搜索结果：European child & adolescent psychiatry

The ability to predict the risk of severe mental disorders holds considerable promise for individuals at risk, potentially enabling prevention and early intervention. Although the clinical application of such predictive models in child and adolescent psychiatry remains a future prospect, it is essential to consider their social and ethical implications that their use may entail. This study explores child and adolescent psychiatrists' views on these issues through a cross-sectional online survey distributed to members of the European Society for Child and Adolescent Psychiatry. Of the 81 respondents, the majority identified the most significant benefits of using prediction tools as enabling earlier intervention by healthcare professionals (81.5%), improving the quality of care (77.8%), and helping families enhance their resilience (63%). Participants also expressed concern about potential harms, particularly violations of privacy (74.1%), discrimination (92.6%), and the lack of explainability in Artificial Intelligence algorithms (74.1%). While most participants recognise potential medical benefits in the clinical use of predictive tools, numerous concerns must be addressed before such technologies can be considered viable. These include unresolved ethical challenges, such as risks related to privacy, potential of stigmatisation and discrimination, and algorithmic opacity, as well as limitations of healthcare systems.

To elucidate the genetic architecture of blood pressure (BP) and heart rate (HR) during early life and assess their potential relevance to adult health outcomes. The largest genome-wide association study (GWAS) meta-analyses to date of childhood systolic BP, diastolic BP, pulse pressure, and mean arterial pressure (n = 28 425) and HR (n = 22 565) were conducted in children of European ancestry aged 4-17 years. Follow-up analyses included comparisons with adult GWAS results, polygenic risk score (PRS) analyses in independent cohorts of diverse ancestries, and a phenome-wide association study in the UK Biobank. Eight genome-wide significant loci were identified for childhood BP (KIAA2013, CACNB2, PLCE1, PAX2, COL4A2, RP11-236L14.1, CFDP1, TPX2) and three loci for childhood HR (CCDC141, ACHE, MYH6); all novel in children but previously reported in adults. Childhood PRSs explained up to 1.6% of BP variance and 5.2% of HR variance among children of European ancestry. Genetic correlations between childhood and adulthood BP traits were moderate (rg = 0.4-0.7), suggesting age-specific genetic effects on BP. In the UK Biobank, higher childhood BP PRS levels were significantly associated with a broad range of adult health outcomes, particularly cardiometabolic outcomes such as hypertension, angina, myocardial infarction, and cardiovascular disease-related mortality. These findings advance the understanding of the genetic architecture of childhood BP and HR and provide compelling genetic evidence linking childhood BP to a broad spectrum of adult health outcomes-particularly cardiometabolic conditions-which may inform targeted prevention strategies from a young age.

Evidence-based parenting programmes are widely used to prevent violence against children and improve parenting and mental health. Despite hundreds of randomised trials, little is known about their outcomes when delivered at scale within routine delivery. This study assesses the WHO-endorsed and UNICEF-endorsed Parenting for Lifelong Health programme for caregivers and adolescents, delivered through non-governmental organisation and government in Botswana, the Democratic Republic of the Congo, Eswatini, South Africa, South Sudan, Tanzania, Zambia and Zimbabwe, with support from the President's Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID) and the European Union. Pre-post surveys for caregivers and adolescents were integrated into service data collection between 2016 and 2022. Abbreviated standardised measures of physical abuse, emotional abuse, approval of corporal punishment, positive involved parenting, monitoring/supervision, caregiver depressive symptoms, parenting stress and adolescent depressive symptoms and externalising behaviour were used. Individual country scores were analysed separately for caregivers and adolescents using generalised linear mixed-effects models, and cross-country data were combined using a random-effects meta-analytic model. 123 050 participants were included (93% retention, 57 908 adolescents (96% female), 56 423 caregivers at follow-up). In all-country meta-analyses, estimates showed reduced physical abuse (-65%; 95% CI 51% to 74%), emotional abuse (-59%; 95% CI 48% to 68%) and approval of corporal punishment (-55%; 95% CI 48% to 60%). Positive involved parenting increased (+52%; 95% CI 24% to 87%) and poor supervision/monitoring decreased (-48%; 95% CI 34% to 58%). Caregiver depressive symptoms (-25%; 95% CI 8% to 48%), parenting stress (-46%; 95% CI 41% to 52%), adolescent depressive symptoms (-22%; 95% CI 1% to 38%) and adolescent externalising behaviour problems (-43%; 95% CI 29% to 54%) all declined. There was heterogeneity in pre-intervention scores and extent of change between humanitarian and development settings, and between different target groups, but strong consistency across caregiver and adolescent reports. In eight African countries, including humanitarian and pandemic-affected contexts, an evidence-based parenting programme showed consistent associations with reduced violence against adolescent girls and improved parenting and mental health.

