One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited.

To enumerate risk factors associated with constipation in this population.

A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation.

Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender.

People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.

After the rapid implementation of digital health services during the COVID-19 pandemic, a paucity of research exists about the suitability of remote consulting in people with intellectual disabilities and their carers, particularly for neuropsychiatric reviews.

This study examines when remote neuropsychiatric routine consulting is suitable for this population.

A survey was conducted of people with intellectual disabilities and their carers, examining their preference between face-to-face and video consultations for ongoing neuropsychiatric reviews within a rural countywide intellectual disability service in Cornwall, England (population: 538 000). The survey was sent to all adults with intellectual disabilities open to the service on 30 July 2022, closing on 30 September 2022. Participants were asked to provide responses on 11 items predesigned and co-produced between clinicians and experts by experience. The entire service caseload of people had White ethnicity, reflecting the ethnic demographics of Cornwall. Responses received without consent were excluded from the study dataset.

Of 271 eligible participants, 119 responses were received, 104 of whom consented to having their anonymised data used for research analysis. There were no significant differences between preferences and age and gender variables. There was no statistically significant difference regarding preference for the reintroduction of face-to-face appointments (52.0%) compared with video consultations (48.0%). Travel distance (>10 miles) to the clinical setting was important but did not outweigh benefits for those preferring a face-to-face appointment.

This study offers insights into the factors that influence preferences about what type of neuropsychiatric appointment is most suitable for people with intellectual disabilities.

Suicide rates in adolescents with major depressive disorder (MDD) change with age and gender. Early adulthood is an important transitional stage between late adolescence and adulthood, in which an individual's mind gradually matures. However, there are fewer studies on prevalence and variables linked to the suicide attempts of young adults with MDD.

To explore gender differences in the prevalence and risk factors associated with suicide attempts in young adults with first-episode drug-naive MDD.

The Hamilton Rating Scale for Depression (HRSD), Hamilton Rating Scale for Anxiety (HRSA) and Positive Subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess depression, anxiety and psychotic symptoms respectively and various biochemical indicators were assessed.

Among 293 young adults with first-episode drug-naive MDD, the prevalence of suicide attempts was 15.45% (19/123) for males and 14.12% (24/170) for females. Males with suicide attempts had higher levels of thyroid-stimulating hormone (TSH) and higher PANSS Positive Subscale scores, whereas females with suicide attempts had higher TSH, serum total cholesterol, fasting blood glucose and diastolic blood pressure levels and higher scores on the HRSD, HRSA, PANSS Positive Subscale (all Bonferroni corrected P < 0.05). In males, PANSS Positive Subscale score (B = 0.17, P = 0.03, OR = 1.19, 95% CI 1.02–1.38) was a risk factor for suicide attempts.

There were significant gender differences in the risk factors for suicide attempts in young adults with first-episode drug-naive MDD.

The COVID-19 pandemic negatively affected students’ mental health, increasing pre-existing psychosocial vulnerabilities. University students worldwide have presented differences in their mental health status; however, cross-country studies comparing students’ mental health during the pandemic are lacking.

To investigate potential differences between university students from Brazil and those from Germany with respect to (a) depressive symptoms and alcohol and drug consumption, (b) social and emotional aspects (loneliness, self-efficacy, perceived stress, social support and resilience) and (c) attitudes towards vaccination.

Two online cross-sectional studies were conducted with university students during the COVID-19 pandemic in Brazil (November 2021 to March 2022) and in Germany (April to May 2022). Depressive symptoms, alcohol consumption, loneliness, self-efficacy, perceived stress, social support, resilience, sociodemographic information and attitudes towards vaccination were assessed. Data were analysed using univariate and bivariate models.

The total sample comprised N = 7911 university students, with n = 2437 from Brazil and n = 5474 from Germany. Brazilian students presented significantly more depressive symptoms and suicidal thoughts, higher levels of perceived stress, higher frequency of drug or substance consumption, and lower levels of perceived social support and resilience than German students, whereas German students presented higher levels of loneliness than Brazilian students. A more favourable opinion towards vaccinations in general was found among Brazilian students compared with German students.

In both countries, low-threshold (online) counselling targeting university students is needed. The differences between the samples could indicate country and/or cultural differences which justify further research in this area.

