Aims: Clozapine, the first and most effective atypical antipsychotic for schizophrenia, is typically reserved for treatment-resistant cases due to its serious adverse effects. Recent studies have linked clozapine to an increased risk of haematological malignancies (HM). This meta-analysis is the first to systematically investigate this association.

Methods: We performed this study in accordance with the Cochrane Handbook for Systematic Reviews and Meta-analysis of Interventions. Eligible studies included involving patients treated with clozapine, regardless of the primary psychiatric diagnosis, cohort, case-control, cross-sectional that reported the association between clozapine use and the risk of haematological malignancies.

Results: Five studies were included in our meta-analysis (three retrospective cohorts and two case-control studies) involving a total of 211,427 patients. The overall odds of developing HM were significantly higher in the clozapine group compared with the control group (OR=2.1, 95% CI, 1.39–3.18, p=0.00005, I2=83%). Sensitivity analysis was conducted, and heterogeneity was resolved by exclusion of the study by Brainerd et al. The overall effect after its exclusion suggested a significant increase in the odds of HM (OR=2.45, 95% CI, 1.75–3.43, p< 0.00001, I²=48%). Subgroup analysis showed that the odds of developing leukaemia (OR=4.02, 95% CI, 2.22–7.27, p<0.00001), and lymphoma (OR=6.27, 95% CI, 2.83–13.9, p<0.00001) were significantly higher than the combined risk for all HM. There was no significant association between clozapine and HM with a cumulative dose of <999 defined daily doses (DDD) (OR=1.11, 95% CI, 0.85–1.46, p=0.44) or 1000–2999 DDD (OR=1.34, 95% CI, 0.76–2.34, p=0.31). However, for patients with a cumulative dose of 3000–4999 DDD and >5000 DDD, the risk of HM was significantly higher in the clozapine group (OR=2.04, 95% CI, 1.46–2.86, p<0.0001), (OR=2.45, 95% CI, 1.32–4.48, p=0.004), respectively. The association between clozapine and haematological malignancies became statistically significant after 5 years of follow-up (OR=2.32, 95% CI, 1.5–3.59, p=0.0002).

Conclusion: Despite the increased risk of HM, clozapine treatment in schizophrenia patients is associated with a significantly lower long-term all-cause mortality rate compared with other antipsychotic use. The small risk should not deter its use or not fuel “clozapine-phobia”. The clinical implication of our study is to raise awareness among the psychiatrists about this risk. Haematological abnormalities could be interpreted as typical adverse effects of clozapine, leading to diagnostic bias and delays in malignancy diagnosis.

Aims: It has been shown that 5-hydroxytryptamine3 (5-HT3) receptors are involved in the pathogenesis of schizophrenia. This systematic review and meta-analysis of randomized clinical trials (RCTs) evaluates the efficacy and safety of ondansetron, a potent 5-HT3 receptor antagonist, as adjunctive treatment for the management of schizophrenia, especially the negative symptoms and cognitive deficits.

Methods: A comprehensive search of electronic databases, including PubMed, Scopus, Cochrane, and Web of Science, was performed in October 2024. We included only randomized controlled trials (RCTs), and their data were extracted and analysed using RevMan 5.4 software. The primary outcome was the PANSS (Positive and Negative Syndrome Scale) negative subscale.

Results: Eight RCTs involving 533 patients were included in the study. Ondansetron showed a statistically significant improvement in PANSS negative subscale at 12 weeks [pooled as mean difference, MD=−2.96, 95% CI [−4.69, −1.24], p=0.00007] and in general psychopathology scale [MD= −2.71, 95% CI [−3.52, −1.90]] compared with placebo. However, ondansetron and placebo did not differ in reduction of PANSS positive subscale [MD= 0.1, 95% CI [−1.19, 1.38], p=0.88], and depression scale (SMD= 0.71, 95% [−0.35, 1.77], p=0.19). Ondansetron showed no significant difference regarding tardive dyskinesia between the two groups. However, constipation was significant in the ondansetron group over placebo.

Conclusion: The study’s findings support the use of ondansetron as adjuvant therapy in the management of schizophrenia, particularly the negative symptoms and cognitive deficits.

Aims: Major depressive disorder (MDD) may be linked to broader pathophysiological pathways such as oxidative stress, inflammation, vascular dysfunction, and neuroplasticity alterations. Pentoxifylline (PTX), a pleiotropic drug, targets all these pathways through non-specific phosphodiesterase (PDE) inhibition. This is the first systematic review and meta-analysis to examine the role of PTX in major depressive disorder.

