Attention-deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in adolescents, and a full syndrome diagnosis requires a combination of persistent symptoms. In a multicentre cross-sectional study from Italy using a non-clinical sample from a secondary school comprising 440 adolescents, published in this issue of BJPsych Open, Gostoli et al examined whether unhealthy lifestyle habits are linked to both clinical manifestation of ADHD and subclinical symptomatology. In line with the literature, the authors demonstrate an association between clinical ADHD diagnosis, unhealthy lifestyle behaviours and psychosocial impairments. Modifiable, adverse lifestyle behaviours are also prevalent in subclinical ADHD manifestations. This observation may be important for child and adolescent psychiatry when considering targeted health promotion approaches that delay or prevent progression from subclinical to clinical ADHD. In this article, we discuss from a clinical perspective the putative relevance of addressing subclinical ADHD symptoms in the context of the existing literature.

Aims: The study examined and compared the association between personality traits and psychiatric disorders among violent and non-violent offenders in a correctional centre in Nigeria.

Methods: This cross-sectional comparative study involved 268 participants, evenly divided between violent and non-violent offenders from the Nigerian Correctional Centre in Abeokuta, Ogun State, Nigeria. All consenting participants completed a sociodemographic questionnaire, the Big Five Personality Inventory (BFI-44) to assess personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness), and the Mini-International Neuropsychiatric Interview Version 7 (MINI 7.0) to identify psychiatric disorders. The Chi-Square test (χ²) and Fisher’s exact test (FET) were used to determine statistical significance and associations between personality traits and psychiatric disorders with p-value set at <0.05 and confidence interval of 95%. Ethical approval was granted by the Health Research and Ethics Committee of the Neuropsychiatric Hospital Aro, Abeokuta, Ogun State.

Results: Openness was the only personality trait with a statistically significant difference between the two offender groups. Violent offenders exhibited a higher proportion of both low (18.7%) and high (17.9%) scores compared with non-violent offenders (11.9% and 9.7%, respectively) (χ²=7.351, p=0.025).

The prevalence of any lifetime psychiatric disorder was significantly higher among violent offenders (35.8%) than non-violent offenders (21.6%) (χ²=0.84, p=0.001). No significant association was found between any personality traits and Depression, Anxiety, Bipolar Affective Disorder, or Antisocial Personality Disorder in both offender groups.

Among violent offenders, low Openness scores were associated with current psychotic disorders (FET=5.57, p=0.039). In contrast, among non-violent offenders, average and high Neuroticism scores were linked to current psychotic disorders (FET=6.51, p=0.022), while low and high Conscientiousness scores were associated with lifetime psychotic disorders (FET=12.15, p=0.002).

Furthermore, among non-violent offenders, low Agreeableness scores were associated with alcohol use disorder in the past 12 months (FET=7.28, p=0.014), while high Openness scores were linked to substance use disorders in the past 12 months (FET=6.29, p=0.041).

Conclusion: The study revealed that the association between personality traits and psychiatric disorders varies between violent and non-violent offenders. Although this adds modestly to existing knowledge, larger studies are necessary to generate more robust findings.

Aims: To examine current monitoring practices for valproate users within Mayo Mental Health Services and analyse the conditions for which it is prescribed.

Methods: Information on sodium valproate users was collected from clinical records using a data collection tool specifically developed to capture indicative parameters.

Results: Data was collected from 6 community clinics and 4 inpatient units with a total of 69 patients on sodium valproate treatment within the service. Licensed indication was accounted for in 24.6% of patients with 63.8% prescribed valproate for unlicensed use and 11.6% for unknown indication. Amongst the prescribed users 33.3% were male and 66.7% were female with 27.5% of participants being under 55 years old and 72.5% over 55 years old. Out of 39 females using valproate 20.5% were on effective contraceptives and 79.5% were not using any. Regarding the annual physical health check, all participants in the approved inpatient units were compliant as it was part of the inpatient care requirement. 54.5% of patients in the community clinic on valproate had annual physical health reviews and 45.5% were not compliant.

Conclusion: Our examination of Mayo Mental Health Service shows that most valproate use was for unlicensed indications with the majority of the users being female, most of whom were over 55 years of age. This reflects the high percentage of non-effective contraceptive users. There is also inadequate physical health monitoring for patients in the community.

Aims: Body dissatisfaction and disordered eating behaviours are significant global health concerns, yet their prevalence and predictors among Muslim females remain underexplored. This systematic review aimed to compare the prevalence and associated factors of body dissatisfaction and disordered eating behaviours in Muslim and non-Muslim females, with a focus on religiosity and cultural practices.

Methods: The inclusion criteria encompassed primary observational studies published in English that compared body dissatisfaction and disordered eating behaviours between Muslim and non-Muslim females. Studies that did not report prevalence data on these outcomes or included male participants were excluded. Following PRISMA guidelines, a comprehensive search was conducted across Medline, Embase, PsycINFO, and Scopus up to August 18, 2024, supplemented by references and grey literature. Methodological quality was assessed using the ROBINS-E and JBI Prevalence tools. Relevant data were extracted and analysed through quantitative and narrative syntheses.

