Aims: The objective of this study was to investigate the effects of group arts therapy based on emotion management training on emotional expression, positive and negative emotion, alexithymia, depression and quality of life patients with schizophrenia.

Methods: 24 patients of 160 inpatients with schizophrenia from H Mental Health Care Facilities in G city were randomly assigned to either an experimental or control group. Each group were consist of 12 patients. Group arts therapy was conducted on the experimental group twice a week, 60 minutes per session, for a total of 16 sessions. The following scales were used for assessment: Berkeley Expressivity Questionnaire (BEQ), Positive Affect and Negative Affect Schedule (PANAS), Toronto Alexithymia Scale (TAS-20K), Depression Scale for Schizophrenia (K-CDSS), and Schizophrenia Quality of Life Scale (SQLS). Repeated measures ANOVA was conducted to confirm the differences for scores of each scales regarding groups, measuring timing, and also the interaction between groups and measuring timing.

Results: Group arts therapy increased emotional expression (total score, expressivity and impulse strength subscale socre of BEQ) in experimental group compared with control group (p<.001). Group arts therapy increased positive emotion (p<0.001) as well as decreased negative emotion (p<0.05) in experimental group compared with the control group. Group arts therapy increased score of difficulty identifying feelings of TAS-20 (p<0.01) in experimental group compared with the control group. Group arts therapy decreased depression (p<0.01) in experimental group compared with the control group. Group arts therapy increased quality of life (p<0.01) in experimental group compared with the control group.

Conclusion: The group arts therapy significantly improved the emotional expression and positive emotion, and decreased negative emotion, alexithymia and depression in patients with schizophrenia and also improved quality of life. These results suggest that group arts therapy based on emotion management training could be a useful intervention for emotional disturbance in patients with schizophrenia.

Aims: To assess the impact of newly implemented guidelines on the prescribing practices of valproate products in a clinical setting. Specifically, comparing the proportions of inpatients over 65 on valproate before and after the new guidelines were implemented in January 2024.

Methods: This was a retrospective comparative study involving 2 patient cohorts admitted on the older adults ward at the North Staffordshire Combined Healthcare NHS Trust in Stoke-On-Trent, Staffordshire. Cohort 1: 30 patients who were admitted from October to December 2023 (approximately 1 month prior to implementation of new guidelines). Cohort 2: 30 patients who were admitted from July to September 2024 (approximately 6 months after implementation of new guidelines). Statistical significance between the 2 groups was determined using the Chi-square test.

Results: A notable decrease (16.7% to 6.7%) was observed in the percentage of patients who were admitted on valproate after the new guidelines were implemented (2 out of 30) as compared with the group admitted prior to their implementation (5 out of 30). However, based on a Chi- square test, the proportion of patients prescribed sodium valproate before and after the implementation of new guidelines is not statistically significant in this study. This reduction may suggest that, although, not yet statistically significant, the new guidelines are influencing prescribing practices regarding valproate products.

Conclusion: Although not statistically significant in this study, these findings suggest that there may be a trend toward reduced prescribing of valproate products after the introduction of these new treatment guidelines. This trend could be attributed to increased awareness among healthcare providers regarding the risks associated with valproate products. However, this study was limited by its sample size, scope and age group of participants, therefore, further research is warranted to explore more extensive datasets and longer follow-up periods. Such studies would provide a clearer understanding of the long-term influence of implementing these new guidelines on prescribing practices and patient safety.

Aims: Dementia is a pressing global health challenge affecting more than 50 million people worldwide with a net impact on the global economy of 1 trillion USD. One aspect of the condition is the potential for deterioration to the point where a crisis situation occurs requiring emergency intense psychiatric support, either in the form of intense community care or admission to an inpatient facility. Such care is only needed for a minority of patients. If patients can be identified at the point of diagnosis, it raises the potential for stratified care pathways for those at highest risk with the aim of improving outcomes. Our previous work from two United Kingdom sites found that younger, male patients, and those with impaired cognition were at risk of deteriorating. In this study, we aimed to create mathematical models of risk and use the results to develop a mobile application that is ready for clinical use.

Methods: Using on our retrospective cohort study (n=253,260) we have identified several epidemiological, and behavioural factors that showed the highest association with subsequent need for enhanced care. The top 10 variables were selected using dominance analysis and systematic regression in Cambridgeshire and the models externally validated in a second data set from London. The same threshold was used for classifying patients into the high and low risk groups as in our previous retrospective study.

Results: The top predictive variables in Cambridgeshire were age (OR: 0.97, p<0.001), gender (OR: 1.74, p<0.001), marital status (OR: 1.34, p<0.05), dementia subtype (OR<0.61, p<0.05), and the following 6 Health of the Nation Outcome Score (HoNOS) subcategories: behaviour (OR: 1.43, p<0.001), hallucinations (OR: 1.20, p<0.05), cognitive (OR: 1.19, p<0.05), disability (OR: 0.79, p<0.001), other mental and behavioural problems (OR: 1.23, p<0.01) and relationships (OR: 1.26, p<0.01). The AUC was 0.74–0.79 for 1–4 years after diagnosis in Cambridgeshire with a similar AUC of 0.74 in the validation dataset in London. The resulting PREDICDEM app is a tool which can be used to stratify people in terms of risk at the point of dementia diagnosis.

