BJPsych Open最新文献

Background: Depression screening in primary care has been widely discussed, but its economic implications have remained largely unexplored. The GET.FEEDBACK.GP randomised controlled trial evaluated feedback interventions after depression screening in primary care. The study arms were (a) feedback provided to the general practitioner; (b) feedback to both the patient and the treating general practitioner; and (c) a control group without feedback. Analysis of clinical effectiveness revealed that feedback interventions were not associated with decreased depression severity. Their economic implications were the subject of this study.

Aims: To evaluate the economic impact of general-practitioner- and patient-targeted feedback following depression screening for adults in German primary care.

Method: A cost-effectiveness analysis from a societal perspective of feedback interventions after depression screening with a time horizon of 12 months was conducted. Direct and indirect costs were estimated. Quality-adjusted life years were calculated on the basis of the EQ-5D-5L, and incremental cost-effectiveness ratios and cost-effectiveness acceptability curves based on the net monetary benefit were constructed. Sensitivity analyses and post hoc explorative subpopulation analyses were performed. Trial registration: ClinicalTrials.gov, NCT03988985.

Results: In total, 987 participants who screened positive for at least moderate depression were included. Feedback provision was not significantly associated with changes in costs or quality-adjusted life years during follow-up. Cost-effectiveness probabilities of feedback interventions were lower than 50% compared with no feedback. Higher cost-effectiveness probabilities were observed in patients whose suspected depression was confirmed 1 month post-screening and in those with previous depression.

Conclusions: The analysed feedback interventions cannot be considered to be cost-effective for the investigated population. Patient-targeted feedback was potentially cost-effective for subpopulations, particularly patients with a later confirmed depression diagnosis; this requires further research.

Background: By 2021, we found that 88 Recovery Colleges were operating in England. Recovery Colleges adhere to shared principles including adult education and co-production, but are also heterogeneous, varying in the populations they serve, their sources of funding and access to resources. Previous research has not explored the organisational factors that influence the set-up of Recovery Colleges, nor the factors which facilitate or pose challenges to their sustainable operation.

Aims: To identify how Recovery Colleges vary in their operation and to ascertain how organisational factors facilitate or hinder the set-up, running and sustainability of English Recovery Colleges.

Method: Semi-structured interviews with 31 Recovery College managers across England were analysed using framework analysis.

Results: Four themes were identified: Recovery College pioneers; Adapting to the local context; Degree of autonomy within the National Health Service; and Ongoing organisational work. Colleges were commonly established by key individuals from diverse backgrounds, leveraging their organisational positions and lived experience to facilitate implementation. Colleges were adapted to fit local contexts, shaped by factors including existing services, regional demographics and community resources. Colleges varied in their relations with key funders, with some operating comparatively autonomously and others tied closely to their 'parent' organisations. Sustaining college operations involved ongoing organisational work to respond to changing pressures.

Conclusions: Recovery Colleges exhibit consistent values and aims oriented around supporting recovery through education and co-production but are diverse in their operation. These colleges are highly complex interventions, and their sustainability requires organisational agility to manage competing pressures.

Background: The mental healthcare workforce supporting people with dementia and comorbid mental disorders requires specific skills and knowledge.

Aims: We co-designed and conducted a survey to understand key issues facing community mental healthcare services accessed by older adults.

Method: We invited all English National Health Service (NHS) older people's community mental health teams (OPCMHTs) in England to complete the survey. We compared service structures, resourcing and waiting times between regions, and considered how responses might inform current policy priorities.

Results: A total of 182 out of 242 (75.2%) English NHS OPCMHTs participated. We estimated there were 120 233 referrals to OPCMHT services per year, with 77.5% of services reporting increasing referral rates. In a quarter of services (n = 46, 25.3%), clients waited over a month from referral to initial assessment. Most services (107/181, 59.1%) experienced difficulties accessing in-patient beds for people with dementia, with rural regions more likely to report these difficulties. Half of the services (n = 100, 55.2%) reported providing higher-quality care for people with dementia than 5 years ago, despite increasing caseload complexity. Resource limitations challenged opportunities for prevention, care quality and collaborative working, and respondents rated team relationships with social services (n = 86, 47.8%), general hospital in-patient (n = 74, 41.4%) and out-patient (n = 54, 30.2%) services, and primary care (n = 54, 30.2%) as poor or requiring improvement.

