BJPsych Open最新文献

Background: The novel South London and Maudsley Brain Health Clinic (SLaM BHC) leverages advances in remote consultations and biomarkers to provide a timely, cost-efficient and accurate diagnosis in mild cognitive impairment (MCI).

Aims: To describe the organisation, patient cohort and acceptability of the remote diagnostic and interventional procedures.

Method: We describe the recruitment, consultation set-up, the clinical and biomarker programme, and the two online group interventions for cognitive wellbeing and lifestyle change. We evaluate the acceptability of the remote consultations, lumbar puncture, saliva genotyping, and remote cognitive and functional assessments.

Results: We present the results of the first 68 (mean age 73, 55% female, 43% minoritised ethnicity) of 146 people who enrolled for full remote clinical, cognitive, genetic, cerebrospinal fluid and neuroimaging phenotyping. A total of 86% were very satisfied/satisfied with the remote service. In all, 67% consented to lumbar puncture, and 95% of those were very satisfied, all having no significant complications. A total of 93% found taking saliva genotyping very easy/easy, and 93% found the cognitive assessments instructions clear. In all, 98% were satisfied with the Cognitive Wellbeing Group, and 90% of goals were achieved in the Lifestyle Intervention Group.

Conclusions: The SLaM BHC provides a highly acceptable and safe clinical model for remote assessments and lumbar punctures in a representative, ethnically diverse population. This allows early and accurate diagnosis of Alzheimer's disease, differentiation from other MCI causes and targets modifiable risk factors. This is crucial for future disease modification, ensuring equitable access to research, and provides precise, timely and cost-efficient diagnoses in UK mental health services.

Background: Music therapy is a commonly used intervention added to usual care for psychiatric disorders.

Aims: We review the evidence for music therapy and assess its efficacy as an adjunct therapy across psychiatric disorders.

Method: A systematic literature search was conducted in four scientific databases to identify relevant meta-analyses. Articles were assessed with the AMSTAR-2 tool. The results of the high-quality articles were recalculated with the data from the primary studies. We decided to add the results of the lower-rated articles, using a narrative approach. We pooled the primary studies and calculated standardised mean differences (SMD) for the transdiagnostic outcomes of depression, anxiety and quality of life. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the level of evidence.

Results: Meta-analyses were available for autism, dementia, depression, insomnia, schizophrenia and substance use disorders. We identified 40 relevant articles. One article per domain was identified as high quality. Music therapy added to treatment as usual showed therapeutic value in each disorder. The transdiagnostic results showed a positive effect of music therapy on depression (SMD = 0.57, 95% CI 0.36-0.78), anxiety (SMD = 0.47, 95% CI 0.27-0.66) and quality of life (SMD = 0.47, 95% CI 0.24-0.71). However, these effects were not maintained at follow-up, and all results were based on low or very low evidence.

Conclusions: Music therapy shows promising potential as an adjunctive treatment for psychiatric disorders, but methodological weaknesses and variability limit the evidence. More high-quality, well-powered studies are needed to reliably confirm its effect size.

Background: Little is known about the prevalence of post-traumatic stress disorder (PTSD) in emerging adults living with HIV in low-income countries.

Aims: Determine prevalence of trauma exposure, prevalence of probable PTSD and conditional prevalence of probable PTSD for different traumatic events; and better understand the experiences of individuals with HIV and PTSD.

Method: This mixed method study used secondary data from a cross-sectional survey of people (N = 222) aged 18 to 29 living with HIV in Zimbabwe and primary qualitative data collection. The PTSD Checklist for DSM-5 (PCL-5) and the Life Events Checklist for DSM-5 (LEC-5) were used to measure PTSD and exposure to traumatic events, both translated to Shona. In-depth interviews (n = 8) with participants who met the criteria for probable PTSD were analysed using thematic analysis.

Results: In all, 68.3% [95% CI (61.4-74.1)] of participants reported exposure to at least one traumatic event. The observed prevalence of probable PTSD was 8.6% [95% CI (5.2-13.0)], most observed following exposure to fire or explosion 29.0% [95% CI (13.0-45.0)] and sexual assault 27.8% [95% CI (7.2-48.7)]. Probable PTSD was also more prevalent following multiple exposure to trauma; four and six events, N = 4 (21%) [95% CI (5.1-8.8)] each, two and three events N = 3 (15.7%) [95% CI (5.9-9.2)] each, and five events N = 1 (5.4%) [95% CI (7.5-9.6)]. Qualitative results indicated that HIV stigma exacerbated psychological distress from trauma.

