An independent evaluation of The Resilience Project’s School Partnership Program in Australian secondary schools found that longer participation (6+ years) in this whole-school programme was associated with improved student outcomes, including reduced symptoms of depression and anxiety. This commentary aims to: (a) describe whole-school approaches to improving health and well-being, with reference to their historical context and some selected key studies; (b) highlight the lack of data on the effectiveness of whole-school approaches for reducing depression and anxiety; (c) signal the potential benefits of whole-school approaches when sustainably implemented; and (d) reinforce the need for research that examines links between implementation factors and outcomes. Overall, this commentary underscores the value of viewing schools as complex social systems where multiple components can align to enhance mental health and well-being outcomes for students.

Aims: This meta-analysis aims to review safety and effectiveness of pimavanserin compared with other antipsychotics in managing psychotic symptoms in Alzheimer’s disease and Parkinson’s disease dementia.

Methods: We conducted a comprehensive literature search of controlled trials evaluating efficacy of pimavanserin versus placebo and other antipsychotics. A thorough search was made using specific terms in Pubmed, Web of Science, EMBASE, SIGLE and CINAHL. Of 423 studies only 2 studies met our requirements once detailed ROB 2 analysis was performed. The primary dependent measure was NPI and the CGI-I as the secondary measure;safety data being the other dependent measure.

Results: With active treatment by pimavanserin, there was a mean reduction of 4.5 points on NPI score, the SMD was −1.07 compared with placebo. It was more effective than other antipsychotics and it came with more acceptable side effects. Side effects included extrapyramidal symptoms, however this was significantly lower in the pimavanserin group (7% versus 15% with olanzapine) and minimal metabolic side effects.

Conclusion: Pimavanserin stands as a relatively new treatment approach for management of neuropsychiatric symptoms in dementia that has similar effectiveness when compared with other antipsychotics, yet exhibiting fewer side effects. Its mechanism of action as a selective serotonin inverse agonist may offer some advantage in controlling and managing psychotic symptoms without worsening of motor functions in patients with Parkinson’s disease dementia.

Aims: In this systematic review, the effectiveness and safety of viloxazine ER in the treatment of ADHD in children and adolescents aged between 6–17 years will be assessed.

Methods: This review identified articles through a systematic approach using PubMed, EMBASE, and the Cochrane Library. Randomized controlled trials with viloxazine ER in an active comparator condition versus placebo or other stimulant/non-stimulant ADHD drugs were included.

The first set of outcomes for assessing efficacy was a decrease in the severity of ADHD symptoms as measured by the ADHD-RS-5 and CGI-I scales. Safety outcomes comprised comparability in the rates of adverse events and treatment discontinuation rates.

Results: A meta-analysis showed that viloxazine ER is effective in managing ADHD symptoms compared with placebo at 10–12 weeks. Very few side effects were reported with this medication and those reported were mostly mild to moderate in nature. Mild side effects were noted to be decreased appetite, somnolence, and headache. The rates of treatment disappearance were similar compared with other oral ADHD drugs.

Conclusion: The research implies that viloxazine ER may be useful to paediatric patients with ADHD as a new treatment approach. We hypothesize that its profile of being an NRI and 5-HT2B antagonist may be beneficial for patients who have not shown sufficient improvement with more common treatments. The use of once daily dosing of the extended release formulation may enhance compliance compared with drugs taken more than once per day.

In a general manner, viloxazine ER seems to be a safe and efficacious therapy in children and adolescents affected by ADHD. Because it has a unique mechanism of action and can be taken once daily, it complements other ADHD medications well. More prospective, multicentre trials of longer duration are, therefore, required to determine the success and risks of the technique in the long run.

Aims: People with Severe Mental Illness (SMI) have a reduced life expectancy of 15–20 years compared with the general population. This disparity is largely due to preventable health conditions like cardiovascular disease and diabetes. Certain antipsychotics (APs) can contribute to this increased burden due to their association with cardio-metabolic side-effects. Despite the availability of lower-risk APs, risperidone, olanzapine, and quetiapine remain the most prescribed APs in the UK. Switching to improve cardio-metabolic side-effects is rarely implemented in clinical practice. Improving the physical health of people with SMI is a key NHS priority. We conducted a qualitative study to explore the perceptions and experiences of patients and their caregivers surrounding switching APs for physical health benefits to inform the development of an educational intervention for clinicians to support switching APs.

