Pub Date : 2026-01-22DOI: 10.1016/j.lanepe.2026.101596
Xingzuo Zhou , Ana Correa , Tom Palmer , Mingze Sun , Elena Pizzo , Pedro Gomes , Jolene Skordis
{"title":"Earned settlement: the value of international health and care workers in the UK","authors":"Xingzuo Zhou , Ana Correa , Tom Palmer , Mingze Sun , Elena Pizzo , Pedro Gomes , Jolene Skordis","doi":"10.1016/j.lanepe.2026.101596","DOIUrl":"10.1016/j.lanepe.2026.101596","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101596"},"PeriodicalIF":13.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21eCollection Date: 2026-02-01DOI: 10.1016/j.lanepe.2025.101556
Xintong Li, Yuchen Guo, Agustina Giuliodori Picco, Anna Palomar-Cros, Antonella Delmestri, Wai Yi Man, Isabella Kaczmarczyk, James T Brash, Katia Verhamme, Mees Mosseveld, Talita Duarte-Salles, Daniel Prieto-Alhambra, Edward Burn
Background: An increase in the use of medications for Attention-Deficit Hyperactivity Disorder (ADHD) has been reported globally. This study aims to estimate the trends of ADHD medications use among children and adults across Europe from 2010 to 2023.
Methods: We conducted a population-level observational study using electronic health records from five European countries: Belgium, Germany, the Netherlands, Spain, and the UK. We estimated the prevalence and incidence of methylphenidate, dexamphetamine, lisdexamfetamine, atomoxetine and guanfacine use among individuals aged 3 years and older. We used the proportion of patients covered to measure treatment adherence. All analyses were reported by country and stratified by age group and sex.
Findings: The prevalence of ADHD medication use increased across all five countries during the study period. Between 2010 and 2023, prevalence rose more than threefold in the UK (from 0.12% to 0.39%) and more than doubled in the Netherlands (from 0.67% to 1.56%). Adult use increased substantially in all countries, particularly among females. In the UK, prevalence among adults aged over 25 increased from 0.01% in 2010 to approximately 0.20% in 2023, representing a more than twenty-fold increase in females and fifteen-fold in males. Although ADHD medication use remained higher among males, the sex gap in treatment narrowed over time and with increasing age. After 1-year of medication initiation, 14.9%, 16.0%, 43.9%, and 30.8% of participants were covered by treatment in Germany, the Netherlands, Spain, and the UK respectively. Among initiators, the prevalence of psychiatric conditions and prior use of psycholeptic medications was higher in females and in older age groups.
Interpretation: Over 14 years, ADHD medication prevalence increased across Europe, with varying incidence trends by country, age, and sex. Understanding the utilisation of ADHD medications can provide useful information in monitoring use, as well as for anticipation and planning to minimise potential shortages.
{"title":"Trends in use of Attention-Deficit Hyperactivity Disorder medications among children and adults in five European countries, 2010 to 2023: a population-based observational study.","authors":"Xintong Li, Yuchen Guo, Agustina Giuliodori Picco, Anna Palomar-Cros, Antonella Delmestri, Wai Yi Man, Isabella Kaczmarczyk, James T Brash, Katia Verhamme, Mees Mosseveld, Talita Duarte-Salles, Daniel Prieto-Alhambra, Edward Burn","doi":"10.1016/j.lanepe.2025.101556","DOIUrl":"https://doi.org/10.1016/j.lanepe.2025.101556","url":null,"abstract":"<p><strong>Background: </strong>An increase in the use of medications for Attention-Deficit Hyperactivity Disorder (ADHD) has been reported globally. This study aims to estimate the trends of ADHD medications use among children and adults across Europe from 2010 to 2023.