In 1966, a researcher at the Massachusetts Institute of Technology introduced ELIZA, a computer program that simulated a psychotherapist in the Rogerian tradition, rephrasing a patient's words into questions according to simple but effective scripts. This was one of the first (and few) successes of early artificial intelligence (AI). To the dismay of its creator, some people took ELIZA for a real psychotherapist

The ICD-11, the first major revision of the ICD in three decades, was approved by the 72nd World Health Assembly in May 2019, and came into effect as a basis for reporting of health statistics by World Health Organization (WHO) member states in January 2022. Countries around the world are in various stages of implementing the ICD-11 in their clinical and health information systems, a process that will

Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of

Features of autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorders, intellectual disabilities, and communication and motor disorders usually emerge early in life and are associated with atypical neurodevelopment. These “neurodevelopmental conditions” are grouped together in the DSM-5 and ICD-11 to reflect their shared characteristics. Yet, reliance on categorical diagnoses

The process of scientific validation of the ICD-11 Clinical Descriptions and Diagnostic Requirements (CDDR) for Mental Disorders has spanned more than 10 years, being remarkably comprehensive and inclusive as well as truly international, with the involvement of many hundreds of clinicians and researchers from all regions of the world. The field trials of the ICD-11 CDDR – contrary to those of the ICD-10

The movement to a descriptive, symptom-based diagnostic system that started with the DSM-III was in part a response to widespread concerns and criticisms regarding the reliability of psychiatric diagnoses. This fueled an emphasis on increasingly precise operationalization of diagnostic constructs and criteria, based on the assumption that this would produce successive improvements in reliability.

The recent addition of prolonged grief disorder (PGD) to the ICD-11 and the DSM-5-TR has brought changes in what many mental health experts consider to be best practice in bereavement care. Because PGD is newly recognized as an official mental disorder, clinicians may be unfamiliar with current approaches to its detection, diagnosis and treatment. Here we provide answers to common questions that have

Suicide is a global public health issue, claiming over 700,000 lives annually worldwide. Opportunities for intervention are ample, as half of suicide decedents contacted a health care provider within a month of their deaths. In these encounters, suicide risk assessments are based on patients' self-report of suicidal intent and chronic risk factors, such as past attempts and prior psychiatric diagnoses

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their

The paper by Galderisi et al1 raises an array of ethical challenges, each of which would warrant an extended response. Here I will focus on a few overarching issues. First, it is extremely heartening to see the paper's engagement with the Convention on the Rights of Persons with Disabilities (CRPD). This has not always been the case: engagement from psychiatrists has in the past been frosty at best

Galderisi et al1 provide an excellent overview of the complex ethical challenges in psychiatry. We subscribe to the authors’ criticism of mental health laws employing a “disorder + risk” schema for involuntary intervention, and their conclusion that these laws discriminate against people with a mental health condition. The authors put forward instead a “single law” proposal in which “involuntary treatment

Galderisi et al1 address advance directives in the section on non-discriminatory mental health law, illustrating the need for better operationalization of concepts such as “will and preferences”, if we are to honor persons’ autonomy consistently and meaningfully. Advance directives provide useful fodder for debating autonomy and decision-making capacity in the midst of health crises. However, I would

As a medical student in the 1970s, my deep concern about the civil rights of the mentally ill was one of the main reasons for my interest in psychiatry and which ultimately inspired me to enter the field. These were “negative rights” which needed to be addressed and still do. Galderisi et al1 devote most of their paper to the protection of these civil rights. Less extensively addressed are the “positive

Galderisi et al1 provide an insightful overview of current ethical challenges in psychiatry, including those presented by digital psychiatry, as well as recommendations for addressing these challenges. As they discuss, “digital psychiatry” encompasses an array of different digital tools, including mental health apps, chatbots, telehealth platforms, and artificial intelligence (AI). These tools hold

Galderisi et al1 quite rightly draw our attention to the ethical dilemmas that emerge when one considers ending life. An area fraught with complexity takes a quantum leap when mental ill-health is added. The need to rethink a position is nothing new. Whilst we may perceive change as gradual, over a decade it may become seismic, and constant re-evaluation of values may be necessary. The ground-shaking

