There is still little information available on the negative impact of online activities on psychotic experiences. This limitation is further compounded for online gaming, where even a beneficial impact has been suggested via the evocation of positive emotions. We aimed to examine how problematic online gaming (POG) is associated with subsequent psychotic experiences in adolescents.

This birth cohort study employed randomly sampled adolescents born between September 2002 and August 2004. The eligibility criterion was those who did not have psychotic experiences at age 14. We analyzed the association between POG at age 14 and subsequent psychotic experiences at age 16. Adolescents were categorized into the no, low, and high POG groups based on the behaviors and emotions related to online gaming at age 14. Missing data were handled using random forest imputations.

A total of 1722 adolescents without psychotic experiences at age 14 were analyzed. At age 16, 55 adolescents exhibited psychotic experiences, while 225 showed potential psychotic experiences. Compared with the no POG group, a higher risk of psychotic experiences was shown in both the low (RR 1.93, 95% CI 1.74–2.15) and high (RR 2.81, 95% CI 2.50–3.15) POG groups. Findings were consistent when analyzing potential psychotic experiences.

POG appears detrimental to the development of psychotic experiences in adolescents. Our findings provide public health implications in the context of policymaking.

Diabulimia is an increasingly used term referring to “an eating disorder (ED) with type 1 diabetes”. It is difficult to detect and presents in multiple ways, which can potentially include feelings of body dissatisfaction (BD), which in itself is a complex symptom to quantify clinically.

This rapid systematic review aimed to identify whether feelings of BD are a risk factor for diabulimia by researching if and how BD is assessed in patients with the condition.

A rapid systematic review was undertaken. A literature review was performed on Ovid Medline (all) and Ovid Embase databases using search terms for Type 1 Diabetes, ED, and BD and looked at cross-sectional studies only. One reviewer performed the literature search and screened titles and abstracts. Out of 589 papers screened, four papers met the inclusion criteria. These papers then went through critical appraising using the Appraisal tool for Cross-Sectional Studies, with all papers showing mid-level quality clearing 16 to 17/20 questions. Therefore, data was extracted from all of them.

All four papers came from different countries and used a wide range of sample sizes (43–477).

There was widespread heterogeneity between the data collected in each study due to the various tools used to identify BD, paired with differences in analysing extracted data.

To ensure transparency and quality of the results provided, the Synthesis Without Meta-analysis tool was used. Three studies looked at effects on adolescents and three had a higher proportion of females. All papers used previously established and tested BD screening methods. Two papers found female diabetics were more likely to have BD symptoms, and one paper saw that males were more at risk. All four papers concluded that BD had some correlations with one or more aspects of diabetes and/or other ED symptoms related to diabulimia. Two commented on positive correlations between BD and HbA1c levels and one commented on BD symptoms and insulin restriction trending together. Two papers also saw BD symptoms and depressive symptoms correlating in patients as well.

All four studies showed that BD was related to diabulimia, both from a psychological and diabetic perspective, and most highlighted how BD manifested between the different sexes of diabetics. This review highlights the need for more standardised and comprehensive BD questionnaires to draw out key signs of EDs in diabetics that could improve screening, detection and management of diabulimia.

Patients experiencing Medically Unexplained Symptoms (MUS) are some of the costliest in both primary and secondary care. Psychotherapy is one of the most efficacious ways of treating them although the most superior modality is unclear. Cognitive Behavioural Therapy (CBT) has the greatest evidence base, but a growing number of studies have investigated the role of Psychodynamic Psychotherapy (PPT). This is the first study to compare the two modalities concerning their impact on healthcare utilisation and cost to the NHS.

Patients referred to the Oxford Community Psychological Medicine Service in 2021 and who went on to complete a course of psychotherapy for MUS were included. 78 patients were referred, 66 patients were assessed, 16 patients began treatment and 9 patients completed treatment. 4 received CBT and 5 received PPT based on a ‘best fit’ assessment. Their healthcare utilisation (GP appointments, health investigations, A&E attendances, inpatient admissions and outpatient appointments) was assessed during the 6 months prior to their initial assessment and compared with the 6 months after therapy had ended using data from ‘Health Information Exchange’.

Overall, psychotherapy reduced primary care use but our data was insufficiently powered for this to be statistically significant. There was a significant reduction in outpatient appointments after psychotherapy, mostly representing mental health consults.

Significant differences between pre-therapy and post-therapy were only observed for the number of health investigations in the PPT group which, surprisingly, increased with a large effect size (d = 1.19 95% CI 1.12–2.88, P = 0.03). The same trend towards increased utilisation were observed for every outcome measure in PPT besides outpatient appointments. Conversely, all outcome measures showed an improvement after CBT apart from the number of health investigations which marginally increased.

CBT significantly decreased GP appointments at 6 months follow-up compared with PPT with a large effect size (η2 = 0.5, p < 0.05). A similar trend was seen for total cost (η2 = 0.5, p < 0.06) with each PPT patient costing £790 more on average than their CBT counterparts during the 6 months after therapy.

