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}
Pub Date : 2025-10-07DOI: 10.1016/s2215-0366(25)00263-9
Camilla Rosan, Kim Alyousefi-van Dijk, Victoria Cornelius, Ed Waddingham, Zoe Darwin, Daphne Babalis, Lani Richards, Hannah Hopson, Stephen Pilling, Pasco Fearon, Jessica Deighton, Elena Pizzo, Peter Fonagy
<h3>Background</h3>Perinatal mental health difficulties are common and, if untreated, are associated with long-term adverse child outcomes. Substantial evidence gaps exist in group-based and parent–infant interventions for perinatal mental health difficulties. Circle of Security-Parenting (COS-P) groups have shown preliminary efficacy, although previous studies were methodologically weak or not specific to relevant populations. This study aimed to evaluate whether the hybrid delivery of COS-P plus treatment-as-usual reduces psychopathology in birthing parents accessing National Health Service community perinatal mental health services, compared with treatment-as-usual alone.<h3>Methods</h3>The study was a pragmatic, multicentre, parallel-arm, assessor-masked, randomised controlled trial, with an internal pilot. Participants were recruited from ten geographically spread National Health Service (NHS) Trusts across England, including in Cheshire, Merseyside, North and South Yorkshire, Cumbria, Northamptonshire, Devon, Sussex, and Hampshire. Sites were eligible if they had a specialist community perinatal mental health service and had clinical equipoise to delivering COS-P. Participants were eligible for inclusion if they were aged 18 years or older; receiving care from the participating community perinatal mental health service sites between January, 2021, and October, 2023; had clinical-level psychopathology (average Clinical Outcomes in Routine Evaluation–Outcome Measure [CORE–OM] ≥1·1); bonding difficulties (total Postpartum Bonding Questionnaire ≥12); and were the birthing parent of a child aged younger than 1 year. Participants currently experiencing active psychosis were excluded. Participants were randomly assigned (2:1) to COS-P plus treatment-as-usual or treatment-as-usual alone. Randomisation was stratified by recruitment site and cohort, with random allocation lists generated in advance. Investigators and assessors were masked. COS-P is an attachment-informed parenting group delivered in ten 90-min sessions, predominantly online. The primary outcome was psychopathology, assessed by the average CORE–OM score across all follow-up timepoints of 3 months, 7 months, and 12 months post-baseline. Analyses followed the intention-to-treat principle and sensitivity analyses were done using multiple imputation to account for missing data. People with lived experience were involved in the design, delivery, and dissemination of the trial. This study is registered as an International Standard Randomised Controlled Trial, ISRCTN18308962, and was completed in January, 2025.<h3>Findings</h3>Between Jan 4, 2022, and Oct 26, 2023, 3171 individuals were screened for eligibility, 2785 were ineligible, and 371 were randomly assigned to a group (248 to the COS-P plus treatment-as-usual group and 123 to the treatment-as-usual group. All participants were assigned female at birth and were the birthing parent to the index child. 332 (89%) participants identified a
{"title":"Clinical effectiveness of the Circle of Security-Parenting group intervention for birthing parents in perinatal mental health services in England (COSI): a pragmatic, multicentre, assessor-masked, randomised controlled trial","authors":"Camilla Rosan, Kim Alyousefi-van Dijk, Victoria Cornelius, Ed Waddingham, Zoe Darwin, Daphne Babalis, Lani Richards, Hannah Hopson, Stephen Pilling, Pasco Fearon, Jessica Deighton, Elena Pizzo, Peter Fonagy","doi":"10.1016/s2215-0366(25)00263-9","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00263-9","url":null,"abstract":"<h3>Background</h3>Perinatal mental health difficulties are common and, if untreated, are associated with long-term adverse child outcomes. Substantial evidence gaps exist in group-based and parent–infant interventions for perinatal mental health difficulties. Circle of Security-Parenting (COS-P) groups have shown preliminary efficacy, although previous studies were methodologically weak or not specific to relevant populations. This study aimed to evaluate whether the hybrid delivery of COS-P plus treatment-as-usual reduces psychopathology in birthing parents accessing National Health Service community perinatal mental health services, compared with treatment-as-usual alone.<h3>Methods</h3>The study was a pragmatic, multicentre, parallel-arm, assessor-masked, randomised controlled trial, with an internal pilot. Participants were recruited from ten geographically spread National Health Service (NHS) Trusts across England, including in Cheshire, Merseyside, North and South Yorkshire, Cumbria, Northamptonshire, Devon, Sussex, and Hampshire. Sites were eligible if they had a specialist community perinatal mental health service and had clinical equipoise to delivering COS-P. Participants were eligible for inclusion if they were aged 18 years or older; receiving care from the participating community perinatal mental health service sites between January, 2021, and October, 2023; had clinical-level psychopathology (average Clinical Outcomes in Routine Evaluation–Outcome Measure [CORE–OM] ≥1·1); bonding difficulties (total Postpartum Bonding Questionnaire ≥12); and were the birthing parent of a child aged younger than 1 year. Participants currently experiencing active psychosis were excluded. Participants were randomly assigned (2:1) to COS-P plus treatment-as-usual or treatment-as-usual alone. Randomisation was stratified by recruitment site and cohort, with random allocation lists generated in advance. Investigators and assessors were masked. COS-P is an attachment-informed parenting group delivered in ten 90-min sessions, predominantly online. The primary outcome was psychopathology, assessed by the average CORE–OM score across all follow-up timepoints of 3 months, 7 months, and 12 months post-baseline. Analyses followed the intention-to-treat principle and sensitivity analyses were done using multiple imputation to account for missing data. People with lived experience were involved in the design, delivery, and dissemination of the trial. This study is registered as an International Standard Randomised Controlled Trial, ISRCTN18308962, and was completed in January, 2025.