The challenges in providing mental healthcare in an ethnically diverse society exist within the limited frameworks of psychopathologies. Ethnocultural communities suggest relative syndrome of beliefs and practices so that experiences of mental illness differ and may not fit into the concept of colonial psychiatry. This review examines the necessity to recognise these trends as social determinants in the effectiveness and accessibility of healthcare and in preventing disparities.

According to the Centre for Reviews and Dissemination (CRD), this abstract adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Standards using a search strategy of major online databases. The published studies selected were based on inclusion and exclusion criteria surrounding cultural competency in clinical practice in the context of global mental health. The studies were analysed and synthesised with quality appraisal tools and reported in a narrative approach.

The outcome from the pool of studies revealed the following common themes.

Culturally informed clinical practice/transcultural psychiatry: Integrating the perspectives of the client's explanatory model with the clinician lens in a shared narrative through ethnographic principles. The cultural consultation service (CCS) recommendations increased knowledge of the specific issues of the patient's background and improved empathy and communication.

The improvement of therapeutic alliance: A focus on the aspects of religiosity/spirituality on human life experiences and the implication in healing and psychotherapy for better positive clinical outcomes.

The impact of psychosocial stressors: The clinician highlights the significant contributing factor to the mental distress of the patient, which may include cultural stressors, to provide tailored care and solutions within a multidisciplinary team.

The research on cultural competency in the mental health setting is multifaceted. The ongoing discussion on transcultural psychiatry, integrating biomedical and traditional practices and specialised clinical formulations, can improve mental health service delivery in a global society.

Films are known to influence the public's perception about mental health conditions. Dementia's prevalence in society has been increasing due to the ageing population. Cinema has long struggled with its depiction of mental health as seen with the depiction of schizophrenia, autism and psychosis in many blockbusters and award winning films. However, the depiction of dementia in films has not been as widely explored. The aim of this paper is to evaluate the depiction of dementia in films to assess its clinically accuracy.

A systematic search of keywords related to dementia was completed on the Internet Movie Database. The search was conducted in May 2022. Non-foreign language feature films were used in this paper. Films from 2000 and onwards were used. The films were analysed on the type of dementia they portrayed. 8 themes and tropes were assessed for each film. The portrayal of healthcare was also assessed. Each film was measured against the Neuropsychiatric Inventory-Questionnaire.

42 films were used from an initial sample of 1,320. Alzheimer's was found to be the most frequently portrayed cause of dementia. Time-shifting was the most common theme. There was a predominantly negative portrayal of care homes with a positive portrayal of carers. The films, measured against the NPI-Q, produced on average a lower severity of neuropsychiatric symptom score and carer distress score.

The depiction of dementia was mild in comparison to dementia's clinical manifestation. Films showed a positive portrayal of healthcare workers which can be considered rare when looking at cinema's history with psychiatry. Overall, films did not accurately portray the clinical aspect of dementia as they tended to focus more on the early stages of the diagnosis. However, films were realistic in their depiction of the emotional challenges that comes with a diagnosis of dementia. Film's powerful role in influencing the public's perception could be used to help reduce stigma and misunderstanding. Filmmakers could work with clinicians to help produce accurate portrayals of dementia. Patients experience the emotive aspect of their diagnosis but also equally experience the symptomatic aspects and cinema should be able to embody that. An accurate portrayal can still maintain the appeal of cinema and at the same time help with reducing misunderstanding and stigma held by the public about dementia which can help improve health outcomes.

To evaluate the potential superiority of donanemab vs. aducanumab on the percentage of participants with amyloid plaque clearance (≤24.1 Centiloids [CL]) at 6 months in patients with early symptomatic Alzheimer's disease (AD) in phase 3 TRAILBLAZER-ALZ-4 study. The amyloid cascade in AD involves the production and deposition of amyloid beta (Aβ) as an early and necessary event in the pathogenesis of AD.

Participants (n = 148) were randomized 1:1 to receive donanemab (700 mg IV Q4W [first 3 doses], then 1400 mg IV Q4W [subsequent doses]) or aducanumab (per USPI: 1 mg/kg IV Q4W [first 2 doses], 3 mg/kg IV Q4W [next 2 doses], 6 mg/kg IV Q4W [next 2 doses] and 10 mg/kg IV Q4W [subsequent doses]).

Baseline demographics and characteristics were well-balanced across treatment arms (donanemab [N = 71], aducanumab [N = 69]). Twenty-seven donanemab-treated and 28 aducanumab-treated participants defined as having intermediate tau.

Upon assessment of florbetapir F18 PET scans (6 months), 37.9% donanemab-treated vs. 1.6% aducanumab-treated participants achieved amyloid clearance (p < 0.001). In the intermediate tau subpopulation, 38.5% donanemab-treated vs. 3.8% aducanumab-treated participants achieved amyloid clearance (p = 0.008).

