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.

This study explores the relationship between depressive symptoms and emotional regulation–specifically emotional attention, clarity, and repair–among Pakistani medical students, with an emphasis on gender-based differences.

A cross-sectional study was conducted among 216 medical students at a single medical college in Pakistan. Participants completed the Beck Depression Inventory (BDI) and the Trait Meta-Mood Scale (TMMS). Data on demographics, physical activity, and hobbies were also collected. Gender-stratified chi-square analyses were used to assess associations between depression severity and emotional regulation.

Moderate to severe depressive symptoms were reported by 41.6% of students, while 58.4% exhibited minimal to mild symptoms. Females were significantly more likely to report insufficient emotional attention (12.6% vs. 2.5%,p=0.038), while males more frequently reported sports as a primary hobby and higher levels of vigorous physical activity. No significant gender differences were found in depression severity, emotional clarity, or emotional repair. Overall, 91.7% of students demonstrated adequate or excessive emotional attention, 82.4% had excessive clarity, but a striking 79.6% reported insufficient emotional repair. Lifestyle patterns were also concerning, with 58.3% of students engaging in less than two hours of moderate physical activity per week. Emotional repair was consistently poor across all depression categories and both genders, suggesting a universal deficit in emotion regulation rather than a gender-specific trend.

High levels of depression and emotional dysregulation were observed across the student body, regardless of gender. Within Pakistan’s context of limited mental health services, academic pressure, and cultural stigma, these findings highlight a critical need for institutional support structures. Emotion regulation training, particularly targeting emotional repair, and broader access to psychological services should be prioritized. Given the sample was drawn from a single institution, the generalizability of findings is limited.

Perinatal hypoxia–ischaemia (HI) is a major cause of neonatal mortality and, importantly, of long-term neurodevelopmental morbidity. Children who suffered perinatal asphyxia show a higher risk of developing a wide spectrum of psychiatric disorders, alterations that often coexist with sensorimotor deficits and cognitive problems. Therefore, perinatal HI is increasingly recognized not only as a neurological condition but also as a strong developmental risk factor for later psychopathology.

To evaluate behavioural outcomes closely linked to psychiatric vulnerability (specifically motor function and different memory domains) and to examine possible sex-dependent differences in neonatal rats subjected to a preclinical model of severe HI and treated with the epigenetic modulator Tubastatin-A (Tub-A).

Seven-day-old (P7) Sprague Dawley rats were randomly assigned to: i) HI (left common carotid artery ligation + 150 min of hypoxia (8%O2/92%N2); n=18, 10 males, 8 females); ii) HI + Tub-A (25 mg/kg; one i.p. dose immediately after HI and three more doses spread over the next 72 hours; n=18, 9 males, 9 females); iii) Sham (without HI; n=18, 9 males, 9 females). At P8 and P14, the animals underwent righting reflex, negative geotaxis, and front limb suspension tests to analyse their sensorimotor abilities. At P40 and P90, the animals underwent the cylinder test (to measure sensory-motor deficits), novel object recognition (NOR, to analyse the non-spatial memory) and T-maze test (spatial memory and learning ability). These domains are fundamental for adaptive behaviour and are frequently compromised in psychiatric conditions.

In short-term tests, P8 animals in the Tub-A-treated group showed a better motor response in the front limb suspension test (p=0.004), and especially in males (p=0.0033). At P40, the cylinder test revealed differences in females in the HI group and those treated with Tub-A (p=0.044). In the NOR test, a notable improvement was seen in all treated animals (p=0.0001 vs HI), independent of sex (males: p=0.0022; females: p=0.0012). At P90, the improvement in NOR was maintained overall (p=0.0462) and in males (p=0.0004), but not in females. In the T-maze test, Tub-A-treated males had better results (p=0.0404) at P40, whereas this improvement was enhanced at P90 for both sexes (males: p=0.0083; females: p=0.0423).

Perinatal HI-induced long-term behavioural impairments related to psychopathologies may be improved after Tub-A treatment.

Hypoxia-ischaemia (HI) is one of the leading causes of neurological injury and death among newborns. In developed countries, its incidence is estimated in approximately 1/1000 neonates, while globally it can represent up to 23% of children’s mortality rate. In those who survive, long-term neuropsychological impairments may emerge as a consequence of HI, causing a significant impact in quality of life.

Using a preclinical model of neonatal HI, the aim of this study was to investigate whether a progression in HI severity (from moderate to severe) may be associated with worsened functional and psycho-behavioural performance.

Seven-day-old (P7) Sprague Dawley neonatal rats were randomly assigned to: i) HI-moderate (left common carotid artery ligation + 120 min of 8%O2/92%N2 hypoxia; n=13); ii) HI-severe (same surgical procedure and 150min of hypoxia; n=18); Sham (without HI, n=36). At P42 (early young equivalent) and P90 (adult), animals underwent three behavioural tests: the novel object recognition (NOR) test to analyse cognitive deficits in recognition memory, the cylinder test to measure sensorimotor asymmetries and deficits, and the T-maze test to evaluate possible cognitive disabilities.

