{"title":"Targeting best bets for psychiatric research: lessons from oncology.","authors":"Michael Berk,Elizabeth D Williams,Niall Boyce","doi":"10.1192/bjp.2025.10521","DOIUrl":"https://doi.org/10.1192/bjp.2025.10521","url":null,"abstract":"","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"8 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145785825","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}
Forthcoming changes to clozapine monitoring present an opportunity to expand, not dilute, specialist care for chronic schizophrenia. Reduced administrative burden should support timely clozapine use, structured assessment, access to psychological therapies and embedded physical health care. Experience from Cambridgeshire shows that secondary-plus clinics within community mental health teams can deliver sustained, equitable long-term care.
{"title":"Clozapine clinics at the crossroads and the opportunity to redesign services for people with chronic schizophrenia.","authors":"Emilio Fernandez-Egea","doi":"10.1192/bjp.2025.10513","DOIUrl":"https://doi.org/10.1192/bjp.2025.10513","url":null,"abstract":"Forthcoming changes to clozapine monitoring present an opportunity to expand, not dilute, specialist care for chronic schizophrenia. Reduced administrative burden should support timely clozapine use, structured assessment, access to psychological therapies and embedded physical health care. Experience from Cambridgeshire shows that secondary-plus clinics within community mental health teams can deliver sustained, equitable long-term care.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"66 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771563","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}
Half a century of neuroimaging has transformed our understanding of psychiatric disorders but not our clinical practice. This piece examines why that promise remains unfulfilled and argues that the future lies not in ever newer tools but in rigorous, mechanistically grounded and clinically embedded imaging approaches that bridge brains, behaviours and treatments.
{"title":"Why doesn't neuroimaging work in psychiatry?","authors":"Robert A McCutcheon,Sameer Jauhar,Toby Pillinger","doi":"10.1192/bjp.2025.10517","DOIUrl":"https://doi.org/10.1192/bjp.2025.10517","url":null,"abstract":"Half a century of neuroimaging has transformed our understanding of psychiatric disorders but not our clinical practice. This piece examines why that promise remains unfulfilled and argues that the future lies not in ever newer tools but in rigorous, mechanistically grounded and clinically embedded imaging approaches that bridge brains, behaviours and treatments.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"15 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765032","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":"Exploring adverse childhood experiences in Barbara Kingsolver's Demon Copperhead - Psychiatry in literature.","authors":"Nadine A M Abdalla","doi":"10.1192/bjp.2025.10438","DOIUrl":"https://doi.org/10.1192/bjp.2025.10438","url":null,"abstract":"","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"21 1","pages":"88"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765033","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}
BACKGROUNDAs the global shift towards autocracy continues and soft political repression rises, it is crucial to understand its long-term health implications. Typical tactics of soft political repression are surveillance, denunciation and harassment, operating beneath the threshold of criminal or violent persecution. Despite its prevalence, soft repression remains underexplored, particularly in terms of its psychobiological health consequences.AIMSThe current study investigates the long-term sequelae of soft political repression in the German Democratic Republic (GDR: 1949-1990), focusing on psychological distress, systemic inflammation and cellular ageing.METHODThe cross-sectional laboratory study included 100 50-78 years old participants from the states of Thuringia and Saxony in Germany. Participants in the repression group (n = 49) had experienced at least two forms of state-organised soft repression in the GDR. The age, gender and origin matched control group reported no such experiences. Psychological measures included depressive, anxiety and trauma symptoms. Physiological health outcomes were measured through the inflammatory markers interleukin-6 and high sensitivity C-reactive protein (hs-CRP), as well as telomere length as a marker of cellular ageing. Resilience, social support and socioeconomic status were included in the analyses as potential buffers of repression effects.RESULTSParticipants with repression experience (versus control group) scored significantly higher on all psychological distress variables. Furthermore, they exhibited higher levels of interleukin-6, indicating increased systemic inflammation. No group differences were found for hs-CRP or telomere length. However, in the repression group, lower social support was associated with shorter telomeres.CONCLUSIONSThis study is the first to explore the psychobiological health consequences of soft political repression. Findings emphasise its long-term consequences on the psyche and immune system and highlight the potential role of social support in mitigating cellular ageing. As authoritarian tactics are becoming more prevalent worldwide, understanding the impact of soft repression on health is essential for supporting affected individuals.
