The significance for psychiatry of a patient’s subjective or “lived” experience seems obvious even on casual reflection, especially in cases of severe mental illness. It is likely that curiosity and concern about what a patient is experiencing is a prerequisite for building trust or a therapeutic alliance, particularly when the experiences seem highly unsettling and unusual. Few would deny that grasping

There is an old joke told of a tourist asking for directions, only to be advised by a local: “Well, I would not start from here”. We have the acute mental health services we have inherited. Asylums closed during the great era of deinstitutionalization, clunkily evolving into our current inpatient estates. Crisis teams were established (without any real evidence) to provide choice and less coercive

Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for

When it comes to symptom emergence and treatment of disorders, psychiatry and neuroscience do not always find common ground. On the one hand, neuroscientific research approaches mental disorders through their biological correlates using brain recordings; on the other, clinical psychiatry relies on self-report measures collected during face-to-face interviews. Taking into account both neural and experiential

Continuous outcome measurement in psychotherapies has become a central research topic only in the last two decades1. Here we provide a short introduction to the relevant concepts and discuss the opportunities and challenges of their implementation in clinical practice. Most continuous outcome measurement systems comprise short self-report questionnaires which assess patient progress on a session-by-session

The Vaccination Act of 1853, which mandated smallpox vaccination for infants in England, prompted the emergence of the Anti-Vaccination League, widespread street protests, and the appearance of several anti-vaccination journals. Various criticisms were levelled: that vaccines were unsafe; that vaccinations were “unchristian”; that the mandate was a violation of personal liberties. Conspiracy theories

The DSM-5 Text Revision (DSM-5-TR)1 is the first published revision of DSM-5 since its original publication in 2013. Like the previous text revision (DSM-IV-TR), the main goal of DSM-5-TR is to comprehensively update the descriptive text that is provided for each DSM disorder based on reviews of the literature since the release of the prior version. However, in contrast to DSM-IV-TR, in which updates

Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with

Johnson et al1 provide an overview of the huge transformation occurring in a­­cute mental health care during the last two decades. The authors enumerate and discuss an extensive array of novel alternatives, while underscoring the lack of ro­­bust evidence to support their implementation. We provide here some complementary in­­formation to further understand the context of this reform and the current

Johnson et al1 review different aspects of acute psychiatric care, with the aim to identify evidence-based practices in order to increase the range of services and improve access and quality of care. They acknowledge the assortment of services involved as well as the divergent settings across health systems and countries. Crises are multidimensional phenom­ena and result from complex interactions be­­­­tween

Johnson et al1 provide a comprehensive overview of the range of acute services and models of care currently considered and utilized by mental health systems, primarily in high-income countries. Their paper represents an excellent starting point for the evaluation of the range, access and quality of support available to those who experience acute psychosocial distress2. The authors make clear that there

In their comprehensive review, Johnson et al1 emphasize that acute psychiatric care consumes a substantial part of the resources available for mental health services, but that evidence on which models are associated with the most positive patient experiences and outcomes remains surprisingly limited. It is well documented that continuity of care and therapeutic relationships are regarded as important

Johnson et al1 provide a comprehensive and illuminating review of the evidence and key issues in relation to acute and crisis mental health care. As they suggest, psychiatric inpatient care is most often un­­popular – with both patients and many staff – and can be traumatizing, re-traumatizing and coercive. Huge tensions exist around keeping se­­verely mentally distressed people safe whilst trying

The review by Johnson et al1 tells a com­­pelling story: the evidence is significantly lacking in major domains regarding acute and crisis mental health services. We address here the major gaps in this area that relate to research on existing inequities in access to and quality of crisis services, as well as the degree to which new models and interventions are able to advance equity. In the US, calls

Johnson et al1 provide a comprehensive account of the different service models aimed to address mental health crises, focusing on assessment and immediate management of the crisis, intensive treatment following crisis, further perspectives on crisis care including prevention, and crisis care in low- and middle-income countries. They conclude that a variety of options exist, but also that the evidence

Johnson et al1 make a forceful argument for the need to improve quality and access to acute psychiatric services. However, once the acute crisis abates, there are usually enduring symptoms and functional deficits associated with mental illness, notably for people living with psychotic disorders, such as schizophrenia. These individuals need access to rehabilitation-oriented services to prevent relapses

People with schizophrenia die 15-20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random-effects meta-analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical

Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community

It is common experience for practising psychiatrists that individuals with schizophrenia vary markedly in their symptomatic response to antipsychotic medication. What is not clear, however, is whether this variation reflects variability of medication-specific effects (also called “treatment effect heterogeneity”), as opposed to variability of non-specific effects such as natural symptom fluctuation

According to current evidence and guidelines, continued antipsychotic treatment is key for preventing relapse in people with schizophrenia-spectrum disorders, but evidence-based recommendations for the choice of the individual antipsychotic for maintenance treatment are lacking. Although oral antipsychotics are often prescribed first line for practical reasons, long-acting injectable antipsychotics

The construct of alliance (alternatively addressed as therapeutic, working or helping) was first formulated within psychoanalytic circles, before it was reconsidered in trans-theoretical terms and became recognized as an integrative variable, common factor, and generalizable change process or “principle of” change1, 2. Much has been written over the years about the role of alliance in the adherence

Post-traumatic stress disorder (PTSD) entered the DSM just over 40 years ago. Since then, there have been more than 300 com­pleted randomized controlled trials (RCTs) of therapies for this condition, about two thirds of which have included one or more psychotherapies1. It is therefore not surprising that there is a robust evidence base of effective psychotherapies for PTSD. Trauma-focused psychotherapies

