Psychiatric in-patient populations are heterogeneous. Severe and enduring psychiatric illness (SEPI) and trauma, stressor-related and substance use (TSRS) presentations differ clinically, but their service demands and mortality within one system are poorly characterised.

To characterise in-patient service use and mortality across clinical trajectories in one National Health Service general adult psychiatry (GAP) service.

Longitudinal cohort study of 5204 in-patient episodes (2016–2024) aggregated to 2665 patients classified as SEPI (schizophrenia spectrum, bipolar disorder, severe unipolar depression) or TSRS, the latter subdivided into borderline personality disorder (BPD) and non-psychotic mood, stress-related and substance-use presentations. Analyses used person-years, standardised mortality ratios (SMRs), survival analysis and years of life lost.

SEPI comprised 28.9% of patients but 69.3% of bed utilisation, with longer, recurrent admissions. TSRS presentations were brief and crisis-driven; BPD had the highest admission frequency with short stays. Cumulative mortality was 53% higher in SEPI than TSRS (13.5 v. 8.8%), but after adjustment for age and illness duration mortality was similar across groups (SMR 4.87). TSRS deaths occurred at younger ages, particularly in BPD, whereas SEPI deaths reflected common physical illnesses occurring far earlier than in the general population. Most deaths (98.5%) occurred outside in-patient settings.

GAP services accommodate two trajectories with contrasting demands but similarly high mortality (SMR 4.87): enduring, medically managed illness with high cumulative resource use, and episodic brief crisis presentations. Recognising this is essential for service design, since current models combine structurally distinct demands within a single system.

Exercise is increasingly utilised as a complementary therapy within eating disorder treatment because of the emerging evidence for the psychological and physical benefits of exercise in eating disorders. Despite this, there is currently limited guidance on assessment within exercise therapy and eating disorders.

This review aimed to (a) outline outcome assessments used in the exercise and eating disorder literature, including interventional and cross-sectional studies; and (b) provide an overview of the general impacts of exercise intervention trials in eating disorders.

A scoping review was employed with searches on databases PsycINFO, Medline and EMBASE, with terms related to eating disorders, exercise and health outcomes. Data extraction included study and intervention characteristics, assessments and outcome change.

Twenty-six intervention and cross-sectional studies were included, consisting of anorexia nervosa (n = 27%), binge eating disorder (n = 19%), bulimia nervosa (n = 4%) and mixed diagnostic populations (n = 50%). Body composition assessment was conducted with the greatest frequency of included studies (n = 26), followed by eating disorder psychopathology (n = 21), subjective physical activity level (n = 13) and exercise assessment (n = 11), including strength assessment (n = 6) and cardiorespiratory fitness testing (n = 6). No adverse events were reported in the included studies.

The results of this review outline that comprehensive assessment within exercise interventions and eating disorders, including strength and cardiorespiratory fitness exercise tests, are safe when conducted in appropriate contexts and may offer additional insight into patient health and function beyond current standard practice. The results of this review may guide future exercise professionals in eating disorder services on relevant assessment as part of exercise therapy.

A proportion of patients with anorexia nervosa require compulsory admission due to treatment refusal in the context of high medical or psychiatric risk.

The clinical characteristics and treatment outcomes of patients with anorexia nervosa compulsorily admitted for in-patient care (current and previous) were compared with those of patients admitted voluntarily. The characteristics of their caregivers were also evaluated.

This is a secondary analysis of the Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise trial. We included 274 patient–caregiver dyads: 62 on compulsory admission (‘current compulsory’), 48 on voluntary admission with a history of compulsory treatment (‘previous compulsory’) and 164 on voluntary admission without a history of compulsory treatment (‘voluntary’). Baseline demographic and clinical characteristics, and longitudinal clinical outcomes at 3–6 and 9–12 months, were compared across groups.

Patients in the current compulsory group had an earlier age of onset, a higher proportion of obsessive–compulsive disorder comorbidity and less motivation and confidence to change compared with the voluntary group. The previous compulsory group showed a longer illness duration, older age and lower body mass index (BMI) compared with the other groups. All groups showed improvement, with similar outcomes at the end of the study except for depression symptoms and BMI. Caregivers had varying levels of distress and caregiving skills at baseline, which had improved by the end of the study.

People receiving current or previous compulsory treatment presented with diverse clinical presentations. Further studies are needed to determine whether more individualised approaches improve outcomes in these subgroups.

Trial registration number and data-set information: ISRCTN14644379.

Little is known about health-related quality of life (HRQoL) in familial intellectual disability. Economic evaluations of interventions for familial intellectual disability require HRQoL measured through utility data.