Conclusion: We have used routinely collected clinical data to model risk of needing enhanced care in dementia. This data can be incorporated into models of risk prediction and into a smartphone app. This will allow stratification of patients at the time of diagnosis and facilitate trials of interventions to decrease the risk of crisis events.

Aims: The UK Biobank is a large-scale prospective cohort study with data collected on over 500,000 individuals within the United Kingdom. We sought to understand whether the years around the menopause are associated with an increased likelihood of depressive symptoms, using the PHQ-2 questionnaire, which screens for depressive disorders. A score of 3 or above is suggestive of a depressive disorder. Our analysis looked at the likelihood of having significant depressive symptoms in the years before and after the final menstrual period.

Methods: Exclusion criteria included male participants, participants who had bilateral oophorectomies, those who were unsure of when their FMP was due to having a hysterectomy, those whose age at final menstrual period was under 40 or preferred not to say, and those whose reported age at final menstrual period differed by >2 years when asked on different occasions. Participants who did not give an answer to either of the two screening questions were also excluded.

The PHQ-2 enquires about depressive mood and anhedonia over the prior two weeks at baseline assessment. Possible answers were not at all, several days, more than half the days, and nearly every day. Using logistic regression, odds ratios were calculated for likelihood of having a PHQ-2 score above 3 from 9 years prior to the final menstrual period to 9 years after, compared with the year of the final menstrual period.

Results: In females undergoing natural menopause (n=143,685) those assessed who were within a year of their final menstrual period had the highest rate of depressive symptoms. 7.6% of women within a year of their final menstrual period had a PHQ-2 score of 3 or more. Depressive symptoms at all other timepoints were less frequent, ranging from 3.9% to 7.1%, with the OR compared with year of final menstrual period ranging between 0.49 to 0.93. In the 2 years either side of the final menstrual period, depressive symptoms were not significantly lower than the year of the final menstrual period, particularly at 2 years prior (6.0%, OR 0.77 (95% CI (0.58, 1.02)), one year post (6.9%, OR 0.90 (95% CI (0.78, 1.05)) and 2 years post (7.1%, OR 0.93 (95% CI (0.80, 1.08)).

Conclusion: These results suggest that the proportion of women experiencing significant depressive symptoms increases in the years around the final menstrual period. There is an increased likelihood of significant depressive symptoms in the year of the final menstrual period compared with surrounding years.

Aims: In adult humans, WM-related EEG theta dynamics are hypothesized to reflect involvement of prefrontal-hippocampal theta-rhythms in the integration of working-memory associations into unitary coherent memory representations accessible for selection during memory retrieval. Therefore, medial temporal lobe (MTL) theta oscillations are hypothesized to drive the retention of novel verbal WM associations in humans. Several studies in adult samples reported an increase in theta activity during the WM retention delay. However, the impact of ageing on fronto-temporal power during verbal WM tasks (associated with MTL network plasticity), and on WM performance differences between younger age groups versus older people needs to be further examined. Thus, we aimed to show a significant relationship between theta activity and WM across the lifespan, and to suggest novel diagnostic markers sensitive to early WM memory impairment associated with ageing and prodromal stages of Alzheimer’s disease (AD). Thus, increased theta power, which is required to maintain verbal information under different WM loads is predicted to be lower in older adults versus younger adults, specifically, under lateral fronto-temporal-parietal electrode locations, and during verbal WM retention intervals.

Methods: The current investigation examined EEG theta power dynamics in older people (ages 55–84) versus younger people (ages 18–36 years) during verbal working memory task intervals at lateral temporal cortex locations and frontal cortex locations according to the international EEG 10–20 system. All participant were in healthy condition without psychiatric or neurological history.

Results: Age was significantly related to verbal WM performance (accuracy and RTs) and to right temporal theta power during WM retention intervals. In accordance, as we age, our right temporal theta activity decreases during WM retention intervals. Importantly, mean theta power during WM retention periods significantly distinguished the young sample from the older sample. All other frontal or parietal theta activity was not related to age, and the effects of age were only detected during the retention intervals occurring during the verbal WM task.

Conclusion: If investigated and validated further in MCI and AD patients, excessive left-temporal power in older people with WM impairments observed in mild cognitive impairment (MCI) patients versus healthy controls may represent insufficient neural excitability in global frontal-parietal-MTL networks to sustain verbal memory storage and retrieval functions in aging individuals. Thus, we suggest that future studies on noting left-prefrontal excessive frontal alpha and left-temporal theta activity during routine medical procedures in older people as a biomarker of white matter deterioration (e.g., related to impairments in long-range interhemispheric connectivity) within these networks, also known to precede Alzheimer’s disease (AD). Replicating these findings in larger elderly populations versus AD patients longitudinally, may facilitate EEG-based early detection of AD, as well as facilitate early preventive noninvasive brain-stimulation interventions targeting the right temporal cortex to enhance verbal WM functioning in older people displaying early MCI symptoms, and possibly delay the onset of more pervasive dementia (AD) symptoms.