Percent change in brain amyloid levels were −65.2%±3.9% (baseline: 98.29 ± 27.83 CL) and −17.0%±4.0% (baseline: 102.40 ± 35.49 CL) in donanemab and aducanumab arms, respectively (p < 0.001). In the intermediate tau subpopulation, percent change in brain amyloid levels were −63.9%±7.4% (baseline: 104.97 ± 25.68 CL) and −25.4%±7.8% (baseline: 102.23 ± 28.13 CL) in donanemab and aducanumab arms, respectively (p ≤ 0.001).

62.0% of donanemab-treated and 66.7% of aducanumab-treated participants reported an adverse event (AE), there were no serious AEs due to ARIA in donanemab arm and 1.4% serious AEs (one event) due to ARIA were reported in aducanumab arm.

This study provides the first active comparator data on amyloid plaque clearance in patients with early symptomatic AD. Significantly higher number of participants reached amyloid clearance and amyloid plaque reductions with donanemab vs. aducanumab at 6 months.

Previously presented at the Clinical Trials on Alzheimer's Disease - 15th Conference, 2022.

This literature review aims to identify and understand the mental health needs of women in prison going through care proceedings in the perinatal period, in order for professionals to effectively care and support these women. Mental health difficulties in the perinatal period has been found to effect up to 27% of new and expectant mothers. The likelihood of experiencing these specific mental health issues is increased when there is past psychiatric and/or trauma history. Women in prison are more likely to have experienced childhood adversity and have psychiatric illnesses than the general population, which make them more susceptible to developing perinatal mental ill health. It has also been acknowledged that going through care proceedings can impact maternal mental health, which in prison brings specific and unique challenges. Therefore, the perinatal women in prison who are going through these proceedings have specific needs that have previously been overlooked, which this literature review aims to identify.

The databases searched for literature written since 2008 were: PubMed, PsychNet, Web of Science, Springer Link. Search strategy key words were: prison, perinatal, care proceedings and maternal mental health. Data were then collected and summarised thematically. 16 studies met the inclusion criteria.

The negative effects of going through care proceedings during the perinatal period include: earlier rates of maternal mortality, increased trauma symptoms, lack of support and increase in shame and issues with self-esteem and identity. Additionally, literature that focused specifically on women in prison going through care proceedings, found additional effects such as increased self-harming behaviours and depressive mood symptoms.

In order to address these difficulties, the following interventions have been recommended: more trauma informed training for professionals, oppositional identity work, a focus on building Epistemic Trust and ensuring interventions are delivered within 18 months of removal as this has been identified as a window of opportunity to make meaningful impact.

Going through care proceedings in the perinatal period has been identified as a significant challenge for mothers, which has increased complexity for women in prison. This literature review highlights the need for specific trauma-informed support and specialist perinatal mental health interventions for this population. Future research should focus on identifying the needs of women in prison going through care proceedings further, as it has previously been overlooked.

Postpartum depression (PPD) is the experience of depressed mood that begins anytime within the first four weeks after delivery. When left untreated, it can affect the infant's emotional and cognitive development and mother's health and family. South Indian studies on this topic are sparse. This study aimed at identifying the prevalence and risk factors of PPD in a tertiary care centre in Puducherry.

This was a prospective cohort study which included 140 antenatal women between 34 and 36 weeks’ period of gestation, and followed up at 6 weeks postpartum. Tools used in the study were semi-structured questionnaire to collect the sociodemographic details, Postpartum Depression Predictive Inventory – Revised version and Edinburgh Postnatal Depression Scale.

10% were found to have antepartum depression and at the postpartum visit, 18.6% were found to have depression. The risk factors identified were inadequate spousal support, unsatisfactory marital relationship, poor relationship with in-laws, prenatal anxiety and depression, low self esteem, maternity blues, child care stress, infant temperament, health problems and frequent hospital visits. Among these, presence of maternity blues (OR = 30.370) and infant health problems (OR = 14.742) had the highest risk.

Majority of the women with PPD reported depressive symptoms in the third trimester itself, hence antenatal and postnatal women should be routinely screened for depression and managed promptly. Failing to attach significance to prolonged maternity blues and frequent infant health problems has been found to increase the risk for developing PPD significantly.

An Early Intervention in Psychosis (EIP) service offers treatment in the community to people with a first episode of psychosis. EIP is meant to be given for three years; after this time, those who are well are discharged to their GP, while those with ongoing symptoms and care needs are transferred to a general community mental health team. People can become unwell at this time of change and might benefit from longer treatment with EIP. We also know that some people who are well could possibly have been discharged back to their GP earlier. The EXTEND programme aims to develop a more tailored approach to EIP services based on the needs of each individual and understand the health, social, and cost-benefits of this approach.

This qualitative study sits within a larger programme of work. Ethics and HRA approvals gained. Semi-structured interviews were conducted with health care professionals from primary and specialist care, managers and commissioners, to understand why and how decisions about duration of EIP care are made. Interviews have been transcribed and thematic analysis using principles of constant comparison is being conducted. Patient and public involvement is key to all stages of the study.