When evaluating cognitive deficits in recognition memory with NOR test, both moderate (p<0.01) and severe (p<0.05) injured animals showed worse performance than sham at P42. At P90, this was also observed in moderate-injured animals (p<0.001). In the cylinder test, HI-moderate (p<0.01) and HI-severe (p<0.001) groups showed significant sensorimotor asymmetries when compared to sham at P42 and P90, which were independent of HI severity. Similarly, all HI-animals revealed a reduction in alternation in the T-maze test, thus suggesting cognitive disabilities in both moderate (p<0.05) and severe (p<0.0001)models vs sham. Again, no differences were found when comparing severities.

Psycho-behavioural assessments showed the development of cognitive deficits and neuromotor impairments in the long term after neonatal HI. Further studies may confirm if the absence of differences between moderate and severe HI models may relate to a critical threshold reached in the former and/or to possible compensatory mechanisms in the latter.

Population ageing in India is accelerating, accompanied by a rising burden of neurocognitive disorders that contribute substantially to disability, healthcare utilisation, and loss of independence. Cognitive impairment (CI), particularly in its mild and early stages, remains under-detected in low- and middle-income settings due to limited screening, low literacy levels, and restricted access to specialist services. Rural and socioeconomically disadvantaged populations are especially vulnerable, yet robust multicentric data from South India remain scarce. This study aimed to estimate the prevalence of cognitive impairment across specific cognitive domains among older adults in South India and to examine its association with socio-demographic and clinical variables.

A multicentric cross-sectional survey was conducted across selected centres in South India, enrolling 122 participants aged 60 years and above. Data were collected from medical outpatient clinic attendees, using a structured proforma capturing age, gender, education, employment status, socioeconomic status (SES), medical comorbidities, and alcohol/substance use. Cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA), a validated and widely used screening instrument for detecting cognitive impairment. Cognitive impairment was categorised into mild, moderate and severe, based on established cut-offs. Statistical analyses were performed to identify significant correlates of cognitive impairment.

The study population was predominantly male (68.9%), below 65 years of age (58.2%), and residing in rural areas (79.5%). The overall prevalence of cognitive impairment was strikingly high at 77.9%. Of those identified with impairment, 59.8% had mild cognitive impairment, indicating a substantial burden of potentially reversible or modifiable cognitive decline. Cognitive impairment showed significant associations with increasing age, lower educational attainment, unemployment or engagement in unskilled labour, and lower socioeconomic status. In contrast, no statistically significant associations were observed with gender, rural versus urban residence, medical comorbidities, or alcohol/substance use.

This study demonstrates a markedly high prevalence of cognitive impairment among older adults in South India, with a large proportion experiencing early or mild cognitive deficits that are likely undetected in routine care. The strong association with social and educational disadvantage highlights cognitive impairment as not only a medical condition but also a social determinant, driving health inequity. These findings emphasise the urgent need to integrate routine cognitive screening into primary healthcare and geriatric services. Early identification and timely intervention may help delay progression, reduce disability, and preserve functional independence, thereby improving quality of life for India’s rapidly ageing population.

Autistic females are less likely to receive an autism diagnosis in childhood than autistic males. In recent years, increasing numbers of adults have come to identify as autistic prior to, or in the absence of, a formal diagnosis. While existing research has examined experiences of receiving an autism diagnosis in adulthood, comparatively little is known about how adults come to self-diagnose, the meanings they attach to this process, and how self-diagnosis shapes decisions about seeking formal assessment.

This qualitative study involved 30 female participants aged 18–43 who had, at some point, identified as autistic without holding a formal diagnosis. Participants took part in one-to-one, online, semi-structured interviews exploring their understandings of autism, pathways to self-diagnosis, perceived barriers and facilitators, attitudes towards both self- and professional diagnosis, and intentions regarding formal assessment. Interview transcripts were analysed using Framework Analysis.

Framework Analysis identified six interrelated themes.

First, participants described self-diagnosis as a prolonged sense-making process involving extensive reflection and information-seeking, challenging portrayals of self-diagnosis as impulsive or trend-driven.

Second, accounts reflected heterogeneous social representations of autism: older, male-centred stereotypes were frequently rejected, while gender differences were instead mapped onto alternative frameworks such as high–low functioning distinctions.

Third, self-diagnosis was commonly experienced as an “aha” moment of epistemic and affective clarity following extended uncertainty, countering social contagion narratives.

Fourth, an economy of legitimacy shaped participants’ experiences. Structural barriers to professional diagnosis, including gendered underdiagnosis and lengthy waiting lists, positioned self-diagnosis as a necessary substitute for institutional validation, while media discourses framing self-diagnosis as “trendy” or as social contagion undermined its credibility and generated self-doubt.

Fifth, participants adopted a reflexive stance towards self-diagnosis, emphasising its provisional status, distancing themselves from “frivolous” self-identification, and expressing ambivalence about the label; social media was viewed as both informative and epistemically suspect.

