The British Journal of Psychiatry最新文献

{"title":"Examining what works for whom and how in mindfulness-based cognitive therapy (MBCT) for recurrent depression: moderated-mediation analysis in the PREVENT trial","authors":"Jesus Montero-Marin, Verena Hinze, Shannon Maloney, Anne Maj van der Velden, Rachel Hayes, Edward R. Watkins, Sarah Byford, Tim Dalgleish, Willem Kuyken","doi":"10.1192/bjp.2024.178","DOIUrl":"https://doi.org/10.1192/bjp.2024.178","url":null,"abstract":"<span>Background</span><p>Personalised management of recurrent depression, considering individual patient characteristics, is crucial.</p><span>Aims</span><p>This study evaluates the potentially different mediating role of mindfulness skills in managing recurrent depression using mindfulness-based cognitive therapy (MBCT) among people with varying depression severity.</p><span>Method</span><p>Data from the Prevention of Depressive Relapse or Recurrence (PREVENT) trial, comparing MBCT (with antidepressant medication (ADM) tapering support, MBCT-tapering support) versus maintenance-ADM, were used. The study included pre, post, 9-, 12-, 18- and 24-month follow-ups. Adults with ≥3 previous major depressive episodes, in full/partial remission (below threshold for a current episode), on ADM, were assessed for eligibility in primary care practices in the UK. People were randomised (1:1) to MBCT-tapering support or maintenance-ADM. We used the Beck Depression Inventory-II to evaluate depressive symptom changes over the six time points. Pre-post treatment, we employed the Five Facets of Mindfulness Questionnaire to gauge mindfulness skills. Baseline symptom and history variables were used to identify individuals with varying severity profiles. We conducted Latent Profile Moderated-Mediation Growth Mixture Models.</p><span>Results</span><p>A total of 424 people (mean (s.d.) age = 49.44 (12.31) years; with 325 (76.7%) self-identified as female) were included. A mediating effect of mindfulness skills, between trial arm allocation and the linear rate of depressive symptoms change over 24 months, moderated by depression severity, was observed (moderated-mediation index = −0.27, 95% CI = −0.66, −0.03). Conditional indirect effects were −0.42 (95% CI = −0.78, −0.18) for higher severity (expected mean BDI-II reduction = 10 points), and −0.15 (95% CI = −0.35, −0.02) for lower severity (expected mean BDI-II reduction = 3.5 points).</p><span>Conclusions</span><p>Mindfulness skills constitute a unique mechanism driving change in MBCT (versus maintenance-ADM). Individuals with higher depression severity may benefit most from MBCT-tapering support for residual symptoms. It is unclear if these effects apply to those with a current depressive episode. Future research should investigate individuals who are not on medication. This study provides preliminary evidence for personalised management of recurrent depression.</p><span>Trial Registration:</span><p>ISRCTN26666654.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"9 7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597146","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":"Schizophrenia – new treatments soon","authors":"Jeremy Hall","doi":"10.1192/bjp.2024.195","DOIUrl":"https://doi.org/10.1192/bjp.2024.195","url":null,"abstract":"<p>Antipsychotic medications targeting dopamine receptors were identified 70 years ago. Recent clinical trials have shown that agonists of muscarinic acetylcholinergic receptors can improve both psychotic and negative symptoms in schizophrenia. Here, this new approach to the treatment of schizophrenia is reviewed in anticipation of the drugs being licensed clinically.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597148","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":"Associations of psychotic symptom dimensions with clinical and developmental variables in twin and general clinical samples","authors":"Alastair G. Cardno, Judith Allardyce, Steven C. Bakker, Timothea Toulopoulou, Eugenia Kravariti, Marco M. Picchioni, Fergus Kane, Frühling V. Rijsdijk, Tariq Mahmood, Soumaya Nasser el din, Deline du Toit, Lisa A. Jones, Diego Quattrone, James T. R. Walters, Sophie E. Legge, Peter A. Holmans, Robin M. Murray, Evangelos Vassos","doi":"10.1192/bjp.2024.129","DOIUrl":"https://doi.org/10.1192/bjp.2024.129","url":null,"abstract":"<span>Background</span><p>Positive, negative and disorganised psychotic symptom dimensions are associated with clinical and developmental variables, but differing definitions complicate interpretation. Additionally, some variables have had little investigation.</p><span>Aims</span><p>To investigate associations of psychotic symptom dimensions with clinical and developmental variables, and familial aggregation of symptom dimensions, in multiple samples employing the same definitions.</p><span>Method</span><p>We investigated associations between lifetime symptom dimensions and clinical and developmental variables in two twin and two general psychosis samples. Dimension symptom scores and most other variables were from the Operational Criteria Checklist. We used logistic regression in generalised linear mixed models for combined sample analysis (<span>n</span> = 875 probands). We also investigated correlations of dimensions within monozygotic (MZ) twin pairs concordant for psychosis (<span>n</span> = 96 pairs).</p><span>Results</span><p>Higher symptom scores on all three dimensions were associated with poor premorbid social adjustment, never marrying/cohabiting and earlier age at onset, and with a chronic course, most strongly for the negative dimension. The positive dimension was also associated with Black and minority ethnicity and lifetime cannabis use; the negative dimension with male gender; and the disorganised dimension with gradual onset, lower premorbid IQ and substantial within twin-pair correlation. In secondary analysis, disorganised symptoms in MZ twin probands were associated with lower premorbid IQ in their co-twins.</p><span>Conclusions</span><p>These results confirm associations that dimensions share in common and strengthen the evidence for distinct associations of co-occurring positive symptoms with ethnic minority status, negative symptoms with male gender and disorganised symptoms with substantial familial influences, which may overlap with influences on premorbid IQ.