King's College London's (KCL) Psychiatry Society's ‘Psych for 6th’ programme is an outreach initiative for aspiring medical students in year 12 at sixth forms in South London. The aims of the programme are to raise students’ awareness of mental illnesses; for students to gain a better understanding of the style of learning in medicine through the lens of psychiatry; to widen participation in medicine; and to promote a career in psychiatry.

25 state sixth forms in Southwark and Lambeth were invited to take part in the programme via email. The programme took place at 4 sixth forms for aspiring medical students in year 12 between September to November 2022. The programme involved 2 one hour sessions over 2 consecutive weeks and was run by KCL Psychiatry Society committee members. Session 1 covered the philosophy of health, illness, mental health and mental illness; an overview of the different mental health professionals and how to become a psychiatrist; an introduction to history taking; and an interactive history-taking activity. Session 2 covered the aetiology, pathophysiology, epidemiology, presentation, diagnosis and management of depression; mental health cases; and an interactive psychiatric history-taking activity. Pre- and post-programme questionnaires were sent to the attendees.

The percentage of students considering a career in psychiatry increased by 20% on completion of the programme. The average attendee confidence with talking to patients increased from 2.3 to 4.2 on completion of the programme, with 1 being not confident at all and 5 being very confident. Students gained a better understanding of the different types of mental health conditions psychiatrists manage - “I thought the information about the different [mental health] disorders was very interesting.” In response to “What did you enjoy the most about these workshops?”, 78% of the students commented on the interactive role-play activity where they were given the opportunity to practise taking a history. The programme also gave students a “broader and deeper understanding of what medical school [is like]”.

The sessions were well received by the students with for many of them this programme being their first exposure to psychiatry. KCL Psychiatry Society looks forward to delivering the programme at further South London sixth forms in 2023, working with other university psychiatry societies to run the programme across the UK, and with other mental health multidisciplinary student societies to expand the programme to delve deeper into other mental health careers.

Protecting all human rights of people with mental health conditions is globally important. However, to facilitate practical implementation of rights, it is often necessary to decide which of these rights should be given priority, especially when they conflict with each other.

The aim of the Priorities of Human Rights and Mental Health (PHRAME) project is to develop a replicable approach to establish a proposed set of high-priority human rights of people with mental health conditions, to facilitate practical decision-making and implementation of such rights.

A two-stage Delphi-style study with stakeholders was conducted to generate a list of key rights of people with mental health conditions, and rank priorities among these rights in terms of feasibility, urgency and overall importance.

The stakeholders in this study consistently ranked three rights as top priorities: (a) the right to freedom from torture, cruel inhuman treatment and punishment; (b) the right to health and access to services/treatment; and (c) the right to protection and safety in emergency situations.

Insights from PHRAME can support decision-making about the priority to be given to human rights, to guide practical action. This approach can also be used to assess how human rights are prioritised in different settings and by different stakeholders. This study identifies the clear need for a central voice for people with lived experience in research and implementation of decisions about the priority of human rights, ensuring that action respects the opinion of people whose rights are directly affected.

Compulsory community treatment orders (CTOs) are controversial because the right to refuse treatment is overridden, even when patients may not be acutely unwell. Scrutiny of outcomes associated with CTOs is therefore required. This editorial provides an overview of the evidence for CTOs. It also discusses recent papers reporting outcomes associated with CTOs and makes recommendations for researchers and clinicians to consider.

Trainees in Barnet, Enfield and Haringey (BEH) Mental Health Trust reported feeling isolated and burnt out after COVID-19. Offers of "online mindfulness" or "resilience training", as a substitute for in-person gatherings, felt very inadequate. Well-being initiatives are known to improve staff morale, mental health, patient care, recruitment and retention of trainees. We created and delivered a pilot well-being programme to improve the well-being of trainee psychiatrists working within BEH between September 2022 and January 2023.

We developed a WellBEHing brand for our trust and a committee of trainees dedicated to improving the well-being of themselves and their colleagues.

We ran a focus group for all trainees to submit ideas for sessions and activities they would enjoy.

We developed a programme of monthly WellBEHing events during protected well-being time, that was funded by medical education and the local division.

