Individuals with substance use disorders (SUDs) are at increased risk for COVID-19 infection and for adverse outcomes of the infection. Though vaccines are highly effective against COVID-19, their effectiveness in individuals with SUDs might be curtailed by compromised immune status and a greater likelihood of exposures, added to the waning vaccine immunity and the new SARS-CoV-2 variants. In a population-based

Huge progress has been made in the development of evidence-based psychotherapies for a wide array of mental disorders1. However, significant socioeconomic and sociocultural divides exist in the access to these interventions. The unavailability of psychotherapies for a large proportion of the world’s population presents a major challenge to the future of mental health care. There are currently both

Listening to patient preferences when making health care decisions is increasingly considered an essential element of evidence-based practice. Patient preferences refer to the specific activity, treatment and provider conditions that patients desire for their health care experience1, 2. For example, patients may prefer medication or psychotherapy, have preferences for one type of medication over another

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies – such as smartphone apps, vir­tual reality, chatbots, and social media – have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall

The clinical construct of “anxiety neurosis” was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional

Although precise estimations of the absolute risk are still difficult to provide, it is clear that depression and anxiety are predominant symptoms in post-acute COVID-19, and that they are more pronounced in patients who have been hospitalized for COVID-19 than in those hospitalized for other respiratory tract infections1. Also, cognitive impairment has been reported in several people who have had

The past two decades have seen an increasing recognition of the contribution of mental disorders to global disease burden. There has also been an awareness that therapeutic innovation based on sound understanding of disease mechanisms has evaded single companies working within a conventional competitive market-based model. Governments, charities and philanthropists are increasingly willing to fund

Consistent with early definitions of schizophrenia as marked by a fragmentation of thought, emotion and desire1, psychosis is currently understood as involving deep disturbances in the sense that persons have of themselves and their connection with the world2. Though endemic across psychosis3, it has remained unclear how to operationalize and measure the processes which underlie and sustain these alterations

There has been increasing consensus that the classification of personality disorder in the DSM-IV and ICD-10 was no longer fit for purpose. There was no good evidence that there are nine to eleven discrete personality disorder categories, the system was too complex, and most categories were not used. The evidence pointed toward the dimensional nature of personality disturbance, with severity being

For decades, cognitive and behavioral therapies (CBTs) have been tested in randomized controlled trials for specific psychiatric syndromes that were assumed to represent expressions of latent diseases. Although these protocols were more effective as compared to psychological control conditions, placebo treatments, and even active pharmacotherapies, further advancement in efficacy and dissemination

Hayes and Hofmann1 provide a sweeping history of behavioral approaches to clinical practice, from applied behavior analysis, through cognitive behaviorism, to contemporary “third-wave” approaches. Reviewing their history from my vantage points – as a clinician, a motivational researcher, and a psychological theorist – engenders different reactions, two quite positive and one more skeptical. As a clinician

Hayes and Hofmann1 argue for the value of “third-wave” cognitive behavioral therapies (CBTs) – with which I heartily agree – and call for a renewed focus on targeting an expanded range of processes of change. They highlight five features of “third-wave” therapies: a) a focus on context and function; b) the view that new mod­els and meth­ods should build on other strands of CBT; c) a focus on broad

We appreciate the rich, thought-provoking paper by Hayes and Hofmann1, including their inspiring account of the work of so many intervention scientists on whose shoulders we all stand. The directions they propose warrant close attention by all of us who seek to strengthen psychotherapies. Here, we focus specifically on how their ideas may apply to youth psychotherapy and idiographic treatment of youth

Hayes and Hofmann’s paper1 provides a new framework to conceptualize psychological therapy as a process-based clinical intervention. The authors describe the history of cognitive behavioral therapy (CBT) in three waves and formulate the process-based orientation as the step beyond theoretical orientations. They outline a shift from protocols treating syndromes to idiographic approaches using process-based

Hayes and Hofmann1 discuss the neglect of processes of change in psychotherapy and the lessons we can learn from process research in the context of “third-wave” cog­nitive behavioral therapies (CBTs). They criticize the notion of psychiatric syndromes and argue that these newer therapies should be considered in the context of an idio­graphic approach to process-based functional analysis. Although I

Hayes and Hofmann’s paper1 is much welcome. As they argue, there is a need to re-evaluate assessment and treatment prac­tices that are solely or primarily based on psychiatric diagnoses. Diagnoses do not sufficiently account for individual differences, and additional information is usually needed to implement a psychological intervention. In one of our clinical trials aimed at decreasing the symptoms

