BJPsych Open最新文献

Background: Cognitive impairment is a significant, yet often overlooked, non-motor symptom of Parkinson's disease, and a strong predictor of quality of life for those affected. Despite the availability of both pharmacological and non-pharmacological treatment options for Parkinson's disease, their efficacy for the cognitive symptoms of the disease specifically is unclear, as no 'gold standard' treatment strategy for cognitive impairment in the disease has yet emerged. Further, a comparative understanding of the efficacy of each of these treatment options is severely lacking.

Aims: This systematic review aims to critically evaluate the efficacy of non-pharmacological interventions for the treatment of cognitive impairment in Parkinson's disease.

Method: A comprehensive systematic search will be conducted to identify studies involving participants clinically diagnosed with Parkinson's disease that assess non-pharmacological interventions targeting cognitive impairment. If feasible, results will be synthesised using meta-analysis; otherwise, narrative synthesis will be used.

Results: This is a protocol for a systematic review that is yet to be conducted.

Conclusions: The findings from this review will provide critical insight into the efficacy of non-pharmacological treatment options for cognitive impairment in Parkinson's disease, which may help to influence clinical recommendations for the treatment of cognitive impairment in Parkinson's disease and highlight existing gaps in the literature.

Background: Negative symptoms in schizophrenia, particularly motivational deficits, pose significant challenges to treatment and recovery. Despite their profound impact on functional outcomes, these symptoms remain poorly understood and inadequately addressed by current interventions.

Aims: The CHANSS (Characterising Negative Symptoms in Schizophrenia) study aims to dissect the cognitive mechanisms underlying motivational impairments by focusing on three interconnected domains: executive cognition, motivational cognition and meta-cognition.

Method: This large, international, cross-sectional study recruits a heterogeneous sample of patients across illness stages - from first-episode psychosis to treatment-resistant schizophrenia - and uses a comprehensive cognitive battery, clinical scales, self-report measures and computerised cognitive tasks. Four novel tasks assess key processes in motivated behaviour: option generation, reward-based decision-making, risk sensitivity and performance self-evaluation. By incorporating control for secondary influences like depression, psychosis, sedation and illness chronicity, the study seeks to identify distinct cognitive and behavioural subtypes within motivational dysfunction.

Results: CHANSS tests the hypothesis that specific patient profiles exhibit predominant impairments in one or more cognitive domains, which may differentially affect goal-directed behaviour. The study's design allows exploration of hierarchical relationships between cognitive processes, such as how neurocognitive deficits may cascade to impair motivation and self-evaluation.

Conclusions: Ultimately, CHANSS aims to advance mechanistic understanding of motivational deficits in schizophrenia and pave the way for personalised, targeted interventions. Its findings may inform future clinical trials and contribute to a shift away from one-size-fits-all approaches towards more effective, stratified treatment strategies in schizophrenia.

Background: In-person, therapist-supported interventions targeting emotion regulation have been shown to improve the mental health of adolescents. Increasingly, self-directed digital interventions (e.g. mobile apps) are being developed as a cost-effective, scalable solution to widen access to support. However, evidence of the acceptability and feasibility of these interventions has yet to be synthesised.

Aims: To identify existing evidence on the benefits, acceptability and feasibility of self-directed digital interventions that target emotion regulation in adolescents (aged 11-18 years).

Method: A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-guided systematic review was conducted to identify studies published from 1 January 2010 to 13 November 2024 investigating self-directed digital emotion regulation interventions for adolescents. A total of ten electronic databases were searched (e.g. PsycInfo). Data on the effects, and perceived acceptability, of the interventions were extracted, with results narratively synthesised. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment tool.

Results: Six out of 9049 studies met the eligibility criteria and included preliminary evidence on self-directed digital interventions that target emotion regulation, in a pooled sample of 1271 adolescents. All interventions identified were brief (most <1 month) and included different components to target emotion regulation (e.g. mindfulness, mood monitoring). Most interventions demonstrated benefits for emotion regulation and were acceptable for use by an adolescent population.

Conclusions: Although the evidence base was small, the included studies demonstrate preliminary evidence of the benefits and acceptability of self-directed, digital interventions for emotion regulation in adolescents. Future research should focus on approaches beyond mindfulness, including components to target the related skills required to access emotion regulation strategies (e.g. emotional awareness) and use them flexibly.

Background: Professionals engaged in community work within their own communities frequently encounter challenges associated with dual relationships. The psychological impacts of dual roles are often overlooked.