Finally, attitudes towards professional diagnosis were ambivalent: a strong desire for validation coexisted with fears of dismissal, misrecognition, or gendered misdiagnosis, shaped by material and emotional barriers and mediated by social relationships influencing disclosure and decisions about seeking assessment.

Self-diagnosis functions as a meaningful response to diagnostic exclusion rather than a trivial or trend-driven practice. Recognising its role has important implications for clinical practice, service access, and how autism is understood beyond traditional diagnostic pathways.

The purpose of this review was to methodically assess data from randomised controlled trials (RCTs) that looked at how orange-spectrum or circadian-relevant light interventions affected sleep, behaviour, and circadian outcomes in patients with dementia. Synthesising important findings and critically evaluating methodological quality using the Cochrane Risk of Bias 2 tool were secondary goals.

A systematic research of PubMed was conducted from database inception to the most recent search date, using Medical Subject Headings and free-text terms related to dementia and light-based interventions. Only human RCTs were included. Outcomes of interest included sleep quality, agitation, circadian rhythm measures, and neuropsychiatric symptoms. Data were extracted into standardised tables, and methodological quality was assessed using the RoB 2 tool.

Five excellent RCTs satisfied the requirements for inclusion. People with moderate to severe dementia in residential care and community settings in the USA,UK and Europe were included in the study populations. Bright or circadian-effective lighting was the main intervention, though some studies also included less exposure to blue light in the evening. Agitation, sleep efficiency and circadian rhythm stability were the main results. The results showed mixed effects on agitation and behavioural symptoms, with only slight improvements in sleep and circadian outcomes. The overall risk of bias was rated as low to moderate, with blinding and selective outcome reporting being common issues.

Circadian-oriented lighting interventions showed potential advantages for sleep and behavioural regulation, even though no trials specifically assessed orange-spectrum light. A promising non-pharmacological strategy for treating sleep and behavioural issues in dementia patients may be circadian-friendly lighting interventions. To improve the body of evidence and guide clinical recommendations, high-quality RCTs that specifically look at orange-spectrum lighting are needed.

Alcohol use in the workplace is typically addressed through impairment-focused policies or reactive disciplinary responses. Yet national data suggest a deeper, systemic relationship between work-related stressors and higher-risk alcohol consumption. The aim of this work is to quantify the prevalence of higher-risk alcohol use among full-time workers and investigate the role of work-related stressors and workplace-specific barriers in shaping drinking behaviour and help-seeking patterns.

Data from a population survey of 2,037 UK adults (mean age=48.77 years, standard deviation=17.74; 1,066 female [52.33%], 971 male [47.67%]) were analysed to examine the prevalence of higher-risk drinking among full-time workers, demographic distribution, attribution of drinking to life stressors, and work-specific barriers that inhibit help-seeking.

Higher-risk alcohol use was substantially elevated among full-time workers (30.8%), second only to students, and distributed across all income levels, including 40% earning £50,000+. Only 9.6% of this group self-identified as heavy drinkers. Work-related pressures emerged as a core driver: 25.7% of higher-risk workers cited work stress, nearly double the rate among all drinkers (14.3%), with additional attribution to cost-of-living pressures, loneliness, and remote working (2.4× more common than in the general sample).These findings support a model in which alcohol use reflects a stress-response pattern rather than individual pathology. Workplace structures also shaped barriers to accessing support: concerns about career impact (17.8%) and difficulty taking time off work (17.1%) featured prominently among higher-risk adults, indicating that traditional clinic-based services are poorly aligned with the needs of working populations.

Workforce alcohol harm in the UK is widespread, socially invisible, and tightly linked to occupational and economic stressors. Reliance on self-disclosure, performance deterioration, or manager-led referral will systematically miss the majority of affected workers. These findings emphasise the importance of incorporating AUDIT-C screening into occupational health processes and routine workplace wellbeing assessments, ensuring that alcohol-related risk is identified proactively rather than reactively. Alcohol use should be recognised as a meaningful indicator of occupational mental health, considered alongside other markers such as workplace stress, sleep disruption, and burnout. It is also essential to commission flexible, digital, or remote care pathways that minimise career-related stigma and reduce the need for employees to take time away from work in order to access support. Finally, workplace alcohol interventions should be reframed away from an emphasis on individual responsibility and instead approached as part of a broader organisational mental health strategy, acknowledging the role of workplace conditions in shaping alcohol-related risk.

Maladaptive daydreaming (MD) is a pattern of immersive and emotionally charged daydreaming that can significantly interfere with an individual’s social functioning and daily activities. MD is not formally recognised as a mental disorder in the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM–5–TR). This study aimed to determine the prevalence of MD and attention-deficit/hyperactivity disorder (ADHD) among medical students, identify the association of the two conditions, and assess the impact of socio-demographic factors.