Pediatric obesity (OB) treatments show small effects and high dropout rates, potentially due to low motivation in participating families. Motivation prior to a weight management program is referred to as "readiness to change" (RTC). Understanding RTC is key to improving outcomes. Previous studies observed determinants for RTC, but results are heterogenous and data about adolescents' RTC are lacking. Baseline data of the STARKIDS trial were used to find determinants of RTC in (a) adolescents (n = 125), (b) their caretakers (n = 185), and (c) caretakers of younger children (n = 325). Potential determinants were sociodemographic variables, weight, general quality of life (QoL), OB-related QoL, self-efficacy, and body image of caretakers and children. Pearson correlations (t-tests and ANOVA) and multiple linear regression analyses were performed. The RTC of adolescents and of both groups of caretakers was determined by adolescents'/children's OB-related QoL. The RTC of caretakers of younger children was also determined by children's BMI-SDSLMS. OB-related QoL plays a major role in determining adolescents' and caretakers' motivation prior to weight management. In all groups, most significant determinants refer to corresponding family members, showing that the mutual influence is large. German Clinical Trials Register (DRKS) DRKS000228 13 (acknowledged primary register of the World Health Organization).

To compare the short-term efficacy and tolerability of second-generation antipsychotics (SGAs) versus placebo for schizophrenia-spectrum disorders in children and adolescents using pairwise meta-analysis of randomized trials, and to summarize prospective long-term evidence. We pooled acute double-blind randomized controlled trials (RCTs) (≤12 weeks; participants ≤19 years; Diagnostic and Statistical Manual of Mental Disorders [DSM]/International Classification of Diseases [ICD] schizophrenia-spectrum) with random-effects models. Efficacy was change in Positive and Negative Syndrome Scale (PANSS) or Brief Psychiatric Rating Scale [BPRS] total score, expressed as standardized mean difference (SMD) versus placebo. Short-term tolerability was defined as adverse event-related outcomes and expressed as risk ratios (RRs) for potentially drug-related treatment-emergent adverse events (TEAEs) versus placebo. Trials without a placebo arm and long-term prospective studies were synthesized narratively. Seventeen acute RCTs were identified; ten were placebo-controlled and entered pooling (agents: olanzapine [OLZ], risperidone [RSP], asenapine [ASP], aripiprazole [APZ], brexpiprazole [BRX], blonanserin [BNS], quetiapine [QTP], lurasidone [LUR], paliperidone [PAL], ziprasidone [ZPD]); seven head-to-head or open-label trials were not pooled. Placebo-referenced efficacy favored several agents: OLZ -1.12 [-1.44 to -0.81], RSP -0.93 [-1.22 to -0.63], BNS -0.50 [-0.89 to -0.11], ASP -0.41 [-0.65 to -0.17], APZ -0.37 [-0.61 to -0.13], BRX -0.34 [-0.61 to -0.07], QTP -0.33 [-0.61 to -0.06], LUR -0.31 [-0.54 to -0.08], PAL -0.25 [-0.57 to -0.07], and ZPD -0.06 [-0.31 to -0.19]. For tolerability, most drugs showed numerically higher TEAE risk versus placebo with wide confidence intervals (typical RR ≈ 2-3); APZ showed a statistically higher risk (RR 2.34 [1.42-3.86]), whereas the point estimate for LUR was below 1 (0.47 [0.18-1.17]). One randomized maintenance study and 12 open-label extensions were reviewed narratively and were not meta-analyzed. Several SGAs produce short-term symptom reductions versus placebo in children and adolescents with schizophrenia-spectrum disorders, with heterogeneity in TEAE risk across agents. Evidence for long-term maintenance and continuation remains limited, underscoring the need for adequately powered randomized continuation trials to guide sustained treatment in this population.

