The study examines the behavioural and psychological symptoms (BPSs) associated with dementia and mild cognitive impairment (MCI), highlighting the prevalence and impact of these symptoms on individuals with varying levels of cognitive function, particularly in the context of the increasing incidence of dementia among the ageing population.

To explore the BPSs among out-patients with different cognitive statuses.

This cross-sectional study enrolled out-patients who attended the cognitive assessment out-patient clinic at our hospital between January 2018 and October 2022. The patients’ cognitive status was evaluated using the Neuropsychiatric Inventory (NPI), Activities of Daily Living and the Montreal Cognitive Assessment-Basic scales.

The study enrolled 3273 out-patients, including 688 (21%) with cognitively unimpairment, 1831 (56%) with MCI and 754 (23%) with dementia. The NPI score, the percentage of patients with BPSs and the number of BPSs increased with decreasing cognition level. Unordered logistic regression analysis showed that after adjustment of confounding variables, delusions, depression, euphoria and psychomotor alterations were independently associated with MCI. Delusions, agitation, euphoria, apathy, psychomotor alterations and sleep change were independently associated with dementia.

NPI scores, the percentage of patients with BPSs and the numbers of BPSs increased with declining cognitive function.

Cannabis use severely affects the outcome of people with psychotic disorders, yet there is a lack of treatments. To address this, in 2019 the National Health Service (NHS) Cannabis Clinic for Psychosis (CCP) was developed to support adults suffering from psychosis to reduce and/or stop their cannabis use.

Examine outcome data from the first 46 individuals to complete the CCP's intervention.

The sample (N = 46) consisted of adults (aged ≥ 18) with psychosis under the care of the South London and Maudsley NHS Foundation Trust, referred to the CCP between January 2020 and February 2023, who completed their intervention by September 2023. Clinical and functional measures were collected before (T0) and after (T1) the CCP intervention (one-to-one sessions and peer group attendance). Primary outcomes were changes in the Cannabis Use Disorders Identification Test-Revised (CUDIT-R) score and pattern of cannabis use. Secondary outcomes included T0–T1 changes in measures of delusions, paranoia, depression, anxiety and functioning.

A reduction in the mean CUDIT-R score was observed between T0 (mean difference = 17.10, 95% CI = 15.54–18.67) and T1, with 73.91% of participants achieving abstinence and 26.09% reducing the frequency and potency of their use. Significant improvements in all clinical and functional outcomes were observed, with 90.70% being in work or education at T1 compared with 8.70% at T0. The variance in CUDIT-R scores explained between 34 and 64% of the variance in our secondary measures.

The CCP intervention is a feasible strategy to support cannabis use cessation/reduction and improve clinical and functional outcomes of people with psychotic disorders.

An increasing number of observational studies have reported associations between frailty and mental disorders, but the causality remains ambiguous.

To assess the bidirectional causal relationship between frailty and nine mental disorders.

We conducted a bidirectional two-sample Mendelian randomisation on genome-wide association study summary data, to investigate causality between frailty and nine mental disorders. Causal effects were primarily estimated using inverse variance weighted method. Several secondary analyses were applied to verify the results. Cochran's Q-test and Mendelian randomisation Egger intercept were applied to evaluate heterogeneity and pleiotropy.

Genetically determined frailty was significantly associated with increased risk of major depressive disorder (MDD) (odds ratio 1.86, 95% CI 1.36–2.53, P = 8.1 × 10−5), anxiety (odds ratio 2.76, 95% CI 1.56–4.90, P = 5.0 × 10−4), post-traumatic stress disorder (PTSD) (odds ratio 2.56, 95% CI 1.69–3.87, P = 9.9 × 10−6), neuroticism (β = 0.25, 95% CI 0.11–0.38, P = 3.3 × 10−4) and insomnia (β = 0.50, 95% CI 0.25–0.75, P = 1.1 × 10−4). Conversely, genetic liability to MDD, neuroticism, insomnia and suicide attempt significantly increased risk of frailty (MDD: β = 0.071, 95% CI 0.033–0.110, P = 2.8 × 10−4; neuroticism: β = 0.269, 95% CI 0.173–0.365, P = 3.4 × 10−8; insomnia: β = 0.160, 95% CI 0.141–0.179, P = 3.2 × 10−61; suicide attempt: β = 0.056, 95% CI 0.029–0.084, P = 3.4 × 10−5). There was a suggestive detrimental association of frailty on suicide attempt and an inverse relationship of subjective well-being on frailty.

