Aims: Delusional misidentification syndromes (DMS) are characterised by a delusional belief of misidentification concerning familiar individuals, places or objects and by the conviction that they have been replaced or transformed. Violent behaviours towards the “impostor” are often observed and can take the form of verbal threats or physical assault. This review explores the specific factors that increase the risk of violence in individuals with DMS.

Methods: An initial search was conducted in PsycInfo, MEDLINE, PubMed and PsycArticles in May 2023, followed by a subsequent search in November 2024, to identify publications reporting severe violence (e.g. homicide, attempted murder, assault) in individuals with DMS. 13 papers comprising 16 case reports were included in the review.

Results: The majority of patients were male (N=15), aged 29–43 (i.e. early- to mid-adult years) (N=14) at the time of the offence and had a prior diagnosis of a psychiatric disorder (N=13) (i.e. psychotic disorder). In 13 of 16 cases, the DMS was Capgras syndrome. The violent act most commonly perpetrated was homicide (including uxoricide, matricide, patricide, parricide and filicide) (N=21). Victims were mostly acquaintances or strangers (N=16), followed closely by familiar individuals (N=13). In 13 cases, social behaviour of the patients prior to the offence was described as “hostile”, “aggressive”, “solitary” or involving “poor social interactions from a young age”. Only 3 patients were described as “lively” or “social”.

Conclusion: The current systematic review identified specific factors such as a prior psychiatric diagnosis (i.e. of psychotic disorders), as well as male gender, early- to mid-adulthood, the type of DMS (i.e. Capgras syndrome) and social behaviour marked by isolation and hostility prior to the offence as potential contributors to severe violence in individuals with DMS. However, the lack of available case reports and empirical studies makes it challenging to understand the psychopathology exhibited and its relationship with violent behaviour. Further research is needed to advance our understanding of the possible factors associated with and the possible causes underlying the severity of violence exhibited in DMS.

Aims: The North London Foundation Trust was established in 2024. The partnership has created a new clinical strategy for the next 5 years (2024–2029) and some of the main priorities are: “For all services to use a trauma informed approach”, “Service users must be involved in co-production and decision making”, “Value feedback from service users”, “Facilitate communication and information sharing with service users”.

For these priorities to be addressed there need to be forums in which service users are able to be heard and fed back to using a trauma informed approach. Currently there are community meetings on the inpatient wards for service users and staff to feedback on any issues within the ward environment. On my ward these are poorly attended by both staff and patients and feedback from patients is that they raise the same issues, but nothing gets acted on. There is no set policy/protocol for how these meetings should run and who should be in attendance. By formalising the structure of the community meetings using a trauma informed framework, my hope is that both patients and staff benefit from the shared space and that the learning can be shared with other wards.

Objectives: To develop an evidence-based protocol for running community meetings on an inpatient psychiatric ward that fits within a trauma-informed framework; Improved attendance from staff and patients at the ward community meeting; Improved satisfaction from staff and patients attending community meetings; Share learning with other wards in the partnership.

Methods: A literature search to establish current best practice for running community meetings.

Qualitative questionnaires/ structured interviews and thematic analysis of staff interviews.

Development of protocol for running community meetings on inpatient wards.

3 month pilot of the new community meetings.

Attendance records pre and post intervention.

Results: Attendance records show improved attendance of both staff and patients at the weekly community meetings. Prior to the intervention, thematic analysis showed that staff thought there was a lack of clarity about goals, diverse interpretations of community meetings, and mixed expectations about patient involvement. Post intervention, analysis revealed that community meetings were widely appreciated as a valuable initiative that enhanced the ward culture, patient recovery, and staff-patient relationships. Despite challenges, many participants felt these meetings brought significant benefits.

Conclusion: Having a trauma-informed, semi-structured proforma for running inpatient community meetings helps to improve attendance, satisfaction and positive outcomes from the meetings for both staff and patients.

Aims: We hypothesise that mental health impacts of flooding will be greater in India compared with the UK. Climate change is causing an increase in flooding due to the rising frequency of extreme weather patterns globally. The major impacts of flooding on mental health include displacement, financial hardship, and loss of access to healthcare. These can lead to conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD).

