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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Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(3), P. 393 - 414

Published: Sept. 8, 2022

Psychiatry has always been characterized by a range of different models and approaches to mental disorder, which have sometimes brought progress in clinical practice, but often also accompanied critique from within without the field. Psychiatric nosology particular focus debate recent decades; successive editions DSM ICD strongly influenced both psychiatric practice research, led assertions that psychiatry is crisis, advocacy for entirely new paradigms diagnosis assessment. When thinking about etiology, many researchers currently refer biopsychosocial model, this approach received significant critique, being considered some observers overly eclectic vague. Despite development evidence-based pharmacotherapies psychotherapies, current evidence points treatment gap research-practice health. In paper, after considering we discuss proposed novel perspectives recently achieved prominence may significantly impact research future: neuroscience personalized pharmacotherapy; statistical nosology, assessment research; deinstitutionalization community health care; scale-up psychotherapy; digital phenotyping therapies; global task-sharing approaches. We consider extent transitions practices reflect hype or hope. Our review indicates each contributes important insights allow hope future, provides only partial view, any promise paradigm shift field not well grounded. conclude there crucial advances that, despite progress, considerable need further improvements intervention; such will likely be specific shifts rather incremental iterative integration.

Language: Английский

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Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019

Molecular Psychiatry, Journal Year: 2023, Volume and Issue: 28(12), P. 5319 - 5327

Published: July 27, 2023

Language: Английский

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Mental health care for older adults: recent advances and new directions in clinical practice and research

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(3), P. 336 - 363

Published: Sept. 8, 2022

The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the health care these people and their family caregivers labor-intensive. At same time, ageism a big problem for people, with without disorders. Positive elements such as resilience, wisdom prosocial behaviors, need to be highlighted promoted, both combat stigma help protect improve positive psychiatry aging not oxymoron, but scientific construct strongly informed by research evidence. We champion broader concept geriatric - one that encompasses well illness. In present paper, we address issues context four are greatest source years lived disability: neurocognitive disorders, major depression, schizophrenia, substance use emphasize implementation multidisciplinary team care, comprehensive assessment, clinical management, intensive outreach, coordination mental, physical social services. also underscore further into moderators mediators treatment response variability. Because optimal adults patient-focused family-centered, call enhancing well-being caregivers. To optimize safety efficacy pharmacotherapy, attention metabolic, cardiovascular neurological tolerability much needed, together development testing medications reduce risk suicide. normal cognitive antidote catalyst change way think per se late-life more specifically. It this provide directions future research.

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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New insights from the last decade of research in psychiatric genetics: discoveries, challenges and clinical implications

World Psychiatry, Journal Year: 2023, Volume and Issue: 22(1), P. 4 - 24

Published: Jan. 14, 2023

Psychiatric genetics has made substantial progress in the last decade, providing new insights into genetic etiology of psychiatric disorders, and paving way for precision psychiatry, which individual profiles may be used to personalize risk assessment inform clinical decision‐making. Long recognized heritable, recent evidence shows that disorders are influenced by thousands variants acting together. Most these commonly occurring, meaning every a each disorder, from low high. A series large‐scale studies have discovered an increasing number common rare robustly associated with major disorders. The most convincing biological interpretation findings implicates altered synaptic function autism spectrum disorder schizophrenia. However, mechanistic understanding is still incomplete. In line their extensive epidemiological overlap, appear exist on continua share large degree one another. This provides further support notion current diagnoses do not represent distinct pathogenic entities, ongoing attempts reconceptualize nosology. also influences range behavioral somatic traits diseases, including brain structures, cognitive function, immunological phenotypes cardiovascular disease, suggesting shared potential importance. Current polygenic score tools, predict susceptibility illness, yet provide clinically actionable information. likely improve coming years, they eventually become part practice, stressing need educate clinicians patients about use misuse. review discusses key possible applications, suggests future directions.

Language: Английский

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Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

World Psychiatry, Journal Year: 2023, Volume and Issue: 22(3), P. 366 - 387

Published: Sept. 15, 2023

Populations with common physical diseases – such as cardiovascular diseases, cancer and neurodegenerative disorders experience substantially higher rates of major depressive disorder (MDD) than the general population. On other hand, people living MDD have a greater risk for many diseases. This high level comorbidity is associated worse outcomes, reduced adherence to treatment, increased mortality, health care utilization costs. Comorbidity can also result in range clinical challenges, more complicated therapeutic alliance, issues pertaining adaptive behaviors, drug‐drug interactions adverse events induced by medications used mental disorders. Potential explanations prevalence above involve shared genetic biological pathways. These latter include inflammation, gut microbiome, mitochondrial function energy metabolism, hypothalamic‐pituitary‐adrenal axis dysregulation, brain structure function. Furthermore, several antecedents related social factors (e.g., socioeconomic status), lifestyle variables activity, diet, sleep), stressful live childhood trauma). Pharmacotherapies psychotherapies are effective treatments comorbid MDD, introduction interventions well collaborative models digital technologies provide promising strategies improving management. paper aims detailed overview epidemiology specific including bidirectional risk; pathways potentially implicated pathogenesis diseases; socio‐environmental that serve both protective factors; management prevention treatment. We conclude future directions emerging research optimal

Language: Английский

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The Role of the Oral Microbiota Related to Periodontal Diseases in Anxiety, Mood and Trauma- and Stress-Related Disorders

Frontiers in Psychiatry, Journal Year: 2022, Volume and Issue: 12

Published: Jan. 27, 2022

The prevalence of anxiety, mood and trauma- stress-related disorders are on the rise; however, efforts to develop new effective treatment strategies have had limited success. To identify novel therapeutic targets, a comprehensive understanding disease etiology is needed, especially in context holobiont, i.e., superorganism consisting human its microbiotas. Much emphasis has been placed role gut microbiota development, exacerbation, persistence psychiatric disorders; data for oral limited. cavity houses second most diverse microbial community body, with over 700 bacterial species that colonize soft hard tissues. Periodontal diseases encompass group infectious inflammatory affect periodontium. Among them, periodontitis defined as chronic, multi-bacterial infection elicits low-grade systemic inflammation via release pro-inflammatory cytokines, well local invasion long-distance translocation periodontal pathogens. Periodontitis can also induce or exacerbate other chronic such atherosclerosis diabetes lead adverse pregnancy outcomes. Recently, pathogens implicated pathophysiology neuropsychiatric (such depression schizophrenia), dysregulation immune system plays an integral these disorders. This review will discuss associated Epidemiological individuals be presented, followed by discussion microbiological immunological links between central nervous system. Pre-clinical clinical findings related phenotypes reviewed, bi-directionality oral-brain axis. Lastly, we focus target future interventions alleviate symptoms debilitating

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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Work-related causes of mental health conditions and interventions for their improvement in workplaces

The Lancet, Journal Year: 2023, Volume and Issue: 402(10410), P. 1368 - 1381

Published: Oct. 1, 2023

Language: Английский

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