BJPsych Open最新文献

Background: Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) may coexist in children and adolescents and present with several overlapping features.

Aims: We aimed to assess the prevalence of ASD traits and diagnosis in children and adolescents with OCD, explore the correlation between OCD severity and ASD traits/diagnosis, and examine the impact of ASD traits/diagnosis on global functioning in this population.

Method: Electronic searches were carried out on Pubmed, Embase and PsycINFO, using selected keywords and specified inclusion and exclusion criteria. Meta-analysis was performed with R Version 4.3.1.

Results: Of 1410 studies initially identified, 29 reported on the prevalence of ASD traits or diagnosis. Pooled mean prevalence rate was 8.0% (95% CI 5.0-13%). ASD questionnaire scores were higher in OCD versus control groups (standardised mean difference: 1.23; 95% CI 0.76-1.69). There was limited significant correlation between ASD questionnaire scores and OCD questionnaire scores, and no significant differences in these scores were demonstrated between OCD samples and samples diagnosed with comorbid OCD and ASD (mean difference -0.41; 95% CI -1.23 to 0.40). Functional impairment appeared elevated with ASD traits/diagnosis in OCD, but meta-analysis feasibility was limited.

Conclusions: This review indicates higher ASD traits and diagnosis in children and adolescents with OCD compared with the general population. Limited data and methodological constraints in trials limit generalisability, warranting further research.

Background: Trauma, a psychological phenomenon, can contribute to several mental health disorders such as acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). Understanding the impacts of childhood adversities on mental disorders is essential, since early trauma can profoundly shape an individual's reaction to subsequent trauma.

Aims: To study the association between childhood adversities and full-threshold and subthreshold PTSD onset, either directly or through the intermediary role of ASD.

Method: Data were collected longitudinally from healthcare workers aged 18 years and above, working at Saint George Hospital University Medical Center, at three distinct time points: 9-15 days (wave 1), 21-27 days (wave 2) and 6-7 months (wave 3) following the Beirut port blast on 4 August 2020.Childhood adversities, encompassing physical, emotional and sexual abuse, were collected. ASD and PTSD were assessed, respectively, using the Acute Stress Disorder Scale and the PTSD Checklist for DSM-5. Odds ratios, both unadjusted and adjusted, with 95% confidence intervals, were calculated to study the associations.

Results: Emotional abuse was found to be a significant predictor of ASD at wave 2 (21-27 days), and both full-threshold and subthreshold PTSD at wave 3 (6-7 months) post-blast. Individuals with negative ASD status at waves 1 and 2 who experienced emotional abuse in childhood showed approximately double the rates of subthreshold PTSD.

Conclusions: Childhood emotional abuse was a strong predictor of both ASD and PTSD. Screening for past childhood adversities is important, even in individuals without ASD, as they remain more vulnerable to later PTSD.

Background: Compared with well-studied internal adaptive systems, there remains a lack of comprehensive exploration of external correlated factors of resilience, as well as the way in which each ingredient of resilience is influenced.

Aims: This study aims to explore the dimensional associations among resilience and several factors, including parenting rearing style, childhood trauma and negative life events.

Method: A series of social demographic variables, parental rearing patterns, childhood trauma, negative life events and resilience were assessed. Multiple linear regression analysis was used to explore correlated factors of resilience, with all the above factors included in the model. Network analysis was conducted to identify the central factor and key associations, and to visualise complex interactions among resilience, parenting rearing style, childhood trauma and negative life events.

Results: This cross-sectional study was conducted among 4302 freshmen (2388 females, 55.5%; mean 18.59; s.d. = 0.95) from three colleges between October and December 2020. Three key associations were discovered: 'learning pressure and emotional control' (r = -0.195, P < 0.05), 'emotional neglect and family support' (r = -0.129, P < 0.05) and 'maternal care family support' (r = 0.193, P < 0.05). 'Emotional abuse' (bridge expected influence, -0.588) was the core node of the estimated network.

Conclusions: This study found that learning pressure, emotional neglect and maternal care emerged as the most critical external correlates of resilience. Emotional abuse occupies the most central position in the external correlated network of resilience. Future longitudinal research should clarify the temporal impacts of these associations, and the key factors, in the dynamic resilience system.

Background: People who gamble experience elevated rates of suicidal thoughts and behaviours. Longitudinal studies have been scarce, and none has focused on those who regularly gamble in the UK.

Aims: To examine the relationship between specific products and locations of gambling activity (and their combinations) and risk of subsequent suicidal thoughts.

Method: We analysed a UK longitudinal survey of 3927 adults (18 years old or over) who regularly bet on sports. Data were collected online between June and November 2020. Latent class analysis was used to identify groups of people with similar gambling profiles on the basis of 13 types of gambling activity. Weighted group characteristics are presented. Regression modelling was used to test associations between gambling groups and suicidal thoughts, adjusting for baseline characteristics.

