There is currently no definitive method for identifying individuals with psychosis in secondary care on a population-level using administrative healthcare data from England.

To develop various algorithms to identify individuals with psychosis in the Mental Health Services Data Set (MHSDS), guided by national estimates of the prevalence of psychosis.

Using a combination of data elements in the MHSDS for financial years 2017–2018 and 2018–2019 (mental health cluster (a way to describe and classify a group of individuals with similar characteristics), Health of the Nation Outcome Scale (HoNOS) scores, reason for referral, primary diagnosis, first-episode psychosis flag, early intervention in psychosis team flag), we developed 12 unique algorithms to detect individuals with psychosis seen in secondary care. The resulting numbers were then compared with national estimates of the prevalence of psychosis to ascertain whether they were reasonable or not.

The 12 algorithms produced 99 204–138 516 and 107 545–134 954 cases of psychosis for financial years 2017–2018 and 2018–2019, respectively, in line with national prevalence estimates. The numbers of cases of psychosis identified by the different algorithms differed according to the type and number (3–6) of data elements used. Most algorithms identified the same core of patients.

The MHSDS can be used to identify individuals with psychosis in secondary care in England. Users can employ several algorithms to do so, depending on the objective of their analysis and their preference regarding the data elements employed. These algorithms could be used for surveillance, research and/or policy purposes.

The risk of cancers associated with psychiatric disorders is understudied.

To investigate whether cancer risk varies with the presence of psychiatric disorders.

Patients diagnosed with psychiatric disorders in South Korea between 1 January and 31 December 2017 were included in the study and referred to as the psychiatric disorder group. The non-psychiatric-disorder group, selected using a stratified random sampling technique based on age and gender, comprised individuals who had never been diagnosed with a psychiatric disorder. The primary outcome was a new cancer diagnosis, assessed over a 5-year period (1 January 2018 to 31 December 2022).

Following 1:1 propensity score matching, the final analysis included data for 686 570 adults (343 285 in each group). The cancer incidence in the psychiatric disorder group from 2018 to 2022 was 15.4% (52 948/343 285), whereas in the non-psychiatric-disorder group, it was 12.8% (43 989/343 285). Cox regression analysis revealed that the psychiatric disorder group had a 23% higher occurrence of cancer compared with non-psychiatric-disorder controls (hazard ratio: 1.23, 95% CI: 1.21, 1.24; P < 0.001). Significant associations between cancer incidence and specific psychiatric disorders were observed in individuals with alcohol-related disorders (hazard ratio: 1.27, 95% CI: 1.23, 1.32; P < 0.001), anxiety disorders (hazard ratio: 1.15, 95% CI: 1.14, 1.17; P < 0.001) and major depressive disorder (hazard ratio: 1.16, 95% CI: 1.15, 1.18; P < 0.001).

Individuals with psychiatric disorders were more likely to develop cancer than those without. We identified associations of alcohol-related disorders, anxiety disorders and major depressive disorder with cancer risk.

Malignant catatonia represents a severe and life-threatening neuropsychiatric syndrome that demands prompt recognition and intervention. This condition poses particular diagnostic and management challenges in adolescents, especially when genetic predispositions and neurodevelopmental vulnerabilities complicate the clinical picture.

This report examines a complex case of malignant catatonia in a 17-year-old female with developmental delay but no prior psychiatric diagnoses, who developed severe cognitive and behavioural deterioration. We explore the diagnostic complexities, therapeutic challenges and potential genetic contributions to her presentation.

We present a comprehensive case analysis documenting clinical progression, treatment responses and genetic findings through whole-exome sequencing. The patient’s journey spans from initial presentation to long-term follow-up, with systematic assessment using standardised catatonia rating scales.

The patient’s condition manifested as severe psychomotor impairment, mutism and autonomic instability, showing minimal response to initial treatment. Electroconvulsive therapy yielded significant but temporary amelioration of symptoms. Genetic analysis revealed a heterozygous mutation in the pogo transposable element derived with zinc finger domain (POGZ) gene – a gene implicated in neurodevelopmental disorders – suggesting this variant contributed to her neurobiological vulnerability. Concurrent features of functional neurological disorder further compounded the diagnostic complexity, illustrating the intricate interplay between genetic susceptibility and clinical presentation.

