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“You don't have to be a survivor of abuse to be worried about smears”: Cervical screening experience of forensic inpatientsPurpose: Childhood trauma, especially sexual abuse is linked to higher health risks including cervical cancer. Forensic inpatients often have complex trauma histories placing them at increased risk of cervical cancer. The uptake of screening in patient forensic inpatient services is sub-optimal, although little is known about their experiences. This study focuses on the cervical screening experiences of people nursed in forensic service inpatients. This group present with unique health challenges and are an under-researched and vulnerable population with a higher risk of cervical cancerMethods: A qualitative study used purposive sampling to recruit eight participants from two NHS secure forensic services. All participants were inpatients detained under the Mental Health Act (1983, revised 2007) in Women’s pathways. Data was collected through semi-structured interviews and was analysed using Interpretive Phenomenological Analysis.Results: Two superordinate themes were developed: (1) Internal Conflict linked past experiences to screening beliefs, and (2) Manufacturing Control showed how individuals employed strategies to feel psychological ready for screening.Conclusions: This study aimed to understand the facilitators and barriers to cervical screening among forensic in-patients and identify ways to improve their experiences to increase engagement in screening. The results identify how participants experiences prior to and within forensic services impact cervical screening uptake. Forensic inpatients require psychological readiness and feelings of control and safety to engage in cervical screening to minimise examinations reminding or re-enacting their trauma history. Systemic factors can enhance safety perceptions and encourage screening in this group.
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Prevalence of emotional and binge eating among patients with obesity attending a specialist weight management service for bariatric surgery in the United KingdomBACKGROUND: Emotional eating (EE) is a tendency to consume food in response to positive or negative emotions, leading to obesity and an increased Body Mass Index (BMI). Evidence supports the positive association between EE and binge eating disorder (BED), but little is known about its prevalence among patients referred for bariatric surgery and the psychological characteristics of this patient population. We aim to examine (i) the prevalence of binge eating and EE, (ii) its association with the prevalence of anxiety, depression, diabetes and hypertension and (iii) the correlation between anxiety and depression with emotional and binge eating behaviours among patients attending a regional bariatric service in the UK. METHOD: A cross-sectional case file design involving 285 participants (mean age = 43.88 ± 11.5, female (80.7%) and male (19.3%)) was used. Outcome measures included body weight, BMI, the Weight Loss Readiness (WLR) Questionnaire, Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorders Identification Test- Consumption (AUDIT-C). RESULTS: Within this patient group, the prevalence of binge eating and EE were 28.8% and 22.1% respectively. Among these, 19.3% had diabetes mellitus, 24.8% hypertension, 21% harmful alcohol use, 65% had high anxiety score and 77% high depression scores. Most correlations between body weight and variables like AUDIT-C, GAD-7, PHQ-9 scores and WLR scores for hunger, binge eating and EE were not significant. A positive association was observed between depression and anxiety with binge eating, and EE behaviours. CONCLUSION: Patients awaiting bariatric surgery have a wide range of mental and physical health comorbidities, with evidence of positive associations between higher depression and anxiety levels with abnormal eating behaviours. These findings highlight the need for screening for comorbidities in this patient population to optimise patient outcomes postbariatric surgery.
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Patient and carer feedback and engagement with ECHOMANTRA, a digital guided intervention for anorexia nervosaOBJECTIVE: We developed ECHOMANTRA, a digital guided intervention for patients with anorexia nervosa and their carers to provide support during transition from inpatient care to community settings. This study reports on participants' engagement with, and feedback of, ECHOMANTRA. METHOD: Patients and carers (N = 184 dyads) were given access to ECHOMANTRA for 12 months. The intervention included online groups, a workbook and recovery-oriented videoclips. Satisfactory engagement was defined as attendance of a minimum of four online groups by each dyad. Participants received an Intervention Feedback Form to measure frequency of use and provide feedback of the intervention. Those who did not meet the engagement criterion were asked to complete an Obstacles to Engagement Form. RESULTS: 19% of the sample reached the engagement criterion. Seventy-six patients and 60 carers completed the Intervention Feedback Form. Of those, approximately 60% reported using at least a quarter of the workbook and videoclips. Overall, participants found the materials useful and easy to access (median = 3 on a scale 1-5). Obstacles to engagement (35 patients and 14 carers) included lack of time due to caring responsibilities, treatment, work/school commitments. CONCLUSION: A more personalised form of support may be needed to enhance motivation and ability to change following inpatient care.
