Suicide is a global public health issue that requires sensitive research to inform effective prevention and treatment strategies. Despite the benefits of such research, it is accompanied by significant ethical challenges such as the potential for harm to participants' wellbeing. Various studies have explored the views of researchers in suicide research. This qualitative study aimed to explore the research ethics committee (REC) members’ experiences with suicide-related study applications to ascertain whether there are differences in approaches to dealing with suicide-related study applications.

We conducted semi-structured interviews with members of RECs (n = 9) from research-intensive universities and ethics committees in Pakistan. We also conducted a discussion group (n = 13) with members of REC from Pakistan, Nigeria and Sri Lanka. The topic guide delved into the opinions of REC members regarding ethical issues that they have come across while reviewing self-harm/suicide-related research proposals, the relevance of these issues with specific study designs, recommendations to resolve these issues, their approach to balancing risk and benefit, and guidance for researchers.

The preliminary findings from thematic analysis revealed five major themes; 1) Ethical challenges, 2) Reasons for application rejection, 3) Areas of improvement, 4) Suggestions for addressing ethical issues, and 5) Researchers' attitudes towards amendments. Challenges in self-harm and suicide research included the sensitivity and stigma surrounding the topic, lack of interest and support, and difficulties in participant recruitment. The application faced rejection from the ethics committees primarily due to methodological errors, lack of procedural clarity, and insufficient understanding of the research procedure. Identified areas for improvement were the need for enhanced methodology and research patterns, as well as a better understanding of the methodological procedure. Recommendations for developing a robust research proposal included training and supervision for intervention studies, the inclusion of comprehensive ethical elements and practical plans in the proposal, and a focus on data protection, confidentiality, risk management, and harm identification. While a significant number positively acknowledged reviewer comments, some researchers opted for in-depth discussions rather than directly addressing the issues.

The study highlights the importance of ethical considerations and emphasises the need to address the lack of robust methodological procedures in self-harm and suicide research. Addressing these challenges and adopting suggested improvements is paramount for advancing ethical and impactful research in this context.

Suicide and substance use all contribute significantly to the global burden of mortality and morbidity. While existing evidence establishes the association between substance use and suicidal behaviour in Lower- and Middle-Income Countries (LMICs), only a few studies illustrate how substance use affected deceased people's lifestyles and suicide attempts. The study addresses this gap by exploring the role of substance use (particularly, alcohol and drug use) in overall lifestyles and suicides of deceased with substance use in Pakistan – an underexplored and under-researched country regarding suicide and substance use.

We conducted in-depth qualitative interviews (N = 11) with close relatives and friends of those who died by suicide and have a history of substance use. The topic guide was comprised of a narrative part exploring the circumstances that surrounded the suicidal death of the deceased and a problem-focused part collecting comprehensive details about the deceased's personal, family, psychological, and social context and the role of substance use in the lifestyles and the suicide of the deceased.

The content analysis of interviews revealed five key themes: 1) Reasons for suicide, 2) Personality traits, 3) Psychological distress, 4) Initiation of substance use, and 5) Suicidal tendencies. Most of the participants reported the reason for their loved one's suicide was either an overdose of drugs or alcohol, family dynamics, or societal attitudes such as difficulty in building trust and finding acceptance within the family or society. Deceased individuals were perceived as impulsive with low control over their emotional states. Participants highlighted the underlying psychological distress in the deceased, emphasising the complexity of mental health and substance use problems. Participants reported that the deceased initiated drugs at an early age; had suicidal ideations; and overdosed themselves as a means of suicide.

This study provides valuable insights into the role of substance use in suicide. The findings highlight the need for a holistic approach to understanding the multifaceted factors that may influence suicidal behaviours in individuals with substance use. Understanding these factors can help develop targeted suicide prevention and intervention strategies, particularly in low-resource settings such as Pakistan.

Therapeutic Patient Education (TPE) aims to help patients self-manage their chronic condition over their lifetime, adapting to their evolving circumstances, as well as changes in their condition and treatment. The National Institute for Clinical and Healthcare Excellence underscores the importance of patient education as a crucial part of early interventions for mental disorders. This systematic review aimed to review TPE programmes in managing psychiatric disorders, considering the diversity in delivering agents, intervention formats, targeted skills, and therapeutic outcomes.

Comprehensive database searches, including Web of Science, PubMed, and COCHRANE, were conducted from September 2019 to January 2023, yielding 514 unique records, with 33 making it through rigorous evaluation for full-text review. Eleven studies met the inclusion criteria, focusing on various psychiatric disorders such as depression, bipolar disorder, psychosis, and multiple serious mental illnesses. A total of 38 studies were included from our previous review to supplement the current database search.

Among 49 included interventions, 13 were aimed at bipolar disorder, depression (n = 12), multiple serious mental illnesses and comorbidities (n = 11), schizophrenia and psychoses (n = 13). A total of 21 interventions were delivered in groups followed by individual (n = 12), mixed format (n = 14) and electronically (n = 2).

