BJPsych Bulletin最新文献

Aims and method: To examine whether unconscious and systemic biases regarding ethnicity have an impact on equity of access to a national tic service for children and young people (CYP) at Great Ormond Street Hospital for Children, London, UK. We retrospectively reviewed triaged referrals over an 18-month period and examined differences in triage decision, re-referrals required before acceptance and symptom severity at initial assessment by clinician-perceived and self-assigned ethnicity.

Results: There was no evidence of an unconscious bias within the triage process. CYP from racially minoritised ethnic backgrounds were underrepresented and presented with greater overall need at initial assessment.

Clinical implications: Better recording of ethnicity is a requisite starting point for research. We encourage local services to audit ethnicity of the CYP they refer to national and specialist services. Findings call for greater awareness of challenges faced by patients from racially minoritised ethnic backgrounds.

We consider that the current National Institute for Health and Care Excellence (NICE) guideline CG185 on bipolar disorder does not provide sufficiently specific guidance for the safe monitoring of plasma lithium levels in older people. We feel this needs correction, and laboratories across the UK should lower the range recommended for monitoring older people's lithium levels in line with guidelines from the International Society for Bipolar Disorder. This would provide a safety net in older people in order to prevent lithium toxicity without compromising efficacy.

Aims and method: There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping.

Results: A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients.

Clinical implications: The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.

Aims and method: This study aimed to evaluate an artificial intelligence-assisted tool for psychiatric case formulation compared with human trainees. Twenty trainees and an artificial intelligence system produced formulations for three simulated psychiatric cases. Formulations were scored using the integrated case formulation scale (ICFS), assessing content, integration and total quality. Time taken was recorded, and assessor predictions of formulation origin were analysed.

Results: Artificial intelligence produced formulations significantly faster (<10 s) than trainees (mean 52.1 min). Trainees achieved higher ICFS total scores (mean difference 8.3, P < 0.001), driven by superior content scores, while integration scores were comparable. The assessor identified artificial intelligence-generated formulations with 71.4% sensitivity, but overall accuracy of who produced the formulations was only 58.3%.

Clinical implications: Artificial intelligence shows promise as a time-saving adjunct in psychiatric training and practice, but requires improvements in generating detailed content. Optimising teaching methods for trainees and refining artificial intelligence systems can enhance the integration of artificial intelligence into clinical workflows.

Background: Maternity outcomes for women from certain ethnic groups are notably poor, partly owing to their not receiving treatment from services.

Aims: To explore barriers to access among Black and south Asian women with perinatal mental health problems who did not access perinatal mental health services and suggestions for improvements, and to map findings on to the perinatal care pathway.

Method: Semi-structured interviews were conducted in 2020 and 2021 in the UK. Data were analysed using the framework method.

Results: Twenty-three women were interviewed, and various barriers were identified, including limited awareness of services, fear of child removal, stigma and unresponsiveness of perinatal mental health services. Whereas most barriers were related to access, fear of child removal, remote appointments and mask-wearing during COVID-19 affected the whole pathway. Recommendations include service promotion, screening and enhanced cultural understanding.

Conclusions: Women in this study, an underrepresented population in published literature, face societal, cultural, organisational and individual barriers that affect different aspects of the perinatal pathway.

In this opinion article, we discuss the application of critical realism as an alternative model to the biopsychosocial model in the understanding of psychiatric disorders. Critical realism presents a stratified view of reality and recognises mental disorders as emergent phenomena; that is, their full explanation cannot be reduced to explanations at any lower level of biological processes alone. It thus underscores the significance of the depth of ontology, the interaction between agency and structure, and the context dependency and complex nature of causality. Critical realism provides the conceptual and epistemological basis for a more subtle understanding of the aetiology of psychiatric conditions, which is polyfactorial and includes biological, psychological and social dimensions. Through the realisation of the conceptual and applicative shortcomings in the biopsychosocial model, critical realism promises to advance the understanding of mental disorders and enable a more holistic approach to the problem of people with mental disorders.

Aims and method: This study aimed to explore the experiences and support requirements of psychiatrists undergoing investigations within their mental health organisation. An anonymous online survey was distributed to all non-training psychiatrists registered as members of the Royal College of Psychiatrists.

Results: Of the 815 psychiatrists who responded to the survey, 287 (35%) had been investigated. The majority (76%) were unaware of the concerns before being notified, 36% lacked understanding and 62% experienced timeline deviations. Furthermore, 34% had concerns over conflicts of interest, with 52% perceiving the investigation as unfair, 62% were not informed of their rights. Many respondents reported feeling isolated and lacking support and experienced significant psychological distress, such as symptoms of post-traumatic stress disorder. Suggestions for improvement included better communication, transparency, impartiality, adherence to timelines, proactive support and oversight, and opportunities for learning and reparation post-investigation.

Clinical implications: Mental health service providers should recognise the multifaceted nature of complaints and provide comprehensive support and guidance to psychiatrists undergoing investigations.

Aims and method: Patients prescribed clozapine are increasingly living into old age. However, there is a lack of studies to guide prescribing in this age group. We sought to identify all clozapine patients in Hertfordshire Partnership NHS Foundation Trust over a 5-year period and review side-effect burden and co-prescribing in all patients aged over 65 years.

Results: We identified 69 patients. The majority (61%) were stable in terms of mental state; 94% of cases had experienced a side-effect within the past year, with constipation occurring most commonly (65% of cases).

Clinical implications: Our findings reveal a significant side-effect burden, particularly in relation to constipation. Clozapine-induced gastrointestinal hypomotility (CIGH) can be fatal; however, increasing age has not been a recognised risk factor for constipation in clozapine patients to date. This raises questions about increasing risk to physical health as patients age and adds to concerns about the lack of monitoring for CIGH.