</p><p><strong>Methods: </strong>We conducted a population-level observational study using electronic health records from five European countries: Belgium, Germany, the Netherlands, Spain, and the UK. We estimated the prevalence and incidence of methylphenidate, dexamphetamine, lisdexamfetamine, atomoxetine and guanfacine use among individuals aged 3 years and older. We used the proportion of patients covered to measure treatment adherence. All analyses were reported by country and stratified by age group and sex.</p><p><strong>Findings: </strong>The prevalence of ADHD medication use increased across all five countries during the study period. Between 2010 and 2023, prevalence rose more than threefold in the UK (from 0.12% to 0.39%) and more than doubled in the Netherlands (from 0.67% to 1.56%). Adult use increased substantially in all countries, particularly among females. In the UK, prevalence among adults aged over 25 increased from 0.01% in 2010 to approximately 0.20% in 2023, representing a more than twenty-fold increase in females and fifteen-fold in males. Although ADHD medication use remained higher among males, the sex gap in treatment narrowed over time and with increasing age. After 1-year of medication initiation, 14.9%, 16.0%, 43.9%, and 30.8% of participants were covered by treatment in Germany, the Netherlands, Spain, and the UK respectively. Among initiators, the prevalence of psychiatric conditions and prior use of psycholeptic medications was higher in females and in older age groups.</p><p><strong>Interpretation: </strong>Over 14 years, ADHD medication prevalence increased across Europe, with varying incidence trends by country, age, and sex. Understanding the utilisation of ADHD medications can provide useful information in monitoring use, as well as for anticipation and planning to minimise potential shortages.</p><p><strong>Funding: </strong>European Medicines Agency.</p>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"101556"},"PeriodicalIF":13.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12882648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.lanepe.2025.101587
Mathias Luderer , Dorothea Stockreiter , Annette Binder , Laura Müller , Franca Burger , Nathalie Stüben , Andreas Reif
Background
Stigmatization of individuals with substance use disorders (SUDs) by healthcare professionals (HCPs) is a recognized problem, but its direct impact on patient treatment choices has not been systematically quantified. We aimed to provide first robust, quantitative metrics of non-disclosure, treatment avoidance, and treatment discontinuation for any medical treatment directly attributable to HCP stigma and to explore the lived experiences underpinning these behaviors.
Methods
We conducted a prospective mixed-methods study with 119 adult inpatients with SUDs at a German university hospital (2021–2024). A self-developed questionnaire assessed stigma-related behaviors and their association with self-stigmatization. Qualitative data were analyzed using reflexive thematic analysis (RTA). A person with lived experiences contributed to writing up the manuscript.
Findings
49.6% (95% CI 40.3–58.9; n = 59/119) reported non-disclosure of substance use, 36.1% (95% CI 27.5–45.5; n = 43/119) avoided necessary medical treatment, and 29.4% (95% CI 21.4–38.5; n = 35/119) discontinued treatment due to stigma. Internalized stigma significantly predicted all three outcomes (aORs 1.055–1.075, p ≤ .001). RTA identified “Institutional Stigma” (addiction as a “moral failing”), “Barriers to Care” (obstacles to respectful treatment), and “Cost of Disclosure” (negative consequences such as hostility after revealing substance use).
Interpretation
Stigma from HCPs is a quantifiable contributor of treatment disengagement, representing a direct threat to patient safety and a major contributor to the SUD treatment gap. These findings underscore the urgent need for evidence-based interventions, including training HCPs across all specialties in non-stigmatizing communication, to improve healthcare engagement for this vulnerable population and narrow the substantial treatment gap.
Funding
None.
