Negative symptoms in schizophrenia, particularly motivational deficits, pose significant challenges to treatment and recovery. Despite their profound impact on functional outcomes, these symptoms remain poorly understood and inadequately addressed by current interventions.

The CHANSS (Characterising Negative Symptoms in Schizophrenia) study aims to dissect the cognitive mechanisms underlying motivational impairments by focusing on three interconnected domains: executive cognition, motivational cognition and meta-cognition.

This large, international, cross-sectional study recruits a heterogeneous sample of patients across illness stages – from first-episode psychosis to treatment-resistant schizophrenia – and uses a comprehensive cognitive battery, clinical scales, self-report measures and computerised cognitive tasks. Four novel tasks assess key processes in motivated behaviour: option generation, reward-based decision-making, risk sensitivity and performance self-evaluation. By incorporating control for secondary influences like depression, psychosis, sedation and illness chronicity, the study seeks to identify distinct cognitive and behavioural subtypes within motivational dysfunction.

CHANSS tests the hypothesis that specific patient profiles exhibit predominant impairments in one or more cognitive domains, which may differentially affect goal-directed behaviour. The study’s design allows exploration of hierarchical relationships between cognitive processes, such as how neurocognitive deficits may cascade to impair motivation and self-evaluation.

Ultimately, CHANSS aims to advance mechanistic understanding of motivational deficits in schizophrenia and pave the way for personalised, targeted interventions. Its findings may inform future clinical trials and contribute to a shift away from one-size-fits-all approaches towards more effective, stratified treatment strategies in schizophrenia.

The marketing of foods and non-alcoholic beverages (hereafter: food) high in fat, salt and/or sugar (HFSS) is implicated in the development of poor dietary habits, overweight and obesity. Digital media, including video game live streaming platforms (VGLSP), are an increasingly prominent source of food marketing exposure, particularly for young people. This study aimed to experimentally examine the impact of food marketing via VGLSP on eating behaviour in young people.

A between-subjects randomised controlled trial design was used to explore the impact of exposure to HFSS food marketing in a video game live stream (a static food banner advert present throughout the footage) on immediate consumption of the marketed snack and an ‘alternative brand’ of the same snack in a sample of adolescents (n 91, Mage = 17·8, 69 % female). Relationships with food-advertising-related attentional bias and inhibitory control in relation to branded food cues were also examined.

University Psychology laboratory.

Exposure to HFSS food marketing, compared with non-food marketing, did not significantly impact immediate marketing or overall snack intake. Additionally, no significant effects for attentional bias or inhibitory control were found. However, although the overall model was non-significant, greater weekly use of VGLSP was significantly associated with greater marketed snack intake.

Findings suggest that while acute exposure to food marketing in VGLSP did not impact snack intake, perhaps more sustained exposure is impactful. Further exploration of this effect is needed, as well as studies investigating the potential impacts of other food marketing formats within VGLSP.

To explore the meanings that newly arrived refugee adolescents residing in the Southeastern USA attribute to foods.

We used methods from cognitive anthropology to assess whether adolescents from different countries share a cultural model of eating behaviours.

A school-based study in a community in the Southeastern USA.

Adolescents (10–17 years) who arrived in the USA on a refugee visa in the previous year.

Adolescents showed consensus in grouping items and in identifying some foods as associated with adults and others with children. There was evidence of a shared model of eating practices across age, gender and number of siblings. Adolescents who had lived in a refugee camp were significantly different in how they grouped items.

Adolescents from nine countries shared a model of eating behaviours; these patterns are consistent with rapid dietary acculturation within 1 year of arrival or with shared models held from pre-arrival. Our finding that adolescents who recently arrived in the USA generally agree about how foods relate to one another holds promise for generalised nutrition and dietary interventions across diverse adolescent groups.

Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.

To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.

We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.

Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (n = 652) versus sEIP alone (n = 375) was 1.07 (95% CI 0.76–1.49; P = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.

We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.

Childhood bullying is a public health priority. We evaluated the effectiveness and costs of KiVa, a whole-school anti-bullying program that targets the peer context.

A two-arm pragmatic multicenter cluster randomized controlled trial with embedded economic evaluation. Schools were randomized to KiVa-intervention or usual practice (UP), stratified on school size and Free School Meals eligibility. KiVa was delivered by trained teachers across one school year. Follow-up was at 12 months post randomization. Primary outcome: student-reported bullying-victimization; secondary outcomes: self-reported bullying-perpetration, participant roles in bullying, empathy and teacher-reported Strengths and Difficulties Questionnaire. Outcomes were analyzed using multilevel linear and logistic regression models.

Between 8/11/2019–12/02/2021, 118 primary schools were recruited in four trial sites, 11 111 students in primary analysis (KiVa-intervention: n = 5944; 49.6% female; UP: n = 5167, 49.0% female). At baseline, 21.6% of students reported being bullied in the UP group and 20.3% in the KiVa-intervention group, reducing to 20.7% in the UP group and 17.7% in the KiVa-intervention group at follow-up (odds ratio 0.87; 95% confidence interval 0.78 to 0.97, p value = 0.009). Students in the KiVa group had significantly higher empathy and reduced peer problems. We found no differences in bullying perpetration, school wellbeing, emotional or behavioral problems. A priori subgroup analyses revealed no differences in effectiveness by socioeconomic gradient, or by gender. KiVa costs £20.78 more per pupil than usual practice in the first year, and £1.65 more per pupil in subsequent years.

