The British Journal of Psychiatry最新文献

{"title":"Clarifying our language for better women’s brain health: what do we really mean when we say ‘menopause’ and ‘hormone therapy’?","authors":"Noelia Calvo, Gillian Einstein","doi":"10.1192/bjp.2025.109","DOIUrl":"https://doi.org/10.1192/bjp.2025.109","url":null,"abstract":"<p>Interest in women’s brain health has grown rapidly. However, the terms ‘menopause’ and ‘hormone therapy’ have been used as general concepts embracing different types of menopause and treatments. In this editorial, we make a plea for accurate description of each type to generate precision evidence.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218880","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":"Neurosteroid treatment of postpartum depression and beyond","authors":"Kristina M. Deligiannidis, Samantha Meltzer-Brody","doi":"10.1192/bjp.2025.90","DOIUrl":"https://doi.org/10.1192/bjp.2025.90","url":null,"abstract":"<p>Depression occurring during pregnancy or after delivery is one of the most common complications of childbirth and is associated with maternal morbidity and mortality. Here we review the breakthrough development of the first neuroactive steroid-based antidepressants approved for postpartum depression in the USA and their potential in other psychiatric illnesses.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218881","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":"Multidisciplinary consensus on prevention, screening and monitoring of clozapine-associated myocarditis and clozapine rechallenge after myocarditis","authors":"Elias Wagner, Nicole Korman, Marco Solmi, Matin Mortazavi, Zahra Aminifarsani, Douglas Dubrovin Leão, Matthew K. Burrage, Dan Siskind, Laura McMahon, Oliver D. Howes, Christoph U. Correll, CAM Expert Group, Alkomiet Hasan","doi":"10.1192/bjp.2025.89","DOIUrl":"https://doi.org/10.1192/bjp.2025.89","url":null,"abstract":"<span>Background</span><p>Clozapine is the antipsychotic of choice for people with treatment-resistant schizophrenia (TRS) but is associated with the uncommon but potentially life-threatening adverse effect of myocarditis. However, there are no criteria for diagnosing clozapine-associated myocarditis (CAM) or global guidelines on detection and risk reduction, or for restarting clozapine after CAM.</p><span>Aims</span><p>To develop criteria for CAM and algorithms for clozapine initiation and clozapine rechallenge after CAM in a multiprofessional consensus process.</p><span>Method</span><p>We conducted a systematic literature search for cases of clozapine rechallenge following CAM using the PubMed, EMBASE, CINAHL and PsycINFO databases, followed by a multidisciplinary international two-step Delphi consensus process in July and October 2024. The Delphi panel comprised psychiatrists, cardiologists, pharmacists, psychopharmacologists and nurses with expertise on clozapine or myocarditis.</p><span>Results</span><p>Ninety-three clinicians and academics with experience in prescribing clozapine from six continents participated in the Delphi process. A consensus was reached on a definition of CAM according to modified clinical criteria from the European Society of Cardiology for myocarditis associated with immune checkpoint inhibitors. Titration schemes slower than those given in the Summary of Product Characteristics for clozapine were recommended to minimise CAM risk. Minimum and enhanced requirements for screening and monitoring were developed to account for global perspectives and limited resources in certain healthcare systems, and an approach to clozapine rechallenge was elaborated.</p><span>Conclusions</span><p>This multidisciplinary project represents the first guidance for CAM and will inform clinicians, other caregivers and patients, as well as facilitating the development of national guidelines on CAM prevention, screening and monitoring and rechallenge after an index episode of myocarditis in individuals taking clozapine.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144193145","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":"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}