TPE programmes exhibited diversity in delivering agents and intervention formats, with a notable presence of multidisciplinary teams and various professionals. The interventions prioritized coping strategies and disease management techniques, though the extent varied based on the disorder. Examining the different skills imparted during the interventions, the focus predominantly leaned towards the teaching of coping strategies. These encompassed both cognitive and behavioural coping skills, including areas such as self-confidence (n = 37), stress management (n = 39), critical thinking (n = 26), problem-solving (n = 18), goal setting (n = 31), situational awareness (n = 36), and self-care (n = 36), with unspecified coping skills also noted (n = 32).

Effectiveness was heterogeneous across studies; some interventions showed significant benefits in areas such as symptom management, coping, and functional improvement, while others reported no significant outcomes.

The findings underscore the potential of TPE in psychiatric care, revealing its multifaceted nature and varied impact. TPE not only addresses deficits but also leverages patients' existing strengths and capabilities. Despite the reported benefits, a portion of the interventions lacked statistical significance, indicating the necessity for continuous refinement and evaluation.

A precision medicine approach to clozapine dosing aims to personalise it in two ways: i) during titration, and ii) for succeeding dose adjustments. This requires valid models of dose/concentration relationships, but cross-sectional models suffer from population-level artefacts and individual problems due to poor adherence or stopping smoking. Longitudinal data sets from two mental health trusts allowed poor adherence and smoking cessation to be identified. We then modelled dose/concentration relationships to construct personalised targets for i) and ii).

Demographics and co-prescribed medication were recorded for 137 patients from Greater Manchester Mental Health (GMMH) Trust who had two or more successive plasma levels and doses from 2016–2018. 412 patients from Pennine Care Foundation Trust (PCFT) who had successive plasma levels and doses from 2009–2023 were also recorded. In each sample, adherent patients (88 from GMMH and 371 from PCFT) were identified after excluding: > two-fold variation between blood samples in clozapine/norclozapine ratios, > two-fold variation in dose/concentration ratios, a clozapine/norclozapine ratio > 3, or a dose/concentration ratio > two standard deviations from the sample mean. Those whose smoking status (smoker vs non-smoker) changed between samples were excluded.

To identify i) titration targets, we used raw data in first samples (checked with logistic regression) to identify dose thresholds which produced most levels above 0.35 μg/ml (therapeutic) and no levels greater than 1 μg/ml (toxic). To model ii) effective dose adjustment, we used the equation Dt = Dc(Ct/Cc) to identify the most effective dose for the second samples. Dt was target dose, Dc current dose, Ct target level (0.45 μg/ml), and Cc current level.

First sample dose/concentration ratio in adherent patients correlated r > 0.75 with second samples’ dose/concentration. >84% of plasma levels were within 20% of the mean across both samples.

1. i. The GMMH dataset titration targets were 325 mg, 300 mg, 225 mg, and 175 mg daily for male smokers, female smokers, male non-smokers, and female non-smokers, respectively. In PCFT, data suggested corresponding targets of 375 mg, 325 mg, 225 mg and 175 mg. Targets avoided toxicity and gave therapeutic levels in > 50% of cases.

2. ii. Target dose, ascertained using the equation, and actual second dose were compared: in adherent cases, toxicity only occurred when actual doses were 1.5-fold greater than target dose, and above target all plasma levels exceeded 0.35 μg/ml in GMMH. PCFT data appeared similar.

Relatively safe and effective titration targets for smokers and non-smokers from both sexes were identified. A simple equation would improve precision and effectiveness of dose adjustment thereafter.

Objectives: In youth and young adults, it is common to encounter non-medical use of benzodiazepines, defined as use without a prescription or use for reasons other than that for which the medication is intended. Benzodiazepine use disorder remains understudied and overlooked, especially in youth and young adults. The primary objective of our study was to highlight the proportion of youth and young adults with aberrant use of benzodiazepines and diagnosed with benzodiazepine use disorder in a single centre. The secondary objective was to determine factors associated with aberrant benzodiazepine use and benzodiazepine use disorder in that sample.

This retrospective chart review screened for benzodiazepine use in 310 adolescent patients aged 12–19 seen for the first time in a concurrent disorders clinic, at a tertiary care clinic in Canada. Of those 310 patients, 167 were included in the final chart review.

97.6% of patients who used benzodiazepines demonstrated aberrant use, and 39.3% of patients received a diagnosis of benzodiazepine use disorder.

This review showed that a substantial percentage of youth and young adults in a concurrent disorders clinic in Canada are presenting with aberrant benzodiazepine use and are being diagnosed with benzodiazepine use disorder. Despite this prevalence, there is little by way of literature to guide treatment of benzodiazepine use disorder in this population.