Our findings show bidirectional causal associations between frailty and MDD, insomnia and neuroticism. Additionally, higher frailty levels are associated with anxiety and PTSD, and suicide attempts are correlated with increased frailty. Understanding these associations is crucial for the effective management of frailty and improvement of mental disorders.

Clinical characteristics of psychosis in HIV infection have been described, but there have been limited comparative studies in HIV-endemic low-resource regions.

To compare clinical characteristics of psychosis in HIV-positive and HIV-negative patients at the main psychiatric referral units in Uganda.

Patients with psychosis were consecutively recruited and completed a standardised demographic questionnaire and psychiatric and laboratory assessments including an HIV test. The Mini International Neuropsychiatric Interview was used to diagnose psychiatric illness. Psychosis symptoms were compared between HIV-positive and HIV-negative individuals using bivariate methods. A logistic regression model was used to assess the effects of age, gender and HIV status on different types of psychosis.

There were 478 patients enrolled, of which 156 were HIV positive and 322 were HIV negative. The mean age was 33.2 years (95% CI 31.8–34.5) for the HIV-positive group and 29.6 years (95% CI 28.7–30.5) for the HIV-negative group (P < 0.001). Female patients had a higher proportion of seropositivity 40.6% (95% CI 34.8–46.4) compared with males 21.8% (95% CI 16.1–27.5) (P < 0.001). Psychotic disorder not otherwise specified occurred more in the HIV-positive individuals (88% (95% CI 82.9–93.1) v. 12% (95% CI 8.4–15.5), P < 0.001). Motor activity, irritability, emotional withdrawal, feelings of guilt, mannerisms and posturing, grandiosity, suspiciousness, unusual thoughts, blunted affect, excitement and disorientation were associated with HIV seropositivity.

The presentation of psychosis in patients with HIV is unique to this HIV endemic setting. Characterisation of the symptomatology of patients presenting with psychosis is important for proper diagnosis and care.

Vaping is increasing in popularity. Vape products are offered in a wide variety and promise to reduce harms associated with cigarette smoking, among other claims. The motivations for vaping in patients with substance use disorder are largely unknown.

To describe perceptions and motivations regarding vaping among patients with opioid use disorder (OUD) who vape.

A convergent mixed-methods study design was used, and individual, semi-structured interviews were conducted with 41 individuals with OUD who were receiving medication for OUD and also vaped. An inductive data-driven approach was employed to characterise perspectives on vaping.

The mean ages at which participants had been introduced to vaping and initiated regular vaping were 33.95 years (s.d. 12.70) and 34.85 years (s.d. 12.38), respectively. Daily vaping (85%) of nicotine, flavoured nicotine or cannabis was common, with 27% reporting vaping both nicotine and cannabis. Qualitative analysis identified 14 themes describing motivations for vaping, including viewing vaping as a smoking cessation tool, convenience and popularity among youth.

Mixed-methods findings indicated that patients with OUD who vape perceived vaping to be healthier, cleaner and more convenient than cigarette and cannabis smoking, without appreciating the health risks. The perspectives reflected the importance of health education, guidelines and screening tools for vaping and could provide direction for healthcare providers and future vaping cessation programmes.

Promoting a ‘timely’ diagnosis is a global policy directive.

This review adopts an intersectional approach, visually mapping the existing literature to highlight gaps in the evidence base on barriers and facilitators to dementia diagnosis.

A systematic approach was undertaken, following the PRISMA guidelines, updating previous reviews. The literature search was conducted on PubMed, PsycINFO, CINAHL Complete and Scopus. In line with mapping review methodology, we report the current state of the literature by describing the number of studies that outline barriers and facilitators to seeking help for a dementia diagnosis, split by social categorisation.

On the 7 June 2024, a total of 45 studies were identified. Our mapping demonstrated the majority of studies were derived from high-income countries and did not specify whether they were exploring barriers and facilitators through a specific social lens. Ethnicity was one of the few social categories where a range of evidence was reported. Other categories, such as socioeconomic status, gender and sexual orientation, received limited research attention.

