To identify quantitative studies of patients with psychotic disorders prescribed second generation antipsychotics (SGAPs), measuring new-onset or worsening obsessive compulsive symptoms (OCS) after treatment, and to evaluate whether SGAPs induce or exacerbate these symptoms.

A systematic review was conducted using MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science, following PRISMA guidelines. Search terms covered psychosis, OCS and SGAPs. Of 2524 references retrieved, 1939 remained after duplicate removal. Screening by two independent reviewers identified 58 eligible abstracts, with 43 full-text studies included. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the most commonly used outcome measure.

Across 43 studies, 9044 participants with psychotic disorders were included, predominantly with schizophrenia (mean age 36 years). Clozapine was studied in 28 reports, with additional evidence for risperidone, olanzapine, ziprasidone and aripiprazole. Seventeen studies demonstrated statistically significant results, most associating clozapine with de novo OCS. Olanzapine was also linked to emergence or worsening of OCS symptoms, while adjunctive aripiprazole showed evidence of improvement in some cases. Most studies were observational, limiting causal inference.

Preliminary evidence suggests clozapine is associated with new-onset OCS, potentially mediated by 5HT2a and 5HT2c antagonism. The association is less clear for other SGAPs, though there is evidence that olanzapine can contribute to a worsening in severity of OCS or emergence of new-onset OCS, and evidence that adjunctive aripiprazole can improve OCS outcomes. Further longitudinal, prospective trials are required to clarify these associations.

Approximately 14% of children live with a physical chronic illness (CI), which often imposes significant strain on them and the family system. Acceptance and Commitment Therapy (ACT) aims to enhance psychological flexibility, enabling individuals to remain present and pursue meaningful goals even when faced with distressing thoughts or emotions, ultimately leading to more fulfilling lives aligned with personal goals.

This review evaluated the effectiveness of ACT for paediatric patients with CI (0–18 years) and their caregivers across: parental wellbeing; parenting practices; child adjustment; and clinical markers.

A systematic search of eleven databases and international trial registers was conducted for randomised controlled trials, of ACT for paediatric patients with CI (0–18 years) and/or their caregivers, published between December 2014 and July 2024. Risk of Bias (RoB) was assessed using the Cochrane RoB 2 tool via the Miguel et al. (2025) psychotherapy framework. A narrative synthesis was performed due to clinical and methodological heterogeneity. PRISMA guidelines were followed. PROSPERO CRD42021268686.

Eighteen reports representing 14 unique studies were identified. Overall methodological quality was judged as low, with 100% of studies rated “High Risk” or “Some Concerns” primarily driven by unblinded self-reports, high attrition (up to 60%) and widespread use of waitlist control designs.

ACT demonstrated a signal of change in reducing condition-specific affect, including caregiving-related guilt and worry in oncology (d=0.88, p=0.010) and rumination in Cerebral Palsy (p<0.01). Global distress results were inconsistent, often limited by baseline “floor effects”. Standalone ACT interventions demonstrated a positive signal of effect on parental emotional availability (specifically non-intrusiveness), parental mindfulness, comfort with diagnosis. Blinded observations of ACT noted improved child involvement (p=0.011) and reduced parental intrusiveness (p=0.050).

Gains in child quality of life and life satisfaction were observed in diabetes (p<0.001), heterogeneous CI (total HRQoL β=0.52, p=0.015), and Cerebral Palsy (social wellbeing β=10.14, p=0.025). Clinical gains included an 80% reduction in asthma-related Emergency Department visits (IRR=0.20, p=0.001) and reduced pain interference (r=−0.51, p<0.001) without corresponding shifts in absolute pain intensity (p=0.346). There was a signal for psychological flexibility as a mechanism of change present across several studies.

ACT shows promise in shifting how families relate to chronic illness, improving quality of life and managing caregiver distress; however, overall certainty of evidence is low. Rigorous, fully powered trials utilizing blinded clinician assessments are required to confirm these exploratory signals.

