Pub Date : 2024-11-19DOI: 10.1016/s2215-0366(24)00327-4
Fran Baum, Melissa Raven, Jon Jureidini, Matt Fisher, Miriam van den Berg
No Abstract
无摘要
{"title":"Challenges in addressing youth mental health","authors":"Fran Baum, Melissa Raven, Jon Jureidini, Matt Fisher, Miriam van den Berg","doi":"10.1016/s2215-0366(24)00327-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00327-4","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"99 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673000","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 : 2024-11-19DOI: 10.1016/s2215-0366(24)00353-5
Clara S Humpston, Todd S Woodward
No Abstract
无摘要
{"title":"On the perceptual characteristics of auditory verbal hallucinations – Authors' reply","authors":"Clara S Humpston, Todd S Woodward","doi":"10.1016/s2215-0366(24)00353-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00353-5","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"14 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673004","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 : 2024-11-19DOI: 10.1016/s2215-0366(24)00292-x
Priya Venkatesan
No Abstract
无摘要
{"title":"Chyrell D Bellamy: using lived experience to give a voice to others","authors":"Priya Venkatesan","doi":"10.1016/s2215-0366(24)00292-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00292-x","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"179 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673006","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 : 2024-11-19DOI: 10.1016/s2215-0366(24)00364-x
Jane E Gillham, Steven M Brunwasser
No Abstract
无摘要
{"title":"Psychological interventions to prevent depression: a cause for hope","authors":"Jane E Gillham, Steven M Brunwasser","doi":"10.1016/s2215-0366(24)00364-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00364-x","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"112 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672996","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 : 2024-11-19DOI: 10.1016/s2215-0366(24)00324-9
Gisli Gislason, Olafur S Indridason, Engilbert Sigurdsson, Runolfur Palsson
<h3>Background</h3>The association between lithium use and chronic kidney disease, and the effect of comorbidities on this association are poorly understood. Our aim was to examine the risk of developing stage 3 or higher chronic kidney disease among people receiving lithium therapy.<h3>Methods</h3>This was a retrospective, population-based cohort study of all adults (aged ≥18 years) in Iceland treated with lithium for a mood disorder who had two or more serum creatinine measurements available in the years 2008–17, irrespective of duration of lithium therapy, identified from the Prescription Medicines Register of the Directorate of Health, or through blood lithium measurements. The control group comprised all eligible outpatients with mood disorders (ICD-10 codes F30–F39) who had not been prescribed lithium and who had attended the national tertiary referral centre in 2014–16. Individuals with chronic kidney disease (identified by ICD codes or an estimated glomerular filtration rate [eGFR] <60 mL/min per 1·73 m<sup>2</sup>) before Jan 1, 2008, or those with glomerular disease, genetic or congenital kidney disease, or small kidneys diagnosed before or after 2008 were excluded. Chronic kidney disease stages 3 and higher were defined according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, and the eGFR was calculated from serum creatinine; all ICD-10 and ICD-9 diagnosis codes, serum creatinine and blood lithium concentrations, and urine albumin-to-creatinine ratios were obtained from health-care institutions and laboratories. Risk of developing stage 3 or higher chronic kidney disease between Jan 1, 2008, and Dec 31, 2017, was assessed using time-to-event regression analysis, accounting for competing risk of death. People with lived experience were not involved in the design or conduct of this study.<h3>Findings</h3>We identified 4310 individuals (2695 who had received lithium and 1615 control participants), of whom 3198 were included in the study. 2025 (75·1%) individuals in the lithium group (1165 [57·5%] female and 860 [42·5%] male) and 1173 (72·6%) in the control group (737 [62·8%] female and 436 [37·2%] male) were included in the study at end of follow-up. The mean age of the study sample at the end of follow-up was 46·6 years (SD 16·4; range 18·5–98·9). Ethnicity data were not available. In the lithium group, 211 (10·4%) of 2025 individuals developed stage 3 or higher chronic kidney disease, compared with 35 (3·0%) of 1173 individuals in the control group (hazard ratio [HR] 1·90, 95% CI 1·32–2·75 after adjusting for sex, age, and comorbid conditions). Compared with control participants, the risk of stage 3 or higher chronic kidney disease was significantly increased for subgroups with a mean blood lithium concentration of 0·60–0·79 mmol/L (HR 2·93, 95% CI 1·97–4·36) or 0·80–0·99 mmol/L (4·31, 2·66–6·99), but not for the subgroup with a mean blood
