Research indicates that treatment outcomes are poorer for people with long-term physical health conditions (LTCs) in Talking Therapies services (formerly known as Improving Access to Psychological Therapies). However, the impact of having an LTC on attendance at assessment and treatment appointments within Talking Therapies remains unclear. Internet-enabled therapies may be one way to overcome barriers to treatment engagement in Talking Therapies. However, their effect on engagement and the influence of LTC status on receipt of internet-enabled therapies is unknown.

To explore the association between LTC status and assessment attendance, treatment engagement and internet-enabled therapy receipt within Talking Therapies services, and whether receipt of internet-enabled treatment bolsters engagement.

We used anonymous patient-level data from two inner London Talking Therapies services during January to December 2022 (n = 17 095 referrals). Binary logistic regression models were constructed to compare differences between LTC and non-LTC groups on (a) assessment attendance, (b) engagement and (c) internet-enabled therapy receipt. In our regression models, we controlled for key clinical and demographic covariates.

There were no differences between patients with or without an LTC in assessment attendance or treatment engagement, after controlling for covariates. Across the whole sample, receiving internet-enabled treatment increased engagement. People with an LTC were less likely to receive an internet-enabled treatment.

Having an LTC does not negatively affect assessment attendance and engagement with talking therapies. However, receiving an internet-enabled treatment bolstered engagement in our regression models. People with an LTC were less likely to receive internet-enabled treatment.

Previous studies have found substantial costs to be associated with depression and insomnia (as separate entities).

To estimate healthcare service use and costs associated with insomnia in Australian adults experiencing subthreshold depression or major depressive disorder (MDD).

Healthcare service use and productivity loss were extracted from the cross-sectional 2020–2022 National Survey of Mental Health and Wellbeing data. Insomnia and depression were assessed using questions aligned with DSM-IV criteria. Weighted two-part models were used to calculate average annual costs (presented as 2021–2022 Australian dollars).

The analytical sample meeting subthreshold depression or MDD criteria consisted of 1331 adults (aged 40.5 ± 16.1 years; 59% female; insomnia prevalence: 84%). Healthcare service use and healthcare costs between individuals with insomnia and those without insomnia were similar in the MDD group. For subthreshold depression, healthcare costs were significantly higher for those with insomnia compared with those without insomnia (Δ = A$990, 95% CI: 234 to 1747), but healthcare resource use was not significantly different. Productivity loss among employed people and reduced employment were much greater (although the difference did not reach statistical significance) in adults with insomnia compared with those without insomnia.

Healthcare resource use among adults with depression was similar in those with and without insomnia. However, higher healthcare costs associated with insomnia were observed in adults with subthreshold depression. Further studies are encouraged to understand the nature of the increased healthcare cost associated with insomnia in individuals with subthreshold depression and to optimise healthcare service use in people with comorbid depression and insomnia.

Pupils in alternative education provision, known as ‘Educated in Other Than At School’ (EOTAS) in Wales, UK, are among the most vulnerable learners and who, for reasons such as mental health or behavioural challenges, do not attend a mainstream or special school.

We compared self-harm, neurodevelopmental disorders and mental health conditions between EOTAS pupils and controls with similar characteristics, before and after being in EOTAS provision.

This population-based electronic cohort study included pupils in Wales aged 7–18 years, from the academic years 2010–11 to 2018–19. We linked data from Education Wales to primary and secondary healthcare records within the Secure Anonymised Information Linkage (SAIL) Databank. Individuals included in the EOTAS data-set were identified as cases. Controls were pseudo-randomly selected based on equivalent age and academic year distribution.

This study included 8056 pupils in EOTAS and 224 247 controls. Higher levels of deprivation, childhood maltreatment, self-harm, neurodevelopmental disorders and mental health conditions before EOTAS entry were linked to higher odds of being in EOTAS. Pupils in EOTAS provision had increased incidence of self-harm, neurodevelopmental disorders and mental health conditions, from 1 year after entering EOTAS provision up to 24 years of age, than pupils with similar characteristics not in EOTAS provision.