Aggression is prevalent in forensic psychiatric inpatient settings and poses significant safety risks to both patients and staff. A variety of interventions have been implemented to manage aggressive behaviour; however, no study has comprehensively synthesized and clearly summarized the existing evidence on these interventions. This scoping review aimed to identify and map the therapeutic interventions used to mitigate aggression among forensic psychiatric inpatients and to summarize the reported outcomes of these interventions.

This review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the PRISMA-ScR guidelines. Database search was performed in MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, EMCARE, and Evidence-Based Medicine (EBM) Reviews, without restrictions on date or language to identify eligible reports. Study selection, data extraction, and quality assessment were performed independently by at least two reviewers.

Of the 1375 records identified, 58 studies were included in the final review. Psychological and behavioural interventions comprised nearly two-thirds of included studies and were generally associated with consistently positive outcomes. Approximately, 75% of studies reported reductions in the frequency and/or severity of aggression, most commonly assessed using observational measures. Interventions that were both staff- and patient-centred demonstrated the most favourable effects. However, substantial methodological heterogeneity and incomplete reporting limited comparability across studies.

Evidence suggests that structured, multi-component therapeutic interventions are beneficial in reducing aggression among forensic psychiatric inpatients. Future research should emphasize standardized outcome measures and more rigorous comparative study designs are needed to improve the clinical applicability of findings.

Mental health problems are the leading contributors to disease in children, with rising prevalence exerting significant pressures on Child and Adolescent Mental Health Services (CAMHS). Services are currently unable to meet demand, resulting in prolonged waiting lists.

CAMHS operates on a crisis-driven model, despite the recent WHO and Darzi reports recommending early intervention strategies, including the use of community-based lay practitioners to do initial assessments.

The aim in this study was to explore the translation of community-based interventions from low-resource settings into a UK context.

Participants were purposively selected from multi-agency teams and professionals working with children were invited to take part in a qualitative study using thematic analysis following informed consent. These professionals included CAMHS clinicians, managers, people with lived experience and educational professionals.

Six themes with four associated subthemes emerged: ‘CAMHS Structure and Accessibility’, ‘Pathologisation of Suffering’, ‘Workforce and Professional Challenges’, ‘Community-based Interventions’, ‘Structural and Policy Reform’, and ‘Future Governance of Layworkers’.

Findings emphasised the urgent need for structural and policy reform, with focus on innovative approaches to early intervention and adaptation of successful programmes from low-resource settings as models of task-sharing. This would fulfil two of the Darzi recommendations: a move from treatment to prevention, and a move from hospital to community.

Translation of community and lay practitioner models (CLPs) into the UK has potential to improve access, promote early intervention, and align with government recommendations. However, further research using focus groups and clinical trials is required to assess the feasibility of implementing CLP training and supervision in the UK.

Antipsychotics (APs) may cause significant adverse events (AEs) resulting in treatment discontinuation and relapse. Xanomeline/trospium chloride (KarXT), a dual M1/M4 muscarinic receptor agonist combined with a peripheral pan muscarinic receptor antagonist, has a favourable side-effect profile, potentially lowering the risk of cardiometabolic and extrapyramidal AEs. Healthcare providers may benefit from clinical data and guidance on switching patients from traditional APs to KarXT.

This 8-week, multicenter, randomized, open-label, outpatient trial assessed efficacy and safety of a switch from atypical APs to KarXT monotherapy in adults with schizophrenia based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Participants were randomized 1:1 to 2 treatment groups: slower transition from AP to KarXT over 4 weeks (25% reduction in AP dose/week) or faster transition from AP to KarXT over 2 weeks (50% reduction in AP dose/week). Participants in both treatment groups followed the same titration schedule, initiating KarXT at 50 mg/20 mg twice daily for 1 week and uptitrating to a target maintenance dosage of 125 mg/30 mg over 8 weeks. The primary endpoint was all-cause discontinuation of KarXT. Secondary endpoints included change from baseline to week 8 in Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity (CGI-S), and Personal and Social Performance (PSP) scores. Safety endpoints included KarXT AE-related discontinuations and AE incidence.

