The British Journal of Psychiatry最新文献

{"title":"Long-term segregation and seclusion for people with an intellectual disability and/or autism in hospitals: critique of the current state of affairs","authors":"Samuel J. Tromans, Indermeet Sawhney, Mahesh Odiyoor, Jana de Villiers, Jane McCarthy, Harm Boer, Regi Alexander, Ken Courtenay, Stuart Wallace, Satheesh Gangadharan, Ashok Roy, Amy Blake, Kiran Purandare, Anupama Iyer, Richard Laugharne, Vivien Weisner, Rohit Shankar","doi":"10.1192/bjp.2024.211","DOIUrl":"https://doi.org/10.1192/bjp.2024.211","url":null,"abstract":"<p>In November 2023, the Department of Health and Social Care published guidance, entitled ‘Baroness Hollins’ Final Report: My Heart Breaks – Solitary Confinement in Hospital Has no Therapeutic Benefit for People with a Learning Disability and Autistic People’. The report's commendable analysis of the problems and identification of the areas where practice should be improved is unfortunately not matched by many of its recommendations, which appear to be contrary to evidence-based approaches. The concerns are wide-ranging, from the use of the term ‘solitary confinement’ for current long-term segregation (LTS) and seclusion, to presumption that all LTS and seclusion is bad, to holding clinicians (mainly psychiatrists) responsible for events beyond their locus of control. Importantly, there is a no guidance on how to practically deliver the recommendations in an evidence-based manner. This Feature critically appraises the report, to provide a comprehensive summary outlining potential positive impacts, identifying specific concerns and reflecting on best practice going forward.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763294","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 changing doctor–patient relationship in psychiatry: observations on recent trends in autism, attention-deficit hyperactivity disorder, gender dysphoria and mental distress","authors":"Ben Beaglehole, Bridgette Thwaites, Bess Kew, Roger Mulder","doi":"10.1192/bjp.2024.243","DOIUrl":"https://doi.org/10.1192/bjp.2024.243","url":null,"abstract":"<p>This editorial highlights increasing prevalence and treatment rates of apparently disparate disorders. We ask whether cross-disorder factors including greater mental health literacy, social media and a shift to psychiatric explanations for distress contribute to these trends. We highlight a consequence: the changing doctor–patient relationship and its impacts.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763251","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":"Accelerometer-derived movement behaviours and risk of mortality among individuals with pre-existing depression: prospective cohort study","authors":"Tingshan Duan, Zhi Cao, Xuemei Wang, Jiahao Min, Tao Sun, Hong Luo, Chenjie Xu","doi":"10.1192/bjp.2024.227","DOIUrl":"https://doi.org/10.1192/bjp.2024.227","url":null,"abstract":"<span>Background</span><p>Evidence is largely limited regarding the extent to which abnormal behavioural profiles, including physical inactivity, sedentary behaviour and inadequate sleep duration, impact long-term health conditions in individuals with pre-existing depression.</p><span>Aims</span><p>To investigate the associations between accelerometer-derived daily movement behaviours and mortality in individuals with pre-existing depression.</p><span>Method</span><p>Between 2013 and 2015, a total of 10 914 individuals with pre-existing depression were identified from the UK Biobank through multiple sources including self-reported symptoms, records of antidepressant usage and diagnostic recording based on the 10th Revision of the International Classification of Diseases (ICD-10) codes F32–F33. These participants were subsequently followed up until 2021. Wrist-worn accelerometers were used for objective measurement of sleep duration, sedentary behaviour, moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) over a span of seven consecutive days.</p><span>Results</span><p>During a median follow-up of 6.9 years, 434 deaths occurred among individuals with pre-existing depression. We observed a U-shaped association between sleep duration and mortality in individuals with pre-existing depression, with the lowest risk occurring at approximately 9 h/day. Both MVPA and LPA exhibited an L-shaped pattern in relation to mortality, indicating that engaging in higher levels of physical activity was associated with lower risk of mortality in individuals with pre-existing depression, but the beneficial effect reached a plateau after 50 min/day for MVPA and 350 min/day for LPA. We found a positive association between sedentary time and mortality, and the risk apparently increased above 8 h/day. Moreover, substituting 1 hour/day of sedentary time with LPA or MVPA was significantly associated with a 12% (hazard ratio: 0.88, 95% CI: 0.83–0.94) and 24% (hazard ratio: 0.76, 95% CI: 0.61–0.94) lower risk of mortality, respectively.