This study investigated the impact of accelerated Transcranial Magnetic Stimulation (aTMS) compared to daily sessions on outcomes in depression patients. While traditional TMS protocols involved daily sessions 4/5 times per week, this can be inconvenient for patients, particularly those travelling long distances to a TMS clinic. Recent well-designed studies have demonstrated that multiple sessions per day (aTMS) can be as effective as daily TMS. It was expected that these findings would be replicated in a clinical setting and that aTMS would be just as effective at reducing symptoms of depression as daily TMS.

A retrospective chart review of 240 patients (126 males, mean age = 42.36, range = 16–86) was analysed using multiple regression. Patients were treated for unipolar depression over the left Dorsolateral Prefrontal Cortex (LDLPFC) using TMS protocols that have been shown to deliver equivalent outcomes (Blumberger et al, 2018).

The aTMS intensity variable (aTMSiv) was calculated by dividing total number of TMS sessions by number of days between the first and last session (minimum of five days for inclusion). Therefore, a patient who had 30 sessions over 15 days would have an aTMSiv of 2. The mean number of sessions delivered was 24.46 (SD = 8.01, Range = 7–45) and the mean days between first and last treatment was 35 (SD = 20.21 Range = 6–105).

The main outcome variable was percentage reduction of PHQ-9 scores from baseline (mean = 17.89) to treatment completion (mean = 10.76). The mean reduction in PHQ-9 was 40%. The independent variables (IVs) included: aTMSiv, PHQ-9 baseline score, number of sessions, age and sex.

Collectively the IVs predicted PHQ-9 reduction at a statistically significant level (F (5,234) =7.91, p = 6.70E-07, R2 = 0.14). Individual analysis of predictors revealed that aTMSiv did not significantly predict PHQ-9 reduction (F (1,238) = 0.05, p = 0.82, R2 = 0.0002). Only number of sessions significantly predicted PHQ-9 reduction in this model (t = 6.04, p = 5.88E-09).

As the aTMSiv did not predict the change in PHQ-9, this suggests the frequency at which TMS is delivered does not affect the outcome when treating depression. Thus, either daily sessions or aTMS can be utilised to best fit the schedule and lifestyle of the patient.

This study sought to elucidate the occupational health risk perception and psychological impact during the early phase of the COVID-19 pandemic on healthcare workers in a general hospital in Singapore, and factors that influenced risk perception and psychological impact.

Healthcare workers from a general hospital in Singapore were invited to participate in an online survey in June 2020. It posed questions on demographic and occupational information (age, gender, nationality, marital status, profession, working area, length of working experience in healthcare), 20 items on occupational health risk perception and psychological impact of COVID-19, and the Depression Anxiety and Stress Scale-21 (DASS-21).

The 20 items were adapted from a previous study during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak and designed to assess participants’ perceived exposure risk, risk acceptance, families’ perception, stigmatisation, feelings of appreciation, workload, and perceived effectiveness of workplace protective measures. Participants’ responses were obtained on a 6-point Likert scale (strongly agree, agree, somewhat agree, somewhat disagree, disagree, strongly disagree).

For data analysis, responses on occupational risk perception were regrouped into three levels. Depression, anxiety, and stress scores were categorised into quartiles. Ordinal logistics regression was used to compare the association of occupational risk perception with DASS-21 scores, and demographic factors with occupational risk perception. Variables that showed statistical significance (set at P <0.05) in univariate analysis were included in the multivariate ordinal logistics regression model to identify independent predictors.

There were 1252 respondents (92 doctors, 661 nurses, 318 allied health professionals, 181 administrative and support personnel). 85% felt an increased risk of exposure to COVID-19 while 90% accepted the risk as part of their jobs. Stigmatisation against healthcare workers was present, with 45% reported they were shunned and 21% reported their families were avoided. 78% experienced increased workload. Fortunately, most (94%) found workplace protective measures adequate, and felt appreciated by their employer (87%) and society (81%).

Increased perception of occupational health risk was significantly associated with nursing profession, workers in patient-facing areas, and staff with shortest working experience in healthcare.

The mean DASS-21 scores were 9.2 (borderline normal) for Depression, 8.5 (borderline mild) for Anxiety, and 10.9 (normal) for Stress. Increased DASS-21 scores were significantly associated with greater occupational risk perception, younger age, and less years of working experience.

Occupational risk perception amid the early COVID-19 pandemic is associated with adverse mental health among healthcare workers. Nurses, younger staff, and staff with least working experience are more vulnerable.