{"title":"Long-term consequences of soft political repression on psychological well-being, systemic inflammation and cellular ageing.","authors":"Ruth Marheinecke,Jost Blasberg,Jue Lin,Nils Opel,Carsten Spitzer,Bernhard Strauss,Elissa Epel,Veronika Engert","doi":"10.1192/bjp.2025.10493","DOIUrl":"https://doi.org/10.1192/bjp.2025.10493","url":null,"abstract":"BACKGROUNDAs the global shift towards autocracy continues and soft political repression rises, it is crucial to understand its long-term health implications. Typical tactics of soft political repression are surveillance, denunciation and harassment, operating beneath the threshold of criminal or violent persecution. Despite its prevalence, soft repression remains underexplored, particularly in terms of its psychobiological health consequences.AIMSThe current study investigates the long-term sequelae of soft political repression in the German Democratic Republic (GDR: 1949-1990), focusing on psychological distress, systemic inflammation and cellular ageing.METHODThe cross-sectional laboratory study included 100 50-78 years old participants from the states of Thuringia and Saxony in Germany. Participants in the repression group (n = 49) had experienced at least two forms of state-organised soft repression in the GDR. The age, gender and origin matched control group reported no such experiences. Psychological measures included depressive, anxiety and trauma symptoms. Physiological health outcomes were measured through the inflammatory markers interleukin-6 and high sensitivity C-reactive protein (hs-CRP), as well as telomere length as a marker of cellular ageing. Resilience, social support and socioeconomic status were included in the analyses as potential buffers of repression effects.RESULTSParticipants with repression experience (versus control group) scored significantly higher on all psychological distress variables. Furthermore, they exhibited higher levels of interleukin-6, indicating increased systemic inflammation. No group differences were found for hs-CRP or telomere length. However, in the repression group, lower social support was associated with shorter telomeres.CONCLUSIONSThis study is the first to explore the psychobiological health consequences of soft political repression. Findings emphasise its long-term consequences on the psyche and immune system and highlight the potential role of social support in mitigating cellular ageing. As authoritarian tactics are becoming more prevalent worldwide, understanding the impact of soft repression on health is essential for supporting affected individuals.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"14 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760004","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":"Reimagining occupational psychiatry in Asia: the case for mental health digital twins.","authors":"Ajay Jose,Sonia Mathew","doi":"10.1192/bjp.2025.10515","DOIUrl":"https://doi.org/10.1192/bjp.2025.10515","url":null,"abstract":"","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"228 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752627","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}
Mina Fazel,Emma Soneson,Michael Parker,Danielle Newby,Jonathan Herring
Adolescents, particularly today's Generation Alpha, face uncertainty about whether, when and how their autonomy will be respected, especially in mental health contexts. Existing consent and confidentiality practices may not reflect adolescents' preferences, potentially deterring help-seeking. This Feature examines the tension between adolescent autonomy and parental authority in mental healthcare. We synthesise interdisciplinary perspectives from the developmental sciences, medical ethics and law. We present data from 20 844 students (aged 11-18 years) in the 2023 OxWell Student Survey regarding barriers to accessing mental health support. Among those who wanted but had not accessed additional support (n = 2792), 72.3% reported privacy/confidentiality concerns, with half (50.3%) specifically citing that they did not want their parents to know. These concerns were particularly common among students reporting self-harm, gender-diverse adolescents and those in less stable home environments. We argue that respecting adolescent autonomy must be central to healthcare planning, not only as an ethical and legal imperative, but also to enable timely support. A capacity-based, adolescent-centred approach - grounded in greater transparency, clearer explanations of when and how information may be shared (including the option to involve a trusted adult) and consistent, aligned policies across institutions, especially around parental involvement, could help address a key barrier to care.