Conclusions: OPCMHT service leads are committed to integrated working, but services are insufficiently resourced to realise their potential. Addressing challenges related to workforce retention, training and ways of working could optimise OPCMHT contributions to integrated care for people with dementia.

Background: Treatment-resistant depression (TRD) poses a significant clinical challenge, with limited evidence guiding long-term pharmacological strategies. Esketamine, a glutamatergic modulator, has demonstrated short-term efficacy in TRD, but data on its extended use in real-world settings remains scarce.

Aims: This study aimed to evaluate the long-term effectiveness and side-effects of intranasal esketamine in adults with TRD over more than 100 treatment sessions.

Method: We conducted a retrospective, single-arm, pre-post study of 20 patients with TRD at a psychiatric out-patient clinic in the United Arab Emirates. All participants received ≥100 sessions of intranasal esketamine alongside oral antidepressants. Depression and anxiety symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) scales. Side-effects were monitored through blood pressure, sedation, dissociation, urinary symptoms and psychiatric symptoms.

Results: After an average of 129 esketamine sessions (mean duration 2.5 years), PHQ-9 and GAD-7 scores significantly decreased (P < 0.001). A total of 85% of patients improved in depressive severity, with 25% achieving remission; 65% improved in anxiety severity, and 20% reached remission. Esketamine was generally well tolerated; side-effects were mild and transient, with no serious adverse events. However, urinary symptoms suggestive of cystitis occurred in 20% of patients, highlighting the need for ongoing monitoring in long-term treatment.

Conclusions: Intranasal esketamine demonstrated sustained effectiveness and an acceptable side-effect profile in a real-world TRD cohort with extensive psychiatric comorbidity. These findings support its long-term use in complex clinical populations, and underscore the need for further prospective, multi-site studies.

Background: Forensic mental health services need a reliable and repeatable outcome measure to assess the progression of self-rated recovery during the forensic journey. The Questionnaire about the Process of Recovery (QPR) was developed in individuals with psychosis, and has been used to assess recovery in people with severe mental illness; however, its psychometric properties have not been studied in a forensic psychiatric cohort.

Aims: This study aimed to assess the psychometric properties of the QPR in a sample of individuals who currently access, or formerly accessed, high-security psychiatric care, including internal consistency, test-retest reliability, factor structure and criterion validity.

Method: Psychometric analysis was undertaken in a sample of 146 current or former high-security patients. Confirmatory and exploratory factor analysis examined the latent test structure. Non-parametric comparisons of QPR score indices tested for differences according to individuals' current setting (high-, medium- or low-security or open wards; community) as evidence of criterion validity.

Results: A unique two-factor structure related to self-actualisation/empowerment and growth/insight fit forensic patients' QPR responses. Internal consistency and test-retest reliability were adequate for QPR all-item scores for the original and shortened scales, as well as for the new forensic factor scores. QPR score indices differentiated patients by current setting (eta² = 0.03-0.04), although only the forensic factor related to growth/insight was significant in corrected post hoc comparisons.

Conclusions: The original QPR is recommended for use to assess recovery progress in a forensic psychiatric sample. Forensic patients' scores may be best represented using the unique two-factor structure identified.

Background: In England, 354 000 people were homeless on a given night in 2024. It has long been recognised that the physical and mental health of people who are homeless is poorer than for those who are stably housed. There are few peer-reviewed studies to inform health- and social care around depression or anxiety for people who are homeless in this setting.

Aims: To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe the distribution of symptoms across sociodemographic, health-related characteristics and indicators of social vulnerability.

Method: We surveyed 311 adults between August and December 2021. We measured anxiety and depression symptoms using the four-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of sociodemographic, social vulnerability and health-related characteristics, and tested for associations with the Kruskal-Wallis test.

