Since the 1950's, there has been increasing interest in the potential of the psychedelic experience to generate an enhanced state of emotional well-being in those suffering from a range of mental disorders. Following the so-called ‘War on Drugs’, much of this research was curtailed until a new surge of interest resulting in a ‘psychedelic renaissance’. This has come at a time where powerful institutions, including the medical sphere, are being asked to address their oppressive and damaging pasts; these narratives bear particular relevance to psychedelic research given the widespread use of entheogenic plants as medicines and tools for spiritual healing amongst indigenous groups worldwide, and the political history of the War on Drugs. The aim of this study was to explore how those in the psychedelic community have come to understand what it means to ‘decolonise’ this space and to situate these conversations within existing literature.

Semi-structured interviews were conducted with 10 participants who were recruited using theoretical and snowball sampling. Data collection and analysis were carried out from a critical theoretical standpoint, further borrowing from aspects of constructivist grounded theory methodologies. This involved open coding of existing literature to devise an interview guide, followed by coding of interview transcripts to generate several key themes as they emerged from the primary data.

Analysis of the data generated 8 sub-themes, which were then combined to create the 4 main themes;

• • The Making of a ‘New’ Medicine

• • Scientism and Spirituality

• • Appreciation vs Appropriation

• • Beyond Decriminalisation

The study demonstrated the participants’ willingness to engage in a discussion which explored some uncomfortable truths regarding psychedelic research. There was a suggestion amongst some participants that the space can never be truly decolonised given the capitalist and neo-colonial manifestations within the current space. Future research should seek to facilitate more critical discussion of the epistemic, material, and geopolitical injustices which exist, and critical indigenous methodologies offer a meaningful way of understanding and undoing the hierarchical power structures currently at play.

Background: The impact of the pandemic and resultant restrictions on suicidal thoughts may vary across populations, geographical areas, between high and low socio-economic groups and vulnerable populations. Aim: To investigate the psychological impact of COVID-19 and resultant restrictions on suicidal thoughts in the United Kingdom.

The study group conducted a cross sectional survey using a questionnaire based on published approaches (Generalised Anxiety Disorder 7, Patient Health Questionnaire 9, Impact of Events Scale-Revised) to understand the psychological impact of COVID-19 and the resultant restrictions on suicidal thoughts. The study was conducted in 3 phases to capture the different phases of the pandemic restrictions:

• Phase 1: 1st May 2020 to 31st July 2020

• Phase 2: 12th November 2020 to 12th February 2021

• Phase 3: 1st July 2021 to 30th September 2021

Analysis strategy: Descriptive analysis and logistic regression is applied in this study.

The study recruited 29133 participants in phase 1; 83851 participants in phase 2 and 75204 participants in phase 3. The largest age group of participants was 45–64 years. About two thirds of respondents were female. Majority of participants were of White British ethnicity. 31% participants in phase 1, 30% in phase 2 and 19% in phase 3 reported suicidal thoughts.

The preliminary regression analysis indicates that younger and male participants reported more suicidal thoughts among other findings which will be reported in the presentation.

Limitations: The non-probability sample design and time limited surveys meant that longitudinal changes were not possible to elicit.

There is mixed evidence on whether rates of suicidal thoughts increased during the pandemic. The results of this study will add to the evidence base and influence future pandemic planning and efforts to developing resilience and good mental health in society.

This research assessed healthcare workers' vaccination practices for influenza, hepatitis, and pneumonia, as well as their desire to get COVID-19 vaccine when accessible, and investigated their 7C psychological antecedents (confidence, complacency, collective responsibility, compliance, calculation, constraints and conspiracy). Stress variables and vaccination intention for COVID-19 were also compared to see whether psychological stress had a meditative impact on the relationship.

An analytical cross-sectional survey was conducted among health care professionals including nurses and doctors of tertiary care hospitals of Rawalpindi. Data were collected from February to April 2021 to get the COVID-19 vaccination when it became available, and looked into their 7C mental forebears (confidence, complacency, collective responsibility, compliance, calculation, constraints and conspiracy). A total of 642 health care professionals voluntarily participated in our research. Demographic Details, questions like pneumonia vaccination, hepatitis vaccination, influenza vaccination and 7C questions were asked. Data were entered and analysed through SPSS 26.0 and Python. Correlation, linear and non linear regression, and mediation analysis were applied.

The immunization rates for influenza, hepatitis, and pneumonia vaccines, as well as the percentage of those who received COVID-19 vaccination, were 43.4%, 65.2%, 42.8%, and 39.7%, respectively. Hepatitis vaccination was significantly associated with the 7C model, influenza vaccination with conspiracy, whereas pneumonia was significantly associated with compliance. confidence (r = 0.11), complacency (r = −0.19), constraints (r = −0.20), calculation (r = 0.08), collective responsibility (r = 0.18), and compliance (r = 0.19) were significantly corelated with the COVID-19 Vaccine Intention. Contrary to direct effect, the indirect effect of patient contact frequency (β = −0.01, ρ<0.05) and terrified of contracting virus (β = −0.05, ρ<0.05) via psychological stress on COVID-19 Vaccination intention were significant depicting full mediation.