Methods: This study was conducted as a comparative analysis. Data was collected by a systematic search of peer-reviewed articles. Standardised tools were used to evaluate psychological outcome and mental health morbidities such as the Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), WHO-5 and the PTSD checklist (PCL-6). Data concerning the mental health consequences caused by the floods (specifically regarding anxiety, depression and PTSD), financial impacts and access to mental health services in both countries were extracted. Our findings were then thematically analysed to compare the patterns and disparities.

Results: In both countries, the research conducted on the effects of flooding on mental health has identified that the three main mental health morbidities that arose are depression, anxiety and PTSD. India has an average percentage of 43.2% depression, 32.19% anxiety and 36.46% PTSD amongst individuals affected by flooding, while the UK shows equivalent rates of 25.52% depression, 24.2% anxiety and 31.49% PTSD. These results suggest that socioeconomic differences and access to mental health resources play a significant role in post-flood psychological states. In both countries a larger financial impact links to higher rates of psychological stress.

Conclusion: Although effects are noted in both the UK and India, the prevalence of mental health conditions arising from flooding affect both the UK and India. However, our findings indicate that the mental health impacts are more severe in India, supporting our hypothesis. In disaster recovery, mental health funding is frequently deprioritised in favour of immediate concerns such as physical health and infrastructure.

Stigma surrounding mental health, particularly affecting developing countries, contributes to under-reporting and therefore the accuracy of assessments. To improve outcomes, a public health approach may destigmatise mental health, and enhance social support. Additionally, Psychological First Aid has set international foundations for psychosocial care following distressing events, a framework which supports people whilst respecting culture and abilities.

Aims: Extreme weather events refer to weather events that are dramatically different from typical patterns. These can be catastrophic, unexpected and pose a risk to the population. This review aims to examine whether sufficient evidence exists to demonstrate a link between extreme weather events and an increase in mental health conditions, specifically PTSD, anxiety, and depression.

Methods: We conducted a literature search across multiple electronic databases, including PubMed, Web of Science, Scopus, and PsycINFO, for articles published between January 2000 and January 2025. Keywords include Extreme weather; Mental health; Depression; Anxiety; Post traumatic stress disorder. From this we used four articles reporting quantitative data on the prevalence of mental health conditions in those exposed to extreme weather events. The selection of these four articles is justified based on the relevance to our research question. They provide figures which allow us to compare mental health prevalence before and after extreme weathers took place. Furthermore, they offer a vast array of data, from various populations to weather patterns, enabling us to conduct more thorough research.

Results: All four studies reported a rise in PTSD, anxiety, depression following extreme weather events like floods, heatwaves, and wildfires. A meta-analysis of surveys that targeted people who had been affected by floods in the previous 12 months found that the prevalence rates of anxiety (25.2%), depression (26.3%), and PTSD (30.4%) were generally higher in this group than in the overall population. The prevalence of anxiety (5.7%) and PTSD (7.8%) in the overall population was considerably lower than this. In contrast, depression did not experience such a large spike (20.6%). However, a cross-sectional analysis aiming to assess the relationship between flooding and psychological morbidity concluded that those experiencing cumulative and repeated exposure to extreme weather events such as flooding had a significant increased risk of developing depression but did not impact the levels of anxiety or PTSD. Two studies highlighted vulnerable groups including older adults and those with pre-existing mental health conditions are more susceptible to experience deteriorating symptoms.

Conclusion: Overall, there is sufficient evidence to highlight the strong association between extreme weather leading to an increase in prevalence of mental health conditions. These findings emphasize the urgent need for mental health support and early intervention strategies for the communities affected.

Aims: A recently published systematic review studying the link between COVID-19 and new-onset dementia (NOD) concluded that COVID-19 infection is likely to be a risk factor for developing NOD in older adults at 12 months, but no increased risk was noted at 3 or 6 month post-infection. We present a case of an elderly gentleman ‘X’ with no prior history of any cognitive deficit, who developed behavioural problems and cognitive decline within 6 weeks of a COVID-19 infection.