{"title":"Risk of chronic kidney disease in individuals on lithium therapy in Iceland: a nationwide retrospective cohort study","authors":"Gisli Gislason, Olafur S Indridason, Engilbert Sigurdsson, Runolfur Palsson","doi":"10.1016/s2215-0366(24)00324-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00324-9","url":null,"abstract":"<h3>Background</h3>The association between lithium use and chronic kidney disease, and the effect of comorbidities on this association are poorly understood. Our aim was to examine the risk of developing stage 3 or higher chronic kidney disease among people receiving lithium therapy.<h3>Methods</h3>This was a retrospective, population-based cohort study of all adults (aged ≥18 years) in Iceland treated with lithium for a mood disorder who had two or more serum creatinine measurements available in the years 2008–17, irrespective of duration of lithium therapy, identified from the Prescription Medicines Register of the Directorate of Health, or through blood lithium measurements. The control group comprised all eligible outpatients with mood disorders (ICD-10 codes F30–F39) who had not been prescribed lithium and who had attended the national tertiary referral centre in 2014–16. Individuals with chronic kidney disease (identified by ICD codes or an estimated glomerular filtration rate [eGFR] <60 mL/min per 1·73 m<sup>2</sup>) before Jan 1, 2008, or those with glomerular disease, genetic or congenital kidney disease, or small kidneys diagnosed before or after 2008 were excluded. Chronic kidney disease stages 3 and higher were defined according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, and the eGFR was calculated from serum creatinine; all ICD-10 and ICD-9 diagnosis codes, serum creatinine and blood lithium concentrations, and urine albumin-to-creatinine ratios were obtained from health-care institutions and laboratories. Risk of developing stage 3 or higher chronic kidney disease between Jan 1, 2008, and Dec 31, 2017, was assessed using time-to-event regression analysis, accounting for competing risk of death. People with lived experience were not involved in the design or conduct of this study.<h3>Findings</h3>We identified 4310 individuals (2695 who had received lithium and 1615 control participants), of whom 3198 were included in the study. 2025 (75·1%) individuals in the lithium group (1165 [57·5%] female and 860 [42·5%] male) and 1173 (72·6%) in the control group (737 [62·8%] female and 436 [37·2%] male) were included in the study at end of follow-up. The mean age of the study sample at the end of follow-up was 46·6 years (SD 16·4; range 18·5–98·9). Ethnicity data were not available. In the lithium group, 211 (10·4%) of 2025 individuals developed stage 3 or higher chronic kidney disease, compared with 35 (3·0%) of 1173 individuals in the control group (hazard ratio [HR] 1·90, 95% CI 1·32–2·75 after adjusting for sex, age, and comorbid conditions). Compared with control participants, the risk of stage 3 or higher chronic kidney disease was significantly increased for subgroups with a mean blood lithium concentration of 0·60–0·79 mmol/L (HR 2·93, 95% CI 1·97–4·36) or 0·80–0·99 mmol/L (4·31, 2·66–6·99), but not for the subgroup with a mean blood","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"99 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673010","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 : 2024-11-17DOI: 10.1016/s2215-0366(24)00375-4
Alessandro Massazza, Naro Alonzo, Jura Augustinavicius, Claudia Selin Batz, Jess Beagley, Luiz Roberto Carvalho, Mercian Daniel, Juliana Fleury, Narmin Guluzade, Zeinab Hijazi, Emma L Lawrance, Omnia el Omrani, Saad Uakkas, Victor Ugo, Harshita Umesh
No Abstract
无摘要
{"title":"Why mental health should be embedded across climate and health discussions at COP29","authors":"Alessandro Massazza, Naro Alonzo, Jura Augustinavicius, Claudia Selin Batz, Jess Beagley, Luiz Roberto Carvalho, Mercian Daniel, Juliana Fleury, Narmin Guluzade, Zeinab Hijazi, Emma L Lawrance, Omnia el Omrani, Saad Uakkas, Victor Ugo, Harshita Umesh","doi":"10.1016/s2215-0366(24)00375-4","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00375-4","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"39 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665417","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 : 2024-11-12DOI: 10.1016/s2215-0366(24)00334-1
Dost Öngür, Martin P Paulus
The understanding and treatment of psychiatric disorders present unique challenges due to these conditions' multifaceted nature, comprising dynamic interactions between biological, psychological, social, and environmental factors. Traditional reductionistic approaches often simplify these conditions into linear cause-and-effect relationships, overlooking the complexity and interconnectedness inherent in psychiatric disorders. Advances in complex systems approaches provide a comprehensive framework to capture and quantify the non-linear and emergent properties of psychiatric disorders. This Personal View emphasises the importance of identifying rules for generative models that govern brain and behaviour over time, which might contribute to personalised assessments and interventions for psychiatric disorders. For instance, mood fluctuations in bipolar disorder can be understood through dynamical systems modelling, which identifies modifiable parameters, such as circadian disruption, that can be addressed through targeted therapies such as light therapy. Similarly, recognition of depression as an emergent property arising from complex interactions highlights the need for integrated treatment strategies that enhance adaptive reactions in the individual. A framework for quantifying multilevel interactions and network dynamics can help researchers and clinicians to understand the interplay between neural circuits, behaviours, and social contexts. Probabilistic models and self-organisation concepts contribute to building concrete dynamical systems models of mental disorders, facilitating early identification of risk states and promoting resilience through adaptive interventions delivered with optimal timing. Embracing these complex systems approaches in psychiatry could capture the true nature of psychiatric disorders as properties of a dynamic complex system and not the manifestation of any lesion or insult. This line of thinking might improve diagnosis and treatment, offering new hope for individuals affected by psychiatric conditions and paving the way for more effective, personalised mental health care.