For herd immunity, the probability for COVID-19 vaccination uptake among healthcare professionals was less than optimal. The 7C structures may help predict immunization against influenza, hepatitis, and pneumonia, but not vaccination against COVID-19.

Carers of individuals presenting with complex behavioural and mental health needs report that service users may not receive the provision of care they require, particularly when presenting following suicide attempts and self-harm. Carers are an integral part of the care system and often feel ignored and marginalised by services; there is a lack of involvement of carers and paucity of their views of support needs to be explored. The aim of the study is to understand carers’ experiences of caring for service users with complex mental health needs who self-harm and/or attempt suicide, and the support received from mental health care services.

Ten carers of service users with complex mental health needs were interviewed about their views on the psychiatric admission, treatment and discharge process for the people they were caring for. Data were gathered during semi-structured, one-to-one interviews remotely over the phone or online platforms. Interviews were audio-recoded and transcribed verbatim. A transcript-based conceptual analysis was conducted to identify and explore emerging themes.

Carers identified both positive and negative aspects of the psychiatric admission and care within community settings. The following key themes emerged from the interviews: lack of control and information from mental health services, the importance of support from staff, or conversely its absence; concerns about service users’ vulnerability, negative staff attitudes and opportunities for involvement; negative experiences of generic psychiatric settings; positive experiences were encountered when there were supportive and caring staff, good information sharing and satisfactory discharge arrangements.

Important areas for service improvements are highlighted. Recommendations included: the need for support; information about suicidal behaviour and advice on managing further incidents at home; more support in coping with regular and escalating self-harming and suicidal behaviours, particularly, severe consequences of staff safeguarding errors and inappropriate discharge, and the importance of supportive and adept staff. These findings identify the need for tailored support for carers regarding the management of self-harm and suicidal behaviours in the community.

Individuals presenting with complex behavioural and mental health needs may not receive the provision of care needed. Those presenting with a more complex clinical presentation may have a history of self-harm and suicide attempts. A common risk factor for preceding suicide is previous self-harm, suicide attempts or discharge from inpatient units. Understanding the descriptive symptom domains for inpatients and those treated in the community and the relationship between them could inform suicide prevention. The aim of this study was to explore the extent of self-harm and suicidal behaviours in individuals with complex mental health needs across inpatient and community settings.

A cohort study design of in-depth written medical notes (n = 80) for people who were known to have complex mental health needs across inpatient and community settings. Data were extracted from medical records onto a coproduced questionnaire. As well as demographic data, information was collated about previous self-harm, suicide planning, suicide attempts, and support seeking regarding suicidal thoughts. The study will include a quantitative in-depth description and inferential analysis of the demographic clinical characteristics of the patient group.

Medical case notes were reviewed for 80 service users with complex mental health needs. Across both groups, approximately three-quarters of participants had previously self-harmed (76%), or planned suicide (n = 73%), and/or attempted suicide (63%). Self-harm (83% vs. 70%) and suicide attempts (72% vs. 65%) were more prevalent in the inpatient group compared to the community group. Social support was received more by community patients than inpatients (70% vs. 50%), even though inpatients were more likely to sough help when experiencing suicidal thoughts compared to people cared for in the community (38% vs. 30%). In both groups, there were often multiple suicide plans and attempts made over their timeline of contact with services.

Self-harm, suicide planning, and suicide attempts were prevalent for people treated across both inpatient and community settings. Self-harm and suicide planning was indicative of a later suicide attempt within both settings. In those experiencing suicidal thoughts, few had sought help, suggesting the importance in staff training to enable then to recognise and identify patterns of self-harming and suicidal behaviours in individuals with complex mental health needs. Social support needs for inpatients should be increased, particularly when they sought help for suicidal thoughts. This may help to reduce length of stays in hospital or future readmissions to hospital; thus, reducing the cost implications for the NHS mental health services.

Brazil is the eighth in number of suicides in the American continent, and 4th in the number of suicides in Latin America. From 2011–2016, there were 33,269 cases in women and 14,931 in men, with 24.1% and 17.2% in populations aged 10–19 years, respectively. Regarding self-harm, there were 116,113 cases (25.9%), and 60,098 cases (19.6%). And in both, the recurrence rate was high, with 25.3–33.1%. Properly employed, the Singular Therapeutic Project (STP) can prevent further events and even completed suicide. In this way, there is a reduction in stigma in this population and for family members, adequacy of mental health services, in addition to lower public spending on hospitalizations. We analysed the effectiveness of the STP in cases of suicide attempt and self-harm, in an outpatient setting, through the comparison of a group of patients with more adherence with the STP, in relation to the group with less adherence in a multidisciplinary context.

It was a retrospective cohort, with adolescents aged 12 to 18 years, from the south of Sao Jose do Rio Preto (Brazil), during the period of 2015–2019, with follow-up for more than 3 months.

