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Journal Cover British Journal of Psychiatry
  [SJR: 2.674]   [H-I: 178]   [168 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 0007-1250 - ISSN (Online) 1472-1465
   Published by Royal College of Psychiatrists Homepage  [3 journals]
  • Highlights of this issue [Highlights of this issue]
    • Authors: Dean; K.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.A15
      Issue No: Vol. 211, No. 4 (2017)
  • Prolonged, but not complicated, grief is a mental disorder [EDITORIALS]
    • Authors: Maciejewski, P. K; Prigerson, H. G.
      Pages: 189 - 191
      Abstract: The DSM and ICD have taken steps to introduce a grief disorder as a new diagnostic entity. Evidence justifies the inclusion of prolonged grief disorder, but not complicated grief, as a new mental disorder.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.116.196238
      Issue No: Vol. 211, No. 4 (2017)
  • The Hunger Games: a portrayal of PTSD in teenage fiction - psychiatry in
           literature [Extras]
    • Authors: Ghoshal, N; Wilkinson, P. O.
      Pages: 191 - 191
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.199414
      Issue No: Vol. 211, No. 4 (2017)
  • Implementing magnetic resonance imaging into clinical routine screening in
           patients with psychosis' [EDITORIALS]
    • Authors: Borgwardt, S; Schmidt, A.
      Pages: 192 - 193
      Abstract: In this issue, Falkenberg et al explore the practicability of magnetic resonance imaging (MRI) as part of the initial clinical assessment in patients with first-episode psychosis and the prevalence, nature and clinical significance of radiological abnormalities in these patients. They provide evidence for the use of MRI data to detect gross brain abnormalities. In addition, improvements in quantitative analyses makes MRI an indispensable tool to elucidate the neurobiological substrates that might underlie primary (or idiopathic) psychotic illness.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.199919
      Issue No: Vol. 211, No. 4 (2017)
  • Improving life expectancy in people with serious mental illness: should we
           place more emphasis on primary prevention' [Analysis]
    • Authors: Ilyas, A; Chesney, E, Patel, R.
      Pages: 194 - 197
      Abstract: People with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. One approach to address this is regular physical health monitoring. However, physical health monitoring is poorly implemented in everyday clinical practice and there is little evidence to suggest that it improves physical health. We argue that greater emphasis should be placed on primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.203240
      Issue No: Vol. 211, No. 4 (2017)
  • Treatment of depression in schizophrenia: systematic review and
           meta-analysis [Review articles]
    • Authors: Gregory, A; Mallikarjun, P, Upthegrove, R.
      Pages: 198 - 204
      Abstract: BackgroundDepression in schizophrenia predicts poor outcomes, including suicide, yet the effectiveness of antidepressants for its treatment remains uncertain.AimsTo synthesise the evidence of the effectiveness of antidepressants for the treatment of depression in schizophrenia.MethodMultiple databases were searched and inclusion criteria included participants aged over 18 years with schizophrenia or related psychosis with a depressive episode. Papers were quality assessed used the Cochrane risk bias tool. Meta-analyses were performed for risk difference and standardised mean difference of all antidepressants, antidepressant class and individual antidepressant where sufficient studies allowed.ResultsA total of 26 moderate- to low-quality trials met inclusion criteria. In meta-analysis a significant risk difference was found in favour of antidepressant treatment, with a number needed to treat of 5 (95% CI 4–9). Studies using tools specifically designed to assess depression in schizophrenia showed a larger effect size. However, after sensitivity analysis standardised mean difference of all antidepressants did not show a statistically significant improvement in depression score at end-point, neither did any individual antidepressant class.ConclusionsAntidepressants may be effective for the treatment of depression in schizophrenia, however, the evidence is mixed and conclusions must be qualified by the small number of low- or moderate-quality studies. Further sufficiently powered, high-quality studies are needed.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.116.190520
      Issue No: Vol. 211, No. 4 (2017)
  • Petrichor - poems by doctors [Extras]
    • Authors: Racey; D.
      Pages: 204 - 204
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.204461
      Issue No: Vol. 211, No. 4 (2017)
  • Systematic review and meta-analysis of factors that help or hinder
           treatment decision-making capacity in psychosis [Review articles]
    • Authors: Larkin, A; Hutton, P.