Aims: Over a six-month period the Great North Children’s Hospital saw more than 150 children presenting with self-harm, suicidal ideation and/or suicide attempts. It is recognised that early identification reduces incidence of self-harm and suicide in children and young people, but how can these patients be identified? The aim of this study was to perform a retrospective review concentrating on who attends (sex, age, looked after child status) and where patients are presenting from in comparison to areas of deprivation across the region.

Methods: A data search performed on all patients attending Paediatric Emergency at the Great North Children’s Hospital with a coding of 'suicidal', 'self-harm', 'intoxicated’ and 'overdose’ returned 271 presentations. Patients were reviewed on a case-by-case basis and removed if deemed to be not meeting criteria (e.g. accidental overdose, no evidence of intent throughout the triage process). Following review, 199 presentations remained of which, taking into account repeat presentations, a total of 158 patients were included in this study. Details for each patient including age, sex, number of presentations in a six-month period, looked after child status, and patient postcodes were recorded.

Results: Of the 158 patients assessed the most common presentations were of females aged between 13 and 15 years (58%). 16% of patients were looked after children. Patient postcodes were used to generate a heat map which was then compared with mapping of deprivation across the city of Newcastle-upon-Tyne in the North East of England. This map revealed increased presentations to ED with self-harm, suicidal ideation and suicide attempts amongst patients living in deprived areas.

Conclusion: Early identification has been recognised as being effective in preventing self-harm and suicide in children and young people. This study has identified potential key demographics that may be at increased risk: females between the age of 13–15; those who are looked after children; and those from deprived areas. Having identified these at risk-groups further research is warranted to investigate how early help offered to these groups compares with the wider background demographic in order to ascertain whether there is any discrepancy that could be addressed with targeted interventions.

Aims: Large-scale neuroimaging projects rely on automated pipelines to reconstruct white matter tracts from diffusion MRI (dMRI) data. However, these reconstructions are not always accurate and often require labour-intensive manual review to identify artefacts. To address this challenge and extend the reach of science engagement beyond traditionally accessible groups, we developed NeuroSwipe: a web-based platform designed to involve the public in evaluating the quality of dMRI data. This initiative also aimed to enhance participants’ understanding of brain imaging techniques and the scientific process, fostering broader public involvement in research.

Methods: The initial concept was developed by a multidisciplinary team of computational neuroscientists, physicists, science engagement specialists, and clinical researchers. The NeuroSwipe prototype was created by students at the National Software Academy, Cardiff University, and co-designed with ten citizen scientists during a co-production workshop held at the Cardiff University Brain Research Imaging Centre (CUBRIC). The platform included a short interactive training module to guide participants. Users were tasked with approving or rejecting anonymised dMRI images based on their quality. To ensure diverse participation, we partnered with Diverse Cymru, a charity that facilitated engagement with BAME and traditionally harder-to-reach populations. User decisions were recorded and compared with expert classifications. A post-test questionnaire assessed usability, knowledge gains, and engagement.

Results: A total of 89 individuals, identified through community organisations, tested the NeuroSwipe platform over three months. Of these, 82 completed the training module before rating images. Classifications by citizen scientists showed high consistency with expert evaluations, with no significant differences observed. Post-test feedback indicated that 72% of participants found the platform ‘easy’ or ‘very easy’ to use, and 63% thought the training module provided ‘about the right amount of information’, although 9% felt it was insufficient. Importantly, 92% described the platform as ‘engaging’ or ‘informative.’ Free-text comments revealed increased understanding of brain imaging techniques and a sense of contribution to scientific research. The project was later publicised by BBC News and Wales Online, further amplifying its reach.

Conclusion: This project highlights the potential of engaging citizen scientists in neuroimaging research through a web-based platform like NeuroSwipe. The findings demonstrate that citizen scientists can meaningfully contribute to assessing dMRI data quality while enhancing their understanding of brain imaging research. Future developments could include scaling the platform to incorporate other imaging modalities and integrating more advanced training modules to further expand public participation in neuroimaging research.

Aims: Burnout among healthcare workers has been a significant issue exacerbated by the COVID-19 pandemic. This review aims to synthesise the existing literature on the prevalence, signs, symptoms, and risk factors of burnout among healthcare workers during the pandemic.