Methods: Semi-structured interviews were conducted with patients who have experienced AP-induced cardiometabolic side-effects (ascertained by the treating clinician) and their caregivers. Participants were recruited through two NHS trusts and primary care. Interviews were by telephone or online and transcripts were thematically analysed using NVIVO. A patient advisory group contributed to all phases of the study.

Results: Seventeen interviews (16 one-on-one and one dyadic) were conducted with thirteen people with SMI (Bipolar Disorder [9], Schizophrenia [2], Psychosis [2]) and five caregivers.

We will present two themes:

(1) Managing the dual challenge of mental and physical health conditions: Managing this challenge can be overwhelming and impact their everyday life; patients often normalise side-effects of medication as a necessary trade-off for mental health stability.

(2) Enabling a change in medication: The possibility of medication changes was met with optimism as well as apprehension. Past experiences of medication adjustments, fear of relapse and concerns about new side-effects were important from both patient and caregiver perspectives; addressing these requires inviting patients and caregivers into decision-making. Carers play a crucial role in supporting patients, and recognising their contributions can ease the transition. Improving collaboration at the system level is equally important.

Conclusion: The study highlights the complex interplay between mental and physical health; patients and caregivers often face significant challenges in balancing mental and physical health. Switching medication is a challenge for patients and their caregivers. Addressing patients’ concerns like fear of relapse, lack of support, and clear communication would help foster confidence in switching. Recognising the importance of caregivers is essential for effective patient support. Improving overall collaboration can foster a more patient-centred approach to managing the switching process.

Aims: Peripheral Arterial Disease (PAD) is linked to vascular cognitive impairment and vascular depression due to concurrent cerebrovascular disease. Cognitive impairment and mental health disorders in surgical patients lead to poorer recovery and rehabilitation. Awareness of these diagnoses in this population is important when considering suitability for surgical input – especially high-risk procedures such as limb revascularisation. In the UK population, evidence suggests that 33–42% of cognitive impairment and 26.5% of anxiety and depressive disorders remain undiagnosed. In this high-risk PAD population, this is likely an underestimate. We aim to determine the prevalence of cognitive impairment and anxiety and depressive disorders within this group while controlling for possible confounders.

Methods: 100 unselected PAD patients were identified pragmatically from a Vascular outpatient setting at Addenbrooke’s Hospital. Inclusion criteria required patients to be >65, and have radiological or clinical evidence of PAD. Written consent was obtained for assessment. Patients came from a wide area in the East of England with a catchment of 1.8 million people, demonstrating significant socio-geographical variety for a single centre study. The assessment pack included the 6-CIT screening tool for cognitive impairment, HADS for anxiety and depression, 4AT for delirium, SASQ for alcohol use, and a brief clinical history covering memory, attention, visuospatial skills, speech, and personality.

Results: 100 patients were assessed over 6 months. 20.5% met the 6-CIT cut-off for memory clinic referral (mean score 12). The estimated general prevalence of cognitive impairment including dementia in those over 65 is 7.1%. 26.8% met the HADS cut-off for anxiety or depression (mean score 15). The prevalence of anxiety and depression in the general over 65 population is estimated to be around 9% and 12.5%, respectively. Hence, there appears to be a significant increase in possible prevalence of both diagnoses, compared with a general age matched population. No significant age or gender differences were found between those scoring above the cut offs and those not (p=0.79).

Conclusion: Cognitive impairment and anxiety/depression appear more prevalent in PAD patients. Given these conditions impact surgical outcomes, raising awareness of underdiagnoses is crucial. Future follow up will include memory clinic assessment, cerebral and peripheral imaging, and exploring surgical outcomes. Cost-effectiveness analyses are needed to assess the benefits of pre-operative screening.