Benzodiazepines are commonly used medications that have the potential for dependence and use disorder. Despite these harms, they are regularly prescribed and acquired from non-prescription sources. It has been established that benzodiazepine use is a widespread problem in youth and young adults. Little evidence exists to guide management of benzodiazepine use in this population. This scoping review aims to gather literature on the management of benzodiazepine use and identify the gaps in the literature to guide further research, particularly in youth and young adults.

Methodology followed the Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews guidelines. MEDLINE (Ovid), Embase, Cochrane, and Cumulated Index to Nursing and Allied Health Literature (CINAHL) were searched, together with a search of the grey literature. A survey of experts in the field of addiction medicine was completed. Broad inclusion criteria were used to capture any available literature. Data were compiled using Covidence software, and two independent reviewers screened titles, abstracts, and full texts against the eligibility criteria. Data were extracted using a modified JBI data charting table. Descriptive statistics and a simple thematic analysis were performed to summarize the data collected.

Of the 835 papers retrieved, 104 papers published from December 1982 to March 2023 were included in the final review. Two of the papers included in this review pertained to youth and young adults. The rest of the papers were based on the adult population. Gradual dose reduction is the only method with evidence for efficacy in youth. Several therapies show efficacy in adults and could be future areas of research in youth, including benzodiazepine maintenance therapy, carbamazepine, gabapentin, pregabalin, trazodone, flumazenil slow infusion, and buprenorphine in various clinical contexts. Valproic acid, agomelatine, tricyclic antidepressants, paroxetine, buspirone, progesterone, cyamemazine, magnesium aspartate, clonidine, lithium, hydroxyzine, chlorpromazine, alpidem, captodiame, and ondansetron were deemed ineffective, unsafe in youth, or were not available for use in Canada. Topiramate, lamotrigine, oxcarbamazepine, phenobarbital, propranolol, baclofen, mirtazapine, and nicotinic acid had preliminary, low-quality evidence in adults, and would require further study.

Benzodiazapine use disorder in youth is dangerous and common, and the lack of pharmacotherapeutic options has been deemed significant by our research team. The results of this review are promising in that they provide some further guidance on the management of this condition.

The purpose of this study was investigating the differences in temperament, personality, and cognitive function among athletes and non-athletes, as well as differences within athlete groups participating in different-paced sports like baseball and basketball.

A total of 57 professional basketball players, 51 professional baseball players, and 44 non-athletes subjected to temperament and characteristics inventory assessments and computerized neurocognitive function test. One-way analysis of variance (ANOVA) was employed to analyze the average differences in demographic characteristics, temperament, personality traits, and cognitive functions among the three groups, followed by Bonferroni post hoc tests. Comparisons between starters and non-starters within the athlete groups were conducted using the Mann–Whitney U test.

In the analysis of temperament, the basketball and baseball player groups exhibited higher reward dependence and persistence compared with the control group. Additionally, in the assessment of personality traits, both basketball and baseball player groups scored higher in self-directedness and cooperativeness compared with the control group, whereas self-transcendence scores were lower. In cognitive ability assessments, baseball and basketball players outperformed the control group in emotional perception tests. Both baseball and basketball players showed lower card movement counts compared with the control group.

This study compared the differences in temperament, personality, and cognitive abilities between professional basketball and baseball players and non-athletes. These results provide valuable insights into the temperament, personality, and cognitive abilities of professional athletes, contributing important information for athlete development and coaching goals in the future.

Evidence supports associations between polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and psychosis risk. However, longitudinal PUFA trajectories in the general population have not been characterised. The aims of this study were: 1) To describe longitudinal trajectories of plasma omega-6:omega-3 ratio and DHA levels in a large general population sample; and 2) To evaluate associations between these trajectories and psychosis-spectrum outcomes in early adulthood. Based on previous research, we hypothesised that trajectories characterised by higher omega-6:omega-3 ratio and lower DHA levels would be associated with increased odds of psychosis-spectrum outcomes.

We examined a large cohort in the Avon Longitudinal Study of Parents and Children (n = 3635, 2247 [61.8%] female). Plasma omega-6:omega-3 ratio and DHA % total fatty acids were measured by nuclear magnetic spectroscopy at 7, 15, 17 and 24 years, then standardised by sex. Trajectories were evaluated using curvilinear growth mixture modelling, contemporaneously adjusting for body mass index. Psychosis-spectrum outcomes were assessed at 24 years. Psychotic experiences (PEs), At-Risk-ental-State status, psychotic disorder and number of PEs were measured using the Psychosis-Like Symptoms interview. Negative symptoms score was measured using the Community Assessment of Psychic Experiences. Associations were evaluated using logistic, negative binomial or linear regression as appropriate, adjusting for sex, ethnicity, parental social class, smoking and alcohol use. Multiple imputation was used to impute missing exposure and covariate data across ten imputed datasets.

