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Bangladesh needs to put a stop to malpractice in mental health-care services. 孟加拉国需要制止心理保健服务中的不当行为。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 DOI: 10.1016/S2215-0366(24)00185-8
Md Omar Faruk, Shamsul Haque, Muhammad Kamruzzaman Mozumder, Mohammad Kadir, Azharul Islam, Tarun Kanti Gayen, John Martin
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引用次数: 0
Stepped care approaches for people with personality disorder. 针对人格障碍患者的阶梯式护理方法。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 Epub Date: 2024-06-12 DOI: 10.1016/S2215-0366(24)00167-6
Gary Lamph, Mike Crawford
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引用次数: 0
Nurse prescribers as key players in shared decision making in psychiatry. 护士处方者是精神病学共同决策的关键参与者。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 Epub Date: 2024-04-30 DOI: 10.1016/S2215-0366(24)00113-5
Junqiang Zhao, Yumi Aoki, Yaara Zisman-Ilani
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引用次数: 0
Concomitant use of antidepressants and benzodiazepines during pregnancy and associated risk of congenital malformations: a population-based cohort study in Taiwan. 怀孕期间同时服用抗抑郁药和苯并二氮杂卓与先天畸形的相关风险:一项基于台湾人口的队列研究。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 Epub Date: 2024-07-02 DOI: 10.1016/S2215-0366(24)00176-7
Hui-Min Chuang, Lin-Chieh Meng, Chih-Wan Lin, Wen-Wen Chen, Yi-Yung Chen, Chi-Yung Shang, Liang-Kung Chen, Fei-Yuan Hsiao
<p><strong>Background: </strong>Despite the frequent co-administration of antidepressants and benzodiazepines, the association between such concomitant use during pregnancy and the risk of congenital malformations remains inadequately explored. This study aims to examine the association between concomitant use of antidepressants and benzodiazepines during the first trimester and organ-specific congenital malformations.</p><p><strong>Methods: </strong>We conducted a population-based cohort study using Taiwan's National Birth Certificate Application database, the Maternal and Child Health database, and Taiwan's National Health Insurance database. Pregnant people aged 15-50 years with singleton births between Jan 1, 2004, and Dec 31, 2018, were included. Use of antidepressants and benzodiazepines was defined as at least one prescription during the first trimester, and concomitant use was defined as the overlapping prescription of both drugs with an overlapping prescription period. The primary outcomes were overall congenital malformations and eight organ-specific malformations, consisting of the nervous system, heart, respiratory system, oral cleft, digestive system, urinary system, genital system, and limb malformations. Logistic regression models with propensity score fine stratification weighting approach were used to control for measured confounders. Analyses controlling for confounding by indication and sibling comparison analyses were done to address unmeasured confounders. No individuals with lived experience participated in the research or writing process.