Aims: In 2021–2022, 10.5% of UK citizens provided unpaid informal care, saving the government £162 bn annually. Many carers reside in high-deprivation areas, where access to appropriate health and social care services is limited. Previous studies indicate that carers are more prone to depression, anxiety, and physical symptoms, and these negative outcomes are higher among socio-economically disadvantaged carers. The shift of some health and social care services online, combined with ‘digital poverty’ (having no suitable electronic devices with Internet access or limited access or skills concerning the Internet), may exacerbate difficulties with accessing health and social care support, potentially increasing unmet needs and burdens among socioeconomically disadvantaged carers. The aim is to understand how informal carers with marginalised socioeconomic status (SES) access existing health and social care services and how this impacts their mental health. The second aim of the project is to explore how potential digital poverty may shape a carer’s mental health outcomes.

Methods: A systematic literature review will identify barriers and facilitators of accessing health and social care by informal carers, the impact of access/non-access on mental health, stratified by carer SES and care-recipient’s health conditions. Followed by a qualitative photovoice study to explore carers’ experiences of accessing health and social care and the effects of digital poverty, analysed through critical discourse analysis. Thirdly a survey (N >300) examining how factors underpinning access to health and social care are related to informal carers’ mental health as moderated or mediated by the caregiver SES, carers’ perceptions of access to health and social care and of digital poverty analysed by structural equation modelling.

Results: We will identify if and how informal carers with a marginalised socioeconomic background access health and social care services. Which will allow us to develop an evidence-based health promotion model.

Conclusion: This study will offer us a unique opportunity to develop an evidence-based health promotion model for these carers that shows how to mitigate existing pathways of health inequalities. Based on key findings, recommendations will be generated and shared with researchers, clinicians, and policymakers via academic publications, conferences, exhibitions of carers’ photographs, and carer forums with NHS Trust(s).

Aims: A handful of studies argue that ED treatment would benefit from a network analysis of social influences, particularly in girls and young women pressured by socio-culturally prescribed beauty standards, and reinforced by peers and family. The study’s aim was to investigate the impact of social network density on a person’s acquisition, perpetuation, and recovery from an eating disorder (ED). It was hypothesized that one’s connectedness within dense social networks of others with EDs would increase the likelihood of an ED diagnosis and resistance to treatment and recovery.

Methods: One thousand participants, largely from North America and Europe, completed an online survey of ED social networks. Respondents were asked whether they had an ED diagnosis, and if so, the diagnosis/typology, whether they knew others with an ED, whether they were in recovery, and, if so, the extent of social supports. Indices and latent structural equation model (SEM) variables were constructed from respondents’ identification of siblings, peers, friends, parents, other relatives, spouses, and neighbours with an ED. Similar indices were constructed for others identified as supportive of recovery. Social media influence was measured by asking if pro-anorexic or recovery websites were viewed. Data were analysed using bivariate statistics and Lavaan’s SEM R program.

Results: Social network density (knowing others with EDs) was highly predictive of ED diagnosis, including multiple EDs. Internet media was equally impactful. Same-sex siblings and peers had the greatest influence, exceeding parents or other relatives/friends. Networks of supportive others were highly predictive of recovery, outweighing negative ED models and media.

Conclusion: Our results were highly revealing of dense networks of family and peer models of EDs as well as supportive networks for recovery. The density/richness of social networks of others with an ED was highly predictive of an ED diagnosis, particularly of multiple EDs. Same-sex peers and siblings with an ED were especially strong influences. “Rich” day-to-day networks of multiple social contacts with EDs were associated with multiple ED diagnoses. Media appeared to complement these social contacts. However, only dense networks of supportive others were significantly predictive of recovery. Effective ED treatment requires a careful consideration of social influences who may model ED attitudes and behaviours; same-sex siblings and peers are especially critical. ED treatment and recovery might be compromised if these significant others model and reinforce a patient’s ED attitudes and behaviours.

Aims: Forests are important for planetary and human health, but deforestation is increasing. Poor mental health is increasingly affecting the world’s population. This study aims to investigate the association between forestry area, deforestation and mental health, at country level, worldwide.

Methods: Forestry area in each country was sampled in 2006 and 2016; the country prevalence of mental health disorders or substance abuse was sampled in 2006 and 2016; and the relative disability-adjusted life years (DALYs) in 2010 and 2016. Crude and multivariate linear regression analyses were run, adjusting for peace index, wealth and inequalities, and urbanisation at country level. A sensitivity analysis including sanitation and food security was run. Interaction with country gross domestic product per capita was assessed.

