Racial microaggressions occur when subtle or often automatic exchanges of aversive and covert racism are directed towards people identifying as racialized groups. Consequently, affecting individuals' mental and physical health. Healthcare professionals are a vulnerable group to the effects of racial microaggressions, given the high prevalence of burnout. The aim of the review was to explore healthcare professionals and students' experience of racial microaggressions in healthcare settings

A PROSPERO registered scoping review was conducted using the PRISMA extension for scoping review guidelines. The literature search was undertaken in August 2020, of five databases, MEDLINE, EMBASE, CINAHL, PsycINFO, EMCARE and we also searched the ‘grey literature.’ Studies featuring primary data on racialized or migrant microaggressions towards professionals or students in healthcare settings were included. We excluded studies that were not in English. QDA Miner was used to analyse the data, using a non-essentialist perspective, which suggests that ‘culture’ is a movable concept used by different people at different times to suit purposes of identity, politics and science.

Our search identified 8 papers (5 qualitative, 2 mixed and 1 quantitative) on the experience of microaggressions towards healthcare professionals and students (n = 602). Almost all (87.5%) were conducted in North America and only one (12.5%) in the UK. The primary themes were as follows:

Intersectionality: Individual and group social categorizations of race, class, and gender were described as interconnected, leading to interdependent systems of discrimination or disadvantage. Healthcare professionals indicated that increasing diversity and racial representation can reduce bias and thus microaggressions among stakeholders in the culture of work.

Workplace culture and lack of senior support: The healthcare curriculum, and the manner of its delivery were found to propagate ideas encouraging racial microaggressions. Seniors behaving as role-models by challenging microaggressions could encourage an open and accountable environment. Supervision was a tool for allyship that reduced the threat of negative race-related incidents.

Intervention: Acknowledging racial microaggressions within healthcare, as well as quantifying their presence with tools, encouraged a stronger and more effective response from institutions. Teaching curriculum also served as a useful platform to teach and address microaggressions.

Racial microaggressions were experienced as having a detrimental impact on healthcare professionals’ well-being and mental health. Consequently, this affected the efficiency, the workplace culture, patient outcomes and job satisfaction. Given the multifaceted nature of racial microaggressions, tackling them requires a complex and wide-ranging response from institutions.

Individuals with intellectual and developmental disability (IDD) can have a high prevalence of pain, which can be managed with prescription opioids. However, the prevalence of substance use disorder is also high in this population, raising concern about opioid-related adverse events.

To assess the risk of opioid-related adverse events following opioid initiation among adults with versus without IDD.

We conducted a population-based, propensity score matched cohort study on all adults starting prescription opioid therapy in Ontario, Canada, between January 2013 and December 2018. The outcomes of interest were opioid toxicity, new opioid use disorder (OUD) diagnosis and dose escalation (≥90 mg morphine or equivalent) in the year after opioid initiation. We used Cox proportional hazards models to assess the association between IDD diagnosis and each outcome.

The hazards of opioid toxicity and OUD were significantly higher in those with IDD compared with those without IDD in unmatched analyses (opioid toxicity hazard ratio 3.19, 95% CI 2.81–5.18; OUD hazard ratio 2.36, 95% CI 2.10–2.65), whereas the hazard of dose escalation was significantly lower (hazard ratio 0.76, 95% CI 0.66–0.88). Findings were no longer significant in propensity score matched models for opioid toxicity and dose escalation, whereas the hazard of OUD diagnosis was attenuated substantially in those with IDD (hazard ratio 0.79, 95% CI 0.68–0.91).

IDD diagnosis is not a driver of opioid-related harm. The increased risk we observed is likely driven by various risk factors often present in this population.

The COVID-19 pandemic has impacted community mental health, but the effect on psychiatric admissions is unknown. We investigated factors contributing to acute psychiatric admissions, and whether this changed during the first UK lockdown.

A retrospective case-note review study with an exploratory mixed-methods design was used to examine factors in psychiatric admissions following the first UK 2020 lockdown compared to the same time periods in 2019 and 2018.

