Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

Molecular Psychiatry, Journal Year: 2021, Volume and Issue: 27(1), P. 281 - 295

Published: June 2, 2021

Promotion of good mental health, prevention, and early intervention before/at the onset disorders improve outcomes. However, range peak ages at for are not fully established. To provide robust, global epidemiological estimates age disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis birth cohort/cross-sectional/cohort studies, representative general population, reporting any ICD/DSM-mental identified in PubMed/Web Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were proportion individuals before 14, 18, 25, onset, disorder across International Classification Diseases 11 diagnostic blocks. Median specific was additionally investigated. Across 192 studies (n = 708,561) included, 25 34.6%, 48.4%, 62.5%, 14.5 years (k median interquartile (IQR) 11-34). For blocks, as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 21, median=12, IQR 7-16), anxiety/fear-related 38.1%, 51.8%, 73.3%, 73, 17, 9-25), obsessive-compulsive/related 24.6%, 45.1%, 64.0%, 20, 19, 14-29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 11, 15-23), conditions specifically associated stress 16.9%, 27.6%, 43.1%, 16, 30, 17-48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 58, 20-41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 36, 20-34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 6, 20-33), mood 2.5%, 11.5%, 34.5%, 79, 31, 21-46). No significant difference emerged by sex, or definition onset. mapped on time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis (17-22 years), followed schizophrenia, personality, panic alcohol (25-27 finally post-traumatic/depressive/generalized anxiety/bipolar/acute transient (30-35 overlap among groups no clustering. These results inform timing health promotion/preventive/early intervention, updating current system structured around child/adult service schism 18.

Language: Английский

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Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment

Molecular Psychiatry, Journal Year: 2023, Volume and Issue: 28(5), P. 1902 - 1918

Published: Jan. 23, 2023

Abstract Cognitive deficits are a core feature of schizophrenia, account for much the impaired functioning associated with disorder and not responsive to existing treatments. In this review, we first describe clinical presentation natural history these deficits. We then consider aetiological factors, highlighting how range similar genetic environmental factors both cognitive function schizophrenia. review pathophysiological mechanisms thought underlie symptoms, including role dopamine, cholinergic signalling balance between GABAergic interneurons glutamatergic pyramidal cells. Finally, management impairments candidate novel

Language: Английский

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Neurocognitive Functioning in Individuals at Clinical High Risk for Psychosis

JAMA Psychiatry, Journal Year: 2021, Volume and Issue: 78(8), P. 859 - 859

Published: June 16, 2021

Importance

Neurocognitive functioning is a potential biomarker to advance detection, prognosis, and preventive care for individuals at clinical high risk psychosis (CHR-P). The current consistency magnitude of neurocognitive in CHR-P are undetermined.

Objective

To provide an updated synthesis evidence on the CHR-P.

Data Sources

Web Science database, Cochrane Central Register Reviews, Ovid/PsycINFO trial registries up July 1, 2020.

Study Selection

Multistep literature search compliant with Preferred Reporting Items Systematic Reviews Meta-analyses Meta-analysis Observational Studies Epidemiology performed by independent researchers identify original studies reporting Extraction Synthesis Independent extracted data, clustering tasks according 7 Measurement Treatment Research Improve Cognition Schizophrenia (MATRICS) domains 8 domains. Random-effect model meta-analyses, assessment publication biases study quality, meta-regressions were conducted.

Main Outcomes Measures

primary effect size measure was Hedgesgof (1) compared healthy control (HC) or (2) first-episode (FEP) (3) stratified longitudinal transition psychosis.

Results

A total 78 included, consisting 5162 (mean [SD; range] age, 20.2 [3.3; 12.0-29.0] years; 2529 [49.0%] female), 2865 HC 21.1 [3.6; 12.6-29.2] 1490 [52.0%] 486 FEP 23.0 [2.0; 19.1-26.4] 267 [55.9%] female). Compared individuals, showed medium large deficits Stroop color word reading task (g = −1.17; 95% CI, −1.86 −0.48), Hopkins Verbal Learning Test–Revised −0.86; −1.43 −0.28), digit symbol coding test −0.74; −1.19 −0.29), Brief Assessment Scale Symbol Coding −0.67; −0.95 −0.39), University Pennsylvania Smell Identification Test −0.55; −0.97 −0.12), Hinting Task −0.53; −0.77 Rey Auditory −0.50; −0.78 −0.21), California (CVLT) −0.64 −0.36), National Adult Reading −0.52; −1.01 −0.03). Individuals less impaired than FEP. Longitudinal from state associated CVLT −0.58; −1.12 −0.05). Meta-regressions found significant effects age education processing speed.

