People with Severe Mental Illness (SMI) are at increased risk of developing diabetes. There is currently a lack of monitoring and standardisation of diabetes care in the NHS psychiatric inpatient setting. This presents as a missed opportunity, as inpatient admission could be used to improve diabetes care for this population. We surveyed the multi-disciplinary teams in psychiatric inpatient units across England to develop understanding of current diabetes care in this setting.

A 13-item questionnaire was designed to assess the knowledge, attitudes and skills relating to diabetes care. This was piloted via think out loud interviews with 5 staff at a Forensic unit. Amendments were then made to the questionnaire to improve the validity prior to national roll-out.

Site coordinators working within General Adult, Old Age, Rehabilitation and Forensic inpatient services were recruited via medical education and academic links. This included 19 inpatient sites within 11 NHS Mental Health Trusts across England. Site coordinators circulated the questionnaire, primarily via electronic survey. A small number of paper responses were also collected.

156 responses were collected via the national survey (electronic = 136, paper = 20). 6 responses were excluded due to missing professional role information or roles not involving physical healthcare. Respondents included within the analysis comprised 43 Doctors, 55 Nurses and 52 Allied Healthcare Professionals.

93% of respondents agreed that addressing physical health needs was an important part of the mental health team's role, although only 28% had received physical healthcare training within the last 12 months.

68% agreed that they had adequate skills and knowledge to manage diabetes safely on the ward. 69% agreed that the diabetic care on the ward was of an acceptable standard according to National Institute for Health and Care Excellent (NICE) guidelines. This reflects a need for appropriate training and guidance to help improve this aspect of care.

Additionally, only 51% agreed that they felt able to refer a patient with diabetes to the most appropriate diabetes service based on type of diabetes and medication prescribed. This highlights an important issue, as cohesive shared-care and clear referral pathways are key when considering effective diabetes management.

Psychiatric inpatient admission could be used opportunistically to improve the healthcare disparities for people with comorbid diabetes and SMI. This national survey highlights key areas that would need to be addressed to standardise and optimise diabetes care in this setting. This includes appropriate training, clear guidelines and cohesive shared-care pathways.

In recent years there has been accelerated clinical interest in Mindfulness based interventions (MBI's) leading to an upswell in research due the impact of its wide clinical application. Mindfulness Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) have recently been investigated for the beneficial treatment of anxiety-based disorders in adults. The aim of the current review was to appraise and synthesise findings of studies published within the last decade, in determining the efficacy of MBCT and ACT in treating anxiety disorders in adults, given gaps identified in the existing literature.

Scoping searches were conducted using MEDLINE, PsycINFO, Emcare, and Cochrane databases. The Synthesis Without Meta-analysis protocol (SWiM) was adopted for this review, in evaluating the efficacy of MBCT and ACT for anxiety disorders in adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Standards.

The results of this review suggest that MBCT and ACT are effective therapeutic modalities in improving anxiety in adult populations. The results are, however, tentative. Whilst both MBI's show promise in the treatment of anxiety disorders, with the paucity of existing systematic reviews and methodological flaws within overall primary study design, the results should be interpreted with caution.

The overall therapeutic effectiveness of MBI's has been assessed and the general data support its efficacy. However, a judicious approach is required as results continue to remain inconclusive grounded in the totality of the evidence.

The current review revealed the ongoing methodological concerns encountered in determining the comparative effectiveness of MBCT and ACT for anxiety disorders in adults. Due to the current limited number of comparative studies of mindfulness based with mindfulness informed interventions, it could be suggested that a lack of systematic research is slowly influencing a collective understanding of MBI's being a homogenous group of treatments. The lack of delineation can have an impact on research, clinical practice and policy making. Further high quality research is required to continue to bridge the science practice gap. Without depth of understandings associated with the mechanisms of change and the impact that contextual aspects have on the outcome effectiveness, there are significant implications for practice and patient care. It is of importance that the adaptation and subsequent developments in clinical practice do not outpace the research base to fully understand the mechanisms that make each MBI effective, for which population and diagnoses.

Defensive medical practice has become an increasingly global phenomenon and encompasses all medical specialties. In the UK it was defined in the case of Sidaway v Board of Governors of the Bethlem Royal Hospital [1985] UKHL 1 (21 February 1985) as “the practice of doctors advising and undertaking the treatment which they think is legally safe even though they may believe that it is not the best for their patient”. This narrative review surveys the literature to establish the forms in which defensive practice may manifest itself within psychiatry.

In this narrative review, various terms pertaining to defensive medical practice in psychiatry were searched in both medical and legal databases.

