Pub Date : 2025-10-22DOI: 10.1016/s2215-0366(25)00300-1
Richard Braithwaite,Ana Jelovac,Charles H Kellner,Alexander Sartorius,Pascal Sienaert,Declan M McLoughlin
{"title":"Ketamine versus ECT for major depression: flawed evidence base.","authors":"Richard Braithwaite,Ana Jelovac,Charles H Kellner,Alexander Sartorius,Pascal Sienaert,Declan M McLoughlin","doi":"10.1016/s2215-0366(25)00300-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00300-1","url":null,"abstract":"","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"109 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369487","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 : 2025-10-17DOI: 10.1016/s2215-0366(25)00248-2
Samuele Cortese, Miguel Garcia-Argibay, Dominic Oliver, Zheng Chang, Luis C Farhat, Michael H Bloch, Gonzalo Salazar de Pablo, Henrik Larsson, Marco Solmi, Christoph U Correll, Paolo Fusar-Poli
In this Personal View, we address key questions to support evidence-based prevention and management of psychotic symptoms that might occur during ADHD pharmacotherapy. We begin by examining evidence showing a significantly increased occurrence of psychotic disorders in individuals with ADHD, independent of ADHD medications (pooled relative risk, odds ratio, or hazard ratio=4·74, 95% CI 4·11–5·46). We then examine whether ADHD medications play a causal role, noting that current evidence does not support such a causal link, at least for methylphenidate. We explore how vulnerability to psychosis varies across individuals with ADHD. Regarding the different steps involved in prescribing ADHD medications, we discuss the importance of balancing potential risks—such as emergence of psychotic symptoms—against the demonstrated benefits of pharmacological treatment for ADHD. Next, we present strategies for screening individuals for vulnerability to psychosis before initiating ADHD medication. We then offer guidance on the clinical management of psychotic symptoms that might arise during ADHD pharmacotherapy, including considerations of dosage and medication type. Finally, we identify key research priorities in this area. Overall, this paper provides an empirical framework, grounded in evidence and clinical practice, to guide the next steps in the field.
在本个人观点中，我们提出了一些关键问题，以支持以证据为基础的预防和管理ADHD药物治疗期间可能出现的精神病症状。我们首先检查的证据显示，独立于ADHD药物治疗的ADHD患者的精神障碍发生率显著增加（综合相对风险、优势比或风险比= 4.74,95% CI 4.11 - 5.46）。然后我们检查ADHD药物是否起因果作用，注意到目前的证据不支持这种因果关系，至少对于哌醋甲酯。我们探讨了多动症患者对精神病的易感性是如何不同的。关于ADHD药物处方的不同步骤，我们讨论了平衡潜在风险（如精神病症状的出现）与ADHD药物治疗已证实的益处的重要性。接下来，我们提出了在开始ADHD药物治疗之前筛查个体易患精神病的策略。然后，我们为ADHD药物治疗期间可能出现的精神病症状的临床管理提供指导，包括剂量和药物类型的考虑。最后，我们确定了该领域的关键研究重点。总体而言，本文提供了一个实证框架，以证据和临床实践为基础，指导该领域的下一步工作。
{"title":"Psychotic symptoms during pharmacological treatment of ADHD: clinical considerations and research needs","authors":"Samuele Cortese, Miguel Garcia-Argibay, Dominic Oliver, Zheng Chang, Luis C Farhat, Michael H Bloch, Gonzalo Salazar de Pablo, Henrik Larsson, Marco Solmi, Christoph U Correll, Paolo Fusar-Poli","doi":"10.1016/s2215-0366(25)00248-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00248-2","url":null,"abstract":"In this Personal View, we address key questions to support evidence-based prevention and management of psychotic symptoms that might occur during ADHD pharmacotherapy. We begin by examining evidence showing a significantly increased occurrence of psychotic disorders in individuals with ADHD, independent of ADHD medications (pooled relative risk, odds ratio, or hazard ratio=4·74, 95% CI 4·11–5·46). We then examine whether ADHD medications play a causal role, noting that current evidence does not support such a causal link, at least for methylphenidate. We explore how vulnerability to psychosis varies across individuals with ADHD. Regarding the different steps involved in prescribing ADHD medications, we discuss the importance of balancing potential risks—such as emergence of psychotic symptoms—against the demonstrated benefits of pharmacological treatment for ADHD. Next, we present strategies for screening individuals for vulnerability to psychosis before initiating ADHD medication. We then offer guidance on the clinical management of psychotic symptoms that might arise during ADHD pharmacotherapy, including considerations of dosage and medication type. Finally, we identify key research priorities in this area. Overall, this paper provides an empirical framework, grounded in evidence and clinical practice, to guide the next steps in the field.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"45 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314673","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 : 2025-10-17DOI: 10.1016/s2215-0366(25)00308-6
