Aims: Digital interventions have gained prominence as effective tools for improving outcomes across various psychiatric disorders. These interventions offer scalability, thus enhancing access to mental health services, particularly in resource-limited settings. While substantial evidence supports the efficacy of digital interventions for neurotic disorders, there is a notable gap in data regarding their effectiveness in severe, enduring mental illnesses like schizophrenia. This systematic review aims to evaluate the types of digital interventions used in the treatment of psychotic disorders and assess their effectiveness in improving both positive and negative symptoms.

Methods: We conducted a comprehensive search of multiple databases, including PubMed, up to December 2024, for studies evaluating digital interventions in psychotic disorders using a pre-tested search strategy. After retrieving relevant bibliographic records, two reviewers independently screened titles, abstracts, and full texts. Data extraction was performed by both reviewers working separately. Key variables extracted included study design, intervention type and platform, target population, and intervention components. The primary outcomes assessed were the severity of positive and negative symptoms following the intervention.

Results: Nine studies met the inclusion criteria. Three studies focused on interventions for participants with schizophrenia (n=3), two studies focused on first episode psychosis (n=2), and four studies were on schizophrenia spectrum disorders (n=4). Of these, four studies employed randomized controlled trial (RCT) designs, while the remaining studies assessed intervention development (n=1) and feasibility (n=4). The digital platforms used in the interventions included apps designed for symptom monitoring, self-management, and early relapse identification. Notable features of the apps included affect monitoring (n=3), diary keeping (n=2), reminders (n=3), and peer networking (n=3). Two apps specifically aimed at monitoring early relapse used active symptom tracking (n=1) and passive behavioural monitoring via GPS (n=1). The intervention strategies were rooted in psychosocial principles, with some apps utilizing cognitive-behavioural therapy for psychosis (CBTp; n=4) and behavioural activation for exercise engagement (n=1). One study combined the Actissist and CliniTouch apps, with the CliniTouch app prompting users to respond to PANSS-based items, while the Actissist app delivered CBTp-based interventions. Positive outcomes were observed in areas such as paranoia, delusions, motivation, and overall PANSS scores.

Conclusion: The use of digital interventions in the treatment of psychotic disorders has increased, with diverse strategies showing potential for improving both mental and physical health outcomes. Although promising, further randomized controlled trials are necessary to establish firm recommendations for integrating these digital tools into clinical practice.

Aims: Bipolar personality disorder (BPD) is associated with a deficiency in cognitive empathy, defined as the ability to infer other’s mental state by imagining their perspective and interpreting cues like facial expression. However, patients with BPD tend to have a typical or heightened emotional empathy – having reciprocal feeling state. We hypothesise that an empathy measure that discriminates between cognitive and affective empathy could aid diagnosis, quantify severity, inform prognosis, and stratify treatment of BPD.

The Questionnaire of Cognitive and Affective Empathy (QCAE) was produced by assimilating the most discriminating aspects of other well-validated questionnaires. It clearly defines empathy and is easy to use. The QCAE has also been shown to capture the characteristic empathy difference in people with BPD compared with non-clinical controls, but studies using non-clinical controls cannot determine whether these empathy differences discriminate between different mental disorders or are generally symptomatic of mental distress. Therefore, we measured empathetic aptitude using the QCAE in a BPD group and comparable group of people with other mental disorders.

This study aims to assess whether empathetic amplitude – cognitive and emotional empathy scores on QCAE, is different in BPD compared with other mental health disorders.

Methods: Participants diagnosed with BPD were recruited in outpatient appointments and in inpatient settings. Diagnoses were affirmed using DSM–IV diagnostic criteria by consultant psychiatrists. QCAE results were compared with a clinical control group with other mental disorders, also recruited in outpatient and inpatient settings.

