Understanding the effects of ketamine on depressive symptoms could help identify which patients might benefit and clarify its mechanism of action in both the early (≤1 day post-infusion) and late (e.g. 2–30 days post-infusion) post-infusion periods. Symptom network analyses could provide complementary information regarding relationships between symptoms.

To identify the effects of ketamine on symptom-level changes in depression across both the early and late post-infusion periods and on depressive symptom network changes.

In this secondary analysis of 152 adults with treatment-resistant depression (with 38.8% reporting suicidal ideation at baseline), we compared symptom changes in the early and late post-infusion periods between individuals randomised to a single 40 min infusion of intravenous ketamine 0.5 mg/kg (n = 103) or saline (n = 49) and identified changes in symptom networks between pre- and post-ketamine treatment using network analyses.

In the early post-infusion period, the greatest improvement (comparing ketamine with saline) was in depressive symptoms related to sadness. In network analyses, symptom network connectivity increased following ketamine infusion. Symptoms of sadness and lassitude showed persistent improvement in the first week post-infusion, whereas improvements in suicidal thoughts first emerged 3–4 weeks post-infusion.

Ketamine improved all symptoms but showed the greatest effect on symptoms of sadness, both immediately and in the initial week after treatment. Ketamine also rapidly altered the topology of symptom networks, strengthening interrelationships between residual symptoms. The efficacy of ketamine (compared with saline) regarding suicidal symptoms emerged later. Our findings suggest potentially divergent efficacy, time courses and mechanisms for different symptoms of depression.

Despite the high prevalence of social and performance anxiety, current treatments do not meet the full needs of patients. Development of novel anxiolytics with rapid onset of action for on-demand treatment of social and performance anxiety is an active area of clinical research.

To examine the anxiolytic effect of VQW-765, an α7-nAChR agonist, in subjects with performance anxiety.

We conducted a randomised, double-blind, placebo-controlled trial of 230 adults with a history of public speaking anxiety. Participants were randomly assigned to receive a single oral dose of 10 mg VQW-765 (n = 116) or placebo (n = 114), followed by a Trier Social Stress Test (TSST). Anxiety levels were assessed by the Subjective Units of Distress Scale (SUDS). Heart rate was monitored during the TSST. Plasma concentration of VQW-765 was measured after the TSST.

Subjects receiving VQW-765 showed a trend of improvement in intensity of anxiety, as measured by the SUDS, during the performance phase of a TSST compared with placebo (P = 0.1443). Females showed a larger magnitude and significant response to VQW-765 (P = 0.034). The pharmacokinetic/pharmacodynamic analysis observed an inverted U-shaped exposure–response relationship. Subjects in the middle 50% quantiles of VQW-765 plasma concentration showed significant improvement in the SUDS rating compared with placebo (P = 0.033); however, subgroup analysis revealed this was true only for females (P = 0.005). VQW-765 was safe and well tolerated.

This is the first study showing anxiolytic effect of an α7-nAChR agonist in humans. VQW-765 is a promising candidate to be developed for on-demand treatment of social anxiety disorder.

The duration of undiagnosed or untreated bipolar disorder (DUBD) has become a focus of research interest. However, its relationship with clinical characteristics and outcomes remains poorly understood.

The objective of this systematic review and meta-analysis was to examine DUBD and explore its relationships with clinical characteristics and outcomes in bipolar disorder.

We conducted a systematic search of the literature to identify studies reporting on DUBD and its relationships with clinical characteristics and outcomes including frequency of relapse into mood episodes, severity and persistence of mood symptoms, functional and cognitive measures, suicidality, hospital admission rate, and comorbidities such as substance use disorders.

Thirty articles met inclusion criteria for the systematic review, and 23 studies were included in the three different sets of meta-analyses. The pooled mean DUBD across all studies was 9.10 years. Early onset, depression as the polarity of the first mood episode, lifetime suicide attempts, comorbid anxiety and alcohol use disorders, and family history of bipolar disorder were associated with significantly longer DUBD, whereas diagnosis of bipolar I disorder and lifetime psychotic symptoms were associated with shorter DUBD. Studies that investigated outcomes subsequent to the diagnosis of bipolar disorder yielded conflicting results.

DUBD may be associated with certain adverse outcomes. This association indicates the importance of adopting a more comprehensive approach to assessing mood disorders, with an emphasis on prioritising early screening for bipolar disorder. The significant heterogeneity among included studies suggests a need for improved methodological rigour in future research.