A three-trajectory solution was optimal for both omega-6:omega-3 ratio and DHA. Relative to stable average, persistently high omega-6:omega-3 ratio and persistently low DHA trajectories were associated with increased odds of PEs and psychotic disorder, with these associations explained by included covariates. In fully adjusted analyses, the persistently high omega-6:omega-3 ratio trajectory was associated with number of PEs (adjusted β 0.41, 95% confidence interval [CI] 0.05–0.78) and negative symptoms score (adjusted β 0.43, 95%CI 0.14–0.72), as was the persistently low DHA trajectory (number of PEs: adjusted β 0.45, 95%CI 0.14–0.76; negative symptoms: adjusted β 0.35, 95%CI 0.12–0.58).

In this first description of plasma PUFA trajectories in a large general population cohort, trajectories characterised by persistently high plasma omega-6:omega-3 ratio and persistently low plasma DHA levels were associated with psychosis-spectrum outcomes in early adulthood. In the case of number of PEs and negative symptoms, these associations were not fully explained by included covariates. Optimisation of PUFA status during development warrants further investigation as a malleable protective factor in relation to specific psychosis symptom domains in early adulthood.

To examine the legal framework governing psychiatric practice, specifically focusing on the Mental Health Act, within a singular psychiatric centre in Moshi, Tanzania. The primary objective was to explore the intersection of culture and legalities in shaping ethical practice within this emerging unit. Drawing on a comparative analysis of contents and the implementation of the MHA in Tanzania and in the UK, the study aims to understand the ways in which cultural contexts influence the legal and ethical dimensions of psychiatric care.

This was a multi-method study that combined literature analysis, structured interviewing, and structured reflective practice.

1. 1. Direct comparison of the UK and Tanzanian MHA.

2. 2. Evaluation of clinician understanding of the MHA through structured interviewing of clinicians with respect to their knowledge of the MHA, its existence, and its key components.

3. 3. Analysis of implementation of the MHA in liaison psychiatry in both centers. Compared through unstructured interviewing and reflective practice.

1. 1. The most striking difference is the length of the documents. The Tanzanian MHA is 27 pages while the UK MHA is 173. This additional length covers: Admission and Discharge Procedures, explanation of the Roles and Powers of Professionals, and further discussion on Safeguards and Rights of Individuals.

2. 2. When interviewed, only 15% of Tanzanian physicians could explain what the MHA is, compared with 100% of UK physicians (N = 40).

3. 3. In the UK, all doctors use the MHA and implement DOLS. In Tanzania, this falls under the role of liaison psychiatrists. This is likely because, the MHA is included in the UK's medical curricula but not in Tanzania's.

Lack of understanding of the MHA and other key laws in psychiatry is a global issue, not limited to the UK or Tanzania. However, physicians with strong understanding are more scarce in Tanzania. This scarcity puts additional pressures on psychiatric services, as psychiatrists are called to assess issues of capacity or consent that could be assessed by any doctors in the UK. However, this means that the MHA and MCA are almost solely used by psychiatrists and therefore often assessed to a very high standard. It must be considered that on reflection, I have also observed physicians with limited understanding of the MHA, capacity and consent within the NHS. Imposing a higher standard on another culture would be unethical. Efforts into educating medical students and professionals is required in the UK and Tanzania.

There is still little information available on the negative impact of online activities on psychotic experiences. This limitation is further compounded for online gaming, where even a beneficial impact has been suggested via the evocation of positive emotions. We aimed to examine how problematic online gaming (POG) is associated with subsequent psychotic experiences in adolescents.

This birth cohort study employed randomly sampled adolescents born between September 2002 and August 2004. The eligibility criterion was those who did not have psychotic experiences at age 14. We analyzed the association between POG at age 14 and subsequent psychotic experiences at age 16. Adolescents were categorized into the no, low, and high POG groups based on the behaviors and emotions related to online gaming at age 14. Missing data were handled using random forest imputations.

A total of 1722 adolescents without psychotic experiences at age 14 were analyzed. At age 16, 55 adolescents exhibited psychotic experiences, while 225 showed potential psychotic experiences. Compared with the no POG group, a higher risk of psychotic experiences was shown in both the low (RR 1.93, 95% CI 1.74–2.15) and high (RR 2.81, 95% CI 2.50–3.15) POG groups. Findings were consistent when analyzing potential psychotic experiences.

POG appears detrimental to the development of psychotic experiences in adolescents. Our findings provide public health implications in the context of policymaking.

Diabulimia is an increasingly used term referring to “an eating disorder (ED) with type 1 diabetes”. It is difficult to detect and presents in multiple ways, which can potentially include feelings of body dissatisfaction (BD), which in itself is a complex symptom to quantify clinically.

This rapid systematic review aimed to identify whether feelings of BD are a risk factor for diabulimia by researching if and how BD is assessed in patients with the condition.