Results: Based on data for 230 countries, country forestry area is negatively associated with the prevalence of mental health disorders in 2016 (β −0.02 (195% C.I. −0.04/−0.01). This association was maintained in sensitivity analyses, and found mainly in lower- and upper-middle income countries. Change in forestry area is not associated with mental health prevalence nor estimated DALYs due to mental health.

Conclusion: This is the first study showing that forestry area at country level is associated with a lower prevalence of mental health disorders. If these results are replicated at individual level, this would suggest that public health implications should play a strong role in weighting ecological decisions, such as optimising forestry area coverage.

Aims: Gambling Disorder is a mental health condition in which people experience impaired ability to control or stop gambling behaviours despite adverse consequences. It is associated with psychiatric co-morbidities and risk factors for physical health conditions. There is growing exploration into physical health conditions associated with gambling disorder and this study sought to further contribute towards understanding that association. The first aim was to describe rates of physical health conditions. The second aim was to explore potential associations between physical health conditions and individuals’ sociodemographic characteristics.

Methods: Dataset one comprised aggregated anonymised subject-level data from clinical trials conducted in participants with gambling disorder (n=423). Dataset two comprised aggregated anonymised patient data from the NHS Southern Gambling Service (n=352). Descriptive characteristics of people with versus without physical health co-morbidities were presented. Statistical tests were undertaken to compare those with versus without physical health co-morbidities, independent t-tests were utilised to compare continuous variables whereas Chi Square or Fisher’s Exact test were utilised when comparing categorical variables.

Results: In dataset one 42.9% reported one or more physical health condition, the most frequent reported physical health conditions were musculoskeletal, cardiovascular, and endocrine and metabolic conditions. People in dataset one with physical health condition(s) versus without had significantly older age. In dataset two 27.1% reported one or more physical health condition, with respiratory, musculoskeletal, and endocrine and metabolic being the most reported. The presence of physical health conditions, musculoskeletal conditions, and endocrine and metabolic conditions was associated with significantly older age and female sex.

Conclusion: Increased age in individuals with gambling disorder is a crucial sociodemographic factor regarding physical health morbidity. In dataset two being female was identified as a risk factor for having physical health morbidity. Implementation of treatments targeting these risk factors may reduce the public health and individual health burden of gambling disorder.

Aims: Changes in body biomechanics – that is, changes in gait, posture, and balance – have been identified during episodes of major depressive disorder (MDD). Whilst biomechanical changes are related to the level of disability experienced by people with MDD, such changes are rarely asked about by clinicians or addressed directly by interventions. As part of a project studying whether interventions that target biomechanics might be helpful for MDD, we are conducting an initial non-patient study quantifying biomechanics, mood and anxiety, before and after physiotherapist-directed interventions.

Methods: Twenty young people (aged 19–21) from a higher education setting have completed baseline measurements so far. The baseline protocol consists of questionnaire measures, a happy–sad emotional bias task, and a comprehensive biomechanical assessment including walking tasks, static and dynamic balance tasks, and postural measures.

The baseline walking-task metrics described here were collected using a force plate flush with the floor of a 10-metre walkway. Participants were asked to walk at a comfortable pace across the walkway six times. Walking speed was recorded, and the plate measured reaction forces from which were derived peak/mean forces in three dimensions, as well as variability in these forces across the six repetitions. There were no exclusion criteria for baseline analyses, other than physical disability preventing completion of key measures.

Results: In the fifteen participants (13 male) for whom baseline analyses are complete, mean PHQ-8 (self-reported depressive symptoms) ranged from 0–11 (none to low-moderate), and mean GAD-7 (self-reported anxiety) ranged from 0–25 (none to severe). One participant was taking sertraline, the others reported no mental health medications. Ratings of pain and mobility difficulties were low (EQ-5D domains, scored 1–5: fourteen participants scored 1, one participant scored 2).

Whilst there were no significant relationships between PHQ-8 total score and baseline gait metrics, mean reaction time to sad faces on the emotional bias task was correlated with variability in vertical and horizontal walking forces (28–50% variance explained, r2, across individual metrics, p=0.042–0.003). Greater GAD-7 total score was associated with greater walking speed and mean vertical and horizontal force (32–39% variance explained, p=0.029–0.012).