We surveyed trainees pre and post WellBEHing autumn/winter programme to record the impact on their sense of well-being. We also collected qualitative data on their experiences of being part of a WellBEHing community.

Prior to the WellBEHing autumn/winter programme we surveyed 40 trainees in BEH and only 12.5% of them rated their well-being as good or great. 35% of trainees felt unvalued or uncared about at work.

At the end of the autumn/winter WellBEHing programme 73% of trainees felt valued at work, with 60% of trainees feeling "happy and cared for".

Some of the qualitative feedback showed the impact well-being events can have on trainees “Seeing everyone in person, and being able to do so during the working day made me feel that BEH values me enough as an employee to prioritise my well-being. The quiz was also excellent and had clearly had a lot of effort put into it.”

Meaningful well-being initiatives take time, effort and funding. They require the support of management and consultants. Our results demonstrate that when well-being is designed and led by trainees, they feel valued and cared for as employees. We are beginning the second phase of project development where we will focus on making the programme sustainable and embedded in trainee life at BEH long-term.

From a global perspective, eating disorders are increasingly common, probably because of societal transformation and improved detection. However, research on the impact of migration on the development of eating disorders is scarce, and previously reported results are conflicting.

To explore if eating disorder symptom prevalence varies according to birth region, parents’ birth region and neighbourhood characteristics, and analyse if the observed patterns match the likelihood of being in specialist treatment.

This study uses data from a large population-based health survey (N = 47 662) among adults in Stockholm, Sweden. A general linear model for complex samples, including adjustment for gender and age, was used to explore self-reported eating disorder symptoms. Odds ratios were calculated for individual symptoms.

Eating disorder symptoms are substantially more common in individuals born abroad, especially for migrants from a non-European country. This holds true for all surveyed symptoms, including restrictive eating (odds ratio 5.5, 95% CI 4.5–6.7), compensatory vomiting (odds ratio 6.1, 95% CI 4.6–8.0), loss-of-control eating (odds ratio 2.6, 95% CI 2.3–3.1) and preoccupation with food (odds ratio 2.3, 95% CI 1.9–2.8). Likewise, symptoms are more common in individuals with both parents born abroad and individuals living in districts with a high percentage of migrant residents. A gap exists between district-level symptom scores and the likelihood of being in specialist eating disorder treatment.

These findings call for oversight of current outreach strategies, and highlight the need for efforts to reduce stigma and increase eating disorder symptom recognition in broader groups.

The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services.

We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group.

Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made.

In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women.

Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.

Down syndrome is the most common genetic cause of intellectual disability and Alzheimer's disease. In the general population, common mental disorders (CMDs), including anxiety, depression and obsessive–compulsive disorder, are linked to cognitive decline and higher risk for dementia. It is not known how CMDs affect longer-term cognitive outcomes in Down syndrome, and there is often diagnostic uncertainty in older people with Down syndrome and psychiatric comorbidity.

To study the influence of CMDs on cognitive ability and whether they are related longitudinally to development of clinical signs of Alzheimer's disease in Down syndrome.

We followed 115 individuals with Down syndrome, 27 of whom were diagnosed with a CMD, over approximately 3 years. Changes in cognitive and behavioural outcomes between baseline and follow-up assessment were analysed, with comparisons made between those with and without a comorbid CMD. Age, gender, apolipoprotein E status and level of intellectual disability were included as covariates.

No significant association between presence of a CMD and poorer performance on cognitive tasks or informant-rated decline over time was observed (P > 0.05).

Our results suggest that a diagnosis of a CMD does not have a significant negative effect on long-term cognitive or behavioural outcomes in individuals with Down syndrome. In individuals with stable or treated CMD, subsequent cognitive decline is likely indicative of Alzheimer's disease rather than a consequence of mental disorder.

Community-based organisations continue to take on a greater role in supporting children and young people in the UK with their mental health. However, little evidence exists on the capacity and capability of these settings to effectively implement evidence-based interventions (EBIs).

To identify barriers and facilitators of the implementation of EBIs within community settings in the UK, for children and young people's mental health promotion, prevention and treatment.

A PRISMA-guided, rapid scoping review was conducted, using predefined criteria and a relevant search strategy on eight databases: Ovid EMBASE, Ovid Medline, Ovid PsycINFO, Ovid Global Health: Scopus, Web of Science All Databases, EBSCO CINAHL and EBSCO ERIC. Study characteristics and data on barriers and facilitators were extracted, with results narratively synthesised.