While EOTAS provision plays an important role, our findings indicate that it is not sufficient on its own to meet pupils’ social, emotional, behavioural and mental health needs. Additional support and better integration with health and social services are required.

Adolescence marks a critical transition period, with significant mental health challenges including anxiety and depression symptoms that affect long-term happiness. There has been a lack of research exploring the factors mediating adolescent happiness.

To investigate the mediating effects of anxiety and depression on adolescent happiness, as well as the contributions of sociodemographic factors.

We recruited 392 adolescents. Anxiety symptoms, depression symptoms and happiness were assessed by the seven-item Generalized Anxiety Disorder scale, nine-item Patient Health Questionnaire and single-item happiness scale, respectively. Self-administered questionnaires were used to collect sociodemographic information.

Spearman correlation analysis showed significant negative correlations of happiness with anxiety (r = −0.37, P < 0.0001) and depression (r = −0.47, P < 0.0001). Positive predictors of happiness included quality of parents’ marriage (β = 0.12, P = 0.006), regular physical exercise (β = 0.13, P = 0.006) and regular diet (β = 0.10, P = 0.03). Mediation analysis indicated that depressive symptoms (estimate = 0.50, 95% CI: 0.25 to 0.80) and anxiety symptoms (estimate = 0.32, 95% CI: 0.12 to 0.57) partially mediated the relationship between regular exercise and happiness, whereas depressive symptoms completely mediated the relationship between anxiety symptoms and happiness (estimate = −0.14, 95% CI: −0.20 to −0.08).

The findings of this study highlight the intricate interplay of mental health issues, lifestyle factors and adolescent happiness and emphasise the need for comprehensive interventions focusing on enhancing physical activity and addressing psychological health to foster happiness among adolescents.

Individuals with schizophrenia experience significantly higher rates of chronic physical health conditions, driving a 20-year reduction in life expectancy. Poor diet quality is a key modifiable risk factor; however, owing to side-effects of antipsychotic medication, cognitive challenges and food insecurity, standard dietary counselling may not be sufficient for this population group.

To evaluate the feasibility, acceptability and preliminary effectiveness of two dietary interventions – pre-prepared meals and meal kits – for individuals with schizophrenia.

The Schizophrenia, Nutrition and Choices in Kilojoules (SNaCK) study is a 12-week, three-arm, cross-over, randomised controlled trial. Eighteen participants aged 18–64 years diagnosed with schizophrenia or schizoaffective disorder will be recruited from community mental health services in Australia. Participants will be randomised to receive pre-prepared meals, meal kits or a supermarket voucher as a control, crossing-over at the end of weeks 4 and 8, so that all participants experience all three study arms. Primary outcomes include feasibility (recruitment rate and retention, number of days participants use pre-prepared meals or meal kits, adherence to meals as prescribed, difficulty in meal preparation and meal wastage) and acceptability (meal provision preference ranking and implementation) of the nutrition interventions. Secondary outcomes include the effects of the intervention on metabolic syndrome components, dietary intake, quality of life and food security measures.

Feasible, acceptable and effective dietary interventions for people with schizophrenia are urgently needed. Findings from this trial will inform future larger randomised controlled trials that have the potential to influence policy and improve health outcomes for this vulnerable population.

Stress could increase delay discounting in subjects with bulimia nervosa and alcohol use disorder (AUD), meaning that the short-term benefits of coping through eating or drinking outweigh the long-term negative consequences. Therefore, this study explores differences in delay discounting between patients and healthy controls, the impact of stress on food and alcohol delay discounting and associated changes in brain activity.

A total of 102 female participants (AUD, 27; bulimia nervosa, 25; healthy controls, 50) underwent repeated functional magnetic resonance imaging scanning. Initially, all participants performed a monetary delay discounting task (DDT), followed by a food or alcohol DDT before and after stress induction. Specifically, those with bulimia nervosa completed a food DDT, those with AUD completed an alcohol DDT and healthy controls were randomly allocated to one or either DDT.

