International Review of Psychiatry最新文献

The global increase in number of people living with dementia and its mental health implications is closely linked to the development of Old Age Psychiatry (OAP) in the past 50 years. OAP focuses on addressing the complex psychiatric and physical needs of older adults, particularly those with dementia. Reflecting on the significance of early neuropsychiatric symptoms (NPS) in dementia, recent breakthroughs in early diagnostics and the amyloid targeting therapy (ATT) for Alzheimer's disease, it is time to examine the ongoing challenges and the role of OAP clinicians in managing dementia. The future of collaboration with medical, technological, and social experts presents opportunities for OAP to optimize dementia care beyond medication or social assistance, addressing the needs of people living with and their families along the whole disease spectrum.

The field of psychiatry has experienced an incredible development within the last three decades as it is no longer an institution/medically based profession but rather is more inclusive of community care with emphasis on human rights and cultural sensitivity. Globally, neuroscience, psychopharmacology and psychotherapy developments have increased treatment options, whereas advocacy has reduced stigma and helped in patient autonomy. However, there are still challenges that comprise a widening treatment gap, workforce shortages, and inequities in access, particularly in low- and middle-income countries. In Kenya, psychiatry has transitioned from its historical monopoly by Mathari National Teaching and Referral Hospital to more widespread decentralization, policy reforms and integration into the general health systems. Nonetheless, a paucity of resources, unequal investment across counties, and entrenched stigma continue to hinder progress. The next three decades will require context-specific, culturally based strategies, which take into consideration utilization of digital innovations, integrating mental and physical health care, equity and inclusivity. The future of psychiatry is not only in the scientific breakthroughs but the ability to develop strong structures that address the local realities and at the same time connect with the global innovation.

Addiction remains one of the most complex challenges in psychiatry, marked by conceptual ambiguity and persistent treatment gaps. Advances in neuroscience, genetics, neuroimaging and artificial intelligence have deepened understanding of reward circuitry, vulnerability and relapse trajectories, yet controversies endure regarding whether addiction is best conceived as disease, disordered choice or socially constructed phenomenon. This article aims to synthesize current debates and outline future perspectives in addiction psychiatry through an integrative framework that bridges biological, technological, systemic and humanistic approaches. Findings highlight the promise and limitations of precision psychiatry, pharmacogenetics and neurocircuit-guided interventions, as well as the ethical and equity challenges of AI-based tools and biomarker-driven approaches. Novel consumption forms (dual vaping, synthetic cannabinoids) demand adaptive clinical and regulatory responses. Values-based practice and phenomenological psychiatry emerge as essential for truly person-centered care. The future of addiction psychiatry lies in integrating science, technology, humanism and values to deliver ethically grounded, patient-centered and socially responsive care.

The problem of global inequity in access to health care - including mental health care - remains a persistent challenge worldwide. The disparities are largely the product of social, economic, and political structures. If we are to address health inequity, targeted medical interventions are not sufficient. It calls for a transformation of the systems and policies that shape daily life. Bridging these gaps demands both local leadership and international solidarity. Marginalized groups-whether defined by ethnicity, gender identity, poverty or migratory status-face systemic barriers that demand more than superficial reforms but empowerment and provision of culturally competent care, without institutional biases. We need to integrate equity into all layers of health and social policy. International professional organizations may play an important role but the crucial role of UN agencies needs support and recognition when they bring forward actions like safeguarding the human rights of all marginalized groups regardless of their legal status and strengthening access to mental health care. Marginalized people remain marginalized if governments disregard responsibility and let them stay at the edge of society.

In this century, psychiatry for people with intellectual disability in the United Kingdom has undergone profound shifts, shaped by deinstitutionalization, legislative reform, a focus on psychotropic reduction, an increasing recognition of the premature mortality, and a growing recognition of rights-based, person-centred approaches. Despite progress, entrenched challenges remain, including fragmented services, inconsistent outcome measures, inappropriate psychotropic prescribing, and health inequalities. The coming decades promise transformative opportunities through genomics, digital health, and personalized interventions, through integrated management of co-occurring conditions, but risk deepening inequities if inclusion is not intentional. This paper synthesizes past developments, including the impact of abuse scandals, legal reforms, medication optimization initiatives, recognition of premature mortality, outcome measurement advances, and evolving care models. It explores future trajectories, focusing on genomic medicine, technology, holistic care, and patient and carer co-production, emphasizing the role of shared genetic vulnerabilities and digital phenotyping in early detection and integrated care. By reflecting on past shortcomings and future potential, we propose an agenda that centres rights, equity, and evidence, ensuring that people with intellectual disability are not left behind in the next era of psychiatric innovation and equally that psychiatry remains integral to the welfare of people with intellectual disability.