Whilst CBT appears to be efficacious in the short-term, PPT caused significantly increased healthcare utilisation compared with CBT in the 6 months after therapy. This aligns with similar studies that demonstrate a ‘sleeper effect’ in which patients who receive PPT, but not CBT, deteriorate before improving over long-term follow-up.

Additional research is needed to correlate this data with symptoms and capture the long-term benefits of these psychotherapies for MUS.

Exposure to traumatic experiences during childhood and adolescence is a significant risk factor for the development of psychiatric disorders in adulthood. An estimated 50% of the worldwide incidence of depression and anxiety can be attributed to childhood maltreatment (Li et al., 2016). In addition, approximately one-third of psychotic experiences are attributable to a history of developmental trauma (McGrath et al., 2017). It is thought that long-lasting, trauma-induced adaptive changes in neurobiological function may lead to a predisposition towards pathophysiology (McCrory and Viding, 2015). However, the precise mechanisms through which developmental trauma exposure alters brain function on cellular and circuit levels remain poorly elucidated.

A systematic literature search and meta-analysis was performed to establish how dopaminergic functioning in adulthood is affected by developmental stress in rodents. Three databases, Medline®, Embase®, and PsycINFO®, were systematically searched initially on 2nd December 2023. Terms for three superordinate concepts (‘childhood’ terms, ‘trauma’ terms, and ‘dopamine’ terms) were combined. Cohen's d statistic was used for effect sizes. This protocol is pre-registered on PROSPERO® (ID: CRD42018106382).

A total of 104 studies met our inclusion criteria. Meta-analysis indicated that developmental stress exposure leads to complex and long-lasting effects in basal and post-amphetamine extracellular dopamine concentrations in the medial prefrontal cortex, amygdala, and nucleus accumbens. In addition, there is a significant downregulation of D1 receptors and upregulation of D2 receptors in prefrontal and striatal regions involved in threat and reward processing. Effect sizes ranged from 0.36 to 1.55.

These findings strongly suggest that dopaminergic dysfunction is a mechanistic link between developmental trauma and vulnerability towards mental illness in adulthood.

Recent studies have focussed on detecting white matter abnormalities in subjects who transition to psychosis (UHR-T). Research suggests that fractional anisotropy (FA), may be decreased in UHR-T. However, global and regional findings have been inconsistent. By objectively combining data in a meta-analysis, we have investigated white matter alterations associated with transition, by comparing FA in UHR-T with subjects that do not transition (UHR-NT) and healthy volunteers.

The meta-analysis was registered on PROSPERO (ID: CRD42021265348) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA guidance. A systematic database search of PUBMED and EMBASE identified reports, which were screened by 2 independent researchers (CN and DD) for inclusion, from inception to 20 July 2021. Discrepancies were decided on consensus with a third researcher (KM). Reference lists of eligible studies were also screened. Authors of screened reports were contacted to provide parametric maps. Coordinate-based meta-analysis was conducted using Seed-based d-Mapping software to combine parametric map and coordinate data from reports, using a random-effects model. Quality and risk of bias analysis were conducted using the Newcastle-Ottowa Scale. Heterogeneity and sensitivity analyses were also conducted.

The search strategy identified 889 potential studies, from which 6 met eligibility criteria. A total of 71 UHR-T, 142 UHR-NT and 148 healthy volunteers were included. Weighted-mean decreases in FA were observed in UHR-T compared with: UHR-NT (d = −0.99; p < 0.0001; 95% CI −1.43 to −0.55); and healthy volunteers (d = −0.91; p = 0.04; 95% CI −1.78 to −0.05). The level of heterogeneity for the former was not significant. For UHR-T, regional FA decreases were observed in areas including the left genu of the corpus callosum (Z-score = −1.76, 204 voxels, p < 0.0001) compared with UHR-NT, while FA increases were most observed in the white matter region adjacent to the left postcentral gyrus (Z-score = 1.64, voxels = 16, p < 0.0001). These findings persisted despite sensitivity analyses.

The findings suggest that white matter alterations, specifically in left frontotemporal tracts, are associated with an increased risk of transition to psychosis. The neurobiological implications of these findings, and their contribution to UHR-T prediction efforts, are explored, as are avenues for further research.

Additional Author: Mr Gunnar Gronlid.1

To determine: i. the nature of the associations between three domains of psychopathology (depressive, hyperactivity and conduct symptoms) and cognitive/academic performance among adolescents i.e., whether these reflect causal processes and/or common genetic effects; ii. The extent to which these associations vary by comorbidity.

The sample comprised participants in the UK Twins Early Development Study (TEDS; n≈12,000 individuals) assessed for depressive, hyperactivity and conduct symptoms using standardised questionnaires. Cognitive and academic performance were assessed using Standard Progressive Matrices and GCSE scores respectively. Comorbidity was derived as a count of borderline/high psychopathology scores present per individual. Twin modelling was used to investigate preliminary correlations and moderation effects. Genetic models were further used to determine the most likely direction of causal effects with/without genetic correlations.

