South London and Maudsley NHS Foundation Trust

Background Mental health professionals play a crucial role in promoting the physical well-being of people with mental illness. Awareness of HIV status can enable professionals in mental health services to provide more comprehensive care. However, it remains uncertain whether mental health professionals consistently document HIV status in mental health records. Aims To investigate the extent to which mental health professionals document previously established HIV diagnoses of people with mental illness in mental health records, and to identify the clinical and demographic factors associated with documentation or lack thereof. Methods A retrospective cohort study was conducted using an established data linkage between routinely collected clinical data from secondary mental health services in South London, UK, and national HIV surveillance data from the UK Health Security Agency. Individuals with an HIV diagnosis prior to their last mental health service contact were included. Documented HIV diagnosis in mental health records was assessed. Results Among the 4,032 individuals identified as living with HIV, 1,281 (31.8%) did not have their diagnosis recorded in their mental health records. Factors associated with the absence of an HIV diagnosis included being of Asian ethnicity, having certain primary mental health diagnoses including schizophrenia, being older, being with a mental health service for longer, having more clinical mental health appointments, and living in a less deprived area. Conclusions A significant number of individuals living with HIV who are receiving mental healthcare in secondary mental health services did not have their HIV diagnosis documented in their mental health records. Addressing this gap could allow mental healthcare providers to support those living with HIV and severe mental illness to manage the complexity of comorbidities and psychosocial impacts of HIV. Mental health services should explore strategies to increase dialogue around HIV in mental health settings.

Aim HOPE (National Institute for Health and Care Research Global Health Research Group on Homelessness and Mental Health in Africa) aims to develop and evaluate interventions that address the unmet needs of people who are homeless and have severe mental illness (SMI) living in three African countries in ways that are rights-based, contextually grounded, scalable and sustainable. Methods We will work in the capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and the capital city (Nairobi) and a rural county (Makueni) in Kenya to understand different approaches to intervention needed across varied settings. We will be guided by the MRC/NIHR framework on complex interventions and implementation frameworks and emphasise co-production. Formative work will include synthesis of global evidence (systematic review, including grey literature, and a Delphi consensus exercise) on interventions and approaches to homelessness and SMI. We will map contexts; conduct focused ethnography to understand lived experiences of homelessness and SMI; carry out a cross-sectional survey of people who are homeless (n = 750 Ghana/Ethiopia; n = 350 Kenya) to estimate prevalence of SMI and identify prioritised needs; and conduct in-depth interviews and focus group discussions with key stakeholders to understand experiences, challenges and opportunities for intervention. This global and local evidence will feed into Theory of Change (ToC) workshops with stakeholders to establish agreement about valued primary outcomes, map pathways to impact and inform selection and implementation of interventions. Intervention packages to address prioritised needs will be co-produced, piloted and optimised for feasibility and acceptability using participatory action research. We will use rights-based approaches and focus on community-based care to ensure sustainability. Realist approaches will be employed to analyse how contextual variation affects mechanisms and outcomes to inform methods for a subsequent evaluation of larger scale implementation. Extensive capacity-strengthening activities will focus on equipping early career researchers and peer researchers. People with lived experience of SMI and policymakers are an integral part of the research team. Community engagement is supported by working closely with multisectoral Community Advisory Groups. Conclusions HOPE will develop evidence to support action to respond to the needs and preferences of people experiencing homelessness and SMI in diverse settings in Africa. We are creating a new partnership of researchers, policymakers, community members and people with lived experience of SMI and homelessness to enable African-led solutions. Key outputs will include contextually relevant practice and policy guidance that supports achievement of inclusive development.