Themes of psychopathology, risk, social stressors, community treatment issues, and physical health concerns were generated. The mean number of codes per case was 6⋅19 (s.d. = 2⋅43), with a mean number of categories per case of 3⋅73, (s.d. = 0⋅98). Changes in routines and isolation were common factors in the study year; accommodation and substance abuse were more prominent in the control year. Relationship stressors featured strongly in both groups. There were significantly more women (χ2(1, N = 98) = 20⋅80, p < 0⋅00001) and older adults (χ2(1, N = 98) = 8⋅61, p = 0⋅0033) in the study group than the control. Single people, compared to those in a relationship (χ2(1, N = 45) = 4.46, p = 0⋅035), and people with affective disorders compared to psychotic disorders ((χ2(1, N = 28) = 5.19, p = 0⋅023), were more likely to have a COVID-19 related admission factor.

The COVID-19 pandemic amplified pre-existing psychosocial vulnerabilities with a disproportionate psychiatric admissions impact on the mental health of women, the elderly and those with affective disorders.

Little is known about which factors exacerbate and buffer the impact of coronavirus disease 2019 (COVID-19)-related adversities on changes in thinking about and engaging in self-harm over time.

To examine how changes in four social factors contribute to changes in self-harm thoughts and behaviours over time and how these factors in turn interact with adversities and worries about adversities to increase risk for these outcomes.

Data from 49 227 UK adults in the UCL COVID-19 Social Study were analysed across the first 59 weeks of the pandemic. Fixed-effects logistic regressions examined time-varying associations between social support quality, loneliness, number of days of face-to-face contact for >15 min and number of days phoning/video calling for ≥15 min with self-harm thoughts and behaviours. We then examined how these four factors in turn interacted with the total number of adversities and worries about adversity and how this affected outcomes.

Increases in the quality of social support were associated with decreases in the likelihood of both outcomes, whereas greater loneliness was associated with an increase in their likelihood. Associations were less clear for telephone/video contact and face-to-face contact with outcomes. Social support buffered and loneliness exacerbated the impact of adversity experiences on self-harm behaviours.

These findings suggest the importance of the quality of one's social support network, rather than the mere presence of contact, for reducing the likelihood of self-harm behaviours in the context of COVID-19 pandemic-related adversity and worry.

Assessment of personality functioning in different stages of psychotic disorders could provide valuable information on psychopathology, course of illness and treatment planning, but empirical data are sparse.

To investigate personality functioning and sense of self in individuals at ultra-high risk (UHR) for psychosis and with first-episode psychosis (FEP) in comparison with a clinical control group of individuals with borderline personality disorder (BPD) and healthy controls.

In a cross-sectional design, we investigated personality functioning (Structured Interview of Personality Organization, STIPO; Level of Personality Functioning Scale, LPFS) and disturbances of the basic self (Examination of Anomalous Self-Experience, EASE) in 107 participants, comprising 24 individuals at UHR, 29 individuals with FEP, 27 individuals with BPD and 27 healthy controls.

The UHR, FEP and BPD groups had moderate to severe deficits in personality organisation (STIPO) compared with the healthy control group. Self-functioning with its subdomain (facet) ‘self-direction’ (LPFS) was significantly worse in participants with manifest psychosis (FEP) compared with those at-risk for psychosis (UHR). The FEP group showed significantly worse overall personality functioning than the UHR group and significantly higher levels of self-disturbance (EASE) than the BPD group, with the UHR group lying between these diagnostic groups. Hierarchical cluster analysis based on the seven STIPO domains yielded three clusters differing in level of personality functioning and self-disturbances.

Our data demonstrate that psychotic disorders are associated with impaired personality functioning and self-disturbances. Assessment of personality functioning can inform treatment planning for patients at different stages of psychotic disorder.

There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry.

To explore variables associated with involuntary care in the largest database of involuntary admissions published.

We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression.

A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61–5.38), and psychosis (odds ratio 4.48, 95% CI 4.31–4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85–5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56–2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99–2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57–1.74); unmarried status (odds ratio 1.62, 95% CI 1.49–1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35–1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24–1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62–0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87–0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86–0.93).

