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Advance directives as a care planning tool for patients with complex mental health needs: service evaluation. 预先指示作为复杂心理健康需求患者的护理计划工具：服务评估。
IF 2.9
BJPsych Bulletin Pub Date : 2026-08-01 Epub Date: 2026-01-08 DOI: 10.1192/bjb.2025.10172
Immanuel Amrita Rhema, Mohamed Ibrahim, Hajara Begum, Paul Binfield, Doris McMeel, Sophia Parveen, Lara O'Connell, Frank Röhricht
{"title":"Advance directives as a care planning tool for patients with complex mental health needs: service evaluation.","authors":"Immanuel Amrita Rhema, Mohamed Ibrahim, Hajara Begum, Paul Binfield, Doris McMeel, Sophia Parveen, Lara O'Connell, Frank Röhricht","doi":"10.1192/bjb.2025.10172","DOIUrl":"10.1192/bjb.2025.10172","url":null,"abstract":"<p><strong>Aims and method: </strong>This study investigated the prevalence of advance directives among patients receiving community care within the East London NHS Foundation Trust (ELFT), and to identify factors associated with their clinical application.We analysed data from electronic health records of 4807 patients (aged 18-75 years), managed under the Care Programme Approach (CPA) in ELFT during 2021-2022. Demographic, clinical, service-level and patient-reported measures were analysed (binomial logistic regression).</p><p><strong>Results: </strong>A total of 31.2% of patients on the CPA had an advance directive. Black ethnicity, treatment in the forensic service or Newham, Luton and Bedfordshire localities, housing in socio-therapeutic facilities, diagnosis of personality disorder, ten or more previous admissions and engagement with DIALOG+ were positively associated with having an advance directive. DIALOG+ is the first approach that has been specifically developed to make routine patient-clinician meetings therapeutically effective. It is based on quality of life research, utilising the DIALOG scale (a patient-reported outcome measure), concepts of patient-centred communication, IT developments and components of solution-focused therapy, and is supported by an app.</p><p><strong>Clinical implications: </strong>This study highlights a complex interplay of cultural, social and systemic factors that influence advance care plan status. Structured communication, stronger therapeutic relationships and staff facilitation are likely to encourage advance care planning.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"303-310"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating evidence behind popular trauma narratives: neurobiological and treatment claims in The Body Keeps the Score. 评估流行创伤叙事背后的证据：《身体记分》中的神经生物学和治疗主张。
IF 2.9
BJPsych Bulletin Pub Date : 2026-08-01 Epub Date: 2025-11-03 DOI: 10.1192/bjb.2025.10174
Michael S Scheeringa
{"title":"Evaluating evidence behind popular trauma narratives: neurobiological and treatment claims in <i>The Body Keeps the Score</i>.","authors":"Michael S Scheeringa","doi":"10.1192/bjb.2025.10174","DOIUrl":"10.1192/bjb.2025.10174","url":null,"abstract":"<p><p>Bessel van der Kolk's book <i>The Body Keeps the Score</i> has maintained exceptional cultural and clinical influence since its publication in 2014, remaining a best-seller and shaping public discourse on trauma. Its central claims - that trauma causes lasting neurobiological damage and that body-based treatments are uniquely effective - have been widely embraced but seldom subjected to systematic critical evaluation in peer-reviewed literature. This commentary synthesises the evidentiary basis for these claims as a counterweight to an influential narrative. It situates these findings within broader discussions of neuroscience framing, cultural appeal and evidence-based communication, underscoring the need for rigorous, balanced engagement with widely disseminated mental health narratives.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"345-347"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Negative symptoms in schizophrenia: clinical framework linking emotional experience and identity. 精神分裂症的阴性症状：连接情感体验和身份的临床框架。
IF 2.9
BJPsych Bulletin Pub Date : 2026-08-01 Epub Date: 2026-07-20 DOI: 10.1192/bjb.2026.10261
Carol Palma, Susana Ochoa
{"title":"Negative symptoms in schizophrenia: clinical framework linking emotional experience and identity.","authors":"Carol Palma, Susana Ochoa","doi":"10.1192/bjb.2026.10261","DOIUrl":"10.1192/bjb.2026.10261","url":null,"abstract":"","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":"50 4","pages":"360"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The value of person-first language in forensic mental health services. 以人为本的语言在法医精神卫生服务中的价值。
IF 2.9
BJPsych Bulletin Pub Date : 2026-08-01 Epub Date: 2026-04-21 DOI: 10.1192/bjb.2026.10230
Jack Tomlin, Asya Mitisheva, Sarah Kilbane, Sarah Markham, John Tully
