People with severe mental illness (SMI) show significantly shorter life expectancy, mostly due to more prevalent cardiovascular disease. Although age is a prominent contributor to contemporary risk assessment and SMI usually affects younger people, these assessments still do not reveal the actual risk. By assessing advanced glycation end products (AGEs), cardiovascular risk can be assessed independent of age.

To establish whether detection of AGEs with the AGE-reader will give a more accurate cardiovascular risk assessment in people with SMI.

We compared assessment with the AGE-reader with that of the Systematic Coronary Risk Evaluation (SCORE) table in a group of 120 patients with SMI.

The AGE-reader showed an increased cardiovascular risk more often than the SCORE table, especially in the youngest group.

Because of its ease of use and substantiation by studies done on other chronic diseases, we advocate use of the AGE-reader in daily care for patients with SMI to detect cardiovascular risk as early as possible. However, the findings of the current study should be evaluated with caution and should be seen as preliminary findings that require confirmation by a prospective longitudinal cohort study with a substantial follow-up observation period.

None.

Substantial evidence indicates that perinatal mental disturbances are associated with the risk for negative maternal-newborn outcomes. A neuroendocrine brain-placenta interaction has been described to explain the association between prenatal stress-related disorders and placental abnormalities. Whether these mechanisms may affect the likelihood of mother-to-child transmission (MTCT) of infections has never been investigated.

To evaluate the role of psychological factors in cytomegalovirus (CMV) MTCT in pregnant women with primary CMV infection.

A cohort of 276 pregnant women with primary CMV infection underwent assessment of (a) reactive psychopathological symptoms, such as current depressive symptoms and ongoing symptoms of post-traumatic stress disorder; and (b) stable personality traits, such as alexithymia and Type D (distressed) personality. Congenital infection was diagnosed by CMV DNA amplification from blood and/or urine and saliva from newborn at birth.

The occurrence of congenital CMV disease in the newborn was independently predicted by post-traumatic stress symptoms during pregnancy.

Our findings suggest that psychological stress-related disturbances may weaken the physical and immunological barrier against the mother-to-fetus transmission of viruses.

COVID-19 is an on-going pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent evidence suggests that SARS-CoV-2 may be associated with various neuropsychiatric symptoms, including mania. We present a case of a middle aged man presenting with acute mania with psychotic symptoms 20 days post COVID infection in the absence of prior psychiatric illness. This report highlights the need for rigorous neuropsychiatric assessment in patient with symptoms of SARS-CoV-2 infection.

A 52-year-old man of West African origin with past history of hypertension and no previous history of mental health illness presented with acute manic symptoms on background of two weeks of high fever, diarrhoea, mild headache, dry cough and anosmia. He was tested positive for SARS-CoV-2 infection on COVID PCR test. He was under self-isolation along with his family members who exhibited mild symptoms of SARS-CoV-2, none of them required hospital admission. He was initially fearful to seek medical attention but was brought in by family after exhibiting behaviour changes, obsession with toilet cleaning, reckless spending and getting aggressive approximately two weeks after the onset of acute upper respiratory symptoms. He presented elated in mood with pressure of speech and grandiose ideas. Investigations like neuroimaging and bloods were unremarkable. Initial psychiatric assessment found symptoms consistent with acute mania and he was detained under the Mental Health Act. During admission, he was sexually disinhibited and agitated on the ward requiring IM antipsychotics. He was treated with high dose of Olanzapine and Sodium valproate and his symptoms subsided within two weeks.

This case emphasises the manifestation of neuropsychiatric illness post COVID-19 without a background of psychiatric illness, hypoxemia and cerebral infarction.

Based on the CORONERVE Programme and latest retrospective Lancet cohort studies, the period between 14 and 90 days after diagnosis, 5.8% COVID-19 survivors had their first recorded diagnosis of psychiatric illness.

It is also important to consider other organic disease given the simultaneous diagnosis of COVID-19. Although it is not yet possible to confirm here due to the lack of a validated CSF-PCR assay, previous reports have implicated SARS-CoV-2 in the development of viral encephalitis, and this remains an important differential.

Clinicians should be alert to the possibility of patients with COVID-19 developing neuropsychiatric complications post SARS-CoV-2 infection, mandating the need for vigilant initial neuropsychiatric assessment and possibly follow-up care in 3 months.

Opioid dependence has high risks and opioid substitution treatment (OST) improves outcomes and reduces deaths. Attendance at addiction specialist prescribers may be limited, particularly in rural areas. Telemedicine, such as videoconferencing, can reduce travel and improve access and attendance. Pre-COVID-19, we started a telemedicine service for patients with opioid dependence, prescribed opioid substitution treatment, requiring addiction specialist prescriber consultations. We present patient experience and assess whether patients recommend telemedicine.