This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.

Family functioning is associated with anxiety and depression. Perinatal depression and anxiety are common and influence the well-being of women, partners and their offspring. However, little is known about differences in associations between family functioning and mood symptoms in women and their partners in early pregnancy.

Investigating differences in associations between family functioning and anxious and depressive symptoms in women and their partners in early pregnancy.

In total, 171 woman–partner pairs were enrolled. The Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item scale (GAD-7) and Family Assessment Device (FAD) were performed. Correlation analysis and multiple linear regression analysis were applied to investigate the associations.

In pregnant women, all the subscale scores on the FAD were correlated with total scores on the EPDS and GAD-7 (all P < 0.05), whereas only the Roles subscale showed a predicting effect in regression models (P < 0.01). In partners, all the subscale scores on the FAD were related to total scores on the PHQ-9 (all P < 0.05), whereas only the Problem Solving subscale showed a predicting effect (P = 0.029).

Our findings indicate that family functioning in the domain of roles is associated with anxious and depressive symptoms in pregnant women and functioning in the domain of problem solving is associated with depressive symptoms in partners. Clinicians should pay special attention to roles and problem solving when assessing mood symptoms in pregnant women and their partners. This study also provides a basis for family health education in early pregnancy.

Studies about brain structure in bipolar disorder have reported conflicting findings. These findings may be explained by the high degree of heterogeneity within bipolar disorder, especially if structural differences are mapped to single brain regions rather than networks.

We aim to complete a systematic review and meta-analysis to identify brain networks underlying structural abnormalities observed on T1-weighted magnetic resonance imaging scans in bipolar disorder across the lifespan. We also aim to explore how these brain networks are affected by sociodemographic and clinical heterogeneity in bipolar disorder.

We will include case–control studies that focus on whole-brain analyses of structural differences between participants of any age with a standardised diagnosis of bipolar disorder and controls. The electronic databases Medline, PsycINFO and Web of Science will be searched. We will complete an activation likelihood estimation analysis and a novel coordinate-based network mapping approach to identify specific brain regions and brain circuits affected in bipolar disorder or relevant subgroups. Meta-regressions will examine the effect of sociodemographic and clinical variables on identified brain circuits.

Findings from this systematic review and meta-analysis will enhance understanding of the pathophysiology of bipolar disorder. The results will identify brain circuitry implicated in bipolar disorder, and how they may relate to relevant sociodemographic and clinical variables across the lifespan.

In the Philippines, there is a need for preventive, early intervention programs for perinatal and infant mental health. This is the first local study that investigated an attachment-based, therapeutic play programme (Baby Bonding) on infant temperament, parent-infant relationship and maternal reflecting functioning.

This study was an effort towards bridging the “10/90 gap in infant mental health research” wherein 90% of the world's infants are born in low- middle-income countries (Population Reference Bureau, 2013b) and “only 10% of the worldwide spending on health research is directed towards the problems that primarily affect the poorest 90% of the world's population (Tomlinson et al., 2014).

Phase I involved local validation of the Parent-Rated Outcome Measures (PROM)- Infant Characteristics Questionnaire (ICQ), Mother Object Relations Scale (MORS) and Parental Reflective Functioning Questionnaire (PRFQ).Healthy mother-baby dyads, from the low socio-economic stratum, were screened using Parent Evaluation of Developmental Status (PEDS) and Hospital and Anxiety Depression Scale (HADS).

Phase II carried out randomized controlled design wherein mother-baby dyads were enrolled either in the usual care group or the 6-weekly Baby Bonding intervention.

102 mothers answered the PROM. Their responses constituted the training set of the study tools. Baseline responses of the mothers from the usual care (N = 51) and intervention (N = 53) groups formed the evaluation set for the Filipino- translated instruments. In both the training and evaluation sets, if certain identified questions were to be removed from the PROM, better and acceptable Cronbach values were consistently generated.