卫生保健专业人员（HCPs）对物质使用障碍（sud）患者的污名化是一个公认的问题，但其对患者治疗选择的直接影响尚未系统量化。我们的目的是为直接归因于HCP病耻感的任何药物治疗提供第一个可靠的、定量的不披露、治疗回避和治疗停止指标，并探索支撑这些行为的生活经历。方法对德国某大学医院（2021-2024）的119例成年sud住院患者进行了一项前瞻性混合方法研究。一份自我开发的问卷评估了耻感相关行为及其与自我耻感的关系。定性数据采用反身主题分析（RTA）进行分析。研究结果：49.6% （95% CI 40.3-58.9; n = 59/119）报告未披露药物使用情况，36.1% （95% CI 27.5-45.5; n = 43/119）避免必要的药物治疗，29.4% （95% CI 21.4-38.5; n = 35/119）因耻辱感而停止治疗。内化污名显著预测了这三个结果（aORs为1.055 ~ 1.075,p≤0.001）。RTA确定了“制度耻辱”（成瘾是一种“道德失败”），“护理障碍”（尊重治疗的障碍）和“披露成本”（披露药物使用后的负面后果，如敌意）。来自医护人员的耻辱感是导致脱离治疗的可量化因素，是对患者安全的直接威胁，也是造成SUD治疗缺口的主要因素。这些发现强调了对循证干预措施的迫切需要，包括对所有专业的医护人员进行非污名化沟通培训，以提高弱势群体的医疗保健参与度，缩小实质性的治疗差距。
{"title":"Stigma from healthcare professionals and care-limiting behaviors in individuals with substance use disorders: a mixed-methods study","authors":"Mathias Luderer , Dorothea Stockreiter , Annette Binder , Laura Müller , Franca Burger , Nathalie Stüben , Andreas Reif","doi":"10.1016/j.lanepe.2025.101587","DOIUrl":"10.1016/j.lanepe.2025.101587","url":null,"abstract":"<div><h3>Background</h3><div>Stigmatization of individuals with substance use disorders (SUDs) by healthcare professionals (HCPs) is a recognized problem, but its direct impact on patient treatment choices has not been systematically quantified. We aimed to provide first robust, quantitative metrics of non-disclosure, treatment avoidance, and treatment discontinuation for any medical treatment directly attributable to HCP stigma and to explore the lived experiences underpinning these behaviors.</div></div><div><h3>Methods</h3><div>We conducted a prospective mixed-methods study with 119 adult inpatients with SUDs at a German university hospital (2021–2024). A self-developed questionnaire assessed stigma-related behaviors and their association with self-stigmatization. Qualitative data were analyzed using reflexive thematic analysis (RTA). A person with lived experiences contributed to writing up the manuscript.</div></div><div><h3>Findings</h3><div>49.6% (95% CI 40.3–58.9; n = 59/119) reported non-disclosure of substance use, 36.1% (95% CI 27.5–45.5; n = 43/119) avoided necessary medical treatment, and 29.4% (95% CI 21.4–38.5; n = 35/119) discontinued treatment due to stigma. Internalized stigma significantly predicted all three outcomes (aORs 1.055–1.075, p ≤ .001). RTA identified “Institutional Stigma” (addiction as a “moral failing”), “Barriers to Care” (obstacles to respectful treatment), and “Cost of Disclosure” (negative consequences such as hostility after revealing substance use).</div></div><div><h3>Interpretation</h3><div>Stigma from HCPs is a quantifiable contributor of treatment disengagement, representing a direct threat to patient safety and a major contributor to the SUD treatment gap. These findings underscore the urgent need for evidence-based interventions, including training HCPs across all specialties in non-stigmatizing communication, to improve healthcare engagement for this vulnerable population and narrow the substantial treatment gap.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101587"},"PeriodicalIF":13.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.lanepe.2025.101584
Daniele De Luca , Luca Bonadies , Costanza Neri , Barbara Loi , Teresa Maria Silva-Garcia , Guillermo Ramos Noguera , Laura Vivalda , Giulia Res , Maria de las Nieves Cidoncha-Fuertes , Carlos Baena-Palomino , Lorenzo Zanetto , Luca Vedovelli , Dario Gregori , Eugenio Baraldi , Almudena Alonso-Ojembarrena
Background
We lack data about the early evolution of lung pathophysiology in infants developing moderate-to-severe broncho-pulmonary dysplasia (msBPD). We aimed to describe lung aeration and gas exchange during the early phase of msBPD development and identify the critical moments at which they change.
Methods
Prospective, multicentre, cohort study performed in three European centres enrolling preterm (≤30 weeks’ gestation) infants evaluated at 10, 21, 28 days (D) of life and 34 and 36 weeks (W) post-menstrual age, while receiving as little invasive ventilation as possible. Lung aeration was assessed with quantitative lung ultrasound. Pulse oximetry and transcutaneous blood gas measurements were used to calculate the SpO2/FiO2 and PtcO2/FiO2 ratios. msBPD was defined using NIH-2001, NICHD-2018 and Jensen definitions.
Findings
347 infants were studied, of which 80, 79 and 89 had msBPD, using the three definitions, respectively. Lung aeration and oxygenation were always poorer, since D10, in patients with msBPD than in those without it. The difference in lung aeration (β ranging from +0.009 (95% CI: 0; 0.01) to +0.012 (95% CI: 0.01; 0.02), depending on the used definition, p < 0.001) and carbon dioxide (β ranging from +0.01 (95% CI: 0; 0.02) to +0.014 (95% CI: 0.01; 0.02), depending on the used definition, p < 0.001) between patients with and without msBPD increased overtime. Results were similar regardless of the BPD definition. The strongest discrimination was obtained by the lung aeration evolution (β(t) = 0.227 (95% CI: 0.152, 0.302), p < 0.001) with a peak at 26 days.