{"title":"The value of person-first language in forensic mental health services.","authors":"Jack Tomlin, Asya Mitisheva, Sarah Kilbane, Sarah Markham, John Tully","doi":"10.1192/bjb.2026.10230","DOIUrl":"10.1192/bjb.2026.10230","url":null,"abstract":"<p><p>Labels in healthcare influence perceptions, treatment and stigma. Although they can aid diagnosis and guide care, pejorative labels can dehumanise and perpetuate prejudice. Person-first language, which foregrounds the individual rather than a condition or behaviour, has been linked to reduced blame, stigma and social distance across mental health and forensic populations. Evidence suggests it may foster empathy, recovery-oriented attitudes and rehabilitation, while challenging essentialist and pessimistic views of mental illness and offending. Limitations include minimising structural coercion and lived experience. This editorial explores the evidence, mechanisms and practical applications of person-first language in forensic mental health, advocating cautious implementation and further research.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"299-302"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147727919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When 'disorder' doesn't translate: DSM categories, lived illness and social sickness across cultures. 当“障碍”无法翻译时：DSM分类，生活疾病和跨文化的社会疾病。
IF 2.9
BJPsych Bulletin Pub Date : 2026-07-31 DOI: 10.1192/bjb.2026.10272
Yasuhiro Kotera
{"title":"When 'disorder' doesn't translate: DSM categories, lived illness and social sickness across cultures.","authors":"Yasuhiro Kotera","doi":"10.1192/bjb.2026.10272","DOIUrl":"https://doi.org/10.1192/bjb.2026.10272","url":null,"abstract":"<p><p>Diagnostic classifications (DSM, ICD and other system frameworks) make distress legible for clinical and institutional action. That is their strength. Yet classification is not a mirror of lived suffering: it necessarily prioritises operationalisable criteria over the cultural, relational and moral meanings through which people experience distress and decide whether help is needed. Building on Kleinman's distinction between illness (lived experience), disease/disorder (practitioner/system categories) and sickness (social recognition and response), this paper argues that cross-cultural failures in mental healthcare often reflect 'layer misalignment': disorder labels, illness meanings and sickness recognition diverge. Using <i>taijin kyofusho</i>, in which concerns about offending others can be mistranslated into standard self-focused social anxiety, as an illustrative case, this paper outlines a practical approach to reduce miscommunication: eliciting explanatory models, translating idioms into meanings, three-layer formulation, alignment checks and culturally safer service design.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"1-5"},"PeriodicalIF":2.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629514","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}
引用次数: 0
Clinical guidelines addressing complex and 'wicked' problems. 解决复杂和“邪恶”问题的临床指南。
IF 2.9
BJPsych Bulletin Pub Date : 2026-07-31 DOI: 10.1192/bjb.2026.10271
Helene Speyer, Marte Ustrup, David Roe, Awais Aftab
{"title":"Clinical guidelines addressing complex and 'wicked' problems.","authors":"Helene Speyer, Marte Ustrup, David Roe, Awais Aftab","doi":"10.1192/bjb.2026.10271","DOIUrl":"https://doi.org/10.1192/bjb.2026.10271","url":null,"abstract":"<p><p>Clinical guidelines aid decision-making, but their simplifying strength becomes a limitation in complex, value-laden situations. Once meant to summarise evidence, they now function as prescriptive standards used in quality and legal assessments. Overly rigid directives can undermine autonomy, hide uncertainty and restrict clinical judgement. Using complexity science and 'wicked problem' theory, we introduce 'wicked complexity' to better match guidelines design to real clinical challenges. Applying this to deprescribing psychoactive drugs, we show how traditional, adherence-focused guidance can prompt defensive practice. Guidelines for wicked complexity should instead clarify risks, support moral deliberation and support shared, iterative decision-making across healthcare.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"1-4"},"PeriodicalIF":2.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629486","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}
引用次数: 0
Franz Kafka: the hunger artist. 弗兰茨·卡夫卡：饥饿艺术家。
IF 2.9
BJPsych Bulletin Pub Date : 2026-07-31 DOI: 10.1192/bjb.2026.10273
Lawrence Ratna
{"title":"Franz Kafka: the hunger artist.","authors":"Lawrence Ratna","doi":"10.1192/bjb.2026.10273","DOIUrl":"https://doi.org/10.1192/bjb.2026.10273","url":null,"abstract":"<p><p>Franz Kafka has often been posthumously diagnosed with anorexia nervosa, but recent research impels a re-evaluation of his disordered eating. This study presents a qualitative analysis of Kafka's diaries, correspondence, medical reports and fiction, focusing on appetite, diet, somatic symptoms, and cognitions concerning food and fasting. Diagnostic indicators are matched against DSM-5 criteria for anorexia nervosa and avoidant/restrictive food intake disorder. Kafka's clinical profile, which is characterised by diminished appetite, anorexia, selective intake, obsessive mastication, low body weight and undernourishment needing repeated sanatorium admissions, suggests a presentation more consistent with avoidant/restrictive food intake disorder. These disturbances are reflected in his fiction, in which food operates as a symbolic register of alienation, ontological anxiety and existential resistance, most notably in <i>The Metamorphosis</i> and <i>A Hunger Artist.