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

{"title":"Predicting relapse or recurrence of depression: systematic review of prognostic models.","authors":"Andrew S Moriarty, Nicholas Meader, Kym I E Snell, Richard D Riley, Lewis W Paton, Sarah Dawson, Jessica Hendon, Carolyn A Chew-Graham, Simon Gilbody, Rachel Churchill, Robert S Phillips, Shehzad Ali, Dean McMillan","doi":"10.1192/bjp.2021.218","DOIUrl":"10.1192/bjp.2021.218","url":null,"abstract":"<p><strong>Background: </strong>Relapse and recurrence of depression are common, contributing to the overall burden of depression globally. Accurate prediction of relapse or recurrence while patients are well would allow the identification of high-risk individuals and may effectively guide the allocation of interventions to prevent relapse and recurrence.</p><p><strong>Aims: </strong>To review prognostic models developed to predict the risk of relapse, recurrence, sustained remission, or recovery in adults with remitted major depressive disorder.</p><p><strong>Method: </strong>We searched the Cochrane Library (current issue); Ovid MEDLINE (1946 onwards); Ovid Embase (1980 onwards); Ovid PsycINFO (1806 onwards); and Web of Science (1900 onwards) up to May 2021. We included development and external validation studies of multivariable prognostic models. We assessed risk of bias of included studies using the Prediction model risk of bias assessment tool (PROBAST).</p><p><strong>Results: </strong>We identified 12 eligible prognostic model studies (11 unique prognostic models): 8 model development-only studies, 3 model development and external validation studies and 1 external validation-only study. Multiple estimates of performance measures were not available and meta-analysis was therefore not necessary. Eleven out of the 12 included studies were assessed as being at high overall risk of bias and none examined clinical utility.</p><p><strong>Conclusions: </strong>Due to high risk of bias of the included studies, poor predictive performance and limited external validation of the models identified, presently available clinical prediction models for relapse and recurrence of depression are not yet sufficiently developed for deploying in clinical settings. There is a need for improved prognosis research in this clinical area and future studies should conform to best practice methodological and reporting guidelines.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"448-458"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39711965","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 Lawn Hospital, Lincoln, and Dr Robert Gardiner Hill - psychiatry in pictures.","authors":"R H S Mindham","doi":"10.1192/bjp.2021.210","DOIUrl":"https://doi.org/10.1192/bjp.2021.210","url":null,"abstract":"","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"503-504"},"PeriodicalIF":10.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40613987","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":"Optimal dose of aripiprazole for augmentation therapy of antidepressant-refractory depression: preliminary findings based on a systematic review and dose-effect meta-analysis.","authors":"Yuki Furukawa,&nbsp;Tasnim Hamza,&nbsp;Andrea Cipriani,&nbsp;Toshi A Furukawa,&nbsp;Georgia Salanti,&nbsp;Edoardo G Ostinelli","doi":"10.1192/bjp.2021.165","DOIUrl":"https://doi.org/10.1192/bjp.2021.165","url":null,"abstract":"<p><strong>Background: </strong>Aripiprazole augmentation is proven effective for antidepressant-refractory depression, but its licensed dose range is wide and optimal dosage remains unclear.</p><p><strong>Aims: </strong>To find the optimal dosage of aripiprazole augmentation.</p><p><strong>Method: </strong>Multiple electronic databases were searched (from inception to 16 February 2021) to identify all assessor-masked randomised controlled trials evaluating aripiprazole augmentation therapy in adults (≥18 years old, both genders) with major depressive disorder showing inadequate response to at least one antidepressant treatment. A random-effects, one-stage dose-effect meta-analysis with restricted cubic splines was conducted. Outcomes were efficacy (treatment response: ≥50% reduction in depression severity), tolerability (drop-out due to adverse effects) and acceptability (drop-out for any reason) after 8 weeks of treatment (range 4-12 weeks).