Pub Date : 2025-09-16DOI: 10.1016/s2215-0366(25)00206-8
Lauren McPhail, Caroline Smartt, Christine Musyimi, Joel Agorinya, Sewit Timothewos, Fetuma Feyera, Ruth Tsigebrhan, Tigist Eshetu, Eleni Misganaw, Laura Asher, Ursula Read, Victoria Mutiso, David Ndetei, Charlotte Hanlon
Homelessness and severe mental illness are inter-related issues, the co-occurrence of which leads to poor outcomes for affected individuals. Evidence for effective interventions in high-income countries is accruing, but little is known about how to intervene in the diverse sociocultural contexts of low-income and middle-income countries (LMICs). The aim of this systematic review was to synthesise peer-reviewed and grey literature on programmes for people experiencing homelessness and severe mental illness in LMICs. We synthesised effects, programme components, and implementation strategies. We identified 80 sources describing 45 programmes across ten LMICs. Programme components spanned seven domains: service models, basic needs, health care, outreach, empowerment, community level, and macro level. Most programmes were multicomponent and included diverse delivery agents. Evaluation studies (n=21), although few in number and quality, reported clinical improvements; family reintegration ranged from 6% to 69%. Frequently reported implementation strategies included network weaving, educational meetings, and involvement of patients and family members. We identified programmes that show promise and can serve as starting points for local adaptation. This systematic review identifies common domains of programmatic interventions that are important to include in combination for future programme design, while considering local contexts and population-specific needs. Future research should prioritise rigorous evaluations, with particular emphasis on programme effects and cost benefits.
{"title":"Programmes for people who are homeless and have severe mental illness in low-income and middle-income countries: a systematic review","authors":"Lauren McPhail, Caroline Smartt, Christine Musyimi, Joel Agorinya, Sewit Timothewos, Fetuma Feyera, Ruth Tsigebrhan, Tigist Eshetu, Eleni Misganaw, Laura Asher, Ursula Read, Victoria Mutiso, David Ndetei, Charlotte Hanlon","doi":"10.1016/s2215-0366(25)00206-8","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00206-8","url":null,"abstract":"Homelessness and severe mental illness are inter-related issues, the co-occurrence of which leads to poor outcomes for affected individuals. Evidence for effective interventions in high-income countries is accruing, but little is known about how to intervene in the diverse sociocultural contexts of low-income and middle-income countries (LMICs). The aim of this systematic review was to synthesise peer-reviewed and grey literature on programmes for people experiencing homelessness and severe mental illness in LMICs. We synthesised effects, programme components, and implementation strategies. We identified 80 sources describing 45 programmes across ten LMICs. Programme components spanned seven domains: service models, basic needs, health care, outreach, empowerment, community level, and macro level. Most programmes were multicomponent and included diverse delivery agents. Evaluation studies (n=21), although few in number and quality, reported clinical improvements; family reintegration ranged from 6% to 69%. Frequently reported implementation strategies included network weaving, educational meetings, and involvement of patients and family members. We identified programmes that show promise and can serve as starting points for local adaptation. This systematic review identifies common domains of programmatic interventions that are important to include in combination for future programme design, while considering local contexts and population-specific needs. Future research should prioritise rigorous evaluations, with particular emphasis on programme effects and cost benefits.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"35 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072284","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00212-3
Charlotte L Lee, Min Gao, Margaret C Smith, Xue Dong, Felicity Waite, Paul N Aveyard, Carmen Piernas
<h3>Background</h3>Excess weight is common in people with severe mental illness, including schizophrenia spectrum disorders, bipolar disorder, and other non-organic psychotic disorders. Rapid weight gain often follows use of antipsychotics, but long-term weight trajectories are unclear. We aimed to compare 15-year weight trajectories and assess the incidence of weight management advice and referrals among people with and without severe mental illness.<h3>Methods</h3>In this retrospective, matched cohort study, we used the Clinical Practice Research Datalink Aurum to identify people aged 18–65 years registered at 1454 primary care practices in England (UK) between Jan 1, 1998, and Oct 31, 2020. 