There were no statistical differences on parent-infant relationship and reflective functioning between the usual care and intervention group. There was movement of the intervention group from high-challenging onto intermediate to low-levels of challenging temperament in the dull-dimension of the ICQ after 6 sessions. In comparison, infants in the control group remained in the high-challenging temperament after 6 weeks of usual care.

Linguistically validated study instruments (ICQ and MORS) provided accurate assessments of infant temperament and parent-child relationship. The Filipino-translated PRFQ has limited validity in evaluating parental reflective functioning (RF). “On-line” measures that video mother-baby interactions could have better captured changes in RF. As measured by the dull dimension of the ICQ, the Baby Bonding programme improved sociability of the infants (7 months or younger).

Depression is a highly recurrent disorder, with more than 50% of those affected experiencing a subsequent episode. Although there is relatively little stability in symptoms across episodes, some evidence indicates that suicidal ideation may be an exception. However, these findings warrant replication, especially over longer periods and across multiple episodes.

To assess the relative stability of suicidal ideation in comparison with other non-core depressive symptoms across episodes.

We examined 490 individuals with current major depressive disorder (MDD) at baseline and at least one subsequent episode during 9-year follow-up within the Netherlands Study of Depression and Anxiety (NESDA). The Inventory of Depressive Symptomatology (IDS) was used to assess DSM-5 non-core MDD symptoms (fatigue, appetite/weight change, sleep disturbance, psychomotor disturbance, concentration difficulties, worthlessness/guilt, suicidal ideation) at baseline and 2-, 4-, 6- and 9-year follow-up. We examined consistency in symptom presentation (i.e. whether the symptom met the diagnostic threshold, based on a binary categorisation of the IDS) using kappa (κ) and percentage agreement, and stability in symptom severity using Spearman correlation, based on the continuous IDS scores.

Out of all non-core depressive symptoms, insomnia appeared the most stable across episodes (r = 0.55–0.69, κ = 0.31–0.47) and weight decrease the least stable (r = 0.03–0.33, κ = 0.06–0.19). For suicidal ideation, correlations across episodes ranged from r = 0.36 to r = 0.55 and consistency ranged from κ = 0.28 to κ = 0.49.

Suicidal ideation is moderately stable in recurrent depression over 9 years. Contrary to prior reports, however, it does not exhibit substantially more stability than most other non-core symptoms of depression.

Hypersalivation is a major side-effect of clozapine in patients with treatment-resistant schizophrenia.

We investigated the efficacy of topical anticholinergic formulation sofpironium bromide gel for improving hypersalivation in patients with treatment-resistant schizophrenia receiving clozapine.

A double-blind, controlled crossover study was conducted with sofpironium bromide gel and a placebo gel to treat clozapine-induced hypersalivation in 16 patients with treatment-resistant schizophrenia. Patients were randomly divided between groups A and B (each n = 8). Group A was treated with sofpironium bromide gel for 6 weeks, followed by a 2-week washout period and 6 weeks of placebo gel, after which they were observed for another 2 weeks. In contrast, group B was treated with placebo gel for 6 weeks, followed by a 2-week washout period, 6 weeks of sofpironium bromide gel and a 2-week observation period. One-minute saliva volume, objective salivation ratings (Drooling Severity and Frequency Scale and Nocturnal Hypersalivation Rating Scale) and subjective salivation ratings (Visual Analogue Scale) were assessed every 2 weeks.

All patients completed the trials. Three patients reported mild, spontaneously resolved skin itching. Compared with baseline values, the 1-min saliva volumes of both groups were significantly decreased by approximately 30% at the second week of sofpironium bromide gel treatment (P < 0.001), and significantly decreased by >40% at the fourth and sixth weeks of treatment (P < 0.001). The effects were maintained for over 2 weeks even after the treatment was discontinued.

We suggest that sofpironium bromide gel is effective in treating clozapine-induced hypersalivation in patients with treatment-resistant schizophrenia.