In the United Kingdom, 14.6 million people reported having a disability in the year 2020–2021. Cognition may be one factor that contributes to disability, as previous studies have shown that cognitive abilities predict later health outcomes and prevalence of disability increases with decreasing cognitive function. Furthermore, studies have demonstrated a link between cognition and common psychiatric disorders, such as depression and anxiety. To our knowledge, no studies have examined the role of current mental health in the association between cognition and disability in a general population sample. The aim of this study was to examine the relationship between cognition, mental health and measures of disability/daily functioning in an online population sample. Our hypotheses were: 1) that lower cognitive performance would be associated with increased reported disability, and 2) that this association would be partly explained by current depression and anxiety symptoms.

The sample consisted of 3679 participants recruited from HealthWise Wales. Participants completed the Cardiff ONline Cognitive Assessment, a web-based battery of five tasks assessing processing speed, working memory, vocabulary, reasoning, and emotion identification. Disability was assessed using the World Health Organisation Disability Assessment Schedule (WHODAS). Real world measures of functioning were also included (currently employed, living with a partner, children and ever married). Current depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Linear and logistic regressions were conducted to assess the associations between cognitive performance and measures of disability/functioning. Structural equation modelling was performed to assess whether these associations could be partially explained by HADS scores, as well as measures of education and health/lifestyle factors.

Higher cognitive performance was associated with lower overall WHODAS scores (B=−0.1, SE = 0.01, P = 1 × 10–13), living with a partner (OR = 1.13, 95% CIs = 1.06–1.21, P = 4.3 × 10–4) and being in employment or education (OR = 1.22, 95% CIs = 1.13–1.33, P = 2.1 × 10-6). HADS scores partially explained the relationship between cognition and: 1) WHODAS (80%), 2) employment (63%) and 3) living with a partner (37%). In addition, smoking status explained 3% of the relationship between cognition and WHODAS.

Current symptoms of depression and anxiety partially explained the relationship between cognition and three measures of disability/functioning. Alleviating these symptoms may improve patients’ daily difficulties. Future research should establish the direction of causality of these associations.

Recruitment and retention of medical staff is a national issue. Leicestershire Partnership NHS Trust (LPT) has significant challenge like many other neighbouring Trusts in this regard. Low level of staff means challenges in provision of adequate and efficient patientcare. There is a lack of flexibility for clinicians to get time for Supported Programmed Activity (SPA). Burn out of existing clinicians and loosing good will is common which increases patients’ complaint and potential risk of near misses and serious incidents. Despite the East Midland being one of the popular deaneries among STs, retention of locally trained STs post CCT remained a challenge. Thus, the aim of this study was to find out proportion of speciality trainees (STs) doctors satisfied with current job and to explore their views on current difficulties and ways to retain and support them post CCT in career progression within the training Trust.

It was a cross-sectional survey. The target population was STs working in the East Midland deanery. An online questionnaire was developed for data collection. Data were gathered through open (free text) and close (options provided) questions. Information was collected regarding job satisfaction, positive and negative of job, difficulties and challenges in current role, willingness to continue post CCT within Trust and if they would recommend friends or colleagues to join LPT. Results are reported in percentages for descriptive statistics.

About 59% of the STs were satisfied with their current training. Key positive of jobs include helpful colleagues, good trainers and supervision, autonomy, flexibility, good on-call rota pattern, work life balance, and protected time for teaching. Interest is shown for various SPA activities (teaching, audit, QI project, research, leadership and management). However, wide variety of challenges being also reported at individual, team and organisational level.

Over 70% of the participants shown interest to work for LPT post CCT but requested for additional support in term of flexibility of job description and role whereas remaining 30% reported to move into private sector due to better pay and work life balance. Surprisingly only 23.5% clearly stated, they would recommend a friend or a colleague to join LPT.

Majority of STs doctors were satisfied and willing to continue working post CCT in LPT. However, reported challenges need prompt response and early discussion and planning with STs in term of what local Trust can offer and support would ensure their retention and enhance recruitment while they are being advocate for the LPT.

Recruitment and retention of medical staff is a national issue. Low level of staff means challenges in provision of adequate and efficient patientcare. There is a lack of flexibility for clinicians to get time for Supported Programmed Activity (SPA). Burn out of existing clinicians and loosing good will is common which increases patients’ complaint and potential risk of near misses and serious incidents. Leicestershire Partnership NHS Trust (LPT) has significant challenge like many other neighbouring Trusts in term of recruitment and retention of consultant psychiatrists. The aim of this research was to find out proportion of consultant psychiatrists satisfied with current job and to explore their views on current difficulties and ways to support and retain them within their current Trust.

It was a cross-sectional survey. The target population was consultant psychiatrists working in LPT. An online questionnaire was developed for data collection. Data were gathered through open (free text) and close (options provided) questions. Information was collected regarding job satisfaction, positive and negative of job, difficulties and challenges in current role, willingness to continue work within Trust and if they would recommend friends or colleagues to join LPT. Results are reported in percentages for descriptive statistics.

