BJPsych Open最新文献

Background: Known influences on tic severity include medical, biological and contextual factors.

Aims: We aimed to further understanding of contextual factors by exploring if tic severity is influenced by calendar month.

Method: This study used data from the Calgary Child Tic Registry. Children are extensively clinically phenotyped at their first visit and followed prospectively until adulthood. We evaluated the mean Yale Global Tic Severity Scale-Revised (YGTSS-R) total tic severity score based on the calendar month. Multivariable linear regression models were fit to assess the individual months adjusted for age, gender, comorbidity and tic treatment variables.

Results: The study included 370 participants, with 549 assessments of tic severity performed. In the univariable analysis based on calendar month, August had the lowest tic severity, with a mean YGTSS-R total tic severity score of 15.68 (95% CI 13.41-17.95). This was significantly lower than the month with the highest tic severity, February, with a mean score of 20.41 (95% CI 18.19-22.63). In multivariable models adjusted for age, gender, comorbidity and treatment for tics, the omnibus test for whether month contributes to a better fit were not significant (YGTSS-R total tic score P-value: 0.495). The only significant predictors of increased tic severity were treatment for tics (P < 0.0001), diagnosis of depression (P = 0.003) and diagnosis of obsessive-compulsive disorder (P = 0.02).

Conclusions: While our univariate analysis of tic severity by calendar month supported significantly lower tic severity in August compared with February, this association was no longer statistically significant when controlling for other variables known to impact tic severity.

Background: Perinatal obsessive-compulsive disorder (pOCD) is a common mental health difficulty. For some women with pOCD, a psychiatric in-patient admission is deemed necessary. In the UK, Mother and Baby Units (MBUs) are currently best practice for in-patient admission in the perinatal period. Wider OCD literature and pOCD case studies suggest the MBU environment may pose challenges to the treatment of pOCD.

Aims: To date, there has been no research exploring pOCD on MBUs, therefore, this study aimed to qualitatively explore women and professionals' experiences of pOCD on MBUs.

Method: Semi-structured interviews were conducted with eight women who self-identified as having experienced pOCD and an admission to an MBU, and ten professionals who had experience working with women with pOCD on MBUs. Interviews took place virtually and were recorded and transcribed. Reflexive thematic analysis was used to analyse the data.

Results: Six themes were identified. (a) 'MBU a last resort for OCD', (b) 'Developing a shared understanding of OCD', (c) 'A whole team approach to treatment', (d) 'Choice and control over exposure', (e) 'Ward as a safety net' and (f) 'Transitioning back to real life'.

Conclusions: The research highlighted a number of challenges in providing treatment for pOCD in this environment and suggestions are made for the development of clinical guidelines for supporting women with pOCD and designing specific training for MBU professionals.

Background: The COVID-19 pandemic caused by the SARS-CoV-2 virus was the biggest global health emergency in the past century. The impact of the pandemic on society, and demand for health services, especially mental health services is not fully understood.

Aims: We describe the change in activity in a single UK NHS mental health trust during and following the pandemic.

Method: We conducted a retrospective service evaluation using a population-based referral rates and clinical activity for mental health disorders in Cambridgeshire over the period 1 January 2017 to 31 December 2023. We divided the time period into pre-pandemic period, during the pandemic, and post-pandemic months. A negative binomial regression model was fitted to the monthly rates to yield incidence rate ratios. Subgroup analyses were performed by age, gender, ethnicity, and level of deprivation.

Results: There was a steep decline in both referrals and clinical contacts during the lockdowns with a subsequent and steep increase in these measures during the immediate post-pandemic period. Increased numbers of referrals and contacts have been sustained well into the post-pandemic period.

Conclusions: In a single county-wide mental health service in the UK, the prolonged and sustained increase in both referrals and activity post-pandemic was not matched by equal increase in resource to meet demand. Our findings may be useful to effectively plan mental health services before, during and after any future pandemics.

Background: Suicidal ideation following trauma exposure is frequently associated with depressive and post-traumatic stress disorder (PTSD) symptoms; however, the interactive effects of depression and distinct PTSD symptom clusters on suicidal ideation remain poorly understood.

