A diagnostic label can have harms and benefits, particularly when provided following routine health screening tests. Whether these are discussed in clinical encounters is unknown.

To investigate whether potential impacts of diagnostic labelling are discussed before routine screening for non-cancer health conditions and explore the perceived value of such discussions by general practitioners (GPs) and healthcare consumers.

Eleven semi-structured interviews with GPs and two focus groups with eight consumers were conducted. Interviews and focus groups were audio-recorded, transcribed and analysed using thematic analysis methods based on framework analysis.

Prior to routine screening, most GPs did not discuss the potential consequences of diagnostic labelling, and no consumer recalled discussions of this nature. In contrast, many GPs provided information regarding the screening procedure and possible test limitations. Both GPs and consumers identified that it would be valuable to discuss the potential impacts of a diagnostic label; however, preferences varied as to the content and timing (i.e. before or after screening) of this discussion. Six themes that examine the utility of discussing the consequences of diagnostic labelling were identified: patient empowerment, patient variability, condition-specific information, GP and patient interactions and relationship, GP role and responsibilities, and characteristics of screening.

The practice and perceived value of discussing diagnostic labelling consequences were recognised as important by both GPs and consumers. However, preferences regarding the content of discussions and whether these occurred in clinical encounters before or after screening varied.

The study examines the behavioural and psychological symptoms (BPSs) associated with dementia and mild cognitive impairment (MCI), highlighting the prevalence and impact of these symptoms on individuals with varying levels of cognitive function, particularly in the context of the increasing incidence of dementia among the ageing population.

To explore the BPSs among out-patients with different cognitive statuses.

This cross-sectional study enrolled out-patients who attended the cognitive assessment out-patient clinic at our hospital between January 2018 and October 2022. The patients’ cognitive status was evaluated using the Neuropsychiatric Inventory (NPI), Activities of Daily Living and the Montreal Cognitive Assessment-Basic scales.

The study enrolled 3273 out-patients, including 688 (21%) with cognitively unimpairment, 1831 (56%) with MCI and 754 (23%) with dementia. The NPI score, the percentage of patients with BPSs and the number of BPSs increased with decreasing cognition level. Unordered logistic regression analysis showed that after adjustment of confounding variables, delusions, depression, euphoria and psychomotor alterations were independently associated with MCI. Delusions, agitation, euphoria, apathy, psychomotor alterations and sleep change were independently associated with dementia.

NPI scores, the percentage of patients with BPSs and the numbers of BPSs increased with declining cognitive function.

Clinical guidelines for personality disorder emphasise the importance of patients being supported to develop psychological skills to help them manage their symptoms and behaviours. But where these mechanisms fail, and hospital admission occurs, little is known about how episodes of acutely disturbed behaviour are managed.

To explore the clinical characteristics and management of episodes of acutely disturbed behaviour requiring medication in in-patients with a diagnosis of personality disorder.

Analysis of clinical audit data collected in 2024 by the Prescribing Observatory for Mental Health, as part of a quality improvement programme addressing the pharmacological management of acutely disturbed behaviour. Data were collected from clinical records using a bespoke proforma.

Sixty-two mental health Trusts submitted data on 951 episodes of acutely disturbed behaviour involving patients with a personality disorder, with this being the sole psychiatric diagnosis in 471 (50%). Of the total, 782 (82%) episodes occurred in female patients. Compared with males, episodes in females were three times more likely to involve self-harming behaviour or be considered to pose such a risk (22% and 70% respectively: p < 0.001). Parenteral medication (rapid tranquillisation) was administered twice as often in episodes involving females than in males (64 and 34% respectively: p < 0.001).

Our findings suggest that there are a large number of episodes of acutely disturbed behaviour on psychiatric wards in women with a diagnosis of personality disorder. These episodes are characterised by self-harm and regularly prompt the administration of rapid tranquillisation. This has potential implications for service design, staff training, and research.

Cannabis use severely affects the outcome of people with psychotic disorders, yet there is a lack of treatments. To address this, in 2019 the National Health Service (NHS) Cannabis Clinic for Psychosis (CCP) was developed to support adults suffering from psychosis to reduce and/or stop their cannabis use.

Examine outcome data from the first 46 individuals to complete the CCP's intervention.

The sample (N = 46) consisted of adults (aged ≥ 18) with psychosis under the care of the South London and Maudsley NHS Foundation Trust, referred to the CCP between January 2020 and February 2023, who completed their intervention by September 2023. Clinical and functional measures were collected before (T0) and after (T1) the CCP intervention (one-to-one sessions and peer group attendance). Primary outcomes were changes in the Cannabis Use Disorders Identification Test-Revised (CUDIT-R) score and pattern of cannabis use. Secondary outcomes included T0–T1 changes in measures of delusions, paranoia, depression, anxiety and functioning.

