The British Journal of Psychiatry最新文献

{"title":"Importance of patient online activities","authors":"Scott Monteith, Tasha Glenn, John R. Geddes, Peter C. Whybrow, Eric Achtyes, Rita Bauer, Michael Bauer","doi":"10.1192/bjp.2025.32","DOIUrl":"https://doi.org/10.1192/bjp.2025.32","url":null,"abstract":"<p>Online platforms and activities, including smartphones, computers, social media, video games and applications involving artificial intelligence, have become a regular part of daily life and offer individuals a wide range of benefits. The purpose of this document is to increase psychiatrists’ awareness of the frequency and potential risks associated with excessive internet use, and to emphasise the need for psychiatrists to routinely question patients about their online activities. Internet use may become excessive and result in both psychological distress and physical impairments. Treatments and countermeasures may be required to address the harmful consequences of excessive internet use. Psychiatrists should be aware of patient online activities. Understanding of a patient’s online behaviour should now be a routine part of a psychiatric interview.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979775","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 and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study.","authors":"Kirstie O'Hare,Ulla Lång,Colm Healy,Ioanna Kougianou,Animesh Talukder,Robin Murray,Stephen M Lawrie,Ann John,Ian Kelleher","doi":"10.1192/bjp.2025.48","DOIUrl":"https://doi.org/10.1192/bjp.2025.48","url":null,"abstract":"BACKGROUNDCurrent approaches to identifying individuals at risk for psychosis capture only a small proportion of future psychotic disorders. Recent Finnish research suggests a substantial proportion of individuals at risk of psychosis attend child and adolescent mental health services (CAMHS) earlier in life, creating important opportunities for prediction and prevention. To what extent this is true outside Finland is unknown.AIMSTo establish the proportion of psychotic and bipolar disorder diagnoses that occurred in individuals who had attended CAMHS in Wales, UK, and whether, within CAMHS, certain factors were associated with increased psychosis risk.METHODWe examined healthcare contacts for individuals born between 1991 and 1998 (N = 348 226), followed to age 25-32. Using linked administrative healthcare records, we identified all psychotic and bipolar disorder diagnoses in the population, then determined the proportion of cases where the individual had attended CAMHS. Regression analyses examined associations between sociodemographic and clinical risk markers with psychotic and bipolar disorder outcomes.RESULTSAmong individuals diagnosed with a psychotic or bipolar disorder, 44.78% had attended CAMHS (hazard ratio = 6.28, 95% CI = 5.92-6.65). Low birth weight (odds ratio = 1.33, 95% CI = 1.15-1.53), out-of-home care experience (odds ratio = 2.05, 95% CI = 1.77-2.38), in-patient CAMHS admission (odds ratio = 1.49, 95% CI = 1.29-1.72) and attending CAMHS in childhood (in addition to adolescence; odds ratio = 1.16, 95% CI = 1.02-1.30) were all within-CAMHS risk markers for psychotic and bipolar disorders.CONCLUSIONSA substantial proportion (45%) of future psychotic and bipolar disorder cases emerge in individuals who had attended CAMHS, demonstrating large-scale opportunities for early intervention and prevention within CAMHS.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"17 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945534","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":"Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators.","authors":"Mathias Harrer,Antonia A Sprenger,Susan Illing,Marcel C Adriaanse,Steven M Albert,Esther Allart,Osvaldo P Almeida,Julian Basanovic,Kim M P van Bastelaar,Philip J Batterham,Harald Baumeister,Thomas Berger,Vanessa Blanco,Ragnhild Bø,Robin J Casten,Dicken Chan,Helen Christensen,Marketa Ciharova,Lorna Cook,John Cornell,Elysia P Davis,Keith S Dobson,Elsien Dozeman,Simon Gilbody,Benjamin L Hankin,Rimke Haringsma,Kristof Hoorelbeke,Michael R Irwin,Femke Jansen,Rune Jonassen,Eirini Karyotaki,Norito Kawakami,J Philipp Klein,Candace Konnert,Kotaro Imamura,Nils Inge Landrø,María Asunción Lara,Huynh-Nhu Le,Dirk Lehr,Juan V Luciano,Steffen Moritz,Jana M Mossey,Ricardo F Muñoz,Anna Muntingh,Stephanie Nobis,Richard Olmstead,Patricia Otero,Mirjana Pibernik-Okanović,Anne Margriet Pot,Charles F Reynolds,Barry W Rovner,Juan P Sanabria-Mazo,Lasse B Sander,Filip Smit,Frank J Snoek,Viola Spek,Philip Spinhoven,Liza Stelmach,Yannik Terhorst,Fernando L Vázquez,Irma Verdonck-de Leeuw,Ed Watkins,Wenhui Yang,Samuel Yeung Shan Wong,Johannes Zimmermann,Masatsugu Sakata,Toshi A Furukawa,Stefan Leucht,Pim Cuijpers,Claudia Buntrock,David Daniel Ebert","doi":"10.1192/bjp.2025.56","DOIUrl":"https://doi.org/10.1192/bjp.2025.56","url":null,"abstract":"BACKGROUNDIt remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.AIMSTo synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.METHODRandomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment-covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.RESULTSIPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = -0.48 to -0.27). Effects could not be ascertained up to 24 months (s.m.d. = -0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27-2.79), reliable improvement (relative risk = 1.38-3.17), deterioration (relative risk = 0.67-0.54) and close-to-symptom-free status (relative risk = 1.41-2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = -0.33 for PHQ-9 = 5).CONCLUSIONSPsychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"91 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945532","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":"Post-traumatic stress disorder rates in trauma-exposed children and adolescents: updated three-level meta-analysis","authors":"Ilse Visser, Malindi van der Mheen, Hannah Dorsman, Rik Knipschild, Janneke Staaks, Irma Hein, Noah van Dongen, Wouter Staal, Mark Assink, Ramón J. L. Lindauer","doi":"10.1192/bjp.2025.30","DOIUrl":"https://doi.org/10.1192/bjp.2025.30","url":null,"abstract":"<span>Background</span><p>In the past decade, no meta-analytical estimates of the prevalence of post-traumatic stress disorder (PTSD) among children and adolescents have been published, despite a host of new prevalence studies and updated DSM-5 criteria.</p><span>Aims</span><p>We set out to estimate the prevalence rates of PTSD in trauma-exposed children and adolescents on the basis of DSM-IV and DSM-5 criteria, and investigate differences in prevalence across trauma type, gender, time since exposure, type of informant and diagnostic measures.</p><span>Method</span><p>Studies identified in a previous meta-analysis were combined with more recent studies retrieved in a new systematic literature search, resulting in a total of 95 studies describing 64 independent samples (<span>n</span> = 6745 for DSM-IV, <span>n</span> = 12 644 for DSM-5) over a 30-year period. Three-level random-effects models were used to estimate prevalence for DSM-IV and DSM-5 criteria separately, and for testing coded variables as moderators.</p><span>Results</span><p>The DSM-IV meta-analysis estimated a PTSD prevalence of 20.3% (95% CI 14.9–26.2%) using 56 samples with age range 0–18 years, and revealed moderating effects of gender, trauma type and diagnostic interview type. The DSM-5 meta-analysis found an overall prevalence of 12.0% (95% CI 3.7–24.2%) using eight samples with age range 1–18 years. There was insufficient data for moderation analyses.</p><span>Conclusions</span><p>Although most trauma-exposed children and adolescents do not develop PTSD, a significant proportion (20% under DSM-IV criteria and 12% under DSM-5 criteria) do, particularly girls and individuals exposed to interpersonal trauma. These findings highlight the urgent need of continuous efforts in prevention, early trauma-related screening, and effective diagnostics and treatment to address the substantial burden of PTSD.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939770","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":"Effects of ketamine on individual symptoms and symptom networks of depression in a randomised controlled trial of ketamine for treatment-resistant depression","authors":"Shabnam Hossein, Manivel Rengasamy, Aiyedun Uzamere, Crystal Spotts, Robert H. Howland, Meredith L. Wallace, Sanjay J. Mathew, Rebecca B. Price","doi":"10.1192/bjp.2024.276","DOIUrl":"https://doi.org/10.1192/bjp.2024.276","url":null,"abstract":"<span>Background</span><p>Understanding the effects of ketamine on depressive symptoms could help identify which patients might benefit and clarify its mechanism of action in both the early (≤1 day post-infusion) and late (e.g. 2–30 days post-infusion) post-infusion periods. Symptom network analyses could provide complementary information regarding relationships between symptoms.</p><span>Aims</span><p>To identify the effects of ketamine on symptom-level changes in depression across both the early and late post-infusion periods and on depressive symptom network changes.</p><span>Methods</span><p>In this secondary analysis of 152 adults with treatment-resistant depression (with 38.8% reporting suicidal ideation at baseline), we compared symptom changes in the early and late post-infusion periods between individuals randomised to a single 40 min infusion of intravenous ketamine 0.5 mg/kg (<span>n</span> = 103) or saline (<span>n</span> = 49) and identified changes in symptom networks between pre- and post-ketamine treatment using network analyses.