Research in the area of mHealth, has shown much promise in the development of mobile phone interventions which look at the assessment and treatment in real-time of psychiatric disorders. Within the context of Severe Mental Illnesses (SMI), such as psychosis, communication and understanding between health professionals and service users in the reporting of distress and reoccurrence of symptoms is essential in reducing the chances of relapse. An alternative pathway which uses mobile technology to engage with services, may hold the key to gaining a deeper understanding of the lived experiences of those with mental health difficulties, in particular experiences of recovery from SMI's. AIM: The aim of the study was to explore the perspectives and opinions of health professionals on the development and refinement of the TechCare App for psychosis. A qualitative approach was adopted for data collection, which provided an understanding of factors in relation to the development of the intervention.

A total of two focus groups were held with health professionals to elicit their views on optimising the utility of the TechCare App. The total sample size for the focus groups was n = 16 with a total of 6 males and 10 females. This qualitative study was part of a feasibility study, investigating a novel intervention (TechCare) (Husain et al., 2016; Gire et al., 2021) which monitored participants symptoms and provided a tailored psychosocial response in real-time. Data obtained from the focus groups was transcribed. Framework analysis were used to analyse the data for emerging themes, focusing on feasibility, acceptability and further development.

The key themes that emerged from the data were; access and usage of digital technologies, implications for clinical practice, challenges & barriers to delivery and development and refinement considerations for the TechCare App.

Results of the focus group with health professionals provided a unique perspective of conducting mHealth research within an EIS context, and the differing challenges professionals anticipated facing in delivering the TechCare App intervention. The main finding of the focus group was that professionals saw the potential for the TechCare App to increase access to digital technologies, providing service users with an alternative medium to communicate with EIS health professionals. However, the participants felt that despite mHealth Apps being a useful platform to deliver interventions, face-to-face contact should remain an important aspect of routine care.

Intensive treatment for eating disorders include day treatment programme and specialist inpatient. COVID-19 pandemic led to lockdown in the UK on the 23rd March 2020. Adult Eating Disorders Day Treatment Programme in Surrey started delivering their care on the virtual platform from that date. It offered a combination of ‘virtual’ only and ‘blended’ care (virtual and in person) for more than a year. This service evaluation examined the safety of delivering intensive eating disorders treatment on the virtual platform.

Data from March 2020 to March 2021 were retrospectively collected from Electronic patient record. Two clinicians collected the data on age, referral origin, accommodation, employment status, diagnosis (subtype), length of illness, comorbid mental and physical health diagnosis, duration of day care treatment, medication, admission weight and BMI, discharge weight and BMI, changes in bloods and ECG, acute hospital admission, risk-to-self events, admissions to Specialist Eating Disorders Unit and reasons for discharge.

Data indicated that 21 patients were admitted in day treatment programme over 1 year period. 10 patients had solely virtual treatment and 11 patients had blended day treatment programme. 11 patients had anorexia nervosa restrictive subtype, 5 patients had Anorexia Binge purge subtype and 5 patients had Anorexia Nervosa, Unspecified.

Average length of illness was 4.49 years. Mean age for the group was 24.7 years and most patients lived with family (n 18) and were unemployed (n 11). More than 2/3rd (76%) patients had comorbid mental health diagnosis and 48% (n 10) had comorbid physical health diagnosis.

Average length of admission was 5.26 months. Mean BMI on admission was 15.3 (Range 12–19) and mean BMI on discharge was 16.9 (Range 13.65–22).

Safety and outcome data indicated that there were no serious incidents recorded in that time period. 1 (5%) patients required admission to acute hospital as their physical health deteriorated. 8 (38%) patients required specialist inpatient admission as the day care did not affect any changes to their eating behaviours, and 4 (19%) patients had events indicating self harm episodes(19%).

Our service evaluation data indicated that it is relatively safe to deliver day treatment programme on the virtual platform. Weekly face to face physical health monitoring (weight, BP, Pulse, temperature) and regular physical health investigations (Blood tests and ECG) were integral part of managing risks to health. On the other hand, delivering day treatment programme on the virtual platform has enabled the day treatment programme to prevent any significant outbreak of COVID-19 in a vulnerable group of patients and allowed them to receive uninterrupted support during pandemic.

