Longitudinal studies have revealed that raised levels of inflammatory markers and trauma in childhood are associated with psychopathology in adulthood.

To examine whether inflammation in childhood mediates the effects of genetic risk and trauma on psychopathology in early adulthood.

Measures of trauma exposure, inflammation and psychopathology were collected from the Avon Longitudinal Study of Parents and Children. Exposure to trauma was measured from 5 to 11 years of age; C-reactive protein and interleukin-6 levels were measured at 9 years; and depression, anxiety disorders, negative symptoms and psychotic experiences were assessed at 24 years. Polygenic risk scores (PRSs) were created for schizophrenia, depression, anxiety and psychotic experiences. Mediation analyses were conducted using imputed data (N: 7859 to 8700) to investigate whether inflammation mediated the associations of genetic risk and childhood trauma with psychopathology.

Most psychiatric PRSs were associated with multiple psychopathological outcomes in adulthood, with the exception of the PRS for psychotic experiences. Childhood trauma was associated with all psychopathology. However, there was no strong evidence that inflammatory markers in childhood mediated associations among PRSs, trauma and psychopathology. Sensitivity analyses using outcomes from age 18 and PRSs based on single-nucleotide polymorphisms that met more stringent standards of evidence of association gave results consistent with those of our primary analyses.

We found little evidence that interleukin-6 or C-reactive protein mediated the pathway between genetic liability for psychiatric phenotypes or trauma and subsequent psychopathology. Longitudinal investigation of other inflammatory and non-inflammatory pathways is required to identify modifiable targets and inform novel treatment strategies for individuals at genetic or trauma-related risk of psychiatric illness.

Catatonia, a neuropsychiatric syndrome, can be associated with inflammatory conditions of the central nervous system.

To explore steroid-responsive catatonia with possible autoimmune origins.

A retrospective investigation was conducted of clinical and paraclinical features, including imagining, serum, and cerebrospinal fluid findings in ten patients presenting with subacute onset catatonia and treated with steroid pulse therapy between January 2022 and January 2024.

A retrospective chart review identified ten patients (of a total of 56) with steroid-responsive subacute onset catatonia. Catatonia types varied. All patients were positive for delirium and psychotic symptoms. Imaging and cerebrospinal fluid results indicated non-specific signs of central nervous system inflammation. Intravenous 1 g methylprednisolone pulse therapy resulted in complete remission in all patients. Autoantibodies for limbic and paraneoplastic encephalitis were negative for all patients. None of the patients fulfilled the criteria for definite autoimmune encephalitis or autoantibody-negative probable autoimmune encephalitis.

Diagnosis of autoimmune catatonia is challenging without autoantibody markers, but steroid responsiveness, combined with clinical and paraclinical features, may suggest an autoimmune mechanism.

Long-acting injectable antipsychotic medications (LAIs) are more beneficial than oral medications for people with schizophrenia. However, some individuals are unable to visit out-patient clinics due to their symptoms, resulting in missed monthly LAI injections and subsequent relapse. Home visits for administration of LAIs could potentially reduce treatment failure, but there are no comparative studies on their effectiveness.

This study aims to evaluate whether home visit administration of LAIs, compared with the out-patient clinic, reduces treatment failure for those with schizophrenia.

We conducted a retrospective cohort study using electronic medical records from Seijin Hospital. Patients diagnosed with schizophrenia and treated with LAIs during hospitalisation between 1 April 2020 and 31 March 2023 were included. Following discharge, patients were followed for 1 year, either under home visits or out-patient clinic visits. The primary outcome was defined as treatment failure, including psychiatric rehospitalisation, discontinuation of treatment or death. Multivariate Cox proportional hazards regression analysis was performed to evaluate treatment failure risks.

A total of 125 patients in the home visit group and 117 in the out-patient group were included. During the follow-up period, home visits significantly reduced the risk of treatment failure (hazard ratio 0.62, 95% CI 0.40–0.97). However, having two or more psychiatric hospitalisations (hazard ratio 2.32, 95% CI 1.28–4.37) and living alone following discharge (hazard ratio 1.77, 95% CI 1.07–2.86) were associated with significantly increased risk of treatment failure.

Home visits, compared with out-patient clinic care, significantly reduce treatment failure in individuals with schizophrenia undergoing LAI treatment.