Five out of 4899 studies met the inclusion criteria, addressing the barriers and facilitators of community-based implementation of EBIs for children and young people's mental health promotion, prevention and treatment. All of the studies that were identified focused on school settings, but we identified no studies that included data on barriers or facilitators of implementing EBIs in other community-based or voluntary sector settings.

There is a lack of available evidence on the capacity and capability of community settings in the UK to effectively implement EBIs and adhere to evidence-based practice. However, existing findings within schools have highlighted key barriers and facilitators to implementation, such as the importance of meaningful involvement of stakeholders throughout the research process, and greater allocation of resources to support evidence-based decision-making in these settings.

The 2018–2020 MBRACE report highlights that 1.5 women per 100,000 die by suicide during pregnancy or up to 6 weeks postpartum in the UK, a threefold increase since the 2017–2019 report. Raising awareness of the variety and severity of perinatal mental illness is vital in order to reduce stigma and ultimately save lives. Hollyoaks is a soap opera with a target audience aged 16–24 years. In 2020 the show aired the storyline of Liberty Savage, a woman whom developed postpartum psychosis. In 2021 the show aired the story of Diane Hutchinson as she develops symptoms of Obsessive Compulsive Disorder (OCD) during her pregnancy. In this article we analyse both storylines for clinical accuracy and consider the impact that this may have.

EC and AS held structured discussions in order to assess the accuracy of the portrayal of each illness, comparing each presentation to diagnostic criteria. Further discussions were held to establish themes and to consider the impact of the information/misinformation delivered to viewers.

The production team worked with the charity Action on Postpartum Psychosis when producing Liberty's story. The storyline addresses that Liberty hallucinates, although creative licence is used. She is emotionally labile and highly anxious with a fixation on her baby's well-being.

Unfortunately there are many elements of Liberty's storyline that do not accurately portray post-partum psychosis. She has no delusional beliefs, no thought disorder and is fully orientated. Liberty is consistently immaculately presented and while there is mention that she is sleeping poorly this is not explicitly seen. We do not see any interaction with a psychiatrist and Liberty is not admitted to hospital.

Diane's story begins when she falls pregnant during the COVID-19 pandemic. The production team worked with the charity OCD UK.

Diane's presentation is focused around contamination. Her intrusive thoughts are voiced out-loud for the viewer to hear yet are distinguishable from the spoken dialogue. Her intrusive thoughts escalate during labour and in the immediate postpartum period and her distress is palpable throughout these scenes.

Diane's storyline concludes with an evaluation from a supportive psychiatrist who gives a clinically accurate explanation of her presentation and offers reassurance.

The mainstream media can provide a useful tool to raise awareness of perinatal mental illness in the general population and may play a vital role in reducing stigma. However, variations in clinical accuracy are likely to be present, even within the same television programme, limiting potential positive impact.

Euthanasia review committees (Regionale Toetsingscommissies Euthanasie, RTE) scrutinise all Dutch cases of euthanasia and physician-assisted suicide (EAS) to review whether six legal ‘due care’ criteria are met, including ‘unbearable suffering without prospect of improvement’. There are significant complexities and ethical dilemmas if EAS requests are made by people with intellectual disabilities or autism spectrum disorders (ASD).

To describe the characteristics and circumstances of people with intellectual disabilities and/or ASD who were granted their EAS request; investigate the main causes of suffering that led to the EAS request; and examine physicians’ response to the request.

The online RTE database of 927 EAS case reports (2012–2021) was searched for patients with intellectual disabilities and/or ASD (n = 39). Inductive thematic content analysis was performed on these case reports, using the framework method.

Factors directly associated with intellectual disability and/or ASD were the sole cause of suffering described in 21% of cases and a major contributing factor in a further 42% of cases. Reasons for the EAS request included social isolation and loneliness (77%), lack of resilience or coping strategies (56%), lack of flexibility (rigid thinking or difficulty adapting to change) (44%) and oversensitivity to stimuli (26%). In one-third of cases, physicians noted there was ‘no prospect of improvement’ as ASD and intellectual disability are not treatable.

