The British Journal of Psychiatry最新文献

{"title":"May we have your attention, please? Adult-onset attention-deficit hyperactivity disorder","authors":"Shuichi Suetani, Stephen Parker, James G. Scott","doi":"10.1192/bjp.2025.129","DOIUrl":"https://doi.org/10.1192/bjp.2025.129","url":null,"abstract":"<p>Attention-deficit hyperactivity disorder (ADHD) is commonly considered a neurodevelopmental disorder, with symptoms present before 12 years of age. Increasingly, adults who have no evidence of impairment in childhood are seeking treatment for ADHD. In this Editorial, we propose that psychiatry considers conceptual changes to better understand impairment and distress caused by inattention and disorganisation in adulthood.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive behavioural therapy for sleep problems in psychosis: systematic review of effectiveness and acceptability","authors":"Hannah Wilkinson, Louise C. Johns, Rachel Batchelor, Alex Lau-Zhu","doi":"10.1192/bjp.2025.86","DOIUrl":"https://doi.org/10.1192/bjp.2025.86","url":null,"abstract":"<span>Background</span><p>Sleep problems are common among people with psychosis. Research suggests poor sleep is causally related to psychosis, anxiety and depression.</p><span>Aims</span><p>This review investigates the effectiveness and acceptability of cognitive–behavioural therapy (CBT) in targeting sleep problems in people with and at risk of psychosis.</p><span>Method</span><p>Four databases were searched in line with PRISMA guidelines. Eligible studies either evaluated (a) CBT targeting sleep problems in people with or at risk of psychosis, or (b) subjective experiences of this treatment. Articles not published in peer-review journals were excluded. Treatment effectiveness was investigated for sleep, psychosis and other clinical outcomes. Acceptability was evaluated using qualitative data, drop-out rates, adverse events and relevant questionnaires. Adaptations to standard treatment protocols were described. Research quality was appraised using Cochrane Risk of Bias tools for randomised and non-randomised trials, and a checklist was developed for qualitative papers.</p><span>Results</span><p>Of the 975 records identified, 14 were eligible. The most common CBT target was insomnia. Treatment protocols were typically adapted by omitting sleep restriction. Large effect sizes were reported for sleep outcomes; however, effects for other clinical outcomes were less clear. Qualitative data and acceptability outcomes suggest that treatment was received positively by participants.</p><span>Conclusions</span><p>CBT is an effective and acceptable treatment for sleep problems in people with and at risk of psychosis. However, our conclusions are limited by few good-quality studies and small samples. Further gold-standard research is required to inform evidence-based guidelines.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the strength of innovations in the treatment of depression.","authors":"Pim Cuijpers,Mathias Harrer,Toshi Furukawa","doi":"10.1192/bjp.2025.98","DOIUrl":"https://doi.org/10.1192/bjp.2025.98","url":null,"abstract":"Although treatments for depression are effective, many patients do not respond. Many new innovations are currently being developed, claiming to substantially improve outcomes. We propose a new method to assess the strength of these innovations. Based on response rates of current treatments, we can estimate how many treatments are needed in total to realise response in >99% of patients if they were to be offered another treatment when the previous one did not work. Using a basic model as a benchmark, we can show that none of the current innovations likely represents a 'silver bullet' that will dramatically change the outcomes. Improvement of mental healthcare for depression needs to be done by multiple, incremental innovations. Only together can these innovations substantially improve outcomes.