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[Personal View] Autism in schizophrenia and its original link to self-disorder: returning a borrowed concept

Autism was introduced by Eugen Bleuler in 1910 as a defining feature of schizophrenia, and it remained so for 80 years. However, the concept was borrowed by Leo Kanner and Hans Asperger to describe another condition (infantile autism) and eventually awareness of autistic features in schizophrenia declined. Today, autistic features are by default considered indicative of autism spectrum disorder, and patients with schizophrenia, who exhibit autistic features, risk being misdiagnosed with autism spectrum disorder and receiving inadequate treatment.

[Review] Postpartum anxiety: a state-of-the-art review

Although there has been increasing interest in the study of postpartum anxiety in recent years, it remains an emerging field. We present a state-of-the-art review of postpartum anxiety, with the aim of comprehensively surveying postpartum anxiety literature and presenting a synthesis of the complete body of knowledge around postpartum anxiety. We found an estimated global prevalence of 12·3% for postpartum anxiety. Postpartum anxiety is associated with primiparity and younger maternal age. Multiple screening tools are validated for use in postpartum anxiety, although none of these tools are validated for ongoing assessment.

[Articles] Metformin for overweight and obese children and adolescents with bipolar spectrum and related mood disorders treated with second-generation antipsychotics: a randomised, pragmatic trial

Although its effect on weight is modest, we conclude that for most patients, the benefits of metformin outweigh the risks. The findings from this trial suggest that clinicians should consider prescribing metformin for young people with bipolar spectrum disorder and related mood disorders who are overweight or obese and are treated with second-generation antipsychotics.

[Insight] Bon voyage

I had put the kids to bed and was cleaning up the kitchen when I received the text from Lisa. It was a link to an untitled document, in response to a “Happy 40th Birthday!” message I had sent earlier in the day. I opened the document with one hand while unloading the dishwasher with the other.

[Correspondence] Lifestyle interventions in mental health care in the Philippines

In their third report, entitled Implementing lifestyle interventions in mental health care, the Lancet Psychiatry Physical Health Commission discussed the fact that people with mental illness face higher rates of physical health issues, which contribute to a 13–15-year reduction in life expectancy.1 Although lifestyle interventions can improve physical and mental health, they are not consistently included in mental health services.1 Tailoring these interventions to socioeconomic conditions is crucial, particularly in low-income and middle-income countries (LMICs), where mental health systems are often underdeveloped and underfunded.

[Comment] The power of words: respectful language in ADHD research

Language is powerful. It reflects and shapes our understanding of the difficulties people face, the paradigms in which researchers and clinicians conduct research and practice while also influencing public perceptions and the expectations of people with lived experiences. Here, we aim to start a constructive dialogue around language use (ie, language that is respectful, not stigmatising, or discriminatory) related to ADHD, to encourage researchers, clinicians, and others to consider the potential impact of their words.

[Comment] Integrating moral injury into forensic psychiatry

Moral injury has garnered increasing attention in contemporary research, expanding from its initial association with military veterans to encompass a broader range of populations exposed to trauma and adversity. Potentially morally injurious events involve perceived transgressions of one's own moral code (perpetration) or betrayals by trusted authorities who have exposed the person to unnecessary danger or harm. The betrayal dimension was first highlighted by Shay in Vietnam veterans,1 by Freyd in people who have experienced child abuse,2 and more recently in ethnic, sexual, and gender minorities following perceived breaches of trust by family, friends, and public services, with adverse outcomes.

[Comment] Clozapine: superior yet underused

In The Lancet Psychiatry, Jurjen J Luykx and colleagues compared the effectiveness of clozapine with other psychotropic drugs using nationwide register-based data from Finland and Sweden on nearly 20 000 individuals treated with clozapine.1 The primary outcome was psychiatric hospitalisation, and—with the exception of borderline personality disorder—the investigators found superiority of clozapine over other antipsychotics (and, in bipolar disorder, over other mood stabilisers) for all diagnoses examined.

[Comment] Enhancing cognitive function in schizophrenia: we must make better choices

In this issue of the Lancet Psychiatry, Richard S E Keefe and colleagues1 report on the findings from a set of three phase 3 randomised, placebo-controlled, double-blind clinical trials of a drug called iclepertin for the treatment of cognitive impairment associated with schizophrenia (CIAS). Iclepertin is a selective GlyT1 inhibitor that was designed to try to improve NMDA receptor hypofunction in schizophrenia, one mechanism hypothesised to contribute to CIAS.

[Comment] Metformin: translating the evidence for prevention of weight gain

Melissa DelBello and colleagues1 should be commended on their clinical trial evaluating the effectiveness of metformin in mitigating weight gain in young people with bipolar disorder and related mood disorders taking second-generation antipsychotics. This clinical trial has many merits, including being sufficiently powered, and focusing on children and adolescents who are often neglected in clinical trials but are more prone to metabolic side effects. Furthermore, the trial had a long follow-up period of 2 years and examined the efficacy of an agent that is long off patent.

[Editorial] The importance of partnerships

The 2025 UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health marked an important turning point for mental health. Never before had the UN General Assembly put forth a political declaration with mental health as a central component. Although the declaration did not reach formal consensus endorsement, the message from the high-level meeting was clear: mental health is a global concern that requires a coordinated global response.

[Personal View] Lithium as a disease-modifying drug for bipolar disorder

Lithium is a classic, primary treatment for bipolar disorder that has paradoxically been used less over time, especially in North America, which goes against the accumulating evidence for its efficacy. Bipolar disorder is increasingly conceptualised as a chronic, potentially progressive condition worsened and accelerated by each mood episode, which might resemble multiple sclerosis or rheumatoid arthritis as a condition that requires disease-modifying treatments to change illness trajectory. In this Personal View, we argue that lithium acts like a disease-modifying drug in bipolar disorder.

[Review] Brain structure in schizophrenia: what do we know and what next?

Meta-analyses and mega-analyses of structural MRI and diffusion MRI studies in thousands of people with schizophrenia have shown reduced brain volumes and structural connectivity relative to healthy control participants. Some of these structural differences probably present pre-morbidly. Severity of schizophrenia symptoms and cognitive impairment consistently correlate. Convergent findings with different analytical methods show that the results are not artefactual. Post-mortem studies add validity and point to a pathophysiology of reduced neuronal size and dendritic arborisation, which is multifactorial.

[Articles] Association between hyperemesis gravidarum and depression: a national register-based controlled study in Finland

The bidirectional association between hyperemesis gravidarum and depression suggests shared underlying biological mechanisms and highlights the long-term mental health burden associated with hyperemesis gravidarum. This finding emphasises the importance of systematic psychiatric screening during and after pregnancy, as well as the assessment of lifetime depression history in reproductive care. Improved collaboration between psychiatry, gynaecology, and primary care is essential to enhance patient outcomes.

[Articles] Disease relapse, all-cause mortality, and adverse events associated with long-acting injectable antipsychotics versus oral antipsychotics in older people with schizophrenia in Hong Kong: a population-based within-subject analysis

In older individuals with schizophrenia, LAI antipsychotics were associated with lower risk of disease relapse and mortality, without increased risk of adverse events, than oral antipsychotics, except for elevated risk of extrapyramidal symptoms specifically related to first-generation LAI antipsychotics. Overall, LAI antipsychotics, especially second-generation medications, could be more broadly considered for long-term use among this population, particularly at an early stage of disease.