There were small to moderate negative correlations between adolescent psychopathology domains and cognitive performance (−0.01 ≤ r≤−0.15) and academic performance (−0.06 ≤ r≤−0.23). Correlations were smallest for depressive symptoms and larger for hyperactivity/conduct symptoms. The correlation between hyperactivity symptoms and cognitive performance was significantly more negative as comorbidities increased (moderation coefficient – βmod = 0.07, 95% CI: 0.02, 0.12). Similarly, the association between depressive symptoms and academic performance also became more negative as comorbidities increased (βmod = −0.08, 95% CI: −0.11, −0.05). Twin modelling indicated that hyperactivity symptoms were causally associated with poorer cognitive and academic performance. In contrast, poorer cognitive performance was causally associated with conduct symptoms.

These preliminary findings indicate the impact of comorbidity on the functioning of adolescents with hyperactivity and depressive symptoms. They further suggest the need to specifically recognise these comorbidities during assessment and treatment planning to promote optimal functioning. Our findings also suggest differential mechanisms for the links between different psychopathology domains and impaired functioning. Further analyses will investigate moderation of the causal links and/or genetic correlations and whether these associations vary by indicators of marginalisation (sex and ethnicity).

This study investigated the relationship between common genetic variation and co-occurring mental health conditions among autistic individuals.

The study was conducted with the Simons Foundation Powering Autism Research (SPARK) dataset, V9 release, and included probands [n = 17,582] with confirmed diagnosis of autism, who were also in the SPARK iWES1 array genotyping dataset. Six co-occurring mental health conditions (attention deficit hyperactivity disorder or ADHD, bipolar disorder, depression, schizophrenia, anxiety disorder and disruptive behaviour disorders) were analysed. Polygenic scores (PRS) were generated with PRScs software, using summary statistics from the most recent genome wide association studies (GWAS) for autism, ADHD, schizophrenia, bipolar disorder, depression, anxiety, neuroticism, p-factor, intelligence, educational attainment and hair colour (negative control). General linear models (GLM) and Cox proportional hazards models were computed, with age at registration, sex, cognitive impairment and genetic principal components included in both sets of models. Multiple testing correction was done using the Benjamini-Yekutieli method. Results were calculated using odds ratios (OR), 95% Confidence Intervals (CI) and corrected p values (p).

There were similar patterns of association and interaction for both GLMs and Cox models. Polygenic scores for educational attainment were significantly lower for those with co-occurring ADHD (GLM: OR=8.85E-01, 95% CI=8.48e-01–9.23e-01, p = 2.91E-07; Cox: OR=8.94E-01, 95% CI=8.66e-01–9.22e-01, p = 4.76E-11), bipolar disorder (GLM: OR=7.45E-01, 95% CI=6.54e-01–8.49e-01, p = 2.40E-04; Cox: OR=7.25E-01, 95% CI=6.39e-01–8.23e-01, p = 3.96E-05), depression (GLM: OR=8.63E-01, 95% CI=8.04e-01–9.26e-01, p = 5.13E-04; Cox: OR=8.56E-01, 95% CI=8.03e-01–9.12e-01, p = 2.80E-05), schizophrenia (GLM: OR=6.94E-01, 95% CI=5.71e-01–8.42e-01, p = 3.99E-03; Cox: OR=6.67E-01, 95% CI=5.52e-01–8.05e-01, p = 1.41E-03), anxiety disorder (GLM: OR=8.77E-01, 95% CI=8.37e-01–9.20e-01, p = 9.88E-07; Cox: OR=8.81E-01, 95% CI=8.49e-01–9.15e-01, p = 1.46E-09) and disruptive behaviour disorders (GLM: OR=7.10E-01, 95% CI=6.63e-01–7.60e-01, p = 3.22E-21; Cox: OR=7.10E-01, 95% CI=6.67e-01–7.57e-01, p = 1.35E-24).

Polygenic scores for educational attainment were associated with the co-occurrence of several mental health conditions among autistic individuals.

Ward rounds are complex clinical interactions crucial in delivering high-quality, safe, and timely patient care. They serve as a platform for the multidisciplinary team to collaboratively assess a patient's condition and actively involve the patient and their caregivers in shared decision-making to formulate a care plan. Ward rounds involve an intersection of factors worthy of consideration separate from the wider literature on inpatient experience and multidisciplinary team meetings. With this review our primary aim is to systematically identify what methods and perspectives researchers are using to understand ward rounds.

The databases searched were Medline, CINAHL, British Nursing Index, PsychInfo, and ASSIA as well as reference and citation checking. The search terms used were psychiatr* AND (ward round OR “multi disciplinary team meeting” OR “clinical team meeting”). Studies were included if they were peer reviewed, included primary research on psychiatric inpatient ward rounds in which patients are participants with no restriction on the type of ward or hospital, patient group, country or methodology.