</p><span>Conclusions</span><p>Our study found the beneficial effect of adequate sleep duration, high levels of physical activity and short sedentary time on risk of mortality among individuals with pre-existing depression.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763250","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":"Parsing stigma's relationship with the psychosocial functioning of youth identified as at clinical high risk for psychosis: evaluating whether symptom stigma or labelling stigma is stronger","authors":"Lawrence H. Yang, Margaux M. Grivel, Drew Blasco, Ragy R. Girgis, Debbie Huang, Kristen A. Woodberry, Cheryl M. Corcoran, William R. McFarlane, Bruce G. Link","doi":"10.1192/bjp.2024.209","DOIUrl":"https://doi.org/10.1192/bjp.2024.209","url":null,"abstract":"<span>Background</span><p>The clinical high risk for psychosis (CHR-p) syndrome enables early identification of individuals at risk of schizophrenia and related disorders. We differentiate between the stigma associated with the at-risk identification itself (‘labelling-related’ stigma) versus stigma attributed to experiencing mental health symptoms (‘symptom-related’ stigma) and examine their relationships with key psychosocial variables.</p><span>Aims</span><p>We compare labelling- and symptom-related stigma in rates of endorsement and associations with self-esteem, social support loss and quality of life.</p><span>Method</span><p>We assessed stigma domains of shame-related emotions, secrecy and experienced discrimination for both types of stigma. Individuals at CHR-p were recruited across three sites (<span>N</span> = 150); primary analyses included those who endorsed awareness of psychosis risk (<span>n</span> = 113). Paired-sample <span>t</span>-tests examined differences in labelling- versus symptom-related stigma; regressions examined associations with psychosocial variables, controlling for covariates, including CHR-p symptoms.</p><span>Results</span><p>Respondents reported greater symptom-related shame, but more labelling-related secrecy. Of the nine significant associations between stigma and psychosocial variables, eight were attributable to symptom-related stigma, even after adjusting for CHR-p symptoms.</p><span>Conclusions</span><p>Stigma attributed to symptoms had a stronger negative association with psychosocial variables than did labelling-related stigma among individuals recently identified as CHR-p. That secrecy related to the CHR-p designation was greater than its symptom-related counterpart suggests that labelling-related stigma may still be problematic for some CHR-p participants. To optimise this pivotal early intervention effort, interventions should address the holistic ‘stigmatising experience’ of having symptoms, namely any harmful reactions received as well as participants’ socially influenced concerns about what their experiences mean, in addition to the symptoms themselves.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763296","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 associated with cannabis withdrawal: systematic review and case series","authors":"Edward Chesney, Thomas J. Reilly, Fraser Scott, Ikram Slimani, Ananya Sarma, Daisy Kornblum, Dominic Oliver, Philip McGuire","doi":"10.1192/bjp.2024.175","DOIUrl":"https://doi.org/10.1192/bjp.2024.175","url":null,"abstract":"<span>Background</span><p>Abrupt cessation of heavy cannabis use can cause a withdrawal syndrome characterised by irritability, anxiety, insomnia, reduced appetite and restlessness. Recent reports have also described people in whom cannabis withdrawal immediately preceded the acute onset of psychosis.</p><span>Aims</span><p>To identify cases of psychosis associated with cannabis withdrawal.</p><span>Method</span><p>We completed a systematic review of the literature, which comprised case reports, case series and other studies. We also searched a large electronic database of psychiatric healthcare records.</p><span>Results</span><p>The systematic review identified 44 individuals from 21 studies in whom cannabis withdrawal preceded the development of acute psychosis. In the health record study, we identified another 68 people, of whom 47 involved a first episode of psychosis and 21 represented further episodes of an existing psychotic disorder. Almost all people were daily cannabis users who had stopped using cannabis abruptly. Individuals who continued to use cannabis after the acute psychotic episode had a much higher risk of subsequent relapse than those who abstained (odds ratio 13.9 [95% CI: 4.1 to 56.9]; <span>χ</span><span>2</span> = 20.1, <span>P</span> &lt; 0.00001).