About 34% of the responders (n = 38) were satisfied with their current job, whereas about 45% reported unsatisfied or very unsatisfied. Regarding quality of admin support, nearly 40% were unsatisfied. Similarly, about 1/3 of the responders reported un-satisfaction with available office and clinic space for clinical and admin activities. Nearly 2/3 reported not getting adequate time for SPA activities, instead 37.5% reported 5 or more hours per week spending over their contracted hours. Over 97% said, their job can be more rewarding by acknowledging their contribution, involving them in Trust activities, provision of adequate clinic space, reducing case load with enhance recruitment. Surprisingly 71.1% reported thought of leaving LPT in the last six months and only 28.9% clearly stated, they would stay within Trust and also recommend a friend or a colleague to join.

Majority of the consultant psychiatrists were unsatisfied with their current job and reported thought of leaving Trust in the last six months. There is an urgent need to address the highlighted challenges and early discussion with them in term of what local Trust can offer and support them to ensure their retention and enhance recruitment while they are being advocate for the LPT.

Sexual Harassment (SH) in colleges and universities in Nigeria is often shrouded in secrecy. Survivors rarely report the SH experience. This is often because of unequal power relations, fear of loss of status, marks, or job as retaliation, and the attendant stigma. The sexual harassment policy, implementation, and campus climate also have huge roles to play in reportage. This study aimed to investigate the experience of SH by men and women in heterosexual and same-sex situations in first-generation universities in South West Nigeria.

Students and staff who had survived SH were targeted for IDIs focused on the experience of SH from the perspective of the survivor including the consequences, reportage, outcomes, and whether justice had been served. A purposive approach was adopted in identifying respondents and a snowballing method guided the process across the three universities. The sensitivity of the topic and the stigma attached called for a recruitment strategy that ensured privacy, confidentiality, and freedom to share experiences without reservation. About four IDIs were conducted in each university. Interviews were held on several (face-to-face via telephone or Whatsapp calls) platforms. Analysis commenced with verbatim transcription of the audio recordings. The accuracy, integrity, and completeness of all transcriptions were verified. A thematic analysis was conducted and all transcripts were coded by three experts which were organized into categories. The most prominent and salient thematic findings were brought forward by merging codes while maintaining the integrity of the individual categories. A cluster analysis of code associations was also performed to facilitate pattern recognition in the data. NVivo Pro v.12 was used to facilitate the analysis. Themes were categorized into four distinct areas: experience of SH, consequences, reportage, and outcome.

The experience of SH ranged from sexual assault to unsolicited physical touch and verbal harassment. In terms of consequences, survivors experienced low self-esteem, had problems in their relationships with others, became less trusting, and increased risk-taking behaviour. Most survivors were not aware of anti-SH policies in their institutions. None reported to law enforcement agents due to stigma, lack of financial means, and lack of trust in the system.

Institutions need to do more than develop adequate antisexual harassment policies. There is a need to interrogate the culture around implementation and training to improve prevention and raise awareness.

Sexual harassment (SH) is a widespread and recurring problem in educational settings. SH is not easy to define, partly because it does not involve a homogenous set of behaviours. There are gender variations in the experience and perception of SH. Risk factors for SH include female gender and gender inequality, same-sex attraction, poverty, poorly trained, underpaid, and understaffed educators. The study aimed to determine the prevalence rates and correlates of heterosexual and same-sex SH and to explore the social and mental health sequelae of SH among students and staff of first-generation universities in South-west Nigeria.

A cross-sectional survey was done in three first-generation universities in southwest Nigeria. A sample size of 550 participants per institution was estimated with a margin of error of 2.5%, a 95% confidence level. This gave a total sample size of 1650 respondents participants for the study. In each university, Students and staff were categorized by faculties into 3 clusters: science, social science, and arts. A proportionate sampling technique was used. Participants were assessed for SH, age, sexual orientation, gender, motivation for dressing, depressive symptoms, and suicidality. Associations were tested using Pearson correlations.

SH was higher with age, among females, among lesbian, gay, and bisexual (LGB), participants with sexual motivation for dressing, high sexual desire, high suicidality, and low perception of campus safety. In terms of gender differences, correlation with age was slightly higher in females while correlations with lesbian/gay status was higher in males. In terms of sexual orientation, correlation with age was largest in LGB, association with dressing motivation, sexual desire, and depressive symptoms scores was greatest in heterosexual participants, association with suicidality scores was greatest with lesbian/gay status; and correlation with perception of campus as safe lowest among bisexual participants. Generally, the associations were weakest among staff compared to students.

There are certain demographics (heterosexual and bisexual females and gay men) that appear to be more vulnerable to SH in tertiary institutions. The correlates of SH also vary in the different sample groups. These should be considered when programming for prevention and response to SH in Nigerian tertiary institutions.

