Aims: To identify the difficulties International Medical Graduate (IMG) doctors face when starting their first job in the UK.

Methods: A survey was created on Google Forms. It included questions about the basic demographic of the IMG doctor, their experience of getting support and the difficulties they faced when they first started working in the UK. The survey had a mixture of tick boxes and free text options. The survey was distributed using social media forums and shared across IMG doctors’ social media groups. The survey link was open from December 18 to December 31, 2024. We received a total of 367 responses and 300 relevant responses were analysed, they represent the IMG doctors currently working in the UK and starting in the last 3 years.

Results: The 61% (185) responders were females, 35% (107) were male and the rest did not disclose their gender. Around 50% (148) were in their first year of job in the NHS while the rest were within 3 years of working in the UK. Only 7% (23) started their first job in the UK on a training grade whereas the rest had their first job as non-training grade or locally employed doctors.

76% (228) reported that they received shadowing periods as part of their first job experience and 70% (200) reported getting formal induction when they first started. 46% (125) were given access to the portfolio and 49% (134) had access to the study budget. 40% (122) did not feel they had enough senior support when they first started working in the UK. The free text boxes asked for suggestions around how the experience of IMG doctors can be improved in the UK and the responses indicated better induction as the most important factor.

Conclusion: The unique learning needs of the IMG doctors should be identified, and support systems should be in place accordingly. An IMG doctor-focused and tailored induction is required for the newly starting doctors. The shadowing period can also be a particularly useful tool in helping people understand the new systems and improve their confidence, but it is not offered to all new doctors.

Some IMG doctors may require enhanced supervision during the initial months, this can be delivered by peer and senior support. IMG doctors should feel welcomed in the new team as it helps to build psychological safety which can help to improve their performance.

Aims: This study aims to report the outcomes of mental health (MH) camps organized at various locations on a voluntary basis in District Tharparkar, an underserved area in the Sindh province of Pakistan. The camps aimed to screen, assess, educate, and treat patients with MH disorders. The study also reported the distribution of prevalent MH conditions in the Tharparkar area, barriers to attaining MH, and a possible solution to the MH professional shortage in remote areas.

Background: Mental disorders have become increasingly prevalent in Pakistan, affecting millions of people while there is a significant shortage of MH practitioners. MH camps play a crucial role in increasing awareness among the general population, reducing the stigma associated with MH conditions and offering an opportunity for the underserved population to approach MH professionals. Nonetheless, a more permanent solution is needed to address the needs of the patients in underserved remote communities.

Methods: A pre-structured Case Report Form was prepared to document the baseline characteristics, including family income, distance from a psychiatrist, duration of illness, perception regarding patients’ illnesses, healthcare visits in the last 6 months, and diagnosis of the patients.

Results: In 2022, a total of 460 patients were screened, and 164 (35.6%) were diagnosed with or considered for MH disorder. Out of these 164 patients, the mean age was 29.44 years (1–76). There were 94 (57.3%) males and 70 (42.7%) females. The average household income was PKR 25,758 (<£100), and the mean distance to a psychiatrist was 99 minutes, whereas the mean duration of presenting illness was 4.36 months. Depression was the most common illness reported (32%), followed by anxiety disorders (12%), psychotic disorders (9%), substance use (3%), and bipolar disorder (2%). Other mental health disorders were found in 28% of patients, and in 14%, diagnosis was not established.

Conclusion: More than half of patients sought help from a general practitioner in the last 6 months with the presenting complaints. The distance from the psychiatrist who serves as the primary care provider for MH needs in Pakistan and financial constraints are additional barriers for individuals residing in Tharparkar to attain help for MH needs. Therefore, task-shifting to general physicians (GPs) and incorporating MH into the primary care system could solve MH professionals’ deficiencies in remote areas. In light of the findings, it was recommended to initiate capacity-building sessions for the GPs in Sindh to train and educate them regarding the MH needs of their target population.

Aims: To determine the prevalence of metabolic abnormalities in patients with severe mental health illness (SMI) prescribed antipsychotics by the local Community Mental Health Team at the North Staffordshire Combined Healthcare NHS Trust.

Methods: This cross-sectional study collected data for patients who were on antipsychotic medications in 2022. The variables assessed include age, sex, smoking status, ethnicity, substance use, body mass index (BMI), prolactin, HBA1c, HDL, LDL, non-HDL, and total cholesterol. The statistical analyses were performed using SPSS version 26.

