Green care in psychiatry.

Engagement with natural environments is associated with improved health and well-being in the general population. This has implications for mental healthcare. Implementation of targeted nature-based interventions (green care) meets recovery needs and would enable research to develop, clarifying what works best for whom.

Temperature-related deaths in people with psychosis, dementia and substance misuse.

BACKGROUND: Climate change is expected to have significant effects on human health, partly through an increase in extreme events such as heatwaves. People with mental illness may be at particular risk. AIMS: To estimate risk conferred by high ambient temperature on patients with psychosis, dementia and substance misuse. METHOD: We applied time-series regression analysis to data from a nationally representative primary care cohort study. Relative risk of death per 1°C increase in temperature was calculated above a threshold. RESULTS: Patients with mental illness showed an overall increase in risk of death of 4.9% (95% CI 2.0-7.8) per 1°C increase in temperature above the 93rd percentile of the annual temperature distribution. Younger patients and those with a primary diagnosis of substance misuse demonstrated greatest mortality risk. CONCLUSIONS: The increased risk of death during hot weather in patients with psychosis, dementia and substance misuse has implications for public health strategies during heatwaves.

Using electronic patient records to assess the impact of swine flu (influenza H1N1) on mental health patients.

BACKGROUND: Electronic patient records are increasingly used in primary care research, but rarely in psychiatric research. Little is known about how people with pre-existing mental illness respond to public health threats. AIMS: To outline the swine flu related concerns and behaviours of mental health patients and to determine whether marked concern was associated with any specific demographic or diagnostic groups. METHODS: We searched a database containing electronic patient records from a large mental health trust for references to swine flu made between 15 April and 15 July 2009. Thematic analysis was used to code swine flu related concerns and behaviours. A case-control approach sought to determine whether there were demographic or diagnostic associations with expressing moderate/severe concern about swine flu. RESULTS: A range of swine flu related behaviours were noted and considerable impact was recorded for some patients. Children and patients with neurotic and somatoform disorders were over-represented amongst those expressing moderate/severe swine flu concerns. CONCLUSION: Research databases using electronic clinical records are a useful way to track responses to emerging public health threats. Children receiving mental health care and patients with neurotic and somatoform disorders may be particularly psychologically vulnerable to infectious disease epidemics.

The Readiness of Psychiatrists to Implement Psychedelic-Assisted Psychotherapy.

Introduction: Psychedelic-assisted psychotherapy is a promising approach in psychiatry; evidence is growing and it may not be long before mainstream services are expected to offer it to selected patients. This pilot study examined the attitudes and knowledge of NHS psychiatrists of all levels towards psychedelic-assisted psychotherapy and explored potential barriers and facilitators to its implementation. Methods: A mixed-methods approach was adopted, using a cross-sectional survey and focus groups. All psychiatrists in one NHS mental health trust were approached by email to participate. The survey was analysed using a simple descriptive approach and thematic analysis was used for the focus groups. Results: Eighty-three (25.7%) psychiatrists participated in the survey. All psychiatrists were familiar with one or more psychedelic substances. Although 77.2% felt that there should be a role for controlled or therapeutic use of psychedelics, trainees appeared better informed than non-training grade psychiatrists. Psychiatrists of all grades did not feel prepared to participate in the delivery of psychedelic-assisted psychotherapy. Thematic analysis of the focus groups identified three main themes in relation to psychedelic-assisted psychotherapy: "need for knowledge," "openness to change," and "uncertainty." Discussion: NHS psychiatrists are positive about the potential for psychedelic-assisted therapy to advance psychiatric practise. However, psychiatrists are lacking in confidence or preparedness to implement this treatment should it become a mainstream option and significant training needs were identified. Thematic analysis highlighted the need for societal shifts as well as professional ones.

Inflammatory bowel disease psychological support pilot reduces inflammatory bowel disease symptoms and improves psychological wellbeing.

