BJPsych Open最新文献

Retrograde amnesia for autobiographical memories is a commonly self-reported cognitive side-effect of electroconvulsive therapy (ECT), but it is unclear to what extent objective performance differs between ECT-exposed and ECT-unexposed patients with depression. We investigated the association between exposure to brief-pulse (1.0 ms) bitemporal or high-dose right unilateral ECT and retrograde amnesia at short- and long-term follow-up, compared with inpatient controls with moderate-to-severe depression without lifetime exposure to ECT and receiving psychotropic pharmacotherapy and other aspects of routine inpatient care. In propensity score analyses, statistically significant reductions in autobiographical memory recall consistency were found in bitemporal and high-dose right unilateral ECT within days of an ECT course and 3 months following final ECT session. The reduction in autobiographical memory consistency was substantially more pronounced in bitemporal ECT. Retrograde amnesia for items recalled before ECT occurs with commonly utilised ECT techniques, and may be a persisting adverse cognitive effect of ECT.

Background: Vaping is increasing in popularity. Vape products are offered in a wide variety and promise to reduce harms associated with cigarette smoking, among other claims. The motivations for vaping in patients with substance use disorder are largely unknown.

Aims: To describe perceptions and motivations regarding vaping among patients with opioid use disorder (OUD) who vape.

Method: A convergent mixed-methods study design was used, and individual, semi-structured interviews were conducted with 41 individuals with OUD who were receiving medication for OUD and also vaped. An inductive data-driven approach was employed to characterise perspectives on vaping.

Results: The mean ages at which participants had been introduced to vaping and initiated regular vaping were 33.95 years (s.d. 12.70) and 34.85 years (s.d. 12.38), respectively. Daily vaping (85%) of nicotine, flavoured nicotine or cannabis was common, with 27% reporting vaping both nicotine and cannabis. Qualitative analysis identified 14 themes describing motivations for vaping, including viewing vaping as a smoking cessation tool, convenience and popularity among youth.

Conclusions: Mixed-methods findings indicated that patients with OUD who vape perceived vaping to be healthier, cleaner and more convenient than cigarette and cannabis smoking, without appreciating the health risks. The perspectives reflected the importance of health education, guidelines and screening tools for vaping and could provide direction for healthcare providers and future vaping cessation programmes.

Background: Anxiety disorders are among the most common mental disorders worldwide, and most previous studies have focused solely on alcohol drinking or tobacco smoking as risk factors for anxiety.

Aim: This study investigated the associations of alcohol drinking and tobacco smoking with anxiety.

Method: The data of 30 836 individuals in the Taiwan Biobank were retrieved and analysed in our study. To investigate the associations of tobacco and alcohol use with anxiety, we analysed Patient Health Questionnaire 4 (specifically scores for the first two questions assessing generalised anxiety disorder) results of the included participants and data on their tobacco and alcohol use, and other covariates.

Results: Participants who used only tobacco and those using both tobacco and alcohol were more likely to experience anxiety than were those who did not use tobacco or alcohol. Among men, the use of alcohol and/or tobacco was associated with a significantly higher risk of anxiety. Among women, the use of both alcohol and tobacco was associated with a significantly higher risk of anxiety. Older age was associated with a lower risk of anxiety.

Conclusions: Tobacco and alcohol use significantly influence the risk of anxiety, particularly in men, and older age also influences this risk. The associations of anxiety with tobacco and alcohol use in women may change because of the increasing prevalence of their use among women in Taiwan in recent years.

Background: The study examines the behavioural and psychological symptoms (BPSs) associated with dementia and mild cognitive impairment (MCI), highlighting the prevalence and impact of these symptoms on individuals with varying levels of cognitive function, particularly in the context of the increasing incidence of dementia among the ageing population.

Aims: To explore the BPSs among out-patients with different cognitive statuses.

