding acceptability, al
{"title":"Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis","authors":"Edoardo G Ostinelli, Marcel Schulze, Caroline Zangani, Luis C Farhat, Anneka Tomlinson, Cinzia Del Giovane, Samuel R Chamberlain, Alexandra Philipsen, Susan Young, Phil J Cowen, Andrea Bilbow, Andrea Cipriani, Samuele Cortese","doi":"10.1016/s2215-0366(24)00360-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00360-2","url":null,"abstract":"<h3>Background</h3>The comparative benefits and harms of available interventions for ADHD in adults remain unclear. We aimed to address these important knowledge gaps.<h3>Methods</h3>In this systematic review and component network meta-analysis (NMA), we searched multiple databases for published and unpublished randomised controlled trials (RCTs) investigating pharmacological and non-pharmacological interventions for ADHD in adults from database inception to Sept 6, 2023. We included aggregate data from RCTs comparing interventions against controls or any other eligible active intervention for the treatment of symptoms in adults (ages ≥18 years) with a formal diagnosis of ADHD. Pharmacological therapies were included only if their maximum planned doses were considered eligible according to international guidelines. We included RCTs of at least 1-week duration for medications, of at least four sessions for psychological therapies, and of any length deemed appropriate for neurostimulation. For RCTs of medications, cognitive training, or neurostimulation alone, we included only double-blind RCTs. At least two authors independently screened the identified records and extracted data from eligible RCTs. Our primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). We estimated standardised mean differences (SMDs) and odds ratios (ORs) using random effects pairwise and component NMA, dismantling interventions into specific therapeutic components. This study was registered with PROSPERO (CRD42021265576). People with relevant lived experience were involved in the conduct of the research and writing process.<h3>Findings</h3>Of 32 416 records, 113 unique RCTs encompassing 14 887 participants were eligible for analysis (6787 [45·6%] females, 7638 [51·3%] males, 462 [3·1%] sex not reported). The RCTs encompassed pharmacological therapies (63 [55·8%] of 113 RCTs; 6875 participants), psychological therapies (28 [24·8%] of 113 RCTs; 1116 participants), neurostimulatory therapy and neurofeedback (ten [8·8%] of 113 RCTs; 194 participants), and control conditions (97 [85·8%] of 113 RCTs; 5770 participants). For reduction of ADHD core symptoms at 12 weeks on both self-reported and clinician-reported rating scales, atomoxetine (self-reported scale SMD –0·38, 95% CI –0·56 to –0·21; clinician-reported scale –0·51, –0·64 to –0·37) and stimulants (0·39, –0·52 to –0·26; –0·61, –0·71 to –0·51) had higher efficacy than placebo (Confidence in Network Meta-Analysis [CINeMA] ranging between very low and moderate). Cognitive behavioural therapy (–0·76, –1·26 to –0·26), cognitive remediation (–1·35, –2·42 to –0·27), mindfulness (–0·79, –1·29 to –0·29), psychoeducation (–0·77, –1·35 to –0·18), and transcranial direct current stimulation (–0·78; –1·13 to –0·43) were better than placebo only on clinician-reported measures. Regarding acceptability, al","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"114 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841234","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 : 2024-12-09DOI: 10.1016/s2215-0366(24)00333-x
Carolina Seybert, Nina Schimmers, Lucio Silva, Joost J Breeksema, Jolien Veraart, Bárbara S Bessa, Dora d'Orsi, Robert A Schoevers, Albino J Oliveira-Maia
Although studies of psychedelic-assisted psychotherapy are accumulating, there is no consensus regarding best practice of the psychotherapeutic component. In this systematic review, we summarised the quality of reporting on psychological interventions in research about psychedelic treatments. The design followed PRISMA guidelines and was preregistered in PROSPERO (CRD42022319221). We searched MEDLINE, PsycINFO, and Embase for original studies on psychedelic-assisted psychotherapy and included 45 studies assessing psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (known as LSD), or ayahuasca, for the treatment of mental disorders. Psychological interventions were done heterogeneously across studies, and completeness of information reported about these interventions was mostly low, according to an adaptation of the Template for Intervention Description and Replication checklist. In studies including MDMA, psychotherapy was more homogeneous and more procedural details were provided. Improved reporting on psychological interventions of psychedelic treatments will support replicability, generalisability, and accurate interpretation of research, while enhancing feasibility and safety of future clinical research and real-world implementation of treatments.
