The British Journal of Psychiatry最新文献

{"title":"The association between relapse and the outcome of schizophrenia and recurrent psychotic disorders","authors":"Joanna Moncrieff, Elizabeth Pillai, Louise Marston, Glyn Lewis, Thomas R. E. Barnes, Sonia Johnson, Stefan Priebe","doi":"10.1192/bjp.2024.304","DOIUrl":"https://doi.org/10.1192/bjp.2024.304","url":null,"abstract":"<span>Background</span><p>Having a relapse of schizophrenia or recurrent psychosis is feared by patients, can cause social and personal disruption and has been suggested to cause long-term deterioration, possibly because of a toxic biological process.</p><span>Aims</span><p>To assess whether relapse affected the social and clinical outcomes of people enrolled in a 24-month randomised controlled trial of antipsychotic medication dose reduction versus maintenance treatment.</p><span>Methods</span><p>The trial involved participants with a diagnosis of schizophrenia or recurrent, non-affective psychosis. Relapse was defined as admission to hospital or significant deterioration (assessed by a blinded end-point committee). We analysed the relationship between relapse during the trial and social functioning, quality of life, symptom scores (Positive and Negative Syndrome Scale) and rates of being in employment, education or training at 24-month follow-up. We also analysed changes in these measures during the trial among those who relapsed and those who did not. Sensitivity analyses were conducted examining the effects of ‘severe’ relapse (i.e. admission to hospital).</p><span>Results</span><p>During the course of the trial, 82 out of 253 participants relapsed. There was no evidence for a difference between those who relapsed and those who did not on changes in social functioning, quality of life, symptom scores or overall employment rates between baseline and 24-month follow-up. Those who relapsed showed no change in their social functioning or quality of life, and a slight improvement in symptoms compared to baseline. They were more likely than those who did not relapse to have had a change in their employment status (mostly moving out of employment, education or training), although numbers changing status were small. Sensitivity analyses showed the same results for those who experienced a ‘severe’ relapse.</p><span>Conclusions</span><p>Our data provide little evidence that relapse has a detrimental effect in the long term in people with schizophrenia and recurrent psychosis.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827698","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":"Dog-assisted interventions for children and adults with mental health or neurodevelopmental conditions: systematic review","authors":"Emily Shoesmith, Sophie Hall, Amanda Sowden, Heidi Stevens, Jodi Pervin, Jenny Riga, Dean McMillan, Daniel Mills, Chris Clarke, Qi Wu, Selina Gibsone, Elena Ratschen","doi":"10.1192/bjp.2025.8","DOIUrl":"https://doi.org/10.1192/bjp.2025.8","url":null,"abstract":"<span>Background</span><p>Dog-assisted interventions (DAIs) to improve health-related outcomes for people with mental health or neurodevelopmental conditions are becoming increasingly popular. However, DAIs are not based on robust scientific evidence.</p><span>Aims</span><p>To determine the effectiveness of DAIs for children and adults with mental health or neurodevelopmental conditions, assess how well randomised controlled trials (RCTs) are reported, and examine the use of terminology to classify DAIs.</p><span>Methods</span><p>A systematic search was conducted in Embase, PsycINFO, PubMed, CINAHL, Web of Science and the Cochrane Library. RCTs were grouped by commonly reported outcomes and described narratively with forest plots reporting standardised mean differences and 95% confidence intervals without a pooled estimate. The quality of reporting of RCTs and DAIs was evaluated by assessing adherence to CONSORT and the Template for Intervention Description and Replication (TIDieR) guidelines. Suitability of use of terminology was assessed by mapping terms to the intervention content described.</p><span>Results</span><p>Thirty-three papers were included, reporting 29 RCTs (with five assessed as overall high quality); a positive impact of DAIs was found by 57% (8/14) for social skills and/or behaviour, 50% (5/10) for symptom frequency and/or severity, 43% (6/14) for depression and 33% (2/6) for agitation. The mean proportion of adherence to the CONSORT statement was 48.6%. The TIDieR checklist also indicated considerable variability in intervention reporting. Most DAIs were assessed as having clear alignment for terminology, but improvement in reporting information is still required.</p><span>Conclusions</span><p>DAIs may show promise for improving mental health and behavioural outcomes for those with mental health or neurodevelopmental conditions, particularly for conditions requiring social skill support. However, the quality of reporting requires improvement.