Conclusion: Gait variability was associated with a sensitive mood marker (average reaction time to sad faces), in this non-patient sample with low levels of self-reported depression. Self-reported anxiety was associated with average walking force and speed. Ongoing work is examining changes in metrics following physiotherapist-directed interventions and adapting the approach, with lived experience experts, for clinical studies.

Aims: The objective of this scoping review is to understand the extent and type of evidence in relation to psychotherapeutic interventions for older adults with depression and/or anxiety.

Methods: Prior to undertaking this scoping review, a preliminary search of the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, PubMed, CINAHL and American Journal of Psychiatry was conducted and no identical current or underway systematic reviews or scoping reviews on the topic were identified. The terms ‘old age psychiatry’ and ‘psychotherapy’ were used, and results were filtered for reviews and systematic reviews only. The scoping review will be conducted in accordance with the JBI methodology for scoping reviews. An electronic search for articles will be conducted using PubMed, American Journal of Psychiatry, Cambridge Core (BJPsych,) PsychInfo and Open Journal of Psychiatry. The databases will be searched for the following components: Older person’s mental health (using terms geriatric psychiatry, older person’s mental health, old age psychiatry.) AND Psychotherapy (using terms psychotherapy, talking therapies, cognitive behavioural therapy, cognitive analytical therapy, interpersonal therapy, group therapy, dialectical behavioural therapy, mindfulness, self help, psychodynamic therapy, psychoanalytical therapy, brief intervention, motivational interviewing.) AND Depression (using terms depression, loneliness, suicide, low mood) OR anxiety (using terms anxiety, panic disorder, generalised anxiety) using the title and abstract.

Only primary research studies to be included. Once the articles have been retrieved, they will be saved to an Excel spreadsheet and uploaded to Rayyan. The articles will then be checked and any duplicates will be removed. Two reviewers will check the articles by abstract and either include, exclude. The included articles will then be read, and analysed and written up into the scoping review report.

Results: Preliminary search: This returned 570 articles: 109 of these were relevant to this topic. The results returned 855. Results: 121 were included and 734 excluded. Psychotherapy research is worldwide but the main areas for primary research are North America and Europe. The majority of papers were randomised controlled trials looking at short-form therapy such as randomised controlled trials.

Conclusion: This scoping review has provided a foundation for the current evidence base looking at psychotherapeutic interventions for older adults with anxiety and depression. It would be good to do a similar review for older adults with other mental disorders such as mild cognitive impairment. It provides the foundation for researchers to move on to systematic reviews.

Aims: Delusional misidentification syndromes (DMS) are characterised by a delusional belief of misidentification concerning familiar individuals, places or objects and by the conviction that they have been replaced or transformed. Violent behaviours towards the “impostor” are often observed and can take the form of verbal threats or physical assault. This review explores the specific factors that increase the risk of violence in individuals with DMS.

Methods: An initial search was conducted in PsycInfo, MEDLINE, PubMed and PsycArticles in May 2023, followed by a subsequent search in November 2024, to identify publications reporting severe violence (e.g. homicide, attempted murder, assault) in individuals with DMS. 13 papers comprising 16 case reports were included in the review.

Results: The majority of patients were male (N=15), aged 29–43 (i.e. early- to mid-adult years) (N=14) at the time of the offence and had a prior diagnosis of a psychiatric disorder (N=13) (i.e. psychotic disorder). In 13 of 16 cases, the DMS was Capgras syndrome. The violent act most commonly perpetrated was homicide (including uxoricide, matricide, patricide, parricide and filicide) (N=21). Victims were mostly acquaintances or strangers (N=16), followed closely by familiar individuals (N=13). In 13 cases, social behaviour of the patients prior to the offence was described as “hostile”, “aggressive”, “solitary” or involving “poor social interactions from a young age”. Only 3 patients were described as “lively” or “social”.