Examination of societal support for suffering associated with lifelong disability, and debates around the acceptability of these factors as reasons for granting EAS, are of international importance.

To explore factors influencing the progression and retention of Psychiatric trainees in training posts within the Health Education England Wessex region. Specifically: To understand what trainees value most in their training; to determine the degree to which trainees feel supported and valued in their training; to determine self-reported burnout measures in trainees; to understand factors that have a negative impact on training experience; to understand factors that are important to trainees when considering future job roles.

Online questionnaire survey, capturing both qualitative and quantitative data, open to all Wessex Psychiatric trainees and doctors who had left or completed a Wessex Psychiatry training scheme since 1.1.2018. Responses were collected between 7.6.2021 and 31.7.2021. The survey included a burnout scale, questions about how supported and valued trainees felt during training, and questions regarding career intentions. This project received approval from the Health Research Authority (IRAS 296985).

• • 50 participants completed the survey and were included in analysis.

• • 38% were at risk or high risk of burnout.

• • Trainees felt more supported and valued by individuals such as clinical supervisors (70% felt well or very well supported and valued) than by organisations (41% felt well supported and 34% felt well valued by their Trust and Deanery).

• • Trainees rated ‘work-life balance’ as the thing they valued most in training (64%).

• • Poorly resourced services, trainee workload, lack of role models, experiences of aggression, and defensive practice of seniors were cited as reasons trainees considered leaving Psychiatric training.

• • The three most important factors cited by participants when considering a consultant post were ‘Position available with flexible working’(62%), ‘Position available within a supportive team of colleagues’ (54%) and ‘Positive experience working in the Trust as a Trainee’ (46%).

• • 81% of higher trainees wished to work less than full time in a consultant position once they had completed training.

Flexible working arrangements and work life balance need to be considered in workforce planning. Measures to reduce burnout in psychiatric trainees need to be pro-actively explored by employing Trusts and Deaneries. Mentoring schemes, facilitation of peer support, and clear processes for how to raise concerns regarding supervision are recommended to enhance support for trainees. Junior doctor awards, improved feedback between Trusts and junior doctors and engagement of the Trust board with junior doctors are proposed to improve the sense of value trainees feel. Positive experiences as a trainee are likely to improve retention of local trainees into the local consultant workforce.

The structure of negative symptoms of schizophrenia is still a matter of controversy. Although a two-dimensional model (comprising the expressive deficit dimension and the motivation and pleasure dimension) has gained a large consensus, it has been questioned by recent investigations.

To investigate the latent structure of negative symptoms and its stability over time in people with schizophrenia using network analysis.

Negative symptoms were assessed in 612 people with schizophrenia using the Brief Negative Symptom Scale (BNSS) at baseline and at 4-year follow-up. A network invariance analysis was conducted to investigate changes in the network structure and strength of connections between the two time points.

The network analysis carried out at baseline and follow-up, supported by community detection analysis, indicated that the BNSS's items aggregate to form four or five distinct domains (avolition/asociality, anhedonia, blunted affect and alogia). The network invariance test indicated that the network structure remained unchanged over time (network invariance test score 0.13; P = 0.169), although its overall strength decreased (6.28 at baseline, 5.79 at follow-up; global strength invariance test score 0.48; P = 0.016).

The results lend support to a four- or five-factor model of negative symptoms and indicate overall stability over time. These data have implications for the study of pathophysiological mechanisms and the development of targeted treatments for negative symptoms.

Little is known about the safety of mental healthcare provided remotely by digital mental health services (DMHS), which do not offer face-to-face contact.

To examine the circumstances of suicide by patients registered with a national DMHS.

Data from 59 033 consenting patients registered with a national DMHS, the MindSpot Clinic, between 1 January 2013 and 31 December 2016 were linked with the Australian National Death Index and documents held by the National Coronial Information System (NCIS). Data extracted included demographic information, the nature of contact, duration between last contact and death, symptom scores and information in police, autopsy, toxicology and coroners’ reports.