We aimed to estimate HRQoL in individuals with familial intellectual disability and their carers and spouses, and identify factors associated with HRQoL.

Families with at least one member with familial intellectual disability were recruited and completed a tailored questionnaire. HRQoL was measured with the Assessment of Quality-of-Life 8D for carers and spouses, and the Health Utilities Index 2 (HUI2) and 3 (HUI3) for individuals with intellectual disability.

A total of 108 carers and 35 spouses, caring for 171 individuals with intellectual disability, completed the survey. Health utility values for carers (0.58) and spouses (0.63) were significantly lower than age- and gender-adjusted population norms (0.8) (p < 0.05). Utility values for individuals with intellectual disability were 0.51 (HUI2) and 0.31 (HUI3), also significantly below age-adjusted norms (p < 0.05). In carers, approximately half reported a mental health condition, and multivariate regression showed that having a mental health disorder, financial stress and caring for someone with aggressive behaviour were associated with lower HRQoL. In individuals with intellectual disability, greater disability severity and need for full-time supervision were associated with lower HRQoL, whereas living with their carer was associated with higher HRQoL.

Familial intellectual disability is associated with significantly lower quality of life of individuals with intellectual disability, their carers and their spouses. HRQoL across the family may help guide planning of health and social support, and demonstrate to policy makers the additional support needs for these families.

Israel’s 2015 mental health reform transferred responsibility for mental health services from the government to community health maintenance organisations (HMOs), aiming to improve accessibility and equity and reduce stigma. However, its implications for different populations remain significantly underresearched.

To examine trends in mental health service utilisation and psychiatric medication issue rates among Arab and Ultra-Orthodox Jewish populations before and after the 2015 mental health reform.

A retrospective cohort study using data from Israel’s four HMOs (2012–2019), including all individuals with mental/behavioural disorder diagnosis, psychiatric medication or a community-based mental health service encounter (N = 2 847 184). Participants were classified as either general (non-Ultra-Orthodox Jewish), Ultra-Orthodox Jewish or Arab. The study analysed annual community visits to mental health professionals and dispensed psychiatric prescriptions.

Between 2012 and 2019 the number of mental health service users increased across all populations, most prominently among Ultra-Orthodox Jewish and Arab populations (1.94- and 1.91-fold, respectively), compared with 1.55-fold in the general population. Annual community visits increased 2.4-fold in the general population, 2.2-fold in the Ultra-Orthodox Jewish population and 3.7-fold among Arabs, who had the lowest baseline utilisation. Psychiatric medication issue rates increased most in the Ultra-Orthodox Jewish population (2.5-fold), compared with 1.7-fold in the Arab and 1.5-fold in the general population. Women consistently used more services than men, with the greatest relative increase among Arab women.

The findings suggest improved access to mental health services over the study period spanning the 2015 mental health reform, particularly in previously underserved populations. Continued progress requires culturally sensitive, community-tailored interventions for Arab and Ultra-Orthodox Jewish populations.

The National Health Service in England has encouraged the development of specialised services for patients with high-intensity use of emergency departments: liaison psychiatry services in emergency departments and community services.

To evaluate the effect of different types of high-intensity use services on attendances at emergency departments, for those with 5 (HU5) or 10 (HU10) or more attendances in the previous 12 months, and the subset of this group with probable mental health problems, versus emergency departments without locality high-intensity use services.

A retrospective longitudinal study was conducted using nationally sourced data from 13 hospitals in England, spanning 1 April 2016 to 1 January 2020. An interrupted time-series analysis assessed the impact of three high-intensity use service models on weekly emergency department attendances: emergency department-based services with and without designated staffing, and community based services. Patients and clinicians contributed throughout the project.

A total of 2 938 510 emergency department attendances were analysed. Statistically significant associations were identified between the implementation of community-based services and reductions in weekly attendances by HU10 patients (rate ratio 0.83, 95% CI 0.71–0.97), and HU5 and HU10 patients with mental health-related attendances (HU5 rate ratio 0.82, 95% CI 0.75–0.91; HU10 rate ratio 0.70, 95% CI 0.59–0.84). Emergency department-based services with designated staff were associated with a reduction in mental health-related attendances among HU10 patients (rate ratio 0.88, 95% CI 0.80–0.98).

Services targeting patients with high-intensity use of emergency departments in England demonstrate promising potential in reducing emergency department attendances among this patient group. Community-based interventions show the most substantial impact, whereas hospital-based services often run by liaison psychiatry teams also contribute to reductions in those with high-intensity use with mental health issues. These findings support further development and expansion of tailored high-intensity use services across the country.

