To identify the patterns of psychiatric help seeking behaviour among patients with psychotic illness presenting to mental health institute in Pakistan.

This Descriptive, Cross-Sectional Design comprised of a sample of 103 patients with psychotic diseases, chosen via non-probability – consecutive sampling at Outpatient Department of Sir Cowasjee Jehangir Institute of Psychiatry, Hyderabad. The relatives of psychotic patients who were between 18 and 65 years of age with either gender and living with at least one family member were interviewed after taking informed written consent. An anonymous self-structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, psychiatric diagnosis and disease particulars, pattern of help seeking and time and reasons for delay.

The mean age of the sample stood at 32 years (±9.5 SD). 1/3 of the sample comprised of male patients while only 24% were comprised of female population. The mean time elapsed after first episode psychosis till interview was 82 ± 32 months (7 years) while mean delay in help seeking to any helper was reported to be 41 ± 17 months (3.5 years). Majority of the patients approached first to faith healers (Aamil Baba, Witch Doctor, Pir, Religious Leader, Molvi, Imam or Religious Cleric) while only 1/5 of the patients approached to psychiatrists for treatment of first psychotic episode. The mean time duration to approach to psychiatrist after first episode psychosis was reported to be 73 ± 38 months (around 6 years).

The study showed that most frequent source of health care for psychiatric patients were faith healers (Aamil Baba, Witch Doctor, Pir, Religious Leader, Molvi, Imam or Religious Cleric) as compared with one-third who went to qualified healthcare providers like psychiatrists or physicians. There is a huge delay in proper help seeking among psychiatric patients. Health education aiming at increasing awareness among general population regarding treatment options for psychiatric illness is recommended to improve the quality of life of people living in our locality.

Individuals with schizophrenia, schizoaffective disorder, and bipolar affective disorder have higher rates of cardiometabolic disease and have a reduced life expectancy compared with healthy controls. These mental health conditions are highly heritable and neurodevelopmental copy number variants (CNVs) are known to increase the risk of these disorders. Neurodevelopmental CNVs have also been associated with a range of cardiometabolic disorders. The aim of this research was to examine the relationship between neurodevelopmental CNVs and cardiometabolic disease in individuals with schizophrenia, schizoaffective disorder, and bipolar disorder.

Using data from the UK Biobank, a group of individuals with schizophrenia, schizoaffective disorder and bipolar affective disorder was defined (n = 2,611) based on first-occurrence data. CNVs had previously been called using PennCNV and a set of 53 neurodevelopmental loci annotated. I carried out association analyses between neurodevelopmental CNVs and cardiometabolic disease phenotypes using logistic regression with age and sex as covariates.

There was a higher frequency of ischaemic heart disease, hypertension, obesity, and type 2 diabetes mellitus in individuals with schizophrenia, schizoaffective disorder and bipolar disorder than in controls. 2.1% of individuals with these mental health conditions carried a neurodevelopmental CNV. Carrying a neurodevelopmental CNV was significantly associated with type 2 diabetes mellitus (OR = 1.94, 95% CI 1.09–3.57, p = 0.025). However, this result did not survive Bonferroni correction for four tests (p value threshold 0.0125). I did not find any mediators of the neurodevelopmental CNV – type 2 diabetes mellitus association (of obesity, hypertension, cognition, smoking and socioeconomic status).

The relationship between neurodevelopmental CNVs and type 2 diabetes mellitus should be examined in independent samples.

Traditional antipsychotic treatment improves positive symptoms in schizophrenia but has little impact on negative and cognitive symptoms. TMS is a non-invasive neuromodulation technique which has been suggested to impact negative and cognitive symptoms of schizophrenia. This systematic review critically appraised the research evaluating the effect of TMS on negative and cognitive symptoms of schizophrenia. Furthermore, we carried out a meta-analysis of randomised controlled trials of the effect of TMS on negative symptoms in schizophrenia.

Systematic review was carried out according to PRISMA guidelines. Cochrane Library, Ovid Medline, Science Direct and PubMed databases were searched for relevant studies using the search terms: “transcranial magnetic stimulation” OR “TMS” OR “repetitive transcranial magnetic stimulation” OR “r-TMS” OR “theta burst stimulation” OR “TBS” AND “negative symptoms” OR “cognitive dysfunction” OR “cognitive impairment” AND “schizophrenia” OR “psychosis”. Only randomised controlled trials evaluating the effect of TMS (rTMS or iTBS, intermittent theta burst) on negative and/or cognitive symptoms in schizophrenia were selected. Thirty-three studies were included in the systematic review. The Standardised mean difference (SMD) with 95% confidence interval (CI) was calculated for each study and pooled across studies using an inverse variance random effect model.

Sixteen studies demonstrated significant improvement in negative symptoms with a superior effect of TMS compared with sham intervention. Eight studies showed improvement in certain domains of cognition and one study showed a delayed effect on negative symptoms. Studies which showed positive effects on negative symptoms have used similar TMS parameters such as 10 Hz over L-DLPFC (Left dorsolateral prefrontal cortex) except for a few studies. Ten studies reported negative results for negative and/or cognitive symptoms, TMS parameters and duration of treatment used varied among these studies. Overall, SMD for SANS (Scale for Assessment of Negative Symptoms) was 0.89 (95%CI: 0.46–1.32, P < 0.00001) and for PANSS-N (Positive and Negative Syndrome scale-negative) was 0.67 (95%CI: 0.22–1.12, P < 0.00001), both in favour of TMS. The heterogeneity of the included studies was high, I2- 85% for SANS and 92% for the PANSS-N subscale with a small to moderate risk of publication bias.

