bluuebunny/crossref_metadata_2025 huggingface dataset:
What Are the Precipitating Factors of Suicide in South Korea? A Systematic Review
Authors: Gasimzade Fatima , Edney Sian Marie , Kirov George
Published: August 2024

Aims

Today the problem of suicide remains one of the topical issues among Asian countries like South Korea. The primary objective of this Systematic Review (SR) was the identification of the risk factors in suicide attempts and completions in South Korea. South Korea has one of the highest reported suicide rates in the world, and there was no prior systematic review on this topic. The main intention was to provide evidence-based results for future research studies and to inform suicide prevention policies.

Methods

PubMed, Science Direct, and Medline databases were searched from 1990 to October 2022. Studies focused on the problem of suicide in South Korea were selected with an emphasis on risk factors. Since the rate of suicide rises with age, studies examining 18-year-olds and above were included. Studies examining people of different sociodemographic backgrounds and people diagnosed with psychiatric/psychological disorders and those who attempted suicide, as well as those without a psychiatric/psychological problem, were also included. To assess the overall quality of the included studies, the Critical Appraisal Skills Programme (CASP) checklist was applied for the evaluation of case-control and cohort studies. The National Institutes of Health (NIH) Quality Assessment Tool was implemented for the evaluation of cross-sectional studies. The Jadad Scale was used to assess the risk of bias. PRISMA reporting guidelines were followed.

Results

Ten studies met the eligibility criteria to be included in SR: Four cross-sectional, two cross-cultural, and four cohort studies. Risk of bias assessment demonstrated low quality and moderate risk of bias. The quality assessment showed an acceptable level of relevance and quality. Findings suggested factors leading to suicide in South Korea were mental health conditions, financial status, such as unemployment and low income, education level less than high school, and households with poor living conditions. The identified risk factors significantly increased the likelihood of suicide ideation, suicide attempt and suicide completion among people in South Korea. Stigma was identified as a barrier to those with mental health conditions seeking professional help.

Conclusion

The identified risk factors are similar across the world; however, the suicide rates are not as high in other Western cultures as they are in South Korea. Future studies could compare Western countries to hierarchical countries to identify if there are any local risk factors that can help guide local prevention policies and educational programs with city officials’ engagement. Moreover, it would be essential to investigate the impact of stigma thoroughly since it is still hard to clarify whether it is a cultural issue or a worldwide issue preventing individuals from getting professional help.
Longitudinal Trend Evaluation and Prescription Cost Analysis (PCA) of Clozapine in the United Kingdom
Authors: Gire Nadeem , Asif Atta , Husain Nusrat
Published: August 2024

Aims

Severe Mental Illnesses (SMI) are a group of disorders which can have a debilitating impact on an individual's daily life functioning. The National Institute for Health and Care Excellence (NICE) has set out clinical guidelines for the treatment of SMI including the use of Second Generation Antipsychotic (SGA) medication as well as psychological therapies. However, Treatment Resistant Schizophrenia (TRS) affects approximately 34% of patients with schizophrenia. Clozapine, a SGA, has shown superiority in treatment resistant schizophrenia as well as its potential benefits in reducing suicidality and improving functioning.

Methods

The following study aimed to examine the longitudinal trends in prescribing clozapine based on the NHS Digital prescription cost analysis (PCA) between 2015–2023.

Results

The results show that a number of prescriptions decrease simultaneously from the financial year 2015 (n = 5536) to 2023 (n = 3059). The cost was also found to be reducing until the financial year 2018–19 where there was an increase in costs which reached the maximum (14%) despite the number of prescriptions being lower as compared with 2015–16. In addition, it was found that clozapine prescribing trends have been reducing over time, despite a large proportion of service users with schizophrenia experiencing TRS (34%). Overall, since 2015–2023 a total of n = 34,440 items of clozapine were prescribed costing £1,252,052.27.

Conclusion

Considering clozapine's superior efficacy in the treatment of TRS, further research is required to better understand prescribing practices, monitoring compliance of clozapine and treatment adherence. Further qualitative research is needed to better understand the views and perspectives of both service users and prescribers in the clinical use of clozapine. Future research may also look at referrals of clozapine-prescribed patients to psychological services, the impact of clozapine in TRS patients who are offered psychological therapy, and the potential clinical and cost implications of not prescribing clozapine.
The Acceptability of Yoga as a Family Intervention: Using Family Journals as a Data Collection Tool
Authors: Graves Hayley , Merdian Hannah , Smith Sharron , Miller Kirsty
Published: August 2024

Aims

The number of children and young people across the UK experiencing mental health difficulties is rising, with 1 in 6 young people aged 6–16 with a diagnosable mental health condition.

The school environment can be a crucial setting for mental health promotion as it can reach such a large number of young people.

The application of mindfulness for wellbeing is becoming increasingly popular. Research demonstrates mindfulness is an effective treatment for many psychological conditions and adding a yoga element is thought to bring additional benefits.