Results: A total of 296 patients (mean age 51.4 years), 161 (54.4%) males and 135 (45.6%) females were included in the study. Most of the patients (91.5%) were white, whereas others belonged to Asian (2.36%), Black (1%), other ethnicities(2.02%), and 3.04% did not state their backgrounds. 112 (37.8%) were smokers, 86 (29%) were ex-smokers, and 90 (30.4%) were non-smokers. More than two-thirds, 256 (86.4%) of the patients had no history of substance use, but the remaining 40 (13.5%) were using or had a history of substance use. More than two-thirds (80.9%) of the patients were overweight, obese, or severely obese. 18.2% and 0.67% of the patients were normal or underweight, respectively. The HbA1c was increased in 85 (28.7%) and was in the normal range and not documented in 207 (69.9%) and 4 (1.35%) of the patients. Prolactin was found to be in the normal range in 192 (64.86%) cases but out of the normal range in more than a third of patients, 101 (34.12%), and was not reported in 3 (1.01%) cases. LDL was found to be within range in 224 (75.6%) of the patients, out of range in 46 (15.5%), and not recorded in 26 (8.7%) cases. Furthermore, HDL and total cholesterol were found within the normal values for 214 (72.3%) and 197 (66.55) of the patients, out of range for 77 (26.01%) and 95 (32.09%) cases and not documented for 5 (1.68%) and 4 (1.35%) of patients, respectively.

Conclusion: Patients on antipsychotic medications have a higher prevalence of metabolic abnormalities, such as increased risk of obesity, diabetes, and deranged cholesterol; however, the variation in metabolic profile in patients on different antipsychotics needs to be further explored. It is recommended that these patients be monitored at recommended intervals in accordance with the NICE guidelines for early detection and intervention of metabolic abnormalities to improve quality of life.

Aims: This study examines the demographic factors and severity of pornography addiction in India, analysing the impact of age, relationship status, co-morbid conditions, and socio-cultural norms on addiction patterns and treatment outcomes.

Methods: A retrospective, observational, cross-sectional study was conducted with 589 participants (583 males, 6 females) aged 18 and older, diagnosed with pornography addiction as per the International Classification of Diseases, 11th revision (Compulsive Sexual Behavior Disorder criteria). Participants sought treatment through Allo Health’s online and offline platforms. Data on demographics, clinical diagnoses, and treatment outcomes were extracted from electronic health records and analysed using IBM Statistical Product and Service Solutions (SPSS-14). Treatment options included pharmacological interventions (Selective Serotonin Reuptake Inhibitors, bupropion) and psychotherapy (cognitive-behavioural therapy, motivational interviewing, relapse prevention strategies).

Results: The majority (374) were under 30, with a mean age of 28.98 years. Most were single (287), followed by married (167), in relationships (112), and divorced (6). Regarding sexual orientation, 568 identified as heterosexual, 15 as bisexual, 2 as homosexual, and 4 preferred not to disclose.

A strong association was found between younger age and higher addiction severity (p=0.004), suggesting early exposure to explicit content and digital overuse contribute to compulsive consumption. Single individuals exhibited significantly higher addiction severity than those in relationships or married (p<0.001), likely due to limited sexual expression opportunities.

Treatment varied, with 338 receiving medication alone, 207 undergoing therapy only, and 42 receiving a combination. Younger individuals were more likely to receive therapy, reflecting growing acceptance of psychological treatment. Two individuals were ineligible for treatment.

Conclusion: This study highlights the complexity of pornography addiction in India, showing a strong link between age, relationship status, and addiction severity. Younger individuals are particularly vulnerable due to early exposure, poor coping mechanisms, and excessive digital engagement. Socio-cultural factors influence addiction, with single individuals facing limited sexual expression in a conservative society. Stigma surrounding sexual health discourages help-seeking, especially in collectivist cultures.

The findings emphasize the need for culturally sensitive interventions, including awareness campaigns, digital literacy programmes, and public health initiatives. Future research should focus on longitudinal studies, gender disparities, and the impact of emerging digital technologies on addiction trends.

Aims: Depressive disorders, as defined by the International Classification of Diseases (11th Revision), involve a depressive mood (feeling sad, irritable, or empty) along with other symptoms affecting a person’s ability to function. Botulinum toxin, used for conditions like migraines and muscle spasms, is being researched as a treatment for depression. The theory is based on facial feedback, where paralysing facial muscles could reduce the brain’s ability to process negative emotions, potentially improving mood. This review aims to explore how botulinum toxin might work in depression treatment and summarize the current research and future directions in this field.

Methods: We searched PubMed. Inclusion criteria were paper should discuss depression and botulinum. We excluded papers before 2010 and papers which included botulinum toxin in patient comorbid migraine.

Results: Magid et al. reviewed 2 case series, 3 randomized controlled trials (RCTs), and one meta-analysis on botulinum toxin for depression. 29\39 U was injected. They concluded that botulinum toxin was not yet an appropriate treatment.

Kugar and Wollmer examined studies on botulinum toxin’s effects on depression, especially patients with chronic migraine. 29/39 U was injected. Some improvement but called for further research.

Wollmer et al. (2019) analysed 4 RCTs and 3 case series, confirming the efficacy of botulinum toxin in treating depression. They found a lasting effect of about 3 months with a single treatment but recommended further research.

Qian et al. (2020) conducted a systematic review of RCTs and concluded that botulinum toxin might offer a new treatment option for major depressive disorder. However, the effects on depression secondary to other conditions remain unclear.

Danilo et al. (2021) analysed 5 RCTs, finding botulinum toxin more effective than a placebo in treating depression. They noted low risk of bias, with statistically significant results.