A rapid systematic review was undertaken. A literature review was performed on Ovid Medline (all) and Ovid Embase databases using search terms for Type 1 Diabetes, ED, and BD and looked at cross-sectional studies only. One reviewer performed the literature search and screened titles and abstracts. Out of 589 papers screened, four papers met the inclusion criteria. These papers then went through critical appraising using the Appraisal tool for Cross-Sectional Studies, with all papers showing mid-level quality clearing 16 to 17/20 questions. Therefore, data was extracted from all of them.

All four papers came from different countries and used a wide range of sample sizes (43–477).

There was widespread heterogeneity between the data collected in each study due to the various tools used to identify BD, paired with differences in analysing extracted data.

To ensure transparency and quality of the results provided, the Synthesis Without Meta-analysis tool was used. Three studies looked at effects on adolescents and three had a higher proportion of females. All papers used previously established and tested BD screening methods. Two papers found female diabetics were more likely to have BD symptoms, and one paper saw that males were more at risk. All four papers concluded that BD had some correlations with one or more aspects of diabetes and/or other ED symptoms related to diabulimia. Two commented on positive correlations between BD and HbA1c levels and one commented on BD symptoms and insulin restriction trending together. Two papers also saw BD symptoms and depressive symptoms correlating in patients as well.

All four studies showed that BD was related to diabulimia, both from a psychological and diabetic perspective, and most highlighted how BD manifested between the different sexes of diabetics. This review highlights the need for more standardised and comprehensive BD questionnaires to draw out key signs of EDs in diabetics that could improve screening, detection and management of diabulimia.

Patients experiencing Medically Unexplained Symptoms (MUS) are some of the costliest in both primary and secondary care. Psychotherapy is one of the most efficacious ways of treating them although the most superior modality is unclear. Cognitive Behavioural Therapy (CBT) has the greatest evidence base, but a growing number of studies have investigated the role of Psychodynamic Psychotherapy (PPT). This is the first study to compare the two modalities concerning their impact on healthcare utilisation and cost to the NHS.

Patients referred to the Oxford Community Psychological Medicine Service in 2021 and who went on to complete a course of psychotherapy for MUS were included. 78 patients were referred, 66 patients were assessed, 16 patients began treatment and 9 patients completed treatment. 4 received CBT and 5 received PPT based on a ‘best fit’ assessment. Their healthcare utilisation (GP appointments, health investigations, A&E attendances, inpatient admissions and outpatient appointments) was assessed during the 6 months prior to their initial assessment and compared with the 6 months after therapy had ended using data from ‘Health Information Exchange’.

Overall, psychotherapy reduced primary care use but our data was insufficiently powered for this to be statistically significant. There was a significant reduction in outpatient appointments after psychotherapy, mostly representing mental health consults.

Significant differences between pre-therapy and post-therapy were only observed for the number of health investigations in the PPT group which, surprisingly, increased with a large effect size (d = 1.19 95% CI 1.12–2.88, P = 0.03). The same trend towards increased utilisation were observed for every outcome measure in PPT besides outpatient appointments. Conversely, all outcome measures showed an improvement after CBT apart from the number of health investigations which marginally increased.

CBT significantly decreased GP appointments at 6 months follow-up compared with PPT with a large effect size (η2 = 0.5, p < 0.05). A similar trend was seen for total cost (η2 = 0.5, p < 0.06) with each PPT patient costing £790 more on average than their CBT counterparts during the 6 months after therapy.

Whilst CBT appears to be efficacious in the short-term, PPT caused significantly increased healthcare utilisation compared with CBT in the 6 months after therapy. This aligns with similar studies that demonstrate a ‘sleeper effect’ in which patients who receive PPT, but not CBT, deteriorate before improving over long-term follow-up.

Additional research is needed to correlate this data with symptoms and capture the long-term benefits of these psychotherapies for MUS.

Exposure to traumatic experiences during childhood and adolescence is a significant risk factor for the development of psychiatric disorders in adulthood. An estimated 50% of the worldwide incidence of depression and anxiety can be attributed to childhood maltreatment (Li et al., 2016). In addition, approximately one-third of psychotic experiences are attributable to a history of developmental trauma (McGrath et al., 2017). It is thought that long-lasting, trauma-induced adaptive changes in neurobiological function may lead to a predisposition towards pathophysiology (McCrory and Viding, 2015). However, the precise mechanisms through which developmental trauma exposure alters brain function on cellular and circuit levels remain poorly elucidated.

A systematic literature search and meta-analysis was performed to establish how dopaminergic functioning in adulthood is affected by developmental stress in rodents. Three databases, Medline®, Embase®, and PsycINFO®, were systematically searched initially on 2nd December 2023. Terms for three superordinate concepts (‘childhood’ terms, ‘trauma’ terms, and ‘dopamine’ terms) were combined. Cohen's d statistic was used for effect sizes. This protocol is pre-registered on PROSPERO® (ID: CRD42018106382).