Five interviews with General Practitioners and twelve interviews with EIP healthcare professionals, managers and commissioners have been conducted. Initial analysis suggests that access to EIP services can be challenging. Initial engagement is needed before therapy can begin. Decisions about duration of care can depend upon availability of access to Community Mental Health teams. Discharge planning rarely involves communication between primary and specialist care, and this can be a difficult transition, particularly when discharge is back to primary care. The pathway back into mental health care following discharge can be difficult. Trusting relationships between service users and EIP professionals are key to the success of EIP care. Healthcare professionals would value - and in some cases are given - flexibility to extend EIP care beyond 3 years.

We have developed a model to illustrate the patient journey through the EIP service which will be presented for the first time at the conference.

This research provides a framework to understand decision-making around duration of care, discharge planning and practices, and post-discharge support for EIP service users. The next phase of the study will be interviews with service users and carers to explore their experiences of EIP services, duration of care and discharge planning.

Antipsychotic treatment is associated with metabolic disturbance, with clear differences observed between drugs in the adult population. However, the degree to which metabolic alterations occur with different antipsychotics in children and adolescents is unclear. As such, we aimed to compare and rank antipsychotics based on their metabolic and endocrine side-effects when used in the treatment of schizophrenia in this age population.

We searched MEDLINE, EMBASE, and PsycINFO from inception until October 30, 2022. We included double blinded, randomised controlled trials comparing 12 antipsychotics and placebo in acute treatment of schizophrenia in individuals aged <18 years. We performed random-effects network meta-analyses to investigate treatment-induced changes in body weight, BMI, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose, and prolactin concentrations. We performed meta-regressions to examine the relationship between metabolic/endocrine change and age, sex, and ethnicity

Of 6697 citations, we included 15 randomised controlled trials, consisting of 2501 patients. Antipsychotics included in analyses were aripiprazole, asenapine, blonanserin, clozapine, haloperidol, lurasidone, molindone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. Median treatment duration was 6 weeks (IQR 6-12). Mean age was 15.13 (SD 0.94) years. Mean differences for weight gain compared with placebo ranged from -2.04 kg (95% CI -4.24 to 0.17) kg for molindone to 4.11 kg (-0.55 to 8.77) for clozapine; for BMI from -0.55 kg/m2 (-1.37 to 0.27) for molindone to 1.92 kg/m2 (0.16 to 3.68) for quetiapine; for total cholesterol from -0.14 mmol/L (-0.70 to 0.41) for risperidone/paliperidone to 0.46 mmol/L (0.00 to 0.90) for quetiapine; for LDL cholesterol from -0.32 mmol (-0.76 to 0.12) for aripiprazole to 0.24 mmol/L (-0.15 to 0.63) for olanzapine; for HDL cholesterol from 0.10 mmol/L (-0.05 to 0.26) for aripiprazole to -0.23 mmol/L (-0.52 to 0.06) for risperidone/paliperidone; for triglycerides from -0.01 mmol/L (-0.21 to 0.34) for molindone to 0.62 mmol/L (0.04 to 1.2) for clozapine; for glucose from -0.33 mmol/L (-0.64 to -0.02) for ziprasidone to 0.81 mmol/L (0.28 to 1.34) for clozapine; for prolactin from -1.92 ng/mL (-15.37 to 11.53) for aripiprazole to 28.10 ng/mL (16.23 to 39.96) for risperidone/paliperidone. Higher baseline age predicted by greater increases in body weight (p = 0.014).

We found significant differences between antipsychotics in terms of metabolic and endocrine side-effects when used in children and adolescents. Treatment guidelines should be updated to reflect our findings. However, the choice of antipsychotic should be made on an individual basis, considering the clinical circumstances and preferences of young people, carers, and clinicians.

Self-harm is a common presentation in emergency services, and ambulance clinicians are often the first professionals involved. The aims of this study were to explore the experiences of Yorkshire Ambulance Service (YAS) clinicians of caring for people who self-harm, and to seek their views of the care provided to this group in the pre-hospital setting.

This preliminary cross-sectional study involved a self-completed questionnaire using an online platform (Online Surveys, www.onlinesurveys.ac.uk). The questionnaire was designed by the research team, piloted by four academic paramedics, and shared with ambulance clinicians employed by YAS via social media and email bulletins. Multiple-choice answers were analysed using descriptive statistics, and two researchers (DR, EG) independently analysed free-text responses thematically. Participants could only proceed to the questionnaire if they agreed to an online consent statement. Ethical approval was granted by the University of Leeds.

26 clinicians responded to the questionnaire (1.0% response rate), of whom 17 (65%) were female and 16 (62%) were paramedics. 17 (65%) indicated that they had not received specific mental health training in their roles. Only nine (35%) respondents felt comfortable caring for this group, and four (15%) thought that their training had adequately prepared them.

Respondents identified the following as facilitators to high-quality clinical care for people who have self-harmed: previous clinical experience, training in mental health and injury management, availability of mental health advice and services, good communication skills, relevant online resources, and support from senior colleagues. Barriers identified included patient factors, a lack of mental health pathways, services and support and a lack of training and education in mental health. Suggested improvements to emergency services for self-harm were alternatives to emergency departments, greater availability of mental health support, more staff, mental health training for ambulance clinicians, and guidance for the management of patients declining to attend hospital.

