The British journal of psychiatry : the journal of mental science最新文献

{"title":"Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.","authors":"Davide Papola,&nbsp;Giovanni Ostuzzi,&nbsp;Federico Tedeschi,&nbsp;Chiara Gastaldon,&nbsp;Marianna Purgato,&nbsp;Cinzia Del Giovane,&nbsp;Alessandro Pompoli,&nbsp;Darin Pauley,&nbsp;Eirini Karyotaki,&nbsp;Marit Sijbrandij,&nbsp;Toshi A Furukawa,&nbsp;Pim Cuijpers,&nbsp;Corrado Barbui","doi":"10.1192/bjp.2021.148","DOIUrl":"https://doi.org/10.1192/bjp.2021.148","url":null,"abstract":"<p><strong>Background: </strong>Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence.</p><p><strong>Aims: </strong>To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis.</p><p><strong>Method: </strong>We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258).</p><p><strong>Results: </strong>We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive-behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = -0.67, 95% CI -0.95 to -0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI -0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = -0.61, 95% CI -1.15 to -0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54-1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU.</p><p><strong>Conclusions: </strong>CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"507-519"},"PeriodicalIF":10.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39837259","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":"Social isolation and alcohol use: lessons from <i>The Queen's Gambit</i> - psychiatry in television.","authors":"Faraan Cheema,&nbsp;Paul Wilkinson","doi":"10.1192/bjp.2022.46","DOIUrl":"https://doi.org/10.1192/bjp.2022.46","url":null,"abstract":"The Queen’s Gambit is a 2020 Netflix miniseries that follows Beth Harmon, a fictional orphan chess prodigy battling to become the world’s best player while simultaneously struggling with alcohol and drug dependency. Although some have argued that the depiction of Beth’s recovery from addiction is unrealistic, these criticisms fail to acknowledge the detailed presentation of the factors that lead to Beth’s substance use and subsequent sobriety.","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"537"},"PeriodicalIF":10.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40627609","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":"Impact of early intervention on the population prevalence of common mental disorders: 20-year prospective study.","authors":"Paul Moran,&nbsp;Margarita Moreno-Betancur,&nbsp;Carolyn Coffey,&nbsp;Elizabeth A Spry,&nbsp;George C Patton","doi":"10.1192/bjp.2022.3","DOIUrl":"https://doi.org/10.1192/bjp.2022.3","url":null,"abstract":"<p><strong>Background: </strong>The potential for early interventions to reduce the later prevalence of common mental disorders (CMD) first experienced in adolescence is unclear.</p><p><strong>Aims: </strong>To examine the course of CMD and evaluate the extent to which the prevalence of CMD could be reduced by preventing adolescent CMD, or by intervening to change four young adult processes, between the ages of 20 and 29 years, that could be mediating the link between adolescent and adult disorder.</p><p><strong>Method: </strong>This was a prospective cohort study of 1923 Australian participants assessed repeatedly from adolescence (wave 1, mean age 14 years) to adulthood (wave 10, mean age 35 years). Causal mediation analysis was undertaken to evaluate the extent to which the prevalence of CMD at age 35 years in those with adolescent CMD could be reduced by either preventing adolescent CMD, or by intervening on four young adult mediating processes: the occurrence of young adult CMD, frequent cannabis use, parenting a child by age 24 years, and engagement in higher education and employment.</p><p><strong>Results: </strong>At age 35, 19.2% of participants reported CMD; a quarter of these participants experienced CMD during both adolescence and young adulthood. In total, 49% of those with CMD during both adolescence and young adulthood went on to report CMD at age 35 years. Preventing adolescent CMD reduced the population prevalence at age 35 years by 3.9%. Intervening on all four young adult processes among those with adolescent CMD, reduced this prevalence by 1.6%.