{"title":"Quality of reporting on psychological interventions in psychedelic treatments: a systematic review","authors":"Carolina Seybert, Nina Schimmers, Lucio Silva, Joost J Breeksema, Jolien Veraart, Bárbara S Bessa, Dora d'Orsi, Robert A Schoevers, Albino J Oliveira-Maia","doi":"10.1016/s2215-0366(24)00333-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00333-x","url":null,"abstract":"Although studies of psychedelic-assisted psychotherapy are accumulating, there is no consensus regarding best practice of the psychotherapeutic component. In this systematic review, we summarised the quality of reporting on psychological interventions in research about psychedelic treatments. The design followed PRISMA guidelines and was preregistered in PROSPERO (CRD42022319221). We searched MEDLINE, PsycINFO, and Embase for original studies on psychedelic-assisted psychotherapy and included 45 studies assessing psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (known as LSD), or ayahuasca, for the treatment of mental disorders. Psychological interventions were done heterogeneously across studies, and completeness of information reported about these interventions was mostly low, according to an adaptation of the Template for Intervention Description and Replication checklist. In studies including MDMA, psychotherapy was more homogeneous and more procedural details were provided. Improved reporting on psychological interventions of psychedelic treatments will support replicability, generalisability, and accurate interpretation of research, while enhancing feasibility and safety of future clinical research and real-world implementation of treatments.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"94 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796824","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 : 2024-12-04DOI: 10.1016/s2215-0366(24)00410-3
Zavlis O, Luyten P, Pilling S, Fonagy P. Pressing need for clinical trial research on dimensional personality disorder. Lancet Psychiatry 2024; published online Nov 21. https://doi.org/10.1016/s2215-0366(24)00365-1. In this Correspondence, the second sentence of the first paragraph should read, “However, national health guidelines (such as those from the UK's National Institute of Clinical Excellence) have not been updated to reflect changes from the previous categorical model of personality disorders”. The third sentence of the fifth paragraph should read “Recent work also supports the predictive superiority of dimensional personality disorder over categorical personality disorders by revealing that dimensional personality difficulties (such as personality disorder severity and traits) are stronger predictors of various clinical outcomes (including general psychiatric severity, psychosocial functioning, and quality of life), compared to categorical personality diagnoses.” These corrections have been made to the online version as of Dec 4, and will be made to the printed version.
{"title":"Correction to Lancet Psychiatry 2024; published online Nov 21. https://doi.org/10.1016/S2215-0366(24)00365-1","authors":"","doi":"10.1016/s2215-0366(24)00410-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00410-3","url":null,"abstract":"<em>Zavlis O, Luyten P, Pilling S, Fonagy P. Pressing need for clinical trial research on dimensional personality disorder. Lancet Psychiatry 2024; published online Nov 21. https://doi.org/10.1016/s2215-0366(24)00365-1</em>. In this Correspondence, the second sentence of the first paragraph should read, “However, national health guidelines (such as those from the UK's National Institute of Clinical Excellence) have not been updated to reflect changes from the previous categorical model of personality disorders”. The third sentence of the fifth paragraph should read “Recent work also supports the predictive superiority of dimensional personality disorder over categorical personality disorders by revealing that dimensional personality difficulties (such as personality disorder severity and traits) are stronger predictors of various clinical outcomes (including general psychiatric severity, psychosocial functioning, and quality of life), compared to categorical personality diagnoses.” These corrections have been made to the online version as of Dec 4, and will be made to the printed version.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"10 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776644","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 : 2024-12-04DOI: 10.1016/s2215-0366(24)00361-4
Ellie May Robson, Hanafi M Husin, Seydeh Ghazaleh Dashti, Nandita Vijayakumar, Margarita Moreno-Betancur, Paul Moran, George C Patton, Susan M Sawyer
