BJPsych Open最新文献

Background: Studies have consistently found that up to 20% of people with anorexia nervosa experience a persistent illness, resulting in considerable psychosocial impairment, morbidity and mortality. This has been variously termed severe and enduring anorexia nervosa or longstanding anorexia nervosa (L-AN). Conflicting findings have hindered progress in distinguishing the nosological features of individuals with persistent illness.

Aims: This study aims to investigate the putative defining features of individuals reporting symptoms of L-AN, including consideration of their treatment trajectory.

Method: This cross-sectional study, drawing from a mixed-methods design, utilised a sample of symptomatic individuals who reported experiencing eating disorder treatment (n = 208). Several qualitative and quantitative data strands (a-c) were embedded within a single, self-report questionnaire measuring eating disorder severity and treatment experiences. Between-group comparisons were used to compare those of shorter (<3 years) and longer (>7 years) duration of illness.

Results: No between-group differences were found in measures of severity, including body mass index (kg/m²), eating disorder symptom scores, psychological distress or perceived health-related quality of life. However, those with L-AN had a significantly higher number of mental and physical health comorbidities, longer treatment delay, greater number of episodes of treatment and poorer subjective ratings of their treatment experiences.

Conclusions: Delineating L-AN by severity may be inappropriate; anorexia nervosa of any duration is a severe illness. This study suggests that treatments, or lack thereof, may have an inadvertent impact on duration of illness. Future focus needs to be on reconceptualising L-AN and its treatments. Treatment refinements informed by lived experience are proposed.

Background: An increasing number of children and adolescents are prescribed second-generation antipsychotic medications, which may lead to cardiometabolic or other physical health impairments. It is unknown whether lifestyle interventions can prevent or manage these adverse effects.

Aims: To evaluate the effectiveness of lifestyle interventions for preventing or managing cardiometabolic risks and other adverse physical health outcomes in this population.

Method: Four bibliographic databases were searched up to February 2024. Randomised controlled trials reporting a physical health outcome of children or adolescents (aged 6-17 years) taking antipsychotics and participating in a lifestyle intervention compared with treatment as usual (TAU) were eligible for inclusion. The Cochrane Risk of Bias 2 tool was used to assess risk of bias. Data were synthesised via a random-effects meta-analysis and narrative synthesis.

Results: Four studies with a total of 370 participants were included. Most (75%) had a high risk of bias. Lifestyle interventions resulted in moderate but statistically non-significant reductions in participants' body mass index (standard mean difference -0.70, 95% CI: -1.70 to 0.31) compared with TAU. Some studies reported improvements in other physical health outcomes favouring the intervention, although findings were inconsistent and varied across different measures. Reporting of secondary indicators of physical health, including participant or family health behaviours, was limited.

Conclusions: The effectiveness of lifestyle interventions for preventing or managing the cardiometabolic risk and other adverse physical health outcomes in this population is unclear due to the limited number of available trials, small samples and high risk of bias. Larger trials are needed.

Background: Subjective perspectives on aetiological factors in atypical depression have not been previously explored from the viewpoint of those with lived experience.

Aims: This study aimed to explore individuals' subjective experiences and explanations of atypical depression, and to examine whether perceived gender-specific influences might contribute to the observed gender disparity in atypical depression prevalence.

Method: Semi-structured, one-to-one interviews were conducted online with 16 individuals. Data were analysed using thematic analysis, employing an inductive approach and interpreted within a constructionist framework. Data coding was conducted using NVivo.

Results: Key themes centred on the prevalence of comorbid conditions and how they affected atypical depression presentation; how trauma was seen as both a causal factor and catalyst; the subjective impact of gender identity and roles; how environmental factors seemed to affect atypical depression onset and presentation; the difficulties experienced with atypical depression symptom variability in daily life; and reported coping behaviours.

Conclusions: These findings highlight how individuals with atypical depression believed onset to be linked to experiences of trauma and comorbidity, in addition to ongoing influences of varied environmental factors. The variability of atypical depression symptoms in both the short and long term appears to be a core challenge in this subgroup. The gender disparity of atypical depression is also explored through the lens of lived experience and gender identity. Future research would benefit from exploring further these potential contributing factors, to provide a better understanding of their complex influences on atypical depression onset and maintenance.

Background: Existing research demonstrates that insomnia is common, with significant negative impacts on health and quality of life. Cognitive-behavioural therapy for insomnia (CBT-I), the first-line treatment, is highly cost-effective. However, healthcare records have not been used in the UK to establish real-world insomnia prevalence, inequalities or unmet need.