12 people with lived experience of severe mental illness informed the research objectives and study design. Registered individuals who had been diagnosed with severe mental illness (ICD-10 F20–39) were eligible. Each person with severe mental illness was frequency-matched with up to four people without severe mental illness on age, sex, practice, and calendar year. The first coprimary outcome was change in weight (kg), as per all recorded weight measures in the electronic health record. The second coprimary outcome was the incidence of advice and referral to weight management services. We estimated weight trajectories using hierarchical mixed-effects linear regression models and the incidence of advice and referrals using zero-inflated Poisson regression models.<h3>Findings</h3>We included 113 904 individuals (mean age 39·17 years [SD 12·38]), of whom 51 062 (44·8%) were male and 62 842 (55·2%) were female; 90 620 (79·6%) self-identified as White, 7430 (6·5%) as Black, 12 288 (10·8%) as Asian, 1983 (1·7%) as mixed, and 1583 (1·4%) as other. 90 879 (79·8%) individuals did not have severe mental illness; 23 025 (20·2%) individuals had received a diagnosis of severe mental illness: 11 039 (47·9%) had a schizophrenia spectrum disorder, 11 942 (51·9%) had bipolar disorder, and 44 (0·2%) had other psychoses. Weight in people with severe mental illness increased by 2·10 kg (95% CI 1·98–2·22; p<0·0001) at year 1 and by 5·55 kg (5·24–5·86; p<0·0001) at year 15, compared with 0·58 kg (0·51–0·65; p<0·0001) at year 1 and 1·62 kg (1·42–1·82; p<0·0001) at year 15 in people without severe mental illness. After adjusting for age, sex, race and ethnicity, socioeconomic status, alcohol consumption status, smoking status, and BMI, people with severe mental illness and a BMI of 25 kg/m<sup>2</sup> or higher were 10% more likely to receive weight advice than people without severe mental illness (incidence rate ratio 1·10 [95% CI 1·07–1·13]; 8·51 × 10<sup>−10</sup>). There were no differences in the rates of referral to weight management programmes between people with and without severe mental illness.<h3>Interpretation</h3>People with severe mental illness are more likely to gain weight rapidly after diagnosis than the general population, with effects lasting up to
背景体重过重在严重精神疾病患者中很常见，包括精神分裂症谱系障碍、双相情感障碍和其他非器质性精神障碍。服用抗精神病药物后，体重通常会迅速增加，但长期的体重轨迹尚不清楚。我们的目的是比较15年的体重轨迹，并评估有和没有严重精神疾病的人的体重管理建议和转诊的发生率。方法在这项回顾性、匹配队列研究中，我们使用临床实践研究数据链Aurum来识别1998年1月1日至2020年10月31日期间在英国1454个初级保健诊所登记的18-65岁人群。12名有严重精神疾病生活经历的人告知了研究目标和研究设计。被诊断患有严重精神疾病（ICD-10 F20-39）的登记个体符合条件。每个患有严重精神疾病的人与多达四名没有严重精神疾病的人在年龄、性别、实践和日历年上进行频繁匹配。第一个主要结局是体重（kg）的变化，根据电子健康记录中记录的所有体重测量值。第二个主要结果是体重管理服务的建议和转诊的发生率。我们使用分层混合效应线性回归模型估计体重轨迹，使用零膨胀泊松回归模型估计建议和转诊的发生率。结果纳入113 904例个体（平均年龄39.17岁[SD 12.38]），其中男性51 062例（44.8%），女性62 842例（55.2%）；90620人（79.6%）自认为是白人，7430人（6.5%）自认为是黑人，12288人（10.8%）自认为是亚洲人，1983年（1.7%）自认为是混血儿，1583人（1.4%）自认为是其他。90879人（79.8%）无严重精神疾病；23 025人（20.2%）被诊断患有严重精神疾病：11 039人（47.9%）患有精神分裂症谱系障碍，11 1942人（51.9%）患有双相情感障碍，44人（0.2%）患有其他精神病。严重精神疾病患者的体重在第1年增加了2.10 kg (95% CI 1.98 - 2.22; p< 0.0001)，在第15年增加了5.55 kg (5.24 - 5.86; p< 0.0001)，而非严重精神疾病患者的体重在第1年增加了0.58 kg （0.51 - 0.65; p< 0.0001）和1.62 kg（1.42 - 1·82;p< 0.0001）。在调整了年龄、性别、种族和民族、社会经济地位、饮酒状况、吸烟状况和BMI等因素后，患有严重精神疾病且BMI为25 kg/m2或更高的人比没有严重精神疾病的人接受体重建议的可能性高10%（发病率比为1.10 [95% CI 1.07 - 1.13]; 8.51 × 10−10）。在有和没有严重精神疾病的人之间，转介到体重管理项目的比率没有差异。与一般人群相比，患有严重精神疾病的人在诊断后更有可能迅速增加体重，其影响可持续长达15年。尽管经常建议减肥，但体重增加与转介到体重管理服务的比率并不匹配。早期干预对于减少超重和相关的心脏代谢风险至关重要。
{"title":"Weight trajectories and access to weight management services in individuals with severe mental illness in the UK: a population-based, matched cohort study","authors":"Charlotte L Lee, Min Gao, Margaret C Smith, Xue Dong, Felicity Waite, Paul N Aveyard, Carmen Piernas","doi":"10.1016/s2215-0366(25)00212-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00212-3","url":null,"abstract":"<h3>Background</h3>Excess weight is common in people with severe mental illness, including schizophrenia spectrum disorders, bipolar disorder, and other non-organic psychotic disorders. Rapid weight gain often follows use of antipsychotics, but long-term weight trajectories are unclear. We aimed to compare 15-year weight trajectories and assess the incidence of weight management advice and referrals among people with and without severe mental illness.<h3>Methods</h3>In this retrospective, matched cohort study, we used the Clinical Practice Research Datalink Aurum to identify people aged 18–65 years registered at 1454 primary care practices in England (UK) between Jan 1, 1998, and Oct 31, 2020. 12 people with lived experience of severe mental illness informed the research objectives and study design. Registered individuals who had been diagnosed with severe mental illness (ICD-10 F20–39) were eligible. Each person with severe mental illness was frequency-matched with up to four people without severe mental illness on age, sex, practice, and calendar year. The first coprimary outcome was change in weight (kg), as per all recorded weight measures in the electronic health record. The second coprimary outcome was the incidence of advice and referral to weight management services. We estimated weight trajectories using hierarchical mixed-effects linear regression models and the incidence of advice and referrals using zero-inflated Poisson regression models.