Aims: This study explores the experiences of Muslim professionals in Christchurch, New Zealand, following the 15 March 2019 mosque terrorist attacks. It examines how they balance their community roles with their professional responsibilities while also safeguarding their personal well-being.

Method: Semi-structured interviews were conducted with 20 Muslim professionals engaged in dual relationships within their community. Participants were selected through purposive sampling from diverse sectors, including government agencies, research positions and community support services. Reflexive thematic analysis was utilised to identify key themes.

Results: Participants reported significant emotional strain, including vicarious trauma and burnout, driven by their dual roles. Faith emerged as a key motivator, with altruism framed as a spiritual duty. Identity struggles were common, shaped by societal scrutiny and a desire for validation. While formal support systems were sometimes inadequate, peer support and culturally attuned leadership provided relief. The findings highlight the complex interplay of psychological, spiritual and structural factors in sustaining professionals following a disaster.

Conclusions: This research highlights the emotional toll on Muslim professionals supporting their community following a terrorist attack, with broader implications for minority groups responding to similar incidents. The findings highlight the need for culturally competent, trauma-informed support systems within community care organisations. Recommendations include strengthening of peer support, training supervisors in cultural responsiveness and ensuring tailored mental health resources to support well-being and professional effectiveness in high-impact roles.

Background: The effects of pandemic-related restrictions on people in prisons who tend to have multiple complex health needs are not well understood.

Aims: We aimed to measure changes in adjudications and self-harm among people in prisons before and during the pandemic.

Method: We examined effects of time and demographic characteristics on odds and counts of adjudications and self-harm over a three-year period, starting one year before the COVID-19 pandemic, in 861 individuals from 21 Offender Personality Disorder Pathway prison sites.

Results: The odds of adjudicating were lower in people of older age (odds ratio 0.98 (95% CI: 0.96-0.99)), and during COVID-19 year one (odds ratio 0.37 (95% CI: 0.23-0.60)) and year two (odds ratio 0.40 (95% CI: 0.25-0.65)) compared to pre-COVID-19. Being of White ethnicity was associated with increased odds (odds ratio 4.42 (95% CI: 2.06-9.47)) and being older was associated with reduced odds (odds ratio 0.97 (95% CI: 0.95-0.99)) of self-harm. The odds of self-harm were significantly reduced during COVID-19 year two (odds ratio 0.45 (95% CI: 0.26-0.78)), but not during COVID-19 year one (odds ratio 0.68 (95% CI: 0.40-1.14)), compared with the 12 months before COVID-19.

Conclusions: Although adjudications and self-harm were generally lower during the pandemic, younger people showed increased odds of adjudications and self-harm compared with older people, while White people showed increased odds of self-harm compared with people of the global majority. Our findings highlight the importance of considering potential health inequities and environmental effects of lockdowns for people in prisons.

Background: Given the complex challenges facing people experiencing homelessness, existing mental health recovery models are probably insufficient for this population.

Aims: To investigate qualitative accounts of mental health personal recovery in people with experience of homelessness, and to adapt the widely adopted connectedness, hope, identity, meaning and empowerment (CHIME) model of personal recovery to better represent the experiences of this population.

Method: PROSPERO registration no. CRD42023366842. A systematic review identified qualitative studies investigating first-person accounts of mental health personal recovery in people with experience of homelessness. Nine databases were searched: CINAHL, SCOPUS, Embase, Medline, PsychINFO, PubMed, Web of Science, ASSIA and Social Services Abstracts. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist. Included studies underwent 'best fit' framework synthesis, comprising deductive analysis using the CHIME first- and second-order themes, as well as inductive analysis to capture aspects not covered by the a priori framework.

Results: The review expanded the CHIME model and identified the following recovery processes in this population: security and stability; encouragement and hope; constructing identity; understanding and meaning; relationships and connectedness; and empowerment and dual recovery (SECURED). Importantly, security and stability were identified as a necessary prerequisite for the other recovery processes. Challenges within each recovery process were also identified.

Conclusions: SECURED offers a transdiagnostic framework to support understanding of mental health personal recovery in the context of homelessness. Findings support the Housing First model of service provision. However, findings also highlight that housing alone is not sufficient and that the other processes must also be supported.

