INTERNATIONAL REVIEW OF PSYCHIATRY

The future of psychiatry: a dozen questions while gazing into the crystal ball
Basu D
After musing over the possible reasons for our persistent preoccupation with the 'future of psychiatry', I formulate twelve arbitrary questions on this topic, and venture into their possible answers in two ways: first, what I would thirty years hence (a playful fantasy); and second, what I thirty years hence (a putative projection). These questions range from: will psychiatry survive, as psychiatry, to: What about Low-and Middle-Income Countries? While gazing into this crystal ball armed with the current state of knowledge, attitude and practices, in the end it becomes clearer to me that, whatever psychiatry will experience over the ensuing decades, it should be imperative to sustain the essential core of psychiatry, both as a science and as an art of therapy: socioecological and political-commercial determinants of mental health along with its burgeoning biological determinants; the need for effective communication and relation at every level; and that precious thing called therapeutic alliance or bonding. The value of these will continue to exist, and perhaps increase, over the years and decades, provided we value these values and nurture these as essential components of psychiatric training.
Vulnerability factors and mental health outcomes in children and adolescents
Ventriglio A, Castaldelli-Maia JM and Torales J
Nuclear psychopathy? Exploring psychopathic trait estimates in Cold War political leaders inferred from expert-informant ratings
Smith A, Graña J, Bitterlich N, Bhugra D, Guttormsen S and Liebrenz M
Recently, resurgent personalist regimes and geopolitical instabilities have amplified concerns about psychopathic personality traits in high office. Yet, psychopathic traits and their associated correlates remain explicitly underexamined within the dynamics of international conflict, particularly nuclear flashpoints, where individual decision-making could entail disproportionate consequences. As part of a cumulative project on functional and psychological factors in Cold War leadership, preliminary psychopathic trait estimates were generated for 13 leaders central to the Suez Crisis (1956), the Cuban Missile Crisis (1962), and the Yom Kippur War (1973). Subject-matter experts ( = 149) rated leaders at-a-distance using an adapted 33-item Comprehensive Assessment of Psychopathic Personality-Lexical Rating Scale, a dimensional, non-diagnostic inventory suitable for non-clinicians. Inferred from over 5,000 item-level responses (155 total ratings;  = 11.9/leader), trait profiles revealed domain-specific and between-leader accentuations, many of which converged with historical and behavioural evidence. Representing disparate political systems, higher-scoring leaders exhibited pronounced "Dominance", "Self", and "Behavioural" dimensions (M ≈ 2.04-3.00; 1-4 scale), suggesting recurring tendencies and transideological psychopathic trait manifestations. Strong average-measure interrater reliability supported the robustness of these exploratory estimates, notwithstanding possible respondent artefacts. Accordingly, this study further demonstrates the methodological feasibility of retrospective psychopathic trait evaluations, underpinning future triangulation and potential investigations into their conflict-relevant intersections.
Reflections on the future of child & adolescent mental health
van der Gaag RJ
There is a worldwide mental health crisis. The WHO estimates that 1 in 7 children suffers from and is impaired by mental problems and disorders. There are epidemics of neurodevelopmental disorders, eating disorders, substance and behavioural addictions in youth. The suicide figures worldwide are shifting. A decrease of suicides in elder people especially men and increase in suicide in young people especially women. Social media have an enormous impact on youngsters, with obvious benefits but big backlashes too: screen- fear of missing out-addictions and a worry impact of cyber bullying! In this paper the necessity of mental health services adapting in a flexible way to the increasing demand and possibilities are highlighted including peer support by Emphasis is put on the appeal to (mental) healthcare workers to speak up and address the causes. Mental health should be a responsibility of all, especially politicians and decision makers.