</p><p><strong>Conclusions: </strong>In this Australian cohort, a large proportion of adolescent CMD resolved by adulthood, and by age 35 years, the largest proportion of CMD emerged among individuals without prior CMD. Time-limited, early intervention in those with earlier adolescent disorder is unlikely to substantially reduce the prevalence of CMD in midlife.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"558-566"},"PeriodicalIF":10.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39893187","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":"Life expectancy and years of potential life lost in bipolar disorder: systematic review and meta-analysis.","authors":"Joe Kwun Nam Chan,&nbsp;CoCo Ho Yi Tong,&nbsp;Corine Sau Man Wong,&nbsp;Eric Yu Hai Chen,&nbsp;Wing Chung Chang","doi":"10.1192/bjp.2022.19","DOIUrl":"https://doi.org/10.1192/bjp.2022.19","url":null,"abstract":"<p><strong>Background: </strong>There is increasing research examining excess mortality in people with bipolar disorder using life expectancy and related measures, which quantify the disease impact on survival. However, there has been no meta-analysis to date summarising existing data on life expectancy in those with bipolar disorder.</p><p><strong>Aims: </strong>To systematically review and quantitatively synthesise estimates of life expectancy and years of potential life lost (YPLL) in people with bipolar disorder.</p><p><strong>Method: </strong>We searched Embase, Medline, PsycINFO and Web of Science databases up to 31 March 2021. We generated pooled life expectancy using random-effects models, and derived YPLL summary estimate by calculating averaged values weighted by sample size of individual studies. Subgroup analyses were conducted for gender, geographical region, study period, a given age (set-age) for lifespan estimation and causes of death. The study was registered with PROSPERO (CRD42021241705).</p><p><strong>Results: </strong>Eleven and 13 studies were included in the review for life expectancy (<i>n</i> = 96 601) and YPLL (<i>n</i> = 128 989), respectively. Pooled life expectancy was 66.88 years (95% CI 64.47-69.28; <i>I</i>² = 99.9%, <i>P</i> < 0.001), was higher in women than men (70.51 (95% CI 68.61-72.41) <i>v</i>. 64.59 (95% CI 61.16-68.03); <i>z</i> = 2.00, <i>P</i> = 0.003) and was lowest in Africa. Weighted average YPLL was 12.89 years (95% CI 12.72-13.07), and was greatest in Africa. More YPLL was observed when lifespan was estimated at birth than at other set-age. YPLLs attributable to natural and unnatural deaths were 5.94 years (95% CI 5.81-6.07) and 5.69 years (95% CI 5.59-5.79), respectively.</p><p><strong>Conclusions: </strong>Bipolar disorder is associated with substantially shortened life expectancy. Implementation of multilevel, targeted interventions is urgently needed to reduce this mortality gap.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"567-576"},"PeriodicalIF":10.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39938438","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":"Autistic psychiatrists: Royal College of Psychiatrists response.","authors":"Conor James Joseph Davidson,&nbsp;Peter Carpenter,&nbsp;Rajesh Mohan","doi":"10.1192/bjp.2022.84","DOIUrl":"https://doi.org/10.1192/bjp.2022.84","url":null,"abstract":"","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"582"},"PeriodicalIF":10.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40627611","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":"Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis.","authors":"Jutta M Stoffers-Winterling,&nbsp;Ole Jakob Storebø,&nbsp;Mickey T Kongerslev,&nbsp;Erlend Faltinsen,&nbsp;Adan Todorovac,&nbsp;Mie Sedoc Jørgensen,&nbsp;Christian P Sales,&nbsp;Henriette Edemann Callesen,&nbsp;Johanne Pereira Ribeiro,&nbsp;Birgit A Völlm,&nbsp;Klaus Lieb,&nbsp;Erik Simonsen","doi":"10.1192/bjp.2021.204","DOIUrl":"https://doi.org/10.1192/bjp.2021.204","url":null,"abstract":"<p><strong>Background: </strong>A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD).</p><p><strong>Aims: </strong>To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely.</p><p><strong>Method: </strong>We applied the same methods as the 2020 Cochrane review, but focused on adult samples and comparisons of active treatments and unspecific control conditions. Standalone treatments (i.e. necessarily including individual psychotherapy as either the sole or one of several treatment components) and add-on interventions (i.e. complementing any ongoing individual BPD treatment) were analysed separately. Primary outcomes were BPD severity, self-harm, suicide-related outcomes and psychosocial functioning. Secondary outcomes were remaining BPD diagnostic criteria, depression and attrition.