Low-level viremia (LLV) has been associated with an increased risk of virological failure among adults on antiretroviral therapy (ART). However, evidence on the clinical implications of LLV among adolescents living with HIV remains limited. This study aimed to assess the prevalence and predictors of LLV and to determine the association between LLV and subsequent virological failure. We analysed data from an integrated prospective cohort of adolescents living with HIV linked to the National Institute for Communicable Diseases (NICD) data warehouse in South Africa. Using routine viral load data from 2015 to 2021, we estimated the prevalence of LLV at the first test. We then used mixed-effects logistic regression to identify socio-demographic factors associated with LLV. Among adolescents with at least three viral load measurements, we assessed the association between LLV and subsequent virological failure using a Cox proportional hazards model in RStudio. Among 730 adolescents, the prevalence of LLV ranged between 10.4% and 20.1%. Older adolescents aged 15-19 years (aOR: 1.92; 95% CI: 1.44-2.55) and those ≥20 years (aOR: 1.69; 95% CI: 1.12-2.57) had significantly higher odds of LLV compared to those 10-14 years. Among 617 adolescents, 13.3% had LLV, of which 17.1% subsequently progressed to virological failure. Those experiencing LLV were associated with a four-fold (aHR 4.91; 95% CI: 2.46-9.79) increased hazard of virological failure compared to suppressed adolescents. The prevalence of LLV among adolescents living with HIV on ART is high and LLV strongly predicts virological failure. Enhanced adherence support for adolescents with LLV is needed to minimize the risk of long-term virological failure.

Eating disorders (EDs) are heritable, yet the developmental pathways through which genetic liability manifests in early life remain unclear. To investigate the associations between genetic liability for anorexia nervosa (AN) and binge eating (BE) and disordered eating behaviors (DEB) across childhood, and to identify the mediating roles of metabolic and psychosocial traits. This longitudinal observational study used genomic and behavioral data from the Adolescent Brain Cognitive Development SM (ABCD®) Study, a multisite, population-based cohort of children recruited between 2016 and 2018 at ages 9 to 10 years from 21 research centers across the United States. A three-wave temporal design was employed, utilizing data from baseline (T0), Year 1 (T1), and Year 2 (T2) follow-ups. Primary analyses focused on 5,618 participants of genetically inferred European (EUR) ancestry, with exploratory analyses conducted in a diverse sample of 9,132 participants. Polygenic scores (PGS) for AN and BE were calculated using summary statistics from the most recent genome-wide association studies. Mediators included BMI, ADHD, anxiety/depression, and social problems from the Child Behavioral Checklist assessed at Year 1 follow-up (T1). Parent reported DEB symptoms via the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS). For longitudinal association analyses, DEB were pooled across T0, T1 and T2 to assess the relationship between genetic liability and childhood symptom severity. For mediation analyses, DEB at T2 follow-up were used to ensure a clear temporal sequence between mediators at T1 and the outcomes. Among 5,618 EUR participants (mean [SD] age, 9.91 [0.62] years; 47% female), longitudinal association models revealed that higher AN-PGS was associated with increased AN symptoms, while BE-PGS was associated with increased BE and AN symptoms. These patterns were largely consistent in exploratory cross-ancestry analyses. Mediation analyses showed that BMI mediated genetic risks across sexes, while ADHD and anxiety/depression symptoms emerged as additional mediators in females. Genetic liabilities to AN and BE contribute to childhood DEB through sex-dependent pathways, highlighting the developmental continuity of ED risk from childhood. Integrating genetic profiles with behavioral markers may facilitate early identification and support multifaceted interventions.

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Cross-cultural empirical evidence on the validity of measures of depression and anxiety symptoms in adolescents is scarce and inconclusive. The present study investigated the cross-national measurement invariance and convergent validity evidence of the Depression and Anxiety scales of the Depression Anxiety and Stress Scales (DASS-21). We sampled 16,802 adolescents (58.1% female) aged 14-19 years across 30 countries from five continents. Both exact and approximate measurement invariance were tested. The results provided evidence for the exploratory structural equation model (ESEM) as the best representation of the data in most countries. Full scalar invariance was not supported when tested across all countries, but only among two Southern Asian countries (Bangladesh, India), two Northern European countries (Estonia, Lithuania), the six former republics of Yugoslavia, and European and American countries grouped by UN subregions. Results of the alignment method supported the approximate invariance of the ESEM model across 29 countries. Associations between Depression and Anxiety ESEM factors and life satisfaction, positive affect, and negative affect conformed to the theoretical expectations in most countries. Our findings indicate that the Depression and Anxiety scales of the DASS-21 have potential for use in cross-national research on adolescent internalizing symptoms, but we highlight issues of using it outside of Western (European, North American) settings.

