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British Journal of Psychiatry
Journal Prestige (SJR): 2.844
Citation Impact (citeScore): 3
Number of Followers: 240  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0007-1250 - ISSN (Online) 1472-1465
Published by Cambridge University Press Homepage  [386 journals]
  • BJP volume 216 issue 2 Cover and Front matter
    • PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.271
      Issue No: Vol. 216, No. 2 (2020)
  • BJP volume 216 issue 2 Cover and Back matter
    • PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.272
      Issue No: Vol. 216, No. 2 (2020)
  • Why we need to take personality disorder out of the doghouse
    • Authors: Peter Tyrer
      Pages: 65 - 66
      Abstract: The diagnosis of personality disorder is sometimes tolerated but often reviled as a label to attach to people we do not like. This is hardly surprising when we consider that problems in interpersonal relationships constitute the main feature of the disorder. But we cannot escape the fact that personality problems are extremely common and rejection on grounds of perceived undesirability is doltish. Both the DSM-5 (2013) alternative model and new ICD-11 classification of personality may help understanding as they are more in tune with science. Most of the previous classifications have failed to help practitioners or patients.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.125
      Issue No: Vol. 216, No. 2 (2020)
  • Food for thought: bringing eating disorders out of the shadows
    • Authors: Dasha Nicholls; Anne Becker
      Pages: 67 - 68
      Abstract: Eating disorders are prevalent, potentially lethal, and treatable, yet remain underprioritised within clinical care, research and policy. Further, with rising public health focus on obesity, there is heightened risk for inadvertent exacerbation of disordered eating and further marginalisation of these serious mental disorders. This editorial calls for corrective action.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.179
      Issue No: Vol. 216, No. 2 (2020)
  • The prevalence of personality disorders in the community: a global
           systematic review and meta-analysis
    • Authors: Catherine Winsper; Ayten Bilgin, Andrew Thompson, Steven Marwaha, Andrew M. Chanen, Swaran P. Singh, Ariel Wang, Vivek Furtado
      Pages: 69 - 78
      Abstract: BackgroundPersonality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders.AimsTo calculate the worldwide prevalence of personality disorders and examine whether rates vary between high-income countries and low- and middle-income countries (LMICs).MethodWe systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from January 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094).ResultsA total of 46 studies (from 21 different countries spanning 6 continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8% (95% CI 6.1–9.5). Rates were greater in high-income countries (9.6%, 95% CI 7.9–11.3%) compared with LMICs (4.3%, 95% CI 2.6–6.1%). In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage v. one-stage assessment), county income (high-income countries v. LMICs) and interview administration (clinician v. trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of cluster A, B and C personality disorders were 3.8% (95% CI 3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%).ConclusionsPersonality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.166
      Issue No: Vol. 216, No. 2 (2020)
  • Day hospital versus intensive out-patient mentalisation-based treatment
           for borderline personality disorder: multicentre randomised clinical trial
    • Authors: Maaike L. Smits; Dine J. Feenstra, Hester V. Eeren, Dawn L. Bales, Elisabeth M. P. Laurenssen, Matthijs Blankers, Mirjam B. J. Soons, Jack J. M. Dekker, Zwaan Lucas, Roel Verheul, Patrick Luyten
      Pages: 79 - 84
      Abstract: BackgroundTwo types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.AimsTo compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.MethodIn a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.ResultsSignificant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.ConclusionsAlthough MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.9
      Issue No: Vol. 216, No. 2 (2020)
  • The role of prenatal stress as a pathway to personality disorder:
           longitudinal birth cohort study
    • Authors: Ross Brannigan; Antti Tanskanen, Matti O. Huttunen, Mary Cannon, Finbarr P. Leacy, Mary C. Clarke
      Pages: 85 - 89