</p><p><strong>Results: </strong>Thirty-one randomised controlled trials totalling 1870 participants were identified. Among standalone treatments, statistically significant effects of low overall certainty were observed for dialectical behaviour therapy (self-harm: standardised mean difference (SMD) -0.54, <i>P</i> = 0.006; psychosocial functioning: SMD -0.51, <i>P</i> = 0.01) and mentalisation-based treatment (self-harm: risk ratio 0.51, <i>P</i> < 0.0007; suicide-related outcomes: risk ratio 0.10, <i>P</i> < 0.0001). For adjunctive interventions, moderate-quality evidence of beneficial effects was observed for DBT skills training (BPD severity: SMD -0.66, <i>P</i> = 0.002; psychosocial functioning: SMD -0.45, <i>P</i> = 0.002), and statistically significant low-certainty evidence was observed for the emotion regulation group (BPD severity: mean difference -8.49, <i>P</i> < 0.00001), manual-assisted cognitive therapy (self-harm: mean difference -3.03, <i>P</i> = 0.03; suicide-related outcomes: SMD -0.96, <i>P</i> = 0.005) and the systems training for emotional predictability and problem-solving (BPD severity: SMD -0.48, <i>P</i> = 0.002).</p><p><strong>Conclusions: </strong>There is reasonable evidence to conclude that psychotherapeutic interventions are helpful for individuals with BPD. Replication studies are needed to enhance the certainty of findings.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"538-552"},"PeriodicalIF":10.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866140","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":"St Patrick's Hospital, Dublin, of 1749 - psychiatry in pictures.","authors":"R H S Mindham","doi":"10.1192/bjp.2021.209","DOIUrl":"https://doi.org/10.1192/bjp.2021.209","url":null,"abstract":"","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"501-502"},"PeriodicalIF":10.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40613988","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":"Changes in brain function during negative emotion processing in the long-term course of depression.","authors":"Verena Enneking,&nbsp;Melissa Klug,&nbsp;Tiana Borgers,&nbsp;Katharina Dohm,&nbsp;Dominik Grotegerd,&nbsp;Lisa Marie Frankenberger,&nbsp;Carina Hülsmann,&nbsp;Hannah Lemke,&nbsp;Susanne Meinert,&nbsp;Elisabeth J Leehr,&nbsp;Nils Opel,&nbsp;Janik Goltermann,&nbsp;Maike Richter,&nbsp;Lena Waltemate,&nbsp;Joscha Böhnlein,&nbsp;Lisa Sindermann,&nbsp;Jonathan Repple,&nbsp;Jochen Bauer,&nbsp;Mareike Thomas,&nbsp;Udo Dannlowski,&nbsp;Ronny Redlich","doi":"10.1192/bjp.2021.223","DOIUrl":"https://doi.org/10.1192/bjp.2021.223","url":null,"abstract":"<p><strong>Background: </strong>Relapses in major depression are frequent and are associated with a high burden of disease. Although short-term studies suggest a normalisation of depression-associated brain functional alterations directly after treatment, long-term investigations are sparse.</p><p><strong>Aims: </strong>To examine brain function during negative emotion processing in association with course of illness over a 2-year span.</p><p><strong>Method: </strong>In this prospective case-control study, 72 in-patients with current depression and 42 healthy controls were investigated during a negative emotional face processing paradigm, at baseline and after 2 years. According to their course of illness during the study interval, patients were divided into subgroups (<i>n</i> = 25 no-relapse, <i>n</i> = 47 relapse). The differential changes in brain activity were investigated by a group × time analysis of covariance for the amygdala, hippocampus, insula and at whole-brain level.</p><p><strong>Results: </strong>A significant relapse × time interaction emerged within the amygdala (<i>P</i>_TFCE-FWE = 0.011), insula (<i>P</i>_TFCE-FWE = 0.001) and at the whole-brain level mainly in the temporal and prefrontal cortex (<i>P</i>_TFCE-FWE = 0.027), resulting from activity increases within the no-relapse group, whereas in the relapse group, activity decreased during the study interval. At baseline, the no-relapse group showed amygdala, hippocampus and insula hypoactivity compared with healthy controls and the relapse group.