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"218 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827699","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":"When the future escapes: study of the sense of control in predictions about the future over time after exposure to a traumatic event","authors":"Laura Charretier, Mickael Laisney, Jacques Dayan, Florence Fraisse, Denis Peschanski, Vincent de La Sayette, Pierre Gagnepain, Francis Eustache, Peggy Quinette","doi":"10.1192/bjp.2024.297","DOIUrl":"https://doi.org/10.1192/bjp.2024.297","url":null,"abstract":"<span>Background</span><p>Traumatic experiences can trigger post-traumatic stress disorder (PTSD) and influence one’s future perspective, which can change over time with the sense of control.</p><span>Aims</span><p>We measured changes in predictions about the future among individuals who experienced a traumatic event, with or without PTSD, according to their sense of control, and its relationship with post-traumatic change (post-traumatic stress symptom severity, well-being and coping strategies).</p><span>Method</span><p>Eighty-one exposed individuals (who experienced the 2015 Paris terrorist attacks), some with PTSD, and 71 non-exposed controls (who had not experienced the attacks) were asked to estimate the probable future occurrence of 20 controllable and 20 uncontrollable events, 7–18 and 31–43 months after the attacks. Repeated-measures analysis of variance and correlations were performed to measure inter-group differences in outcomes and relationships with post-traumatic change.</p><span>Results</span><p>Exposed participants with PTSD and without PTSD estimated uncontrollable future events to be more likely over time. Uncontrollable predictions were related to increases in post-traumatic stress symptom severity for individuals without PTSD. Uncontrollable predictions were not correlated with well-being or coping in exposed individuals.</p><span>Conclusions</span><p>Over time, exposed individuals provide increasingly high probability ratings for the future occurrence of uncontrollable events, a tendency associated with an increase in post-traumatic stress symptom severity in exposed individuals without PTSD. This may reflect potential delayed PTSD symptoms over time in individuals who did not initially develop PTSD following the attacks. The range of the measurements and the use of a self-constructed questionnaire limit the internal validity of the results.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818960","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":"Protecting and promoting editorial independence - CORRIGENDUM.","authors":"Kamaldeep Bhui,Aileen O'Brien,Rachel Upthegrove,Alexander C Tsai,Mustafa Soomro,Giles Newton-Howes,Matthew R Broome,Andrew Forrester,Patricia Casey,Anne M Doherty,William Lee,Kenneth R Kaufman","doi":"10.1192/bjp.2025.62","DOIUrl":"https://doi.org/10.1192/bjp.2025.62","url":null,"abstract":"","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"34 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822631","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":"Introduction of point-of-care blood testing in early intervention in psychosis services: effects on physical health screening","authors":"Monty Lyman, Jack B. Fanshawe, Joshua Brewin, Thomas R. Fanshawe, Philip J. Turner, Margaret Glogowska, Ian Smith, Sarah Amani, Gail Hayward, Belinda Lennox","doi":"10.1192/bjp.2025.28","DOIUrl":"https://doi.org/10.1192/bjp.2025.28","url":null,"abstract":"<span>Background</span><p>There is a significant mortality gap between the general population and people with psychosis. Completion rates of regular physical health assessments for cardiovascular risk in this group are suboptimal. Point-of-care testing (POCT) for diabetes and hyperlipidaemia – providing an immediate result from a finger-prick – could improve these rates.</p><span>Aims</span><p>To evaluate the impact on patient–clinician encounters and on physical health check completion rates of implementing POCT for cardiovascular risk markers in early intervention in psychosis (EIP) services in South East England.</p><span>Method</span><p>A mixed-methods, real-world evaluation study was performed, with 40 POCT machines introduced across EIP teams in all eight mental health trusts in South East England from March to May 2021. Clinician training and support was provided. Numbers of completed physical health checks, HbA<span>1c</span> and lipid panel blood tests completed 6 and 12 months before and 6 months after introduction of POCT were collected for individual patients. Data were compared with those from the South West region, which acted as a control. Clinician questionnaires were administered at 2 and 8 months, capturing device usability and impacts on patient interactions.