A reduction in the mean CUDIT-R score was observed between T0 (mean difference = 17.10, 95% CI = 15.54–18.67) and T1, with 73.91% of participants achieving abstinence and 26.09% reducing the frequency and potency of their use. Significant improvements in all clinical and functional outcomes were observed, with 90.70% being in work or education at T1 compared with 8.70% at T0. The variance in CUDIT-R scores explained between 34 and 64% of the variance in our secondary measures.

The CCP intervention is a feasible strategy to support cannabis use cessation/reduction and improve clinical and functional outcomes of people with psychotic disorders.

An increasing number of observational studies have reported associations between frailty and mental disorders, but the causality remains ambiguous.

To assess the bidirectional causal relationship between frailty and nine mental disorders.

We conducted a bidirectional two-sample Mendelian randomisation on genome-wide association study summary data, to investigate causality between frailty and nine mental disorders. Causal effects were primarily estimated using inverse variance weighted method. Several secondary analyses were applied to verify the results. Cochran's Q-test and Mendelian randomisation Egger intercept were applied to evaluate heterogeneity and pleiotropy.

Genetically determined frailty was significantly associated with increased risk of major depressive disorder (MDD) (odds ratio 1.86, 95% CI 1.36–2.53, P = 8.1 × 10−5), anxiety (odds ratio 2.76, 95% CI 1.56–4.90, P = 5.0 × 10−4), post-traumatic stress disorder (PTSD) (odds ratio 2.56, 95% CI 1.69–3.87, P = 9.9 × 10−6), neuroticism (β = 0.25, 95% CI 0.11–0.38, P = 3.3 × 10−4) and insomnia (β = 0.50, 95% CI 0.25–0.75, P = 1.1 × 10−4). Conversely, genetic liability to MDD, neuroticism, insomnia and suicide attempt significantly increased risk of frailty (MDD: β = 0.071, 95% CI 0.033–0.110, P = 2.8 × 10−4; neuroticism: β = 0.269, 95% CI 0.173–0.365, P = 3.4 × 10−8; insomnia: β = 0.160, 95% CI 0.141–0.179, P = 3.2 × 10−61; suicide attempt: β = 0.056, 95% CI 0.029–0.084, P = 3.4 × 10−5). There was a suggestive detrimental association of frailty on suicide attempt and an inverse relationship of subjective well-being on frailty.

Our findings show bidirectional causal associations between frailty and MDD, insomnia and neuroticism. Additionally, higher frailty levels are associated with anxiety and PTSD, and suicide attempts are correlated with increased frailty. Understanding these associations is crucial for the effective management of frailty and improvement of mental disorders.

Clinical characteristics of psychosis in HIV infection have been described, but there have been limited comparative studies in HIV-endemic low-resource regions.

To compare clinical characteristics of psychosis in HIV-positive and HIV-negative patients at the main psychiatric referral units in Uganda.

Patients with psychosis were consecutively recruited and completed a standardised demographic questionnaire and psychiatric and laboratory assessments including an HIV test. The Mini International Neuropsychiatric Interview was used to diagnose psychiatric illness. Psychosis symptoms were compared between HIV-positive and HIV-negative individuals using bivariate methods. A logistic regression model was used to assess the effects of age, gender and HIV status on different types of psychosis.

There were 478 patients enrolled, of which 156 were HIV positive and 322 were HIV negative. The mean age was 33.2 years (95% CI 31.8–34.5) for the HIV-positive group and 29.6 years (95% CI 28.7–30.5) for the HIV-negative group (P < 0.001). Female patients had a higher proportion of seropositivity 40.6% (95% CI 34.8–46.4) compared with males 21.8% (95% CI 16.1–27.5) (P < 0.001). Psychotic disorder not otherwise specified occurred more in the HIV-positive individuals (88% (95% CI 82.9–93.1) v. 12% (95% CI 8.4–15.5), P < 0.001). Motor activity, irritability, emotional withdrawal, feelings of guilt, mannerisms and posturing, grandiosity, suspiciousness, unusual thoughts, blunted affect, excitement and disorientation were associated with HIV seropositivity.

The presentation of psychosis in patients with HIV is unique to this HIV endemic setting. Characterisation of the symptomatology of patients presenting with psychosis is important for proper diagnosis and care.