To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads, as well as within subgroups, served as an integral part of the guideline development process. New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.

The World Psychiatric Association, the American Psychiatric Association, the European Psychiatric Association, and the Global Expert Task Force on ECT welcome the WHO's emphasis on rights-based, person-centered, and recovery-oriented mental health policies. However, they express concern that the WHO Guidance contains scientifically inaccurate and misleading statements particularly regarding electroconvulsive therapy (ECT). These portray ECT as inherently dangerous and advocate for its restriction or prohibition, thereby reinforcing stigma and potentially limiting access to evidence-based care for severely ill patients. Substantial scientific evidence shows that ECT is an effective, safe, and well-tolerated treatment, supported by decades of research and international clinical guidelines. Although acknowledging global variations in regulation and access, the associations stress that denying ECT in life-threatening situations, including in children and adolescents or in patients who lack decision-making capacity, would be unethical. The authors call on WHO to integrate robust scientific evidence and lived experience into future guidance.

To develop an evidence-based, consensus-driven service model for the identification, assessment and treatment of tic disorders in children and young people (CYP) in England, addressing the absence of dedicated pathways and national clinical guidance. Two-stage consensus study comprising a Delphi survey, expert/patient and public involvement (PPI) review and regional stakeholder workshops. UK healthcare and community settings relevant to tic disorder assessment and management (primary care, neurodevelopmental services, child and adolescent mental health services). Stage 1: UK-based clinicians, researchers and practitioners with expertise in tic disorders (Delphi panel; n=49; 98% retention across rounds). Stage 2: regional stakeholders including clinicians, commissioners, service managers, third-sector representatives and parents/carers (n=36). Eligibility required relevant professional or lived experience; no exclusions applied beyond this criterion. Identification of a consensus-based component of a best-practice service model for tic disorders and barriers and facilitators to implementation across regional pathways. The Delphi process generated consensus on 40 core components, refined to 43 following expert and PPI review. Agreed features included referral criteria, comprehensive assessment, psychoeducation, behavioural interventions, pharmacological options and integrated cross-service working. Stakeholder workshops highlighted key implementation challenges, including workforce training, funding constraints and coordination across neurodevelopmental and mental health services, informing practical adaptations to the model. This consensus-informed service model provides structured, UK-specific guidance to support earlier identification, appropriate intervention and improved care coordination for CYP with tic disorders. Future research should assess real-world implementation and impact. The model offers actionable recommendations for referral pathways, intervention provision and service configuration. Adoption may reduce diagnostic delays, minimise misdiagnosis and strengthen collaboration between primary, neurodevelopmental and mental health services, leading to improved outcomes for CYP with tic disorders.

This work presents a policy analysis regarding Problematic Usage of the Internet (PUI) across seven countries (Netherlands, Spain, Hungary, Lithuania, Portugal, Estonia, and Switzerland) belonging to or associated with the European Union (EU). I It examines legislative instruments addressing PUI and its multifaceted impacts on society, including social, economic, and political dimensions. Despite the growing prevalence of PUI, particularly among adolescents, and its association with various mental health concerns, the study reveals a notable gap in direct policy interventions targeting PUI within these countries. Existing regulations largely focus on broader digital governance issues like data protection, cybersecurity, and market regulation, offering only indirect approaches to mitigating PUI's adverse effects. Our findings highlight a pressing need for innovative policy frameworks that incorporate mental health considerations into digital governance, promoting a balanced approach that fosters market innovation while ensuring robust public health protections. Building on the policy discourse examined in this study, future research should focus on developing targeted, multidimensional strategies to mitigate the risks associated with problematic internet use (PUI), with particular emphasis on safeguarding the well-being of vulnerable populations.

