BJPsych Open最新文献

Background: To date, little is known about the evidence of a potential risk of psychiatric adverse events following COVID-19 vaccination in large populations with adequate study design.

Aims: To investigate whether COVID-19 vaccination is associated with increased risk of psychiatric adverse events.

Method: We used South Korea's linkage database to obtain registry data and claims data from 2019 to 2021, and conducted a population-based self-controlled case series study including 11 751 806 individuals. Primary outcomes included anxiety/nervousness, mood disorders, perceptual disturbances/psychoses, aggression/behavioural disturbances, cognitive impairments and sleep disorders within 21 days of COVID-19 vaccination. Secondary outcomes were the stratified primary outcomes according to each individual's psychiatric history. Conditional Poisson regression was used to estimate incidence rate ratios (IRR) and 95% confidence intervals.

Results: COVID-19 vaccination did not increase the rate of anxiety and nervousness (adjusted IRR 0.95, 95% CI 0.95-0.96), mood disorders (adjusted IRR 0.75, 95% CI 0.75-0.76), perceptual disturbances and psychoses (adjusted IRR 0.72, 95% CI 0.70-0.74), aggression and behavioural disturbances (adjusted IRR 0.93, 95% CI 0.89-0.97), cognitive impairment (adjusted IRR 0.68, 95% CI 0.67-0.69) or sleep disorders (adjusted IRR 0.90, 95% CI 0.89-0.91). Secondary outcomes were consistent with the primary outcome, although the adjusted IRRs for anxiety and nervousness (adjusted IRR 1.17, 95% CI 1.15-1.18) and sleep disorders (adjusted IRR 1.07, 95% CI 1.06-1.09) were statistically significant in individuals with no history of psychiatric disorders. Sensitivity analyses showed consistent results with our main findings.

Conclusions: Our findings provide short-term safety profiles for COVID-19 vaccines regarding psychiatric adverse events. Continuous monitoring of anxiety/nervousness or sleep disorders after COVID-19 vaccination is required regardless of history of psychiatric comorbidities.

Background: Social function is increasingly demonstrated as a factor in risk, maintenance and outcome of eating disorders, but not emphasised in theoretical models of, and treatment approaches to, adolescent eating disorders.

Aims: To adapt Schmidt and Treasure's cognitive interpersonal model of anorexia nervosa to incorporate developmental and transdiagnostic components.

Method: Qualitative interviews with young people aged 12-16 years (inclusive), who are in contact with child and adolescent community eating disorders services, and their parents, subjected to thematic analysis.

Results: Five key themes emerged that were mutually dependent on a sixth theme of emotion regulation and coping. These themes were: peer relationships, change and uncertainty, thinking styles, appearance and achievement-based values, and family relationships.

Conclusions: Peer relationships emerged as distinct from family relationships in this population, and a unifying theme was emotion regulation and coping. The framework could guide clinical assessment and the development or adaptation of interventions to address the themes identified. Research is needed to understand the role of the themes in treatment response and outcomes.

Background: The high comorbidity of substance use disorders (SUDs) among people with severe mental health conditions (MHCs) poses major challenges to providing effective care, particularly in low- and middle-income countries (LMICs), where treatment options are limited.

Aims: The aim of this scoping review was to produce an overview of the current evidence on psychosocial interventions for people with comorbid MHCs and SUDs in LMICs.

Method: The following databases were searched from their inception to 23 July 2024: PubMed/Medline, Global Health, Embase, PsycINFO and Global Index Medicus. We also searched for grey literature, using Google Scholar, ProQuest and Clinicaltrials.gov. Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Studies were eligible if they focused on any psychosocial intervention targeting substance use in people with severe MHCs from LMICs. Of the 6304 records screened by titles and abstracts, 138 full-text articles were assessed and included for data extraction.

Results: Of the 6304 records screened by titles and abstracts, 138 full-text articles were assessed and 13 articles were included for data extraction. Many of the studies (n = 9) had a quasi-experimental design, and were from Latin America and South Asia. Four studies were randomised controlled trials. The primary outcomes examined were substance use abstinence, treatment engagement and retention, reduction in psychiatric symptoms, functioning and suicidal behaviours. Despite some heterogeneity in study designs, target populations and evaluated outcomes, interventions including various tobacco cessation programmes, screening and brief intervention with family support, and community-based programmes, have demonstrated positive outcomes in reducing tobacco, alcohol and khat use, respectively.

Conclusions: The review shows that there have been few initiatives to design and test psychosocial interventions for individuals with comorbid severe MHCs and SUDs in LMICs. There is a clear need to design and test feasible, acceptable, and effective interventions to address both severe MHCs and substance use when they co-occur.