</p><p><strong>Findings: </strong>The cohort included 2 634 021 singleton pregnancies, and 8599 (0·3%) individuals were concomitant users of antidepressants and benzodiazepines during the first trimester (mean age at delivery was 31·8 years [SD 5·2] for pregnancies with exposure to antidepressants and benzodiazepines vs 30·7 years [SD 4·9] for pregnancies without exposure). All study participants were female, and information about ethnicity was not available. Absolute risk of overall malformations was 3·81 per 100 pregnancies with exposure, compared with 2·87 per 100 pregnancies without exposure. The propensity score-weighted odds ratios (weighted ORs) did not suggest an increased risk for overall malformations (weighted OR 1·10, 95% CI 0·94-1·28), heart defects (1·01, 0·83-1·23), or any of the other organ-specific malformations, except for digestive system malformations, for which the weighted OR remained statistically significant after adjustment (1·63, 1·06-2·51). The absence of an increased risk for overall congenital malformations associated with concomitant use of antidepressants and benzodiazepines was supported by the analyses controlling for confounding by indication and sibling-matched comparisons.</p><p><strong>Interpretation: </strong>The findings of this study suggest that the concomitant use of antidepressants and benzodiazepines during the first trimester is not associated wi
背景:尽管抗抑郁药和苯二氮卓类药物经常被同时使用,但孕期同时使用这两种药物与先天性畸形风险之间的关系仍未得到充分探讨。本研究旨在探讨妊娠头三个月同时服用抗抑郁药和苯二氮卓类药物与器官特异性先天畸形之间的关系:我们利用台湾全国出生证明申请数据库、妇幼保健数据库和台湾国民健康保险数据库开展了一项基于人群的队列研究。研究纳入了 2004 年 1 月 1 日至 2018 年 12 月 31 日期间单胎分娩的 15-50 岁孕妇。抗抑郁药和苯二氮卓类药物的使用定义为在怀孕头三个月内至少开过一次处方,同时使用定义为这两种药物的处方期重叠。主要结果为总体先天性畸形和八个器官特异性畸形,包括神经系统、心脏、呼吸系统、口腔裂隙、消化系统、泌尿系统、生殖系统和肢体畸形。采用倾向评分精细分层加权法的逻辑回归模型来控制测量的混杂因素。针对未测量的混杂因素,还进行了控制适应症混杂因素的分析和同胞比较分析。没有有生活经验的个人参与研究或撰写过程:队列中包括 2 634 021 例单胎妊娠,其中 8599 例(0-3%)在妊娠头三个月同时服用抗抑郁药和苯并二氮杂卓(暴露于抗抑郁药和苯并二氮杂卓的妊娠的平均分娩年龄为 31-8 岁 [SD 5-2],未暴露于这两种药物的妊娠的平均分娩年龄为 30-7 岁 [SD 4-9])。所有研究参与者均为女性,有关种族的信息不详。每 100 例接触过抗抑郁药和苯并二氮杂卓的妊娠中畸形的绝对风险为 3-81 例,而未接触过的妊娠中畸形的绝对风险为 2-87 例。倾向得分加权的几率比(加权 OR)并不表明总体畸形(加权 OR 1-10,95% CI 0-94-1-28)、心脏缺陷(1-01,0-83-1-23)或任何其他器官特异性畸形的风险增加,但消化系统畸形除外,其加权 OR 经调整后仍具有统计学意义(1-63,1-06-2-51)。同时使用抗抑郁药和苯二氮卓类药物不会增加总体先天畸形的风险,这一点在控制适应症混杂因素和同胞匹配比较的分析中得到了证实:本研究结果表明,妊娠头三个月同时使用抗抑郁药和苯二氮卓类药物与大多数畸形亚型的风险大幅增加无关。然而,考虑到同时使用这两种药物的其他潜在不良影响,全面评估其风险和益处对于临床决策至关重要:国家科学技术委员会。
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引用次数: 0
Polypharmacy for perinatal mood and anxiety disorders. 围产期情绪和焦虑症的多重药物治疗。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 Epub Date: 2024-07-02 DOI: 10.1016/S2215-0366(24)00215-3
Adele C Viguera
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引用次数: 0
Applying the EU regulatory framework for the clinical use of psychedelics. 将欧盟监管框架应用于迷幻剂的临床使用。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-04 DOI: 10.1016/S2215-0366(24)00203-7
Florence Butlen-Ducuing, Francisca Silva, Ivana Silva, Pavel Balabanov, Steffen Thirstrup
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引用次数: 0
Psychological and psychosocial interventions for treatment-resistant schizophrenia: a systematic review and network meta-analysis. 针对难治性精神分裂症的心理和社会心理干预:系统综述和网络荟萃分析。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-01 DOI: 10.1016/S2215-0366(24)00136-6