{"title":"Adolescent consent and Generation Alpha: bridging policy, practice and empirical evidence in healthcare.","authors":"Mina Fazel,Emma Soneson,Michael Parker,Danielle Newby,Jonathan Herring","doi":"10.1192/bjp.2025.10488","DOIUrl":"https://doi.org/10.1192/bjp.2025.10488","url":null,"abstract":"Adolescents, particularly today's Generation Alpha, face uncertainty about whether, when and how their autonomy will be respected, especially in mental health contexts. Existing consent and confidentiality practices may not reflect adolescents' preferences, potentially deterring help-seeking. This Feature examines the tension between adolescent autonomy and parental authority in mental healthcare. We synthesise interdisciplinary perspectives from the developmental sciences, medical ethics and law. We present data from 20 844 students (aged 11-18 years) in the 2023 OxWell Student Survey regarding barriers to accessing mental health support. Among those who wanted but had not accessed additional support (n = 2792), 72.3% reported privacy/confidentiality concerns, with half (50.3%) specifically citing that they did not want their parents to know. These concerns were particularly common among students reporting self-harm, gender-diverse adolescents and those in less stable home environments. We argue that respecting adolescent autonomy must be central to healthcare planning, not only as an ethical and legal imperative, but also to enable timely support. A capacity-based, adolescent-centred approach - grounded in greater transparency, clearer explanations of when and how information may be shared (including the option to involve a trusted adult) and consistent, aligned policies across institutions, especially around parental involvement, could help address a key barrier to care.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"20 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752618","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}
Ian Goodyer,Raphael Kelvin,Anne-Marie Burn,Rasanat Nawaz,Polly Ashford,Julia Gledhill,Charlotte Catignani,Tamsin Ford
The UK Government's new 10-year health plan encourages a move to digital strategies. Digital mental health interventions (DMHIs) may reduce symptoms and impairments in people who have mental health conditions. While many apps have been produced, few undergo formal evaluation and fewer still are regulated as medical devices. Service providers struggle to know which to deploy. DMHIs could reduce distress and preserve or improve function among young people, as well as prepare young people on waiting lists to engage in psychotherapy once seen. However, it is essential that DMHIs are rigorously evaluated, co-developed with all major stakeholders and then monitored during implementation.
{"title":"Building a digital intervention to support young people with disordered mood and on the waiting list to optimise safety, acceptability and effectiveness.","authors":"Ian Goodyer,Raphael Kelvin,Anne-Marie Burn,Rasanat Nawaz,Polly Ashford,Julia Gledhill,Charlotte Catignani,Tamsin Ford","doi":"10.1192/bjp.2025.10492","DOIUrl":"https://doi.org/10.1192/bjp.2025.10492","url":null,"abstract":"The UK Government's new 10-year health plan encourages a move to digital strategies. Digital mental health interventions (DMHIs) may reduce symptoms and impairments in people who have mental health conditions. While many apps have been produced, few undergo formal evaluation and fewer still are regulated as medical devices. Service providers struggle to know which to deploy. DMHIs could reduce distress and preserve or improve function among young people, as well as prepare young people on waiting lists to engage in psychotherapy once seen. However, it is essential that DMHIs are rigorously evaluated, co-developed with all major stakeholders and then monitored during implementation.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"11 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752671","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 2023 Barbie movie became an unexpected touchstone in my clinical practice. In the months after the film's general release, children, young people and adults quoted from the film's comedic moments and inspirational monologues, using them as a shorthand for complex emotional experiences, and to identify struggles and experiences of care and recovery. The film's playful tone and layered themes allowed for moments of humour alongside serious introspection. This paper describes an exploration of the Barbie movie as a shared cultural language that facilitated therapeutic conversations and provided a narrative framework for self-exploration. Drawing upon concepts from narrative medicine, psychoanalytic theory and the enduring cultural symbolism of Barbie, this discussion positions the Barbie film as a displacement object, a transitional space, a narrative tool and a fitting metaphor for adolescent development as well as recovery. I consider the impact of the film's rich cineliteracy on clinical practice, against a background of historical psychiatric discourses around the Barbie doll, and her enduring cultural symbolism. Fictionalised clinical encounters illustrate how young people engaged with Barbie to explore issues of gender, trauma and institutional structures. This paper argues that an openness to integrating popular media into psychiatric practice expands the scope of assessment and therapeutic engagement, allowing children, young people and adults to express their experiences through culturally familiar, accessible narratives.