This prospective service evaluation aimed to determine if integrated psychological support for patients with inflammatory bowel disease (IBD) enhanced outcomes. 75 patients were assessed and treated by a specialist liaison psychiatric service between 2015 and 2017; 43 received psychiatric intervention alone, 32 were referred for psychological intervention by clinical health psychologist; 26 completed this. Pre-post data (n=15 available) included global impression, quality of life, and psychiatric and IBD symptom scores. Referrer/patient satisfaction and cost-effectiveness were retrospectively calculated. Psychological intervention led to reductions in IBD symptoms (ΔSIBD; p=0.003), alongside improvements in depression scores (ΔPHQ-9, p=0.006) and global impression (ΔCGI; p=0.046). Patient/referrer satisfaction was very high. Indicative data comparing service utilisation 1 year before and after engagement found reductions in outpatient appointments and in imaging. This small study suggests consideration of increased access to integrated psychological support services to improve outcomes and gather further evidence of efficacy.

Frequency and predictors of mass psychogenic illness.

BACKGROUND: Mass psychogenic illness refers to outbreaks of illness attributed to a toxic agent but for which no plausible organic cause is found. We determined the frequency and predictors of mass psychogenic illness within a sample of chemical incidents. METHODS: Information was collected on a random sample of 280 chemical incidents. We developed consensus operational criteria for mass psychogenic illness and estimated its frequency. We then assessed environmental, emergency, and health service indicators for their association with mass psychogenic illness. RESULTS: Nineteen "chemical incidents" were probable episodes of mass psychogenic illness. This represented 16% of incidents for which people reported symptoms and 7% of all incidents. Odor was a robust predictor of mass psychogenic illness. These illnesses were especially likely to occur in schools or healthcare facilities. CONCLUSIONS: A substantial minority of chemical incidents may be mass psychogenic illness.

A functional magnetic resonance imaging study of inhibitory control in obsessive-compulsive disorder.

People with obsessive-compulsive disorder (OCD) have abnormalities in cognitive and motor inhibition, and it has been proposed that these are related to dysfunction of fronto-striatal circuits. However, nobody has investigated neuro-functional abnormalities during a range of inhibition tasks in adults with OCD. The aims of the study were to compare brain activation of people with OCD and controls during three tasks of inhibitory control. Ten unmedicated adults with OCD and 11 healthy controls performed three different tasks of motor and cognitive inhibitory control during event-related functional magnetic resonance imaging: a Go/No-go task (motor inhibition), a motor Stroop task (interference inhibition) and a Switch task (cognitive flexibility). People with OCD displayed significantly different patterns of brain activation compared to controls during all three tasks. During the Go/No-go and Switch experiments, people with OCD had underactivation in task-relevant orbitofrontal/dorsolateral prefrontal, striatal and thalamic regions. During the motor Stroop and Switch tasks, people with OCD also displayed underactivation in temporo-parietal areas. In the Go/No-go and motor Stroop tasks the OCD group showed increased activation compared to controls in cerebellum and predominantly posterior brain regions. OCD is associated with task-relevant fronto-striatal dysfunction during motor inhibition and cognitive switching. In addition, parieto-temporal dysfunction was observed during tasks with a higher attentional load.

Air Pollution and Suicide in 10 Cities in Northeast Asia: A Time-Stratified Case-Crossover Analysis.