To analyze the behavior of numerical variables, descriptive statistics, boxplot plots and the specific test for Kolmogorov-Smirnov will be considered. Comparisons of continuous variables between two independent groups will be performed using Student's t test or Mann-Whitney test; comparisons of categorical variables with Pearson's chi-square test or Fisher's exact test.

The study sample consisted of 88 patients, 79.5% of whom were girls, 1.1% were illiterate, 34.2% were referred from the health unit, 29.5% from the hospital emergency. Patients with new episodes of suicide attempts accounted for 14.7% (1 attempt −10.2%, 2–1.1%, 3–3.4%), and self-harm 23.8% (1–12.5%, 2–2.3%, 4–4.5%, 5–2.3%, 6–1.1%, 7–1.1%).

There was no statistical significance between the group with adherence to STP and without adherence in relation to new suicide attempts (p = 1.0) and recurrence of self-harm (p = 0.309). In addition, both outcomes were not statistically significant with sociodemographic data, psychoactive substance use, and negative life events.

The adolescents' adherence on STP was not associated in recurrence of suicide attempts and self-harm. We hypothesized that the sample size may have influenced the power of the statistical analysis. This pilot study is the first phase of the still ongoing study on all city.

With extensive evidence and track record on efficiency, third-wave psychotherapies, i.e. mindfulness-based interventions (MBIs), have gained popularity in the United Kingdom (UK) as the mainstream tool for mental health and well-being. During the COVID-19 pandemic, a lot of MBI training has shifted from physical meetings to online to improve access nationally. To date, there is limited data on the differences of online MBIs available in the UK. This web pages review is aimed to elucidate the available resources for online training on MBIs in the UK.

Google Search engine was used to identify web pages providing MBI training in the UK from February 2021 to March 2021. The search words used were “mindfulness”, “acceptance commitment therapy”, “dialectical behaviour therapy”, “DBT”, “Compassion focused therapy”, “CFT”, “England”, “Northern Ireland”, “Scotland”, “Wales”, and “United Kingdom”. The search word “ACT” was omitted due to a high number of irrelevant search results. Inclusion criteria were any web page providing mindfulness training in the English language, based in the UK. Exclusion criteria were web pages that were not from the UK with limited information and the web page was not about the provision of mindfulness training. Given the high number of web pages appearing in the Google Search for each of the localities, further search was stopped when all ten web pages that appeared on a Google search page were all excluded.

The total number of web pages returned from searches was 23,030,000 of which were 13.1 million for England, 2.89 million for Scotland, 3.09 million for Wales, 2.18 million for Northern Ireland, and 1,770,000 were unspecified. Only 165 web pages offering MBI training were included. Among those, 57% were for the general public while 30% had information for both professionals and the public. The majority of them, i.e. 65% offered online training courses when only 25% of them offered both online and face-to-face training. There were 25% of web pages offering free basic courses for the public. There was a similar split between the group, individual and mixed training.

There is a significant amount of MBI training resources available online for both public and professionals. One interesting finding is that a significant portion of them provide free basic training which is very encouraging and certainly has a positive impact on the accessibility of mindfulness education during the pandemic disruption.

Introduction: Mental health literacy (MHL) is defined as “one's knowledge and beliefs about mental disorders” (Nishida-Hikiji et al., 2021). Additionally, it includes the capability to recognise specific disorders, distinguish risk factors and causes, recognise self-treatments and available professional help, and it is an attitude that encourages recognition and appropriate help-seeking (Jorm et al., 1997). Background: In the UK mental health problems are one of the main public health issues as it affects one in four individuals. It specifically has a high prevalence among university students which is between the ages of 16–24 years (Kessler et al., 2005)

The study design used for this study was a systematic literature review in which data were collected from PubMed, EBSCO and ScienceDirect using specific keywords in the advanced search. The amount of papers found were 953 after abstract screening for keywords only 34 papers were left and then final abstract and full-text article screening for the inclusion and exclusion criteria was done leaving it with only 8 papers. A quality assessment was done for the eight papers using CASP tool for RCT papers and EPHH tool for cross-sectional papers.

The findings showed that there are different levels of MHL between university students depending on their gender, education year, faculty and ethnicity. It was also found that the professional help seeking behaviour is not significantly different between genders but there was a difference regarding those identifying themselves as bisexuals despite them having high MHL scores.

In conclusion the MHL of university students in the UK was found to be lower than those in Australia thus stating that more attention should be drawn to the issue and the need for easily accessible counselling services should be provided and promoted by universities. So that students can know about their existence and make good use of it whenever needed.

Medicine is an undoubtedly challenging degree but studying medicine during the COVID-19 pandemic has posed added challenges for medical students across the UK. With teaching being moved online, practical exams cancelled, and final year students being fast-tracked onto the NHS frontline, there has been a dramatic change in how traditional medicine is being taught- with a ‘hands-on’ approach being swapped for video calls and remote teaching. This study will highlight the impact of the COVID-19 pandemic on the mental health of medical students, how they have coped through what has been an unprecedented two years and what can be done to support them through their medical training.