Prenatal air pollution exposure is associated with altered neurodevelopmental outcomes in childhood. It is unknown whether specific infant characteristics or prenatal exposure windows influence the relationship between prenatal exposure and neurodevelopmental outcomes. We studied 498 (262 male) toddlers born at 23+6-43+4 gestational weeks (125 born <37+0 weeks) who were recruited to the developing human connectome project. We characterised the association between average prenatal exposure to particulate matter [PM2.5 and PM10] and nitrogen dioxide (NO2) across gestation in each trimester modelled using maternal residential postcode, and cognitive, language and motor abilities assessed with the Bayley Scales of Infant and Toddler Development-3rd edition (age at assessment 17.3-34.5&#xa0;months). Higher first trimester exposure to all pollutants was associated with lower language scores in toddlerhood adjusting for sex, ethnic group, maternal pregnancy complications, gestational age at birth, birth-weight z-score, home language environment and socioeconomic deprivation. Moderation analyses revealed higher exposure to all pollutants across gestation was associated with lower motor scores in preterm infants adjusting for sex, birth-weight z-score, ethnic group, maternal pregnancy complications, socioeconomic deprivation and duration of respiratory support. Increased air pollution exposure early in pregnancy is associated with altered early language development. Preterm infants demonstrate increased vulnerability to the adverse effects of gestational pollutant exposure on motor development in early childhood. Maternal exposure to air pollution during pregnancy is a potentially modifiable risk factor and reductions may improve neurodevelopmental outcomes. KEY POINTS: The effect of prenatal air pollution exposure on neurodevelopment in toddlers was examined. Higher 1st trimester exposure was associated with lower language scores. Higher exposure across gestation was associated with worse motor skills in very preterm infants.

Risperidone, an atypical antipsychotic, is increasingly prescribed in pediatric patients with psychiatric disorders. It is primarily metabolized by CYP2D6 to 9-hydroxyrisperidone, an active metabolite associated with a higher risk of adverse effects. The CYP2D6*17 and *29 alleles are prevalent in individuals of African ancestry and less studied than variants found in European ancestry individuals. This knowledge gap contributes to differences in health outcomes in individuals of non-European origin. The primary objective of this study is to replicate recently identified risperidone-specific activity for the CYP2D6*17 and *29 alleles. During psychiatric hospitalization, CYP2D6 was genotyped as part of routine care. Remnant plasma specimens were analyzed for risperidone and 9-hydroxyrisperidone by tandem liquid chromatography mass spectrometry in 161 patients administered risperidone. The log-transformed metabolite-to-parent ratio was used to estimate CYP2D6 enzymatic activity. The effect of each CYP2D6 allele on activity was assessed with linear regression that included strong CYP2D6 inhibitor use. Patients were predominantly white, non-Hispanic youth, ages 5-18&#x2009;years old (mean 12.5&#x2009;years), and 26.7% were prescribed concomitant CYP2D6 inhibitors. The frequency of *17 and *29 alleles were 15.5% and 8.3%, respectively, among Black patients (n&#x2009;=&#x2009;42). After accounting for CYP2D6 inhibitors in the model, the activity of the *17 allele was >&#x2009;4-fold that of the *1 allele (p&#x2009;=&#x2009;0.006) and the *29 allele was 10% that of the *1 allele (p&#x2009;=&#x2009;0.021), comparable to alleles with no function. The *17 allele confers greater metabolic activity for risperidone than reflected in current pharmacogenetic guidelines. Using existing activity scores may underestimate metabolism in *17 carriers and overestimate it in *29 carriers. Incorporating substrate-specific activity scores and dosing recommendations would support improved dosing.

Using data from the EU-GEI Work Package 2 (EU-GEI WP2) programme, we sought to test several hypotheses related to gaps in our knowledge of associations between childhood adversities and psychosis. EU-GEI WP2 comprises incidence and case-control studies of first-episode psychosis conducted in 17 sites in 6 countries. In each site, over 2-year periods, we identified and collected relevant data from individuals aged 18-64 with a first-episode psychosis and with no history of psychosis. Missing data were imputed. We used multi-level logistic regression to test our hypotheses. In total, 1071 cases and 1497 controls were included. We found variations in the prevalence and the magnitude of associations between any adversity and psychosis by place (eg, odds ratios ranged from 0.4 [Cuenca, Spain] to 12.1 [Madrid, Spain]). The weighted percentages reporting adversities in control samples were associated with site incidence rates (eg, 3+ adversities: Spearman's rho 0.56, P .025). We found variations in the magnitude of associations by sex (eg, effect of physical and sexual abuse stronger among women), by age of exposure, and by severity and frequency of adversities (eg, largest odds ratios for adversities involving hostility, threat, and violence). Variations across populations in prevalence and effects of adversities may contribute to variations in rates of psychosis. Variations in effects by sex and age of onset may point to sex-specific mechanisms and to developmentally sensitive periods. Adversities involving severe threat, hostility, and violence may have the largest effects on risk of psychosis.