Aims: This study's aim was to establish the above in North Central London.

Method: Data were extracted from primary care records across three London boroughs for 765 035 patients. Prevalence was determined by identifying those with a recent code for insomnia, insomnia treatment or sleeping tablet prescription.

Results: Insomnia prevalence was 4.3%. Prevalence increased steadily with age, and was highest for women (4.9%), those of Bangladeshi ethnicity (7.3%) and those in the most deprived quintile (5.2%). Prevalence was significantly higher in patients with comorbidities (including chronic obstructive pulmonary disease (17.5%), severe mental illness (16.6%) and depression (14.1%)). Only 1.7% of people with insomnia had been referred for CBT-I.

Conclusions: Findings suggested that insomnia is at least as common as illnesses receiving high levels of focus and resourcing in the UK, and that prevalence estimates were probably underestimates. Variation in prevalence by demographic factors and deprivation may represent health inequalities. Insomnia was particularly common among patients with certain comorbidities and of advancing age, indicating that those groups should be actively screened. Concerningly, referral rates for CBT-I were extremely low. This has important implications regarding population health management, commissioning and training. Prevalence and unmet need are likely to be high in many other areas and should be investigated locally.

Background: AVATAR therapy, a digitally supported intervention, utilises avatars to promote recovery in people who experience distressing auditory hallucinations. This approach was recently evaluated in a multicentre randomised controlled trial comparing brief (AV-BRF) and extended (AV-EXT) forms of therapy with treatment as usual (TAU). There was evidence for the effectiveness of therapy, particularly for AV-EXT. However, value for money needs to be assessed.

Aims: To compare separately the cost utility of the brief and extended forms of AVATAR therapy with TAU.

Method: In a three-arm randomised controlled trial the use of health services was measured, and costs (2021/2022; pounds sterling) calculated from a health and social care perspective over a 28-week follow-up period. Quality-adjusted life years (QALYs; derived from the 5-level version of the EuroQol 5-Dimension questionnaire) were combined with costs.

Results: AV-BRF resulted in extra costs of £319 (95% CI, -£1558 to £2496), and AV-EXT in lower costs of £1965 (95% CI, -£1912 to £1519), compared with TAU. Over the follow-up, AV-BRF resulted in 0.0159 (95% CI, -0.0103 to 0.0422) and AV-EXT in 0.0173 (95% CI, -0.0049 to 0.0395) more QALYs than TAU. The cost per QALY for AV-BRF compared with TAU was £20 016, while AV-EXT dominated TAU (lower costs and more QALYs).

Conclusions: Neither version of AVATAR had a substantial impact on QALYs. However, AV-EXT did result in reduced care costs - albeit not statistically significant - and was potentially cost-effective compared with TAU. AV-BRF had an incremental cost-effectiveness ratio that indicated lower potential cost-effectiveness. These findings are uncertain, but could still inform decision-making regarding interventions in this field.

Background: Obsessive-compulsive disorder (OCD) is a debilitating mental disorder commonly treated with selective serotonin reuptake inhibitors, atypical antipsychotic augmentation and cognitive-behavioural therapy. However, up to 60% of people with OCD do not respond to these treatments. Therefore, a novel intervention, psilocybin-assisted psychotherapy (PAP), is an option of interest. Moreover, there is a need to better understand the mechanisms underpinning PAP's effect on OCD symptoms.

Aims: We aimed to (a) establish the feasibility, tolerability and safety of administering PAP to adults with treatment-resistant OCD; (b) provide preliminary data on the clinical effects of PAP for treatment-resistant OCD, to inform the design of larger clinical trials; and (c) compare neuroimaging and neurophysiological markers pre- and post-PAP in treatment-resistant OCD.

Method: In this 12-week open-label trial, ten adults with treatment-resistant OCD will receive one 25 mg dose of psilocybin combined with psychological support. Feasibility, tolerability and safety will be assessed throughout. Clinical outcomes will be measured with the Yale-Brown Obsessive-Compulsive Scale. Exploratory measures will include brain imaging examining changes in dynamic connectivity from pre to post treatment, electroencephalogram to investigate changes in brain dynamics associated with psilocybin under acute conditions, and transcranial magnetic stimulation-electroencephalogram measures between baseline, provocation of OCD symptoms and up to 1-week post-dose.

Results: The study will provide important preliminary data on the feasibility and efficacy of PAP in adults with treatment-resistant OCD, as well as inform our understanding of neurobiological mechanisms.