Results: The median PHQ-4 score was 7 out of 12, with 38% having scores warranting clinical attention. While PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and marijuana use. The most common barrier to accessing healthcare related to transportation (60%).

Conclusions: People who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support further coordination between health- and social care sectors.

The emerging evidence for cannabis in the management of tics in Tourette syndrome has come almost exclusively from studies in adult patients. We now have two published feasibility studies of cannabis for adolescents with Tourette syndrome. Although both readily recruited adolescent participants, there was no explicit requirement for prior trials with standard evidence-based treatments. This is of concern given the known harms of regular cannabis use in adolescents, especially the association with psychosis. Investigating cannabis as an option for tics in adolescents with Tourette syndrome is worthwhile, but a high degree of caution is warranted.

Background: People diagnosed with schizophrenia can have functional impairments in multiple domains. Cognitive impairment is central to schizophrenia and has substantial prognostic value compared with other symptoms of schizophrenia. However, no study has previously investigated directed relationships in a complex system of cognitive, sociodemographic, clinical and quality of life (QOL) variables in people diagnosed with schizophrenia.

Aims: To identify the complex relationships of components of cognition with other cognitive components, as well as with clinical and QOL variables.

Method: This study included data from 1450 participants in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The present study reconstructed a Bayesian network from this data using cognition, clinical, sociodemographic and QOL variables.

Results: Processing speed was centrally associated with all other cognitive domains. Cognitive domains were conditionally independent of positive symptoms but moderately associated with negative symptoms (β = -0.25; P < 0.001). The positive symptoms subscale was independent of QOL, conditioning on third variables. Negative symptoms were moderately associated with QOL (β = -0.33; P < 0.001), and processing speed had a weak association with QOL (β = -0.12; P < 0.001). Processing speed was a central variable in the network.

Conclusions: Intervening with respect to processing speed may be the most beneficial way of improving other cognitive functions. More research is needed on directed networks that include social cognition and global levels of functioning.

Background: Effective implementation of novel digital technologies to improve health outcomes requires an in-depth understanding of end-users' perspectives and experiences.

Aims: We sought the perspectives of people with schizophrenia and schizophrenia-related disorders (SSD) on the acceptability of a novel short text message-delivered intervention targeting metabolic health, called Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART).

Method: Twenty-nine participants with SSD and either at risk of type 2 diabetes (T2D) or with T2D, were recruited from 3 mental health sites in Brisbane, Australia. They were provided, for 12 weeks, with SMART text messages that embedded psychoeducation and behaviour change techniques to facilitate lifestyle behaviours crucial for metabolic health. Interviews explored participants' experiences of SMART, barriers to its use and suggestions for improvement. The qualitative data were collected by three mental health researchers and analysed using thematic analysis.

Results: Three themes were generated: acceptability and user experience, feasibility and implementation considerations, and mechanisms supporting change. SMART was found to be highly accessible and engaging, and participants reported positive lifestyle changes, including healthier eating, increased physical activity, weight loss and smoking cessation. The messages reinforced learning and supported participants' readiness for change.

Conclusions: SMART is a world-first digital intervention aimed at improving metabolic health and diabetes self-management in individuals with SSD. High levels of acceptability of SMART highlight its strong potential as a digital innovation that can support its users in protecting their metabolic health while limiting the detrimental side effects of antipsychotic medications.

Catatonia can be associated with a diverse range of conditions, including autoimmune encephalitis. Although rare, autoimmune encephalitis accounts for a significant proportion of catatonia cases with autoimmune aetiologies. In instances where autoimmune mechanisms are suspected, autoantibody testing is a key component of the diagnostic evaluation. However, test results should always be interpreted in conjunction with clinical findings. This article highlights the diagnostic challenges involved, advocating for structured diagnostic algorithms and timely initiation of immune therapy in carefully selected cases - particularly when antibody confirmation is absent. It revisits the paper, 'Retrospective chart review of cases with steroid-responsive catatonia: exploring a potential autoimmune etiology'.