Ketamine for major depression in adolescents: a systematic review and meta-analysis of efficacy and safety
Magalhães IPA, Lopes DN, Amato I, Ribeiro MVV, Luz R, Lacerda ALT, Asevedo E, Martins CB and Caetano SC
Major depressive disorder (MDD) significantly impairs adolescents' development, with increasing rates of treatment resistance and suicide risk. Ketamine has emerged as a promising, rapid-acting antidepressant in adults, but its efficacy and safety in adolescents remain unclear. This systematic review and meta-analysis aimed to evaluate short-term outcomes of ketamine administration in youth with mood disorders. Following PRISMA guidelines and PROSPERO registration (CRD42024568658), four studies were included, comprising 272 adolescents aged 12-18 years. Three studies (n = 189) contributed data to the meta-analysis. At 24 hours post-administration, ketamine showed a small, non-significant effect on depressive symptoms compared to placebo (SMD = -0.19; 95% CI: -0.41 to 0.04). Clinical response and remission were not significantly different between groups, but ketamine was associated with a significantly higher rate of suicidal ideation remission (RR = 1.49; 95% CI: 1.06 to 2.08). Adverse events were generally mild, transient, and consistent with known pharmacological effects. While findings support ketamine's potential role in acute presentations, current evidence is preliminary. Larger randomized controlled trials with extended follow-up are needed to clarify the clinical utility, optimal protocols, and long-term safety of this approach in adolescent populations.
Mental health's next wave in India: professionals driving collective care
Thomas B
India, with its vast sociocultural diversity faces unique and complex mental health challenges that reflect profound regional, economic, and demographic variations. This paper examines the current landscape and future directions of mental health practices in India, arguing that a paradigm shift is essential to move beyond traditional, clinic-based approaches toward integrated, community-oriented care models. It highlights key challenges including significant treatment gaps, urban-centric service delivery, stigma, and insufficient workforce capacity. In response, the paper proposes a reimagined role for psychiatry - one that embraces multidisciplinary collaboration, leverages digital health technologies, and prioritizes culturally resonant frameworks. By anchoring mental health care within communities, strengthening primary care integration, and adopting scalable, socially responsive interventions, Indian psychiatry can not only address its own systemic challenges but also emerge as a leader in global mental health, particularly for low- and middle-income countries. The recommendations underscore the need for policies that support task-sharing, innovative training, and public engagement to build a more inclusive, effective, and resilient mental health ecosystem for India's future.
Language and psychiatric symptom overlap in FTD: an SLP perspective
Masson-Trottier M
Frontotemporal dementia (FTD) often presents with complex behavioural and communication changes that are frequently misinterpreted as primary psychiatric disorders, contributing to delayed diagnoses, inappropriate interventions, and caregiver distress. This commentary explores overlapping clinical features of psychiatric and language symptoms in FTD and highlights the important role that speech-language pathologists (SLPs) can play in early identification, care planning, and psychosocial support. Drawing on two illustrative vignettes, an individual living with behavioural variant frontotemporal dementia (bvFTD) and another living with semantic variant primary progressive aphasia (svPPA), this paper examines how communication impairments overlap psychiatric conditions and how SLP-led interventions can clarify diagnoses, reframe behaviours, and foster functional participation. These cases emphasise the importance of SLP involvement in interdisciplinary teams, not only for language rehabilitation but also for caregiver education and relational scaffolding. Despite a growing understanding of FTD, clinical frameworks often fail to integrate speech-language assessment early into pathways, particularly in younger individuals. This paper advocates for earlier SLP referral, structured caregiver supports, and formal recognition of communication disorders as diagnostic and therapeutic entry points for neurodegenerative disease. Enhanced awareness of the communicative dimensions of FTD may improve diagnostic accuracy, reduce stigma, and promote more holistic and relationship-centred models of care.
Sociodemographic, clinical, and global functioning vulnerabilities in Mexican children and adolescents with and without autism spectrum disorders
de la Peña FR, Ulloa RE, Rosetti MF, Díaz Sánchez R, Soto-Briseño AI, Mayer-Villa PA, Escamilla-Orozco RI and Medina-Rodríguez JC
Research indicates that sociodemographic, clinical, and global functioning are associated with autism spectrum disorder (ASD). To measure and compare sociodemographic, clinical, and global functioning vulnerability profiles of a sample of Mexican children and adolescents with and without ASD. The study was done at two outpatient institutions in Mexico City. The assessment used semi-structured interviews with rating scales, and -tests and chi-squared () tests were run to evaluate group comparisons. A latent class analysis was executed to generate probabilistic vulnerability profiles. A total of 103 participants were recruited, 22 with ASD (21.3%, mean age 12.8 ± 3.17, 77.27% male). Those without ASD showed a significantly special education placement ( = 3.91,  = 0.048), had oppositional and defiant symptoms ( = 3.32,  = 0.001), and lower global functioning as measured by the Children's Global Assessment Scale ( = 11.78;  = 0.001) and the World Health Organization Disability Assessment Schedule 2.0 ( = -4.10;  = 0.001). Vulnerability was identified in a subgroup of participants with ASD due to increased psychosocial and psychopathological symptoms and lower global functionality. Mexican children and adolescents with ASD experience special education placement and impaired global functioning.