224 records were retrieved and screened from the database search and 10 from other sources. 35 full texts were reviewed for eligibility and 26 included in the review. 16 studies had no particular theoretical perspective, 2 were constructivist, 2 critical realist, 2 lean methodology, 1 systems research, 1 phenomenological, 1 trauma informed and 1 critical theory. 9 focussed on patient experience, 5 ward round structure, 3 on power relationships, 3 on efficiency, 2 on shared decision making and 4 had a unique focus. Though often not explicit, critical theory influenced discussion of power is common in papers focused on patient experience and ward round structure. Cross-sectional surveys, interviews, focus groups and audit cycles were the most common methods. Key themes which emerge are anxiety provoked by ward rounds, preparation and communication, and the negotiation of power structures. Key tensions identified include being multidisciplinary versus overcrowding, efficiency versus personalisation and reliability versus responsiveness.

For a central part of inpatient psychiatric practice there is a limited range of research on psychiatric ward rounds. The influence of critical theories’ focus on power was widespread with limited representation of other theoretical perspectives and concerns. There was no research using experimental methods, but there was some implementation research. Key tensions are highlighted which services may wish to consider when revisiting ways of working on inpatient psychiatric wards.

This review delves into the understanding of depression within African communities, extending its scope to nations with significant African populations, aiming to enhance service provision for these patients. While focusing on cultural experiences of depression that transcend geographical boundaries, it builds upon existing literature predominantly centred on sub-Saharan African countries.

A comprehensive literature search was conducted across multiple databases, yielding 13 relevant articles after applying stringent criteria. Following Cochrane guidelines, search terms encompassed population (Africa, Africans, African communities), exposure (Depression, Depressive disorder, Dysphoria, Dysthymia, Low mood), and outcomes (Cultural expressions, Cultural variations, Somatization, Cultural framework, Cross-cultural research, Service provision).

Analysing selected articles through the CASP checklist, a narrative synthesis of qualitative studies over the past twelve years elucidated diverse perceptions and expressions of depression in African communities compared with Western contexts. Three major themes emerged: Expressions of depression (with subthemes: Attitudes towards depression), Perceptions of depression (including Stigmatization), and culturally acceptable forms of treatment (including Barriers towards treatment).

The review underscores the significance of integrating culturally acceptable treatment methods into psychological therapy for improved healthcare delivery. Collaboration between clinicians and patients is pivotal, with religious assistance emerging as a culturally acceptable treatment avenue. Establishing therapeutic alliances with religious communities could enhance treatment effectiveness. Further research is warranted to explore the impact of religious activity on depression symptoms and progression, as well as the influence of mental health providers' religious backgrounds on treatment dynamics. This holistic approach is crucial for addressing the unique cultural nuances surrounding depression in African communities and optimizing patient care.

The contribution of mental illness towards total Disability Adjusted Life Years is increasing according to the Global Burden of Disease study. As the need for mental health services increases, technological advances are being deployed to improve the delivery of care and lower costs.

The emergence of Artificial Intelligence (AI) technology in mental health and companionship is an evolving topic of discussion. There have been increasing debates about the use of AI in managing mental health problems. As the AI technology and its use grows, it is vital to consider potential harms and ramifications.

There are very limited discussions about the use of chatbots and relevant AI by humans to commit crime especially in those suffering from mental illness. AI can potentially serve as an effective tool to misguide a vulnerable person going through a mental health problem e.g. encourage someone to commit a serious offence. There is evidence that some of the most used AI chatbots tend to accentuate any negative feelings their users already had and potentially reinforce their vulnerable thoughts leading to concerning consequences.

The objective of this study is to review existing evidence for harmful effects of AI chatbots on people with serious mental illness (SMI).

We conducted a review of existing evidence in five databases for relevant studies. The search sources were 4 bibliographical databases (PsycINFO, EMBASE, PubMed, and OVID), the search engine “Google Scholar” and relevant grey literature. Studies were eligible if they explored the role of AI and related technology in causing harm in those with SMI.

Initial searches constrained the scope of review to the harmful effects of AI use in mental health and psychiatry and not just the association with crime due to very limited existing data.

Whilst current AI technology has shown potential in mental healthcare, it is important to acknowledge its limitations. At present, the evidence base for benefits of AI chatbot in mental healthcare is only just getting established and not enough is known or documented around the harmful effects of this technology. Nevertheless, we are seeing increasing cases of vulnerable mental health patients negatively influenced by AI technology. The use of AI chatbots raises various ethical concerns often magnified in people experiencing SMI. Further research will be valuable in understanding the ramifications of AI in psychiatry. This will also help guide the developers of this important and emerging technology to meet recognised ethical frameworks hence safeguarding vulnerable users.