Interventions focusing on wellbeing are found to demonstrate more consistent improvements when parents are involved, supporting the concept of a family intervention.

A 6 week family intervention was developed specifically for children, to promote overall wellbeing.

Aim:

1.

To ascertain the acceptability of yoga as a family intervention.

2.

To ascertain the acceptability of family journals as method to collect data.

Methods

•

6 weekly, 1hr, yoga and mindfulness intervention.

•

9 children aged 6–11, 9 adults.

•

A weekly family journal was used collect data.

•

Data from the journals were analysed using Thematic Analysis.

•

A Linear Numeric Scale was used pre and post intervention rating 1–5: asking the participants to rate their confidence in relation to breathing techniques, yoga, working as part of a group, and understanding mindfulness.

Results

1. Acceptability of yoga as a family intervention

Results from the pre post tests, indicate a significant relationship between the intervention and the participants.

Confidence in yoga P < 0.008 (mean pre test 1, post test 4).

Confidence with breathing P < 0.008 (mean pre test 3, post test 5).

Confidence with mindfulness P < 0.004 (mean pre test 1, post test 4).

Working as part of a group P < 0.004 (mean pre test 3, post test 5).

2. Acceptability of family journals as a method to collect data

The journals provided sufficient qualitative responses and meaningful quantitative data to consider the intervention acceptable. The weekly logs in the family journals were thematically analysed and four key themes were identified as having a positive impact: yoga, breathing techniques, mindfulness activities, improved connection.

Conclusion

This study has highlighted promising findings relating to yoga as a family intervention.

Families reported applying the techniques, outside of the sessions to manage emotions. The family journals were a space where adults had the freedom to choose what they wrote, this method allowed us to identify the intervention had a positive impact upon family connections. Using the journals was a simple way to capture the voices of the participants.
Developing a Framework for Examining and Improving Decision-Making in Complex Mental Health Systems
Authors: Nathan Rajan , Harris Dave
Published: August 2024

Aims

Whether focusing on clinical or non-clinical roles, activity within organizations (and, by extension, outcomes) depends on decision-making. The conscious experience of decision-making (as if it is the outcome of an objective and explicit appraisal of pertinent information) belies the complex nexus of influences on this process. Whilst extensive research has been undertaken on both organizational and clinical decision-making, these literatures have largely remained separate. The authors contend that, when account is taken not only of the interplay between decisions that are deemed either ‘organizational’ or ‘clinical’, but also that this dichotomy itself is invalid, there is an imperative to take a whole system approach to decision-making in health organizations.

The aim of this study was to develop a framework for understanding decision-making that has applicability across a complex mental health system.

Methods

•

Step 1: Define the domain of discourse (i.e. decision-making in a complex adaptive mental health system including clinical and non-clinical settings);

•

Step 2: Generate a dataset of domain-relevant statements by iterative reflection on the respective areas of practice (clinical and non-clinical);

•

Step 3: Thematically analyse the dataset to identify a thematic structure.

Results

A hierarchical thematic structure was identified. At the highest order, this structure comprises a dichotomy between embodied and disembodied conceptualizations. The embodied theme is further divisible by perspectives that are intra- or inter-personal. The former includes ways of thinking, assumptions, approximations, uncertainty, holding the model, and epistemic humility; and the latter includes relationships, trust/resentment, and disagreeing well. The disembodied theme incorporates both broad-brush characteristics of the system (such as holistic, connections, relata and complexity) and those characteristics with explanatory power (such as nonlinear, fuzziness and nondeterministic).

Conclusion

The framework defined by this analysis has the potential to facilitate the examination of facets of, and influences on, decision-making across a mental health organization. With further empirical testing and revision, such a framework can be used to inform the improvement of approaches to making decisions.
Behavioral Addictions Prevalence and Impact on Medical Sciences Students' Mental Health: A Systematic Review and Meta-Analysis
Authors: Mohammed Omer A. , Ibrahim Danya , Mohamed Shima Algam , Babikir Shaza K. , Zuhair Ayman
Published: August 2024

Aims

This study aims to illuminate the prevalence of various behavioral addictions among health professions students and examine their negative effects on mental health.

Methods

In March 2023, a systematic literature search was conducted, encompassing randomized controlled trials, cohort, case-control, and cross-sectional studies from the past five years in PubMed and ScienceDirect. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 19 papers underwent qualitative analysis, while 15 studies were subjected to quantitative analysis following a quality assessment review.

Results

The study included 9,994 health professions students, primarily in the field of medicine, aged between 18 and 23 years. The majority of the students were unmarried, females, and most were in clinical years. The prevalence of behavioral addiction was 36% (95% CI: 20–51), with smartphone addiction being the highest at 46%, followed by internet addiction (42%), social media disorder (22%), and gaming disorder (4%). Substantial heterogeneity was observed among the studies. A funnel plot analysis assessed the potential for publication bias, revealing no significant indication of bias. A significant difference was observed between the groups.

