The British Journal of Psychiatry最新文献

{"title":"Systematic review of risk factors for violence in psychosis: 10-year update","authors":"Tyra Lagerberg, Sinéad Lambe, Anabelle Paulino, Rongqin Yu, Seena Fazel","doi":"10.1192/bjp.2024.120","DOIUrl":"https://doi.org/10.1192/bjp.2024.120","url":null,"abstract":"<span>Background</span><p>Understanding risk factors for violence in people with psychosis can inform risk management and violence prevention. However, much of the evidence comes from cross-sectional studies, and previous reviews require updating.</p><span>Aims</span><p>To synthesise evidence from longitudinal studies on risk factors for violence in people with schizophrenia-spectrum disorders, bipolar disorder or other affective psychoses.</p><span>Method</span><p>We searched five bibliographic databases up to June 2022. We identified longitudinal studies reporting risk factors for violence in individuals diagnosed with schizophrenia or other psychoses using DSM or ICD criteria. If ≥3 independent samples reported a risk factor, we conducted random-effects meta-analyses to provide a pooled estimate. We also meta-analysed risk factors by major domains.</p><span>Results</span><p>We identified 47 longitudinal studies on risk factors for violence in psychosis, representing 41 independent samples – 21 from the original and 20 from the updated review – and 203 297 individuals. A total of 30 risk factors were present in ≥3 independent samples. Criminal history factors were associated with the greatest risk of violent outcomes (pooled odds ratio 3.50, 95% CI = 2.37, 5.16), followed by substance misuse factors (odds ratio 2.36, 95% CI = 1.99, 2.80). Many treatment-related factors were protective (odds ratio 0.54, 95% CI = 0.34, 0.85). Effect estimates were attenuated in inpatient settings. We also identified novel risk factors, including cannabis use, in a secondary analysis (odds ratio 3.34, 95% CI = 2.32, 4.82).</p><span>Conclusions</span><p>Using longitudinal evidence, we have validated comorbid substance misuse and criminal history as major risk factors for violence in psychosis. Novel factors such as cannabis use need further replication. Several identified factors are possible intervention targets if associations are found to be causal.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635776","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":"Maladaptive daydreaming should be included as a dissociative disorder in psychiatric manuals: position paper","authors":"Nirit Soffer-Dudek, Eli Somer, David Spiegel, Richard Chefetz, John O’Neil, Martin J. Dorahy, Etzel Cardeña, Daniel Mamah, Adriano Schimmenti, Alessandro Musetti, Suzette Boon, Annemiek van Dijke, Colin Ross, Ellert Nijenhuis, Annegret Krause-Utz, Paul Dell, Steven N. Gold, Igor Pietkiewicz, Joyanna Silberg, Kathy Steele, Andrew Moskowitz, Nel Draijer, Paula Thomson, Peter Barach, Philip Kinsler, Peter Maves, Vedat Şar, Christa Krüger, Warwick Middleton","doi":"10.1192/bjp.2024.279","DOIUrl":"https://doi.org/10.1192/bjp.2024.279","url":null,"abstract":"<p>Maladaptive daydreaming is a distinct syndrome in which the main symptom is excessive vivid fantasising that causes clinically significant distress and functional impairment in academic, vocational and social domains. Unlike normal daydreaming, maladaptive daydreaming is persistent, compulsive and detrimental to one’s life. It involves detachment from reality in favour of intense emotional engagement with alternative realities and often includes specific features such as psychomotor stereotypies (e.g. pacing in circles, jumping or shaking one’s hands), mouthing dialogues, facial gestures or enacting fantasy events. Comorbidity is common, but existing disorders do not account for the phenomenology of the symptoms. Whereas non-specific therapy is ineffective, targeted treatment seems promising. Thus, we propose that maladaptive daydreaming be considered a formal syndrome in psychiatric taxonomies, positioned within the dissociative disorders category. Maladaptive daydreaming satisfactorily meets criteria for conceptualisation as a psychiatric syndrome, including reliable discrimination from other disorders and solid interrater agreement. It involves significant dissociative aspects, such as disconnection from perception, behaviour and sense of self, and has some commonalities with but is not subsumed under existing dissociative disorders. Formal recognition of maladaptive daydreaming as a dissociative disorder will encourage awareness of a growing problem and spur theoretical, research and clinical developments.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635777","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 and screens: attention-deficit hyperactivity disorder in the digital age","authors":"Paul Kudlow, Karline Treurnicht Naylor, Elia Abi-Jaoude","doi":"10.1192/bjp.2025.15","DOIUrl":"https://doi.org/10.1192/bjp.2025.15","url":null,"abstract":"<p>This editorial examines the rise of attention-deficit hyperactivity disorder (ADHD) in the digital age, suggesting that excessive digital media use may mimic or exacerbate ADHD symptoms. We propose examining ADHD through the lens of a spectrum condition, highlighting the importance of considering both genetic and environmental factors in its diagnosis and treatment.