Dementia is a debilitating disease with multiple potential causes, no cure and rising incidence. New studies suggest that gut bacteria not only aid in the digestion of bowel products but also other bodily functions such as immune systems and relaying messages to the brain. This review aims to examine the potential link between gut microbiota and dementia by performing a systematic review to assess whether gut bacteria play a role in the development of dementia.

The systematic review was designed and conducted according to PRISMA guidelines. A modified PICO model was used to perform a literature search in Medline, CINAHL PLUS and APA PsychInfo databases. The search identified 401 articles, 49 of which met the predefined inclusion criteria. Twenty-one final studies were included in the results; 14 cross-sectional, two cohort, three case-control, one randomised control study and one case report. The reviewer extracted and analysed data from these studies for quality using the AXIS and CASP tools. A narrative synthesis of the results was performed due to the heterogeneity of the data.

Individuals with dementia have lower microbial diversity than healthy controls, including changes in specific bacterial taxa, pro-inflammatory and anti-inflammatory balance. The results of the review were subdivided into four identified themes which helped further identify that microbial metabolites, diet and gastrointestinal disease can also influence the composition of gut microbiomes and, therefore, the development of cognitive impairment and dementia.

This systematic review found a link between gut bacteria, bacterial metabolites, gastrointestinal health, diet, and dementia. Although the studies were mostly observational, they suggest that gut microbiota can affect brain function through dysbiosis, which can lead to neuroinflammation and dementia. More research is needed to confirm a causal relationship, but targeting the gut microbiota could be a potential therapy for MCI and AD. Innovative strategies may help combat the growing challenge of dementia.

This digital ethnographic study explores the varying perceptions of anorexia within the pro-anorexia (pro-ana) subculture by utilizing Professor Marinker's framework of disease, illness, and sickness to qualitatively analyse how individuals within this community interpret anorexia as a personal experience, a societal role, or a deliberate choice.

This study examines insights from the pro-ana community, obtained through pro-ana spaces on social media platforms and dedicated pro-ana online forums contributing to understanding their viewpoints on anorexia. Drawing from established literature on anorexia nervosa and the pro-ana subculture, this study employs a qualitative analysis of online pro-ana spaces, examining discussions, narratives, and beliefs shared within these communities. The study also integrates historical perspectives, cultural critiques, and psychological theories to offer a comprehensive understanding.

The pro-ana subculture presents diverse perspectives on anorexia, challenging traditional definitions of illness and sickness. Some individuals view anorexia positively, perceiving it as a means of discipline and self-improvement. Cultural and historical influences, including the feminine expectation, the normalization of the disordered eating habits of the ‘gym bro', and societal beauty standards, further shape perceptions within the pro-ana community. There is some debate on how the media influences the proliferation of eating disorders and the evolving definitions of anorexia – including the introduction of atypical anorexia. There is also an ascetic spirituality associated with anorexia, which can be seen as a matter of faith or delusion.

The concept of anorexia within the pro-ana subculture challenges traditional definitions of illness, sickness, and choice. This study highlights the cultural, historical, and gendered dimensions influencing these perspectives. Understanding this complex interplay can inform mental health professionals, educators, and policymakers about the potential risks posed by pro-ana communities. It emphasizes the importance of preventive measures, media responsibility, and a nuanced approach to engaging with individuals influenced by the pro-ana subculture. Recognizing the multifaceted nature of anorexia within this community is crucial for developing effective interventions and support strategies for patients with anorexia who engage with the online pro-ana community.

"Euphoria,” an American television show portraying the lives of teenagers, centers around Rue Bennett, a seventeen-year-old biracial girl grappling with substance misuse and comorbid mental health conditions, including obsessive-compulsive disorder and bipolar disorder. Rue's risky behaviors in the series mirror real-life challenges faced by adolescents dealing with substance misuse. This study aims to explore harm reduction strategies that could benefit Rue, emphasizing the need for such approaches to improve safety in non-abstinent adolescents. By focusing on harm reduction rather than strict abstinence, the goal is to meet individuals where they are in their journey and foster sustainable positive change.

Employing a qualitative approach, this study conducted a thematic content analysis of relevant episodes from seasons 1 and 2 of “Euphoria.” Additionally, a literature search was carried out using online databases, including PubMed, PsychINFO, and Google Scholar, to identify relevant literature on harm reduction strategies for adolescent opiate users from 2019 to 2024.

The analysis uncovered multiple instances of Rue's risky behavior. Major themes included polydrug use, self-medication, overdose, association with dangerous individuals, self isolation and withdrawal management. Examining Rue's journey identified harm reduction strategies which could minimise her risk of harm, such as fentanyl test strips, Narcan, and psychoeducation in safer consumption practices, supported by existing literature.