Cognitive–behavioural therapy (CBT) is a first-line treatment for depressive disorders, but research on its neurobiological mechanisms is limited. Given the heterogeneity in CBT response, investigating the neurobiological effects of CBT may improve response prediction and outcomes.

To examine brain functional changes during negative emotion processing following naturalistic CBT.

In this case-control study, 59 patients with depressive disorders were investigated before and after 20 CBT sessions using a negative-emotion-processing paradigm during functional magnetic resonance imaging, clinical interviews and depressive symptom questionnaires. Healthy controls (n = 60) were also assessed twice within an equivalent time interval. Patients were classified into subgroups based on changes in diagnosis according to DSM-IV criteria (n = 40 responders, n = 19 non-responders). Brain activity changes were examined using group × time analysis of variance for limbic areas, and at the whole-brain level.

Analyses yielded a significant group × time interaction in the hippocampus (P family-wise error [PFWE] = 0.022, ηP2 = 0.101), and a significant main effect of time in the dorsal anterior cingulate cortex (PFWE = 0.043, ηP² = 0.098), resulting from activity decreases following CBT (PFWE ≤ 0.024, ηP² ≤ 0.233), with no changes in healthy controls. Hippocampal activity decreases were driven by responders (PFWE ≤ 0.020, ηP² ≤ 0.260) and correlated with symptom improvement (r = 0.293, P = 0.024). Responders exhibited higher pre-treatment hippocampal activity (PFWE = 0.017, ηP² = 0.189).

Following CBT, reduced activity in emotion-processing regions was observed in patients with depressive disorders, with hippocampal activity decreases linked to treatment response. This suggests successful CBT could correct biased emotion processing, potentially by altering activity in key areas of emotion processing.Hippocampal activity may function as a predictive marker of CBT response.

Cannabis use is linked to treatment non-adherence and relapses in psychotic disorders. Antipsychotic medication is effective for relapse prevention in primary psychoses, but its effectiveness after cannabis-induced psychosis (CIP) remains unclear.

To examine the effectiveness of antipsychotic medication for relapse prevention following the first clinically diagnosed CIP.

A cohort of 1772 patients (84.1% men) with incident CIP was identified from the Swedish National Patient and Micro Data for Analyses of Social Insurance registers. The primary outcome was hospitalisation due to any psychotic episode. Drug use data were collected from the Prescribed Drug Register and modelled into drug use periods using the PRE2DUP method. A within-individual Cox regression model was used to study the risk of outcomes during the use of different oral or long-acting injectable (LAI) antipsychotics compared with non-use.

The mean age at first diagnosis was 26.6 years (s.d. = 8.3). Of the cohort, 1343 (75.8%) used antipsychotics and 914 (51.3%) experienced psychosis hospitalisation during the follow-up. Any antipsychotic use was associated with a decreased risk of psychosis hospitalisation (adjusted hazard ratio (aHR) 0.75; 95% CI 0.67–0.84). Specific antipsychotics associated with decreased risk included aripiprazole LAI (aHR 0.27; 95% CI 0.14–0.51), olanzapine LAI (aHR 0.28; 95% CI 0.15–0.53), clozapine (aHR 0.55; 95% CI 0.34–0.90), oral aripiprazole (aHR 0.64; 95% CI 0.45–0.91), antipsychotic polytherapy (aHR 0.74; 95% CI 0.63–0.87) and oral olanzapine (aHR 0.81; 95% CI 0.69–0.94).

In particular, LAIs, clozapine and oral aripiprazole were associated with a decreased risk of psychosis relapse following CIP. Prescribers should consider using more LAIs for better treatment outcomes after CIP.

The identification of early warning signs is of great importance for identifying individuals at risk for mental disorders. Especially in the case of bipolar disorder, these research endeavours are imperative considering that the frequently delayed diagnoses and longer illness duration are associated with symptom exacerbation and lower recovery rates.

To multimodally investigate associations between hypomanic personality traits and altered social affect and social cognition to probe their role as early warning signs of bipolar disorder.

In a community sample (n = 140; 50.71% female), we investigated associations between hypomanic personality traits and both behavioural and neural activity measures of empathy and theory of mind (ToM) based on data from a functional magnetic resonance imaging paradigm.

