The author has not supplied his declaration of competing interest.

The 2020 coronavirus pandemic sparked sudden change in all spheres of life, not least health services. Across Europe clinical research had to adapt. The virus peaked in different places at different times, with London’s first wave in March-May. The National Institute for Health Research paused all face to face research at NHS and social care sites except for nationally prioritised Urgent Public Health (UHP) Covid-19 studies. The first UPH studies focused on acute Covid-19, largely in physical health settings. Research leaders quickly highlighted the need for high quality research data on the effects of the pandemic on the mental health of the general population, as well as the mental health and neuropsychiatric effects of the virus itself, to allow for the development and evaluation of mitigation strategies. The major UK research funders have resourced this. Once the first wave abated, paused research was restarted according to national prioritisation guidance. In Maudsley we worked closely with research teams to develop strategies to make our research programmes as Covid-19 adaptive as possible, maximising remote interaction with research participants, with robust infection prevention procedures if face to face meetings were necessary. Examples of innovative strategies will be shared. In January 2021 with the more transmissible variant of SARS CoV2, face to face research paused again, except where risk was outweighed by patient benefit in continuing. As patients benefit hugely from research and innovation and have better outcomes if treated in ‘research-active’ hospitals, maintaining access to research opportunities without increasing risk of contracting Covid-19 will be key in coming months.

No significant relationships.

Pregabalin is a well-established anti-epileptic drug in the treatment of epilepsy. It is also indicated for the treatment of generalised anxiety disorder and neuropathic pain. In addition, it has mood modulating properties. In people with intellectual disabilities it is used to treat epilepsy. There is little evidence of the use of pregabalin in managing mental health difficulties in people with intellectual disabilities.

To describe the use of pregabalin in adults with intellectual disabilities.

A descriptive case series of adults with intellectual disabilities living in the community, under the care of a community psychiatrist, who are prescribed Pregabalin. Outcomes of treatment were measured using the health of the nation outcome scale for people with intellectual disabilities (HoNOS-LD).

Fourteen cases were identified in the community service of adults with Intellectual Disabilities. Twelve were men and two were women. The average age of the sample was 29 years. The range in duration of using pregabalin was from 3 to 72 months. Thirteen adults had a diagnosis of Autism of which three also had ADHD. The indications for using pregabalin and numbers were : anxiety (12); liability of mood (2); generalised anxiety disorder (1); epilepsy (1). The daily dose range was from 150 mg to 300 mg The mean change in HoNOS-LD scores was 32%.

Pregabalin is a useful treatment in people with intellectual disabilities who experience anxiety. It is especially effective among adults with ID and autism to modulate mood and anxiety symptoms.

The authors have not supplied their declaration of competing interest.

Homelessness is a problem which affects all the areas of those who suffer it, affecting their health seriously. These risks increase when the affected person has carried out a migratory process. Another risk factor, apart from immigration, is to be woman.

To analyse the gender demographic differences in a total cohort of homeless people in the city of Girona in 2006 and continued until the present day.

Prospective longitudinal study of the total population of homeless people in Girona. In 2006, a list was made of all the homeless people detected by both specialized and non-specialized teams which have been followed until the present day.

The total number of women in the sample is lower (n = 106, 11.2%). There are fewer immigrant than autochthonous women (Chi2 = 23,1, df = 1, P < 0.001).

After following the total homeless population in 2006, we can confirm that currently we can still identify 62 people in the territory (6.7%). In this subsample there are no differences between genders (man: n = 54, 6.5% vs. woman: n = 8, 7.5%; Chi2 = 0.21, df = 2, P = 0.89). That is, men and women remain in their homeless condition in a proportional way. This fact presents great limitations, since we do not know what happened with the other 93% of the initial sample.

The masculinisation of the homeless people from Maghreb has tended to increase the gender differences in the homeless population, in itself more masculine. This presents a risk of increasing the invisibility of homeless women.

The authors have not supplied their declaration of competing interest.

To describe therapeutic features of 120 panic disorder (PD) patients treated with clonazepam, paroxetine, or clonazepam + paroxetine for 3 years and their follow-up for more 6 years.

A prospective open study randomized 120 PD patients to 2 mg/day clonazepam or 40 mg/day paroxetine. Poor responders were switched after 8 weeks to combined treatment with ∼2 mg/day clonazepam + ∼40 mg/day paroxetine. Tapered withdrawal of all treatments was performed after 3 years. Efficacy, safety, and cumulative relapse and remission were studied over the following 6 years, using panic attack (PA) count, clinical global impression-severity (CGI-S), and Hamilton anxiety scale (HAMA).

94 patients completed 3 years treatment. All were free of panic attacks since at least one year before undergoing tapered drug withdrawal. After two months of tapering, 80% of clonazepam patients were drug-free, versus 55% on paroxetine. No serious or severe adverse event were observed but PA/month, CGI-S, and HAMA worsened slightly. In annually studied patients the relapse rates were similar after the 3 treatments with an advantage of clonazepam over the combination (p=0.0035) and paroxetine (p=0.08, exact Fisher) at the first year after drug withdrawal. Cumulative relapses rate were 41%, 77%, and 94% at years 1, 4, and 6, but relapse therapy with either clonazepam or paroxetine was successful in nearly all cases.