Deliberate self-harm is one of the common psychiatric emergencies in medical practice, and bipolar disorder carries one of the highest risks for self-harm among various other psychiatric and physical disorders. The relationship between self-harm and bipolar disorder and its risk factors has not been sufficiently studied in Pakistan and remains an area of investigation elsewhere. The objective of our study was to determine the frequency and factors associated with deliberate self-harm in patients with bipolar disorder.

This cross-sectional study was conducted in the outpatient department of psychiatry of a tertiary care hospital in Lahore, Pakistan, from May 2020 to April 2021. A total of 165 patients living with bipolar disorder, between the ages of 15 and 65 years, were included in our study. The diagnosis was in accordance with the criteria in International Classification of Diseases 11th Revision (ICD-11). Deliberate self-harm was defined as a non-fatal act in which an individual deliberately causes self-injury or ingests a substance in excess of any prescribed or generally recognized dosage. This was assessed through history (during last 6 months) and physical examination performed by the psychiatrist.

Sociodemographic variables like age, gender, educational status, marital status and employment status, and the clinical variable of treatment compliance, were documented. The data were recorded and analysed using Statistical Package for the Social Sciences (SPSS) version 20. The association of above factors with the presence of self-harm in our study participants was then explored with Pearson Chi-Square test. The p-value of less than 0.05 was considered as significant.

Out of 165 cases included in the study, 62.42% (n = 103) were male and 37.58% (n = 62) were females. The frequency of deliberate self-harm in bipolar disorder was 35.15%. In terms of association, only female gender was found to have a statistically significant relationship (p-value <0.001) with the presence of self-harm in our study.

We concluded that deliberate self-harm is a common finding in cases of bipolar disorder in Pakistan. Additionally, vulnerable subgroups, such as female patients in this study, should receive more clinical attention and safeguarding support.

Deep brain stimulation (DBS), an invasive neurosurgical treatment where electrical stimuli are delivered in target brain areas, is an intervention that has traditionally been used for neurological movement disorders, but that has recently been considered for the management of psychiatric conditions, one of these being obsessive compulsive disorder (OCD). This review aimed to identify and assess clinical practice guidelines on the use of DBS for OCD, and, secondly, whether or not recommendations are tailored to individual patient characteristics, such as age, gender and comorbidities.

A systematic search of MEDLINE, EMBASE, APA Psych Info and Scopus was conducted, along with guideline development organisation websites, using all relevant synonyms of: “Guideline and DBS and OCD”. Studies were assessed by two independent reviewers, and discrepancies managed by a third reviewer. The protocol was registered with PROSPERO, following the PRISMA checklist. Included guidelines were appraised using the AGREE-II instrument.

Nine guidelines were identified in total. Eight recommended DBS as a last-line option in the management of OCD, whilst the National Institute for Health and Care Excellence (NICE) recommended DBS should be used for research purposes only in OCD. Variability in the recommendations was also noted; indeed, only NICE undertook a cost-effectiveness analysis, and only the Congress of Neurological Surgeons (CNS) recommended target areas for electrode placement (i.e. subthalamic nucleus and nucleus accumbens). No guidelines clarified DBS settings, nor peri-operative optimisation measures. Patients’ preferences, age groups differences, ethnicity or comorbidities were not considered by any guideline. The guidelines’ quality ranged from moderate to high (50–92%), as per AGREE-II, with domains ‘scope and purpose’ and ‘editorial independence’ scoring the highest and ‘applicability’ and ‘stakeholder involvement’ the lowest across all guidelines.

Whilst eight guidelines supported the use of DBS for OCD as last-line therapy, a lack of cost-analysis, specific DBS settings, peri-operative procedures, and patients’ circumstances were analysed. Given the lack of randomised controlled trials in this field, more rigorous research is needed prior to wider DBS implementation.

Background: The number of suicide-related presentations to emergency departments (EDs) has significantly increased over recent years; thus, making staff often the first point of contact for people in suicidal crisis. Despite this, staff receive minimal psychiatric training and few opportunities for education on the treatment and management of people presenting in suicidal emergencies. Understanding the needs of those who work within EDs is key to maximising the opportunity to reduce suicidal behaviour. Aims: To examine staff perspectives and experiences of working with people presenting to emergency departments in suicidal crisis.

Qualitative study guided by thematic analysis of semi-structured interviews with ED administrative, medical and mental health staff.

Twenty-three staff participated. Three key themes were identified: (1) factors influencing staff decision-making; (2) quality of care for both staff and patients; (3) staff burnout, mental health and well-being. Staff described an overall lack of confidence and training related to asking patients about suicidal thoughts, which resulted in defensive practice and risk adverse decision-making. Quality of care for both patients and staff were discussed in relation to availability of resources, staffing pressures and team collegiality.