Method: This cross-sectional study enrolled out-patients who attended the cognitive assessment out-patient clinic at our hospital between January 2018 and October 2022. The patients' cognitive status was evaluated using the Neuropsychiatric Inventory (NPI), Activities of Daily Living and the Montreal Cognitive Assessment-Basic scales.

Results: The study enrolled 3273 out-patients, including 688 (21%) with cognitively unimpairment, 1831 (56%) with MCI and 754 (23%) with dementia. The NPI score, the percentage of patients with BPSs and the number of BPSs increased with decreasing cognition level. Unordered logistic regression analysis showed that after adjustment of confounding variables, delusions, depression, euphoria and psychomotor alterations were independently associated with MCI. Delusions, agitation, euphoria, apathy, psychomotor alterations and sleep change were independently associated with dementia.

Conclusions: NPI scores, the percentage of patients with BPSs and the numbers of BPSs increased with declining cognitive function.

Background: In-patient mental health rehabilitation services provide specialist treatment to people with complex psychosis. On average, rehabilitation admissions last around a year and usually follow several years of recurrent and often lengthy psychiatric hospital admissions.

Aims: To compare in-patient service use before and after an in-patient rehabilitation admission, using electronic patient healthcare records in one National Health Service Trust in London.

Method: We carried out a retrospective cohort study comprised of individuals with an in-patient rehabilitation admission lasting ≥84 days between 1 January 2010 and 30 April 2019, with at least ≥365 days of records available before and after their rehabilitation admission. We used negative binomial regression models to compare the number of in-patient days before and after the rehabilitation admission.

Results: A total of 172 individuals met our eligibility criteria. The median percentage of days spent as an in-patient before the rehabilitation admission was 29% (interquartile range 18-52%), and 8% (interquartile range 0-31%) after the admission. The regression model adjusted for potential confounder variables produced an incidence rate ratio of 0.520 (95% CI 0.367-0.737).

Conclusions: The rate of in-patient service use was halved in the period after an in-patient rehabilitation admission compared with the period before. This suggests that in-patient rehabilitation is a clinical and cost-effective intervention in the treatment and support of people with complex psychosis.

Background: Adolescence marks a critical transition period, with significant mental health challenges including anxiety and depression symptoms that affect long-term happiness. There has been a lack of research exploring the factors mediating adolescent happiness.

Aims: To investigate the mediating effects of anxiety and depression on adolescent happiness, as well as the contributions of sociodemographic factors.

Methods: We recruited 392 adolescents. Anxiety symptoms, depression symptoms and happiness were assessed by the seven-item Generalized Anxiety Disorder scale, nine-item Patient Health Questionnaire and single-item happiness scale, respectively. Self-administered questionnaires were used to collect sociodemographic information.

Results: Spearman correlation analysis showed significant negative correlations of happiness with anxiety (r = -0.37, P < 0.0001) and depression (r = -0.47, P < 0.0001). Positive predictors of happiness included quality of parents' marriage (β = 0.12, P = 0.006), regular physical exercise (β = 0.13, P = 0.006) and regular diet (β = 0.10, P = 0.03). Mediation analysis indicated that depressive symptoms (estimate = 0.50, 95% CI: 0.25 to 0.80) and anxiety symptoms (estimate = 0.32, 95% CI: 0.12 to 0.57) partially mediated the relationship between regular exercise and happiness, whereas depressive symptoms completely mediated the relationship between anxiety symptoms and happiness (estimate = -0.14, 95% CI: -0.20 to -0.08).

Conclusion: The findings of this study highlight the intricate interplay of mental health issues, lifestyle factors and adolescent happiness and emphasise the need for comprehensive interventions focusing on enhancing physical activity and addressing psychological health to foster happiness among adolescents.

Background: Clozapine-induced gastrointestinal hypomotility (CIGH) can cause constipation, which may progress to ileus, intestinal perforation and other life-threatening conditions. There were at least 527 unique cases of harmful CIGH (172 deaths) assessed by strict criteria in the UK, 1992-2017.