Of the 59 033 patients, 90 (0.15%) died by suicide in a follow-up period of up to 5 years. The mean time between last contact and death was 560 days. Coroners’ reports were located for 81/90 patients. Most (87.0%) were receiving face-to-face care around the time of death, 60.9% had a documented previous suicide attempt, 52.2% had been in hospital in the previous 6 months and 22.2% had severe mental illness, mainly schizophrenia or bipolar disorder. Other common findings were current treatment with psychotropic medication (79.2%) and the presence of alcohol (41.6%), benzodiazepines (31.2%), and illegal drugs and non-prescribed opioids (20.8%) at time of death.

Those who died by suicide after contact with the DMHS had more severe illness, were mostly engaged with face-to-face services and often had disinhibiting substances, especially benzodiazepines, present at the time of death.

Growing evidence suggests that in addition to pathophysiological, there are psychological risk factors involved in the development of Long COVID. Illness-related anxiety and dysfunctional symptom expectations seem to contribute to symptom persistence.

With regard to the development of effective therapies, our primary aim is to investigate whether symptoms of Long COVID can be improved by a targeted modification of illness-related anxiety and dysfunctional symptom expectations. Second, we aim to identify additional psychosocial risk factors that contribute to the persistence of Long COVID, and compare them with risk factors for symptom persistence in other clinical conditions.

We will conduct an observer-blinded, three-arm, randomised controlled trial. A total of 258 patients with Long COVID will be randomised into three groups of equal size: targeted expectation management in addition to treatment as usual (TAU), non-specific supportive treatment plus TAU, or TAU only. Both active intervention groups will comprise three individual online video consultation sessions and a booster session after 3 months. The primary outcome is baseline to post-interventional change in overall somatic symptom severity.

The study will shed light onto the action mechanisms of a targeted expectation management intervention for Long COVID, which, if proven effective, can be used stand-alone or in the context of broader therapeutic approaches. Further, the study will enable a better understanding of symptom persistence in Long COVID by identifying additional psychological risk factors.

Acute behavioural disturbance (ABD) is a controversial descriptor for presentations of severe agitation, aggression and physiological compromise.

To characterise the use of ABD-related terms in the electronic record of a large UK provider of mental health services during 2006–2021.

The free text of all records relating to patient contacts with acute assessment mental health teams during 2006–2021 were searched for references to ABD. Identified text was coded for context of use and presence of clinical features of ABD described in the literature. Poisson regression was used to analyse differences in rates of use over time and between demographic groups.

Mentions of ABD increased by an average of 1.12 (95% confidence interval (CI), 1.08–1.17) per year, with the greatest increase from 2019 to 2021. Black people were more than twice as likely as White people to have reference to ABD included in their assessments (rate: 2.4/1000 (95% CI 1.8–3.1) in Black people compared with 1.0/1000 (95% CI 0.8–1.3) in White people). The clinical characteristics in notes describing a current presentation of ABD rarely corresponded to those included in UK medical guidelines on ABD.

The term ABD in mental health notes appears to often, but not exclusively, be a synonym for severe agitation and conveys little meaning beyond this. However, the term's connection to a literature emphasising the high risk of physical health collapse and need for urgent treatment means that its disproportionate use in Black people may contribute to existing racial inequalities in the use of coercive measures during crisis presentations.

Several longitudinal studies have cast doubt on the aetiological overlap between child and adult attention-deficit hyperactivity disorder (ADHD). However, a lack of genetically sensitive data following children across adulthood precludes direct evaluation of aetiological overlap between child and adult ADHD.

We circumvent the existing gap in longitudinal data by exploring genetic overlap between maternal (adult) and offspring (child) ADHD and comorbid symptoms in an extended family cohort.

Data were drawn from the Norwegian Mother, Father and Child Cohort Study, a Norwegian birth registry cohort of 114 500 children and their parents. Medical Birth Registry of Norway data were used to link extended families. Mothers self-reported their own ADHD symptoms when children were aged 3 years; reported children's ADHD symptoms at age 5 years; and children's ADHD, oppositional defiant disorder (ODD), conduct disorder, anxiety and depression symptoms at age 8 years. Genetic correlations were derived from Multiple-Children-of-Twins-and-Siblings and extended bivariate twin models.