{"title":"Embracing complexity in psychiatry—from reductionistic to systems approaches","authors":"Dost Öngür, Martin P Paulus","doi":"10.1016/s2215-0366(24)00334-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00334-1","url":null,"abstract":"The understanding and treatment of psychiatric disorders present unique challenges due to these conditions' multifaceted nature, comprising dynamic interactions between biological, psychological, social, and environmental factors. Traditional reductionistic approaches often simplify these conditions into linear cause-and-effect relationships, overlooking the complexity and interconnectedness inherent in psychiatric disorders. Advances in complex systems approaches provide a comprehensive framework to capture and quantify the non-linear and emergent properties of psychiatric disorders. This Personal View emphasises the importance of identifying rules for generative models that govern brain and behaviour over time, which might contribute to personalised assessments and interventions for psychiatric disorders. For instance, mood fluctuations in bipolar disorder can be understood through dynamical systems modelling, which identifies modifiable parameters, such as circadian disruption, that can be addressed through targeted therapies such as light therapy. Similarly, recognition of depression as an emergent property arising from complex interactions highlights the need for integrated treatment strategies that enhance adaptive reactions in the individual. A framework for quantifying multilevel interactions and network dynamics can help researchers and clinicians to understand the interplay between neural circuits, behaviours, and social contexts. Probabilistic models and self-organisation concepts contribute to building concrete dynamical systems models of mental disorders, facilitating early identification of risk states and promoting resilience through adaptive interventions delivered with optimal timing. Embracing these complex systems approaches in psychiatry could capture the true nature of psychiatric disorders as properties of a dynamic complex system and not the manifestation of any lesion or insult. This line of thinking might improve diagnosis and treatment, offering new hope for individuals affected by psychiatric conditions and paving the way for more effective, personalised mental health care.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"41 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601164","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 : 2024-11-12DOI: 10.1016/s2215-0366(24)00314-6
Mikkel Højlund, Ole Köhler-Forsberg, Anton T Gregersen, Christopher Rohde, Angelina I Mellentin, Simon J Anhøj, Adam F Kemp, Nina B Fuglsang, Anne Christine Wiuff, Louise Nissen, Marc A Sørensen, Nanna M Madsen, Christina B Wagner, Armaghan Agharazi, Cecilie Søndergaard, Marie Sandmark, Jana Reinhart, Christoph U Correll
<h3>Background</h3>Antipsychotic polypharmacy remains a clinical reality, despite an increased risk of adverse events and little evidence of additional efficacy compared with antipsychotic monotherapy. In this systematic review and meta-analysis, we aimed to provide a comprehensive assessment of antipsychotic polypharmacy prevalence, trends, and correlates across mental disorders.<h3>Methods</h3>We searched MEDLINE and Embase from Jan 1, 2009 to April 30, 2024, for any original study (observational and interventional) reporting antipsychotic polypharmacy prevalence in populations with mental disorders or use of antipsychotics, regardless of age or diagnosis. Relevant studies before May 1, 2009, were identified from two previous systematic reviews of antipsychotic polypharmacy prevalence. Pooled antipsychotic polypharmacy prevalence was estimated using random-effects meta-analysis. Using subgroup and mixed-effects meta-regression analyses, we sought to identify relevant correlates of antipsychotic polypharmacy. People with lived experience were not involved in the project. This review is registered with PROSPERO (CRD42022329953).