Rue Bennett's character in “Euphoria” underscores the imperative need for harm reduction approaches in substance use interventions for adolescents. The study highlights the potential effectiveness of harm reduction strategies, including Narcan and psychoeducation in minimizing risks associated with opiate use. Rue's narrative emphasizes how these methods could contribute to creating a safer consumption environment for non-abstinent individuals. Integrating harm reduction principles into real-world interventions is crucial for promoting holistic well-being and challenging stigmatizing attitudes toward substance use.

This paper sought to estimate the number of potential candidates per year, within the boundaries of the Mid and South Essex Integrated Care System, for the receipt of Lecanemab, a novel treatment of Alzheimer's pathology.

One of the four memory assessment services within the region was selected at random, following which all referrals to that service in January and February 2023 were retrieved from the electronic patient record system (n = 45). These records were then screened to assess whether the patient met the criteria for treatment with Lecanemab. The inclusion and exclusion criteria from the original CLARITY-AD phase 3 clinical trial (van Dyck et al., 2022) were combined with those of the Appropriate Use Recommendations released by the Alzheimer's Disease and Related Disorders Therapeutics Work Group (Cummings et al., 2023)1,2. Patients could not be identified as certainly suitable for treatment, but simply as potential candidates, as current practice does not include all the necessary investigations to receive the new drug, for example undergoing amyloid PET or CSF testing.

11 of 45 referrals were potential candidates for novel therapeutics (24.4%). Of the 11, 3 were diagnosed with Alzheimer's disease (27%), and 8 with Mild Cognitive Impairment (73%). 8 were male, 3 female, with a mean age of 78 years (range 70 to 87). The mean score on the Addenbrooke's Cognitive Examination III was 82/100. Two patients had co-morbid mental illness, both mixed anxiety and depression, currently in remission. Extrapolating from this rate of eligibility for treatment, it is suggested that approximately 260 patients per year would be eligible for Lecanemab treatment within Mid and South Essex.

This paper estimates that approximately 260 patients per year would be eligible for Lecanemab treatment within Mid and South Essex based on the inclusion and exclusion criteria stated above. This estimate is given with caution, particularly as neither amyloid PET nor CSF testing was performed, and it is still not clear what other stipulations may be made by the UK regulatory bodies (for example the degree of vascular pathology permitted on neuroimaging). This paper does however provide a useful, early estimate of eligibility in order to facilitate planning for potential treatment pathways.

Glutamatergic signalling deficits contribute to the neuropathology of cognitive symptoms in schizophrenia. Iclepertin (BI 425809), a glycine transporter-1 inhibitor, enhances N-methyl-D-aspartate receptor signalling in the brain by increasing synaptic levels of its co-agonist glycine. The Phase III CONNEX programme aims to assess the efficacy, safety and tolerability of iclepertin in improving cognition and functioning in schizophrenia.

CONNEX includes 3 randomised, double-blind, placebo-controlled parallel group trials in patients with schizophrenia from multiple centres across 41 countries in Asia, North and South America, Europe, and Asia Pacific Region (NCT04846868, NCT04846881, NCT04860830) receiving stable antipsychotic treatment. Each trial aims to recruit ~586 patients, 18–50 years old, treated with 1–2 antipsychotic medications (≥12 weeks on current drug; ≥35 days on current dose before treatment), who have functional impairment in day-to-day activities and interact ≥1 hour/week with a designated study partner. Patients with cognitive impairment due to developmental, neurological or other disorders, or receiving cognitive remediation therapy ≤12 weeks before screening will be excluded. Patients will be randomised 1:1 to once-daily oral iclepertin 10 mg (n = 293) or placebo (n = 293) for 26 weeks. Primary endpoint: change from baseline (CfB) in Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) overall composite T-score. Key secondary endpoints: CfB in Schizophrenia Cognition Rating Scale (SCoRS) total score and adjusted total time T-score in the Virtual Reality Functional Capacity Assessment Tool (VRFCAT).

Trial completion is expected in Q1 2025. By 31/01/2024, there have been 811, 699 and 655 patients screened, 533, 474 and 458 randomised, and 320, 299 and 281 who have completed the trial medication for CONNEX-1, -2 and -3, respectively. Most patients are male (CONNEX-1: 69.3%, CONNEX-2: 69.0%, CONNEX-3: 63.3%) with similar age (mean [standard deviation; SD]) (CONNEX-1: 34.0 [8.9], CONNEX-2: 35.9 [8.4], CONNEX-3: 34.0 [8.8] years). For CONNEX-1, -2 and -3, mean (SD) duration of illness is 10.6 (8.3), 12.2 (7.9) and 9.6 (7.6) years and duration of previous schizophrenia treatment is 3.9 (4.6), 4.5 (4.9) and 3.3 (4.4) years. Baseline mean (SD) MCCB overall composite T-score (1: 28.4 [13.7], 2: 27.3 [13.8], 3: 29.7 [13.7]), SCoRS total score (1: 40.5 [11.1], 2: 39.9 [9.7], 3: 38.0 [10.0]) and VRFCAT adjusted total time T-score (1: 29.6 [22.3], 2: 30.7 [20.8], 3: 33.6 [18.1]) were similar across trials.

