Religious and spiritual preoccupation is clinically salient in bipolar affective disorder, especially during manic and mixed episodes. The boundary between culturally sanctioned religious experience and psychopathological religiosity is contested across cultures, creating diagnostic, therapeutic and ethical challenges.

To map evidence on religious preoccupation in bipolar disorder across cultural and religious settings, synthesise clinical and cultural determinants, and identify research gaps.

This scoping review followed Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews guidance, and was pre-registered on the Open Science Framework (10.17605/OSF.IO/V3WA6). PubMed/Medline, Scopus, Google Scholar and four regional databases were searched. Bipolar-specific empirical studies were analysed separately from contextual reviews, historical and conceptual publications, and mixed or non-clinical samples. Data were synthesised narratively and thematically.

Eighty-three sources published between 1966 and 2026 were included, comprising 46 bipolar-specific empirical studies and 37 contextual sources. Religious preoccupation, including hyper-religiosity, religious delusions, grandiosity and spiritual experiences, was documented across all six World Health Organization regions. Cultural context shaped explanatory models, pathways to care, diagnostic interpretation, medication adherence and outcomes. Religiosity was associated with protective effects, including lower suicidality and better coping, and adverse effects, including treatment delay and negative religious coping. Evidence gaps remain for Islamic, East Asian, Indigenous and secular-pluralistic populations.

Religious preoccupation in bipolar disorder is cross-cultural and remains understudied outside Western settings. Clinicians require cultural competence and cultural formulation approaches to distinguish psychopathology from normative religious expression. Future research should prioritise underrepresented regions, culturally validated tools and care models integrating religious leaders.

Healthcare can be a demanding career, and there is a rising interest in fostering the well-being of healthcare workers (HCWs).

To examine self-reported use of mental health and well-being support available to HCWs and explore predictors of use.

Data were collected by a longitudinal cohort study. The baseline survey was distributed from April 2020, followed by three surveys at 6 months (time 1; n = 10 514), 12 months (time 2; n = 10 429) and 32 months (time 3; n = 6382) post baseline. Use of mental health support (e.g. therapy) was assessed at each follow-up, and 96 supports were measured at time 1 only. Multilevel regression modelling was used to explore baseline predictors.

At time 1, we developed seven support categories. Practical supports (e.g. free or discounted food or parking) were the most commonly used (58%), whereas employee assistance programmes were least commonly used (5%). Furthermore, 21% of HCWs reported never using any support. Mental health support access varied: 23% of participants had used support before August 2021 (time 1), 17% between March 2020 and January 2022 (time 2), and 21% between February 2022 and May 2023 (time 3). HCWs who were male, older and/or of Asian ethnicity had lower odds of accessing support, whereas those who reported symptoms of common mental disorders at baseline had higher odds.

Most HCWs (79%) reported having accessed some support, whereas 21% had not. Practical and informal supports were most used, whereas uptake of employee assistance programmes was low. Future research should explore and address barriers faced by male, older, Asian and non-permanent staff to improve access and, in turn, the well-being, performance and patient care of these individuals.

Genome-wide association studies in East Asian populations have identified the gene variant, rs12415800, of the Sirtuin 1 gene (SIRT1) as a major depressive disorder (MDD) risk locus with the A allele conferring increased risk. Accumulating evidence suggests that SIRT1-related genetic effects extend beyond MDD.

To investigate the association between rs12415800 and bipolar disorder, with additional analysis of MDD.

We analysed data from the Taiwan Biobank linked to the National Health Insurance Research Database, including 145 780 participants of Han Chinese ancestry. Clinically diagnosed bipolar disorder and MDD were identified using standardised ICD-9-CM and ICD-10-CM codes. Multivariable logistic regression models were applied with the GG genotype as the reference, adjusting for age and sex. Stratified analyses were conducted by age group and sex.