</p><p><strong>Results: </strong>Ten studies met the inclusion criteria. All were individually randomised, placebo-controlled, multi-centre, parallel studies including 2625 participants in total. The maximum target dose-efficacy curve showed an increase up to doses between 2 mg (odds ratio OR = 1.46, 95% CI 1.15-1.85) and 5 mg (OR = 1.93, 95% CI 1.33-2.81), and then a non-increasing trend through the higher licensed doses up to 20 mg (OR = 1.90, 95% CI 1.52-2.37). Tolerability showed a similar trend with greater uncertainty. Acceptability showed no significant difference through the examined dose range. Certainty of evidence was low to moderate.</p><p><strong>Conclusions: </strong>Low-dose aripiprazole as augmentation treatment might achieve the optimal balance between efficacy, tolerability and acceptability in the acute treatment of antidepressant-refractory depression. However, the small number of included studies and the overall moderate to high risk of bias seriously compromise the reliability of the results. Further research is required to investigate the benefits of low versus high dose.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"440-447"},"PeriodicalIF":10.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39837258","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":"Author reply.","authors":"Joanna Moncrieff,&nbsp;Mark Horowitz","doi":"10.1192/bjp.2022.59","DOIUrl":"https://doi.org/10.1192/bjp.2022.59","url":null,"abstract":"well-controlled and psychologically informed treatment contexts can occur safely and mediate subsequent benefits that persist well beyond the day of administration. These treatment ‘highs’ can then be examined through a lens that considers addiction but not exclusively so. We propose that there is value to a broader perspective on the emotional and subjective qualities associated with intoxication – one which acknowledges risk and the prospect of a conceptually novel approach to the varieties of suffering that compel individuals to seek psychiatric care. Psilocybin and MDMA, but not cocaine, seem to support enduring and complex possibilities for self-learning that can be harnessed with psychological interventions. Such data indicate granularity and suggest that positively experienced intoxication is not alone sufficient for therapeutic growth. Similarly, ketamine and its derivatives are not routinely administered in contexts that include psychotherapy, but the combination may facilitate new insights and ways of being for people. Although biological psychiatry has not always concerned itself with these aims, the field is uniquely positioned to help. The ongoing study of medical hallucinogens may at times overestimate their benefits and underestimate their risks, and, for this, scientific integrity is essential. Moreover, not every ‘high’ is therapeutic, and models for hallucinogen use that contribute to experiential avoidance, medication dependence and a diminished sense of agency for patients should be scrutinised. However, a nuanced evaluation of risk and appropriate mitigation strategies can support the development of a new kind of psychiatry. Emerging psychiatric interventions, in our view, should not be condemned merely on the basis that some patients report enjoying the associated subjective effects – an intervention is not ‘bad’ just because it feels ‘good’.","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"497-498"},"PeriodicalIF":10.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40613986","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":"Association between a history of clinical depression and dementia, and the role of sociodemographic factors: population-based cohort study.","authors":"Kaarina Korhonen,&nbsp;Lasse Tarkiainen,&nbsp;Taina Leinonen,&nbsp;Elina Einiö,&nbsp;Pekka Martikainen","doi":"10.1192/bjp.2021.217","DOIUrl":"https://doi.org/10.1192/bjp.2021.217","url":null,"abstract":"<p><strong>Background: </strong>Depression is associated with an increased dementia risk, but the nature of the association in the long-term remains unresolved, and the role of sociodemographic factors mainly unexplored.</p><p><strong>Aims: </strong>To assess whether a history of clinical depression is associated with dementia in later life, controlling for observed sociodemographic factors and unobserved factors shared by siblings, and to test whether gender, educational level and marital status modify the association.</p><p><strong>Method: </strong>We conducted a national cohort study of 1 616 321 individuals aged 65 years or older between 2001 and 2018 using administrative healthcare data. A history of depression was ascertained from the national hospital register in the period 15-30 years prior to dementia follow-up. We used conventional and sibling fixed-effects Cox regression models to analyse the association between a history of depression, sociodemographic factors and dementia.