Patients walking out of ED during mental health crises are commonly encountered in Liaison Psychiatry. Responsibility for high-risk or vulnerable walkouts had predominantly fallen on the police due to resource pressures in health and social care services. In 2023, London's Metropolitan Police announced a new partnership model, the “Right Care Right Person” (RCRP) approach. This supported the withdrawal of police involvement in mental health crises and allowed health and social care agencies who have the expertise and authority to act, to fulfil their role. This QI project aimed to understand the extent of police involvement in ED walkouts prior to the implementation of RCRP, introduce a new protocol for managing these situations, and evaluate its impact in terms of resource use and patient outcomes.

The Trust's incident reporting system was used to identify mental health-related ED walkouts between May–August 2023, prior to the introduction of RCRP. Patients’ notes were reviewed to identify immediate actions taken following the walkout, including whether the police were involved, what action they took and patient outcomes. This was used to create a new Trust-wide ED walkout protocol, incorporating the Metropolitan Police's risk assessment tools. This was disseminated to frontline staff. A repeat analysis took place in November–December 2023, post-RCRP, to analyse how ED walkouts were being managed, and by which service. Furthermore, the analysis explored the nature of any patient harm which occurred following the incidents.

We found 29 walkouts from A&E between May–August 2023 (pre-RCRP), compared with 35 between November–December 2023 (post-RCRP). Police were called in 79% of cases pre-RCRP and 74% post-RCRP. Pre-RCRP police was not involved in 41% of cases, and in 81% of cases post-RCRP. Mental health services made first contact following walkout in 41% of cases pre-RCRP, and in 46% post-RCRP. LAS made contact in 29% of cases post-RCRP. Post-RCRP 26% of patients who walked out were admitted to a Mental Health Trust within 7 days. 20 patients had their treatment delayed, 5 suffered from neglect. 3 patient walkouts resulted in harm to others, and 2 resulted in self-harm.

As expected, police responded to fewer walkout reports, and our data shows this gap has been filled by other services. The Trust's risk assessment-based approach to managing walkouts has shown promising results. The next stage of the project will focus on developing local protocols for the identification and management of patients at high risk of walkout.

Lewy body dementia (LBD) is a prevalent yet frequently underdiagnosed form of dementia, accounting for up to 15% of all dementia cases.

This study aims to increase awareness and advocacy for LBD by gathering and critically assessing the economic evidence, including the cost of illness and cost-effectiveness of interventions for managing LBD.

A systematic literature review was undertaken with EMBASE, Medline, CINAHL, PsycINFO, NHS Economic Evaluation Database and EconLit. This search was supplemented by grey literature on Google Scholar and reviewing the reference lists of identified studies. The papers included in the review were published between 2008 and 2023, and involved participants with LBD (dementia with Lewy bodies or Parkinson's disease dementia), which either addressed the cost of illness or conducted an economic evaluation.

Thirteen papers were included, comprising ten cost-of-illness studies and three economic evaluations. The cost of LBD tends to be higher than that of other forms of dementia, such as Alzheimer's disease, and these costs escalate more steeply as the disease progresses. These cost differences may not be solely influenced by the subtype of dementia, but possibly also by patient characteristics like physical and cognitive abilities. Cost-effectiveness of potential interventions for LBD is limited.

Despite numerous drug trials and other interventions for dementia, very few have targeted LBD, let alone explored the cost-effectiveness of such therapies for LBD. This disparity highlights the urgent need for cost-effective strategies and interventions targeting LBD. We propose the establishment of universally accepted standards for LBD research.

Given the high rates of common mental disorders and limited resources, task-shifting psychosocial interventions are needed to provide adequate care. One such intervention developed by the World Health Organization is Problem Management Plus (PM+).

This review maps the evidence regarding the extent of application and usefulness of the PM+ intervention, i.e. adaptability, feasibility, effectiveness and scalability, since it was introduced in 2016.

We conducted a scoping review of seven literature databases and grey literature from January 2015 to February 2024, to identify peer-reviewed and grey literature on PM+ around the world.

Out of 6739 potential records, 42 met the inclusion criteria. About 60% of the included studies were from low- and middle-income countries. Findings from pilot/feasibility trials demonstrated that PM+ is feasible, acceptable and safe. Results from definitive randomised controlled trials at short-term follow-up also suggested that PM+ is effective, with overall moderate-to-large effect sizes, in improving symptoms of common mental health problems. Although PM+ was more effective in reducing symptoms of common mental disorders, it was found to be costlier compared to usual care in the only study that evaluated its cost-effectiveness.