Conclusion

This study identifies five distinct forms of behavioral addictions influencing the mental health and daily activities of health professions students. The findings underscore the need for longitudinal and interventional studies to address this technological threat.
Admissions to the National Forensic Mental Health Service Anteceding and Succeeding Its Relocation: A Dundrum Forensic Redevelopment Evaluation Study (D-FOREST)
Authors: Iqbal Muhammad Umer , Umer Waqar M. , Kennedy Harry G , Davoren Mary
Published: August 2024

Aims

The Central Mental Hospital is the Republic of Ireland's only secure forensic hospital and the seat of its National Forensic Mental Health Service (NFMHS). We scrutinised admission patterns in the NFMHS during the period 01/01/2018–01/10/2023; before and after relocating from the historic 1850 site in Dundrum to a modern facility in Portrane on 13/11/2022.

Methods

This prospective longitudinal cohort study included all patients admitted during the above period. The study initially commenced in Dundrum and continued afterwards in Portrane. Data gathered included demographics, diagnoses, capacity to consent to treatment, and the need for intramuscular medication (IM) after admission. Therapeutic security needs and urgency of need for admission were collated from DUNDRUM-1 and DUNDRUM-2 scores rated pre-admission. Hours spent in seclusion during the first day, week, and month after admission were calculated. Data were collected as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST).

Results

There were 117 admissions during the 69-month period. The majority were male (n = 98). Most were admitted from prisons (87%). Schizophrenia was the most common diagnosis (55.8%). Mean DUNDRUM-1 triage security scores were in the medium-security range (2.84–3.15) during this period. At the time of admission, 53.8% required seclusion, 25.6% required IM medication, and 79.5% lacked capacity to consent to treatment. Those who required seclusion on admission had worse scores on the DUNDRUM-2 triage urgency scale (F = 20.9, p < 0.001). On linear logistic regression, the most parsimonious model resolved with five predictors of hours in seclusion during the first day and week, which were: D1 item 8 – Victim sensitivity/public confidence issues, D1 item 10 – Institutional behaviour, D2 item 2 – Mental health, D2 item 4 – Humanitarian, and D2 item 6 – Legal urgency. 50% required IM medication during their first week of admission and these patients had significantly worse scores on: D1 item 8 – Victim sensitivity/public confidence issues, D1 item 10 – Institutional behaviour, D2 item 2 – Mental health, and D2 item 4 – Humanitarian (all p < 0.05).

Conclusion

There was an increase in the frequency of admissions since relocating to Portrane. The results suggest that there was no change in overall triage security and urgency needs during the time period in question. Major mental illness related factors impacted the need for seclusion early in the admission, whereas factors linked to prison behaviour or personality-related factors were more associated with an ongoing need for seclusion at month one.
Ketamine Efficacy Across All Formulations in Treatment Resistant Depression in Adult Population: A Rapid Review
Authors: Jaiswal Bikramaditya , Singh Neha , Benjamin Benson
Published: August 2024

Aims

The primary aim of this rapid review was to evaluate the evidence base for the efficacy of ketamine across all formulations and routes of administrations in the treatment of adult patients with treatment resistant depression (TRD).

Methods

This rapid review retrieved controlled trials on use of ketamine across all of its formulations, including all isomers and across all routes of administration in TRD patients for achieving response and remission. This review included PubMed and PsycINFO databases. The retrieved studies were screened with the help of a screening tool and data were extracted by using data extraction forms by two authors. The studies were evaluated for quality of evidence, ethical issues and critically analyzed. Narrative synthesis was used for data synthesis.

Results

This review retrieved 10 placebo controlled randomized controlled trials (RCT) on intravenous (IV) ketamine, IV esketamine, intranasal (IN) ketamine and IN esketamine in TRD patients. IV ketamine and esketamine showed higher rates of remission and response in comparison with placebo groups in TRD patients. There was no significant improvement in response and remission rates in TRD patients on IN esketamine in comparison with placebo. The adverse effects in the intervention groups were of mild to moderate severity and short lasting mostly resolving within a day.

Conclusion

This review recommends IV ketamine and esketamine can help in achieving early response and remission in TRD patients and it seems to be a well-tolerated treatment option. Further studies are needed to assess these issues around safety, ease of administration and potential for dependence.
Vitamin-D Deficiency & Depression: Is There an Association? Average Data From Gulf Cooperation Council Countries
Authors: Wanigaratne Shamil , Ahamd Amar , Al Anouti Fatme , Al Balushi Mitha , Javaid Syed
Published: August 2024

Aims

The evidence for the association between vitamin-D deficiency and depression, although equivocal, has been established in several populations in different countries and supported by meta-analytical studies1. Much of the evidence for this comes from Western countries2. Similarly, the evidence for the benefits of supplementation, although shown, also comes from similar populations and is equivocal3. Need for data from different populations and for randomized controlled trials to establish causality is stressed by most researchers. This study aims for presentation reviews of the association between vitamin-D and depression in the GCC, using the publicly available data of Our World in Data.