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608013","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":"Changing patterns in suicide mortality 1999–2019 in the USA: age–period–cohort analyses including gender and race","authors":"Fengsu Hou, Jinghua Li, Huiming Liu, Eric D. Caine","doi":"10.1192/bjp.2025.6","DOIUrl":"https://doi.org/10.1192/bjp.2025.6","url":null,"abstract":"<span>Background</span><p>Despite a global decline in suicide rates, the USA has witnessed a concerning rise in suicide mortality over the past two decades.</p><span>Aims</span><p>This study aims to elucidate the changing patterns of suicide mortality in the USA from 1999 to 2019, with a particular focus on gender and racial differences.</p><span>Method</span><p>We utilised national mortality data for causes of suicide (X60–X84, Y87.0) from the Centers for Disease Control and Prevention for 1999–2019. The age–period–cohort analysis was conducted to explore the effects of age, period and birth cohort effects on suicide mortality by gender and race.</p><span>Results</span><p>Between 1999 and 2019, the suicide rate and the number of suicides in the USA increased 33% and 62%, respectively. We discerned an emerging peak of suicide among young adult populations even as increases affected nearly all groups. Females have shown increasing period risk, which has exceeded that of males since 2011. Their cohort risk, which slowly increased and exceeded males in post-1959 cohorts, exhibited a steep J-shaped pattern, especially among those born after 1977. Although Americans of all races have experienced increased period risk since 2011, it was highest among American Indians and Alaska Natives by the end of the 20-year span. With the mortality risk increasing rapidly in all post-1959 cohorts, the risk showed an obvious cliff-shaped pattern among the Asian/Pacific Islander population born after 1989.</p><span>Conclusions</span><p>The shifting burden of suicide mortality towards younger populations, transcending gender and racial boundaries, underscores the need for the implementation of tailored public health strategies.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599612","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":"Examining the needs, outcomes and current treatment pathways of 2461 people with treatment-resistant depression: mixed-methods study","authors":"Kiranpreet Gill, Danielle Hett, Max Carlish, Rebekah Amos, Ali Khatibi, Isabel Morales-Muñoz, Steven Marwaha","doi":"10.1192/bjp.2024.275","DOIUrl":"https://doi.org/10.1192/bjp.2024.275","url":null,"abstract":"<span>Background</span><p>A substantial subset of patients with major depressive disorder (MDD) experience treatment-resistant depression (TRD), typically defined as failure to respond to at least two sequential antidepressant trials at adequate dose and length.</p><span>Aims</span><p>To examine clinical and service-level associations of TRD, and the experiences of people with TRD and clinicians involved in their care within a large, diverse National Health Service trust in the UK.</p><span>Method</span><p>This mixed-methods study integrated quantitative analysis of electronic health records with thematic analysis of semi-structured interviews. Chi-squared tests and one-way analysis of variance were used to assess associations between lines of antidepressant treatments and sociodemographic and clinical variables, and binary logistic regression was used to identify associations of TRD status.</p><span>Results</span><p>Nearly half (48%) of MDD patients met TRD criteria, with 36.9% having trialled ≥4 antidepressant treatments. People with TRD had higher rates of recurrent depression (odds ratio = 1.24, 95% CI: 1.05–1.45, <span>P</span> = 0.008), comorbid anxiety disorders (odds ratio = 1.21, 95% CI: 1.03–1.41, <span>P</span> = 0.019), personality disorders (odds ratio=1.35, 95% CI: 1.10–1.65, <span>P</span> = 0.003), self-harm (odds ratio = 1.76, 95% CI: 1.06–2.93, <span>P</span> = 0.029) and cardiovascular diseases (odds ratio = 1.46, 95% CI: 1.02–2.07, <span>P</span> = 0.0374). Greater treatment resistance was linked to increased economic inactivity and functional loss. Qualitative findings revealed severe emotional distress and frustration with existing treatments, as well as organisational and illness-related barriers to effective care.</p><span>Conclusions</span><p>TRD is characterised by increasing mental and physical morbidity and functional decline, with individuals experiencing barriers to effective care. Improved pathways, service structures and more effective biological and psychological interventions are needed.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"17 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599494","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 zero suicide approach: style over substance","authors":"Calina Ouliaris, Pramudie Gunaratne, Christopher Ryan, Sebastian Rosenberg, Luis Salvador-Carulla, Neeraj Gill","doi":"10.1192/bjp.2025.9","DOIUrl":"https://doi.org/10.1192/bjp.2025.9","url":null,"abstract":"<p>The zero suicide approach is based on the belief that all deaths from suicide in healthcare settings are preventable. We caution that the narrow focus on suicide prevention as a key indicator for measuring mental health system performance may have adverse consequences.