Our mapping review suggests the large body of work within this field tends to treat people with dementia and their carers as homogenous and androgenous groups. To better inform this key policy directive, studies are needed that explore the influence of social determinants on people’s experiences of seeking a dementia diagnosis. Such work would create a richer, more nuanced evidence base that better elicits ways of addressing inequalities and inequities that arise at this key stage of people’s dementia care journey.

Residential treatment facilities for eating disorders are becoming increasingly common and purport to provide recovery-orientated care in a less restrictive environment than traditional hospital settings. However, minimal attention has focused on individuals’ lived experiences of these residential services.

This study explores participants’ lived experiences of care at Australia’s first residential facility for the treatment of eating disorders.

Qualitative data were collected as part of a clinical evaluation (June 2021 to August 2023). Fifteen women participated in semi-structured interviews about their experience of treatment following discharge. Data were analysed with inductive reflexive thematic analysis.

Three main themes were generated from the data that included participants’ journeys to treatment, experiences of treatment and the transitions associated with and following discharge. Cutting across these main themes were participants’ encounters of barriers, setbacks and hope. Participant experiences of residential treatment were complex and multifaceted, marked by inherent ideological dilemmas that arose in balancing standardised treatment protocols with person-centred and recovery-oriented care. Participants also spoke of reclaiming a sense of self and identity beyond their eating disorder, emphasising the importance of relationships and consistent and collaborative care.

Participant accounts of residential treatment emphasised the importance of holistic, person-centred and recovery-oriented care. Despite the complexities of treatment experiences, participant narratives underscored how recovery may be more about the reclamation of a sense of identity outside of the eating disorder than merely symptom improvement. As such, adopting person-centred and recovery-oriented treatment approaches within residential treatment settings may maximise individual autonomy and promote holistic recovery pathways.

Nearly 25% of people with intellectual disability (PwID) have epilepsy compared to 1% of the UK general population. PwID are commonly excluded from research, eventually affecting their care. Understanding seizures in PwID is particularly challenging because of reliance on subjective external observation and poor objective validation. Remote electroencephalography (EEG) monitoring could capture objective data, but particular challenges and implementation strategies for this population need to be understood.

This co-production aimed to explore the accessibility and potential impact of a remote, long-term EEG tool (UnEEG 24/7 SubQ) for PwID and epilepsy.

We conducted six, 2-hour long workshops; three with people with mild intellectual disability and three with families/carers of people with moderate–profound intellectual disability. Brief presentations, easy read information and model demonstrations were used to explain the problem and device. A semi-structured guide developed by a communication specialist and art-based techniques facilitated discussion with PwID. For family/carers, active listening was employed. All conversations were recorded and transcribed. Artificial intelligence-based coding and thematic analysis (ATLAS.ti and ChatGPT) were synthesised with manual theming to generate insights.

Co-production included four PwID, five family members and seven care professionals. Three main themes were identified: (1) perceived benefits for improving seizure understanding, informing care and reducing family and carer responsibility to accurately identify seizures; (2) the device was feasible for some PwID but not all; and (3) appropriate person-centred communication is essential for all stakeholders to reduce concerns.

The workshops identified key benefits and implementing barriers to SubQ in PwID.

Glucuronic acid (GlcA) is crucial in the glucuronidation pathway, facilitating the metabolism and elimination of various substances and drugs. Recent studies have noted elevated GlcA levels in patients with schizophrenia (SCZ) compared with healthy individuals. However, it remains unclear whether this elevation contributes to SCZ pathophysiology or results from medication effects.

This study investigated the relationship between peripheral GlcA levels and clinical characteristics in patients with SCZ and assess whether these associations persist independently of psychotropic medication effects to provide insight into the potential role of GlcA in the pathophysiology of SCZ.

Plasma GlcA levels were analysed in 218 patients with SCZ, examining their association with clinical features. The correlation between GlcA levels and symptom severity, assessed using the Positive and Negative Syndrome Scale (PANSS), was analysed in 35 patients. In addition, multiple regression analysis was conducted to adjust for age and psychotropic medication effects.

Significant correlations were observed between GlcA levels and PANSS scores for negative symptoms, general psychopathology and total scores. After adjustment for age and psychotropic medications, significant correlations between GlcA levels and PANSS scores persisted for negative symptoms (adjusted β [95% CI], 13.926 [2.369, 25.483]) and general psychopathology (adjusted β [95% CI], 19.437 [3.884, 34.990]), while the total score was no longer significant (adjusted β [95% CI], 34.054 [–0.517, 68.626]).