Both the rs12415800 AG and AA genotypes were associated with an increased risk of bipolar disorder. Compared with GG genotype carriers, AA genotype carriers had a significantly higher risk of bipolar disorder overall (adjusted odds ratio (aOR) = 1.20, 95% CI = 1.05–1.37), particularly among participants aged ≥50 years (aOR = 1.38, 95% CI = 1.14–1.68). The overall and age-stratified associations remained materially similar after excluding participants with schizophrenia or schizo-affective disorder, although sex-specific findings were inconsistent.

Our findings suggest that genetic variation near SIRT1, particularly the rs12415800 risk A allele, may be associated with bipolar disorder susceptibility, especially among older individuals. Given prior evidence linking this allele to reduced SIRT1 mRNA expression, further investigation of SIRT1-related pathways in the pathophysiology of bipolar disorder is warranted.

Employment rates remain critically low among individuals with severe mental illness. Although social cognition explains a significant portion of the variance in functional outcomes, research into social cognitive interventions has remained scarce.

To evaluate the impact of a social cognitive remediation (SCR) programme on functional and psychological outcomes over a 6-month post-intervention period.

This randomised controlled trial was conducted across three sheltered employment centres in France (2020–2024; ClinicalTrials.gov protocol record: 2019-A00124-53). We evaluated the efficacy of a 12-week SCR programme versus an active control with respect to the ratio of hours effectively worked versus those expected at 6 months post treatment (primary outcome). Secondary outcomes included patient-reported measures of self-esteem, internalised stigma, recovery and anxiety. Intention-to-treat and per-protocol effects were estimated using targeted minimum loss-based estimation, with attrition accounted for through inverse probability of censoring weights.

Of the 105 randomised participants (SCR: n = 53; control: n = 52; mean age: 35.6 [s.d. = 8.8] years; 71% male), 39 dropped out, yielding a per-protocol sample of 33 participants per arm. Attrition was 28% immediately after the intervention and 37% at 6-month follow-up. SCR was associated with a 6.5% increase in the ratio of hours worked versus those expected in the intention-to-treat analysis and a 3.6% increase in the per-protocol analysis (both P < 0.05). SCR also reduced internalised stigma at 6 months post treatment (P < 0.03).

Our findings suggest that a 3-month SCR programme improves employment maintenance and reduces internalised stigma in individuals with severe mental illness. Future research should use larger samples and improve retention to confirm these findings.

Preventing episodes involving aggression and reducing coercive measures are important goals in in-patient mental health settings. Antecedents may provide insight into how episodes are described to develop. However, most studies reflect staff perspectives, and often describe and temporally specify antecedents inconsistently.

This scoping review mapped reported antecedents to episodes involving aggression and episodes involving coercive measures, and identified which appeared shared or specific to either phenomenon.

This review followed the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidance, and included 39 studies from systematic searches across Ovid Medline, APA PsycINFO and Scopus. Reported antecedents were extracted, standardised and mapped to six analytical domains.

The review mapped 240 antecedents, many of which appeared shared across the phenomena. Patient studies emphasised experiences of restrictive care, loss of autonomy and poor interaction quality. Staff studies emphasised immediate, observable situations related to risk management, such as patient aggression, denied requests and interpersonal conflict. Most studies did not specify the temporal boundaries of antecedents.

The perspectives represented in studies and the ways antecedents are conceptualised influence which antecedents become visible in the literature. Overlapping antecedents indicate that episodes involving aggression and episodes involving coercive measures are often described as part of the same escalation process, although patient and staff studies seem to highlight different stages. Prevention efforts therefore require attention to the entire trajectory, and to the point at which staff perceive intervention as necessary. Future studies should incorporate both perspectives, prioritise patient involvement, and more clearly define and temporally specify antecedents.

Parental substance use (PSU) is associated with increased psychiatric risk among offspring, but evidence from Sub-Saharan Africa remains limited.

To examine cross-sectional associations between PSU and Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) algorithm-defined adolescent psychiatric symptom profiles in Lagos, Nigeria, and assess whether family dysfunction statistically attenuates these associations.