Aims: To assess the impact of strengthened warnings about the risks of CIGH, such as those issued by the UK Medicines and Healthcare products Regulatory Agency (MHRA) (2017) and the US Food and Drug Administration (2020), on reports of harmful CIGH in the UK.

Method: We audited UK MHRA Yellow Card reports recorded as clozapine-related gastrointestinal disorders, 2018-end 2022.

Results: Of 335 unique reports (36 fatal, 26 male) that met initial CIGH criteria, there were 129 (22 fatal, 18 male) that met the final CIGH inclusion criteria. Reports of non-fatal CIGH (final criteria) averaged 26 per year (15 in 2022). Deaths averaged four per year (two in 2022). Where data were available the greatest proportion of deaths occurred after 10-14 years of clozapine treatment.

Conclusions: Publicity aimed at raising awareness of the problem posed by CIGH has been associated with a reduction in harmful CIGH as reported to the UK MHRA since 2017. Continued vigilance is needed to reduce risk. Stopping smoking may pose a particular risk and should be monitored carefully.

Background: Glucuronic acid (GlcA) is crucial in the glucuronidation pathway, facilitating the metabolism and elimination of various substances and drugs. Recent studies have noted elevated GlcA levels in patients with schizophrenia (SCZ) compared with healthy individuals. However, it remains unclear whether this elevation contributes to SCZ pathophysiology or results from medication effects.

Aims: This study investigated the relationship between peripheral GlcA levels and clinical characteristics in patients with SCZ and assess whether these associations persist independently of psychotropic medication effects to provide insight into the potential role of GlcA in the pathophysiology of SCZ.

Methods: Plasma GlcA levels were analysed in 218 patients with SCZ, examining their association with clinical features. The correlation between GlcA levels and symptom severity, assessed using the Positive and Negative Syndrome Scale (PANSS), was analysed in 35 patients. In addition, multiple regression analysis was conducted to adjust for age and psychotropic medication effects.

Results: Significant correlations were observed between GlcA levels and PANSS scores for negative symptoms, general psychopathology and total scores. After adjustment for age and psychotropic medications, significant correlations between GlcA levels and PANSS scores persisted for negative symptoms (adjusted β [95% CI], 13.926 [2.369, 25.483]) and general psychopathology (adjusted β [95% CI], 19.437 [3.884, 34.990]), while the total score was no longer significant (adjusted β [95% CI], 34.054 [-0.517, 68.626]).

Conclusions: Elevated GlcA levels in patients with SCZ are associated with specific symptom severity irrespective of the medication dose, suggesting a potential role of GlcA in SCZ pathophysiology.

Background: Care planning for recovery and to work towards hospital discharge is integral to good practice in mental health in-patient settings. Authorised leave from hospital, especially for those who are detained, can be used to check readiness for discharge and to maintain social connections that support a patient's recovery journey. Leave therefore often involves friends and family, or 'carers'. However, carer involvement in planning leave is limited, and carers struggle with feeling unsupported during the leave.

Aims: This study aimed to explore carers' and mental health practitioners' subjective experiences of leave in the context of implementing a set of practice guidelines for involving carers in planning and undertaking leave from hospital.

Method: Nine wards in six National Health Service trusts were recruited to implement the guidelines. Interviews were undertaken with carers (n = 6) and practitioners (n = 3) from these implementation wards and with carers (n = 7) from nine usual care wards. A further ten practitioners completed an anonymous online survey. Data were analysed thematically.

Results: Carers' experiences on both implementation and usual care wards indicated variable levels of involvement, with carers positioned as partners in care, observers of care or outsiders to care. Practitioner perspectives highlighted practical, structural and conceptual challenges in working with carers, which precluded effective implementation of the guidelines.

Conclusions: The guidelines reflected what both carers and practitioners described as good practice, but resource limitations, unclear responsibilities and perceptions of carer roles limited engagement. Implementing approaches to working with carers in in-patient settings requires resourcing and clear role definition within staff-carer relationships.