Though the literature in psychiatry compared to other medical specialties is more limited, some common themes occur across all jurisdictions surveyed. Defensive psychiatric practice included admitting the patient even though they may be managed within the community (as reported by 21% of psychiatrists surveyed in the North of England) and employing more coercive practice, either using the mental health legislation or implied or actual threats. Once hospitalised, defensive practice manifests itself by placing patients on higher levels of nursing observations than necessary.

Across inpatient and outpatient settings between one and two thirds of psychiatrists reported altering the way they document to attend to medicolegal considerations. Prescribing habits were also altered due to fears of litigation; an Israeli study found that almost half of psychiatrists surveyed reported they prescribed smaller doses of medication than what they felt was required to pregnant woman and ninety percent reported the same when it came to the treatment of elderly patients.

When looked at by seniority it was felt that junior doctors were more prone to admitting patients defensively than consultants. In this respect, psychiatry differs from most other medical specialties as, in general, the evidence suggests that increased seniority is more likely to lead to admission.

Defensive practice in psychiatry appears to be widespread and takes a number of different forms. However, the research in psychiatry is limited and does not explore key areas common to other medical specialties such as clinician avoidance of certain cases or increased use of diagnostic tests. Furthermore, there is little examination of how psychiatrists may utilise mental health legislation within their defensive practice.

Anecdotally, NHS staff feel unsupported in breastfeeding when returning to work from maternity leave. The NHS provides clear guidance to employers about provisions required for breastfeeding employees (clean lockable room, adequate time, clean fridge). We aimed to establish if these provisions were provided for NHS staff, and to further explore the difficulties reported.

We conducted a pilot study of NHS doctors, exploring their experiences of feeding on returning to work. The results highlighted difficulties for many of the 519 cases. We extended the study to encapsulate the experiences of all NHS professionals.

The survey was distributed via various professional social media accounts.

We received 1201 responses.

• • 79% of women were breastfeeding when they returned to work. 59% wished to continue on return.

• • 78% of women were unaware of the local breastfeeding policy. Of those that were, only 7% were informed of the policy by their employer.

• • 90% of women were unaware that they needed to inform their employer of their intention to breastfeed.

• • Only 6% of women had a breastfeeding risk assessment on their return to work.

• • Basic requirements were not consistently met (50% did not have access to a lockable room, 51% to a fridge, 69% to adequate time).

• • 55% were interrupted whilst expressing.

• • 23% of women expressed in changing rooms; 32% in toilets; 25% in their cars; 15% in cupboards.

• • 88% of women did not have their duties adapted. 91% regularly held the bleep whilst expressing.

• • 52% of women reported embarrassment and humiliation at work. 60% reported stress directly due to their difficulties expressing, with a further 15% experiencing mental health problems. 10% of women felt their experiences negatively affected their bond with their child.

Only 1% of UK mothers continue to breastfeed at six months. There is a huge NHS drive to improve this statistic. 76.7% of NHS staff are women. These women are also NHS patients. NHS breastfeeding guidelines are not being consistently followed within the organisation. There is a direct impact on mother and child, and on patient care.

We must support our NHS family, create a positive breastfeeding culture, and lead UK change.

“I was ridiculed… it set me apart from my colleagues.”

“Resigning was my only option.”

“Subject to eye rolls and whispers… rude, unsupported and unkind.”

“He unlocked the door and walked in while I shouted “stop”.”

Looked after children (LAC) are one of the most vulnerable groups in our society. Often, after experiences of neglect and abuse, they are more likely to experience poor mental health, attachment difficulties and problems in educational progress. This review aims to explore literature published over the past decade which addresses the mental health needs and management of LAC within CAMHS in the UK.

A literature review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 structure. Selection criteria was used. The total number of papers identified after this initial search was thirty-six across the database.

Literature titles and abstracts were then screened to exclude papers with an irrelevant focus. Full-texts of the remaining twenty-two papers were then assessed for relevant and conclusive information. The total number of full papers included in the research was thirteen.

To analyse the literature identified, a framework of three themes has been highlighted. These include:

• • the mental health needs of LAC,

• • factors relevant to the assessment of LAC in mental health services

• • considerations associated with the management of LAC with mental health conditions.

Mental health needs of LAC included numerous emotional, behavioural and social problems. These were largely focused around substance misuse, emotional disorders and poor relationships with peers.