Methods: A comprehensive search of electronic databases, including PubMed, Scopus, Cochrane, and Web of Science, was performed in October 2024. We included only randomized controlled trials (RCTs), and their data were extracted and analysed using Reman 5.4 software. The inclusion criteria as follows: adult patients diagnosed with MDD were included as the population. The intervention considered was pentoxifylline, either alone or in combination with selective serotonin reuptake inhibitors. Comparators included placebo, either alone or combined with SSRIs. Eligible studies needed to report outcomes such as the Hamilton Depression Rating Scale (HAM-D).

Results: Four RCTs with 318 patients were included in the study. PTX showed a statistically significant improvement in HAM-D scores at the primary endpoint compared with the placebo (MD=−3.84, 95% CI [−4.87 to −2.81], p<0.00001). Moreover, PTX showed a statistically significant increase in serotonin and BDNF levels (MD=20.76 ng/mL, 95% CI [5.49 to 36.04], p=0.008; and MD=10.83 ng/mL, 95% CI [−0.22 to 21.88], p=0.05, respectively) and a statistically significant decrease in TNF-α and IL-6 levels (MD=−3.24 pg./mL, 95% CI [−4.12 to −2.36], p<0.00001; and MD=−2.64 pig/mL, 95% CI [−3.79 to −1.48], p<0.00001, respectively). There was no statistically significant difference between the PTX and placebo in any of the reported side effects including nausea, vomiting, headache, diarrhoea, increased appetite, and sexual dysfunction.

Conclusion: The study findings suggest that PTX may be effective and safe as an adjuvant antidepressant agent in patients with MDD, demonstrating a significant reduction in HAM-D scores. The results of this study need to be interpreted with caution considering several limitations.

Aims: It is estimated that the prevalence of obsessive-compulsive disorder (OCD) in the UK is 2–3%, with a lifetime prevalence of anxiety and/or depression being reportedly much higher (estimated at 20–25%). Prevalence rates within medical students have, however, been reported by numerous studies and systematic reviews to exceed those identified in the general population. The primary aim of the current pilot study was to investigate the efficacy of an Acceptance and Commitment Therapy (ACT)-based online intervention in reducing symptom severity within a sample of medical students screened for OCD, anxiety and depressive traits and symptoms. The hypothesis was that the ACT-based online intervention would reduce symptom severity in participants.

Methods: Participants were recruited from Cardiff University’s School of Medicine and were required to complete baseline screening measures for OCD, anxiety, and depressive traits using the Obsessive-Compulsive Inventory-Revised version (OCI-R), the State Trait Anxiety Inventory (STAI), and the Beck Depression Inventory-Revised version (BDI-II), respectively. A total of 11 medical students were recruited following screening and completed two parts of an online ACT-based intervention over a two-week period. Participants were required to complete the same measures post-intervention and were debriefed following their participation. Ethical approval for this study was provided by the university’s School of Medicine Research Ethics Committee.

Results: Data collated was analysed to measure for any differences pre and post intervention. A reduction in OCD symptom severity was reported, however with findings approaching significance (z=−1.362, p>0.05). A significant difference in pre and post intervention scores was not revealed for depressive traits, however a significant reduction in anxiety was revealed using the STAI measure pre and post intervention, (z=−2.59, p<0.01).

Conclusion: The findings of the current pilot highlight the efficacy of our ACT-based online intervention in significantly reducing anxiety in a cohort of medical students. Whilst a small sample was recruited for this pilot, the results warrant further investigation and consideration by university student services in adopting the intervention for students.

Aims: Withania somnifera widely known as “Ashwagandha”, is a key treatment herb in the Indian system of medicine that has been used for thousands of years. It has anti-inflammatory, neuroprotective, adaptogenic, and immunomodulatory activities.

Methods: From inception through September 8, 2024, we searched for randomized clinical trials investigating the effect of ashwagandha on adults. The literature search involved PubMed, Web of Science, Scopus, and Cochrane databases. We included all randomized controlled trials that met the following criteria: (1) conducted on adult participants with stress and/or anxiety; (2) investigated the effects of ashwagandha supplementation compared with a placebo or other active treatments; (3) reported outcomes using validated measures of stress and anxiety. Two reviewers independently extracted the relevant data from the included studies using an Excel sheet. The analysis was carried out using R (version 4.4.1) and the metafor package (version 4.6.0).