Understanding prescription trends and costs of psychotropic drugs is essential to inform mental healthcare policy and practice. However, comprehensive national evidence across psychotropic drug classes is limited, and little is known on how prescription volumes changed during the COVID-19 pandemic.

We examined prescription trends and costs of psychotropic drugs in the UK and assessed changes in prescription volumes following the onset of the COVID-19 pandemic.

We analysed national Prescription Cost Analysis data from 2013 to 2023, for six major psychotropic drug classes. Annual prescription volumes, total costs and average costs per drug were estimated. Linear regression was used to assess temporal trends and changes in prescription volume during the pandemic years. Costs were adjusted for inflation to 2023 prices.

Between 2013 and 2023, psychotropic prescriptions grew 4% (95% CI 3.9–4.2) annually. Prescriptions for antidepressants, antipsychotics, stimulants and anti-dementia drugs increased, but not for hypnotics and anxiolytics and drugs used in substance dependence. In contrast, total costs declined by approximately £328 million, and the average cost per drug dropped from £11 to £5.9. Prescription volume remained unchanged during the pandemic years, except for anti-dementia medications, which showed an annual reduction of 17.2% (95% CI 7.8–26.6) relative to the underlying temporal trend during the study period.

Our observed rising prescription trend is consistent with global evidence on availability and use of psychotropic drugs. Furthermore, we found a decrease both in total drug costs and average costs per drug.

Bipolar disorder in youths is associated with metabolic dysregulation, impaired inhibitory control and limbic network connectivity changes.

To investigate whether limbic network connectivity is associated with appetite hormones and inhibitory control in youths with bipolar disorder.

The current study included 68 youths with bipolar disorder and 57 age- and gender-matched controls. They completed clinical assessments, the go/no-go (GNG) task, fasting appetite hormone (leptin, adiponectin, insulin and ghrelin) tests and resting-state functional magnetic resonance imaging. Region of interest (ROI)-to-ROI functional connectivity was analysed across 17 limbic ROIs. Cluster-level inferences were derived by using threshold-free cluster enhancement with family-wise error correction (p < 0.05). Furthermore, associations with appetite hormones and GNG task parameters were investigated.

Compared with the control individuals, youths with bipolar disorder exhibited elevated leptin (p = 0.005) and insulin levels (p < 0.001), poorer performance on the GNG task and hyperconnectivity within the limbic network, identifying a significant cluster comprising the right anterior parahippocampal gyrus (aPHG)–right thalamus and right aPHG–hypothalamus edges (cluster-level family-wise error-corrected p = 0.045). No significant correlations were observed between limbic hyperconnectivity, appetite hormone levels and GNG task performance.

Current cross-sectional cohort indicates that youths with bipolar disorder exhibit concurrent alterations in appetite hormones, inhibitory control and limbic connectivity. These findings provide a characterisation of youth bipolar disorder across multiple indices, although longitudinal studies are necessary to understand how these features relate to long-term clinical trajectories.

Serious incidents, such as patient suicide, profoundly impact clinicians. In mental health settings, these events are uniquely distressing. Despite policy shifts towards learning from serious incidents, many doctors report inadequate support and significant emotional distress. Resident doctors, already vulnerable to burnout and emotional exhaustion, are particularly at risk.

This study aimed to understand resident psychiatry doctors’ experiences of serious incidents. It sought to gather in-depth insights about how resident psychiatrists navigate the serious incident process, and the effect the process has on their professional and personal lives.

A qualitative study recruited 10 participants via email in 1 National Health Service (NHS) trust. Semi-structured online interviews were audio-recorded, transcribed and analysed using Braun and Clarke’s six-phase thematic analysis, employing an iterative, constant comparative approach.

Descriptive characteristics of the participants are reported. Three overarching themes were identified: (a) when the process becomes the experience, with subthemes focusing on how open and transparent the investigation process was, about communication during the process and how doctors felt the process impacted their clinical role; (b) from theory to practice: when training meets reality. Subthemes here reflected on whether resident doctors felt prepared and knowledgeable about the process. There was also focus on the experience itself being a learning opportunity; (c) the emotional undercurrents: trauma, grief and support. Here the subthemes focused on the emotional toll of an incident and investigation, the grief and wider impact of a patient death and lastly, the need for support to resident doctors including supervisor and peer-to-peer support. Themes are reported accompanied by verbatim quotes from participants.

Findings confirm prior studies investigating the negative impact of serious incidents on resident doctors’ well-being and career confidence, highlighting the need for robust support. The study adds to the literature through emphasising the inadequacy of current support and highlights rectifiable issues such as the need for structured peer support and improved supervisor/resident training for emotional and professional complexities. Future research should compare these findings with experiences under the new Patient Safety Incident Framework (PSIRF) system to assess improvements.