A total of 104 studies met our inclusion criteria. Meta-analysis indicated that developmental stress exposure leads to complex and long-lasting effects in basal and post-amphetamine extracellular dopamine concentrations in the medial prefrontal cortex, amygdala, and nucleus accumbens. In addition, there is a significant downregulation of D1 receptors and upregulation of D2 receptors in prefrontal and striatal regions involved in threat and reward processing. Effect sizes ranged from 0.36 to 1.55.

These findings strongly suggest that dopaminergic dysfunction is a mechanistic link between developmental trauma and vulnerability towards mental illness in adulthood.

Recent studies have focussed on detecting white matter abnormalities in subjects who transition to psychosis (UHR-T). Research suggests that fractional anisotropy (FA), may be decreased in UHR-T. However, global and regional findings have been inconsistent. By objectively combining data in a meta-analysis, we have investigated white matter alterations associated with transition, by comparing FA in UHR-T with subjects that do not transition (UHR-NT) and healthy volunteers.

The meta-analysis was registered on PROSPERO (ID: CRD42021265348) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA guidance. A systematic database search of PUBMED and EMBASE identified reports, which were screened by 2 independent researchers (CN and DD) for inclusion, from inception to 20 July 2021. Discrepancies were decided on consensus with a third researcher (KM). Reference lists of eligible studies were also screened. Authors of screened reports were contacted to provide parametric maps. Coordinate-based meta-analysis was conducted using Seed-based d-Mapping software to combine parametric map and coordinate data from reports, using a random-effects model. Quality and risk of bias analysis were conducted using the Newcastle-Ottowa Scale. Heterogeneity and sensitivity analyses were also conducted.

The search strategy identified 889 potential studies, from which 6 met eligibility criteria. A total of 71 UHR-T, 142 UHR-NT and 148 healthy volunteers were included. Weighted-mean decreases in FA were observed in UHR-T compared with: UHR-NT (d = −0.99; p < 0.0001; 95% CI −1.43 to −0.55); and healthy volunteers (d = −0.91; p = 0.04; 95% CI −1.78 to −0.05). The level of heterogeneity for the former was not significant. For UHR-T, regional FA decreases were observed in areas including the left genu of the corpus callosum (Z-score = −1.76, 204 voxels, p < 0.0001) compared with UHR-NT, while FA increases were most observed in the white matter region adjacent to the left postcentral gyrus (Z-score = 1.64, voxels = 16, p < 0.0001). These findings persisted despite sensitivity analyses.

The findings suggest that white matter alterations, specifically in left frontotemporal tracts, are associated with an increased risk of transition to psychosis. The neurobiological implications of these findings, and their contribution to UHR-T prediction efforts, are explored, as are avenues for further research.

Additional Author: Mr Gunnar Gronlid.1

To determine: i. the nature of the associations between three domains of psychopathology (depressive, hyperactivity and conduct symptoms) and cognitive/academic performance among adolescents i.e., whether these reflect causal processes and/or common genetic effects; ii. The extent to which these associations vary by comorbidity.

The sample comprised participants in the UK Twins Early Development Study (TEDS; n≈12,000 individuals) assessed for depressive, hyperactivity and conduct symptoms using standardised questionnaires. Cognitive and academic performance were assessed using Standard Progressive Matrices and GCSE scores respectively. Comorbidity was derived as a count of borderline/high psychopathology scores present per individual. Twin modelling was used to investigate preliminary correlations and moderation effects. Genetic models were further used to determine the most likely direction of causal effects with/without genetic correlations.

There were small to moderate negative correlations between adolescent psychopathology domains and cognitive performance (−0.01 ≤ r≤−0.15) and academic performance (−0.06 ≤ r≤−0.23). Correlations were smallest for depressive symptoms and larger for hyperactivity/conduct symptoms. The correlation between hyperactivity symptoms and cognitive performance was significantly more negative as comorbidities increased (moderation coefficient – βmod = 0.07, 95% CI: 0.02, 0.12). Similarly, the association between depressive symptoms and academic performance also became more negative as comorbidities increased (βmod = −0.08, 95% CI: −0.11, −0.05). Twin modelling indicated that hyperactivity symptoms were causally associated with poorer cognitive and academic performance. In contrast, poorer cognitive performance was causally associated with conduct symptoms.

These preliminary findings indicate the impact of comorbidity on the functioning of adolescents with hyperactivity and depressive symptoms. They further suggest the need to specifically recognise these comorbidities during assessment and treatment planning to promote optimal functioning. Our findings also suggest differential mechanisms for the links between different psychopathology domains and impaired functioning. Further analyses will investigate moderation of the causal links and/or genetic correlations and whether these associations vary by indicators of marginalisation (sex and ethnicity).

This study investigated the relationship between common genetic variation and co-occurring mental health conditions among autistic individuals.