A cross-sectional analytical study was conducted among medical students enrolled at the University of Rwanda and the University of Medical Sciences and Technology, with participants primarily residing in Rwanda, Tanzania, and other countries. Respondents were classified into two groups–maladaptive daydreamers (MDers) and non-maladaptive daydreamers (non-MDers)–based on the 16-item Maladaptive Daydreaming Scale (MDS-16). Data were collected using validated paper-based and online Google Forms self-administered questionnaires (MDS-16 and Adult ADHD Self-Report Scale [ASRS-v1.1]). Ethical approval was obtained, and data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.

Our study included 584 respondents (52.9% male, 47.1% female) with a mean age of 21.6 ± 1.7 years. The prevalence of probable MD was 22.9%, while ADHD was reported in 21.4% of participants. Among students with MD, 48% screened positive for ADHD,compared with 16.2% who did not meet criteria for ADHD. Both MD and ADHD were significantly associated with poor academic performance (p <0.003 and p <0.001, respectively). Using logistic regression, there was a strong positive correlation between MD and ADHD (p <0.001; R²=0.168).

MD and ADHD show a significant positive relationship, and their co-occurrence is associated with a measurable decline in academic performance as perceived by the participants. These findings underscore the need for early screening strategies, the provision of counselling and psycho-educational support for affected students. Future longitudinal and randomised studies are warranted to establish standardised diagnostic criteria and therapeutic guidelines for MD and to differentiate it from related attentional and behavioural disorders across diverse populations.

To systematically review the literature on psychedelic-related mechanisms relevant to forensic psychiatry, examining potential therapeutic benefits linked to reduction in crime-related behaviour, associated clinical and legal risks, and the practical considerations required were such approaches ever to be explored within UK forensic mental health services.

A systematic literature search was conducted in PubMed and PsycINFO in accordance with PRISMA principles. Peer-reviewed publications were screened, including randomised controlled trials, observational and qualitative studies, mechanistic and neurobiological research, reviews, and translational papers relating to psychedelic-assisted therapies. Additional literature addressing trauma, substance misuse, offending behaviour, psychosis risk, forensic rehabilitation, capacity, consent, and criminal responsibility was included. Given heterogeneity in populations, interventions, and outcomes, findings were synthesised using a structured narrative and thematic approach, interpreted within the context of UK forensic psychiatric practice and legal frameworks.

The literature identified several mechanisms with potential indirect relevance to forensic psychiatry. These included enhanced trauma and emotional processing, increased psychological flexibility, disruption of rigid self-concepts and offence-supportive beliefs, improved empathy and perspective-taking, and reductions in substance misuse–factors associated with offending behaviour and recidivism. Such mechanisms are theoretically relevant to offence-related psychotherapy, substance misuse treatment, and rehabilitative interventions within secure services.

However, substantial and consistent risks were also identified, particularly precipitation or exacerbation of psychosis, affective instability, behavioural disinhibition, impaired judgement, and significant challenges in assessing capacity and criminal responsibility during altered states of consciousness. Practical analysis indicated that any hypothetical consideration would require extremely stringent patient selection excluding psychotic disorders, delivery within highly specialised and non-coercive settings, close integration with established psychotherapeutic models, and robust safeguards aligned with the Mental Health Act, Mental Capacity Act, and the forensic mandate of public protection. No evidence supports routine or near-term clinical use in forensic populations.

This systematic review highlights a complex balance between theoretical therapeutic promise and significant clinical, ethical, and legal risks associated with psychedelic-informed approaches in forensic psychiatry. While direct implementation is currently inappropriate within UK forensic services, critical engagement with this literature offers valuable insights into mechanisms of psychological change, rehabilitation, and risk formulation. Any future consideration would require exceptional safeguards, specialist expertise, and a clear ethical mandate centred on patient welfare, legal responsibility, and public safety.

To examine whether psychedelic-like states of consciousness can be induced through brain stimulation techniques, evaluate their potential advantages over pharmacological psychedelics, and explore how stimulation-assisted psychotherapy may offer a clinically viable model for mental health treatment.

A structured narrative review was conducted using PubMed and PsycINFO,examining peer-reviewed studies of non-invasive and invasive brain stimulation techniques, including transcranial magnetic stimulation (TMS), transcranial alternating current stimulation (tACS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). Literature describing subjective phenomenology, neuroimaging findings, and therapeutic outcomes was reviewed alongside evidence from psychedelic-assisted psychotherapy to enable mechanistic comparison. Findings were synthesised thematically with reference to clinical relevance.

Across multiple studies, targeted brain stimulation was shown to induce transient alterations in perception, emotional salience, self-experience, and cognitive flexibility–phenomenological features overlapping with psychedelic states. Neuroimaging and electrophysiological data indicate that both psychedelic states and brain stimulation modulate large-scale brain networks, particularly through reduced dominance of the default mode network, increased global connectivity, and altered thalamocortical and corticolimbic signalling.

Unlike pharmacological psychedelics, brain stimulation avoids systemic drug exposure, reducing risks of prolonged perceptual disturbance, pharmacokinetic unpredictability, substance interactions, and psychosis precipitation related to serotonergic agonism. Stimulation parameters can be titrated, paused, or terminated in real time, offering enhanced safety, reproducibility, and clinical governance.