<h3>Background</h3>Adolescent mental health appears to be in crisis, yet few studies have comprehensively charted the course of common mental disorders (CMDs; depression and anxiety) across this key life stage. We aimed to describe the course of CMD symptoms in adolescence by summarising annual prevalence, cumulative incidence, and course for depression and anxiety, both separately and as comorbid CMDs, by sex assigned at birth in a contemporary Australian cohort.<h3>Methods</h3>The Child to Adult Transition Study (CATS) was established in 2012 to form a representative cohort of adolescents in Melbourne, VIC, Australia. 43 schools were recruited using a stratified sampling approach, and all 2289 students aged 8–9 years were invited to participate. 1239 (54·1%) students obtained parental written informed consent and were followed up annually from 2012 to 2019 for a total of ten waves. Data from waves 3–10 (ages 10 to 18 years) were used for the current study and analysed to describe the course of symptoms of CMDs across adolescence. Primary measures of interest were clinically relevant depressive symptoms, clinically relevant anxiety symptoms, and any CMD (clinically relevant depressive or anxiety symptoms) at waves 3–10. A secondary measure of interest was comorbid CMDs (concurrent reporting of clinically significant anxiety and depressive symptoms) at waves 3–10. Depressive symptoms in the past 2 weeks were self-reported using the 13-item validated Short Mood and Feelings Questionnaire (SMFQ) at each wave, with a threshold score of 12 or more indicating clinically relevant symptoms. Anxiety symptoms in the past two weeks were self-reported using an 8-item shortened version of the Spence Children's Anxiety Scale (SCAS) at each wave, with a threshold score of 11 or higher indicating clinically relevant symptoms. The course of CMDs was described using annual prevalence, cumulative incidence for depression and anxiety, separately and combined. Missing data were handled via multiple imputation. An author with lived experience was involved in the research and writing process.<h3>Findings</h3>Of the 1239 adolescents who participated in the study, 667 (53·8%) were female and 572 (46·2%) were male. 769 (62·1%) of 1239 were classified as socioeconomically advantaged, 675 (66·4%) of the 1016 with available data had a mother whose highest level of education was vocational or tertiary, and 579 (70·7%) of the 819 participants with ethnicity data identified as Anglo-Celtic or European. Overall, incidence of any clinically significant CMD symptoms during adolescence was 74% (95% CI 70–77; 84% [81–88] for females and 61% [55–66] for males). Independently, incidences of clinically significant depressive symptoms and anxiety symptoms were 65% (62–68) and 58% (55–62), respectively. Incidence of comorbid CMD was 48% (45–52). The estimated mean ages of first report in adolescence for both sexes were 14·1 years (95% CI 13·9–14·4) and 13·6 years (3·3–13·9) for depressi
青少年心理健康似乎处于危机之中，但很少有研究全面描绘了常见精神障碍(CMDs；抑郁和焦虑)贯穿这个关键的人生阶段。我们的目的是通过总结年度患病率，累积发病率，抑郁和焦虑的病程，单独的和共病的CMD，在当代澳大利亚队列中按出生性别划分，来描述青春期CMD症状的过程。方法采用分层抽样方法，于2012年在澳大利亚墨尔本市建立了具有代表性的青少年过渡研究（CATS），共招募了43所学校的2289名8-9岁的学生。1239名（54.1%）学生获得家长书面知情同意，2012年至2019年每年随访10次。目前的研究使用了3-10期（10 - 18岁）的数据，并对其进行了分析，以描述青春期CMDs的症状过程。主要感兴趣的测量是临床相关的抑郁症状，临床相关的焦虑症状，以及任何CMD（临床相关的抑郁或焦虑症状）在波3-10。另一个重要的测量指标是第3-10波的共病CMDs（同时报告临床显著的焦虑和抑郁症状）。过去两周的抑郁症状是自我报告的，每一波使用13项经验证的短期情绪和感觉问卷（SMFQ），阈值得分为12或更高，表明临床相关症状。过去两周的焦虑症状是用斯宾塞儿童焦虑量表（SCAS）的8项缩短版自我报告的，每一波的阈值得分为11或更高，表明有临床相关症状。用年度患病率、抑郁和焦虑的累计发病率分别和合并来描述慢性疾病的病程。缺失数据通过多次插值处理。一位有生活经验的作者参与了研究和写作过程。结果1239名青少年中，女性667人（53.8%），男性572人（46.2%）。1239人中有769人（61%）被归类为社会经济优势，1016人中有675人（66.4%）的母亲的最高教育水平是职业或高等教育，819名参与者中有579人（77%）的种族数据被确定为盎格鲁-凯尔特人或欧洲人。总体而言，青春期任何临床显著CMD症状的发生率为74% (95% CI 70-77；女性84%[81-88]，男性61%[55-66])。独立地，临床显著抑郁症状和焦虑症状的发生率分别为65%（62-68）和58%（55-62）。合并CMD的发生率为48%（45-52）。对于抑郁和焦虑症状，男女首次报告的青少年估计平均年龄分别为14.1岁（95% CI 13.9 - 14.4）和13.6岁（3.3 - 13.9）。在那些在10到18岁之间达到任何CMD阈值的人中，超过一半的人有慢性（三波或更多）病程(抑郁症54% [49-60]；焦虑52%[47-58])，三分之一在随后的任何一波中都符合完全缓解的标准(抑郁症30% [25-35]；焦虑33%[27-39])。与男性相比，女性一直被认为有更糟糕的青少年CMDs病程（例如，64%[58-70]的女性有慢性抑郁症状病程，而男性为37%[26-48]）。在这项当代多波队列研究中，几乎四分之三的青少年报告了CMD症状。慢性CMD症状（即复发）的可能性很高。迫切需要采取普遍应对措施来解决这一重大的公共卫生问题。澳大利亚国家卫生和医学研究委员会和皇家儿童医院基金会。
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Pub Date : 2024-12-04DOI: 10.1016/s2215-0366(24)00402-4
Karolin Rose Krause, Peter Szatmari
No Abstract
没有抽象的
{"title":"Nuanced epidemiology for nuanced care: addressing the substantial mental health needs of adolescents","authors":"Karolin Rose Krause, Peter Szatmari","doi":"10.1016/s2215-0366(24)00402-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00402-4","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"46 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776646","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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