</p><span>Conclusions</span><p>Abrupt cannabis withdrawal may act as a trigger for the first episode of psychosis and a relapse of an existing psychosis. Acute psychotic symptoms can emerge after the cessation, as well as following the use, of cannabis.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760487","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":"Securing the base: the need for attachment-informed interventions in the perinatal period","authors":"Karyn Ayre, Caoimhe McLoughlin","doi":"10.1192/bjp.2024.131","DOIUrl":"https://doi.org/10.1192/bjp.2024.131","url":null,"abstract":"<p>‘Each has shaped the other.’<span>1</span></p><p>Evidence abounds on the salience of attachment to early development and beyond. In 2018, Adshead distilled the relevance of 20 years of attachment theory to psychiatric practice.<span>2</span> We argue research funders must move one step further: develop the evidence around perinatal attachment-informed interventions.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758490","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":"Efficacy of esketamine nasal spray over quetiapine extended release over the short and long term: sensitivity analyses of ESCAPE-TRD, a randomised phase IIIb clinical trial","authors":"Allan H. Young, Pierre-Michel Llorca, Andrea Fagiolini, Peter Falkai, Narcís Cardoner, René E. Nielsen, Ola Blomqvist, Yordan Godinov, Benoît Rive, Joris Diels, Siobhán Mulhern-Haughey, Andreas Reif","doi":"10.1192/bjp.2024.124","DOIUrl":"https://doi.org/10.1192/bjp.2024.124","url":null,"abstract":"<span>Background</span><p>In patients with treatment resistant depression (TRD), the ESCAPE-TRD study showed esketamine nasal spray was superior to quetiapine extended release.</p><span>Aims</span><p>To determine the robustness of the ESCAPE-TRD results and confirm the superiority of esketamine nasal spray over quetiapine extended release.</p><span>Method</span><p>ESCAPE-TRD was a randomised, open-label, rater-blinded, active-controlled phase IIIb trial. Patients had TRD (i.e. non-response to two or more antidepressive treatments within a major depressive episode). Patients were randomised 1:1 to flexibly dosed esketamine nasal spray or quetiapine extended release, while continuing an ongoing selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor. The primary end-point was achieving a Montgomery–Åsberg Depression Rating Scale score of ≤10 at Week 8, while the key secondary end-point was remaining relapse free through Week 32 after achieving remission at Week 8. Sensitivity analyses were performed on these end-points by varying the definition of remission based on timepoint, threshold and scale.</p><span>Results</span><p>Of 676 patients, 336 were randomised to esketamine nasal spray and 340 to quetiapine extended release. All sensitivity analyses on the primary and key secondary end-point favoured esketamine nasal spray over quetiapine extended release, with relative risks ranging from 1.462 to 1.737 and from 1.417 to 1.838, respectively (all <span>p</span> &lt; 0.05). Treatment with esketamine nasal spray shortened time to first and confirmed remission (hazard ratio: 1.711 [95% confidence interval 1.402, 2.087], <span>p</span> &lt; 0.001; 1.658 [1.337, 2.055], <span>p</span> &lt; 0.001).</p><span>Conclusion</span><p>Esketamine nasal spray consistently demonstrated significant superiority over quetiapine extended release using all pre-specified definitions for remission and relapse. Sensitivity analyses supported the conclusions of the primary ESCAPE-TRD analysis and demonstrated robustness of the results.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758492","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 Early Youth Engagement (EYE-2) intervention in first-episode psychosis services: pragmatic cluster randomised controlled trial and cost-effectiveness evaluation","authors":"Kathryn Greenwood, Christopher Jones, Nahel Yaziji, Andrew Healey, Carl May, Stephen Bremner, Richard Hooper, Shanaya Rathod, Peter Phiri, Richard de Visser, Tanya Mackay, Gergely Bartl, Iga Abramowicz, Jenny Gu, Rebecca Webb, Sunil Nandha, Belinda Lennox, Louise Johns, Paul French, Jo Hodgekins, Heather Law, James Plaistow, Rose Thompson, David Fowler, Philippa Garety, Anastacia O'Donnell, Michelle Painter, Rebecca Jarvis, Stuart Clark, Emmanuelle Peters","doi":"10.1192/bjp.2024.154","DOIUrl":"https://doi.org/10.1192/bjp.2024.154","url":null,"abstract":"<span>Background</span><p>Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.</p><span>Aims</span><p>To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.