BJPsych Bulletin最新文献

Aims and method: This scoping review examines the literature on psychiatric in-patient ward rounds, a crucial and ubiquitous but understudied component of psychiatric care. We sought to examine the methods and perspectives used in research on ward rounds and identify recommendations for practice.

Results: The review identified 26 studies from diverse in-patient settings but predominantly UK-based, which made 21 recommendations for practice. The commonest methods used were staff surveys and patient interviews. Patient experience, structure, efficiency and power dynamics were the commonest research foci.

Clinical implications: Key recommendations for improving psychiatric ward rounds include reducing participant numbers, increasing patient involvement, structured documentation and regular scheduling. Despite weak empirical evidence supporting these suggestions, they are seen as feasible starting points for quality improvement. The review calls for future research to triangulate patient and staff reports with direct observation to better assess ward round effectiveness and outcomes.

Aims and method: The British Paediatric Surveillance Unit of the UK Royal College of Paediatrics and Child Health contacts participating consultant paediatricians each month to survey whether particular rare conditions or events have been seen in their services. This national surveillance of rare paediatric events has allowed a large amount of research into multiple paediatric conditions. In 2009, the Royal College of Psychiatrists established a similar system - the Child and Adolescent Psychiatry Surveillance System (CAPSS) - to survey consultant psychiatrists in UK and Ireland. Since many conditions involve mental and physical health features, seven studies have been run using reporting to both systems, with simultaneous surveillance across both paediatricians and psychiatrists. Given the desire by policymakers, commissioners and clinicians for well-integrated physical and mental healthcare ('joined-up working'), and if the surveillance systems were functioning well, the CAPSS Executive expected high rates of parallel reporting of individual patients to the two systems. The current study synthesises the rates of parallel reporting of cases to those two systems. We assimilate rates of parallel reporting across the seven studies using figures that have already been published, and by contacting contributing research groups directly where the relevant figures are not currently published. No new primary data were collected.

Results: Of the 1211 confirmed cases, 47 (3.9%) were reported by both psychiatrists and paediatricians. No parallel reporting occurred in four of the seven studies.

Clinical implications: Our findings raise questions about whether joined-up working in mental and physical healthcare is happening in practice. Research into challenges to obtaining comprehensive surveillance will help epidemiologists improve their use of surveillance and control for biases.

Clinicians across medical disciplines are intimately familiar with an unusual feature of descriptive diagnoses. The diagnostic terms, despite their non-aetiological nature, seem to offer an explanatory lens to many patients, at times with profound effects. These experiences highlight a striking, neglected and unchristened medical phenomenon: the therapeutic effect of a clinical diagnosis, independent of any other intervention, where clinical diagnosis refers to situating the person's experiences into a clinical category by either a clinician or the patient. We call this the Rumpelstiltskin effect. This article describes this phenomenon and highlights its importance as a topic of empirical investigation.

Aims and method: To determine the most acceptable term for borderline personality disorder (BPD). We conducted a cross-sectional study of patients who know what it feels like to be diagnosed with a mental disorder. The main outcome measures were the proportion of participants offended and confused by alternative terms for BPD.

Results: Seventy-two people participated in the study. Being diagnosed with a condition was more offensive than being diagnosed with a disorder (χ² = 41.18, d.f. = 1, P < 0.01). Fluxithymia offended the fewest participants (13%), but was the most confusing term (31%). Emotionally unstable personality disorder was the most offensive term (63%). After fluxithymia, emotional intensity disorder was the least offensive term, and not especially confusing (11%). Changing BPD to emotional intensity disorder would avoid an offensive event every 3.6 diagnostic announcements.

Clinical implications: The diagnostic term BPD should be replaced with emotional intensity disorder, because this term provides a balance of clarity and inoffensiveness.

Aims and method: Alcohol use disorder (AUD) is a major global health concern associated with limited treatment efficacy and high relapse rates. Recent research highlights the gut microbiota as a critical modulator of AUD pathophysiology through its influence on the gut-brain axis. Chronic alcohol consumption induces gut dysbiosis, characterised by reduced microbial diversity, impaired gut barrier function and systemic inflammation, which perpetuate neuroinflammation, stress dysregulation and neurotransmitter imbalances. These disruptions exacerbate addiction-related behaviours, contributing to the cycle of dependence and relapse. This critical review synthesises current evidence on the role of gut microbiota in AUD, examining the mechanisms linking dysbiosis to addiction and evaluating therapeutic interventions such as probiotics, prebiotics, faecal microbiota transplantation (FMT), psychobiotics and dietary modifications.

Results: The strategies evaluated show significant potential in restoring microbial homeostasis and improving AUD outcomes, but challenges remain, including gaps in mechanistic understanding, variability in methodologies, and barriers to clinical translation.

Clinical implications: There is a need for multi-omics research, personalised medicine approaches and integrated treatment models to advance microbiota-based therapies. Gut microbiota-targeted strategies might then transform AUD management, offering innovative and personalised solutions for addiction recovery.

Aims and method: Advances in generative artificial intelligence, particularly through large language models, like GPT-4, have opened opportunities to develop cognitive agents to enhance clinical productivity, especially in complex secondary and tertiary care settings. However, as artificial intelligence begins to occupy the cognitive space traditionally held by human clinical reasoning, transparency becomes a significant concern. Unlike human decision-making, artificial intelligence-generated outputs may not be traceable to a transparent chain of clinical reasoning, potentially impacting safety if used without adequate 'clinician reach' into the reasoning space of artificial intelligence.

Results: We highlight the need for a consensus framework to guide the responsible use of generative artificial intelligence in mental healthcare, which, it is argued, has cognitive demands and features distinct from physical medicine. We propose such a framework, Clinical Reach into the Cognitive Space (CRITiCS), to support clinician involvement in the deployment of these technologies.

Clinical implications: This paper aims to spark dialogue and interest in both the clinical and artificial intelligence development communities.

Aims and method: To truly understand the efficacy of attention-deficit hyperactivity disorder (ADHD) psychoeducation, we need to know what is commonly included in it. This scoping review aims to describe the content of psychoeducation interventions for ADHD in published research. A literature search was conducted to identify relevant papers. Descriptions of psychoeducation aimed at children, parents/carers, adults and teachers were identified and compared narratively.

Results: After screening, 57 papers were identified for data extraction and coding. Content themes included 'information about ADHD'; 'practical advice'; 'impact of ADHD'; 'treatment of ADHD'; 'co-occurrence'; and 'self-image/self-esteem'. 'Information about ADHD' and 'practical advice' were the most common themes, with variance on inclusion of other themes. Most of the identified research involved psychoeducation for parents of children with ADHD.

Clinical implications: This review provides greater understanding of the content and delivery of ADHD psychoeducation. Further research could use this understanding to ascertain the efficacy of different content themes in supporting those with ADHD.

Aims and method: The study evaluated a package of measures to improve sleep on psychiatric wards admitting patients from children and young people's services (CYPS). Sleep disturbance has significant impact on adolescent mental health, and in-patient wards can directly cause sleep disturbance, independent of the problem that led to admission. We developed a CYPS-specific package (TeenSleepWell) that promoted a better sleep environment, enhanced staff education about sleep, screened for sleep disorders, and raised awareness of benefits and side-effects of hypnotics. This included personalised sleep care plans that allowed a protected 8 h sleep period when safe.

Results: Evaluation over 2 years showed enhanced in-patient care: 57% of patients were able to have a protected sleep period. There was no increase in adverse events and there was a decrease in hypnotics issued.

Clinical implications: Improving sleep during in-patient CYPS admissions is possible and personalised sleep care plan should be a care standard.