Feasibility and tolerability of low-dose lithium for the treatment of agitation and abnormal motor behaviors in Frontotemporal Dementia
Zide BS, Barker MS, Silverman HE, Manoochehri M, Fremont R, Stein C, Kunicki ZJ, Lee S, Devanand DP and Huey ED
Agitation and abnormal motor behaviors are common, distressing symptoms of Frontotemporal Dementia (FTD). While these symptoms currently lack efficacious and safe pharmacological treatments, case reports in FTD and a clinical trial in Alzheimer's disease suggest that patients may benefit from lithium treatment. We designed a randomized, double-blind, placebo-controlled, 12-week clinical trial to evaluate low-dose lithium for the treatment of agitation and abnormal motor behaviors in FTD. However, the trial did not meet its recruitment target (n = 60). This report assesses the trial's feasibility and tolerability using recruitment, study completion, and safety metrics. Sixteen adults with FTD (median age 59.5 years; 69% female) were enrolled from 2017 to 2021. Fourteen participants (88%) completed the trial. The majority of participants on lithium were taking the maximum daily dose by Week 12 (600 mg), had median (interquartile range) final serum lithium levels of 0.42 (0.37-0.57), and reported minimal side effects, including drowsiness, diarrhea, constipation and insomnia. Preliminary data from intended efficacy outcomes showed no median pre-post changes between treatment groups. Low-dose lithium is feasible and well-tolerated in an FTD population. Further systematic study of lithium and its efficacy to treat agitation and abnormal motor behaviors in FTD is warranted.
The role of 'modern-type depression" in youth depression: sex-based differences and associated affective temperaments
Orsolini L, Longo G and Volpe U
The emergence of new psychopathological constructs, e.g. "modern-type depression" (MTD), arose concerns in diagnosis and treatment of youth depression. Our study explored the role of MTD within an Italian youth sample (n = 273; aged 14-25) with major depressive disorder (MDD), through MINI 7.0.0, BDI-II, TACS-22 and TEMPS-M. Around 49.8% of MTD depression was found, specifically among females (p < 0.001). Only depressive and cyclothymic temperaments together with TACS-22 "complaint" subscale were found positive predictors of depressive severity (F(4,170)=55.872, p < 0.001, R=0.568). Binomial logistic regression analyses found sex differences in the explanatory effects of affective temperamental profiles on the likelihood of developing MTD depression. In males, both depressive and cyclothymic temperaments (both, p = 0.004) are risky factors, while hyperthymic temperament is a protective factor (p = 0.010). In females, only cyclothymic temperament was found to be a positive predictor (p = 0.018). According to our findings, MTD may have a clinical relevance in youth MDD. There is the need to routinely include MTD assessment in clinical practice for a better MDD characterization and for offering tailored therapeutic approaches to MTD depression, based on sex differences and affective temperamental profile.
An early career psychiatrist perspective on the future of psychiatry: retaining our roots in times of growth
Lemon CA
Psychiatry is a discipline emergent from parts of other disciplines. This places it in a precarious position in society. Its practitioners must work with great uncertainty, formulate complex problems and respond to issues that fall outside the scope of other disciplines. Knowledge is always being added across psychiatry's biopsychosocial domains, and its purpose is constantly evolving in response to shifting societal perspectives on its role. Change in the coming decades will span data and knowledge, contexts of care, roles and relationships, as well as treatment advances. These changes will not manifest as obvious examples of linear progress, but instead as twists and turns characterised by rejections and revisions of ideas. This paper aims to explore how early career psychiatrists might navigate such changes by drawing on the enduring core skills and contributions of psychiatry. In doing this, one realises that while there may be observable differences in 30 years' time, at a deeper level, much may remain the same. This is not a pessimistic view, but instead one of optimism which highlights the continuous value psychiatry in the complex terrain of mental health care amongst its many other practitioners, systems and structures. In times of growth, our roots will be our guide.