Aims: To examine whether specific PTSD symptom clusters - namely intrusion, avoidance and hyperarousal - moderate the association between depressive symptoms and suicidal ideation, and whether these effects vary across different trauma types.

Method: Medical records of 127 psychiatric out-patients with a history of at least one traumatic event were analysed. All participants had completed the Hamilton Rating Scale for Depression, the Impact of Event Scale-Revised, and the suicidal ideation item of the Beck Depression Inventory II. Trauma types were categorised into early versus late, single versus multiple, and interpersonal versus non-interpersonal.

Results: Hierarchical regression analyses identified a significant moderating effect of avoidance symptoms on the relationship between depression and suicidal ideation (β = 0.19, P = 0.012), whereas intrusion and hyperarousal symptoms did not show such effects. Specifically, higher levels of avoidance were associated with a stronger positive relationship between depression and suicidal ideation. This moderating effect was observed only among individuals with late (β = 0.28, P = 0.002), single (β = 0.29, P = 0.002) or non-interpersonal trauma (β = 0.34, P = 0.018); it was not evident among those with early, multiple or interpersonal trauma.

Conclusions: These findings underscore the relevance of targeting avoidance symptoms to mitigate suicidal ideation, particularly in individuals with late-onset, single-incident or non-interpersonal trauma exposure. Exposure-based therapeutic interventions may offer particular benefit for reducing suicidal ideation among trauma-exposed individuals with depressive symptoms.

Background: In 2018, the UK government commissioned National Health Service Talking Therapies (NHS TT) services to provide integrated mental and physical health care for individuals with a long-term condition (LTC) and coexisting depression and/or anxiety. Nevertheless, evidence on the effectiveness of NHS TT in physical LTCs remains inconsistent.

Aims: This review aims to evaluate the impact of NHS TT on mental health outcomes among adults with physical LTCs.

Method: We conducted a systematic review and meta-analysis of quantitative studies published between 2008 and 2024. We used several databases for the search, including Embase, MEDLINE, Cochrane Library, NHS Evidence, PsycINFO, Bielefeld Academic Search Engine and ProQuest. We combined terms related to NHS TT, LTCs and mental health outcomes to identify eligible studies. The Population, Intervention, Comparison, Outcomes and Study framework guided the development of the inclusion criteria. We employed the random-effects model for meta-analysis and assessed heterogeneity bias using the I² statistic, and the Newcastle-Ottawa scale to evaluate the overall quality of the evidence.

Results: Twenty-four studies met the inclusion criteria. The meta-analysis revealed a significant pre-post NHS TT intervention effect on reliable improvement (odds ratio 0.77, 95% CI: 0.60-0.98) and reliable recovery (odds ratio 0.80, CI: 0.68-0.95). There were no significant differences in NHS TT accessibility (e.g. treatment engagement) between participants with and without LTCs (odds ratio 0.97, 95% CI: 0.82-1.14). However, heterogeneity between the studies was high (>90%).

Conclusions: The observed evidence provides reassurance for individuals with LTCs engaging with treatment; however, the association with post-treatment distress is still of concern. Furthermore, extensive and rigorous research is needed to strengthen and guide service development for individuals with LTCs, thereby improving effectiveness.

Background: Depressive and anxiety disorders often co-occur with insomnia, creating complex treatment challenges. Although clinical guidelines recommend psychotherapy as first-line treatment for these comorbid conditions, limited access to psychological services in primary healthcare facilities in China often leads to heavy reliance on pharmacological therapy.

Aims: To the appropriateness of psychotropic medications for patients with insomnia comorbid with depressive or anxiety disorders at primary healthcare facilities in China.

Method: This cross-sectional study included patients with documented diagnoses of insomnia comorbid depressive or anxiety disorders in 2022 at all 67 primary healthcare facilities in Dongcheng District, Beijing, China. The primary outcome was the prescribing rate of guideline-recommended psychotropic medications.