Results: In the BPD group: N=40 (38 female), cognitive empathy mean on QCAE was 35.075 (SD 7.917) whereas emotional empathy mean was 46.80 (SD 12.90). Meanwhile in the clinical control group: N=23 (9 female, depression 5, schizophrenia 10, dissociative disorder 1, mania 4, NDD 2, delusional disorder 1), cognitive empathy mean was 55 (SD 10.531) while emotional empathy averaged at 35.609 (SD 6.103). There was a significant cognitive empathy score difference between the control and BPD group (p=0.012), with Cohen’s d of 0.696, the difference in emotional empathy was not significant (p=0.781).

Conclusion: These results corroborate the characteristic BPD empathy difference of an impaired cognitive empathy but a typical emotional empathy; people with BPD struggle to understand the motives and intentions of others, but their own emotions can be roused. This convincingly explains why it can be difficult for affected people to navigate interpersonal challenges. QCAE empathy testing could add objectivity to the otherwise subjective BPD diagnosis. However, prospective trials are needed to determine the prognostic utility of the QCAE tool.

An independent evaluation of The Resilience Project’s School Partnership Program in Australian secondary schools found that longer participation (6+ years) in this whole-school programme was associated with improved student outcomes, including reduced symptoms of depression and anxiety. This commentary aims to: (a) describe whole-school approaches to improving health and well-being, with reference to their historical context and some selected key studies; (b) highlight the lack of data on the effectiveness of whole-school approaches for reducing depression and anxiety; (c) signal the potential benefits of whole-school approaches when sustainably implemented; and (d) reinforce the need for research that examines links between implementation factors and outcomes. Overall, this commentary underscores the value of viewing schools as complex social systems where multiple components can align to enhance mental health and well-being outcomes for students.

Aims: This meta-analysis aims to review safety and effectiveness of pimavanserin compared with other antipsychotics in managing psychotic symptoms in Alzheimer’s disease and Parkinson’s disease dementia.

Methods: We conducted a comprehensive literature search of controlled trials evaluating efficacy of pimavanserin versus placebo and other antipsychotics. A thorough search was made using specific terms in Pubmed, Web of Science, EMBASE, SIGLE and CINAHL. Of 423 studies only 2 studies met our requirements once detailed ROB 2 analysis was performed. The primary dependent measure was NPI and the CGI-I as the secondary measure;safety data being the other dependent measure.

Results: With active treatment by pimavanserin, there was a mean reduction of 4.5 points on NPI score, the SMD was −1.07 compared with placebo. It was more effective than other antipsychotics and it came with more acceptable side effects. Side effects included extrapyramidal symptoms, however this was significantly lower in the pimavanserin group (7% versus 15% with olanzapine) and minimal metabolic side effects.

Conclusion: Pimavanserin stands as a relatively new treatment approach for management of neuropsychiatric symptoms in dementia that has similar effectiveness when compared with other antipsychotics, yet exhibiting fewer side effects. Its mechanism of action as a selective serotonin inverse agonist may offer some advantage in controlling and managing psychotic symptoms without worsening of motor functions in patients with Parkinson’s disease dementia.

Aims: In this systematic review, the effectiveness and safety of viloxazine ER in the treatment of ADHD in children and adolescents aged between 6–17 years will be assessed.

Methods: This review identified articles through a systematic approach using PubMed, EMBASE, and the Cochrane Library. Randomized controlled trials with viloxazine ER in an active comparator condition versus placebo or other stimulant/non-stimulant ADHD drugs were included.

The first set of outcomes for assessing efficacy was a decrease in the severity of ADHD symptoms as measured by the ADHD-RS-5 and CGI-I scales. Safety outcomes comprised comparability in the rates of adverse events and treatment discontinuation rates.

Results: A meta-analysis showed that viloxazine ER is effective in managing ADHD symptoms compared with placebo at 10–12 weeks. Very few side effects were reported with this medication and those reported were mostly mild to moderate in nature. Mild side effects were noted to be decreased appetite, somnolence, and headache. The rates of treatment disappearance were similar compared with other oral ADHD drugs.