Methods: This systematic review follows the PRISMA guidelines. We searched the Web of Science and Scopus for relevant studies published between January 2020 and December 2022. Inclusion criteria were studies reporting burnout prevalence among healthcare workers during the COVID-19 pandemic. Data were extracted and analysed using a structured framework

Results: The review included 50 studies, with a total sample size of 30,000 healthcare workers. Prevalence of burnout varied significantly across regions, with the highest rates reported in Saudi Arabia (75%) and Kuwait (76.9%). Common symptoms included emotional exhaustion, depersonalisation, and reduced personal accomplishment. Key risk factors identified were high work demands, lack of personal protective equipment (PPE), and prolonged working hours.

Conclusion: The COVID-19 pandemic has significantly impacted the mental health of healthcare workers, leading to high burnout rates. Tailored interventions are needed to address this issue and support healthcare workers during global health emergencies.

Aims: The study evaluates the use of transcranial direct current stimulation (tDCS) via a portable device, called Flow FL-100, within Community Mental Health Services (CMHT) for patients with depression. This service targets individuals who either did not benefit from medication or sought alternatives to it.

Flow is a tDCS treatment for depression that patients can use at home. It is safe, well-tolerated, and free from the side effects commonly associated with antidepressants. Backed by over 30 years of research, tDCS has shown significant improvements in depressive symptoms, with high clinical response rates. Recent studies show remission rates of up to 45% with Flow. The treatment is CE-marked for use in Europe, and a recent NICE briefing (2023) highlights its efficacy and safety. The evaluation also references positive results from randomised controlled trials (RCTs), showing Flow leads to better outcomes than placebo stimulation.

Methods: This service evaluation assessed the use of tDCS for treating depression in Community Mental Health Teams (CMHT) for patients who hadn’t responded well to medication or wanted an alternative. After a clinical interview and assessment, eligible patients were offered the treatment. Outcome data was collected at baseline and again after 6 weeks, using the Montgomery– Åsberg Depression Rating Scale (MADRS). The treatment involved patients self-administering tDCS for 30 minutes, five times a week for three weeks, then three times a week for three more weeks, with option of continuing as needed. The “Flow” system also includes a lifestyle training app and symptom tracking, allowing patients and clinicians to monitor progress online.

The study used an open-label design without a control group, with 20 participants (12 males, 8 females), of whom 16 shared their progress on the online platform and were included in the analysis.

Results: We analysed 16 data sets, which showed the following Results: the average MADRS score at the initial assessment was 32. By week 6, 82% (12/16) of participants had improved on the MADRS scale, with 44% (7/16) demonstrating clinically significant improvement, marked by a reduction of more than 25% in their MADRS score.

Conclusion: These results indicate that tDCS portable device “Flow” treatment is a promising and valuable intervention for treating depression in adults in CMHT service.

Aims: This research aims to investigate whether there is a significant correlation between head injuries and the development of violent, repetitive criminal behaviours, particularly serial killers. Examining the neurological and psychological factors associated with head injuries. This study seeks to understand better their influence on criminal tendencies and patterns of behaviour.

Methods: 1. Neuroimaging: This showed reduced amygdala and frontal cortex interconnection.

2. Documented cases of serial killers with a history of head injuries.

3. Nature and timing of head injury; behavioural changes post-injury.

4. Statistics from findings out of 11 serial killers that were studied.

Results: 1. Neuroimaging showed reduced amygdala and frontal cortex interconnection and decreased grey matter.

2. High-profile serial killers who had documented head injuries: Richard Ramirez, Glen Edward Rogers, and John Wayne Gacy. Arthur Shawcross, Fred West.

3. Nature: Richard Ramirez, aged 2; a dresser fell on him and aged 5 was knocked out by a swing in the park; both of these caused him to have epileptic seizures throughout his childhood (temporal lobe epilepsy). Glen Edward Rogers, aged 1–2, would rock back and forth, continually banging his forehead against hard surfaces; Arthur Shawcross, aged 16, was hit in the head with a sports discus; and Arthur Shawcross, aged 19, fell off a ladder, concussing himself. Fred West, aged 17, had a motorcycle accident, and aged 19, was punched in the face, which led him to fall two floors, causing him to black out and frequently suffer from violent rages. Brain injuries before the age of 5 permanently disrupt the development of key foundational brain structures, whereas brain injuries in teenage years disrupt ongoing development, altering existing behaviour. Behavioural changes post-injury: emotional instability, social withdrawal, impulsiveness, and poor decision-making.

4. 80% of the most high-profile serial killers have had significant brain injuries.

Conclusion: The findings suggest that head injuries, especially those affecting specific brain regions, can lead to problems with impulse control, emotional regulation, and decision-making. Findings also suggest that timing plays a key role too. Early-life brain injuries, particularly during critical developmental stages, disrupt emotional and social development, whereas brain injuries during adolescence often impair impulse control and judgment. For example, the parts of Richard Ramirez’s brain that were damaged were his prefrontal cortex and temporal lobe. These injuries link to his crime as his crimes escalated in brutality, his sadistic behaviour, and also his opportunistic and impulsive nature. Arthur Shawcross similarly, although his injuries were in adolescence, led to sexual deviance and compulsions leading to abnormal sexual behaviour.

