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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Review of the Endocannabinoid System

Biological Psychiatry Cognitive Neuroscience and Neuroimaging, Journal Year: 2020, Volume and Issue: 6(6), P. 607 - 615

Published: Aug. 1, 2020

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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Preventive psychiatry: a blueprint for improving the mental health of young people

World Psychiatry, Journal Year: 2021, Volume and Issue: 20(2), P. 200 - 221

Published: May 18, 2021

Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing public health, Gordon's, US Institute Medicine, World Health Organization, and good frameworks, neurodevelopmentally-sensitive clinical staging models. We then review evidence supporting primary prevention psychotic, bipolar common disorders promotion as potential transformative strategies to reduce incidence these Within indicated approaches, high-risk psychosis paradigm has received most empirical validation, while states are increasingly becoming a focus attention. Selective mostly targeted familial vulnerability non-genetic risk exposures. screening psychological/psychoeducational interventions vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy reducing psychotic/bipolar/common is unproven. physical exercise anxiety disorders. Universal symptoms not prevent depressive/anxiety disorders, universal targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) hold greatest profile population whole. The approach currently fragmented. leverage knowledge from develop blueprint future research practice psychiatry people: integrating frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing infrequent disorders; burden together; implementing stratified/personalized prognosis; establishing evidence-based interventions; developing an ethical framework, through education/training; consolidating cost-effectiveness psychiatry; decreasing inequalities. These goals can only be achieved urgent individual, societal, global level response, which promotes vigorous collaboration across scientific, care, societal governmental sectors much at stake people with emerging

Language: Английский

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The social determinants of mental health and disorder: evidence, prevention and recommendations

World Psychiatry, Journal Year: 2024, Volume and Issue: 23(1), P. 58 - 90

Published: Jan. 12, 2024

People exposed to more unfavourable social circumstances are vulnerable poor mental health over their life course, in ways that often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage health. Addressing these challenges is an imperative matter justice. In this paper we provide a roadmap address the determinants cause ill Relying as far possible on high-quality evidence, first map out literature supports causal link between later outcomes. Given breadth topic, focus most pervasive across those common major disorders. We draw primarily available evidence from Global North, acknowledging other global contexts will face both similar unique sets require equitable attention. Much our focuses groups who marginalized, thus multitude intersecting risk factors. These include refugees, asylum seekers displaced persons, well ethnoracial minoritized groups; lesbian, gay, bisexual, transgender queer (LGBTQ+) living poverty. then introduce preventive framework for conceptualizing disorder, can guide much needed primary prevention strategies capable reducing inequalities improving population Following this, review concerning candidate intervene interventions fall broadly within scope universal, selected indicated strategies, but also briefly important secondary tertiary promote recovery with existing Finally, seven key recommendations, framed around justice, constitute action research, policy public Adoption recommendations would opportunity advance efforts modifiable affect

Language: Английский

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Probability of Transition to Psychosis in Individuals at Clinical High Risk

JAMA Psychiatry, Journal Year: 2021, Volume and Issue: 78(9), P. 970 - 970

Published: July 14, 2021

Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to holds paramount importance preventive care and applied research.To quantitatively examine consistency magnitude transition in individuals at CHR-P.PubMed Web Science databases until November 1, 2020. Manual search references previous articles.Longitudinal studies reporting risks CHR-P.Meta-analysis compliant with Preferred Reporting Items Systematic Reviews Meta-analyses (PRISMA) Meta-analysis Observational Studies Epidemiology (MOOSE) guidelines; independent data extraction, manually through digitalization Kaplan-Meier curves.Primary effect size was cumulative 0.5, 1.5, 2, 2.5, 3, 4, more than 4 years' follow-up, estimated using numbers CHR-P each time point. These analyses were complemented by meta-analytical curves speed (hazard rate). Random-effects meta-analysis, between-study heterogeneity analysis, study quality assessment, meta-regressions conducted.A total 130 9222 included. The mean (SD) age 20.3 (4.4) years, 5100 (55.3%) male. 0.09 (95% CI, 0.07-0.10; k = 37; n 6485) 0.5 0.15 0.13-0.16; 53; 7907) 1 year, 0.20 0.17-0.22; 30; 5488) 1.5 0.19 44; 7351) 2 0.25 0.21-0.29; 19; 3114) 2.5 0.22-0.29; 29; 4029) 3 0.27 0.23-0.30; 16; 2926) 0.28 0.20-0.37; 14; 2301) years. 0.08 0.08-0.09; 4860) 0.14 0.13-0.15; 3408) 0.17 0.16-0.19; 2892) 0.19-0.21; 2357) 0.23-0.26; 1444) 0.25-0.28; 1029) 0.26-0.29; 808) 3.5 0.29 0.27-0.30; 737) 0.35 0.32-0.38; 114) 10 hazard rate only plateaued follow-up. Meta-regressions showed that lower proportion female (β -0.02; 95% -0.04 -0.01) higher brief limited intermittent psychotic symptoms 0.02; 0.01-0.03) associated an increase risk. Heterogeneity across (I2 range, 77.91% 95.73%).In this 25% developed within Transition continued increasing long term. Extended monitoring may be beneficial patient population.

