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Integrated mental health care could improve treatment of older hospital inpatients with complex health needs. 综合心理保健可以改善对有复杂健康需求的老年住院病人的治疗。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1016/S2215-0366(24)00246-3
Wolfgang Söllner
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引用次数: 0
Proactive integrated consultation-liaison psychiatry and time spent in hospital by older medical inpatients in England (The HOME Study): a multicentre, parallel-group, randomised controlled trial. 积极主动的综合会诊-联络精神病学与英格兰老年住院病人的住院时间(HOME 研究):一项多中心、平行分组、随机对照试验。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1016/S2215-0366(24)00188-3
Michael Sharpe, Jane Walker, Maike van Niekerk, Mark Toynbee, Nicholas Magill, Chris Frost, Ian R White, Simon Walker, Ana Duarte, Colm Owens, Chris Dickens, Annabel Price
<p><strong>Background: </strong>Older people admitted to hospital in an emergency often have prolonged inpatient stays that worsen their outcomes, increase health-care costs, and reduce bed availability. Growing evidence suggests that the biopsychosocial complexity of their problems, which include cognitive impairment, depression, anxiety, multiple medical illnesses, and care needs resulting from functional dependency, prolongs hospital stays by making medical treatment less efficient and the planning of post-discharge care more difficult. We aimed to assess the effects of enhancing older inpatients' care with Proactive Integrated Consultation-Liaison Psychiatry (PICLP) in The HOME Study. We have previously described the benefits of PICLP reported by patients and clinicians. In this Article, we report the effectiveness and cost-effectiveness of PICLP-enhanced care, compared with usual care alone, in reducing time in hospital.</p><p><strong>Methods: </strong>We did a parallel-group, multicentre, randomised controlled trial in 24 medical wards of three English acute general hospitals. Patients were eligible to take part if they were 65 years or older, had been admitted in an emergency, and were expected to remain in hospital for at least 2 days from the time of enrolment. Participants were randomly allocated to PICLP or usual care in a 1:1 ratio by a database software algorithm that used stratification by hospital, sex, and age, and randomly selected block sizes to ensure allocation concealment. PICLP clinicians (consultation-liaison psychiatrists supported by assisting clinicians) made proactive biopsychosocial assessments of patients' problems, then delivered discharge-focused care as integrated members of ward teams. The primary outcome was time spent as an inpatient (during the index admission and any emergency readmissions) in the 30 days post-randomisation. Secondary outcomes were the rate of discharge from hospital for the total length of the index admission; discharge destination; the length of the index admission after random allocation truncated at 30 days; the number of emergency readmissions to hospital, the number of days spent as an inpatient in an acute general hospital, and the rate of death in the year after random allocation; the patient's experience of the hospital stay; their view on the length of the hospital stay; anxiety (Generalized Anxiety Disorder-2); depression (Patient Health Questionnaire-2); cognitive function (Montreal Cognitive Assessment-Telephone version); independent functioning (Barthel Index of Activities of Daily Living); health-related quality of life (five-level EuroQol five-dimension questionnaire); and overall quality of life. Statisticians and data collectors were masked to treatment allocation; participants and ward staff could not be. Analyses were intention-to-treat. The trial had a patient and public involvement panel and was registered with ISRTCN (ISRCTN86120296).</p><p><strong>Findings: </strong>274