Aims: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that affects social interaction, communication, and behaviour. Many children with ASD experience emotional dysregulation, heightened anxiety, and challenges in mainstream educational settings. Nature-based learning (NBL), including forest schools and outdoor education, has been proposed as an alternative approach that may support the emotional well-being and behavioural outcomes of autistic children. This systematic review examines the impact of NBL on children with ASD, focusing on emotional health, behavioural changes, and educational engagement.

Methods: A systematic search was conducted across four databases (PsycINFO, CINAHL, PubMed, and Embase) to identify primary studies examining the effects of NBL on autistic children. Additional sources, including grey literature and reference lists, were screened. Studies were included if they assessed behavioural, emotional, and educational outcomes in children under 18 years old diagnosed with ASD. Data were extracted and synthesized narratively to identify common themes.

Results: Eight studies met the inclusion criteria, comprising qualitative, quantitative, and mixed-methods research. Findings indicated that participation in NBL was associated with improvements in emotional regulation, reduced anxiety, enhanced social interactions, and increased engagement in learning activities. Some studies also reported positive effects on attendance and independence. Parents and educators perceived NBL as beneficial, although concerns were noted regarding disruption or routines and challenges with implementation.

Conclusion: Nature-based learning appears to offer significant benefits for children with ASD, particularly in supporting emotional well-being and social development. However, variations in study methodologies and small sample sizes highlight the need for further large-scale research. Future studies should explore standardized outcome measures, long-term impacts, and strategies for integrating NBL into educational provisions, ensuring tailored support for children with diverse needs.

Aims: The excessive use of digital devices and social media has been associated with stress, poor focus, and a decline in overall well-being. Healthcare professionals, often working in high-pressure environments, are particularly susceptible to these effects due to their reliance on digital tools for work and personal purposes. This study aimed to assess the feasibility, adherence, and outcomes of a two-week digital detox intervention among medical professionals, focusing on its impact on digital device usage, stress levels, productivity, and overall well-being.

Methods: Thirty medics were invited to participate in a structured digital detox programme. Participants were given the option to either completely abstain from using digital devices or reduce their overall usage, with a particular focus on limiting social media engagement. Surveys were conducted at three stages: before the intervention to capture baseline device usage and social media habits, during the intervention to assess adherence, and after the detox to evaluate outcomes. Participants were encouraged to document their experiences through diaries or video reflections. The collected data included quantitative measures (e.g., screen time, adherence rates) and qualitative feedback on participants’ challenges and perceived benefits.

Results: Of the 30 invited participants, 24 (80%) agreed to participate in the digital detox, with 20 (83%) completing the two-week intervention. Pre-detox surveys revealed that participants spent an average of 5.5 hours daily on digital devices, with 40–50% of that time dedicated to social media. Post-intervention findings highlighted significant improvements, with 60% of participants reporting enhanced focus and productivity, 50% experiencing reduced stress levels, 40% noting improved sleep quality, and 30% engaging more in offline activities, such as hobbies and personal relationships.

However, challenges were reported, particularly during the initial stages, with 50% of participants experiencing restlessness or boredom. Furthermore, 20% found it difficult to balance the detox with work-related demands on digital tools, which limited their adherence. Despite these challenges, participants expressed increased mindfulness and a reduced dependency on devices by the end of the detox.

Conclusion: This study highlights the feasibility and potential benefits of a digital detox intervention among medics. The findings suggest that reducing device usage can significantly improve focus, stress levels, and work-life balance. Future studies should explore personalised and sustainable detox strategies that account for the unique demands of professional and personal digital use.

Aims: To investigate how anticholinergic burden of medications changes during hospital stay for Intensive Care Unit (ICU) patients and to review whether anticholinergic burden predicts delirium and mortality.

Delirium is a common cause of morbidity and mortality within ICU. Anticholinergic Burden (ACB) and Anticholinergic Effect on Cognition (AEC) tools are validated to assess anticholinergic effects from medication. Scores of ≥3 are associated with increased delirium and mortality. This study investigates anticholinergic burden from ICU admission through to hospital discharge.

Methods: Retrospective, ethically approved study of adults (N= 6,305) admitted to ICU in University Hospitals Birmingham over 3 years (2021–2023). Subjects were excluded if <48 hours spent in ICU or readmissions (within a year). Both ACB and AEC tools were used to assess anticholinergic burden (AEC is more sensitive to the cognitive effects of medications). Timepoints assessed: ICU admission, ICU discharge, hospital discharge, and maximum score. We explored secondary outcomes including delirium and mortality. Research performed in collaboration with PIONEER (Health Data Research Hub for Acute Care).

Results: Median age 60.0 years, 61.9% male, and 71.6% of white ethnicity. Median time from hospital to ICU admission 17.1 hours, 86.3% emergency admissions. Median length of stay in ICU 5.2 days (19.2 days in hospital).