Data came from the Lagos Schools Emotional and Behavioural Health Survey, a school-based sample of 9437 adolescents aged 11–17 years. PSU was categorised as neither parent, only father, only mother or both parents using substances, defined as adolescent-reported at least weekly parental alcohol consumption or tobacco use over the past 12 months. Psychiatric symptom profiles were identified using structured MINI-KID self-report algorithms administered with trained research-assistant support. Logistic regression estimated adjusted odds ratios (aORs). Family dysfunction, defined as domestic violence or high family conflict, was examined using cross-sectional statistical attenuation models.

PSU was reported by 20.0% of adolescents: 17.3% father-only, 1.3% mother-only and 1.4% both parents. Associations followed a graded pattern. Dual-parent PSU was associated with increased odds of symptoms meeting algorithm thresholds for substance use disorder (aOR = 5.84, 95% CI 3.42–9.97), alcohol use disorder (aOR = 4.98, 95% CI 3.09–8.03) and major depressive disorder (aOR = 2.81, 95% CI 1.94–4.07). Family dysfunction partially attenuated selected associations.

PSU was associated with elevated adolescent psychiatric symptom profiles in a graded fashion. Findings are cross-sectional and do not establish causality. Outcomes represent self-reported symptoms meeting MINI-KID algorithm thresholds, not clinician-confirmed diagnoses.

People who are agitated, confused or distressed seldom receive holistic care within acute general hospitals. Unmet needs relating to conditions such as mental illnesses, learning disabilities or dementia can contribute to patient behaviours which staff find challenging to manage (e.g. self-harm). Enhanced observation, involving one-to-one care and monitoring, is a restrictive intervention often used to manage these presentations. The characteristics and outcomes of high-quality enhanced observation in this setting remain ill-defined, compromising quality and safety.

To understand what constitutes high-quality, safe enhanced observation in an acute general hospital for patients presenting with agitated, confused or distressed behaviours.

A systematic review was performed, involving searches of five bibliographic databases, hand-searching, and forward and backward citation searching. Data describing the characteristics of high-quality, safe enhanced observation practice were eligible and included in a framework-based synthesis. Quality and safety outcomes were summarised thematically. Studies were appraised for quality, and data interpretation was shaped by lived experience experts.

Fifty studies were included. Enhanced observation practice was influenced by individual staff members (e.g. attitudes), teams (e.g. teamwork fluency) and wider organisational factors (e.g. leadership, organisational culture). The quality and safety problems identified included self-harm, aggression and staff neglect of caring responsibilities during enhanced observation.

Findings on the characteristics and outcomes of high-quality, safe enhanced observation provision should inform the development of evidence-based guidance to support improved, standardised practice in acute general hospitals. Evidence gaps with respect to patient experiences of enhanced observation and trauma-informed approaches to its delivery warrant urgent attention.

Older people have higher rates of death by suicide, and both self-harm and suicidal ideation are major risk factors for suicide. There is limited data relating to this group internationally.

The objective of this study was to identify the clinical and sociodemographic variables associated with psychiatric admissions for older people who present with self-harm and suicidal ideation to emergency departments in Ireland.

This is a cohort study of older people in Ireland, utilising data collected by the National Clinical Programme for Self-Harm and Suicide-Related Ideation (NCPSHI). It is a national data-set including anonymised data from all participating emergency departments in Ireland, comprising 72 810 presentations over 5 years (2018–2020). We examined the characteristics of people aged over 60 presenting with self-harm and suicidal ideation (n = 4866). The variables associated with suicidal ideation and behaviours were explored using multivariable analysis.

Nationally, 7% of the patients presenting were aged over 60 years. One-quarter (26.8%) of older people presenting with self-harm required psychiatric admission (16.3% all-ages). On multivariable analysis, the relationship between self-harm and psychiatric admission was not statistically significant (reference group was those with suicidal ideation), after controlling for gender, year of presentation, substance use and need for medical admission odds ratio 0.977 (CI0.936–1.020).