From a historical perspective, Engel1 conceptualized psychopathology as resulting from an interaction of three orders of factors: biological, psychological and social. The first half of the 20th century has been mostly devoted to conceptualizing the psychological component of mental disorders, the second half to the understanding of the biological component. We are now, in the 21st century, busy at

The involvement of people with lived experience (PWLE) in the mental health field has been and still is very debated from several points of view1. One of the most discussed areas refers to their involvement in decision-making processes2. These processes occur at the individual level, where PWLE need to be involved in decisions concerning treatment and care; at the social level, where PWLE have to be

The concept of ultra-high risk for psychosis (UHR) has been at the forefront of psychiatric research for several decades, with the ultimate goal of preventing the onset of psychotic disorder in high-risk individuals. Orygen (Melbourne, Australia) has led a range of observational and intervention studies in this clinical population. These datasets have now been integrated into the UHR 1000+ cohort,

People with physical diseases are reported to be at elevated risk of subsequent mental disorders. However, previous studies have considered only a few pairs of conditions, or have reported only relative risks. This study aimed to systematically explore the associations between physical diseases and subsequent mental disorders. It examined a population-based cohort of 7,673,978 people living in Denmark

Children who have a parent with a psychotic disorder present an increased risk of developing psychosis. It is unclear to date, however, what proportion of all psychosis cases in the population are captured by a familial high-risk for psychosis (FHR-P) approach. This is essential information for prevention research and health service planning, as it tells us the total proportion of psychosis cases that

The concept of emotion regulation (ER) is receiving considerable attention in research on psychiatric disorders and their treatment. The popularity of the concept is largely rooted in its premise that deficits in adaptive responses toward undesired affective states contribute to the development and maintenance of most forms of psychopathology. This appears obvious when considering psychiatric disorders

It is firmly established that personal relationships play a pivotal role in adolescent mental health and well-being. During adolescence, individuals become aware of their distinctiveness and uniqueness from others, initiating the development of a personal identity. Developing a coherent sense of identity is crucial for adolescent mental health, and relationships serve as a vital source of support that

Adolescence is a time of dramatic change in physical, behavioral, emotional, cognitive and social domains, and the context in which one matures plays a crucial role. The early 2020s provided a unique context for adolescent development, filled with unprecedented events across multiple levels of life. These contextual forces potentially impacted what we know from previously studied developmental trajectories

In the late 1980s, the ICD-10 Working Party on Personality Disorders had little evidence on which to base its decisions and, understandably, followed the lead of the DSM, with its well-funded and popular third and subsequent editions. When the Working Party came to the sensitive subject of individual personality disorders, it found that the evidence for “borderline personality disorder” was insufficient

At their most basic level, classification systems provide health professionals with tools to assist them in identifying people in need of health services and deciding which treatments are most likely to be effective. Moreover, the World Health Organization (WHO) expects the ICD-11 chapter on mental, behavioural and neurodevelopment disorders to provide its member states with a tool to help them reduce

Since 2007, China has been actively collaborating with the World Health Organization (WHO) and international colleagues in the revision, field testing, training, and implementation of the ICD-11 chapter on mental, behavioural and neurodevelopmental disorders, and the related Clinical Descriptions and Diagnostic Requirements (CDDR)1. In 2018, the National Health Commission clearly highlighted the importance

The use of psychoactive substances is highly prevalent and contributes substantially to risk behaviours, morbidity and mortality. The United Nations Office on Drugs and Crime World Drug Report1 estimated that, in 2021, one in every 17 people aged 15-64 in the world had used an illicit drug in the year before. Users increased from 240 million in 2011 to 296 million in 2021, substantially more than accounted

On October 7, 2023, about 4,000 civilians attending the Nova open-air music festival in southern Israel were the victims of a sudden terrorist attack. They had to swiftly react to the attack by running and hiding for extended periods of time to protect their lives. At the time of the attack, a significant proportion of these people were under the influence of various recreational drugs. We hypothesized

Since 2014, the United Nations Office on Drugs and Crime (UNODC) - World Health Organization (WHO) Informal Scientific Network (ISN) has brought the voice of science to international drug policy discussions at the Commission on Narcotic Drugs, the drug-control policy-making body of the United Nations (UN). The public health dimensions of substance use, including prevention and treatment of substance