Methods: X is a 70-year-old gentleman with no previous history of psychiatric illness prior to March 2020, when he contracted COVID-19. Within 6 weeks of a positive swab, there was an acute change in his behaviour and cognition, wherein he was noted to be more talkative, disinhibited, presenting with grandiose ideas, sleeping very little at night and displaying intermittent episodes of confusion. X had never complained of problems with his memory and the family had never previously raised concerns about the same. However, cognitive testing carried out at 3 months post-infection revealed a significant decline in cognitive ability (Montreal Cognitive Assessment 17/30).

X was referred to the neurology team, which carried out a battery of tests including MRI scans, DAT scan, cerebrospinal fluid analysis and antibody screens. These largely came back negative and no organic cause could be determined for X’s presentation. However, the screen for Neurofilament Light Polypeptide (NFL) was positive, which was reported to possibly indicate damage following COVID-19 infection. NFL is known to have links with Alzheimer’s disease pathology. Cognitive tests repeated in 2024 have returned a MOCA score of 16/30, indicating that X’s cognitive impairment continues to persist.

Results: A retrospective cohort study by Taquet et al. which looked at the association between COVID-19 infection and psychiatric disorder found that there was a two to three times increased risk of dementia after COVID-19 infection. A subsequent larger study by the same authors published in Lancet Psychiatry which looked at 6-month neurological and psychiatric outcomes following COVID-19 infection confirmed the link between COVID-19 and risk of NOD. The presentation of our patient X is consistent with this finding.

Conclusion: Our case study highlights the increased risk of cognitive decline and NOD following COVID-19 infection in older adults.

There is a great potential for carefully designed economic empowerment programmes to improve mental health in recipients and their significant others. Onono and colleagues interviewed 62 caregiver-adolescent dyads on the effect of an economic empowerment intervention consisting of microcredits to purchase farming implements and a water pump to irrigate crops throughout the year combined with agricultural and financial training. Their intersectoral economic empowerment intervention decreased parental stress, parental absenteeism as well as harsh parenting and disciplining practices. This translated to better caregiver-adolescent communication and improved household dynamics, thus increasing the psychological well-being of adolescents. The research contributes to a growing evidence base on the importance of economic empowerment interventions for mental health by generating hypotheses on mechanisms of action.

Aims: The prevalence of Alzheimer’s disease (AD) is increasing across the world, yet extensive research has not yielded effective curative treatment. Traditional Chinese Medicine (TCM) has shown benefits and potential in treating AD. However, there were no recent systematic reviews of the different TCM modalities in treating AD specifically. The primary aim of this systematic review (SR) was to investigate the effectiveness of TCM either as a standalone or adjunct treatment alongside conventional medication for AD. The secondary aim was to provide recommendations for treating AD by exploring the addition of TCM in clinical practice.

Methods: A systematic review with meta-analysis was performed, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search was performed on Medline, Allied and Complementary Medicine Database (AMED), Web of Science and Scopus, while grey literature was searched on Overton. There were no filters set on the date of publication, language, subject and author. The search terms of Traditional Chinese Medicine and Alzheimer’s disease were searched till 27 July 2024. The studies were screened to target patients with AD, therapies and herbs that have corresponding names in TCM and are randomised controlled trials (RCTs). This led to eleven included RCTs for narrative review and meta-analyses. Study Risk of Bias Assessment and quality assessment were performed. A random effects model was used in the meta-analysis to assess the efficacy of treatments.

Results: A total of 11 randomised controlled trials that comprise 1155 patients with AD were included. The included studies showed that TCM therapies of saffron, cistanches herba, MLC601, and Shenfu or Shenmai with Deproteinized Calf Blood Injection (DCBI) had therapeutic benefits as stand-alone therapy for improving cognitive function in patients with AD. Combined with results from the meta-analyses, bushenhuatanyizhi, Guilingji and Jiannao Yizhi formula also showed potential as stand-alone therapy in improving cognitive function and activities of daily living. Two studies supported adding Dengzhan Shengmai or Huanglian Jiedu decoction as an adjunct to conventional treatment. Hachimijiogan showed some effect in slowing cognitive decline as an adjunct therapy, while Yokukansan can help with managing behavioural and psychological symptoms of dementia.

Conclusion: This review adds support to the current literature of the potential of TCM therapies in treating AD. A search on the Chinese databases, investigating the mechanisms behind how these interventions work and using a combination of TCM therapies are potential future studies on alternate forms of treatment for patients with AD.

