Aims: Intergenerational programmes provide meaningful social contact for older people, and address negative stereotypes of ageing in children. Reading aloud improves language acquisition and literacy in children, however in regions of socio-economic deprivation, many children lack this opportunity. The aim of this qualitative research was to explore the experiences and perspectives of teachers and volunteers involved in an intergenerational reading project within a primary school in an area of high socioeconomic deprivation.

Methods: In the ROCKET project, senior volunteers (aged >75) were supported to join an established volunteer reading scheme in a primary school with the support of an existing volunteer. The students who took part in the project were those identified by teachers to have the greatest need for support with reading. This qualitative study incorporated semi-structured interviews with teachers and volunteers in June–August 2024, a year after the project began. Seven participants took part in an interview, including four teachers, an existing volunteer lead and two volunteers over the age of 75 years old. Videos were audio-recorded and transcribed before thematic analysis by two of the authors.

Results: Thematic analysis identified six subthemes: improved reading ability in children, children’s social development, reduced loneliness, volunteers’ sense of purpose/enjoyment and future potential of ROCKET and challenges to overcome.

Volunteers valued the social interaction, the sense of purpose, enjoyment and improved confidence that participating provided them. The teachers described students as benefiting from improved confidence and reading ability, and the positive impact of meeting people outside of their usual social sphere. Participants were optimistic about the future potential of ROCKET and felt it could expand beyond literacy to other subjects such as maths or comprehension, and include other year groups. They also felt that communication could be improved between teaching staff and volunteers involved within the project.

Conclusion: Data from this small qualitative study suggests that the ROCKET project has the potential to improve student’s literacy skills and confidence, and to positively impact volunteers through reduced loneliness, a sense of purpose and being a part of a community. Participants felt that improved communication between volunteers and teacher would enhance its success, and that there was scope to broaden the project to include other school subjects and a wider range of students.

Aims: Concern that antipsychotic over-prescribing has been harmful for autistic adults has led to deprescribing initiatives, including NHS England’s “Stopping the overmedication of people with ID, autism, or both” (STOMP) in 2015. It is unclear if there has been a subsequent change in prescribing rates or other possible aspects of over-prescribing. Thus, we sought to compare antipsychotic prescribing rates, recorded indications, mean doses and long-term use between autistic adults with and without intellectual disabilities (ID) and non-autistic adults in England from 1997 to 2023.

Methods: Using population-representative primary care records from the Clinical Practice Research Datalink Aurum, we identified adults 16–64 years old between 1997 and 2023 and stratified them into three groups: autistic adults with intellectual disability (ID), autistic adults without ID, and non-autistic adults. For each calendar year and group, we calculated (i) the proportion of adults prescribed an antipsychotic; (ii) the proportion of adults starting an antipsychotic; (iii) the proportion of first-time prescriptions with possible indications recorded 2 months either side; (iv) the mean daily doses for quetiapine, risperidone, aripiprazole and olanzapine; (v) the proportion of new courses that lasted over 1 year. We also performed analyses stratified by sex and age-group (16–29, 30–44, 45–64 years old).

Results: 45,143 autistic adults with ID, 121,071 autistic adults without ID, and 30,218,564 non-autistic adults entered the study. From 2001 to 2023 the percentage prescribed antipsychotics changed from 44% to 22% for autistic adults with ID, from 10% to 7% for autistic adults without ID, and from 1.1% to 1.2% for non-autistic adults. Over the same period, new prescription rates dropped from 5.2% to 1.6% for autistic adults with ID, from 2.0% to 1.1% for those without ID, and from 0.3% to 0.2% for non-autistic adults. Autistic adults with ID had consistently lower recording of possible indications: 40% in 2023 compared with 60% for the other two groups. They also had consistently higher proportions of courses lasting more than 1 year: 53% in 2022 compared with 43–44% in the other two groups. Mean doses prescribed were generally lowest for autistic adults with ID, followed by autistic adults without ID. Trends were largely similar across sex and age strata, with an exception being that prescribing rates have increased among autistic females without ID, from 6% in 2001 to 8% in 2023.

Conclusion: Disparities in antipsychotic prescribing rates in England have narrowed over the last 25 years, both before and after the 2015 launch of STOMP by NHS England.

Aims: Dual diagnosis in the context of alcohol dependence refers to the co-occurrence of alcohol dependence syndrome and another mental health condition, such as depression, anxiety, bipolar disorder, schizophrenia, or personality disorders. Understanding the clinical profile of patients with dual diagnosis can lead to more effective treatment and outcome. This retrospective study compares the trend and associated factors of clinical profile of people with alcohol dependence with and without dual diagnosis.