Our findings indicate that PM+, in its individual and group formats, can be adapted and effectively delivered by trained helpers to target a wide range of common mental health concerns. More effectiveness and implementation evidence is required to understand the long-term impact of PM+, its cost-effectiveness and scalability, and moderators of treatment outcomes such as gender and delivery formats.

The adverse effects of COVID-19 and the associated restrictions on eating disorder populations have been discussed in recent literature. However, little is known about the presentation of cases with avoidant/restrictive food intake disorder (ARFID) during this period.

To explore the extent of the literature on the presentation of ARFID, and ARFID-like cases, during the COVID-19 pandemic.

Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE (Ovid) and Medline (Ovid) were searched for publications between March 2020 and May 2023. Google Scholar and reference lists were hand searched. At least two reviewers independently screened each paper. Narrative synthesis was used.

Seven papers were included: four case reports and three cohort studies (total ARFID sample of 46). Included papers were assessed as having high (n = 3) or moderate (n = 4) quality. Findings did not suggest an increase in ARFID cases during the COVID-19 pandemic, although it is unclear if this is because of a lack of impact or underrecognition of ARFID. A need for a multidisciplinary approach to differentiate between ARFID and organic causes of ARFID-like presentations (e.g. gastrointestinal effects of COVID-19) was highlighted.

Publications specifically pertaining to ARFID presentations during the COVID-19 pandemic have been few. Papers found have been of small sample sizes and lack subanalyses for ARFID within broader eating disorder samples. Continued surveillance is needed to evaluate any COVID-19-specific effects on the development, identification, treatment and outcomes of ARFID.

Existing self-rated depression measurement tools possess a range of psychometric drawbacks, spanning a range of validity and reliability constructs. The gold standard self-rated depression scales contain several variable items that are often non-specific, require respondents to have a certain level of language understanding and limited scoring options resulting in low sensitivity. The Maudsley three-item visual analogue scale (M3VAS) was developed to address these challenges.

This study aimed to translate the M3VAS into Chinese and test its reliability and validity.

First, both M3VAS scales (assessing current severity and change in severity) were translated according to a standardised protocol to finalise the Chinese version. Reliability and validity were then examined among 550 young people with moderate to severe depression (patient health questionnaire-9 (PHQ-9) score ≥15) in a cross-sectional opportunistic questionnaire survey.

The content validity of each item (six items, across both scales) ranged from 0.83 to 1.00. Exploratory factor analysis denoted a total of two common factors, with a variance contribution rate of 64.34%. The total score correlated positively with the PHQ-9 total score (r = 0.241, P < 0.01). The Chinese version of the M3VAS had good reliability and validity values, and the confirmatory factor model fit well.

The psychometric properties of the Chinese version of the M3VAS suggest that this scale can feasibly evaluate depression among young people in China.

The intensive psychiatric care unit (IPCU) is a 10-bedded unit which houses some of the most unwell psychiatric inpatients, generally those with psychosis and mania who require enhanced care and restriction. Admissions can be long and involve high levels of clinical complexity. This project identified the need for clear communication at the point of discharge with regards to rationale for decision making, mental health act status, risk and outstanding issues. The aim was to develop and test a tool for communicating this: the step-down summary.

Three plan, do, study, act cycles were run. The first involved creating a draft proforma and testing this with 3 complex patients, gathering qualitative feedback from receiving clinicians. The proforma was then improved and a full-scale trial including all patients with stays of 2 weeks or more was conducted, a total of 18 patients. Data were collated on the timing of summary completion and further improvements to the proforma were made based on consultant feedback. Finally, a third cycle was run to establish whether the new process was sustainable between rotating trainees.

Initial feedback was positive with clinicians highlighting that the summaries saved time reading extensive notes, clearly identified outstanding tasks, and helped with final discharge document writing. It became clear that there was a need to agree a cut-off time of how long a patient should be in IPCU to merit a stepdown summary. Of the 18 patients who met this cut-off in the 2nd cycle all had a stepdown summary at the point of transfer with 89% of these fully complete before their next clinical review. During the 3rd cycle, there were 19 relevant patients only one of whom did not have a summary, due to their transfer coinciding with trainee leave. Feedback remained positive, highlighting that the summaries avoided duplication of work.