Staff felt inadequately equipped to deal with suicide-related presentations. Organisational support is lacking with increased staffing pressures, poor service availability and lack of beds. Negative staff attitudes often reflected an inherent unintentional use of language. Changing ED culture from top-down is imperative to address negative language and behaviours towards suicidal crisis and improve patient pathways and experience. Mandatory and ongoing training is needed to improve staff confidence, knowledge and attitudes.

The recording of suicidal ideation in emergency departments (EDs) is inconsistent and lacks precision, which can impede appropriate referral and follow-up. EDs are often the first point of contact for people experiencing suicide-related distress, but while data are available on attendances for self-harm, no comparable data exist for suicidal crisis.

Data were collected from six EDs across Cheshire and Merseyside (N = 42,096). Data were derived from presenting complaints, chief complaints and diagnosis codes for all suicidal crisis attendances (suicidal ideation, self-harm, suicide attempt) from January 2019 to December 2021.

There was inconsistent coding within and between ED sites for people presenting in suicidal crisis. Attendances for suicidal ideation were often given the chief complaint code of ‘depressive disorder’ (12%). There was a high level of missing data related to the coding of suicide-related presentations (65%). Variation in coding was also reported for individual presentations; for example, 12% of attendances reported to be due to ‘self-inflicted injury’ were given a primary diagnosis code of ‘depressive disorder’ rather than ‘deliberate self-harm’. There was also high variability in the routinely collected data (e.g., demographic information, attendance source and mode, under the influence at time of arrival) both within and between EDs.

Accurate detection and documentation of suicidal crisis is critical to understand future risk and improve services. Research and development in monitoring systems for suicidal crisis should be a priority for health services, and a national data collection tool is urgently needed to maximise accuracy and utility. Better data could be used to inform crisis care policy and to target suicide-prevention resources more effectively.

1) To compare blood brain barrier (BBB) permeability between AD and controls. 2) To examine the relationship between BBB permeability and cognitive decline in AD. 3) To examine the relationship between BBB permeability and peripheral markers of inflammation.

This pilot study combines the use whole brain DCE-MRI, with measures of peripheral inflammation in serum and urine. This is a clinical cohort study with longitudinal and cross-sectional arms, involving n = 15 AD and n = 17 age and gender matched controls. BBB permeability is measured using DCE-MRI and inflammation is measured by comparing serum cytokine and urine neopterin concentrations. AD participants attend three study visits over 12 months; control participants attend two over one week. Urinary neopterin analysis is being conducted in February 2023.The 12 month follow up visits complete in May 2023. Both neopterin and longitudinal cognitive assessment data will be included in the poster presentation in July.

AD and control groups were well matched with no significant differences in demographics and multi-morbidity. We measured blood cytokine profiles for IL-6, IL-8, IL-2, IL-4, IL-1b, IL-10, IL13, IL-12p70-, TNF-alpha and INF-gamma. Only INF-Gamma was significantly different; higher in AD vs Controls (mean ± SD; 28.758 ± 90.226 AD, 3.773 ± 2.256 Control, P = 0.03). There were no significant differences in markers of neurodegeneration NfL and pTau-181, or vascular markers VCAM1, ICAM1, CRP and SAA between the groups. Ki is being calculated for overall whole brain, white matter, grey matter and hippocampus regions; an interim analysis showed no significant differences between the tissue categories, but analysis is ongoing.

There are currently no prognostic biomarkers that accurately predict decline in AD. We believe this pilot study will add to the literature about the utility and feasibility of DCE-MRI to measure BBB permeability. We hope that combining DCE-MRI with blood and urine biomarkers will further our knowledge of the pathophysiology of AD and help to develop minimally invasive biomarkers for identifying patients with AD, including those who are at risk of faster progression.

Psychosis is a symptom of various health disorders characterised by hallucinations and delusions. Medication and appointment compliance amongst sufferers of psychosis remains a major issue. The aim of this study is to explore factors affecting compliance to inform interventions for improving service quality.

A rapid systematic review was conducted on PubMed. Following screening, these papers were extracted and assessed using the hawker tool. 161 papers were identified with a search criterion and 33 were screened after removing non- English records, paid articles and pre-2015 papers. Abstracts of 33 papers were screened and 9 studies were looked at in detail.

33 papers were identified after establishing a search criterion, from this 9 progressed to the inclusion stage. After using the Hawker tool, the quality of the papers averaged 32.8/36 and several significant factors were identified. The most significant factors that affect compliance are: insight, type of treatment, early signs of psychosis, ethnicity, income and qualitative factors.