Methods: This is a retrospective medical records review conducted in a tertiary care de-addiction centre in South India. We reviewed the data of 2105 patients admitted to the centre with a diagnosis of alcohol dependence syndrome over 10 years from April 2007 to March 2017. Socio-demographic data, alcohol drinking pattern, clinical profile and dual diagnosis were extracted from the patient intake proforma and case records. Statistical analysis was done using R software. Trend of clinical profile was visualized by line diagram as dependent variable (y), years of study as independent variable (x) and analysis was done using linear regression. Chi square and Fisher exact tests were applied as univariate analysis and logical regression for multivariate analysis.

Results: Out of 2105 patients, all were males, with mean age 36 years (SD=9). Among them 1566 (74%) had a dual diagnosis of Bipolar disorder [974 (62%)], depression [323 (20%)], psychotic disorders [162 (10%)], antisocial personality disorder [107 (7%)] and others [16 (1%)]. Trend analysis revealed that the proportion and pattern of dual diagnosis and socio-demographic and clinical profile remained the same over years. In univariate analysis factors like binge drinking (p=0.002), domestic violence (p=0.04), occupational dysfunction (p=0.038) and debts (p=0.029) had significance in patients with dual diagnosis. However multivariate analysis did not support the same.

Conclusion: Comparing the existing literature, proportion of dual diagnosis is higher in our study, mood disorders being the commonest. Though there are changes in social conditions over the decade the profile of patients seeking de-addiction remained almost same. The social complications of alcohol were more pronounced in the dual diagnosis group. The findings can help train healthcare professionals to better understand and manage dual diagnosis cases. Dual diagnosis is not only a diagnostic challenge, but it should alert the treatment team regarding the pharmacological and psychosocial management as well. Research on dual diagnosis and alcohol dependence is vital for improving patient outcomes, reducing societal burdens, and advancing scientific understanding.

Aims: 1. To evaluate and understand the sociodemographic characteristics of the patients admitted to rehabilitation wards who were subjected to CTO. 2. To evaluate the rehabilitation of inpatients discharged with or without CTO in place and compare their readmission rate.

Methods: The LIRO is the biggest database of inpatients in rehabilitation services in the NHS to our knowledge. The data is collected from admissions to inpatient mental health rehabilitation services between 2014 and 2020. The inpatient services involved two rehabilitation hospitals in Leicestershire, with a total of 68 beds.

Results: 361 admissions were identified. 72 (19.94%) patients were discharged on a CTO and 289 (80.05%) patients were discharged without CTO. 21% of the total of male patients (n=46) were discharged on a CTO vs 17.01% (n=25) of the female patients, one transgender patient was discharged on a CTO (p=0.311). Demographically, 34 (14.47%) Caucasian patients were discharged under CTO while 37 (30.33%) were non-Caucasian (p<0.001). 49 (68.05%) of the patients on CTO were discharged on depot antipsychotic as treatment, compared with 72 (24%) of patients without a CTO (p<0.0001).

Upon one year follow up, 32 (44.44%) patients on CTO were readmitted to mental health services within 12 months, while 126 patients discharged without CTO were readmitted within 12 months of discharge (43.60%) (p=0.97).

Conclusion: Patients subjected to the CTO are more likely to be discharged on depot medications from rehabilitation services. Significant number of non-Caucasian patients in rehabilitation services tend to be discharged on CTO. This is similar to national findings. There is no difference identified in readmission rate after discharge from rehabilitation ward within one year between the patients on CTO or not. This adds to the growing evidence that CTO is not stopping revolving door presentation.

Aims: Experiences of trauma are highly prevalent within the UK. Within acute psychiatric care, current risk management includes the use of restrictive interventions. Frequent reports of re-traumatisation among service users have sparked debate about its effectiveness and acceptability. Trauma-informed care (TIC) has garnered more attention in recent years as a safer and more acceptable approach, aiming to recognise and respond to trauma in a way which resists re-traumatisation, but there is wide variation as to how this is implemented in the UK at present. The aim of this systematic review is to assess the effectiveness and acceptability of TIC in acute psychiatric care in the UK, and to determine its potential for national implementation.

Methods: Five databases (Embase; Global Health; Medline; PsycINFO; Web of Science) were searched for eligible studies between 21/10/24–09/12/24. A total of 2005 studies were found after applying the search terms. Following screening, 12 studies met inclusion criteria; 7 studies from database searching and a further 5 from reference list searching. Qualitative data was analysed and categorised into 7 global themes using thematic synthesis. Quantitative data was summarised in a narrative manner.