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Stepping into day treatment approach versus inpatient treatment for adults with anorexia nervosa: the DAISIES RCTBACKGROUND: A substantial proportion of anorexia nervosa patients require intensive treatments, commonly inpatient or day-patient treatment. The relative merits of these treatments for adults with anorexia nervosa are unknown. Therefore, a trial investigating the clinical effectiveness and cost-effectiveness of inpatient treatment-as-usual versus a stepped-care day-patient approach in adults with anorexia nervosa (DAISIES) was commissioned. This trial terminated prematurely due to poor recruitment, mainly resulting from COVID-19's impact on service provision. OBJECTIVE: We describe the rationale, methods and available outcomes of the DAISIES trial. Reasons behind the trial's failure and implications for future research are investigated. DESIGN: A two-arm multicentre open-label parallel-group non-inferiority randomised controlled trial, evaluating the effectiveness, acceptability and cost-effectiveness of two intensive treatments for adults with severe anorexia nervosa. SETTING: Specialist eating-disorder services in the United Kingdom with inpatient and/or day-patient treatment facilities. PARTICIPANTS: Adults (age 17 +) with severe anorexia nervosa (body mass index ≤ 16 kg/m(2)) requiring intensive treatment and (optionally) their carers. Intended sample size: 386. INTERVENTIONS: Inpatient treatment-as-usual and a stepped-care day-patient treatment approach (with the option of initial inpatient treatment for medical stabilisation). MAIN OUTCOME MEASURES: The primary outcome was body mass index at 12 months post randomisation. Qualitative interviews conducted during the trial included semistructured interviews to investigate patients', families' and clinicians' views on treatments. RESULTS: During the 16-month recruitment period (November 2020 to March 2022), 53 patients were approached. Of these, 15 were enrolled and randomly allocated to the inpatient treatment-as-usual (n = 7) or day-patient treatment (n = 8) treatment arms. All participants were female with a mean (standard deviation) age of 24.8 (9.1) years and a mean (standard deviation) body mass index of 14.4 (1.6) kg/m(2). Patients' body mass indexes had increased similarly in both groups at 12 months. Participants perceived the stepped-care day-patient treatment approach to be more acceptable than inpatient treatment-as-usual. Qualitative interviews with patients, carers and clinicians suggested valued (e.g. multidisciplinary provision of care) and disliked (e.g. perceived over-focus on weight gain) aspects of treatment. Investigation of the reasons behind the trial's failure revealed strong treatment preferences among patients as the most common reason for non-participation, alongside the impact of COVID-19 on service provision. LIMITATIONS: The main trial questions could not be answered due to low participant numbers. CONCLUSIONS: No conclusions can be drawn concerning the clinical and cost-effectiveness of inpatient treatment-as-usual or stepped-care day-patient treatment. The day-patient treatment approach was perceived more positively by patients and carers. Service-related (e.g. reduced clinician time for research), patient-related (e.g. treatment preferences) and wider systemic factors (e.g. reduced service capacity and patient throughput nationally during COVID-19) seem to have contributed to the failure of the DAISIES trial. FUTURE WORK: Despite the trial's failure, the need to investigate the effectiveness and experience of intensive treatments of adult anorexia nervosa remains. Alternative trial designs incorporating patient preferences and investigating community-based intensive treatment options have potential to improve acceptability and recruitment. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number HTA 17/123/03.