Results: Five distinct groups were identified. One group (5.6% of the sample) reported multiple types of both in-person and online gambling. This group was the most likely to use electronic gambling machines. After adjustment for baseline suicidal thoughts, this group had significantly higher odds of subsequent suicidal thoughts (adjusted odds ratio 3.42; 95% CI: 1.18-9.89) than other groups.

Conclusions: Although many profiles of gambling activity present suicide risk, some types present greater risk. National Institute for Health and Care Excellence guidelines recommend enquiry in primary care settings about gambling behaviours. Our findings suggest that clinicians should consider asking questions on mode (online or in-person) and product (especially electronic gambling machines) to identify those at heightened risk of suicidal ideation. Gambling should also be considered routinely in psychosocial assessments across clinical settings and incorporated into suicide prevention campaigns.

Background: Electroconvulsive therapy (ECT) is highly effective for major depressive disorder (MDD), but about 50% of patients relapse within 1 year. A comprehensive review of all potential relapse-prevention strategies is lacking.

Aims: This systematic review aimed to identify, summarise and critically evaluate the available evidence on pharmacological, neuromodulatory, psychological and combination strategies to prevent relapse following successful ECT for MDD.

Method: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO: no. CRD42023392575). We searched PubMed, Embase, PsychInfo and Cochrane Library up to March 2025. Eligible studies included adults (>18 years) with unipolar MDD who responded to acute ECT and were followed for ≥3 months. We included randomised controlled trials (RCTs), cohort studies and case series (over ten cases). Risk of bias and quality were assessed and a narrative synthesis conducted.

Results: A total of 28 studies (N = 11 119) were included. Lithium (alone or with antidepressants) was most consistently associated with reduced relapse in 10 studies. Continuation ECT (C-ECT), particularly when combined with pharmacotherapy, also reduced relapse in several RCTs. Evidence for psychotherapy (e.g. cognitive-behavioural therapy) is limited (two studies), warranting further studies. No studies on repetitive transcranial magnetic stimulation or ketamine were found. Study quality varied, with some being underpowered or having used inconsistent definitions of relapse.

Conclusions: Pharmacotherapy with lithium and, separately, C-ECT combined with medication, showed the strongest evidence for relapse prevention following ECT. The evidence base is limited by heterogeneity, small sample sizes and few studies on novel or psychological strategies. More robust clinical studies are needed to identify optimal long-term strategies.

Background: Understanding the neuroanatomical correlates of treatment response in schizophrenia is crucial for improving clinical stratification and clarifying underlying pathophysiological mechanisms.

Aims: To examine subcortical volumetric differences across clinically defined schizophrenia treatment-response subgroups.

Method: T1-weighted structural magnetic resonance imaging data were analysed from 109 participants, including 79 individuals with schizophrenia and 30 healthy controls. Patients were categorised into three distinct treatment response groups: ultra-treatment-resistant (UTR; n = 22), clozapine-responsive (n = 28) and first-line antipsychotic responsive (FLR; n = 29). Group differences were examined across 33 regions of interest, including subcortical, ventricular and hippocampal subfield regions.

Results: The UTR group had higher antipsychotic dosages and exhibited greater symptom severity than other patient groups. Across all schizophrenia subgroups, hippocampal and amygdala volumes were smaller relative to controls. Treatment-resistant patients (UTR and clozapine-responsive) also showed reduced nucleus accumbens volumes, whereas FLR patients demonstrated larger pallidal volumes. In addition, the UTR subgroup exhibited enlarged lateral ventricles. Hippocampal subfield analyses revealed widespread reductions in treatment-resistant patients, most prominently in the CA4/dentate gyrus, subiculum and stratum, whereas FLR patients showed more focal reductions in the CA4/dentate gyrus and left subiculum.

Conclusions: These results suggest that smaller hippocampal and amygdala volumes represent a shared neuroanatomical signature of schizophrenia, whereas reduced accumbens and enlarged pallidal volumes may differentiate treatment-resistant and treatment-responsive profiles, respectively. The findings underscore the heterogeneity of schizophrenia and highlight the need for longitudinal research to disentangle illness-related pathology from medication effects.

Emetophobia is a specific fear of vomiting. Although it is a relatively unknown anxiety disorder that has received limited attention in research, many psychotherapists are familiar with it because they frequently encounter persons with emetophobia in clinical practice. While animal-related phobias are the most common specific phobias in general, a recent study by Veale and colleagues (2025) suggests that, among persons seeking treatment for specific phobias, emetophobia appears to be the most prevalent. Furthermore, the study indicates that persons with emetophobia differ from those with other specific phobias (e.g. in terms of gender ratio or treatment setting). These findings dovetail with results from other recent studies suggesting that emetophobia may be a more impairing disorder and is, therefore, more likely to require treatment than other specific phobias.

Background: Many studies have observed a link between mortality and mental illness, although the contribution of violence exposure to mortality in people with mental illness remains under-researched.

Aims: To examine the association of violence exposure, such as being physically assaulted, with general and cause-specific mortality in a population using mental health services.