Background A third of epilepsy patients fail to enter seizure remission despite optimal therapeutic management. Cannabis‐based medicinal products (CBMPs) have shown promise as a potential therapy. However, a paucity of high‐quality literature regarding CBMPs’ efficacy and safety profile means further investigation is needed. The study aimed to examine changes in epilepsy‐specific and general health‐related quality of life (HRQoL) patient‐reported outcome measures (PROMs) in individuals with treatment‐resistant epilepsy. Methods A case series of patients with epilepsy from the UK Medical Cannabis Registry analyzed changes in Quality of Life in Epilpesy‐31 (QOILE‐31), Single‐Item Sleep Quality Score (SQS), EQ‐5D‐5L, Generalized Anxiety Disorder‐7 (GAD‐7) and Patient Global Impression of Change (PGIC) between baseline, one, three, and six months. Adverse events (AEs) were collected and classified by severity. p < 0.050 was considered statistically significant. Results There were 134 patients included. Improvements were recorded from baseline to one, three, and six months in QOILE‐31 and all HRQoL PROMs (p < 0.050). Forty patients (29.85%) reported a minimal clinically important difference in Quality of Life in Epilepsy‐31 (QOLIE‐31) at six months. There were 18 (13.43%) AEs reported by 5 (3.73%) patients, mainly mild and moderate. Discussion The proportion of patients achieving a clinically significant change is similar to existing CBMPs in epilepsy literature. AE incidence was lower than similar studies although this may be due to the large proportion (67.16%) of individuals who were not cannabis naïve. Conclusion Initiation of CBMPs was associated with an improvement across all PROMs. CBMPs were well tolerated across the cohort. However, randomized controlled trials are needed to help determine causality. Clinical Trial Registration

Background Opioid-related deaths are increasing globally, and synthetic opioids intensify overdose risk. Naloxone can prevent fatalities, although too much can precipitate withdrawal and other negative reactions for the person overdosing. There is an increasing range of naloxone products, some providing very high doses, and this has generated different opinions on how much naloxone is necessary to save a life without causing harm. This paper explores how non-medical first-responders administer naloxone at opioid overdoses in the UK. Methods Qualitative telephone interviews were conducted (2021–2023) with people who used services (n = 21, of whom 20 used opioids) and staff working with people who used opioids (n = 7). Participants had all been supplied with naloxone (predominantly injectable Prenoxad) and routine naloxone training as part of a separate cohort study. All had witnessed an overdose in the previous six months. Interviews were semi-structured, audio-recorded and transcribed. Data were coded and analyzed via Iterative Categorization. Results Overdoses occurred within a framework of uncertainty. Participants were often unsure of the types and quantities of drugs consumed and did not always know if, or how much, naloxone had been administered. No deaths and few cases of withdrawal were reported, but other negative effects (including disorientation and anger) were common. On witnessing a potential overdose, participants made numerous decisions quickly. These included confirming the overdose and deciding whether naloxone was needed, who would administer it, when doses should be given, and when to stop dosing. These decisions were influenced by contextual factors, including the availability of a naloxone device, panic, prior knowledge of the person who overdosed, the helpfulness (or otherwise) of others present, and any training previously received. Conclusions Naloxone dosing is complex and often reactive rather than purely scientific. Non-medical responders are competent at saving lives using naloxone, but do not always achieve resuscitation without negative effects. Findings highlight the value of offering optional advanced training and regular refresher training. This should focus on locally used naloxone products and dosing decision-making, plus experiential training that might enable people to anticipate how they would feel in a time-pressured overdose-related situation and so respond more calmly.

Seasonal and weather changes can significantly impact depression severity, yet findings remain inconsistent across populations. This study explored depression variations across the seasons and the interplays between weather changes, physical activity, and depression severity among 428 participants in a real-world longitudinal mobile health study. Clustering analysis identified four participant subgroups with distinct patterns of depression severity variations in 1 year. While one subgroup showed stable depression levels throughout the year, others peaked at various seasons. The subgroup with stable depression had older participants with lower baseline depression severity. Mediation analysis revealed temperature and day length significantly influenced depression severity, which in turn impacted physical activity levels indirectly. Notably, these indirect influences manifested differently or even oppositely across participants with varying responses to weather. These findings support the hypothesis of heterogeneity in individuals’ seasonal depression variations and responses to weather, underscoring the necessity for personalized approaches in depression management and treatment.

Objectives Existing youth mental health services are unable to meet a rising demand for care. Changes are required to align care with young people’s needs and priorities. In this paper, we present a case study examining the developmental stages of a community-based participatory research project in which young people and professional stakeholders co-designed a youth mental health service blueprint in Southern England. Methods We took a reflexive approach to critique, appraise and evaluate how our subjectivity – as embedded researchers – influenced the research process. Findings In this paper, we reflect on (1) the impact of an immersive approach on the development of trust with stakeholders and participants; (2) our methodology for developing and implementing community-based research and (3) the ways in which the complexity and the fragmentation of youth mental health services affected the research process. Conclusion A participatory approach can be complex and challenging; however, we argue that by engaging with communities and building relationships and trust, researchers can develop a deeper and more nuanced understanding of how to create and shape services that better reflect local needs and priorities.