Results: A total of 15 studies were included with a combined sample size of 873 patients. We found that ashwagandha supplementation significantly reduced anxiety compared with placebo according to the Hamilton Anxiety Rating Scale (HAM-A) before μ =−1.55 (95% CI: −2.45 to −0.65, p=0.0007) and at 8 weeks of treatment μ=−3.52 (95% CI: −6.00 to −1.04, p=0.0053). It has also showed a signifacnt effect in reducing both stress (Perceived Stress Scale (PSS) μ=−4.88 (95% CI: −7.84 to −1.91, p=0.0013)) and cortisol levels μ=−2.3626 (95% CI: −3.2622 to −1.4629), p<0.0001) at 8 weeks of treatment. On the other hand, no improvement in the quality of life has been observed μ =−1.7618 (95% CI: −5.6118 to 2.0881, p=0.3698).

Conclusion: Ashwagandha supplementation is safe and effective in reducing stress and anxiety in adult patients. In our study, it resulted in a statistically significant reduction of cortisol levels, PSS scale, and HAM-A scale. However, it showed no statistically significant improvement in the quality of life of participants receiving it.

Aims: Sex and gender are critical determinants in the diagnosis, progression, and management of psychiatric conditions, influencing disease epidemiology, symptom presentation, treatment responses, and access to care. However, the extent to which these factors are systematically incorporated into UK psychiatric clinical guidelines has been unclear. To date, no review has assessed how sex and gender considerations are addressed in guidelines produced by the National Institute for Health and Care Excellence (NICE) or the Scottish Intercollegiate Guidelines Network (SIGN).

This study aimed to evaluate the extent of sex and gender integration within psychiatric guidelines. It is the first to systematically assess these dimensions across NICE’s “Mental health, behavioural, and neurodevelopmental conditions” category and SIGN’s “Mental health and behavioural conditions” category, which encompass psychiatric and related conditions.

Methods: A systematic review of all NICE and SIGN psychiatry guidelines was conducted to assess how sex and gender considerations were incorporated across key areas: epidemiology, clinical presentation, investigations, and management. The gender composition of guideline committee chairs was also evaluated. Psychiatry guidelines were ranked relative to other medical specialties to determine their comparative performance.

Results: This review identified significant gaps in the integration of sex and gender considerations across NICE and SIGN psychiatry guidelines. Across NICE psychiatry guidelines, only 72% referenced sex and/or gender, and just 28% addressed these factors beyond reproductive contexts. While differential disease management (52%) and epidemiology (28%) were the most frequently considered aspects, investigations (17%) and clinical presentation (7%) were rarely discussed.

Psychiatry ranked second among NICE specialty categories for integrating sex and gender considerations, and scored second-best for women committee chair representation. This is significant because guidelines chaired by women tended to incorporate sex and gender considerations more comprehensively than those chaired by men. Results from SIGN psychiatry guidelines demonstrated similar trends.

Thematic analysis revealed that NICE and SIGN psychiatry guidelines were more likely than other specialties to acknowledge gendered challenges in accessing care, caregiving roles, social support networks, and current evidence gaps.

Conclusion: As a specialty in which both biological and social determinants are central to diagnosis and treatment, psychiatry is well-positioned to lead improvements in sex and gender-sensitive clinical guidance. Despite psychiatry’s relatively strong performance compared with other specialties, significant gaps remain, particularly in differentiated clinical presentations. NICE and SIGN must establish robust mechanisms to embed sex and gender disaggregated evidence into guidelines. Psychiatrists have a critical opportunity to drive improvements to enhance equity and patient outcomes.

Aims: It is estimated that 1 in 100 individuals in the UK population are on the autistic spectrum. There is known to be a marked gender difference, with a male to female ratio of about 3:1. Previously, this diagnostic discrepancy was attributed to autism spectrum disorder (ASD) being known as a “male-dominant” condition, but in recent years this concept has been disproven and the prevalence of ASD in females is thought to be similar to that of males. This literature review aims to explore current research investigating the gender differences in the clinical presentation of ASD, and how this may contribute to the challenges many girls and women experience in receiving a timely diagnosis.

Methods: Three databases (PubMed, Scopus, and Medline) were searched for studies on the gender differences in the presentation of ASD in children and adolescents. In the screening process, an exclusion criterion was applied to the records according to relevance to the research question. The studies identified were then assessed for eligibility against a final inclusion criterion, resulting in six studies being included in the final review.

Results: Results showed that girls with ASD typically received a diagnosis at an older age than their male counterparts. Girls were also more likely to receive an alternative diagnosis to ASD, often mental health-related, before being given an ASD diagnosis. Repeated and Restricted Behaviours and Interests (RRBIs), which are considered as characteristic and often diagnostic features in ASD, were more prevalent in boys in early childhood. Girls with ASD often had to present with more severe deficits in intellectual ability (IQ), social and communicative skills, or speech and language skills, to be diagnosed with ASD in comparison with their male counterparts.