      Pages: 205 - 215
      Abstract: BackgroundThe evidence on factors that may influence treatment decisional capacity (‘capacity’) in psychosis has yet to be comprehensively synthesised, which limits the development of effective strategies to improve or support it.AimsTo determine the direction, magnitude and reliability of the relationship between capacity in psychosis and a range of clinical, demographic and treatment-related factors, thus providing a thorough synthesis of current knowledge.MethodWe conducted a systematic review, meta-analytical and narrative synthesis of factors that help or hinder treatment decision-making capacity in psychosis, assessing the direction, magnitude, significance and reliability of reported associations.ResultsWe identified 23 relevant studies (n = l823). Psychotic symptoms had small, moderate and strong associations with appreciation, understanding and reasoning respectively. Both verbal cognitive functioning and duration of education had small to moderate correlations with understanding and reasoning. Better capacity was also associated with better insight, better metacognitive ability, higher anxiety and lower perceived coercion. No linear relationship with depression was observed. Interventions linked to improved capacity over time were in-patient care, information simplification, shared decision-making and metacognitive training.ConclusionsAlthough much is known about the role of symptoms and other clinical variables, effective and acceptable psychological interventions to support capacity in this group are lacking.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.116.193458
      Issue No: Vol. 211, No. 4 (2017)
  • Autobiographical memory: a candidate latent vulnerability mechanism for
           psychiatric disorder following childhood maltreatment [PAPERS]
    • Authors: McCrory, E. J; Puetz, V. B, Maguire, E. A, Mechelli, A, Palmer, A, Gerin, M. I, Kelly, P. A, Koutoufa, I, Viding, E.
      Pages: 216 - 222
      Abstract: BackgroundAltered autobiographical memory (ABM) functioning has been implicated in the pathogenesis of depression and post-traumatic stress disorder and may represent one mechanism by which childhood maltreatment elevates psychiatric risk.AimsTo investigate the impact of childhood maltreatment on ABM functioning.MethodThirty-four children with documented maltreatment and 33 matched controls recalled specific ABMs in response to emotionally valenced cue words during functional magnetic resonance imaging.ResultsChildren with maltreatment experience showed reduced hippocampal and increased middle temporal and parahippocampal activation during positive ABM recall compared with peers. During negative ABM recall they exhibited increased amygdala activation, and greater amygdala connectivity with the salience network.ConclusionsChildhood maltreatment is associated with altered ABM functioning, specifically reduced activation in areas encoding specification of positive memories, and greater activation of the salience network for negative memories. This pattern may confer latent vulnerability to future depression and post-traumatic stress disorder.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.201798
      Issue No: Vol. 211, No. 4 (2017)
  • Childhood cognitive development in 22q11.2 deletion syndrome: case-control
           study [PAPERS]
    • Authors: Chawner, S. J. R. A; Doherty, J. L, Moss, H, Niarchou, M, Walters, J. T. R, Owen, M. J, van den Bree, M. B. M.
      Pages: 223 - 230
      Abstract: Background22q11.2 deletion syndrome (22q11.2DS) is associated with a high risk of childhood as well as adult psychiatric disorders, in particular schizophrenia. Childhood cognitive deterioration in 22q11.2DS has previously been reported, but only in studies lacking a control sample.AimsTo compare cognitive trajectories in children with 22q11.2DS and unaffected control siblings.MethodA longitudinal study of neurocognitive functioning (IQ, executive function, processing speed and attention) was conducted in children with 22q11.2DS (n = 75, mean age time 1 (T1) 9.9, time 2 (T2) 12.5) and control siblings (n = 33, mean age T1 10.6, T2 13.4).ResultsChildren with 22q11.2DS exhibited deficits in all cognitive domains. However, mean scores did not indicate deterioration. When individual trajectories were examined, some participants showed significant decline over time, but the prevalence was similar for 22q11.2DS and control siblings. Findings are more likely to reflect normal developmental fluctuation than a 22q11.2DS-specific abnormality.ConclusionsChildhood cognitive deterioration is not associated with 22q11.2DS. Contrary to previous suggestions, we believe it is premature to recommend repeated monitoring of cognitive function for identifying individual children with 22q11.2DS at high risk of developing schizophrenia.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.116.195651
      Issue No: Vol. 211, No. 4 (2017)
  • Clinical utility of magnetic resonance imaging in first-episode psychosis
    • Authors: Falkenberg, I; Benetti, S, Raffin, M, Wuyts, P, Pettersson-Yeo, W, Dazzan, P, Morgan, K. D, Murray, R. M, Marques, T. R, David, A. S, Jarosz, J, Simmons, A, Williams, S, McGuire, P.
      Pages: 231 - 237
      Abstract: BackgroundThere is no consensus as to whether magnetic resonance imaging (MRI) should be used as part of the initial clinical evaluation of patients with first-episode psychosis (FEP).Aims(a) To assess the logistical feasibility of routine MRI; (b) to define the clinical significance of radiological abnormalities in patients with FEP.MethodRadiological reports from MRI scans of two FEP samples were reviewed; one comprised 108 patients and 98 healthy controls recruited to a research study and the other comprised 241 patients scanned at initial clinical presentation plus 66 healthy controls.ResultsIn the great majority of patients, MRI was logistically feasible. Radiological abnormalities were reported in 6% of the research sample and in 15% of the clinical sample (odds ratio (OR)=3.1, 95% CI 1.26–7.57, 2(1) = 6.63, P = 0.01). None of the findings necessitated a change in clinical management.ConclusionsRates of neuroradiological abnormalities in FEP are likely to be underestimated in research samples that often exclude patients with organic abnormalities. However, the majority of findings do not require intervention.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.116.195834
      Issue No: Vol. 211, No. 4 (2017)
  • When unbearable suffering incites psychiatric patients to request
           euthanasia: qualitative study [PAPERS]
    • Authors: Verhofstadt, M; Thienpont, L, Peters, G.-J. Y.