Abreaction was once a common treatment for functional neurological disorder (FND) but has since fallen out of use. Norman Poole argues that abreaction is compatible with many findings from modern neuroscience, and should be studied and tested as a treatment for FND.

Psychosis is a serious comorbidity to Parkinson's disease associated with high levels of distress and disability but access to effective treatments remain limited, leading to high rates of emergency hospitalization. Here, we propose a new framework for how cognitive behavioural therapy (CBT) may be used to treat Parkinson's disease psy- chosis. We note specific adaptions, including aims that focus on reducing distress and disability and extending quality of life; tailored psychoeducation; assessment and formulation that additionally includes disease course, medication effects and side-effects, and Parkinson's specific social factors; addressing anxiety and depression alongside cognitive appraisals for the types of psychotic symptoms more common in Parkinson's disease; appropriate reality testing sensitive to disease progression; and trigger monitoring and management for hallucinations and delusions that carefully distinguishes this from avoidant coping. We review preliminary case study-level evi- dence for the successful use of CBT for Parkinson's disease psychosis and suggest a road map for its formal evaluation before integration into evidence-based healthcare.

Studies have found that the Mental Health Act is used disproportionally among minoritised ethnicities. Yet, little research has been conducted to understand how the intersectionality of ethnicity with sociodemographic factors relates to involuntary admission. This study aimed to investigate whether an association between ethnicity and involuntary hospitalisation is altered by variations in service-users’ sociodemographic positions. A retrospective cohort study using records from the South London and Maudsley identified 18,569 service-users with a first episode of hospitalisation in a 13-year period. Logistic regression was used to calculate odds ratios for involuntary hospitalisation across ethnicities while adjusting for sociodemographic (age, gender, area-level deprivation, homelessness, and migration) and clinical factors (psychiatric diagnosis and HoNOS scores). Interaction analysis was conducted to identify intersectional effects between ethnicity and sociodemographic variables, potentially modifying the odds ratios of involuntary admission across ethnic groups. Increased odds of involuntary hospitalisation compared to White British service-users were observed among 10 of the 14 ethnicities, with around, or just under twice the odds observed for Asian Chinese, Black African, and Black Caribbean. Women were found to have increased odds of involuntary admission. Significant interactions were present between ethnicity and age, area-level deprivation, homelessness, and migration in the unadjusted models. These effect modifications were not significant after adjustment for confounders. Ethnic inequalities were observed in involuntary hospitalisation among service-users on first admission. No evidence of intersectional effects was present when adjusting for sociodemographic and clinical factors. Further research needs to identify the mechanisms causing the inequalities.

Genome-wide association studies (GWAS) have characterized the contribution of common variants to breast cancer (BC) risk in populations of European ancestry, however GWAS have not been reported in resident African populations. This GWAS included 2485 resident African BC cases and 1101 population matched controls. Two risk loci were identified, located between UNC13C and RAB27A on chromosome 15 (rs7181788, p = 1.01 × 10⁻⁰⁸) and in USP22 on chromosome 17 (rs899342, p = 4.62 × 10⁻⁰⁸). Several genome-wide significant signals were also detected in hormone receptor subtype analysis. The novel loci did not replicate in BC GWAS data from populations of West Africa ancestry suggesting genetic heterogeneity in different African populations, but further validation of these findings is needed. A European ancestry derived polygenic risk model for BC explained only 0.79% of variance in our data. Larger studies in pan-African populations are needed to further define the genetic contribution to BC risk.

Whilst uncommon in pregnancy, hypercalcaemia can lead to significant maternal and fetal morbidity. An important complication of hypercalcaemia is uncontrolled hypertension. This case outlines an example of refractory hypercalcaemia exacerbating an emerging hypertensive crisis. The proposed aetiology was parathyroid hormone-related protein (PTHrP)-mediated hypercalcaemia secondary to a necrotic uterine fibroid. We highlight how effective and prompt involvement of the Maternal Medicine Network and multidisciplinary team led to a successful pregnancy outcome.