Overall, the use of stepdown summaries proved useful to receiving clinicians in both communicating important information and in saving further time when later creating final discharge documents. It was sustainable between trainees, however there remained an issue with these not being produced during trainee leave. It may be useful to consider alternate clinicians who can support with the production of summaries to minimise this as well as measuring more clear clinical outcomes, such as the repetition of investigations. This would support an expansion to other UK IPCUs.

Children and young people (CYP) with attention deficit hyperactive disorder (ADHD) under Brent Child and Adolescent Mental Health Services (CAMHS) experience long waiting times before treatment with medication is initiated: on average 3 months. Therefore, the aims were firstly, to create an electronic platform (e-platform) to educate parents about ADHD medication and facilitate its initiation in Brent CAMHS. The e-platform replaced the previous method of medication initiation which was typically delivered to a group over Zoom. Secondly, to reduce time-to-treatment initiation (TTI) by January 2024. Thirdly, to increase the proportion of patients with ADHD who were initiated on medication (when appropriate) by the same date.

The content from neurodevelopmental clinicians counselling parents about ADHD medication was transcribed. Individual transcripts were collated into a master transcript to standardise the information delivered to parents. Medication initiation psychoeducation videos were created using the master transcript and a videographer and editor, in collaboration with the Trust's Director of Communications and Web Development Team. The videos were integrated electronically with a question-and-answer section, a useful websites section and a medication decision section to construct an e-platform, which was embedded in the Brent CAMHS website.

Following the QI model-of-improvement, objective clinical measures included TTI, the proportion of CYP initiated on medication, and total clinical and administrative time saved. User-reported outcomes were measured using a pre- and post-intervention questionnaire combining Likert scale and free-response items.

TTI reduced by 37% from 92 days (Zoom) to 58 days (e-platform). The proportion of CYP initiated on medication increased from 64% (Zoom) to 72% (e-platform). Over a 2-month period, 9 hours of clinician time was saved. Based on 20 respondents, overall user satisfaction increased from 4.13/5 (Zoom) to 4.71/5 (e-platform). Qualitative feedback revealed that users found the e-platform ‘easy to understand’, ‘easy to access, quick and useful’ and ‘provided clear explanations’.

The results indicate the positive impact of the e-platform initiative which can be derived from both clinical and user-reported outcomes. By integrating standardized educational content, user-friendly features and streamlined processes, the e-platform empowers parents with knowledge, enhances communication between families and the neurodevelopmental team, and ultimately expedites ADHD medication initiation and saves clinical time. Regional spread has commenced, and the authors are engaged in discussions with other CAMHS to facilitate this further.

Suicide-related internet use (SRIU), defined as internet use related to one's own feelings of suicide, can be both a risk and protective factor, especially for isolated individuals. Despite its influence on suicidality, clinicians face challenges in assessing SRIU because of the private nature of internet usage. Current recommendations on enquiring about SRIU in a clinical setting concern mostly young people.

To address the gap in understanding SRIU among patients of all ages, this study aims to explore mental health clinicians’ experiences, attitudes and beliefs regarding enquiring about SRIU, as well as the risks and benefits it presents in the assessment and management of patients. Finally, the study aims to establish the role SRIU potentially plays in the assessment and management of patients.

Twelve clinicians practising at secondary mental health services in England participated in interviews. Thematic analyses were used for data interpretation.

Clinicians who participated in interviews rarely initiate discussions on SRIU with their patients despite considering this an important factor in suicidality. Age of both patients and clinicians has the potential to influence enquiry into SRIU. Clinicians recognise the potential benefits of patients finding supportive online communities but also express concerns about harmful and low-quality online content related to suicide.

Integrating SRIU enquiry into standard clinical practice, regardless of the patient's age, is an important step towards comprehensive patient care. Broader training for clinicians on enquiring about online behaviours is essential to mitigate potential risks and harness the benefits of SRIU in mental health patients.

The ‘at-risk mental state’ (ARMS) for psychosis has been critiqued for its limited prognostic ability and identification of a limited proportion of those who will develop a first episode of psychosis (FEP). Broadening the search for high-risk groups is key to improving population-level ascertainment of psychosis risk.

To explore risk enrichment in diagnostic, demographic and socio-functional domains among individuals referred to an early intervention in psychosis (EIP) service not meeting ARMS or FEP criteria.