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Improving the utility, safety, and ethical use of a passive mood-tracking app for people with bipolar disorder using coproduction: Qualitative focus group studyBACKGROUND: Coproduction with users of new digital technology, such as passive mood monitoring, is likely to improve its utility, safety, and successful implementation via improved design and consideration of how such technology fits with their daily lives. Mood-monitoring interventions are commonly used by people with bipolar disorder (BD) and have promising potential for digitization using novel technological methods. OBJECTIVE: This study aims to explore how a passive behavioral monitoring platform, Remote Assessment of Disease and Relapse, would meet the needs of people with BD by specifically considering purpose and function, diversity of need, personal preference, essential components and potential risks, and harms and mitigation strategies through an iterative coproduction process. METHODS: A total of 17 people with BD were recruited via national charities. We conducted 3 web-based focus groups as a part of an iterative coproduction process in line with responsible research and innovation principles and with consideration of clinical challenges associated with BD. Data were analyzed thematically. Results were cross-checked by someone with lived experience of BD. RESULTS: Focus groups were transcribed and analyzed using thematic analysis. Six themes were identified as follows: (1) the purpose of using the app, (2) desired features, (3) when to use the app, (4) risks of using the app, (5) sharing with family and friends, and (6) sharing with health care professionals. CONCLUSIONS: People with BD who are interested in using passive technology to monitor their mood wish to do so for a wide variety of purposes, identifying several preferences and potential risks. Principally, people with BD wished to use this novel technology to aid them in self-managing their BD with greater insight and a better understanding of potential triggers. We discuss key features that may aid this functionality and purpose, including crisis plans and sharing with others. Future development of passive mood-monitoring technologies should not assume that the involvement of formal mental health services is desired.
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Transcriptome-wide alternative splicing and transcript-level differential expression analysis of post-mortem lewy body dementia brainsLewy body dementias (LBD) are the second most common dementia. Several genes have been associated with LBD, but little is known about their contributions to LBD pathophysiology. Each gene may transcribe multiple RNA, and LBD brains have extensive RNA splicing dysregulation. Hence, we completed the first transcriptome-wide transcript-level differential expression analysis of post-mortem LBD brains for gaining more insights into LBD molecular pathology that are essential for facilitating discovery of novel therapeutic targets and biomarkers for LBD. We completed transcript-level quantification of next-generation RNA-sequencing data from post-mortem anterior cingulate (ACC) and dorsolateral prefrontal cortices (DLPFC) of people with pathology-verified LBD (LBD = 14; Controls = 7) using Salmon. We identified differentially expressed transcripts (DET) using edgeR and investigated their functional implications using DAVID. We performed transcriptome-wide alternative splicing analysis using DRIMseq. We identified 74 DET in ACC and 96 DET in DLPFC after Benjamini-Hochberg false discovery rate (FDR) correction (5%). There were 135 and 98 FDR-corrected alternatively spliced genes in ACC and DLPFC of LBD brains, respectively. Identified DET may contribute to LBD pathology by altering DNA repair, apoptosis, neuroplasticity, protein phosphorylation, and regulation of RNA transcription. We confirm widespread alternative splicing and absence of chronic neuroinflammation in LBD brains. Transcript-level differential expression analysis can reveal specific DET that cannot be detected by gene-level expression analyses. Therapeutic and diagnostic biomarker potential of identified DET, especially those from TMEM18, MICB, MPO, and GABRB3, warrant further investigation. Future LBD blood-based biomarker studies should prioritise measuring the identified DET in small extracellular vesicles.
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Identifying digital markers of attention-deficit/hyperactivity disorder (ADHD) in a remote monitoring setting: Prospective observational studyBACKGROUND: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)-base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. OBJECTIVE: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. METHODS: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. RESULTS: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). CONCLUSIONS: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes.