<h3>Findings</h3>We included 113 904 individuals (mean age 39·17 years [SD 12·38]), of whom 51 062 (44·8%) were male and 62 842 (55·2%) were female; 90 620 (79·6%) self-identified as White, 7430 (6·5%) as Black, 12 288 (10·8%) as Asian, 1983 (1·7%) as mixed, and 1583 (1·4%) as other. 90 879 (79·8%) individuals did not have severe mental illness; 23 025 (20·2%) individuals had received a diagnosis of severe mental illness: 11 039 (47·9%) had a schizophrenia spectrum disorder, 11 942 (51·9%) had bipolar disorder, and 44 (0·2%) had other psychoses. Weight in people with severe mental illness increased by 2·10 kg (95% CI 1·98–2·22; p<0·0001) at year 1 and by 5·55 kg (5·24–5·86; p<0·0001) at year 15, compared with 0·58 kg (0·51–0·65; p<0·0001) at year 1 and 1·62 kg (1·42–1·82; p<0·0001) at year 15 in people without severe mental illness. After adjusting for age, sex, race and ethnicity, socioeconomic status, alcohol consumption status, smoking status, and BMI, people with severe mental illness and a BMI of 25 kg/m<sup>2</sup> or higher were 10% more likely to receive weight advice than people without severe mental illness (incidence rate ratio 1·10 [95% CI 1·07–1·13]; 8·51 × 10<sup>−10</sup>). There were no differences in the rates of referral to weight management programmes between people with and without severe mental illness.<h3>Interpretation</h3>People with severe mental illness are more likely to gain weight rapidly after diagnosis than the general population, with effects lasting up to ","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"5 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072290","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00267-6
Teng Gao, Meng Jin, Rowalt Alibudbud, Sawitri Assanangkornchai, Yankun Sun, Lin Lu
No Abstract
没有抽象的
{"title":"Etomidate misuse: a digital era threat to youth and a call for anticipatory control","authors":"Teng Gao, Meng Jin, Rowalt Alibudbud, Sawitri Assanangkornchai, Yankun Sun, Lin Lu","doi":"10.1016/s2215-0366(25)00267-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00267-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"28 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072296","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00265-2
Sri Mahavir Agarwal, Nicolette Stogios, Margaret Hahn
No Abstract
没有抽象的
{"title":"Weight management in severe mental illness: bridging the gap between guidelines and primary care","authors":"Sri Mahavir Agarwal, Nicolette Stogios, Margaret Hahn","doi":"10.1016/s2215-0366(25)00265-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00265-2","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"21 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072287","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00264-0
Mark Weiser, Itai Pessach, Amitai Ziv
No Abstract
没有抽象的
{"title":"Running a psychiatric ward in times of war","authors":"Mark Weiser, Itai Pessach, Amitai Ziv","doi":"10.1016/s2215-0366(25)00264-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00264-0","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"29 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072289","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00270-6
Ahmed Alhaj
No Abstract
没有抽象的
{"title":"Psychiatric care in Gaza: prescribing amid systematic health care collapse","authors":"Ahmed Alhaj","doi":"10.1016/s2215-0366(25)00270-6","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00270-6","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"52 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072409","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00279-2
Ole Köhler-Forsberg, Oleguer Plana-Ripoll, Nina Friis Bak Fuglsang
No Abstract
没有抽象的
{"title":"Respiratory diseases in individuals with severe mental illness","authors":"Ole Köhler-Forsberg, Oleguer Plana-Ripoll, Nina Friis Bak Fuglsang","doi":"10.1016/s2215-0366(25)00279-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00279-2","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"40 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072288","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00261-5
Holly Christina Smith, Irene Petersen, Joseph F Hayes, Kelvin P Jordan, Magnus Boman, Sube Banerjee, Kate Walters, Claudia Cooper, Juan Carlos Bazo-Alvarez
Background
In the UK, it is recommended by the National Institute for Health and Care Excellence (NICE) that if antipsychotics are initiated in people living with dementia, treatment should be at the lowest dose for the shortest time possible (1–3 months). In this study, we aimed to investigate how dose and duration of antipsychotic medication adhere to UK clinical guidelines and explore treatment restart details in those who stop treatment.