      Pages: 238 - 245
      Abstract: BackgroundThe concept of ‘unbearable suffering’ is central to legislation governing whether euthanasia requests may be granted, but remains insufficiently understood, especially in relation to psychiatric patients.AimsTo provide insights into the suffering experiences of psychiatric patients who have made a request for euthanasia.MethodTestimonials from 26 psychiatric patients who requested euthanasia were analysed using QualiCoder software.ResultsFive domains of suffering were identified: medical, intrapersonal, interpersonal, societal and existential. Hopelessness was confirmed to be an important contributor. The lengthy process of applying for euthanasia was a cause of suffering and added to experienced hopelessness, whereas encountering physicians who took requests seriously could offer new perspectives on treatment.ConclusionsThe development of measurement instruments to assess the nature and extent of suffering as experienced by psychiatric patients could help both patients and physicians to better navigate the complicated and sensitive process of evaluating requests in a humane and competent way. Some correlates of suffering (such as low income) indicate the need for a broad medical, societal and political debate on how to reduce the burden of financial and socioeconomic difficulties and inequalities in order to reduce patients' desire for euthanasia. Euthanasia should never be seen (or used) as a means of resolving societal failures.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.199331
      Issue No: Vol. 211, No. 4 (2017)
  • Invited commentary on ... When unbearable suffering incites psychiatric
           patients to request euthanasia: a qualitative study [Invited Commentaries]
    • Authors: Pearce; S.
      Pages: 246 - 247
      Abstract: Although the paper in this issue by Verhofstadt et al sheds some light on the features of unbearable suffering stemming from psychiatric disorder leading to a request for euthanasia, this is limited. The bulk of the paper illustrates the particular ethical challenges posed by the policy of making euthanasia available in these circumstances.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.199687
      Issue No: Vol. 211, No. 4 (2017)
  • Invited commentary on ... When unbearable suffering incites psychiatric
           patients to request euthanasia [Invited Commentaries]
    • Authors: Kelly; B. D.
      Pages: 248 - 249
      Abstract: Euthanasia is available in Belgium and Luxembourg for untreatable and unbearable suffering resulting from ‘physical and/or psychological suffering that cannot be alleviated and results from a serious and incurable disease, caused by accident or illness’. Verhofstadt et al's valuable analysis of testimonials from psychiatric patients requesting euthanasia demonstrates that elements of this suffering might well be alleviated. We should not kill our patients.
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.199695
      Issue No: Vol. 211, No. 4 (2017)
  • Magnetic resonance imaging in first-episode psychosis [Correspondence]
    • Pages: 250 - 250
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.250
      Issue No: Vol. 211, No. 4 (2017)
  • Authors' reply [Correspondence]
    • Pages: 250 - 250
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.250a
      Issue No: Vol. 211, No. 4 (2017)
  • Hallucinations in BPD: more prevalent than community sample study
           suggests' [Correspondence]
    • Pages: 250 - 251
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.250b
      Issue No: Vol. 211, No. 4 (2017)
  • Author's reply [Correspondence]
    • Pages: 251 - 251
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.251
      Issue No: Vol. 211, No. 4 (2017)
  • Observing our psychiatric practice [Correspondence]
    • Pages: 252 - 252
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.252
      Issue No: Vol. 211, No. 4 (2017)
  • Correction [Correction]
    • Pages: 252 - 252
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.252a
      Issue No: Vol. 211, No. 4 (2017)
  • Losing Touch: A Man Without his Body [Book reviews]
    • Pages: 253 - 253
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.203406
      Issue No: Vol. 211, No. 4 (2017)
  • Mentored by a Madman: The William Borroughs Experiment [Book reviews]
    • Pages: 253 - 254
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.bp.117.202838
      Issue No: Vol. 211, No. 4 (2017)
  • Kaleidoscope [Kaleidoscope]
    • Authors: Tracy, D. K; Joyce, D. W, Shergill, S. S.
      Pages: 256 - 257
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.256
      Issue No: Vol. 211, No. 4 (2017)
  • Ethical and empowering communications: preventing death, disability and
           failed expectations [From the Editor's desk]
    • Authors: Bhui; K.
      Pages: 258 - 258
      PubDate: 2017-10-02T00:05:18-07:00
      DOI: 10.1192/bjp.211.4.258
      Issue No: Vol. 211, No. 4 (2017)
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