Our results outline the characteristics of older people presenting to Irish emergency departments with self-harm and suicidal ideation, which are associated with psychiatric admission. Further research is needed to understand the factors driving these presentations and to tailor our services to meet the needs of older people.

Refugee youth are at elevated risk for post-traumatic stress disorder (PTSD) and other mental health disorders, yet systemic and cultural barriers limit access to care. Scalable, transdiagnostic interventions such as Problem Management Plus (PM+) are promising, but their impact on trauma symptoms is modest. Incorporating brief trauma-focused components may enhance effectiveness.

To evaluate the feasibility and acceptability of PM+ with an emotional processing module (PM+EP) for refugee youth aged 16–25 years in the Netherlands.

Refugee youth with elevated psychological distress (K10 > 15) and impaired functioning (World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) > 16) were randomised into PM+EP, PM+ with supportive counselling (PM+SC), or care as usual (CAU). Feasibility and acceptability were assessed via recruitment, adherence, fidelity and qualitative interviews. Psychological distress, PTSD symptoms, functioning and self-identified problems were measured at baseline, post-intervention and follow-up. Registered in Overview of Medical Research in the Netherlands (OMON; Trial ID: NL-OMON56254).

Fifty-two participants were randomised (PM+EP: n = 17; PM+SC: n = 19; CAU: n = 16). Attendance and fidelity were high, and PM+ interventions were rated as acceptable and culturally appropriate. No significant between-group differences were observed in the primary analyses. Exploratory analyses suggested greater short-term symptom reduction for probable depression in PM+EP versus CAU (b = –0.79, s.e. = 0.38, p = 0.04). Effect size estimates ranged from small to large across outcomes (Hedges’ g = –0.98 to 0.19).

PM+ is feasible, acceptable and safe for refugee youth aged 16 years and older. The potential added value of the EP module remains unclear and warrants further investigation.

The trial was registered in the Dutch clinical trial registration: Overview of Medical Research in the Netherlands (OMON) (Trial ID: NL-OMON56254; https://onderzoekmetmensen.nl/en/trial/56254).

The 7 October 2023, terrorist attack at the Nova Festival in southern Israel caused deaths, injuries, hostage-taking and prolonged life-threatening exposure, creating an urgent need for early interventions to reduce post-traumatic morbidity. Although prolonged exposure is an established post-traumatic stress disorder (PTSD) treatment, its feasibility and benefit during ongoing threat remain unclear.

This preliminary study evaluated a war-adapted brief prolonged exposure protocol (WBPE) delivered shortly after trauma in Nova Festival survivors with acute stress disorder.

Forty survivors completed the WBPE and were assessed at baseline and immediately post treatment. A subsample of 27 WBPE completers and 18 untreated wait-list controls was reassessed after 5 months. Outcomes were PTSD (PDS-5), depression (PHQ-9) and anxiety (GAD-7) symptom severity.

WBPE was associated with significant reductions in PTSD, depression and anxiety immediately after treatment. At 5 months, WBPE participants showed greater reductions in PTSD and depressive symptom severity and lower PTSD and depression symptom scores than controls, with large effect sizes. Anxiety symptoms improved in both groups, consistent with possible natural recovery. Clinically significant depressive symptoms (48.15 v. 77.78%) and anxiety symptoms (37.04 v. 72.22%) were less frequent in WBPE participants than controls, whereas probable PTSD rates did not differ significantly. Substance use during the study period was associated with poorer outcomes and smaller symptom reductions.

WBPE appears feasible and potentially beneficial under wartime conditions, with meaningful improvements in PTSD and depression despite persistent threat. Substance use was linked to poorer recovery and should be systematically assessed in post-trauma care.

Early intervention increases the likelihood of eating disorder recovery but many young people delay help-seeking. We developed a smartphone-friendly, online decision-making tool to address this gap (FREED-Mobile (FREED-M)).

To conduct a randomised controlled feasibility trial of the FREED-M decision-making tool with 16- to 25-year-olds with a suspected eating disorder and no previous treatment for this.