Hayes and Hofmann1 describe how the context around cognitive behavioral therapy (CBT), a context that has supported significant success for many years, may now be stifling progress1. They say that it is now time for a new strategic approach. In their words, a focus on syndromes, diagnostic categories, and the development of treatment protocols based on studies of group data, has dominated the field

Intervention science has set for itself a noble goal. How do we reduce mental health problems, promote happiness, and help people to engage in behaviour that is effective and in their best interest? The scientific community has now spent hundreds of millions of dollars and decades to answer this question. The good news is that we have made excellent progress. Meta-analyses suggest that a wide variety

Major depression is often a relapsing disorder. It is therefore important to start its treatment with therapies that maximize the chance of not only getting the patients well but also keeping them well. We examined the associations between initial treatments and sustained response by conducting a network meta-analysis of randomized controlled trials (RCTs) in which adult patients with major depression

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method increasingly used to treat psychiatric disorders, primarily depression. Initial studies suggest that rTMS may help to treat addictions, but evaluation in multicenter randomized controlled trials (RCTs) is needed. We conducted a multicenter double-blind RCT in 262 chronic smokers meeting DSM-5 criteria for

Dopaminergic and glutamatergic dysfunction is believed to play a central role in the pathophysiology of schizophrenia. However, it is unclear if abnormalities predate the onset of schizophrenia in individuals at high clinical or genetic risk for the disorder. We systematically reviewed and meta-analyzed studies that have used neuroimaging to investigate dopamine and glutamate function in individuals

Decades of research have revealed numerous risk factors for mental disorders beyond genetics, but their consistency and magnitude remain uncer­tain. We conducted a “meta-umbrella” systematic synthesis of umbrella reviews, which are systematic reviews of meta-analyses of individual studies, by searching international databases from inception to January 1, 2021. We included umbrella reviews on non-purely

Research over the last few decades has reported high rates of victimization in people with severe mental health problems1, and this is increasingly viewed as a key adverse outcome to prevent. Consequences can arise directly: more commonly, worsening of psychiatric conditions through the effects of trauma, but also physical health morbidities and even death. Indirect consequences may be disruptions

Medical malpractice claims offer patients who have experienced harm as the result of negligence by physicians, hospitals and other health care providers the opportunity to obtain financial compensation. Negligence in malpractice cases is defined as the failure to conform to an accepted standard of care, i.e., in one common formulation, to fail to behave as a reasonable physician would in a similar

Suicide remains a leading cause of death worldwide1. A key reason for limited progress is inadequate understanding about the transition from suicidal ideation to suicide attempts. This knowledge is important because the majority of instances of suicidal ideation do not lead to suicide attempts. A World Health Organization study found that approximately two-thirds of individuals with suicidal ideation

Patients suffering from mental health problems often complain about thinking too much. Their mind is frequently focused on negative thoughts about their symptoms, problems, or negative experiences. Traditionally, researchers and clinicians have either regarded this type of rumination as an epiphenomenon or consequence of suffering from mental health problems, or – as in the case of cognitive therapy

While achievements in detection and prognostic assessment of young people at clinical high risk for psychosis (CHR-P) have been recently consolidated, the efficacy of preventive interventions remains unclear1. Cognitive behavioural therapy (CBT) is the currently recommended preventive intervention, but the most updated network meta-analysis2 found no robust evidence to favour it (and any of the other

Only 40% of trials of psychotherapies for depression publish­ed between 2015 and 2018 were prospectively registered, and discrepancies between publications and protocols were noted for 76% of registered trials1. It is often assumed that such divergences are the result of intentionally favoring statistically significant findings (“selective reporting”). However, discrepancies could be due to other reasons

Estimating the reproducibility of psychotherapy effects is essential. This is particularly crucial for trials with large effects, as the inclusion of false-positive trials can lead to erroneous conclusions about treatment efficacy in research syntheses1. Multicenter studies allow researchers to estimate the reproducibility of effects directly across centers under comparable study conditions (e.g.,

The importance of shared decision-making between clinician and patient as the basis of personalized care is increasingly widely recognized. In the UK, for example, a recent Supreme Court decision, developed in part from precedents in international human rights law, made shared decision-making the basis of consent to treatment1, and there have since been corresponding updates in regulatory guidance