Phenotypic correlations between adult ADHD symptoms and child ADHD, ODD, conduct disorder, anxiety and depression symptoms at age 8 years were underpinned by medium-to-large genetic correlations (child ADHD: rG = 0.55, 95% CI 0.43−0.93; ODD: rG = 0.80, 95% CI 0.46−1; conduct disorder: rG = 0.44, 95% CI 0.28−1; anxiety: rG = 0.72, 95% CI 0.48−1; depression: rG = 1, 95% CI 0.66−1). These cross-generational adult–child genetic correlations were of a comparable magnitude to equivalent child–child genetic correlations with ADHD symptoms at age 5 years.

Our findings provide genetically sensitive evidence that ADHD symptoms in adulthood share a common genetic architecture with symptoms of ADHD and four comorbid disorders at age 8 years. These findings suggest that in the majority of cases, ADHD symptoms in adulthood are not aetiologically distinct from in childhood.

The psychiatry ‘bootcamp’ forms part of the psychiatry induction for junior doctors within NHS Lanarkshire. It was developed to better prepare them for common scenarios on-call and therefore alleviate any anxieties. The session is based upon a weekend on call where a fictional patient is admitted to the psychiatry ward with a psychotic presentation. It introduces the participant to the topics of Mental Health Act utilisation, capacity, acute behavioural disturbance management, and adverse effects of psychotropic medications.

Focussed teaching regarding fundamental theory for each topic is provided. Following this the facilitators engage the audience through reflective group discussion. Relevant parts of the session involve practical work including individual completion of detention paperwork. Targeted teaching is provided by the facilitators for any knowledge gaps identified.

Pre and post course questionnaires are completed by participants where they provide both written feedback and score various domains between 0 (least confident) and 10 (most confident). Domains are capacity assessment, assessing detention criteria, the process of detaining a patient, and recognition and management of extrapyramidal side-effects.

This course has been run on two separate occasions with a total of 28 participants. All domains assessed on feedback questionnaires have shown an increase in confidence amongst the participants. Following analysis of all pre and post course questionnaires session one showed an average improvement from 4.87/10 to 7.56/10 across all domains. Session two showed an average improvement from 5.34/10 to 8.6/10.

Themes identified on participant feedback included the benefit of having the opportunity to individually practice completing detention paperwork. Another theme identified was that participants found the case used for session delivery relevant to their practice. A final theme identified was the engaging nature of the session which encouraged the participants to ask questions. If a didactic approach was used this could restrict such discussion.

Feedback received suggested that this session was well received by all participants and was felt to be beneficial in both preparing them for and alleviating anxieties ahead of their first shift on-call within psychiatry. Feedback demonstrated that running the session in small groups with a blended approach of direct teaching, reflective discussion, and practical work maximised engagement and was an appropriate approach for session delivery. Feedback suggests that this session has the potential to be an essential part of future junior doctor inductions due to it identifying and meeting the learning needs of the participant.

Randomised controlled trials (RCTs) of psilocybin have reported large antidepressant effects in adults with major depressive disorder and treatment-resistant depression (TRD). Given psilocybin's psychedelic effects, all published studies have included psychological support. These effects depend on serotonin 2A (5-HT2A) receptor activation, which can be blocked by 5-HT2A receptor antagonists like ketanserin or risperidone. In an animal model of depression, ketanserin followed by psilocybin had similar symptomatic effects as psilocybin alone.

To conduct a proof-of-concept RCT to (a) establish feasibility and tolerability of combining psilocybin and risperidone in adults with TRD, (b) show that this combination blocks the psychedelic effects of psilocybin and (c) provide pilot data on the antidepressant effect of this combination (compared with psilocybin alone).

In a 4-week, three-arm, ‘double dummy’ trial, 60 adults with TRD will be randomised to psilocybin 25 mg plus risperidone 1 mg, psilocybin 25 mg plus placebo, or placebo plus risperidone 1 mg. All participants will receive 12 h of manualised psychotherapy. Measures of feasibility will include recruitment and retention rates; tolerability and safety will be assessed by rates of drop-out attributed to adverse events and rates of serious adverse events. The 5-Dimensional Altered States of Consciousness Rating Scale will be a secondary outcome measure.

This trial will advance the understanding of psilocybin's mechanism of antidepressant action.

This line of research could increase acceptability and access to psilocybin as a novel treatment for TRD without the need for a psychedelic experience and continuous monitoring.