Participants were randomly allocated to FREED-M or an active control in a parallel group, two-arm trial. Outcomes were measured at weeks 0 (baseline), 4 (post-intervention) and 12 (follow-up). The primary feasibility outcome was attrition at follow-up. Other outcomes included motivational, clinical and economic measures.

We over-recruited with 204 randomised participants (including 20 fraudulent participants). Main analyses were conducted with 184 genuine responders (FREED-M: n = 91, control: n = 93). At baseline, participants’ mean age was 21.0 (s.d. 2.0) years, 89% identified as female and 64% as White. Mean body mass index was 23.1 kg/m2 (6.3). N = 83 participants had an anorexia nervosa-like disorder, 101 had another eating disorder or high eating disorder risk. Attrition at week 12 was n = 112 (61%). Of the n = 42 FREED-M participants who provided acceptability ratings, 79% liked the intervention and 66% found it useful. Between-group effect sizes for motivation and readiness to change were small to medium at 4 weeks (d = 0.27 and d = 0.15, respectively) favouring FREED-M, but differences were not sustained at follow-up (d = −0.02 and d = −0.12, respectively).

Although the attrition rate was high, recruitment exceeded expectations. Acceptability of FREED-M was high among participants who provided acceptability ratings. Motivation/readiness to change and help-seeking are candidates for primary outcomes in a future randomised controlled trial.

Acute behavioural disturbance (ABD) is a contested term describing severe agitation and behavioural dysregulation, often preceding sudden death. Concerns regarding diagnostic clarity, racial bias and law enforcement restraint have been raised, and its clinical and forensic utility have been questioned.

To characterise fatal ABD cases following substance use to inform clinical management, forensic interpretation and policy.

Fifty-one deaths consistent with ABD were identified from the National Programme on Substance Use Mortality (NPSUM) using textual screening and Royal College of Emergency Medicine and Faculty of Forensic & Legal Medicine criteria.

All cases met Royal College of Emergency Medicine criteria and most met Faculty of Forensic & Legal Medicine (84.3%) criteria. Agitation was the most frequently observed sign (86.3% of cases). Stimulants, particularly cocaine and amphetamines, were also detected in 86.3% of cases, but not necessarily in the same cases, and the rate of stimulant detection was almost three times higher than that in in the broader NPSUM cohort (32.1%). Cocaine concentrations were higher in ABD cases than in all NPSUM cocaine-related deaths (0.848 mg/L v. 0.105 mg/L). Compared with the NPSUM cohort, ABD decedents were significantly younger (30.2 ± 7.5 v. 40.5 ± 13.4) and more likely to be male (92.2 v. 73.4%), from racially minoritised backgrounds (21.7 v. 3.9%) and living in deprived areas (87.0 v. 75.9%).

Variability in diagnostic criteria highlights a need for clearer ABD definitions. Toxicology testing may assist in refining the ABD construct, but its results must be interpreted within broader clinical and social contexts. These findings support avoiding use of ABD as a stand-alone cause of death but retaining it as a clinical descriptor prompting urgent treatment, monitoring and reduced reliance on prolonged restraint.

International guidance recommends that long-acting injectable (LAI) antipsychotics be considered for routine management of first-episode schizophrenia. Reliable national estimates of utilisation are lacking for most countries, including Ireland.

To determine the prevalence of LAI antipsychotic prescribing in Ireland between 2014 and 2024 and explore the effects of age, sex and socioeconomic status on prescribing trends.

The annual prescribing prevalence was calculated per 1000 individuals with schizophrenia aged 15–69 using the national pharmacy claims database. The effects of year, age, sex, socioeconomic class and antipsychotic medication on LAI antipsychotic prescribing trends were examined using log-linear regression.