Difference in mean score from ICU admission to ICU discharge was +0.38 (p<0.001) for ACB, and +0.29 (p<0.001) for AEC; from ICU discharge to hospital discharge was −0.12 for ACB (p<0.001) and +0.36 (p=0.005) for AEC.

There was a significant rise in patients with high-risk scores (ACB or AEC ≥3): admission to ICU 9.9% had ACB ≥3, and at discharge from ICU 19.9% (p<0.001), with no significant fall back at hospital discharge (18.9%, p=0.229). The AEC tool showed similar Results: admission to ICU, 4.9% of patients had AEC ≥3 and at discharge from ICU 10.5% (p<0.001) However, this tool showed a further rise by hospital discharge 12.3% (p<0.003). Delirium was inadequately recorded.

Results showed anticholinergic burden significantly increases following ICU admission. The proportion of patients with high-risk scores doubles during ICU admission and does not significantly reduce prior to discharge. We were unable to link these scores to delirium with insufficient data collected, but investigations on possible links to mortality are ongoing.

Conclusion: This study demonstrated a significant rise in anticholinergic burden linked to ICU admission, persisting to hospital discharge. This places such patients at risk of drug-induced morbidity and mortality.

Aims: Advancements in smartphone technology and wearable devices allow for novel ways to monitor behaviour, mood, and mental state, as well as to develop new interventions. Understanding the perspectives and preferences of individuals with bipolar disorder (BD) is essential for the success of these mood monitoring interventions and for Ecological Momentary Assessment (EMA) as a data collection method.

This systematic review and meta-synthesis aimed to explore the user experience of mood monitoring and EMA, including the barriers and facilitators for both individuals with BD and clinicians, as well as the intended purposes of these tools.

Methods: A systematic review and meta-synthesis of qualitative studies were conducted (PROSPERO: CRD42023396473), focusing on the experiences of participants, users, and clinicians with mood monitoring and EMA in BD. Eight electronic databases were searched, and mixed-methods studies were included. A meta-synthesis approach was used to analyse the data, employing first-, second-, and third-order constructs, guided by Noblit & Hare's meta-ethnography framework. Studies were assessed for the risk of bias in qualitative research. Results were checked for coherence by individuals with lived experience and psychiatrists.

Results: The search identified 23,515 papers. A total of 20 studies using 12 different EMA protocols were identified and included in the meta-synthesis, from which nine overarching themes emerged: adverse effects, barriers to mood monitoring, facilitators of mood monitoring, the purpose of mood monitoring, negative experiences of data sharing, positive experiences of data sharing, clinician-related barriers and concerns, clinician-related facilitators and suggestions, and desired features.

Conclusion: This review highlights key factors that can enhance user experience, engagement, retention, usability, and acceptance of EMA and mood monitoring protocols for individuals with BD. A central finding is that users strongly value control over their data, with an emphasis on customisability and personalisation. Many users were sceptical about involving formal mental health services and preferred to use the tool as an aid for self-managing their condition in highly personal and iterative ways. We also report key adverse effects experienced by individuals with BD when engaging in mood monitoring, which may need to be addressed by incorporating additional therapeutic elements into the intervention — for example, subjective worsening of mood and the monitoring process serving as an unhelpful reminder of their mental illness.

Aims: 1. Examine efficacy and durability of antidepressant effects. 2. Identify specific symptoms of improvement. 3. Compare response rates and duration of antidepressant effects in failed to respond to previous treatments.

Methods: Prospective review study of patients who received off-label rapid dissolve wafer for SL delivery in hospital setting 2–3 times a week for 4 weeks. The study examined the effectiveness and safety of the clinical use on depression and anxiety symptoms. The regimen was determined by Psychiatrist experiential CME in ketamine therapy. Dosing increases were made based on patient’s report, clinical response and side effects. Optimisation of maintenance dose based on pharmacokinetic modelling to achieve serum (2–2.5 mg/kg wt.). Clinician rated scales MADRS, MoCA and CADSS were completed to evaluate response & KSET protocol for side effects. Patient completed the online experience survey within 24 hours of dose administration.

Results: N=60 with no dropouts from treatment and no patients were hospitalized during treatment course. The mean patient age was 45.4, most common comorbid psychiatric diagnoses were Generalized Anxiety Disorder and mean of 3.6 previous psychotropic drug trials. Responders had > dissociation (mean CADSS 11.8). We found a moderately strong but not statistically significant correlation between the CADSS score during treatment and the reduction in MADRS from baseline to week 4 (r=0.52, p=0.059). Minor adverse events and side effects including nausea, dizziness, headache, loss of balance, were assessed and were self-limited and resolved without medical intervention.

Effectiveness – nearly 50% of patients with moderate to severe depression saw an improvement of MADRS and GAD-7 scores. This reduction rate improved to 60% in patients who completed a clinically recommended 12 ketamine course.

