Hallucinations and other unusual sensory experiences (USE) are common in people with psychosis. Yet access to effective psychological therapies remains limited. We evaluated if we can increase access to psychological therapy by using a brief treatment, focused only on understanding and dealing with hallucinations (Managing Unusual Sensory Experiences; MUSE), delivered by a less trained but more widely available workforce that harnessed the benefits (engaging content, standardisation) afforded by digital technology. The delivery of this in a real-world setting was considered within the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework.

Thirty-eight people with psychosis and distressing hallucinatory experiences were offered sessions of MUSE, delivered by trained and supervised assistant psychologists. MUSE was evaluated within an uncontrolled study conducted in routine clinical practice. Assessments pre- and post-treatment enabled consideration of the impact of the real-world intervention.

There was good uptake (88.4%), and receipt of MUSE (89% received four or more sessions). On average participants received 8.69 sessions. The participants reported significant reductions in voice hearing, paranoia, as well as improved quality of life. The feedback from the participants indicated that MUSE delivered by a less trained workforce was acceptable and beneficial.

In a real-world setting we were able to offer and deliver sessions of a brief psychological psycho-education and coping skills enhancement package to people with distressing USE in the context of psychosis. The delivery of MUSE when considered against the NASSS framework appears to be a good candidate for adoption in services.

Understanding the factors influencing alcohol use disorder (AUD) treatment outcomes is essential. More knowledge about patient characteristics that predict treatment outcomes can help personalise interventions, improve treatment planning and address the needs of specific subgroups. The frequency of treatment attendance may also affect drinking outcomes after treatment. Despite research efforts, uncertainty remains about how patient factors and treatment attendance influence treatment outcomes.

To examine how patient factors and treatment attendance predict high- or low-risk drinking at the end of treatment.

We used data (N = 92) from a multisite observational study of treatment-seeking individuals with AUD attending group treatment. Sociodemographic measures, alcohol and substance use measures, cognitive functioning, psychological distress, personality functioning and quality of life were screened in univariate analyses. Significant variables were entered into a binary logistic regression model.

Individuals with a higher percentage of treatment attendance (odds ratio 0.96 [95% CI 0.93, 0.96]) and with greater responsiblity scores on the Severity Indices of Personality Functioning (odds ratio 0.30 [95% CI 0.14, 0.64]) had a decreased likelihood of high-risk drinking at treatment end. Substance use, psychological distress and cognitive functioning were not associated with drinking levels at the end of treatment.

A higher percentage of treatment attendance has a minor effect on drinking levels. Being more responsible, as reflected in higher scores on the responsibility domain, reduces the likelihood of high-risk drinking at the end of treatment. Clinicians are encouraged to screen and assess personality functioning when planning treatment for individuals with AUD.

Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents.

A randomized clinical trial was conducted across nine Spanish hospitals (January 2021–March 2024) with 261 adolescents (12–17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors.

After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321–1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390–1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004–1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814–0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009–1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039–1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677–0.996), p=0.045].

While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.

Peripartum depression (PPD) is a prevalent mental health disorder in the peripartum period. However, a recent systematic review of clinical guidelines relating to PPD has revealed a significant inconsistency in recommendations.

This study aimed to collect up-to-date evidence on the effectiveness of interventions and provide recommendations for prevention, screening and treating PPD.

A series of umbrella reviews on the effectiveness of PPD prevention, screening and treatment interventions was conducted. A search was performed in five databases from 2010 until 2023. The guidelines were developed according to the GRADE framework and AGREE II Checklist recommendations. Public stakeholder review was included.

One hundred and forty-five systematic reviews were included in the final analysis and used to form the guidelines. Forty-four recommendations were developed, including recommendations for prevention, screening and treatment. Psychological and psychosocial interventions are strongly recommended for preventing PPD in women with no symptoms and women at risk. Screening programmes for depression are strongly recommended during pregnancy and postpartum. Cognitive–behavioural therapy is strongly recommended for PPD treatment for mild to severe depression. Antidepressant medication is strongly recommended for treating severe depression in pregnancy. Electroconvulsive therapy is strongly recommended for therapy-resistant and life-threatening severe depression during pregnancy. Other recommendations are offered to healthcare professionals, stakeholders and researchers in managing PPD in different contexts.

Treatment recommendations should be implemented after carefully considering clinical severity, previous history, risk–benefit for mother and foetus/infant and women’s values and preferences. Implementation of evidence-based clinical practice guidelines within country-specific contexts should be facilitated.

To describe the process of the development of evidence-based guidelines on the assessment and clinical management of internal contamination with transuranic actinides (specifically plutonium, americium, and curium) in incidents where workers, emergency responders, and the public might uptake these radionuclides internally through inhalation, ingestion, or wound contamination.