Psychiatry at the turn of the century and a vision for future developments
Oquendo MA, Barrigon ML and Baca-Garcia E
From 1995 to 2025, psychiatry evolved from a primarily syndromic discipline toward a field increasingly shaped by neuroscience, digital technology, globalization, and shifting social expectations surrounding mental health. This transformation included major advances in diagnostic frameworks, brain imaging and genomics, psychopharmacology, evidence-based psychotherapies, and global mental health initiatives. The COVID-19 pandemic accelerated the adoption of telepsychiatry and exposed critical gaps in mental health infrastructure, while growing recognition of health disparities brought social determinants and equity to the forefront of research and clinical priorities.
Antisocial and criminal behavior in Young onset dementia - A Narrative review
Eaton JE and Darby R
Antisocial and criminal behavior is an underrecognized aspect of neurodegenerative diseases. These behaviors are defined as behaviors and actions that violate the basic rights of others. Antisocial behaviors are seen in relatively high rates in behavioral variant frontotemporal dementia, but can be seen in other conditions. Several recent tools have been developed in attempt to quantify antisocial behaviors and neuroimaging studies have helped identify likely brain regions and networks involved in the genesis of antisocial behaviors. These regions include the anterior insula, ventral striatum, orbitofrontal cortex, and prefrontal cortices. The management of such symptoms is challenging with limited high quality studies available at this time. The recognition of antisocial behaviors can help limit complications. Further work is needed to more clearly delineate the pathophysiology of antisocial behavior.
The future of psychiatry: clinical practice, diagnosis, and treatment
Turner S, Yadav P, Morrin H and Bhat A
This paper overviews the future of clinical practice in psychiatry, covering diagnosis, treatment, and public health. We consider recent advances and new controversies as psychiatry moves from a categorical to a dimensional approach to diagnosing and classifying mental illness; as well as the potential pitfalls of overdiagnosis, underdiagnosis, and misdiagnosis. We also review some of the most exciting new developments in treatment modalities, such as psychedelic treatments, ketamine, and new antipsychotics. The potential of interventional psychiatry using technology, and review techniques including neuromodulation, neurofeedback, brain-computer interfaces, AI-assisted psychotherapy, and virtual reality is also discussed in the context of future of public mental health strategy, including the important issue of online disinformation and how it can influence the public's understanding of mental health. Finally, we consider the evolving understanding of addiction, particularly behavioural and technological addictions. We conclude with a brief discussion of how best to influence the political leadership in using these new advances to develop evidence-based, scientifically-informed healthcare policy.
Early intervention for psychiatry itself: the invisible hands for future psychiatry
Chen EYH, Wong SMY, Lee J, Killackey E, Nelson B, Yim BHY, Arunachaleeswaran P, Ramachandran P, Raghavan Dhandapani V, Li Y, Rajagopalan A, Gao C, Thompson A, Clark S, Schubert OK, Chan SKW, Suen YN, Hui CLM, Honer WG and McGorry P
This narrative review probes the future trends of psychiatry from the perspectives of professionals working in the field of early intervention for psychosis and youth mental health. The review is co-constructed by a diverse group of clinicians and researchers, including those with lived experience, working in high- to low-resource settings in the Asia-Pacific. Grounded in the consideration of psychiatry When the early intervention lens is applied to the state of psychiatry itself, several 'at-risk' factors have been observed: dilution of the doctor-patient relationship, lack of a robust integrated model of the human person and psychopathology, increased commercialisation, excessive reliance on other professionals, disconnection of knowledge generation and transmission, and tension between the healing and public safety roles of psychiatry. The complexity of mental illness, coupled with high stigma and low resources (even in relatively affluent populations), continues to undermine the proper functioning of psychiatry as a medical speciality. These challenges are likely to intensify in the future. Psychiatry as a profession needs to consolidate a robustly integrated medical approach to mental illness that resists splitting into 'biomedical' and 'psychosocial' perspectives, in the form of a biopsychosocially-informed medical psychotherapeutic practice. It will need to work with other stakeholders in the broader landscape of public mental health without diluting the healing roles in treating mental disorders. Behind a number of recent changes, the 'invisible hand' of the market economy is potentially driving psychiatry towards more inequity and escalating costs. Some of these have been fuelled by decreased effectiveness of the conventional academic platform and the rise of new information platforms that are increasingly challenging to manage. A thoughtful, prudent, and coordinated approach by the profession is essential in ensuring a healthy trajectory for the future of mental health care.