PD is a chronic disorder, with many patients relapsing after 3 years treatment. Response to retreatment was excellent. Paroxetine and clonazepam were associated with similar long-term prognoses but clonazepam was better tolerated.

With about 12 million people, Roma constitute the largest ethnic minority group in the EU. Children from Roma communities are much more likely to be out of school than their peers from majority communities, with a strong impact in global mental health status.

This paper reports the findings of an integrative review conducted to analyze recent empirical and theoretical literature on the factors of school absenteeism in Roma Children.

A comprehensive multi-step search (published 2004–2014) using databases such as SciELOand search engine such as B-on and EBSCO-host was performed. A sample of 8 final research reports met the inclusion criteria and was included in the review. A systematic and interactive approach was used to extract and reduce the data to draw conclusions.

The integrative literature review shows that there are three major groups of factors related to school absenteeism in Roma children – factors related to the children, factors related 8 to the school organization and factors related to the Roma families. These factors exist at the individual, community and institutional levels and are largely consistent with conceptual and empirical framework on mental health vulnerabilities factor’s

The sexuality of schizophrenics is a neglected dimension. The majority of schizophrenics experience a progressive deterioration in their social and sociosexual functioning. This deterioration often starts before the first psychotic episode and would be one of the negative symptoms of schizophrenia. All type of antipsychotics can lead to sexual dysfunctions. Impaired sexual functioning is believed to negatively impact treatment compliance as well as the quality of life.

The frequency of sexual dysfunctions in patients taking classic antipsychotics is not known. This study attends to ascertain the level of sexual dysfunction in such patients.

The level of sexual dysfunction was assessed in 41 patients taking classic antipsychotic medication and 28 normal controls. All the participants were physically healthy. We examined the following complaints or symptoms loss of libido, anorgasmia, impotence, premature ejaculation, galactorrhea, gynecomastia for males; amenorrhea, dysmenorrhea, dyspaurenia, galactorrhea, loss of libido and anorgasmia for females.

There were a significantly higher proportion of persons with sexual dysfunctions in the schizophrenic group compared with the normal controls. There were no significant differences in the demographic characteristics (age and gender) between the 2 groups. Male patient had normal levels of libido but were highly likely to report erectile and ejaculatory dysfunctions.

Patient taking conventional antipsychotic medication report high levels of sexual dysfunction. The high level of sexual dysfunctions indicated that clinicians should monitor and openly discuss these issues with patients in order to improve overall satisfaction and adherence to treatment.

To assess the level of emotional burn-out (EB) and its relation to affective state and personality characteristics of medical doctors in the region of Moscow.

A random sample of 80 medical doctors (MD) (mainly internists, aged 25 - 72, M/F 6/74) was given Boyko's Emotional Burn-out Test (BEBT), Spilberger's State/Trait Anxiety Inventory (STAI), Zung depression scale (ZDS), Minnesota Multiphasic Personality Inventory (MMPI), Job's Satisfaction Scale (JSS), Professional Attitudes/Locus of Control Scale and Specialty knowledge Test (SKT).

EB was present in 34/80 (42.5%) MD, with no difference between hospital and ambulatory doctors and no correlation with age, years in profession, SKT score, professional locus of control and attitudes towards patients' autonomy. It increased with the number of patients seen monthly (r=0.25, p<0.05) and was inversely related to JSS score (r= -0.47, p<0.001). MD's with EB, compared to those without, scored higher on state (33.5±10.5[32] vs. 26.9±9.0[25], p=0.004) and trait anxiety (52.4±10.6[52] vs. 43.1±8.4[45], p<0.001) and ZDI (37.9±7.6[39] vs. 33.4±6.7[32], p=0.008), respectively. MD's with EB scored significantly higher on MMPI scales Depression, Paranoia and Social Introversion and significantly lower on Masculinity.

EB, affecting a large proportion of MD's in the Moscow region, is only weakly linked to workload, if at all. It is associated with depressive/anxious affect and personality traits, such as more rigid thinking and low confidence with others, sensitivity and vulnerability, decreased ability/willingness to communicate. If some of these traits predispose to EB or represent various types of reaction to EB, remains to be assessed prospectively.

To explore the feature of functional connectivity of default mode network (DMN), central-executive network(CEN), and salience network (SN) in patients with schizophrenia during a resting state by functional magnetic resonance imaging (fMRI).

The SPM8, DPARSFA, conn, REST softwares combined with data-driven region of interest analysis were used to compare the functional connectivity (FC) of the DMN, CEN, and SN in 74 patients with schizophrenia(SZ) and 79 age- and gender-matched normal controls(NC). Medial prefrontal cortex(MPFC)was selected as seed region for identifying DMN and CEN; right anterior insula(rAI) for SN.