Respondents generally felt unconfident and unprepared when called to assess and manage people who have harmed themselves. Improvements in mental health training for ambulance clinicians and greater availability of mental health services are needed to improve pre-hospital care for people who self-harm. Although the study was limited by a low response rate, it has begun to address the literature gap in paramedic care for self-harm. Questionnaire responses corroborate NICE recommendations that alternative services to emergency departments, where appropriate, could improve patient satisfaction and the quality of clinical care. This should be considered by commissioners and policymakers.

National health services are facing an increased burden of alcohol-related problems. Between 2019–2020, 280,000 hospital admissions were attributable to alcohol use (1). This was 2% higher than 2018–2019, and 8% higher than 2016–2017. The UK Government has taken some action by recommending a maximum weekly alcohol consumption limit in units; however it is unclear whether psychiatrists are aware of these recommendations. It can often be difficult to calculate accurately the units of alcohol consumed, due to differences in the alcohol concentration of apparently similar drinks (3). The aim of this online survey was to assess junior doctors’ knowledge and their understanding of alcohol unit conversions.

This was a cross-sectional study, administered via an online questionnaire. We invited junior and middle grade doctors working in Psychiatric Inpatient Units and CMHTs in the North Wales region via e-mail. We have used the same questionnaire that was used in previous studies. The questionnaire captured respondents’ training level, their current alcohol consumption and perception about their knowledge of alcohol unit conversions, as well as assessing their knowledge about alcohol unit conversions using four test scenarios. The data were gathered using the Microsoft office forms (online) and analysed descriptively (i.e., frequency and percentage) using Microsoft Excel.

Twenty-three medical doctors working in Psychiatry completed the online questionnaire, of which the majority were junior doctors (n = 15; 65%). Almost three-quarters of the respondents (n = 17; 74%) reported regular consumption of alcohol. The majority of respondents (n = 20; 86%) reported that they had knowledge of alcohol units.

Nearly half of the respondents were able to calculate correct daily allowance of alcohol in units for males (n = 13; 56%) and for female (n = 12; 52%). Twelve respondents were able to calculate the correct allowance in units for both genders. About one quarter of the respondents (n = 5; 22%) mentioned weekly limits instead of daily limits of alcohol in units.

In response to test scenarios, seven respondents (30%) were able to correctly calculate 9 units of alcohol in a 750ml bottle of 12% wine. Ten respondents (43%) were able to correctly calculate 30 units in the bottle of whiskey. For the lager scenario, the volume was given in pints, and only one respondent was able to calculate 47.6 units correctly. For a wine (36.4 units) and sherry (12 units), only 6 (26%) and 4 (17%) respondents answered correctly, respectively.

We found that medical doctors working in psychiatry do not have adequate knowledge of alcohol unit conversions. To tackle the increasing burden of alcohol-related problems, learning about alcohol unit conversions should be incorporated into teaching programmes for psychiatry practitioners.

Mental illness has been very common lately and the mentally ill are a special population with their own particular set of needs and challenges. In general physical health of the mentally ill is poorer than that of the general population and oral health is especially neglected hence the desire to quantify this.

This study was a cross-sectional hospital based study conducted in the outpatient clinic of Taha Basher Psychiatric teaching hospital. The sample (90) was selected randomly from among the adult patient attendants who agreed to participate in the study.

The mean DMF was 4.91 +/-4.46 . It was positively correlated to age and duration of illness. It was higher in females and the greatest proportion was due to missing teeth and the smallest proportion was the filled teeth. There were no dentures used by any of the patients.

Those involved in the study reflect the poor level of oral health among the mentally ill population and this deficiency is unfortunately not receiving enough attention of care givers or mental health professionals. The dental community ought to establish a professional referral system with such facilities to facilitate patient care.

Differential attainment is a term used to describe variation in the achievement of groups of doctors based on certain characteristics. Evidence suggests that international medical graduates (IMGs) in the UK struggle at different stages of training in many specialties including psychiatry. This project aims to explore the experience of psychiatry trainee doctors and their trainers at SABP to understand this issue and identify areas for quality improvement.

This was an exploratory study using a mixed methods approach. Qualitative data were collected via semi-structured interviews and focus groups conducted with trainees and trainers. Interviews and focus groups were recorded and transcribed, then analysed for themes. Quantitative data were collected via an online survey sent to trainees and trainers and were analysed using descriptive statistics. Informed consent was obtained from all participants. This project received approval from the Health Education England research governance committee and was conducted in accordance with British Educational Research Association (BERA) guidelines.

The online survey had a good response rate of 60.4% for trainees (26 out of total 43 trainees) and 64.7% for trainers (22 out of total 34 trainers). Challenges identified by the participants both in qualitative and quantitative data mirrored the national picture. Five main themes that were identified from semi-structured interviews and focus groups were: 1) the impact of professional and informal support, 2) challenges faced by IMGs in adjusting to the new system, 3) communication barriers, 4) Stress and burnout impacting trainees’ performance and 5) unconscious bias during recruitment, exams, and ARCP on the training experience of IMGs.