Conclusion: The studies included in this literature review demonstrated that, whilst in some cases differences in clinical presentation of ASD in boys and in girls may be mild, there are undoubtedly differences present. This is not surprising considering the heterogeneity of ASD as a spectrum disorder. Research investigating the various phenotypes of ASD is hugely beneficial in widening the perception from the traditional concept of ASD being viewed as a “male disorder”. There is a clear need for more research to be done to close the gender gap in the diagnosis of ASD and facilitate more timely diagnosis in girls and women and appropriate interventions at an earlier stage, thereby improving quality of life.

Aims: Schizophrenia affects approximately 20 million people worldwide, with 30% of cases being classified as treatment resistant schizophrenia (TRS) cases. Clozapine remains the gold standard for managing TRS, but around 40% of patients treated with clozapine fail to demonstrate optimal treatment response. This literature review aims to evaluate various augmentation strategies used to enhance clozapine’s effectiveness for TRS, assessing data from systematic reviews and meta-analyses published between 2010 and 2024, the aim of which is to identify whether there is a consensus surrounding augmentation strategies used, whilst simultaneously assessing the quality of the existing research, and recommending where further research could guide future clinical practice and prescribing in TRS.

Methods: A systematic search was conducted in February 2024 across Ovid and PubMed databases using the keywords “schizophrenia”, “clozapine”, and “augmentation”. Inclusion criteria were: studies focusing on clozapine augmentation with another pharmacological agent, systematic reviews or meta-analyses published between 2010 and 2024, and studies from credible peer-reviewed sources. Case reports, single-agent studies, and non-peer-reviewed sources were excluded. A total of 181 papers were screened and, after applying inclusion and exclusion criteria, three systematic reviews were selected for analysis. The quality of each study was assessed using the CASP checklist.

Results: Grover et al. (2022) concluded that augmentation with antipsychotics (specifically aripiprazole) and Electroconvulsive Therapy (ECT) provided the most promising results. Siskind et al. (2018) supported the use of aripiprazole, fluoxetine, sodium valproate, and memantine for overall psychosis symptoms, while memantine was highlighted for its use in negative symptoms of schizophrenia. Porcelli et al. (2011) emphasised that several strategies showed promise, but methodological limitations prevented firm recommendations being made. Aripiprazole and ECT were highlighted, but only tentatively given the sample sizes and potential biases. Across all reviews, aripiprazole was identified as an effective pharmacological augmentation agent option, with ECT also emerging as a beneficial adjunct. However, many trials were repeated across the reviews, which may introduce bias and skew conclusions, limiting their relevance within the broader treatment realms.

Conclusion: This review establishes a need for more rigorous longitudinal studies to determine the most effective augmentation strategies for clozapine in TRS patients. The evidence remains inconclusive due to methodological issues like small sample sizes and study heterogeneity. Future research should prioritise comparative efficacy trials, long-term follow-ups, and increased participant diversity – especially addressing under-representation of women in schizophrenia research. These efforts are essential to improving treatment outcomes for TRS patients who remain symptomatic despite being on clozapine.

Aims: Major depressive disorder (MDD) and treatment-resistant depression (TRD) are significant public health challenges that not only severely affect quality of life but also place a substantial burden on healthcare systems. Individuals with TRD are at an increased risk of suicide, making early intervention essential.

Two prominent neuromodulation treatments, electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), are commonly used in clinical practice. Despite numerous studies comparing these interventions, definitive conclusions regarding their relative efficacy in treating depression are still lacking. This systematic review aims to compare the antidepressive effects of ECT and TMS, as measured by the Hamilton Depression Rating Scale (HAM-D), whilst also evaluating their clinical feasibility, tolerability, and patient acceptability to guide evidence-based treatment decisions.

Methods: A systematic literature review was conducted using the PubMed and Scopus databases, using keywords “TMS AND depression”, “ECT AND depression”, and “TMS OR ECT AND depression”. Out of 170 initially retrieved articles, six studies met the inclusion criteria of directly comparing the effects of ECT and TMS in patients diagnosed with MDD or TRD. Three other studies were also included in the analysis for their valuable insights on related outcomes.

Results: The findings suggest that ECT has a superior short-term antidepressive effect compared with TMS. Specifically, ECT achieved a response rate of 64.4% and remission rate of 53%, whereas high frequency rTMS (HFrTMS) yielded response and remission rates of 48.7% and 32.2%, respectively. Low frequency rTMS (LFrTMS) demonstrated a notably lower response rate of 20%. In cases of psychotic depression, ECT led to a 58.8% reduction in HAM-D scores, whilst TMS produced a 38% reduction. However, bilateral rTMS (BL-rTMS) emerged as a promising option, offering moderate efficacy alongside superior tolerability and lower dropout rates.