Methods

The statistical analysis used median prevalence depressive disorders data (from 1990–2019) in the GCC countries (both sex and age-standardized (%)), which was downloaded from Our World in Data and was last updated on August 28, 2022. Vitamin D deficiency data were collected through a literature review search using PubMed and Google Scholar. A linear regression model was performed with the median prevalence of depressive disorders data as an outcome. The prevalence of vitamin-D deficiency, population median age and the interaction term between prevalence of vitamin-D deficiency and population median age were used as predictors. The effects of prevalence of depressive disorders both sex age standardized (AS) percentage (%) were estimated with 95% confidence interval (95% CI) using bootstrap covariance matrix estimator. Fitted model's likelihood ratio chi-square (LR χ2) test with corresponding p-value was computed and reported.

Results

A positive association was observed between the median prevalence of depressive disorders and the prevalence of vitamin-D deficiency, adjusted for population median age, were observed (LR χ2 p-value = 0.005) and adjusted R2 = 0.706.

Conclusion

Prevalence of depressive disorders was associated with prevalence of vitamin D deficiency among the population of GCC countries. Future randomized control trials on Vitamin D supplementation are needed to confirm these observations.
Rapid Review: Ascertaining the Type of Potentially Life-Threatening Cardiovascular Events and Eventual Cardiovascular Mortality From Antipsychotic Use in Clinical Practice
Authors: Lee Reagan , Han Oscar , Wang Jingjing
Published: August 2024

Aims

According to the World Health Organization (WHO), there has been a 13% increase in mental health and substance abuse disorders within the last decade. Typical and atypical antipsychotics are the most common treatment mechanisms for mental health-related disorders such as schizophrenia, depression with psychotic symptoms and bipolar disorders. However, antipsychotic usage is associated with more than a 50% increase in CVD such as ischaemic heart disease, resulting in cardiovascular-related mortality.

This review aims to investigate the most common type of cardiovascular event causing mortality due to antipsychotic use.

Methods

A systematic search within PubMed and Medline was conducted on 3 October 2023. Selection criteria were limited to English, full-text studies excluding case reports. The time frame selected was up to 3 October 2023. All studies included adults only. Interventions of focus include typical and atypical antipsychotics licensed in the UK. Outcome measures include cardiovascular mortality/events post-antipsychotic prescription.

Results

13 studies were included out of 1088 records. Studies originated from 4 nations with the most studies coming from the USA (n = 7), UK (n = 2), Taiwan (n = 2) and Canada (n = 2).

The most common antipsychotic reported in the records was risperidone (n = 11), followed by haloperidol (n = 9), olanzapine (n = 8) and quetiapine (n = 8).

From data extraction, the most common cardiovascular events leading to death were sudden cardiac death/arrest (n = 6), ventricular arrhythmias (n = 6), myocardial infarction (n = 4), and heart failure (n = 2).

Due to data heterogeneity, discrete outcome measures were extracted from each record. This included outcomes measuring: relative risk between various groups (n = 9), rate of cardiovascular event per 100 patient year (n = 3), and mortality post cardiovascular event (n = 1).

Conclusion

From this study, ventricular arrhythmias and sudden cardiac deaths were the most common cardiovascular events secondary to antipsychotic use leading to mortality. Owing to patient safety and benefits, patients with psychotic illness are unable to go untreated. They are consequently very vulnerable to the cardiovascular side effects of prescribed high-dose antipsychotic drugs. Despite current monitoring guidelines worldwide, cardiovascular-associated mortality in patients on antipsychotics is still elevated. This may indicate the potential inadequacy of current measures for these patients while demonstrating the need for more aggressive cardioprotective interventions and monitoring.
Neural Correlates of Disgust Processing in Childhood Maltreatment and Peer Victimisation
Authors: Lim Lena
Published: August 2024

Aims

Childhood maltreatment (CM) and peer victimisation (PV) are common sources of early-life interpersonal stress. CM is associated with atypical fronto-limbic emotion processing and regulation, and increased vulnerability for self-harm/suicide. However, few studies have compared the neurofunctional correlates between caregiver-inflicted versus peer-inflicted mistreatment. We compared the alterations of neurofunctional correlates of facial emotion processing in young people exposed to CM or PV and explored their associations with self-harm.

Methods

fMRI data were collected from 114 age- and gender-matched youths (39 CM, 37 PV and 38 controls) during an emotion discrimination task. Region-of-interest (amygdala, insula) and whole-brain analyses were conducted.

Results

Groups differed significantly during processing of disgust only. Both CM and PV groups had lower activation in right amygdala and bilateral posterior insula than controls, where the left insular underactivation was furthermore related to increased self-harm in maltreated youths. At the whole-brain level, both CM and PV groups also had underactivation compared with controls in a cluster of bilateral limbic-thalamic-striatal, precuneus/posterior cingulate, temporal, fusiform/lingual and cerebellar regions, which was negatively associated with emotional problems in controls, as well as a cluster of somatosensory regions associated with increased self-harm in maltreated youths.