Elevated GlcA levels in patients with SCZ are associated with specific symptom severity irrespective of the medication dose, suggesting a potential role of GlcA in SCZ pathophysiology.

Music therapy is a commonly used intervention added to usual care for psychiatric disorders.

We review the evidence for music therapy and assess its efficacy as an adjunct therapy across psychiatric disorders.

A systematic literature search was conducted in four scientific databases to identify relevant meta-analyses. Articles were assessed with the AMSTAR-2 tool. The results of the high-quality articles were recalculated with the data from the primary studies. We decided to add the results of the lower-rated articles, using a narrative approach. We pooled the primary studies and calculated standardised mean differences (SMD) for the transdiagnostic outcomes of depression, anxiety and quality of life. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the level of evidence.

Meta-analyses were available for autism, dementia, depression, insomnia, schizophrenia and substance use disorders. We identified 40 relevant articles. One article per domain was identified as high quality. Music therapy added to treatment as usual showed therapeutic value in each disorder. The transdiagnostic results showed a positive effect of music therapy on depression (SMD = 0.57, 95% CI 0.36–0.78), anxiety (SMD = 0.47, 95% CI 0.27–0.66) and quality of life (SMD = 0.47, 95% CI 0.24–0.71). However, these effects were not maintained at follow-up, and all results were based on low or very low evidence.

Music therapy shows promising potential as an adjunctive treatment for psychiatric disorders, but methodological weaknesses and variability limit the evidence. More high-quality, well-powered studies are needed to reliably confirm its effect size.

Anxiety disorders are among the most common mental disorders worldwide, and most previous studies have focused solely on alcohol drinking or tobacco smoking as risk factors for anxiety.

This study investigated the associations of alcohol drinking and tobacco smoking with anxiety.

The data of 30 836 individuals in the Taiwan Biobank were retrieved and analysed in our study. To investigate the associations of tobacco and alcohol use with anxiety, we analysed Patient Health Questionnaire 4 (specifically scores for the first two questions assessing generalised anxiety disorder) results of the included participants and data on their tobacco and alcohol use, and other covariates.

Participants who used only tobacco and those using both tobacco and alcohol were more likely to experience anxiety than were those who did not use tobacco or alcohol. Among men, the use of alcohol and/or tobacco was associated with a significantly higher risk of anxiety. Among women, the use of both alcohol and tobacco was associated with a significantly higher risk of anxiety. Older age was associated with a lower risk of anxiety.

Tobacco and alcohol use significantly influence the risk of anxiety, particularly in men, and older age also influences this risk. The associations of anxiety with tobacco and alcohol use in women may change because of the increasing prevalence of their use among women in Taiwan in recent years.

Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.

To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.

This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.

The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1–24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4–35.1). The most prevalent disorders were obsessive–compulsive disorder (8.2%, 95% CI 5.7–11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7–8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).

Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.

Clozapine-induced gastrointestinal hypomotility (CIGH) can cause constipation, which may progress to ileus, intestinal perforation and other life-threatening conditions. There were at least 527 unique cases of harmful CIGH (172 deaths) assessed by strict criteria in the UK, 1992–2017.

To assess the impact of strengthened warnings about the risks of CIGH, such as those issued by the UK Medicines and Healthcare products Regulatory Agency (MHRA) (2017) and the US Food and Drug Administration (2020), on reports of harmful CIGH in the UK.

We audited UK MHRA Yellow Card reports recorded as clozapine-related gastrointestinal disorders, 2018–end 2022.

Of 335 unique reports (36 fatal, 26 male) that met initial CIGH criteria, there were 129 (22 fatal, 18 male) that met the final CIGH inclusion criteria. Reports of non-fatal CIGH (final criteria) averaged 26 per year (15 in 2022). Deaths averaged four per year (two in 2022). Where data were available the greatest proportion of deaths occurred after 10–14 years of clozapine treatment.

Publicity aimed at raising awareness of the problem posed by CIGH has been associated with a reduction in harmful CIGH as reported to the UK MHRA since 2017. Continued vigilance is needed to reduce risk. Stopping smoking may pose a particular risk and should be monitored carefully.