High-frequency rTMS is more effective than sham in improving negative and cognitive symptoms in schizophrenia. Our results suggest the need for well-designed randomised controlled trials with larger sample sizes and standard harmonised cognitive assessments to assess the effect of TMS on negative and cognitive symptoms to provide sufficient evidence for inclusion in routine clinical practice.

Learning about and appreciating the use of Electroconvulsive therapy remains an integral part of the undergraduate psychiatry curriculum. The existing literature indicates that medical students frequently have unfavourable views regarding ECT and its adverse effects.

Therefore, this study aimed to introduce a new teaching tool that supplements traditional didactic ECT teaching with simulation-based procedural demonstration thus providing a real-life experience of an ECT room and subsequently evaluate the learning gains conferred by such a curriculum.

The demonstration was carried out by Clinical teaching Fellow with the help of a high-fidelity manikin and a live actor who played the role of the patient, in the ECT suite in Birmingham.

Participants of the study were fourth year medical students who completed a self-administered questionnaire before and after the simulation session. This survey was designed to explore changes in knowledge, attitudes, and perceptions of the students towards ECT and its side effects.

Within a cohort of 88 students, 52 students successfully completed the pre-session questionnaire, and 43 students completed the post-session questionnaire. Students reported a global improvement in knowledge regarding ECT, when comparing results from both questionnaires. Prior to the simulation, many students used negative terms to describe ECT such as ‘torture’, ‘barbaric’ and ‘uncontrolled’, suggesting outdated stigmas around ECT. However, after the simulation, many students expressed a positive change in opinion, describing ECT as ‘controlled’, ‘beneficial’ and effective’.

Additionally, students reported improved knowledge about the side effects of ECT, especially regarding pain, memory loss and brain injury. Many students reported that their initial apprehension had been addressed over the course of the ECT simulation. Many noted ECT was more effective and beneficial than originally thought and the process was less extreme and invasive than they believed.

The results of the study reflect that the use of simulated ECT within medical students can help disperse some of the stigma and myths regarding this treatment. Simulation can humanise the process and shift attitudes around ECT by allowing students to become fully immersed into an almost real-life scenario. It can also address knowledge gaps around ECT indications, process, risks, side effects and benefits. This will in turn help educate future clinicians have a better understanding about ECT in the treatment of severe mental illness, thus optimising the utilisation of this effective treatment. Furthermore, such technique can be a useful tool for demonstrating ECT to potentially wider group of students, trainees and other health practitioners.

The TERMS (Technology Enabled Remote Monitoring in Schools) project aimed to elucidate the operational dynamics of remote monitoring with bluetooth-enabled physical health monitoring devices. The focus was on measuring key parameters such as usage, perceived value, accuracy, and satisfaction among patients, their families, and healthcare staff. Additionally, we sought to explore the potential future integration of remote monitoring in educational settings through school site workshops.

Digital healthcare has become an indispensable part of effective healthcare provision on a global level. Remote monitoring is the use of technology, to monitor patients outside of a clinical setting with the help of medical devices, questionnaires, and clinical dashboards, allowing clinicians to review the data to assist in clinical assessment and decision-making. While this method is already established for conditions like Diabetes and Asthma it is not for other conditions like ADHD. This is especially a challenge for the younger demographic.

Schools are pivotal for promoting student well-being and early interventions, leading to reduced negative outcomes like exclusion and school absence and enhanced academic attainment. The TERMS project strives to bridge the gap between education and healthcare by collaborating with schools and clinicians. This is in alignment with the digital and data strategy for health and social care in Wales as outlined by the Welsh Government(2023).

This study had 2 parts:

Clinical Site Testing:

Blue tooth-enabled clinical monitoring device readings were obtained after they were monitored first with traditional clinical monitoring devices. Additional qualitative feedback was also obtained.

Educational Workshops:

Workshops were carried out with students and teaching staff to collect qualitative and quantitative feedback on the remote monitoring equipment and patient-facing dashboard. This also set out to determine if remote monitoring in schools is feasible and how it could be implemented.

A total of 47 clinical patient cases were included. The accuracy of the bluetooth-enabled device readings and those of traditional equipment were compared. Analysis of the qualitative data revealed useful domains and subdomains of opinions along with the user-friendliness of the software interface.

Overall, we have identified that patient and family perception of remote monitoring is positive, suggesting an improved/comparable level of care for their condition. Additionally, school workshops highlight that this service could be implemented within a school setting. As long as considerations were made for who would conduct the remote monitoring and what the role of the school would be.

Food insecurity, defined as lacking regular access to nutritious food due to financial hardship, is associated with a range of adverse developmental outcomes for children and adolescents. Emerging evidence suggests food insecurity in adults may be associated with disordered eating behaviours, including binge eating and unhealthy weight control strategies. However, the nature of this relationship in adolescents remains unclear. This study aimed to investigate whether an association exists between food insecurity and eating disorder symptomatology in a large and diverse sample of adolescents living in England.