Conclusions Relevance

Findings this meta-analysis support dysfunction as detection prognostic These findings may research inform approaches.

Language: Английский

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The lived experience of psychosis: a bottom‐up review co‐written by experts by experience and academics

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(2), P. 168 - 188

Published: May 7, 2022

Psychosis is the most ineffable experience of mental disorder. We provide here first co-written bottom-up review lived psychosis, whereby experts by primarily selected subjective themes, that were subsequently enriched phenomenologically-informed perspectives. First-person accounts within and outside medical field screened discussed in collaborative workshops involving numerous individuals with psychosis as well family members carers, representing a global network organizations. The material was complemented semantic analyses shared across all collaborators cloud-based system. early phases (i.e., premorbid prodromal stages) found to be characterized core existential themes including loss common sense, perplexity lack immersion world compromised vital contact reality, heightened salience feeling something important about happen, perturbation sense self, need hide tumultuous inner experiences. episode stage denoted some transitory relief associated onset delusions, intense self-referentiality permeated self-world boundaries, internal noise, dissolution self social withdrawal. Core experiences later stages relapsing chronic) involved grieving personal losses, split, struggling accept constant chaos, new diagnosis an uncertain future. receiving psychiatric treatments, such inpatient outpatient care, interventions, psychological treatments medications, included both positive negative aspects, determined hope achieving recovery, understood enduring journey reconstructing personhood re-establishing lost bonds others towards meaningful goals. These findings can inform clinical practice, research education. one painful upsetting experiences, so dizzyingly alien our usual patterns life unspeakably enigmatic human.

Language: Английский

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Towards a youth mental health paradigm: a perspective and roadmap

Molecular Psychiatry, Journal Year: 2023, Volume and Issue: 28(8), P. 3171 - 3181

Published: Aug. 1, 2023

Abstract Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance this period for pathogenesis, diagnosis, treatment ill-health. This perspective addresses interactions risk protective factors brain development as key pillars accounting emergence psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis interventions are required reflect evolution emerging psychopathology, service models, knowledge exchange science practitioners. Taken together, transformative intervention paradigm research clinical care could significantly enhance health young people initiate shift prevention severe disorders.

Language: Английский

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Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction

World Psychiatry, Journal Year: 2023, Volume and Issue: 22(1), P. 86 - 104

Published: Jan. 14, 2023

Empirical evidence indicates a significant bidirectional association between mental disorders and physical diseases, but the prospective impact of men­tal on clinical outcomes diseases has not been comprehensively outlined. In this PRISMA‐ COSMOS‐E‐compliant umbrella review, we searched PubMed, PsycINFO, Embase, Joanna Briggs Institute Database Systematic Reviews Implementation Reports, up to March 15, 2022, identify systematic reviews with meta‐analysis that examined any disorder diseases. Primary were disease‐specific mortality all‐cause mortality. Secondary incidence, functioning and/or disability, symptom severity, quality life, recurrence or progression, major cardiac events, treatment‐related outcomes. Additional inclusion criteria further applied primary studies. Random effect models employed, along I 2 statistic, 95% prediction intervals, small‐study effects test, excess significance bias risk (ROBIS) assessment. Associations classified into five credibility classes (I IV non‐significant) according established criteria, complemented by sensitivity subgroup analyses examine robustness main analysis. Statistical analysis was performed using new package for conducting ( https://metaumbrella.org ). Population attributable fraction (PAF) generalized (GIF) then calculated class I‐III associations. Forty‐seven meta‐analysis, encompassing 251 non‐overlapping studies reporting 74 associations, included (68% at low ROBIS assessment). Altogether, 43 (disease‐specific mortality: n=17; n=26) 31 secondary investigated. Although 72% associations statistically (p<0.05), only two showed convincing (class I) evidence: depressive in patients heart failure (hazard ratio, HR=1.44, CI: 1.26‐1.65), schizophrenia cardiovascular (risk RR=1.54, 1.36‐1.75). Six highly suggestive II) those diabetes mellitus (HR=2.84, 2.00‐4.03) kidney (HR=1.41, 1.31‐1.51); events myocardial infarction (odds OR=1.52, 1.36‐1.70); dementia (HR=2.11, 1.77‐2.52); alcohol use decompensated liver cirrhosis hepatitis C (RR=3.15, 2.87‐3.46); cancer (standardized mean SMR=1.74, 1.41‐2.15). Sensitivity/subgroup confirmed these results. The largest PAFs 30.56% (95% 27.67‐33.49) C, 26.81% 16.61‐37.67) mellitus, 13.68% 9.87‐17.58) infarction, 11.99% 8.29‐15.84) 11.59% 9.09‐14.14) failure. GIFs preventive capacity This review demonstrates increase poor outcome several Prevention targeting – particularly disorders, can reduce incidence adverse people These findings inform practice trans‐speciality approaches cutting across psychiatric somatic medicine.