Conclusion: The research implies that viloxazine ER may be useful to paediatric patients with ADHD as a new treatment approach. We hypothesize that its profile of being an NRI and 5-HT2B antagonist may be beneficial for patients who have not shown sufficient improvement with more common treatments. The use of once daily dosing of the extended release formulation may enhance compliance compared with drugs taken more than once per day.

In a general manner, viloxazine ER seems to be a safe and efficacious therapy in children and adolescents affected by ADHD. Because it has a unique mechanism of action and can be taken once daily, it complements other ADHD medications well. More prospective, multicentre trials of longer duration are, therefore, required to determine the success and risks of the technique in the long run.

Aims: People with Severe Mental Illness (SMI) have a reduced life expectancy of 15–20 years compared with the general population. This disparity is largely due to preventable health conditions like cardiovascular disease and diabetes. Certain antipsychotics (APs) can contribute to this increased burden due to their association with cardio-metabolic side-effects. Despite the availability of lower-risk APs, risperidone, olanzapine, and quetiapine remain the most prescribed APs in the UK. Switching to improve cardio-metabolic side-effects is rarely implemented in clinical practice. Improving the physical health of people with SMI is a key NHS priority. We conducted a qualitative study to explore the perceptions and experiences of patients and their caregivers surrounding switching APs for physical health benefits to inform the development of an educational intervention for clinicians to support switching APs.

Methods: Semi-structured interviews were conducted with patients who have experienced AP-induced cardiometabolic side-effects (ascertained by the treating clinician) and their caregivers. Participants were recruited through two NHS trusts and primary care. Interviews were by telephone or online and transcripts were thematically analysed using NVIVO. A patient advisory group contributed to all phases of the study.

Results: Seventeen interviews (16 one-on-one and one dyadic) were conducted with thirteen people with SMI (Bipolar Disorder [9], Schizophrenia [2], Psychosis [2]) and five caregivers.

We will present two themes:

(1) Managing the dual challenge of mental and physical health conditions: Managing this challenge can be overwhelming and impact their everyday life; patients often normalise side-effects of medication as a necessary trade-off for mental health stability.

(2) Enabling a change in medication: The possibility of medication changes was met with optimism as well as apprehension. Past experiences of medication adjustments, fear of relapse and concerns about new side-effects were important from both patient and caregiver perspectives; addressing these requires inviting patients and caregivers into decision-making. Carers play a crucial role in supporting patients, and recognising their contributions can ease the transition. Improving collaboration at the system level is equally important.

Conclusion: The study highlights the complex interplay between mental and physical health; patients and caregivers often face significant challenges in balancing mental and physical health. Switching medication is a challenge for patients and their caregivers. Addressing patients’ concerns like fear of relapse, lack of support, and clear communication would help foster confidence in switching. Recognising the importance of caregivers is essential for effective patient support. Improving overall collaboration can foster a more patient-centred approach to managing the switching process.

Aims: Peripheral Arterial Disease (PAD) is linked to vascular cognitive impairment and vascular depression due to concurrent cerebrovascular disease. Cognitive impairment and mental health disorders in surgical patients lead to poorer recovery and rehabilitation. Awareness of these diagnoses in this population is important when considering suitability for surgical input – especially high-risk procedures such as limb revascularisation. In the UK population, evidence suggests that 33–42% of cognitive impairment and 26.5% of anxiety and depressive disorders remain undiagnosed. In this high-risk PAD population, this is likely an underestimate. We aim to determine the prevalence of cognitive impairment and anxiety and depressive disorders within this group while controlling for possible confounders.

Methods: 100 unselected PAD patients were identified pragmatically from a Vascular outpatient setting at Addenbrooke’s Hospital. Inclusion criteria required patients to be >65, and have radiological or clinical evidence of PAD. Written consent was obtained for assessment. Patients came from a wide area in the East of England with a catchment of 1.8 million people, demonstrating significant socio-geographical variety for a single centre study. The assessment pack included the 6-CIT screening tool for cognitive impairment, HADS for anxiety and depression, 4AT for delirium, SASQ for alcohol use, and a brief clinical history covering memory, attention, visuospatial skills, speech, and personality.

