The true incidence of treatment-resistant schizophrenia (TRS) remains uncertain, largely because earlier studies relied on heterogeneous definitions and retrospective assessments. The Treatment Response and Resistance in Psychosis (TRRIP) consensus established standardised diagnostic criteria, but these have rarely been applied prospectively.

To estimate the incidence of TRS prospectively by using operationalised TRRIP criteria within a large community-based trial, and to examine whether baseline demographic or clinical variables predict its emergence.

We applied TRRIP criteria to 1334 participants with chronic schizophrenia enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. TRS was defined as persistent symptoms and functional impairment following two adequate antipsychotic trials, each meeting TRRIP thresholds for duration, dose and adherence. Incidence was estimated with bootstrap resampling, and logistic regression examined associations between baseline variables and TRS onset.

Of 1334 participants, 782 (58.6%) met TRRIP absolute symptom thresholds at baseline; 77 (9.8%) fulfilled full criteria for TRS during follow-up. The incidence rate was 5.68 per 100 person-years (95% CI 4.51–7.02) overall and 9.20 per 100 person-years (95% CI 7.43–11.39) among above-threshold participants. Higher baseline Positive and Negative Syndrome Scale positive and negative subscale scores and greater global illness severity were associated with TRS, although predictive performance was poor.

This first prospective application of TRRIP criteria to a randomised trial data-set provides robust estimates of TRS incidence. Routine clinical and demographic variables have limited predictive value, supporting the need for longitudinal, biologically informed studies that use TRRIP-aligned frameworks.

Two functional genetic polymorphisms, ADH1B rs1229984 and ALDH2 rs671, play key roles in ethanol metabolism and are especially prevalent in East Asian populations. The rs1229984 variant accelerates the conversion of ethanol to acetaldehyde, whereas rs671 reduces enzymatic activity for converting acetaldehyde into acetic acid. These variants affect alcohol use disorder risk and have been implicated in various systemic conditions.

To investigate the broader associations of ADH1B rs1229984 and ALDH2 rs671 with habitual alcohol use in large, unselected populations.

We analysed data from 146 374 Taiwanese adults (aged 20–90 years) enrolled in the Taiwan Biobank.

Both variants showed clear associations with habitual alcohol use. The ADH1B rs1229984 CC genotype was associated with a higher prevalence of drinking, indicating a substantial contribution to alcohol-related behaviour. The ALDH2 rs671 A allele was linked to markedly reduced drinking, reflecting known intolerance among carriers rather than implying a uniformly larger effect than ADH1B. Beyond alcohol use, rs671 showed a protective association with gout, whereas rs1229984 was not significantly associated with chronic diseases after correction.

In this large population sample, both ADH1B rs1229984 and ALDH2 rs671 demonstrate meaningful, genotype-dependent effects on habitual alcohol use. Their combined effects underscore the importance of evaluating gene–gene interactions rather than attributing disproportionate influence to a single locus.

The increasing demand for adolescent eating disorder services during and following the COVID-19 pandemic necessitated alternative treatment approaches. Traditional in-patient and daycare settings faced challenges, including resource limitations and geographical accessibility.

To describe and evaluate the outcomes of the Hospital at Home (H@H) service, an innovative, virtual, intensive treatment programme designed to prevent in-patient admissions or shorten length of in-patient stay.

A prospective cohort of 71 consecutive admissions from October 2021 to December 2024 was established. Data included percentage median body mass index (%mBMI), Eating Disorders Examination Questionnaire (EDE-Q), Children’s Global Assessment Scale (CGAS) and any readmissions for in-patient treatment within the following 6 months. Qualitative feedback was also sought from staff and a sample of patients and family members.

Of the 71 admissions to H@H, only 9 (13%) required hospitalisation. Mean %mBMI increased significantly, from 82.4% (s.d. 8.17) on admission to 90.07% (s.d. 9.44) on discharge (p < 0.001, 95% CI 5.67 to 9.61). Global EDE-Q score improved significantly, from 3.75 (s.d. 1.32) on admission to 2.62 (s.d. 1.45) on discharge (p < 0.001, 95% CI −1.47 to −0.78). Average CGAS improved significantly, from 38.7 (s.d. 7.4) on admission to 51.8 (s.d. 14.2) on discharge (p < 0.001, 95% CI 10.06 to 16.11). Families and patients reported high satisfaction with the virtual care model.