Clinical placements are essential in healthcare education, offering practical experience and skill development under experienced supervision. However, little research has explored the characteristics of effective psychiatry placements. Understanding the factors considered vital by psychiatry core trainees for a successful placement is crucial amid concerns about trainee attrition in psychiatry programmes.

This study aims to identify key elements that contribute to a successful psychiatric placement, as perceived by final-year core trainees.

This qualitative study uses one-hour, semi-structured interviews with 15 core trainees in their final placement within the South London and Maudsley Training Programme. Interviews were guided by appreciative inquiry principles, and two independent researchers employed a classic thematic analysis method while maintaining appropriate reflexivity throughout.

A central theme emerges regarding the importance of a well-designed learning environment, which includes a robust training infrastructure, psychological safety, active learning opportunities, access to role models and structured feedback. The supervisor–supervisee relationship is emphasised, with the ideal supervisor being both knowledgeable and empathetic and offering mentorship and pastoral support. These factors are key to professional growth, well-being and job satisfaction, and they are strongly linked to retention in the field.

Core trainees value placements that address foundational training needs and cultivate psychological safety while facilitating experiential learning. Addressing these aspects in training programmes enhances the educational experience and improves retention. Future research should explore supervisors’ perspectives and examine how to balance ideal and practical supervisory roles.

There is an urgent need to address the poor quality of mental healthcare and human rights violations within mental health systems and communities. To achieve this, efforts must focus on changing the attitudes that perpetuate stigma and discrimination against individuals with mental health conditions, as well as psychosocial, intellectual and cognitive disabilities. The World Health Organization (WHO) QualityRights e-training on mental health, recovery and community inclusion is tackling these issues in several countries; however, its global impact has yet to be evaluated.

This study aims to assess the changes in attitudes following the completion of the WHO QualityRights e-training in countries worldwide.

Data from 3026 participants were analysed in this pre-post intervention study. Changes in scores on the WHO QualityRights Attitudes questionnaire were evaluated with the paired t-test and Wilcoxon signed-rank test.

The mean differences from baseline to post-training on the WHO QualityRights Attitudes questionnaire were 9.91 (95% CI 9.58–10.24, d = 1.07) for the total sample, 8.95 (95% CI 8.59–9.31, d = 0.99) for the high-income countries sample; and 12.75 (95% CI 12.03–13.47, d = 1.33) for the low- and middle-income countries sample. These findings indicate that participants, after completing the e-training, showed a decrease in negative attitudes toward individuals with mental health conditions and psychosocial, intellectual and cognitive disabilities.

This study suggests that the WHO QualityRights e-training has a positive, large effect in reducing negative attitudes toward individuals with mental health conditions and psychosocial, intellectual and cognitive disabilities, and can contribute to reduced stigma and greater alignment with rights-based approaches. These findings support the scale-up of the WHO QualityRights e-training programme.

Constipation is a significant problem for people with intellectual disabilities, with a prevalence of 33–50%, causing at least five deaths annually in England. Individualised bowel care plans (IBCP) are recommended in England and Wales.

We evaluated the feasibility and impact of IBCPs for people with intellectual disabilities who are in in-patient psychiatric units, and the effect on clinical outcomes.

People with intellectual disabilities who were at risk of constipation were recruited from four specialist in-patient psychiatric units in England and Wales. A constipation questionnaire was used to capture relevant data to devise IBCPs. Baseline, 3- and 6-monthly Health of the Nation Scales – Learning Disability (HoNOS-LD) were completed after the intervention. Descriptive statistics, Wilcoxon signed-rank, Mann-Whitney U, repeated-measures analyses of variance, with Bonferroni adjustment and Mauchly’s tests were conducted. Significance was taken at P < 0.05.

Of 24 people with intellectual disabilities recruited from four units, all three data points were available for 18 patients. Constipation rates showed no statistically significant decline. The total HoNOS-LD score (18 items) did not decline. HoNOS-LD item 12 for physical functioning showed significant improvement for PwID with constipation compared with those without, between baseline and 6 months.

This quality improvement project suggests that a bigger study of IBCPs is feasible. Most outcomes examined via the HoNOS-LD, particularly those linked with mental illness, challenging behaviour and quality of life, did not show significant change, possibly because of the small sample size. However, people with intellectual disabilities and constipation showed positive changes in their physical functioning outcomes compared with those without constipation. Further in-depth evaluation of this intervention is needed.