Yang Li et al. (2021) reviewed 10 RCTs and confirmed that studies support botulinum toxin as a potential alternative treatment for depression.

Wollmer et al. (2022) evaluated 5 studies and found botulinum toxin effective for patients although the exact mechanisms are still under study.

Conclusion: While botulinum toxin has shown potential in treatment for depression, particularly for patients who didn’t respond to antidepressants or who experience side effects, the current evidence remains preliminary. Several studies indicate that botulinum toxin may offer symptomatic relief. However, the overall quality of the evidence is limited by small sample sizes, methodological inconsistencies, and the need for more trials.

Aims: While personality traits are known to influence values, beliefs, and professional preferences, limited research has explored their impact on attitudes toward psychiatry, particularly in Middle Eastern contexts and among non-medical students. Personality traits also influence perceptions of mental illness among individuals, helping to understand the basis of societal mental health stigma. Understanding the relationship between personality traits and attitudes toward psychiatry is crucial for developing educational strategies that support positive perceptions, ultimately enhancing healthcare outcomes for individuals living with mental illnesses.

Methods: This study employed a cross-sectional design to evaluate how personality dimensions correlate with perceptions of psychiatry in a sample of 503 students, including 377 medical and 126 psychology students from three major universities in the United Arab Emirates. Attitudes toward psychiatry were assessed using the Attitudes Towards Psychiatry (ATP-30) scale, and personality traits were evaluated using the Big Five Inventory. Spearman’s rank correlation was employed to analyse the relationships between ATP scores and personality dimensions: extraversion, agreeableness, conscientiousness, emotional stability, and openness to experience.

Results: Significant positive correlations were found between ATP-30 scores and four personality traits: extraversion (r=0.11, p=0.01), agreeableness (r=0.22, p<0.001), conscientiousness (r=0.10, p=0.03), and openness (r=0.28, p<0.001). Emotional stability did not exhibit a significant correlation (r=−0.03, p=0.58). Medical students demonstrated similar patterns, with openness (r=0.26, p<0.001) and agreeableness (r=0.20, p<0.001) being the strongest predictors. Among psychology students, only agreeableness (r=0.21, p=0.02) and openness (r=0.30, p<0.001) showed significant associations.

Conclusion: These findings underscore the influence of personality traits – particularly agreeableness and openness – on attitudes toward psychiatry. They highlight the need for tailored educational approaches to promote positive perceptions of psychiatry, with implications for improving both training outcomes and therapeutic relationships.

Aims: Emergency NHS services are under considerable pressures from patient demand and ineffectual care and social pathways. This is especially felt within the mental health services where demand has grown from long periods of austerity and the Covid pandemic. To reduce demand on both ambulances and emergency departments Welsh ambulance implemented the roll out of mental health practitioners within its 999 call centres which has been very successful, however, the successful closure/treatment rate is less than half the callers. Over half of all mental health 999 callers require face to face intervention therefore ambulances within Wales need to implement mental health response vehicles in order to achieve this.

Methods: To test this further between January and March this year a pilot was conducted in Aneurin Bevan University Health Board over a 9-week period operating Friday to Sunday 1 pm to 12 am.

Results: The pilot achieved very positive outcomes in staff satisfaction and perceived patient satisfaction, along with 74% see, treat and close at scene rate, 7% conveyance to mental health facilities and 19% Emergency department conveyance rate.

Conclusion: The project has been a huge success and demonstrates how working in partnerships across organisations can achieve significant success through overcoming barriers as and when they arise. Mental health patients can face long waits and psychological hardships whilst they wait for treatments. MHRV can provide not only rapid responsive assessments but also provide a therapeutic intervention to those patients, thereby improving quality of care to mental health patients and releasing further ED and ambulance resource to the general public.

Finally, a national rollout of this way of working will require a significant investment, both financially and staffing; obtaining suitably qualified, experienced and skilled staff will represent a significant burden upon Welsh health boards or English Trusts. English ambulance trusts have already faced issues with recruiting staff into their services, which may be the same in WAST or if successful will mean that health boards will lose staff from within their organisations placing an additional burden upon their services (in 2023 the National Commissioning and Collaborative Unit reported that there were circa 500 mental health nurse vacancies across Wales).

The authors propose that a partnership approach is required with the Welsh NHS executive, HEIW, Welsh universities and health boards to explore training options and create a national mental health education package for Wales. WAST will be able to train and equip its existing staff with mental health knowledge and skills to treat patients utilising the ambulance service.

Aims: Individuals with severe mental illness (SMI) face two–three times higher-risk of early death; over 60% are deaths linked to preventable physical health issues. Commonly prescribed antipsychotics (APs) like olanzapine, quetiapine, and risperidone effectively manage mental health (MH) symptoms but carry serious cardiometabolic risks. Although lower-risk APs have been available for nearly a decade, most patients remain on higher-risk APs as switching to improve cardio-metabolic side-effects is rarely implemented due to clinician uncertainty and relapse concerns. We aimed to co-design an educational intervention to support clinicians in evidence-based AP switching, incorporating input from clinicians, patients and caregivers.