There is a need for developmentally tailored intervention approaches that empower parents to respond to adolescent school refusal in the context of internalising disorders. Partners in Parenting Plus-Education (PiP-Ed+) is a manualised coach-assisted online parenting programme that has been co-designed with parents, youth and education-sector experts to fill this gap. It addresses multiple parenting factors associated with adolescent school refusal and internalising disorders.

This study aimed to evaluate the acceptability, feasibility and preliminary indications of efficacy of PiP-Ed+.

An open-label, uncontrolled trial was conducted using a mixed-methods design. Participants were 14 Australian parents of adolescents (12–18 years) who had refused school in the context of internalising disorders.

PiP-Ed+ was viewed as highly acceptable and feasible. Coaching sessions in particular were perceived as valuable and appropriate to the parents’ level of need, although longer-term support was suggested to sustain progress. Between baseline and post-intervention, there were significant increases in parents’ self-efficacy to respond to adolescent school refusal and internalising problems, and concordance with evidence-based parenting strategies to reduce adolescent anxiety and depression. Days of school refused and carer burden did not change.

Findings support the value of proceeding to evaluate the efficacy of PiP-Ed+ in a randomised-controlled trial. Results are interpreted in the context of study limitations.

Literature has shown that a significant minority of bereaved people are at risk of prolonged grief disorder (PGD). However, studies on its prevalence and correlates within Italian samples remain scarce.

This study aimed to explore the prevalence and correlates of PGD symptom severity among 1603 bereaved Italian adults.

Self-reported data on PGD, suicidal ideation, depression, anxiety and stress were gathered. Descriptive characteristics and bereavement-related information were also collected.

Among participants who lost a close other person at least 12 months prior, the prevalence of probable PGD and severe suicidal ideation was 7.7% (n = 104) and 0.7% (n = 9), respectively. The overall prevalence of severe suicidal ideation in the sample was 4.5%, rising to 18.2% among those with probable PGD. The probable PGD diagnosis showed minimal agreement with reported depression (phi = 0.25), anxiety (phi = 0.19), and stress (phi = 0.26), suggesting potentially limited overlap and supporting their distinctiveness. The severity of PGD symptoms was significantly positively associated with older age and suicidal ideation, and negatively associated with lower educational background and time since loss. PGD severity also varied by kinship, cause of death and place of residence. Specifically, bereaved individuals who lost a grandparent due to natural causes associated with ageing and lived in small- to medium-sized cities reported lower PGD symptom severity relative to others.

These findings contribute to the understanding of PGD symptomatology in bereaved individuals in Italy, although the results may not generalise to the entire Italian population.

Vaping is increasing in popularity. Vape products are offered in a wide variety and promise to reduce harms associated with cigarette smoking, among other claims. The motivations for vaping in patients with substance use disorder are largely unknown.

To describe perceptions and motivations regarding vaping among patients with opioid use disorder (OUD) who vape.

A convergent mixed-methods study design was used, and individual, semi-structured interviews were conducted with 41 individuals with OUD who were receiving medication for OUD and also vaped. An inductive data-driven approach was employed to characterise perspectives on vaping.

The mean ages at which participants had been introduced to vaping and initiated regular vaping were 33.95 years (s.d. 12.70) and 34.85 years (s.d. 12.38), respectively. Daily vaping (85%) of nicotine, flavoured nicotine or cannabis was common, with 27% reporting vaping both nicotine and cannabis. Qualitative analysis identified 14 themes describing motivations for vaping, including viewing vaping as a smoking cessation tool, convenience and popularity among youth.

Mixed-methods findings indicated that patients with OUD who vape perceived vaping to be healthier, cleaner and more convenient than cigarette and cannabis smoking, without appreciating the health risks. The perspectives reflected the importance of health education, guidelines and screening tools for vaping and could provide direction for healthcare providers and future vaping cessation programmes.

Promoting a ‘timely’ diagnosis is a global policy directive.

This review adopts an intersectional approach, visually mapping the existing literature to highlight gaps in the evidence base on barriers and facilitators to dementia diagnosis.

A systematic approach was undertaken, following the PRISMA guidelines, updating previous reviews. The literature search was conducted on PubMed, PsycINFO, CINAHL Complete and Scopus. In line with mapping review methodology, we report the current state of the literature by describing the number of studies that outline barriers and facilitators to seeking help for a dementia diagnosis, split by social categorisation.