The comorbidity of post-traumatic stress disorder (PTSD) with a range of other mental disorders is common. This comorbidity is often attributed to either overlapping symptoms between PTSD and other disorders or to the variety of psychiatric conditions that can arise in the wake of exposure to a traumatic experience. However, this comorbidity may also be due to the fact that PTSD can moderate the onset

Domestic violence and abuse is a global public health issue adversely impacting both physical and mental health. Intimate partner violence is one of the most common forms, and includes physical, sexual and emotional abuse (including technology-enabled abuse) and controlling or coercive behaviour from a partner or ex-partner. Women and girls are particularly at risk for intimate partner violence. Globally

Early in the COVID-19 pandemic, repurposing some already-approved drugs was proposed for reducing the morbidity and mortality risk of those who were infected. For example, the UK RECOVERY trial demonstrated the benefits of dexamethasone for severe respiratory illness, leading to its widespread adoption by mid-2020. Many psychiatric drugs have antiviral and immune modulatory effects, and are candidates

Obsessive-compulsive disorder (OCD) is characterized by time-consuming obsessions and compulsions that cause distress and impairment1. It can affect people of all ages and has a lifetime prevalence of 1-2%2, 3. The severity of OCD is assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)4, 5. Despite extensive use of this scale for several decades, there is still uncertainty about what constitutes

The expression “third-wave cognitive behavior therapy (CBT)” has become a trade mark. It has been argued that it represents a new “process-based therapy”, which targets the relationship of the client to his/her own experiences in a transdiagnostic approach1. However, a look at both history and present practice suggests that modern CBT encompasses at least a dozen “waves”, or basic theoretical concepts

The American Psychiatric Association recently announced the inclusion in the DSM-5-TR of a new category for prolonged grief disorder (PGD)1, 2, following introduction of this category in the ICD-11. Our group previously demonstrated the efficacy of a targeted treatment (complicated grief therapy, CGT) for complicated grief, a condition corresponding in many respects to PGD. We examined now the performance

Recent publications have documented that a proportion of COVID-19 patients develop psychiatric symptoms during or after acute infection1. We investigated this risk in the context of the National COVID Cohort Collaborative (N3C) – a centralized, harmonized, high-granularity electronic health record (EHR) repository2 – using the largest retrospective cohort reported to date. Two previous large-scale

We are witnessing exponential growth in a heavily capitalized digital health industry which promises to transform behavioral and mental health care1, 2. Consequently, it is critical that there is no ambiguity about the evidence standards necessary for the safe and effective treatment of psychiatric disorders through digital approaches. In our opinion, these standards should be essentially the same

Perinatal mental health problems account for a substantial health burden across the world. Almost one in two women aged under 25 report some form of common mental disorders during pregnancy1. The use of psychotropic medications, especially antidepressants and antipsychotics, has doubled in the past two decades, with a disproportionate increase amongst women at childbearing age and during pregnancy2

Since 2015, the United Nations Office on Drugs and Crime (UNODC) – World Health Organization (WHO) Informal Scien­tific Network (ISN) has brought the voice of science to international drug policy discussions, especially at the Commission on Narcotic Drugs, the prime policy-making body of the United Nations (UN) for drug control matters. In recent years, the public health dimensions of the world drug

The year 2021 has been another tough one for us all. Uncertainty about the COVID situation, restrictions about travel, and difficulties in getting connected have been the major issues that have affected our professional work and personal lives during that year. The WPA has also struggled coping with these limitations. However, that period has given us some motivation and new insight to work under difficult

The WPA Council is the organ including the Past Presidents of the WPA, which has the mandate to offer recommendations and advice to the WPA Executive Committee about any matters affecting the mission and strategy of the Association. It is currently chaired by me, and its other members are Profs. J.A. Costa e Silva, F. Lieh-Mak, N. Sartorius, J.E. Mezzich, M. Maj, P. Ruiz, D. Bhugra and H. Herrman.

The WPA Action Plan 2020-20231-3 coincides with a much-needed focus on the mental health needs of people with intellectual disabilities/intellectual developmental disorders (IDD). A Working Group on IDD has been formed and has met for the first time at a Presidential Symposium during the 19th World Congress of Psychiatry in Lisbon, Portugal in August 20194. A recent international review of service

Psychiatric issues impact individuals of all ages globally. Shortage of mental health professionals is a major concern especially in low- and middle-income countries. Fur­th­er, the COVID-19 pandemic has led to downsizing and even closure of various men­tal health services worldwide1-4. In the WPA Action Plan 2020-2023, capacity build­ing and promotion of psychiatry among medi­cal students is an important

Mental disorder is reported to account for almost a third of global disease burden as measured by years lived with disability (YLDs)1. On the other hand, mental well-being results in broad positive impacts2. Effective public mental health interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well-being and resilience2, 3.

The 11th revision of the International Classification of Diseases (ICD-11) has come into effect on January 1, 2022. All the Member States of the World Health Organization (WHO) will now be asked to use this new version of the classification to report their morbidity and mortality statistics. An implementation package has been made available to facilitate the transition from the ICD-10 to the ICD-11

According to current evidence and guidelines, continued antipsychotic treatment is key for preventing relapse in people with schizophrenia-spectrum disorders, but evidence-based recommendations for the choice of the individual antipsychotic for maintenance treatment are lacking. Although oral antipsychotics are often prescribed first line for practical reasons, long-acting injectable antipsychotics

People with schizophrenia die 15-20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random-effects meta-analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical

Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community

Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative

It is common experience for practising psychiatrists that individuals with schizophrenia vary markedly in their symptomatic response to antipsychotic medication. What is not clear, however, is whether this variation reflects variability of medication-specific effects (also called "treatment effect heterogeneity"), as opposed to variability of non-specific effects such as natural symptom fluctuation

Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with