A cross-sectional survey was performed on medical students at University College London. This involved a combination of face-to-face interviews and an online survey. They were asked about the impact on their overall mental well-being, as well as what the most challenging aspect of studying medicine during the pandemic was. They were also asked how optimistic they feel about their future in the medical profession. The data gathered were then analysed.

There were 30 responses, which were a combination of face to face and an online survey. Students unanimously agreed that the most challenging aspects were loneliness, lack of face-to-face teaching and minimal social interaction. 60% stated that their mental health has suffered significantly, and everyone felt that they have missed out on certain aspects of teaching during the pandemic, namely cadaveric dissections, time on wards and gaining vital communication skills. However, the benefits of online teaching included learning at their own pace and being able to take breaks to avoid burnout.

There are limited studies looking at the long-term effect of COVID-19 on medical students in the UK. This survey highlights the detrimental impact of the pandemic on medical training and the mental health of these students. To address the possibility of burnout before they start their medical career, more resources could be signposted by medical schools to students during this challenging time. As we are transitioning out of the pandemic, we should be mindful not to forget the cohort of students who studied medicine alone in their homes. Most importantly, we must ensure this generation of doctors is well supported as they begin to care for members of the public.

To explore the reasons for relapse after receiving in-patient detoxification and de-addiction treatment for alcohol dependence syndrome, through in-depth interviews and thematic analysis.

This study was conducted in a tertiary care teaching hospital in South India. After obtaining Institutional ethics committee approval, patients of 18 years and above, who were admitted for the management of alcohol withdrawal syndrome, were approached and informed consent was obtained. Patients were screened with Clinical Institutes Withdrawal Assessment-Alcohol Revised (CIWA-Ar) and 15 patients who scored less than 7, who did not have any severe medical or psychiatric illness, whose cognition was intact according to Hindi Mental Status Examination (HMSE) and those who had two de-addiction treatments in the past were recruited. In-depth interviews were conducted in Tamil, audio-recorded, and transcribed. A semi-structured guided interview format was used to gather their narratives. The transcripts were translated to English on the same day and a step-by-step thematic analysis recommended by Braun et al was followed. The interviews were conducted in a soundproof room ensuring privacy and confidentiality. The recorded audios and the transcripts were firewall protected. The transcripts were read multiple times to familiarize the investigators. By using a general inductive method the data were retrieved, coded, and systematically organized according to patterns and themes. Two investigators coded the transcripts separately and any conflict was resolved by discussion. Thematic saturation was attained with the 14th transcript but the coding was completed for all 15 manuscripts. The mean age of the participants was 26.4 years.

The analysis resulted in the identification of reasons attributed by the patients for resuming drinking after receiving in-patient detoxification and de-addiction treatment for 21 days. This 21 days deaddiction program comprises of detoxification, motivation enhancement therapy, group therapy, and family interventions. The reasons for relapse included peer pressure, confidence that they will not become dependent again, craving, stressors, and health issues such as pain and insomnia and to test whether the treatment works or not. Reasons for the delay in help-seeking were lack of motivation, poor social support, financial constraints, lack of hope in medical treatment, did not feel the necessity to take treatment, fear of whether the doctors would be upset for relapsing again and, the guilt of letting down the treatment team. The reasons why they finally came for treatment were having severe withdrawal symptoms, pressure from a family member or employee, guilt and a desire to change, and fear of dying.

This research provides avenues to understand patients’ perspectives on relapse of alcohol dependence. Understanding these would be beneficial in psychotherapy while managing relapses. It also helps us to reflect on our practice and to address these issues before discharging the patients to minimize the relapses.

This study aimed to determine the prevalence of problematic mobile phone use and its association with the chronotypes among the doctors of a medical college hospital in Puducherry, India. It also aimed to assess the feasibility of the University of Rochester Modified CAGE Questionnaire as a brief screening tool for problematic mobile phone use.

This cross-sectional study was conducted at a tertiary care teaching hospital in South India. After obtaining the Institutional ethics committee approval, doctors including consultants, higher trainees, core-trainees, and junior doctors working in various departments were approached and requested to participate in the study. Those who agreed were provided with the participant information sheet and written informed consent was obtained. Part-A of the questionnaire contained requests for personal and professional details and part B had the following questionnaires to assess problematic mobile phone use, chronotypes, phantom ringing and vibration and, sleep quality.

• • Problematic use of mobile phone scale (PUMP)

• • Reduced Morningness Eveningness Questionnaire (r MEQ)

• • Questionnaire for Phantom ringing and Phantom vibration

• • The Pittsburgh Sleep Quality Index (PSQI)

• • University of Rochester Modified CAGE Questionnaire

• • Data were analysed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). Nonparametric tests were used as the data were skewed. The data were summarized by frequencies and percentages for categorical variables and median and interquartile range for continuous variables. The chi-square test was used to find the association between two categorical variables. Kruskal Wallis test was used to compare the chronotype with the continuous variables such as CAGE total, PUMP, and PSQ score. Correlation between different continuous variables was studied by using Spearman rank correlations. Kappa statistics were used to evaluate the concordance between PUMP and the University of Rochester Modified CAGE questionnaire.

