BJPsych Open最新文献

Background: Western Australia's response to the COVID-19 pandemic was swift and effective in implementing public health protections and preventing the spread of the virus for the first 2 years. However, healthcare staff continued to be at increased risk of mental health concerns.

Aims: To investigate the longitudinal patterns of post-traumatic stress symptoms (PTSS), depression and anxiety among healthcare workers in Western Australia, and the risk and protective factors associated with changes in status during the first wave.

Method: Participants comprised 183 healthcare staff working at tertiary hospitals and major clinics across Perth, for whom longitudinal data were available. Questionnaire data were collected before Western Australia's first major COVID-19 community wave in early 2022 and following the first wave in late 2022. Online surveys comprised validated measures assessing psychological symptoms, risk and protective factors, and original measures of workplace factors.

Results: Overall rates of PTSS, depression and anxiety remained stable across the two assessment points. However, latent growth models revealed that those with lower PTSS, depression or anxiety symptoms at baseline reported a larger increase in symptoms over time, and those with higher symptoms at baseline had a smaller decline over time, indicating a 'catch-up' effect. Workplace stressors, sleep difficulties and trauma exposure were key risk factors for changes in psychological symptoms from baseline, and workplace and social supports played protective roles.

Conclusions: Improvements in systemic workplace factors are needed to support healthcare workers' mental health during periods of acute stress, even in settings with high levels of emergency preparedness.

The UK has seen an outbreak of riots after the death of three children in a knife attack. Misinformation about the suspect's heritage and religion was spread by social media, which was then used to incite violence and racism resulting in damage to property, terror and injuries. We put forward arguments that this was an extremist act and draw on the literature on terrorism, extremism and identity to put forward a deeper analysis of how this happened and what can be done to prevent future riots. We bring an interdisciplinary perspective drawing on research from social, cultural, psychological and political perspectives.

The aim of this study was to determine whether there was a significant change in cardiac [123I]-metaiodobenzylguanidine uptake between baseline and follow-up in individuals with mild cognitive impairment with Lewy bodies (MCI-LB) who had normal baseline scans. Eight participants with a diagnosis of probable MCI-LB and a normal baseline scan consented to a follow-up scan between 2 and 4 years after baseline. All eight repeat scans remained normal; however, in three cases uptake decreased by more than 10%. The mean change in uptake between baseline and repeat was -5.2% (range: -23.8% to +7.0%). The interpolated mean annual change in uptake was -1.6%.

Background: Early worsening of plasma lipid levels (EWL; ≥5% change after 1 month) induced by at-risk psychotropic treatments predicts considerable exacerbation of plasma lipid levels and/or dyslipidaemia development in the longer term.

Aims: We aimed to determine which clinical and genetic risk factors could predict EWL.

Method: Predictive values of baseline clinical characteristics and dyslipidaemia-associated single nucleotide polymorphisms (SNPs) on EWL were evaluated in a discovery sample (n = 177) and replicated in two samples from the same cohort (PsyMetab; n₁ = 176; n₂ = 86).

Results: Low baseline levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides, and high baseline levels of high-density lipoprotein cholesterol (HDL-C), were risk factors for early increase in total cholesterol (P = 0.002), LDL-C (P = 0.02) and triglycerides (P = 0.0006), and early decrease in HDL-C (P = 0.04). Adding genetic parameters (n = 17, 18, 19 and 16 SNPs for total cholesterol, LDL-C, HDL-C and triglycerides, respectively) improved areas under the curve for early worsening of total cholesterol (from 0.66 to 0.91), LDL-C (from 0.62 to 0.87), triglycerides (from 0.73 to 0.92) and HDL-C (from 0.69 to 0.89) (P ≤ 0.00003 in discovery sample). The additive value of genetics to predict early worsening of LDL-C levels was confirmed in two replication samples (P ≤ 0.004). In the combined sample (n ≥ 203), adding genetics improved the prediction of new-onset dyslipidaemia for total cholesterol, LDL-C and HDL-C (P ≤ 0.04).

Conclusions: Clinical and genetic factors contributed to the prediction of EWL and new-onset dyslipidaemia in three samples of patients who started at-risk psychotropic treatments. Future larger studies should be conducted to refine SNP estimates to be integrated into clinically applicable predictive models.

We investigated the impact of COVID-19 restrictions on the duration of untreated psychosis (DUP). First-episode psychosis admissions (n = 101) to the STEP Clinic in Connecticut showed DUP reduction (P = 0.0015) during the pandemic, with the median reducing from 208 days pre-pandemic to 56 days in the early pandemic period, and subsequently increasing to 154 days (P = 0.0281). Time from psychosis onset to antipsychotic prescription decreased significantly in the pandemic (P = 0.0183), with the median falling from 117 to 35 days. This cohort study demonstrates an association between greater pandemic restrictions and marked DUP reduction, and provides insights for future early detection efforts.

Background: The COVID-19 pandemic has disproportionately affected women's mental health. However, most evidence has focused on mental illbeing outcomes, and there is little evidence on the mechanisms underlying this unequal impact.

Aims: To investigate gender differences in the long-term trajectories of life satisfaction, how these were affected during the pandemic and the role of time-use differences in explaining gender inequalities.

Method: We used data from 6766 (56.2% women) members of the 1970 British Cohort Study (BCS70). Life satisfaction was prospectively assessed between the ages of 26 (1996) and 51 (2021) years, using a single question with responses ranging from 0 (lowest) to 10 (highest). We analysed life satisfaction trajectories with piecewise latent growth curve models, and investigated whether gender differences in the change in the life satisfaction trajectories with the pandemic were explained by self-reported time spent doing different paid and unpaid activities.