Language: Английский

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The clinical characterization of the patient with primary psychosis aimed at personalization of management

World Psychiatry, Journal Year: 2021, Volume and Issue: 20(1), P. 4 - 33

Published: Jan. 12, 2021

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica­tion prescribed, second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy rarely used in the vast majority countries, although there evidence support its efficacy. Psychosocial interventions are provided, especially chronic cases, but those applied frequently not validated by research. Evidence‐based family and supported employment programs seldom implemented ordinary practice. Although notion that at increased risk for cardiovascular diseases diabetes mellitus widely shared, it frequent appropriate measures be address this problem. view patient should personalized endorsed clinicians, personalization lacking or inadequate most clinical contexts. many mental health services would declare themselves “recovery‐oriented”, common a focus on empowerment, identity, meaning resilience ensured present paper aims situation. It describes systematically salient domains considered characterization individual aimed management. These include positive negative symptom dimensions, other psychopathological components, onset course, neurocognition social cognition, neurodevelopmental indicators; functioning, quality life unmet needs; staging, antecedent concomitant psychiatric conditions, physical comorbidities, history, history obstetric complications, early recent environmental exposures, protective factors resilience, internalized stigma. For each domain, simple assessment instruments identified could use practice included standardized decision tools. A encouraged which takes into account available treatment modalities whose efficacy research evidence, selects modulates them basis characterization, addresses patient’s needs terms employment, housing, self‐care, relationships education, offers resilience.

Language: Английский

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From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States

American Journal of Psychiatry, Journal Year: 2021, Volume and Issue: 178(7), P. 599 - 610

Published: May 3, 2021

The authors examine U.S.-based evidence that connects characteristics of the social environment with outcomes across psychosis continuum, from psychotic experiences to schizophrenia. notion inequitable and economic systems society significantly influence risk through proxies, such as racial minority immigrant statuses, has been studied more extensively in European countries. While there are existing international reviews determinants psychosis, none authors' knowledge focus on factors U.S. context specifically-an omission leaves domestic treatment development prevention efforts incomplete underinformed. In this review, first describe how a legacy structural racism United States shaped gradient, highlighting consequential inequities environmental conditions. offer hypothesized model linking interwoven intermediary based theoretical models review literature. Neighborhood factors, cumulative trauma stress, prenatal perinatal complications were three key areas selected for because they reflect conditions may affect common pathway by racism. showing Black Latino people suffer disproportionately within these areas, large part result discrimination disadvantage. This broad individual community is intended provide consolidated space growing body research guide continued inquiries into contexts.

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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Immune System Abnormalities in Schizophrenia: An Integrative View and Translational Perspectives

Frontiers in Psychiatry, Journal Year: 2022, Volume and Issue: 13

Published: April 25, 2022

The immune system is generally known to be the primary defense mechanism against pathogens. Any pathological conditions are reflected in anomalies parameters. Increasing evidence suggests involvement of dysregulation and neuroinflammation pathogenesis schizophrenia. In this systematic review, we summarized available abnormalities We analyzed impairments all components assessed level bias evidence. It has been shown that schizophrenia associated with components: from innate adaptive immunity humoral cellular immunity. Abnormalities organs have also observed Evidence increased C-reactive protein, cytokines chemokines, elevated levels neutrophils autoantibodies, microbiota lowest risk bias. Peripheral contribute neuroinflammation, which cognitive neuroanatomical alterations contributes However, signs severe inflammation only about 1/3 patients Immunological parameters may help identify subgroups individuals who well respond anti-inflammatory therapy. Our integrative approach identified gaps knowledge schizophrenia, new horizons for research proposed.

Language: Английский

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