Cross-sectional data were collected from 34,730 young people in school years 7 to 13 (aged 11 to 18) in classrooms across England, as part of the OxWell 2023 Student Survey. Eating Disorder symptomatology was measured, on a scale of 0 to 6, with five self-report screening questions from the Eating Disorder Section of the Development and Well-Being Assessment (DAWBA) and one additional question on meal skipping due to shape/weight concerns. Food insecurity was measured, on a scale of 0 to 6, with three questions adapted from the Wales Young People's Survey on Child & Family Poverty 2019. A complete case analysis was conducted using Stata, v18. Regression analyses were performed to test for associations between food insecurity and eating disorder symptomatology, stratified by gender and adjusting for age and ethnicity.

12,571 (36.2%) participants were excluded due to missing data in key study variables. Our final sample comprised 22,159 adolescents with a mean age of 13.8 years (50.8% female, 54.4% white ethnicity). 63.6% of participants reported experiencing at least one eating disorder symptom and 45.7% scored ≥2 on the DAWBA screening items, a more stringent cut-off for possible eating disorder. Food insecurity was found to be a significant predictor of eating disorder symptomatology in participants of all genders (female: β 0.54, 95% CI 0.48–0.60, p < 0.001, male: β 0.40, 95% CI 0.36–0.44, p < 0.001, other: β 0.52, 95% CI 0.43–0.61, p < 0.001). The association was particularly marked amongst those reporting purging behaviours (OR 1.62, 95% CI 1.55–1.69, p < 0.001).

In keeping with previous research, our findings indicate that adolescents experiencing food insecurity exhibit increased rates of eating disorder symptomatology. Further research is needed to explore potential mechanisms behind this association, as well as to develop effective intervention strategies. Our study adds to a body of evidence identifying a high-risk and disenfranchised group of young people who may benefit from targeted support.

Functional somatic symptoms (FSS) is an umbrella term for symptoms inadequately explained by structural disease or damage. FSS show complex causality, and fall between the gaps in mainstream medical epistemology and/or mind-body dualism. Lack of explanations for FSS exacerbates uncertainty, anxiety and stigma for patients, and contributes to fragmented care and inappropriate management. We aimed to develop an open access health-educational resource that provides an acceptable, relevant, and usable explanatory model of FSS to internet users.

We carried out a participatory design study to develop the website bodysymptoms.org. Explanatory concepts were developed through iterative stages of dialogue between individuals with lived experience of multi-system FSS (n = 7), researchers, healthcare professionals and designers/developers. Initial explanatory components were collected from currently existing patient education about FSS, a review of the literature, and participants’ illness narratives. Principles were developed to filter, and organize these explanatory components into a coherent model. The model was translated into 5 European languages and through iterative rounds of feedback incorporated a diverse range of perspectives.

We describe the explanatory model that developed through the bodysymptoms project, and considerations that arose through the dialogic process. The model is based on the body as a complex adaptive system with causal interactions operating across bio-psycho-socio-ecological levels. Mechanistic processes that can maintain persistent symptoms were chosen as the main nodes (or topics) of the model, and minor topics were structured to demonstrate interactions between mechanisms. Considerations that arose during the process included coherence across philosophic, scientific and clinical levels of explanation; a therapeutic model of agency, within which explanations empowered without blame; the need to introduce notions of biological time, like body rhythms and body memory; and the role of multi-media, embodied metaphors and lived experience narratives in communication of the explanatory model. Personalisation of the model was achieved through embedding the structure of the model into the graphical and navigational structure of the website, which allows website visitors to explore the model in a non-linear manner, tailored by relevance, acceptability, and prefered level of information.

We present results from a research in action study to develop a novel resource for understanding functional somatic symptoms. bodysymptoms.org is based on the model of the body as a complex system that adapts in personal ways. To explain FSS there is a need for new ways to understand the body and how we become unwell. Bringing diverse perspectives into dialogue generated new forms of knowledge and allowed the power of scholarship to be harnessed for immediate shared value.

Recommendations from the NHS and the Royal College of Psychiatrists advise that patients receive a copy of all correspondence that is sent on to the GP. Often, within psychiatric services, letters are not routinely sent to patients.

To improve communication with patients and their carers, the Aneurin Bevan Learning Disability team have been writing letters directly to patients and sending a copy to the GP.

There is limited use of jargon, and the complexity of the language aims to reflect the individual's reading level.

This study aimed to gain feedback from local GPs on the new letter format to ensure effective communication between teams.

We contacted Primary Care Services in the local area to gain feedback on how our clinic letters were being processed, we were informed that letters are reviewed by an admin team and only sent on to GPs if there are specific tasks to action, meaning that many of our letters remain unread.

We identified 16 GP practices in the Torfaen and Monmouthshire area and sent a survey by email to gain feedback on the new correspondence style. The survey was sent out three times within a 12-month period.

Of 16 GP practices just 6 responded, with just 1 GP stating that they had noticed a change in the letter style. 50% of GPs felt they received relevant information in the letters from the CLDT. The comments were largely positive with suggestions reflecting changes that have already been made. There is no feedback that suggests GPs feel they are not receiving adequate clinical information.

The lack of response may highlight how infrequently GPs are reviewing the letters from the CLDT confirming the importance of prioritising doctor–patient correspondence. The limited communication from GP to CLDT emphasises the need for improvement in liaison between secondary and primary care services.