      Abstract: BackgroundMany studies have reported associations between prenatal stress and the development of psychotic, anxiety and depressive disorders; however, to date no studies have investigated potential associations with personality disorders.AimsThis study investigated potential associations between exposure to prenatal stress and personality disorder in offspring.MethodIn a subsample (N = 3626) of a large Finnish birth cohort, we used logistic regression models to examine associations between self-reported maternal stress during pregnancy, collected monthly during antenatal clinic appointments, and personality disorder in offspring. Familial and outcome information were obtained by linking data from the Finnish Hospital Discharge Register and the Finnish Population Register.ResultsCompared with those unexposed, children exposed to any maternal stress during gestation had three times the odds of developing a personality disorder (odds ratio 3.28, 95% CI 1.75–6.15, P < 0.0001). Those exposed to moderate stress had three times the odds (odds ratio 3.13, 95% CI 1.42–6.88, P = 0.005) and those exposed to severe stress had seven times the odds (odds ratio 7.02, 95% CI 2.08–23.66, P = 0.002) of developing a personality disorder. These associations remained after adjusting for parental psychiatric history, comorbid psychiatric diagnoses, prenatal smoking and antenatal depression.ConclusionsExposure to stress during gestation increases the odds of personality disorder in offspring, independent of other psychiatric disorders. These results suggest the assessment of maternal stress and well-being during pregnancy may be useful in identifying those at greatest risk of developing personality disorder, and highlight the importance of prenatal care for good maternal mental health during pregnancy.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.190
      Issue No: Vol. 216, No. 2 (2020)
  • Eighteen-year trajectories of depressive symptoms in mothers with a
           lifetime eating disorder: findings from the ALSPAC cohort
    • Authors: Yu Wei Chua; Gemma Lewis, Abigail Easter, Glyn Lewis, Francesca Solmi
      Pages: 90 - 96
      Abstract: BackgroundTwo longitudinal studies have shown that depressive symptoms in women with eating disorders might improve in the antenatal and early postnatal periods. No study has followed up women beyond 8 months postnatal.AimsTo investigate long-term trajectories of depressive symptoms in mothers with lifetime self-reported eating disorders.MethodUsing data from the Avon Longitudinal Study of Parents and Children and multilevel growth curves we modelled trajectories of depressive symptoms from the 18th week of pregnancy to 18 years postnatal in women with lifetime self-reported anorexia nervosa, bulimia nervosa or both anorexia and bulimia nervosa. As sensitivity analyses we also investigated these trajectories using quintiles of a continuous measure of body image in pregnancy.ResultsOf the 9276 women in our main sample, 126 (1.4%) reported a lifetime diagnosis of anorexia nervosa, 153 (1.6%) of bulimia nervosa and 60 (0.6%) of both anorexia and bulimia nervosa. Women with lifetime eating disorders had greater depressive symptoms scores than women with no eating disorders, before and after adjustment for confounders (anorexia nervosa: 2.10, 95% CI 1.36–2.83; bulimia nervosa: 2.28, 95% CI: 1.61–2.94, both anorexia and bulimia nervosa: 2.86, 95% CI 1.81–3.90). We also observed a dose–response association between greater body image and eating concerns in pregnancy and more severe trajectories of depressive symptoms, even after adjusting for lifetime eating disorders which also remained independently associated with greater depressive symptoms.ConclusionsWomen with eating disorders experience persistently greater depressive symptoms across the life-course. More training for practitioners and midwives on how to recognise eating disorders in pregnancy could help to identify depressive symptoms and reduce the long-term burden of disease resulting from this comorbidity.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.89
      Issue No: Vol. 216, No. 2 (2020)
  • Anorexia nervosa: 30-year outcome
    • Authors: Sandra Rydberg Dobrescu; Lisa Dinkler, Carina Gillberg, Maria Råstam, Christopher Gillberg, Elisabet Wentz
      Pages: 97 - 104
      Abstract: BackgroundLittle is known about the long-term outcome of anorexia nervosa.AimsTo study the 30-year outcome of adolescent-onset anorexia nervosa.MethodAll 4291 individuals born in 1970 and attending eighth grade in 1985 in Gothenburg, Sweden were screened for anorexia nervosa. A total of 24 individuals (age cohort for anorexia nervosa) were pooled with 27 individuals with anorexia nervosa (identified through community screening) who were born in 1969 and 1971–1974. The 51 individuals with anorexia nervosa and 51 school- and gender-matched controls were followed prospectively and examined at mean ages of 16, 21, 24, 32 and 44. Psychiatric disorders, health-related quality of life and general outcome were assessed.ResultsAt the 30-year follow-up 96% of participants agreed to participate. There was no mortality. Of the participants, 19% had an eating disorder diagnosis (6% anorexia nervosa, 2% binge-eating disorder, 11% other specified feeding or eating disorder); 38% had other psychiatric diagnoses; and 64% had full eating disorder symptom recovery, i.e. free of all eating disorder criteria for 6 consecutive months. During the elapsed 30 years, participants had an eating disorder for 10 years, on average, and 23% did not receive psychiatric treatment. Good outcome was predicted by later age at onset among individuals with adolescent-onset anorexia nervosa and premorbid perfectionism.ConclusionsThis long-term follow-up study reflects the course of adolescent-onset anorexia nervosa and has shown a favourable outcome regarding mortality and full symptom recovery. However, one in five had a chronic eating disorder.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.113