Importantly, evidence from psychedelic research indicates that therapeutic benefit is primarily mediated through psychotherapeutic processes–such as insight generation, emotional processing, and narrative restructuring–rather than the altered state alone. Brain stimulation may similarly act as a catalyst for psychological change by transiently increasing neural and cognitive flexibility, thereby enhancing responsiveness to psychotherapy across conditions including depression, trauma-related disorders, and addiction.

Brain stimulation techniques may offer a controllable, non-pharmacological means of accessing key neural and psychological mechanisms associated with psychedelic states, while mitigating many drug-related risks. When integrated with structured psychotherapy, stimulation-assisted models may provide a pragmatic translational pathway for harnessing psychedelic-relevant mechanisms within existing mental health services. Further research is required to establish optimal stimulation parameters, safety profiles, and disorder-specific applications before routine clinical use.

Child and Adolescent Mental Health Services (CAMHS) face unprecedented demand, with many referrals rejected due to incomplete clinical information. Standardized digital tools like the Development and Well-Being Assessment (DAWBA), that generate algorithm-based probable diagnoses from multi-informant symptom reports, could improve referral outcomes. However, thereal-world impact of these tools on referral outcomes remains underexplored. In this context, the current study aimed to examine whether diagnostic probabilities generated by the DAWBA predict referral acceptance in CAMHS. It also explored how the information available to triage team, including referral source, influences referral outcomes.

We conducted a secondary analysis of anonymised data extracted from a randomized controlled trial conducted across eight NHS Trusts in England. The sample included 483 participants aged 5–17 years with documented DAWBA diagnostic probabilities and referral outcomes. Sociodemographic characteristics and clinical variables were also examined.

Overall, 54.5% (n=263) of referrals were rejected. There were no significant differences in referral acceptance by sex, ethnicity, deprivation, or referral source. Referral acceptance was associated with older age, higher Strength and Deficit Questionnaire (SDQ)parent-rated impact scores, history of previous CAMHS referral, and study recruitment site. Binomial logistic regression showed higher parent impact scores (OR=1.1, 95% CI: 1.01, 1.21) and previous CAMHS referral (OR=2.3, 95% CI: 1.38, 3.69) increased odds of referral acceptance. Referral acceptance also varied with recruitment site. However, a high to very high probability of DAWBA generated diagnoses did not increase chances of referral acceptance with 54% emotional disorders, 78.6% behavioural disorders, or 52.9% comorbid emotional and behavioural disorders being rejected.

This study highlights key gaps in the current CAMHS referral process. While previous CAMHS referral and parent-rated SDQ impact scores were associated with referral acceptance, DAWBA diagnostic probabilities were not. This suggests that children with clinically significant difficulties, identified via standardised assessment, may still face barriers in accessing care. Significant site-level variation in referral acceptance underscores the need for more equitable referral processes.

Hallucinogen Persistent Perception Disorder (HPPD) is characterised by a recurrence of hallucinogen-induced perceptual symptoms after the cessation of hallucinogen use, leading to clinically significant impairment in functioning. It remains difficult to diagnose due to multiple comorbid diagnoses and poor understanding in psychiatry. For these reasons documented incidence also remains low. There are currently no established guidelines on treatment of HPPD which is a major gap in existing literature. This review aims to assimilate current evidence on treatment of HPPD, and suggest avenues for further systematised research into this complex disease.

Our inclusion criteria was any review article, meta-analysis, randomised control trial, case report, and letter to the editor on treatment of HPPD published in English until December 2025. Research databases PubMed and GoogleScholar were searched using the key words “Hallucinogen Persistent Perception Disorder” yielding 111 articles. These were then screened to meeting inclusion criteria and relevance to aim. 34 studies were included in our final review.

Our review of studies on HPPD treatment found that several (n=9) advocate for α2 adrenergic agonists (particularly clonidine) orbenzodiazepines (particularly clonazepam) to be effective. These target the distress and anxiety associated with HPPD. The perceptual symptoms of HPPD have shown good response to anti-epileptic drugs (particularly lamotrigine) in case reports (n=5). Studies (n=5) on treatment with antipsychotic agents counterintuitively demonstrated poor response and worsening of perceptual symptoms. Two case reports (n=2) demonstrated improvement on combination therapy (olanzapine with fluoxetine and risperidone with escitalopram) however selective serotonin reuptake inhibitors alone (n=1) have not shown improvement.

Anecdotal treatments in literature include conservative measures, psychotherapy, eye movement desensitisation and reprocessing, onabotulinum toxinA, and naltrexone.

Neuromodulation has been successful at treating HPPD in two case reports using transcranial direct current stimulation and repetitive transcranial magnetic stimulation, with sustained responses at 4 weeks and 4 months respectively. More robust studies with longer term follow-up are needed.