On the 7 June 2024, a total of 45 studies were identified. Our mapping demonstrated the majority of studies were derived from high-income countries and did not specify whether they were exploring barriers and facilitators through a specific social lens. Ethnicity was one of the few social categories where a range of evidence was reported. Other categories, such as socioeconomic status, gender and sexual orientation, received limited research attention.

Our mapping review suggests the large body of work within this field tends to treat people with dementia and their carers as homogenous and androgenous groups. To better inform this key policy directive, studies are needed that explore the influence of social determinants on people’s experiences of seeking a dementia diagnosis. Such work would create a richer, more nuanced evidence base that better elicits ways of addressing inequalities and inequities that arise at this key stage of people’s dementia care journey.

Residential treatment facilities for eating disorders are becoming increasingly common and purport to provide recovery-orientated care in a less restrictive environment than traditional hospital settings. However, minimal attention has focused on individuals’ lived experiences of these residential services.

This study explores participants’ lived experiences of care at Australia’s first residential facility for the treatment of eating disorders.

Qualitative data were collected as part of a clinical evaluation (June 2021 to August 2023). Fifteen women participated in semi-structured interviews about their experience of treatment following discharge. Data were analysed with inductive reflexive thematic analysis.

Three main themes were generated from the data that included participants’ journeys to treatment, experiences of treatment and the transitions associated with and following discharge. Cutting across these main themes were participants’ encounters of barriers, setbacks and hope. Participant experiences of residential treatment were complex and multifaceted, marked by inherent ideological dilemmas that arose in balancing standardised treatment protocols with person-centred and recovery-oriented care. Participants also spoke of reclaiming a sense of self and identity beyond their eating disorder, emphasising the importance of relationships and consistent and collaborative care.

Participant accounts of residential treatment emphasised the importance of holistic, person-centred and recovery-oriented care. Despite the complexities of treatment experiences, participant narratives underscored how recovery may be more about the reclamation of a sense of identity outside of the eating disorder than merely symptom improvement. As such, adopting person-centred and recovery-oriented treatment approaches within residential treatment settings may maximise individual autonomy and promote holistic recovery pathways.

Nearly 25% of people with intellectual disability (PwID) have epilepsy compared to 1% of the UK general population. PwID are commonly excluded from research, eventually affecting their care. Understanding seizures in PwID is particularly challenging because of reliance on subjective external observation and poor objective validation. Remote electroencephalography (EEG) monitoring could capture objective data, but particular challenges and implementation strategies for this population need to be understood.

This co-production aimed to explore the accessibility and potential impact of a remote, long-term EEG tool (UnEEG 24/7 SubQ) for PwID and epilepsy.

We conducted six, 2-hour long workshops; three with people with mild intellectual disability and three with families/carers of people with moderate–profound intellectual disability. Brief presentations, easy read information and model demonstrations were used to explain the problem and device. A semi-structured guide developed by a communication specialist and art-based techniques facilitated discussion with PwID. For family/carers, active listening was employed. All conversations were recorded and transcribed. Artificial intelligence-based coding and thematic analysis (ATLAS.ti and ChatGPT) were synthesised with manual theming to generate insights.

Co-production included four PwID, five family members and seven care professionals. Three main themes were identified: (1) perceived benefits for improving seizure understanding, informing care and reducing family and carer responsibility to accurately identify seizures; (2) the device was feasible for some PwID but not all; and (3) appropriate person-centred communication is essential for all stakeholders to reduce concerns.

The workshops identified key benefits and implementing barriers to SubQ in PwID.

Loneliness and social isolation pose significant public health concerns globally, with adverse effects on mental health and well-being. Although the terms are often used interchangeably, loneliness refers to the subjective feeling of lacking social connections, whereas social isolation is the objective absence of social support or networks.

To investigate the prevalence of loneliness and social isolation and their associations with psychiatric disorders.

This study used data from the Republic of Korea National Mental Health Survey 2021, a nationally representative survey. A total of 5511 adults aged 18–79 residing in South Korea participated in the survey. Loneliness and social isolation were assessed using the Loneliness and Social Isolation Scale, whereas psychiatric disorders were evaluated using the Korean version of the Composite International Diagnostic Interview. Multivariate logistic regressions were performed after adjustment for sociodemographic variables.

Among the participants, 11.8% reported experiencing loneliness, 4.3% reported social isolation and 3.4% reported both. Co-occurrence of loneliness and social isolation was significantly associated with psychiatric disorders (adjusted odds ratio (AOR) 7.59, 95% CI: 5.48–10.52). Loneliness alone was associated with greater prevalence and higher probability of psychiatric disorders (AOR 3.12, 95% CI: 2.63–3.71), whereas social isolation did not show any significant association (AOR 0.88, 95% CI: 0.64–1.22).