背景:急诊入院的老年人往往住院时间过长,导致病情恶化、医疗费用增加、床位减少。越来越多的证据表明,他们的问题具有生物心理社会复杂性,包括认知障碍、抑郁、焦虑、多种内科疾病以及因功能依赖而产生的护理需求,这使得医疗效率降低,出院后护理规划更加困难,从而延长了住院时间。我们的目标是在 "居家 "研究中评估通过积极主动的综合咨询-联络精神病学(PICLP)加强老年住院患者护理的效果。我们之前已经介绍了患者和临床医生报告的 PICLP 的益处。在这篇文章中,我们报告了PICLP强化护理与单纯常规护理相比,在缩短住院时间方面的有效性和成本效益:我们在英国三家急诊综合医院的 24 个内科病房进行了一项平行分组、多中心、随机对照试验。患者年龄在 65 岁或以上,急诊入院,预计从入院时算起至少住院 2 天,即有资格参加该试验。参与者按照1:1的比例被随机分配到PICLP或常规护理中,该数据库软件算法根据医院、性别和年龄进行分层,并随机选择区块大小以确保分配的隐蔽性。PICLP 临床医生(咨询联络精神科医生,由辅助临床医生提供支持)对患者的问题进行积极主动的生物-心理-社会评估,然后作为病房团队的综合成员提供以出院为重点的护理。主要结果是随机分配后 30 天内的住院时间(指标入院期间和任何急诊再入院期间)。次要结果包括指标入院总时间内的出院率、出院目的地、随机分配后指标入院时间截断为30天、急诊再入院次数、在急诊综合医院的住院天数以及随机分配后一年内的死亡率;患者的住院经历;他们对住院时间的看法;焦虑(广泛性焦虑症-2);抑郁(患者健康问卷-2);认知功能(蒙特利尔认知评估-电话版);独立功能(日常生活活动巴特尔指数);与健康相关的生活质量(EuroQol 五维问卷);以及整体生活质量。统计人员和数据收集人员对治疗分配进行了遮蔽,但参与者和病房工作人员不能被遮蔽。分析采用意向治疗。结果:2018年5月2日至2020年3月5日期间,2744名参与者(1399名[51-0%]男性和1345名[49-0%]女性)被纳入试验;1373名被分配到PICLP,1371名被分配到常规护理。参与者的平均年龄为 82-3 岁(SD 8-2),2565 人(93-5%)为白人。随机分配后30天的平均住院时间(对2710名[98-8%]参与者进行分析)为:PICLP为11-37天(SD 8-74),常规护理为11-85天(SD 9-00);调整后的平均差异为-0-45(95% CI -1-11 to 0-21;P=0-18)。在次要结果中,唯一具有显著统计学和临床意义的差异是出院率,PICLP 的出院率要高出 8.5%(比率比 1-09 [95% CI 1-00 至 1-17];P=0-042),这一差异在住院超过 2 周的患者中最为明显。据估计,与常规护理相比,PICLP在1个月和3个月内可略微节省费用,具有成本效益,但在12个月内不具成本效益。未发生与干预相关的严重不良事件:这是首次对 PICLP 进行随机对照试验。老年住院病人和病房工作人员都认为,PICLP 能够加强医疗护理。在短期内,它还可能节约成本。尽管该试验并未提供 PICLP 可缩短住院时间的有力证据,但却为其未来的发展和评估提供了支持和信息:英国国家健康与护理研究所。
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引用次数: 0
Pre-migration decision-making support for people affected by climate change. 为受气候变化影响的人们提供移民前决策支持。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-07-10 DOI: 10.1016/S2215-0366(24)00216-5
Muhammad Kamruzzaman Mozumder
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引用次数: 0
Correction to Lancet Psychiatry 2024; 11: 526-35. 柳叶刀精神病学》2024;11:526-35 的更正。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-07-31 DOI: 10.1016/S2215-0366(24)00253-0
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引用次数: 0
Prevention of in-hospital suicide in China. 在中国预防院内自杀。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-07-10 DOI: 10.1016/S2215-0366(24)00219-0
Lifeng Xiao, Qishuo Zhang
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引用次数: 0
WHO treatment guideline for mental disorders. 世卫组织精神障碍治疗指南。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-07-24 DOI: 10.1016/S2215-0366(24)00169-X
Falk Leichsenring, Allan Abbass, Peter Fonagy, Kenneth N Levy, Peter Lilliengren, Patrick Luyten, Nick Midgley, Barbara Milrod, Christiane Steinert
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引用次数: 0
The overlap of disordered eating, autism and ADHD: future research priorities as identified by adults with lived experience. 饮食失调、自闭症和多动症的重叠:有生活经验的成年人确定的未来研究重点。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-14 DOI: 10.1016/S2215-0366(24)00186-X
Johanna Keller, Moritz Herle, William Mandy, Virginia Carter Leno

The focus of mental health research in emerging fields should be driven by the priorities of people with relevant lived experience. Autism and ADHD are childhood-onset neurodevelopmental conditions that are associated with a range of health inequalities, including increased risk for eating disorders. The evidence base for how best to support neurodivergent individuals who experience disordered eating is still in its infancy, but research suggests that existing clinical approaches are not currently fit for purpose. In this Personal View, through community consultation with autistic people and people with ADHD who have experienced disordered eating, we present a comprehensive ranked list of research topics that people with lived experience prioritise. These priorities could be clustered into two areas: improving outcomes and identifying causal mechanisms. Within the theme of improving disordered eating outcomes, priorities are the improvement of treatment, the need for neurodiversity training in clinical services, and the identification and minimisation of unintended adverse effects of psychological intervention. Within the theme of identifying causal mechanisms, priorities are the identification of risk factors and a better understanding of the effect of autistic or ADHD neurocognitive profiles as potential contributors to eating disorder vulnerability. The final top ten research priorities are contextualised in terms of how they compare to the existing literature on the overlap between autism or ADHD and eating disorders, and concrete suggestions are made for how to implement these research priorities as testable hypotheses. Research informed by these priorities will build necessary understanding of the reasons behind the increased risk for eating disorders in neurodivergent people, and how to best support people who are affected by disordered eating to live positive and fulfilling lives.