</p><p><strong>Conclusions: </strong>This study reveals course of illness-associated activity changes in emotion processing areas. Patients in full remission show a normalisation of their baseline hypo-responsiveness to the activation level of healthy controls after 2 years. Brain function during emotion processing could further serve as a potential predictive marker for future relapse.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"476-484"},"PeriodicalIF":10.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39861565","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 simple gesture - reflection.","authors":"Leif Gregersen","doi":"10.1192/bjp.2021.214","DOIUrl":"https://doi.org/10.1192/bjp.2021.214","url":null,"abstract":"","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"458"},"PeriodicalIF":10.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40532936","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 conundrum of therapeutic intoxication.","authors":"David S Mathai,&nbsp;David B Yaden,&nbsp;Kelley C O'Donnell","doi":"10.1192/bjp.2022.58","DOIUrl":"https://doi.org/10.1192/bjp.2022.58","url":null,"abstract":"This editorial on the use of intramuscular clozapine has the potential to mislead readers. The authors question the efficacy of intramuscular clozapine on the grounds that it is not always given when prescribed and go on to recommend the use of intramuscular haloperidol or olanzapine as alternatives to intramuscular clozapine.Most patients who respond to clozapine are willing to continue taking it once their insight has improved but may be initially reluctant while acutely unwell. In many instances, a short period of assertive treatment is justified in order to establish the patient on an effective long-term treatment which they will ultimately accept, and this is where intramuscular clozapine is useful. All the patients in the study had declined to take clozapine prior to being prescribed intramuscular clozapine. Once prescribed intramuscular clozapine, all were again encouraged to accept oral treatment as an alternative to intramuscular. As the data show, around half then accepted oral treatment without a single administration of intramuscular clozapine but would not have done so had intramuscular clozapine not been prescribed. Intramuscular forms of haloperidol and olanzapine may have the advantage of being licensed products (although there is no UK-licensed intramuscular olanzapine at the moment), but their use in treatment-resistant patients is ethically unsupportable given the near certainty that they will be ineffective as antipsychotics in this patient group. In Kane’s landmark study of clozapine, 305 enrolled patients were initially treated with haloperidol at an average dose of 61 mg/day. Fewer than 2% of patients responded, and there was no mean change in symptom score for this cohort as a whole. In the study proper, 30% of these patients responded to clozapine within 6 weeks. Likewise, in a smaller study, olanzapine 25 mg/day was associated with response in only 5% of a treatmentresistant group, and 41% of the same patients subsequently responded to clozapine. Some studies have shown benefit for non-clozapine antipsychotics in resistant patients, but these trials are methodologically flawed and subject to funder bias. Most clinicians accept that clozapine is uniquely effective in refractory schizophrenia. We agree with the authors that intramuscular clozapine might have limited potential as an ad hoc intervention to prevent gaps in treatment, but not primarily because of the time this would take to arrange. The main problem with using intramuscular clozapine for those on higher maintenance doses is that the maximum oral equivalent dose to one 4 mL injection is 200 mg, and large variation in clozapine dosages can be dangerous. Rather, intramuscular clozapine is most useful as part of a pre-discussed and well-planned multidisciplinary team initiation regimen. The editorial’s authors draw the reader’s attention to the risks associated with inadvertently administering an overdose of intramuscular clozapine to a clozapine-naïve patient. Th","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"496-497"},"PeriodicalIF":10.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40532938","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}