</p><span>Results</span><p>Post-POCT, South East England saw significant increases in HbA<span>1c</span> testing (odds ratio 2.02, 95% CI 1.17–3.49), lipid testing (odds ratio 2.38, 95% CI 1.43–3.97) and total completed health checks (odds ratio 3.61, 95% CI 1.94–7.94). These increases were not seen in the South West. Questionnaires revealed improved patient engagement, clinician empowerment and patients’ preference for POCT over traditional blood tests.</p><span>Conclusions</span><p>POCT is associated with improvements in the completion and quality of physical health checks, and thus could be a tool to enhance holistic care for individuals with psychosis.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"218 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818965","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":"The impact of immigration detention on children’s mental health: systematic review","authors":"Isabella Priestley, Sarah Cherian, Georgia Paxton, Zachary Steel, Peter Young, Hasantha Gunasekera, Caroline Hunt","doi":"10.1192/bjp.2025.29","DOIUrl":"https://doi.org/10.1192/bjp.2025.29","url":null,"abstract":"<span>Background</span><p>There are 117.3 million people forcibly displaced because of war, conflict and natural disasters: 40% are children. With growing numbers, many high-income countries have adopted or are considering increasingly restrictive policies of immigration detention. Research on the impact of detention on mental health has focused on adults, although recent studies report on children.</p><span>Aims</span><p>To synthesise data on the impact of immigration detention on children’s mental health.</p><span>Method</span><p>Systematic searches were conducted in PsycINFO, MEDLINE and Embase databases and grey literature and studies assessed using PRISMA guidelines (PROSPERO registration CRD42023369680). Included studies were quantitative, assessed children younger than 18 years who had been in immigration detention and reported mental health symptoms or diagnoses. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses estimated prevalence for major depression and post-traumatic stress disorder (PTSD).</p><span>Results</span><p>Twenty-one studies reported data on 9620 children. Most studies were cross-sectional, had small sample sizes and used convenience sampling. A profoundly detrimental impact on children’s mental health across a variety of countries and detention settings was demonstrated. Meta-analysis found pooled prevalence of 42.2% for depression [95% CI 22.9, 64.3] and 32.0% for PTSD [95% CI 19.4, 48.0]. Severity of mental health impact increased with exposure to indefinite or protracted held detention.</p><span>Conclusions</span><p>Immigration detention harms children. No period of detention can be deemed safe, as all immigration detention is associated with adverse impacts on mental health. Our review highlights the urgency of alternative immigration policies that end the practice of detaining children and families.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813594","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":"Antipsychotic therapy and suicide risk in patients with treatment-resistant depression: target trial emulation framework study","authors":"Daniel Hsiang-Te Tsai, Avery Shuei-He Yang, Zi-Xuan Wong, Albert Tzu-Ming Chuang, Michael Chun-Yuan Cheng, Chin-Yao Shen, Shih-Chieh Shao, Edward Chia-Cheng Lai","doi":"10.1192/bjp.2024.283","DOIUrl":"https://doi.org/10.1192/bjp.2024.283","url":null,"abstract":"<span>Background</span><p>Previous studies investigating the effectiveness of augmentation therapy have been limited.</p><span>Aims</span><p>To evaluate the effectiveness of antipsychotic augmentation therapies among patients with treatment-resistant depression.</p><span>Method</span><p>We included patients diagnosed with depression receiving two antidepressant courses within 1 year between 2009 and 2020 and used the clone-censor-weight approach to address time-lag bias. Participants were assigned to either an antipsychotic or a third-line antidepressant. Primary outcomes were suicide attempt and suicide death. Cardiovascular death and all-cause mortality were considered as safety outcomes. Weighted pooled logistic regression and non-parametric bootstrapping were used to estimate approximate hazard ratios and 95% confidence intervals.</p><span>Results</span><p>The cohort included 39 949 patients receiving antipsychotics and the same number of matched antidepressant patients. The mean age was 51.2 (standard deviation 16.0) years, and 37.3% of participants were male. Compared with patients who received third-line antidepressants, those receiving antipsychotics had reduced risk of suicide attempt (sub-distribution hazard ratio 0.77; 95% CI 0.72–0.83) but not suicide death (adjusted hazard ratio 1.08; 95% CI 0.93–1.27). After applying the clone-censor-weight approach, there was no association between antipsychotic augmentation and reduced risk of suicide attempt (hazard ratio 1.06; 95% CI 0.89–1.29) or suicide death (hazard ratio 1.22; 95% CI 0.91–1.71). However, antipsychotic users had increased risk of all-cause mortality (hazard ratio 1.21; 95% CI 1.07–1.33).