Conclusion

Early-life interpersonal stress from caregivers or peers is associated with common underactivation of limbic-thalamic-striatal, precuneus/posterior cingulate and somatosensory regions during disgust processing. The hypoactivation of key emotion and sensory processing and self-referential brain regions could be a potential suppressive mechanism to cope with the aversive emotion; however, it may also entail increased risk of affective psychopathology in seemingly healthy youths.
Metabolic Syndrome, Sleep Quality and Lung Function in Persons With Schizophrenia: A Cross-Sectional Study
Authors: M Dinesh , Kataria Dinesh , Mondal Sunita , Prasad Shiv , Rehman Sajjadur
Published: August 2024

Aims

Persons with schizophrenia typically have a 20% shorter lifespan and mortality rates two times higher than the general population. More than 2/3 of this is due to different forms of physical diseases, like cardiovascular and metabolic syndrome. Systematic meta-analyses and various studies in schizophrenic patients revealed the prevalence of metabolic syndrome to range from 11 to 69%, poor sleep quality 30% to 80%, and impaired lung function ~30%. Both in the general population and in persons with schizophrenia, poor sleep quality and impaired lung function are associated with a heightened risk of metabolic and cardiovascular diseases. Hence, this study aimed to look for the magnitude of metabolic syndrome, poor sleep quality, and impaired lung function, and any association among them, if proven, may be helpful in better management.

Methods

We included sixty cooperative patients through purposive sampling with an age range of 18 to 65 years, meeting the DSM–5 criteria for schizophrenia, and excluded patients with co-morbid substance use disorder except for smokeless tobacco and caffeine. Harmonized criteria were used to diagnose metabolic syndrome; the Pittsburgh Sleep Quality Index (PSQI) for sleep quality and lung function was interpreted as per the Spirometry for Health Care Providers, Global Initiative for Chronic Obstructive Lung Disease.

Results

55% were found to have metabolic syndrome. Poor sleep quality (PSQI > 5) was found in 60% of cases, with the most common sleep abnormality being increased sleep latency (95%). Restrictive Lung Dysfunction (RLD) was found in 46.7% of cases. 66.7% of the participants with metabolic syndrome had RLD, whereas only 22.2% without metabolic syndrome had RLD. The difference was statistically significant. No statistically significant difference was found between metabolic syndrome and sleep quality or sleep quality and RLD.

Conclusion

From the results obtained, it is clear that the prevalence of metabolic syndrome in people with schizophrenia is twice that of the general population, which also contributes to their increased mortality. Thereby, early identification of metabolic disturbances and correcting poor sleep quality and impaired lung function that are associated with an increased risk of metabolic syndrome will lead to increased life expectancy and a decrease in the mortality rate. Since lung function is studied in only a very few studies all over the world and ours being a novel approach in India showing significant association, it needs to be replicated in a larger sample size.
Management of Benzodiazepine Use in Youth and Young Adults: A Scoping Review
Authors: Kakamousias Nia , Miller Laura , Etches Selene , MacInnis Melanie
Published: August 2024

Aims

Benzodiazepines are commonly used medications that have the potential for dependence and use disorder. Despite these harms, they are regularly prescribed and acquired from non-prescription sources. It has been established that benzodiazepine use is a widespread problem in youth and young adults. Little evidence exists to guide management of benzodiazepine use in this population. This scoping review aims to gather literature on the management of benzodiazepine use and identify the gaps in the literature to guide further research, particularly in youth and young adults.

Methods

Methodology followed the Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews guidelines. MEDLINE (Ovid), Embase, Cochrane, and Cumulated Index to Nursing and Allied Health Literature (CINAHL) were searched, together with a search of the grey literature. A survey of experts in the field of addiction medicine was completed. Broad inclusion criteria were used to capture any available literature. Data were compiled using Covidence software, and two independent reviewers screened titles, abstracts, and full texts against the eligibility criteria. Data were extracted using a modified JBI data charting table. Descriptive statistics and a simple thematic analysis were performed to summarize the data collected.

Results

Of the 835 papers retrieved, 104 papers published from December 1982 to March 2023 were included in the final review. Two of the papers included in this review pertained to youth and young adults. The rest of the papers were based on the adult population. Gradual dose reduction is the only method with evidence for efficacy in youth. Several therapies show efficacy in adults and could be future areas of research in youth, including benzodiazepine maintenance therapy, carbamazepine, gabapentin, pregabalin, trazodone, flumazenil slow infusion, and buprenorphine in various clinical contexts. Valproic acid, agomelatine, tricyclic antidepressants, paroxetine, buspirone, progesterone, cyamemazine, magnesium aspartate, clonidine, lithium, hydroxyzine, chlorpromazine, alpidem, captodiame, and ondansetron were deemed ineffective, unsafe in youth, or were not available for use in Canada. Topiramate, lamotrigine, oxcarbamazepine, phenobarbital, propranolol, baclofen, mirtazapine, and nicotinic acid had preliminary, low-quality evidence in adults, and would require further study.