This project was used to generate ideas for quality improvement with regard to the experience of trainees and the reduction of differential attainment within the trust. Findings from this research have guided SABP in the development of interventions to support IMGs and trainers, particularly regarding professional and non-professional support. These interventions include an induction booklet for doctors joining the trust, an IMG support network, and a mentorship scheme for all the trainees. We aim to explore the experience of IMGs trainees and trainers using a similar method in the future to evaluate the success of these interventions. Our findings will have an impact on other organisations providing postgraduate training in psychiatry and other specialties.

Violence is not uncommonly seen in patients with mental illness and personality disorders. Various medications have been used to control aggression including antipsychotic medications. Clozapine has proven effectiveness in the treatment of resistant schizophrenia. Recently studies tried to explore its effectiveness as anti-aggression medication. The aim of the review is to explore the efficacy of Clozapine in controlling violence in adults with mental illness and personality disorders.

comprehensive psychiatric literature review was conducted. Screening of the relevant articles in the national and international databases covering the period between 1973 and 2012. Multiple data sources searched. The author used the Cochrane Library, Ovid on line and NHS Evidence journals and databases to access health care databases advanced search to find articles on EMBASE, MEDLINE, AMED , CINAHL ,PsycINFO, Health Business Elite and HMIC. The studies narrowed down following a flowchart, based on the PRISMA statement. Studies including patients with brain injury, moderated/ severe learning disabilities were excluded. Quality assessment of literature completed.

52 robust studies were retrieved showing consistent evidence to support the use of Clozapine as anti-aggressive medications in patients with schizophrenia and schizoaffective disorders. Studies has shown that a dose of 500 mg daily has a superior effect on controlling aggression, A serum Clozapine level of 0.35 mcg/l can exert anti aggression effect. Some studies noted that its anti-aggression effect could be observed from 5 weeks onwards after treatment is initiated.

The evidence supporting its use in individual with personality disorders has been little. Neither randomized controlled trial nor prospective case controlled trials were conducted to support its anti-aggressive effect in this group. However, few studies reported some reduction in the aggressive behaviour when small dose of 100 mg daily was used in patients with emotionally unstable personality disorder.

There is sufficient evidence to support the use of Clozapine in controlling aggression and violence in patients with schizophrenia and schizoaffective disorders. Its use in personality disorders needs further exploration and support by robust studies. Studies has found anxiety disorders very common in borderline personality disorders, 88% of personality disorder patients involved in a study had co morbid Anxiety disorder. It is possible that the sedative effect of clozapine; may have lowered anxiety levels and subsequently contributed to the reduction in impulsivity and aggression.

Among the consequences of natural disasters, post-traumatic stress disorder (PTSD) has been one of the most prevalent mental health issue. Nepal has been categorized as a region prone to natural disasters including earthquakes and avalanches. However, mental health implications of such disasters have been rarely explored in Nepal especially in remote regions like Langtang.In this research, we have estimated the prevalence of post-traumatic stress disorders (PTSD) among the survivors 7 years after the mega earthquake and avalanche in 2015 in rural mountainous region of Langtang in Nepal. We also explored the association between sociodemographic parameters and PTSD scores.

A Cross sectional quantitative observational study was carried out in 2022. Study population included the residents of Langtang who are the survivors of 2015 earthquake. Simple random sampling was done and participants aged 18 years and above who consented to the study were included. Sociodemographic details were assessed using a predesigned structured questionnaire and PTSD symptoms were measured using the Nepali version of PTSD Symptom Checklist 5 (PCL 5). PCL-5 scores of >31 was used as cutoff for presence of PTSD. Data were analysed using SPSS software.

A total of 124 participants were included in the study. PTSD symptoms score were above the cut off in 7.3% . Most respondents were males (60.5%), young adults aged 18–30 years (36.3%), with no formal education (53.2%), with at least loss of one family member (66.1), and majority rescued after a week(42.7%). Sociodemographic variables such as age group, education, occupation, location during the incident, rescue time and substance use were significantly associated with the PTSD scores. Middle aged respondents were observed to have significantly high PTSD scores followed by older age group(p = 0.04). Similarly, PTSD scores were significantly higher among the respondents with no formal education and who had agriculture/tourism as their main occupation(p = 0.02). Likewise, respondents who were in Langtang during the incident were found to have significantly higher scores(p < 0.001). Interestingly, PTSD scores were found higher among those respondents who were rescued within a week from the time of incident as compared to individuals who were rescued after a week(p < 0.001). Also, PTSD scores were higher among the respondents who consumed any type of substance(p = 0.002).

PTSD was prevalent even 7 years after the incident in the Langtang community. Certain sociodemographic parameters were identified to be associated with increased PTSD symptoms.

