BJPsych Open最新文献

Background: Early in the SARS-CoV-2 pandemic, most jurisdictions implemented mandatory face covering policies across healthcare settings. This intervention, which lasted multiple years, was unprecedented in psychiatry. Masks may affect the delivery of mental healthcare, given its reliance on nuanced communication and establishing a therapeutic alliance.

Aims: This scoping review aimed to provide an overview of the current literature concerning the impact of face masks in mental health settings beyond infection control and identify research gaps to guide future research and policy.

Method: Systematic searches were completed in the MEDLINE, Embase, PsycINFO, Scopus and CINAHL databases on 14 August 2024. Articles were eligible if they described peer-reviewed empirical studies involving people with mental disorders or mental health clinicians that reported on impacts of face coverings.

Results: Twenty-eight studies were selected for inclusion, involving 5385 participants. There was considerable heterogeneity among studies. Negative effects of face masks were reported in 26 studies in at least one domain. Themes from the survey-based literature included face masks negatively affecting communication, the therapeutic relationship and overall assessment quality. Experimental studies using emotion recognition tasks showed that people with mental disorders were disadvantaged by masks when interpreting emotions from facial expressions. The most commonly studied population was people with autism spectrum disorder. Children and people with severe or acute mental illness were underrepresented. Only two studies expressly recruited psychiatrists.

Conclusions: Policy makers should be aware of adverse impacts of mask-wearing in mental health settings and consider these in evolving risk-benefit analyses. Further research is needed to establish the extent of impacts on population subgroups.

Background: Self-harm among UK prisoners has risen over the past decade.

Aims: To explore self-harm risk factors and mental health conditions in prisoners, pre- and during imprisonment, compared with the general population.

Method: This retrospective cohort study linked electronic health records and Ministry of Justice data for Welsh male prisoners (2019), and a comparison general population cohort. We examined imprisonment likelihood based on prior self-harm and mental health conditions using logistic regression. We also studied self-harm risk up to three years during imprisonment through Generalised Estimating Equations and time-stratified Cox regression, using a pre-imprisonment comparator (3 years before).

Results: Prisoners (N = 6095) had higher rates of self-harm and mental health conditions pre-imprisonment compared with non-prisoners (e.g. self-harm odds ratio: 2.1 (1.9, 2.2)). Self-harm risk was 5.25-6.47 times higher in prisoners than non-prisoners, both pre- and during imprisonment. Risk was highest shortly after incarceration, then declined, becoming lower than pre-imprisonment after 7 months. While most conditions correlated with higher self-harm risk during imprisonment (e.g. drug use, hazard ratios: 1.5-3.0), some (e.g. depression and alcohol use) showed weaker links in prisoners than non-prisoners, particularly from 7 months after imprisonment. Self-harm risk was seemingly higher in prisoners on remand compared with those sentenced.

Conclusions: Pre-imprisonment, self-harm in male prisoners is already high compared with the general population, potentially driving a saturation effect, where known general population risk factors have a weaker effect in prisoners. Self-harm prevention should target people in contact with criminal justice, irrespective of imprisonment. In prisons, prevention efforts deployed at inception should target those with prior self-harm, drug use, learning difficulties, bipolar disorder and those on remand.

Background: The negative symptoms of psychosis are heterogeneous, which complicates efforts to understand their pathophysiology and develop effective treatments. Factor analytic studies of the Positive and Negative Syndrome Scale (PANSS) have reported two factorial negative symptom models, expressive deficit and social amotivation, albeit with different compositions. Although models derived from other assessment scales have been directly compared, no study has previously applied this approach to PANSS.

Aims: Our objectives were to (a) to establish which negative PANSS-derived factorial model provided the best fit to our data, (b) test its stability and (c) determine its clinical and demographic correlates.

Method: A cohort of medication naive or minimally treated patients with first-episode schizophrenia (n = 446) were assessed using the PANSS scale before and 4 weeks after amisulpride treatment. Confirmatory factor analysis was performed to test five PANSS models. Hierarchical multiple regression was conducted to examine the associations between identified dimensions and clinical and demographic variables.