Results: 100 patients were assessed over 6 months. 20.5% met the 6-CIT cut-off for memory clinic referral (mean score 12). The estimated general prevalence of cognitive impairment including dementia in those over 65 is 7.1%. 26.8% met the HADS cut-off for anxiety or depression (mean score 15). The prevalence of anxiety and depression in the general over 65 population is estimated to be around 9% and 12.5%, respectively. Hence, there appears to be a significant increase in possible prevalence of both diagnoses, compared with a general age matched population. No significant age or gender differences were found between those scoring above the cut offs and those not (p=0.79).

Conclusion: Cognitive impairment and anxiety/depression appear more prevalent in PAD patients. Given these conditions impact surgical outcomes, raising awareness of underdiagnoses is crucial. Future follow up will include memory clinic assessment, cerebral and peripheral imaging, and exploring surgical outcomes. Cost-effectiveness analyses are needed to assess the benefits of pre-operative screening.

Aims: In 2021–2022, 10.5% of UK citizens provided unpaid informal care, saving the government £162 bn annually. Many carers reside in high-deprivation areas, where access to appropriate health and social care services is limited. Previous studies indicate that carers are more prone to depression, anxiety, and physical symptoms, and these negative outcomes are higher among socio-economically disadvantaged carers. The shift of some health and social care services online, combined with ‘digital poverty’ (having no suitable electronic devices with Internet access or limited access or skills concerning the Internet), may exacerbate difficulties with accessing health and social care support, potentially increasing unmet needs and burdens among socioeconomically disadvantaged carers. The aim is to understand how informal carers with marginalised socioeconomic status (SES) access existing health and social care services and how this impacts their mental health. The second aim of the project is to explore how potential digital poverty may shape a carer’s mental health outcomes.

Methods: A systematic literature review will identify barriers and facilitators of accessing health and social care by informal carers, the impact of access/non-access on mental health, stratified by carer SES and care-recipient’s health conditions. Followed by a qualitative photovoice study to explore carers’ experiences of accessing health and social care and the effects of digital poverty, analysed through critical discourse analysis. Thirdly a survey (N >300) examining how factors underpinning access to health and social care are related to informal carers’ mental health as moderated or mediated by the caregiver SES, carers’ perceptions of access to health and social care and of digital poverty analysed by structural equation modelling.

Results: We will identify if and how informal carers with a marginalised socioeconomic background access health and social care services. Which will allow us to develop an evidence-based health promotion model.

Conclusion: This study will offer us a unique opportunity to develop an evidence-based health promotion model for these carers that shows how to mitigate existing pathways of health inequalities. Based on key findings, recommendations will be generated and shared with researchers, clinicians, and policymakers via academic publications, conferences, exhibitions of carers’ photographs, and carer forums with NHS Trust(s).

Aims: A handful of studies argue that ED treatment would benefit from a network analysis of social influences, particularly in girls and young women pressured by socio-culturally prescribed beauty standards, and reinforced by peers and family. The study’s aim was to investigate the impact of social network density on a person’s acquisition, perpetuation, and recovery from an eating disorder (ED). It was hypothesized that one’s connectedness within dense social networks of others with EDs would increase the likelihood of an ED diagnosis and resistance to treatment and recovery.

Methods: One thousand participants, largely from North America and Europe, completed an online survey of ED social networks. Respondents were asked whether they had an ED diagnosis, and if so, the diagnosis/typology, whether they knew others with an ED, whether they were in recovery, and, if so, the extent of social supports. Indices and latent structural equation model (SEM) variables were constructed from respondents’ identification of siblings, peers, friends, parents, other relatives, spouses, and neighbours with an ED. Similar indices were constructed for others identified as supportive of recovery. Social media influence was measured by asking if pro-anorexic or recovery websites were viewed. Data were analysed using bivariate statistics and Lavaan’s SEM R program.

