BJPsych Open最新文献

Background: Bilateral sensory stimulation (BLS), such as eye movements or alternating tactile stimulation, is a key component of Eye Movement Desensitisation and Reprocessing (EMDR), a recommended treatment for post-traumatic stress disorder (PTSD). However, the neurophysiological mechanisms underlying BLS remain poorly understood.

Aims: This study examined the physiological effects of visual and tactile BLS on frontal electroencephalography (EEG) activity and autonomic arousal in patients with PTSD and healthy controls, by varying the type of stimulation in different emotional stimuli.

Method: Twenty female PTSD patients and twenty matched healthy controls participated in a counterbalanced, within-subjects design. Participants recalled a subjectively stressful or neutral event while receiving visual or tactile BLS. Frontal EEG and peripheral psychophysiological measures were recorded before and after stimulation. Data were analysed using mixed model analysis to examine the effects of stimulation type, memory condition and group.

Results: Both visual and tactile BLS significantly increased the total power of frontal EEG and decreased spectral edge frequency and peripheral physiological activation. These effects were consistent between the groups and memory conditions.

Conclusions: BLS, regardless of visual or tactile modality or emotional memory content, is associated with increased frontal EEG activity and reduced autonomic arousal. These findings support the hypothesis that BLS facilitates top-down cortical regulation, potentially aiding emotional processing in EMDR by using an inherent mechanism to promote psychological recovery. More research is needed to clarify the neural mechanisms and clinical implications.

Background: Despite overlapping diagnostic criteria and aetiology, the frequency of complex post-traumatic stress disorder (C-PTSD) in people being treated for borderline personality disorder (BPD) is unknown.

Aims: To establish the frequency and correlates of probable C-PTSD in people meeting the diagnostic criteria and being treated for BPD.

Method: C-PTSD was assessed in 87 patients meeting the diagnostic criteria for BPD and initiating treatment in out-patient personality disorder services in the UK, using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders diagnostic interview, items from the Structured Interview for Disorders of Extreme Stress - Self Report and other measures. The cross-sectional association between C-PTSD and demographics, trauma and clinical variables was evaluated with logistic, ordinal and linear regression.

Results: A total of 93% of participants reported a trauma history (95% CI 88-98%), and 57% met the criteria for probable C-PTSD (95% CI 47-67%). Previous sexual trauma increased the odds of probable C-PTSD (odds ratio 6.22, 95% CI 2.21-17.54, P < 0.001). Probable C-PTSD was associated with an increased odds of self-harm in the past 12 months (odds ratio 9.41, 95% CI 1.87-47.27, P = 0.01) and higher levels of abandonment fears (odds ratio 2.78, 95% CI 1.17-6.55, P = 0.02), abandonment-avoidant behaviour (odds ratio 4.25, 95% CI 1.30-13.91, P = 0.02) and identity instability (odds ratio 4.39, 95% CI 1.79-10.78, P < 0.01).

Conclusions: C-PTSD symptoms are likely to be common in people diagnosed with BPD, and are associated with higher overall psychiatric severity, with potential implications for formulation and treatment.

Through rich qualitative interviews, Simon and colleagues highlight how parents of suicidal adolescents navigate the process of lethal means restriction (LMR). Parents face challenges throughout the course of LMR that impact not only their ability to implement it effectively, but also the family dynamic at large. Results underscore a need for standardised, comprehensive training in LMR for clinical and medical professionals, as well as for policy solutions that can have more widespread influence and reduce the burden on parents as they support their children through an extraordinarily difficult time.

Background: The dysconnection hypothesis of schizophrenia posits that widespread synaptic inefficiencies lead to altered macroscale brain connectivity, contributing to symptom severity and cognitive deficits in individuals with schizophrenia spectrum disorders (SSD). Emerging evidence suggests that physical exercise may help to ameliorate these connectivity abnormalities and associated clinical impairments.

Aims: This study investigated whether reductions in functional dysconnectivity following exercise therapy were associated with clinical improvements in individuals with SSD. In addition, it explored the genetic underpinnings of these changes using imaging transcriptomics.