Interpretation
Patients who develop msBPD consistently demonstrate early and typical pathophysiological phenotypes regardless of the BPD definition. These data highlight critical moments in the development of msBPD and are not captured by currently available BPD definitions.
Funding
Only institutional funding to support the author's working time was used.
{"title":"Lung aeration and gas exchange in preterm infants developing moderate-to-severe bronchopulmonary dysplasia: a multicentre prospective study from the PATH-BPD cohort","authors":"Daniele De Luca , Luca Bonadies , Costanza Neri , Barbara Loi , Teresa Maria Silva-Garcia , Guillermo Ramos Noguera , Laura Vivalda , Giulia Res , Maria de las Nieves Cidoncha-Fuertes , Carlos Baena-Palomino , Lorenzo Zanetto , Luca Vedovelli , Dario Gregori , Eugenio Baraldi , Almudena Alonso-Ojembarrena","doi":"10.1016/j.lanepe.2025.101584","DOIUrl":"10.1016/j.lanepe.2025.101584","url":null,"abstract":"<div><h3>Background</h3><div>We lack data about the early evolution of lung pathophysiology in infants developing moderate-to-severe broncho-pulmonary dysplasia (msBPD). We aimed to describe lung aeration and gas exchange during the early phase of msBPD development and identify the critical moments at which they change.</div></div><div><h3>Methods</h3><div>Prospective, multicentre, cohort study performed in three European centres enrolling preterm (≤30 weeks’ gestation) infants evaluated at 10, 21, 28 days (D) of life and 34 and 36 weeks (W) post-menstrual age, while receiving as little invasive ventilation as possible. Lung aeration was assessed with quantitative lung ultrasound. Pulse oximetry and transcutaneous blood gas measurements were used to calculate the SpO<sub>2</sub>/FiO<sub>2</sub> and PtcO<sub>2</sub>/FiO<sub>2</sub> ratios. msBPD was defined using NIH-2001, NICHD-2018 and Jensen definitions.</div></div><div><h3>Findings</h3><div>347 infants were studied, of which 80, 79 and 89 had msBPD, using the three definitions, respectively. Lung aeration and oxygenation were always poorer, since D10, in patients with msBPD than in those without it. The difference in lung aeration (β ranging from +0.009 (95% CI: 0; 0.01) to +0.012 (95% CI: 0.01; 0.02), depending on the used definition, <em>p</em> < 0.001) and carbon dioxide (β ranging from +0.01 (95% CI: 0; 0.02) to +0.014 (95% CI: 0.01; 0.02), depending on the used definition, <em>p</em> < 0.001) between patients with and without msBPD increased overtime. Results were similar regardless of the BPD definition. The strongest discrimination was obtained by the lung aeration evolution (β(t) = 0.227 (95% CI: 0.152, 0.302), <em>p</em> < 0.001) with a peak at 26 days.</div></div><div><h3>Interpretation</h3><div>Patients who develop msBPD consistently demonstrate early and typical pathophysiological phenotypes regardless of the BPD definition. These data highlight critical moments in the development of msBPD and are not captured by currently available BPD definitions.</div></div><div><h3>Funding</h3><div>Only institutional funding to support the author's working time was used.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101584"},"PeriodicalIF":13.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.lanepe.2025.101580
Lotte Werner , Vita W. Jongen , Sylvia M. Bruisten , Maarten F. Schim van der Loeff , Elske Hoornenborg , Henry J.C. de Vries , Janneke C.M. Heijne
{"title":"Prioritising meaningful outcomes in the practice evaluation of new chlamydia testing guidelines—Authors’ reply","authors":"Lotte Werner , Vita W. Jongen , Sylvia M. Bruisten , Maarten F. Schim van der Loeff , Elske Hoornenborg , Henry J.C. de Vries , Janneke C.M. Heijne","doi":"10.1016/j.lanepe.2025.101580","DOIUrl":"10.1016/j.lanepe.2025.101580","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101580"},"PeriodicalIF":13.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.lanepe.2025.101581
Rosalie Lear, Shiranee Sriskandan, Tom Parks
{"title":"Viral infections and invasive group a streptococcal disease incidence during 2022–2023","authors":"Rosalie Lear, Shiranee Sriskandan, Tom Parks","doi":"10.1016/j.lanepe.2025.101581","DOIUrl":"10.1016/j.lanepe.2025.101581","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101581"},"PeriodicalIF":13.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.lanepe.2025.101579