The main themes which have come out of research in relation to the treatment of LAC include:

• • the importance of supporting healthy social relationships with primary care-givers, peers and teachers

• • maximising the informal support of family, friends and pets

• • the provision of early, holistic and flexible mental health services, rather than disjointed agencies

The literature published over the past decade has indicated the great number of adverse outcomes amongst LAC and has made useful suggestions for the assessment and treatment of these children within a CAMHS setting.

Through targeted support into residential placements, offering intensive and direct psychological input at an early stage and continuing even after they have been adopted, as well as, working alongside schools to promote peer interaction could significantly reduce the adverse outcomes of LAC.

Additionally, by referring patients along with their carers for psycho-education can be extremely beneficial. Alongside this, the young people ought to be directed to support groups with other LAC to meet peers who are in similar situations as themselves.

To evaluate psychiatric morbidity among the patients of first ever ischemic stroke

This sectional comparative study was carried out in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1st July 2013 to 30th June 2014. Sixty six ischaemic stroke patients of first attack between 2 weeks to 2 years of stroke, aged above 18 years irrespective of sex and 66 accompanying healthy person of the patients and other patients without any kind of stroke matching age and sex fulfilling inclusion and exclusion criteria were taken in Group-A and Group-B respectively. Diagnosis of ischaemic stroke was made in these patients by the consultant neurologists reviewing the history, clinical examination and accompanying investigations reports specially CT scan of brain. Psychiatric assessment was done using General Health Questionnaire (GHQ12) as screening tool. All GHQ12 positive cases were evaluated using mental state examination and recorded in a MSE sheet. Diagnosis of psychiatric disorders of all respondents was confirmed by psychiatrist according to DSM-5 criteria.

The patients with ischaemic stroke and control subjects were similar in age [57.6 (SD ± 5.5) years vs 57.1 (SD ± 4.5) years; p > 0.130] and sex [48 (72.7%) male and 18 (27.3%) female vs 45 (68.2%) male and 21 (31.8%) female; p = 0.567]. Comorbid psychiatric disorder was found in 23 (34.8%) patients of ischaemic stroke and 9 (13.6%) control subjects. The comorbid psychiatric disorder was significantly higher in patients of ischaemic stroke than that of control g subjects (p = 0.004). Comorbid specific psychiatric disorders were generalized anxiety disorder in 9 (13.6%) and major depressive disorder in 14 (21.2%) in stroke group; while comorbid specific psychiatric disorders were generalized anxiety disorder in 2 (3.0%) and major depressive disorder in 7 (10.6%) respondents in control group (p < 0.013).

Comorbid psychiatric disorders are quite common among patients with first ever ischaemic stroke in the form of major depressive disorder and generalized anxiety disorder. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients’ emotional stress and personal suffering, which could improve their neurological outcome.

Service user involvement (SUI) in recovery-oriented care planning (ROCP) warrants more sophisticated theorisation and explanation to support practice improvement. This study investigated which changes to practice work best, in what circumstances, and to what extent, to embed an active role for service users’ involvement in ROCP during the acute inpatient mental health care pathway.

A realist synthesis, combined with qualitative methods, was conducted to theoretically explore the causal mechanisms that underlie SUI in ROCP and how contextual factors influence the link between these causal mechanisms and outcomes. The study was conducted in three stages: theory-gleaning, theory-refinement and theory-consolidation. Initial programme theories were developed in the theory-gleaning stage. Theories were refined iteratively in the theory-refinement stage, using evidence from a realist review and interview data. With stakeholder involvement, refined programme theories were finely tuned using ‘if-then’ statements in the consolidation stage.

Five programme theories relating to the acute care pathway were identified following the realist synthesis:

1. 1) ‘Provider-controlled care transition’ (admission to acute inpatient mental health units), referring to limitations to service users’ active involvement. The focus of care and access to acute inpatients units should be needs-led, rather than resource-led or demand-driven;

2. 2) ‘Care plan as a recovery tool?’ – addressing infrastructural and organisational limitations to active SUI in care-plan formulation. The use of multidisciplinary meetings as a forum for care-plan formulation can create a cohesive approach and facilitate shared ownership;

3. 3) ‘Ward rounds as a non-inclusive arena for shared decision making’, highlighting their unfulfilled potential for shared decision making about treatment. Professionals should focus on preparing service users for the ward-round process. Opportunities and access for service users to build therapeutic relationships with treating doctors are vital components;

4. 4) ‘Peer support worker intervention' as a key factor in service users’ recovery’, concerning their positive impact. Their presence in ward rounds and care-planning meetings might create a more user-friendly atmosphere for service users; and

5. 5) ‘Provider-controlled care transition’ (discharge from acute inpatient mental health units), increasing focus on preparing service users for transition into the community, and constraints on resources should not dictate or anticipate decisions on discharging service users.