Health Research Authority approval for Randomized Controlled Trial of Telemedicine versus Face-to-Face (control) appointments in large semi-rural community addictions service (2500km2) using a modified Hub-and-Spoke (outreach). Adult opioid dependent patients prescribed OST and attending outreach clinics recruited. Participants received two consultations in group. Telemedicine delivered using Skype-for-business videoconferencing. Patients attended outreach clinic, where an outreach worker undertook drug testing and telemedicine conducted via the outreach workers laptop. Specialist addiction prescribers located remotely, at the Hub. Patients self-completed NHS Friends and Family Test (FFT) immediately after appointment, separate from the wider research study. Data collected Sept 2019– March 2020 (pre-COVID-19 lockdown), Microsoft Excel analysis, with qualitative thematic free-text analysis.

Thirty completed FFTs were received, of which all participants were ‘extremely likely’ (n = 19;67%) or ‘likely’ (n = 11;37%) to recommend the Telemedicine service to friends or family, if they needed similar care. Two themes for reasons for recommending the service were; 1. Convenience (reduced travel, reduced travel time and reduced travel costs) and 2. Supportive Staff (including listening, caring and good support). One patient mentioned ‘it is a convenient way to communicate with medical staff, saving time and effort’. Regarding Telemedicine appointments, most participants responded that the timing of telemedicine appointments was good (n = 26;87%), given enough information (n = 30;100%), enough privacy (n = 28;93%), enough time to talk (n = 30;100%), involved as much as they wanted (n = 25;83%), given advice on keeping well (n = 28;93%), and NHS staff were friendly and helpful (n = 29;97%). No participants thought they were treated unfairly. When asked what went well, patient themes were: 1. Everything and 2. Communication (including listening and explaining). One patient stated ‘Everything better, telemedicing good, heard it well, everything improved this year’. In terms of what the service could do better, there were no issues identified.

The Telemedicine in Addictions service was overwhelmingly highly recommended by patients. Patients recommended the service because of convenience and supportive staff. The use of telemedicine is acceptable to patients and could be considered more widely. Due to COVID-19, this technology may be beneficial access to addiction services.

Schizophrenia is a severe mental illness and a common indication for electroconvulsive therapy (ECT). Research is lacking on the factors that influence response to acute ECT treatment in schizophrenia patients.

This study examined the response rate and associated factors in patients with schizophrenia undergoing bilateral ECT.

Demographic data, clinical characteristics, ECT data and treatment response were respectively reviewed in patients with schizophrenia undergoing bilateral ECT from January 2013 to June 2022.

Forty-six patients were included. Nine responded after the first three sessions, 17 after six sessions, 20 after nine sessions, 25 after 12 sessions and 28 after the last ECT session, cumulatively. The mean of the baseline Brief Psychiatric Rating Scale psychotic symptom subscale score was significantly higher in responders (17.0) than non-responders (10.9) (P < 0.05). The mean of duration of electroencephalogram seizure was significantly longer in responders (53.9) than in non-responders (42.7). There was no association between demographic and ECT data and treatment response. Among 28 responders, 20 responded to ECT after nine sessions (faster responders) and eight responded later (slower responders). The number of failed antipsychotics prior to ECT was 2.8 for faster responders and 4.4 for slower responders (P = 0.02). Nominal logistic regression showed that the number of failed antipsychotics prior to ECT was associated with speed of response to ECT (P = 0.037, odds ratio = 1.77).

ECT is an effective treatment for schizophrenia and may be influenced by the number of failed antipsychotics prior to ECT.

Adolescence is a pivotal stage vulnerable to mental health problems such as anxiety and depression. Although self-acceptance and social comparison are known to affect adolescent mental health, their interactive and moderating roles are not fully understood.

To explore the role of self-acceptance, social comparison and attributional style in predicting these mental health outcomes among adolescents in clinical settings.

A cross-sectional study was conducted on a sample of 242 adolescents. Participants completed measures assessing self-acceptance, social comparison, attributional style and mental health outcomes (depression and anxiety). Mediation models and multi-group analysis were used to examine the relationships among these variables.

Our findings demonstrated a significant relationship between self-acceptance, social comparison, depression and anxiety (rs = 0.32–0.88). Specifically, lower self-acceptance and higher social comparison were associated with higher levels of depression and anxiety. Additionally, individuals with external attributional tendencies reported higher depression (Cohen's d = 0.61) and anxiety (d = 0.58) compared with those with internal tendencies. Mediation modelling showed that social comparison is a mediator between self-acceptance and depression (effect size −0.04, 95% CI −0.08 to −0.01) and anxiety (effect size −0.06, 95% CI −0.10 to −0.02). Crucially, multi-group analysis showed that the impact of social comparison on mental health outcomes varied significantly based on attributional style.