Conclusion

Benzodiazapine use disorder in youth is dangerous and common, and the lack of pharmacotherapeutic options has been deemed significant by our research team. The results of this review are promising in that they provide some further guidance on the management of this condition.
Comparison of the Legal Infrastructure Governing Psychiatric Practice and Its Implementation in Tanzania and the UK
Authors: Morgan Jessica
Published: August 2024

Aims

To examine the legal framework governing psychiatric practice, specifically focusing on the Mental Health Act, within a singular psychiatric centre in Moshi, Tanzania. The primary objective was to explore the intersection of culture and legalities in shaping ethical practice within this emerging unit. Drawing on a comparative analysis of contents and the implementation of the MHA in Tanzania and in the UK, the study aims to understand the ways in which cultural contexts influence the legal and ethical dimensions of psychiatric care.

Methods

This was a multi-method study that combined literature analysis, structured interviewing, and structured reflective practice.

1.

Direct comparison of the UK and Tanzanian MHA.

2.

Evaluation of clinician understanding of the MHA through structured interviewing of clinicians with respect to their knowledge of the MHA, its existence, and its key components.

3.

Analysis of implementation of the MHA in liaison psychiatry in both centers. Compared through unstructured interviewing and reflective practice.

Results

1.

The most striking difference is the length of the documents. The Tanzanian MHA is 27 pages while the UK MHA is 173. This additional length covers: Admission and Discharge Procedures, explanation of the Roles and Powers of Professionals, and further discussion on Safeguards and Rights of Individuals.

2.

When interviewed, only 15% of Tanzanian physicians could explain what the MHA is, compared with 100% of UK physicians (N = 40).

3.

In the UK, all doctors use the MHA and implement DOLS. In Tanzania, this falls under the role of liaison psychiatrists. This is likely because, the MHA is included in the UK's medical curricula but not in Tanzania's.

Conclusion

Lack of understanding of the MHA and other key laws in psychiatry is a global issue, not limited to the UK or Tanzania. However, physicians with strong understanding are more scarce in Tanzania. This scarcity puts additional pressures on psychiatric services, as psychiatrists are called to assess issues of capacity or consent that could be assessed by any doctors in the UK. However, this means that the MHA and MCA are almost solely used by psychiatrists and therefore often assessed to a very high standard. It must be considered that on reflection, I have also observed physicians with limited understanding of the MHA, capacity and consent within the NHS. Imposing a higher standard on another culture would be unethical. Efforts into educating medical students and professionals is required in the UK and Tanzania.
Association Between Problematic Online Gaming and Subsequent Psychotic Experiences in Adolescents: A Birth Cohort Study
Authors: Narita Zui , Yamasaki Syudo , Yamaguchi Satoshi , Ando Shuntaro , Nishida Atsushi
Published: August 2024

Aims

There is still little information available on the negative impact of online activities on psychotic experiences. This limitation is further compounded for online gaming, where even a beneficial impact has been suggested via the evocation of positive emotions. We aimed to examine how problematic online gaming (POG) is associated with subsequent psychotic experiences in adolescents.

Methods

This birth cohort study employed randomly sampled adolescents born between September 2002 and August 2004. The eligibility criterion was those who did not have psychotic experiences at age 14. We analyzed the association between POG at age 14 and subsequent psychotic experiences at age 16. Adolescents were categorized into the no, low, and high POG groups based on the behaviors and emotions related to online gaming at age 14. Missing data were handled using random forest imputations.

Results

A total of 1722 adolescents without psychotic experiences at age 14 were analyzed. At age 16, 55 adolescents exhibited psychotic experiences, while 225 showed potential psychotic experiences. Compared with the no POG group, a higher risk of psychotic experiences was shown in both the low (RR 1.93, 95% CI 1.74–2.15) and high (RR 2.81, 95% CI 2.50–3.15) POG groups. Findings were consistent when analyzing potential psychotic experiences.

Conclusion

POG appears detrimental to the development of psychotic experiences in adolescents. Our findings provide public health implications in the context of policymaking.
The Gut-Brain Connection: Do Gut Bacteria Play a Role in the Development of Dementia? A Systematic Review
Authors: Pokharel Prakriti
Published: August 2024

Aims

Dementia is a debilitating disease with multiple potential causes, no cure and rising incidence. New studies suggest that gut bacteria not only aid in the digestion of bowel products but also other bodily functions such as immune systems and relaying messages to the brain. This review aims to examine the potential link between gut microbiota and dementia by performing a systematic review to assess whether gut bacteria play a role in the development of dementia.

Methods

The systematic review was designed and conducted according to PRISMA guidelines. A modified PICO model was used to perform a literature search in Medline, CINAHL PLUS and APA PsychInfo databases. The search identified 401 articles, 49 of which met the predefined inclusion criteria. Twenty-one final studies were included in the results; 14 cross-sectional, two cohort, three case-control, one randomised control study and one case report. The reviewer extracted and analysed data from these studies for quality using the AXIS and CASP tools. A narrative synthesis of the results was performed due to the heterogeneity of the data.