Methods
We did a retrospective cohort study using longitudinal UK primary care data from the IQVIA Medical Research Database. We included people living with dementia aged 60–85 years who received their first antipsychotic prescription between Jan 1, 2000, and Dec 31, 2023. Individuals with any previous antipsychotic prescriptions in their records more than 1 year before a dementia diagnosis and those who had missing social deprivation information were excluded from the study. Duration of first and subsequent antipsychotic treatment episodes, medication dosage, and treatment discontinuation and reinitiation rates were investigated. Duration and discontinuation were defined by grouping consecutive prescriptions into treatment episodes using the waiting time distribution method (80% inter-arrival density, 59 days). Daily doses were derived from strength and frequency information and categorised as low or moderate or high based on established minimum effective dose equivalences. People with lived experience of dementia care contributed throughout this project, shaping the research question and advising on interpretation and dissemination strategies.
Findings
In our dataset search, we identified 108 910 people with a record indicating dementia at any time. In total, 99 091 cases were excluded (ie, individuals with no antipsychotic prescription between the ages of 60 and 85 years between 2000 and 2023, a previous history of antipsychotics, missing deprivation information, or only one eligible prescription). We included 9819 people living with dementia aged 60–85 years who received their first antipsychotic prescription between 2000 and 2023 in the study. 5310 (54·1%) were female and 4509 (45·9%) were male, with a mean age of 77·1 years (SD 5·6 years), and ethnicity data were not available. The first treatment episode lasted a median of 7 months (IQR 6·6–8·7), exceeding NICE guidelines of 1–3 months and 18·1% [95% CI 17·4–18·9]) were initiated on a prescription above the minimum effective dose (ie, low dose). Of the 1781 participants who started on a moderate or high dose, 519 (29·1%) had a moderate or high dose in all quarters of the first year of treatment. 1 year after treatment initiation, 5136 (78·3%) of 6559 eligible individuals remained on medication (48·9% [95% CI 47·7–50·1] on low dose, 14·8% [13·9–15·6] on moderate or high dose of haloperidol, olanzapine, quetiapine or risperidone; and 14·6% [13·8–15·5] on other antipsychotics). Of the 5547 individuals eligible to restart treatment af
{"title":"Antipsychotic prescriptions in people with dementia in primary care: a cohort study investigating adherence of dose and duration to UK clinical guidelines","authors":"Holly Christina Smith, Irene Petersen, Joseph F Hayes, Kelvin P Jordan, Magnus Boman, Sube Banerjee, Kate Walters, Claudia Cooper, Juan Carlos Bazo-Alvarez","doi":"10.1016/s2215-0366(25)00261-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00261-5","url":null,"abstract":"<h3>Background</h3>In the UK, it is recommended by the National Institute for Health and Care Excellence (NICE) that if antipsychotics are initiated in people living with dementia, treatment should be at the lowest dose for the shortest time possible (1–3 months). In this study, we aimed to investigate how dose and duration of antipsychotic medication adhere to UK clinical guidelines and explore treatment restart details in those who stop treatment.<h3>Methods</h3>We did a retrospective cohort study using longitudinal UK primary care data from the IQVIA Medical Research Database. We included people living with dementia aged 60–85 years who received their first antipsychotic prescription between Jan 1, 2000, and Dec 31, 2023. Individuals with any previous antipsychotic prescriptions in their records more than 1 year before a dementia diagnosis and those who had missing social deprivation information were excluded from the study. Duration of first and subsequent antipsychotic treatment episodes, medication dosage, and treatment discontinuation and reinitiation rates were investigated. Duration and discontinuation were defined by grouping consecutive prescriptions into treatment episodes using the waiting time distribution method (80% inter-arrival density, 59 days). Daily doses were derived from strength and frequency information and categorised as low or moderate or high based on established minimum effective dose equivalences. People with lived experience of dementia care contributed throughout this project, shaping the research question and advising on interpretation and dissemination strategies.