Results: The following themes were identified: 1) variation in the experiences of staff and service users; 2) barriers to providing psychosocial care; 3) the importance of trauma-informed training; 4) sustainability of TIC; 5) the importance of staff-service user relationships; 6) the importance of a patient-centred approach; and 7) governance and leadership issues. Results showed a decrease in restraint and seclusion incidents post-TIC implementation in acute psychiatric care facilities. Although most service users reported feeling safer and more in control of their treatment, others described feeling forced into reliving their trauma. There was a general consensus that feeling listened to and genuinely cared for by staff helped them to understand their feelings and find ways to address their trauma. Feelings of unpreparedness and unfamiliarity of TIC were common amongst staff. Most agreed that trauma-informed training packages helped them to feel more confident in delivering care.

Conclusion: TIC is an invaluable tool for trauma recovery, with existing literature suggesting that it is an acceptable and effective approach to psychiatric care. National implementation of TIC across the UK would likely benefit a large proportion of individuals. However, this study identifies key issues which still need to be considered, including training, sustainability factors, patient involvement, and leadership. Political backing, staff time and resource management would additionally need addressing.

Aims: Clozapine is the only licensed medication for treatment-resistant schizophrenia although it is underused. Healthcare providers’ (HCP) competence and confidence appear to have an effect on clozapine underutilisation. This review aims to synthesize the most pertinent literature examining the factors influencing HCP competence and confidence in the management of clozapine and how these factors influence variation in prescribing practice.

Methods: A review of the literature focusing on these elements was conducted. The Population, Context, Outcome (PCO) framework was adopted to support the literature search. The databases Medline, Psychinfo, Scopus, Cinahl, Pubmed, Embase, British Library, Ethos e-thesis, Google Scholar, Dart Europe e-thesis were consulted; the search was completed in January 2025. Screening, selection, data extraction and quality assessment were conducted independently by 2 researchers. Thematic analysis was used to investigate and compare the data emerging from the studies.

Results: Thirty-four articles were included in the review. Six themes were identified: attitude toward and knowledge about clozapine, misconceptions (regarding side effects, monitoring and co-morbidities), guidance, education, training and experience. Clinicians self-reported as competent with guidelines, yet they expressed less confidence in their ability to adhere to them and were uncertain about managing side effects. Lack of education, training and insufficient exposure to clozapine management were significant factors impacting competence and confidence resulting in clozapine underuse. Few studies involving non-medical professionals highlighted a general lack of education and training related to clozapine use.

Conclusion: Deficiencies in knowledge and experience were identified among professionals. However, the studies included in this review were lacking in the involvement of non-medical professionals. Given their crucial role in managing side effects and educating patients and carers, it is evident that their inclusion in future research is imperative.

Aims: Hatred can manifest in several ways. This article aims to explore what information can be obtained from the medical literature to address a variety of manifestations and expressions of hatred.

Methods: A systematic search of the medical literature from the PubMed medical library was used to identify articles dealing with hatred. A review of 1226 articles from 2015 to the date of data collection was performed. 87 of these discussed the issue of addressing hatred by various means. Full text search of these 87 articles was carried out. Data collected was interpreted utilising thematic analysis.

Results: The thematic analysis of data suggests that there are three major ways of addressing hatred: a need to understand various aspects related to hatred; the usefulness of and/or unhelpfulness of various tools, methods or means to address hatred; and lastly, utilising various interventions to address hatred.

Conclusion: As there are several forms and manifestations of hatred, with unique background and presentation, there cannot be a single method or suggestion that can be provided to address hatred. Medical researchers concur that hatred exists, and several related aspects require attention. Useful details of several tools, methods, means and strategies are offered that may help to tackle numerous forms and manifestations of hatred. Furthermore, they share with us evidence in favour of several interventions that they found helpful in addressing hatred.

Aims: This study aims to assess the role of psychiatric intensive care units (PICU) in preventing long-term admissions in psychiatric facilities which is a major issue in developing countries like Pakistan.

Methods: It was a retrospective cohort study. Data obtained from patients’ admission and discharge registers from Psychiatric ICU and two inpatient units in Punjab Institute of Mental Health Lahore for a time period of 6 months from November 2023 till April 2024 was studied and length of stay in PICU was compared with other units.

Results: 82% of PICU patients (n=110) were discharged within 6 days(S.D±3.08) after stabilization, with follow-up in OPD, while the remaining 18% were transferred to inpatient Unit B (n=52) for further management with average stay of 12 days.(S.D±5.23) Only 53% of the patients (n=26) admitted in Unit D (operating without PICU) were discharged, with the rest remaining hospitalized. Unit D had a longer average hospital stay of 41 days. The units were similar in demographic features but varied in treatment programmes and involvement of family in treatment.

