BJPsych Bulletin最新文献

Aims and method: This cross-sectional study, carried out from 2021 to 2022, investigated the factors associated with domestic violence in 400 Brazilian pregnant women during the COVID-19 pandemic. Violence was assessed with the World Health Organization's Violence Against Women questionnaire and the Abuse Assessment Screen. Demographic, socioeconomic, obstetric, lifestyle and mental health data were collected.

Results: Violence at any time in their lives was reported by 52.2% of the women, and psychological violence was the most prevalent type (19.5%). Violence was associated with being single and mental health changes. Pregnant women exposed to any lifetime violence and psychological violence were, respectively, 4.67 and 5.93 times more likely to show mental health changes compared with women with no reported violence.

Clinical implications: Training health professionals involved in prenatal care in the early detection of single women and women with mental health changes could be important in preventing domestic violence.

Aims and method: Dementia in-patient units (DIU) are mental health wards that care for people living with dementia (PLWD) whose symptoms are causing severe distress or potential risk. DIUs look after some of the most vulnerable and unwell people in society, yet they are environments that are underresearched: a recent systematic review revealed only 36 articles worldwide relating to DIUs. To better understand research priorities in DIUs, we undertook a two-round online Delphi survey of PLWD with experience of DIUs, their carers and professionals who work in DIUs.

Results: Ten research priorities were described and ranked. The top three were how to use non-pharmacological techniques to manage non-cognitive symptoms of dementia, supporting families and better understanding of how to discharge PLWD safely and healthily.

Clinical implications: This is the first Delphi consensus to describe DIU research priorities. This paper will help researchers focus on the areas that matter most to people who use DIUs.

EDAC (Eating Disorders and Autism Collaborative) is an innovative project aiming to increase research capacity by supporting collaboration in the fields of eating disorders and autism. EDAC comprises four integrated workstreams to co-produce interdisciplinary research, directed by Autistic individuals with lived experience of eating disorders. Workstream 1 will outline best collaborative practices, informing the research network. Workstream 2 will use arts-based methodologies to set research priorities, with emphasis on the perspectives of underrepresented groups. Workstream 3 will support interdisciplinary collaborations to develop innovative research. Finally, workstream 4 will maximise knowledge mobilisation with the aim of reducing barriers to rapid incorporation of research into policy and clinical practice. A core aim of EDAC is to embed a neurodiversity-affirming culture within eating disorder research and to support the development of a new generation of researchers conducting innovative and meaningful research with the potential to improve clinical outcomes.

Over the past 50 years, mental health services have evolved significantly, influenced by shifts in theoretical and practical approaches to mental disorders. Key among these changes are the biopsychosocial and recovery models, which highlight resilience and quality of life in treatment. However, traditional psychiatry has often struggled to embrace these changes because of reductionist perspectives that overlook psychosocial factors, resulting in fragmented care and reduced accessibility. Proposed solutions have faced implementation barriers in absence of a coherent theoretical framework. Here, we outline how attachment theory may offer a promising framework to drive systemic change in mental health by emphasising secure emotional bonds at both the organisational and individual level. Within an attachment-informed culture, services may act as 'organisational caregivers' that promote continuity of care, independence and stronger clinical relationships. In turn, this may foster more inclusive, responsive and resilient mental healthcare systems that prioritise patients' needs and empowerment.

Past experiences of mental healthcare which have been perceived as harmful can present significant barriers to accessing treatment again. This article draws upon research and lived experience to consider the ways in which conceptualisations of 'trauma-informed care' may better incorporate the role of iatrogenic harm, thus providing more acceptable and equitable treatment for those who have previously found treatment to be harmful. A more restorative approach is offered, founded in shared responsibility and compassionate relationships, to help minimise harms and create a more healing system for patients and clinicians alike.

This editorial explores dual harm - the co-occurrence of self-harm and aggression - particularly among forensic populations. Historically approached as two separate and even opposing behaviours, emerging evidence shows that those who engage in self-harm and aggression experience greater adversity and poorer outcomes. This underscores the importance of enhancing our understanding of dual harm. We review key developments within the field, including how dual harm may be best conceptualised and managed, and identify critical gaps in the literature. In order to improve the care and outcomes of those who engage in self-harm and aggression, emphasis is placed on adopting more integrated approaches that consider the duality of these behaviours, as well as the complex needs of this high-risk group, within research and practice.

Aims and method: The COVID-19 pandemic prompted a surge in adolescent eating disorders and rapid changes in the delivery of intensive community treatments. This study investigates the modification from a group-based day programme to an intensive family treatment approach. A retrospective chart review was performed on data from 190 patients who accessed the intensive service for anorexia nervosa in the past 6 years. Outcomes from the traditional model were compared with the new intensive family model, namely length of admission, percentage median body mass index difference and transfers to in-patient services.

Results: There was a significant reduction in the length of intensive treatment (from 143.19 to 97.20 days). The number of transfers to specialist eating disorder in-patient services also significantly reduced, and is decreasing year on year.

Clinical implications: The findings hold particular relevance as intensive services for adolescent eating disorders continue to be established within health services, with no clear unified approach to treatment.

The royal charter of the Royal College of Psychiatrists is generally taken to enhance its status. However, the concept of a hereditary monarchy is intellectually indefensible and the realities of the British monarchy exacerbate inequalities in the UK. The connection is particularly problematic for psychiatrists because of their role in the compulsory detention and treatment of patients. The Royal affiliation can only serve to emphasise the power inequalities in society associated with these activities. College members should feel free to discuss whether this situation should continue or whether we should be British rather than Royal.

Mainstream psychiatric practice requires a solid grounding in neuroscience, an important part of the biopsychosocial model, allowing for holistic person-centred care. There have been repeated calls for better integration of neuroscience into training, although so far with less focus on implementation for life-long learning. We suggest that such training should be accessible and utilised by all psychiatrists, not solely those with a special interest in neuropsychiatry. By considering recent positive developments within the general psychiatry curricula and neuropsychiatric resource implementation, we propose strategies for how this can be progressed, minimising regional disparities within the growing world of virtual learning.

Aims and method: To better understand factors supporting young people's (age <18 years) mental health during pandemic-type conditions, we aimed to identify whether coping strategies adopted during the COVID-19 pandemic could be dichotomised according to manifesting positive or negative psychological outcomes. Medline, EMBASE, CINAHL, PsycINFO, Scopus and ASSIA databases were used to identify empirical studies that examined coping strategies used by young people experiencing psychological challenges during COVID-19.

Results: Twenty-five international studies were included, identifying that coping strategies adopted could be significantly dichotomised according to reducing or exacerbating psychological challenges. Positive coping strategies were proactive and solutions-oriented, whereas negative coping strategies were more avoidant and emotion-oriented.

Clinical implications: An internal locus of control may account for why adolescents exercised more proactive coping compared with their younger counterparts, although parents of younger children may offset the impact of stressors by drawing on a proposed coping framework emphasising proactivity and engagement. This would be an invaluable addition to future pandemic preparedness planning cycles.