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"I want to get out … I've got a child at home": Intersubjectivity, reality disjunctures and distress in the care of people living with dementia in the acute hospitalThe pivotal role of language in achieving and maintaining intersubjectivity in interaction creates particular problems where one party has a medical condition affecting language use. Dementia can have significant impact on language comprehension, expression and memory; this creates challenges not only for people living with dementia (PLWD) but also those who care for them. In UK hospitals approximately 25% of beds are occupied by PLWD (Alzheimer's Society, 2009) and the need for improved care is widely acknowledged. One specific challenge is the issue of competing realities, where a PLWD may not be oriented to time or place, and may produce what appear to healthcare professionals (HCPs) to be inaccurate, untrue or even bizarre statements. As part of a wider UK-based study identifying ways to avoid, de-escalate or resolve distress for PLWD in the acute hospital setting, and prompted by their co-occurrence with distress, we used conversation analysis to examine interactions involving these 'reality disjunctures' (Pollner, 1975). We analysed 54 HCP/PLWD interactions collected across four acute wards in two large teaching hospitals. We found that responses to reality disjunctures fell into four categories across a continuum: challenging the competing reality expressed by the PLWD; diverting the interaction to an alternative aspect of reality that could be shared; finding a commonality in the PLWD's reality; and co-constructing the PLWD's reality. Our findings show similarities with Lindholm's (2015) analysis of 'confabulation' by a single PLWD in a day-care centre; however the range, distribution and detail of the practices differed in ways that reflected the contingencies of the acute care setting. Approaches in the middle of our continuum, which work to create some kind of shareable world or experience, are one way in which skilled staff support PLWD not only to manage distress, but also to maintain a social self rather than a subjective one. Identifying these approaches makes them available to others to improve patient care.
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The impact of child and adolescent inpatient psychiatric admissions out-of-area or to adult wards: A systematic reviewAims/Background Child and adolescent psychiatric inpatient admissions out-of-area or to adult wards are frequently discussed in the national media. No previous systematic reviews have investigated the impact of such admissions. Methods Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, PsycArticles, King's Fund, Google Scholar, The Health Foundation, Social Care Online, Cochrane Library, Royal College of Psychiatrists, Web of Science and Econ light databases were conducted alongside grey literature searches. All eligible studies investigating the impact of acute psychiatric inpatient admission out-of-area or to adult wards in children and adolescents were included. Risk of bias was assessed using an adapted version of the Hawker critical appraisal tool. Results 18 studies were included (4 reported on out-of-area admissions, 13 on adult ward admissions, 1 study reported on both). Study quality was variable. Out-of-area admission impacts included longer emergency department waits, higher travel costs for families, and were described as 'time-inefficient'. For studies of admissions of under-18s to adult psychiatric wards the most commonly reported impact was on length of stay. Opinions from staff and young people of these types of admissions were mostly negative. Conclusion Further studies looking at the full range of impacts of these admissions over the long term are needed.
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The cellular and extracellular proteomic signature of human dopaminergic neurons carrying the LRRK2 G2019S mutationBACKGROUND: Extracellular vesicles are easily accessible in various biofluids and allow the assessment of disease-related changes in the proteome. This has made them a promising target for biomarker studies, especially in the field of neurodegeneration where access to diseased tissue is very limited. Genetic variants in the LRRK2 gene have been linked to both familial and sporadic forms of Parkinson's disease. With LRRK2 inhibitors entering clinical trials, there is an unmet need for biomarkers that reflect LRRK2-specific pathology and target engagement. METHODS: In this study, we used induced pluripotent stem cells derived from a patient with Parkinson's disease carrying the LRRK2 G2019S mutation and an isogenic gene-corrected control to generate human dopaminergic neurons. We isolated extracellular vesicles and neuronal cell lysates and characterized their proteomic signature using data-independent acquisition proteomics. Then, we performed differential expression analysis to identify dysregulated proteins in the mutated line. We used Metascape and gene ontology enrichment analysis on the dysregulated proteomes to identify changes in associated functional networks. RESULTS: We identified 595 significantly differentially regulated proteins in extracellular vesicles and 3,205 in cell lysates. We visualized functionally relevant protein-protein interaction networks and identified key regulators within the dysregulated proteomes. Using gene ontology, we found a close association with biological processes relevant to neurodegeneration and Parkinson's disease. Finally, we focused on proteins that were dysregulated in both the extracellular and cellular proteomes. We provide a list of ten biomarker candidates that are functionally relevant to neurodegeneration and linked to LRRK2-associated pathology, for example, the sonic hedgehog signaling molecule, a protein that has tightly been linked to LRRK2-related disruption of cilia function. CONCLUSION: In conclusion, we characterized the cellular and extracellular proteome of dopaminergic neurons carrying the LRRK2 G2019S mutation and proposed an experimentally based list of biomarker candidates for future studies.