Language: Английский

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The schizophrenia syndrome, circa 2024: What we know and how that informs its nature

Schizophrenia Research, Journal Year: 2023, Volume and Issue: 264, P. 1 - 28

Published: Dec. 12, 2023

Language: Английский

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Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: the case for transdiagnostic assessment

Molecular Psychiatry, Journal Year: 2023, Volume and Issue: 28(6), P. 2291 - 2300

Published: June 1, 2023

Comorbid mental disorders in subjects at clinical high risk for psychosis (CHR-P) may impact preventive care. We conducted a PRISMA/MOOSE-compliant systematic meta-analysis, searching PubMed/PsycInfo up to June 21st, 2021 observational studies/randomized controlled trials reporting on comorbid DSM/ICD-mental CHR-P ( protocol ). The primary and secondary outcomes were baseline follow-up prevalence of disorders. also explored the association compared with versus psychotic/non-psychotic control groups, their functioning transition psychosis. random-effects meta-analyses, meta-regression, assessed heterogeneity/publication bias/quality (Newcastle Ottawa Scale, NOS). included 312 studies (largest meta-analyzed sample = 7834, any anxiety disorder, mean age 19.98 (3.40), females 43.88%, overall NOS > 6 77.6% studies). was 0.78 (95% CI 0.73-0.82, k 29) non-psychotic 0.60 0.36-0.84, 3) anxiety/mood disorders, 0.44 0.39-0.49, 48) mood 0.38 0.33-0.42, 50) depressive disorder/episode, 0.34 0.30-0.38, 69) 0.30 0.25-0.35, 35) major 0.29 CI, 0.08-0.51, trauma-related 0.23 0.17-0.28, 24) personality <0.23 other (I2 50% 71.01% estimates). disorder decreased over time (0.51, 95% 0.25-0.77 96 months), except substance use which increased (0.19, 0.00-0.39, 2, >96 months). Compared controls, status associated higher anxiety, schizotypal personality, panic, alcohol (OR from 2.90 1.54 without psychosis), 9.30 2.02) lower 0.41, psychosis). Higher disorder/schizotypal negatively (beta -0.40 -0.15), while dysthymic disorder/generalized 0.59 1.49). disorder/agoraphobia -2.39 -0.27) In conclusion, three-quarters have modulate functionig Transdiagnostic health assessment should be warranted CHR-P.

Language: Английский

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Efficacy and effectiveness of antipsychotics in schizophrenia: network meta-analyses combining evidence from randomised controlled trials and real-world data

The Lancet Psychiatry, Journal Year: 2024, Volume and Issue: 11(2), P. 102 - 111

Published: Jan. 9, 2024

Language: Английский

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Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ): Rationale and Study Design of the Largest Global Prospective Cohort Study of Clinical High Risk for Psychosis

Schizophrenia Bulletin, Journal Year: 2024, Volume and Issue: 50(3), P. 496 - 512

Published: March 7, 2024

Abstract This article describes the rationale, aims, and methodology of Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ). is largest international collaboration to date that will develop algorithms predict trajectories outcomes individuals at clinical high risk (CHR) for psychosis advance development use novel pharmacological interventions CHR individuals. We present a description participating research networks data processing analysis coordination center, their processes harmonization across 43 sites from 13 countries (recruitment North America, Australia, Europe, Asia, South America), flow quality assessment processes, analyses, transfer National Institute Mental Health (NIMH) Data Archive (NDA) by community. In an expected sample approximately 2000 640 matched healthy controls, AMP SCZ collect clinical, environmental, cognitive along with multimodal biomarkers, including neuroimaging, electrophysiology, fluid biospecimens, speech facial expression samples, measures derived digital health technologies smartphone-based daily surveys, passive sensing as well actigraphy. The study investigate range over 2-year period, transition psychosis, remission or persistence status, attenuated positive symptoms, persistent negative mood anxiety psychosocial functioning. global reach its harmonized innovative methods promise catalyze new treatments address critical unmet public needs in

Language: Английский

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