Compared with NC, SZ showed increased FC with bilateral dorsolateral prefrontal cortex(DLPFC) and bilateral putamen of the MPFC, and increased FC with left middle frontal cortex and precuneus/ posterior cingulate cortex(Pcu/PCC) of the rAI. SZ also showed enhanced interconnectivity strengths of CEN-DMN, CEN-SN, and DMN-SN(p>0.05). Correlation analyses showed that the increased FC between MPFC and left DLPFC significantly negatively correlated with PANSS-negative symptoms(r=-0.224,p=0.030) and increased FC between rAI and Pcu/PCC significantly correlated with PANSS-positve symptoms (r=0.243,p=0.020).

This study provides evidence for resting state functional abnormalities of DMN, CEN, and SN in schizophrenia patients. These aberrant functional connectivities in some key brain regions of the three network could be responsible for the schizophrenic symptoms.

Remission and recovery rates for people who have had a first episode psychosis (FEP) remain uncertain.

We conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies and conducted meta regression analyses to investigate potential moderators.

A systematic literature search of major electronic databases without language restrictions was conducted from database inception until July 1, 2016. Longitudinal studies with follow up greater than 1 year reporting data on remission or recovery rates in FEP were included.

Seventy-nine studies were included representing 19,072 FEP patients (mean age = 26.9 years, male = 59.5%). The pooled rate of remission among 12,301 individuals with FEP was 57.9% (95%CI: 52.7–62.9, Q = 1536.3, P< 0.001, n = 60 studies, mean follow up = 5.5 years). Restricting the analysis to studies, which used the remission in schizophrenia working group (RSWG) criteria (n = 25 studies, n = 6909 patients), the pooled remission rate was 56.9% (95%CI: 48.9–64.5, Q = 656.9). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 37.9% (95%CI: 30.0–46.5, Q = 1450.8, studies = 35, P = 0.006, average follow up = 7.2 years). Recovery rates were higher (P< 0.05) in North America compared to other regions.

Our data suggest that remission and recovery rates in FEP may be more favorable than previously thought. We observed stability of recovery rates after the first two years, suggesting that a progressive deteriorating course of illness is not typical. While remission rates have improved over time, recovery rates have not, raising questions about the effectiveness of specialist early intervention services in achieving improved recovery.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Obsessive-compulsive disorder (OCD) has high rates of comorbidity with mood disorders, mainly major depressive disorder (MDD). Symptoms of depression are usually secondary to severe and disabling OCD. Electroconvulsive therapy (ECT) has been an effective and well tolerated therapeutic alternative in the management of refractory MDD. Other neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), have well known efficacy in MDD and also have shown positive results, in clinical trials, treating other psychiatric disorders such as OCD.

To determine the efficacy of combining rTMS, ECT and clomipramine in the treatment of severe OCD with comorbid severe MDD.

The authors report a case of a 54-year-old male patient diagnosed with severe OCD for 23 years. He has been submitted to several drug treatments and intensive cognitive-behavioural therapy (CBT) always with poor response. The patient was admitted in the beginning of 2016 in our inpatient unit. Besides continuing drug treatment (clomipramine IV) and CBT, he was submitted to 12 ECT sessions during one month (3 sessions per week) and to daily sessions of rTMS during the following month.

Outcome measures were obtained using Y-BOCS for OCD and HAM-D for depression.

Our patient responded to ECT with mood improvement after session 4 to full euthymic state at the final session. He also responded well to rTMS with Y-BOCS score reduction.

Combined ECT and rTMS treatment with clomipramine IV and CBT was effective in our patient with a severe form of both disorders (OCD and MDD).

The authors have not supplied their declaration of competing interest.

Chronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.

Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.

The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.

To draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.

Case report and non-systematic literature review of the current data.

A 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.

Psychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.

None Declared

In the dawn of increasing interest in climate changes, including extreme weather events, e.g. the Foehn winds, and their influence on public health, it is of great importance to understand their role in suicide.

The association between suicides in the Tatra Mountains, Poland from 1999 to 2014 and the Foehn wind (called Halny in this region) was examined. The belief that suicides are affected by Halny seems to be firmly rooted in local language and culture.

The purpose of the study was to assess the Halny wind as a suicide risk factor.

Data concerning all suicides in the region were included. Meteorological data were derived every three hours during the period of the study. Halny was defined as a complex of interacting meteorological conditions. The two days preceding and following the wind were recognized as the period of the Foehn influence (FI). The probability of suicide in the presence of Halny and during the FI period was calculated.

From 1st January 1999 to 31 December 2014 (5844 days), 210 consecutive suicides were registered. The number of suicides in men was markedly higher than in women. Halny did not change the overall probability of suicide. However, the presence of Halny modified the suicide risk according to the season (P = 0.00095, two-way ANOVA test). The FI periods appeared to increase suicide risk in summer and autumn.

Halny may contribute to the increased suicide risk in summer and autumn. It should be taken into account in suicide preventive interventions in this region.

The authors have not supplied their declaration of competing interest.