Neither type (NT) was the most common chronotype (41.5%), followed by morning type (38%) and evening type (20%). Eight (5.6%) doctors had problematic mobile phone use, and 38(26.8%) had poor sleep quality. Evening chronotype (p-value- 0.002), being a female (p-value- 0.014), working in a clinical department (p-value 0.017) and experiencing phantom ringing (p-value- 0.001) had significant association with higher PUMP score. Even though females had a higher median PUMP score, problematic mobile phone use was more among males. University of Rochester Modified CAGE Questionnaire had a sensitivity of 81.73% (73–88.6%), and a specificity of 28.95% (15.4–45.9%).

Doctors should be aware of their mobile phone usage. This study has reiterated the predilection evening chronotype has for behavioral addictions and doctors of evening type should be extra cautious.

To assess the association between executive dysfunction and the severity of alcohol dependence, age at first drink, and the number of deaddiction treatments in the past (indicating current relapse).

This cross-sectional study was carried out in the in-patient unit of the Department of Psychiatry of a tertiary care teaching hospital in South India. Institutional Ethics committee approval was obtained. 43 Adult patients who were diagnosed with alcohol dependence syndrome according to the International Classification of Diseases (ICD-10), admitted for deaddiction treatment, whose withdrawal symptoms were adequately treated, and who did not have a severe mental or physical illness were included in the study. The hospital has the policy to offer 21 days of inpatient treatment which comprises of detoxification, motivation enhancement therapy, group therapy, and family interventions. Only those patients previously treated in the same hospital were considered to maintain, homogeneity. After briefing the patients about the procedure, a participant information sheet was provided and informed consent was obtained. A semi-structured proforma was used to collect the demographic details and information regarding alcohol consumption. AUDIT (Alcohol Use Disorder Identification Test) Questionnaire was used to assess the severity of alcohol dependence. After familiarising the participants with the study and the procedure, their executive function was assessed using Frontal Assessment Battery (FAB).

The mean age of the participants was 36(SD 7.8) years. The mean age of the first drink was 21 years (SD 6). The mean duration of alcohol dependence was 5.6(SD 3.6) years. The total number of de-addiction treatments was 2.2(SD 1.2). 58% at least had a middle school education, 30% were unemployed and 48.2% belonged to lower socioeconomic status. 72% were married and 60% had a family history of significant alcohol consumption. The average duration of total abstinence was 147.5(SD 74) days. 86% consumed spirits and 14% consumed arrack regularly. The mean score on the AUDIT scale was 26.8 (SD 7.3). The mean FAB score was 11.2(SD 4.2). 53.4% had a score of less than or equal to 12 indicating executive dysfunction. Age, (p-value-0.02) number of de-addiction treatments (p-value- 0.014) and the AUDIT score (p-value-0.04) had statistically significant negative correlation with the FAB score. Age had a positive correlation with the number of de-addiction treatments

There is a bidirectional relationship between alcohol use and executive dysfunction. By establishing a significant association between executive dysfunction and the number of de-addiction treatments indicating relapses, this study reiterates the importance of assessing executive dysfunction among this population, to prevent relapses. It can be used as a high-risk indicator for relapse and adequate preventive measures should be in place while treating these patients.

Along with the numerous structural and cultural changes in healthcare brought about by the COVID-19 pandemic has had an overwhelming psychosocial impact on marginalized communities. Those with substance use disorders (SUD) are a particularly vulnerable group as they are more susceptible to infections and now have less access to healthcare. Smoking cigarettes is known to increase risk of respiratory tract infections due to suppression of respiratory function and impairment of the immune system. It is important to study the smoking rates and relapses over the course of the pandemic to observe whether the increased risk of COVID inflection in smokers and the psychosocial stress of the lockdown have affected the behavior.

We searched databases including PubMed, PsycArticles, and Cochrane Library using applicable keywords for Substance-Related Disorders, Smoking, and the COVID-19 pandemic lockdown. 69 articles from the results were reviewed, out of which 1 was a meta-analysis and 1 was a systematic review. Other reviews and papers were also consulted to consider case studies and smaller group analyses.

The results of the analysis showed that COVID-19 lockdowns have been negatively affecting those who struggle with substance use disorders, especially that of tobacco use. Evidence suggests a surge of addictive behaviors (both new and relapse) including behavioral addiction over the two years. Recent studies have noted an increase of tobacco use during the pandemic. In some studies, smoking frequency numbers remained stable, and quit attempts decreased.

