Medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS) are debilitating to patients. As many specific PPS syndromes share common behavioural, cognitive, and affective influences, transdiagnostic treatments might be effective for this patient group. We evaluated the clinical efficacy and cost-effectiveness of a therapist-delivered, transdiagnostic cognitive behavioural intervention (TDT-CBT) plus (+) standard medical care (SMC) v. SMC alone for the treatment of patients with PPS in secondary medical care.

A two-arm randomised controlled trial, with measurements taken at baseline and at 9, 20, 40- and 52-weeks post randomisation. The primary outcome measure was the Work and Social Adjustment Scale (WSAS) at 52 weeks. Secondary outcomes included mood (PHQ-9 and GAD-7), symptom severity (PHQ-15), global measure of change (CGI), and the Persistent Physical Symptoms Questionnaire (PPSQ).

We randomised 324 patients and 74% were followed up at 52 weeks. The difference between groups was not statistically significant for the primary outcome (WSAS at 52 weeks: estimated difference −1.48 points, 95% confidence interval from −3.44 to 0.48, p = 0.139). However, the results indicated that some secondary outcomes had a treatment effect in favour of TDT-CBT + SMC with three outcomes showing a statistically significant difference between groups. These were WSAS at 20 weeks (p = 0.016) at the end of treatment and the PHQ-15 (p = 0.013) and CGI at 52 weeks (p = 0.011).

We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS. However, further study is required to maximise or maintain effects seen at end of treatment.

We aimed at testing whether an assertive outreach team (AOT) run by a Black voluntary organisation is more acceptable to Black people with severe mental illness.

A randomised controlled trial (RCT) of 83 Black (African, African Caribbean or Black British) patients with severe mental illness with treatment as usual (TAU) or Assertive Outreach (AO) by a non-statutory sector Black AOT. Frequency of admissions, duration of admissions, symptom severity and client satisfaction with clinical interventions were assessed.

The mean length of admission at follow-up was not significantly different between the two groups (74.64 v. 64.51; mean difference = 10.13, 95% CI −2.86, 23.11, p = 0.125), neither was the mean number of admissions (1.32 v. 1.20; mean difference = 0.13, 95% CI −0.18, 0.43, p = 0.401). Mean Brief Psychiatric Rating Scale (BPRS) ratings at 1-year follow-up were significantly lower in the AOT group than in the TAU group (56.34 v. 63.62; mean difference = 7.27, 95% CI 0.66, 13.88, p = 0.032), and people were significantly more satisfied with AOT 24/29 (83%) than the generic services: 4/26 (15%), p < 0.001.

While the AO service was highly culturally acceptable to Black people, there was no evidence that the provision of AOT reduces frequency or duration of hospital admission.