Conclusion: Whilst ECT remains the most effective short-term treatment for depression, its need for general anaesthesia and seizure induction may limit its acceptability. Despite being considered safe and effective by many psychiatrists, the stigma surrounding ECT creates a potential barrier to its widespread acceptance. TMS, particularly BL-rTMS, presents a less invasive alternative with better tolerability, making it a potentially reasonable option for patients and clinicians. These findings highlight the importance of personalised treatment plans that consider clinical severity, patient preference, and available resources. Future longitudinal studies are needed to assess long-term outcomes and adverse effects, such as the mild memory loss associated with ECT in the long term, to further refine the role of these neuromodulation therapies in managing MDD and TRD.

Aims: This study aimed to assess help-seeking intentions for personal and emotional problems, suicidal thoughts, and sources of help, and to evaluate perceived stigma about psychological treatment among participants.

Methods: This cross-sectional study was conducted in December 2022. A total of 101 participants filled out an online survey through interviews. The questionnaire is composed of sociodemographic characteristics; 14 items of a structured standardized questionnaire of general help-seeking behaviour using the General Help-Seeking Questionnaire (GHSQ) and Stigma scale for receiving psychological help (SSRPH).

Results: The majority of the participants were above 30 years (70.3%). The level of stigma was predominantly low (58%) and high stigma was at 24%. The majority of the participants experienced suicidal thoughts (68%) and mostly were males. Most of the participants preferred to seek help from a mental health professional (M=5, SE=0.26) followed by their partner (M=4.5, SE=0.26) then parents and family members (M=4.4, SE=0.25).

Conclusion: Stigma has a significant impact on the people of Sudan, affecting individual behaviours and creating barriers for others. Recommendations include focusing on mental health advocacy, reaching out to individuals with suicidal thoughts, and providing mental health services in rural areas, particularly in Al-Karad village.

Aims: To determine the prevalence of psychological distress among Sudanese medical students and its association with their sociodemographic characteristics.

Methods: In this cross-sectional study, 353 Sudanese medical students completed an online questionnaire containing socio-demographic data such as gender, age, year of study, marital status, monthly income, and residency. Additionally, the Depression, Anxiety, and Stress Scale-21 (DASS-21) items were employed to gauge the levels of psychological distress among the participants and to explore the association with the demographic data. Utilizing the Pearson chi-square test, the analysis delved into the associations between socio-demographics data and psychological distress.

Results: Anxiety was the most prevalent psychological distress among medical students, as 76.8% of them exhibited anxiety symptoms. This was followed by depression, with a prevalence of 70.2%, and 56.7% of the students reported suffering from stress. The study found significant associations between depression and stress with age and gender, as well as a significant association of anxiety with age.

Conclusion: A considerable number of medical students are experiencing psychological distress. It is recommended to implement intervention programmes to educate Sudanese medical students about mental health issues and psychological distress.

Aims: This study aimed to assess the knowledge and awareness of ADHD among medical students at a Sudanese university.

Methods: This cross-sectional study was conducted at Ahfad University for Women (AUW) from December 2019 to February 2020. A self-administered questionnaire was distributed to 212 female medical students in their fifth and sixth years to assess their knowledge and awareness of ADHD.

Results: Out of the 212 students approached, 131 (61.8%) completed the questionnaire. Participants’ ages ranged from 23–25 years. Most students (64.2%, n=82) were familiar with ADHD through their medical curriculum. While 71.3% (n=93) correctly identified key symptoms of ADHD, only 32.6% (n=43) were aware of evidence-based management strategies. Additionally, 62.3% (n=82) expressed dissatisfaction with the amount of information provided in their psychiatry courses.

Conclusion: This study highlights a significant knowledge gap among medical students regarding ADHD, particularly in evidence-based management. The findings underscore the need for improvements in the psychiatry curriculum at Ahfad University for Women to better equip future doctors to address ADHD in clinical practice.

Aims: This study aimed to assess the different dimensions of quality of life in children with type one diabetes including physical, social, emotional, and school function. Also, to identify the relationship between the quality of life and demography, duration of illness, and control of diabetes

Methods: The participants were selected randomly from the biggest two paediatric hospitals in Khartoum. The child and their parent or legal guardian were interviewed face-to-face. Descriptive statistics were employed to evaluate quality of life (QoL) using the Short Form-12 scale (SF-12). The Pearson correlation test was utilized to examine the relationship between QoL and various independent variables, including demographic factors (age, gender, parents’ education, residency, and occupation of both parents), family income, duration of illness, and diabetes control.