Results: Eleven studies met the eligibility criteria. Overall, findings indicated lower rates of body dissatisfaction and disordered eating behaviours among Muslim females, particularly among those practising veiling, compared with non-Muslim females. However, conflicting results were noted in several studies, possibly due to acculturation and sociocultural stressors. The heterogeneity in study methodologies and cultural contexts limited the generalizability of these findings. While religiosity appeared to be a protective factor, the variability in results underscores the need for more robust, longitudinal studies to better understand the complex interplay of religious, cultural, and psychosocial factors.

Conclusion: This review highlights the importance of integrating cultural and religious contexts into effective interventions and prevention strategies for body dissatisfaction and disordered eating in Muslim populations.

Aims: Treatment-resistant depression (TRD), defined as failure to achieve remission despite adequate antidepressant trials, remains a pervasive clinical conundrum, linked to reduced quality of life, increased mortality, and higher healthcare costs. Pharmacogenomics-guided treatment (PGT) offers a potential solution to the ongoing challenge of TRD by using genomic testing to identify genetic factors influencing drug metabolism and response. This systematic review aimed to assess whether PGT improves symptom remission in adults with TRD compared with treatment as usual (TAU). Secondary objectives included evaluating the impact of PGT on treatment response and overall symptom improvement.

Methods: A systematic review of clinical studies published up to 8 July 2023 was conducted across PubMed and Cochrane Library databases based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms were defined using the ‘Population, Intervention, Comparison, Outcome’ (PICO) framework. Studies were selected using predefined inclusion and exclusion criteria. Clinical trials or observational studies evaluating the efficacy of PGT for TRD in at least 10 adult participants were included. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) checklist.

Results: The systematic literature search identified 307 records, 15 of which were included in a qualitative synthesis. Among 14 studies evaluating remission, 13 (92.9%) reported improvements with PGT compared with TAU, with 8 (57.1%) showing significant gains. For treatment response, 12 out of 13 studies (92.3%) demonstrated enhancements with PGT, 8 (61.5%) of which were significant. All 8 studies assessing symptom improvement reported benefits with PGT, with 5 (62.5%) showing significant results. Notable findings included more consistent effects in patients with fewer prior antidepressant failures and improved response rates even in the absence of remission. However, variability in study designs, scoring systems, and definitions of TRD limited the generalisability of results.

Conclusion: PGT demonstrates promise in enhancing remission, treatment response, and symptom outcomes in TRD. By tailoring treatment to individual genetic profiles, this approach may reduce the trial-and-error process associated with antidepressant therapies, thereby improving patient well-being and alleviating healthcare burdens. Nevertheless, further studies, including meta-analyses and cost-benefit evaluations, are warranted to establish the clinical and economic viability of PGT for widespread implementation in healthcare systems like the NHS.

Aims: We aimed to determine differences in subgenual anterior cingulate cortex (sgACC) resting-state functional connectivity (rsFC) in Major Depressive Disorder (MDD) vs. healthy volunteers (HV) using 7-Tesla functional magnetic resonance imaging (fMRI). Abnormalities in the sgACC are linked to MDD, but the sgACC is anatomically and functionally diverse, including Brodmann area (BA) 25 (Cg25) and the subgenual portion of area 32 (Cg32). The differences in rsFC between Cg25 and Cg32 in MDD compared with HVs have not been directly examined. High-resolution 7T fMRI offers an unrivalled opportunity to measure differences in rsFC between these two subregions which otherwise suffer from signal dropout.

Methods: We used resting state 7T fMRI to compare rsFC between Cg25 and Cg32 in 40 patients with MDD, and 38 HVs. Within the MDD group, we correlated rsFC changes with anhedonia (SHAPS) and anxiety (STICSA) scores together with baseline high-sensitivity C-reactive protein (hsCRP) measures.

Results: Across all 78 participants, Cg25 and Cg32 showed regionally distinct rsFC patterns despite their proximity. Cg25 had increased rsFC to the orbitofrontal cortex, amygdala, hippocampus and dorsolateral (dl)PFC/BA46, while Cg32 showed increased rsFC to the perigenual (pg) and dorsal (d)ACC, dlPFC/BA9, posterior cingulate cortex (PCC), ventral striatum, and ventral tegmental area. When comparing MDD patients to HV, both Cg25 and Cg32 exhibited increased rsFC to the anterior (ant)PFC/BA10, amygdala and hypothalamus, together with key nodes of the default mode network (DMN), including pgACC, rostral ventromedial prefrontal cortex (vmPFC) and the PCC. rsFC to nodes of the central executive and salience networks, such as the right dlPFC/BA46 and the bilateral insula, was decreased. Within the MDD group, Cg32-antPFC/BA10 and Cg32-dlPFC/BA9 rsFC was positively correlated with anhedonia scores; additionally, subthreshold clusters were identified in the ventral striatum, pgACC and hypothalamus. Cg25-antPFC/BA10 and Cg25-PCC rsFC was negatively correlated with anxiety scores. Cg32 rsFC to the insula, dlPFC/BA9 and and dmPFC/BA10 showed negative correlations with hsCRP measures.