The psychosocial changes brought on by the pandemic have increased the incidence of smoking frequency and relapse in ex-smokers. This might be due to the increased financial, social, and physical stress, and due to the increased difficulty in accessing healthcare services due to the lockdown. Other stressors contributing to increased smoking could be the stress of contracting a fatal disease, possibility of loss of employment, prolonged confinement, and feeling of boredom. Smoking-related behaviors also increase the risk for contracting the infection due to frequent physical interactions to purchase cigarettes, hand-to-mouth contact when smoking, and increased use of communal smoking places. COVID-19 and addiction are the two pandemics which concurrently can cause a major public health threat. It is important to make the public aware of the increased COVID-19 infection risk attributed to smoking. Hospitals should also resume de-addiction services and provide easy access to advice, support, and pharmacotherapy to those in need.

The aim of this systematic review is to identify and appraise pharmacological options available for management of ADHD in pregnant women and adverse effects of ADHD medications on pregnancy and foetus (malformations or long-term effects).

Systematic review of prospective or retrospective cohort studies, available on this topic till September 2021 after PubMed and MEDLINE search, carried out by 2 reviewers independently. The preliminary search was conducted in March 2021, though the reviewers carried out timely cross-referencing as required. All cohort studied except those with ambiguous methodology were included. The data were further extracted using Microsoft excel after Quality Assessment was completed using NewCastle Ottawa Scale. A narrative synthesis was undertaken as meta-analysis was not feasible owing to heterogeneity between studies included.

Eighteen Cohort studies were included (N = 28227 pregnant women with ADHD) of which 16 were deemed as good quality. Multiple confounders were identified.

The review noted that use of stimulants/non-stimulants reduced symptoms and improved functionality in these expectant mothers. Findings from our review overall indicate low risk of developing malformations with ADHD medications, with only Methylphenidate (notably cardiac) and Modafinil showing slightly increased though statistically significant risk. We also noted slightly increased risk for reduced Apgar scores, abortions on maternal request, pre-eclampsia and preterm births. There was no conclusive association noted between neuro-developmental delay or future ADHD in baby/child.

A case-by-case approach needs to be adopted for every patient, looking at how ADHD affects daily functioning and balancing that against adverse pregnancy outcomes. Also, innovative practices like drug holidays, as required medications, drug free trial while planning pregnancy etc. will help practitioners streamline the treatment of this group of patients better. Issues like research being restricted to certain countries, small sample size, record-based analysis, issues in ascertaining adherence, confounding factors, ethical conundrums etc. were noted.

The aim of this study was to ascertain the correlations between patients’ views of their recovery and clinicians’ views of patients recovery, symptoms and risk, in a cohort of patients in the National Forensic Service Dundrum (NFMHS).

A cross sectional study was performed of all inpatients in the NFMHS Dundrum. The self-rated Dundrum tool was offered to all 96 in-patients and completed by 64. Clinican rated measures of violence risk (HCR-20), programme completion (Dundrum-3), recovery (Dundrum-4), symptoms (PANSS) and functioning (GAF MIRECC) were rated. ANOVA and concordance ratings were calculated using SPSS

A total of 64 patients agreed to participate, of whom 10 were female. The self-rated Dundrum-3 correlated with the staff rated Dundrum-3 (0.471, p < 0.001). The self-rated Dundrum-4 correlated with the staff rated Dundrum-4 (0.373, p = 0.003). The self-rated Dundrum-3 correlated with the HCR-20 total (0.0352, p = 0.005), HCR-C (0.3677, p = 0.004), and HCR-R (0.301, p = 0.018). The self-rated Dundrum-3 correlated significantly with GAF occupational (-0.273, p = 0.48), symptomatic (-0.299, p = 0.03). The self-rated Dundrum-4 correlated only with the GAF symptomatic (-0.333, p = 0.05). The self-rated Dundrum-3 correlated with PANSS positive (0.457, p = 0.001), PANSS negative (0.514, p < 0.001), PANSS general (0.395, p = 0.004) and PANSS total (0.352, p = 0.005). The self-rated Dundrum-4 correlated with PANSS positive (0.356, p = 0.01) and PANSS negative (0.413, p = 0.002).

There was good correlation between patient and clinician ratings of programme completion and recovery. Patient self-ratings of programme completion and recovery correlated with staff ratings of functioning and symptoms. The directions of agreement were correct

Studies of thalamic structure and function in Progressive Supranuclear Palsy (PSP) suggest it may play a role in key aspects of the clinical syndrome. This study examined thalamic changes across PSP phenotypes investigating (i) thalamic atrophy (ii) thalamic functional connectivity and (iii) the relationship between thalamic structural and functional connectivity changes with clinical severity.

Participants

92 participants with PSP [63 PSP-Richardson's Syndrome (RS), 24 PSP-cortical, 5 PSP-subcortical] and 104 age-matched controls were recruited from the Cambridge Centre for Parkinson's Plus Disorders cohort. Clinical assessments and imaging were conducted within 1 year of diagnosis.

Structural Analysis

Thalamic volumes (TVs) were obtained using FreeSurfer. Bayesian multiple regression (brms, R) was used to model (i) mean TVs (ii) group differences in mean TVs (iii) relationships between Z-standardised clinical scores and TVs with age, gender, and total grey matter as covariates.