Courtney Worrell, Bernhard T Baune, Francesco Benedetti, Annamaria Cattaneo, Livia De Picker, Jennifer C Felger, Stefan M Gold, Femke Lamers, Marion Leboyer, Giulia Lombardo, Fanni-Laura Mäntylä, Andrew H Miller, Valeria Mondelli, Brenda W J H Penninx, Luca Sforzini, Dan J Stein, Benedetta Vai, Erik Van der Eycken, Anthony Woods, Carmine M Pariante, Joël Zwiep
No Abstract
没有抽象的
{"title":"Anti-inflammatories for depression: challenges and ASPIRations","authors":"Courtney Worrell, Bernhard T Baune, Francesco Benedetti, Annamaria Cattaneo, Livia De Picker, Jennifer C Felger, Stefan M Gold, Femke Lamers, Marion Leboyer, Giulia Lombardo, Fanni-Laura Mäntylä, Andrew H Miller, Valeria Mondelli, Brenda W J H Penninx, Luca Sforzini, Dan J Stein, Benedetta Vai, Erik Van der Eycken, Anthony Woods, Carmine M Pariante, Joël Zwiep","doi":"10.1016/s2215-0366(25)00308-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00308-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"2 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314675","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 : 2025-10-15DOI: 10.1016/s2215-0366(25)00272-x
Emma Johanne Poulsen Siig, Viktoria-Maria Hvidtfelt Lykke, Ana Maria Mantilla Herrera, Terese Sara Høj Jørgensen, Alize J Ferrari, Damian F Santomauro
Background
Somatoform disorders have adverse health impacts but are excluded from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). This study aimed to present a proof of concept for quantifying the global prevalence and health burden of somatoform disorders measured in years of life with disability (YLDs).
Methods
We conducted a systematic review and meta-analysis estimating the global prevalence and burden of somatoform disorders. We searched PsycINFO, Embase, and PubMed for epidemiological surveys of the general population, published between Jan 1, 1980, and Feb 19, 2024, and adhering to definitions from the DSM or the ICD. Meta-regressions pooled prevalence for subtypes of somatoform disorders and their aggregate, while testing sources of variation in the data. Pooled adjusted prevalence estimates for the aggregate of somatoform disorders were combined with GBD disability weights to estimate YLDs. Authors of this paper have lived experience perspectives in mental disorders but individuals diagnosed with somatoform disorders were not consulted for this work. This study is registered with PROSPERO, CRD42024517736.
Findings
We included 41 studies, from 23 countries, mostly covering the GBD high-income super-region. There were 122 153 individuals (mean age 46·3 years, range 11–99 years). The proportion of female participants ranged from 37·5% to 66·4% in studies reporting sex-disaggregated data. Disaggregations by ethnicity were not available. The pooled prevalence of somatoform disorders was 4·6% (95% CI 3·1–7·0). Prevalence among females (7·7% [5·1–11·5]) was significantly higher than among males (2·8% [1·8–4·3], p<0·0001). The prevalence across subtypes of somatoform disorders varied by age and sex depending on the disorder. YLDs were estimated at 662·4 (350·2–974·6) per 100 000 person-years, suggesting somatoform disorders could be the second most burdensome mental disorder globally compared against mental disorders from GBD 2021.
Interpretation
Somatoform disorders are common and disabling disorders that warrant further consideration within future GBD studies, and more broadly within mental health planning and response. More effort is required to accumulate data from low-income and middle-income countries and explore temporal trends in the prevalence of somatoform disorders.
Funding
University of Copenhagen, Queensland Health, and University of Queensland.