Zoïe W. Alexiou , Nicole H.T.M. Dukers-Muijrers
{"title":"Prioritising meaningful outcomes in the practice evaluation of new chlamydia testing guidelines","authors":"Zoïe W. Alexiou , Nicole H.T.M. Dukers-Muijrers","doi":"10.1016/j.lanepe.2025.101579","DOIUrl":"10.1016/j.lanepe.2025.101579","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101579"},"PeriodicalIF":13.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.lanepe.2025.101569
Walter Pirker , Joaquim J. Ferreira , Olivier Rascol , Werner Poewe
Hallucinations and delusions are among the most disabling long-term complications of Parkinson's disease (PD). Their pathogenesis is based on a complex interaction of neurodegeneration in critical areas for visual and cognitive processing and PD medication effects. Management rests on the identification and treatment of acute triggers, simplification of PD medication and treatment with antipsychotics. Despite the high prevalence of psychosis in advanced PD there is still a lack of familiarity with its manifestations and therapeutic approaches. This gap is further enhanced by recent developments in drug availability and therapeutic monitoring. Pimavanserin is the only approved drug for the treatment of PD psychosis in the U.S., but currently not marketed elsewhere. The aim of this review is to provide an update on the management options for PD psychosis in other regions of the world with a focus on clinical practice in Europe. Quetiapine and clozapine remain cornerstones of treatment of PD psychosis in Europe. Despite limited evidence for efficacy, quetiapine is often used as first-line therapy, whereas severe PD psychosis usually requires treatment with clozapine, with clozapine demonstrating efficacy without worsening of motor symptoms in randomised, controlled trials. Other antipsychotics should be avoided in PD psychosis due to their ineffectiveness or high potential for worsening parkinsonian motor symptoms. Novel drugs with a better risk-benefit ratio in the treatment of PD psychosis are needed. Non-pharmacological treatments should be explored in relation to their potential to prevent or mitigate psychotic reactions in prospective studies.
{"title":"Management of Parkinson's disease psychosis—a European perspective","authors":"Walter Pirker , Joaquim J. Ferreira , Olivier Rascol , Werner Poewe","doi":"10.1016/j.lanepe.2025.101569","DOIUrl":"10.1016/j.lanepe.2025.101569","url":null,"abstract":"<div><div>Hallucinations and delusions are among the most disabling long-term complications of Parkinson's disease (PD). Their pathogenesis is based on a complex interaction of neurodegeneration in critical areas for visual and cognitive processing and PD medication effects. Management rests on the identification and treatment of acute triggers, simplification of PD medication and treatment with antipsychotics. Despite the high prevalence of psychosis in advanced PD there is still a lack of familiarity with its manifestations and therapeutic approaches. This gap is further enhanced by recent developments in drug availability and therapeutic monitoring. Pimavanserin is the only approved drug for the treatment of PD psychosis in the U.S., but currently not marketed elsewhere. The aim of this review is to provide an update on the management options for PD psychosis in other regions of the world with a focus on clinical practice in Europe. Quetiapine and clozapine remain cornerstones of treatment of PD psychosis in Europe. Despite limited evidence for efficacy, quetiapine is often used as first-line therapy, whereas severe PD psychosis usually requires treatment with clozapine, with clozapine demonstrating efficacy without worsening of motor symptoms in randomised, controlled trials. Other antipsychotics should be avoided in PD psychosis due to their ineffectiveness or high potential for worsening parkinsonian motor symptoms. Novel drugs with a better risk-benefit ratio in the treatment of PD psychosis are needed. Non-pharmacological treatments should be explored in relation to their potential to prevent or mitigate psychotic reactions in prospective studies.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101569"},"PeriodicalIF":13.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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