Results: Women had consistently higher life satisfaction than men before the pandemic (Δ_{intercept,unadjusted} = 0.213, 95% CI 0.087-0.340; P = 0.001) and experienced a more accelerated decline with the pandemic onset (Δ_{quad2,unadjusted} = -0.018, 95% CI -0.026 to -0.011; P < 0.001). Time-use differences did not account for the more accelerated decrease in women's life satisfaction levels with the pandemic (Δ_{quad2,adjusted} = -0.016, 95% CI -0.031 to -0.001; P = 0.035).

Conclusions: Our study shows pronounced gender inequalities in the impact of the pandemic on the long-term life satisfaction trajectories of adults in their 50s, with women losing their pre-pandemic advantage over men. Self-reported time-use differences did not account for these inequalities. More research is needed to tackle gender inequalities in population mental health.

Background: There is a high incidence of serious mental illness (SMI) and antipsychotic use in the respiratory high dependence unit (HDU) compared with the general population. However, there is a paucity of data in the extant literature evaluating the relationships between respiratory failure and antipsychotics.

Aims: To investigate the relationship between antipsychotics and respiratory failure in people admitted to a respiratory HDU, and to gain a better understanding of the potential impact of antipsychotic medications on respiratory outcomes.

Method: Medical, demographic and clinical outcome data were collected for a consecutive sample of 638 individuals admitted to a respiratory HDU between the dates 1 January 2018 and 29 May 2021 at a large quaternary hospital.

Results: Multivariate models controlling for confounders found that antipsychotic medications increased risk of admission for type 2 respiratory failure and chronic obstructive pulmonary disease exacerbation without hypercapnia by 3.7 and 11.45 times, respectively. For people admitted with type 2 respiratory failure, antipsychotic use increased the risk of requiring non-invasive ventilation by 4.9 times. Those prescribed an antipsychotic were more likely to be readmitted within 30 days. Over 30% of individuals were prescribed antipsychotics for an unlicensed indication.

Conclusions: Poor respiratory outcomes may be a previously unknown adverse drug reaction of antipsychotics. Modifications to clinical care and clinical pathways for those with SMI prescribed antipsychotic medications, including optimising their chronic health and deprescribing where appropriate, should be prioritised.

Background: Adults with intellectual disability experience increased rates of mental health disorders and adverse mental health outcomes.

Aim: Explore childhood risk factors associated with adverse mental health outcomes during adulthood as defined by high cost of care, use of psychotropic medication without a severe mental illness and psychiatric hospital admissions.

Method: Data on 137 adults with intellectual disability were collected through an intellectual disability community service in an inner London borough. Childhood modifiable and non-modifiable risk factors were extracted from records to map onto variables identified as potential risk factors. Logistic and linear regression models were employed to analyse their associations with adverse outcomes.

Results: We showed that the co-occurrence of intellectual disability with autism spectrum disorder and/or attention-deficit hyperactivity disorder (ADHD) were associated with psychotropic medication use and high-cost care packages. However, when challenging behaviour during childhood was added, ADHD and autism spectrum disorder were no longer significant and challenging behaviour better explained medication prescribing and higher cost care. In addition, the severity of intellectual disability was associated with higher cost care packages. Ethnicity (Black and mixed) also predicted higher cost of care.

Conclusions: Challenging behaviour during childhood emerged as a critical variable affecting outcomes in young adulthood and mediated the association between adult adverse mental health outcomes and co-occurring neurodevelopmental conditions, that is, ADHD and autism. These findings emphasise the need for effective early intervention strategies to address challenging behaviour during childhood. Such interventions for challenging behaviour will need to take into consideration autism and ADHD.

Background: Rates of self-harm among children and young people (CYP) have been on the rise, presenting major public health concerns in Australia and worldwide. However, there is a scarcity of evidence relating to self-harm among CYP from culturally and linguistically diverse (CALD) backgrounds.

Aims: To analyse the relationship between self-harm-related mental health presentations of CYP to emergency departments and CALD status in South Western Sydney (SWS), Australia.

Method: We analysed electronic medical records of mental health-related emergency department presentations by CYP aged between 10 and up to 18 years in six public hospitals in the SWS region from January 2016 to March 2022. A multilevel logistic regression model was used on these data to assess the association between self-harm-related presentations and CALD status while adjusting for covariates and individual-level clustering.

Results: Self-harm accounted for 2457 (31.5%) of the 7789 mental health-related emergency department presentations by CYP; CYP from a CALD background accounted for only 8% (n = 198) of the self-harm-related presentations. CYP from the lowest two most socioeconomic disadvantaged areas made 63% (n = 1544) of the total self-harm-related presentations. Findings of the regression models showed that CYP from a CALD background (compared with those from non-CALD backgrounds) had 19% lower odds of self-harm (adjusted odds ratio 0.81, 95% CI 0.66-0.99).

Conclusions: Findings of this study provide insights into the self-harm-related mental health presentations and other critical clinical features related to CYP from CALD backgrounds that could better inform health service planning and policy to manage self-harm presentations and mental health problems among CYP.

There is a considerable literature on the relationship of thyroid function with risk of depression and responsiveness to depression treatment. This literature is briefly reviewed here, followed by a focus on the incremental advance provided by the findings of Luo et al on autoimmune thyroiditis and suicide attempts.