Fountain House Lahore - integrating psychosocial rehabilitation and microfinancing in a holistic model of mental health recovery
Naeem F, Saleem R, Wakif Z, Abbasian H, Iqbal R and Javed A
In Pakistan, mental health disorders constitute an escalating global burden of disease. Under-resourced healthcare systems coupled with recent economic and environmental challenges exacerbate mental health distress and impedes the recovery of those suffering from mental health issues. Psychosocial rehabilitation provides a sustainable pathway to strengthen health systems capacity by focusing on functional recovery and community reintegration. Since 1971, Fountain House has been providing psychosocial rehabilitation to people suffering from mental health issues in Pakistan through its community-based social services. Poverty is both a cause and consequence of mental illness. Akhuwat, a non-profit organization, aims to address this gap by providing interest-free micro loans, vocational training and subsidized health and housing assistance to those deprived of formal financial services. This article explores early outcomes of a collaborative venture between Fountain House and Akhuwat, working at the intersection of poverty and mental health with the combined goal of psychosocial rehabilitation and economic empowerment.
Neuropsychiatric symptoms in behavioral variant frontotemporal dementia: a narrative review
Page J, Pontone GM and Davydow DS
Frontotemporal dementia (FTD) is one of the most frequent forms of early-onset neurocognitive disorders worldwide. Behavioral variant FTD (bvFTD), the most common FTD phenotype, is frequently associated with neuropsychiatric symptoms (NPS) such as apathy, depression, impulsivity, and repetitive behaviors that lead to diminished quality of life for patients and their loved ones. Common NPS in bvFTD are also similar to symptoms that can be present in psychiatric disorders, complicating diagnosis. The present review describes the clinical significance of NPS in bvFTD, provides guidance to psychiatrists with differentiating NPS due to bvFTD from psychiatric disorders along with an overview of tools that may aid clinical evaluations, and presents direction on future avenues of research into improving the care of patients with NPS due to bvFTD.
Eating disorders and psychiatry: past, present, and future
Ayton A, Kumar A and Downs J
Eating disorders (EDs) are complex conditions at the interface of mental and physical health, associated with high morbidity, mortality, and chronic disability. Historically, ED psychiatry has shifted from early medical observation to psychiatric formulation and, more recently, to psychology- and nursing-led service models. Despite advances in evidence-based psychological therapies and community expansion, outcomes remain modest and access to treatment is limited. Recent workforce growth centred on allied health professionals has not been paralleled by investment in psychiatric training, academic capacity, or consultant posts, resulting in limited specialist expertise. This imbalance has produced fragmented care and a two-tier system in which child and adolescent services have advanced while adult provision remains critically underfunded. Future progress will depend on revitalising eating-disorder psychiatry through sustained investment in training, workforce, and translational research. Integrating metabolic psychiatry, neurobiology, behavioural science, and digital health offers a path toward comprehensive, equitable, and improved treatments.
Depressive disorders in young people: phenomenology, prognostic features, and clinical outcome
Della Rocca B, Di Vincenzo M, Toni C, Luciano M, Sampogna G and Fiorillo A
Depressive disorders with onset during adolescence and young adulthood are common, disabling, and often difficult to diagnose due to their heterogeneous and developmentally specific presentation. Compared with adult depression, young people more frequently display irritability, somatic complaints, and behavioural problems, which can obscure recognition and delay treatment. This narrative review aims to synthesize current evidence on depressive disorders in young people, while highlighting implications for treatment and prevention. The keywords ("youth" OR "adolescent" OR "childhood" OR "child" OR "young") AND ("depression" OR "depressive symptoms" OR "mood disorder" OR "depressed mood") were entered in the main databases and combined through Boolean operators. Findings confirm that youth depression presents with distinct clinical features and strong sociocultural influences, is frequently comorbid with other psychiatric disorders, and follows a recurrent and impairing course. Psychotherapy remains the most effective intervention, with selective serotonin reuptake inhibitors indicated for moderate-to-severe cases. Preventive and school-based strategies show promising results but are unevenly implemented. In conclusion, depressive disorders in young people require early detection and developmentally sensitive, multimodal treatment strategies. Future work should prioritize scalable interventions that integrate psychosocial, pharmacological, and digital tools, with special attention to prevention and to the influence of cultural and contextual factors.