Conclusion: These findings suggest that sgACC subregions have distinct rsFC patterns which are altered in MDD. rsFC changes are differentially related to symptoms of anhedonia and anxiety, together with inflammatory status. This has important implications for the development of targeted neuromodulation treatment strategies.

We investigated the quality of 100 discharge letters from mental health specialists to better understand the role of cross-sectoral communication in patients’ readmissions or other unplanned recontacts with mental health specialist care. Using a case-control design, we compared 50 letters for patients readmitted or for whom a formal request for additional specialist mental healthcare was made by the patient’s GP (recontact) within 30 days of discharge, and 50 letters for those without readmission or recontact. The 26-item checklist Quality of Discharge letters – Mental Health was used to assess discharge letter quality. No significant differences in total checklist scores were found, suggesting that discharge letter quality does not influence the rates of readmission or unplanned recontact in mental healthcare.

Aims: The primary objective of this descriptive systematic review of case reports is to describe the clinical commodities, presentations and outcomes in children and adolescents presenting with onset of non-delirious psychosis during or shortly after a SARS-CoV-2 infection and to find out statistically various other factors that might be linked to demographics of young people. The review also explores if the clinical presentation of the Covid-19 psychosis is different from early onset non-organic psychosis occurring in children and adolescents.

Methods: On 23 September 2023, the author searched six electronic databases including PubMed, Scopus, Web of Science, PsycInfo, Google Scholar, and CINAHL, using the following search terms: (COVID-19 OR SARS-CoV-2* OR Severe Acute Respiratory Syndrome Coronavirus 2* OR COVID*) AND (Psychosis) AND (Adolescent OR Children OR Teenager). An updated search was completed on 10 August 2024. Search results from six databases were manually checked to remove any duplication. The extracted data was then arranged in a standardised template. The extracted data included: demographic characteristics of the patients including age, gender, ethnicity, past personal and family psychiatric history, clinical features including neurological and psychotic symptoms and management including outcome.

Results: This descriptive systematic review identified 15 cases of incident psychosis in patients with antecedent or concurrent Covid-19. Out of 15 cases, 9 were males, 4 were females and 2 did not report any sex. The mean age of patients in our sample was 15.1 years with 2 cases not reporting the actual age. Delusions were present in all cases (100%) of patients, whereas hallucinations were reported in only 33% of the cases. Disorganised speech or behaviour was reported in 40% of the cases. Psychotic symptoms lasted from approximately 7–90 days. Family history was positive for 2/15 cases (7.5%) with psychosis and BPAD respectively. Only 2 cases had past personal history of mental illness (Depression and anxiety). All patients received anti-psychotic medications as a part of the treatment, whereas 33% patients received intravenous immunoglobulins concurrently with antipsychotic medication. Full remission was obtained in nearly all cases after treatment.

Conclusion: Covid-19 related psychosis differs in various aspects and should be considered as a separate entity when considering the assessment and management. It differs in many ways from a typical early onset psychotic episode both in presentation and treatment response.

Aims: The aim of this study is to investigate public attitudes towards transgender individuals, seeking to understand the relationship between socio-demographic factors, gender beliefs and approach towards this minority group. The research acknowledges the widespread stigma faced by transgender people due to the incongruence between their gender identity and sex assigned at birth, which negatively impacts their access to resources and overall well-being.

Methods: This is a cross-sectional survey conducted across rural, suburban and cosmopolitan cities in India. A total of 500 participants were randomly selected using multistage sampling. Inclusion criteria for participants included the age range 18–60 years, no history of mental illness, and having no known family members with transgender characteristics.

This specific demographic targeting aimed to isolate general public perception, excluding potentially biased viewpoints from those with direct personal connections to transgender individuals or pre-existing mental health conditions.

Results: The study revealed a predominantly young adult sample, with 52.6% of respondents falling between the ages of 26 and 40. The sample was fairly distributed across both genders, male (56%), females (44%). Majority were married (62.4%), educated at graduate level (61%) and employed. This socio-demographic breakdown provides context for interpreting the attitudinal data.

Key findings indicated a concerning trend: younger, unmarried males with higher education demonstrated more negative attitudes towards transgender individuals. This finding contradicts some expectations, as higher education is often associated with more liberal and inclusive viewpoints. Furthermore, the study found that highly educated individuals, in general, held more negative attitudes, while married individuals tended to express more positive attitudes. Interestingly, there was no significant difference in attitudes towards transgender men compared with transgender women.

Conclusion: The study concludes by emphasizing the need for targeted educational interventions, particularly aimed at younger, unmarried, highly educated males. The authors argue that these interventions are crucial for promoting cultural competence and ensuring that transgender individuals are afforded their due rights. By focusing on education and awareness, the study suggests a potential pathway for mitigating the negative attitudes identified and fostering a more inclusive and accepting society for transgender individuals. The study highlights the importance of understanding the complex interplay between socio-demographic factors and attitudes towards marginalized groups to develop effective strategies for social change.