Nurul Husna Salahuddin, Alexandra Schütz, Gabi Pitschel-Walz, Susanna Franziska Mayer, Anna Chaimani, Spyridon Siafis, Josef Priller, Stefan Leucht, Irene Bighelli
<p><strong>Background: </strong>Many patients with schizophrenia have symptoms that do not respond to antipsychotics. This condition is called treatment-resistant schizophrenia and has not received specific attention as opposed to general schizophrenia. Psychological and psychosocial interventions as an add-on treatment to pharmacotherapy could be useful, but their role and comparative efficacy to each other and to standard care in this population are not known. We investigated the efficacy, acceptability, and tolerability of psychological and psychosocial interventions for patients with treatment-resistant schizophrenia.</p><p><strong>Methods: </strong>In this systematic review and network meta-analysis (NMA), we searched for published and unpublished randomised controlled trials (RCTs) through a systematic database search in BIOSIS, CINAHL, Embase, LILACS, MEDLINE, PsychInfo, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for articles published from inception up to Jan 31, 2020. We also searched the Cochrane Schizophrenia Group registry for studies published from inception up to March 31, 2022, and PubMed and Cochrane CENTRAL for studies published from inception up to July 31, 2023. We included RCTs that included patients with treatment-resistant schizophrenia. The primary outcome was overall symptoms. We did random-effects pairwise meta-analyses and NMAs to calculate standardised mean differences (SMDs) or risk ratios with 95% CIs. No people with lived experience were involved throughout the research process. The study protocol was registered in PROSPERO, CRD42022358696.</p><p><strong>Findings: </strong>We identified 30 326 records, excluding 24 526 by title and abstract screening. 5762 full-text articles were assessed for eligibility, of which 5540 were excluded for not meeting the eligibility criteria, and 222 reports corresponding to 60 studies were included in the qualitative synthesis. Of these, 52 RCTs with 5034 participants (1654 [33·2%] females and 3325 [66·8%] males with sex indicated) comparing 20 psychological and psychosocial interventions provided data for the NMA. Mean age of participants was 38·05 years (range 23·10-48·50). We aimed to collect ethnicity data, but they were scarcely reported. According to the quality of evidence, cognitive behavioural therapy for psychosis (CBTp; SMD -0·22, 95% CI -0·35 to -0·09, 35 trials), virtual reality intervention (SMD -0·41, -0·79 to -0·02, four trials), integrated intervention (SMD -0·70, -1·18 to -0·22, three trials), and music therapy (SMD -1·27, -1·83 to -0·70, one study) were more efficacious than standard care in reducing overall symptoms. No indication of publication bias was identified.</p><p><strong>Interpretation: </strong>We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice. Other psychological a