Treatment modalities recommended for HPPD have a weak evidence base. The ambiguity of HPPD presentation, frequent comorbid conditionsinfluencing pharmacological choice and variability in response to treatments make it difficult to draw large-scale conclusions from these results. Larger scale and case-controlled studies remain a challenge owing to diagnostic and ethical considerations. We propose that, given the safety and efficacy of neuromodulation, this should be explored further. Additionally, more research needs to be done for pharmacological treatments to confirm efficacy.

There is a high prevalence of metabolic abnormalities in patients with severe mental illness. Metabolic abnormalities are more likely to be present among individuals of black, Asian or minority ethnic groups. This study aims to assess the ethnic breakdown of the Early Intervention Service (EIS) for first episode of psychosis in Sheffield Health Partnership University NHS Trust. We aim to assess the metabolic parameters (blood pressure, HbA1c, BMI, triglycerides and cholesterol) in Asian patients on the EIS caseload.

Data on ethnicity was collected for all patients on the EIS caseload in 2025 using electronic patient records. Data on BMI, blood pressure and blood results were collected for patients of Asian ethnicity. Data was analysed using descriptive statistics and presented on graphs using Microsoft Excel.

Out of the 309 patients on the EIS caseload, 9.2% (29 patients) identified as Asian or Asian British.72% of Asian patients had a recorded BMI. Of these, the majority (71%) had a raised BMI. 13% of patients with recorded data had raised blood pressure. 83% of Asian patients had blood tests for lipids, cholesterol and HbA1c. The mean HbA1c was 36.08mmol/mol and no patients had a HbA1c in the pre-diabetic or diabetic range. 29.2% of Asian patients had a raised TG:HDL ratio.

We used the diagnostic criteria of metabolic syndrome as at least 3 of: waist circumference >102cm for men or 89cm for women, triglyceride >1.7mmol/L, HDL <1.0mmol/L for men or <1.3mmol/L for women, BP >130/85 or fasting BM >5.6. This identified 20.7% of Asian patients as having metabolic syndrome. However, only 3 patients (10.3%) had all 5 parameters recorded, suggesting there could be unidentified patients with metabolic syndrome.

The majority of Asian patients on the EIS caseload had a raised BMI, highlighting a potential area of intervention to improve health outcomes. Some Asian patients have raised blood pressure, increased TG:HDL ratio and metabolic syndrome. This study identifies low rates of measurement of metabolic parameters; it is striking that 89.7% of patients did not have all the recorded data that is needed to make a diagnosis of metabolic syndrome. It is likely that there are unidentified patients with metabolic syndrome who are not able to access appropriate lifestyle support and medical treatment to improve health outcomes.

Over 90% of patients with depression report troublesome sleep-wake disturbances, and patients with depression are more likely to have comorbid sleep disorders such as insomnia. They also display small but significant deficits in a variety of cognitive domains, and both sleep and cognitive problems can persist into remission. Sleep disturbances also adversely affect cognition, however due to heterogeneity of methods and results in the extant literature, further research is required to assess how sleep disturbances affect cognition in depression.

Forty participants aged 18–65 with unipolar depression and 40 gender- and age-matched controls were recruited to this naturalistic observational study. Baseline measures of mood and sleep were completed, and participants then wore a triaxial accelerometer (actigraph) and completed a sleep diary. At the second study visit 14 days later participants completed a battery of neuropsychological tasks, including the Psychomotor Vigilance (PVT), Continuous Performance (CPT), Digit Symbol Substitution (DSST), and Trail-Making-Test (TMT).

Following exclusions, 34 participants in each group were included in the final analysis. In the depression group the average age was 49.5, 53% were female, and 94% White British Ethnicity. 44.1% were diagnosed with comorbid disorders (e.g. anxiety) and were prescribed a median 2 psychotropic medications. Eight patients were not currently depressed as assessed by the Hamilton Depression Rating Scale. The depression group were significantly more likely to report insomnia symptoms than controls, and although there was no difference in the average hours of night-time sleep (depression=6.39, control=6.69), the depression group had a significantly lower Sleep Regularity Index and more nights of short sleep (depression=6, control=4). There were no significant group differences between the primary outcomes PVT and CPT, however the depression group demonstrated significantly slower DSST and TMT-A performance. There were few significant correlations between sleep and cognitive variables, with the strongest observed between insomnia symptoms and slower DSST performance. Multiple regression analyses showed that insomnia symptoms, but not actigraph-measured hours of sleep, moderated the relationship between depression symptoms and PVT performance.

In this study, participants with depression reported significantly more insomnia, and had a less regular sleep schedule than controls. There were no group differences on the primary outcome sustained attention tasks, but the depression group demonstrated significantly slower psychomotor processing. The relationship between depression symptoms and sustained attention was moderated by insomnia symptoms but not average hours of sleep.