The lack of negative feedback about the letters is encouraging. There is no feedback that suggests GPs feel they are not receiving adequate clinical information and clear feedback that GPs want clear and accessible information, particularly regarding specific actions for GPs.

A clear limitation of this work is the lack of response to our survey. Reviewing these letters from our team is a very small proportion of a GPs workload, more time may be needed to ensure GPs have had contact with our team and are able to provide more detailed feedback.

To identify if COVID-19 has changed the experience for patients under the care of Crisis Resolution Home Treatment teams (HTT).

To identify if COVID-19 altered the response for HTT patients in the context of Personality Disorder (PD).

To provide useful demographic and experiential information about patients using HTT with PD during crisis.

Data regarding the demographics of patients with personality disorders under the care of the Croydon crisis home treatment team were collected retrospectively for two, predetermined time windows. The first window was pre-COVID-19 (26/03/2019–25/03/2020) and the second window was during COVID-19 (26/03/2020–25/03/2021). The demographics of patients with personality disorder referred to the team during these two time periods included were compared.

More patients with personality disorder were referred to the Croydon HTT during COVID-19 (n = 82) when compared with the window before (n = 58). The proportion of referred patients with Emotionally Unstable Personality Disorder (EUPD) was constant before and during COVID-19. The average length of stay reduced from 22.6 days before COVID-19 to 18.7 days during COVID-19. The proportion of rejected referrals to the HTT of patients with personality disorder increased during COVID-19. Finally, the proportion of BAME (Black, Asian, Minority Ethnicity) referrals of patients with personality disorder increased during COVID when compared with before, with this finding not being replicated in any other ethnic group.

Increased numbers of referrals may indicate worsening mental health in the community. This may have been compounded by an inability of community mental health teams and inpatient services to meet such an increase in demand for services. An overall reduction in inpatient admissions during COVID-19 supports this idea. There was a relatively larger drop in duration of admission for patient with personality disorder during COVID-19, when compared with all patients. This may be due to staff feeling unable to offer quick management for patients with personality disorder. Subsequently, staff may have selectively discharged such patients earlier. The rate of rejected referrals to the Croydon HTT was consistently higher than the acceptances both pre- and post- COVID-19. Therefore, HTT clinicians may feel unable to adequately treat PD.

In conclusion, the number of referrals to the HTT increased during COVID-19, however, with a reduced average duration of stay with HTT for patients. The rejection rates for personality disorder patients were consistently higher than for other patient groups, both before and during COVID-19. Additionally, the proportion of patients with personality disorder from BAME backgrounds increased during COVID-19.

Eating disorders (ED) have significant physical and psychosocial impacts, and the highest mortality rates of any psychiatric illness. About a third of patients with Anorexia Nervosa or Bulimia Nervosa do not recover and develop persistent ED. Development of novel treatments is a priority to prevent adverse effects on young people's physical, relational and educational development. Virtual reality (VR) has shown promising efficacy as an innovative mental health treatment, and has potential therapeutic value within ED. People with lived experience (PWLE) and clinicians have demonstrated enthusiasm for a VR café intervention to practice social and food-related challenges. A VR café would enable gradual exposure to challenges in a protected environment, aiming to support people with ED to return to real-life cafés and social eating. This study aims to explore the opinions of key stakeholders to help inform the development of a VR café scenario as an adjunctive treatment for ED.

We conducted semi-structured focus groups and 1:1 interviews with PWLE aged 14–25 years (n = 15), parents/carers (n = 4), and clinicians (n = 6). Participants were recruited via social media, advertisement via ED charities, posters in public places, and snowballing. Following completion of an online screening survey, eligible individuals were invited to participate using purposive sampling to ensure diversity of ages, ethnicities, genders, ED diagnoses, and health professional roles. Data were analysed thematically.

Preliminary analysis indicates that PWLE, parents/carers and clinicians expressed mostly positive opinions regarding a VR café adjunctive treatment. Expressed concerns related to themes of intervention efficacy, translation of learnt skills to real life, and use of VR technology. Most participants agreed a VR café intervention should be a repeated experience (many suggested graded exposure), realistic, and maximally individualised. All stakeholder groups identified a similar range of challenges to experience within a VR café, with themes including choosing food, other people, eating socially or alone, and the café environment. Differences in specific aspects of the scenario that might make challenges harder or easier reflected the unique experiences of individual participants.

These findings build upon previous research demonstrating support from PWLE, parents/carers, and clinicians for the development of a VR café adjunctive treatment for ED. Themes identified are largely consistent across stakeholder groups and relate to the design of a VR café scenario and its implementation as a treatment. This analysis enables the perspectives of key stakeholders to be incorporated into the design of a novel VR café intervention to optimise efficacy and acceptability.

To carry out systematic literature search on an international medical database to find what the emerging categories in which the word hatred is used in medical literature are, and to gather information regarding the generation of the emotion of hatred in human beings by thematically analysing the relevant collected data.

To identify the information on hatred relevant for mental health professionals, we performed a systematic review using a systematic approach and criteria.

Six themes regarding generation of hatred identified.

Theme one: Targets of hatred.

Theme two: Self-hatred.

Theme three: Self-perceived hatred.

Theme four: Hatred towards inanimate objects.

Theme five: Reasons for hating other humans.

