The National Health Service Race and Health Observatory provides an evidence-based approach to tackling racial disparities in health and making policy recommendations. Its Mental Health Advisory Group is responsible for commissioning research into racial and ethnic disparities in mental health, and in this regard, improving access to psychological therapies became a key focus.
{"title":"Racial disparities influence access and outcomes in talking therapies","authors":"J. S. Bamrah, Sam Rodger, Habib Naqvi","doi":"10.1192/bjp.2024.174","DOIUrl":"https://doi.org/10.1192/bjp.2024.174","url":null,"abstract":"<p>The National Health Service Race and Health Observatory provides an evidence-based approach to tackling racial disparities in health and making policy recommendations. Its Mental Health Advisory Group is responsible for commissioning research into racial and ethnic disparities in mental health, and in this regard, improving access to psychological therapies became a key focus.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330096","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}
Konstantinos Ioannidis, Naomi A. Fineberg, Samuel R. Chamberlain
In our ever digitalising society, our engagement with the online world has significant potential to have a negative impact on our mental health. Although the roles of public health and psychiatry are debated, clinicians are in a strategic position to assess usage and intervene, to prevent harms from problematic engagement with the internet.
{"title":"Taming the Chimaera–Hydra: disconnecting from the net to fortify our mental health","authors":"Konstantinos Ioannidis, Naomi A. Fineberg, Samuel R. Chamberlain","doi":"10.1192/bjp.2024.159","DOIUrl":"https://doi.org/10.1192/bjp.2024.159","url":null,"abstract":"<p>In our ever digitalising society, our engagement with the online world has significant potential to have a negative impact on our mental health. Although the roles of public health and psychiatry are debated, clinicians are in a strategic position to assess usage and intervene, to prevent harms from problematic engagement with the internet.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142317134","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}
Acknowledging the impact of imperialist and colonialist attitudes on the development of psychiatry allows for the recovery of the work of practitioners whose contribution may have been overlooked, as well as recognising racist attitudes in predominant thinking. These combined approaches aid in the construction of a more complete critical history.
{"title":"Racism in psychiatry and the case of presentism","authors":"Rina Arya","doi":"10.1192/bjp.2024.171","DOIUrl":"https://doi.org/10.1192/bjp.2024.171","url":null,"abstract":"<p>Acknowledging the impact of imperialist and colonialist attitudes on the development of psychiatry allows for the recovery of the work of practitioners whose contribution may have been overlooked, as well as recognising racist attitudes in predominant thinking. These combined approaches aid in the construction of a more complete critical history.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276946","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}
Daniel J. Smith, Elise McGlashan, John Gottlieb, Nicholas Meyer, Matt W. Jones
This editorial summarises the clinical relevance of ‘chronopsychiatry’, defined as the interface between circadian science and mental health science. Chronopsychiatry represents a move towards time-variable perspectives on neurobiology and symptoms, with a greater emphasis on chronotherapeutic interventions.
{"title":"Chronopsychiatry","authors":"Daniel J. Smith, Elise McGlashan, John Gottlieb, Nicholas Meyer, Matt W. Jones","doi":"10.1192/bjp.2024.81","DOIUrl":"https://doi.org/10.1192/bjp.2024.81","url":null,"abstract":"<p>This editorial summarises the clinical relevance of ‘chronopsychiatry’, defined as the interface between circadian science and mental health science. Chronopsychiatry represents a move towards time-variable perspectives on neurobiology and symptoms, with a greater emphasis on chronotherapeutic interventions.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276945","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}
Scott Monteith, Tasha Glenn, John R. Geddes, Eric D. Achtyes, Peter C. Whybrow, Michael Bauer
The malicious use of artificial intelligence is growing rapidly, creating major security threats for individuals and the healthcare sector. Individuals with mental illness may be especially vulnerable. Healthcare provider data are a prime target for cybercriminals. There is a need to improve cybersecurity to detect and prevent cyberattacks against individuals and the healthcare sector, including the use of artificial intelligence predictive tools.
{"title":"Artificial intelligence and cybercrime: implications for individuals and the healthcare sector","authors":"Scott Monteith, Tasha Glenn, John R. Geddes, Eric D. Achtyes, Peter C. Whybrow, Michael Bauer","doi":"10.1192/bjp.2024.77","DOIUrl":"https://doi.org/10.1192/bjp.2024.77","url":null,"abstract":"<p>The malicious use of artificial intelligence is growing rapidly, creating major security threats for individuals and the healthcare sector. Individuals with mental illness may be especially vulnerable. Healthcare provider data are a prime target for cybercriminals. There is a need to improve cybersecurity to detect and prevent cyberattacks against individuals and the healthcare sector, including the use of artificial intelligence predictive tools.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276944","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}
The biopsychosocial model remains a key paradigm for healthcare, despite widely recognised scientific and philosophical shortcomings. Here we report on recent updates integrating evolutionary theory with the biopsychosocial model to provide a more comprehensive and scientifically complete approach to understanding the multiple relevant levels of causation of medical and psychiatric problems.