Results: Most participants were aged 13–18 years (63.8%), with 55.1% identifying as female. Most fathers had completed secondary education (36.2%), while a similar percentage of mothers had completed primary education (36.2%). Additionally, a significant proportion of fathers were self-employed (69.6%), whereas most mothers were unemployed (66.7%). Family income was reported to be less than 50,000 per month for 46.6% of families. A significant association was identified between QoL scores and gender, father’s occupation, and family income (p<0.005). Lower QoL scores were prevalent among 61% of participants. A notable correlation was also found between QoL and the promotion of exercise (p=0.002).

Conclusion: The study highlights a reduction in the social and emotional functioning of health-related quality of life (HrQoL) among children and adolescents. It concludes that the father’s occupation and monthly income are significant predictors of improved HrQoL, alongside exercise promotion. Additionally, female gender emerged as a predictor of lower HrQoL scores.

Aims: Dementia, including Alzheimer’s disease and other forms of cognitive impairment, often goes undiagnosed due to demographic, societal, and healthcare factors. Addressing these challenges is essential to enhance early diagnosis, improve patient outcomes, and reduce the societal and economic burden of dementia. This scoping review explores the prevalence, barriers, impacts, diagnostic tools, and interventions associated with undiagnosed dementia, identifying knowledge gaps and providing recommendations for research, clinical practice, and policy development.

Methods: Following PRISMA Extension for Scoping Reviews, an extensive search was done through PubMed, Scopus, Web of Science, Science Direct and CINAHL. The inclusion criteria in this study were studies published in English, on human subjects, and where undiagnosed dementia has been explicitly discussed within the context of the research questions. Studies were excluded if they related only to diagnosed dementia or other cognitive impairments without any implications for the undiagnosed part. From 235 studies, 119 duplicates were removed, and 25 studies met the inclusion criteria.

Results: The review identified five key themes: (1) Prevalence and Demographics of Undiagnosed Dementia: Prevalence rates varied widely across populations, influenced by factors such as age, gender, socioeconomic status, and ethnicity. Undiagnosed dementia was more common in rural areas and low-income settings, with older age and lower education as significant risk factors. (2) Barriers to Diagnosis and Recognition: Key barriers included societal stigma, cultural beliefs normalizing cognitive decline, limited healthcare access, and inconsistencies in diagnostic practices. (3) Impact on Patients and Caregivers: Undiagnosed dementia caused psychological, physical, and economic strain on patients and caregivers, exacerbated by delays in accessing treatment and support services. (4) Screening and Diagnostic Tools: Tools like MMSE, MoCA, and emerging technologies such as AI and electronic health records (EHRs) showed promise but faced challenges related to accuracy, cultural adaptation, and implementation. (5) Interventions and Recommendations: Proposed solutions included public health campaigns, standardized screening protocols, culturally sensitive tools, multidisciplinary care approaches, and policy reforms to improve early diagnosis and equitable access to dementia care.

Conclusion: This scoping review provides a comprehensive overview of the existing literature on undiagnosed dementia, highlighting that its prevalence varies across different populations. Interventions are needed to reduce diagnostic delays and improve early diagnosis, particularly among high-risk individuals in the community. Additionally, further research is required to develop and validate culturally sensitive diagnostic tools and screening protocols tailored to diverse populations.

Aims: This study aimed to identify the prevalence of post-traumatic stress disorder (PTSD) and to assess coping strategies among Sudanese individuals. Also, to evaluate the relationship between PTSD and coping mechanisms with sociodemographic characteristics.

Methods: This study utilized a cross-sectional design to assess PTSD and coping strategies in 716 Sudanese adults affected by war, selected through convenience sampling. Participants completed a Google Form questionnaire that included sociodemographic data, the PTSD Checklist for DSM–5 (PCL-5), and a coping scale. The analysis was conducted using SPSS software version 26, applying various statistical tests to evaluate relationships and differences.

Results: The findings revealed that nearly 43% of the sample met the criteria for a potential diagnosis of PTSD. About 69% of participants were female, with a median age of 23 years. Most participants were single (81%) and had been externally displaced (51%). Coping strategies varied among the participants: 34% focused on improving their habits, while others used reflective approaches (36%), sought positive perspectives (30%), employed humour (21%), or chose to wait for problems to resolve on their own (17%). Family income was significantly associated with PTSD symptoms (p=0.020). Participants with higher PTSD symptoms exhibited lower coping effectiveness, and both age and marital status significantly influenced coping mechanisms (p=0.027 and 0.037, respectively). Those who had been living in conflict zones for over six months reported the highest coping scores.