</p><p><strong>Results: </strong>A history of depression was related to an adjusted hazard ratio of 1.27 (95% CI 1.23-1.31) for dementia in the conventional Cox model and of 1.55 (95% CI 1.09-2.20) in the sibling fixed-effects model. Depression was related to an elevated dementia risk similarly across all levels of education (test for interaction, <i>P</i> = 0.84), but the association was weaker for the widowed than for the married (<i>P</i> = 0.003), and stronger for men than women (<i>P</i> = 0.006). The excess risk among men attenuated following covariate adjustment (<i>P</i> = 0.10).</p><p><strong>Discussion: </strong>This study shows that a history of depression is consistently associated with later-life dementia risk. The results support the hypothesis that depression is an aetiological risk factor for dementia.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"410-416"},"PeriodicalIF":10.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39832740","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 full CIRCLE: inclusion of autistic doctors in the Royal College Of Psychiatrists' values and <i>Equality Action Plan</i>.","authors":"Sue McCowan,&nbsp;Sebastian C K Shaw,&nbsp;Mary Doherty,&nbsp;Bernadette Grosjean,&nbsp;Paula Blank,&nbsp;Malcolm Kinnear","doi":"10.1192/bjp.2022.14","DOIUrl":"https://doi.org/10.1192/bjp.2022.14","url":null,"abstract":"<p><p>Autistic psychiatrists bring strengths and values to the workforce and ask to be acknowledged and supported as part of the Royal College of Psychiatrists' CIRCLE values and <i>Equality Action Plan</i>. Courage and collaboration are required to jointly learn and innovate, promoting well-being, resilience and excellence for autistic doctors.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"371-373"},"PeriodicalIF":10.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39913398","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 World Health Organization's QualityRights initiative: rights and recovery-oriented services should be at the centre not the margins of psychiatry.","authors":"Peter McGovern","doi":"10.1192/bjp.2022.25","DOIUrl":"https://doi.org/10.1192/bjp.2022.25","url":null,"abstract":"<p><p>The World Health Organization's QualityRights initiative represents an exciting shift towards creating mental health services that respect human rights and promote recovery. The initiative is the subject of a recent <i>BJPsych</i> editorial. In this article I challenge previously articulated criticism of QualityRights and suggest that psychiatry has much to gain from promoting rights-based practice.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"428-430"},"PeriodicalIF":10.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39820057","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":"Investigating the causal nature of the relationship of subcortical brain volume with smoking and alcohol use.","authors":"Emma Logtenberg,&nbsp;Martin F Overbeek,&nbsp;Joëlle A Pasman,&nbsp;Abdel Abdellaoui,&nbsp;Maartje Luijten,&nbsp;Ruth J van Holst,&nbsp;Jacqueline M Vink,&nbsp;Damiaan Denys,&nbsp;Sarah E Medland,&nbsp;Karin J H Verweij,&nbsp;Jorien L Treur","doi":"10.1192/bjp.2021.81","DOIUrl":"https://doi.org/10.1192/bjp.2021.81","url":null,"abstract":"<p><strong>Background: </strong>Structural variation in subcortical brain regions has been linked to substance use, including the most commonly used substances nicotine and alcohol. Pre-existing differences in subcortical brain volume may affect smoking and alcohol use, but there is also evidence that smoking and alcohol use can lead to structural changes.</p><p><strong>Aims: </strong>We assess the causal nature of the complex relationship of subcortical brain volume with smoking and alcohol use, using bi-directional Mendelian randomisation.</p><p><strong>Method: </strong>Mendelian randomisation uses genetic variants predictive of a certain 'exposure' as instrumental variables to test causal effects on an 'outcome'. Because of random assortment at meiosis, genetic variants should not be associated with confounders, allowing less biased causal inference. We used summary-level data of genome-wide association studies of subcortical brain volumes (nucleus accumbens, amygdala, caudate, hippocampus, pallidum, putamen and thalamus; <i>n</i> = 50 290) and smoking and alcohol use (smoking initiation, <i>n</i> = 848 460; cigarettes per day, <i>n</i> = 216 590; smoking cessation, <i>n</i> = 378 249; alcoholic drinks per week, <i>n</i> = 630 154; alcohol dependence, <i>n</i> = 46 568). The main analysis, inverse-variance weighted regression, was verified by a wide range of sensitivity methods.