A retrospective file review of 16 years of referrals to a tertiary EIP service in Ireland was undertaken. Diagnostic outcomes from standardised assessments (Structured Clinical Interview for DSM), demographic (age, gender, family history, nationality) and socio-occupational (relationship status, living status, working status) variables were compiled for those not meeting criteria. These were compared with individuals diagnosed with an FEP in the same period.

From 2005 to 2021 inclusive, of 2025 index assessments, 27.6% (n = 558) did not meet either FEP or ARMS criteria, which is notably higher than the 5.4% (n = 110) meeting ARMS criteria. This group had high psychiatric morbidity, with 65.4% meeting criteria for at least one DSM Axis I disorder. Depressive, anxiety and substance use disorders predominated. Their functional markers were poor, and comparable to the FEP cohort.

This group is enriched for psychosis risk factors. They are a larger group than those meeting ARMS criteria, a finding that may reflect EIP service configuration. They may be an important focus for further study in the search for at-risk populations beyond the current ARMS model.

Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events.

This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure.

The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3–4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode).

Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3–4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors.

Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.

Borderline personality disorder (BPD) is a severe psychiatric disorder conceptualised as a disorder of emotion regulation. Emotion regulation has been linked to a frontolimbic network comprising the dorsolateral prefrontal cortex and the amygdala, which apparently synchronises its activity via oscillatory coupling in the theta frequency range.

To analyse whether there are distinct differences in theta oscillatory coupling in frontal brain regions between individuals with BPD and matched controls during emotion regulation by cognitive reappraisal.

Electroencephalogram (EEG) recordings were performed in 25 women diagnosed with BPD and 25 matched controls during a cognitive reappraisal task in which participants were instructed to downregulate negative emotions evoked by aversive visual stimuli. Between- and within-group time–frequency analyses were conducted to analyse regulation-associated theta activity (3.5–8.5 Hz).

Oscillatory theta activity differed between the participants with BPD and matched controls during cognitive reappraisal. Regulation-associated theta increases were lower in frontal regions in the BPD cohort compared with matched controls. Functional connectivity analysis for regulation-associated changes in the theta frequency band revealed a lower multivariate interaction measure (MIM) increase in frontal brain regions in persons with BPD compared with matched controls.

Our findings support the notion of alterations in a frontal theta network in BPD, which may be underlying core symptoms of the disorder such as deficits in emotion regulation. The results add to the growing body of evidence for altered oscillatory brain dynamics in psychiatric populations, which might be investigated as individualised treatment targets using non-invasive stimulation methods.

The respect of a patient's autonomy and choices is one of the cornerstones of good psychiatric care. Key to this is ensuring the timely and thorough assessment of a patient's capacity to consent to admission and treatment once in contact with mental health services.

The aim of this quality improvement project was to optimise the Trustwide completion of capacity assessments for all newly admitted patients within 24 hours of admission at South West London and St Georges Mental Health NHS Trust. Our goal was for 100% completion of the Trust's Brief Capacity and Consent (BCAC) form by July 2023.

We obtained a list of all new admissions to inpatient wards across the Trust's three hospital sites between 1–14 February 2023. A retrospective audit was then undertaken to establish the baseline BCAC completion rate. Following this a quality improvement strategy was created using the Plan-Do-Study-Act (PDSA) model of creating change. A series of three interventions were implemented and subsequently analysed using the PDSA model. These included creating an admission checklist and placing this in doctors' on-call rooms across the trust, distributing the checklist to wards across hospital sites and service lines and lastly, sending out reminder emails to doctors at the Trust. A re-audit was completed after each intervention.

The baseline BCAC completion rate was 60.5% (n = 76) in February 2023. This increased to 63.75% (n = 80) following the creation of the admission checklist. Distributing the checklist throughout the Trust resulted in a further improvement to 76.5% (n = 81). In July 2023, the final data collected 6 weeks post reminder email demonstrated a BCAC completion rate of 75% (n = 68).

Through the application of the PDSA model, alongside focused interventions aimed at raising Trust-wide awareness of the BCAC form, we managed to obtain a 14.5% increase in BCAC completion rates between 13 February and 31 July 2023. Whilst not achieving the initial goal of 100% completion, this quality improvement project helped to bring a renewed focus to the timely completion of capacity and consent assessments at the Trust. Moving forward, we hope to build on this improvement by exploring additional strategies to reach a 100% BCAC completion rate, thereby promoting patient safety and autonomy.