Aims: In obsessive-compulsive disorder (OCD), treatment non-response is common with recommended medications; hence there is a need to investigate the role of alternative agents. It was intended to evaluate the evidence base involving ondansetron as a treatment strategy for OCD in adults, considering its role as a 5-HT3 receptor antagonist primarily in the limbic system.

Methods: Various electronic databases (PubMed, CINAHL, EMBASE, PsycInfo, Cochrane, Clinical Trials Registers, and PROSPERO) were searched for articles with keywords of ‘ondansetron’, ‘obsessive-compulsive disorder’ or ‘OCD’, and ‘clinical trial’, in the English language, published up to October 2024.

Results: Nine studies were included in this systematic review. Studies used Yale–Brown Obsessive Compulsive Scale (YBOCS) scale for assessment and ondansetron mostly as an augmenting drug. More than half of the studies (five out of nine) had patients with treatment-resistant OCD, and serotonin reuptake inhibitors as the active drug. All trials reported improvement in OCD with ondansetron augmentation, except the study which involved chart review for treatment-resistant OCD. The improvement was observed as early as two weeks following ondansetron augmentation. The reported range of decrease in YBOCS score from baseline in various studies has been 23.2–55%. Treatment response was reported between 37–86.4%. Improvement was noticed in both OCD and treatment-resistant OCD groups. Discontinuation of ondansetron led to worsening of symptoms which was reported in two studies. Overall adverse effects of ondansetron were mild to moderate in degree, with no major clinical concerns, and were generally well tolerated. Commonly reported side effects were constipation, headache, diarrhoea, decreased appetite, dizziness, insomnia, anxiety, nervousness, sweating, dry mouth, muscle cramp and sexual dysfunction. Available studies have major limitations which are mostly small sample sizes and short duration of trials.

Conclusion: Current evidence suggests ondansetron may be beneficial in the treatment of OCD and treatment-resistant OCD, mostly as an augmentation agent; however the evidence is scarce to draw any firm conclusion. Further trials with adequate sample size and duration are required.

Legal epidemiology is an emerging field that examines how laws and policies influence human rights and health outcomes, particularly in areas such as in-patient psychiatric treatment, community treatment orders and child maltreatment, This editorial highlights contributions from BJPsych Open that apply legal epidemiological methods to assess issues relevant to child maltreatment and coercion in psychiatric care. Findings emphasise the need for early intervention, standardised evaluation measures and reforms that prioritise human rights and well-being. Legal epidemiology can offer a scientific basis for improving legal frameworks, as well as promoting equitable and effective mental healthcare.

Aims: Could a hypothetical future Artificial General Intelligence (AGI) suffer from a mental illness? While this question may evoke differing intuitions, the following arguments propose that such an AGI could indeed experience mental pathology.

Methods: To prove that an AGI could suffer from a mental illness, the method of philosophical thought experiment using a priori deductive reasoning has been employed. The argument’s premises are justified by known principles of computer science and psychiatry.

Results: Though AGI systems do not yet exist, exploring their potential nature can offer valuable insights into conceptualising the pathogenesis of psychiatric illness. Consider the following deductive inference: Premise 1: People can suffer from mental illness. Premise 2: A future AGI will be a person, i.e. a conscious entity capable of generating new knowledge. Conclusion: An AGI will be a person and therefore can suffer from a mental illness.

Conclusion: From computer science and physics, we know in principle that AGI must be possible. The intuition that an AGI would be conscious, and therefore susceptible to mental illness, finds support from the Church–Turing–Deutsch principle. That is to say, any Turing-complete system, which includes all modern computers, can simulate any physical system, including the human brain. The human brain is a known structure that supports general intelligence, minds and consciousness. While brains are not isolated systems and have internal and external environmental inputs and outputs, these could also be computationally simulated. The key question is whether such a simulated brain would actually be conscious or merely simulate consciousness. It seems logically incoherent to “simulate” consciousness, as a successful attempt to simulate a conscious brain would necessarily result in the creation of a conscious being. Therefore, like a human mind, it seems consistent to suggest the mind of an AGI can suffer from mental illness.