新兴领域的心理健康研究重点应由具有相关生活经验的人优先考虑。自闭症和多动症是儿童时期发病的神经发育疾病,与一系列健康不平等现象有关,包括饮食失调的风险增加。如何为饮食失调的神经变异者提供最佳支持的证据基础仍处于起步阶段,但研究表明,现有的临床方法目前并不适用。在本篇《个人观点》中,通过与自闭症患者和多动症患者(他们都曾有过饮食紊乱的经历)进行社区咨询,我们提出了一份综合排名清单,列出了有生活经验者优先考虑的研究课题。这些优先事项可分为两个方面:改善结果和确定因果机制。在改善饮食失调结果这一主题中,优先考虑的问题包括:改善治疗方法、在临床服务中开展神经多样性培训的必要性,以及识别和尽量减少心理干预的意外不良影响。在确定因果机制这一主题中,优先事项是确定风险因素,以及更好地了解自闭症或多动症神经认知特征对饮食失调脆弱性的潜在影响。最后列出的十大研究重点与现有的自闭症或多动症与饮食失调症重叠文献进行了比较,并就如何将这些研究重点作为可检验的假设加以实施提出了具体建议。根据这些研究重点开展的研究将有助于人们了解神经变异者患饮食失调风险增加的原因,以及如何为受饮食失调影响的人提供最佳支持,使他们过上积极而充实的生活。
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引用次数: 0
Cortical structure and subcortical volumes in conduct disorder: a coordinated analysis of 15 international cohorts from the ENIGMA-Antisocial Behavior Working Group. 行为障碍的皮层结构和皮层下体积:对 ENIGMA 反社会行为工作组的 15 个国际队列进行的协调分析。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 DOI: 10.1016/S2215-0366(24)00187-1
Yidian Gao, Marlene Staginnus
<p><strong>Background: </strong>Conduct disorder is associated with the highest burden of any mental disorder in childhood, yet its neurobiology remains unclear. Inconsistent findings limit our understanding of the role of brain structure alterations in conduct disorder. This study aims to identify the most robust and replicable brain structural correlates of conduct disorder.</p><p><strong>Methods: </strong>The ENIGMA-Antisocial Behavior Working Group performed a coordinated analysis of structural MRI data from 15 international cohorts. Eligibility criteria were a mean sample age of 18 years or less, with data available on sex, age, and diagnosis of conduct disorder, and at least ten participants with conduct disorder and ten typically developing participants. 3D T1-weighted MRI brain scans of all participants were pre-processed using ENIGMA-standardised protocols. We assessed group differences in cortical thickness, surface area, and subcortical volumes using general linear models, adjusting for age, sex, and total intracranial volume. Group-by-sex and group-by-age interactions, and DSM-subtype comparisons (childhood-onset vs adolescent-onset, and low vs high levels of callous-unemotional traits) were investigated. People with lived experience of conduct disorder were not involved in this study.</p><p><strong>Findings: </strong>We collated individual participant data from 1185 young people with conduct disorder (339 [28·6%] female and 846 [71·4%] male) and 1253 typically developing young people (446 [35·6%] female and 807 [64·4%] male), with a mean age of 13·5 years (SD 3·0; range 7-21). Information on race and ethnicity was not available. Relative to typically developing young people, the conduct disorder group had lower surface area in 26 cortical regions and lower total surface area (Cohen's d 