Intellectual disability is defined as an IQ of 70 or below. Women with intellectual disability frequently experience menstrual distress leading to the use of hormonal medications such as depot medroxyprogesterone acetate (DMPA). Despite risks such as reduced bone mineral density (BMD) and weight gain, DMPA is widely used in this cohort, prompting investigation into its suitability and risks.

A narrative review and local service evaluation were conducted to determine whether clinical management reflected recommendations in the literature.

PsycINFO and Medline were searched for articles post-1995 on contraception in menstruating women with intellectual disability. Contraceptive use in 100 randomly selected women was evaluated. Data were collected on physical health issues, general practitioner records were reviewed for contraceptive administration and risk discussions, and surveys assessed risk understanding and satisfaction.

The review identified 27 papers with higher DMPA use in the intellectual disability population compared to the general population, and specific BMD risks. The case series found 23 women with intellectual disability using DMPA, and revealed knowledge gaps in risk and monitoring, inappropriate use given individual risk, and poor proactive risk management.

Findings indicate disproportionate DMPA use in women with intellectual disability, with inadequate clinical justification and risk awareness. Many women and carers were unaware of BMD risks, and DMPA alternatives were rarely considered. Individualised contraceptive management and closer review of DMPA use in this cohort is needed. Monitoring could include dual X-ray absorptiometry (DEXA) scans, vitamin D and calcium supplementation, and weight management. Further research is needed into higher DMPA use and risks within this population.

Over 1% of the world’s population have been forcibly displaced. Asylum seekers and refugees (ASR) are at higher risk of serious mental illnesses. Despite a high need for care, little is known about the attitudes, knowledge and competencies of psychiatrists who may treat ASR subjects.

The study aimed to identify perceived gaps in psychiatric training that could help guide medical education and policymaking related to treating ASR mental health.

We conducted the first national survey of UK-based psychiatrists to assess attitudes, knowledge and competencies around treating ASR subjects. The online survey was sent to all psychiatrists (N = 18 182) and registered trainees (N = 4700) on the Royal College of Psychiatrists databases in 2022. We used exploratory and confirmatory factor analyses to identify the optimal factor structure underlying the questionnaire. Variations in scores on extracted latent constructs by sociodemographic and clinical variables were explored using linear regression.

Data from 609 psychiatrists (77%) and trainees (22%) were included in the final analysis. We identified four latent constructs concerning perceived knowledge, positive attitudes, negative attitudes and perceived distress. Only 42% of respondents felt they had sufficient knowledge to work competently with ASR subjects, and 34.7% found the work emotionally distressing. Greater knowledge predicted both more positive (β = 0.26, 95% CI: 0.20–0.33) and more negative (β = 0.17, 95% CI: 0.09–0.26) attitudes, and was associated with less self-reported distress among psychiatrists (β = –0.34, 95% CI: –0.43 to –0.21). Female psychiatrists reported more distress related to treating ASR subjects (β = 0.29, 95% CI: 0.14–0.44).

Less than half of psychiatrists in this survey believed they possessed adequate knowledge to treat ASR subjects, and some found working with such individuals distressing. Our results suggest that these issues could be mitigated by improving knowledge related to treating ASR subjects.

Self-harm is widespread and often occurs in the community without resulting in hospital presentation. Individuals with depressive symptoms are at elevated risk. There are limited self-harm interventions designed for community and primary care settings. The Community Outpatient Psychological Engagement Service for Self-harm (COPESS) is a brief talking therapy intervention for self-harm based in community settings.

To assess the feasibility of evaluating the COPESS intervention in a community setting in relation to participant recruitment, retention, data collection and the acceptability of the intervention.

We used a mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone. Adults with depressive symptoms and self-harm in the past 6 months were recruited from general practices. Secondary outcome measures were assessed at baseline and 1 month, 2 months and 3 months after randomisation. The trial was pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.

Fifty-five people were randomised (of an initial target of 60). Retention rates at follow-up assessments were high (>75%), as was attendance by all participants for all therapy sessions (93%). At 3 months, there were trends towards lower levels of self-harm urges, depressive symptoms and distress in the COPESS group compared with controls. Fidelity to the manualised COPESS therapy was moderate to high.

All progression criteria were met, supporting further evaluation of the intervention in a full-scale efficacy and/or cost-effectiveness trial. These findings add to the growing evidence base supporting the utility of brief psychological interventions for self-harm. COPESS has potential as a brief primary-care-based intervention for those struggling with self-harm.