Conclusion: Our findings confirmed a high level of PTSD symptoms among the participants. Duration of residency in the conflict zone impacted the coping adopted and income played a crucial role in developing PTSD. This study underscores the need for urgent specific psychological support for individuals affected by the conflict. Further research is required to foster mental well-being, and put more attention to this issue.

Aims: Major Depressive Disorder (MDD) is a leading global health concern, significantly impacting quality of life. Conventional treatments like antidepressants are effective but not universally successful, prompting interest in adjunctive therapies. Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are thought to offer neuroprotective and anti-inflammatory benefits that may help manage MDD. This systematic review and meta-analysis assessed the efficacy of omega-3 supplementation in reducing depressive symptoms, improving remission rates, and enhancing overall treatment outcomes in adults with MDD.

Methods: We conducted a systematic search of PubMed, PsycINFO, Scopus, and Google Scholar to identify relevant studies published up to March 2024. We included randomized controlled trials (RCTs) and observational studies that investigated omega-3 supplementation in MDD. Studies were selected based on their focus on depressive symptom reduction, remission rates, or relapse prevention. Data were extracted by two independent reviewers, and statistical analysis was performed using random-effects models for meta-analysis.

Results: Twenty studies, including 15 RCTs and 5 observational studies with 2,300 participants, met inclusion criteria. Omega-3 supplementation significantly reduced depressive symptoms compared with placebo, with a pooled effect size of Hedge’s g = −0.45 (p<0.01). The most pronounced effects were observed in individuals with moderate-to-severe depressive symptoms. Subgroup analysis revealed that EPA supplementation was more effective when combined with antidepressants. Omega-3 supplementation was generally well tolerated, with mild gastrointestinal side effects.

Conclusion: Omega-3 supplementation, particularly EPA and DHA, is effective in reducing depressive symptoms in adults with MDD. Its favourable safety profile makes it a promising adjunctive treatment, especially for patients who do not respond fully to antidepressants. Further research is needed to optimize dosage and identify patient characteristics that predict the best outcomes.

Aims: Schizophrenia is a psychiatric disorder characterized by diverse clinical presentations, posing challenges in early diagnosis and prognosis. Machine learning (ML) has emerged as a promising tool to enhance diagnostic accuracy, predict disease progression, and personalize treatment strategies. This systematic review and meta-analysis synthesized current evidence on the application of ML in schizophrenia diagnosis, prognosis, and treatment response prediction.

Methods: A search was conducted across databases including PubMed, Embase, Scopus, Web of Science, and IEEE Xplore, adhering to PRISMA guidelines. Studies employing ML algorithms for schizophrenia classification, risk prediction, or treatment response modelling were included. Extracted data encompassed ML model types, sample sizes, data modalities (e.g., neuroimaging, clinical, genetic), and performance metrics such as accuracy, sensitivity, specificity, and area under the curve (AUC). A meta-analysis was performed to estimate pooled diagnostic performance, with heterogeneity assessed using I² statistics and publication bias evaluated via funnel plots and Egger’s test.

Results: A total of 31 studies involving task-based functional MRI (t-fMRI) data were included in the meta-analysis. The pooled sensitivity and specificity for ML-based schizophrenia classification were both 0.83 (95% CI: 0.78–0.88), indicating a high level of diagnostic accuracy. Notably, studies focusing on selective attention tasks demonstrated higher specificity (0.86) compared with those assessing working memory tasks (0.79). Significant heterogeneity (I² = 72%) was observed, attributable to variations in neuropsychological domains, participant demographics, and clinical features.

Conclusion: Machine learning exhibits substantial potential in improving schizophrenia diagnosis and outcome prediction, particularly when utilizing task-based neuroimaging data. However, challenges related to data heterogeneity, external validation, and clinical implementation persist. Future research should focus on standardizing ML methodologies, integrating multi-modal data, and enhancing model interpretability to facilitate translation into clinical psychiatry.

Aims: In the medical field, there is a growing emphasis on fostering creativity and innovation in medical students to prepare them for the unpredictable nature of patient care. This study aimed to explore the perspectives of both lecturers and medical students on the current teaching practices and their influence on the development of creative thinking skills.

Methods: The study was conducted as qualitative research at the Malaysian Faculty of Medicine and Health Sciences and included a purposeful sample of eight medical students and seven lecturers. Data were gathered through individual semi-structured interviews held via the Google Meet platform and analysed using a thematic analysis approach.