Legal epidemiology is an emerging field that examines how laws and policies influence human rights and health outcomes, particularly in areas such as in-patient psychiatric treatment, community treatment orders and child maltreatment, This editorial highlights contributions from BJPsych Open that apply legal epidemiological methods to assess issues relevant to child maltreatment and coercion in psychiatric care. Findings emphasise the need for early intervention, standardised evaluation measures and reforms that prioritise human rights and well-being. Legal epidemiology can offer a scientific basis for improving legal frameworks, as well as promoting equitable and effective mental healthcare.

Background: Patients with psychiatric disorders are more likely to experience financial difficulties. Yet, there is limited knowledge about the longitudinal relationship between psychopathology in adolescence and debts or experienced financial scarcity in emerging adulthood.

Aims: We aimed to examine whether distinct types of psychological symptoms in mid-adolescence precede the occurrence of unsecured debts and experienced financial scarcity in emerging adulthood.

Method: Data from a Dutch adolescent cohort (N = 659, 53.9% female) oversampled on the risk of psychopathology was used. Psychological symptoms were self-reported at baseline (mean age 14.80 years, s.d. = 0.79), using the Youth Self-Report and the Prodromal Questionnaire-16. At follow-up (mean age 17.95 years, s.d. = 0.80), adolescents reported presence of unsecured debts and completed the Psychological Inventory of Financial Scarcity. Logistic and linear regression analyses were applied, adjusting for the baseline characteristics of sex, age, ethnic background, parental psychopathology and household income as an indicator of family socioeconomic status.

Results: More attention-deficit/hyperactivity problems (adjusted odds ratio 1.15, 95 CI% 1.04-1.27), oppositional defiant problems (adjusted odds ratio 1.17, 95 CI% 1.00-1.35) and psychotic experiences (adjusted odds ratio 1.10, 95 CI% 1.01-1.21) at age 15 years were associated with unsecured debts at age 18 years. Depressive, anxiety, somatic and conduct problems were not associated with later unsecured debts. Depressive, anxiety, attention-deficit/hyperactivity, oppositional defiant, conduct problems and psychotic experiences at age 15 years were associated with increased experienced financial scarcity at age 18 years.

Conclusions: Psychological symptoms during mid-adolescence precede both objective and subjective financial difficulties when entering adulthood. Integrating financial education into prevention efforts could potentially provide significant long-term benefits, particularly for those with mental health problems.

Background: Peer-supported Open Dialogue (POD) integrates peer practitioners within mental health teams, fostering a collaborative, person-centred and social network approach to care. Although peer practitioners are increasingly involved in Open Dialogue, the role of peer practitioners within such teams remains underexplored.

Aims: This study aimed to explore (a) the experiences of peer practitioners working within Open Dialogue teams in the Open Dialogue: Development and Evaluation of a Social Intervention for Severe Mental Illness trial, and (b) the perspectives of non-peer Open Dialogue practitioners regarding peer involvement. Our further objectives were to understand the nature, degree and perceived impact of peer practitioner involvement in Open Dialogue.

Method: A qualitative study was conducted using semi-structured interviews and joint interviews with peer practitioners (n = 9). Additionally, excerpts from 11 interviews and 4 focus groups (n = 18), in which non-peer practitioners discussed peer practitioners' contributions in Open Dialogue, were analysed. Thematic analysis was employed to identify key themes.

Results: Three themes were developed. The first focuses on the perceived influence of peer practitioners on Open Dialogue network meetings; the second explores the opportunities and challenges of working as a peer practitioner in Open Dialogue, while the third details the perceived impact of peer practitioners on team and organisational culture.

Conclusions: Open Dialogue's emphasis on a flattened hierarchy facilitates the integration of peer practitioners, enabling them to contribute meaningfully to network meetings and team culture. Despite the overall positive experiences, peers still faced common challenges faced by those in other services, such as low pay and occasional instances of a compromised, flattened hierarchy.

Background: The association between serum tumor necrosis factor-alpha (sTNF-α) levels and antidepressant treatment responses remains controversial.

Aims: This study aimed to examine the impact of sTNF-α levels on 12-week antidepressant treatment outcomes, and to explore the moderating effects of functional status on this relationship in patients with depressive disorders.

Method: We measured baseline sTNF-α and evaluated functional status with the Social and Occupational Functioning Assessment Scale (SOFAS) in 1086 patients undergoing stepwise antidepressant treatment. Remission, defined as a score of ≤7 on the Hamilton Rating Scale for Depression, was assessed at 12 weeks. Logistic regression analyses were performed to adjust for relevant covariates.