Results: A nine-item PANSS model comprising social amotivation and expressive deficit dimensions outperformed the other models: comparative fit index = 0.98, goodness of fit index = 0.97, Tucker-Lewis index = 0.97, root mean square error of approximation = 0.06 (CI 90%: 0.04-0.08), Bayesian information criterion = 191.9, Akaike information criterion = 101.7. At baseline, the social amotivation dimension was associated with more severe depression whereas the expressive deficit dimension was associated with younger age. Both dimensions at baseline were associated with poor functioning, but expressive deficit to a lesser extent.

Conclusions: A nine-item PANSS model incorporating social amotivation and expressive deficit dimensions appeared to best reflect the underlying structure of negative symptoms in our sample.

Background: Cognitive impairment varies widely in bipolar disorder. Identifying cognitive subgroups and their biological correlates may improve understanding of the disorder. Brain-derived neurotrophic factor (BDNF) and C-reactive protein (CRP) are key candidates due to their roles in neuroplasticity and inflammation.

Aims: The aim was to investigate cognitive subgroups in patients with bipolar disorder and their association with serum levels of BDNF and CRP.

Method: A cross-sectional study was conducted on 149 bipolar disorder patients and 48 healthy controls. Cognitive performance was assessed using a comprehensive battery of neuropsychological tests. Cluster analysis was performed to identify cognitive subgroups, followed by discriminant function analysis to validate the classification. Serum levels of BDNF and CRP were measured and compared across cognitive subgroups.

Results: Cluster analysis identified three cognitive subgroups: intact cognition, selectively impaired cognition (SIC) and globally impaired cognition (GIC). SIC exhibited the highest BDNF levels, while GIC demonstrated the highest CRP levels. CRP levels were negatively associated with performance across all cognitive domains. BDNF showed a negative correlation with verbal fluency, short-term memory and working memory. CRP levels exceeding 4.3 mg/L predicted global cognitive impairment with a sensitivity of 72.41% and specificity of 73.63%.

Conclusion: Cognitive impairments in bipolar disorder patients can be classified into distinct subgroups, which are associated with serum levels of BDNF and CRP. These findings suggest that inflammation and neuroplasticity play key roles in the pathophysiology of cognitive decline in bipolar disorder, providing potential biomarkers for identifying patients at risk for severe cognitive impairments.

In an article published in BJPsych Open, a study by Fleetwood and colleagues used Scottish administrative registers to show that not only have people with severe mental illnesses a profoundly reduced average life expectancy compared with the general population, but that the life expectancy gap had been further widening for those with schizophrenia and bipolar disorder over the past 20 years. This study has substantial clinical and public health importance, providing robust evidence to help in evaluation and planning of healthcare services in Scotland. Furthermore, this work raises important questions concerning the study of premature mortality in people with mental disorders per se, as well as the utility of administrative registers to study this phenomenon, which we highlight in this Editorial.

Background: Children displaced by armed conflict are at high risk of experiencing psychological distress. The ongoing war in Gaza has resulted in widespread trauma among Palestinian youth, yet limited data exist on their mental health following displacement. This study assessed the prevalence and correlates of anxiety and depressive symptoms among war-displaced Palestinian refugee children and adolescents resettled in Qatar.

Aims: To estimate the prevalence of clinically significant anxiety and depressive symptoms and to identify psychosocial and trauma-related factors associated with symptom severity in this population.

Method: A cross-sectional study was conducted among 350 Palestinian children (aged 8–17 years) residing in a residential compound in Qatar. Symptoms of anxiety and depression were measured using the Screen for Child Anxiety Related Emotional Disorders-Child Version and the Short Mood and Feelings Questionnaire-Child Version, respectively. A Resilience and Demographic Questionnaire was devised to assess trauma exposure and psychosocial variables. Multiple linear regression identified factors associated with symptom severity.

Results: Clinically significant anxiety and depressive symptoms were found in 70.9 and 46.0% of participants, respectively. Separation anxiety was the most common subtype. Female gender, witnessing death, physical injury and disrupted caregiving were significantly associated with worse outcomes.

Conclusions: This study highlights the urgent need for trauma-informed, culturally sensitive mental health services for displaced Palestinian children and young people. While clinical interventions are vital, a sustainable resolution to the conflict is essential to mitigate further psychological harm.