Erotomanic delusions involve the fixed false belief that another person (often of higher social status) is in love with the individual. Although rare, erotomania is clinically significant due to its association with stalking, harassment, and, in some cases, serious violence. Risk assessment framework deficits have contributed to fragmented understanding of factors associated with violent escalation. Existing evidence is largely confined to case reports and case series, limiting systematic synthesis of clinical and contextual risk factors. This scoping review aimed to synthesise published case-level evidence on erotomania associated with stalking and/or violent behaviour. The primary objective was to identify individual, clinical, and contextual factors linked to stalking or violence in people with erotomanic delusions. Secondary objectives were to describe the nature and severity of violence and to identify gaps in the literature.

A literature search was conducted in January 2026 using six databases. Eligible publications included case reports, case series, and observational or qualitative studies describing erotomanic delusions in connection with stalking or violence. Data were extracted using Covidence capturing sociodemographic, clinical and criminological factors. Results were synthesised descriptively and reported as frequencies and percentages overall and by sex. Fifty publications comprising 87 cases were included.

The sample included 51 males (58.6%) and 36 females (41.4%), with a mean age of 36.0 years (SD 11.7). Most individuals were single, socially isolated and had unstable living arrangements. Erotomanic delusions were most commonly described in the context of a primary diagnosis of a psychotic illness (90.8%). Co-occurring delusional themes were common, particularly referential, persecutory, and grandiose delusions.

Stalking was reported in 88.5% of cases, typically involving a single object. Victims were predominantly female (64.5%) and most often professionals (e.g. clinicians, employers). Violence occurred in 49.4% of cases, with males significantly more likely to perpetrate severe violence. Common motivations included delusional beliefs of reciprocated love and perceived rejection. Criminal charges arose in over half of cases, particularly among male offenders.

Erotomania associated with stalking and violence represents a high-risk clinical and forensic phenomenon. The literature remains dominated by descriptive reports underscoring the need for structured risk assessment approaches, clearer diagnostic guidance, and targeted management strategies to prevent escalation and harm.

Adolescent boys experience high rates of suicide, substance-related harm and school exclusion compared to other genders. However, large-scale studies report lower prevalence of common mental health disorders in boys, raising concern that boys’ mental distress is under-recognised in research and clinical settings. We aimed to examine how constructions of masculinity influence the expression, recognition and measurement of mental distress in adolescent boys aged 10–16. We explored whether current research tools adequately capture male-typical presentations of mental distress, with implications for psychiatric research, clinical assessment and service provision.

A critical narrative synthesis approach was used, using research from adolescent psychiatry, men’s health and public health literature. Evidence from large population-based studies of young people was considered alongside qualitative and epidemiological studies looking at gendered patterns of symptoms, help-seeking behaviour and clinical recognition. Masculinity was conceptualised as a socially constructed and context-dependent set of norms that interact with biological and structural factors. Disordered eating and body image concerns were used as a focused case study to illustrate how male-typical expressions of distress may not be captured by common questionnaires used clinically and in research.

The literature suggests that adolescent boys are more likely to express mental distress through externalising behaviours, irritability, risk-taking, and body-focused practices, which are less likely to be identified by commonly used mental health questionnaires. Survey items frequently reflect female-typical symptom profiles and ideals when assessing body dysmorphia and disordered eating, potentially contributing to an under-detection of eating disorders in boys. Masculine norms around emotional restriction, physical strength and self-reliance may influence how boys experience, interpret and report symptoms, while professional biases and service structures can limit recognition and care when boys do seek help. These factors contribute to a cycle of poor identification, research support, and outcomes.

Current gender-blind measurements of adolescent mental health risk systematically under estimate clinically significant mental distress in adolescent boys. Greater attention to how masculinity affects the expression, reporting and identification of psychiatric symptoms is needed to improve the accuracy of research and psychiatric assessment to ensure boys’ needs are adequately recognised. Incorporating male-typical presentations into screening tools and engaging boys in the design of research measures may improve how boys’ mental health is conceptualised and measured. Addressing these gaps has significant implications for child and adolescent mental health services, prevention strategies and psychiatric training – which has the potential to benefit not only boys, but everyone whose distress does not align with typical diagnostic criteria.

Many people with eating disorders experience body image disturbance, and there is evidence to suggest that body image difficulties not effectively addressed through eating disorder treatment can contribute to later relapse. Virtual reality (VR) interventions designed to target body image difficulties associated with eating disorders have begun to demonstrate promising evidence of efficacy. However, little is known about the perspectives of people with eating disorders and those who care for them around such interventions. This study aims to explore stakeholders’ views of factors that could impede or support use of such interventions.

Eleven young people with lived or living experience of eating disorders (PWLE), four parents/carers of people with eating disorders, and five clinicians with experience of treating eating disorders took part in semi-structured interviews or focus groups. Qualitative data was coded inductively and analysed using reflexive thematic analysis. Themes and subthemes were iteratively refined through discussions between the authors.