Conclusion: The current systematic review identified specific factors such as a prior psychiatric diagnosis (i.e. of psychotic disorders), as well as male gender, early- to mid-adulthood, the type of DMS (i.e. Capgras syndrome) and social behaviour marked by isolation and hostility prior to the offence as potential contributors to severe violence in individuals with DMS. However, the lack of available case reports and empirical studies makes it challenging to understand the psychopathology exhibited and its relationship with violent behaviour. Further research is needed to advance our understanding of the possible factors associated with and the possible causes underlying the severity of violence exhibited in DMS.

Aims: The North London Foundation Trust was established in 2024. The partnership has created a new clinical strategy for the next 5 years (2024–2029) and some of the main priorities are: “For all services to use a trauma informed approach”, “Service users must be involved in co-production and decision making”, “Value feedback from service users”, “Facilitate communication and information sharing with service users”.

For these priorities to be addressed there need to be forums in which service users are able to be heard and fed back to using a trauma informed approach. Currently there are community meetings on the inpatient wards for service users and staff to feedback on any issues within the ward environment. On my ward these are poorly attended by both staff and patients and feedback from patients is that they raise the same issues, but nothing gets acted on. There is no set policy/protocol for how these meetings should run and who should be in attendance. By formalising the structure of the community meetings using a trauma informed framework, my hope is that both patients and staff benefit from the shared space and that the learning can be shared with other wards.

Objectives: To develop an evidence-based protocol for running community meetings on an inpatient psychiatric ward that fits within a trauma-informed framework; Improved attendance from staff and patients at the ward community meeting; Improved satisfaction from staff and patients attending community meetings; Share learning with other wards in the partnership.

Methods: A literature search to establish current best practice for running community meetings.

Qualitative questionnaires/ structured interviews and thematic analysis of staff interviews.

Development of protocol for running community meetings on inpatient wards.

3 month pilot of the new community meetings.

Attendance records pre and post intervention.

Results: Attendance records show improved attendance of both staff and patients at the weekly community meetings. Prior to the intervention, thematic analysis showed that staff thought there was a lack of clarity about goals, diverse interpretations of community meetings, and mixed expectations about patient involvement. Post intervention, analysis revealed that community meetings were widely appreciated as a valuable initiative that enhanced the ward culture, patient recovery, and staff-patient relationships. Despite challenges, many participants felt these meetings brought significant benefits.

Conclusion: Having a trauma-informed, semi-structured proforma for running inpatient community meetings helps to improve attendance, satisfaction and positive outcomes from the meetings for both staff and patients.

Aims: We hypothesise that mental health impacts of flooding will be greater in India compared with the UK. Climate change is causing an increase in flooding due to the rising frequency of extreme weather patterns globally. The major impacts of flooding on mental health include displacement, financial hardship, and loss of access to healthcare. These can lead to conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD).

Methods: This study was conducted as a comparative analysis. Data was collected by a systematic search of peer-reviewed articles. Standardised tools were used to evaluate psychological outcome and mental health morbidities such as the Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), WHO-5 and the PTSD checklist (PCL-6). Data concerning the mental health consequences caused by the floods (specifically regarding anxiety, depression and PTSD), financial impacts and access to mental health services in both countries were extracted. Our findings were then thematically analysed to compare the patterns and disparities.

Results: In both countries, the research conducted on the effects of flooding on mental health has identified that the three main mental health morbidities that arose are depression, anxiety and PTSD. India has an average percentage of 43.2% depression, 32.19% anxiety and 36.46% PTSD amongst individuals affected by flooding, while the UK shows equivalent rates of 25.52% depression, 24.2% anxiety and 31.49% PTSD. These results suggest that socioeconomic differences and access to mental health resources play a significant role in post-flood psychological states. In both countries a larger financial impact links to higher rates of psychological stress.

Conclusion: Although effects are noted in both the UK and India, the prevalence of mental health conditions arising from flooding affect both the UK and India. However, our findings indicate that the mental health impacts are more severe in India, supporting our hypothesis. In disaster recovery, mental health funding is frequently deprioritised in favour of immediate concerns such as physical health and infrastructure.

Stigma surrounding mental health, particularly affecting developing countries, contributes to under-reporting and therefore the accuracy of assessments. To improve outcomes, a public health approach may destigmatise mental health, and enhance social support. Additionally, Psychological First Aid has set international foundations for psychosocial care following distressing events, a framework which supports people whilst respecting culture and abilities.