The WPA Section on Anxiety and Obsessive-Compulsive Disorders focuses its activities on a broad range of common and burdensome psychiatric conditions encompassing anxiety and fear-related disorders, obsessive-compulsive and related disorders, and behavioural addiction disorders, including problematic Internet use. This is an exciting area of developing clinical practice, as anxiety and obsessive-compulsive

International migration is not a single “event”. In many cases, migration is a voluntary decision, due to social, economic and political contexts in the home country, or perceived opportunities in the destination country. Nearly one billion people (12.5% of the world's population) now live in a country other than the one in which they were born. In other cases, migration is involuntary or forced, i

The practice of addiction psychiatry and the relevant training vary among different world regions and countries. Despite the challenges that the subspecialty has been facing, the past decade has witnessed new insights and advances in the field. In particular, the rapid development of technologies has contributed to a better understanding of addiction and its mechanisms and to the development of new

Personalized psychiatry has recently become an important component of the overall shift towards personalized medicine, aiming to address unmet medical needs in the field of mental health. Mental disorders, particularly depression and anxiety disorders, are major contributors to the global health burden. Although various treatment options are available, they often lead to unsatisfactory outcomes. This

Education of mental health professionals should reflect the changes occurring at scientific, clinical and sociocultural levels, and thus it should be continuously updated. However, in many parts of the world, psychiatric education is still based on a knowledge formed in the last century, and the most recent knowledge on the structure and functioning of the brain, human behaviors and social relationships

The WPA has been actively supporting the World Health Organization (WHO) in the development and scientific validation of the Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders (CDDR). Several WPA officers and experts served as chairpersons or members of the ICD-11 Working Groups that produced the drafts of the various sections of the CDDR

Discrete emotional episodes – belonging to established categories such as fear, anger and joy – both regulate and dysregulate cognition and behavior. They also need to be regulated themselves, and the term “emotion regulation” usually refers specifically to this latter process. Although there are different definitions of emotion regulation, it is generally taken to encompass a range of strategies,

Psychotherapies are efficacious in the treatment of depression, albeit only with a moderate effect size. It is hoped that personalization of treatment can lead to better outcomes. The network theory of psychopathology offers a novel approach suggesting that symptom interactions as displayed in person-specific symptom networks could guide treatment planning for an individual patient. In a sample of

Even within the ever-evolving landscape of digital mental health interventions, the advent of generative artificial intelligence (GAI), large language models (LLMs), and generative pre-trained transformers (GPTs) represents a paradigm shift. These technologies bring the promise of scalable and personalized diagnostics, psychoeducation and treatment that may help close a stubborn access-to-care gap1

The most important advances in mental health care in this millennium have not come, as many had expected, from neurobiological research, funded with billions of dollars worldwide. Nor has digitalization been as powerful and scalable a tool as initially thought, due to a number of technical and ethical issues, as outlined by Galderisi et al1. The most important, and hopefully sustainable, progress worldwide

There is an unmet treatment need for people at clinical high risk (CHR) for psychosis1. As only a minority of them go on to develop a psychotic disorder, interventions need to be particularly safe and well tolerated. Cannabidiol (CBD), a non-intoxicating constituent of cannabis, has potential anxiolytic and antipsychotic properties2 and a good safety profile. In two out of three clinical trials in

Psychotic depression (PD) is a severe mental disorder leading to functional disability and high risk of suicide, but very little is known about the comparative effectiveness of medications used in its maintenance treatment. The objective of this study was to investigate the comparative effectiveness of specific antipsychotics and antidepressants, and their combinations, on the risk of psychiatric hospitalization

Psychotherapies are first‐line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist

Effect sizes of psychotherapies currently stagnate at a low‐to‐moderate level. Personalizing psychotherapy by algorithm‐based modular procedures promises improved outcomes, greater flexibility, and a better fit between research and practice. However, evidence for the feasibility and efficacy of modular‐based psychotherapy, using a personalized treatment algorithm, is lacking. This proof‐of‐concept

The impact of air pollution and climate change on mental health has recently raised strong concerns. However, a comprehensive overview analyzing the existing evidence while addressing relevant biases is lacking. This umbrella review systematically searched the PubMed/Medline, Scopus and PsycINFO databases (up to June 26, 2023) for any systematic review with meta‐analysis investigating the association