      Issue No: Vol. 216, No. 2 (2020)
  • Shining the light on eating disorders, incidence, prognosis and profiling
           of patients in primary and secondary care: national data linkage study
    • Authors: Joanne C. Demmler; Sinead T. Brophy, Amanda Marchant, Ann John, Jacinta O. A. Tan
      Pages: 105 - 112
      Abstract: BackgroundDiagnosing eating disorders can be difficult and few people with the disorder receive specialist services despite the associated high morbidity and mortality.AimsTo examine the burden of eating disorders in the population in terms of incidence, comorbidities and survival.MethodWe used linked electronic health records from general practitioner and hospital admissions in Wales, UK within the Secure Anonymised Information Linkage (SAIL) databank to investigate the incidence of new eating disorder diagnoses. We examined the frequency of comorbid diagnoses and prescribed medications in cases and controls in the 2 years before and 3 years after diagnosis, and performed a survival analysis.ResultsA total of 15 558 people were diagnosed with eating disorders between 1990 and 2017. The incidence peaked at 24 per 100 000 people in 2003/04. People with eating disorders showed higher levels of other mental disorders (odds ratio 4.32, 95% CI 4.01–4.66) and external causes of morbidity and mortality (odds ratio 2.92, 95% CI 2.44–3.50). They had greater prescription of central nervous system drugs (odds ratio 3.15, 95% CI 2.97–3.33), gastrointestinal drugs (odds ratio 2.61, 95% CI 2.45–2.79) and dietetic drugs (odds ratio 2.42, 95% CI 2.24–2.62) before diagnosis. These excess diagnoses and prescriptions remained 3 years after diagnosis. Mortality was raised compared with controls for some eating disorders, particularly in females with anorexia nervosa.ConclusionsIncidence of diagnosed eating disorders is relatively low in the population but there is a major longer term burden in morbidity and mortality to the individual.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.153
      Issue No: Vol. 216, No. 2 (2020)
  • A state of mind – Poem
    • Authors: Jack Wellington
      Pages: 112 - 112
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.257
      Issue No: Vol. 216, No. 2 (2020)
  • A longitudinal study of eating behaviours in childhood and later eating
           disorder behaviours and diagnoses
    • Authors: Moritz Herle; Bianca De Stavola, Christopher Hübel, Mohamed Abdulkadir, Diana Santos Ferreira, Ruth J. F. Loos, Rachel Bryant-Waugh, Cynthia M. Bulik, Nadia Micali
      Pages: 113 - 119
      Abstract: BackgroundEating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.AimsWe investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.MethodData on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3–9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.ResultsChildhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).ConclusionsOur results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.174
      Issue No: Vol. 216, No. 2 (2020)
  • Electroconvulsive therapy effectiveness and harm
    • Authors: Marco Chiesa
      Pages: 120 - 120
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.227
      Issue No: Vol. 216, No. 2 (2020)
  • Author's reply
    • Authors: Derek Tracy
      Pages: 120 - 120
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.228
      Issue No: Vol. 216, No. 2 (2020)
  • The+Hidden+Psychiatry+of+the+Old+Testament+By+George+Stein.+Hamilton+Books+(Rowman+&+Littlefield).+2018.+610+pp.+£42.95+(pb).+ISBN+9780761870470&rft.title=British+Journal+of+Psychiatry&rft.issn=0007-1250&">The Hidden Psychiatry of the Old Testament By George Stein. Hamilton Books
           (Rowman & Littlefield). 2018. 610 pp. £42.95 (pb). ISBN 9780761870470
    • Authors: Stuart Hannabuss
      Pages: 121 - 121
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.210
      Issue No: Vol. 216, No. 2 (2020)
  • Kaleidoscope
    • Authors: Derek K. Tracy; Dan W. Joyce, Dawn N. Albertson, Sukhwinder S. Shergill
      Pages: 123 - 124
      PubDate: 2020-02-01T00:00:00.000Z
      DOI: 10.1192/bjp.2019.274
      Issue No: Vol. 216, No. 2 (2020)
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