<h3>Findings</h3>Between Jan 4, 2022, and Oct 26, 2023, 3171 individuals were screened for eligibility, 2785 were ineligible, and 371 were randomly assigned to a group (248 to the COS-P plus treatment-as-usual group and 123 to the treatment-as-usual group. All participants were assigned female at birth and were the birthing parent to the index child. 332 (89%) participants identified a","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"108 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241510","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 : 2025-10-07DOI: 10.1016/s2215-0366(25)00301-3
Alain Favina, Dan Lutasingwa, Mark Mohan Kaggwa
No Abstract
没有抽象的
{"title":"Harm reduction among people who inject drugs in Rwanda","authors":"Alain Favina, Dan Lutasingwa, Mark Mohan Kaggwa","doi":"10.1016/s2215-0366(25)00301-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00301-3","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"112 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241511","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 : 2025-10-07DOI: 10.1016/s2215-0366(25)00298-6
Jennifer Theule, Kylee Clayton
No Abstract
没有抽象的
{"title":"COS-P as an adjunct treatment for perinatal mental health difficulties","authors":"Jennifer Theule, Kylee Clayton","doi":"10.1016/s2215-0366(25)00298-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00298-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"30 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241512","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 : 2025-10-01DOI: 10.1016/s2215-0366(25)00306-2
McPhail L, Smartt C, Musyimi C, et al. Programmes for people who are homeless and have severe mental illness in low-income and middle-income countries: a systematic review. Lancet Psychiatry 2025; published online Sept 16. https://doi.org/10.1016/S2215-0366(25)00206-8—In this systematic review, table 1 has been updated to correct programme information. This correction has been made to the online version as of Oct 1, 2025, and will be made to the printed version.
{"title":"Correction to Lancet Psychiatry 2025; published online Sept 16. https://doi.org/10.1016/S2215-0366(25)00206-8","authors":"","doi":"10.1016/s2215-0366(25)00306-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00306-2","url":null,"abstract":"<em>McPhail L, Smartt C, Musyimi C, et al. Programmes for people who are homeless and have severe mental illness in low-income and middle-income countries: a systematic review.</em> Lancet Psychiatry <em>2025; published online Sept 16. https://doi.org/10.1016/S2215-0366(25)00206-8</em>—In this systematic review, table 1 has been updated to correct programme information. This correction has been made to the online version as of Oct 1, 2025, and will be made to the printed version.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"9 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203337","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 : 2025-09-30DOI: 10.1016/s2215-0366(25)00278-0
Rajesh R Tampi
No Abstract
没有抽象的
{"title":"Antipsychotics for older adults with schizophrenia","authors":"Rajesh R Tampi","doi":"10.1016/s2215-0366(25)00278-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00278-0","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194960","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 : 2025-09-30DOI: 10.1016/s2215-0366(25)00268-8
Yue Wei, Vincent K C Yan, David J Castle, Caige Huang, Eunice Kehui Deng, Shek-Ming Leung, Hei Hang Edmund Yiu, Kyung Jin Lee, Simon S Y Lui, Vanessa W S Ng, Joseph F Hayes, Francisco T T Lai, Huali Wang, Eric W C Yan, Esther W Chan
Background
Older individuals (aged ≥65 years) with schizophrenia are at increased risk of treatment non-adherence due to cognitive decline and complex polypharmacy. Use of long-acting injectable (LAI) antipsychotics in this population has not been systematically investigated. We aimed to compare risk of disease relapse, all-cause mortality, and adverse events associated with LAI versus oral antipsychotics among older people with schizophrenia.
Methods
In this population-based within-subject analysis, we used territory-wide electronic health records from the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority. Individuals diagnosed with schizophrenia (ICD-9-CM code 295) in inpatient, outpatient, or emergency department settings between Jan 1, 1993, and Dec 31, 2023, were identified, and people aged 65 years and older who were prescribed LAI or oral antipsychotics between Jan 1, 2004, and Dec 31, 2023, were considered for inclusion. Individuals with incomplete demographic information were excluded. The primary outcome was disease relapse, defined as hospital admission for schizophrenia. The secondary outcomes comprised all-cause mortality and adverse events, including cardiovascular hospital admission, extrapyramidal symptoms, acute liver injury, and acute kidney injury, which were identified using ICD-9-CM codes or laboratory tests. A self-controlled case series study using Poisson regression was conducted to compare the risk of disease relapse and adverse events between the treatment periods of LAI and oral antipsychotics. An individual-stratified Cox regression was performed for all-cause mortality. Time-varying confounders, including age, season, class of antipsychotics, COVID-19 stringency index, and concomitant treatment with antidepressants, benzodiazepines or Z-drugs, mood stabilisers, and antiparkinsonian drugs, were adjusted for. People with lived experience of schizophrenia were not involved in the design or conduct of the study.