BACKGROUND: There is growing evidence suggesting an association between air pollution and suicide. However, previous findings varied depending on the type of air pollutant and study location. OBJECTIVES: We examined the association between air pollutants and suicide in 10 large cities in South Korea, Japan, and Taiwan. METHODS: We used a two-stage meta-analysis. First, we conducted a time-stratified case-crossover analysis to estimate the short-term association between nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter [aerodynamic diameter ≤10µm (PM10), aerodynamic diameter ≤2.5µm (PM2.5), and PM10­2.5] and suicide, adjusted for weather factors, day-of-week, long-term time trends, and season. Then, we conducted a meta-analysis to combine the city-specific effect estimates for NO2, SO2, and PM10 across 10 cities and for PM2.5 and PM10­2.5 across 3 cities. We first fitted single-pollutant models, followed by two-pollutant models to examine the robustness of the associations. RESULTS: Higher risk of suicide was associated with higher levels of NO2, SO2, PM10, and PM10­2.5 over multiple days. The combined relative risks (RRs) were 1.019 for NO2 (95% confidence interval [CI]: 0.999, 1.039), 1.020 for SO2 (95% CI: 1.005, 1.036), 1.016 for PM10 (95% CI: 1.004, 1.029), and 1.019 for PM10­2.5 (95% CI: 1.005, 1.033) per interquartile range (IQR) increase in the 0-1 d average level of each pollutant. We found no evidence of an association for PM2.5. Some of the associations, particularly for SO2 and NO2, were attenuated after adjusting for a second pollutant. CONCLUSIONS: Our findings suggest that higher levels of air pollution may be associated with suicide, and further research is merited to understand the underlying mechanisms. https://doi.org/10.1289/EHP2223.

In vivo 1H-magnetic resonance spectroscopy study of amygdala-hippocampal and parietal regions in autism.

OBJECTIVE: The neural basis for autistic spectrum disorders is unclear, but abnormalities in the development of limbic areas and of glutamate have been suggested. Proton magnetic resonance spectroscopy ((1)H-MRS) can be used to measure the concentration of brain metabolites. However, the concentration of glutamate/glutamine in brain regions implicated in autistic spectrum disorders has not yet been examined in vivo. METHOD: The authors used (1)H-MRS to investigate the neuronal integrity of the amygdala-hippocampal complex and a parietal control region in adults with autistic spectrum disorders and healthy subjects. RESULTS: People with autistic spectrum disorders had a significantly higher concentration of glutamate/glutamine and creatine/phosphocreatine in the amygdala-hippocampal region but not in the parietal region. CONCLUSIONS: Abnormalities in glutamate/glutamine may partially underpin the pathophysiology of autistic spectrum disorders, and the authors confirm earlier reports that limbic areas are metabolically aberrant in these disorders.

Psychosocial responses to environmental incidents: a review and a proposed typology.

OBJECTIVE: The objective of this review was to propose a typology for understanding the diversity of psychosocial reactions to environmental incidents. METHODOLOGY: The first section provides an introduction and background to the topic; we then attempt to provide a typology of psychosocial responses to environmental incidents. RESULTS: Response to an environmental incident can be usefully considered in terms of the exposure, the response of the individual, the action of professionals, the response of the community, and the influence of the society in which the incident occurs. We reviewed each of these factors. CONCLUSIONS: By examining incidents in an ordered framework, we suggest that a more comprehensive understanding is possible. We also suggest some basic ways in which the psychosocial management of such difficult and diverse incidents could be improved.

Relationship between daily suicide counts and temperature in England and Wales.

BACKGROUND: Seasonal fluctuation in suicide has been observed in many populations. High temperature may contribute to this, but the effect of short-term fluctuations in temperature on suicide rates has not been studied. AIMS: To assess the relationship between daily temperature and daily suicide counts in England and Wales between 1 January 1993 and 31 December 2003 and to establish whether heatwaves are associated with increased mortality from suicide. METHOD: Time-series regression analysis was used to explore and quantify the relationship between daily suicide counts and daily temperature. The impact of two heatwaves on suicide was estimated. RESULTS: No spring or summer peak in suicide was found. Above 18 degrees C, each 1 degrees C increase in mean temperature was associated with a 3.8 and 5.0% rise in suicide and violent suicide respectively. Suicide increased by 46.9% during the 1995 heatwave, whereas no change was seen during the 2003 heat wave. CONCLUSIONS: There is increased risk of suicide during hot weather.