Participants with AUD, but not healthy controls, displayed a higher discounting of alcohol after stress. Healthy controls, but not those with bulimia nervosa, had nominally higher discounting rates of food following stress, although not significant following multiple testing correction. Participants with AUD displayed a lower activity of the right supplementary motor area while discounting alcohol after stress. Healthy controls showed a lower activity of the frontal cortex and a higher activity of the motor cortex while discounting food after stress, while those with bulimia nervosa displayed a higher activity of the occipital cortex.

The results suggest that, in subjects with AUD, stress induces neurobiological changes that cause them to prefer more immediately available alcohol. However, the results observed in participants with bulimia nervosa suggest a more complex relation between stress and food.

Nitrous oxide may possess antidepressant effects; however, limited data exist on repeated administrations and active placebo-controlled studies in treatment-resistant depression (TRD).

We aimed to test the feasibility of a randomised controlled trial examining a 4-week course of nitrous oxide or midazolam, an active placebo.

In this randomised, active, placebo-controlled pilot trial, 40 participants with TRD were assigned either a 1-h inhalation of 50% nitrous oxide plus intravenous saline (n = 20) or a 1-h inhalation of 50% oxygen plus intravenous midazolam (0.02 mg/kg, up to 2 mg; n = 20) once weekly, for 4 weeks. Feasibility was assessed by examining rates of recruitment, withdrawal, adherence, missing data and adverse events. The main measure of clinical efficacy was the change in depression severity (Montgomery–Åsberg Depression Rating Scale (MADRS)) score from baseline to day 42.

The recruitment rate was 22.3% (95% CI 16.9–29.0). Withdrawal rates were 10% (95% CI 2.8–30.1) in both groups and adherence rates were 100.0% (95% CI 82.4–100) in the nitrous oxide group and 94.4% (95% CI 74.2–99.0) in the placebo group. There were no missing primary clinical outcome data in either group (0.0%, 95% CI 0.0–17.6). MADRS score changed by −20.5% (95% CI −39.6 to −1.3) in the nitrous oxide group and −9.0% (95% CI −22.6 to 4.6) in the placebo group. Nearly all adverse events were mild to moderate and transient.

The findings support the feasibility and necessity of conducting a full-scale trial comparing nitrous oxide and midazolam in patients with TRD.

Safety planning is a commonly used, evidence-based intervention for suicide prevention. There is a need for continuous engagement with safety plans post-discharge, and the improvement of safety plan portability has been discussed within our mental health organisation. This has led to the development of an app, called the Hope App. This study aims to implement this app into routine practice in a Canadian psychiatric emergency department.

We aimed to describe a collaborative, theoretically driven approach to co-design implementation strategies to elicit behaviour change among emergency department clinicians; co-develop a set of tailored, theory-informed, multifaceted implementation strategies for embedding an app into a psychiatric emergency department; and describe engagement evaluation received by the co-design team.

Co-design approaches and the Behaviour Change Wheel were used to develop implementation strategies with clinicians, patients and care partners. The co-design team consisted of 12 members, and we held four design sessions. Design sessions were iterative in nature and organised such that the findings of each session fed into the next session.

We identified 11 implementation strategies encompassing different combinations of intervention functions and behaviour change techniques, targeting barriers and leveraging facilitators identified in our previous work.

The tailored implementation strategies developed in this study have the potential to fill existing gaps in integrating digital technology. A key strength of this study is its use of behaviour change theories and a collaborative approach. The strategies are designed to align with the needs and preferences of clinicians, patients and care partners.

The heterogeneity of chronic post-COVID neuropsychiatric symptoms (PCNPS), especially after infection by the Omicron strain, has not been adequately explored.

To explore the clustering pattern of chronic PCNPS in a cohort of patients having their first COVID infection during the ‘Omicron wave’ and discover phenotypes of patients based on their symptoms’ patterns using a pre-registered protocol.

We assessed 1205 eligible subjects in Hong Kong using app-based questionnaires and cognitive tasks.