Conclusions: The findings of the study will inform the design of larger randomised controlled trials and advance the field of psychedelic-assisted therapies.

Background: Cognitive impairment in major depressive disorder (MDD) may be driven by neuro-inflammatory processes involving pro-inflammatory cytokines.

Aims: This study aimed to examine the relationship between serum tumour necrosis factor-alpha (TNF-α) levels and cognitive performance across different domains in individuals with MDD.

Method: Sixty patients with MDD and 60 healthy controls were recruited. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and serum TNF-α levels were measured via flow cytometry.

Results: After adjusting for covariates, RBANS total and subscale scores were significantly lower in MDD patients compared with controls (P < 0.001), while log₁₀-transformed TNF-α levels were significantly higher in the MDD group (P = 0.006). In MDD patients, log₁₀TNF-α levels were inversely correlated with immediate memory scores after adjusting for confounding factors (r = -0.35, P = 0.009); however, this relationship was not observed in healthy controls (r = -0.02, P = 0.90). Stepwise multivariate regression analysis further confirmed the negative association of log₁₀TNF-α with immediate memory scores in MDD patients (β = -14.58, t = -4.14, P < 0.001), but not in healthy controls (β = -0.02, t = -0.14, P = 0.89).

Conclusions: These findings suggest that elevated serum TNF-α may contribute to the pathophysiology of MDD and is specifically associated with deficits in immediate memory.

Background: There is ample evidence that women do not progress in mental health publishing as quickly as men. The movement from first to last (senior) author is one indicator of progression.

Aims: To understand whether there are changes in women's authorship position following our academic institution's introduction of support mechanisms to reduce the gender gap in career development.

Method: Data from publicly held databases in three cohorts (2016, 2018 and 2020) were assessed for gender and authorship position at the Institute of Psychiatry, Psychology and Neuroscience. Regression analyses included authorship gender and change over time in authorship roles, by school and topic.

Results: We found substantial, statistically significant differences in gender between author roles (χ²(2) = 29.18, P < 0.0001), with women being mainly first authors (marginal mean 62.2:40.1%, respectively, odds ratio 2.463, 95% CI 1.807 to 3.357). The three schools differed (χ²(2) = 14.06, P < 0.001) and, although men were predominant as last authors in all topics in both 2016 and 2020, women did show a modest increase. The trend for an interaction between gender and first-author publications on the likelihood of last-author publications in 2018 (incidence rate ratio 1.839, 95% CI 0.914 to 3.698) had disappeared by 2020.

Conclusions: Although women were represented as first and corresponding authors, there was still a gender gap for last-author positions. Over time, women have increased their representation in many of the topic areas. The disappearance of any gender-moderating effect suggests that institutional policies may have had an effect, in addition to sector-wide changes.

Background: Negative neuropsychiatric symptoms, such as apathy, are a core feature of Alzheimer's disease. Previous studies have shown that levels of fasting plasma proline and differential activity of the catechol-O-methyltransferase (COMT) enzyme, which metabolises dopamine, influence negative symptoms in patients with severe psychiatric illness and those at risk for psychosis. For patients with the COMT high activity enzyme (as assessed via the COMT Val¹⁵⁸Met polymorphism), high plasma proline was associated with less severe negative symptoms. Conversely, high proline was associated with more severe negative symptoms in patients with the low activity COMT enzyme.

Aims: In this proof-of-concept cross-sectional study, we tested the hypothesis that proline and COMT Val¹⁵⁸Met interact to modify negative symptom severity across neuropsychiatric disease, specifically now investigating patients with Alzheimer's disease dementia.

Method: Least Absolute Shrinkage and Selection Operator regression was employed to model the interaction between proline and COMT on negative symptoms in n = 50 patients with probable Alzheimer's disease or mild cognitive impairment with underlying Alzheimer's disease biomarkers.

Results: The proline × COMT interaction significantly predicted symptoms as assessed via the negative items of the Positive and Negative Symptom Scale, interaction coefficient 0.025, p = 0.031, with a trend toward significance when assessed via the Scale for Assessment of Negative Symptoms in Alzheimer's disease, interaction coefficient 0.075, p = 0.055. Higher proline was beneficial for both Val/Val and Val/Met dementia patients, but detrimental to patients with the low activity Met/Met COMT enzyme.

Conclusions: Higher proline also has opposing effects on negative symptoms by COMT genotype in patients with dementia and further supports the development of therapeutics aimed at modulating this interaction pathway across neuropsychiatric disorders.