These findings underscore the importance of considering self-acceptance, social comparison and attributional style in understanding and addressing mental health challenges during adolescence. This could inform the development of targeted interventions to promote mental health and well-being among adolescents. However, further research is needed to confirm these findings in diverse populations and to explore the underlying mechanisms in greater detail.

No published research in Ethiopia has examined the prevalence of suicidal ideation and suicide attempts and associated factors among patients with substance use disorder.

The main aim of this study was to assess the prevalence of suicidal ideation, suicide attempt and associated factors among patients with substance use disorders.

An institution-based cross-sectional study was conducted from 5 May to 13 June 2019 in Addis Ababa. A total of 408 patients were identified using a systematic sampling technique. Data were collected through interviews using the suicidality module of the Composite International Diagnostic Interview. Data were entered into EpiData and analysed using SPSS. Logistic regression analyses were employed. Variables with P < 0.05 were considered to be statistically significant with 95% confidence intervals.

Prevalence rates of suicidal ideation and attempt were found to be 39.5% and 18.6%, respectively. Family history of mental illness (adjusted odds ratio (AOR) = 3.60, 95% CI: 2.17, 5.97), comorbid mental illness (AOR = 3.61, 95% CI: 2.11, 6.16), perceived stigma related to substance misuse (AOR = 4.00, 95% CI: 2.26, 7.07) and alcohol use (AOR = 7.49, 95% CI: 1.99, 28.19) were associated with suicidal ideation. Being female (AOR = 2.46, 95% CI: 1.08, 5.70), family history of suicide (AOR = 3.08, 95% CI: 1.68, 5.64), comorbid mental illness (AOR = 4.09, 95% CI: 2.23, 7.49) and khat use (AOR = 3.73, 95% CI: 1.24, 11.17) were associated with suicide attempt.

The prevalence of suicidal ideation and attempt were both found to be high. In particular, patients who had a comorbid mental illness were at high risk of both suicidal ideation and attempt. Therefore, special attention should be given to those with a family history of suicide or comorbid mental illness.

Self-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety.

To systematically review the experiences, perceptions and attitudes of staff in adult prisons regarding self-harm.

Systematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity.

Two thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (n = 15) or poor (n = 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is ‘manipulative’ or ‘attention-seeking’ were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff–prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care.

There are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.

The Health of the Nation Outcomes Scales (HoNOS) has been widely used as an outcome measure in UK mental health settings for the past decade. The data-set gathered provides a unique opportunity to evaluate the effectiveness of the totality of mental healthcare in ‘real-world’ conditions; much of our clinical evidence currently comes from highly parameterised clinical trials investigating single interventions in highly selected patients.

To examine all outcomes measured by HoNOS for a range of diagnostic groups, evaluate the influence of patient demographics on those outcomes, and observe changes in patient groups over time.

Here we show the data from 6813 adult patients treated in Cambridgeshire between 2012 and 2017. Patients were split into three diagnostic groups: psychosis, non-psychosis and organic. Changes in HoNOS scores from initial assessment to discharge were tested and regressions were used to evaluate the influence of age, gender and ethnicity on the changes, as well as to model changes in the severity of initial presenting symptoms with time.

HoNOS scores significantly improve after treatment for psychotic, non-psychotic and organic conditions in adults and older adults. Age, but not gender or ethnicity, influenced change in HoNOS scores. Patients entering secondary mental health services had increased initial HoNOS scores over time.

The UK repository of HoNOS scores provides a significant and relatively underutilised resource that can be exploited to gain insights into mental illness and treatment effectiveness. This is likely to have many applications, including influencing the commissioning of services.

Autonomy is a key factor in the reduction of inequitable physical healthcare among people with severe mental illness compared with the general population.

To clarify the critical mechanism underlying autonomy in physical health promotion based on the perspectives of people with severe mental illness.

We employed a conventional content analysis of narrative data from the Healthy Active Lives in Japan (HeAL Japan) workshop meetings.

‘Inhibited autonomy’ was extracted as a central component and shaped by the users’ experiences, both in a healthcare setting and in real life. This component emerged based on the lack of an empowerment mechanism in psychiatric services.

A barrier to the encouragement of autonomy in physical health promotion was found in current psychiatric services. An effective strategy should be explored to foster an empowerment mechanism in psychiatric and mental health services.

None.