Fifty-three participants were enrolled in the slower transition group and 52 in the faster transition group; 86% of participants completed 8 weeks of treatment, with discontinuation rates of 15.1% (n=8) and 13.5% (n=7) in the slower and faster transition groups, respectively. No participant discontinued due to lack of efficacy. Mean changes in PANSS total scores from baseline to week 8 were −4.2 (slower transition group) and −3.1 (faster transition group). Mean change in CGI-S score was −0.2 in both transition groups. From baseline to week 8, mean PSP scores increased by 1.1 and 0.7 in the slower and faster transition groups, respectively. Forty-nine per cent of participants had ≥1 treatment-emergent AE (TEAE); none were serious. In the slower and faster transition groups, 1 (1.9%) and 2 (3.8%) participants, respectively, discontinued treatment early due to TEAEs.

Both slower and faster transitions from stable AP treatment to KarXT were generally safe and effective, suggesting that either transition method may be considered. These results aid clinical decision-making, providing healthcare providers with evidence-based guidance on how to switch to KarXT from oral atypical APs.

Large language models (LLMs) are rapidly emerging as tools with potential applications across mental healthcare, yet their implications for psychiatric practice remain unclear. This systematic review explores and categorises LLM use cases in mental healthcare to inform clinicians, researchers, and policymakers about emerging applications, opportunities, evidence gaps, and safety challenges relevant to psychiatric assessment, risk management, clinical documentation, and patient-facing support.

We searched EMBASE, MEDLINE, PsycINFO, PubMed, the ACL Anthology, the ACM Digital Library, arXiv, medRxiv, and bioRxiv (2017–June 2025) and included empirical studies evaluating LLMs for mental healthcare tasks. Screening and extraction wereperformed in line with PRISMA. We summarised use cases using a predefined taxonomy and recorded study design, evaluation setting (synthetic vs clinical), and key safety/ethics issues.

We identified 120 studies, with some addressing more than one use case, reflecting a broad and rapidly expanding set of LLM applications in mental health care. The most common functions related to assessment and detection: symptom identification (14), early detection (15), risk stratification (e.g. suicidality) (9), individual-level risk prediction for developing mental health disorders (12), and analysis of clinical or patient-generated text (1). Patient-facing use cases included psychotherapy (10), conversational agents (15), patient education (6), mood and emotion monitoring (5), accessibility-focused digital interventions (2), and psychiatric rehabilitation (1). Clinician-facing functions included diagnostic support (18), disease classification (7), treatment outcome prediction (3), electronic health record summarisation (3), and documentation support (1). Additional work addressed healthcare policy (8), research (1), education (1), and training (1). Across domains, LLMs were frequently reported to perform comparably to existing automated approaches and, in standardised case evaluations, to human benchmarks. However, the evidence base was highly variable, most studies were exploratory or proof-of-concept and had limited evaluation in routine psychiatric practice. Recurrent concerns included hallucinated or inaccurate outputs, bias and cultural insensitivity, limited transparency and explainability, data privacy risks, and uncertain safety in high-risk clinical contexts.

Current evidence indicates that LLMs may support multiple areas in psychiatry, primarily as augmentative tools rather than replacements for clinical expertise. Promising near-term applications include assessment support, administrative efficiency, psychoeducation, and low-risk supportive interactions. However, clinical integration remainsat an early stage given limited real-world validation and persistent safety concerns. Future research should prioritise evaluation in routine care, strengthened governance and regulatory frameworks, and transparent systems co-designed with clinicians and service users to ensure safe and equitable implementation in psychiatric practice.

Children’s mental illnesses are negatively impacted by poor parental mental health. It is important to consider parents’ mental health for the welfare of their children. It is equally important to consider the impact of children’s mental health on the well-being and stress of their parents. The specific objectives of the study were to assess levels of psychological stress, anxiety, depression, and substance use as reported by the parents/caregivers. It was also ascertained if they had any psychiatric diagnoses and received intervention or support.