The KiVa anti-bullying program is effective at reducing bullying victimization with small-moderate effects of public health importance.

The study was funded by the UK National Institute for Health and Care Research (NIHR) Public Health Research program (17-92-11). Intervention costs were funded by the Rayne Foundation, GwE North Wales Regional School Improvement Service, Children's Services, Devon County Council and HSBC Global Services (UK) Ltd.

Gaming Disorder (GD) was recognised in the addiction field by the International Statistical Classification of Diseases and Related Health Problems in 2018. The National Centre for Gaming Disorders (NCGD) is the first NHS clinic to accept referrals from adults and young people who are struggling with the characteristics of GD. The NCGD opened in 2019. Since then, we have received over 1,000 referrals from either gamers, their family members, or from parents seeking support. The team is multidisciplinary and led by Addiction Psychiatrists and Consultant Psychologists.

This service evaluation aims to understand the demographics, clinical characteristics, and gaming behaviours and trends of those with a GD who are accessing our service.

The data included in this service evaluation is based on 380 gamer referrals. Data was collected through our referral form.

Demographics: The average age of gamers at referral was 19 years, with 60% of gamers aged between 13–18 years old. Male gamers represented 90% of the sample, with the remaining 10% made up of gamers identifying as female (9%), trans, or other. People who identify as White (British, Irish, or Other) represent 74% of referrals. The remaining 26% are from individuals who identify as Asian or Asian British, Mixed, Black or Black British, or of other ethnicities. Individuals based in London, or the South-East of England make up 60% of referrals. Comorbidities: 1 in 10 gamers had been formally diagnosed with a neurodevelopmental disorder at the time of referral. 1 in 8 gamers had an existing mental health condition. Gaming Trends: The three most popular games played were Fortnite, Minecraft, and Call of Duty. Our sample spent on average 10 hours per day gaming. In-game purchases were present in 17% of gamers. The average in-game expenditure at the point of referral was £4,500. In our sample, 46% were aggressive and 30% were physically violent to family members when interrupted from gaming.

As of date, we have had 530 gamer referrals, and we are continuing to extract relevant information on the demographics and characteristics of individuals with a GD. Our data suggests that the typical gamer accessing our service is male, young, white, and from London. The most popular game played is Fortnite. A substantial proportion of our sample are aggressive or physically violent to family members when their gaming is interrupted, whilst others are at risk of spending thousands of pounds on in-game purchases.

A small number of studies have confirmed the advantage of generalised equivalent uniform dose (gEUD) optimisation for some standard clinical scenarios; however, its performance with complicated stereotactic treatments is yet to be explored. Therefore, this study compared two planning optimisation methods, gEUD and Physical dose, in stereotactic treatments for several complex anatomical locations.

Thirty patients were selected, ten each for sites of brain, lung and spine. Two stereotactic plans were generated for each case using the gEUD objective and Physical objective cost functions. Within each of the three sites, dosimetric indices for conformity, gradient and homogeneity, along with parameters of monitor units and dose–volume histograms (DVHs), were compared for statistical significance. Additionally, patient-specific quality assurance was conducted using portal dosimetry, and the gamma passing rate between the two plans was evaluated.

Optimisation was better with a gEUD objective as compared with Physical objective, notably sparing critical organs. Overall, the differences in mean values for six critical organs at risk favoured gEUD-based over Physical-based plans (all six 2-tailed p-values were < 0·0002). Furthermore, all differences in mean values for DVH parameters favoured gEUD-based plans: GTVmean, GTVmax, PTVD100V, homogeneity index, gradient index and monitor unit (treatment time) (each 2-tailed p < 0·05).

gEUD optimisation in stereotactic treatment plans has a clear and general statistical advantage over Physical dose optimisation.

To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years.

Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight.

Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen).

Children under age 5 from nine MENA countries between 1987 and 2016 (n 155 961).

Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan – 7·3 %, Egypt –23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0–18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls.

Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.

Screening for asymptomatic health conditions is perceived as mostly beneficial, with possible harms receiving little attention.

To quantify proximal and longer-term consequences for individuals receiving a diagnostic label following screening for an asymptomatic, non-cancer health condition.

Five electronic databases were searched (inception to November 2022) for studies that recruited asymptomatic screened individuals who received or did not receive a diagnostic label. Eligible studies reported psychological, psychosocial and/or behavioural outcomes before and after screening results. Independent reviewers screened titles and abstracts, extracted data from included studies, and assessed risk of bias (Risk of Bias in Non-Randomised Studies of Interventions). Results were meta-analysed or descriptively reported.

Sixteen studies were included. Twelve studies addressed psychological outcomes, four studies examined behavioural outcomes and none reported psychosocial outcomes. Risk of bias was judged as low (n = 8), moderate (n = 5) or serious (n = 3). Immediately after receiving results, anxiety was significantly higher for individuals receiving versus not receiving a diagnostic label (mean difference −7.28, 95% CI −12.85 to −1.71). On average, anxiety increased from the non-clinical to clinical range, but returned to the non-clinical range in the longer term. No significant immediate or longer-term differences were found for depression or general mental health. Absenteeism did not significantly differ from the year before to the year after screening.

The impacts of screening asymptomatic, non-cancer health conditions are not universally positive. Limited research exists regarding longer-term impacts. Well-designed, high-quality studies further investigating these impacts are required to assist development of protocols that minimise psychological distress following diagnosis.