Conclusion: The results of the study are promising in favour of PICU as it succeeded in reducing length of stay in the hospital and challenges the social perception of psychiatric facilities as a place of incarceration. Rapid mobilization of resources and active involvement of family during the management were important factors impacting the length of stay. There is further room for research for role of PICU in psychiatry wards in multidisciplinary hospitals.

Aims: Advancements in digital technology have increased the potential for EMA to improve assessment efficiency through enabling real-time mood evaluation and raising the possibility of novel and technology informed interventions. The preferences and views of individuals with depression are crucial for the effectiveness of mood monitoring interventions or Ecological Momentary Assessment (EMA) as a data collection method. Concerns have been raised about the negative impact of frequent mood assessments. This is the first systematic review to our knowledge that assesses user experience of mood monitoring and EMA protocols. This systematic review and meta-synthesis evaluated the user experience of mood monitoring and EMA procedures, examining factors such as obstacles and facilitators for both people with depression and clinicians, potential adverse effects, and the intended goals of these methods.

Methods: A systematic review and meta-synthesis of qualitative studies on user and clinician experiences with mood monitoring and EMA for depression was conducted (PROSPERO: CRD42023396473). A search was performed across eight electronic databases. Qualitative studies exploring user perspectives on self-monitoring/EMA in people with depression were included. A meta-synthesis approach was applied to analyse the data, using first, second, and third-order constructs, following Noblit and Hare’s meta-ethnography framework. All qualitative studies were rated for risk of bias by two independent reviewers, and the results were verified for coherence by individuals with lived experience and psychiatrists.

Results: Fourteen studies met the inclusion criteria, from which seven themes emerged. These were: adverse effects, obstacles to mood tracking, enablers of mood tracking, the objective of mood monitoring, clinician-related challenges and concerns, clinician-driven recommendations and support, and desired features. All studies identified demonstrated a low risk of bias.

Conclusion: Many users reported a worsening of their mood and anxiety during EMA/mood monitoring. Users wanted to maintain control over their data and expressed a preference for a simple, intuitive, and passive data protocol. This review highlighted that personalisation should be a core feature of any future protocol development to maximise successful implementation and uptake of future protocol. These protocols should consider testing the incorporation of additional therapeutic elements to manage adverse effects as well as confirming these findings quantitatively. We present additional important concepts that are expected to enhance the user experience, engagement, retention, usability, and acceptance of EMA/mood monitoring protocols for individuals with depression.

Aims: The DIALOG scale has been implemented as a routine patient outcome and experience measure (PROM/PREM) in East London Foundation Trust (EL FT). We used large routinely collected DIALOG data to assess impact of treatment across different domains of life and whether the impact of treatment changed with Community Mental Health Transformation CMH (NHS Long Term Plan). We also carried out secondary disaggregation analysis of pooled data based on protected characteristics interrogating through an equity lens.

Methods: EL FT had commissioned University of Plymouth for the review of CMH transformation. Anonymised pooled data set was obtained from the electronic patient records that were collected as a part of routine clinical practice. DIALOG (PROM and PREM) scores captured routinely from CMH services in ELFT over two time periods (2018–19 and 2021–22) were collected for this purpose.

The anonymised and pooled data was linked with stages of treatment e.g. assessment, review and at discharge and protected characteristics (age, gender, ethnicity and a proxy of social deprivation).

14,813 DIALOG scores from 6,538 unique patients were identified. We analysed each domain of DIALOG separately and the numbers of return of scores on each domain varied depending on response rate. We compared domain based descriptive statistical analyses of mean pooled DIALOG scores looking at means across a range of variables for each domain and then conducted a series of multiple regressions for each of the DIALOG domains, to control for multiple variables together

Results: Our results showed that service user satisfaction in each domain improved with treatment stage (from assessment to review to discharge) reaching statistical significance at each stage. There were minor differences between the two time periods (2018–19 and 2021–22) in a few domains. There was variation in outcomes across ethnicity, age and gender in a few domains.

Conclusion: Large data sets of routinely collected DIALOG data offer valuable insight into the needs of the local population and impact of treatment. Assessment of the impact of the CMH service transformation was confounded by the pandemic. Disaggregated data on protected characteristics reveal interesting and useful information about experiences and outcomes of different population groups over time. Our study also validates DIALOG as a quality of life measure and patient experience measure scale that is sensitive to measure change. It affirms the value and depth that intelligence routine outcome data gathering can offer both to measure change as well as offering an assessment of population need.