The study identified practices required to embed an active role for service users to be involved in ROCP, namely multi-contextual interventions at various levels (macro, meso and micro) of the mental health system. The study uncovered barriers that restrain SUI in ROCP, impacting desirable outcomes.

Around the world rates of self-harm vary, placing immense strain on health services. Approximately 20% of children and adolescents are thought to engage in self-harm. The systematic review aims to explore the characteristics, risks and protective factors of ethnicity and religion on self-harm in comparison to the general population. Better identification of risk factors can help professionals and local authorities develop intervention programs to mitigate the incidence of self-harm.

The Population, Exposure, Outcome, Study design and setting (PEOS) was used as a framework to formulate the question for this systematic review. A literature search was conducted using EMBASE, MEDLINE and APA PsycInfo databases and all English articles published between 2010 and 2020 were screened against the inclusion and exclusion criteria.

Fourteen studies which met the criteria were identified and appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist.

Unintentional injuries, sexual behaviours, adverse childhood experiences, health status and poverty alongside racial discrimination were associated with self-harm and or suicidal ideation in ethnically diverse populations. In African Americans, Hispanics and Whites, violence or physical altercation, illicit substance misuse, sadness and hopelessness increased the risk of self-harm and or suicidal ideation. The association of subtle forms of discrimination and suicidal ideation was noted to be statistically significant for African Americans, whereas for Latinx this was only marginally increased. Low mood and hopelessness in African American girls, substance misuse in American Indian youths, and aggression in the Caribbean cohort were also noted to present with increased self harm.

Adolescent's religiosity and parental monitoring had both a direct and an indirect role for suicidal ideation reduction. Religious importance and attendance at religious services by offspring and parents decreased self-harm in female adolescents more than males.

There was a wide heterogeneity in the population and factors reviewed in the different studies, hence pooling of data for meta-analysis of the quantitative studies was not appropriate to estimate prevalence or association between factors and characteristics of the population.

This narrative synthesis provides evidence that minority ethnic groups have unique factors, which can increase the rate of self-harm. Religion or spirituality favours a protective role in self-harm or suicide but not for suicidal ideation, although there were only a limited number of articles exploring this.

Future studies should focus on defining the ethnic groups further and exploring this and religious factors on a wider scale using standardised parameters.

Addressing the mental health needs of Internally Displaced People (IDPs) in Colombia has been identified as a public health priority. Women and disabled IDPs are recognised as under-researched populations, with differences in vulnerabilities to displacement and resettlement prospects. This thematic network analysis employs an intersectional approach to consider how compounding experiences of oppression impact emotional distress among IDPs to enable informed and appropriate service provision.

This is a qualitative analysis of a subset of data collected by the second author and her research team in 2017–18, as part of a larger action research project. Participants were randomly selected from the Victim's register in an industrialised municipality of Colombia. A subsample (n = 20) were invited to participate in life and family histories. Units of analysis were individual (n = 11) and family interviews (n = 9), with a mixture of self-identifying disabled and non-disabled men and women. River and tree of life tools were used to elicit culturally sensitive discussion of significant life events and ongoing distress. NVivo software and hand coding techniques were used to operationalise thematic webs. The analysis employed a grounded approach to thematic network analysis.

Three global themes, each underpinned by several organisational themes, were developed. The first, Environments and contexts of displacement, considers the loss of land and community alongside the myriad of social institutions, legal entitlements, family circumstances, cultural expectations and stigma influencing participants' access to resources. The second, Making sense of it all, represents the emotional and cognitive responses to perceived injustices and eroded trust. The third, Mechanisms for managing distress, represents strategies employed by IDPs at individual and family levels. Relationships between employment status and gendered divisions of labour were noted, suggesting that non-disabled women were able to meet increased domestic and paid work demands following displacement, though this was a considerable source of stress. Concepts around racial, indigenous and class identities were alluded to by several participants but could not be fully developed due to relative scarcity of accounts within the dataset.

The thematic networks presented illustrate several compounding and interrelated oppressions faced by IDPs, offering explanation as to how this produces and sustains emotional distress. Participants’ well-founded worries about economic security and childcare alongside concerns for safety and acceptance in host communities require co-ordinated, locally informed responses. Prevention and recovery programmes should consider interventions at a family level, whilst strengthening participants’ self-developed strategies for managing distress.