Partial network analysis of chronic PCNPS in this cohort produced two major symptom clusters (cognitive complaint–fatigue and anxiety–depression) and a minor headache–dizziness cluster, like our pre-Omicron cohort. Participants with high numbers of symptoms could be further grouped into two distinct phenotypes: a cognitive complaint–fatigue predominant phenotype and another with symptoms across multiple clusters. Multiple logistic regression showed that both phenotypes were predicted by the level of pre-infection deprivation (adjusted P-values of 0.025 and 0.0054, respectively). The severity of acute COVID (adjusted P = 0.023) and the number of pre-existing medical conditions predicted only the cognitive complaint–fatigue predominant phenotype (adjusted P = 0.003), and past suicidal ideas predicted only the symptoms across multiple clusters phenotype (adjusted P < 0.001). Pre-infection vaccination status did not predict either phenotype.

Our findings suggest that we should pursue a phenotype-driven approach with holistic biopsychosocial perspectives in disentangling the heterogeneity under the umbrella of chronic PCNPS. Management of patients complaining of chronic PCNPS should be stratified according to their phenotypes. Clinicians should recognise that depression and anxiety cannot explain all chronic post-COVID cognitive symptoms.

More people than ever are receiving support for mental health issues, and instances of suicide continue to grow. Although mental health funding has increased, UK government figures evidence that the National Health Service (NHS) does not have the resources required to respond to such growth in demand. The experiences of staff working in mental health services can offer insight into the efficacy of current provision and assist in service evaluation; however, research examining this issue outside of the COVID-19 pandemic, and in the context of community mental health, is lacking.

We aimed to explore the perspectives of staff working in a variety of mental health services in North-West England, to elucidate the current standard of care provided and highlight areas for improvement.

One-to-one interviews were conducted with 26 staff members as part of a qualitative grounded theory analysis.

Findings portrayed a community in crisis, consisting of the following themes: stabilisation not recovery, inefficient pathways and barriers to collaboration.

NHS services are struggling to meet the mental health needs of the population, resulting in lengthy waiting times for therapy, a lack of intervention-focused care and an over-reliance on the third sector. While crisis cafés are provided at low cost and result in satisfaction, policy-makers must ensure that these receive adequate funding and do not become overburdened. Staff reported that collaboration between clinical and non-clinical services would improve care pathways and reduce strain on the NHS, but judgemental attitudes and inflexible service development must be challenged to achieve this.

The rate at which psychosis drugs can be reduced in dose remains unclear. Anecdotal reports exist of people experiencing worsening of mental state before their next dose of long-acting injectable antipsychotic. No research has previously explored this phenomenon, but understanding this may advise on the rate of receptor occupancy change that provokes the emergence of psychotic symptoms.

Exploring the relationship between psychotic symptoms and variations in plasma concentration (and calculated receptor occupancy) of long-acting injectable antipsychotics.

This longitudinal study monitored mental state variation within dosing cycles of people taking depot flupentixol and zuclopenthixol. The Positive and Negative Syndrome Scale (PANSS) monitored global mental state changes, and was stratified into domains according to a five-factor model. Plasma assays at maximal and minimal concentrations allowed prediction of striatal D2 occupancy from published data. We examined correlations between receptor occupancy and the emergence of psychotic symptoms.

Preliminary results from ten participants with psychotic disorders suggest that global mental state deterioration may correlate with increased rate of D2 occupancy reduction. Increased rate of D2 occupancy reduction led to deterioration in ‘positive’ (r = 0.637 [CI: 0.013, 0.904], P = 0.047) and ‘resistance’ (r = 0.726 [CI: 0.177, 0.930], P = 0.018) PANSS clinical domains at minimal concentrations. PANSS score differences were not related to absolute reduction in D2 occupancy.

Our novel observational study design has been demonstrated to be feasible and practicable. Faster reductions in D2 occupancy may increase the risk of increased positive psychotic symptoms and irritability. Slower reductions may minimise this effect. Further recruitment is required before this can be confirmed.