{"title":"The prevalence and estimated burden of somatoform disorders: a systematic review and meta-analysis of their epidemiology","authors":"Emma Johanne Poulsen Siig, Viktoria-Maria Hvidtfelt Lykke, Ana Maria Mantilla Herrera, Terese Sara Høj Jørgensen, Alize J Ferrari, Damian F Santomauro","doi":"10.1016/s2215-0366(25)00272-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00272-x","url":null,"abstract":"<h3>Background</h3>Somatoform disorders have adverse health impacts but are excluded from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). This study aimed to present a proof of concept for quantifying the global prevalence and health burden of somatoform disorders measured in years of life with disability (YLDs).<h3>Methods</h3>We conducted a systematic review and meta-analysis estimating the global prevalence and burden of somatoform disorders. We searched PsycINFO, Embase, and PubMed for epidemiological surveys of the general population, published between Jan 1, 1980, and Feb 19, 2024, and adhering to definitions from the DSM or the ICD. Meta-regressions pooled prevalence for subtypes of somatoform disorders and their aggregate, while testing sources of variation in the data. Pooled adjusted prevalence estimates for the aggregate of somatoform disorders were combined with GBD disability weights to estimate YLDs. Authors of this paper have lived experience perspectives in mental disorders but individuals diagnosed with somatoform disorders were not consulted for this work. This study is registered with PROSPERO, CRD42024517736.<h3>Findings</h3>We included 41 studies, from 23 countries, mostly covering the GBD high-income super-region. There were 122 153 individuals (mean age 46·3 years, range 11–99 years). The proportion of female participants ranged from 37·5% to 66·4% in studies reporting sex-disaggregated data. Disaggregations by ethnicity were not available. The pooled prevalence of somatoform disorders was 4·6% (95% CI 3·1–7·0). Prevalence among females (7·7% [5·1–11·5]) was significantly higher than among males (2·8% [1·8–4·3], p<0·0001). The prevalence across subtypes of somatoform disorders varied by age and sex depending on the disorder. YLDs were estimated at 662·4 (350·2–974·6) per 100 000 person-years, suggesting somatoform disorders could be the second most burdensome mental disorder globally compared against mental disorders from GBD 2021.<h3>Interpretation</h3>Somatoform disorders are common and disabling disorders that warrant further consideration within future GBD studies, and more broadly within mental health planning and response. More effort is required to accumulate data from low-income and middle-income countries and explore temporal trends in the prevalence of somatoform disorders.<h3>Funding</h3>University of Copenhagen, Queensland Health, and University of Queensland.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"84 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295133","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 : 2025-10-14DOI: 10.1016/s2215-0366(25)00303-7
Lisa Vitte, Emmanuel Devouche, Gisele Apter
No Abstract
没有抽象的
{"title":"Hyperemesis gravidarum, perinatal depression, and the need for integrated maternal and infant care","authors":"Lisa Vitte, Emmanuel Devouche, Gisele Apter","doi":"10.1016/s2215-0366(25)00303-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00303-7","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"54 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288729","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 : 2025-10-14DOI: 10.1016/s2215-0366(25)00310-4
Jules Morgan
No Abstract
没有抽象的
{"title":"Theresa Miskimen Rivera: taking her seat at the APA with Latina spirit","authors":"Jules Morgan","doi":"10.1016/s2215-0366(25)00310-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00310-4","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"85 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288731","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 : 2025-10-14DOI: 10.1016/s2215-0366(25)00271-8
Eeva Terävä-Utti, Miina Nurmi, Linda Laitinen, Tiia Rissanen, Tarja Järvenpää, Päivi Polo-Kantola