Theme six: Internal reasons for development of hatred.

The word ‘hatred’ is used in medical literature in a multiplicity of meanings that range from using it in its literal sense to describe a subtle attitude such as a phobia-philia relationship, or to describe a unique outcome that is generated as an interplay of several different kind of factors. These may include cognitions, behaviours, social interactions, attitudes, sentiments, developmental backgrounds, psychodynamic interactions with others in real and virtual worlds etc. Hatred is more like a mind-set that people can develop towards themselves, towards others and towards inanimate objects or situations too. Fear, anger and disgust are primary emotions (that we are born with); human psyche is naturally prone to several inevitable cognitive errors; human thought is subjected to unavoidable logical fallacies; and human ego cannot avoid utilising unhealthy ego-defence mechanisms. Every child is born in a family and culture that has its own unique background and history. We humans are prone to the generation of the hateful mindset as an unavoidable outcome in a variety of scenarios. Keeping these generational patterns in view, it would be reasonable to say that an early detection and addressing the early warning signs towards development of the hateful mind-set would be helpful for ourselves and for others. As the word is used in several different meanings, the background information, context, and overall scenario of the discussion needs to be kept in mind whilst attempting to draw any meanings about the use of hate/hatred in a verbal or written expression. In each case where the word ‘hatred’ is used, needs to be approached with epistemic curiosity and in some instances, it may need detailed epistemic inquiry to fully comprehend the meaning of this word in any given expression.

The first medical textbook in Arabic, ‘Firdaus as-Hikmah’ (The Paradise of Wisdom) by Tabari (808–861) was composed in in year 848. Tabari's classification of insanity is simple and in term of psychosis, he talks about syndromes of ‘Hearing voices in the head’ (hallucinatory psychosis), ‘humm-al-hubbi’ (love fever) and ‘humm-al-sehr’ (fever from enchantment). The first classification of ‘junun’ (psychosis) comes from Râzī (854–925), who in his ‘Al-Hāwī fil Tib’ (The System of Medicine) divides ‘insanity’ (psychosis) into ‘al-junun al-thābet’ or ‘permanent madness’, and ‘a'rāz tābea-tu leamrāz’ or ‘symptomatic psychotic disorders'. The first medical textbook in Persian language, ‘Dāneshnāma’ (Medical Encyclopaedia) by Hakim Maysarī, completed in 978–9 mentions only melancholia and ‘rejā’ (pseudocyesis/pseudopregnancy) and no other psychotic conditions. Prospective generations of Arabic-inscribing physicians, including Majūsī, also known as Haly Abbas (949–990), Avicenna (980–1037), and Persian-inscribing physicians such as Bokhârī̄ (? −983) and Jorjânī̄ (1040–1137) are strongly influenced by Râzī̄ and use similar taxonomy of psychotic disorders. Moreover, the taxonomy introduced by Râzī̄ and other mediaeval physicians has been used in Arabic and Persian speaking medical communities until the past century. Nevertheless, these were substituted by Latin-based language vocabulary reflecting the International Classification of Diseases (ICD).

The aim of this work is to review the input of Arabic and Persian schools in the development of psychiatric knowledge and classification.

Literature search of ‘Firdaus-al-Hikmah’ of Tabari, ‘Kitāb al-Hāwī fī al-ṭibb’ of Râzī̄, ‘Kitābu'l Malikī’ (The Royal Book) by Majūsī, ‘Al-Qānūn fī al-Ṭibb’ (Canon of Medicine) of Avicenna in Arabic; and ‘Hidâyat al-Mutaʽallemin fi al-Ṭibb’ (A Guide for Medical Students) of Al-Akhwayani Bokhârī and 'Zakhīra-i Khwârazmshâhī' (The Treasure of Kwārazmshāh) and Al- ‘Aghrād'ul tibiyah wa'al-mabāhith'ul Ala'iyah’ (The Aims of Medicin) of Jorjânī in Farsi.

1. ‘Transient‘ or symptomatic psychotic disorders, resulting from direct or indirect brain damage:

1. 1.1. ‘Ekhtelāt-ul-takhayyol’ (disorder of perception), ‘when patients imagine perceptible things, such as seeing people, hearing sounds, or sensing smells that have no external reality’.

2. 1.2. 'Ekhtelāt-al-fekr’ (thought disorder), when the perception is intact and patients perceive the outside reality as it is, however, their thinking is impaired.

3. 1.3. ‘Ekhtelāt-al-aqhl’ ('corruption of the mind’), or ‘junun (madness), defined as a condition when patients say things they should not say, like things they should not like, wish unreasonable things, demand what is not demanded, do things they should not do, or hate things that they normally do not hate.

4. 1.4. 'Sobārā', portrayed as a form of agitated madness resulting from ‘sarsām’ (meningitis/encephalitis).

2. 'Permanent’ psychotic disorders also considered as primary ‘brain’ diseases:

1. 2.1. Mania, described as the worst kind of insanity, presenting symptoms of paranoia, constant anxiety, agitation, hyperactivity, vindictiveness, insomnia, hostility, and ferocity.

2. 2.2. ‘Dâ-al-kalb' (‘dog's disease'), portrayed as a mixed psychosis with a fluctuating picture of anger and playfulness, as well as hostility mixed with gentleness.