If successful, CONNEX will provide evidence for iclepertin as the first efficacious medication addressing cognitive impairments in schizophrenia.

Studies funded by Boehringer Ingelheim.

In the densely populated Korail slum of Bangladesh, there is a critical gap in mental health care provision and utilization that was revealed in our ethnographic study. We observed the pivotal role of Community Health Workers (CHWs), Medicine Sellers, and Traditional and Faith-Based Healers (TFHs) in the existing health care service delivery. Moreover, we explored the opportunity to collaborate with them to ensure universal access to biomedical care for serious mental disorders in this slum. As a part of this collaborative approach, we aimed to train these 4 key stakeholders through co-designed training programs that were codeveloped through extensive community engagement including 5 co-designing workshops and 2 writing workshops with them. Furthermore, we refined the initial training program by an expert committee and stakeholders. This training program was piloted to find out the acceptability, feasibility, impact, challenges and areas of improvement.

We followed mixed-methods approach to evaluate the 3-day pilot training with 20 participants at Mirpur, Dhaka. In quantitative part of evaluation we used a) pre and post test assessment that has been carefully designed to assess knowledge, skills, communication, attitudes and motivation, b) session specific questionnaire to find out feedback of the content, activities and time sensitivity of the session, anonymous feedback forms.

In the qualitative part, we conducted a) focus group discussions (FGDs) after completion of training with each group, b) observational notes from each session for deeper understanding.

The pilot training engaged a diverse group of 20 participants and their age ranged from 24 to 52 years, representing 11 different organizations. Though most of the participants were working in the health sector for a long time, we found more than 10% of the participants believed there was no effective biomedical care for the serious mental disorder during pretesting. However, their perception changed during the training. The role playing and case scenario was the most engaging and enjoyable part. We found the participants considered their knowledge regarding the mental health increased up to 80% from their baseline. Our research team also found the increased number of referrals to the biomedical care from the community after the pilot training.

The increased motivation and sense of responsibility reported by participants underscore the training program's effectiveness and the experience and learning from this pilot helped us to further refinements of the training program for the traditional and faith based healer, community health workers and medicine to transform the mental health scenario in Bangladesh.

Limited data suggest that negative mood symptoms in the menopause transition may be associated with a higher prevalence of alcohol misuse and other risk-taking behaviours in menopausal women. Excessive alcohol consumption can exacerbate menopausal symptoms, reduce quality of life and is associated with chronic morbidity that overlaps with the consequences of long-term oestrogen deficiency (such as osteoporosis and cardiovascular disease). The aim of this survey was to explore the impact of mental ill-health on alcohol consumption and gambling habits in menopausal women.

We constructed an anonymous survey consisting of multiple-choice and free-text questions. The survey was distributed online via social media channels on the 22 August 2023 and was open for 6 weeks. All perimenopausal and menopausal women were invited to participate. Responses were collected using the Qualtrics survey platform and analysed in Excel for descriptive statistics.

1,178 responses were submitted. One in three women reported drinking more alcohol during the perimenopause/menopause; 15% of women drink more than the recommended maximum of 14 units per week, and 24% (286) are spending up to £50 per week on alcohol. 70% (332) cited anxiety, stress, and/or depression as the reason for their increased alcohol consumption, whilst 29% (135) said they drank to alleviate menopause symptoms. Further, 5% (54) of respondents admitted gambling more since the onset of perimenopause/menopause; 43% (27) said it was due to anxiety, stress, and/or depression, whilst 13% (9) said they do so to help manage their menopause symptoms.

This anonymous, cross-sectional survey found evidence of an association between menopause and addiction. Increased awareness of this association should facilitate earlier recognition and more timely access to support and effective treatment for addiction, including hormone replacement therapy to treat menopausal symptoms that may underlie and/or exacerbate unhealthy lifestyle behaviours.

Neurodevelopmental disorders (NDDs), such as dyslexia, dyspraxia, and dyscalculia affect cognitive function and therefore share symptomology with neurodegenerative disorders, such as Alzheimer's disease, vascular dementia, and frontotemporal lobe dementia. The primary aim of this narrative systematic review is to ascertain if there is an association between NDDs and neurodegenerative disorders. Secondary aims are what the prevalence of NDDs within a dementia population is and what effect these early life learning disorders have on patients as they get older. It was hypothesised that NDDs would overestimate the severity of cognitive impairment, thereby increasing the severity of dementia staging, and impacting patient care.