In 2020, Afghanistan supplied around 85% of the world's heroin. The recent Taliban takeover and political upheaval seems highly likely to impact the supply chain, but how? This literature review aims to explore the background of heroin production and possible consequences of the recent conflict, both for suppliers and for end users.

In addition to recent mainstream media news articles on the Afghanistan conflict, PubMed search terms “heroin adulteration” were used to find 202 results. Only results published from the year 2000 onwards were examined for relevance, leaving 160 results. These were reviewed for relevance and led to suggestions of similar PubMed articles to arrive at the final 23 sources used.

Studies of previous heroin shortages in Australia and the UK are discussed to gain insight into the potential effects of a future shortage. A reduction in heroin exports from Afghanistan would cut down the supply to most nations excluding North and South America. Sources of evidence for our current understanding of the supply chain are examined. Specific US and UK policy failure which led to the current situation is also provided for context.

Methods of production in Afghanistan and smuggling routes are also examined to help predict impending changes.

Given the number of factors involved it is difficult to anticipate with much certainty how the Taliban takeover of Afghanistan will affect the global heroin trade, but based on the available literature it seems more likely that this will cause shortages rather than an increased supply.

Clinicians should be aware that in line with previous shortages, this may cause a shift towards increased rates of polysubstance use in regular heroin users. We may also see a rise in incidents of harm from heroin adulteration with substances other than the currently widespread paracetamol and caffeine.

The baseline of this study

1. 1) What is the type of psychiatric disturbances in oncology settings?

2. 2) Is there any importance in cancer education?

3. 3) How to manage psychiatric disturbances?

As of lockdown concerning COVID-19, this study is conducted online among 20 cancer patients. This is a cross-sectional study where Each patient has explained the purpose of the study, procedures, and consent was taken from patients then a questionnaire was given, and this was assessed. Among the profile of the study population, 50% were males and 50% were females of the total study population, 60% were married and 40% were unmarried, Participants were aged between 22 and 63 years. The study population also consists of 20% are breast cancer, 25% lung cancer,10% lung cancer, and the rest are other types of cancers. Patient details are collected from the Facebook groups for cancer patients. Assessment has 2 parts, one is based on CES-D Test where each individual was each patient answered 20 question and next part is based on 5 questions regarding Financial Depression, Behavioral changes, Feelings, Education about cancer and Psychiatric support.

It is found that 60% population are normal, 25% had mild Depression, 10% have moderate Depression followed by 5% with severe depression.

Among associations between marital status and various disorders, it was found that psychological disturbances are 2 times fold more in married people while compared to unmarried. There is also an association between treatment modalities are observed, in that anxiety is prevalent with people who had chemotherapy. Based on education and financial status, those who are with less education about cancer and less financially stable have also prominent disturbances.

The study was based on other research study related to the spectrum of psychological disturbance based on treatment stage, financial status, awareness of cancer among patients, and role of marital status among individuals Offering mental health services to patients with cancer is becoming an integral part of oncologic treatments because psychological problems harm cancer management. The most common psychiatric disorders in cancer patients are depression, anxiety disorders, and adjustment disorders. Psychiatrists should be involved in the multidisciplinary treatment team that works with cancer patients. Further research is needed to determine the effectiveness of different psychological and psychopharmacological interventions in psycho-oncology and palliative medicine

In developing countries specially in sub-urban or rural areas, most patients with psychiatric crisis phase don't access intensive care. In India, AYUSH system of medical care is widely used, including crisis resolution and community treatment. However, evidence to support their effectiveness has remained very low. Present study is designed as community based participatory research, where Ayurveda management from acute in-patient care to a community-focused treatment and rehabilitation was studied.

In this evaluation study, we trace the journey of Ayu-Psychiatry Care project, set up as community based mental health rehabilitation program in rural and sub-urban areas of Rajasthan, India, from acute in-patient care to a community-focused treatment and rehabilitation.

While receiving Ayu-Care and promoting early treatment and rehabilitation, community-based treatment demonstrated considerable improvement in maintaining family relationships and employment. Increased treatment adherence, improved self-efficacy, and reduced stigma were all made possible because to this community-based strategy.

The connection between UK and Indian organisations is also explored during the journey. The findings of the study and the principles of long-term international cooperation are laid out by the authors.

Within psychiatry, relationships between doctors and patients with psychosis are significant determinants of attitudes, adherence, and therapeutic outcomes. Current research focuses on communication within psychiatrist-patient interactions with limited evaluation of the patient's perspective. Understanding the components underpinning the patient's relationship with their doctor could help improve outcomes for individuals with psychosis.