The opioid overdose epidemic remains a critical public health crisis. In recent years, synthetic opioids like fentanyl and nitazenes, have driven a sharp rise in deaths. Naloxone, an opioid receptor antagonist, has been established as a key intervention for reversing opioid overdoses and saving lives. However, there remains a critical need to optimize naloxone dosing strategies. This article examines the challenges of both under‐dosing and over‐antagonism in naloxone administration, emphasizing the importance of a tailored approach to overdose management. A ‘just the right dose’ approach is essential for minimizing the risks of over‐antagonism while still reversing opioid overdose. This involves starting with a modest naloxone dose and carefully titrating it based on the patient's response, considering factors such as opioid type, overdose severity, and opioid tolerance. A tailored approach to naloxone dosing may present challenges for non‐medically trained responders but it can ensure that as many people as possible receive the right dose of naloxone when they need it. Training programs should also emphasize the importance of first aid and supportive care, including airway management and alerting emergency services, as well as careful monitoring of the patient's response.

Background Experiences of medical specialist trainees in psychiatry can be informative for those who seek to improve post-graduate training. This study aimed to explore the experience of child and adolescent psychiatry (CAP) trainees across different training settings and cultures worldwide to seek out similarities and differences. Methods A convenience sample of CAP-trainees (n = 36) and -trainers (n = 54) was recruited internationally. All provided a narrative account on aspects of training in their region (n = 27 different countries), either first-person (trainees) or through external perception (trainers). Thematic analysis was used for inductive treatment of the data. Results Trainees’ and trainers’ perspectives covered psychological security of the educational framework (including a comprehensive curriculum; social support and recognition of local context), specific skills to be acquired during training and the effects of the social-cultural dimension on mental health (training). Trainers’ perspectives highlighted the importance of support and training for supervisors; an overall view to make sense of the training framework; and of looking at training through objective and subjective frameworks of thinking to understand and guide trainees’ pathways. Conclusions Experiences from international psychiatry trainees suggest themes that may guide further development of international standards in psychiatry specialist training on a tailored and consistent supervision framework for trainees. For their trainers, a learning community may offer ongoing support, supervision skill development and help reflect on overall views on systems of care.

A fundamental pillar of science is the estimation of the effect size of associations. However, this task is sometimes difficult and error-prone. To facilitate this process, the R package metaConvert automatically calculates and flexibly converts multiple effect size measures. It applies more than 120 formulas to convert any relevant input data into Cohen’s d , Hedges’ g , mean difference, odds ratio, risk ratio, incidence rate ratio, correlation coefficient, Fisher’s r-to-z transformed correlation coefficient, variability ratio, coefficient of variation ratio, or number needed to treat. Researchers unfamiliar with R can use this software through a browser-based graphical interface ( https://metaconvert.org/ ). We hope this suite will help researchers in the life sciences and other disciplines estimate and convert effect sizes more easily and accurately.

Background Late-life affective disorders (LLADs) are common and are projected to increase by 2050. There have been several studies linking late-life depression to an increased risk of dementia, but it is unclear if bipolar affective disorder or anxiety disorders pose a similar risk. Aims We aimed to compare the risk of LLADs progressing to all-cause dementia, and the demographic and clinical variables mediating the risk. Methods We used the South London and Maudsley National Health Service Foundation Trust Clinical Records Interactive Search system to identify patients aged 60 years or older with a diagnosis of any affective disorder. Cox proportional hazard models were used to determine differences in dementia risk between late-life anxiety disorders versus late-life depression, and late-life bipolar disorder versus late-life depression. Demographic and clinical characteristics associated with the risk of dementia were investigated. Results Some 5695 patients were identified and included in the final analysis. Of these, 388 had a diagnosis of bipolar affective disorder, 1365 had a diagnosis of an anxiety disorder and 3942 had a diagnosis of a depressive disorder. Bipolar affective disorder was associated with a lower hazard of developing dementia compared to depression (adjusted model including demographics and baseline cognition, hazard ratio: 0.60; 95% CI: 0.41–0.87). Anxiety disorders had a similar hazard of developing dementia (adjusted hazard ratio: 1.05; 95% CI: 0.90–1.22). A prior history of a depressive disorder reduced the risk of late-life depression progressing to dementia – suggesting the new onset of a depressive disorder in later life is associated with higher risk – but a prior history of anxiety disorders or bipolar affective disorder did not alter risk. Conclusions LLADs have a differential risk of developing all-cause dementia, with demographic- and illness-related factors influencing the risk. Further prospective cohort studies are needed to explore the link between LLADs and dementia development, and mediators of the lower risk of dementia associated with late-life bipolar disorder compared to late-life depression.