<h3>Findings</h3>We analysed 517 studies with 599 individual timepoints reporting on 4 459 149 individuals (mean age 39·5 years [range 6·4–86·3]; data on sex and ethnicity were infrequently reported). Most studies included patients with schizophrenia spectrum disorders (SSDs; k=270, 52%). Overall, 24·8% (95% CI 22·9–26·7) of the populations received antipsychotic polypharmacy, ranging from 33·2% (30·6–36·0) in people with SSDs to 5·2% (4·0–6·8) in people with dementia. Antipsychotic polypharmacy prevalence varied by region from 15·4% (95% CI 12·9–18·2) in North America to 38·6% (27·7–50·6) in Africa. Overall antipsychotic polypharmacy prevalence increased significantly from 1970 to 2023 (β=0·019, 95% CI 0·009–0·029; p=0·0002) and was higher in adults than in children and adolescents (27·4%, 95% CI 25·2–29·8 <em>vs</em> 7·0%, 4·7–10·3; p<0·0001) and among inpatients than among outpatients (31·4%, 27·9–35·2 <em>vs</em> 19·9%, 16·8–23·3; p<0·0001). Compared with antipsychotic monotherapy, antipsychotic polypharmacy was associated with an increased risk of relapse (relative risk [RR] 1·42, 95% CI 1·04–1·93; p=0·028), psychiatric hospitalisation (1·24, 1·12–1·38; p<0·0001), worse global functioning (standardised mean difference [SMD] –0·31, 95% CI –0·44 to –0·19; p<0·0001), and more adverse events, including extrapyramidal symptoms (RR 1·63, 95% CI 1·13–2·36; p=0·0098), dystonia (5·91, 1·20–29·17; p=0·029), anticholinergic use (1·91, 1·55–2·35; p<0·0001), higher side-effect scores (SMD 0·33, 95% CI 0·24–0·42; p<0·0001), longer corrected QT interval (0·24, 0·23–0·26; p<0·0001), and greater all-cause mortality risk (RR 1·19, 95% CI 1·00–1·41; p=0·047).<h3>Interpretation</h3>The prevalence of antipsychotic polypharmacy has increased globally over the past 50 years and is particularly high in patients with SSDs
背景尽管与抗精神病药物单药治疗相比，抗精神病药物多药治疗会增加不良反应的风险，而且几乎没有证据表明其具有额外的疗效，但这仍然是一个临床现实。方法我们检索了 2009 年 1 月 1 日至 2024 年 4 月 30 日期间的 MEDLINE 和 Embase，以查找任何报道精神障碍患者或使用抗精神病药物的人群中抗精神病药物多药滥用流行率的原始研究（观察性和干预性），不论年龄或诊断。2009 年 5 月 1 日之前的相关研究是从之前两篇关于抗精神病药物多药滥用流行率的系统综述中筛选出来的。采用随机效应荟萃分析法估算出抗精神病药物多药合用的总体流行率。通过亚组和混合效应荟萃回归分析，我们试图找出抗精神病药多药滥用的相关因素。有生活经验的人未参与该项目。本综述已在 PROSPERO 注册（CRD42022329953）。研究结果我们分析了 517 项研究，共 599 个时间点，报告了 4 459 149 名患者（平均年龄 39-5 岁 [范围 6-4-86-3]；性别和种族数据很少报告）。大多数研究纳入了精神分裂症谱系障碍患者（SSDs；k=270，52%）。总体而言，24-8%（95% CI 22-9-26-7）的人群接受了抗精神病药物多重治疗，其中精神分裂症患者的比例为33-2%（30-6-36-0），而痴呆症患者的比例为5-2%（4-0-6-8）。不同地区的抗精神病药物综合治疗流行率各不相同，北美为 15-4%（95% CI 12-9-18-2），非洲为 38-6%（27-7-50-6）。从1970年到2023年，抗精神病药的总体使用率显著增加（β=0-019，95% CI 0-009-0-029；p=0-0002），成人高于儿童和青少年（27-4%，95% CI 25-2-29-8 vs 7-0%，4-7-10-3；p<0-0001），住院病人高于门诊病人（31-4%，27-9-35-2 vs 19-9%，16-8-23-3；p<0-0001）。与抗精神病药物单药治疗相比，抗精神病药物多药治疗与复发风险增加（相对风险 [RR] 1-42，95% CI 1-04-1-93；p=0-028）、精神病住院（1-24，1-12-1-38；p<0-0001）、整体功能变差（标准化平均差 [SMD]-0-31，95% CI -0-44至-0-19；p<；0-0001），以及更多的不良事件，包括锥体外系症状（RR 1-63，95% CI 1-13-2-36；p=0-0098）、肌张力障碍（5-91，1-20-29-17；p=0-029）、抗胆碱能药物的使用（1-91，1-55-2-35；p<；0-0001）、更高的副作用评分（SMD 0-33，95% CI 0-24-0-42；p<0-0001）、更长的校正 QT 间期（0-24，0-23-0-26；p<0-0001）和更高的全因死亡风险（RR 1-19，95% CI 1-00-1-41；p=0-047）。释义在过去的50年中，全球范围内抗精神病药物多药合用的流行率有所上升，尤其是在SSD患者中。与单一抗精神病药相比，处方抗精神病药多药与疾病的严重程度和预后较差有关，但并不能解决这些问题。此外，抗精神病药多药治疗与较高的副作用负担有关，包括全因死亡率。