</p><span>Results</span><p>In the early post-infusion period, the greatest improvement (comparing ketamine with saline) was in depressive symptoms related to sadness. In network analyses, symptom network connectivity increased following ketamine infusion. Symptoms of sadness and lassitude showed persistent improvement in the first week post-infusion, whereas improvements in suicidal thoughts first emerged 3–4 weeks post-infusion.</p><span>Conclusion</span><p>Ketamine improved all symptoms but showed the greatest effect on symptoms of sadness, both immediately and in the initial week after treatment. Ketamine also rapidly altered the topology of symptom networks, strengthening interrelationships between residual symptoms. The efficacy of ketamine (compared with saline) regarding suicidal symptoms emerged later. Our findings suggest potentially divergent efficacy, time courses and mechanisms for different symptoms of depression.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939769","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":"Anabolic-androgenic steroid use disorder: case for recognition as a substance use disorder with specific diagnostic criteria","authors":"Morgan Scarth, Ingrid Amalia Havnes, Astrid Bjørnebekk","doi":"10.1192/bjp.2025.73","DOIUrl":"https://doi.org/10.1192/bjp.2025.73","url":null,"abstract":"<p>Approximately one in three people who use anabolic-androgenic steroids (AASs) develop dependence, characterised by both psychiatric and somatic symptoms. Despite this, AAS use disorder (AASUD) is not distinctly recognised in the latest versions of either the ICD or DSM, impeding both clinical care and research progress. It is clear that AASUD shares many features and correlates with substance use disorders (SUDs) that have specific diagnostic criteria in these classification systems, such as stimulants or opioids. We aim to outline the overlap between AASUD and more ‘typical’ SUDs as well as highlight the specific concerns related to AASUD that warrant recognition and distinct diagnostic criteria.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939768","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":"Autobiographical memory after electroconvulsive therapy: systematic review and meta-analysis","authors":"André Beyer Mathiassen, Maria Semkovska, Christoffer Cramer Lundsgaard, Krzysztof Gbyl, Poul Videbech","doi":"10.1192/bjp.2025.2","DOIUrl":"https://doi.org/10.1192/bjp.2025.2","url":null,"abstract":"<span>Background</span><p>Electroconvulsive therapy (ECT) is the most effective treatment of major depression, but autobiographical memory loss may limit its use. Despite previous attempts to synthesise the literature, the nature of autobiographical memory loss after ECT is still debated.</p><span>Aims</span><p>To provide an overview of the effect of ECT on autobiographical memory in patients with depression and explore whether the effect is temporary or permanent. Furthermore, we wanted to analyse if ECT parameters or clinical information are associated with this effect.</p><span>Method</span><p>PubMed, EMBASE, PsycINFO and Web of Science databases were searched on 26 January 2024. We included longitudinal studies measuring autobiographical memory before and after ECT in patients with depression compared to patients with depression receiving other treatment or healthy controls. Synthesis approach was a meta-analysis. PROSPERO ID: CRD42021267901.</p><span>Results</span><p>Nine studies were included (432 patients, 173 controls). At post-ECT, we found that ECT patients had larger autobiographical memory loss than controls (standardised mean difference (SMD) = 0.55; 95% CI = 0.35–0.75). Right unilateral (RUL) ECT entailed a small effect on autobiographical memory (SMD = 0.32; 95% CI = 0.06–0.57), while bilateral ECT yielded a large effect (SMD = 0.82; 95% CI = 0.49–1.15). Higher age was associated with smaller effect. Autobiographical memory was stable at long-term follow-up.</p><span>Conclusions</span><p>The studies suggest that ECT causes autobiographical memory loss in patients with depression. Results also suggest that lost memories are not regained. Furthermore, results support that RUL ECT is less detrimental to autobiographical memory. Strangely, a higher age might mitigate the autobiographical memory loss. Our findings are limited by studies being mainly observational and generally consisting of small sample sizes. Future studies should prioritise long-term follow-up assessments of autobiographical memory.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939819","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":"Real-world studies in psychiatry: insights into antipsychotic-associated breast cancer risk and their broader implications","authors":"Olivier Corbeil, Itziar Montalvo, Javier Labad, Jurjen J. Luykx","doi":"10.1192/bjp.2025.16","DOIUrl":"https://doi.org/10.1192/bjp.2025.16","url":null,"abstract":"<p>Real-world studies provide valuable insights into long-term outcomes across diverse populations. Here, we contextualise recent findings on the association between antipsychotic use and breast cancer risk in women with schizophrenia. We discuss clinical implications and the strengths and limitations of real-world studies in psychiatry. We conclude with future perspectives.