The prevalence of LAI antipsychotic prescribing decreased from 327/1000 in 2014 to 281/1000 in 2024, with an average annual change in prescribing rate of −1.49% [95% CI −1.98, −0.79]. In 2024, paliperidone LAIs were most commonly prescribed (40.2%). Prescribing prevalence increased with age, with the lowest prescribing prevalence occurring among those aged 15–24 years (79/1000) and the highest among those aged 65–69 years (434/1000). The prescribing prevalence increased significantly among those aged 25–34 years only (+2.7% [95% CI 1.7, 4.3]). Prescribing rates decreased across all ages between 45 and 69 years; the largest decrease occurred among those aged 65–69 years (−4.3% [95% CI −5.7, −2.9]). Higher rates of prescribing were seen in male compared with female patients across all age bands, with the highest male-to-female ratio (2.94) occurring among those aged 25–34 years.

Approximately 28% of Irish individuals with schizophrenia are prescribed an LAI antipsychotic. Prescribing rates have decreased by 14% since 2014. Priorities for future research include implementation science studies to identify strategies that can effectively increase LAI antipsychotic prescribing.

Cognitive function is a significant predictor of daily functioning in the population, yet the extent to which common mental health symptoms account for this relationship remains unclear.

This study aimed to examine the relationship between cognition, mental health and functioning across two cohorts.

Participants were recruited from an online population cohort, HealthWise Wales (N = 3679), and a psychiatric cohort, the National Centre for Mental Health (NCMH, N = 1036), to complete a cognitive battery and the World Health Organization Disability Assessment Schedule (WHODAS). We assessed the associations between cognitive performance and the WHODAS, as well as two measures of life functioning: current employment and cohabitation with a partner. We examined the role of current mood, psychiatric and neurodevelopmental history and lifestyle factors using linear and logistic regression.

Higher cognitive performance was associated with fewer functional difficulties on the WHODAS (HealthWise Wales: B = −0.12, 95% CI (−0.15,−0.09), P < 0.001; NCMH: B = −0.1, 95% CI (−0.13,−0.08), P < 0.001), being in employment or education (HealthWise Wales: odds ratio 1.22, 95% CI (1.11,1.34), P < 0.001; NCMH: odds ratio 1.31, 95% CI (1.19,1.46), P < 0.001) and living with a partner (HealthWise Wales only: odds ratio 1.19, 95% CI (1.06,1.32), P = 0.003). Higher levels of depression and anxiety symptoms were consistently associated with reduced functioning across all analyses. The relationship between cognition and functioning remained significant but attenuated after accounting for these symptoms.

Cognitive function was associated with functioning in both clinical and population-derived samples. Current symptoms of depression and anxiety play a key role in this relationship. Both cognitive function and common mental health problems may be potential intervention targets to alleviate daily difficulties.

The first year after diagnosis and the last year of life are critical periods for people with dementia.

To (a) identify subgroups within a large sample of people with dementia, characterised by healthcare use in the year after diagnosis and the last year of life; (b) describe the biopsychosocial characteristics associated with these subgroups; and (c) explore moves between subgroups over time.

A retrospective cohort of people diagnosed with dementia in London, UK, was assembled using linked clinical and administrative data-sets. We used latent class analysis to identify subgroups based on hospital and specialist mental healthcare service use in the year following diagnosis and the year before death. We used multinomial logistic regression to describe biopsychosocial characteristics and class membership, and latent transition analysis to explore moves between subgroups.

Among 8623 people with dementia, we identified 3 subgroups of healthcare use in the year after diagnosis: ‘low use’ (49%), ‘hospital use’ (34%) and ‘mental healthcare use’ (17%). In the last year of life, four subgroups were identified: ‘low use’ (32%), ‘moderate hospital use’ (43%), ‘high hospital use’ (9%) and ‘community healthcare use’ (17%). Biopsychosocial factors, including age, ethnicity, and cognitive and physical problems, associated with subgroups differed for the time periods. Male gender, mixed dementia and vascular dementia diagnoses were associated with a higher risk of unplanned hospital use. Transition probabilities indicated unstable patterns of healthcare use after diagnosis and before death.

Distinct subgroups and healthcare patterns in two care periods can facilitate proactive, needs-based service provision while potentially reducing emergency hospital use.