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"31 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to prioritise the use of participatory research methods for people with intellectual disabilities.","authors":"Madiha Majid,Olamide Todowede,Ashok Roy,Gerald Jordan,Stefan Rennick-Egglestone","doi":"10.1192/bjp.2025.96","DOIUrl":"https://doi.org/10.1192/bjp.2025.96","url":null,"abstract":"People with intellectual disability experience significant health inequality, and consequently poor health outcomes. Although research can facilitate change, there is a risk of researchers propagating inequity by selecting methods that exclude people with some forms of intellectual disability. We argue for participatory research methods that enable inclusion.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"55 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural remission rates of depression among rural adult populations in India: multilevel analysis of the SMART Mental Health Project.","authors":"Pallab K Maulik,Mercian Daniel,Arpita Ghosh,Siddhardha Devarapalli,Sudha Kallakuri,Amanpreet Kaur,Rajesh Sagar,Laurent Billot,Graham Thornicroft,Shekhar Saxena,Anushka Patel,David Peiris","doi":"10.1192/bjp.2025.68","DOIUrl":"https://doi.org/10.1192/bjp.2025.68","url":null,"abstract":"BACKGROUNDNatural remission from common mental disorders (CMDs), in the absence of intervention, varies greatly. The situation in India is unknown.AIMSThis study examined individual, village and primary health centre (PHC)-level determinants for remission across two rural communities in north and south India and reports natural remission rates.METHODUsing pre-intervention trial data from 44 PHCs in Andhra Pradesh and Haryana, adults ≥18 years were screened for CMDs. Screen-positive people (Patient Health Questionnaire-9 Item (PHQ9) or Generalised Anxiety Disorder-7 Item (GAD7) score ≥10, or a score ≥2 on the self-harm PHQ9 question) were re-screened after 5-7 months (mean). Remission was defined <5 scores on both PHQ9 and GAD7 and <2 score on self-harm. Multilevel Poisson regression models with random effects at individual, village and PHC levels were developed for each state to identify factors associated with remission. Time to re-screening was included as offset in regression models.RESULTSOf 100 013 people in Andhra Pradesh and 69 807 people in Haryana, 2.4% and 7.1%, respectively, were screen positive. At re-screening, remission rate in Andhra Pradesh was 82.3% (95% CI 77.5-87.4%) and 59.4% (95% CI 55.7-63.3%) in Haryana. Being female, increasing age and higher baseline depression and anxiety scores were associated with lower remission rates. None of the considered village- and PHC-level factors were found to be associated with remission rate, after adjusting for individual-level factors.CONCLUSIONNatural remission for CMDs vary greatly in two Indian states and are associated with complex, multilevel factors. Further research is recommended to better understand natural remission.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"13 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of people with severe mental illness excluded from incentivised physical health checks in the UK: electronic healthcare record study.","authors":"Naomi Launders,Caroline A Jackson,Joseph F Hayes,Ann John,Robert Stewart,Matthew H Iveson,Elvira Bramon,Bruce Guthrie,Stewart W Mercer,David P J Osborn","doi":"10.1192/bjp.2025.49","DOIUrl":"https://doi.org/10.1192/bjp.2025.49","url":null,"abstract":"BACKGROUNDPhysical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.AIMSTo describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI.METHODWe identified adult patients with SMI from the UK Clinical Practice Research Datalink (CPRD), registered with a general practice between 2004 and 2018. We calculated the annual prevalence of exception reporting and investigated patient characteristics associated with exception reporting, using logistic regression.RESULTSOf 193 850 patients with SMI, 27.7% were exception reported from physical health checks at least once. Exception reporting owing to non-response or declining screening increased over the study period. Patients of Asian or Black ethnicity (Asian: odds ratio 0.72, 95% CI 0.65-0.80; Black: odds ratio 0.86, 95% CI 0.76-0.97; compared with White) and women (odds ratio 0.90, 95% CI 0.88-0.92) had a reduced odds of being exception reported, whereas patients diagnosed with 'other psychoses' (odds ratio 1.19, 95% CI 1.15-1.23; compared with bipolar disorder) had increased odds. Younger patients and those diagnosed with schizophrenia were more likely to be exception reported owing to informed dissent.CONCLUSIONSException reporting was common in people with SMI. Interventions are required to improve accessibility and uptake of physical health checks to improve physical health in people with SMI.