Various measures can be suggested to help improve medication and appointment adherence for service users. Improving insight through targeted-informative leaflets on medication available at first contact with the Psychiatrist or GP. More frequent medication reviews for select patient groups identified with a higher risk of non-adherence. Greater income assistance through food and travel vouchers or information on how funding can be accessed. Lastly, staff training on increasing insight for psychosis patients delivered through a 1-day course/e-learning module.

Transcranial Magnetic Stimulation (TMS) is an in-vivo, non-invasive, and safe method that probes neurophysiological properties associated with cortical glutamatergic (excitatory) and GABAergic (inhibitory) neurotransmission. The combination of TMS with Electroencephalography (EEG) allows us to measure TMS-evoked cortical responses directly from brain activity and it is uniquely placed to elucidate in-vivo cortical Excitatory/Inhibitory processes. Schizophrenia has been associated with Excitation/Inhibition (E/I) imbalance. Cognitive impairment, which is almost ubiquitous in schizophrenia, has been linked with the E/I abnormalities observed in schizophrenia. Among the TMS-EEG evoked potentials (TEPs), the N100 is thought to reflect activation of inhibitory GABA-B cortical circuits and has been associated with attentional processes in healthy individuals, attention deficit hyperactivity disorder (ADHD) and depression. Our aim was to investigate the cortical processes related to the generation of N100 after motor cortex stimulation and its association with attention measures in patients with schizophrenia and healthy controls.

TEPs were recorded following application of 150 TMS pulses at 90% of resting motor threshold on two brain sites, i.e., left primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) in stable patients with schizophrenia (n = 9) and healthy controls (n = 9). Region of Interest (ROI) analysis was performed to calculate the regional average of the N100 peak amplitude in M1 and DLPFC based on previous literature. Attention was assessed with a Continuous Performance Task (CPT).

We found a significant negative correlation between the amplitude of N100 from M1 and CPT score in the patient group (rho = -0.73, p = 0.026). The N100 component from DLPFC in patients did not correlate with the CPT score (rho = -0.034, p = 0.93), which may suggest regional specificity of M1 inhibitory processes in attention in patients with schizophrenia.

N100 is considered to be related to cortical inhibitory processes influenced by cortico–striato–thalamo–cortical loops, with greater cortical inhibitory activity producing a larger N100 amplitude. Our preliminary results suggest association of the GABA-B-ergic TEP N100 with attentional processes in M1 and may represent cortical inhibition beyond motor inhibition in patients with schizophrenia. Overall, TMS-EEG offers the potential to investigate the state and dynamics of E/I imbalance in schizophrenia and cognition.

Contraception is of increased importance for women with mental health conditions. These women are more likely to experience unplanned pregnancies and are at a higher risk of sexually transmitted diseases. NICE (National Institute for Health and Care Excellence) guidelines recommend discussing the use of contraception with women of childbearing potential with mental health problems. Professionals should discuss how pregnancy and childbirth can impact a mental health problem and how a mental health problem and its treatment might affect the woman, the foetus or the baby. It is, therefore, important for professionals to feel confident when advising these women. In this study, we aim to examine the knowledge, practices and attitudes of mental health professionals in providing contraceptive advice to service users of childbearing potential.

An observational quantitative cross-sectional design study was utilised using a 12-item self-report questionnaire. Mental health professionals meeting the inclusion criteria, employed by Surrey and Borders Partnership NHS Foundation, were invited to complete the anonymised survey electronically. Responses were entered into the survey software (Qualtrics) and quantitative data analysis was conducted.

The study was approved by the North West Manchester Ethics Committee.

This is the first arm of the study, and the second arm focuses on service user experience and is currently in progress.

76 professionals responded, including 24 consultants, 17 trainee doctors, 16 nurses, 8 non-trainee doctors, 7 psychologists, 3 social workers and 1 pharmacist. Of the 76 responses, 31% said they felt extremely/very familiar with the NICE guidelines. 38% of respondents said they were somewhat familiar, and 30% said they were not so/not at all familiar. Regarding confidence in discussing contraception and family planning 8% responded extremely/very, 28% responded somewhat and 64% responded not so/not at all. 68% said they would like to receive further training. A third of the professionals surveyed said they were not familiar with the NICE guidance. Two-thirds of respondents do not feel confident offering counselling around contraception, planning and spacing pregnancies. Over two-thirds would like further training

The survey showed a lack of confidence in offering reproductive advice and the need for training to improve knowledge. We aim to develop training in contraception advice to improve the care provided for female service users.

The present study aimed to study maternal bonding impairment among postpartum women at 6–8 weeks postpartum. We compared the severity of bonding impairment among women with high and low risk pregnancies. We also explored gestational factors related to maternal bonding impairment in these women.