This innovative model prevented hospital admissions, demonstrating clinical benefits and high user satisfaction. Expansion and further research are recommended to explore the long-term clinical outcomes and cost-effectiveness.

Many autistic adolescents receive in-patient psychiatric care from services that are ill-equipped to meet neurodivergent needs. However, the outcomes for autistic adolescents accessing in-patient care remain poorly understood.

To document the demographics and clinical outcomes of autistic adolescents referred to in-patient psychiatric services over a 5-year period and compare these with those of their allistic peers accessing the same services.

We conducted a retrospective cohort study involving all adolescents (aged 12–17 years inclusive) referred for in-patient psychiatric care through the Thames Valley Provider Collaborative between 1 April 2019 and 31 March 2024. Clinical characteristics and outcomes of referrals for autistic and allistic adolescents were collected and summarised from routine service data. Inferential statistics (including t-tests and chi-squared tests) were used to compare characteristics between the autistic and allistic groups.

Autistic adolescents were more likely than their allistic peers to be referred in an emergency (24.6 v. 16.6%) and for risk management (53.7 v. 33.5%). Autistic adolescents without an eating disorder had longer average length of stay than their peers (146.1 v. 97.5 days) and were more likely to be discharged to more secure settings following admission (12.9 v. 7.7%). Emerging evidence from routine outcome measures suggests less positive progress during in-patient care and greater impairment among autistic adolescents at both admission and discharge.

There are important differences in outcomes from psychiatric in-patient admissions between autistic and allistic adolescents. Greater work is needed to understand these differences and the factors influencing treatment success for autistic adolescents.

In-patient mental health rehabilitation services provide specialist care to adults with complex psychosis. In England, there are more than 350 such services, half provided by the National Health Service (NHS) and half by the independent sector.

To investigate whether NHS and independent sector in-patient mental health rehabilitation services differ.

We recruited a random sample of NHS and independent sector services across England. We collected cross-sectional data regarding service and patient characteristics through interviews with patients, clinicians and managers, and from healthcare record reviews.

We recruited 411 patients from 48 NHS services and 172 patients from 20 independent sector services. Service characteristics, including standardised quality scores, were similar. Most patients had a diagnosis of schizophrenia (NHS n = 237, 57.7%; independent sector n = 99, 57.6%) or schizoaffective disorder (NHS n = 88, 21.4%; independent sector n = 32, 18.6%). More than half had at least one comorbid condition, but more independent sector patients had at least two (NHS 131 of 411, 31.9%; independent sector 80 of 172, 46.5%; P = 0.001). Current admissions were twice as long for independent sector patients (NHS mean 1.2 years [s.d. 1.5]; independent sector mean 2.4 years [s.d. 2.8]). Standardised ratings of patients’ quality of life, autonomy, time use, satisfaction with care, social and everyday functioning, and challenging behaviours were similar. However, independent sector patients had more needs (NHS mean 6.5 [s.d. 3.2]; independent sector mean 7.9 [s.d. 3.9]; P < 0.001) and more had a history of fire setting (NHS 32, 7.9%; independent sector 28, 17.2%; P = 0.001).

Both NHS and independent sector in-patient rehabilitation services support people with complex psychosis, but independent sector patients may have more complex conditions, which could explain their longer admissions.

Pre-existing cardiovascular disease (CVD) affects 1–4% of pregnancies in the USA and is associated with maternal morbidity. High-risk pregnancies with increased medical supervision are associated with poor postpartum mental health, although the prevalence in those with CVD is unclear.

This scoping review aimed to synthesise estimates of post-pregnancy mental health outcomes among people with pre-existing CVD.

Cochrane Library, Ovid Medline, Ovid EMBASE, Scopus, Google Scholar and Web of Science Core Collection were searched to identify relevant published literature, using controlled vocabulary and keywords for post-pregnancy mental health and CVD in pregnancy. The search was not limited by publication type, year or study design. Studies that included an assessment of post-pregnancy depression, anxiety or post-traumatic stress disorder (PTSD) symptoms after a pregnancy complicated by pre-existing CVD were included.