The future of addiction psychiatry
Arruda FS and Castaldelli-Maia JM
Addiction remains one of the most complex challenges in psychiatry, marked by conceptual ambiguity and persistent treatment gaps. Advances in neuroscience, genetics, neuroimaging and artificial intelligence have deepened understanding of reward circuitry, vulnerability and relapse trajectories, yet controversies endure regarding whether addiction is best conceived as disease, disordered choice or socially constructed phenomenon. This article aims to synthesize current debates and outline future perspectives in addiction psychiatry through an integrative framework that bridges biological, technological, systemic and humanistic approaches. Findings highlight the promise and limitations of precision psychiatry, pharmacogenetics and neurocircuit-guided interventions, as well as the ethical and equity challenges of AI-based tools and biomarker-driven approaches. Novel consumption forms (dual vaping, synthetic cannabinoids) demand adaptive clinical and regulatory responses. Values-based practice and phenomenological psychiatry emerge as essential for truly person-centered care. The future of addiction psychiatry lies in integrating science, technology, humanism and values to deliver ethically grounded, patient-centered and socially responsive care.
The 'virtual emptiness': The interplay role of boredom and loneliness in youth problematic smartphone use
Orsolini L, Longo G and Volpe U
Problematic smartphone use (PSU) among youths has emerged as a significant public health concern. PSU is defined as a pattern of smartphone use characterized by loss of control, preoccupation, and continued use despite negative consequences, often resembling behavioral addiction in its impact on daily functioning and well-being. A nationwide case-control study explored the prevalence and predictive role of boredom and loneliness in a cohort of Italian university students aged 18-24 years, as assessed by Smartphone Addiction Scale-short version (SAS-SV) for the presence/absence of PSU. Among enrolled 1,660 participants, PSU was identified in 31.7% of the sample. Multivariate regression model (sex weighted) revealed that SAS-SV levels were positively predicted by boredom inattention (p < 0.001) and disengagement (p = 0.007), emotional loneliness (p = 0.002) and general loneliness (p < 0.001). Logistic binomial regression analysis documented that PSU is significantly predicted only by higher levels of emotional loneliness and boredom state. Our findings underline the need for early preventive strategies and tailored therapeutic interventions targeting emotional regulation and coping strategies to manage boredom state, in order to reduce the risk of PSU in youths. Both boredom and emotional loneliness seem to be essential psychopathological targets for promoting youth psychological well-being in the digital era.
The future of psychiatry: Reflections on the past three decades and projections for the next three
Ndetei DM, Mutiso VN and Nyamai P
The field of psychiatry has experienced an incredible development within the last three decades as it is no longer an institution/medically based profession but rather is more inclusive of community care with emphasis on human rights and cultural sensitivity. Globally, neuroscience, psychopharmacology and psychotherapy developments have increased treatment options, whereas advocacy has reduced stigma and helped in patient autonomy. However, there are still challenges that comprise a widening treatment gap, workforce shortages, and inequities in access, particularly in low- and middle-income countries. In Kenya, psychiatry has transitioned from its historical monopoly by Mathari National Teaching and Referral Hospital to more widespread decentralization, policy reforms and integration into the general health systems. Nonetheless, a paucity of resources, unequal investment across counties, and entrenched stigma continue to hinder progress. The next three decades will require context-specific, culturally based strategies, which take into consideration utilization of digital innovations, integrating mental and physical health care, equity and inclusivity. The future of psychiatry is not only in the scientific breakthroughs but the ability to develop strong structures that address the local realities and at the same time connect with the global innovation.