<h3>Background</h3>Hyperemesis gravidarum is a severe form of nausea and vomiting that occurs during pregnancy. The connection between psychiatric morbidity, especially depression, and hyperemesis gravidarum has been debated from contradictory findings. Therefore, we aimed to evaluate the associations between hyperemesis gravidarum and both pre-pregnancy and new-onset post-pregnancy depression.<h3>Methods</h3>We conducted a nationwide register-based controlled study in Finland between Jan 1, 2004, and Dec 31, 2017. Data were collected from 2004 to assess at least 1 year of pre-pregnancy depression as deliveries were assessed from 2005 onward. Data on hyperemesis gravidarum and psychiatric diagnoses were obtained from the Finnish Hospital Discharge Register, and delivery data from the Finnish Medical Birth Register. All women with at least one pregnancy resulting in delivery with livebirth during the study period were included. Abortions (ie, spontaneous and induced), ectopic pregnancies, and stillbirths were excluded from the analyses. Women with hyperemesis gravidarum (ICD-10 diagnosis codes O21, O21.0, O21.1, O21.2, O21.8, and O21.9) in their first pregnancy resulting in delivery from Jan 1, 2005, to Dec 31, 2017, were chosen as cases, and women with no hyperemesis gravidarum as controls. The primary outcome was depression (ICD-10 diagnosis codes F32, F33, and F34.1), retrieved from the registers from Jan 1, 2004, to Dec 31, 2017. Associations between depression and hyperemesis gravidarum were analysed using binary logistic regression, adjusted for age, BMI, socioeconomic status, smoking, and psychiatric diagnoses other than depression. People with related lived experience were involved in the study design.<h3>Findings</h3>A total of 437 465 women had pregnancies resulting in delivery between 2005 and 2017, of whom 130 537 were excluded, 4265 were included in the hyperemesis gravidarum group, and 302 663 in the non-hyperemesis gravidarum group as only women whose first pregnancy resulted in a livebirth were included. 377 (8·8%) of 4265 in the hyperemesis gravidarum group and 2874 (1·0%) of 302 663 in the non-hyperemesis gravidarum group had a pre-pregnancy depression diagnosis. The mean age in the hyperemesis gravidarum group was 26·6 years (SD 5·2, range 15·0–46·0) and in the non-hyperemesis gravidarum group 27·9 years (5·3, 13·0–55·0). Ethnicity data were not available. Women in the hyperemesis gravidarum group were more likely to have been diagnosed with pre-pregnancy depression compared with those in the non-hyperemesis gravidarum group (adjusted odds ratio [AOR] 5·2, 95% CI 4·3–6·3; p<0·0001). 210 (4·9%) women in the hyperemesis gravidarum group and 2901 (1·0%) in the non-hyperemesis gravidarum group had a new-onset depression diagnosis after pregnancy (AOR 3·6, 95% CI 3·0–4·4; p<0·0001). Depression was diagnosed more than a year after delivery in most women (170 [81·0%] in the hyperemesis gravidarum group, 2496 [86·0%] in the non-hy
{"title":"Association between hyperemesis gravidarum and depression: a national register-based controlled study in Finland","authors":"Eeva Terävä-Utti, Miina Nurmi, Linda Laitinen, Tiia Rissanen, Tarja Järvenpää, Päivi Polo-Kantola","doi":"10.1016/s2215-0366(25)00271-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00271-8","url":null,"abstract":"<h3>Background</h3>Hyperemesis gravidarum is a severe form of nausea and vomiting that occurs during pregnancy. The connection between psychiatric morbidity, especially depression, and hyperemesis gravidarum has been debated from contradictory findings. Therefore, we aimed to evaluate the associations between hyperemesis gravidarum and both pre-pregnancy and new-onset post-pregnancy depression.<h3>Methods</h3>We conducted a nationwide register-based controlled study in Finland between Jan 1, 2004, and Dec 31, 2017. Data were collected from 2004 to assess at least 1 year of pre-pregnancy depression as deliveries were assessed from 2005 onward. Data on hyperemesis gravidarum and psychiatric diagnoses were obtained from the Finnish Hospital Discharge Register, and delivery data from the Finnish Medical Birth Register. All women with at least one pregnancy resulting in delivery with livebirth during the study period were included. Abortions (ie, spontaneous and induced), ectopic pregnancies, and stillbirths were excluded from the analyses. Women with hyperemesis gravidarum (ICD-10 diagnosis codes O21, O21.0, O21.1, O21.2, O21.8, and O21.9) in their first pregnancy resulting in delivery from Jan 1, 2005, to Dec 31, 2017, were chosen as cases, and women with no hyperemesis gravidarum as controls. The primary outcome was depression (ICD-10 diagnosis codes F32, F33, and F34.1), retrieved from the registers from Jan 1, 2004, to Dec 31, 2017. Associations between depression and hyperemesis gravidarum were analysed using binary logistic regression, adjusted for age, BMI, socioeconomic status, smoking, and psychiatric diagnoses other than depression. People with related lived experience were involved in the study design.<h3>Findings</h3>A total of 437 465 women had pregnancies resulting in delivery between 2005 and 2017, of whom 130 537 were excluded, 4265 were included in the hyperemesis gravidarum group, and 302 663 in the non-hyperemesis gravidarum group as only women whose first pregnancy resulted in a livebirth were included. 