Hundred women at six – eight weeks postpartum, without any significant physical or mental illness, were assessed for bonding failure using the Postpartum Bonding questionnaire. Their antenatal and postnatal records were reviewed to determine various gestational factors and subsequently classify them as high risk or low risk pregnancies. Unpaired t test and multiple regression analysis were used as appropriate for statistical analysis.

7% of the mothers had significant impairment in bonding with their infants. The most prevalent type of bonding impairment was infant focused anxiety (1%) and incipient abuse (1%). Maternal bonding failure (d = 0.74) and rejection of infant (d = 0.45) were significantly higher in women with high risk pregnancies (P < 0.01). Not having a term delivery was the most significant factor associated with impaired maternal bonding (β = - 0.26, P = 0.02). Other factors in the model were maternal BMI, mode of delivery, having an emergency caesarean section, presence of congenital malformations in the baby and history of NICU admission. Overall adjusted R-squared for the model was low (0.07), indicating only 7% of variation can be accounted by the gestational factors in the model.

Women with high risk pregnancies have higher chances of an impaired bond with their infants. Preterm / post term delivery is the most important risk factor.

rTMS (Repetitive transcranial magnetic stimulation) as a brain stimulation modality is approved to treat treatment-resistant depression. Its efficacy in depression and anxiety is well supported in several studies. However, its direct effect on suicidality is still unclear, unlike electroconvulsive therapy. This study aims to evaluate the effectiveness of rTMS on pessimistic and suicidal thoughts. We hypothesized that rTMS reduces pessimistic and suicidal thoughts, alongside other symptoms, in patients experiencing depression and anxiety as the therapy progresses over six weeks.

The study is a retrospective observational study. The study was conducted in the rTMS Clinic, Brentwood. All of the patients undergoing treatment at the rTMS Clinic were assessed with subjective and objective scales for depression. One of the scales was MADRS (Montgomery Asperger's Depression Rating Scale); this was used to study the response of therapy. I looked into the pessimistic and suicidal thoughts component in MADRS, the baseline score was recorded, and its progression on weekly monitoring for six weeks was noted.

63 patients attended the rTMS clinic from January 2019 to October 2022. 21 patients were excluded for reasons that included dropping out before completion of treatment, MADRS weekly scores not being available, and some of them still undergoing treatment. A total of 42 patients, 21 male and 21 female, who successfully finished rTMS therapy at the Neuromodulation clinic were included in the study.

The study showed that rTMS was effective and well-tolerated in reducing pessimistic and suicidal thoughts in the majority of patients. Average baseline scores and their average weekly progressions for pessimistic and suicidal thoughts over six week's period were recorded. The average score of baseline pessimistic thoughts was 3.925, and baseline suicidal thoughts was 3, in the severity scale of 0–6. There was a gradual reduction in scores of pessimistic and suicidal thoughts from baseline to the end of intensive six-week treatment. Scores measured at the end of every week showed a reduction in scores from the previous week of treatment. Average scores at the end of six weeks showed 2.375 and 1.65 in the pessimistic and suicidal thought domains respectively in the MADRS scale.

rTMS is being used for symptoms of depression and anxiety and evidence is encouraging in treating symptoms including pessimistic and suicidal thoughts. rTMS therapy over six weeks showed a gradual reduction in the severity of pessimistic and suicidal thoughts, demonstrated by decreases in average MADRS weekly score.

Under section 23 of the Mental Health Act, the managers of the hospital have the power to order discharge of a patient detained under certain sections. In the past, the need for this power has been questioned, but the debate reared its head following the ‘Modernising the Mental Health Act’ government review in 2018, which initially proposed that the managers’ hearing should be abolished. The aim of this research was to critically analyse the law to determine whether or not managers’ hearings should be removed in legal reform.

A literature review was performed using the legal databases Lexis Library and Westlaw to identify relevant primary legislation, secondary legislation, case law, articles and other secondary sources. These were critically analysed to discuss the managers’ hearing's strengths, weaknesses and potential proposals for reform.

In favour of retaining the managers’ hearing in its existing format, it provides an independent power of discharge that is accessible, subject to scrutiny and an important safeguard, particularly for those lacking capacity. In favour of abolishing the managers’ hearing, the tribunal system satisfies the Government's requirement under Article 5(4) of the European Convention for Human Rights; the managers’ panel could be viewed as a duplication of effort without legal representation and a necessary medical member, with limited powers in comparison to a tribunal and arguably low discharge rates. Its usual procedure was challenged during the COVID-19 pandemic, and the Convention on the Rights of Persons with Disabilities moves away from the traditional medical model, suggesting reforms to the Act may be needed.