Conclusions: Despite trauma exposure being common, prevalence of probable PTSD was not high, but was higher in those with multiple exposures. Participants described coping strategies, including social support and religious thinking.

Background: Clinical characteristics of psychosis in HIV infection have been described, but there have been limited comparative studies in HIV-endemic low-resource regions.

Aim: To compare clinical characteristics of psychosis in HIV-positive and HIV-negative patients at the main psychiatric referral units in Uganda.

Method: Patients with psychosis were consecutively recruited and completed a standardised demographic questionnaire and psychiatric and laboratory assessments including an HIV test. The Mini International Neuropsychiatric Interview was used to diagnose psychiatric illness. Psychosis symptoms were compared between HIV-positive and HIV-negative individuals using bivariate methods. A logistic regression model was used to assess the effects of age, gender and HIV status on different types of psychosis.

Results: There were 478 patients enrolled, of which 156 were HIV positive and 322 were HIV negative. The mean age was 33.2 years (95% CI 31.8-34.5) for the HIV-positive group and 29.6 years (95% CI 28.7-30.5) for the HIV-negative group (P < 0.001). Female patients had a higher proportion of seropositivity 40.6% (95% CI 34.8-46.4) compared with males 21.8% (95% CI 16.1-27.5) (P < 0.001). Psychotic disorder not otherwise specified occurred more in the HIV-positive individuals (88% (95% CI 82.9-93.1) v. 12% (95% CI 8.4-15.5), P < 0.001). Motor activity, irritability, emotional withdrawal, feelings of guilt, mannerisms and posturing, grandiosity, suspiciousness, unusual thoughts, blunted affect, excitement and disorientation were associated with HIV seropositivity.

Conclusion: The presentation of psychosis in patients with HIV is unique to this HIV endemic setting. Characterisation of the symptomatology of patients presenting with psychosis is important for proper diagnosis and care.

Background: Nearly 25% of people with intellectual disability (PwID) have epilepsy compared to 1% of the UK general population. PwID are commonly excluded from research, eventually affecting their care. Understanding seizures in PwID is particularly challenging because of reliance on subjective external observation and poor objective validation. Remote electroencephalography (EEG) monitoring could capture objective data, but particular challenges and implementation strategies for this population need to be understood.

Aim: This co-production aimed to explore the accessibility and potential impact of a remote, long-term EEG tool (UnEEG 24/7 SubQ) for PwID and epilepsy.

Method: We conducted six, 2-hour long workshops; three with people with mild intellectual disability and three with families/carers of people with moderate-profound intellectual disability. Brief presentations, easy read information and model demonstrations were used to explain the problem and device. A semi-structured guide developed by a communication specialist and art-based techniques facilitated discussion with PwID. For family/carers, active listening was employed. All conversations were recorded and transcribed. Artificial intelligence-based coding and thematic analysis (ATLAS.ti and ChatGPT) were synthesised with manual theming to generate insights.

Results: Co-production included four PwID, five family members and seven care professionals. Three main themes were identified: (1) perceived benefits for improving seizure understanding, informing care and reducing family and carer responsibility to accurately identify seizures; (2) the device was feasible for some PwID but not all; and (3) appropriate person-centred communication is essential for all stakeholders to reduce concerns.

Conclusions: The workshops identified key benefits and implementing barriers to SubQ in PwID.

Background: The ICD-11 introduced a new diagnosis of complex post-traumatic stress disorder (CPTSD) defined by disturbances in self-organisation in addition to traditional post-traumatic stress disorder symptoms. The International Trauma Questionnaire (ITQ) is the established measure of this construct and has been validated for use in a variety of populations and languages; however, evidence for the measure's use in Latin America is limited.

Aims: This study sought to validate the factor structure of the Latin American Spanish version of the ITQ in a trauma-exposed sample in Colombia.

Method: Confirmatory factor analysis was used to assess a range of factor models validated previously, including first- and second-order factor models.

Results: Assessment of fit indices demonstrated that a correlated six-factor model comprised of re-experiencing, avoidance, sense of threat, affect dysregulation, negative self-concept and disturbed relationships provided the best fit for these data. Factor loadings for this model were found to be high and statistically significant.

Conclusion: Results concur with prior research validating the use of alternative language versions of the ITQ internationally, and with the theoretical underpinnings of the CPTSD diagnostic category. The ITQ is therefore a valid measure of CPTSD in this Latin American sample. Further validation research is needed in clinical populations in this region.