The COVID-19 pandemic has had a drastic effect on the mental health of the global population that is likely to be felt for years to come. One group particuarly likely to be affected by this in the immediate future are the healthcare professionals working on the frontline of the NHS pandemic response. As members of a foundation cohort of these junior doctors we aimed to create a way to quanitfy the wellbeing of ourselves and our colleagues at this challeging time. We aimed to use a combination of numerous tools to monitor foundation doctors in Blackburn during this crisis. This would inform which measures would be best suited to be put in place to protect this cohort from early burnout and poor mental health in the future.

We designed a survey of 25 questions which we invited our foundation colleagues to fill in anonymously during the first and second waves of the pandemic in response to times when foundation doctors were redeployed to aid the frontline. The survey has been based on the PHQ9, GAD7, Epworth Sleepiness scale, Physician wellbeing index, Medical students wellbeing index, Maslach burnout inventory BMA burnout questionnaire and the QOL scale.

From a cohort of around 140 foundation doctors we had 46 participants in our trial of this tool; 46% had been redeployed and 54% not redeployed. Over 50% of survey respondents reported high stress, poor motivation and depersonalisation over the two weeks at the peak of the pandemic, key early signs of burnout. Lack of interest in their work, poor sleep and anhedonia were increased across both groups (redeployed and non redeployed). The interventions after the first wave data which repondents found beneficial included; financial reassurances during redeployments, protected non clinical areas for rest, a named individual senior staff member for wellbeing support.

Key issues the survey raised were fed back to foundation programme leads in monthly meetings. This allowed us with our foundation leads to make targeted changes in order to support foundation doctors at this time. Without the data from this tool which we tailored to the foundation experience we believe these rapidly worsening issues during the pandemic would not have been addressed so swiftly. We then resurveyed the foundation cohort to assess which of these interventions have been most widely used and appreciated.

The prevalence of cardiovascular diseases (CVD) in people with intellectual disability (ID) is around 14%, higher than the general population. However, CVD risk assessments are not consistently performed. Given the high risk of premature deaths in people with ID, it is important to identify preventable risk factors and follow evidence-based interventions. QRISK-3 is a validated risk-stratification tool, which calculates the 10-year risk of developing a heart attack or stroke (https://qrisk.org/three/index.php). There are no published studies on the use of QRISK-3 in people with ID. This project aimed to understand the use of QRISK-3 in an ID clinic and to quantify individual CVD risks to recommend appropriate management options.

A cross sectional study was performed on 143 patients open to an ID psychiatry clinic. Patients and carers were sent an accessible information leaflet on this study. Basic demographic data and information on psychiatric diagnoses were collected. Patients were grouped according to the presence of severe mental illness (SMI) defined as schizophrenia, bipolar disorder and other psychotic illnesses. QRISK-3 ≥ 10% was defined as elevated risk in accordance with NICE guidelines. Patients who had a high QRISK-3 score were advised to contact their GP.

Of 143 patients, 73 (51.0%) had a mild ID and the remaining had a moderate to severe ID. The mean age was 43.3 years, 53.1% were male. Overall, 28 (19.6%) participants had an elevated CVD risk, of whom 16 (57.1%) were not on statins, which is the recommended treatment. The mean QRISK-3 score was 6.31 (standard deviation [SD] 8.95), and the relative risk is 3.50 (SD 7.13). The proportion of QRISK-3 ≥ 10% and mean score were not significantly different in those with SMI, but those with SMI were more likely to be prescribed statins than those without (14 [31.1%] vs 10 [10.2%], p = 0.002). Statins were given to 24 (16.8%) participants, of whom 12 (50%) had elevated CVD risk. 89% had a blood pressure recording within the past 5 years, 87% had height and 88% had weight recorded. 73% had lipid serology results recorded.

Elevated CVD risk was common in this ID study population, and more than half with elevated QRISK-3 were not on the medical treatment recommended by national guidelines. QRISK-3 could feasibly be implemented in the outpatient setting. Increased routine CVD risk assessment and management should be considered as another measure to reduce morbidity and mortality.