Results: The findings indicate that learner-centred approaches, such as problem-solving exercises and group discussions, seminars, debates, and dramas have a positive impact on enhancing their creative thinking abilities. The use of technology-assisted teaching methods, including e-learning and simulation labs, was also perceived as inspiring, however, limitations in technical infrastructure were noted. Challenging activities like assignments, games, competitions, and online tests encourage creative learning. Hands-on activities, such as bedside teaching and clinical skill learning, are also valuable in learning clinical skills in unique ways, but their effectiveness could be reduced by environmental and personal factors. Furthermore, practicing para-curriculum activities in a supportive and relaxed learning environment was identified as fostering a culture of original thought.

Conclusion: This study suggests that a comprehensive approach to medical education that integrates creative pedagogy can be instrumental in fostering creativity in medical students. Providing opportunities for creative thinking through workshops and addressing technical infrastructure limitations in technology-assisted teaching methods could be considered in enhancing the creative curricula in the South East region. The findings underline the importance of a learner-centred approach and a supportive learning atmosphere in promoting creative learning.

Aims: To identify the difficulties International Medical Graduate (IMG) doctors face when starting their first job in the UK.

Methods: A survey was created on Google Forms. It included questions about the basic demographic of the IMG doctor, their experience of getting support and the difficulties they faced when they first started working in the UK. The survey had a mixture of tick boxes and free text options. The survey was distributed using social media forums and shared across IMG doctors’ social media groups. The survey link was open from December 18 to December 31, 2024. We received a total of 367 responses and 300 relevant responses were analysed, they represent the IMG doctors currently working in the UK and starting in the last 3 years.

Results: The 61% (185) responders were females, 35% (107) were male and the rest did not disclose their gender. Around 50% (148) were in their first year of job in the NHS while the rest were within 3 years of working in the UK. Only 7% (23) started their first job in the UK on a training grade whereas the rest had their first job as non-training grade or locally employed doctors.

76% (228) reported that they received shadowing periods as part of their first job experience and 70% (200) reported getting formal induction when they first started. 46% (125) were given access to the portfolio and 49% (134) had access to the study budget. 40% (122) did not feel they had enough senior support when they first started working in the UK. The free text boxes asked for suggestions around how the experience of IMG doctors can be improved in the UK and the responses indicated better induction as the most important factor.

Conclusion: The unique learning needs of the IMG doctors should be identified, and support systems should be in place accordingly. An IMG doctor-focused and tailored induction is required for the newly starting doctors. The shadowing period can also be a particularly useful tool in helping people understand the new systems and improve their confidence, but it is not offered to all new doctors.

Some IMG doctors may require enhanced supervision during the initial months, this can be delivered by peer and senior support. IMG doctors should feel welcomed in the new team as it helps to build psychological safety which can help to improve their performance.

Aims: This study aims to report the outcomes of mental health (MH) camps organized at various locations on a voluntary basis in District Tharparkar, an underserved area in the Sindh province of Pakistan. The camps aimed to screen, assess, educate, and treat patients with MH disorders. The study also reported the distribution of prevalent MH conditions in the Tharparkar area, barriers to attaining MH, and a possible solution to the MH professional shortage in remote areas.

Background: Mental disorders have become increasingly prevalent in Pakistan, affecting millions of people while there is a significant shortage of MH practitioners. MH camps play a crucial role in increasing awareness among the general population, reducing the stigma associated with MH conditions and offering an opportunity for the underserved population to approach MH professionals. Nonetheless, a more permanent solution is needed to address the needs of the patients in underserved remote communities.

Methods: A pre-structured Case Report Form was prepared to document the baseline characteristics, including family income, distance from a psychiatrist, duration of illness, perception regarding patients’ illnesses, healthcare visits in the last 6 months, and diagnosis of the patients.

Results: In 2022, a total of 460 patients were screened, and 164 (35.6%) were diagnosed with or considered for MH disorder. Out of these 164 patients, the mean age was 29.44 years (1–76). There were 94 (57.3%) males and 70 (42.7%) females. The average household income was PKR 25,758 (<£100), and the mean distance to a psychiatrist was 99 minutes, whereas the mean duration of presenting illness was 4.36 months. Depression was the most common illness reported (32%), followed by anxiety disorders (12%), psychotic disorders (9%), substance use (3%), and bipolar disorder (2%). Other mental health disorders were found in 28% of patients, and in 14%, diagnosis was not established.

Conclusion: More than half of patients sought help from a general practitioner in the last 6 months with the presenting complaints. The distance from the psychiatrist who serves as the primary care provider for MH needs in Pakistan and financial constraints are additional barriers for individuals residing in Tharparkar to attain help for MH needs. Therefore, task-shifting to general physicians (GPs) and incorporating MH into the primary care system could solve MH professionals’ deficiencies in remote areas. In light of the findings, it was recommended to initiate capacity-building sessions for the GPs in Sindh to train and educate them regarding the MH needs of their target population.