</p><span>Method</span><p>We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (<span>N</span> = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.</p><span>Results</span><p>Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (<span>n</span> = 652) versus sEIP alone (<span>n</span> = 375) was 1.07 (95% CI 0.76–1.49; <span>P</span> = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.</p><span>Conclusions</span><p>We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697127","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":"Climate change and mental health: overview of UK policy and regulatory frameworks to stimulate and inform future research and practice","authors":"Andrea Mechelli, Lea Baecker, Ioannis Bakolis, Robert Stewart, Antonio Gasparrini, Michael Smythe, Matthew White, Nick Bridge","doi":"10.1192/bjp.2024.216","DOIUrl":"https://doi.org/10.1192/bjp.2024.216","url":null,"abstract":"<p>In the context of climate change, the impacts of extreme weather events are increasingly recognised as a significant threat to mental health in the UK. As clinicians and researchers with an interest in mental health, we have a collective responsibility to help understand and mitigate these impacts. To achieve this, however, it is vital to have an appreciation of the relevant policy and regulatory frameworks. In this feature article, a collaboration amongst mental health and policy experts, we provide an overview of the integration of mental health within current climate policies and regulations in the UK, including gaps and opportunities. We argue that current policy and regulatory frameworks are lacking in coverage, ambition, detail and implementation, as increases in weather extremes and their negative impacts on mental health outpace action. For example, across current national and local climate policies, there is almost no reference to the impacts of extreme weather events on mental health. Whilst alarming, this provides scope for future research to fill evidence gaps and inform policy and regulatory change. We call for mental health and policy experts to work together to improve our understanding of underlying mechanisms and develop practical interventions, helping to bring mental health within climate policy and regulatory frameworks.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697133","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":"Emergency hospital admissions for stress-related presentations among secondary school-aged minoritised young people in England","authors":"Sorcha Ní Chobhthaigh, Matthew A. Jay, Ruth Blackburn","doi":"10.1192/bjp.2024.123","DOIUrl":"https://doi.org/10.1192/bjp.2024.123","url":null,"abstract":"<span>Background</span><p>Minoritised young people face a double burden of discrimination through increased risk of stress and differential treatment access. However, acute care pathways for minoritised young people with urgent mental health needs are poorly understood.</p><span>Aims</span><p>To explore variation in stress-related presentations (SRPs) to acute hospitals across racial-ethnic groups in England.</p><span>Method</span><p>We examined rates, distribution, duration and types of SRPs across racial-ethnic groups in a retrospective cohort of 11- to 15-year-olds with one or more emergency hospital admissions between April 2014 and March 2020. SRPs were defined as emergency admissions for potentially psychosomatic symptoms, self-harm and internalising, externalising and thought disorders.</p><span>Results</span><p>White British (8–38 per 1000 births) and Mixed White–Black (9–42 per 1000 births) young people had highest rates of SRPs, whereas Black African (5–14 per 1000 births), Indian (6–19 per 1000 births) and White other (4–19 per 1000 births) young people had the lowest rates of SRPs. The proportion of readmissions were highest for Pakistani (47.7%), White British (41.4%) and Mixed White–Black (41.3%) groups. Black Other (36.4%) and White Other (35.8%) groups had the lowest proportions of readmissions. The proportion of admission durations ≥3 days was higher for Black Other (16.6%), Bangladeshi (16.3%), Asian Other (15.9%) and Black Caribbean (15.8%) groups than their White British (11.9%) and Indian (11.8%) peers. The type of SRPs varied across racial-ethnic groups.</p><span>Conclusions</span><p>Patterns of SRP admissions systematically differed across racial-ethnic groups, indicative of inequitable triage, assessment and treatment processes. These findings highlight the need for implementation of race equality frameworks to address structural racism in healthcare pathways.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598163","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}