This was a prospective, questionnaire-based survey of 146 parents attending a Child and Adolescent Mental Health Service (CAMHS) in the West Midlands. We used the Patient Health Questionnaire (PHQ-9) for depression and the Generalised Anxiety Disorder (GAD-7) questionnaire for anxiety. We assessed functional impairment through the Work and Social Adjustment Scale (WSAS).

The sample consisted of 25 fathers and 121 mothers, with the majority (90.9%) being of Caucasian ethnicity. Most of them were working, with 44.5% working full-time, 25.3% working part-time, and 25.3% being unemployed; 42.8% were receiving benefits. Proportions of parents who reported stress in the previous month “sometimes” was 23.4%, “often” 35.2%, and “almost always” 25.5%. Around one third (34.2%) reported having a psychiatric diagnosis; most of these were depression (22.6%). Based on PHQ score ≥10, 44.4% of parents reported symptoms suggestive of moderate to severe depression, and 39.5% had symptoms of moderate to severe anxiety (GAD-7 score ≥10). The anxiety and depression scores were positively correlated. Proportions of parents who reported smoking and using alcohol “often” or “most of the time” was 13.1% for each of these.

The majority (66.9%) had visited their GP for mental health-related issues or stress; a few had consulted a therapist or counsellor (47.9%), and 15.8% were seen by a psychiatrist. More than half (57.9%) of the parents were taking psychotropic medications; 9.0% used over-the-counter medications, and 6.9% used medication for sleep. Almost half of them had functional impairment, which included 28.7% having significant and 16.9% moderately severe or worse impairment.

Considerable proportions of parents of mentally ill children had anxiety, depression, substance use, and functional impairment. Most of them sought help from professionals and received intervention. The results highlighted the extent of parental mental health concerns and the need for support. Besides improving awareness about this, options for screening of mental health problems in parents, and facilities for appropriate interventions are needed.

Data on survival rates of patients with dementia is sparse in Asian populations. Thus the aim of this study is to determine rates of survival of patients with dementia in Sri Lanka.

A descriptive cross-sectional analysis of data was done using the data of patients who have registered at the National Institute of Mental Health Sri Lanka, Older Persons Mental Health Clinic (largest governmental psychogeriatric service provider in Sri Lanka) from 2021 to 2023.

Total registries were 366. Prevalence of Alzheimer’s, vascular and mixed aetiology were 149 (40.41%), 83 (22.67%), 112 (30.6%) respectively. 203 (55.46%) had defaulted up to 2025. Out of 163 under regular follow up 17 (10.43%) had passed away. Mean years of survival with the disease was 3.7 years. Cause of death was dementia and related complications in 13 (76.47%) and vascular events in the rest. Mean age of death had been 77 years and male to female ratio was 0.7. Out of the defaulted 74 (36.45%) had beencontactable. Out of them 57 (77.03%) had passed away. Mean years of survival had been 2.01 years. Cause of death was dementia and related complications in 39 (68.42%) and vascular events in the rest. In the 146 surviving patients under regular follow up mean age was 73. Male to female ratio was 0.55. Mean years of life they had been living with dementia was 4.03 up to 2025. Among 17 surviving contactable patients who had defaulted it was 3.18 years. Odds of death in patients under regular clinic follow up compared with defaulted was 0.035 (Fisher’s exact p-value 2.5´ 10−24)

Regular clinic follow up is associated with a statistically significant lower rate of death compared to defaulters among patients with dementia.

Usage of antipsychotic medications in patients with dementia is associated with heightened incidence of adverse effects and mortality. Yet their prescription is on the rise to contain behavioural and psychological symptoms of dementia (BPSD). Thus the aim of thisstudy is to as certain patterns in antipsychotic prescribing over the years from 2019 to January 2025 among patients with dementia attending Deeghayu psychogeriatric clinic, at the National Institute of Mental Health, Angoda, the largest psychogeriatric clinic facility in Sri Lanka.

A descriptive cross-sectional analysis of the data extracted from the patient records was done.