Aims: Non-suicidal self-injury (NSSI) has been increasingly observed among adolescents as a maladaptive coping mechanism to alleviate emotional distress. Despite its high prevalence, the neurobiological underpinnings linking interpersonal distress to cognitive control deficits remain underexplored. Electroencephalography (EEG) studies suggest that the no-go P3 component may serve as a biomarker for impulsivity and response inhibition, offering insights into the mechanisms underlying NSSI behaviours. This study aimed to investigate the relationship between psychological characteristics, neural activity, and cognitive control in adolescents with NSSI compared with healthy controls (HC).

Methods: A total of 51 adolescents with NSSI and 50 HC were recruited. Psychological characteristics were assessed using standardized scales, including the Interpersonal Needs Questionnaire (INQ) and Short UPPS-P Impulsivity Scale (SUPPS-P). EEG was recorded during a go/no-go task to measure P3 amplitudes. Source analysis was performed to localize neural activity. Group differences were analyzed using ANCOVA to control depression and anxiety, followed by partial correlation and mediation analyses to evaluate relationships among variables.

Results: The NSSI group exhibited significantly lower no-go P3 amplitudes at all electrodes compared with the HC group (p<0.001), even after controlling for depression and anxiety. No-go P3 amplitudes were negatively correlated with INQ scores, suggesting that interpersonal distress impacts response inhibition. Source analysis revealed reduced neural activity in the right superior frontal gyrus, inferior parietal gyrus, and other regions associated with cognitive control and emotional regulation in the NSSI group. However, these differences disappeared after adjusting for depression and anxiety, indicating their potential mediating role.

Conclusion: These findings highlight the interplay between interpersonal distress, depression, anxiety, and cognitive control deficits in adolescents with NSSI. Future longitudinal studies are needed to confirm these pathways and explore therapeutic interventions targeting interpersonal distress and emotional regulation to mitigate NSSI behaviours.

Aims: Approximately 2% of students in higher education are diagnosed with autism, a figure likely underreported due to non-disclosure and diagnostic challenges. Autistic students in higher education face unique challenges that impact their academic persistence and success. These students experience higher dropout rates compared with their neurotypical peers. Identifying the factors leading to high dropout rates is essential for developing interventions that promote a more supportive academic environment for autistic students.

This review systematically investigates and analyses the factors that influence dropout rates among autistic students in higher education, focusing on firsthand accounts of autistic students. It draws on qualitative and mixed-method studies to address the question: What are the key factors influencing dropout rates among autistic university students across various degree programmes and institutions worldwide? The aim is to identify insights that can inform interventions to improve educational outcomes for autistic adults.

Methods: This meta-synthesis, adhering to PRISMA guidelines, utilised the PICOS framework for a systematic review conducted in July 2024. Searches across Scopus, PsychINFO, Medline via OVID, and ERIC yielded 2,303 initial articles. Thirteen studies were selected based on relevance and peer review, involving 521 participants aged 18–54, primarily diagnosed with autism spectrum disorder and based in the UK, USA, and Australia. All participants had either considered dropping out, actually dropped out, or deferred a year. These studies examined dropout rates and potential contributory factors, with findings appraised for quality using the CASP checklist and determined to be of moderate to good quality.

Results: Analysis of the thirteen studies found significant challenges faced by autistic students in higher education, revealing an overarching theme of 'Environmental Discord’ – systemic mismatches between educational structures and autistic students’ needs that exacerbate academic and mental health challenges. Mental health emerged as a critical factor influencing dropout rates with exacerbated conditions such as higher burnouts, anxiety and depression due to academic pressures and social isolation. Additionally, the studies highlighted academic challenges that hinder effective learning and engagement. The analysis also identified gaps in support strategies, indicating that existing services often fail to meet the specific needs of autistic students, necessitating tailored interventions.

Conclusion: This review proposes proactive restructuring of educational environments to better accommodate diverse student needs, enhance success and reduce dropout rates. Further, the review calls for future research to develop and evaluate personalised interventions aimed at the specific challenges faced by autistic students.

Aims: To find out the effectiveness of different strategies of behaviour modification techniques on children having intellectual disability in specific time period under controlled setting and compare pre and post scores.

Methods: 36 children diagnosed with intellectual disability were included in current studies, comprised of 20 boys and 16 girls. A diagnostic criterion of DSM–V for intellectual disability was applied to diagnose the children. Portage Guide to Early Education (PGEE) was selected to then find out the developmental age of children and in some of the cases to find out the functional level of intellectually impaired children. For diagnostic point of view intelligence test including Slosson Intelligence test was administered for screening children and Coloured Progressive Matrices was used to find out the level of mental maturity. Behaviour modification techniques that were selected for administration of IEPs in specific areas were reinforcement techniques, shaping, chaining, prompt-fading and negative punishment. The training programme consists of five days per week and four hours per day by the help of team of trained professionals; specifically all were trained clinical psychologists.