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582817","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":"A better future for mental health science","authors":"Lynsey Bilsland, Niall Boyce","doi":"10.1192/bjp.2025.25","DOIUrl":"https://doi.org/10.1192/bjp.2025.25","url":null,"abstract":"<p>This editorial suggests ways in which mental health science reform could yield more robust research and faster clinical progress. These include better animal and other models, a shift to transdiagnostic and clinically pragmatic classification systems, improved measurement, mission mapping and an entrepreneurial mindset aimed at taking advances rapidly to scale.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582797","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":"A brief critique of the pseudo-diagnosis ‘complex emotional needs’","authors":"Hat Porter, Bethan Edwards, Nell Head, Jee Smith","doi":"10.1192/bjp.2024.291","DOIUrl":"https://doi.org/10.1192/bjp.2024.291","url":null,"abstract":"<p>‘Complex emotional needs’ has emerged in the UK as a label to refer to individuals given a diagnosis of a personality disorder. We argue that this name change is insufficient to address the harms associated with the personality disorder construct; rather, it risks broadening its scope, and thereby the construct’s harms.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518734","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":"Transdiagnostic use of 3,4-methylenedioxymethamphetamine-assisted therapy to treat obsessive–compulsive disorder","authors":"Ziad Saade, Alex S. Keuroghlian","doi":"10.1192/bjp.2024.277","DOIUrl":"https://doi.org/10.1192/bjp.2024.277","url":null,"abstract":"<p>This article explores the potential of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy to enhance exposure and response prevention in obsessive–compulsive disorder treatment. We discuss the mechanisms of MDMA, including fear extinction, psychological flexibility, and empathogenic effects that may improve adherence and efficacy, as well as highlighting important safety considerations for further research.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495158","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":"Professorships in child and adolescent psychiatry relative to a similarly sized medical specialty in the UK and Ireland: cross-sectional study","authors":"Ian Kelleher, Aleksandra Z. Poziemska, Valentina Kieseppä, Anita Thapar, Bernadka Dubicka, Elaine Lockhart, Tamsin Ford, Helen Minnis, Louise Gallagher, Fiona McNicholas, Kirstie O'Hare","doi":"10.1192/bjp.2024.179","DOIUrl":"https://doi.org/10.1192/bjp.2024.179","url":null,"abstract":"<span>Background</span><p>A youth mental health crisis is considered one of the great challenges of our time, and research and clinical services in child and adolescent psychiatry have become a priority for governments and funders. Academic leadership is needed to drive forward research. It is not clear how many senior academic leadership posts (professorships) there are in child and adolescent psychiatry, nor how this benchmarks against a similarly sized medical specialty.</p><span>Aims</span><p>This study aimed to determine the number of professorships in child and adolescent psychiatry in the UK and Ireland compared to a similarly sized specialty. A secondary aim was to identify the number of clinical trials registered for mental and behavioural disorders in children.</p><span>Method</span><p>We identified registered specialists in child and adolescent psychiatry and a similarly sized specialty who held full professorships in medical schools. We searched the International Standard Randomised Controlled Trial Number (ISRCTN) and ClinicalTrials.gov for trials.</p><span>Results</span><p>As of 23 March 2023, there were 1725 doctors on the General Medical Council's (GMC) specialist register in child and adolescent psychiatry. The closest specialty in terms of number of registered specialists was neurology (<span>N</span> = 1724). We identified 24 professors in child and adolescent psychiatry across the UK and Ireland, compared to 124 in neurology. For every intervention trial registered for mental and behavioural disorders in children, there were approximately ten trials registered for diseases of the nervous system.</p><span>Conclusions</span><p>Despite equivalent numbers of medical specialists in child and adolescent psychiatry and neurology, there is a striking disparity in the number of professorship appointments. While young peoples’ mental health has, ostensibly, become a priority for policy-makers and funders, this is not reflected in medical professorship appointments. The paucity of senior academic child and adolescent psychiatrists has real-world implications for training, research, innovation and service development in mental health services.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143258626","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}