Methylphenidate is the leading pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) in childhood and adolescence. Individuals with ADHD have a higher risk of psychosis, but the long-term relationship between methylphenidate and risk of developing psychotic disorders is unknown. To estimate the relationship between methylphenidate treatment and the risk of nonaffective psychosis in children and adolescents diagnosed with ADHD. This cohort study included instrumental variable analysis of data linkage from multiple national Finnish registries for all individuals born from 1987 to 1997 (n&#x2009;=&#x2009;697&#x202f;289). These registries were used to identify childhood and adolescent ADHD diagnoses (age <18 years) from 2003 onwards. Data were analyzed from June 2023 to December 2025. Cumulative amount of treatment with methylphenidate used in 4 intervention windows: within 1, 2, 3, and 4 years after ADHD diagnosis. Hospital district prescribing propensities (average prescribing within each hospital district, within each intervention window) were used as instruments. Diagnosis of nonaffective psychotic disorder (by code from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) by the end of follow-up (December 31, 2016). Instrumental variable analyses were conducted using 2-stage least squares modeling and the Anderson-Rubin test. Risk differences (RDs) were estimated for each intervention window. Among 3956 individuals diagnosed with ADHD (3181 male [80.4%], 775 female [19.6%]; median [IQR] age, 14.16 [11.78-15.93] years), 2728 (69.0%) received methylphenidate at least once. A total of 222 individuals (5.7%) were diagnosed with nonaffective psychosis by mean (SD) age 22.16 (2.39) years (range, 19.00-29.81 years). There was substantial variation in hospital district prescribing propensity (for example, first-year range, 0.07 to 0.30). Instrumental variable analysis indicated that sustained treatment with methylphenidate (30 mg/d) was not associated with the risk of nonaffective psychosis in the overall ADHD sample (1-year RD, -0.14; 95% CI, -0.85 to 0.42; and 4-year RD, -0.15; 95% CI, -0.49 to 0.11). Secondary analyses indicated a reduced risk of nonaffective psychosis among individuals diagnosed in childhood (age <13 years: 3-year RD, -0.24; 95% CI, -0.45 to -0.03; P&#x2009;=&#x2009;.03; 4-year RD, -0.21; 95% CI, -0.48 to -0.07; P&#x2009;=&#x2009;.02). An insufficiently strong instrument precluded the same secondary analyses in those diagnosed in adolescence. This study of national Finnish registry data for individuals with ADHD found no overall relationship between sustained treatment with methylphenidate risk of nonaffective psychosis; in secondary analyses, a potentially protective effect of methylphenidate treatment against later psychosis in children diagnosed with ADHD was found. Further research is needed to evaluate potential effects of treatment in individuals diagnosed in adolescence and adulthood.

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Individuals with severe mental illness (SMI) face significantly reduced life expectancy, mainly driven by natural causes such as cardiovascular disease, pulmonary disease, cancer, and stroke. Although medical care has advanced, the mortality gap between individuals with SMI and the general population has continued to expand in many countries over recent decades. This disparity is exacerbated by systemic healthcare inequities, fragmented healthcare, insufficient use of preventive measures, and the burden of multimorbidity. This paper proposes six actionable strategies to reduce the excess mortality associated with SMI by integrating physical healthcare into psychiatric services. Across all recommendations, we explicitly embed lifestyle interventions, especially structured physical activity given its comparatively stronger evidence base in SMI, alongside sleep and nutrition support delivered through pragmatic, accessible programs. First, psychoeducation should be expanded to include physical health literacy. Second, structured smoking cessation programs must be implemented. Third, early identification and management of obesity, including pharmacological interventions, should be prioritized. Fourth, hypertension should be routinely screened and treated within psychiatric settings. Fifth, dyslipidaemia and diabetes require systematic monitoring and timely initiation of statins, metformin and GLP-1 receptor agonists. Sixth, these interventions must be delivered through integrated care models that ensure continuity, optimal self-management, and long-term outcome monitoring. Together, these six approaches offer a framework to narrow the mortality gap between people with SMI and the general population, as well as support a shift toward holistic, person-centered care. We synthesise the evidence on physical health disparities in SMI and provide practical, evidence-based recommendations for psychiatric settings. Together, these strategies offer a feasible, person-centered framework to improve health outcomes and reduce premature mortality in individuals with SMI.