Total of 493 patients had been viewed including 306 (62%) with dementia. Alzheimer’s, vascular and mixed aetiologies had been the commonest with a prevalence of 124 (40.5%), 69 (22.5%) and 92 (30.6%) respectively. Out of them 228 (74.5%) had BPSD. Among them 172 (75.4%) had been initiated on antipsychotics. Quetiapine, risperidone, olanzapine and aripiprazole had been prescribed for 84 (48.8%), 16, 8 and 1 patients respectively and 63(36.6%) were on a combination of 2 antipsychotics out of which majority 45 (71.4%) were on the combination of risperidone and quetiapine. Among those who were not on antipsychotics for BPSD, 49 (21.5%) were on antidepressants for depression and 7 (3.1%) were solely on behavioural management. Poor sleep, wandering, aggression/agitation, hallucinations, disinhibition, delusions and mania had been the indication for prescription of antipsychotics in 107 (46.3%), 71 (30.7%), 80 (32.6%), 51(22%), 31(13.4%), 26 (11.6%) and 19 (8.2%) patients respectively. Percentage with two types of BPSD were 37.2% while 20.2% had more than two types of BPSD. Out of those with depression 34 (69.4%) had been prescribed antipsychotics out of which 27(79.4%) were on quetiapine.

Antipsychotic prescription is of high prevalence. Identifying and addressing the underlying cause leading to BPSD and usage of non-pharmacological strategies as the firstline of management can minimize the usage of antipsychotics. Further research is warranted to evaluate tolerance and effectiveness of the prescribed antipsychotics.

Though the motives behind filicide had been extensively studied the factors that sow the seeds of those motives and how to take their edges off had rarely been investigated thus far in Sri Lanka and worldwide at large.Thus the aim of this study is to describe the demographic and clinical characteristics and associated factors in female patients referred following filicide to National Institute of Mental Health, the largest in patient forensic psychiatry facility in Sri Lanka over a period of 12 years.

Data was collected from the bed head tickets (BHTs) and descriptive statistics were analysed.

Total of 41 BHTs were examined. 92.7% of the mothers were aged 18–40 years, 78.7% were educated up to grade 11 or below. 61.1% were from rural areas. 17.1% wereemployed. 36.6% had been diagnosed with a psychiatric illness prior to the event with depression (31.3%) being the commonest. 75.6% had not been on treatment. 73.1% of the undiagnosed, had demonstrated symptoms of psychiatric illnesses but had been diagnosed only following the filicide. Harmful use of substances was evident in 44.7% of the fathers and 7.9% doubted the paternity. 61.1% of the mothers had been subjected to domestic violence by their husbands and 63.6% had considered the support received from husbands to be inadequate. Monthly income was <50,000 in 100%. 30.8%, 41% and 25.6% of victims were aged <24 hours, 0–1 year and 1–5 year respectively. 59.5% pregnancies were unplanned. 30.8% had attempted abortions. 28.9% had had home deliveries. 21.1% of the victims had had post-natal complications. 32.4% of the mothers had attempted suicide and 22.2% had attempted homicide of the victim. 23.7% of the victims had been abused; with mother (62.5%) being the commonest abuser. Commonest modes of filicide were drowning (42.9%) and strangulation (28.6%).

Beyond provision of the blanket defence and analysis of the maternal motives, prevention of filicide requires refining of several individual and social factors that have been overlooked.

Behavioural and psychological symptoms of dementia (BPSD),though an integral feature of dementia leading to greater mortality and morbidity, remains understudied in low- and middle-income countries like Sri Lanka. Thus this study is performed to determine prevalence of BPSD and its association with quality of life (QoL) and care giver burden among patients attending Deeghayu clinic at the National Institute of Mental Health (NIMH), Angoda, the largest psychogeriatric facility in Sri Lanka.

A descriptive cross-sectional analysis was carried out at the first clinic visit over a period of one year from 2024 to 2025. Prevalence was as certained with Neuro Psychiatry Inventory (NPI).