背景:许多精神分裂症患者的症状对抗精神病药物无效。这种情况被称为耐药性精神分裂症,与普通精神分裂症相比,尚未受到特别关注。心理和社会心理干预作为药物治疗的附加治疗可能会有所帮助,但它们在这一人群中的作用、相互之间的疗效比较以及与标准治疗的疗效比较尚不清楚。我们研究了心理和社会心理干预对耐药精神分裂症患者的疗效、可接受性和耐受性:在这项系统性综述和网络荟萃分析(NMA)中,我们通过系统性数据库检索,在 BIOSIS、CINAHL、Embase、LILACS、MEDLINE、PsychInfo、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台中检索了已发表和未发表的随机对照试验(RCT),检索时间从开始至 2020 年 1 月 31 日。我们还检索了 Cochrane 精神分裂症小组注册表中从开始至 2022 年 3 月 31 日发表的研究,以及 PubMed 和 Cochrane CENTRAL 中从开始至 2023 年 7 月 31 日发表的研究。我们纳入了包括耐药性精神分裂症患者在内的 RCT 研究。主要研究结果为总体症状。我们进行了随机效应配对荟萃分析和NMA分析,以计算标准化均值差异(SMD)或风险比及95% CI。在整个研究过程中,没有任何有生活经验的人参与其中。研究方案已在 PROSPERO 注册,编号为 CRD42022358696:我们确定了 30 326 条记录,通过标题和摘要筛选排除了 24 526 条记录。对 5762 篇全文文章进行了资格评估,其中 5540 篇文章因不符合资格标准而被排除,60 项研究的 222 份报告被纳入定性综合。其中,52 项 RCT 共 5034 名参与者(1654 名[33-2%]女性和 3325 名[66-8%]男性,标明性别)比较了 20 项心理和社会心理干预措施,为 NMA 提供了数据。参与者的平均年龄为 38-05 岁(23-10-48-50 岁不等)。我们的目标是收集种族数据,但报告的种族数据很少。根据证据质量,认知行为疗法(CBTp;SMD -0-22,95% CI -0-35至-0-09,35项试验)、虚拟现实干预(SMD -0-41,-0-79至-0-02,4项试验)、综合干预(SMD -0-70,-1-18至-0-22,3项试验)和音乐疗法(SMD -1-27,-1-83至-0-70,1项研究)在减轻总体症状方面比标准护理更有效。没有发现发表偏倚的迹象:我们提供的可靠研究结果表明,CBT 可减轻耐药精神分裂症患者的总体症状,因此临床医生可在临床实践中优先考虑这一干预措施。其他心理和社会心理干预措施也显示出良好的效果,但仍需进一步研究:DAAD-ASFE.
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引用次数: 0
Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. 抗抑郁药停药症状的发生率:系统回顾和荟萃分析。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-01 Epub Date: 2024-06-05 DOI: 10.1016/S2215-0366(24)00133-0
Jonathan Henssler, Yannick Schmidt, Urszula Schmidt, Guido Schwarzer, Tom Bschor, Christopher Baethge
<p><strong>Background: </strong>Antidepressant discontinuation symptoms are becoming an increasingly important part of clinical practice, but the incidence of antidepressant discontinuation symptoms has not been quantified. An estimate of antidepressant discontinuation symptoms incidence could inform patients and clinicians in the discontinuation of treatment, and provide useful information to researchers in antidepressant treatments. We aimed to assess the incidence of antidepressant discontinuation symptoms in patients discontinuing both antidepressants and placebo in the published literature.</p><p><strong>Methods: </strong>We systematically searched Medline, EMBASE, and CENTRAL from database inception until Oct 13, 2022 for randomised controlled trials (RCTs), other controlled trials, and observational studies assessing the incidence of antidepressant discontinuation symptoms. To be included, studies must have investigated cessation or tapering of an established antidepressant drug (excluding antipsychotics, lithium, or thyroxine) or placebo in participants with any mental, behavioural, or neurodevelopmental disorder. We excluded studies in neonates, and those using antidepressants for physical conditions such as pain syndromes due to organic disease. After study selection, summary data extraction, and risk of bias evaluation, data were pooled in random-effects meta-analyses. The main outcome was the incidence of antidepressant discontinuation symptoms after discontinuation of antidepressants or placebo. We also analysed the incidence of severe discontinuation symptoms. Sensitivity and meta-regression analyses tested a selection of methodological variables.