Characterisation of General Adult Psychiatry (GAP) Inpatients
Hira Ahmad, David Hayward, Donald MacIntyre, Douglas SteeleAims:
GAP is the largest psychiatric specialty, but most treatment evidence is generated in other populations, or excludes participants with severe conditions, comorbidities and treatment-resistance–essentially omitting most GAP inpatients. Consequently, the published evidence may have limited relevance.
Aimswere to characteriseGAP inpatients–diagnoses, severity, treatment-resistance, comorbidities, and legal status–to benchmark and inform the development of a framework to meta-analyse publications to test how accurately they reflect real-world practice.
Methods:
We characterised consecutive admissions to a GAP ward using the measures usually employed in psychiatric publications. Data included demographics, Brief Psychiatric Rating Scale (BPRS), Inventory of Depressive Symptomatology (IDS-SR), Personality Disorder Severity (PDS-ICD-11), Generalised Anxiety Disorder scale (GAD-7), Substance Use scale (TAPS), and medical abnormalities and comorbidities.
Results:
N=65 (‘GAP-65’, 11 declined/could not be consented). Psychosis Group N=32: 60% treatment-resistant (clozapine protocol), severe psychosis (BPRS mean 58.2), very severe depression (IDS-SR mean 39.4), smoking, alcohol, and cardiometabolic disease frequent. Bipolar Mania Group N=5: Severe mania (YMRS mean 39.6), 60% obese, 50% hypertensive, and frequent metabolic abnormalities (DM II, prolactin elevation). Bipolar Depression Group N=2: All treatment-resistant (Massachusetts General Hospital Staging), 50% DM II and hypertensive. Unipolar Depression Group N=9: Very severe depression (IDS-SR mean 50.6), 57.1% treatment-resistant, 38% obese, 71% hypertensive, and high rates of cardiometabolic and respiratory illness. Axis II Group N=15: 80% PD, 93.3% suicidal ideation, physical comorbidities less common but mean BMI 30.2.
Conclusion:
When these features are operationalised, an extremely low proportion of GAP inpatients would meet criteria for recruitment into even exemplars of contemporary academic psychiatry e.g. 1) translational neuroscience; Rupprechter et al., Brain (2020) (£4.7M, N=475)–92% participants were in the healthy or mild depression range and treatment-resistant patients were excluded c.f. GAP-65 who were all severely ill and mostly treatment-resistant. 2) treatment trials; Jog et al., JAMA Netw Open (2025) (highlighted by evidencealerts.com, including for clinical relevance)–participants were in the moderate depression range, treatment-resistant patients were excluded, and the reduction in depression scores following transcranial direct current stimulation would not move pertinent GAP-65 patients out of the severe range of illness.
Our results highlight a critical gap in psychiatric research: Studies that are highly cited and influential do not adequately represent the severity and complexity of typical GAP inpatients. Correspondingly, we propose a systematic review and meta-analysis of clinically important features of GAP inpatients to evaluate the extent to which psychiatric research represents real-world practice.