Functional Analysis

Voxel-wise seed-based functional connectivity of the thalamus used the Functional Magnetic Resonance Imaging Expert Analysis Tool (FEAT) in FMRIB's Software Library (FSL). Inter-group differences and relationships between clinical scores and functional connectivity for each group were assessed using a general linear model with age and gender as covariates.

Structural Analysis

TVs for all PSP subgroups were smaller than controls. No differences between PSP subgroups were detected. There was evidence for a relationship between TVs for the entire PSP group and Revised Addenbrooke's Cognitive Examination (ACER) scores [ß = 0.28, 95% credible interval (CI) = 0.04–0.53]. Subgroup analysis showed evidence for a relationship between ACER scores and TVs in PSP-RS [ß = 0.33, 95% CI = 0.09–0.57] and PSP-cortical [ß = 0.46, 95% CI = 0.12–0.83] phenotypes. A negative influence of TVs on total PSP rating scale scores was found for the PSP cohort a whole [ß = −0.51, 95% CI = −1.00 – −0.02].

Functional Analysis

PSP patients as a group showed decreased thalamic functional connectivity in higher cortical regions. Subgroup analysis revealed decreased connectivity in those areas compared to controls but in distinct distributions and magnitude. Increased thalamic connectivity with the middle temporal gyrus correlated with ACER scores for PSP patients as a group and in the PSP-cortical subtype.

Thalamic volume loss is a prominent aspect of PSP and is associated with a wide network of changes in functional connectivity that may be distinct between PSP subtypes. Changes in thalamic structure and function predict clinical severity, particularly in PSP-RS and PSP-cortical subtypes.

Since the coronavirus disease 2019 (COVID-19) pandemic began, evidence suggests that people with underlying mental health disorders have worse outcomes from COVID-19 infection. Our aim was to assess the impact of COVID-19 infection on people with pre-existing mental health or neurocognitive disorder including COVID-19 related mortality and severity.

We conducted systematic searches of PubMed, EMBASE, and Cochrane library for articles published between 1 December 2019 and 15 March 2021. The language was restricted to English. We included all case control, cohort and cross sectional studies that reported raw data on COVID-19 associated mortality and severity in participants aged 18 years or older with a pre-existing mental health or neurocognitive disorder compared to those without. Three independent reviewers extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Methodological quality and risk of bias were assessed using the 9-star Newcastle-Ottawa Scale. We calculated the odds ratio as the summary measure along with the corresponding 95% confidence intervals. The random effects model was used to calculate the overall pooled risk estimates. COVID-19 related mortality was the primary outcome measure. The secondary outcome measure was COVID-19 related severity, defined as intensive care unit admission or use of mechanical ventilation.

Fifteen studies were included in the meta-analysis comprising of 8,021,164 participants. There was a statistically significant increased risk of mortality for participants with a pre-existing mental health or neurocognitive disorder compared to those without (OR = 2.18, 95% CI = 1.63–2.90, P < .00001). Increased mortality risk was found on subgroup analysis for participants with pre-existing schizophrenia (OR = 2.55, 95% CI = 1.38–4.71, P = .003) and dementia (OR = 3.83, 95% CI = 2.42–6.06, P < .00001). There was no statistically significant difference in the severity of illness when comparing the two groups. There was a statistically significant increase in the number of participants with comorbid diabetes and chronic lung disease in those with a pre-existing mental health or neurocognitive disorder compared to those without.

The results show that people over 18 years with a pre-existing mental health or neurocognitive disorder have an increased risk of mortality from COVID-19 and are more likely to have comorbid diabetes and chronic lung disease. These results highlight the need for better physical health monitoring and management for this group of people and better integration of mental and physical health services, as well as adding to the evidence that they should be prioritised in the ongoing COVID-19 vaccination schedules worldwide.

To explore the effect of hindsight bias on retrospective reviews of clinical decision making prior to adverse incidents to inform future approaches to incident investigations.

We have undertaken focus groups with doctors of varying grades across the North West of England and North Wales. A vignette based on a real-life case from the publicly available NHS England Homicide Independent Investigation report database was presented to each group in one of three versions which differed in terms of the ending of the vignettes (i.e. suicide, homicide, no adverse incident). Using a semi-structured interview approach, the group participants were encouraged by the facilitators to reflect on issues relating to risk and risk management. All groups were provided with the same vignette which initially made no reference to the outcome and asked to comment on matters of risk and risk management. Halfway through the discussion, one of the three outcomes was disclosed, and further group discussion was held. The recorded interviews were transcribed and thematic analysis was undertaken using an adapted Framework Method.

Preliminary results (n = 10) indicate that participants identified the potential for significant harm, particularly to others, and identified evidence of key psychopathological and historical correlates to support assertive management of risk and admission to hospital.

Whilst knowledge of the outcome did not lead to participants changing their favoured management plans, it did alter how they appraised the case and led to participants constructing “narrative” explanations for the outcome given. The level of conviction participants held for their management plan reduced when their expectations about the outcome were confounded.