</i> Integration of medical and literary perspectives demonstrates the clinical value of phenomenological evidence in capturing lived experience of eating disorders, enriching diagnostic insight by foregrounding cognitive, psychosocial and cultural contexts.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"1-4"},"PeriodicalIF":2.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629581","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}
引用次数: 0
Health of the Nation Outcome Scales scores and C-reactive protein levels in in-patients with anorexia nervosa. 神经性厌食症住院患者的国民健康结局量表评分和c反应蛋白水平
IF 2.9
BJPsych Bulletin Pub Date : 2026-07-27 DOI: 10.1192/bjb.2026.10270
Zuo Zhang, Can Xu, Risha Govind, Johanna Louise Keeler, Robert Stewart, Janet Treasure, Hubertus Himmerich
{"title":"Health of the Nation Outcome Scales scores and C-reactive protein levels in in-patients with anorexia nervosa.","authors":"Zuo Zhang, Can Xu, Risha Govind, Johanna Louise Keeler, Robert Stewart, Janet Treasure, Hubertus Himmerich","doi":"10.1192/bjb.2026.10270","DOIUrl":"https://doi.org/10.1192/bjb.2026.10270","url":null,"abstract":"<p><strong>Aims and method: </strong>The Health of the Nation Outcome Scales (HoNOS) are the most widely used psychiatric clinical outcomes tool in the UK. Nonetheless, HoNOS scores and their change during treatment for people with anorexia nervosa have not been investigated. We retrieved clinical data from the Clinical Records Interactive Search register from 234 with an anorexia nervosa or an eating disorder diagnosis, a body mass index (BMI) <18.5 kg/m<sup>2</sup> and with available HoNOS, BMI and C-reactive protein (CRP) data at admission.</p><p><strong>Results: </strong>From admission to discharge, patients showed a significant moderate improvement in HoNOS total score (mean±s.d.) from 14.30±6.23 to 10.11±4.81, and a significant moderate-to-large increase in BMI from 14.15±1.45 kg/m<sup>2</sup> to 16.22±2.56 kg/m<sup>2</sup>. CRP levels >2 mg/L on admission were significantly associated with age, a personality disorder diagnosis, agitation and hallucinations in the HoNOS.</p><p><strong>Clinical implications: </strong>In-patient treatment for anorexia nervosa improves health and social functioning.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148589497","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}
引用次数: 0
Clinical memory, functionalisation and fragmentation of care in UK psychiatry. 临床记忆，功能化和碎片化护理在英国精神病学。
IF 2.9
BJPsych Bulletin Pub Date : 2026-07-20 DOI: 10.1192/bjb.2026.10269
Swaran P Singh
{"title":"Clinical memory, functionalisation and fragmentation of care in UK psychiatry.","authors":"Swaran P Singh","doi":"10.1192/bjb.2026.10269","DOIUrl":"https://doi.org/10.1192/bjb.2026.10269","url":null,"abstract":"<p><p>Functionalisation - the separation of in-patient and community consultant roles - has eroded the longitudinal clinical memory of individual patients. Unlike specialisation, which deepens expertise, functionalisation has fragmented patient care. In functional models, critical decisions regarding admission, discharge and aftercare are often made without a comprehensive knowledge of the patient's history. National inquiries highlight that risks cluster at these transition points, where information is fragmented and responsibility is unclear. Functional models fail to improve efficiency while significantly damaging continuity of care. Reform must become a proactive clinical priority rather than a reactive response to adverse events or inquiry findings.</p>","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"1-3"},"PeriodicalIF":2.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519833","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}
引用次数: 0
Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review - CORRIGENDUM. 妊娠、分娩和产后期间的功能性神经障碍：系统回顾-勘误表。
IF 2
BJPsych Bulletin Pub Date : 2026-06-16 DOI: 10.1192/bjb.2026.10263
Verónica Cabreira, Caoimhe McLoughlin, Natasha Shivji, Alexandra Lodge, Sanne Van Rhijn, Roxanne C Keynejad, Jan Coebergh, Alan Carson, Jon Stone, Alex Lehn, Ingrid Hoeritzauer
{"title":"Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review - CORRIGENDUM.","authors":"Verónica Cabreira, Caoimhe McLoughlin, Natasha Shivji, Alexandra Lodge, Sanne Van Rhijn, Roxanne C Keynejad, Jan Coebergh, Alan Carson, Jon Stone, Alex Lehn, Ingrid Hoeritzauer","doi":"10.1192/bjb.2026.10263","DOIUrl":"https://doi.org/10.1192/bjb.2026.10263","url":null,"abstract":"","PeriodicalId":8883,"journal":{"name":"BJPsych Bulletin","volume":" ","pages":"1"},"PeriodicalIF":2.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257170","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}
引用次数: 0
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