{"title":"Evolutionary theory can advance and revitalise the biopsychosocial model","authors":"Riadh Abed, Adam Hunt, Paul St John-Smith","doi":"10.1192/bjp.2024.87","DOIUrl":"https://doi.org/10.1192/bjp.2024.87","url":null,"abstract":"<p>The biopsychosocial model remains a key paradigm for healthcare, despite widely recognised scientific and philosophical shortcomings. Here we report on recent updates integrating evolutionary theory with the biopsychosocial model to provide a more comprehensive and scientifically complete approach to understanding the multiple relevant levels of causation of medical and psychiatric problems.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276947","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}
Prominent clinical perspectives posit that the interface of autism and (borderline) personality disorder manifests as either a misdiagnosis of the former as the latter or a comorbidity of both. In this editorial, we integrate these disparate viewpoints by arguing that personality difficulties are inherent to the autistic spectrum.
{"title":"The interface of autism and (borderline) personality disorder","authors":"Orestis Zavlis, Peter Tyrer","doi":"10.1192/bjp.2024.80","DOIUrl":"https://doi.org/10.1192/bjp.2024.80","url":null,"abstract":"<span>Summary</span><p>Prominent clinical perspectives posit that the interface of autism and (borderline) personality disorder manifests as either a misdiagnosis of the former as the latter or a comorbidity of both. In this editorial, we integrate these disparate viewpoints by arguing that personality difficulties are inherent to the autistic spectrum.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276973","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}
We emphasise the existence of two distinct neurophysiological subtypes in schizophrenia, characterised by different sites of initial grey matter loss. We review evidence for potential neuromolecular mechanisms underlying these subtypes, proposing a biologically based disease classification approach to unify macro- and micro-scale neural abnormalities of schizophrenia.
{"title":"Towards a unified theory of the aetiology of schizophrenia","authors":"Yuchao Jiang, Xiao Chang, Jianfeng Feng","doi":"10.1192/bjp.2024.65","DOIUrl":"https://doi.org/10.1192/bjp.2024.65","url":null,"abstract":"<p>We emphasise the existence of two distinct neurophysiological subtypes in schizophrenia, characterised by different sites of initial grey matter loss. We review evidence for potential neuromolecular mechanisms underlying these subtypes, proposing a biologically based disease classification approach to unify macro- and micro-scale neural abnormalities of schizophrenia.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276965","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}
Broadening prediction efforts from imminent psychotic symptoms to neurodevelopmental vulnerabilities can enhance the accuracy of diagnosing severe mental disorders. Early interventions, especially during adolescence, are vital as these disorders often follow a long prodromal phase of neurodevelopmental disturbances. Child and adolescent mental health services should lead a developmentally-sensitive model for timely, effective detection and intervention.
{"title":"Early detection and intervention through the lens of the neurodevelopmental framework: the salience of developmental years and related services","authors":"Andrea Raballo, Michele Poletti, Antonio Preti","doi":"10.1192/bjp.2024.146","DOIUrl":"https://doi.org/10.1192/bjp.2024.146","url":null,"abstract":"<p>Broadening prediction efforts from imminent psychotic symptoms to neurodevelopmental vulnerabilities can enhance the accuracy of diagnosing severe mental disorders. Early interventions, especially during adolescence, are vital as these disorders often follow a long prodromal phase of neurodevelopmental disturbances. Child and adolescent mental health services should lead a developmentally-sensitive model for timely, effective detection and intervention.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276948","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}
Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings.
Aims
To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts.
Method
Data were obtained from the Canadian Institute of Health Information for adults (n = 45 616) and children/youth (n = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics.
Results
In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83–0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49–0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18–1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively.
Conclusions
Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.
{"title":"Clozapine, relapse, and adverse events: a 10-year electronic cohort study in Canada","authors":"Lloyd Balbuena, Shawn Halayka, Andrew Lee, A.G. Ahmed, Tamara Hinz, Nathan Kolla, Jenna Pylypow","doi":"10.1192/bjp.2024.140","DOIUrl":"https://doi.org/10.1192/bjp.2024.140","url":null,"abstract":"<span>Background</span><p>Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings.</p><span>Aims</span><p>To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts.</p><span>Method</span><p>Data were obtained from the Canadian Institute of Health Information for adults (<span>n</span> = 45 616) and children/youth (<span>n</span> = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics.</p><span>Results</span><p>In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83–0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49–0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18–1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively.</p><span>Conclusions</span><p>Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.</p>","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236258","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}