BJPsych Open最新文献

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.

Background: Crime has significant impact on older victims. High rates of anxiety and depression may be associated with crimes.

Aims: This paper aims to evaluate the cost-effectiveness of a victim improvement package (VIP) for the reduction of continued symptoms of depression or anxiety in older victims of community crime, from the societal perspective, in a three-step, parallel-group, single-blind randomised controlled trial.

Method: Participants (N = 131) were randomised to receive either the VIP intervention in addition to treatment as usual (TAU) (n = 65), or to TAU alone (n = 66). Service resource use was collected using the Client Service Receipt Inventory and health-related quality-of-life data via the EQ-5D-5L instrument at 3 months post-crime (baseline), 6 months post-crime (post-intervention) and 9 months post-crime (follow-up).

Results: The mean cost of the VIP intervention was estimated at £1330 per participant in the intervention arm. The mean difference in costs between the VIP and TAU arms over the 6-month trial duration was -£881 (95% CI: -£5947 to £4186). The mean difference in quality-adjusted life-years (QALYs) was -0.011 (95% CI: -0.042 to 0.020).

Conclusions: The addition of VIP to TAU for older victims of community crime generated a lower mean point estimate for costs, and failed to improve quality of life compared with TAU alone. While this places VIP in the south-west quadrant of the cost-effectiveness plane, the magnitude and significance of the QALY difference do not justify declaring VIP cost-effective or TAU not cost-effective. Future research is needed to identify the most cost-effective intervention.

Background: Students, due to their specific academic and psychosocial conditions, are at higher risk of suicide compared with the general population, and suicide is one of the leading causes of death among students worldwide.

Aims: To investigate the prevalence of suicidal ideation and suicide attempts among Iranian university students.

Method: A systematic search was conducted in international and national databases, including Scopus, Web of Science, PsycINFO, PubMed and Magiran, up to February 2025. Title and abstract screening was performed by a single reviewer. Two reviewers independently undertook full-text screening (study selection) and data extraction. Data were analysed using Stata 16. The heterogeneity of studies was tested with Cochran's Q and quantified with the I² statistic. To explore the sources of heterogeneity, we performed sensitivity analyses and meta-regression. The protocol was registered in the International Registration of Systematic Reviews (no. CRD42023471340).

Results: We included 28 studies in this research. The pooled prevalence of suicidal ideation, 12-month suicide attempts and lifetime suicide attempts among Iranian students was 17% (95% CI: 13-21%), 3% (95% CI: 2-4%) and 8% (95% CI: 6-10%), respectively, with substantial heterogeneity (I² = 94.85, 91.16 and 93.46%, respectively).

Conclusions: This study highlights the high prevalence of suicidal ideation and suicide attempts among Iranian university students, underscoring the need for effective preventive strategies and further research.