The ICD-11 introduced a new diagnosis of complex post-traumatic stress disorder (CPTSD) defined by disturbances in self-organisation in addition to traditional post-traumatic stress disorder symptoms. The International Trauma Questionnaire (ITQ) is the established measure of this construct and has been validated for use in a variety of populations and languages; however, evidence for the measure's use in Latin America is limited.

This study sought to validate the factor structure of the Latin American Spanish version of the ITQ in a trauma-exposed sample in Colombia.

Confirmatory factor analysis was used to assess a range of factor models validated previously, including first- and second-order factor models.

Assessment of fit indices demonstrated that a correlated six-factor model comprised of re-experiencing, avoidance, sense of threat, affect dysregulation, negative self-concept and disturbed relationships provided the best fit for these data. Factor loadings for this model were found to be high and statistically significant.

Results concur with prior research validating the use of alternative language versions of the ITQ internationally, and with the theoretical underpinnings of the CPTSD diagnostic category. The ITQ is therefore a valid measure of CPTSD in this Latin American sample. Further validation research is needed in clinical populations in this region.

Little is known about the prevalence of post-traumatic stress disorder (PTSD) in emerging adults living with HIV in low-income countries.

Determine prevalence of trauma exposure, prevalence of probable PTSD and conditional prevalence of probable PTSD for different traumatic events; and better understand the experiences of individuals with HIV and PTSD.

This mixed method study used secondary data from a cross-sectional survey of people (N = 222) aged 18 to 29 living with HIV in Zimbabwe and primary qualitative data collection. The PTSD Checklist for DSM-5 (PCL-5) and the Life Events Checklist for DSM-5 (LEC-5) were used to measure PTSD and exposure to traumatic events, both translated to Shona. In-depth interviews (n = 8) with participants who met the criteria for probable PTSD were analysed using thematic analysis.

In all, 68.3% [95% CI (61.4–74.1)] of participants reported exposure to at least one traumatic event. The observed prevalence of probable PTSD was 8.6% [95% CI (5.2–13.0)], most observed following exposure to fire or explosion 29.0% [95% CI (13.0–45.0)] and sexual assault 27.8% [95% CI (7.2–48.7)]. Probable PTSD was also more prevalent following multiple exposure to trauma; four and six events, N = 4 (21%) [95% CI (5.1–8.8)] each, two and three events N = 3 (15.7%) [95% CI (5.9–9.2)] each, and five events N = 1 (5.4%) [95% CI (7.5–9.6)]. Qualitative results indicated that HIV stigma exacerbated psychological distress from trauma.

Despite trauma exposure being common, prevalence of probable PTSD was not high, but was higher in those with multiple exposures. Participants described coping strategies, including social support and religious thinking.

In-patient mental health rehabilitation services provide specialist treatment to people with complex psychosis. On average, rehabilitation admissions last around a year and usually follow several years of recurrent and often lengthy psychiatric hospital admissions.

To compare in-patient service use before and after an in-patient rehabilitation admission, using electronic patient healthcare records in one National Health Service Trust in London.

We carried out a retrospective cohort study comprised of individuals with an in-patient rehabilitation admission lasting ≥84 days between 1 January 2010 and 30 April 2019, with at least ≥365 days of records available before and after their rehabilitation admission. We used negative binomial regression models to compare the number of in-patient days before and after the rehabilitation admission.

A total of 172 individuals met our eligibility criteria. The median percentage of days spent as an in-patient before the rehabilitation admission was 29% (interquartile range 18–52%), and 8% (interquartile range 0–31%) after the admission. The regression model adjusted for potential confounder variables produced an incidence rate ratio of 0.520 (95% CI 0.367–0.737).

The rate of in-patient service use was halved in the period after an in-patient rehabilitation admission compared with the period before. This suggests that in-patient rehabilitation is a clinical and cost-effective intervention in the treatment and support of people with complex psychosis.

Preliminary evidence suggests that a ketogenic diet may be effective for bipolar disorder.

To assess the impact of a ketogenic diet in bipolar disorder on clinical, metabolic and magnetic resonance spectroscopy outcomes.

Euthymic individuals with bipolar disorder (N = 27) were recruited to a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Clinical, metabolic and MRS measures were assessed before and after the intervention.

Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).

These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.