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Age-dependent phenotypes of cognitive impairment as sequelae of SARS-CoV-2 infectionCognitive changes associated with PASC may not be uniform across populations. We conducted individual-level pooled analyses and meta-analyses of cognitive assessments from eight prospective cohorts, comprising 2,105 patients and 1,432 controls from Argentina, Canada, Chile, Greece, India, Italy, Russia, and the UK. The meta-analysis found no differences by country of origin. The profile and severity of cognitive impairment varied by age, with mild attentional impairment observed in young and middle-aged adults, but memory, language, and executive function impairment in older adults. The risk of moderate to severe impairment doubled in older adults. Moderately severe or severe impairment was significantly associated with infection diagnoses (chi-square = 26.57, p ≤ 0.0001) and the severity of anosmia (chi-square = 31.81, p ≤ 0.0001). We found distinct age-related phenotypes of cognitive impairment in patients recovering from COVID-19. We identified the severity of acute illness and the presence of olfactory dysfunction as the primary predictors of dementia-like impairment in older adults.
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Children and young people with mental health concerns admitted to medical wardsNo abstract available
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Unified protocol vs mentalization-based therapy for adolescents with borderline personality disorder: A randomized controlled trialBACKGROUND: Despite several treatments, e.g., mentalization-based therapy (MBT) and Unified Protocol (UP), being adapted to treat adolescents with borderline personality disorder (BPD), there exists a dearth of literature regarding their relative efficacy. In this study modified forms of MBT and UP - MBT-A and UP-A respectively-were compared in their ability to reduce borderline symptoms in a sample of 91 Iranian adolescents (two-thirds female) with a BPD diagnosis. METHODS: Individuals randomly allocated to one of two treatment groups, MBT-A (N = 45) or UP-A (N = 46) were followed up across 36 months following treatment. A MIXED ANCOVA was applied to compare the effectiveness of these interventions in reducing severity of borderline symptoms (the primary outcome), impulsivity, self-harm, emotion dysregulation and anger (secondary outcomes). The trial was retrospectively registered at IRCT20231106059970N1. RESULTS: Both primary outcomes and secondary outcomes decreased significantly following both MBT-A and UP-A. In comparison with MBT-A, UP-A was more effective in reducing emotional dysregulation, but levels of remission declined progressively up to 36 months of follow-up following both treatments. CONCLUSIONS: UP-A appears to be more effective than MBT-A in reducing emotional dysregulation in adolescents with BPD, despite being a shorter and less intensive treatment. An important caveat is that the treatment induced changes were largely limited to the emotion dysregulation aspect of BPD; other aspects (interpersonal and identity disturbances) were largely unchanged by either treatment.
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Investigating neurometabolite changes in response to median nerve stimulationBACKGROUND: Rhythmic median nerve stimulation (MNS) at 10 Hz has been shown to cause a substantial reduction in tic frequency in individuals with Tourette syndrome. The mechanism of action is currently unknown but is hypothesized to involve entrainment of oscillations within the sensorimotor cortex. OBJECTIVE: We used functional magnetic resonance spectroscopy (fMRS) to explore the dynamic effects of MNS on neurometabolite concentrations. METHODS: Here, we investigated the effects of rhythmic and arrhythmic 10 Hz MNS on glutamate (Glu) and GABA concentrations in the contralateral sensorimotor cortex in 15 healthy controls, using a blocked fMRS design. We used a Mescher-Garwood-semi-localized by adiabatic selective refocusing (MEGA-sLASER) sequence at 7 T. RESULTS: Our results show no difference in the difference-from-baseline measures between the two stimulation conditions. Looking at the effect of MNS over both conditions there is a trend for an initial increase in Glu/tCr (total creatine) followed by a decrease over time, whereas GABA/tCr decreased during each stimulation block. CONCLUSIONS: These results suggest that despite entrainment of oscillations during rhythmic MNS, there are no significant differences in the tonic neuromodulatory effects of rhythmic and arrhythmic stimulation. The reduction in Glu over the course of stimulation may reflect a decrease in the glutamatergic firing due to adaptation. This may make it less likely that an involuntary movement is generated during continuous stimulation.