The DSM is based on extensive observations of patients, with suggestions on categories going back over 100 years. The originators commented that the models were not entirely adequate and needed further modifications1. Current models, too, have been called “a first approximation” needing additional features to achieve better utility and validity2. Specific issues identified as needing improvement include

Anorexia nervosa affects up to 3% of young women and has the highest mortality rate of any psychiatric disorder1, 2, with approximately 5% of patients dying within four years of the diagnosis1. Severe weight loss and malnutrition can cause widespread damage to organs that may persist over time, even if anorexia nervosa is ultimately well-managed1, 2. However, the factors involved in the high mortality

Foundational helping skills are the provider's competencies needed to build a warm and trustworthy relationship with a client. Examples include effective verbal and non-verbal communication, demonstrating empathy, rapport building, and promoting hope and expectancy of change1. These skills have been widely established as an essential and universal prerequisite for the delivery of any effective psychosocial

The COVID-19 pandemic has put tre­mendous burden on health care systems all over the world. Unfortunately, mental health ser­vices have also been severely affected. This is evident in reduced resource alloca­tion and downsizing of many mental health ser­vices or even closing of services world­wide1-4. The WPA has been reviewing its Action Plan 2020-20235 in the light of the pandemic. The plan is already

The World Health Organization (WHO) reports forecast an increase of cancer incidence of 40% in high-income countries and more than 80% in low-income countries by 2030, and a rise of both mortality and long survivorship. Consequently, the agenda of psychiatry in oncology and palliative medicine needs to be reviewed and updated. The mental health implications of oncologic diseases have been in fact repeatedly

Psychotherapy has been an essential component of psychiatric theory and practice for over a century. There is sufficient evidence to consider it a treatment which may produce enduring epigenetic, neuro­endocrine and structural changes in the brain1. Many psychotherapy modalities have been manualized over the last three decades and proven helpful for most mental disorders. Randomized controlled trials

The importance of psychiatry and behavioral health in the delivery of overall health care and optimization of health is widely acknowledged. However, the stigma related to mental illness in society and the separation of psychiatric care from tra­ditional medical settings has resulted in significant challenges in integrating all aspects of care necessary in maintaining op­timal health and well-being

Suicide is a major public health problem, with 817,000 cases worldwide in 2016. The incidence is highest in those aged 70 years or older, among both men and women, in almost all regions of the world1. Effective interventions that mitigate iden­tified risk factors and sustain protective fac­tors are relevant across all age groups, but re­search specifically focused on suicide pre­vention in older adults

The network of WPA Collaborating Centres was established in 2016 with the aim to provide practical advice on teaching, policy, research and clinical activities in psychiatry worldwide1. In 2021, the network has been renewed for three years in order to support the implementation of the WPA Presidential Strategic Plan2 and to build a global alliance for better mental health. The network now includes

The chapter on mental, behavioural and neurodevelopmental disorders of the 11th revision of the International Classification of Diseases (ICD-11), developed by the Department of Mental Health and Substance Use of the World Health Organization (WHO), has been formally adopted by the 72nd World Health Assembly in Geneva on May 25, 2019. The most significant innovations and changes in this chapter with

The principles of prevention espoused by G. Rose1 have underpinned many modern successes in health care. In areas such as cardiometabolic diseases, injuries and violence, and substance abuse, shifting the community distribution of risk factors has become the primary strategy. The ensuing reductions in disease burden have been striking. Psychiatry remains an outlier. Over decades, the quality of clinical

International bodies such as the United Nations (UN), the World Health Organization (WHO), the International Labour Organization (ILO) and the Organization for Economic Co‐operation and Development (OECD) have warned that the COVID‐19 pandemic has made the world a yet more difficult place to be young. The ILO report Youth & COVID‐19: Impacts on Jobs, Education, Rights and Mental Well‐Being 1 found

For many years, psychiatrists have tried to understand factors involved in response to medications or psychotherapies, in order to personalize their treatment choices. There is now a broad and growing interest in the idea that we can develop models to personalize treatment decisions using new statistical approaches from the field of machine learning and applying them to larger volumes of data. In this

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co‐occurrence in the modal case, heterogeneity of presentation within dis­orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility

The COVID-19 pandemic, with its striking inequities in mortality rates between Whites and stigmatized racial/ethnic groups in the US and UK, and the recent global protests about police violence have raised questions about and increased interest in the potential impacts of racism on health and particularly on mental health. Racism is an organized societal system in which the dominant White group categorizes