Results

Individuals with dementia have lower microbial diversity than healthy controls, including changes in specific bacterial taxa, pro-inflammatory and anti-inflammatory balance. The results of the review were subdivided into four identified themes which helped further identify that microbial metabolites, diet and gastrointestinal disease can also influence the composition of gut microbiomes and, therefore, the development of cognitive impairment and dementia.

Conclusion

This systematic review found a link between gut bacteria, bacterial metabolites, gastrointestinal health, diet, and dementia. Although the studies were mostly observational, they suggest that gut microbiota can affect brain function through dysbiosis, which can lead to neuroinflammation and dementia. More research is needed to confirm a causal relationship, but targeting the gut microbiota could be a potential therapy for MCI and AD. Innovative strategies may help combat the growing challenge of dementia.
Understanding the Pro-Ana Subculture: Illness, Sickness or Choice
Authors: Popoola Iyinoluwa
Published: August 2024

Aims

This digital ethnographic study explores the varying perceptions of anorexia within the pro-anorexia (pro-ana) subculture by utilizing Professor Marinker's framework of disease, illness, and sickness to qualitatively analyse how individuals within this community interpret anorexia as a personal experience, a societal role, or a deliberate choice.

Methods

This study examines insights from the pro-ana community, obtained through pro-ana spaces on social media platforms and dedicated pro-ana online forums contributing to understanding their viewpoints on anorexia. Drawing from established literature on anorexia nervosa and the pro-ana subculture, this study employs a qualitative analysis of online pro-ana spaces, examining discussions, narratives, and beliefs shared within these communities. The study also integrates historical perspectives, cultural critiques, and psychological theories to offer a comprehensive understanding.

Results

The pro-ana subculture presents diverse perspectives on anorexia, challenging traditional definitions of illness and sickness. Some individuals view anorexia positively, perceiving it as a means of discipline and self-improvement. Cultural and historical influences, including the feminine expectation, the normalization of the disordered eating habits of the ‘gym bro', and societal beauty standards, further shape perceptions within the pro-ana community. There is some debate on how the media influences the proliferation of eating disorders and the evolving definitions of anorexia – including the introduction of atypical anorexia. There is also an ascetic spirituality associated with anorexia, which can be seen as a matter of faith or delusion.

Conclusion

The concept of anorexia within the pro-ana subculture challenges traditional definitions of illness, sickness, and choice. This study highlights the cultural, historical, and gendered dimensions influencing these perspectives. Understanding this complex interplay can inform mental health professionals, educators, and policymakers about the potential risks posed by pro-ana communities. It emphasizes the importance of preventive measures, media responsibility, and a nuanced approach to engaging with individuals influenced by the pro-ana subculture. Recognizing the multifaceted nature of anorexia within this community is crucial for developing effective interventions and support strategies for patients with anorexia who engage with the online pro-ana community.
Determinants of Physical Health Outcomes in Individuals With Schizophrenia, Schizoaffective Disorder, and Bipolar Affective Disorder
Authors: Rubinsztein Ella , Kendall Kimberley
Published: August 2024

Aims

Individuals with schizophrenia, schizoaffective disorder, and bipolar affective disorder have higher rates of cardiometabolic disease and have a reduced life expectancy compared with healthy controls. These mental health conditions are highly heritable and neurodevelopmental copy number variants (CNVs) are known to increase the risk of these disorders. Neurodevelopmental CNVs have also been associated with a range of cardiometabolic disorders. The aim of this research was to examine the relationship between neurodevelopmental CNVs and cardiometabolic disease in individuals with schizophrenia, schizoaffective disorder, and bipolar disorder.

Methods

Using data from the UK Biobank, a group of individuals with schizophrenia, schizoaffective disorder and bipolar affective disorder was defined (n = 2,611) based on first-occurrence data. CNVs had previously been called using PennCNV and a set of 53 neurodevelopmental loci annotated. I carried out association analyses between neurodevelopmental CNVs and cardiometabolic disease phenotypes using logistic regression with age and sex as covariates.

Results

There was a higher frequency of ischaemic heart disease, hypertension, obesity, and type 2 diabetes mellitus in individuals with schizophrenia, schizoaffective disorder and bipolar disorder than in controls. 2.1% of individuals with these mental health conditions carried a neurodevelopmental CNV. Carrying a neurodevelopmental CNV was significantly associated with type 2 diabetes mellitus (OR = 1.94, 95% CI 1.09–3.57, p = 0.025). However, this result did not survive Bonferroni correction for four tests (p value threshold 0.0125). I did not find any mediators of the neurodevelopmental CNV – type 2 diabetes mellitus association (of obesity, hypertension, cognition, smoking and socioeconomic status).