The study was conducted with the Simons Foundation Powering Autism Research (SPARK) dataset, V9 release, and included probands [n = 17,582] with confirmed diagnosis of autism, who were also in the SPARK iWES1 array genotyping dataset. Six co-occurring mental health conditions (attention deficit hyperactivity disorder or ADHD, bipolar disorder, depression, schizophrenia, anxiety disorder and disruptive behaviour disorders) were analysed. Polygenic scores (PRS) were generated with PRScs software, using summary statistics from the most recent genome wide association studies (GWAS) for autism, ADHD, schizophrenia, bipolar disorder, depression, anxiety, neuroticism, p-factor, intelligence, educational attainment and hair colour (negative control). General linear models (GLM) and Cox proportional hazards models were computed, with age at registration, sex, cognitive impairment and genetic principal components included in both sets of models. Multiple testing correction was done using the Benjamini-Yekutieli method. Results were calculated using odds ratios (OR), 95% Confidence Intervals (CI) and corrected p values (p).

There were similar patterns of association and interaction for both GLMs and Cox models. Polygenic scores for educational attainment were significantly lower for those with co-occurring ADHD (GLM: OR=8.85E-01, 95% CI=8.48e-01–9.23e-01, p = 2.91E-07; Cox: OR=8.94E-01, 95% CI=8.66e-01–9.22e-01, p = 4.76E-11), bipolar disorder (GLM: OR=7.45E-01, 95% CI=6.54e-01–8.49e-01, p = 2.40E-04; Cox: OR=7.25E-01, 95% CI=6.39e-01–8.23e-01, p = 3.96E-05), depression (GLM: OR=8.63E-01, 95% CI=8.04e-01–9.26e-01, p = 5.13E-04; Cox: OR=8.56E-01, 95% CI=8.03e-01–9.12e-01, p = 2.80E-05), schizophrenia (GLM: OR=6.94E-01, 95% CI=5.71e-01–8.42e-01, p = 3.99E-03; Cox: OR=6.67E-01, 95% CI=5.52e-01–8.05e-01, p = 1.41E-03), anxiety disorder (GLM: OR=8.77E-01, 95% CI=8.37e-01–9.20e-01, p = 9.88E-07; Cox: OR=8.81E-01, 95% CI=8.49e-01–9.15e-01, p = 1.46E-09) and disruptive behaviour disorders (GLM: OR=7.10E-01, 95% CI=6.63e-01–7.60e-01, p = 3.22E-21; Cox: OR=7.10E-01, 95% CI=6.67e-01–7.57e-01, p = 1.35E-24).

Polygenic scores for educational attainment were associated with the co-occurrence of several mental health conditions among autistic individuals.

Ward rounds are complex clinical interactions crucial in delivering high-quality, safe, and timely patient care. They serve as a platform for the multidisciplinary team to collaboratively assess a patient's condition and actively involve the patient and their caregivers in shared decision-making to formulate a care plan. Ward rounds involve an intersection of factors worthy of consideration separate from the wider literature on inpatient experience and multidisciplinary team meetings. With this review our primary aim is to systematically identify what methods and perspectives researchers are using to understand ward rounds.

The databases searched were Medline, CINAHL, British Nursing Index, PsychInfo, and ASSIA as well as reference and citation checking. The search terms used were psychiatr* AND (ward round OR “multi disciplinary team meeting” OR “clinical team meeting”). Studies were included if they were peer reviewed, included primary research on psychiatric inpatient ward rounds in which patients are participants with no restriction on the type of ward or hospital, patient group, country or methodology.

224 records were retrieved and screened from the database search and 10 from other sources. 35 full texts were reviewed for eligibility and 26 included in the review. 16 studies had no particular theoretical perspective, 2 were constructivist, 2 critical realist, 2 lean methodology, 1 systems research, 1 phenomenological, 1 trauma informed and 1 critical theory. 9 focussed on patient experience, 5 ward round structure, 3 on power relationships, 3 on efficiency, 2 on shared decision making and 4 had a unique focus. Though often not explicit, critical theory influenced discussion of power is common in papers focused on patient experience and ward round structure. Cross-sectional surveys, interviews, focus groups and audit cycles were the most common methods. Key themes which emerge are anxiety provoked by ward rounds, preparation and communication, and the negotiation of power structures. Key tensions identified include being multidisciplinary versus overcrowding, efficiency versus personalisation and reliability versus responsiveness.

For a central part of inpatient psychiatric practice there is a limited range of research on psychiatric ward rounds. The influence of critical theories’ focus on power was widespread with limited representation of other theoretical perspectives and concerns. There was no research using experimental methods, but there was some implementation research. Key tensions are highlighted which services may wish to consider when revisiting ways of working on inpatient psychiatric wards.

This review delves into the understanding of depression within African communities, extending its scope to nations with significant African populations, aiming to enhance service provision for these patients. While focusing on cultural experiences of depression that transcend geographical boundaries, it builds upon existing literature predominantly centred on sub-Saharan African countries.