0·09-0·26). Cortical thickness differed in the caudal anterior cingulate cortex (d 0·16) and the banks of the superior temporal sulcus (d -0·13). The conduct disorder group also had smaller amygdala (d 0·13), nucleus accumbens (d 0·11), thalamus (d 0·14), and hippocampus (d 0·12) volumes. Most differences remained significant after adjusting for ADHD comorbidity or intelligence quotient. No group-by-sex or group-by-age interactions were detected. Few differences were found between DSM-defined conduct disorder subtypes. However, individuals with high callous-unemotional traits showed more widespread differences compared with controls than those with low callous-unemotional traits.</p><p><strong>Interpretation: </strong>Our findings provide robust evidence of subtle yet widespread brain structural alterations in conduct disorder across subtypes and sexes, mostly in surface area. These findings provide further evidence that brain alterations might contribute to conduct disorder. Greater consideration of this under-recognised disorder is needed in research and clinical practice.</p><p><strong>Funding: </strong>Academy of Medical Sciences and Economic and S
背景:在所有儿童精神障碍中,行为障碍的发病率最高,但其神经生物学特性仍不清楚。不一致的研究结果限制了我们对大脑结构改变在品行障碍中所起作用的理解。本研究旨在确定行为障碍最稳健且可复制的大脑结构相关因素:ENIGMA-反社会行为工作组对来自15个国际队列的核磁共振成像结构数据进行了协调分析。资格标准是样本平均年龄在18岁以下,有性别、年龄和行为障碍诊断数据,至少有10名行为障碍患者和10名发育正常的患者。所有参与者的三维 T1 加权核磁共振成像脑部扫描均采用 ENIGMA 标准化方案进行预处理。我们使用一般线性模型评估了皮层厚度、表面积和皮层下体积的组间差异,并对年龄、性别和颅内总体积进行了调整。我们还研究了各组别与性别、各组别与年龄之间的交互作用,以及 DSM-亚型比较(儿童期发病与青少年期发病,胼胝-非情感特质水平低与高)。有行为障碍生活经历的人未参与本研究:我们整理了 1185 名患有行为障碍的青少年(339 名[28-6%]女性和 846 名[71-4%]男性)和 1253 名发育正常的青少年(446 名[35-6%]女性和 807 名[64-4%]男性)的个人参与者数据,他们的平均年龄为 13-5 岁(SD 3-0; 范围 7-21)。种族和民族信息不详。与发育正常的青少年相比,行为障碍组 26 个皮质区域的表面积和总表面积均较低(Cohen's d 0-09-0-26)。尾部前扣带回皮层(d 0-16)和颞上沟两侧(d -0-13)的皮层厚度不同。行为障碍组的杏仁核(0-13 d)、伏隔核(0-11 d)、丘脑(0-14 d)和海马(0-12 d)体积也较小。在对多动症合并症或智商进行调整后,大多数差异仍然显著。没有发现不同性别或不同年龄组之间的相互作用。DSM定义的行为障碍亚型之间几乎没有差异。然而,与对照组相比,高胼胝-非情感特质的个体比低胼胝-非情感特质的个体表现出更广泛的差异:我们的研究结果提供了强有力的证据,表明行为障碍患者的大脑结构发生了微妙但广泛的改变,这种改变跨越亚型和性别,主要体现在表面积上。这些发现进一步证明了大脑结构的改变可能是导致行为障碍的原因之一。在研究和临床实践中,需要更多地考虑这种认识不足的障碍:医学科学院和经济与社会研究理事会。
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引用次数: 0
Non-medical factors influencing mental health still need evidence. 影响心理健康的非医疗因素仍然需要证据。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 DOI: 10.1016/S2215-0366(24)00168-8
Michael Baber
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引用次数: 0
Samuel Kelton Roberts: any positive change counts. 塞缪尔-凯尔顿-罗伯茨:任何积极的变化都算数。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-01 DOI: 10.1016/S2215-0366(24)00217-7
Jules Morgan
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引用次数: 0
期刊
Lancet Psychiatry
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