Case law has ruled that the managers’ panel has equivalent standing to the tribunal and criticism has been largely anecdotal. The absence of evidence surrounding the process is a major weakness in this debate with no nationally held records of outcomes. Whilst the duplication of effort and overlap with the tribunals’ powers has been a consistent argument for abolishment, the managers’ hearing stands as a robust and accessible safeguard in providing an opportunity for detention under the Act to be reviewed. Any reform must continue to empower and involve patients, supporting them in exercising their rights. On balance, this review concludes that the days of the managers’ hearing should not be numbered without further research.

This research was completed as a Masters in Mental Health Law (LLM) dissertation through the University of Northumbria.

Despite considerable preclinical evidence, clinical trials assessing the effects of probiotics on individuals with major depressive disorder (MDD) are scarce. This study aimed to provide further evidence of the acceptability, tolerability and putative efficacy of probiotics in this patient group and to improve our understanding of the underlying mechanisms of action.

This double-blind randomised placebo-controlled pilot and mechanistic trial investigated the effects of an 8-week adjunctive multi-strain probiotic intervention in adults with MDD taking antidepressants. Psychiatric data and stool and blood samples were collected at baseline, week 4 and week 8. A computer-based emotion recognition task was also administered. Stool samples from 25 matched healthy controls were also obtained.

49 participants, randomised to probiotic (n = 24) or placebo (n = 25), were included in intent-to-treat analyses. Standardised effect sizes (SES) from linear mixed models demonstrated that the probiotic group attained greater improvements in depressive (HAMD week 4: SES [95%CI] = 0.70[0.01, 0.98]; IDS week 8: SES [95%CI] = 0.64 [0.03, 0.87]) and anxiety symptoms (HAMA week 4: SES [95%CI] = 0.67 [0.00, 0.95]; week 8: SES [95%CI] = 0.79 [0.06, 1.05]), compared to the placebo group. Attrition was 8% (n = 3 placebo, n = 1 probiotic), adherence was 97.2% and there were no serious adverse reactions. The probiotic modified the composition of the faecal microbiota by normalising richness and diversity towards healthy control levels. The probiotic also increased levels of specific taxa, including Bacillaceae (FDR p < 0.05), which correlated with reductions in anxiety scores (FDR p < 0.05). There was no impact of treatment on levels of inflammatory cytokines (CRP, TNFα, IL-1β, IL-6, IL-17) or BDNF. However, probiotics showed a tendency to increase positive affective bias and improved the accuracy of recognition of all emotions, except sadness.

Compared to placebo, the probiotic group had greater improvement in depressive and anxiety scores, from as early as 4 weeks. The acceptability, tolerability and estimated effect sizes on key clinical outcomes are promising and encourage further investigation of this probiotic as add-on treatment in MDD. The beneficial effects of probiotics in this patient group may be partially mediated by modification of the composition of the gut microbiota and improvement of affective biases, inherent to depressive disorders.

Service users taking long-acting injectable antipsychotics (LIAs) may experience recurrence of symptoms as they approach trough levels within a steady-state cycle. Limited research exists around symptom variation between peak-to-trough plasma concentrations of LIA inter-dose intervals. Different LIAs have variable rates of change in dopamine receptor occupancy during this peak-to-trough variation due to differing elimination half-lifes. It is unclear what rate of change in D2 blockade is tolerated by patients at present, which this trial aims to determine through observing symptom severity differences during peak-to-trough variation.

A real-world observational longitudinal cohort study is proposed. Inclusion criteria would be working-age adults (18–65 years) who have received five consecutive and timely LIA administrations of a consistent drug and dose. The study would exclude anyone with significant hepatic or renal impairment, anyone on concurrent oral antipsychotic medication or anyone deemed not to yet be within steady-state plasma levels of their LIA medication.

Serum assays for drug level will be obtained at both peak and trough concentrations during an LIA cycle. Expected timings for peak levels will be determined by derived tmax values from existing pharmacokinetic literature for individual drugs. Trough levels will be taken within 24 hours of the next LIA administration being due. Plasma drug concentrations will then be used to calculate expected striatal D2 blockade using EC50 values and maximal occupancy for individual drugs derived from existing PET scan data.

Symptom severity will be assessed by completing Positive and Negative Symptom Scores (PANSS) questionnaires with service users at the time of both peak and trough plasma concentrations of LIA. The difference in these scores will then be plotted alongside the difference in expected D2 blockade derived from plasma drug concentrations.

We hypothesize that the rate of D2 occupancy change would correlate with symptom severity differences in an exponential manner, in that drugs with shorter elimination half-life would have greater difference in symptom severity between peak and trough. We expect that service users would be able to tolerate such change to a degree without significant emergence of symptoms; the trial aims to determine the threshold for what most service users can tolerate, which may then assist in guiding how to effectively reduce and discontinue medications.

This outlines a research protocol to monitor response to pharmacokinetic variation within inter-dose intervals of LIA medication, which may ultimately aid service users in reducing and discontinuing antipsychotics.