Total of 72 patients were diagnosed with dementia, 27.8% were females with a mean age of 76.9 years (SD±11.1). Mean duration of untreated symptoms by the time of diagnosis was 2.07 years (SD±1.54). Prevalence was 61.1% in Alzheimer’s, 4.2% in vascular, 30.5% in mixed (Alzheimer’s with vascular), 1.4% each in Parkinson’s, Lewy body and fronto-temporal dementia. Frequency of severities were 43% mild, 41.7% moderate and 15.3% severe. Severity of dementia was positively correlated with NPI score (Pearson Correlation 0.09). Prevalence of BPSD was 95.8%. 33.3% had delusions, 47.2% hallucinations, 54.2% agitation/aggression, 47.2% depression, 25% anxiety, 15.3% elation, 47.2% apathy, 19.4% disinhibition, 44.4% irritability, 65.3% wandering behaviour, 75% sleep disorder and 47.2% loss of appetite. 15.3% of the patients were initiated on donepezil, 5.6% on memantine, 4.2% on both. 13.9% were initiated on quetiapine alone for management of BPSD and 61.1% on quetiapine along with one or two cognitive enhancers. 51.4% had mild to severe care giver burden according to ZaritCare Giver Burden Scalewhich was positively correlated with NPI score (Pearson Correlation 0.29). All domains of QoL assessed via World Health Association QoL in both care givers and patients were negatively correlated with NPI score except for patients’ social and environmental QoL.

Majority of the patients had BPSD at the time of diagnosing dementia associated with statistically significant heightened care giver burden and diminished QoL. This raises a concern that BPSD had led to accessing services rather than early cognitive and functional decline potentially indicating delayed diagnosis. Thus, this study underscores the need to enhance awareness and screening strategies to promote early detection of dementia in under-resourced settings such as Sri Lanka.

Bodily distress disorder (BDD) involves presence of excessively distressing somatic symptoms to which individuals direct excessive attention despite repeated contacts with healthcare providers or even if another condition is causing the symptoms,paying excessive out of proportion attention to symptoms. BDD is more prevalent following Covid-19, but data from Asia remains sparse. Thus, this study is done to determine the prevalence of BDD among patients seeking outpatient treatment at Colombo North Teaching Hospital (CNTH), Sri Lanka.

We conducted a cross-sectional study recruiting consecutive, consenting patients attending the outpatient department (OPD) of CNTH from April to June 2025. Presence of somatic symptoms were determined by applying Bradford Somatic Inventory. Relationship of somatic symptoms to bodily distress disorder, depression or anxiety was determined according to ICD–11 criteria through clinical interviews by a senior registrar in psychiatry. In patients diagnosed with BDD lack of an adequate biological explanation for symptoms or in patients with established medical conditions contributing to symptoms, degree of attention to symptoms being excessive despite appropriate clinical examination, investigations and reassurance was confirmed by the Consultant Physician in charge of OPD.

We studied 236 patients (female 83.1%, mean age 62±11.8 years, educated up to orbelow grade eleven–83.1%, residency urban or suburban–89%). Prevalence of somatic symptoms was 94.1%. Out of those, BDD was diagnosed in 28.1%, depressive disorder in 14.3% and anxiety disorder in 7.1%. Prevalence of BDD was higher in females 29.1% compared with males 15% (Chi square 3.4,pvalue 0.06) and higher in people with education up to or below grade eleven–27.0% when compared with above grade eleven–25.0% (Chi square 0.7, p value 0.79). BDD was higher in people below 60 years (Chi square 5.6, p value 0.18) and in people residing in urban, and suburban areas (Chi square 11.0, p value 0.00). Number of comorbidities is positively correlated with BDD status. Most common two presenting symptoms were aches and pain (41.8%) and lack of energy/fatiguability (37.2%). Majority of those with BDD were on polypharmacy therapy (60.3%) and 22.2% were on analgesics.

Prevalence of BDD among this whole sample of people seeking outpatient treatment at a tertiary care hospital in Sri Lanka was 26.7%. Age below 60years, urban and suburban residency,multi-morbidity were significantly associated with BDD.

Regulation 28 of the Coroners and Justice Act 2009 enables coroners in England and Wales to issue Prevention of Future Death (PFD) reports when systemic risks are identified. Organisations must respond within 56 days outlining actions taken. Although aimed to prevent future deaths, there is paucity of evidence in regard to the effectiveness of Regulation 28.