Results: Repeated measure t-test has shown significant statistical difference between pre and post ratings of the Intellectually Disabled children on all the domains including Self Help, motor, cognitive, language and socialization of PGEE, results shows the difference respectively; t (35)=−8.82, −8.393, −7.496. −7.541 and −7.4295, p=0.000 two tailed on above mentioned domains. Intellectually disabled children scored higher in post ratings (M=52.25, SD=15.39); (M=54.58, SD=12.46); (M=37.25, SD=18.13); (M=43.44, SD=19.00); (M=52.56, SD=17.33) on Self Help, motor, cognitive. Language and socialization domains of PGEE then pre test rating (M=44.67, SD=16.44); (M=44.78, SD=13.52); (M=29.53, SD=18.13); (M=36.47, SD=19.74); (M=43.75, SD=16.83).

Conclusion: IEPs do work effectively in dealing with children having special needs with use of behavioural intervention as it was found in our research with drastic change in post rating of each adaptive area like self-help, motor, cognitive, language and socialization.

Aims: Chronotype refers to the distribution of an individual’s diurnal preference, ranging from morning type (MT) to intermediate or neither type (NT) to evening type (ET). Chronotype manifests in various physiological functions and influences numerous physical and psychological activities. Addiction is one of the most prevalent mental health issues, with individual studies indicating that ETs are at a greater risk of developing addiction. Given the nonexistence of a systematic review addressing this topic, this study aimed to synthesize results that explored the relationship between chronotype and addictive disorders to define the at-risk population.

Methods: A search strategy was developed using the keywords 'chronotype', 'circadian preference', 'diurnal preference', 'morningness', 'eveningness', 'circadian rhythms’, and 'chronobiology'. And 'addiction', 'dependence', 'problematic use’ and 'abuse'. After registering the protocol with PROSPERO, a data extraction form was developed based on the strict inclusion and exclusion criteria for the selection of studies. Selected articles were screened and the data were extracted. The results of the 16 selected studies were synthesised.

Results: ET had a significant association with substance addiction in four out of six studies and all ten studies of behavioural addiction. One study showed no association with chronotype and one showed a significant association with MT.

Conclusion: ET has a higher risk of developing an addiction. Designing and conducting longitudinal cohort studies would be beneficial in delineating the bidirectional relationship and establishing causality if present. This would also pave the way for developing chronotherapies for addiction.

Aims: Primary hyperparathyroidism (PHPT) is characterized by hypercalcaemia with an elevated or inappropriately normal parathyroid hormone level. In clinical psychiatry, it is often detected through routine blood investigations for hypercalcaemia. PHPT is the most common cause of persistent hypercalcaemia and the third most prevalent endocrine disorder after diabetes and thyroid disease. Although it can occur at any age, it typically presents later in life, with a mean age of diagnosis of 65 years. Women are affected three to four times more frequently than men. As awareness of PHPT screening increases, the number of individuals receiving mental health treatment who also have PHPT is likely to rise.

This literature review was prompted by the presentation of several patients with primary hyperparathyroidism (PHPT) or lithium-associated hyperparathyroidism (LAH) in our clinical practice. Our aim was to synthesize the available evidence to provide an updated overview for clinicians regarding the relationship between PHPT and both depression and cognitive impairment, as well as to review the existing literature on LAH.

Methods: We conducted a narrative review of the literature, focusing on the relationship between PHPT and both depression and cognitive impairment. We did not explore the association between PHPT and psychosis due to the limited literature in this area, which is primarily confined to case reports. Our search yielded 42 full-text articles, which were reviewed in detail by all authors for inclusion in this study. We discussed the findings and reached a consensus. Additionally, we developed three fictionalized case reports based on amalgamated patient presentations from our clinical experience.

Results: Moderate to severe depressive symptoms occur in approximately one-quarter of individuals with PHPT before parathyroidectomy, and about two-thirds show improvement one year post-surgery. Further research is needed to guide antidepressant treatment, particularly regarding when to withdraw this post-operatively if the depression may be attributed to PHPT.

Conclusion: Patients diagnosed with PHPT should be referred to endocrinology clinics. Current surgical criteria primarily focus on classical PHPT symptoms, such as osteoporosis. However, expert panels recognize that non-specific symptoms, including depression, often improve following parathyroidectomy. This suggests that surgery may be a cost-effective intervention to prevent further health deterioration.