Background: According to existing evidence, during menopause transition, women with psychosis may present with exacerbated psychiatric symptoms, due to age-related hormonal changes.

Aims: We aimed to (a) replicate this evidence, using age as a proxy for peri/menopausal status; (b) investigate how clinical presentation is affected by concomitant factors, including hyperprolactinaemia, dose and metabolism of prescribed antipsychotics using cross-sectional and longitudinal analyses.

Method: Secondary analysis on 174 women aged 18-65, from the IMPaCT (Improving physical health and reducing substance use in psychosis) randomised controlled trial. We compared women aged below (N = 65) and above 40 (N = 109) for (a) mental health status with the Positive and Negative Syndrome Scale (PANSS) and Montgomery Asberg Depression Rating Scale; (b) current medications and (c) prolactin levels, at baseline and at follow-up (12/15 months later).

Results: Women aged above 40 showed higher baseline PANSS total score (mean ± s.d. = 53.4 ± 14.1 v. 48.0 ± 13.0, p = 0.01) and general symptoms scores (28.0 ± 7.4 v. 25.7 ± 7.8, p = 0.03) than their younger counterparts. Progressive sub-analysis revealed that this age-related difference was observed only in women with non-affective psychosis (n = 93) (PANSS total score: 57.1 ± 13.6 v. 47.0 ± 14.4, p < 0.005) and in those prescribed antipsychotic monotherapy with olanzapine or clozapine (n = 25) (PANSS total score: 63 ± 16.4 v. 42.8 ± 10.9, p < 0.05).Among all women with hyperprolactinaemia, those aged above 40 also had higher PANSS positive scores than their younger counterparts. No longitudinal differences were found between age groups.

Conclusions: Women aged above 40 showed worse psychotic symptoms than younger women. This difference seems diagnosis-specific and may be influenced by antipsychotics metabolism. Further longitudinal data are needed considering the menopause transition.

Background: Mental health difficulties affect the well-being of doctors and compromise the delivery of healthcare. However, large-scale data on doctors' mental health needs are limited.

Aims: Describe patterns of self-referrals for mental health support among doctors in England and explore associations with demographic factors, speciality, neurodevelopmental and mental health indicators.

Method: Observational study using data from doctors who self-referred for mental health difficulties to a national service in England over a 4-year period. Logistic regression was used to explore associations between speciality and mental health indicators.

Results: Of the 16 815 doctors who self-referred during the study period, 80% were under the age of 49 and 70.6% were female with the two largest ethnicities being 65.1% White and 22.7% Asian. Women were more likely to report higher scores for depression (odds ratio 0.90, 95% CI = 0.84 to 0.97), anxiety (odds ratio 0.78, 95% CI = 0.72 to 0.84) and psychological distress (odds ratio 0.78, 95% CI = 0.70 to 0.87), but males were more likely to screen positive for attention-deficit hyperactivity disorder (ADHD) symptoms. Doctors in general practice accounted for 46.3% of referrals. Compared with them, doctors in most other specialities had higher odds of elevated mental health scores across all measures, including ADHD.

Conclusions: The findings highlight a significant mental health burden among self-referring doctors, particularly for females and doctors in non-general practice specialities. Tailored and easily accessible support strategies that account for both demographic and professional contexts are essential to address the diverse mental health needs of the medical workforce.

Anorexia nervosa is characterised by the fear of gaining weight and a disrupted relationship with food but atypical if the body mass index is within normal limits. Semaglutide is a glucagon-like peptide-1 receptor agonist, indicated in patients with diabetes type 2 and obesity. An adolescent girl was diagnosed with atypical anorexia nervosa. She had a fear of gaining weight, she increased her exercise and decreased her caloric intake. The adolescent was admitted to the paediatric ward with bradycardia and pericardial effusion. During her hospital stay she admitted to having used semaglutide. Semaglutide was prescribed by her general practitioner because she was previously on the verge of being overweight with weight-related dysphoria. After 3 months she stopped using semaglutide, she kept losing weight. The adolescent girl went back to her normal life but after a panic attack caused by gaining 1 kg, she was admitted to an eating disorder ward. Semaglutide can affect mental health in patients who are prone to mental disorders. The importance of restrictively prescribing semaglutide for the right indication with caution and strict follow up is emphasised.