Unlike humans, an AGI will not have a biological brain. Instead, its mind will presumably run on a silicon-based substrate. This suggests that brains are not fundamental to the pathophysiology of mental illness. Rather, we can speculate that information and its aberrant processing play a more central role in the emergence of mental disorders.

Aims: Functional Neurological Disorders (FND) are common but poorly understood causes of disabling symptoms including limb weakness, seizures, fatigue and memory difficulties. Children as young as 5 years old may suffer from the condition and middle adolescence is the most common age of onset. Children with FND are likely to have more difficulties with education and mental health disorders and have experienced more adversity in childhood such as physical, emotional, and sexual abuse. Despite the severity and chronicity of this condition, the literature about FND in children is poor. Children with FND often fall between paediatric and CAMHS services and thus understanding the condition can be better done through cases referred to specialist services. Here we aim to describe the clinical characteristics of referrals made to the sole National and Specialist paediatric liaison service which assesses and treats children with FND.

Methods: Through the South London and Maudsley NHS Foundation Trust, Electronic Patient Journey System, an electronic case record search was completed for all patients who were given a diagnosis of ICD–10 Dissociative Disorders which was made before the patients were 18 years old. From 2015–2025, a total of 196 patients were identified. Individual case records were assessed for demographic and clinical information.

Results: In the group of 196 patients, patients ranged from 7–17 years old (mean 14.11 and mode 15). Sixty-eight per cent (69) of the patients were female. Forty-nine (25%) were coded as dissociative motor disorder, 54 (27.6%) dissociative convulsions, 6 (3%) dissociative amnesia, 71 (36.2%) had mixed or unspecified dissociative symptoms. Sixty-eight per cent of patients reported comorbid anxiety symptoms and 29% of patients reported comorbid depression. Fifty-eight per cent reported experiencing bullying at school.

Conclusion: Children with FND present with a high degree of disability, psychiatric comorbidity and social adversity. A limited evidence base exists as to best practice for paediatric FND yet treatment is essential for positive outcomes in both childhood and subsequent adulthood. Further research should include controlled trials in this age group and an increase in funding specialist services.

Aims: Functional Neurological Disorders (FND) are common but poorly understood causes of disabling neurological symptoms. Children with FND are likely to have more difficulties with education and mental health disorders and have experienced more adversity in childhood such as physical, emotional, and sexual abuse. Emergence of FND in childhood can predict long-standing difficulties into adulthood. Predictors of poor outcomes in adults include a long duration or very severe symptoms, comorbid depression, personality disorder, chronic pain, dysfunctional family dynamics, perceived stigma about FND and social isolation. Each of these represents potential therapeutic targets for children and adolescents with FND.

However, literature about FND in children is poor and few studies describe outcomes and optimal models of care. Here we aim to analyse outcomes of FND in children to look for clinical and demographic predictors of prognosis and potential treatment targets.

Methods: Through the South London and Maudsley NHS Foundation Trust (SLaM), Electronic Patient Journey System, an electronic case record search was completed and 196 patients were identified who had a diagnosis of ICD–10 Dissociative Disorders given before the age of 18 between 2015–2025. Of these patients, 133 have a Dissociate Disorder as their primary diagnosis. Individual case records were assessed for demographic and clinical information and outcomes were defined through case record descriptions.

Results: In the group of 133 patients, 68 (51.1%) were discharged with a favourable outcome, 13 (9.8%) were transferred to adult FND services, 5 (3.7%) were admitted as psychiatric inpatients, 11 (8.3%) discontinued treatment and outcome data is not available, 15 (11.3%) remain under the care of the specialist service for ongoing treatment. Twenty-four (18.3%) were seen for consultation but managed under non-SLaM services. Therefore, in cases with known outcomes, 68/109 (62%) were favourable. Predictors of transfer to adult FND services or psychiatric admission include comorbid self-harm and depression, duration of symptoms prior to referral to paediatric FND services and family unwillingness to accept the diagnosis of FND.

Conclusion: Evidence from this cohort would suggest that positive clinical outcomes can occur in a high number of cases. These patients appear to benefit from specialised services which may include psychoeducation, family and individual therapy and multidisciplinary working. Early diagnosis of FND and treatment of comorbid psychiatric issues may further enhance prognosis. Further controlled studies would highlight specific therapeutic targets and interventions for children with FND.