Results: Higher sTNF-α levels were significantly associated with non-remission at 12 weeks. This association was particularly evident among patients with higher SOFAS scores, whereas no significant association was observed in patients with lower SOFAS scores. The interaction between sTNF-α levels and SOFAS scores remained significant even after adjusting for relevant covariates.

Conclusions: Baseline sTNF-α levels may serve as a useful predictor of 12-week antidepressant treatment outcomes. Incorporating functional status into the predictive model enhances the accuracy of treatment response predictions.

Background: To better meet the growing demand and complexity of clinical need, there is a broad international trend towards greater integration of various elements of health- and social care. However, there has been a lack of research aimed at understanding how healthcare providers have experienced these changes, including facilitators and inhibitors of integration.

Aims: This study set out to generate new understandings of this from three UK staffing 'levels': 'micro' frontline workers, a 'meso' level of those leading a healthcare organisation and a 'macro' level of commissioners.

Method: Using Rogers' Diffusion of Innovation framework, qualitative analysis of individual interviews from provider staff perceptions was undertaken at these three levels (total N = 33) in London.

Results: English legislation and policy captured the need for change, but fail to describe problems or concerns of staff. There is little guidance that might facilitate learning. Staff identity, effective leadership and culture were considered critical in implementing effective integration, yet are often forgotten or ignored, compounded by an overall lack of organisational communication and learning. Cultural gains from integration with social care have largely been overlooked, but show promising opportunities in enhancing care delivery and experience.

Conclusions: Findings are mixed insofar as staff generally support the drivers for greater integration, but their concerns, and means for measuring change, have largely been ignored, limiting learning and optimisation of implementation. There is a need to emphasise the importance of culture and leadership in integrated care, and the benefits from closer working with social care.

Background: Epilepsy is frequently accompanied by psychiatric symptoms, including mood disturbances such as depression, irritability and euphoria. Interictal dysphoric disorder (IDD), characterised by depressive and affective symptoms, is typically managed with psychiatric treatment. However, persistent symptoms, despite adequate psychiatric intervention, may indicate an underlying epileptogenic mechanism.

Aims: To highlight the importance of recognising epileptogenic contributions to persistent psychiatric symptoms, even in patients with apparently well-controlled epilepsy.

Method: We present a case report of a Japanese woman in her 40s with well-controlled epilepsy; however, she developed enduring psychiatric symptoms. Clinical features, psychiatric treatments, neurological evaluation and therapeutic outcomes are described.

Results: The patient experienced anxiety, depression, irritability and fear, leading to an initial diagnosis of IDD. Treatment with escitalopram and olanzapine achieved only partial symptom relief. Residual symptoms prompted further investigation, which revealed symptoms suggestive of temporal lobe epilepsy auras. Adjustment of anti-seizure therapy with lacosamide resulted in complete resolution of psychiatric symptoms, marked functional recovery and a reduction in her Hamilton Depression Rating Scale (HAMD-17) score improved from 23 to 6.

Conclusions: This case highlights that even in apparently well-controlled epilepsy persistent psychiatric symptoms may indicate an underlying epileptogenic mechanism rather than a primary psychiatric disorder. Careful evaluation and appropriate optimisation of anti-seizure medication can yield substantial psychiatric and functional improvements, underscoring the importance of multidisciplinary assessment in such presentations.

Aims: Stress could increase delay discounting in subjects with bulimia nervosa and alcohol use disorder (AUD), meaning that the short-term benefits of coping through eating or drinking outweigh the long-term negative consequences. Therefore, this study explores differences in delay discounting between patients and healthy controls, the impact of stress on food and alcohol delay discounting and associated changes in brain activity.

Method: A total of 102 female participants (AUD, 27; bulimia nervosa, 25; healthy controls, 50) underwent repeated functional magnetic resonance imaging scanning. Initially, all participants performed a monetary delay discounting task (DDT), followed by a food or alcohol DDT before and after stress induction. Specifically, those with bulimia nervosa completed a food DDT, those with AUD completed an alcohol DDT and healthy controls were randomly allocated to one or either DDT.

Results: Participants with AUD, but not healthy controls, displayed a higher discounting of alcohol after stress. Healthy controls, but not those with bulimia nervosa, had nominally higher discounting rates of food following stress, although not significant following multiple testing correction. Participants with AUD displayed a lower activity of the right supplementary motor area while discounting alcohol after stress. Healthy controls showed a lower activity of the frontal cortex and a higher activity of the motor cortex while discounting food after stress, while those with bulimia nervosa displayed a higher activity of the occipital cortex.

Conclusions: The results suggest that, in subjects with AUD, stress induces neurobiological changes that cause them to prefer more immediately available alcohol. However, the results observed in participants with bulimia nervosa suggest a more complex relation between stress and food.