The World Health Organization (WHO) set up a guidelines development group (GDG) that follows the protocol required for producing evidence-based recommendations as described elsewhere. The GRADE® approach was applied throughout the process, including developing research questions formulation, prioritization and rating the importance for the outcomes, assessing the certainty of the evidence, considering contextual factors, and making recommendations.

Through 3 working group meetings held 2023-2024, the GDG defined and rated patient-important health outcomes, and evidence gathered through systematic reviews and its certainty rating, working towards formulating the recommendations using an evidence-to-recommendation (EtR) framework.

The WHO protocol for developing health care management guidelines uses a transparent and robust evidence-based GRADE® approach. Once published, these guidelines will provide the first evidence-based recommendations for assessment and clinical management of internal contamination with transuranic actinides.

About 13% of pregnant women with substance use disorder (SUD) receive treatment and many may encounter challenges in accessing perinatal care, making it critical for this population to receive uninterrupted care during a global pandemic.

From October 2021-January 2022, we conducted an online survey of pregnant and postpartum women and interviews with clinicians who provide care to this population. The survey was administered to pregnant and postpartum women who used substances or received SUD treatment during the COVID-19 pandemic.

Two hundred and ten respondents completed the survey. All respondents experienced pandemic-related barriers to routine health care services, including delays in prenatal care and SUD treatment. Disruptions in treatment were due to patient factors (38.2% canceled an appointment) and clinic factors (25.5% had a clinic cancel their appointment). Respondents were generally satisfied with telehealth (M = 3.97, SD = 0.82), though half preferred a combination of in-person and telehealth visits. Clinicians reported telehealth improved health care access for patients, however barriers were still observed.

Although strategies were employed to mitigate barriers in care during COVID-19, pregnant and postpartum women who used substances still experienced barriers in receiving consistent care. Telehealth may be a useful adjunct to enhance care access for pregnant and postpartum women during public health crises.

Binge-eating disorder (BED) is characterized by highly distressing episodes of loss-of-control over-eating. We have examined the use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of people with BED and associated obesity. Such non-invasive brain stimulation (NIBS) techniques are used therapeutically in several psychiatric conditions and there is an associated scientific rationale.

Sixty participants were randomly allocated to receive 20 sessions of neuronavigated 10 Hz rTMS administered to the left dorsolateral prefrontal cortex (dlPFC) or sham treatment. Primary outcomes were the frequency of binge eating episodes (BEE) and the ‘urge to eat’ (craving) evaluated at baseline and end-of-treatment (8 weeks post-randomization). Secondary outcomes included body mass index (BMI), hunger, general and specific eating disorder psychopathology. Follow-up analyses were conducted for most outcomes at 16 weeks post-randomization. Multilevel models were used to evaluate group, time, and group-by-time interactions for the association between rTMS exposure and outcomes.

The real rTMS group (compared with sham treatment), showed a significantly greater decrease in the number of BEE at the end of treatment (Estimated Mean [EM]: 2.41 95% CI: 1.84–3.15 versus EM: 1.45 95% CI: 1.05–1.99, p = 0.02), and at follow-up (EM: 3.79 95% CI: 3–4.78 versus EM: 2.45 95% CI: 1.88–3.17, p = 0.02; group × time interaction analysis p = 0.02). No group differences were found for other comparisons.

rTMS was associated with reduced BEE during and after treatment: it suggests rTMS is a promising intervention for BED.

We consider the neuroethics of treatment without consent from a broader perspective than the accepted starting point of functional mental capacities. Notably, in common law jurisdictions, consciousness is seldom admitted in criminal law as a topic for expert evidence of mentalistic defenses or impairments in civil proceedings, yet consciousness and personality are central in Roman law jurisdictions.

The framework we have adopted is to consider treatment without consent under the headings goals, processes, treatment, and evaluation. The ECHR and the judges of the European Court of Human Rights (ECtHR) are drawn from both common law and Roman law jurisdictions, so that their interpretations and precedents may be informative concerning alternatives to strict application of capacity tests.

There are variable thresholds for treating without consent according to the complexity and amount of information involved, the seriousness of the consequences of untreated illness, the effectiveness of the treatments available and the benefits of earlier intervention, particularly for disease-modifying treatments. Theory-driven principled approaches and scientific medical process approaches to ethical treatment are contrasted.

Carrara’s emphasis on the importance of consciousness and its layered dysfunctions as evidence of competence or impairment appears more robust than a narrow approach based only on functional mental capacity. Capacity—whether general or functional, remains amenable to rules of evidence and legal judgment at the expense of increasingly excessive simplification. Carrara’s emphasis on the inherent dignity of the person appears most in keeping with modern human rights principles.