Eight participants, recruited through advocacy programmes, were interviewed. All had a diagnosis of psychosis or its subtypes. Interviews lasted between forty and eighty minutes. Thematic analysis of semi-structured interviews allowed exploration of important themes within doctor-patient relationships. Ethical procedures were implemented in accordance with British Psychological Society guidelines.

Participants’ narratives identified three salient themes perceived to influence doctor-patient relationships. Participants explored ‘Interactions with Medical Professionals’, focusing on communication and discussion styles. Doctors were not perceived as empathic, open listeners, reducing trust and limiting conversation during interactions. Participants described reduced engagement due to perceived misunderstanding and highlighted the impact of time constraints, guidelines, and limited medical training on relationships.

Secondly, participants discussed the ‘Diagnostic Process’, suggesting it had a negative influence on the relationship due to delivery methods.

Finally, participants explored ‘Treatment’, highlighting an overwhelming reliance on medication, lack of explanations, and lack of psychological therapies, which contradicted with patients’ preferences.

The narratives describe a relationship in which patients feel misunderstood, furthering patient disengagement and resulting in a vicious cycle of dissonance that limits health outcomes. Findings suggest a need to incorporate psychological therapies into doctor-patient interactions to allow increased communication and understanding.

Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) effects 0.5–3.28% of children. NICE guidance recommends Activity Management, Graded Exercise Therapy or Cognitive Behavioural Therapy for fatigue (CBT-f). Approximately 15% of patients do not achieve full recovery within one year with current treatments. Acceptance and Commitment Therapy (ACT) is an effective treatment in many chronic illnesses. There are no studies investigating ACT for paediatric CFS/ME. This feasability study aimed to assess if ACT is a feasible and acceptable alternative treatment when current treatment has not led to recovery.

This feasability cohort study aimed to enrol a minimum of 12 participants aged 11–18 yearswith CFS/ME attending the Royal United Hospitals Bath NHS Foundation Trust Specialist Paediatric CFS/ME Service, who were still symptomatic after 12 months or 12 sessions of standard treatment and were offered six to 12 sessions of ACT. Retention and recruitment data were analysed. Participants were asked to complete questionnaires before, during and after treatment. A selection of participants and their parents were interviewed about their experience of the study. Interviews were analysed using thematic analysis.

19 participants (95% of those approached) were recruited. Only 4 participants of this hard-to-reach group did not complete treatment.

In almost all sessions participants reported that they felt ‘totally’ listened to in post session questionnaires (31/33 sessions).

Preliminary interviews (n = 12) indicate acceptability of ACT, with all young people and their parents stating that they thought ACT should be offered to this population. Participants particularly commented that the absence of thought challenging (used in CBT-f) was a positive element of ACT. Participant's openness to try new approaches and altruistic desire to be in a study was noted.

Recruitment data indicate that it is feasible to recruit and retain 11–18-year-olds with CFS/ME to a study offering ACT. Interviews with participants and parents were broadly positive suggesting ACT is an acceptable treatment in this population.

Results indicated that it is both feasible and acceptable to offer ACT to 11–18-year-olds with CFS/ME using this protocol, supporting the prospect of an RCT in this area.

Early-life interpersonal stress, particularly childhood maltreatment (CM), is associated with neurobiological abnormalities. However, few studies have investigated the neural effects of peer victimisation (PV). This study examines the common and specific associations between CM, PV and brain structural alterations in healthy youths.

Grey matter volume (GMV) and cortical thickness (CT) data were collected from 105 age-and gender-matched healthy youths (34 CM, 35 PV and 36 controls). Region-of-interest (ROI) and whole-brain analyses were conducted.

For the ROI, the CM group had smaller GMV than controls in left IFG, bilateral anterior insula, postcentral and lingual regions, which were associated with higher emotional abuse, along with smaller insular GMV than the PV group. The PV group had smaller left lingual GMV than controls, which was positively associated with age of bully onset. At the whole-brain level, both CM and PV groups had smaller GMV than controls in a cluster comprising left post/pre-central, inferior frontal, insula, superior parietal and supramarginal gyri. The PV group alone had increased CT in a cluster comprising left superior frontal, anterior cingulate and medial orbitofrontal gyri, which was related to greater cyberbullying.

Early-life interpersonal stress from carers and peers is associated with common structural alterations of the inferior frontal-limbic, sensory and lingual regions involved in cognitive control, emotion and sensory processing. The findings of a CM-specific reduced anterior insular GMV and a PV-specific increased CT in the left medial prefrontal cluster is intriguing and underscores the unique negative effects of CM and PV, particularly cyberbullying.