</p><p><strong>Results: </strong>There was strong evidence that liability to alcohol dependence decreased amygdala and hippocampal volume, and smoking more cigarettes per day decreased hippocampal volume. From subcortical brain volumes to substance use, there was no or weak evidence for causal effects.</p><p><strong>Conclusions: </strong>Our findings suggest that heavy alcohol use and smoking can causally reduce subcortical brain volume. This adds to accumulating evidence that alcohol and smoking affect the brain, and likely mental health, warranting more recognition in public health efforts.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"377-385"},"PeriodicalIF":10.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39925847","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":"Association of severe mental illness with stroke outcomes and process-of-care quality indicators: nationwide cohort study.","authors":"Kelly Fleetwood, Sarah H Wild, Daniel J Smith, Stewart W Mercer, Kirsty Licence, Cathie L M Sudlow, Caroline A Jackson","doi":"10.1192/bjp.2021.120","DOIUrl":"10.1192/bjp.2021.120","url":null,"abstract":"<p><strong>Background: </strong>Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care.</p><p><strong>Aims: </strong>To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit).</p><p><strong>Method: </strong>We conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991-2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction).</p><p><strong>Results: </strong>Among 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16-1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18-1.60) and major depression (aOR = 1.11, 95% CI 1.05-1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators.</p><p><strong>Conclusions: </strong>Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"394-401"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39697727","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":"In-patient psychiatric care and non-substance-related psychiatric diagnoses among individuals seeking treatment for alcohol and substance use disorders: associations with all-cause mortality and suicide.","authors":"Jonna Levola,&nbsp;Riku Laine,&nbsp;Tuuli Pitkänen","doi":"10.1192/bjp.2022.20","DOIUrl":"https://doi.org/10.1192/bjp.2022.20","url":null,"abstract":"<p><strong>Background: </strong>The largest excess mortality risk has been reported for combinations of psychiatric disorders that included substance use disorders.</p><p><strong>Aims: </strong>To study the associations of different non-substance-related in-patient psychiatric diagnoses with all-cause mortality and suicide up to 28 years of age after entering substance use treatment.</p><p><strong>Method: </strong>National register data on psychiatric hospital admissions and death were combined with the treatment records of over 10 000 individuals in substance use treatment between 1990 and 2009. Cox regression was used to calculate hazard ratios (HRs) with 95% CIs for all-cause and suicide-specific mortality from the time of entering substance use treatment.</p><p><strong>Results: </strong>Nearly one-third (31.4%; <i>n</i> = 3330) of the study population had died during follow-up or by their 65th birthday, with more than one in ten (<i>n</i> = 385) from suicide. Over half of the study population (53.2%) had undergone psychiatric in-patient care and 14.1% involuntary psychiatric care during the study period. Bipolar disorder and unipolar depression were associated with a 57% (HR 1.57, 95% CI 1.18-2.10) and 132% (HR 2.32, 95% CI 1.21-4.46) increase in risk of suicide, respectively. Involuntary psychiatric care was associated with a 40% increase in risk of suicide (HR 1.42, 95% CI 1.05-1.94).</p><p><strong>Conclusion: </strong>Severe psychiatric morbidity is common among individuals seeking treatment for alcohol and/or substance use and specifically mood disorders appear to increase the risk of suicide. Treatment service planning needs to focus on integrated care for concomitant substance use and psychiatric disorders to address this risk.</p>","PeriodicalId":520791,"journal":{"name":"The British journal of psychiatry : the journal of mental science","volume":" ","pages":"386-393"},"PeriodicalIF":10.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924363","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}