A rise in mental illness has inspired the UK government to increase mental health service funding by £2.3 billion/year, deepening the need for robust evidence on how to best allocate mental health resources. The STAR methodology was co-developed by the London School of Economics and the Health Economics Unit to help commissioners allocate resources by combining a value-for-money analysis with stakeholder engagement. The aim of this research was to evaluate the potential benefit of implementing the STAR methodology in the allocation of mental health resources.

The barriers and facilitators to commissioning cost-effective mental health services were systematically reviewed. The potential for STAR to overcome these barriers and promote these facilitators was then evaluated by analysing its socio-technical components and assessing its real-world implementation in the COPD pathways of five ICSs.

Fragmentation and cross-sectoral responsibility for the funding and delivery of services can hinder multi-sector buy-in. STAR has overcome this barrier in the COPD pathways of five ICSs by pooling their budgets and building partnerships across sectors through decision conferencing that has facilitated shared priority setting.

Lacking community involvement impedes local stakeholders from embracing change. By championing local stakeholders, STAR's ‘socio’ component involves front-line workers in funding decisions and fosters a sense of ownership over service adjustments.

The value placed on each outcome varies between sectors, often resulting in conflicting incentives. By considering each sector's interests, STAR enables a consensus on which outcomes to optimise for. Furthermore, STAR's ‘technical’ components strengthen the objective value-for-money evaluations of the interventions that contribute to each outcome. When modelling the health gain and cost of COPD interventions, STAR discovered that CBT offers a relatively high return on investment, despite often being overlooked as a core intervention for COPD. STAR's economic evaluations are communicated in easily interpretable ways to facilitate a shared understanding on which resources are most worth funding.

Resource allocation decisions are fuelled by the quality of evidence supporting them. Compared with physical health services, mental health services lack evidence that reflects the qualitative and quantitative nature of their outcomes. In particular, services that rely mostly on subjective reports, such as psychotherapy, lack objective value-for-money evaluations, resulting in a hesitancy for funding. By measuring the health gain and cost of each mental health intervention in a systematic, transparent and objective way, STAR enables commissioners to improve the allocative efficiency of mental health resources, thus improving population mental health without increasing cost.

There is an increasing amount of evidence to suggest that regular physical exercise supports healthy ageing. Regular physical activity provides health benefits for the cardiovascular, respiratory and musculoskeletal systems as well as many other benefits. As well as improving cardiovascular fitness, aerobic activity in particular may also have beneficial effects on cognition among older people. In this paper, we aimed to systematically review the effect of aerobic physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment.

We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, the Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, PsycINFO, LILACS, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch), ClinicalTrials.gov with no language restrictions.

We included all published randomised controlled trials (RCTs) comparing the effect of aerobic physical activity programmes with any other active intervention or no intervention on cognitive function. Participants were ages over 55 with no known cognitive impairment. We looked at trials, which measured effects on both fitness and cognition.

We reviewed the data from trials published since August 2013 to further the research completed by Young J, Angevaren M, Rusted J, Tabet N (published in 2015). This systematic review looked at all the studies completed before August 2013.

There were a few trials that met our inclusion criteria. The aerobic activity programme that participants were subjected to varied in length.

The comparison between aerobic exercise to any active intervention showed no evidence of benefit from aerobic exercise in cognition.

None of our analyses showed a cognitive benefit from aerobic exercise despite the interventions demonstrating benefits to cardiorespiratory fitness

The findings from the available data from the RCTs did not show any evidence that aerobic physical activities, including those which successfully improve cardiorespiratory fitness, have any cognitive benefit in cognitively healthy older adults. Larger studies with longer term interventions and longer follow up would be recommended.

Every day, we may choose something new randomly (random exploration) or select something new with no prior information (de-novo exploration). The link between exploration and anxiety has only been studied using trait-like anxiety questionnaires, but an experimental manipulation of anxiety could have different results. Individual differences (e.g., sex or novelty-seeking (NS) trait) also impact specific exploration strategies. Thus, we examined if anxiety manipulation in a task would influence different exploration strategies while also looking at sex, NS bias and trait anxiety.

117 healthy subjects (58 female) completed online questionnaires (novelty-seeking dimension of the Cloninger's Tridimentional Personality Questionnaire (TPQ-NS), trait anxiety questionnaire (STAI)) and performed the Maggie's farm task. This task allows to review different exploration strategies, promoting exploration via the number of available choices (horizon). The threat of aversive stimuli (loud noises appearing at random times) was used to emulate anxiety, in a between-subject design. Comparing computational models of exploration, the best-fitting model (evaluated by Bayesian Information Criterion) in our data was a Thompson model with an ε-greedy element (random exploration) and a novelty bonus η (de-novo exploration). We used repeated-measures ANOVA, comparing the effect of horizon on the ε and η parameters with the anxiety category as a between-subject factor. We used partial Pearson's correlations of ε and η derivatives (mean and standardised-difference (SD) across horizon) with STAI and TPQ-NS measures correcting for participant's reported stress levels and anxiety category. Partial correlations analyses were repeated after splitting the data by sex.