Background: Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.

Aims: To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.

Method: This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.

Results: The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1-24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4-35.1). The most prevalent disorders were obsessive-compulsive disorder (8.2%, 95% CI 5.7-11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7-8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).

Conclusions: Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.

Background: Cannabis use severely affects the outcome of people with psychotic disorders, yet there is a lack of treatments. To address this, in 2019 the National Health Service (NHS) Cannabis Clinic for Psychosis (CCP) was developed to support adults suffering from psychosis to reduce and/or stop their cannabis use.

Aims: Examine outcome data from the first 46 individuals to complete the CCP's intervention.

Method: The sample (N = 46) consisted of adults (aged ≥ 18) with psychosis under the care of the South London and Maudsley NHS Foundation Trust, referred to the CCP between January 2020 and February 2023, who completed their intervention by September 2023. Clinical and functional measures were collected before (T0) and after (T1) the CCP intervention (one-to-one sessions and peer group attendance). Primary outcomes were changes in the Cannabis Use Disorders Identification Test-Revised (CUDIT-R) score and pattern of cannabis use. Secondary outcomes included T0-T1 changes in measures of delusions, paranoia, depression, anxiety and functioning.

Results: A reduction in the mean CUDIT-R score was observed between T0 (mean difference = 17.10, 95% CI = 15.54-18.67) and T1, with 73.91% of participants achieving abstinence and 26.09% reducing the frequency and potency of their use. Significant improvements in all clinical and functional outcomes were observed, with 90.70% being in work or education at T1 compared with 8.70% at T0. The variance in CUDIT-R scores explained between 34 and 64% of the variance in our secondary measures.

Conclusions: The CCP intervention is a feasible strategy to support cannabis use cessation/reduction and improve clinical and functional outcomes of people with psychotic disorders.

Background: Psilocybin is being investigated as a treatment for a myriad of disorders, including treatment-resistant depression. The main focus has been on positive effects, with little attention paid to negative outcomes, especially in clinical settings. Quantitative methodology limits further exploration of such events and can also miss improvements not captured on rating scales.

Aims: To highlight potential adverse events of psilocybin and underline limits of quantitative methodology, calling for process evaluations alongside clinical trials.

Case presentation: This is a case of a participant in a phase 2b clinical trial of psilocybin for treatment-resistant depression who presented with increased suicidal ideation and a prolonged period of severely restricted eating following administration, leading to a period of destabilisation and a need for support. Despite the difficulties encountered and the participant's limited improvement on rating scales, she found the experience to have been helpful and led her to make changes to her life which she found beneficial. She described her experience in a written account to the authors.

Method: The case was summarised and the written account was thematically analysed and synthesised into a logic model.

Conclusions: Psilocybin could lead to temporary worsening of suicidal ideation and instigate prolonged adverse events that outlast its acute effects. Paradoxically, it could simultaneously lead to an improvement in functional outcomes which is not clear on depression rating scales. This calls for a qualitative exploration of serious adverse events and participant accounts to deepen our understanding of the psilocybin experience and its different outcomes.

Background: Immune dysregulation appears involved in affective disorder pathophysiology. Inflammatory biomarkers have been linked with the cognitive impairment observed in people with bipolar disorders and as such are candidate markers that may improve with, and/or predict outcomes to, cognitive remediation therapies (CRT).

Aims: Nine candidate biomarkers were examined as putative mediators and/or moderators to improvements following CRT compared with treatment as usual (TAU) from a randomised controlled trial.

Method: Euthymic adults with bipolar disorders who had been randomised to CRT (n = 23) or TAU (n = 21) underwent blood testing before and after a 12 week intervention period. Five cytokines and four growth factor proteins, selected a priori, were examined in association with global cognition and psychosocial functioning outcomes.

Results: CRT attenuated a reduction in the brain-derived neurotrophic factor (BDNF), basic fibroblast growth factor and vascular endothelial growth factor-C compared to TAU. For the BDNF, lower baseline levels predicted better functional outcomes across the sample but was more pronounced in TAU versus CRT participants and indicated larger CRT effects in those with a higher BDNF. A moderation effect was also apparent for tumour necrosis factor-β and interleukin-16, with greater CRT versus TAU effects on functioning for participants with lower baseline levels.

Conclusions: Although preliminary, results suggest that CRT may exert some protective biological effects, and that people with lower levels of neurotrophins or cytokines may benefit more from CRT. We note an absence of associations with cognitive (versus functional) outcomes. These findings require further examination in large well-controlled studies.