A comprehensive literature search was conducted across multiple databases, yielding 13 relevant articles after applying stringent criteria. Following Cochrane guidelines, search terms encompassed population (Africa, Africans, African communities), exposure (Depression, Depressive disorder, Dysphoria, Dysthymia, Low mood), and outcomes (Cultural expressions, Cultural variations, Somatization, Cultural framework, Cross-cultural research, Service provision).

Analysing selected articles through the CASP checklist, a narrative synthesis of qualitative studies over the past twelve years elucidated diverse perceptions and expressions of depression in African communities compared with Western contexts. Three major themes emerged: Expressions of depression (with subthemes: Attitudes towards depression), Perceptions of depression (including Stigmatization), and culturally acceptable forms of treatment (including Barriers towards treatment).

The review underscores the significance of integrating culturally acceptable treatment methods into psychological therapy for improved healthcare delivery. Collaboration between clinicians and patients is pivotal, with religious assistance emerging as a culturally acceptable treatment avenue. Establishing therapeutic alliances with religious communities could enhance treatment effectiveness. Further research is warranted to explore the impact of religious activity on depression symptoms and progression, as well as the influence of mental health providers' religious backgrounds on treatment dynamics. This holistic approach is crucial for addressing the unique cultural nuances surrounding depression in African communities and optimizing patient care.

The contribution of mental illness towards total Disability Adjusted Life Years is increasing according to the Global Burden of Disease study. As the need for mental health services increases, technological advances are being deployed to improve the delivery of care and lower costs.

The emergence of Artificial Intelligence (AI) technology in mental health and companionship is an evolving topic of discussion. There have been increasing debates about the use of AI in managing mental health problems. As the AI technology and its use grows, it is vital to consider potential harms and ramifications.

There are very limited discussions about the use of chatbots and relevant AI by humans to commit crime especially in those suffering from mental illness. AI can potentially serve as an effective tool to misguide a vulnerable person going through a mental health problem e.g. encourage someone to commit a serious offence. There is evidence that some of the most used AI chatbots tend to accentuate any negative feelings their users already had and potentially reinforce their vulnerable thoughts leading to concerning consequences.

The objective of this study is to review existing evidence for harmful effects of AI chatbots on people with serious mental illness (SMI).

We conducted a review of existing evidence in five databases for relevant studies. The search sources were 4 bibliographical databases (PsycINFO, EMBASE, PubMed, and OVID), the search engine “Google Scholar” and relevant grey literature. Studies were eligible if they explored the role of AI and related technology in causing harm in those with SMI.

Initial searches constrained the scope of review to the harmful effects of AI use in mental health and psychiatry and not just the association with crime due to very limited existing data.

Whilst current AI technology has shown potential in mental healthcare, it is important to acknowledge its limitations. At present, the evidence base for benefits of AI chatbot in mental healthcare is only just getting established and not enough is known or documented around the harmful effects of this technology. Nevertheless, we are seeing increasing cases of vulnerable mental health patients negatively influenced by AI technology. The use of AI chatbots raises various ethical concerns often magnified in people experiencing SMI. Further research will be valuable in understanding the ramifications of AI in psychiatry. This will also help guide the developers of this important and emerging technology to meet recognised ethical frameworks hence safeguarding vulnerable users.

Dementia is a debilitating disease with multiple potential causes, no cure and rising incidence. New studies suggest that gut bacteria not only aid in the digestion of bowel products but also other bodily functions such as immune systems and relaying messages to the brain. This review aims to examine the potential link between gut microbiota and dementia by performing a systematic review to assess whether gut bacteria play a role in the development of dementia.

The systematic review was designed and conducted according to PRISMA guidelines. A modified PICO model was used to perform a literature search in Medline, CINAHL PLUS and APA PsychInfo databases. The search identified 401 articles, 49 of which met the predefined inclusion criteria. Twenty-one final studies were included in the results; 14 cross-sectional, two cohort, three case-control, one randomised control study and one case report. The reviewer extracted and analysed data from these studies for quality using the AXIS and CASP tools. A narrative synthesis of the results was performed due to the heterogeneity of the data.

Individuals with dementia have lower microbial diversity than healthy controls, including changes in specific bacterial taxa, pro-inflammatory and anti-inflammatory balance. The results of the review were subdivided into four identified themes which helped further identify that microbial metabolites, diet and gastrointestinal disease can also influence the composition of gut microbiomes and, therefore, the development of cognitive impairment and dementia.

This systematic review found a link between gut bacteria, bacterial metabolites, gastrointestinal health, diet, and dementia. Although the studies were mostly observational, they suggest that gut microbiota can affect brain function through dysbiosis, which can lead to neuroinflammation and dementia. More research is needed to confirm a causal relationship, but targeting the gut microbiota could be a potential therapy for MCI and AD. Innovative strategies may help combat the growing challenge of dementia.