There was no between-subject effect of anxiety category on the horizon of either ε (F(1,1) = 0.253, p = 0.6) or η (F(1,1) = 0.305, p = 0.58). SD of ε was negatively correlated with TPQ-NS (r = −0.184, p = 0.050) but no other partial correlation was significant. When splitting by sex, SD of ε was negatively correlated with the STAI score (r = −0.341, p = 0.01) in females and the TPQ-NS score in males (r = −0.275, p = 0.038). The mean η positively correlated with the STAI score (r = 0.318, p = 0.016) in males.

While the experimentally modulated anxiety did not affect the exploration parameters, individual differences in NS and trait anxiety are suggested to affect random and de-novo exploration in a sex-dependent manner. Imaging research, or research into anxiety population could help further solidify these results in the future.

Memory clinic waiting times are at a record high, increasing from 13 weeks in 2019 to 17.7 weeks in 2022. This backlog is partially due to COVID-19 disruption. Staff are concerned that waiting times are resulting in missed diagnoses, particularly with early-onset memory loss, and that relatives of patients with challenging behaviours are not receiving adequate support. At the start of the pandemic, many Memory Service Assessments (MSAs) were done via teleconsultation to ensure patients could access services despite lockdowns. Telemedicine has continued to be used for MSAs and is a strategy proposed to tackle waiting times. This literature review explores whether using telemedicine for MSAs is evidence-based.

A search using the MEDLINE database was conducted, using the terms ‘dementia’, plus ‘telemedicine’, ‘video calls’, and ‘telephone calls’. This identified one relevant systematic review and one clinical trial. The identified evidence was insufficient for a systematic review. A google search carried out with the same terms, identified a variety of non-academic papers: NHS Audits, Quality Improvement Projects, Clinical Network publications, and one governmental publication.

Telemedicine was reported to reduce waiting lists. Appointments could be organised quickly, without infection risk, and without requiring transportation. At-home telemedicine consultations were relaxing for some patients and reduced demand for home visits. However, clinicians reported that some environments were cluttered and noisy, impacting the MSA.

Patients struggled with the complex telemedicine technology; carers were required to facilitate the calls, which increased the risk of an inaccurate assessment. Patients with sensory impairments disliked telemedicine, and clinicians struggled to distinguish between cognitive impairment and poor hearing. Financial inequalities at times prevented telemedicine. Some relatives felt that patients would mask their memory symptoms in teleconsultations, and not speak openly about their concerns. Clinicians felt adequate safeguarding assessments were not possible over teleconsultation. There was no inclusion of the long-term impact of these assessments. No distinction was made between dementia subtypes.

The National Audit of Dementia, RCPsych 2021, encourages the future use of telemedicine for MSAs. However, there is limited evidence to support its use. Telemedicine was essential during COVID-19 and may help reduce waiting times, but may also produce worse outcomes than face-to-face consultations. Only pilot studies without randomisation exist on the topic and none of these are UK based. Further research is required to produce NHS-specific data on the impact telemedicine has on: the quality of MSAs, the patients’, carers’, and clinicians’ experiences, and memory service waiting times.

There is robust research evidence that insomnia is highly prevalent in the general population, with a significant adverse impact on physical and mental health and quality of life. There is also strong evidence of the cost-effectiveness of cognitive-behavioural therapy for insomnia (CBT-I), the first-line treatment for insomnia recommended by the UK's National Institute for Health and Care Excellence. However, data from primary care records has not been used in the UK to establish real-world impact, including local prevalence, treatment rates and inequalities. This study's aim was to establish these in North London.

Pseudonymised data were extracted from primary care records across three North London boroughs for 765,035 patients (aged 15+ years). Insomnia prevalence was determined by identifying patients with a code for insomnia in previous five years, sleeping tablet prescription in previous three months, or code for insomnia treatment. Data were aggregated upon extraction and analysed using descriptive statistics.

Insomnia prevalence was 4.3%. Prevalence increased steadily with age, being highest in those aged 85–90 years (10.8%). There was significant variation by ethnic group and deprivation quintile, with highest prevalence in the most deprived quintile (5.2%) and those of Bangladeshi ethnicity (7.3%). Variation in insomnia prevalence, diagnosis and treatment occurred between GP practices. Prevalence was significantly higher in patients with comorbidities, including those with chronic obstructive pulmonary disease (17.5%), diabetes mellitus (11.8%), severe mental illness (16.6%), and depression (14.1%). 0.3% of people with an insomnia code had been referred for CBT-I.

Insomnia was found to be as common as other illnesses that receive high levels of focus and resourcing in the UK. Prevalence estimates were likely underestimates since patients were only counted as having insomnia if this could be identified from coded data or prescription information. Significant variation in prevalence and treatment rates by factors such as ethnicity and deprivation quintile may represent health inequalities. Additionally, insomnia was particularly common among patients with certain comorbid illnesses and of advancing age, meaning that those groups should be actively screened for insomnia. Concerningly, referral rates for CBT-I were extremely low. It is vital that clinicians receive training in diagnosing insomnia and local treatment pathways, and that culturally appropriate services are commissioned to address this unmet need and ensure equitable access. Although this study included data from only one locality, it is consistent with international research findings. Therefore, prevalence and unmet need is likely to be high in many other areas and should be investigated locally.