Methods: Our intervention was co-designed iteratively, guided by Medical Research Council (MRC) framework for complex interventions. Work Package (WP) 1 formed exploratory basis for intervention development and included (i) two theory of change (ToC) workshops with clinicians (n=28) to identify barriers and opportunities for supporting people with SMI in switching APs; (ii) evidence review and synthesis of 32 clinical practice guidelines on switching APs; (iii) qualitative interviews with patients and caregivers (n=18) to explore perspectives on switching APs. Findings from WP1 were used to develop and refine intervention in WP2 iteratively through (i) two consensus-building workshops (CBWs) with clinicians and lay members (n=26); (ii) early user-feedback will be generated through ongoing think-aloud interviews and role-play activities.

Results: Insights from ToC workshops (28 MH clinicians), qualitative interviews (13 patients and five caregivers), and CBWs (22 MH clinicians and four lay members) highlighted importance of clear communication, collaborative clinician-patient relationships, clinician training, shared decision-making, and patient support while also addressing system-level barriers like poor integration and time constraints. The co-design approach established iSWITCHED, a five-component intervention to support clinicians in switching patients from higher-risk APs to lower-risk alternatives while promoting SDM between patients, carers, and clinicians. Intervention components include (i) a decision-aid that can be embedded in MH record systems to support clinicians in safely managing AP switches; (ii) peer-reviewed evidence-based guidelines for clinicians on AP switching; (iii) SDM guidelines to engage patients and carers; (iv) clinician training to enhance understanding and application of guidance and tool; (v) patient and clinician leaflets to support switching. Think-aloud interviews with 4 psychiatrists and pharmacists have been conducted so far to refine iSWITCHED.

Conclusion: The iSWITCHED switching intervention combines lived experiences, clinical expertise and integrates seamlessly into existing MH record systems. Before wider-implementation, it will be refined using insights from think-aloud interviews and role-play activities and piloted in a larger feasibility study.

Aims: The postpartum period exerts a profound influence on maternal mental health. This study aimed to describe mental health problems and identify associated perinatal factors in women referred to the University Psychiatry Unit, National Hospital of Sri Lanka (NHSL) during the postnatal period.

Methods: A retrospective descriptive cross-sectional study with analytical component was conducted. Data was collected from records of 201 postnatal women randomly selected between 2021–2023 referred from De Soysa Maternity Hospital (DMH) and Castle Street Hospital for Women (CSHW). Women who experienced a perinatal death in their most recent pregnancy were excluded.

Results: The mean age of the study population was 30 years. Most were unemployed (73.4%), completed Advanced Level education (39.3%), lived in Colombo district (71.6%), and were married (89.1%) and referred before 5 days postpartum (52%). Among referred patients, 7% had history of depression. Affective symptoms (33.7%) and anxiety (11.2%) were common reasons for referral. The proportion of patients referred for suicidal thoughts was 4.3% and for heroin use was 8%. During assessment 67.2% were diagnosed with a mental illness. Majority had maternal blues (30.4%), depression in 11.8% and postpartum psychosis in 7.4%. Outpatient treatment was offered to 98% of those diagnosed with 81.3% offered pharmacotherapy. It was found that 34.6% defaulted and 21.6% were not sent for review during admission. Postpartum mental illness was significantly associated with gestational age at delivery (χ2=8.347, p=0.004), whether baby was admitted to Neonatal Intensive Care Unit or High Dependency Unit (χ2=5.424, p=0.02), and spousal support (χ2=5.580, p=0.018). No association was found with age, education, past psychiatric history, parity, mode of delivery, or breastfeeding difficulty.

Conclusion: The high rate of treatment defaulting indicates a need for improved follow-up and support strategies for women with postpartum mental illness. The identified associated factors of gestational age, neonatal admission status and spousal support can be utilized to design targeted preventative interventions.

Aims: 1. Providing practical solutions for richer and broader use of online platforms for education among students. 2. Finding factors related to online education that are involved in causing mental disorders in students and preventing and correcting them.

Methods: This cross-sectional study was conducted after obtaining approval from the Research Council and Ethics Committee of Tehran University of Medical Sciences. Medical students were selected through simple random sampling, and those who met the inclusion criteria completed an online questionnaire that included the PHQ-9 and PSS-10 questionnaires developed by the researcher. Informed consent was obtained from all participants, and the data was analysed using SPSS software.

Results: A total of 330 medical students participated in the study, of whom 137 (41.5%) were female and 193 (58.5%) were male. The results revealed that 73.5% of participants had mild depression, 17.3% had moderate depression, and 9.4% had severe depression. Additionally, 4.2% had mild stress, 91.5% had moderate stress, and 4.2% had severe stress.

Conclusion: The study findings revealed that virtual education quality during the Covid-19 era, accessibility to virtual learning resources, financial and health worries due to Covid-19, and communication level among students with their family and friends significantly influence their mental health. The study suggests that while designing virtual classrooms, it is essential to consider the availability of resources, facilitate peer-group communication, and provide financial support to enhance students’ mental health.