The SARS-CoV-2 pandemic has led to core changes in the healthcare systems worldwide in terms of access, resources and patient's management. Patients admitted to a general hospital with COVID-19 are at a higher risk for developing or exacerbating various psychiatric disorders, due to the virus brain tropism and associated psychosocial factors. However, there are still limited data regarding the psychiatric needs and mental health care of these patients. The present study seeks to evaluate the changes in liaison psychiatry, patients’ characteristics and outcomes, brought on by SARS-CoV-2.

We retrospectively analyzed liaison psychiatry patients’ characteristics during the second wave of COVID-19 pandemic, between October and December 2020, in comparison with the same trimester pre-COVID-19 in 2019.

At admission to hospital, we found no differences between liaison psychiatry pre-COVID-19 (n = 96) and COVID-19 period (n = 114) groups, for age (p = 0.35), gender (p = 0.96), or hospital resource utilization in the previous year : number of hospital admissions (p = .40), Accident and Emergency presentations (p = 0.61), outpatients clinics (p = 0.20). There was, however, a significant association between pre-COVID-19 vs COVID-19 period groups and psychiatric diagnosis during hospitalization (Χ2(5) = 11.56, p = 0.04), influencing overall respective rates of delirium/dementias (29.2 vs 42.1 %), mood disorders (18.8 vs 26.3 %), anxiety and stress related disorders (22.9 vs 14.0 %), psychoactive substance use disorders (12.5 Vs 9.6 %) and psychotic disorders (10.4 vs 2.6 %). Mortality rate in pre-COVID-19 Vs COVID-19 period increased from 5.2 % to 15.8 % (Χ2(1) = 5.98, p = 0.01), mostly due to increased mortality in COVID-19 patients (7.3 vs 30.3 %, p < 0.001). Referrals to liaison psychiatry increased by 18.8 % during the COVID-19 period, 28.8 % of referred patients were positive for SARS-CoV-2 and time to referral was positively correlated with hospital length of stay (ρ = 0.60, p < 0.001). In the COVID-19 period, fewer patients were referred to outpatient psychiatric follow-up after discharge from hospital (p < 0.001), and delayed discharges for social reasons were of shorter duration (p = 0.001).

Our findings are consistent with emerging data on comorbid or superimposed mental illness in hospitalized patients with COVID-19, showing a strong impact in neuropsychiatric mani-festations, clinical prognosis and mortality, as well as clinical management. Consideration should also be given to adequate staffing of psychiatry liaison services during the pandemic, in order to attend and safely manage general hospital inpatients mental health needs.

To introduce and assess the impact of balint groups on core medical trainee (CMT) doctors working within an acute medical trust.

A high rate (80%) of dissatisfaction and burnout has been reported amongst trainee doctors. This has had a significant impact on recruitment with a large proportion of foundation doctors delaying their application into core specialist training. Of those already in training, up to 50% have reported taking time, out citing burnout as a cause. Balint groups are a form of reflective practice groups looking at the doctor-patient interaction. For core psychiatric trainees these groups are a mandatory part of their training.

We piloted a total of three balint groups over a period of three months amongst CMT doctors based at an acute medical trust in London. A specialty registrar (ST6) in psychiatry facilitated the balint groups. Balint facilitators received supervision from a consultant psychiatrist in psychotherapy. CMT doctors were given questionnaires at the beginning of session one and emerging themes later explored. The questionnaires used were taken from the ‘Bristol Trainee-led Balint Group Scheme’.

The pre-questionnaires showed that all CMT doctors surveyed believed psychological factors play an important role on patient presentation and recovery. 14/19 (74%) agreed or strongly agreed that a doctor's reaction to a patient directly influenced care. All doctors agreed or strongly agreed that it was important to reflect on a patient's emotional experience, as it was crucial to their development as a doctor.