This case illuminates the challenges clinicians face when diagnosing and treating complex neuropsychiatric presentations in adolescents, particularly when genetic predispositions intersect with functional neurological symptoms. The findings emphasise how comprehensive, multidisciplinary approaches remain essential for optimal patient care. Moreover, this case highlights the selective utility of genetic investigation in elucidating potential underpinnings of complex, treatment-resistant malignant catatonia, whilst demonstrating that genetic variants may confer vulnerability rather than direct causation.

Despite the recognised links between food insecurity and parenting, few studies have evaluated the perceived impacts of livelihood or food security interventions on parental practices, intra-household functioning, adolescent behaviour and psychosocial outcomes in HIV-affected households in sub-Saharan Africa.

The study aimed to understand the perceived effects of food security on parenting practices and how this was experienced by both adolescent girls (aged 13–19 years) and their caregivers in rural Kenya.

We conducted semi-structured, individual interviews with 62 caregiver–adolescent dyads who were participants in the adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in the Shamba Maisha agricultural and finance intervention trial (NCT01548599). Data were analysed following the principles of thematic analysis.

Compared to control households, the Shamba Maisha intervention households had improved food security and strengthened economic security, which, in turn, improved parenting practices. Intervention households described changes in parenting experiences, including decreased parental stress, reduced absenteeism and harsh parenting and improved caregiver– adolescent relationships. These positive caregiving practices, in turn, contributed to improved mental health and fewer behavioural problems among adolescent girls. Changes in the control households were less noticeable.

These findings demonstrate how an income-generating agricultural intervention may improve food security and positively affect parenting practices, intra-household dynamics and adolescent psychosocial well-being and behaviour. Further research is needed to explore how to harness the social benefits of agricultural interventions to best address the critical intersections among food insecurity, parenting practices and adolescent mental health.

Employment and relationship are crucial for social integration. However, individuals with major psychiatric disorders often face challenges in these domains.

We investigated employment and relationship status changes among patients across the affective and psychotic spectrum – in comparison with healthy controls, examining whether diagnostic groups or functional levels influence these transitions.

The sample from the longitudinal multicentric PsyCourse Study comprised 1260 patients with affective and psychotic spectrum disorders and 441 controls (mean age ± s.d., 39.91 ± 12.65 years; 48.9% female). Multistate models (Markov) were used to analyse transitions in employment and relationship status, focusing on transition intensities. Analyses contained multiple multistate models adjusted for age, gender, job or partner, diagnostic group and Global Assessment of Functioning (GAF) in different combinations to analyse the impact of the covariates on the hazard ratio of changing employment or relationship status.

The clinical group had a higher hazard ratio of losing partner (hazard ratio 1.46, P < 0.001) and job (hazard ratio 4.18, P < 0.001) than the control group (corrected for age/gender). Compared with controls, clinical groups had a higher hazard of losing partner (affective group, hazard ratio 2.69, P = 0.003; psychotic group, hazard ratio 3.06, P = 0.001) and job (affective group, hazard ratio 3.43, P < 0.001; psychotic group, hazard ratio 4.11, P < 0.001). Adjusting for GAF, the hazard ratio of losing partner and job decreased in both clinical groups compared with controls.

Patients face an increased hazard of job loss and relationship dissolution compared with healthy controls, and this is partially conditioned by the diagnosis and functional level. These findings underscore a high demand for destigmatisation and support for individuals in managing their functional limitations.

Former prisoners are a vulnerable population, and suicide rates among this group are high, particularly following release from prison.

To explore former prisoners’ engagement with mental health services before death by suicide, and to examine the demographics, clinical history and clinical care of this patient group and compare them with patients who died by suicide who had not been to prison.

The clinical, sociodemographic and care characteristics of patients in contact with mental health services who died by suicide in the UK were examined in a national clinical survey between 1 January 2001 and 31 December 2021, and comparisons were made between former prisoners and patients with no history of being in prison.

Of the 33 381 (median age 46 years, range 10–100; 65.6% male) patients who died by suicide in the UK and had been in contact with mental health services in the 12 months before death, 3335 (11%) were ex-prisoners (male n = 2988, 90%; female n = 347, 10%). Compared with other patients, ex-prisoner patients had higher frequencies of personality disorder, schizophrenia and delusional disorders, as well as childhood abuse. Ex-prisoner patients were more likely to be male, to be aged between 45 and 65 years (median age 39, range 17–89), to live in deprived areas and to have a history of substance misuse. We found no differences in ethnicity.