Aims: To explore the current availability of psycho-education as a primary prevention against substance misuse in unplanned pregnancies for adolescents in the UK. It was noted that 80% of young adults registered with drugs and alcohol services started misusing substances under the age of 15 years. This poses an apparent risk of young mothers who are abusing drugs to have unplanned pregnancies. Moreover, pregnancies occurring sooner than desired are associated with higher risks to the health of the fetus because of delayed recognition. A study from the United States shows that women who reported using hard drugs, cannabis or smoking cigarettes at age 18 had an increased likelihood of risk behaviours and subsequent unplanned pregnancies.

Methods: The National Office of Statistics and the UK Government website were scanned to retrieve data appropriate to adolescent substance misuse and unplanned pregnancies. It was found that the conception rate for women aged under 18 years in England and Wales in 2021 was 13.2 per 1,000 women. Additionally, 11,326 young people were found to be in contact with alcohol and drug services between April 2021 and March 2022. Out of which 234 (5%) were young mothers or pregnant.

Results: The need for psychological intervention for young women focussing on substance misuse has been an ongoing dilemma. The UK government introduced programmes such as the 10-year Teenage Pregnancy Strategy for England which aimed to reduce the conception rate for women under 18 years. However, medical services often do not have data on substance misuse in young people with unplanned pregnancies as they have not had prior contact with the service. This puts them at increased risk of health complications during the pregnancy and ultimately risk of neonatal withdrawal syndromes. This demonstrates an increasing requirement to introduce psycho-education accessible to adolescents between 16–18 years to create awareness of risks of substance misuse and unplanned pregnancies.

Conclusion: Even though there are programmes preventing and educating regarding unplanned pregnancies, there is little support available to adolescent mothers who have ongoing substance misuse behaviours. Misusing substances while pregnant poses a risk not just to the fetus, but increases the complexities of bearing the responsibility of being a parent with a misuse disorder. Therefore, there is an emergent need for psycho-education accessible to adolescents to educate them against substance misuse during unplanned pregnancies.

Aims: Studies have shown an elevated risk of psychosis among migrants and ethnic minorities, but there has been little investigation of risks for Irish and Chinese ethnic groups in the UK. The aim of this study is to investigate the risk of first-episode psychosis in White Irish and Chinese ethnic groups compared with the White British population in West Yorkshire.

Methods: Data from local census and two Early Intervention in Psychosis services for individuals aged 15–34 with first episode psychosis between 2013–2015 was collected. Risk ratios for combined locations were calculated using Mantel–Haenszel fixed effects models.

Results: The White Irish group showed a non-significant but consistent trend of around a 2-fold elevated risk of first episode psychosis (RR 2.27, 95% CI 0.95 to 5.46). The Chinese group did not show a significantly elevated risk (RR 0.4, 95% CI 0.13 to 1.25).

Conclusion: Although not statistically significant, the study suggests a consistent trend of elevated psychosis risk in the White Irish group. Further research is needed to validate these findings and determine key contributing factors.

Aims: With reform planned for the England and Wales (E&W) Mental Health Act (MHA)1983 as amended by the MHA 2007, a comparison of the current E&W Act with the Australian Capital Territory (ACT) MHA 2015 was undertaken, including to examine whether differences were associated with variations in involuntary hospitalisation and Tribunal reviews.

Methods: A comparative analysis was conducted examining the E&W and ACT MHAs. Cross-jurisdictional analysis incorporated datasets from the Office for National Statistics (E&W) and ACT Health Services for three key metrics: per capita involuntary admission rates, mean duration of detentions, and frequency of Tribunal reviews, and analysed in relation to both legislative frameworks.

Results: The ACT mental disorder definition is narrower, includes intellectual disability but not personality disorder. Applications for the 3-month renewable ACT Psychiatric Treatment Order (PTO), limited to mental illness, are made to the ACT Civil and Administrative Tribunal (ACAT). It applies in hospital, the community, or correctional facilities. In E&W, the comparable Section 3: Admission for treatment detention period is 6 months. ACAT can authorise compulsory medication and ECT, a role in E&W of a Second Opinion Appointed Doctor (SOAD).

Criminal courts can request ACAT to assess a defendant for fitness to enter a plea and if not guilty by reason of mental impairment. This is the criminal courts’ role alone in E&W.

In E&W Crown Courts can make 'hybrid orders', a sentence of imprisonment allowing for treatment in hospital ensuring offenders are placed where their mental health needs can be best met.

Comparing E&W with ACT, the respective approximate populations served were 56 million and 431,000 and the annual involuntary hospitalisation numbers were 48,000–50,000 compared with 300–350 (statistically not significant; 0.087% compared with 0.075% of the population).

The average detention length was longer in E&W (30–45 days compared with 21–35) which has more Forensic units than the ACT.