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142541633","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":"Advancing ketamine in the treatment hierarchy for refractory depression","authors":"Kabir Nigam, Franklin King IV, Fernando Espi Forcen","doi":"10.1192/bjp.2024.217","DOIUrl":"https://doi.org/10.1192/bjp.2024.217","url":null,"abstract":"<p>Evidence indicates that ketamine is highly effective, has a lower side effect profile and is better tolerated compared to many augmentation strategies for refractory depression. This, combined with data on psychiatric treatment outcome mediators, suggests that earlier intervention with ketamine could improve outcomes for patients suffering from refractory depression.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489600","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":"Child and adolescent psychiatric disorders and ICD-11","authors":"M. Elena Garralda","doi":"10.1192/bjp.2024.200","DOIUrl":"https://doi.org/10.1192/bjp.2024.200","url":null,"abstract":"<p>An important change in ICD-11 is the lifespan approach, whereby previous child and adolescent disorders have been amalgamated with adult disorders. There have been changes in the definition/descriptions of neurodevelopmental and disruptive disorders, some of which may have an impact on service development.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488343","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":"Apotychiaphobia: should there be a term for fear of miscarriage?","authors":"Ruth Oshikanlu,Babatunde A Gbolade","doi":"10.1192/bjp.2024.198","DOIUrl":"https://doi.org/10.1192/bjp.2024.198","url":null,"abstract":"","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"67 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486358","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":"Pharmacological interventions for co-occurring psychopathology in people with borderline personality disorder: secondary analysis of the Cochrane systematic review with meta-analyses","authors":"Johanne Pereira Ribeiro, Sophie Juul, Mickey T. Kongerslev, Mie Sedoc Jørgensen, Birgit A Völlm, Henriette Edemann-Callesen, Christian Sales, Julie P. Schaug, Klaus Lieb, Erik Simonsen, Jutta M. Stoffers-Winterling, Ole Jakob Storebø","doi":"10.1192/bjp.2024.172","DOIUrl":"https://doi.org/10.1192/bjp.2024.172","url":null,"abstract":"<span>Background</span><p>Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD)</p><span>Aims</span><p>To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities.</p><span>Method</span><p>Building on the current Cochrane review of medications in BPD, an update literature search was done in March 2024. We followed the methods of this Cochrane review, but scrutinised all identified placebo-controlled trials <span>post hoc</span> for reporting of non BPD-specific (‘co-occurring’) psychopathology, and explored treatment effects in subgroups of samples with and without defined co-occurring disorders. GRADE ratings were done to assess the evidence certainty.</p><span>Results</span><p>Twenty-two trials were available for quantitative analyses. For antipsychotics, we found very-low-certainty evidence (VLCE) of an effect on depressive symptoms (standardised mean difference (SMD) −0.22, <span>P</span> = 0.04), and low-certainty evidence (LCE) of an effect on psychotic–dissociative symptoms (SMD −0.28, <span>P</span> = 0.007). There was evidence of effects of anticonvulsants on depressive (SMD −0.44, <span>P</span> = 0.02; LCE) and anxious symptoms (SMD −1.11, <span>P</span> &lt; 0.00001; VLCE). For antidepressants, no significant findings were observed (VLCE). Exploratory subgroup analyses indicated a greater effect of antipsychotics in samples including participants with co-occurring substance use disorders on psychotic–dissociative symptoms (<span>P</span> = 0.001).</p><span>Conclusions</span><p>Our findings, based on VLCE and LCE only, do not support the use of pharmacological interventions in people with BPD to target co-occurring psychopathology. Overall, the current evidence does not support differential treatment effects in persons with versus without defined comorbidities. Medications should be used cautiously to target co-occurring psychopathology.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142452182","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":"Is too much insight bad for you?","authors":"Javier-David Lopez-Morinigo, Anthony S. David","doi":"10.1192/bjp.2024.173","DOIUrl":"https://doi.org/10.1192/bjp.2024.173","url":null,"abstract":"<p>Insight in psychosis is associated with reduced psychotic symptom severity, less coercive treatment and better functioning. Controversially, it has been suggested that insight may lead to depression, higher suicide risk and worse self-perceived quality of life. Future clinical trials are warranted to address this ‘insight paradox’, particularly the direction of causality.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448259","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":"Genes in context: path to more precise risk prediction in psychiatry?","authors":"Peter J. Na, Robert H. Pietrzak, Joel Gelernter","doi":"10.1192/bjp.2024.151","DOIUrl":"https://doi.org/10.1192/bjp.2024.151","url":null,"abstract":"<p>This guest editorial describes the importance of converging genetics and psychosocial epidemiology research methods to understand the biopsychosocial etiology of psychiatric phenotypes.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448294","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":"Academic psychiatry is everyone's business","authors":"Hugo D. Critchley, Derek K. Tracy, Gin S. Malhi, Laith Alexander, David S. Baldwin, Jonathan Cavanagh, Samuel R. Chamberlain, Andrea Cipriani, Saeed Farooq, Angela Hassiotis, Oliver Howes, Sameer Jauhar, Stephen M. Lawrie, Emmeline Lagunes-Cordoba, Anne Lingford-Hughes, James H. MacCabe, Ismail Memon, Ciaran Mulholland, Musa Sami, Kapil Sayal, Rohit Shankar, Lindsey Sinclair, Oliver Sparasci, Ekkehart F. A. Staufenberg, Lucy E. Stirland, Paul R. A. Stokes, Charlotte Wilson Jones, Peter W. R. Woodruff, Allan H. Young","doi":"10.1192/bjp.2024.152","DOIUrl":"https://doi.org/10.1192/bjp.2024.152","url":null,"abstract":"<p>This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"230 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440221","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}