Patterns of substance use and initiation among LGBTQIAPN+ youth in Brazil: Evidence from a population-based cohort
Figueiredo CPM, Alves Bezerra H, Miguel EC, Rohde LA, Salum GA, Pan PM and Caye A
Sexual and gender minority youth (SGMY) face unique psychosocial stressors that increase vulnerability to substance use. However, evidence from low- and middle-income countries (LMICs) remains limited. Objective: To compare the lifetime prevalence and age of onset of substance use between LGBTQIAPN+ and cisgender heterosexual adolescents in Brazil. Data were drawn from the Brazilian High-Risk Cohort Study for Mental Health Conditions (BHRC), a longitudinal, community-based study. A total of 1,492 participants aged 9-18 at wave 1 and 12-21 at wave 2 provided complete data on sexual orientation, gender identity, and lifetime use of alcohol, tobacco, cannabis, and cocaine. LGBTQIAPN+ adolescents had higher lifetime prevalence of tobacco (OR = 1.66; 95% CI: 1.22-2.26;  = 0.001), cannabis (OR = 1.94; 95% CI: 1.42-2.64;  < 0.001), and cocaine use (OR = 2.28; 95% CI: 1.21-4.13;  = 0.008) than cisgender heterosexual peers. These differences were driven by participants assigned female at birth, with no significant differences among males. LGBTQIAPN+ females also reported earlier initiation of alcohol ( = 0.001), tobacco ( < 0.001), and cannabis ( < 0.001). Conclusions: Brazilian LGBTQIAPN+ youth, especially females, show elevated substance use and earlier initiation, underscoring the need for targeted, gender-sensitive prevention strategies.
The global prevalence of mental disorders among adolescents: Focus on sex, regional and socio-demographic differences
Castaldelli-Maia JM, Ventriglio A and Torales J
Adolescence is a critical developmental period during which many mental and substance use disorders first emerge, yet global estimates remain limited. Using data from the Institute for Health Metrics and Evaluation for the Global Burden of Disease Study 2021, we examined prevalence among adolescents aged 10-19 years across 204 countries. In 2021, 15.2% had at least one mental disorder. Anxiety disorders were most prevalent (4.9%), followed by conduct disorder (2.7%), ADHD (2.6%), and depressive disorders (2.4%), with major depressive disorder affecting 2.0%. Autism spectrum disorders accounted for 0.9%, intellectual disability 1.7%, bipolar disorder 0.3%, and eating disorders 0.3% (anorexia 0.1%, bulimia 0.2%). Schizophrenia (0.04%) and other disorders (0.2%) contributed smaller fractions. Substance use disorders affected 0.8%, mainly drug use (0.5%) and alcohol (0.3%), with cannabis use disorders at 0.4%. Prevalence varied by sex, region, and socio-demographic development: females showed higher internalizing conditions, males higher externalizing disorders. High-SDI regions had highest prevalence (20.7%) versus low-SDI (13.4%); High-Income North America recorded 22.8%, South Asia 9.7%, and Sub-Saharan Africa 11.6%, likely reflecting under-recognition, stigma, and limited diagnostic capacity. These findings highlight the global significance of adolescent mental health, disparities across sexes and regions, and the need for context-specific prevention and treatment strategies.
Dementia care in old age psychiatry over 50 years
Lam LCW, Chan WC and Ikeda M
The global increase in number of people living with dementia and its mental health implications is closely linked to the development of Old Age Psychiatry (OAP) in the past 50 years. OAP focuses on addressing the complex psychiatric and physical needs of older adults, particularly those with dementia. Reflecting on the significance of early neuropsychiatric symptoms (NPS) in dementia, recent breakthroughs in early diagnostics and the amyloid targeting therapy (ATT) for Alzheimer's disease, it is time to examine the ongoing challenges and the role of OAP clinicians in managing dementia. The future of collaboration with medical, technological, and social experts presents opportunities for OAP to optimize dementia care beyond medication or social assistance, addressing the needs of people living with and their families along the whole disease spectrum.
Psychiatry and the future: Expertise, Artificial Intelligence, and emerging technologies
Santhouse A and Harrison S
Psychiatry has long felt itself to be under threat. The authors examine how the perception of threats to psychiatry has evolved over the last 35 years, as exemplified in papers from 1990 and 2011, and how recent development is linked to the current concerns about overmedicalisation and overdiagnosis in medicine and psychiatry. They examine this in the context of the developing technologies and cultures of information and artificial intelligence. They argue that, while psychiatry has always understood the workings of the mind through contemporary social, cultural and technological constructs, and always understood the mind to be embodied by the brain, the task of reaching a diagnosis remains difficult, vital and central to the question of the future of psychiatry.