Inpatient psychiatric rehabilitation services for people with complex psychosis promote independent living and reduce readmissions through multidisciplinary recovery-based practice. Yet, little research has explored how these services are experienced by patients and staff, partly due to the difficulties of conducting qualitative research in such settings using interviews and focus groups. We therefore lack an in-depth understanding of how inpatient rehabilitation operates on the ground, including which aspects are experienced as helpful/unhelpful and which factors determine the feasibility/success of recovery-based practice.

We conducted an ethnographic study of a 16-bed inpatient rehabilitation ward in London comprising six months of participant observation followed by 20 semi-structured interviews with patients (n = 7) and staff (n = 13). For participant observation, over 200 pages of fieldnotes were taken contemporaneously. Semi-structured interviews were audio-recorded and transcribed verbatim. Data were analysed using grounded theory and situational analysis.

Our analysis highlights the fundamental importance of relationality in inpatient rehabilitation. Specifically, complex psychosis is characterised by relational impairments and divergences that lead to significant disability. Working with this complex patient group therefore requires nuanced and specialist relational skills. On the ward, these skills were actively nurtured by staff, especially those at lower pay grades, to provide the essential scaffolding for recovery-based practice. Yet, ward staff were often prevented from prioritising therapeutic relations by prevailing structural and institutional arrangements. For example, greater importance was attached to completing technical and bureaucratic interventions; patient contact was reduced for more experienced staff; and staffing levels and material resources for rehabilitation activities were limited. Already feeling underequipped, staff members described how their motivation to cultivate therapeutic relations was further reduced by experiences of structural inequalities inside and outside the ward and, more proximally, by limited psychological and occupational support structures. The consequent undermining of recovery-based practice led to patients experiencing treatment as more restrictive and less therapeutic than it could have been.

Relationality is a key determinant of the experience of treatment within psychiatric units, and yet the subversion of therapeutic relations identified in this study reflects prevailing currents in psychiatry and mental health systems nationwide and beyond. Recovery-based practice and the cultivation of rich therapeutic relationships have among the strongest evidence bases of any interventions for people with complex psychosis. Therefore, to fulfil its clinical potential, inpatient rehabilitation requires investment in the expertise, well-being, and availability of its frontline staff who make or break these relations. This must be facilitated by broader structural and institutional commitments.

Widely available opioid substitute treatments have numerous limitations including the potential for non-compliance, misuse, diversion and accidental overdose. The advent of a prolonged-release, injectable form of buprenorphine may be the solution to overcoming these issues, as well as reducing the intrusion on the patient's daily life. Initial trials have shown success in achieving a significantly higher percentage abstinence compared to placebo. This systematic review and meta-analysis will examine efficacy, safety and tolerability data.

A systematic review and meta-analysis, including all randomised controlled trials reporting raw data on efficacy, safety and side effects of injectable buprenorphine. Included articles were identified using PubMed, Ovid (EMBASE and MEDLINE), Google Scholar and Cochrane Library.

Participants were either community outpatients or hospital inpatients, aged over 18 years, with opioid use disorder. Interventions were prolonged-release injectablebuprenorphine of any preparation or dosing schedule, compared to a control such as sublingual buprenorphine or placebo.

The primary outcome measure was treatment efficacy, specifically treatment retention and negative urine drug screen results. The secondary outcomes measures were drug related adverse events, severe adverse events, nonfatal serious adverse events, mortality, discontinuation, and drug overdose.

Six articles were selected for inclusion following assessment using our exclusion criteria. Study quality was assessed using the CASP tool and Cochrane Risk of Bias 2. Review Manager 5.4.1 was used for data synthesis.

Our primary endpoint was efficacy, using treatment retention and negative urine samples as surrogate markers. Regarding treatment retention there was a statistically significant increase in the ‘Buvidal’ group compared to the control group (OR = 1.46, 95% CI = 1.12 to 1.89, P = 0.005). There was also a statistically significant increase in negative urine samples in the ‘Buvidal’ group compared to the control group (OR = 1.38, 95% CI = 1.26 to 1.52, P < 0.00001).

We examined a number of secondary outcomes which focussed on safety and tolerability data. These showed no statistically significant differences between the two groups (drug overdose (OR = 0.09), drug related adverse events (OR = 1.75), severe adverse events (OR = 0.93), nonfatal serious effects (OR = 0.65), mortality (OR = 1.63) and discontinuation (OR = 1.52)).

The studies have shown the efficacy of ‘Buvidal’ was statistically significant in comparison to the control groups, with no difference in their side effect profiles.

To our knowledge, this is the first systematic review and meta-analysis of its kind, and our results support the hypothesis that ‘Buvidal’ is an effective and safe treatment for opioid use disorder.