Conclusion: Increased dissociation correlated moderately strongly, but not significantly, with a decrease in depressive symptoms. Reductions in scores matched those with 6 vs 12 completed treatments and it is reasonable to speculate that there would be maintenance of improvement with additional treatments.

Aims: To evaluate the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in treating treatment-resistant depression (TRD), with a focus on changes in depression severity measured by the Montgomery–Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating Scale (HAMD).

Methods: A prospective clinical trial was conducted with 15 patients diagnosed with TRD, defined as having failed at least two adequate antidepressant trials. rTMS was administered using a left dorsolateral prefrontal cortex (DLPFC) protocol, with sessions delivered five times per week over six weeks for the majority of participants. Depression severity was assessed using MADRS and HAMD scores both before and after treatment. Adverse events were monitored throughout the study. Paired t-tests were used to analyse changes in MADRS and HAMD scores, with statistical significance set at p<0.05. Effect sizes were calculated using Cohen’s d.

Results: The average MADRS score decreased from 35.33 pre-intervention to 24.67 post-intervention, reflecting a mean reduction of 10.67 points and a large effect size (Cohen’s d=1.23). Similarly, HAMD scores decreased from 22.83 to 13.67, with a mean reduction of 9.17 points and a large effect size (Cohen’s d=0.98). While most patients demonstrated significant improvement, one patient experienced worsening symptoms. Adverse events were generally mild, with 7 patients reporting no side effects and 4 reporting mild pain at the stimulation site.

Conclusion: rTMS appears to be an effective and well-tolerated treatment option for reducing depressive symptoms in patients with TRD. The significant reductions in MADRS and HAMD scores, along with large effect sizes, support the potential of rTMS as a therapeutic intervention for this population. Further research with larger sample sizes, including the use of a control group, is needed to confirm these findings and explore the long-term efficacy of rTMS in managing TRD.

Aims: The aim of this systematic review was to explore the existing literature on the impact of the ketogenic diet on aggressive and violent behaviour in patients with serious mental illness and the potential mechanisms involved, with the hypothesis that the ketogenic diet can reduce aggression and violence in this patient population. The ketogenic diet has proven to be useful as a therapeutic to reduce some clinical symptoms of certain neurological and psychiatric conditions, so this review was interested to determine if there were any correlations in impacts on behaviour in similar patient populations.

Methods: Following the PRISMA guidelines, a systematic review was conducted of the bibliographic databases MEDLINE, PsycINFO, Scopus, Web of Science, Cochrane Library, PubMed and Open Grey. The sources retrieved were narrowed down using specific inclusion and exclusion criteria and quality appraisal of the relevant sources was carried out using the Joanna Briggs Institute critical appraisal tools.

Results: Of the 32 sources included in the final review, 26 of these, when linked together by association, supported the concept of the ketogenic diet reducing aggression either directly or indirectly via metabolites upon which the ketogenic diet can impact. Increased β-hydroxybutyrate, γ-aminobutyric acid and brain-derived neurotrophic factor were all observed when following the ketogenic diet and were, in most cases, associated with reduced aggression.

Conclusion: Despite the limited literature available on the topic, the majority of the relevant sources supported the notion that the ketogenic diet could generally reduce aggression, an observation that could often be replicated in psychiatric settings. The conclusions made in this review were mostly formed by making associations between the available sources, so future research would need to be conducted with the specific focus of observing the impacts of the ketogenic diet on behaviour in psychiatric settings. Randomised controlled trials should be conducted in both inpatient and outpatient settings to enable further systematic reviews and meta-analyses to evaluate the ketogenic diet’s potential for use as a non-pharmacological therapeutic in prescribing and patient care.

Aims: The Default Mode Network (DMN) is a network of brain regions that are functionally connected and become active during self-directed thought, introspection, and rumination. Rumination refers to the repetitive and passive focus on distressing thoughts, often linked to negative emotional states. Specifically, an increase in the brooding type of rumination is associated with severity of depression. Functional magnetic resonance imaging (fMRI) research offers a unique perspective on how the functional connectivity of the DMN is involved in rumination, shedding light on its neurobiological underpinnings. This systematic review aims to synthesise existing literature that explored the functional connectivity of the DMN in individuals with depressive disorders during episodes of rumination.

Methods: This systematic review investigated activity in DMN in patients with depression using resting state fMRI scans. Literature search was done on PubMed, Medline and Cochrane using search terms “depression OR Major Depressive Disorder OR depressive episode” AND “ruminat*” AND “functional MRI OR fMRI”. 324 studies were identified from the three databases, and after removing 42 duplicates, 274 studies were selected for title and abstract screening.

Abstracts were assessed for eligibility using the following inclusion criteria: original studies in peer-reviewed journals, clinical diagnosis of depressive disorder, measurement of rumination using a validated scale and resting state or task-based fMRI. 193 studies were excluded, and 58 studies were moved to full-text review. Intervention studies were also excluded at this stage. Following the above criteria, 25 studies were selected for full-text review.