Of the 1591 studies screened, 7 met the inclusion criteria. In patients with pre-existing CVD, 4 studies assessed depressive symptoms and found a prevalence of 10.4–32.2%; 2 studies assessed anxiety symptoms and found a prevalence of 22.0–28.5%; and 1 study assessed PTSD and found a prevalence of 26.4% for mild symptoms and 18.2% for moderate symptoms.

The prevalence of post-pregnancy depression, anxiety and PTSD symptoms among people with pre-existing CVD may be similar to, or higher than, estimates from the general population. However, there was high heterogeneity in the included studies. More research is needed to determine if there is an increased risk of postpartum mental health disorders for pregnant people with pre-existing CVD.

Secure psychiatric services (SPS) are vital for people with severe mental disorders who pose significant risks, yet national evidence on referral pathways, acceptance and timeliness of admission is limited. Delays and variability in access are especially concerning in prisons, where mental health crises are frequent and alternatives limited.

This study presents the first national analysis of SPS referral and admission patterns in England following the introduction of provider collaboratives. It identifies predictors of referral acceptance and delays across the referral-to-admission pathway to inform equity and performance improvement.

Data were drawn from 149 low-secure and 98 medium-secure services across 15 provider collaboratives, encompassing 1356 referrals. Multivariable models examined predictors of acceptance and delay, benchmarked against national policy standards.

Almost half of referrals originated from prisons (46%, n = 529), with 55% accepted. Acceptance was associated with gender, legal status, Mental Health Act status, prior secure admission, diagnosis, referral origin and reason for referral, but not with ethnicity or urgency. Substantial site-level variation reflected local practice and resources. Delays were widespread: fewer than a third of urgent referrals were assessed within 2 days, and only 19–25% of accepted prison referrals met recommended assessment and admission targets. Although prison referrals were processed more quickly than community or SPS referrals, national standards were seldom achieved.

Access to SPS remains inconsistent, with substantial variation in acceptance and widespread delays across referral pathways. Despite faster processing of prison referrals, national assessment and admission standards were rarely met, particularly for this group. These findings highlight gaps between policy expectations and practice, indicating a need for improved adherence to national timeframes, greater standardisation of decision-making and enhanced system oversight, to reduce inequities in access.

Peer-supported self-management at discharge from early intervention in psychosis services (EIPS) has received limited attention. The MyPREPED (My Personal Recovery Plan for Early Discharge) trial will evaluate a co-designed, digital and paper-based, peer-delivered recovery and self-management focused intervention, tailored for young people exiting EIPS.

This protocol describes a hybrid type 2 effectiveness–implementation trial designed to assess MyPREPED’s impact, feasibility, real-world implementation and cost–utility.

This multi-site, mixed-method, two-arm (1:1), parallel-group, randomised controlled trial (MyPREPED versus treatment as usual) trial will be delivered across eight Australian EIPS that deliver ultra-high risk and/or first-episode psychosis streams, using a hybrid type 2 implementation–effectiveness design. Eligible participants are young people aged 16 years and over within 6 months of planned discharge from EIPS. Peer coaches will deliver up to ten sessions of using a self-management plan (modules: discharge, recovery, well-being, relapse prevention, goal-setting, service navigation). Co-primary outcomes include (a) mental health recovery (Recovery Assessment Scale – Domains and Stages; effectiveness outcome) and (b) feasibility (Feasibility of Implementation Measure; implementation outcome). Secondary outcomes assess broader effectiveness domains (mental health quality of life, clinical and functional outcomes) and other implementation outcomes. A cost–utility analysis will estimate incremental costs and quality-adjusted life-years associated with MyPREPED, alongside a secondary cost-effectiveness analysis. Analyses will follow intention-to-treat principles, using mixed-effects models.

This study will provide the first rigorous test of a co-designed, peer-delivered recovery and self-management focused intervention specifically targeting EIPS discharge.

The COVID-19 pandemic disrupted healthcare delivery and coincided with increased psychological distress worldwide. In the UK, restrictions on healthcare access, rapid adoption of remote consultations and pressures on mental health services may have influenced prescribing of psychotropic medications. However, evidence comparing prescribing trends across the four UK nations during the pandemic remains limited.

To examine trends in community prescribing of psychotropic medicines across England, Scotland, Wales and Northern Ireland before and during the COVID-19 pandemic.