Results: Social network density (knowing others with EDs) was highly predictive of ED diagnosis, including multiple EDs. Internet media was equally impactful. Same-sex siblings and peers had the greatest influence, exceeding parents or other relatives/friends. Networks of supportive others were highly predictive of recovery, outweighing negative ED models and media.

Conclusion: Our results were highly revealing of dense networks of family and peer models of EDs as well as supportive networks for recovery. The density/richness of social networks of others with an ED was highly predictive of an ED diagnosis, particularly of multiple EDs. Same-sex peers and siblings with an ED were especially strong influences. “Rich” day-to-day networks of multiple social contacts with EDs were associated with multiple ED diagnoses. Media appeared to complement these social contacts. However, only dense networks of supportive others were significantly predictive of recovery. Effective ED treatment requires a careful consideration of social influences who may model ED attitudes and behaviours; same-sex siblings and peers are especially critical. ED treatment and recovery might be compromised if these significant others model and reinforce a patient’s ED attitudes and behaviours.

Aims: Forests are important for planetary and human health, but deforestation is increasing. Poor mental health is increasingly affecting the world’s population. This study aims to investigate the association between forestry area, deforestation and mental health, at country level, worldwide.

Methods: Forestry area in each country was sampled in 2006 and 2016; the country prevalence of mental health disorders or substance abuse was sampled in 2006 and 2016; and the relative disability-adjusted life years (DALYs) in 2010 and 2016. Crude and multivariate linear regression analyses were run, adjusting for peace index, wealth and inequalities, and urbanisation at country level. A sensitivity analysis including sanitation and food security was run. Interaction with country gross domestic product per capita was assessed.

Results: Based on data for 230 countries, country forestry area is negatively associated with the prevalence of mental health disorders in 2016 (β −0.02 (195% C.I. −0.04/−0.01). This association was maintained in sensitivity analyses, and found mainly in lower- and upper-middle income countries. Change in forestry area is not associated with mental health prevalence nor estimated DALYs due to mental health.

Conclusion: This is the first study showing that forestry area at country level is associated with a lower prevalence of mental health disorders. If these results are replicated at individual level, this would suggest that public health implications should play a strong role in weighting ecological decisions, such as optimising forestry area coverage.

Aims: Gambling Disorder is a mental health condition in which people experience impaired ability to control or stop gambling behaviours despite adverse consequences. It is associated with psychiatric co-morbidities and risk factors for physical health conditions. There is growing exploration into physical health conditions associated with gambling disorder and this study sought to further contribute towards understanding that association. The first aim was to describe rates of physical health conditions. The second aim was to explore potential associations between physical health conditions and individuals’ sociodemographic characteristics.

Methods: Dataset one comprised aggregated anonymised subject-level data from clinical trials conducted in participants with gambling disorder (n=423). Dataset two comprised aggregated anonymised patient data from the NHS Southern Gambling Service (n=352). Descriptive characteristics of people with versus without physical health co-morbidities were presented. Statistical tests were undertaken to compare those with versus without physical health co-morbidities, independent t-tests were utilised to compare continuous variables whereas Chi Square or Fisher’s Exact test were utilised when comparing categorical variables.

Results: In dataset one 42.9% reported one or more physical health condition, the most frequent reported physical health conditions were musculoskeletal, cardiovascular, and endocrine and metabolic conditions. People in dataset one with physical health condition(s) versus without had significantly older age. In dataset two 27.1% reported one or more physical health condition, with respiratory, musculoskeletal, and endocrine and metabolic being the most reported. The presence of physical health conditions, musculoskeletal conditions, and endocrine and metabolic conditions was associated with significantly older age and female sex.

Conclusion: Increased age in individuals with gambling disorder is a crucial sociodemographic factor regarding physical health morbidity. In dataset two being female was identified as a risk factor for having physical health morbidity. Implementation of treatments targeting these risk factors may reduce the public health and individual health burden of gambling disorder.