<h3>Findings</h3>In our dataset search, we identified 108 910 people with a record indicating dementia at any time. In total, 99 091 cases were excluded (ie, individuals with no antipsychotic prescription between the ages of 60 and 85 years between 2000 and 2023, a previous history of antipsychotics, missing deprivation information, or only one eligible prescription). We included 9819 people living with dementia aged 60–85 years who received their first antipsychotic prescription between 2000 and 2023 in the study. 5310 (54·1%) were female and 4509 (45·9%) were male, with a mean age of 77·1 years (SD 5·6 years), and ethnicity data were not available. The first treatment episode lasted a median of 7 months (IQR 6·6–8·7), exceeding NICE guidelines of 1–3 months and 18·1% [95% CI 17·4–18·9]) were initiated on a prescription above the minimum effective dose (ie, low dose). Of the 1781 participants who started on a moderate or high dose, 519 (29·1%) had a moderate or high dose in all quarters of the first year of treatment. 1 year after treatment initiation, 5136 (78·3%) of 6559 eligible individuals remained on medication (48·9% [95% CI 47·7–50·1] on low dose, 14·8% [13·9–15·6] on moderate or high dose of haloperidol, olanzapine, quetiapine or risperidone; and 14·6% [13·8–15·5] on other antipsychotics). Of the 5547 individuals eligible to restart treatment af","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"71 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072327","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 : 2025-09-16DOI: 10.1016/s2215-0366(25)00262-7
David Laguna-Muñoz, María P Pata, Ana Jiménez-Peinado, María José Jaén-Moreno, Cristina Camacho-Rodríguez, Gloria Isabel del Pozo, Eduard Vieta, Christoph U Correll, Marco Solmi, Javier Caballero-Villarraso, María Isabel Alarcón-Laguna, Fernando Sarramea
<h3>Background</h3>People with severe mental illness have a 10–20 year reduced life-expectancy compared with the general population. Respiratory diseases are a main cause of this premature mortality, but no comprehensive meta-analysis of overall and respiratory cause-specific mortality risk in this population exists. We aimed to evaluate the mortality from specific respiratory diseases for people with pooled severe mental illnesses and specific diagnoses, alongside mortality for specific mental disorders.<h3>Methods</h3>For this large-scale random-effects meta-analysis, we searched PubMed, PsycINFO, Embase, Scopus, African Index Medicus, and LILACS from database inception to April 6, 2025, for prospective or retrospective cohort studies published in English. We included studies reporting on patients with schizophrenia spectrum disorder, bipolar disorder, major depressive disorder or depressive episodes, or mixed severe mental illness (defined as at least two among bipolar, depressive, and schizophrenia spectrum disorders). Publications had to include a control group from the general population and quantified reporting. We excluded cross-sectional studies, reviews, systematic reviews, and meta-analyses; studies that did not have respiratory-related mortality data; studies of clustered mixed groups that did not have at least 70% of the patient sample corresponding to our diagnoses, or studies in which the data were not suitable for meta-analysis. The primary outcome was adjusted risk ratio (RR) of overall respiratory disease-related mortality in people with severe mental illness (both pooled and for the specific severe mental disorders) versus the general population control group. Two authors extracted the data using a predetermined data extraction form. The information extracted included first author, country, setting (inpatient, outpatient, or both), data source, design of the study (prospective or retrospective), number of participants and their demographics (sex and mean age), specific severe mental illness and respiratory disease diagnosis, and the RR mortality of each respiratory disease. We assessed the risk of bias in each study using the Newcastle–Ottawa scale and heterogeneity was assessed with a multilevel random-effects meta regression. Individuals with lived experience of mental illness were not involved in the design, analysis, or dissemination of this study. The study was conducted in accordance with PRISMA and was registered with PROSPERO (CRD42024563552).<h3>Findings</h3>Our search identified 83 studies that met the eligibility criteria. We included 4 837 720 people with pooled severe mental illness (2 383 821 males [49·3%] and 2 453 899 females [50·7%]; mean age 57·7 years [SD 13·5]). Data on ethnicity or race were insufficiently reported to be included in our study. Our control group comprised 785 538 236 individuals from the general population (382 185 432 [48·7%] males and 403 352 804 [51·3%] females). 57 studies included peopl
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