Method: Using data from the ESPRIT C3 trial, we analysed 23 SSD patients (seven female) undergoing aerobic exercise or flexibility, strengthening and balance training over 6 months. Functional dysconnectivity, assessed at baseline and post-intervention relative to a healthy reference sample (n = 200), was evaluated at the whole-brain, network and regional levels. Linear mixed effect models and voxel-wise Pearson's correlations were used to assess exercise-induced changes and clinical relevance.

Results: Functional dysconnectivity significantly decreased (d = -2.73, P < 0.001), and this decrease was primarily linked to enhanced oligodendrocyte-related gene expression. Reductions in the default-mode network were correlated with improved global functioning, whereas changes in insular regions were associated with symptom severity and functioning. Dysconnectivity reductions in somatomotor and frontoparietal networks were correlated with total symptom improvements, and changes in language-related regions (e.g. Broca's area) were linked to cognitive benefits.

Conclusions: Our findings support the role of oligodendrocyte pathology in SSD and suggest that targeting dysconnectivity in the default-mode, salience and language networks may enhance global functioning, symptom severity and cognitive impairments.

Background: Singapore conducted its second nationwide mental health literacy survey in 2023, following the first survey in 2015.

Aims: This study aimed to ascertain the population's beliefs about the helpfulness of treatments for mental illnesses in Singapore, and assessed changes over an 8-year period.

Method: A nationally representative cohort (n = 4195, aged 18-67 years) was interviewed between September 2022 and February 2024, which replicated the methods of the 2015 survey (n = 3006, aged 18-65 years). Using a vignette-based approach, 3002 respondents rated the perceived helpfulness of 28 treatment options for alcohol abuse, dementia, depression, obsessive-compulsive disorder (OCD) and schizophrenia as either 'helpful' or 'harmful'. Weighted prevalence, stratified by vignettes and logistic regressions, were performed.

Results: Counselling was most frequently rated as being helpful for alcohol use disorder (94.0%) and depression (95.2%), while seeing a psychiatrist was most frequently rated helpful for schizophrenia (93.0%), dementia (85.1%) and OCD (91.6%). Across all vignettes, informal help sources, including family (80.8%) and friends (74.7%), were considered less helpful than mental health professionals, except for 'counselling over the phone' (58.8%) and 'seeing a general practitioner' (69.8%). Participants in 2023 were significantly more likely to endorse psychologists, counsellors and phone counselling as being helpful than in 2015. Face-to-face help was considered more helpful than over-the-phone professional help, highlighting the continued need for a personal touch in mental health services.

Conclusions: Overall, there has been an improvement in the perception of the helpfulness of mental health professionals, but targeted interventions to improve the perception of mental health services by general practitioners and institutions are essential.

Background: Trauma exposure has been associated with the development of psychotic disorders in adolescence and young adulthood. Trauma can compromise the sense of agency, a predictor of psychosis. Symptoms of post-traumatic stress disorder (PTSD) after trauma may also imply significant cognitive impairments that predispose young people to psychotic-like experiences (PLEs). This study investigates whether the two senses of agency subtypes - positive and negative agency, and PTSD symptoms mediated PLEs in youths after trauma.

Aims: The study aimed to explore the mediation of the sense of agency and post-traumatic stress symptoms in the development of psychotic-like experiences after trauma.

Method: Participants were Hong Kong youths aged 12 to 25 who completed surveys online from May 2022 to May 2024. Self-report sense of agency, PLEs and related distress, potentially traumatic life events and PTSD symptoms from 517 youths with a mean age of 20.22 and 72.0% female were analysed. 283 participants (54.7%) experienced at least one potentially traumatic event.

Results: A series of regression analyses revealed that a positive sense of agency mediated the effect of trauma on PLEs and related distress in the full sample. In the subgroup of 283 trauma-exposed youths, PTSD symptoms but not sense of agency mediated the effect of trauma on PLEs and related distress.

Conclusions: The presence of traumatic experiences can increase PLEs by reducing positive agency in community youths. Among trauma-exposed youths, the effect of various traumatic experiences on PLEs may be better explained by PTSD symptoms. Limitations of the study and future directions are discussed.

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.