Roger Mulder

Summary: Broad-spectrum micronutrients (BSM) are shown to improve mental health in randomised controlled trials. Robust positive effects are reported for emotional regulation, irritability and aggression. The effect sizes are modest, but comparable to cognitive–behavioural therapy and antidepressants. It is time to consider BSM as an informed choice when treating psychological distress.

Objective: There are relatively few papers addressing the challenges faced in the care of people with Borderline Personality Disorder in healthcare systems. We therefore present a clinical perspective on multidisciplinary team management of Borderline Personality Disorder. Conclusions: Borderline Personality Disorder has historically attracted significant stigma, partly due to negative, inaccurate beliefs regarding prognosis. Unique challenges may be encountered treating this condition, which, if not appropriately recognised and managed, contribute to and perpetuate stigma and poor outcomes. Potential challenges that may arise for multidisciplinary team care include splitting of teams, negative emotional contagion, fragmentation of care, patient re-traumatisation, frequent admissions, medicalisation, and de-medicalisation of Borderline Personality Disorder. We describe these challenges to facilitate multidisciplinary team discussions that promote greater awareness and better management for the benefit of patients and clinicians.

ICD-11 classification of personality disorder: there is no other way forward

Objective: Psychotherapy is the mainstay of treatment for Borderline Personality Disorder. There are unique benefits for patients through psychotherapy, however there are also complications that are under-recognised and have not been neatly summarised for clinicians and trainees. We present a clinical perspective on the potential complications that may arise from treatment. Conclusions: Addressing complications is an essential part of high quality and ethical clinical practice. Potential complications of psychotherapy for Borderline Personality Disorder include: escalation of Non-Suicidal Self-Injury (NSSI) and suicidal behaviours, dependency, boundary violations, demoralisation, re-traumatisation, labelling, opportunity cost, and financial issues. Recognition and management of these complications may improve treatment and recovery for patients, and is essential to high quality psychotherapy training and peer review. Further research is needed on the broader challenges and complications associated with non-psychotherapeutic aspects of BPD management.

A brief critique of the pseudo-diagnosis ‘complex emotional needs’: commentary, Tyrer and Mulder

Summary: Recent changes in US government priorities have serious negative implications for science that will compromise the integrity of mental health research, which focuses on vulnerable populations. Therefore, as editors of mental science journals and custodians of the academic record, we confirm with conviction our collective commitment to communicating the truth.

Objective: To examine trends in adolescent mental health presentations to Christchurch Emergency Department (ED) and contribute to the limited data on long-term trends in adolescent mental health within New Zealand. Method: A retrospective observational study of mental health presentations by adolescents aged 10–17 years to the Christchurch ED over 2007–2022. Data on patient demographics, rates of frequent presenters (≥5 presentations in a calendar year) and hospital admissions were analysed using simple descriptive statistics. Results: Rates of adolescent mental health ED presentations increased by 289% over 16 years, while rates of adolescent all-cause ED presentations increased by 9.8%. Female presentations increased over five-fold while male rates nearly doubled. Rates of medical hospital admissions increased by 70% and numbers of frequent presenters increased from 0 in 2007 to a peak of 19 in 2022. Conclusion: There has been a significant increase in adolescent mental health ED presentations over the study period. Demographic trends – including higher presentation rates for females and Māori – are consistent with those observed in the Youth2000 survey series. Ongoing monitoring of adolescent mental health ED presentation rates will be an important way of assessing the efficacy of any changes to the mental health system.

Summary: An overview of changes in the classification of personality disorders from ICD-10 to ICD-11 is presented. The new classification incorporates a dimensional approach centred on severity with five domains available to describe personality pathology. The potential clinical utility of the new approach is discussed.

This editorial highlights increasing prevalence and treatment rates of apparently disparate disorders. We ask whether cross-disorder factors including greater mental health literacy, social media and a shift to psychiatric explanations for distress contribute to these trends. We highlight a consequence: the changing doctor–patient relationship and its impacts.