Five themes were generated. These were getting the timing right: highlighting the importance of timing within a person’s treatment journey, with suggestions for optimal timing; tailoring the intervention to the individual: all stakeholders agreed that individualisation to the person accessing treatment was critical; thoughtfully empowering agency: participants suggested that a degree of control over most aspects of the intervention would be helpful, with some key caveats; providing the right support: suggestions were made about both the necessity of support, and what this support might look like; and an overarching theme of on balance is it worth while? This overarching theme involved participants carefully weighing up the risks and benefits of using such an intervention. It included three subthemes: hope of efficacy; fear of difficulty; and desperate belief in necessity.

PWLE, parents and carers and clinicians shared valuable, detailed insights into how they view body image interventions in VR, the key challenging areas and suggestions for how they could be done well. They highlighted that getting these aspects right may make such an intervention on balance worthwhile. Ongoing co-production in order to optimise these components of the intervention should be utilised in the development of VR body image interventions, as they will likely make the difference as to whether people will choose to try them and whether they will be effective.

Personality disorders (PDs) are frequently assumed to confer poorer prognosis in substance use disorder (SUD) treatment and are often viewed as markers of higher clinical risk, reduced treatment responsiveness, and increased likelihood of relapse. These assumptions can influence clinical decision-making, expectations of recovery, and access to specialised services. However, empirical evidence supporting these beliefs remains limited and inconsistent, particularly within mandated rehabilitation systems where treatment engagement, supervision, and monitoring differ substantially from voluntary care. Data from the Middle East are especially sparse. This study aimed to examine the association between comorbid PD and post-discharge relapse following inpatient SUD treatment in Qatar and to characterise the prevalence of dual diagnosis within a mandated rehabilitation population. We hypothesised that comorbid PD would be associated with higher relapse rates following discharge.

A retrospective cohort analysis was conducted using medical records of patients discharged from an inpatient SUD rehabilitation programme operating under a mandated treatment framework. The cohort comprised 72 patients who completed inpatient treatment and entered structured post-discharge monitoring. Patients were categorised according to the presence (n=19, 26.4%) or absence (n=53, 73.6%) of a diagnosed personality disorder documented during admission. Relapse was defined using clinically relevant real-world indicators, including documented positive urine drug screening, self-disclosed substance use during follow-up, or failure to attend scheduled drug testing. Relapse outcomes were compared between groups using chi-squared testing to assess the association between PD status and early post-discharge relapse.

Comorbid PD was identified in over one-quarter of the cohort, demonstrating a substantial burden of dual diagnosis within mandated rehabilitation settings. Relapse occurred in 36.8% of patients with comorbid PD (n=7) compared with 41.5% of patients without PD (n=22). The difference in relapse rates between groups was not statistically significant (χ²=0.0069; p=0.9336). Contrary to prevailing assumptions, relapse rates were numerically higher among patients without PD, although this difference was small and clinically modest. Overall, PD status did not meaningfully differentiate short-term relapse risk following discharge in this cohort.

This study represents one of the first regional evaluations examining relapse outcomes by PD status within a mandated SUD rehabilitation context. Findings challenge assumptions that comorbid PD necessarily predicts poorer early recovery or higher relapse risk. Results support the feasibility of managing dual diagnosis patients within standard addiction treatment pathways when comprehensive assessment, structured monitoring, and integrated care are in place. Larger prospective studies are required to explore the impact of specific PD subtypes and longer-term outcomes.

Eating disorders (ED) are serious mental health conditions characterised by disordered eating behaviour and associated emotional distress. EDs are associated with high rates of mortality and morbidity, yet rates of help-seeking remain low. There is a misconception that EDs only affect “skinny, white, affluent girls” (SWAG) although anyone can be affected. Likewise, despite similar rates in ethnic minorities, studies suggest that help-seeking from this population remain low. The aim of this paper is to identify key barriers and facilitators to accessing ED treatment in the UK and whether ethnic minority groups have different experiences from the majority population in accessing treatment. We hypothesised that barriers and facilitators would differ between ethnic minority and majority populations in the UK.

A systematic review of qualitative and mixed methods studies was conducted following PRISMA guidelines. PsycINFO, Embase, Medline and CINAHL databases were searched for relevant studies published since 2013. Two independent reviewers screened titles/abstracts and reviewed full texts. Eligible articles were coded in NVivo to generate themes following Braun and Clarke’s thematic synthesis guidelines.

Out of14 included studies, two focused exclusively on ethnic minority experiences. Across the studies, commonly shared barriers to accessing care included rigid ED guidelines, negative healthcare professional experiences, difficulty in self-recognising ED, low accessibility and awareness of services, and negative social relationships. Reported facilitators included improving education and recognition of EDs, informed and accessible delivery of care, and supportive communities. The two studies exploring the experiences of people of South Asian heritage highlighted additional barriers, such as concerns about doctor-patient confidentiality, and marriage-related pressures linked to beauty standards. Unique facilitators included suggestions for raising awareness of eating disorders through culturally relevant platforms.

A more holistic approach is required from services and guidelines to tackle stigma associated with EDs and make services more accessible. There is a lack of primary research focusing on ethnic minorities, and further research is required.