Annual numbers of Tribunal reviews were 7000–8000 in E&W, while in ACT 200–250, per detained patient significantly more (p<0.0001).

Conclusion: The definition of mental disorder differs between the two legislations. The new MHA reforms in E&W will raise threshold for detention and require faster access to Tribunals. The ACT PTO applies to patients not only involuntarily hospitalised, but to those in the community and correctional facilities. This, with shorter detention periods and more frequent Tribunal reviews, may be factors in the shorter detention lengths in hospital in ACT compared with E&W.

Compared with E&W, there is a much greater role for the ACAT Mental Health Tribunal, including in authorising mental health orders, medication and ECT, which likely accounts for the significantly greater use of Tribunals in ACT.

In comparison to E&W, ACAT hearings are briefer and rely more on written than oral evidence. Innovatively, ACAT can be delegated by a Criminal Court to determine medico-legal issues in defendants.

Aims: Alzheimer’s disease continues to be a huge health concern around the globe. Although similar recent developments in anti-amyloid therapy are promising, there is concern about some side effects like ARIA. The purpose of this meta-analysis was to systematically review and compare the safety characteristics of three of the most promising anti-amyloid drugs: lecanemab, donanemab and aducanumab, specifically, the frequency of ARIA-E (oedema) and ARIA-H (haemorrhage).

Methods: The present systematic review included only high-quality randomized controlled trials, randomized controlled trials with non-parametric data, and meta-analyses. Data was analysed and visualized by using forest plots, funnel plots and bubble plots. The degree of heterogeneity was examined by I2 of statistics.

Results: The antibody lecanemab had the lowest ARIA-E rate at 12.6% and the highest infusion reaction rate at 26.4%. Mild ARIA-E was evident in 24.0% of the participants, whereas mild ARIA-H was detected in 19.7% of the subjects.

Of the four candidates, aducanumab showed the highest rate in ARIA-E (30.7%) but the lowest rate in infusion reaction (1.2%). The overall ARIA-H rates appeared to be moderate for all drugs (17.3–19.7%).

The odds ratios in the forest plot were above 1 for all the outcomes suggesting increased adverse event risk. There was moderate to high heterogeneity in all the studies examined (I2 = 84.7%).

Conclusion: In essence, the risks and benefits of each drug are different. The ARIA-E risk associated with lecanemab is lower than with aducanumab; however, infusion reaction rates remain high. There is reason to believe that such an aggressive ARIA-E profile would ultimately restrict the value of aducanumab and lecanemab. However, donanemab does bring a kind of medium between the two. This review emphasizes the importance of individualized interventions in treating Alzheimer’s dementia.

Future Directions: More research is thus needed to understand some of the factors that have confounded heterogeneity, and to find ways of managing some of the risks associated with ARIA. The current study indicates the importance of long-term safety data along with head-to-head comparisons regarding clinical decision-making.

Aims: Elevated prolactin levels due to antipsychotic drugs are prevalent in elderly patients and may cause multiple complications. Hence, the purpose of the present study is to compare the effectiveness of changing existing antipsychotic treatments with prolactin-sparing antipsychotics or adding dopaminergic agents to the existing treatment in patients with clinically insignificant hyperprolactinaemia in later life.

Methods: The sample for this systematic review was identified using a broad search strategy in key electronic databases including Pubmed, SIGLE, CINAHL, Web of Science and OVID. To complete the search, only citations that included elderly or geriatric patient populations and hyperprolactinemia associated with antipsychotic medications were used. Normalization of prolactin levels, psychiatric status, and side effects were the main results measured.

Results: The review flagged several main studies: The efficacy of antipsychotic aripiprazole use in the treatment of schizophrenia is discussed about its impacts on prolactin levels in individuals of different ages and gender. There was no effect on prolactin plasma concentrations in postmenopausal patients with depression and a small but significant positive impact in schizophrenia patients.

An innovation that supplements the pattern of traditional Chinese medicine together with a low dose of aripiprazole can be useful for treating antipsychotic-induced amenorrhea. Prolonged exposure to prolactin-elevating antipsychotics was found to raise the risk of fractures, a finding that provided insight into other health risks.

Conclusion: The approach to the management of antipsychotic-induced hyperprolactinemia in older adults is beyond general management. Although studies that counter the aversive effects of antipsychotics with drugs like aripiprazole seem promising, its benefits are somehow relative across populations. Since there may be long-term health risks such as fractures in the future, it is taken fairly seriously and requires vigilance with a concrete individual management plan.

Regarding the limitation of the present study, it is recommended that future research incorporates different antipsychotics, follow-up outcomes longer, and provide strategies to avoid such risk factors among this population.