Although analyses revealed no significant associations between behavioural or neural correlates of empathy and hypomanic personality traits, these traits were significantly associated with elevated ToM-related neural activity in the anterior rostral medial prefrontal cortex and anterior cingulate cortex. These neural activation differences were not accompanied by differences in behavioural ToM performance, suggesting more intense recruitment of task-relevant brain regions but unaffected behavioural outcomes.

Our findings indicate hypomanic personality traits to be positively associated with ToM-related neural activity but not with behavioural ToM performance. Prospectively, our study contributes to driving towards a more comprehensive and potentially neurobiologically grounded phenotype of bipolar disorder risk that contributes to a more differential understanding of risk and resilience mechanisms.

The Kahramanmaraş earthquakes in February 2023 represented a disaster within a disaster, as northwest Syria had been affected by years of war. Literature on the immediate psychological impact of such natural disasters in high-adversity populations is lacking.

To examine prevalences, longitudinal trajectories and cognitive predictors of post-traumatic stress disorder (PTSD), depression and generalised anxiety disorder (GAD) in survivors of armed conflict in northwest Syria exposed to the Kahramanmaraş earthquakes.

We assessed self-reported PTSD, depression and GAD symptoms, as well as self-efficacy and repetitive negative thinking (RNT), at 4, 11 and 18 weeks post-earthquake (T1, T2 and T3, respectively) in 204 war survivors exposed to recent earthquakes. Retention rates for T2 and T3 were 84.4 and 75.8%, respectively. To determine trajectories of PTSD, depression and GAD, we conducted latent class growth analyses with time, self-efficacy and RNT as predictors, and trauma history, education and gender as covariates.

Prevalences of probable PTSD, depression and GAD according to questionnaire cut-offs were 80.4, 79.9 and 70.1% at T1; 62.2, 57.2 and 54.2% at T2; and 62.1, 55.2 and 51.1% at T3. Across all disorders, three developmental trajectories emerged, with most participants following a recovery or low-symptom trajectory. RNT was associated with protracted recovery.

Natural disasters are associated with poor mental health in individuals in war-torn regions. Although latent class growth analyses indicated prevailing recovery trajectories, prevalence remained alarmingly high across time. RNT emerged as a potential transdiagnostic factor across disorders. Research and interventions should prioritise northwest Syrians’ unprecedented mental health needs.

Having a relapse of schizophrenia or recurrent psychosis is feared by patients, can cause social and personal disruption and has been suggested to cause long-term deterioration, possibly because of a toxic biological process.

To assess whether relapse affected the social and clinical outcomes of people enrolled in a 24-month randomised controlled trial of antipsychotic medication dose reduction versus maintenance treatment.

The trial involved participants with a diagnosis of schizophrenia or recurrent, non-affective psychosis. Relapse was defined as admission to hospital or significant deterioration (assessed by a blinded end-point committee). We analysed the relationship between relapse during the trial and social functioning, quality of life, symptom scores (Positive and Negative Syndrome Scale) and rates of being in employment, education or training at 24-month follow-up. We also analysed changes in these measures during the trial among those who relapsed and those who did not. Sensitivity analyses were conducted examining the effects of ‘severe’ relapse (i.e. admission to hospital).

During the course of the trial, 82 out of 253 participants relapsed. There was no evidence for a difference between those who relapsed and those who did not on changes in social functioning, quality of life, symptom scores or overall employment rates between baseline and 24-month follow-up. Those who relapsed showed no change in their social functioning or quality of life, and a slight improvement in symptoms compared to baseline. They were more likely than those who did not relapse to have had a change in their employment status (mostly moving out of employment, education or training), although numbers changing status were small. Sensitivity analyses showed the same results for those who experienced a ‘severe’ relapse.

Our data provide little evidence that relapse has a detrimental effect in the long term in people with schizophrenia and recurrent psychosis.

Dog-assisted interventions (DAIs) to improve health-related outcomes for people with mental health or neurodevelopmental conditions are becoming increasingly popular. However, DAIs are not based on robust scientific evidence.

To determine the effectiveness of DAIs for children and adults with mental health or neurodevelopmental conditions, assess how well randomised controlled trials (RCTs) are reported, and examine the use of terminology to classify DAIs.

A systematic search was conducted in Embase, PsycINFO, PubMed, CINAHL, Web of Science and the Cochrane Library. RCTs were grouped by commonly reported outcomes and described narratively with forest plots reporting standardised mean differences and 95% confidence intervals without a pooled estimate. The quality of reporting of RCTs and DAIs was evaluated by assessing adherence to CONSORT and the Template for Intervention Description and Replication (TIDieR) guidelines. Suitability of use of terminology was assessed by mapping terms to the intervention content described.