Conclusion

The relationship between neurodevelopmental CNVs and type 2 diabetes mellitus should be examined in independent samples.
Does an Association Exist Between Food Insecurity and Eating Disorder Symptoms Among Young People Living in England?
Authors: Sampson Katie , Memory Katherine , Fazel Mina , Moran Paul , Bould Helen
Published: August 2024

Aims

Food insecurity, defined as lacking regular access to nutritious food due to financial hardship, is associated with a range of adverse developmental outcomes for children and adolescents. Emerging evidence suggests food insecurity in adults may be associated with disordered eating behaviours, including binge eating and unhealthy weight control strategies. However, the nature of this relationship in adolescents remains unclear. This study aimed to investigate whether an association exists between food insecurity and eating disorder symptomatology in a large and diverse sample of adolescents living in England.

Methods

Cross-sectional data were collected from 34,730 young people in school years 7 to 13 (aged 11 to 18) in classrooms across England, as part of the OxWell 2023 Student Survey. Eating Disorder symptomatology was measured, on a scale of 0 to 6, with five self-report screening questions from the Eating Disorder Section of the Development and Well-Being Assessment (DAWBA) and one additional question on meal skipping due to shape/weight concerns. Food insecurity was measured, on a scale of 0 to 6, with three questions adapted from the Wales Young People's Survey on Child & Family Poverty 2019. A complete case analysis was conducted using Stata, v18. Regression analyses were performed to test for associations between food insecurity and eating disorder symptomatology, stratified by gender and adjusting for age and ethnicity.

Results

12,571 (36.2%) participants were excluded due to missing data in key study variables. Our final sample comprised 22,159 adolescents with a mean age of 13.8 years (50.8% female, 54.4% white ethnicity). 63.6% of participants reported experiencing at least one eating disorder symptom and 45.7% scored ≥2 on the DAWBA screening items, a more stringent cut-off for possible eating disorder. Food insecurity was found to be a significant predictor of eating disorder symptomatology in participants of all genders (female: β 0.54, 95% CI 0.48–0.60, p < 0.001, male: β 0.40, 95% CI 0.36–0.44, p < 0.001, other: β 0.52, 95% CI 0.43–0.61, p < 0.001). The association was particularly marked amongst those reporting purging behaviours (OR 1.62, 95% CI 1.55–1.69, p < 0.001).

Conclusion

In keeping with previous research, our findings indicate that adolescents experiencing food insecurity exhibit increased rates of eating disorder symptomatology. Further research is needed to explore potential mechanisms behind this association, as well as to develop effective intervention strategies. Our study adds to a body of evidence identifying a high-risk and disenfranchised group of young people who may benefit from targeted support.
The Role of Cognitive Behavioural Therapy, Family Therapy and Psychopharmacological Interventions in Internet Gaming Disorder: A Systematic Review
Authors: Rajan Sathyan Soundara , Uppal Gaurav , Kansal Khushboo , Okafor Ugo , Dhandapani Asha
Published: August 2024

Aims

Internet gaming disorder (IGD) is a recognised mental health condition characterised by impulsive gaming, where gaming takes precedence over all other activities and negatively impacts the life of a person. IGD has an estimated prevalence of 2–5% of all mental health disorders. Limited research exists on the treatment effects of various therapeutic interventions for gaming disorder, highlighting the need for comprehensive investigations of evidence-based approaches and to improve intervention strategies.

This systematic review aims to identify most of the intervention studies on internet gaming disorder using a control group, to determine the effect of the interventions and to examine moderators for these interventions.

Methods

We reviewed available treatment interventions for children and adolescents. A search on Pubmed central, PsycINFO, Embase, MEDLINE, Cochrane, CINAHL and Google Scholar Library was conducted. Various interventions, whether individual or group-based, incorporate Cognitive Behavioural Therapy (CBT), family therapy and pharmacological treatments for gaming disorder and these were selected for this review among all the other interventions examined. Some exclusively use CBT, while others combine it with different treatments. This includes both online and in-person CBT, encompassing behavioural including limited exposure and cognitive elements.

The comprehensive search resulted in 113 studies from 2018–2023 and we ended up with 25 studies by excluding studies according to the exclusion criteria.

Results

This systematic review identified a total of 113 studies, of which 25 studies were finally selected and were included. It examined interventions for internet gaming disorder (IGD). Cognitive Behavioural Therapy (CBT), Family Therapy, and Psychopharmacological treatments were assessed across diverse studies.

Findings indicate significant improvements post-intervention, with CBT and family therapy showing promising results in reducing IGD symptoms. Pharmacotherapy combined with psychotherapy emerged as the most effective treatment option. The study underscores the need for multifaceted approaches in addressing IGD, contributing valuable insights for future treatment strategies.

Conclusion

The review highlights promising outcomes for Internet Gaming Disorder interventions, with Cognitive Behavioural Therapy and Family Therapy demonstrating effectiveness. Combining pharmacotherapy with psychotherapy is most beneficial, emphasising the importance of comprehensive treatments needed for IGDs.