Aims: The study aimed to study the prevalence of problematic online gaming and find out association between problematic gaming with domains of emotional regulation.

Methods: An online survey questionnaire was created by the researchers after approval and validation from experts and sent through various social media platforms. Those who did not consent for the study were excluded. The questionnaire included basic sociodemographic details and questions taken from two scales – (i) Problematic Online Gaming Questionnaire SF for identifying problematic online gaming and (ii) Difficulties in Emotional Regulation Scale (DERS-18) to identify domains of emotional regulation. Descriptive statistics, Pearson correlation, ANOVA were used for statistical analysis.

Results: 108 participants reverted with the completed forms, out of which, 69.4% were regularly engaged in online gaming, 19.4% fell under the domain of problematic online gaming. 4.6% of the participants were engaged in online gaming for more than 8 hours in a day. With regards to various domains of emotional regulation, the mean scores in each subscale of emotional regulation (Nonacceptance of Emotional Responses, Difficulties Engaging in Goal-Directed Behaviour, Impulse Control Difficulties, Lack of Emotional Awareness, Limited Access to Emotion Regulation Strategies and Lack of Emotional Clarity) were more in those with problematic online gaming as compared with non-problematic individuals and was statistically significant (p<0.05). There was also a positive correlation between problematic online gaming and sub-domains of emotional regulation (p<0.01).

Conclusion: The study clearly depicts the rise in online gaming that has been clearly demonstrated in the recent studies worldwide. The results clearly illustrate the association of online gaming with difficulty in handling emotions but also a means to attenuate negative emotions. It could be potentially being used as an escape mechanism. Though details of the causal link between the two parameters were beyond the scope of the study, it would be worth looking at it in future research.

Aims: A diagnosis of depression is three times more likely to occur in people living with HIV/AIDS. Management is imperative,as it not only ensures reduced depressive symptoms but also improves quality of life. Interpersonal psychotherapy (IPT) and cognitive-behavioural therapy (CBT) have been linked to reduced depressive symptoms. This paper will investigate to what degree both treatment options can help reduce depressive symptoms in people living with HIV/AIDS.

Methods: Randomized controlled trial articles from the Cardiff University repository, PsycARTICLES, PsycINFO, Cinahl, and PubMed databases were collected and dated not later than ten years from 2024. The participants were individuals with an HIV/AIDS diagnosis and depression as a comorbidity. They also had been exposed to either IPT or CBT psychotherapy. The articles were screened, and data from19 articles with 4805 participants were extracted.

Results: Findings showed that CBT reduced depressive symptoms, and its effects were visible in the long term, which involves more than six months. Similarly, IPT was found to have long-term effects, but the difference in the symptoms in IPT was minimal compared with CBT. No significant difference in the efficiency of either therapy was observed.

Conclusion: Both the psychotherapy modalities were found to have positive impact by reducing depressive symptoms. There is a need for more research into improving the psychotherapy intervention time and mode of delivery.

Aims: This study aimed to elucidate the modulating effects of serum ghrelin on the relationships between interleukin-6 (IL-6) and antidepressant treatment outcomes, particularly focusing on 12-week remission and 24-month relapse in patients with depressive disorders.

Methods: We analysed baseline serum levels of ghrelin and IL-6 in 1,086 patients engaged in a naturalistic, stepwise antidepressant treatment protocol. Remission was assessed using the Hamilton Depression Rating Scale (HAMD), with a score of 7 or less defining remission at 12 weeks. Patients achieving a response (HAMD ≤14) at this interval were tracked for relapse (HAMD >14) quarterly up to 24 months. Logistic regression models, adjusting for sociodemographic and clinical variables, explored the interactive effects of these biomarkers on treatment outcomes.

Results: Our analysis indicated that while serum ghrelin levels did not directly impact treatment outcomes, they significantly modulated the relationship between high IL-6 levels and the likelihood of non-remission at 12 weeks as well as relapse at 24 months. Notably, elevated IL-6 was strongly associated with these negative outcomes primarily in the context of lower ghrelin levels. The modulatory effects of ghrelin were statistically significant in the context of relapse after controlling for relevant covariates.

Conclusion: The findings from this study underscore the critical interplay between inflammatory and metabolic markers in determining the trajectory of depression treatment outcomes. By demonstrating the significant roles of IL-6 and ghrelin, particularly their interactive effects, this research highlights the potential to enhance personalized antidepressant strategies through the integration of biomarker profiles. Future investigations should focus on unravelling the dynamic mechanisms behind these interactions, which could pave the way for refining prediction models for treatment responsiveness and developing targeted interventions that more effectively address the complexities of managing depression.

Aims: Individuals dissatisfied with their sleep are more likely to seek medical help, to report daytime impairment functioning, and to be diagnosed with a sleep or a mental disorder However, none of the previous studies has examined the relative importance of the various factors correlated to sleep disturbance. This study aims to investigate the prevalence of sleep disturbance and to find the associated factors contributing to sleep disturbance in the general population of Jeju Island, the largest island in the part of South Korea.