Method: We assembled a cohort study using electronic health records from a mental health and substance use treatment provider in south-east London. Records were linked to acute medical admission and emergency department presentation data, as well as to a national mortality register with death certificates for deaths registered in England and Wales. Cox regressions estimated the associations of binary and cumulative violence exposure, as indicated by assault admission and presentation to emergency departments for violence-related reasons. Mortality was adjusted for sociodemographic and clinical potential confounders.

Results: The hazard ratio for assault admission with all-cause mortality was 2.14 (95% CI: 1.93-2.36) following covariate adjustment. Adjusted associations were also found with mortality from the following causes: internal (natural) (hazard ratio 1.72, 95% CI: 1.50-1.98), external (hazard ratio 1.94, 95% CI: 1.51-2.48), suicide (hazard ratio 2.20, 95% CI: 1.38-3.52), respiratory (hazard ratio 2.01, 95% CI: 1.41-2.85), circulatory (hazard ratio 1.71, 95% CI: 1.27-2.28), diabetes-related (hazard ratio 2.86, 95% CI: 1.20-6.86) and alcohol-related (hazard ratio 1.56, 95% CI: 1.10-2.22). Results for cumulative assault were consistent with these in both direction and magnitude. There was evidence for an association of weapon-related assault admission with all-cause mortality (hazard ratio 1.58, 95% CI: 1.14-2.18).

Conclusions: People with mental illness, who are exposed to assault, experience greater mortality than those who are not exposed. Excess mortality attributable to violence exposure in people with mental illness was related to deaths from natural and external causes.

Background: Mental health literacy (MHL) is the ability to recognise mental disorders; have knowledge of professional help available, effective self-help and prevention strategies; and have the skills to support others. MHL is linked to better help-seeking behaviours and better management of mental illness. Mental illness prevalence is increasing in Malawi. Assessing MHL in communities crucially helps identify knowledge gaps, informing the development of evidence-based interventions.

Aims: This study assessed the MHL levels of young adults (16-30 years old) in rural and urban communities in Malawi.

Method: A cross-sectional national survey was administered to 682 people across 13 districts in Malawi, using a self-reporting Mental Health Literacy questionnaire (MHLq) that assessed knowledge of mental health problems, erroneous beliefs/stereotypes, first aid skills, help-seeking behaviour and self-help strategies.

Results: Most respondents were either unemployed (36%) or enrolled in school (43%). A total of 73% completed primary or secondary education, and 48% knew someone with a mental illness, but only 14% of this group could specify the illness. The mean MHL score was 111.8 (s.d. 13.9). Individuals with primary and secondary school qualifications had significantly lower scores in factor 2 (erroneous beliefs/stereotypes) and factor 3 (first aid skills and assistance-seeking behaviour) of the MHLq than those with higher education.

Conclusions: This research highlights persisting mental health misconceptions, limited knowledge about specific mental illnesses and low help-seeking behaviour among young adult Malawians. Higher education is linked to a better understanding of mental health. Prioritising community education on causes, signs, treatments and prognosis of mental illness is crucial for increased MHL.

Background: The new psychosocial goal-setting and manualised support intervention for independence in dementia (NIDUS-Family) is a manualised dementia care intervention.

Aims: To evaluate whether goal-setting plus NIDUS-Family is more effective than the control condition (goal-setting and routine care) in supporting dyads' (family carers and care recipients with dementia) attainment of personalised goals; and to determine participant-perceived goal relevance over 24 months.

Method: We randomised dyads from community settings (2:1): to NIDUS-Family, a manualised psychological intervention tailored to goals that dyads set by selecting modules, delivered in 6-8 video call/telephone sessions over 6 months then 2-3 follow-ups monthly for 6 months; or to control. Outcomes were goal attainment scaling (GAS) (primary) at 18 and 24 months, functioning, quality of life, time until care home admission or death, carer anxiety and depression. Primary analysis, a mixed-effects model, accounted for randomisation group, study site, time, intervention arm facilitator and repeated measurements.

Results: In the period 2020-2021, 204 participants were randomised to intervention and 98 to control; 164 (54.3%) and 141 (46.7%) dyads completed 18- and 24-month outcomes, respectively.In the primary analysis, including 277 participants contributing 6-, 12-, 18- or 24-month outcomes, adjusted GAS mean differences (intervention-control) at 18 and 24 months were 11.78 (95% CI 6.64, 16.93) and 8.67 (95% CI 3.31, 14.02), respectively. Secondary outcome comparisons were not significant. The hazard ratio for dying or care home admission was 0.80 (95% CI 0.45, 1.42; intervention versus control), and 0.87 (95% CI 0.41, 1.82) and 0.59 (95% CI 0.26, 1.33) for death and care home admission, respectively. Among baseline GAS goals, carers considered 436 (78.0%) relevant at 18 months and 383 (78.5%) at 24 months.

Conclusions: NIDUS-Family improved attainment of GAS goals over 2 years.

Trial registration number: ISRCTN11425138.