377 (8·8%) of 4265 in the hyperemesis gravidarum group and 2874 (1·0%) of 302 663 in the non-hyperemesis gravidarum group had a pre-pregnancy depression diagnosis. The mean age in the hyperemesis gravidarum group was 26·6 years (SD 5·2, range 15·0–46·0) and in the non-hyperemesis gravidarum group 27·9 years (5·3, 13·0–55·0). Ethnicity data were not available. Women in the hyperemesis gravidarum group were more likely to have been diagnosed with pre-pregnancy depression compared with those in the non-hyperemesis gravidarum group (adjusted odds ratio [AOR] 5·2, 95% CI 4·3–6·3; p<0·0001). 210 (4·9%) women in the hyperemesis gravidarum group and 2901 (1·0%) in the non-hyperemesis gravidarum group had a new-onset depression diagnosis after pregnancy (AOR 3·6, 95% CI 3·0–4·4; p<0·0001). Depression was diagnosed more than a year after delivery in most women (170 [81·0%] in the hyperemesis gravidarum group, 2496 [86·0%] in the non-hy","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"9 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288732","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 : 2025-10-14DOI: 10.1016/s2215-0366(25)00311-6
No Abstract
没有抽象的
{"title":"Lessons from Greek mythology for an AI world","authors":"","doi":"10.1016/s2215-0366(25)00311-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00311-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"61 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288728","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 : 2025-10-09DOI: 10.1016/s2215-0366(25)00244-5
Jasper Feyaerts, Pavan S Brar, Louis Sass, Barnaby Nelson
In the past three decades, psychiatric research has increasingly focused on the early subthreshold stages of psychosis, with the aim of improving the early identification and treatment of individuals at increased risk of psychotic disorder. Yet, despite considerable research effort, current early psychosis research faces several limitations. In this Personal View, we consider how integrating principles and insights from dynamical systems theory and the phenomenological self-disturbance model of schizophrenia can enhance understanding and prediction of psychosis (on both an individual and group level). We argue that this integration allows the specification of causal processes—ie, distinctive alterations of self-awareness and reality-awareness—whose dynamics can be modelled in dynamical systems terms to anticipate future onset and recurrence of psychotic episodes. We consider how insights afforded by this approach could help to improve early personalised and targeted therapeutic intervention. Empirical hypotheses emerging from this model require testing through intensive longitudinal designs and assessment approaches informed by phenomenological research. To conclude, we discuss theoretical and methodological challenges related to the implementation of our proposal.
{"title":"Integrating dynamical systems theory and phenomenology to enhance early identification and treatment of psychotic disorders","authors":"Jasper Feyaerts, Pavan S Brar, Louis Sass, Barnaby Nelson","doi":"10.1016/s2215-0366(25)00244-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00244-5","url":null,"abstract":"In the past three decades, psychiatric research has increasingly focused on the early subthreshold stages of psychosis, with the aim of improving the early identification and treatment of individuals at increased risk of psychotic disorder. Yet, despite considerable research effort, current early psychosis research faces several limitations. In this Personal View, we consider how integrating principles and insights from dynamical systems theory and the phenomenological self-disturbance model of schizophrenia can enhance understanding and prediction of psychosis (on both an individual and group level). We argue that this integration allows the specification of causal processes—ie, distinctive alterations of self-awareness and reality-awareness—whose dynamics can be modelled in dynamical systems terms to anticipate future onset and recurrence of psychotic episodes. We consider how insights afforded by this approach could help to improve early personalised and targeted therapeutic intervention. Empirical hypotheses emerging from this model require testing through intensive longitudinal designs and assessment approaches informed by phenomenological research. To conclude, we discuss theoretical and methodological challenges related to the implementation of our proposal.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"10 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255199","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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