Fentanyl, a synthetic opioid with analgesic and anesthetic properties, is currently associated with one of the deadliest addiction crises in the US. Misuse of fentanyl (and fentanyl analogues) has been estimated to be responsible for 48,000 (out of a total of 83,335) overdose deaths in the 12 months ending in June 20201, a rate that has increased more than 29 fold since 2012, when the annual fatalities

A psychedelic drug is one that “produces thought, mood and perceptual changes otherwise rarely experienced except in dreams, contemplative and religious exaltation, flashes of vivid involuntary memory, and acute psychosis”1. It does so “without causing physical addiction, craving, major physiological disturbances, delirium, disorientation or amnesia”1. The “classic psychedelics” include mescaline,

Video games are among the most popular consumer electronic products in the world. They are having a growing mass appeal both as an interactive recreational activity, in which one can engage individually or with other players, and as a passive entertainment in the form of viewership of broadcasted gaming events, including e‐sports and live‐streamed games (e.g., twitch.tv). Modern games offer a diverse

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 the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally‐sensitive clinical staging models. We then review the evidence

Six years ago, K. Walhbeck1 proposed in this journal that “the evidence base for public mental health interventions is convincing and the time is now ripe to move from knowledge to action”. Unfortunately, the field of public mental health has moved too slowly. Indeed, the scholarly review by Fusar‐Poli et al2 concludes that “prevention of mental disorders in young people has not yet solidified as global

Fusar‐Poli and eminent colleagues1 con­clude their encyclopedic review of prevention in psychiatry by calling for governments to tackle inequalities in young ­people's men­tal health and to invest in improving its so­cial determinants: education, employment, social care, housing, criminal justice, poverty alleviation, social security/welfare benefits, community development, and immigration. We stand

One major problem of preventive psychiatry is the limited predictive strength of all known risk factors for mental disorders, meaning that most of the individuals who are judged to be at risk have only a small chance of developing a mental disorder within the next period of their lives. Fusar‐Poli et al1 have produced an excellent overview of the current state of preventive psychiatry, and they refer

Fusar‐Poli et al1 comprehensively describe a series of developmental steps that lead to psychosis and related psychiatric illnesses. This perspective is especially relevant when considering prenatal intervention. Several pillars of evidence support the notion that the prenatal period is the first developmental step towards psychosis. The first pillar is the epidemiological ev­idence derived from case‐control

In their landmark paper on the current state of knowledge in the field of preventive psychiatry, Fusar‐Poli et al1 state that “robust genetic and environmental epidemiological knowledge is required to inform evidence‐based preventive approaches”. Indeed, in order to most effectively tailor selective and indicated preventive interventions to an individual's needs, a valid biological and biographical

Fusar-Poli et al1 provide a scholarly and detailed overview of the state of knowledge on preventive approaches in psychiatry. Their paper should be considered an obligatory read for anyone entering or already practicing in this emerging field. The need for preventive approaches in psychiatry is readily transparent. According to the US National Comorbidity Survey2, a nationally representative population-based

Fusar‐Poli et al1 present a comprehensive preventive framework for improving mental health in young people. Prevention in psychiatry is not a high funding priority, which is also reflected in the relatively low number of publications in the field. The responsibility for primary prevention and mental health promotion is placed in the social and educational sectors and, most often, the evidence base

Fusar‐Poli et al's insightful paper1 is a timely appraisal of the foundations of preventive psychiatry. It is a call to action for our field to mount an individual, societal and global response to improve the lives of people with and those at risk for mental disorders. The authors outline a series of ambitious next steps in preventive psychiatry. They seek to advance this goal by integrating universal

This study aimed to determine whether, following two years of specialized support for first‐episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single‐blind randomized controlled trial. Participants were people with first‐episode psychosis (N=170), aged 16‐27 years, in clinical

Top‐tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour­nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter­ventions and brain stimulation techniques are treatment options for children/adolescents with mental disorders

Previous studies have documented the utility of a transdiagnostic internalizing factor in predicting important future outcomes (e.g., subsequent mental disorder diagnoses). To date, however, no study has investigated whether an internalizing factor predicts mortality risk. Also, while pre­vious studies of mortality risk have emphasized its associations with particular internalizing disorders, no study