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The global prevalence of Chlamydia trachomatis genital infection in pregnant women: A meta-analysisBACKGROUND: Chlamydia trachomatis genital infection is one of the most common sexually transmitted bacterial infections with severe detrimental effects on pregnant women and fetuses. CTGI increases the risk of ectopic pregnancy, exogenous fetal infection, and respiratory complications such as bronchitis and pneumonia. According to the different published reports, this systematic review and meta-analysis study aimed to evaluate the global prevalence of CTGI in pregnant women. METHODS: Initial searching was applied using valid databases of PubMed, ScienceDirect, Embase, WoS, Scopus, and Google Scholar using MeSH keywords (by October 2023). Following duplicate detection and data exclusion, the Title and Abstract of other remaining papers were evaluated (primary screening). Full-texts of selected papers were assessed (secondary screening) and eligible studies were included for data extraction (total No of investigated pregnant women and the number of positive cases). The PRISMA approach was used for paper selection, and the quality assessment was determined according to the STROBE checklist. Data meta-analysis, heterogeneity, publication bias, and the factors affecting heterogeneity index were analyzed using CMA software. The findings were presented in the Forest Plot diagram and Static tables. Besides, heterogeneity was analyzed using I(2) test and diffusion bias was demonstrated in Funnel Plot. RESULTS: Among 1061 selected articles, 44 eligible investigations were enrolled for meta-analysis. The global prevalence of chlamydia trachomatis genital infection (CTGI) was found 8.4% (95% CI 5.8 - 12.1). Meta-regression analysis showed that following the increase in sample size and year of paper publication, the prevalence of Chlamydia trachomatis genital infection in pregnant women decreased significantly (p < 0.05). CONCLUSION: The global prevalence of Chlamydia trachomatis genital infection in pregnant women is considerably influenced by some interfering factors including Age, Socioeconomic status, Geographic region, and Individual behaviors. Thus, the implementation of more comprehensive health programs for prevention, screening, and treatment seems necessary, especially for high-risk pregnant cases.
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Mentalisation-based treatment for antisocial personality disorder in males convicted of an offence on community probation in England and Wales (Mentalization for Offending Adult Males, MOAM): A multicentre, assessor-blinded, randomised controlled trialBACKGROUND: Antisocial personality disorder is a major health and social problem, but scepticism about its treatability has restricted development of the evidence base for psychological treatments. Mentalisation-based treatment (MBT) tailored for antisocial personality disorder (MBT-ASPD) can address problematic behaviours by improving the ability to understand and regulate the negative effects of thoughts and feelings. This study aimed to evaluate the clinical and cost-effectiveness of MBT-ASPD compared with probation as usual in reducing aggressive behaviours from baseline to 12 months of follow-up. METHODS: The Mentaliziation for Offending Adult Males (MOAM) trial was a multicentre, two-group, pragmatic, assessor-masked, randomised controlled superiority trial in England and Wales. Eligible participants were male, aged 21 years or older, convicted of an offence and under National Probation Service supervision at one of 13 sites, identified through the Community Personality Disorder Pathways Service, met DSM-5 criteria for antisocial personality disorder, and scored at least 15 on the Overt Aggression Scale-Modified (OAS-M). After a three-stage screening process, consenting participants were randomly allocated (1:1), stratified by site, age, probation order type, and remaining probation duration, to either MBT-ASPD plus probation as usual, or probation as usual alone. Participants in the MBT-ASPD group were offered 12 months of weekly 75-min group therapy sessions and monthly 50 min individual sessions. Probation as usual lasted up to 12 months, after which participants continued under National Probation Service supervision for the remainder of their term. Investigators and data collectors were masked to treatment allocation. The primary outcome was aggression measured by the OAS-M at 12 months after random allocation. Data were collected by a hybrid team of traditional researchers and researchers with lived experience of the criminal justice system. The primary analysis was conducted in the intention-to-treat population using a linear mixed-effects model, adjusted for baseline at each