Results: Out of the 25 studies, 9 used task-based fMRI and 16 used resting state fMRI. Only resting state fMRI studies were included for data extraction. Results from the 16 studies showed that depressed people had both increased and decreased functional connectivity between different regions of the brain during brooding rumination. The connectivity within the DMN was increased, while connectivity between DMN and other areas of brain, including between DMN and TPN (task-positive network) was reduced, when compared with healthy controls.

Conclusion: This review shows widespread associations between depression, rumination and functional connectivity within and between various brain regions. Increase of functional connectivity within the DMN during depression might be responsible for the increase in brooding rumination seen in depressed individuals. A decrease in connectivity of DMN to other areas of the brain might result in difficulties for depressed individuals to switch from a ruminating state into the executive network mode. Overall, this review provides an overview of the neurobiological underpinnings for the increase in brooding rumination in depression.

Aims: Changes in the hippocampus and amygdala are associated with psychotic illnesses. However, there is little research examining the output tracts of these regions in psychosis. The fornix connects the hippocampus to the basal forebrain anteriorly and to the hypothalamus posteriorly, while the stria terminalis (ST) connects the amygdala to these same areas. The anterior commissure divides these tracts into anterior (pre-commissural) and posterior (post-commissural) fibres. This study investigates these two tracts and their pre- and post-commissural fibres in young adolescents with psychotic experiences (PEs) as compared with controls across two timepoints (TP), 2 years apart.

Methods: 51 young adolescents with PEs (37 female) and 43 healthy controls (25 female) underwent high angular diffusion imaging at TP1, while 39 adolescents with PEs and 29 healthy controls underwent same at TP2. Images were processed using ExploreDTI and, using a bespoke method, the fornix and ST were separated and pre-commissural and post-commissural fibres isolated. Analysis of covariance was performed correcting for age, sex and intracranial volume.

Results: Right pre-commissural fornical Mean Diffusivity (MD) (p=0.035) and Radial Diffusivity (RD) (p=0.009) were increased, with decreased Fractional Anisotropy (FA) (p=0.045) at TP1. There was increase across MD (p=0.004), RD (p=0.005) and Axial Diffusivity (AD) (p=0.042) at TP2. Only right pre-commissural fornix MD and RD increases at TP2 survived Bonferroni correction at p=0.0083. No ST differences survived correction for multiple comparisons.

Conclusion: This study uses a novel method to separate the stria terminalis and fornix, using an anatomically driven approach. The results show that the hippocampal output fibres are involved in early psychosis, while the amygdala fibres are not affected. Of the hippocampal fibres, it is the fibres going to the basal forebrain, responsible for motivation and behaviour, that are specifically impacted. These changes in adolescents are entirely right sided, reflecting similar right sided hippocampal changes found in adults with psychotic illnesses. The right basal forebrain is known to influence vigilance, attention and emotional processing, which are affected in patients with psychosis. The findings from this study suggest that the right basal forebrain is affected in children and adolescents with psychotic experiences, which are common in people who go on to develop psychotic illnesses, and thus supports the neurodevelopmental theory of psychosis.

Aims: The national emphasis on improving rates and timeliness of dementia diagnosis is dependent on accessibility of investigative tools. Through locally accessible, point-of-care brain scans, LFMRI has the potential to improve the experience of dementia assessment pathways and time to diagnosis, and to reduce inequalities in access to dementia assessment.

The aim of this qualitative research was to explore perspectives regarding the use of LFMRI scanning within dementia diagnosis pathways, within communities where it may have the greatest impact. We also aimed to learn more about views regarding future LFMRI research, including priorities, concerns and potential facilitators and barriers to participation.

Methods: The qualitative design incorporated focus groups and interviews with individuals with dementia and their carers. The study took place within urban, rural and coastal communities in Kent. 35 participants took part in either a focus group (n=20) or interview (n=15) with an average age of 72 years. Focus groups and interviews were recorded and transcribed verbatim for thematic analysis using NVivo software.

Results: Participants described both positive views as well as caution about the use of this new investigative tool. Five subthemes were identified: access to local neuroimaging, improvement of assessment pathways, accuracy of LFMRI, concerns about expense to the NHS and engagement in future LFMRI research.

Participants were optimistic about the potential of LFMRI within dementia diagnosis pathways. They valued the possibility of access to local scanners and the benefit this would have on timely diagnosis with improved diagnostic pathways. However, there were concerns about the accuracy of these scanners and the cost implications within the NHS.

Conclusion: While the technology will not mean the replacement of traditional MRI scans, LFMRI may have the potential to improve dementia diagnosis pathways. LFMRI may be a lower cost alternative to help to reduce wait times while improving access to pathways for those in underserved communities. This would be welcomed by people with dementia and their carers, if there was trust in the accuracy of the scans. Participants expressed willingness to be involved in further research using LFMRI scanners to support improvements in the dementia diagnostic pathways for others.