BJPsych Bulletin最新文献

High-functioning depression (HFD) describes individuals experiencing persistent depressive symptoms, such as low mood and emotional exhaustion, while maintaining outward success. Owing to preserved functionality, the underlying distress is often unnoticed, misattributed or suppressed. HFD challenges existing psychiatric frameworks, delays diagnosis and increases the risk of progression to major depressive disorder and suicidality. Current screening tools may lack sensitivity, and stigma can lead to disengagement from therapy. Expanded diagnostic awareness, improved clinician training and culturally attuned care are essential for recognising and validating internal suffering in this overlooked population.

Medical Royal Colleges publish obituaries to record and celebrate the lives of colleagues after their deaths. Who is included in this roll of honour, the preferred literary style, and the organisation of the commissioning and publishing all vary between colleges. Since obituaries have fashions, shaped by culture and practical considerations, it is worthwhile, from time to time, for institutions to review the approaches they take. This paper draws on practices past and present, including those of national newspapers and Royal Colleges, to stimulate further discussion on the subject.

Aims and method: Involvement in clinical mental health research can be a challenge for services isolated from academic institutions, limiting opportunities for patients to receive innovative interventions and for clinicians to explore interest in research. We aimed to increase mental health research capacity in Somerset NHS Foundation Trust via a range of initiatives from collaboration between a senior clinician and research and development colleagues.

Results: Over the course of the project, the number of participants recruited to National Institute for Health and Care Research-adopted mental health and dementia research projects quadrupled over a 2-year period, from 57 to 232, and the number of projects hosted rose from 9 to 23. A total of 165 clinicians signed up to receive information about ongoing studies.

Clinical implications: We found considerable appetite for becoming involved in research among mental health clinicians, and were able to provide opportunities for research experience as well as access to innovative studies for local patients.

Aims and method: A collaborative evaluation of remote consultations in mental health services was undertaken by mental health service providers, experts by experience, academic institutions and a Health Innovation Network in south London, UK. 'Learning healthcare systems' thinking was applied. Workstream 1 reviewed international published evidence; workstream 2 synthesised findings from three health provider surveys of the perceptions and experiences of staff, patients and carers; and workstream 3 comprised an electronic survey on local projects.

Results: Remote consultations can be acceptable to patients and staff. They improve access for some while restricting access for others, with digital exclusion being a key concern. Providing tailored choice is key.

Clinical implications: The collaboration generated learning to inform choices by healthcare providers to embed or adapt remote delivery. A key output was freely downloadable survey questions for assessing the quantity and quality of appointments undertaken by phone or video or face to face.

Modern management has much to learn from ancient wisdoms. Management structures based on corporate trends were transferred from business to services such as healthcare to promote cost-efficiency and productivity. In this article, I argue that the short-term approach of corporate leaders being brought into healthcare for 'transformation' has led to a trail of service dismemberment with no discernible clinical gain for those we seek to serve. Bhagwad Gita, the ancient Hindu scripture on right conduct, is an exemplar of how the primary aim of leaders should be to provide better service rather than serve personal interests or those of the 'business' of healthcare.

Aims and method: Artificial intelligence ambient voice technology (AI AVT), which uses a large language model to summarise clinical dialogue into electronic notes and GP letters, has emerged. We conducted a mixed-methods, pre-post (manual versus AVT-assisted documentation) service development pilot to evaluate its use in a child and adolescent out-patient clinic.

Results: The median administration time per clinical encounter reduced from 27 min (manual) to 10 min (AVT) (P < 0.001). On average, AVT-assisted documentation required only 45% of the time for manual documentation (P < 0.001). Clinician-rated accuracy, quality and efficiency were significantly higher for AVT-assisted documentation. Patient acceptance was high, with 97% reporting that clinicians were not distracted by note-taking. Thematic analysis from focus groups identified positive effects derived from AVT (improved productivity and clinician well-being), but was balanced by barriers (technological limitations).

Clinical implications: Integration of AVT into clinical workflows can significantly alleviate documentation burden, reduce cognitive strain and free up clinical capacity.

Aims and method: Questions often follow the suicide of someone who presented to general adult psychiatry (GAP) when expressing suicidal thoughts: 'Why were they not admitted, or managed differently, when they said they were suicidal?' Answering these questions requires knowledge of the prevalence of suicidal ideation in patients presenting to GAP. Therefore, we determined the general clinical characteristics, including suicidal ideation, of a large sample of patients presenting to a GAP emergency assessment service or referred as non-emergencies to a GAP service.

Results: Suicidal ideation was very common, being present in 76.4% of emergency presentations and 33.4% of non-emergency referrals. It was very weakly associated with suicide, varied between different diagnostic categories, and previous assessment by GAP did not appear to affect it. The suicide rate during the contingent episode of care was estimated as 66 per 100 000 episodes.

Clinical implications: This, and other evidence, shows that suicide cannot be predicted with an accuracy that is useful for clinical decision-making. This is not widely appreciated but has serious consequences for patients and healthcare resources.