follow-up timepoint (months 3, 6, 9, 12, 15, 18, 21, and 24). This trial is registered with ISRCTN (ISRCTN 32309003), and all pre-planned follow-ups are complete. FINDINGS: Between Jan 2, 2016, and Aug 31, 2018, 1946 individuals were referred to the study; after the screening process, 313 participants were randomly allocated (156 [50%] to probation as usual and 157 [50%] to MBT-ASPD plus probation as usual). Participants had a mean age of 34·2 years (SD 9·3); the majority of participants (247 [79%]) identified as White British, Irish, or White Other; followed by Black British (Caribbean, African, or Other; 30 [10%]) or Mixed (29 [9%]). At 12 months after random allocation, mean OAS-M scores were significantly higher in the probation as usual group (mean score 186 [SD 153]) than in the MBT-ASPD group (90 [126]), with an adjusted mean difference between groups of -73·5 (95% CI -113·7 to -33·2); p<0·0001, with a medium-to-large effect size of 0·74. During the trial, seven participants died, and one presumed death occurred, all in the probation as usual group after random allocation, with none of the deaths deemed related to trial procedures. INTERPRETATION: MBT-ASPD holds promise as an effective intervention for individuals with antisocial personality disorder within a forensic population. Future research should explore these findings' generalisability and the sustainability of treatment gains. FUNDING: National Institute for Health Research Health Technology Assessment programme.
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Women and mental health symposiumThis symposium will delve into critical topics addressing gender-specific mental health challenges. The first speaker will discuss updated MHRA guidelines for prescribing sodium valproate, a widely used medication for epilepsy and bipolar disorder. Historically, risks associated with valproate have focused on women of childbearing age, with 11% of babies exposed in utero developing birth defects and 30–40% facing developmental issues. Emerging data now indicate a potential risk of neurodevelopmental disorders in children conceived by men on valproate up to three months before conception, raising questions about its future prescription for men. The Indian perspective on this issue will also be explored. The second speaker will highlight SHAPER’s “Breathe Melodies for Mums” initiative, a Wellcome-funded £2.6 million research programme investigating group singing as an intervention for postnatal depression. Findings from this randomized control trial will provide insights into how arts-based social interventions can address mild to moderate postnatal depression. The third speaker will focus on ADHD in young girls, a condition often overlooked due to its atypical presentation, leading to challenges in self-esteem, development, and long-term mental health as women. Early recognition and intervention will be emphasized. The fourth speaker will share her leadership journey as a woman of Indian origin forging a successful career in the UK, mentoring international graduates, and contributing to psychiatry. The symposium promises to offer enriching discussions on these timely issues.
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Thematic Analysis of Coroner's Prevention of future deaths (PFDs) reports in Mental Health related suicides Dr Dean Manning Core Psychiatry TraineeBackground: I am a Core Psychiatry trainee currently working in a Crisis Resolution and Home Treatment Team (CRHT) in which many patients are referred with suicidal ideation in the context of their Mental Health. Aim: To identify professional and organizational-related themes highlighted in Coroner’s PFDs reports in Mental Health related suicides.. Methods: We reviewed Coroner’s PFDs reports via the UK Judiciary website. We filtered reports by those which are both Mental Health related deaths and included the keyword ‘suicide’. 100 reports were reviewed starting with the most recent. Themes were identified and grouped into patient-related, professional-related, and organizational-related factors that may have contributed to the death by suicide. Results: Reports were reviewed from across the UK. The highest number of reports were from the Coroner area of Manchester South (12%). 61% of reports were of males. Analysis: The main professional-related factors identified from thematic analysis of the PFDs reports were; issues around risk assessment and management (45%), lack of interprofessional communication and collaboration (33%), inadequate clinical queries/assessments (25%), Conclusions and Recommendations: It is hoped by identifying common themes arising from PFDs reports in Mental Health related suicides we can identify areas for change in practice that could lead to reduction in death by suicides.