Thirty-three papers were included, reporting 29 RCTs (with five assessed as overall high quality); a positive impact of DAIs was found by 57% (8/14) for social skills and/or behaviour, 50% (5/10) for symptom frequency and/or severity, 43% (6/14) for depression and 33% (2/6) for agitation. The mean proportion of adherence to the CONSORT statement was 48.6%. The TIDieR checklist also indicated considerable variability in intervention reporting. Most DAIs were assessed as having clear alignment for terminology, but improvement in reporting information is still required.

DAIs may show promise for improving mental health and behavioural outcomes for those with mental health or neurodevelopmental conditions, particularly for conditions requiring social skill support. However, the quality of reporting requires improvement.

There are 117.3 million people forcibly displaced because of war, conflict and natural disasters: 40% are children. With growing numbers, many high-income countries have adopted or are considering increasingly restrictive policies of immigration detention. Research on the impact of detention on mental health has focused on adults, although recent studies report on children.

To synthesise data on the impact of immigration detention on children’s mental health.

Systematic searches were conducted in PsycINFO, MEDLINE and Embase databases and grey literature and studies assessed using PRISMA guidelines (PROSPERO registration CRD42023369680). Included studies were quantitative, assessed children younger than 18 years who had been in immigration detention and reported mental health symptoms or diagnoses. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses estimated prevalence for major depression and post-traumatic stress disorder (PTSD).

Twenty-one studies reported data on 9620 children. Most studies were cross-sectional, had small sample sizes and used convenience sampling. A profoundly detrimental impact on children’s mental health across a variety of countries and detention settings was demonstrated. Meta-analysis found pooled prevalence of 42.2% for depression [95% CI 22.9, 64.3] and 32.0% for PTSD [95% CI 19.4, 48.0]. Severity of mental health impact increased with exposure to indefinite or protracted held detention.

Immigration detention harms children. No period of detention can be deemed safe, as all immigration detention is associated with adverse impacts on mental health. Our review highlights the urgency of alternative immigration policies that end the practice of detaining children and families.

Antidepressants are effective for depression, but most evidence excludes individuals with comorbid physical conditions.

To assess antidepressants’ efficacy and tolerability in individuals with depression and comorbid physical conditions.

Systematic review and network meta-analysis of randomised controlled trials (RCTs). Co-primary outcomes were efficacy on depressive symptoms and tolerability (participants dropping out because of adverse events). Bias was assessed with the Cochrane Risk-of-Bias 2 tool and certainty of estimates with the Confidence in Network Meta-Analysis approach. A study protocol was registered in advance (https://osf.io/9cjhe/).

Of the 115 included RCTs, 104 contributed to efficacy (7714 participants) and 82 to tolerability (6083 participants). The mean age was 55.7 years and 51.9% of participants were female. Neurological and cardiocirculatory conditions were the most represented (26.1% and 18.3% of RCTs, respectively). The following antidepressants were more effective than placebo: imipramine, nortriptyline, amitriptyline, desipramine, sertraline, paroxetine, citalopram, fluoxetine, escitalopram, mianserin, mirtazapine and agomelatine, with standardised mean differences ranging from −1.01 (imipramine) to −0.34 (escitalopram). Sertraline and paroxetine were effective for the largest number of ICD-11 disease subgroups (four out of seven). In terms of tolerability, sertraline, imipramine and nortriptyline were less tolerated than placebo, with relative risks ranging from 1.47 (sertraline) to 3.41 (nortriptyline). For both outcomes, certainty of evidence was ‘low’ or ‘very low’ for most comparisons.

Antidepressants are effective in individuals with comorbid physical conditions, although tolerability is a relevant concern. Selective serotonin reuptake inhibitors (SSRIs) have the best benefit–risk profile, making them suitable as first-line treatments, while tricyclics are highly effective but less tolerated than SSRIs and placebo.

Involuntary treatment for patients with anorexia nervosa is common and lifesaving, but also highly intrusive. Understanding how morbidity patterns relate to involuntary treatment can help minimise its use.

We estimate the relative risk of involuntary treatment according to morbidity profiles in patients with anorexia nervosa.