Methods: Seven hundred and thirteen people who consented to participate in this study and completed questionnaires were analysed. The questionnaires were used to assess the participants` sleep satisfaction and general characteristics (sex, age, marital status, occupation, monthly household income, self-perceived health, smoking, drinking status, etc.); in addition, for the clinical evaluation, depression was assessed through the Center for Epidemiologic Studies Depression Scale (CES-D) and social support through Functional Social Support Questionnaire (FSSQ). CES-D cutoff score of 21 was used to define depressive disorder. The collected data were analysed using t-test, chi-square test and logistic regression analysis according to data properties and the purpose of analysis.

Results: In 713 subjects, the mean age was 58.6±17.3 years, and overall, 24.9% of the subjects reported having sleep disturbance. The prevalence of sleep disturbance was higher in women than in men (60.9% vs 39.1%, crude OR=1.49, 95% CI=1.05–2.12, p=0.028) and increased with age (crude OR=1.03, 95% CI=1.02–1.04, p<0.001). The multiple logistic regression analysis demonstrated that the associated factors for the sleep disturbance were age (adjusted OR=1.04, 95% CI=1.02–1.07, p=0.001), smoking (adjusted OR=2.54, 95% CI=1.33–4.86, p=0.005) and depressive symptoms (adjusted OR=6.08, 95% CI=3.47–10.64, p<0.001).

Conclusion: Sleep disturbance was related to increasing age, smoking, and more depressive symptoms. The sleep symptoms are often unresolved by treatment, and confer a greater risk of depression. Previous epidemiological studies have pointed out that sleep problem is a risk factor for depression. There is, therefore, a need for more successful management of sleep disturbance, in order to improve quality of life and reduce an important factor in depression.

Aims: Adverse parenting behaviours (APB) are considered to contribute to the risk of depression and other psychopathologies in young people via changes in the development of the neuroendocrine stress response, particularly of the hypothalamus-pituitary-adrenal (HPA) axis. Anterior pituitary gland volume (aPGV) is emerging as a more stable biomarker of HPA axis dysregulation in comparison to cortisol measures. Although enlarged aPGV is generally understood as being reflective of chronic HPA axis hyperactivation in response to prolonged stress, there is little research that has explored the APB-aPGV relationship. Notably, there are inconsistent findings regarding longitudinal associations between APB and measures of HPA axis function (including aPGV), and it remains unclear whether exposure to APB may result in: 1) accelerated or 2) attenuated HPA axis function during childhood and adolescence. This study aims to investigate the cross-sectional and longitudinal associations between APB and aPGV in late childhood to early adolescence, in the largest sample that has been used to date.

Methods: Participants comprised 268 children and early adolescents from the community, who participated in longitudinal brain imaging and parenting assessments over two waves (in 8–13-year-old children). aPGV was calculated from T1-weighted Magnetic Resonance Imaging (MRI) scans of the children. APB was measured through two parent-report questionnaires. Exploratory factor analysis was used to reduce the subscales of the questionnaire to a three-factor structure; the factors were named neglect, low levels of positive parenting, and maladaptive discipline. Multiple linear regression was used to investigate cross-sectional associations between APB and aPGV, and linear mixed modelling was used to examine longitudinal associations between APB and aPGV.

Results: Neglect was positively associated with greater aPGV both cross-sectionally at baseline and across ages 8–13. Age did not moderate the association between neglect and aPGV longitudinally, which was stable over time. Other parenting variables were not significantly associated with aPGV changes.

Conclusion: Our findings suggest a crucial role for the experience of neglect in the development of the HPA axis during late childhood and early adolescence, supporting theories of HPA axis hyperactivation. The effect of neglect on aPGV was stable across age, suggesting that neglect may lead to advanced aPGV development, with accelerated development potentially occurring earlier in childhood. Further research that investigates the APB-aPGV relationship in a broader age range (i.e., covering the period between early childhood and late adolescence) is needed to understand developmental trajectories of aPGV in the context of APB.

Aims: People with severe mental illness have a reduced life expectancy of 15–20 years compared with the general population. The current literature shows this vulnerable population are 2 to 3 times increased risk of dying from cardiovascular disease, 2 to 6 times more likely to die from respiratory disease, and an increased risk of chronic viral infections such as HIV and hepatitis C. Patient, medication, and healthcare system factors influence the morbidity and mortality of people with severe mental illness. Stigma and discrimination by healthcare workers is a key contributing factor. We conducted this novel study in the Seychelles Islands with the aim of assessing the attitude and mental health knowledge of general practitioners and nurses towards severe mental illness in all 16 government primary healthcare facilities. We also aimed to explore the association of attitude and knowledge variables with sociodemographic characteristics and compare the attitude and knowledge between the two groups. We hypothesized that the greater the knowledge and understanding of severe mental illness the more positive and supportive the attitude would be.

Methods: A probability-stratified sampling technique was utilised to recruit 42 doctors and 97 nurses. The exposure variables were the sociodemographic characteristics. The outcome variables were attitude which was measured using the Mental Illness: Clinician’s Attitude Scale (MICA) and knowledge which was measured using the Mental Knowledge Schedule (MAKS). Chi-square test was used to examine the association between the sociodemographic characteristics with the attitude and knowledge variables. The threshold of significance was set at p<0.05.