Background Recovery Colleges offer an educational approach to personal recovery within mental health services. Fundamentally, course design and delivery incorporates co-production via collaboration between practitioner and peer trainers. Objective What guidance, training and support have been provided for peer and practitioner trainers who participate in the design and delivery of Recovery College courses? Method A scoping review was conducted using Ovid, Embase, PsychoInfo, PsycArticles, HMIC, Global Health, Cochrane, Social Policy and Practice databases. Data were summarised using descriptive analysis focusing on themes including individuals’ experience of co-production, training, guidance and support provided to co-produce courses within the Recovery College setting. Results Of the initial 360 articles identified, 19 met the study inclusion criteria. Across the articles, co-production was recognised as beneficial for those involved. The identified themes were collaborative experience, training, guidance and support provided for trainers co-producing Recovery College education. Conclusion This scoping review highlighted the limited training, guidance and support provided to those participating in co-production of Recovery College education.

Background Sex differences have consistently been identified on autopsy, neuroimaging, and cerebrospinal fluid outcomes related to Alzheimer's disease (AD), but the exact mechanisms for these associations are unclear. Blood-based biomarkers are practical alternatives for the investigation of mechanisms of AD, in addition to accurate disease detection and monitoring. Objective The objective of this study was to examine sex differences across a panel of blood-based plasma biomarkers in participants with and without cognitive impairment due to AD. Methods Plasma samples were collected from 567 participants from across the AD diagnostic continuum (i.e., normal cognition (NC), mild cognitive impairment (MCI), and dementia) and analyzed for glial fibrillary acidic protein (GFAP), neurofilament light (NfL), phosphorylated tau at threonine 181 (p-tau 181 ), and total tau (t-tau). Baseline and longitudinal analyses evaluated for any significant associations between sex and AD-related plasma biomarkers. Results Females were found to have higher plasma GFAP compared to males at baseline regardless of cognitive diagnosis. Among those with AD dementia, females were also found to have higher NfL levels compared to males. Longitudinal analyses found that higher plasma NfL at baseline was associated with an increased risk of worsening AD dementia status only in females. No significant findings were observed for p-tau 181 or t-tau. Conclusions This study found significant sex differences in plasma biomarkers of GFAP and NfL. Further research is needed to better understand the underlying mechanisms mediating these differences.

Background Mental disorders such as depression and anxiety are common for women of reproductive age and impact pregnancy and parenting. Invasive Group B Streptococcus disease (iGBS) is a leading cause of neonatal morbidity and mortality worldwide. Little is known about the short and long-term risk of common mental disorders in birthing parents whose infants had iGBS in the first 89 days after birth. We aimed to examine the risk of depression and anxiety in birthing parents with iGBS-affected infants in a cohort study with prospectively collected data from Danish registries. Materials and Methods Using Danish healthcare registries from 1997 to 2018, we obtained data on iGBS-affected children and their birthing parents. A comparison cohort was randomly sampled (1:50) through risk-set sampling, and matched on persons’ age, year of child´s birth, and parity. The risk of using antidepressant medicines and depression or anxiety diagnosis was analyzed with cumulative incidence function and in Cox proportional hazards regression models. Results During the study period, we identified 1,552 women with iGBS-affected child and 76,879 matched comparators. During a median follow-up of 9∙9 years, the cumulative incidence of antidepressants use among birthing parents with iGBS-affected children was 31% (95% confidence interval, CI: 28–34%), as compared with 29% (95% CI: 28–30%) among members of the comparison cohort (hazard ratio 1∙12 [95% CI: 1∙01–1∙25]). A 16% increase in the rate of diagnosed depression or anxiety was observed in the overall follow-up period. Conclusion Our findings provide evidence of a slightly increased risk of antidepressant use and diagnosed depression or anxiety in parents who gave birth to children with a history of iGBS compared to a matched cohort of birthing parents whose infants did not develop iGBS. Our findings highlight the importance of addressing the mental health needs of birthing parents affected by their children’ iGBS.