3. 2.3. 'Qutrub', outlined as a psychosis when affected individuals dislike people's company and run away from society, rarely resting, and aimlessly moving as if they were in fear of running from someone. Patients become forgetful, and their behaviours disorganised.

The Arabo-Persian classification of mental disorder was progressive and generated a common nomenclature in the Arabo-Persian speaking medical communities, serving the mutual understanding of experts. Moreover, the taxonomy developed was relatively precise and stable, corresponding to modern classification systems. Psychoses were categorised into ‘transient’ and ‘permanent’ disorders, which were considered as a primary ‘brain disease’ of multifactorial aetiology, a concept introduced by Griesinger in the 19th century, known as the ‘organic model’ of mental illnesses.

This research study aims to identify the adverse effects of alcohol and polysubstance misuse on kidneys. The study also highlights the hidden harm caused by prescribed treatments such as PPI (Proton Pump Inhibitors) and other medications.

The study was conducted in the summer of 2022 at an outpatient addiction treatment service. 63 patients (10% of the total prescribers), 49 males and 14 females participated in the study. All participants gave their consent, and data were collected including demographic details, substance misuse history, physical and mental health history, and prescribed treatments. We used a Combur-7 urinary dipstick to analyze the results provided in the kit.

Seven patients were not able to provide a sample. 60/63 patients' result showed abnormalities.

21 out of the 63 samples appeared dark and hazy. 7 samples were foul-smelling. 40 of the 63 patients were detected with a variable amount of leukocytes. 1 of the 63 patients was positive for nitrogen. The pH values range from 5 to 8. Specific gravity values were variable. 3/63 samples were positive for bilirubin. 58/63 samples were positive for protein. 19/63 samples detected variable amounts of red blood cells. 5/63 samples detected for ketones and glucose were negative in all samples.

Long-term alcohol abuse can compromise the ability to manage fluid volume and electrolyte balance. Extreme serious abuse can also impact acid-base balance, homeostasis, and even hormonal control regulated by the kidneys could be affected. This situation further complicates the presence of liver disease.

Cocaine abuse can cause acute kidney injury (AKI), malignant hypertension, and vasculitis and can lead to chronic kidney disease (CKD). Heroin-associated nephropathy (HAN) can lead to nephrotic syndrome and could progress to end-stage renal failure.

Tobacco, solvents, amphetamines, and ecstasy can aggravate a wide range of kidney diseases by their direct or indirect effect on kidney functions.

Long-term use of proton pump inhibitor and other medications such as NSAID, pregabalin, and diuretics, may affect kidney functions.

The Opiate substitute treatment dose needs to be adjusted in the presence of poor kidney functions to reduce morbidity and mortality. Early screening is required for all patients on long-term OST and other medications for comorbid illnesses.

Internet gaming disorder (IGD) is a recognised mental health condition characterised by impulsive gaming, where gaming takes precedence over all other activities and negatively impacts the life of a person. IGD has an estimated prevalence of 2–5% of all mental health disorders. Limited research exists on the treatment effects of various therapeutic interventions for gaming disorder, highlighting the need for comprehensive investigations of evidence-based approaches and to improve intervention strategies.

This systematic review aims to identify most of the intervention studies on internet gaming disorder using a control group, to determine the effect of the interventions and to examine moderators for these interventions.

We reviewed available treatment interventions for children and adolescents. A search on Pubmed central, PsycINFO, Embase, MEDLINE, Cochrane, CINAHL and Google Scholar Library was conducted. Various interventions, whether individual or group-based, incorporate Cognitive Behavioural Therapy (CBT), family therapy and pharmacological treatments for gaming disorder and these were selected for this review among all the other interventions examined. Some exclusively use CBT, while others combine it with different treatments. This includes both online and in-person CBT, encompassing behavioural including limited exposure and cognitive elements.

The comprehensive search resulted in 113 studies from 2018–2023 and we ended up with 25 studies by excluding studies according to the exclusion criteria.

This systematic review identified a total of 113 studies, of which 25 studies were finally selected and were included. It examined interventions for internet gaming disorder (IGD). Cognitive Behavioural Therapy (CBT), Family Therapy, and Psychopharmacological treatments were assessed across diverse studies.

Findings indicate significant improvements post-intervention, with CBT and family therapy showing promising results in reducing IGD symptoms. Pharmacotherapy combined with psychotherapy emerged as the most effective treatment option. The study underscores the need for multifaceted approaches in addressing IGD, contributing valuable insights for future treatment strategies.

The review highlights promising outcomes for Internet Gaming Disorder interventions, with Cognitive Behavioural Therapy and Family Therapy demonstrating effectiveness. Combining pharmacotherapy with psychotherapy is most beneficial, emphasising the importance of comprehensive treatments needed for IGDs.

Irritability is common and easily identified in childhood. It is transdiagnostic and a common reason for referral to mental health services. Irritability which does not decrease during early childhood is associated with adolescent depression. We hypothesised that irritability would be associated with increased risk-taking overall but reduced risk-taking in response to loss.

We used data from the Millennium Cohort Study, a population-based cohort of 18,552 children born in 2000–02. We examined whether irritability at 3, 5 and 7 years is associated with risk-taking on the CGT using multilevel mixed effect generalised linear models (MEGLMs). We also calculated the change in irritability between 3–7 years for each participant using multilevel mixed models. We then examined the association between this change measure and risk-taking on the CGT using MEGLMs. Analyses were adjusted for a broad range of confounders.