{"title":"Life in plastic, it's therapeutic: the Barbie movie and adolescent mental health.","authors":"Sabina Dosani","doi":"10.1192/bjp.2025.10507","DOIUrl":"https://doi.org/10.1192/bjp.2025.10507","url":null,"abstract":"The 2023 Barbie movie became an unexpected touchstone in my clinical practice. In the months after the film's general release, children, young people and adults quoted from the film's comedic moments and inspirational monologues, using them as a shorthand for complex emotional experiences, and to identify struggles and experiences of care and recovery. The film's playful tone and layered themes allowed for moments of humour alongside serious introspection. This paper describes an exploration of the Barbie movie as a shared cultural language that facilitated therapeutic conversations and provided a narrative framework for self-exploration. Drawing upon concepts from narrative medicine, psychoanalytic theory and the enduring cultural symbolism of Barbie, this discussion positions the Barbie film as a displacement object, a transitional space, a narrative tool and a fitting metaphor for adolescent development as well as recovery. I consider the impact of the film's rich cineliteracy on clinical practice, against a background of historical psychiatric discourses around the Barbie doll, and her enduring cultural symbolism. Fictionalised clinical encounters illustrate how young people engaged with Barbie to explore issues of gender, trauma and institutional structures. This paper argues that an openness to integrating popular media into psychiatric practice expands the scope of assessment and therapeutic engagement, allowing children, young people and adults to express their experiences through culturally familiar, accessible narratives.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"20 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752626","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}
BACKGROUNDAnorexia nervosa is associated with high personal and financial costs for sufferers, carers and society in general, but little is known about the long-term health economic burden.AIMSTo examine healthcare utilisation, social assistance, sick leave and disability pension in individuals with anorexia nervosa over a period of 30 years.METHODFifty-one individuals with adolescent-onset anorexia nervosa and 51 matched comparison cases (COMP) were recruited in the community and followed prospectively from 1985. All individuals were examined on five occasions. At the 30-year follow-up, mean age 44, data on in- and out-patient care, prescribed medications, social assistance, sick leave and disability pension were collected from Swedish national registers.RESULTSThe anorexia nervosa group had more days of in-patient care (p < 0.001) and out-patient visits to psychiatry (p < 0.001), more days of sick leave (p = 0.006), more days of disability pension (p = 0.002) and were prescribed more psychotropic medication (p = 0.045) compared with the COMP group. Of the anorexia nervosa group, 22% had ever received a disability pension compared with 2% in the COMP group (p = 0.004) and less than half the anorexia nervosa group worked full-time at the 30-year follow-up. In the anorexia nervosa group, 45% had received social assistance at some point, compared with 22% in the COMP group (p = 0.02). Age at onset of anorexia nervosa emerged as a predictor of healthcare utilisation with significant odds ratios for psychiatric in-patient (odds ratio 0.61, 95% CI: 0.39, 0.94; p = 0.027) and out-patient care (odds ratio 0.63, 95% CI: 0.40, 0.98; p = 0.042), i.e. individuals with a later onset of anorexia nervosa were less likely to require psychiatric care.CONCLUSIONSThe long-term burden of adolescent-onset anorexia nervosa comprises increased utilisation of healthcare and dependence on society for a significant minority. A later onset of anorexia nervosa predicted a lower healthcare utilisation.
{"title":"Thirty-year outcome of anorexia nervosa: healthcare use and disability.","authors":"Sandra Rydberg Dobrescu,Lisa Dinkler,I Carina Gillberg,Christopher Gillberg,Maria Råstam,Kristian Bolin,Elisabet Wentz","doi":"10.1192/bjp.2025.10494","DOIUrl":"https://doi.org/10.1192/bjp.2025.10494","url":null,"abstract":"BACKGROUNDAnorexia nervosa is associated with high personal and financial costs for sufferers, carers and society in general, but little is known about the long-term health economic burden.AIMSTo examine healthcare utilisation, social assistance, sick leave and disability pension in individuals with anorexia nervosa over a period of 30 years.METHODFifty-one individuals with adolescent-onset anorexia nervosa and 51 matched comparison cases (COMP) were recruited in the community and followed prospectively from 1985. All individuals were examined on five occasions. At the 30-year follow-up, mean age 44, data on in- and out-patient care, prescribed medications, social assistance, sick leave and disability pension were collected from Swedish national registers.RESULTSThe anorexia nervosa group had more days of in-patient care (p < 0.001) and out-patient visits to psychiatry (p < 0.001), more days of sick leave (p = 0.006), more days of disability pension (p = 0.002) and were prescribed more psychotropic medication (p = 0.045) compared with the COMP group. Of the anorexia nervosa group, 22% had ever received a disability pension compared with 2% in the COMP group (p = 0.004) and less than half the anorexia nervosa group worked full-time at the 30-year follow-up. In the anorexia nervosa group, 45% had received social assistance at some point, compared with 22% in the COMP group (p = 0.02). Age at onset of anorexia nervosa emerged as a predictor of healthcare utilisation with significant odds ratios for psychiatric in-patient (odds ratio 0.61, 95% CI: 0.39, 0.94; p = 0.027) and out-patient care (odds ratio 0.63, 95% CI: 0.40, 0.98; p = 0.042), i.e. individuals with a later onset of anorexia nervosa were less likely to require psychiatric care.CONCLUSIONSThe long-term burden of adolescent-onset anorexia nervosa comprises increased utilisation of healthcare and dependence on society for a significant minority. A later onset of anorexia nervosa predicted a lower healthcare utilisation.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"150 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728395","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}
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