Findings
Of 24 985 older individuals with schizophrenia, 4696 (18·8%) were prescribed LAI or oral antipsychotics. 10 655 (42·6%) of 24 985 individuals were male and 14 330 (57·4%) were female. Data on ethnicity were not available. Compared with oral antipsychotics, LAI antipsychotics were associated with statistically significantly lower risk of hospital admission for schizophrenia (incidence rate ratio [IRR] 0·71 [95% CI 0·64–0·78], p<0·0001) and all-cause mortality (hazard ratio [HR] 0·23 [95% CI 0·12–0·44], p<0·0001). No statistically significant difference was found in cardiovascular hospital admissions, acute liver injury, and acute kidney injury. LAI antipsychotics were associated with increased risk of extrapyramidal symptoms (IRR 2·17 [1·24–3·80], p=0·0068), but only with first-generation (2·86 [1·41–5·84], p=0·0038) not second-generation LAI antipsychotics.
Interpretation
In older individuals with schizophrenia, LAI antipsychotics were a
{"title":"Disease relapse, all-cause mortality, and adverse events associated with long-acting injectable antipsychotics versus oral antipsychotics in older people with schizophrenia in Hong Kong: a population-based within-subject analysis","authors":"Yue Wei, Vincent K C Yan, David J Castle, Caige Huang, Eunice Kehui Deng, Shek-Ming Leung, Hei Hang Edmund Yiu, Kyung Jin Lee, Simon S Y Lui, Vanessa W S Ng, Joseph F Hayes, Francisco T T Lai, Huali Wang, Eric W C Yan, Esther W Chan","doi":"10.1016/s2215-0366(25)00268-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00268-8","url":null,"abstract":"<h3>Background</h3>Older individuals (aged ≥65 years) with schizophrenia are at increased risk of treatment non-adherence due to cognitive decline and complex polypharmacy. Use of long-acting injectable (LAI) antipsychotics in this population has not been systematically investigated. We aimed to compare risk of disease relapse, all-cause mortality, and adverse events associated with LAI versus oral antipsychotics among older people with schizophrenia.<h3>Methods</h3>In this population-based within-subject analysis, we used territory-wide electronic health records from the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority. Individuals diagnosed with schizophrenia (ICD-9-CM code 295) in inpatient, outpatient, or emergency department settings between Jan 1, 1993, and Dec 31, 2023, were identified, and people aged 65 years and older who were prescribed LAI or oral antipsychotics between Jan 1, 2004, and Dec 31, 2023, were considered for inclusion. Individuals with incomplete demographic information were excluded. The primary outcome was disease relapse, defined as hospital admission for schizophrenia. The secondary outcomes comprised all-cause mortality and adverse events, including cardiovascular hospital admission, extrapyramidal symptoms, acute liver injury, and acute kidney injury, which were identified using ICD-9-CM codes or laboratory tests. A self-controlled case series study using Poisson regression was conducted to compare the risk of disease relapse and adverse events between the treatment periods of LAI and oral antipsychotics. An individual-stratified Cox regression was performed for all-cause mortality. Time-varying confounders, including age, season, class of antipsychotics, COVID-19 stringency index, and concomitant treatment with antidepressants, benzodiazepines or Z-drugs, mood stabilisers, and antiparkinsonian drugs, were adjusted for. People with lived experience of schizophrenia were not involved in the design or conduct of the study.<h3>Findings</h3>Of 24 985 older individuals with schizophrenia, 4696 (18·8%) were prescribed LAI or oral antipsychotics. 10 655 (42·6%) of 24 985 individuals were male and 14 330 (57·4%) were female. Data on ethnicity were not available. Compared with oral antipsychotics, LAI antipsychotics were associated with statistically significantly lower risk of hospital admission for schizophrenia (incidence rate ratio [IRR] 0·71 [95% CI 0·64–0·78], p<0·0001) and all-cause mortality (hazard ratio [HR] 0·23 [95% CI 0·12–0·44], p<0·0001). No statistically significant difference was found in cardiovascular hospital admissions, acute liver injury, and acute kidney injury. LAI antipsychotics were associated with increased risk of extrapyramidal symptoms (IRR 2·17 [1·24–3·80], p=0·0068), but only with first-generation (2·86 [1·41–5·84], p=0·0038) not second-generation LAI antipsychotics.<h3>Interpretation</h3>In older individuals with schizophrenia, LAI antipsychotics were a","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"99 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145195007","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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