We found that children whose irritability did not decrease as would be expected from 3 to 7 years were more likely to stake a higher number of points per trial on the CGT at 11 years. This increase was most evident when the previous trial had been won. Irritability at 7 years was associated with staking a higher number of points per trial on the CGT (coefficient 0.52, 95%CI −0.04–1.08, p = 0.067) in fully adjusted model, whereas irritability at 3 and 5 years were not (3 years – coefficient 0.02, 95%CI -0.62–0.65, p = 0.961; 5 years – coefficient 0.14, 95%CI −0.45–0.73, p = 0.641). There was evidence of an interaction between irritability at seven years and whether the previous trial was won (p = 0.014). Childhood irritability which did not decrease between 3–7 years was associated with staking a higher number of points per trial on the CGT (coefficient 1.36, 95%CI 0.44–2.28, p = 0.004); there was evidence of an interaction between change in irritability and whether the previous trial was won (p = 0.056).

This is the first longitudinal population-based study examining the relationship between changes in irritability during early childhood and risk-taking behaviour measured by the CGT. Our findings illustrate that irritability in children is characterised by an increase in risk-taking at age 11 years, reflecting differences in how children behave in relation to rewards and losses based on prior irritability. Further understanding of how the processes such as risk-taking which link childhood phenotypes such as irritability, relate to future mental health, may enable the development of new interventions focussing on reactions to rewards and losses.

Irritability is a common symptom in children and adolescents, often resulting in referral to mental health services and is associated with depression. Depression in adolescents and adults at familial risk of, and with depression, is associated with reduced risk-taking on the Cambridge Gambling Task (CGT) particularly when the chance of winning is high. However, little is known about risk-taking in irritability. This study tests the hypothesis that increased irritability is longitudinally associated with later risk-taking behaviour on the CGT; specifically, that increasing irritability is associated with lower risk-taking when the chance of a favourable outcome is high.

We conducted a longitudinal study of the biological offspring of parents of children with depression (n = 337). Irritability, the exposure, was measured at wave one using the Child and Adolescent Psychiatric Assessment (CAPA). The primary outcome was risk-taking to obtain reward at varying probability ratios (6:4, 7:3, 8:2 and 9:1) measured by the Cambridge Gambling Task (CGT) at waves two and three. We investigated the longitudinal association between irritability at wave one and average risk-taking at each ratio across waves two and three using multi-level models. The extent to which risk-taking according to probability ratio varied with irritability was tested with interaction terms. We ran univariable models and then multivariable models.

In univariable (n = 207; Coef. 0.006, 95%CI −0.011–0.023, p = 0.470), and fully adjusted (Coef. 0.011, 95%CI −0.007–0.029, p = 0.213) models there was no evidence of a main association between irritability and risk-taking on the CGT. There was evidence of an interaction between irritability and risk-taking ratio (p = 0.019). In fully adjusted models including the interaction, a one-point increase in irritability was associated with relatively higher risk-taking at the less favourable ratios (6:4 – 0.018 (95%CI −0.002–0.037) and 7:3 – 0.015 (95%CI −0.005–0.035)) relative to the more favourable ratios (9:1 – 0.001 (95%CI −0.019–0.021) and 8:1 – 0.011 (95%CI −0.008-0.031)).

We found no evidence of relationship between irritability and subsequent risk-taking on the CGT overall. However, there was some evidence that those with higher irritability were relatively more risk-taking when less likely to win compared with when a favourable outcome was more likely. These findings warrant further investigation of the association between prior irritability and later depression in a larger community cohort. If prior irritability and depression are both associated with risk-taking, this strengthens the case for focussing on risk-taking as a potential target for preventive intervention.

Children and young people (CYP) with intellectual and developmental disabilities (IDD) of known genetic origin experience complex physical and mental health problems; IMAGINE-ID has followed a national UK cohort from childhood to early adulthood. Parents completed structured online psychiatric assessments on repeated occasions. From these assessments, semi-automated personalised reports were generated summarising each child's strengths and difficulties, in collaboration with IMAGINE ID participants and the charity UNIQUE.

We aimed to discover whether providing a structured summary of our mental health and behavioural assessments would be beneficial to families of children with rare genetic conditions and IDD.

574 of the CYP's caregivers completed an online ‘impact’ survey, five years after receiving their initial report, comprising four areas of potential benefit: Quality of Care (whether the report led to an improvement in the child's quality of mental and/or physical health care); Social Impact (whether the report was used as evidence to support an EHCP, disability benefits etc.), Psychological Impact (whether it led to any change in understanding of the child's condition), and Referrals (whether the report led to a referral for Autism/ADHD etc.). We also invited qualitative feedback.

82% of respondents rated the reports as helpful. 35% reported they had led to an improvement in their CYP's quality of care, 24% reported social impact using the report as supporting evidence, 99% reported a psychological impact – a change in their understanding of the child, and 17% used the report to initiate a referral for an assessment of ADHD and/or autism. In our qualitative analysis, families who found the report helpful mentioned it led to ‘reflection’ on their child's condition and that it provided ‘access to benefits’. For those who did not find the report helpful, issues such as ‘it lacked professional input’ and ‘forgetting the contents’ of the report were identified.