The past twenty years, British academic psychiatry has made significant scientific advances in neurosciences, psychopharmacology, imaging and genetics with patients increasingly being involved as research partners. However, this progress has coincided with marked structural deterioration. Despite a 50% expansion in medical school places and rising mental health needs, full-time academic psychiatrists numbers fell from 330 in 2004 to 206 in 2023. This reduction has constrained research capacity, limited educational opportunities, and exacerbated regional disparities. The current academic landscape is precarious. While research-active services deliver demonstrably better patient outcomes and service outcomes (productivity/efficiency), the research workforce remains small and unevenly distributed. Recent calls to action have emphasised how academic psychiatry must be seen as 'everyone's business,' and highlighted its role in fostering critical thinking, high-quality teaching, and impactful research. In future, sustained investment in workforce development, diversity, and infrastructure is essential. Emerging technologies including digital health, artificial intelligence and precision psychiatry offer transformative possibilities. Regional, networked and virtual academic units can democratise participation and broaden engagement. Academic psychiatry must adopt an entrepreneurial mindset, collaborating with diverse stakeholders, including the private sector. This specialty is indispensable for innovation, clinician development and evidence-based compassionate care for our patients but needs to justify it.

With increasing use of AI in public life, various technological tools like ChatGPT are being used for psychotherapy. Psychiatrists face unique ethical challenges in understanding their use. Clinicians have an obligation to advise policymakers and to update scope of practice laws related to the mental health workforce and technology. Coordinating therapeutic interventions with patient use of ChatGPT or other applications, the need for data storage, the maintenance of patient confidentiality, and medico-legal responsibilities of clinicians are discussed.

This review traces the evolution of psychiatry in Egypt and the broader Arab region from 1994 to 2024, offering a comprehensive analysis of reforms in mental health policy, clinical infrastructure, education, legislation and workforce development. This paper examines key challenges, including service fragmentation, sociocultural stigma, refugee mental health and underinvestment. It highlights current contradictions in the field, such as increased demand, limited access and the dominance of imported psychiatric models with insufficient cultural adaptation. Looking ahead to 2050, the review identifies emerging threats, including climate-related stressors, ethical dilemmas in digital psychiatry and persistent workforce shortages, while outlining strategic opportunities in research, digital innovation and culturally responsive care. The article calls for reimagining Arab psychiatry grounded in epistemic sovereignty, interdisciplinary collaboration and decolonial ethics. It advocates for the revitalization of indigenous knowledge systems, the expansion of community-based models and the development of care frameworks that are both globally informed and locally rooted. The review concludes with a vision of an Arab mental health renaissance: a future where psychiatry is equitable, context-sensitive and led by regional voices. This paper serves as a resource for clinicians, policymakers and educators committed to transforming mental health across the Arab world.

The last quarter century has seen a clear move internationally towards greater integration between healthcare service types - including across mental and physical health - as well as with social care. The drivers include growing population complexity and clinical need, and a recognition that the broader evidence base supports better outcomes and cost effectiveness through tackling social determinants of health in a more joined-up and preventative manner. Challenges have included a lack of granularity about which approaches work best at a local level, which data might support learning from these, and how we might disseminate this between often very different systems and populations. The next 25 years will see renewed efforts towards greater integrated and preventative community approaches. However, we still lack a consensus about inpatient provision and need to optimise this through clinically led learning and care models. Technology is at a point where we can have digital infrastructure that pulls large-scale population-level clinical effectiveness data. The opportunity is to anchor this as our key tool to grow and refine better care models, augmenting more traditional process and governance data-sets, and therein also leverage research findings into measured novel implementation in practice.

Depressive disorders with onset during adolescence and young adulthood are common, disabling, and often difficult to diagnose due to their heterogeneous and developmentally specific presentation. Compared with adult depression, young people more frequently display irritability, somatic complaints, and behavioural problems, which can obscure recognition and delay treatment. This narrative review aims to synthesize current evidence on depressive disorders in young people, while highlighting implications for treatment and prevention. The keywords ("youth" OR "adolescent" OR "childhood" OR "child" OR "young") AND ("depression" OR "depressive symptoms" OR "mood disorder" OR "depressed mood") were entered in the main databases and combined through Boolean operators. Findings confirm that youth depression presents with distinct clinical features and strong sociocultural influences, is frequently comorbid with other psychiatric disorders, and follows a recurrent and impairing course. Psychotherapy remains the most effective intervention, with selective serotonin reuptake inhibitors indicated for moderate-to-severe cases. Preventive and school-based strategies show promising results but are unevenly implemented. In conclusion, depressive disorders in young people require early detection and developmentally sensitive, multimodal treatment strategies. Future work should prioritize scalable interventions that integrate psychosocial, pharmacological, and digital tools, with special attention to prevention and to the influence of cultural and contextual factors.