Results: Among 842 patients with insomnia and depressive disorders and 1014 patients with insomnia and anxiety disorders, over 90% received psychotropic medications. Benzodiazepines were the most frequently prescribed classes (55.9 and 69.6%), followed by non-benzodiazepine hypnotics (42.5 and 42.4%), whereas medications recommended by the guideline, including antidepressants with sedative effects, selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, were used infrequently. Only 29.9% of patients with insomnia and depressive disorders and 11.5% of those with insomnia and anxiety disorders received guideline-recommended pharmacotherapy, with lower concordance among older adults.

Conclusions: Guideline-recommended pharmacotherapy for insomnia comorbid with depressive or anxiety disorders was rarely implemented at primary care in China. This highlights the need to facilitate evidence-based practices and improve management of comorbid mental health conditions, particularly for older adults.

Since 2023, the armed conflict in Sudan has displaced nearly 900 000 people into eastern Chad, adding to pre-existing refugee populations and placing immense strain on already fragile health and social systems. Sudanese refugees experience high levels of psychological distress, yet Chad's mental health services remain rudimentary, characterised by severe shortages of trained professionals and fragmented service provision. Despite underfunding, humanitarian agencies have explicitly prioritised mental health within their response framework, integrating mental health support into primary care and community-led initiatives. Cultural idioms of distress, stigma and language barriers continue to complicate care delivery, while simultaneously underscoring the importance of locally grounded approaches. Sustainable progress will require closer integration between humanitarian and development efforts, the strengthening of national systems and the expansion of community capacity. Innovative partnerships such as the Greentree Acceleration Plan offer pathways for scalable, culturally relevant interventions that may ultimately strengthen mental health systems for both refugees and host populations in Chad.

Background: Human papillomavirus (HPV) infection has a negative impact on quality of life (QoL) and sexual function, mainly owing to increased levels of anxiety and distress.

Aims: To examine the potentially moderating effects of general psychological health on the relationships between (a) HPV-related psychosocial burden and QoL and (b) HPV-related psychosocial burden and sexual function.

Method: The HPV Impact Profile, Female Sexual Function Index, General Health Questionnaire-28 and Life Satisfaction Inventory questionnaires were completed by 151 women.

Results: HPV-related psychosocial burden and general psychological health accounted for 23.2% of QoL variability. There was not strong evidence for a moderating effect of general psychological health on the relationship between HPV-related psychosocial burden and QoL. Higher HPV-related psychosocial burden predicted worse sexual function on average. However, HPV-related psychosocial burden accounted for only 4.1% of sexual function variability.

Conclusions: Higher HPV-related psychosocial burden is associated with lower QoL as well as worse sexual function. General psychological health predicts changes in QoL over and above HPV-related psychosocial burden; thus, a deep understanding of emerging mental health issues soon after diagnosis is crucial to improve counselling and enhance women's mental empowerment to achieve a better psychological response.

Background: Studies have shown that klotho, a neuroprotective protein, plays a crucial role in neurodevelopment. However, its association with attention-deficit hyperactivity disorder (ADHD), the most prevalent neurodevelopmental disorder, remains uncertain.

Aims: To elucidate klotho levels in adolescents with ADHD and to clarify its association with executive function.

Method: The present study enrolled 92 adolescents (mean approximate age 14 years) diagnosed with ADHD and 80 age-matched healthy adolescents. All participants had their klotho levels measured and underwent the Wisconsin Card Sorting Test (WCST); their parents fulfilled the Swanson, Nolan and Pelham IV (SNAP-IV) scale and the Child Behavior Checklist-Dysregulation Profile (CBCL-DP).

Results: Results from generalised linear models (GLMs), with adjustments for age, gender, body mass index, clinical symptoms (SNAP-IV and CBCL-DP scores) and ADHD medication use, indicated that adolescents with ADHD had significantly lower klotho levels (P = 0.044) and performed worse on WCST (P = 0.027) compared with healthy adolescents. The GLMs further indicated a negative association between klotho levels and the percentage of non-perseverative errors on WCST (P = 0.002).

Conclusions: Klotho may serve as a novel biomarker of ADHD and play a key role in ADHD-related executive dysfunction.