Social cognition is impaired in a variety of psychiatric conditions; evidence for impairment in individuals with PTSD is increasing. Mentalization is one domain of social cognition that refers to the capacity to understand other people by ascribing mental states to them. The STOMP task (Spontaneous Theory of Mind Protocol) involves an individual watching two minutes of a silent video and describing what they see. As part of a wider project examining social cognition in PTSD, we aimed to find out whether mentalization in the STOMP task differs between patients with PTSD compared to controls.

171 individuals undertook the task: 30 patients were recruited from centres in Cardiff and Bristol at the start of their psychological therapy; 141 controls were recruited through Prolific website. Participants watched a 2-minute silent video and were asked to write 7–10 sentences about the clip. Qualtrics software selected the video and collected the texts. The verbs of the texts were coded and given a score by PM using the Mental-Physical Verb Norms (MPVN) method. MVPN was developed by Orr et al. 2019, to give a value to 250 commonly used verbs based on their mental or physical attributes (the higher the value, the more ‘mental’ the verb). The total score of each text was divided by the number of verbs scored to produce an average that reflects how much mentalization was used. An unpaired t-test was used to calculate the significance in difference between the means of the two groups.

The overall average score of individuals with PTSD was higher than the controls (38.5 vs. 33.5, p value 0.0047). The median score of individuals with PTSD was 37.95 compared to 31.60 with an actual difference of -6.350 and a Hodges-Lehmann difference of -4.650. These results do not support the hypothesis that mentalization is impaired in patients with PTSD.

This case-control study suggests that mentalization could be enhanced in patients with PTSD compared to controls. These results should be interpreted as part of a wider project being undertaken on the topic of social cognition in PTSD. Further studies with more participants from the population of interest and larger sample sizes could produce more reliable results, together with an expansion of the number of verbs coded in the MPVN method.

To estimate the prevalence of depression, anxiety and stress among Sudanese medical students and investigate the relationship and impact of closure periods on depression.

A cross-sectional analytical study was conducted. Data were collected from 1676 enrolled students from 10 medical schools in the capital of Sudan - Khartoum- who faced complete lockdown and agreed to participate in online google form. A self-administered questionnaire containing depression anxiety and stress scale (DASS-42) and socio-demographic inquires was used.

The chief responders were females 1158 (69.1%) while males were 518 (30.9%). The prevalence of stress symptoms was the highest (51.9%), followed by depression symptoms (49.8%) and anxiety symptoms (28.8%). 96 students attempted suicide (6%) and about 5 folds have suicidal ideation (27%). According to multiple binary logistic analyses, college closure time was significantly associated with decreasing chances of getting depression symptoms (OR: 0.39, 95% C.I: 0.21–0.70, p = 0.002), while being a female, COVID-19 patient or having a family history of depression appeared to elevate depression, anxiety and stress levels. The impact of university closure on stress and anxiety is non-significant.

Depression, stress, and to a lesser extent anxiety are widespread among Sudanese medical students and suicidal ideation is noteworthy. All of these require serious and expeditious interventions. Controversially, our findings suggest that university closure serves as a protective factor, relieving depression in medical students but not exaggerating it.

To see the neuromodulatory effects of adjunctive HD-tDCS on white matter connectivity by using Diffusion Tensor Imaging (DTI) in schizophrenia patients with Auditory Verbal Hallucinations (AVH)

This was a randomized, double blind, sham controlled study. 40 patients of schizophrenia with prominent auditory verbal hallucinations and 10 age sex matched healthy controls were selected. The patients were randomly assigned to 2 groups and were given active or sham adjunctive HDtDCS (Active Treatment = 10 sessions of 2 mA current applied for 20 minutes, twice daily for 5 days, at left temporo-parietal Junction (TPJ); Sham treatment = 10 sessions of 1 mA current, twice daily for 5 days was applied for 30 sec at left TPJ). Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed and severity of schizophrenia symptoms and auditory hallucinations were rated on PANSS and PSYRATS-AH at baseline, after 1st week (i.e. end of HDtDCS sessions) and 4 weeks after the end of the HDtDCS sessions). Patients received stable dose of antipsychotics for the total study duration (equivalent to or more than 400 mg of chlorpromazine) to eliminate confounding bias. Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed in healthy controls. DTI data were analysed by DSI Studio software. Statistical analysis was done by SPSS version 25.

1. 1. Both the patient groups were comparable with regard to socio-demographic variables and baseline clinical variables.

2. 2. There was no significant difference in the values of Fractional Anisotropy in Left Arcuate Fasciculus among the patients and healthy controls at baseline.