Participants presented with the suicide outcome vignette described their difficulties appraising risk to others and their over-sensitivity to that risk. Participants faced with the ‘no adverse outcome’ vignette perceived the original management plan far more favourably in hindsight. The groups that were presented with the homicide outcome vignette initially focused on both risks to self and others as well as the perceived need for further information. Following knowledge of the outcome, there was a tendency to highlight parts of the letter pertaining to risk to others which they previously had not given as much attention.

The initial analysis of our data confirms the findings from previous studies that hindsight colours the appraisal of adverse events. However, this study is novel in that it describes the nature of the thought processes underpinning the influence of hindsight on appraisals of risk.

The aim of this proof-of-concept study was to understand the effect of daily intake of a 14-strain probiotic on mood, reward learning and emotional and cognitive processing in adults with low mood in the absence of prescribed medication. Salivary cortisol was measured as a marker for physiological stress.

In this parallel-group double-blind, placebo-controlled trial, 80 healthy adults with self-identified low mood were randomised to receive either the 14-strain probiotic or placebo for a duration of 4 weeks. Data were collected from participants at baseline (week 0) and post-intervention (week 4).

Probiotic intake significantly reduced depression scores (by 50%) compared to baseline, as measured by the Patient Health Questionnaire-9 (PHQ-9) scale (p < 0.05). Analysis of individual items in the PHQ-9 revealed that participants taking probiotics reported improved concentration relative to baseline (+ 51%, p < 0.05) and felt less tired compared to placebo (−21%, p < 0.01).

Regarding emotional processing, the probiotic group was more accurate at recognising facial expressions compared to those receiving placebo (facial emotion recognition test, +12%, p < 0.05). Furthermore, the probiotic group performed less well at the reward learning task relative to the placebo group (probabilistic instrumental learning task, p < 0.05) and was less vigilant to emotional cues compared neutral cues (dot-probe unmasked test, −8%, P < 0.05). The probiotic group also showed increased susceptibility to emotional interference during a cognitive learning task, relative to placebo (auditory visual learning task, −18% p < 0.05).

The study also revealed a downward trend in salivary cortisol in the probiotic group over 4 weeks.

Together, these results suggest that probiotics may work via a different psychological mechanism to that of conventional antidepressants. In other words, probiotics may work by reducing emotional salience across all emotions whereas conventional antidepressants are thought to work by increasing bias to positive emotional cues and decreasing bias to negative ones.

These data suggest that intake of Bio-Kult® Advanced has an effect on mood and that this is achieved in ways distinct from the effects of pharmacological antidepressants. While more research is needed, these results suggest that certain probiotics could form part of an ‘early intervention’ strategy for people experiencing low mood. A second randomised controlled trial (currently recruiting) will provide data on this intervention in patients with a formal diagnosis of depression undergoing concurrent pharmacological treatment.

ClinicalTrials.gov Identifier: NCT03801655

COVID-19 causes cognitive, neurophysical and psychiatric sequalae that persist beyond the acute illness. These appear to be independent of the direct impact on respiratory function although the impact of multiorgan, especially brain pathology, may be a contributory factor – as may psycho-social effects of the disease. We performed a systematic review of literature to assess the sequelae of post-acute COVID-19 syndrome to better understand the need for dedicated interventions to improve functioning.

We conducted a systematic review of reports included in MEDLINE, PsycINFO, and EMBASE. We searched for cohort studies exploring psychiatric and neuro-cognitive sequelae of post-acute COVID-19 in adults with a sample size of at least 100. The search was conducted on 4 February 2022. Findings are reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two authors independently assessed the included studies’ methodological quality using The National Institute of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies and all records were rated as good or fair.

Our search identified 66 records and 14 met protocol requirements. The studies varied in sample size ranging from 100 to 3762 participants. Time to follow-up ranged from 1–12 months. Main symptoms identified by a majority of the studies were; Fatigue (25% to 85%) and Sleep problems (20% to 79%). Psychiatric symptoms; Anxiety (19% to 56%), Depression (11% to 47%), PTSD (6% to 43%) and altered sense of reality (3% to 15%). Neuro-cognitive symptoms; Cognitive dysfunction (25% to 85%), brain fog (12% to 81%), memory problems (24% to 73%), concentration difficulties (25% to 54%), and attention deficit (27%).

Female sex, advanced age, pre-morbid asthma or COPD, increased disease severity, high BMI and new neurological complications during hospitalisation were some of the identified risk factors for persistent symptoms in post-acute COVID-19. One study identified male sex as a risk factor for moderate to severe PTSD. Current evidence suggests that symptoms decrease over time.

There is clear evidence of neuro-physical, psychiatric and neurocognitive sequelae in post-acute COVID-19 syndrome. Differences in assessing and reporting findings makes it difficult to synthesize meaningful information. Identifying and formulating standardised assessments for outcome measures and reporting systems would be useful in future research. Further research into symptoms of post-acute COVID-19, to understand the pathophysiology will better enable us to raise public awareness, introduce preventative measures and incorporate appropriate treatment strategies for rehabilitation.