The co-occurrence of loneliness and social isolation is particularly detrimental to mental health. This finding emphasises the need for targeted interventions to promote social connection and reduce feelings of isolation.

Emotional processing difficulties represent the core psychopathology of non-suicidal self-injury (NSSI), yet the underlying neural mechanisms remain unclear.

To investigate neural alterations associated with emotion reactivity and regulation in individuals with NSSI and examine whether emotional valence is related to these neural patterns.

During functional magnetic resonance imaging scans, unmedicated young adults with NSSI (n = 29) and matched controls (n = 25) completed an emotion regulation task in which they viewed pictures of different emotional categories with instructions to either attend to or regulate their emotions.

Individuals with NSSI showed increased neural activation in the right superior temporal gyrus (STG), right parahippocampal gyrus and right supramarginal gyrus during negative emotion reactivity and increased activation in the right middle temporal gyrus and left STG during positive emotion reactivity. Conversely, those with NSSI exhibited reduced activation in the left supplementary motor area, left inferior frontal gyrus, right putamen, right thalamus and right STG during negative emotion regulation and reduced activation in the left ventral striatum during positive emotion regulation. Notably, both hyperactivation of the STG during negative emotion reactivity and hypoactivation of the supplementary motor area during negative emotion regulation were associated with emotion dysregulation in individuals with NSSI.

We observed distinct neural patterns of emotional processing among individuals with NSSI, characterised by hyperactivation during emotion reactivity and hypoactivation during emotion regulation. Our findings provide a neurophysiological basis for therapeutic interventions that facilitate adaptive emotional processing in individuals with NSSI.

Glucuronic acid (GlcA) is crucial in the glucuronidation pathway, facilitating the metabolism and elimination of various substances and drugs. Recent studies have noted elevated GlcA levels in patients with schizophrenia (SCZ) compared with healthy individuals. However, it remains unclear whether this elevation contributes to SCZ pathophysiology or results from medication effects.

This study investigated the relationship between peripheral GlcA levels and clinical characteristics in patients with SCZ and assess whether these associations persist independently of psychotropic medication effects to provide insight into the potential role of GlcA in the pathophysiology of SCZ.

Plasma GlcA levels were analysed in 218 patients with SCZ, examining their association with clinical features. The correlation between GlcA levels and symptom severity, assessed using the Positive and Negative Syndrome Scale (PANSS), was analysed in 35 patients. In addition, multiple regression analysis was conducted to adjust for age and psychotropic medication effects.

Significant correlations were observed between GlcA levels and PANSS scores for negative symptoms, general psychopathology and total scores. After adjustment for age and psychotropic medications, significant correlations between GlcA levels and PANSS scores persisted for negative symptoms (adjusted β [95% CI], 13.926 [2.369, 25.483]) and general psychopathology (adjusted β [95% CI], 19.437 [3.884, 34.990]), while the total score was no longer significant (adjusted β [95% CI], 34.054 [–0.517, 68.626]).

Elevated GlcA levels in patients with SCZ are associated with specific symptom severity irrespective of the medication dose, suggesting a potential role of GlcA in SCZ pathophysiology.

Specific phobias are common in the community, and much is known from epidemiological surveys about their subtypes and sex ratio.

To determine the subtypes and sex ratio in a treatment-seeking sample of people with a specific phobia.

Patients with a specific phobia were identified by a retrospective search of clinical case records from patient notes in electronic health records at the South London and Maudsley NHS Foundation Trust (the largest secondary mental healthcare provider in Europe).

We identified 1017 patients over 5 years as having a specific phobia. The adult female to male sex frequency ratio for having any specific phobia was 3.9, with the ratio of specific phobia subtypes ranging from 2.4 (natural environment) to 8.2 (animal). The child female to male ratio of specific phobia subtypes ranged from 0.7 (natural environment) to 1.8 (other subtypes). Phobia of vomiting was the most common specific phobia presenting in both adults (n = 161, 17.8% of all specific phobias) and children (n = 26, 23.4%). In adults with a phobia of vomiting, the female to male ratio was 9.1 compared with 3.4 in all other specific phobias, and 4.2 versus 0.98 for children.

There is a stark contrast between the apparent prevalence of phobia of vomiting in epidemiological surveys and being the most common presentation clinically. A very high female to male ratio in phobia of vomiting and animals in adults seeking treatment is also in contrast to findings in the community. This has implications for clinician training and public education.