Mental health services need to focus particularly on patients with a history of being in prison who are experiencing economic adversity and offer substance-use-related interventions to ensure continued patient engagement. The link with deprivation is striking at a time at which rising costs of living are resulting in more health inequalities.

Environmental changes can be positive in mental illness. Systematic, planned and guided environmental change in all its aspects is called nidotherapy. It has shown some benefit but has not been extended to whole communities.

A cluster-randomised step-wedge trial is planned in six village communities in Nottinghamshire, England, covering an adult population of 400.

Adults in six villages will be offered a full personal environmental assessment followed by agreed change in different 3-month periods over the course of 1 year. All six villages have populations between 51 and 100 residents and are similar demographically. Assessments of mental health, personality status, social function, quality of life and environment satisfaction will be made. After the initial baseline period of 3 months, two villages will be randomised to nidotherapy for 3 months, a further two at 6 months and the last two at 9 months.

The primary outcome will be change in social function; secondary outcomes include health-related quality of life, anxiety and depressive symptoms, personality status, costs of nidotherapy and life satisfaction. Adverse events will also be recorded. The analysis will be carried out using a multimodal statistical approach examining (a) the change in scores of the primary outcome (social function); (b) change in scores of all secondary outcomes, including costs; and (c) changes in environmental satisfaction.

The findings of this study should help to determine whether nidotherapy has a place in the early detection and treatment of mental pathology.

Obsessive–compulsive disorder (OCD) is associated with an increased risk of cardiometabolic disorders. We developed a lifestyle intervention, named LIFT, aimed at improving lifestyle habits (physical activity, diet, alcohol and tobacco use, stress, sleep) and reducing cardiometabolic risk factors in OCD.

This study aimed to establish the feasibility and acceptability of LIFT, evaluate its preliminary efficacy and explore experiences of participation.

Individuals with OCD and at least three cardiometabolic risk factors (e.g. physical inactivity, unhealthy diet, overweight/obesity, dyslipidaemia) were offered LIFT, consisting of one individual session to set individual goals, six educational group sessions and 12 exercise group sessions, delivered over 3 months. We collected baseline, post-intervention and 3-month follow-up measures. Preliminary efficacy variables were analysed with linear mixed models and within-group effect sizes. Qualitative interviews were conducted.

Out of 147 screened individuals, 25 were included (68% women, mean age 37.4, s.d. = 10.9). Credibility and satisfaction were high, attrition rates were low (16%) and the programme was generally safe. Recruitment and adherence to the intervention were challenging. Statistically significant improvements were observed in dietary habits, alcohol consumption, stress, OCD symptom severity and general functioning (within-group effect sizes ranging from 0.27 to 0.56). No changes were observed in physical activity, sleep or any physiological or laboratory measures.

Overall, LIFT was a feasible intervention for individuals with OCD. Effects on lifestyle habits, mental health and functioning are promising. Fully powered randomised controlled trials are needed to evaluate its efficacy and cost-effectiveness.

There is no clear evidence about how to support people with borderline personality disorder (BPD) during the perinatal period. Perinatal emotional skills groups (ESGs) may be helpful, but their efficacy has not been tested.

To test the feasibility of conducting a randomised controlled trial (RCT) of perinatal ESGs for women and birthing people with BPD.

Two-arm parallel-group feasibility RCT. We recruited people from two centres, aged over 18 years, meeting DSM-5 diagnostic criteria for BPD, who were pregnant or within 12 months of a live birth. Eligible individuals were randomly allocated on a 1:1 ratio to ESGs + treatment as usual (TAU), or to TAU. Outcomes were assessed at 4 months post randomisation.

A total of 100% of the pre-specified sample (n = 48) was recruited over 6 months, and we obtained 4-month outcome data on 92% of randomised participants. In all, 54% of participants allocated to perinatal ESGs attended 75% of the full group treatment (median number of sessions: 9 (interquartile range 6–11). At 4 months, levels of BPD symptoms (adjusted coefficient −2.0, 95% CI −6.2 to 2.1) and emotional distress (−2.4, 95% CI −6.2 to 1.5) were lower among those allocated to perinatal ESGs. The directionality of effect on well-being and social functioning also favoured the intervention. The cost of delivering perinatal ESGs was estimated to be £918 per person.

Perinatal ESGs may represent an effective intervention for perinatal women and birthing people with BPD. Their efficacy should be tested in a fully powered RCT, and this is a feasible undertaking.

ISRCTN80470632.