Systematic reviews and meta-analyses are often considered the highest level in evidence hierarchies, and therefore are often drawn upon when considering changes in policy. Despite journals implementing measures aiming to enhance the quality of systematic reviews they publish, the authorship raise concerns about the quality of existing and ongoing systematic reviews, particularly relating to transparency and bias minimisation. Building on the current guidelines, standards and tools, we suggest a 'meta checklist' which aims to maximise methodologically sound, unbiased and reproducible reviews of the best scientific quality while considering feasibility throughout the process.

Background: Adult cohorts with generalised joint hypermobility (GJH) report higher rates of neurodevelopmental problems (NDPs). However, the prevalence of GJH in community-dwelling children and its association with NDPs remains unexplored.

Aims: This study aimed to (a) assess the prevalence of GJH, (b) examine its link to musculoskeletal pain and (c) explore associations with NDPs in 11-year-old Swedish children.

Method: An in-school study was conducted as part of the 4th grade health check-up. It included a structured physical examination using the Beighton score (range 0-9) and a comprehensive neurodevelopmental assessment based on behavioural ratings, maternal interviews, medical records and academic performance.

Results: Of 348 eligible children from eight schools, 223 (64%) participated, with Beighton scores measured in 207 (59%). The median Beighton score was 1 (interquartile range 0-2), with no significant gender differences (Wilcoxon test, P = 0.17). A Beighton score of ≥6 approximated the 95th percentile in both sexes. No significant association was found between high Beighton scores and NDPs. Few children with GJH reported weekly pain, indicating a low prevalence of hypermobility spectrum disorders in this age group.

Conclusions: Our findings validate the age-specific Beighton score cut-off and suggest that GJH in children of this age is not linked to NDPs, differing from findings in adults. This may reflect developmental changes during puberty. Additionally, the high prevalence of weekly pain (42%) in the cohort warrants further investigation into its causes and impact.

Background: People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimulus and employ often disproportionate safety behaviours at the expense of other life priorities.

Aims: To characterise the long-term trajectory of severe COVID anxiety, and the factors that influence recovery.

Method: This prospective cohort study followed 285 people with severe COVID anxiety in the UK over 18 months. A nested randomised feasibility trial tested an online cognitive-behavioural therapy (CBT)-based intervention (no. ISRCTN14973494). Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety over 18 months.

Results: Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease, P < 0.001), but a quarter of people (23.7%, 95% CI: 17.8-30.1) continued to worry about COVID every day, and for 13% symptoms remained severe even after the ending of all public health restrictions. Increasing age, being from a minority ethnic background that confers greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms, predicted slower improvements in severe COVID anxiety after adjusting for other clinical and demographic factors. Neither a trial CBT-based intervention, nor contextual factors including daily case rates, vaccination status or having contracted COVID-19, appeared to affect the trajectory of severe COVID anxiety.

Conclusions: For most people severe COVID anxiety improves significantly with time. However, interventions treating depression and health anxiety, and targeting older people and those from greater-risk minority backgrounds, warrant further investigation in future pandemics.

Background: Psilocybin-assisted psychotherapy (PAP) has gained attention as a promising intervention for conditions including depression, anxiety and post-traumatic stress disorder, but understanding of its side-effects is limited. This review evaluates the quality of side-effects reporting in PAP trials, to guide treatment, policy and research.

Aims: To assess side-effects reporting quality in PAP trials for psychiatric conditions, comparing published articles and ClinicalTrials.gov records.

Method: A PROSPERO-registered review (no. CRD42023458960) included English-language PAP trials (2005-2024) identified via Embase, CENTRAL, PubMed and reference searches. Reporting quality was assessed using the CONSORT Harms extension, categorised as either high (17-21), moderate (12-16), low (7-11) or very low (0-6). Randomised controlled trials underwent risk of bias analysis, and descriptive statistics compared side-effects across sources.

Results: Twenty-four trials were included. Reporting quality was high in six studies, moderate in four, low in nine and very low in five. All randomised controlled trials (n = 9) showed high risk of bias for side-effects outcomes. Variability in reporting hindered comparisons between articles and ClinicalTrials.gov, underscoring the need for standardisation. Overall, there was no evidence of systematic underreporting of side-effects in published articles compared with trial registers.

Conclusions: Side-effects reporting in PAP trials is inconsistent but is improving over time. Existing evidence has a high risk of bias. Future trials should align with best-practice guidelines for side-effects reporting. Discussions with patients should prioritise findings from high-quality studies and emphasise the current uncertainty regarding PAP side-effects.