Results: 24 doctors and 64 nurses participated in the study with a response rate of 57.1% and 66% respectively. 66.7% (n=16) of the doctors were expatriates and 93.8% (n=64) of nurses were Seychellois (n=64, 93.8%). 54.69% (n=35) of the nurses had high knowledge and 58% (n=14) of the doctors had positive attitude. Male practitioners were more inclined to have a better knowledge of mental health. Doctors with postgraduate qualification had more positive mental health attitude. No statistically significant association was found between attitude and mental health knowledge in the participants.

Conclusion: The study has shown that half of the primary health workers had inadequate mental health knowledge and half of them had negative mental health attitude. Primary health workers lack training in the area of mental health. The key intervention is training in mental health. Additionally, recommendation may be made to revise the orientation programme for doctors and nurses entering the healthcare system in Seychelles.

Aims: Schizophrenia is a mental illness with chronic course and varied outcomes, characterized by positive, negative, affective and cognitive symptoms along with aggression. Tobacco use is notably more prevalent in individuals with schizophrenia, often accompanied by severe dependence, compared with the general population. This literature review aims to explore the neurobiological mechanisms underlying tobacco use in schizophrenia, as well as potential treatment options and their associated benefits to the individual.

Methods: A comprehensive search was conducted on PubMed using the keywords “Tobacco use” and “Schizophrenia”. Information from Free Full-text articles, including systematic reviews, meta-analyses, clinical trials, randomized controlled trials, review articles and books and documents published within the last 10 years were included, and studies published in languages other than English were excluded.

Results: The prevalence of tobacco use in patients with schizophrenia is 45–88% compared with less than 16% of general population. Nicotine acts via Nicotinic Acetylcholine Receptors (nAChRs) modulating the release of neurotransmitters. It helps improve the connectivity between salience network and other brain regions such as ventrolateral prefrontal cortex and superior parietal lobule, amongst others, which are deficient in schizophrenia.

The self-medication hypothesis suggests that tobacco reduces cognitive deficits. It also reduces extrapyramidal symptoms by inducing cytochrome P450 1A2, interacting with nAChRs in the ventral tegmental area, and inhibiting monoamine oxidase enzymes, which helps counteract dopamine reduction caused by antipsychotics.

The addiction vulnerability hypothesis suggests that genetic, neurobiological, and environmental factors in schizophrenia also increase susceptibility to tobacco use. Animal model studies also suggest that developmental limbic abnormalities which are seen in schizophrenia could also alter behaviour associated with drug use.

From a prognostic point of view, tobacco use in schizophrenia significantly increases the risk of cardiovascular diseases, shortening lifespan by up to 25 years, and raises the likelihood of metabolic syndrome. Pharmacotherapies like varenicline, bupropion (sustained release), nicotine replacement therapies (NRT), and combinations of bupropion and NRT have shown some success. Electronic cigarettes, along with psychological approaches like Acceptance and Commitment Therapy, Mindfulness, and Contingency Management (both digital and in-person), show promise. Neuromodulation via transcranial magnetic stimulation has shown some promise with limited results.

Conclusion: It is seen that tobacco use in schizophrenia is influenced by genetic, neurobiological, and cognitive factors, with nicotine causing long-term health risks and decreased effectiveness of treatment, hence proper understanding is essential for adequate patient care.

Aims: Schizophrenia is a severe mental illness, characterized by positive, negative, cognitive, affective symptoms with aggression, marked by disrupted structural and functional brain connectivity, as evidenced by neuroimaging, neurophysiological and neuropathological studies. Recent epigenetic research highlights the role of deoxyribonucleic acid (DNA) methylation, histone modifications, and non-coding ribonucleic acid (RNA) amongst others in mediating both genetic predisposition and environmental influences on gene expression as seen in schizophrenia.

Methods: A comprehensive search was conducted on PubMed using the keywords “schizophrenia” and “epigenomics”. Information from articles published within the last ten years were selected, including those with free full-text access, including books and documents, clinical trials, meta-analyses, randomized controlled trials, and systematic reviews. Only articles published in the English language were included in the selection process.

Results: The brain methylome consists of DNA methylation marks at cytosine and guanosine separated by phosphate group (CpG) sites in the brain’s genome, which regulate gene expression without altering the DNA sequence. This modification influences cellular processes like gene activity, development, and memory. Dysregulation of gene expression, particularly in the prefrontal cortex (PFC), contributes to schizophrenia’s pathophysiology, impacting neurotransmission, myelination, metabolism, and immune signalling.

Histone modifications (acetylation, deacetylation, methylation, phosphorylation) also regulate gene expression, with reduced Histone Deacetylase 2 (HDAC2) expression seen in the dorsolateral PFC of schizophrenia patients. Additionally, microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) are implicated in gene expression dysregulation in schizophrenia, influencing processes like synaptic plasticity and neural differentiation.