CMT doctors found balint groups useful as it provided them a space, which was not routinely offered to discuss challenging cases. Themes that emerged included a lack of support and difficulties maintaining boundaries when treating complex patients. Litigation was a recurring theme with many trainees reporting anxieties and a lack of support. Trainees reported guilt and worries that they were not doing enough for their patients. These themes appeared to have a direct impact on training experience and burnout.

With increasing burnout and dissatisfaction amongst junior doctors, balint groups provide a unique approach to supporting junior doctors within medical specialties. The current pilot has demonstrated that CMT doctors can make use of balint groups in an effective way. We recommend that balint groups should become an integral part of specialist medical training. Psychiatrists can play a central role in supporting the health and well being of medical trainees through balint group facilitation.

Depression is a major cause of disability worldwide. Recent data suggest that, in industrialised countries, the prevalence of depression peaks in middle age. Identifying factors predictive of future depressive episodes is crucial for developing prevention strategies for this age group.

We aimed to identify future depression in middle-aged adults with no previous psychiatric history.

To predict a diagnosis of depression 1 year or more following a comprehensive baseline assessment, we used a data-driven, machine-learning methodology. Our data-set was the UK Biobank of middle-aged participants (N = 245 036) with no psychiatric history.

Overall, 2.18% of the study population developed a depressive episode at least 1 year following baseline. Basing predictions on a single mental health questionnaire led to an area under the curve of the receiver operating characteristic of 0.66, and a predictive model leveraging the combined results of 100 UK Biobank questionnaires and measurements improved this to 0.79. Our findings were robust to demographic variations (place of birth, gender) and variations in methods of depression assessment. Thus, machine-learning-based models best predict diagnoses of depression when allowing the inclusion of multiple features.

Machine-learning approaches show potential for being beneficial for the identification of clinically relevant predictors of depression. Specifically, we can identify, with moderate success, people with no recorded psychiatric history as at risk for depression by using a relatively small number of features. More work is required to improve these models and evaluate their cost-effectiveness before integrating them into the clinical workflow.

To increase staff confidence about identifying Domestic Abuse (DA), particularly regarding ‘how to ask’ to encourage disclosure and the pathways available for appropriately safeguarding survivors; in a Community Mental Health Team (CMHT) setting.

DA is bi-directionally associated with mental health (MH) disorders; 1:4 women in contact with MH services are currently experiencing DA. MH professionals (MHPs) are in a privileged position to identify DA and support survivors. However, this is dependent on MHPs receiving adequate training about DA. For this, we collaborated with Pathfinder, a national pilot project run by a consortium of five expert partners that aims to establish comprehensive health practice in relation to DA and Violence Against Women & Girls in Acute Hospital Trusts, MH Trusts and Primary Care. In Southampton, Pathfinder has funded two domestic and sexual abuse (DSA) advocates to both train MH staff and take a small caseload of MH service users who are experiencing abuse.

We conducted a baseline survey of staff confidence across the following domains:

Knowing the legal definition of DA,

The process used to escalate a DA concern,

How to make a referral,

How to complete DASH forms,

How and when to refer to Pathfinder,

What the following acronyms mean: PIPPA, MAPPA, MARAC, IDVA, DASH,

What HRDA and MASH mean,

How to ask about DA,

Who to signpost service users to if they make a disclosure, and when to involve the police.

We presented the survey results at the regional Pathfinder strategic group, with Trust management representatives present. This project fits within the strategic group's sustainability aims to increase DA awareness and safeguarding processes across the Trust.

The Pathfinder funded DSA Advisors delivered a four-hour training package targeting the surveyed questions and wider information on DA. We then re-surveyed to see if staff confidence had increased. We are currently analyzing the number of referrals to the Pathfinder service pre- and post-training.

Staff confidence increased across all domains following the training (% mean increase): Qs1 (35%), Qs2 (9%), Qs3 (45%), Qs4 (81%), Qs5 (25%), Qs6 (49%), Qs7 (89%), Qs8 (62%) and Qs9 (48%).

We have now arranged a bi-monthly drop-in at the CMHT by the DSA advisor who provided the training, to embed the link between the services and maintain staff confidence. We will circulate these results to advocate that this training is provided across the Trust.