Using a Population, Exposure, Comparator, Outcome, Setting, and Study design (PECOS) framework, keywords of “dementia”, “dyslexia”, “Dyspraxia/clumsy child syndrome/developmental apraxia/motor learning difficulty/disorder of attention and motor perception” and “dyscalculia/mathematical learning disability” were searched for on 4 databases (SCOPUS, OVID, Cochrane Central Register of Controlled Trials and Web of Science) from January 1, 1960 – June 10, 2022. Studies were included if they discussed both neurodegenerative and neurodevelopmental disorders or compared an intervention typically used in one disorder on the other (e.g., dementia intervention being used on neurodevelopmental disorder). Studies were excluded from grey literature articles, or if they only discussed a neurodevelopmental or neurodegenerative disorder without reference to the other, or if it included acquired, rather than neurodevelopmental dyslexia, dyscalculia, or dyspraxia.

A total of 8 studies were included for narrative synthesis. The main finding was an association between dyslexia and both Alzheimer's disease and frontotemporal dementia. Many studies suggested this was due to a genetic phenotype that caused a vulnerability in the language regions of patients’ cortices. There was also evidence of structural changes associated with NDDs and increased levels of grey and white matter atrophy in dementia subtypes, particularly in the language areas of the brain.

Due to screening and consequently formal diagnosis of neurodevelopmental disorders only recently coming into education systems, many adults currently attending memory clinics did not have a formal diagnosis. As there was limited research on dyspraxia and dementia, partly due to limited research into dyspraxia itself and without a standardized diagnostic tool for adolescents and adults, further research is needed in this area. The hypothesis of NDDs increasing the severity of dementia staging was also not supported by the literature results, and on the contrary, some studies suggested greater global preservation of cognitive function in patients with NDDs and dementia.

The thalamus, a dual grey matter formation within the diencephalon is thought to be involved in psychosis. It consists of distinct nuclei with specific functions. To date no study has investigated the volumes of the thalamic nuclei in young adolescents with Psychotic Experiences (PEs).

This study used T1 imaging with Freesurfer analysis to investigate the differences in thalamic nuclei in 98 young people (53 with PEs) over three time points, from ages 11 to 18. A linear mixed effects (LME) model was used to examine the longitudinal nature of the data.

The findings were entirely left sided – specifically a smaller left whole thalamus (p = 0.04), significant reduction in the size of the left pulvinar (p = 0.008) and a slight increase in the size of left ventral nucleus (p = 0.005).

This study found significant volumetric differences in thalamic functional composite nuclei between adolescents with a history of PE compared with healthy controls. Two such nuclear groups survived post-hoc DTR testing, the left ventral and left pulvinar nuclei. The pulvinar nucleus demonstrated a reduced volume over time in PE groups compared with healthy controls whilst the left ventral nucleus demonstrated an increased volume over time in PE groups compared with controls. The thalamus has been shown to be actively involved in the modulation of cortico-cortical communication via cortico-thalamo-cortical pathways, thus synchronizing the activity of the cortex during tasks that require attention. One of the core deficits believed to be a part of psychotic illnesses is the inappropriate modulation of attention through various cortical networks. This disrupted modulation results in a lack of control of goal-directed behaviour and can be attributed to the changes seen in pulvinar in psychotic illnesses, thus resulting in impairment in the integrity of sensory information and context processing. The affiliation of the ventral thalamic nucleus to the dopaminergic system, particularly the substantia nigra, may aid in explaining why this nucleus demonstrates larger volumes in adolescents with PEs compared with healthy controls over time.

More research needs to be done on following this cohort up, specifically investigating changes in thalamic nuclei in those who develop a diagnosable psychotic disorder.

The present investigation was interested in whether formal thought disorder (FTD) in schizophrenia was in any way related to linguistic creativity. The project's main aims and research questions were the development of operational definitions of linguistic creativity and FTD in schizophrenia, an investigation of creative language processing in schizophrenia, and an investigation of creative language output in schizophrenia.

We designed a psycholinguistic experiment and collected natural language data to build a specialised schizophrenia corpus. Recruitment for the psycholinguist experiment was challenged by the COVID pandemic and the technical abilities of clinical participants. Those data are thus underpowered and not reported in the results. We collected sufficient data for the construction of the specialised corpus.

We tested an operational definition of FTD in schizophrenia (the '4TD Framework') against our natural language dataset. There was good support for the framework, with grammatical and discourse tracking features reliably distinguishing clinical and comparison speakers (p < 0.05). We also examined concordance lines and grouped random concordances into error types. Error types were consistently similar across groups, suggesting that speech disturbances in schizophrenia are on a continuum with those of nonclinical speakers. We also conducted a keyness analysis to examine the key terms and semantic categories present in the corpus and noted significant differences in the clinical cohort. Clinical participants found discussion of the topic of linguistic creativity more challenging, deviating from topic more often. They also involved topics of emotional and personal concern at rates of up to 16 to 32 times more often than comparison participants in some cases.

Our results provide support for the dysexecutive and dyssemantic hypotheses of FTD, as well as work on the Thought Language Index (TLI) that also suggests that language disturbances in schizophrenia and FTD are on a continuum with nonclinical speech. Further research is needed to understand how these phenomena are positioned in relation to FTD as a transdiagnostic entity.