Psychiatric vulnerability in children growing up with a parent with cancer - a systematic review
Montanari S, Koukopoulos A, Anesini MB, Bardi F, Kotzalidis GD, Autullo G, Marconi E, Moriconi F, Chieffo DPR, Camardese G, Sani G, Simonetti A and Janiri D
Psychological trauma is a universal experience among humans; when suffered during developmental ages it might affect development and be at the base of psychopathology. Having a parent diagnosed with cancer is a highly distressing experience for a child and may influence the development of future psychopathology. This PRISMA-adhering systematic review focused on studies of children with a parent diagnosed with cancer and reporting psychiatric diagnoses or clinically significant symptoms assessed with validated instruments. The review included 25 studies spanning from 1994 to 2025. Studies found increased prevalence of anxiety, depressive, and posttraumatic stress disorder in children and adolescents with a parent affected by cancer compared to controls. Internalizing problems were higher than externalizing problems in children and adolescents, especially girls. There have been few implemented programs for children with a parent with cancer, despite recognition of higher psychopathological risk. The few psychotherapeutic trials yielded results with small effect sizes, while there is a dearth of pharmacological trials that does not allow drawing conclusions. There is need to prioritize programs that take care of children with parents with cancer so to reduce future psychopathology. Psychotherapeutic interventions must target the internalizing and externalizing symptoms and address the posttraumatic aspects of the child's suffering.
An exploratory case series on patients with the phenocopy syndrome of frontotemporal dementia and their partners: leads for future research
Overvliet GM, van Haandel ZP, Hage SAL, van Engelen ME, Pijnenburg YAL and Krudop WA
The phenocopy syndrome of behavioural variant frontotemporal dementia (phFTD) refers to patients exhibiting clinical features of the behavioural variant of frontotemporal dementia (bvFTD), but lacking objective functional decline and neuroimaging abnormalities consistent with bvFTD. Although symptoms do not progress into dementia, they are disruptive and cause long-term family dysfunction. This case study aims to explore the social, biographical and demographic features of 8 patients with phFTD and their partners. The feasibility and subjective experience of a support group were explored. Eight phFTD patients and their partners completed self-report questionnaires assessing quality of life, family functioning, and coping styles. Most phFTD patients had some psychological vulnerability or reported a positive family history for psychiatric disorders. All couples showed challenges within family functioning and low quality of life (QOL) in both patients and their spouses. PhFTD patients predominantly utilized passive coping strategies whereas their partners tended to employ more active coping strategies. Our explorative study supports the hypothesis of a multifactorial biopsychosocial vulnerability in phFTD patients. In contrast to bvFTD patients, phFTD patients selfreport low quality of life. The discrepancy in coping styles between patients and their partners possibly contributes to the heavy impact on expressed burden.
Examining neuropsychiatric symptoms and functional decline in behavioral variant frontotemporal dementia
Morrow CB, Sah E and Onyike CU
Neuropsychiatric symptoms (NPS) are core features of behavioral variant frontotemporal dementia (bvFTD), but their association with functional decline is incompletely understood.
Current challenges in psychiatry issues on equity in mental health care in the light of the WHO health for all
Kastrup MC
The problem of global inequity in access to health care - including mental health care - remains a persistent challenge worldwide. The disparities are largely the product of social, economic, and political structures. If we are to address health inequity, targeted medical interventions are not sufficient. It calls for a transformation of the systems and policies that shape daily life. Bridging these gaps demands both local leadership and international solidarity. Marginalized groups-whether defined by ethnicity, gender identity, poverty or migratory status-face systemic barriers that demand more than superficial reforms but empowerment and provision of culturally competent care, without institutional biases. We need to integrate equity into all layers of health and social policy. International professional organizations may play an important role but the crucial role of UN agencies needs support and recognition when they bring forward actions like safeguarding the human rights of all marginalized groups regardless of their legal status and strengthening access to mental health care. Marginalized people remain marginalized if governments disregard responsibility and let them stay at the edge of society.