{"title":"Prevalence, correlates, tolerability-related outcomes, and efficacy-related outcomes of antipsychotic polypharmacy: a systematic review and meta-analysis","authors":"Mikkel Højlund, Ole Köhler-Forsberg, Anton T Gregersen, Christopher Rohde, Angelina I Mellentin, Simon J Anhøj, Adam F Kemp, Nina B Fuglsang, Anne Christine Wiuff, Louise Nissen, Marc A Sørensen, Nanna M Madsen, Christina B Wagner, Armaghan Agharazi, Cecilie Søndergaard, Marie Sandmark, Jana Reinhart, Christoph U Correll","doi":"10.1016/s2215-0366(24)00314-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00314-6","url":null,"abstract":"<h3>Background</h3>Antipsychotic polypharmacy remains a clinical reality, despite an increased risk of adverse events and little evidence of additional efficacy compared with antipsychotic monotherapy. In this systematic review and meta-analysis, we aimed to provide a comprehensive assessment of antipsychotic polypharmacy prevalence, trends, and correlates across mental disorders.<h3>Methods</h3>We searched MEDLINE and Embase from Jan 1, 2009 to April 30, 2024, for any original study (observational and interventional) reporting antipsychotic polypharmacy prevalence in populations with mental disorders or use of antipsychotics, regardless of age or diagnosis. Relevant studies before May 1, 2009, were identified from two previous systematic reviews of antipsychotic polypharmacy prevalence. Pooled antipsychotic polypharmacy prevalence was estimated using random-effects meta-analysis. Using subgroup and mixed-effects meta-regression analyses, we sought to identify relevant correlates of antipsychotic polypharmacy. People with lived experience were not involved in the project. This review is registered with PROSPERO (CRD42022329953).<h3>Findings</h3>We analysed 517 studies with 599 individual timepoints reporting on 4 459 149 individuals (mean age 39·5 years [range 6·4–86·3]; data on sex and ethnicity were infrequently reported). Most studies included patients with schizophrenia spectrum disorders (SSDs; k=270, 52%). Overall, 24·8% (95% CI 22·9–26·7) of the populations received antipsychotic polypharmacy, ranging from 33·2% (30·6–36·0) in people with SSDs to 5·2% (4·0–6·8) in people with dementia. Antipsychotic polypharmacy prevalence varied by region from 15·4% (95% CI 12·9–18·2) in North America to 38·6% (27·7–50·6) in Africa. Overall antipsychotic polypharmacy prevalence increased significantly from 1970 to 2023 (β=0·019, 95% CI 0·009–0·029; p=0·0002) and was higher in adults than in children and adolescents (27·4%, 95% CI 25·2–29·8 <em>vs</em> 7·0%, 4·7–10·3; p<0·0001) and among inpatients than among outpatients (31·4%, 27·9–35·2 <em>vs</em> 19·9%, 16·8–23·3; p<0·0001). Compared with antipsychotic monotherapy, antipsychotic polypharmacy was associated with an increased risk of relapse (relative risk [RR] 1·42, 95% CI 1·04–1·93; p=0·028), psychiatric hospitalisation (1·24, 1·12–1·38; p<0·0001), worse global functioning (standardised mean difference [SMD] –0·31, 95% CI –0·44 to –0·19; p<0·0001), and more adverse events, including extrapyramidal symptoms (RR 1·63, 95% CI 1·13–2·36; p=0·0098), dystonia (5·91, 1·20–29·17; p=0·029), anticholinergic use (1·91, 1·55–2·35; p<0·0001), higher side-effect scores (SMD 0·33, 95% CI 0·24–0·42; p<0·0001), longer corrected QT interval (0·24, 0·23–0·26; p<0·0001), and greater all-cause mortality risk (RR 1·19, 95% CI 1·00–1·41; p=0·047).<h3>Interpretation</h3>The prevalence of antipsychotic polypharmacy has increased globally over the past 50 years and is particularly high in patients with SSDs","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"72 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601163","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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