</p><p><strong>Findings: </strong>From 6095 articles screened, 79 studies (44 RCTs and 35 observational studies) covering 21 002 patients were selected (72% female, 28% male, mean age 45 years [range 19·6-64·5]). Data on ethnicity were not consistently reported. 16 532 patients discontinued from an antidepressant, and 4470 patients discontinued from placebo. Incidence of at least one antidepressant discontinuation symptom was 0·31 (95% CI 0·27-0·35) in 62 study groups after discontinuation of antidepressants, and 0·17 (0·14-0·21) in 22 study groups after discontinuation of placebo. Between antidepressant and placebo groups of included RCTs, the summary difference in incidence was 0·08 [0·04-0·12]. The incidence of severe antidepressant discontinuation symptoms after discontinuation of an antidepressant was 0·028 (0·014-0·057) compared with 0·006 (0·002-0·013) after discontinuation of placebo. Desvenlafaxine, venlafaxine, imipramine, and escitalopram were associated with higher frequencies of discontinuation symptoms, and imipramine, paroxetine, and either desvenlafaxine or venlafaxine were associated with a higher severity of symptoms. Heterogeneity of results was substantial.</p><p><strong>Interpretation: </strong>Considering non-specific effects, as evidenced in placebo groups, the incide
背景:抗抑郁药停药症状正日益成为临床实践的重要组成部分,但抗抑郁药停药症状的发生率尚未量化。对抗抑郁药停药症状发生率的估计可为患者和临床医生提供停药信息,并为抗抑郁治疗研究人员提供有用信息。我们旨在评估已发表文献中停用抗抑郁药和安慰剂的患者中抗抑郁药停药症状的发生率:我们系统地检索了 Medline、EMBASE 和 CENTRAL 数据库中从开始到 2022 年 10 月 13 日评估抗抑郁药停药症状发生率的随机对照试验 (RCT)、其他对照试验和观察性研究。要纳入这些研究,必须对患有任何精神、行为或神经发育障碍的参与者停用或减量既有抗抑郁药物(不包括抗精神病药物、锂或甲状腺素)或安慰剂的情况进行调查。我们排除了针对新生儿的研究,以及使用抗抑郁药物治疗身体疾病(如器质性疾病引起的疼痛综合征)的研究。经过研究筛选、摘要数据提取和偏倚风险评估后,我们对数据进行了随机效应荟萃分析。主要结果是停用抗抑郁药或安慰剂后出现抗抑郁药停药症状的发生率。我们还分析了严重停药症状的发生率。敏感性分析和元回归分析对一些方法学变量进行了测试:从 6095 篇文章中筛选出 79 项研究(44 项 RCT 研究和 35 项观察性研究),涉及 21002 名患者(72% 为女性,28% 为男性,平均年龄 45 岁[19-6-64-5])。有关种族的数据报告并不一致。16 532 名患者停用了抗抑郁药,4470 名患者停用了安慰剂。在62个研究组中,停用抗抑郁药后出现至少一种抗抑郁药停药症状的发生率为0-31(95% CI 0-27-0-35),在22个研究组中,停用安慰剂后出现至少一种抗抑郁药停药症状的发生率为0-17(0-14-0-21)。在纳入的 RCT 研究中,抗抑郁剂组与安慰剂组之间的发病率总差异为 0-08 [0-04-0-12]。停用抗抑郁药后出现严重抗抑郁药停药症状的发生率为0-028(0-014-0-057),而停用安慰剂后的发生率为0-006(0-002-0-013)。去文拉法辛、文拉法辛、丙咪嗪和艾司西酞普兰与较高的停药症状频率相关,丙咪嗪、帕罗西汀、去文拉法辛或文拉法辛与较高的症状严重程度相关。结果的异质性很大:考虑到非特异性影响,如安慰剂组所示,抗抑郁药停药症状的发生率约为 15%,每六到七名停药患者中就有一人受到影响。亚组分析和异质性数据表明,诊断、药物或与试验相关的特征无法解释这些因素,这可能表明研究者、患者或两者的主观因素。在解释结果时需要考虑残留或重新出现的精神病理学,但我们的研究结果可以让临床医生和患者了解抗抑郁药停药症状的可能程度,而不会引起不必要的恐慌:无。
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引用次数: 0
Preventing suicide in people who experience incarceration. 预防服刑人员自杀。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-01 Epub Date: 2024-05-29 DOI: 10.1016/S2215-0366(24)00171-8
Stuart A Kinner, Maha Aon, Rohan Borschmann
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引用次数: 0
Finding my people. 找到我的人
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-01 DOI: 10.1016/S2215-0366(24)00178-0
Amy-Edith Barbour
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引用次数: 0
期刊
Lancet Psychiatry
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