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939771","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 and safety of an alpha 7-nicotinic acetylcholine receptor agonist, VQW-765, in subjects with performance anxiety: randomised, double-blind, placebo-controlled trial.","authors":"Yunsheng He,Christos M Polymeropoulos,Michael A Mohrman,Sunny O Truslow,Changfu Xiao,Yukun Wu,Gunther Birznieks,Mihael H Polymeropoulos","doi":"10.1192/bjp.2025.84","DOIUrl":"https://doi.org/10.1192/bjp.2025.84","url":null,"abstract":"BACKGROUNDDespite the high prevalence of social and performance anxiety, current treatments do not meet the full needs of patients. Development of novel anxiolytics with rapid onset of action for on-demand treatment of social and performance anxiety is an active area of clinical research.AIMSTo examine the anxiolytic effect of VQW-765, an α7-nAChR agonist, in subjects with performance anxiety.METHODWe conducted a randomised, double-blind, placebo-controlled trial of 230 adults with a history of public speaking anxiety. Participants were randomly assigned to receive a single oral dose of 10 mg VQW-765 (n = 116) or placebo (n = 114), followed by a Trier Social Stress Test (TSST). Anxiety levels were assessed by the Subjective Units of Distress Scale (SUDS). Heart rate was monitored during the TSST. Plasma concentration of VQW-765 was measured after the TSST.RESULTSSubjects receiving VQW-765 showed a trend of improvement in intensity of anxiety, as measured by the SUDS, during the performance phase of a TSST compared with placebo (P = 0.1443). Females showed a larger magnitude and significant response to VQW-765 (P = 0.034). The pharmacokinetic/pharmacodynamic analysis observed an inverted U-shaped exposure-response relationship. Subjects in the middle 50% quantiles of VQW-765 plasma concentration showed significant improvement in the SUDS rating compared with placebo (P = 0.033); however, subgroup analysis revealed this was true only for females (P = 0.005). VQW-765 was safe and well tolerated.CONCLUSIONSThis is the first study showing anxiolytic effect of an α7-nAChR agonist in humans. VQW-765 is a promising candidate to be developed for on-demand treatment of social anxiety disorder.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"39 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926286","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":"Duration of untreated or undiagnosed bipolar disorder and clinical characteristics and outcomes: systematic review and meta-analysis","authors":"Kamyar Keramatian, Jairo V. Pinto, Vivian W. L. Tsang, Trisha Chakrabarty, Lakshmi N. Yatham","doi":"10.1192/bjp.2025.63","DOIUrl":"https://doi.org/10.1192/bjp.2025.63","url":null,"abstract":"<span>Background</span><p>The duration of undiagnosed or untreated bipolar disorder (DUBD) has become a focus of research interest. However, its relationship with clinical characteristics and outcomes remains poorly understood.</p><span>Aims</span><p>The objective of this systematic review and meta-analysis was to examine DUBD and explore its relationships with clinical characteristics and outcomes in bipolar disorder.</p><span>Methods</span><p>We conducted a systematic search of the literature to identify studies reporting on DUBD and its relationships with clinical characteristics and outcomes including frequency of relapse into mood episodes, severity and persistence of mood symptoms, functional and cognitive measures, suicidality, hospital admission rate, and comorbidities such as substance use disorders.</p><span>Results</span><p>Thirty articles met inclusion criteria for the systematic review, and 23 studies were included in the three different sets of meta-analyses. The pooled mean DUBD across all studies was 9.10 years. Early onset, depression as the polarity of the first mood episode, lifetime suicide attempts, comorbid anxiety and alcohol use disorders, and family history of bipolar disorder were associated with significantly longer DUBD, whereas diagnosis of bipolar I disorder and lifetime psychotic symptoms were associated with shorter DUBD. Studies that investigated outcomes subsequent to the diagnosis of bipolar disorder yielded conflicting results.</p><span>Conclusion</span><p>DUBD may be associated with certain adverse outcomes. This association indicates the importance of adopting a more comprehensive approach to assessing mood disorders, with an emphasis on prioritising early screening for bipolar disorder. The significant heterogeneity among included studies suggests a need for improved methodological rigour in future research.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920068","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}