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"1 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual patient data meta-analysis of placebo-controlled trials of selective serotonin reuptake inhibitors submitted for regulatory approval in adult obsessive–compulsive disorder","authors":"Sem E. Cohen, Bram W. Storosum, Jasper B. Zantvoord, Taina K. Mattila, Anthonius de Boer, Damiaan Denys","doi":"10.1192/bjp.2025.87","DOIUrl":"https://doi.org/10.1192/bjp.2025.87","url":null,"abstract":"<span>Background</span><p>Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacological treatment for obsessive–compulsive disorder (OCD). However, insufficient response is common and it remains unclear whether specific patient-level factors influence the likelihood of treatment response.</p><span>Aims</span><p>To determine the efficacy and acceptability of SSRIs in adult OCD, and to identify patient-level modifiers of efficacy.</p><span>Methods</span><p>We conducted an individual patient data meta-analysis (IPDMA) of industry-sponsored short-term, randomised, placebo-controlled SSRI trials submitted for approval to the Dutch regulatory agency to obtain marketing approval for treating OCD in adults. We performed a two-stage meta-analysis, using crude data of available trials. The primary outcome was the difference in Yale–Brown Obsessive–Compulsive Scale (YBOCS) change between active treatment and placebo. Secondary outcomes were differences in response (defined as the odds ratio of ≥35% YBOCS point reduction) and acceptability (defined as the odds ratio for all-cause discontinuation). We examined the modifying effect of baseline characteristics: age, gender, illness severity, depressive symptoms, weight, illness duration and history of antidepressant use.</p><span>Results</span><p>After excluding three trials because of missing data, we analysed results from 11 trials (79% of all submitted trials, <span>n</span> = 2372). The trial duration ranged from 10 to 13 weeks. Mean difference of SSRIs relative to placebo was 2.65 YBOCS points (95% CI 1.85–3.46, <span>p</span> &lt; 0.0001), equalling a small effect size (0.33 Hedges’ <span>g</span>). The odds ratio for response was 2.21 in favour of active treatment (95% CI 1.72–2.83, <span>p</span> &lt; 0.0001), with a number needed to treat of seven. Patient characteristics did not modify symptom change or response. Acceptability was comparable for SSRIs and placebo.</p><span>Conclusions</span><p>Our IPDMA showed that SSRIs are well accepted and superior to placebo for treating OCD. The effects are modest and independent of baseline patient characteristics.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of patient online activities","authors":"Scott Monteith, Tasha Glenn, John R. Geddes, Peter C. Whybrow, Eric Achtyes, Rita Bauer, Michael Bauer","doi":"10.1192/bjp.2025.32","DOIUrl":"https://doi.org/10.1192/bjp.2025.32","url":null,"abstract":"<p>Online platforms and activities, including smartphones, computers, social media, video games and applications involving artificial intelligence, have become a regular part of daily life and offer individuals a wide range of benefits. The purpose of this document is to increase psychiatrists’ awareness of the frequency and potential risks associated with excessive internet use, and to emphasise the need for psychiatrists to routinely question patients about their online activities. Internet use may become excessive and result in both psychological distress and physical impairments. Treatments and countermeasures may be required to address the harmful consequences of excessive internet use. Psychiatrists should be aware of patient online activities. Understanding of a patient’s online behaviour should now be a routine part of a psychiatric interview.