Epigenetic changes in peripheral tissues, such as blood and saliva, may serve as biomarkers for schizophrenia.

A comprehensive approach integrates genotyping, epigenotyping, and deep phenotyping to enhance understanding of an individual’s health and treatment responses. Early therapeutic interventions may reverse epigenetic changes, improving outcomes. Incorporating molecular endophenotypes and neuroimaging biomarkers aids in identifying schizophrenia subgroups and enhancing treatment predictions. Omics integration (genomics, transcriptomics, proteomics, metabolomics) increases the precision of schizophrenia risk stratification.

There are various advancements in DNA methylation analysis include high density CpG array system (850,000 sites), whole genome bisulphite sequencing (better resolution but costly), targeted bisulphite sequencing (cost-effective), and emerging single molecule/nanopore sequencing technologies.

Conclusion: Current research in schizophrenia reveals interactions between genetic, environmental, and epigenetic factors. While significant advancements have been made in understanding the role of DNA methylation, histone modifications, and non-coding RNAs, further studies with larger sample size and more robust structure along with using multi-omic approach are desirable for understanding the disease pathophysiology and to deliver personalized treatment.

Aims: Negative symptoms of schizophrenia are disabling and often show inadequate response to antipsychotic treatment. Dysfunction in cortical regions such as the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) has been implicated in these symptoms. While repetitive transcranial magnetic stimulation (rTMS) has shown efficacy, deep transcranial magnetic stimulation (dTMS) offers the advantage of targeting deeper brain structures.

To assess the efficacy of high-frequency dTMS in improving negative symptoms of schizophrenia and to examine its effects as measured by proton magnetic resonance spectroscopy (h-MRS).

Methods: This sham-controlled, double-blind study randomized 46 patients with schizophrenia into active and sham dTMS groups. Participants received 10 sessions of high-frequency (10 Hz) dTMS at 100% of the resting motor threshold using an H7 coil over 2 weeks. Symptom severity was assessed using the Positive and Negative Syndrome for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression (CGI) at baseline, 2 weeks, and 4 weeks post-treatment. h-MRS of the ACC and mPFC was performed at baseline and after 2 weeks of treatment.

Results: A total of 43 patients completed the study. While both groups showed improvement over time, the active dTMS group demonstrated significantly greater improvement in negative symptoms, as reflected by a reduction in SANS scores compared with the sham group (p=0.003) and improvement in the negative subscale of PANSS (p=0.044). h-MRS analysis revealed a positive correlation between ACC total N-acetylaspartate (tNAA) levels after 2 weeks of treatment and baseline SANS anhedonia subdomain scores.

Conclusion: High-frequency dTMS significantly improves negative symptoms and overall illness severity in schizophrenia. These findings highlight the potential role of dTMS as an adjunctive treatment and suggest that h-MRS may serve as a valuable biomarker for treatment response. Future studies with larger sample sizes are needed to further explore the therapeutic and neurobiological effects of dTMS.

Aims: Depression and anxiety are common in every community. Appreciation of the long-term trajectories of these symptoms will inform more targeted interventions for reduction of disease burden. We evaluated the 7th and 9th year episode onset and remission rates of common mental disorders (CMD) in participants of the Hong Kong Mental Morbidity Survey (HKMMS) at baseline (2010–2023), who were reassessed at 7th and 9th years follow up.

Methods: The HKMMS and follow up studies were commissioned by the Medical and Health Research Fund in Hong Kong. Baseline study was conducted from 2010–2013 (n=5,719). We reassessed 1,392 subjects at 7th (2019–2021, COVID pandemic) and 9th (2020–2023, late to post-COVID) years. Depression and anxiety symptoms, episode onset and remission rates of CMD were evaluated with the Clinical Interview Schedule – Revised scores at baseline and follow up. Repeated measures ANCOVA computed factors affecting CISR scores over time.

Results: At 7th year, episodes onset rates of CMD in BL normal (n=832, CISR =<5) and BL subsyndromal (n=332, CISR 6–11) were 8.2% and 26.5% respectively. The corresponding figures were 7.9% and 22.3%. Remission rates of CMD from BL (n= 228) to 7th and 9th years were 39.9% and 50.4%. Repeated measure ANCOVA identified a significant time effect with increase in CISR scores at 7th (p<0.001) and decrease from 7th to 9th year (p<0.001). Women had higher CISR at all time points, interaction with time was not significant. Younger age groups (BL 18–44) reported more CISR symptoms at 7th year and greater drop at 9th year. Older adults with physical comorbidity had a trend for increase symptoms over time.

Conclusion: In this 9 year follow up study of adults in Hong Kong, episode onsets are related to baseline CISR scores, indicating that psychological symptoms confer long-term risks for deterioration. Conversely, a significant proportion of CMD improved with time. The time frames for assessments unintentionally fell into active COVID pandemic (7th) with social distancing measures, and late to post-COVID pandemic (9th) with lifting of COVID social distancing measures. Our repeated measures evaluation suggested that younger adults are possibly more reactive to environmental stresses. Primary care interventions should consider the age factor into design.