The British Journal of Psychiatry最新文献

The Columbia Suicide Severity Rating Scale (C-SSRS) is a predominant tool for screening and scoring suicidal ideation and behaviour to identify individuals at risk. No meta-analysis has examined its predictive significance.

To evaluate the C-SSRS assessment of suicidal ideation and suicidal behaviour as predictors of future fatal and non-fatal suicide attempts.

A systematic search of Medline, PsycInfo, Embase, and Health and Psychosocial Instruments databases was conducted from January 2008 to February 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study was registered in PROSPERO (CRD42022361944). Two independent reviewers screened and extracted data, and assessed the risk of bias. Pooled odds ratios were calculated using random-effects models, and heterogeneity was assessed with the I2 statistic. Publication bias was evaluated with Egger’s test and funnel plots.

The search identified 1071 unique records, of which 28 studies met inclusion criteria. The meta-analysis included 27 studies with independent samples. Suicidal behaviour (pooled odds ratio 3.14, 95% CI 1.86–5.31) and suicide attempts (pooled odds ratio 2.78, 95% CI 1.82–4.24) were predictors of future non-fatal suicide attempts. Suicidal ideation severity (odds ratio 1.46/point, 95% CI 1.28–1.77) was a stronger predictor of future non-fatal suicide attempts than suicideal ideation intensity (odds ratio 1.11/point, 95% CI 1.04–1.18). Two studies linked higher suicidal ideation severity and a history of suicidal behaviour with an increased risk of fatal suicide attempts, though meta-analysis was not feasible for only two studies.

Suicidal behaviour, suicide attempts and to a lesser extent suicidal ideation, identified using the C-SSRS, predicted future non-fatal suicide attempts. These findings support the use of the C-SSRS to detect individuals at higher-risk requiring enhanced preventive interventions.

Individuals with a family history of bipolar disorder are at increased risk of developing affective psychopathology. Longitudinal imaging studies in young people with familial risk have been limited, and cortical developmental trajectories in the progression towards illness remain obscure.

To establish high-resolution longitudinal differences in cortical structure that are associated with risk of bipolar disorder.

Using structural magnetic resonance imaging data from 217 unrelated ‘Bipolar Kids and Sibs study’ participants (baseline n = 217, follow-up n = 152), we examined changes over a 2-year period in cortical area, thickness and volume, measured at each vertex across the cortical surface. Groups comprised 105 ‘high-risk’ participants with a first-degree relative with bipolar disorder (female n = 64; age in years: M (mean) = 20.9, s.d. = 5.5) and 112 controls with no familial psychiatric history (females n = 60; age in years: M = 22.4, s.d. = 3.7).

Accelerated thickness and volume reductions over time were observed in ‘high-risk’ individuals across multiple cortical regions, relative to controls, including right lateral orbitofrontal thickness (β = 0.033, P < 0.001) and inferior frontal volume (β = 0.021, P < 0.001). These differences were observed after controlling for age, sex, ancestry, current medication status, lifetime psychiatric diagnoses and measures of gross brain morphology.

Longitudinal group differences suggest the presence of thicker cortex in familial ‘high-risk’ individuals at earlier developmental stages, followed by accelerated thinning towards the typical age of bipolar disorder onset. Future examination of genetic and environmental components of familial risk and the mechanistic nature (pathological or protective) of cortical-trajectory differences over time may facilitate the identification of prodromal biomarkers and opportunities for early clinical intervention.

Cannabis use increases the risk of psychosis, but cannabis-based medicinal products may provide additional therapeutic opportunities. Decriminalisation of cannabis has led to wider availability in certain jurisdictions, while in the UK regulated medicinal preparations are not readily accessible. A more balanced approach could reduce harms while maximising potential therapeutic benefits.