We conducted a repeated cross-sectional study of national Prescription Cost Analysis data-sets covering March 2019 to March 2023. Monthly utilisation of antidepressants, anxiolytics/hypnotics, antipsychotics and antidementia medicines was measured, using two indicators: number of items dispensed per 1000 inhabitants and defined daily doses per 1000 inhabitants per day. Interrupted time-series regression was applied to assess changes in prescribing levels and trends associated with the first (March 2020) and second (November 2020) UK national lockdowns.

Psychotropic prescribing increased across most medicine classes during the study period. Antidepressant utilisation increased by 24.6% across the UK, representing the largest rise among psychotropic medicines. Antipsychotic prescribing increased by 2.7%; anxiolytic/hypnotic prescribing showed modest overall change (2.7%), but this varied between nations, increasing in Scotland (7.3%) and Northern Ireland (7.4%), and declining in Wales (−9.5%). Antidementia medicines increased modestly overall (9.3%), with variation between countries. Interrupted time-series analyses indicated that most changes occurred gradually rather than abrupt shifts following lockdowns.

Psychotropic prescribing increased during the COVID-19 period, but largely reflected continuation of pre-existing trends rather than immediate effects of lockdown restrictions.

Family harmony, emotion-management skills, problematic social media use and individual social responsibility are relevant to young adults’ psychosocial functioning, but evidence on their interrelations remains limited, particularly in Turkish samples.

This study examined whether emotion-management skills and problematic or dysregulated social media use statistically mediated the association between family harmony and individual social responsibility among Turkish young adults.

A cross-sectional online survey was completed by 854 participants (64.1% female) using the Individual Social Responsibility Scale, Family Harmony Scale, Emotion-Management Skills Scale and the Bergen Social Media Addiction Scale, interpreted here as an indicator of problematic or dysregulated social media use symptoms.

Family harmony showed a significant total association with individual social responsibility (B = 0.77, 95% CI 0.64 to 0.89) and remained directly associated after the mediators were included (B = 0.60, 95% CI 0.47 to 0.72). The total indirect effect was significant (B = 0.17, 95% CI 0.13 to 0.22), including specific indirect associations through emotion-management skills (B = 0.11, 95% CI 0.07 to 0.15), problematic social media use (B = 0.04, 95% CI 0.02 to 0.06) and their serial pathway (B = 0.03, 95% CI 0.01 to 0.04).

Family harmony was associated with individual social responsibility directly and through emotion-related and digital-behavioural correlates. Because the data are cross-sectional, findings should be interpreted as associative rather than causal.

While treatment non-adherence is a well-established relapse risk factor, broader contributors require investigation. Studying chronic, high-risk schizophrenia cohorts in real-world lower middle-income country (LMIC) settingsremains methodologically challenging.

To explore multidimensional factors moderating treatment trajectories in individuals with chronic schizophrenia at high risk of relapse, comparing relapsers and non-relapsers in a real-world LMIC setting.

In this 12-month prospective naturalistic study, 56 clinically stable adults with chronic schizophrenia (≥2 relapses within 3 years), receiving long-acting injectable and/or oral antipsychotics were followed up monthly. Relapse was defined as worsening psychotic symptoms requiring re-hospitalisation. Linear mixed-effects models examined trajectories of Positive and Negative Syndrome Scale (PANSS) total and factor domains (positive, negative and disorganised) and tested group*time*moderator interactions for neurological soft signs (NSS), quality of life (QOL), aberrant salience, anxiety, resilience, self-esteem, social adversity and childhood trauma.

Twenty-three participants (41%) relapsed; overall attrition was 59%, with 21% of discontinuations relapsing. Most relapses (87%) involved non-adherence and substance misuse. No group*time interaction effects were found for PANSS domains. Poorer overall QOL (F(4, 31 = 4.0), p = 0.009) was associated with worse negative symptom trajectory in the relapse group, while more pronounced NSS was associated with worse positive symptom trajectory in the non-relapse group (F(2, 23 = 8.4), p = 0.002).

Conducting longitudinal research in chronic, high-risk schizophrenia populations in LMICs is challenging. Although exploratory and hypothesis-generating, QOL and NSS may represent clinically meaningful moderators of treatment course and potential targets for intervention and future research.