This register-based cohort study included all individuals diagnosed with anorexia nervosa (ICD-10: F50.0, F50.1) between 1 January 2000 and 31 December 2016 in Denmark. Individuals were grouped by prior morbidities using latent class analysis (LCA). Cox proportional hazards regression estimated the relative risk of first involuntary treatment (e.g. involuntary admission, detention, locked wards) after a diagnosis with anorexia nervosa, regardless of the associated diagnosis. The relative risk of involuntary treatment was estimated with latent classes and the number of morbidities as exposure.

A total of 9892 individuals with anorexia nervosa were included (93.3% female), of which 821 (8.3%) individuals experienced at least one involuntary treatment event. The LCA produced six classes, with distinct morbidity profiles. The highest hazard ratio was observed for a group characterised by personality disorders, self-harm and substance misuse (hazard ratio 4.46, 95% CI: 3.43–5.79) followed by a high burden group with somatic and psychiatric disorders (hazard ratio 3.96, 95% CI: 2.81–5.59) and a group with developmental and behavioural disorders (hazard ratio 3.61, 95% CI: 2.54–5.11). The relative risk of involuntary treatment increased primarily with the number of psychiatric morbidities.

Specific morbidity groups are associated with highly elevated risk of involuntary treatment among patients with anorexia nervosa. Targeting preventive interventions to high-risk groups may help reduce the need for involuntary treatment.

Evidence suggests the crucial role of dysfunctional default mode (DMN), salience and frontoparietal (FPN) networks, collectively termed the triple network model, in the pathophysiology of treatment-resistant depression (TRD).

Using the graph theory- and seed-based functional connectivity analyses, we attempted to elucidate the role of low-dose ketamine in the triple networks, namely the DMN, salience and FPN.

Resting-state functional connectivity magnetic resonance imaging (rs–fcMRI) data derived from two previous clinical trials of a single, low-dose ketamine infusion were analysed. In clinical trial 1 (Trial 1), patients with TRD were randomised to either a ketamine or normal saline group, while in clinical trial 2 (Trial 2) those patients with TRD and pronounced suicidal symptoms received a single infusion of either 0.05 mg/kg ketamine or 0.045 mg/kg midazolam. All participants underwent rs–fcMRI pre and post infusion at Day 3. Both graph theory- and seed-based functional connectivity analyses were performed independently.

Trial 1 demonstrated significant group-by-time effects on the degree centrality and cluster coefficient in the right posterior cingulate cortex (PCC) cortex ventral 23a and b (DMN) and the cluster coefficient in the right supramarginal gyrus perisylvian language (salience). Trial 2 found a significant group-by-time effect on the characteristic path length in the left PCC 7Am (DMN). In addition, both ketamine and normal saline infusions exerted a time effect on the cluster coefficient in the right dorsolateral prefrontal cortex a9-46v (FPN) in Trial 1.

These findings may support the utility of the triple-network model in elucidating ketamine’s antidepressant effect. Alterations in DMN, salience and FPN function may underlie this effect.

People with dementia (PwD) and their carers often consider maintaining good quality of life (QoL) more important than improvements in cognition or other symptoms of dementia. There is a clinical need for identifying interventions that can improve QoL of PwD. There are currently no evidence-based guidelines to help clinicians, patients and policy makers to make informed decisions regarding QoL in dementia.

To conduct the first comprehensive systematic review of all studies that investigated efficacy of any pharmacological or non-pharmacological intervention for improving QoL of PwD.

Our review team identified eligible studies by comprehensively searching nine databases. We completed quality assessment, extracted relevant data and performed GRADE assessment of eligible studies. We conducted meta-analyses when three or more studies investigated an intervention for improving QoL of PwD.

We screened 14 389 abstracts and included 324 eligible studies. Our meta-analysis confirmed level 1 evidence supporting the use of group cognitive stimulation therapy for improving QoL (standardised mean difference 0.25; P = 0.003) of PwD. Our narrative data synthesis revealed level 2 evidence supporting 42 non-pharmacological interventions, including those based on cognitive rehabilitation, reminiscence, occupational therapy, robots, exercise or music therapy. Current evidence supporting the use of any pharmacological intervention for improving QoL in dementia is limited.

Current evidence highlights the importance of non-pharmacological interventions and multidisciplinary care for supporting QoL of PwD. QoL should be prioritised when agreeing care plans. Further research focusing on QoL outcomes and investigating combined pharmacological and non-pharmacological interventions is urgently needed.