One critical barrier to the uptake of mental health programmes is the so-called physical healthcare gap, a concern raised by the unattended physical comorbidity and early mortality of persons with severe mental illness.

To evaluate the extension of physical healthcare gap among persons with severe mental illness under chronic drug therapies.

A population-based cohort study was carried out, using Lombardy healthcare utilisation databases. Prevalent patients treated with blood pressure-, lipid- or glucose-lowering agents were identified in January 2017. Among these, those who were receiving care for depression, schizophrenia, bipolar disorder or personality disorder formed the study cohort. A reference cohort was randomly selected from prevalent patients treated with chronic therapies without signs of severe mental disorders, to be matched with study cohort members for gender, age and number of previous contacts with the National Health System. One-year adherence to healthcare was measured through the proportion of days covered (drug adherence), and exposure to selected recommendations (clinical control adherence).

The 55 162 patients with severe mental illness were less likely to have high adherence to blood pressure-lowering, lipid-lowering or antidiabetic agents than the reference cohort by −24% (95% CI −26 to −22%), −10% (95% CI −14 to −6%) and −25% (95% CI −29 to −21%), respectively. The 9250 patients with diabetes and severe mental illness had −18% (95% CI −22% to −13%) reduced likelihood to meet recommendations for the clinical management of diabetes, compared with the reference cohort.

Adherence to chronic drug therapies was sensibly worse among patients living with mental illness than those without signs of mental disorders.

Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or ‘anomie’ is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie.

To examine associations between percentage ‘Leave’ votes in the EU referendum and suicide rates in 2015–2017, the period just prior to, and following, the referendum.

National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined.

Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage ‘Leave’ vote in 2016 and the suicide rate 2015–2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = −0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004).

Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling ‘left behind’/‘left out’ may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context.

Evidence from pandemic and pre-pandemic studies conducted globally indicates that people with disabilities (PWDs) have a higher risk for suicidality. However, none of these studies has assessed suicidality among PWDs in Bangladesh.

The purpose of this study was to determine the prevalence of and factors associated with suicidal ideation among PWDs during the COVID-19 pandemic in Bangladesh.

Using a snowball sampling technique, a cross-sectional survey was conducted from February to April 2021 among PWDs from six districts in the northern region of Bangladesh. Information related to sociodemographic factors, clinical characteristics, behavioural factors and suicidal ideation was collected. Chi-squared test and logistic regression were used to describe the data and explain the relationship of factors associated with suicidal ideation.

The prevalence of COVID-19-related past-year suicidal ideation was 23.9%. The factors associated with suicidal ideation included: age above 35 years, being female, acquiring a disability later in life, lack of sleep and current substance use. In addition, higher education appeared to be a protective factor against suicidal ideation.

This study highlighted that PWDs had an increased risk of suicide; that is, one-fourth of them had past-year suicidal ideation. This may have been because of COVID-19-related restrictions and stressors. Thus, the government and policy makers need to pay more attention to developing effective suicide assessment, treatment and management strategies, especially for at-risk groups, to minimise the impact of the COVID-19 outbreak.

There are a number of candidates as useful outcomes in self-harm research – repetition of self-harm; symptom states; quality of life, social participation. Repetition of self-harm has been the predominant choice of researchers, not least because of its status as a risk for eventual suicide. Use of alternatives would respond to the preferences of study participants, but there are substantial methodological constraints. Nonetheless more attention could be given to the use of outcomes other than repetition. Another option is to broaden the approach to evaluation design, incorporating advances in the use of observational data either alone or linked to data from trials.

During adolescence and young adulthood people appear to be more prone to violent behaviour. A greater tendency to violent behaviour appears to be associated with hyperactivity, impulsivity and low tolerance for frustration and provocation in social settings.

This prospective cohort study aimed to evaluate rates of violent behaviour among young people with mental disorders, compared with older age groups.

A total of 340 individuals with severe mental disorders (125 living in residential facilities and 215 out-patients) were evaluated at baseline with the SCID-I and II, Brief Psychiatric Rating Scale, Specific Level of Functioning scale, Brown–Goodwin Lifetime History of Aggression scale, Buss–Durkee Hostility Inventory, Barratt Impulsiveness Scale and State–Trait Anger Expression Inventory-2. Aggressive behaviour was rated every 15 days with the Modified Overt Aggression Scale (MOAS).

The sample comprised 28 individuals aged 18–29 years, 202 aged 30–49 and 110 aged 50 and over. Younger age was associated with a personality disorder diagnosis, substance use disorder, being single and employed. These results were confirmed even controlling for the gender effect. The patterns of the cumulative MOAS mean scores showed that younger (18–29 years old) individuals were significantly more aggressive than older (≥50) ones (P < 0.001).