</p><span>Conclusions</span><p>Antipsychotic augmentation was not associated with reduced risk of suicide-related outcomes when time-lag bias was addressed; however, it was associated with increased all-cause mortality. These findings do not support the use of antipsychotic augmentation in patients with treatment-resistant depression.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797928","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":"Engaging the next generation of psychiatrists for geriatric psychiatry: call for action on behalf of the European Association of Geriatric Psychiatry","authors":"Richard C. Oude Voshaar, Lia Fernandes, Michel Benoit, Sujoy Mukherjee, Pierre Vandel, Manuel Franco-Martin, Octavian Vasiliu, Timm Strotmann-Tack, Linda Furuäng, Eivind Aakhus, Ninoslav Mimica, Filip Bouckaert","doi":"10.1192/bjp.2025.60","DOIUrl":"https://doi.org/10.1192/bjp.2025.60","url":null,"abstract":"<p>Geriatric (old age) psychiatry faces growing challenges amid Europe’s ageing population. This editorial emphasises the need for specialised training, mentorship and subspecialty recognition to attract young psychiatrists. By addressing structural gaps and fostering innovation, the field offers a rewarding career in enhancing older adults’ mental healthcare and quality of life.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797929","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":"Addressing disparities in eating disorders: underfunding, research gaps and clinical training deficiencies among males and men","authors":"Eshaan Prashar, Kathryn J. Schulze, Joyla A. Furlano","doi":"10.1192/bjp.2025.70","DOIUrl":"https://doi.org/10.1192/bjp.2025.70","url":null,"abstract":"<p>This paper highlights systemic research and clinical deficiencies in addressing eating disorders among males and men, focusing on societal stigma, gender-biased diagnostics and barriers to care. It advocates for comprehensive reforms, including addressing systemic underfunding, closing research gaps, improving clinician training and tailored interventions to reduce disparities and improve outcomes.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790127","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":"Mental health homicide inquiries in England 2010–2023: review of methodology and findings","authors":"Mayura Deshpande, Julia M. A. Sinclair, Zoe Tebbs, David S. Baldwin","doi":"10.1192/bjp.2025.65","DOIUrl":"https://doi.org/10.1192/bjp.2025.65","url":null,"abstract":"<span>Background</span><p>The methodology and impact of independent inquiries of homicides by people in care of mental health services have been questioned.</p><span>Aims</span><p>To analyse characteristics of patients who committed homicide, their victims and inquiries published in England between 2010 and 2023.</p><span>Method</span><p>Documentary and thematic analysis of 162 mental health homicide inquiries. We compared characteristics of perpetrators with those from the National Confidential Inquiry into Suicide and Safety (2018), and characteristics of victims with those in the general population of England and Wales. We examined methodology used by inquiries and thematically analysed root causes, contributory factors, recommendations, action plans, predictability and preventability.</p><span>Results</span><p>Fifty-two per cent of perpetrators had a diagnosis of schizophrenia and 52% had a history of non-adherence to medication and follow-up; 71% of victims in mental health homicides were family, friends or partners compared with 44% in the general population; 77% of inquiries used no clear methodology. The most frequent root causes and contributory factors related to deficits in assessment, treatment, follow-up or discharge, and risk assessment. There was no direct link between putative causes and resulting recommendations. The most frequent recommendations related to changing policy, improving clinical governance and training. Only 4% of inquiries deemed the homcide to be predictable and preventable.</p><span>Conclusions</span><p>There is considerable variation in the methodology of mental health homicide inquiries, with little use of human factors and systems theory. Inquiries repeatedly identify the same themes, and most mental health homicides are found to be neither predictable nor preventable. We make recommendations for improving consistency and usefulness.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775705","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}