Late-life affective disorders (LLADs) are common and are projected to increase by 2050. There have been several studies linking late-life depression to an increased risk of dementia, but it is unclear if bipolar affective disorder or anxiety disorders pose a similar risk.

We aimed to compare the risk of LLADs progressing to all-cause dementia, and the demographic and clinical variables mediating the risk.

We used the South London and Maudsley National Health Service Foundation Trust Clinical Records Interactive Search system to identify patients aged 60 years or older with a diagnosis of any affective disorder. Cox proportional hazard models were used to determine differences in dementia risk between late-life anxiety disorders versus late-life depression, and late-life bipolar disorder versus late-life depression. Demographic and clinical characteristics associated with the risk of dementia were investigated.

Some 5695 patients were identified and included in the final analysis. Of these, 388 had a diagnosis of bipolar affective disorder, 1365 had a diagnosis of an anxiety disorder and 3942 had a diagnosis of a depressive disorder. Bipolar affective disorder was associated with a lower hazard of developing dementia compared to depression (adjusted model including demographics and baseline cognition, hazard ratio: 0.60; 95% CI: 0.41–0.87). Anxiety disorders had a similar hazard of developing dementia (adjusted hazard ratio: 1.05; 95% CI: 0.90–1.22). A prior history of a depressive disorder reduced the risk of late-life depression progressing to dementia – suggesting the new onset of a depressive disorder in later life is associated with higher risk – but a prior history of anxiety disorders or bipolar affective disorder did not alter risk.

LLADs have a differential risk of developing all-cause dementia, with demographic- and illness-related factors influencing the risk. Further prospective cohort studies are needed to explore the link between LLADs and dementia development, and mediators of the lower risk of dementia associated with late-life bipolar disorder compared to late-life depression.

Self-harm, self-poisoning or self-injury, irrespective of the motivation, is a central risk factor for suicide. Still, there is limited knowledge of self-harm among patients with substance use disorders (SUDs) who die by suicide.

We aimed to describe the prevalence of a history of self-harm and identify the factors associated with self-harm, comparing individuals who died by suicide with and without SUDs.

We used data from the Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services, which is based on a national linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, to identify individuals who died by suicide within 1 year after last contact with mental health or substance use services (n = 1140). A questionnaire was retrieved for 1041 (91.3%) of these individuals. We used least absolute shrinkage and selection operator (LASSO) regression to select variables and compared patients with and without SUDs. Conditional selective inference was used to improve 90% confidence intervals and p-values.

The prevalence of self-harm was 55% in patients with SUDs and 52.6% in patients without SUDs. Suicidal ideation (odds ratio 2.98 (95% CI 1.74–5.10)) emerged as a factor shared with patients without SUDs, while personality disorders (odds ratio 1.96 (1.12–3.40)) and a history of violence (odds ratio 1.86 (1.20–2.87)) were unique factors for patients with SUDs.

A history of self-harm is prevalent in patients with SUDs who die by suicide and is associated with suicidal ideation, a history of violence and personality disorders in patients with SUDs.

We rely heavily on cut-off points of brief measures of psychological distress in research and clinical practice to identify those at risk of mental health conditions; however, few studies have compared the performance of different scales.

To determine the extent to which the child- and parent-report Strength and Difficulty Questionnaire (SDQ), Revised Children’s Anxiety and Depression Scale (RCADS), short Mood and Feeling Questionnaire (sMFQ) and child-report KIDSCREEN correlated and identified the same respondents above cut-off points and at risk of mental health conditions.

A cross-sectional survey was conducted among 231 children aged 11–16 years and 289 parents who completed all the above measures administered via a mobile app, MyJournE, including the SDQ, RCADS and sMFQ.

The psychopathology measures identified similar proportions of young people as above the cut-off point and at risk of depression (child report 14.7% RCADS, 19.9% sMFQ, parent report 8.7% RCADS, 12.1% sMFQ), anxiety (child report 24.7% RCADS, 26.0% SDQ-Emotional subscale, parent report 20.1% RCADS, 26% SDQ-Emotional subscale) and child-report internalising problems (26.8% RCADS, 29.9% SDQ). Despite strong correlations between measures (child report 0.77–0.84 and parent report 0.70–0.80 between the SDQ, sMFQ and RCADS) and expected directions of correlation with KIDSCREEN and SDQ subscales, kappa values indicate moderate to substantial agreement between measures. Measures did not consistently identify the same children; half (n = 36, 46%) of those on child report and a third (n = 30, 37%) on parent report, scoring above the cut-off point for the SDQ-Emotional subscale, RCADS total or sMFQ, scored above the cut-off point on all of them. Only half (n = 46, 54%) of the children scored above the cut-off point on child report by the SDQ-Internalising and RCADS total scales.