This study highlights how young age in people with severe mental disorders is correlated with higher levels of impulsivity, anger and hostility, confirming previous analyses. Our results may assist clinicians in implementing early interventions to improve anger and impulsivity control to reduce the risk of future aggressive behaviours.

Low- and middle-income countries contribute to the majority of dementia and mild cognitive impairment cases worldwide, yet cognitive tests for diagnosis are designed for Western cultures. Language and cultural discrepancies mean that translated tests are not always reliable or valid. We propose a model for culturally adapting cognitive tests, one step of which is to assess the quality of any translation and cultural adaptation undertaken. We developed the Manchester Translation Evaluation Checklist (MTEC) to act as a tool for quality assessment and demonstrated its use by assessing a popular cognitive test that had been adapted.

Assess quality of the translation and cultural adaptation of the Urdu Mini-Mental State Examination developed for a Pakistani population.

Two raters completed the MTEC for the Mini-Mental State Examination (MMSE) Urdu and compared feedback. All authors were fluent in English and Urdu and familiar with Pakistani culture.

Raters had 78.5% agreement across the MTEC. The MMSE Urdu was appropriately translated and retained grammar and verb tense, but three questions had spelling errors. Across 20 MMSE questions, 5 required further cultural adaptation because the questions were not understandable in daily use, comfortable to answer, relevant to the language and culture, and relevant to original concepts.

The MTEC highlighted errors in the MMSE Urdu and demonstrated how this tool can be used to improve it. Future studies could employ the MTEC to improve existing translated measures of health assessment, particularly cognitive tests, and act as a quality check when developing new adaptations of tests and before psychometric validation.

Psychological research in the past decade has investigated the psychosocial implications of problematic use of on-demand online video streaming services, particularly series watching. Yet, a psychometric measure of problematic series watching in English is not available.

The present study aimed to test the factor structure, reliability and criterion-related validity of the English version of the Problematic Series Watching Scale, a six-item self-report assessing problematic series watching, based on the biopsychosocial components model of addiction.

Participants were recruited from two UK university student samples. Study 1 (n = 333) comprised confirmatory factor analysis, reliability tests and item response theory analyses to test the original unidimensional model and investigate each item's levels of discrimination and information. Study 2 (n = 209) comprised correlation analyses to test the criterion-related validity of the scale.

There was a good fit of the theoretical model of the scale to the data (Comparative Fit Index = 0.998, Root Mean Square Error of Approximation = 0.024 [90% CI 0.000–0.093], Standardised Root Mean square Residual = 0.048), satisfactory reliability (ω = 0.79) and item levels of discrimination and information. The scale positively correlated with time spent watching series (rs = 0.26, P < 0.001) and negative affect (rs = 0.43, P < 0.001), and correlated negatively with positive affect (rs = −0.12, P > 0.05), mental well-being (rs = −0.25, P < 0.001) and sleep quality (rs = −0.14, P < 0.05).

Results are discussed in relation to the ongoing debate on binge watching and series watching in the context of positive reinforcement versus problematic behaviour.

Mental disorders are currently the greatest global health burden. The coronavirus diseases 2019 (COVID-19) pandemic is having an adverse impact on people's mental health, particularly in vulnerable populations, such as refugees.

The present study was designed to examine the association between COVID-19 and changes in mental health in Syrian refugees in Turkey.

We conducted a two-wave panel survey of a representative sample of 302 of the estimated 500 000 Syrian refugees (ages 18 and older) living under humanitarian support in Istanbul (first wave between 9 and 15 July 2020 and the follow-up between 11 and 14 September 2020). We administered seven items from the CoRonavIruS Health Impact Survey in addition to one-context specific item about life changes because of COVID-19, and measures of depression (10-item Center for Epidemiologic Study Depression Scale, CESD-10), anxiety (6-item State-Trait Anxiety Inventory, STAI-6) and perceived stress (Perceived Stress Scale, PSS-4).

A factor analysis yielded three COVID-19 factors, labelled ‘social relationships’, ‘stress’ and ‘hope.’ We conducted a series of cross-lag panel analyses to test associations between the COVID-19 factors and mental health. We found associations between all COVID-19 factors and CESD-10, between COVID-19 ‘stress’ and STAI-6, and between COVID-19 ‘stress’ and COVID-19 ‘hope’ and PSS-4.

Our measures of life changes because of the COVID-19 pandemic are associated with changes in the mental health of Syrian refugees living in Istanbul. It is therefore important that they are provided with services to reduce what may be particularly debilitating consequences of COVID-19.