Personalised summary reports, based on a structured assessment of their child's behavioural, social and emotional adjustment, are valued by families of children with rare genetic conditions and IDD and can bring about tangible benefits to the child and the family's access to resources.

Functional Neurological Disorders (FNDs) affect motor or sensory functions without a detectable underlying disease. FNDs encompass a range of presentations including non-epileptic seizures, cognitive changes, weakness, and sensory symptoms. The prevalence of FND as a diagnosis is increasing rapidly. Following our clinical observations of a high prevalence of Attention-Deficit Hyperactivity Disorder (ADHD) in people referred with a previous diagnosis of FND to our tertiary Neuropsychiatry pilot service in Derbyshire, we conducted an integrative literature review with the aim to investigate the prevalence of ADHD in people diagnosed with FND.

We conducted an integrative literature review using a systematic approach. A literature search was performed on two databases, PubMed and ScienceDirect. The keywords ‘Functional Neurological Disorder’, ‘Attention-Deficit Hyperactivity Disorder’, ‘Non-Epileptic Seizures’, ‘Functional’ were used. Databases were searched for initial search on 31 November 2023 and the search was repeated on 31 January 2024. Only articles in English language were included. Studies were eligible if reporting the prevalence of ADHD in FND populations. Studies involving adults and children were included. A further search was conducted on reference lists from the selected articles.

Database searches on PubMed and ScienceDirect had 298 and 11,837 results, respectively. Only seven studies were identified that explored the prevalence of ADHD in individuals diagnosed with a FND and were included. In the adult population an association between a FND diagnosis, and ADHD traits identified on screening, or a final ADHD diagnosis was identified. The findings also demonstrate an increased incidence of comorbid ADHD and FND with the presence of another co-existing neurodevelopmental disorder such as Autism Spectrum Disorder. Furthermore, results indicated that the prevalence of an ADHD diagnosis in children with a FND was higher compared with adults. The literature suggests that, in both adults and children with FND-related functional seizures there is an increased prevalence of comorbid ADHD.

In conclusion, the findings from this review demonstrate a lack of evidence looking into the prevalence of Attention-Deficit Hyperactivity Disorder in complex presentations being labelled as Functional Neurological Disorder. However, the existing literature indicates there is an association between FND and ADHD. These findings highlight the importance of considering potential ADHD comorbidity in the assessment and management of FND, potentially informing targeted treatment approaches for affected individuals. Further research could explore the efficacy of ADHD medication and similar dopamine modulating molecules in treating sub-cohort of people with FND.

Rates of acute mental health presentations in youth were rising pre-pandemic internationally. Longitudinal studies following Covid-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions.

This study aimed to examine whether the initial reported post-Covid-19 increase in mental health presentations persisted following the reclassification of Covid-19 to endemic status, which was accompanied by removal of most restrictions.

All referrals to paediatric liaison psychiatry (PLP) between Jan 2018–Dec 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis was conducted examining referrals with respect to different phases of Covid-19 and application of public health restrictions.

1,385 referrals to PLP were received over the 5-year study time-period. There was a significant decrease in PLP referrals immediately post Covid-19, following a significant and sustained increase as the pandemic progressed. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals received. There was no effect of restrictions on other clinical profiles.

Increased referrals for youth with mental health difficulties, reported during the Covid-19 pandemic, persisted into the early endemic stage, after Covid-19 public health restriction have ceased. Potential impacts of restrictions on referrals of youth with suicidal ideation require further study. Investment in child and adolescent mental health services remain a priority, and future pandemic responses need to examine unintended consequences of any enforced public health measure.

To investigate risk assessment and management processes across a health board in the context of the implementation of a new risk screening tool and risk policy using comparison of DATIX incidents before and after implementation of the CRAFT tool.

In mental health services, risk assessment and management are key responsibilities for clinical staff. A risk management tool that is structured and evidence-based aims to assist staff in managing risks including violence, self-harm, suicide and self-neglect.

It is not clear whether risk tools have clinical utility in influencing risk-related decision making and previous reviews within the health board indicated that risk policy was not being adhered to, prompting a review of the policy. Furthermore, policy recommends service user and carer collaboration with staff in all areas of mental health in Scotland but despite these recommendations there is little evidence to suggest they are routinely involved in risk assessment and management processes.

The present study is an opportunity to explore how teams think about and discuss risk management.

We looked at data on patient incidents that occurred over 30 months from 1/1/19 to 30/09/21. The Datix data were subdivided into five main categories: Violence & Aggression, Challenging behaviour, self-harm, absconding/missing and Suicide.

Throughout the study period the category of Violence & Aggression was the most frequently reported Datix category for 28 out of 30 months, followed by Challenging Behaviour which was the second most frequent category for 22 out of 30 months and in the last year reports in this category have increased by 39.35%. The third most frequently reported category was self-harm and the fourth most reported category was Abscondment/Missing. The frequency of reports in this category increased over the study period.

The rate of suicide was consistently the lowest reported category and remained stable throughout the study period. With the exception of Violence and Aggression, all categories showed a general upwards trend in Datix report numbers.

We have seen an increase in significant incidents in all categories reported using the DATIX system with the exception of suicide and violence and aggression during the study period. This suggests that further work is required to ascertain the reasons for this and what impact, if any, the change in CRAFT risk assessment tool has had.