This study highlights the risk of using a screening test to ‘rule out’ potential psychopathology. Screening tests should not be used diagnostically and are best used together with broad assessment.

While cognitive impairment is a core feature of psychosis, significant heterogeneity in cognitive and clinical outcomes is observed.

The aim of this study was to identify cognitive and clinical subgroups in first-episode psychosis (FEP) and determine if these profiles were linked to functional outcomes over time.

A total of 323 individuals with FEP were included. Two-step hierarchical and k-means cluster analyses were performed using baseline cognitive and clinical variables. General linear mixed models were used to investigate whether baseline cognitive and clinical clusters were associated with functioning at follow-up time points (6–9, 12 and 15 months).

Three distinct cognitive clusters were identified: a cognitively intact group (N = 59), a moderately impaired group (N= 77) and a more severely impaired group (N= 122). Three distinct clinical clusters were identified: a subgroup characterised by predominant mood symptoms (N = 76), a subgroup characterised by predominant negative symptoms (N= 19) and a subgroup characterised by overall mild symptom severity (N = 94). The subgroup with more severely impaired cognition also had more severe negative symptoms at baseline. Cognitive clusters were significantly associated with later social and occupational function, and associated with changes over time. Clinical clusters were associated with later social functioning but not occupational functioning, and were not associated with changes over time.

Baseline cognitive impairments are predictive of both later social and occupational function and change over time. This suggests that cognitive profiles offer valuable information in terms of prognosis and treatment needs.

Researchers explore the biology of painful experiences not primarily felt in the body (‘non-physical pain’), sometimes referred to as mental, social or emotional pain. A critical challenge lies in how to operationalise this subjective experience for biological research, a crucial process for translating findings into clinical practice.

To map studies investigating biological features of non-physical pain, focusing on their conceptual features (i.e. terms and definitions of non-physical pain) and methodological characteristics (e.g. experimental paradigms and measures).

This methodological systematic review searched reports of primary research on the biological features of non-physical pain across Embase, MEDLINE and Web of Science. Using a meta-research approach, we synthetised results on terms, definitions, populations, experimental paradigms, confounders, measures of non-physical pain and investigation methods (e.g. functional magnetic resonance imaging).

We identified 92 human studies, involving 7778 participants. Overall, 59.1% of the studies did not report any definition of non-physical pain, and 82% of studies did not use a specific measure. Regarding the possibility of translating results to clinical settings, most of the human studies involved only healthy participants (71.7%) and the seven different experimental paradigms used to induce non-physical pain had unknown external validity. Confounders were not considered by 32.4% of the experimental studies. Animal studies were rare, with only four rodent studies.

Biomedical studies of non-physical pain use heterogeneous concepts with unclear overlaps and methods with unknown external validity. As has been done for physical pain, priority actions include establishing an agreed definition and measurement of non-physical pain and developing experimental paradigms with good external validity.

Scalable assessment tools for precision psychiatry are of increasing clinical interest. One clinical risk assessment that might be improved by such approaches is assessment of violence perpetration risk. This is an important adverse outcome to reduce for some people presenting to services for first-episode psychosis. A prediction tool (Oxford Mental Illness and Violence (OxMIV)) has been externally validated in these services, but clinical acceptability and role need to be examined and developed.

This study aimed to understand clinical use of the OxMIV tool to support violence risk management in early intervention in psychosis services in terms of acceptability to clinicians, patients and carers, practical feasibility, perceived utility, impact and role.

A mixed methods approach integrated quantitative data on utility and patterns of use of the OxMIV tool over 12 months in two services with qualitative data from interviews of 20 clinicians and 12 patients and carers.

The OxMIV tool was used 141 times, mostly in new assessments. Required information was available, with only family history items scored unknown to any notable degree. The OxMIV tool was deemed helpful by clinicians in most cases, especially if there were previous risk concerns. It was acceptable practically, and broadly for the service, for which its concordance with clinical judgement was important. Patients and carers thought it could improve openness. There was some limited impact on plans for clinical support.

The OxMIV tool met an identified clinical need to support clinical assessment for violence risk. Linkage to intervention pathways is a research priority.