3. 3. The group receiving active adjunctive HDtDCS, showed significant improvement in the frequency domain of AVH over time, in time*group comparison by repeat measure ANOVA with Mauchly's test of sphericity and Greenhouse-Geisser correction [p = 0.011 and partial eta square = 0.129].

4. 4. There was no significant difference in change in the Fractional anisotropy of the left arcuate fasciculus noted between the groups over time.

5. 5. Application of HDtDCS was not associated with significant side effects, minor itching and mild burning sensation being the only reported side effects

Adjunctive active HD-tDCS to the left temporo-parietal junction showed a statistically significant improvement in frequency of auditory verbal hallucinations (AVH) in schizophrenia patients, when compared to sham stimulation.

To examine the relationship between self-reported level of workplace support (WS) and various mental health outcomes in HCPs and non-HCPs at different time-points during the COVID-19 pandemic, and to examine whether improved WS is associated with improved mental health outcomes over time. Lastly, to identify what support healthcare professionals (HCPs) perceive to be most helpful.

Cohort survey study at baseline (July-September 2020) and follow-up (approximately four months later).

Setting

HCPs working in primary or secondary care, from UK and other countries, and non-HCP controls from primarily London-based universities.

Participants

1574 HCPs and 147 non-HCPs (academic and research staff at London-based universities). The inclusion criteria for the study were: 1) aged 18 or older, 2) electronic consent given, and 3) identified as HCP or non-healthcare academic staff or self-declared non-HCPs.

Main outcome measures

Presence of generalized anxiety disorder (assessed using the GAD-7), clinical insomnia (ISI), major depressive disorder (PHQ-9), well-being (SWEMWBS), and burnout (emotional exhaustion and depersonalization; EEDP2Q). Qualitative data exploring what support HCPs perceive as most useful was gathered using free-text inputs.

At baseline and follow-up, consistently, compared to those who felt unsupported, those who felt supported had significantly reduced risk (odds) of generalized anxiety disorder (baseline: 59% [95% CI of OR, 0.29 to 0.57], follow-up: 41% [0.38 to 0.92]), clinical insomnia (51% [0.34 to 0.69], 66% [0.20 to 0.55]), major depressive disorder (58% [0.31 to 0.58], 54% [0.31 to 0.74]), emotional exhaustion (65% [0.26 to 0.46], 61% [0.27 to 0.56]) and depersonalization (58% [0.28 to 0.61], 68% [0.21 to 0.50]).

At follow-up, self-reported improved WS (vs. baseline) was associated with significantly improved GAD-7 (adjusted difference. −1.73 [-2.54 to −0.91]), ISI (-0.96 [-1.88 to −0.04]), PHQ−9 (-1.32 [-2.16 to −0.49]), SWEMWBS (0.97 [0.37 to 1.57]) and EEDP2Q (burnout) (-1.30 [-1.82 to −0.79]) scores, independent of baseline level of support.

Five themes were identified constituting WS: ‘managerial support’ was the largest sub-theme.

A consistent association was observed between level of WS and the mental health of HCPs and non-HCPs. Improved WS was associated with improved mental health scores over a four-month period during the pandemic.

To examine links between Adverse Childhood Experiences (ACE) categories and diagnosis of antisocial personality disorder (ASPD) in this population; it is predicted that there will be a positive association between number of ACEs and ASPD. The effectiveness of high secure hospital admission and treatment in reducing number of risk incidents was also examined. ACEs are known to impact significantly on the development of the personality and future psychiatric risk. Currently, research into links between distinct ACE categories and the diagnosis of ASPD in the high-secure inpatient population is limited.

Data were collected from a sample (n = 221) including all patients in the Mental Health, Personality Disorder and Women's Services at a high-secure hospital. Records were examined for evidence of abuse/neglect during childhood, and a number of markers of household dysfunction. The statistical relationship between each ACE category and subsequent diagnosis of ASPD was examined through paired t-tests. Frequency of incident reports (IR1s) involving violence was compared in the first, third and fifth years post-admission.

Significant associations with adult diagnosis of ASPD were seen in categories of childhood physical abuse, sexual abuse, divorced/separated parents, Looked After Child (LAC) status and parental substance misuse, and total number of ACE categories present overall. Significant reductions in frequency of IR1s were seen in all services between first- and fifth- year post admission.

A significant association between ACEs in specific domains and ASPD in adulthood was found. The importance of detailed exploration of childhood circumstances in this group is highlighted, as well as the need for further investigation of the psychological and social mechanisms underlying.