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study.","authors":"Kirstie O'Hare,Ulla Lång,Colm Healy,Ioanna Kougianou,Animesh Talukder,Robin Murray,Stephen M Lawrie,Ann John,Ian Kelleher","doi":"10.1192/bjp.2025.48","DOIUrl":"https://doi.org/10.1192/bjp.2025.48","url":null,"abstract":"BACKGROUNDCurrent approaches to identifying individuals at risk for psychosis capture only a small proportion of future psychotic disorders. Recent Finnish research suggests a substantial proportion of individuals at risk of psychosis attend child and adolescent mental health services (CAMHS) earlier in life, creating important opportunities for prediction and prevention. To what extent this is true outside Finland is unknown.AIMSTo establish the proportion of psychotic and bipolar disorder diagnoses that occurred in individuals who had attended CAMHS in Wales, UK, and whether, within CAMHS, certain factors were associated with increased psychosis risk.METHODWe examined healthcare contacts for individuals born between 1991 and 1998 (N = 348 226), followed to age 25-32. Using linked administrative healthcare records, we identified all psychotic and bipolar disorder diagnoses in the population, then determined the proportion of cases where the individual had attended CAMHS. Regression analyses examined associations between sociodemographic and clinical risk markers with psychotic and bipolar disorder outcomes.RESULTSAmong individuals diagnosed with a psychotic or bipolar disorder, 44.78% had attended CAMHS (hazard ratio = 6.28, 95% CI = 5.92-6.65). Low birth weight (odds ratio = 1.33, 95% CI = 1.15-1.53), out-of-home care experience (odds ratio = 2.05, 95% CI = 1.77-2.38), in-patient CAMHS admission (odds ratio = 1.49, 95% CI = 1.29-1.72) and attending CAMHS in childhood (in addition to adolescence; odds ratio = 1.16, 95% CI = 1.02-1.30) were all within-CAMHS risk markers for psychotic and bipolar disorders.CONCLUSIONSA substantial proportion (45%) of future psychotic and bipolar disorder cases emerge in individuals who had attended CAMHS, demonstrating large-scale opportunities for early intervention and prevention within CAMHS.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"17 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators.","authors":"Mathias Harrer,Antonia A Sprenger,Susan Illing,Marcel C Adriaanse,Steven M Albert,Esther Allart,Osvaldo P Almeida,Julian Basanovic,Kim M P van Bastelaar,Philip J Batterham,Harald Baumeister,Thomas Berger,Vanessa Blanco,Ragnhild Bø,Robin J Casten,Dicken Chan,Helen Christensen,Marketa Ciharova,Lorna Cook,John Cornell,Elysia P Davis,Keith S Dobson,Elsien Dozeman,Simon Gilbody,Benjamin L Hankin,Rimke Haringsma,Kristof Hoorelbeke,Michael R Irwin,Femke Jansen,Rune Jonassen,Eirini Karyotaki,Norito Kawakami,J Philipp Klein,Candace Konnert,Kotaro Imamura,Nils Inge Landrø,María Asunción Lara,Huynh-Nhu Le,Dirk Lehr,Juan V Luciano,Steffen Moritz,Jana M Mossey,Ricardo F Muñoz,Anna Muntingh,Stephanie Nobis,Richard Olmstead,Patricia Otero,Mirjana Pibernik-Okanović,Anne Margriet Pot,Charles F Reynolds,Barry W Rovner,Juan P Sanabria-Mazo,Lasse B Sander,Filip Smit,Frank J Snoek,Viola Spek,Philip Spinhoven,Liza Stelmach,Yannik Terhorst,Fernando L Vázquez,Irma Verdonck-de Leeuw,Ed Watkins,Wenhui Yang,Samuel Yeung Shan Wong,Johannes Zimmermann,Masatsugu Sakata,Toshi A Furukawa,Stefan Leucht,Pim Cuijpers,Claudia Buntrock,David Daniel Ebert","doi":"10.1192/bjp.2025.56","DOIUrl":"https://doi.org/10.1192/bjp.2025.56","url":null,"abstract":"BACKGROUNDIt remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.AIMSTo synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.METHODRandomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment-covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.RESULTSIPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = -0.48 to -0.27). Effects could not be ascertained up to 24 months (s.m.d. = -0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27-2.79), reliable improvement (relative risk = 1.38-3.17), deterioration (relative risk = 0.67-0.54) and close-to-symptom-free status (relative risk = 1.41-2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = -0.33 for PHQ-9 = 5).CONCLUSIONSPsychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"91 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}