This review aimed to map published analyses of mental health- and suicide-related PFD reports, identify recurring systemic concerns, and assess whether Regulation 28 functions as an effective preventive mechanism.

A scoping review was conducted using Arksey and O’Malley’s framework to synthesise heterogeneous evidence. Database used were Embase, Medline and Psychinfo (from 2010–2013) with search terms: Regulation 28; Mental Health; suicide; prevention of future death.

• Included studies were those that:

• Analysed Regulation 28 PFD reports.

• Focused on suicide, mental health-related deaths, medicines implicated in suicide, autism-related deaths, or organisational learning.

A narrative synthesis identified cross-cutting structural domains including communication, risk assessment, service access, prescribing, workforce capacity, and governance.

The search identified 8 studies to include in the scoping review.

Recurring themes were consistent across populations:

Communication failures – poor inter-agency information sharing and discharge planning.

Inadequate risk assessment – incomplete documentation and over-reliance on risk tools.

Barriers to access – long waits, rejected referrals, and crisis care gaps.

Staffing and training deficits – workforce shortages and limited suicide prevention training.

Medicines-related risks – opioids (40%) and antidepressants (30%) frequently implicated.

Policy non-compliance – failure to follow existing procedures.

Response rates to PFDs were inconsistent (as low as 58% in some analyses), and no enforcement mechanism exists. Similar concerns recur across years, suggesting limited demonstrable preventive impact.

Regulation 28 consistently identifies modifiable systemic failings and functions effectively as a diagnostic learning tool. Whilst Regulation 28 holds preventive potential, the effectiveness remains unclear. Its preventive capacity is constrained by weak oversight, inconsistent accountability, and absence of outcome tracking. Without mandatory oversight, standardised reporting, and measurable outcome tracking, PFDs risk remaining a mere procedural issue rather than effectively preventing future deaths.

In summary, though Regulation 28 has theoretical preventive potential, stronger national coordination, mandatory implementation monitoring, and integration into regulatory frameworks are required to translate coronial learning into measurable reductions in mental health-related mortality.

There is increasing recognition of the importance of personality functioning in children and adolescents. The introduction of a dimensional model to conceptualise personality disorders in the ICD–11 and the Alternative Model for Personality Disorders (AMPD) in Section III of the DSM–5, along with the removal of age as a criterion, enables personality disorders to be diagnosed in children and adolescents. This scoping review aimed to explore and map the existing research that included the assessment of the level of personality functioning in this population using an assessment tool.

This scoping review was pre-registered on Open Science Framework (OSF) Registries and conducted in accordance with JBI methodology for scoping reviews. Five databases were searched: Medline (EBSCO), PsycINFO (APA), CINAHL Complete, Embase, Cochrane Library. A limited search of grey literature from Google Scholar was conducted. Articles identified through citation searching of included sources of evidence were also included. A librarian was consulted to develop the search strategy. Key words and synonyms related to (i) children and adolescents, (ii) levels of personality functioning and (iii) assessment. Sources of evidence published up to 2025 and in any language were included. Screening was completed by two reviewers with conflicts resolved through consensus discussion and a third reviewer. One reviewer completed data extraction, and a second reviewer checked a proportion of the data. AI tools were used to translate articles notpublished in English. Covidence software was used to manage data and facilitate the identification of duplicate articles.

The search strategy retrieved 5191 sources of evidence, of which 544 duplicates were removed, 4501 were excluded during abstract screening, 90 during full-text review, and 2 were merged, resulting in a total of 55 sources of evidence in the final analysis. Publication dates ranged from 2011 to 2025, with 51% of publications since 2023. The majority (n=49) were research studies undertaken in 14 countries. Of which, 34 included a clinical population. Eighteen assessment tools were identified; 16 were self-report tools and were used in the majority (n=40) of research studies. The Levels of Personality Functioning Questionnaire for Adolescents (LoPF-Q 12-18) was the most frequently used measure in the studies (n=22).

There is increasing research on assessing levels of personality functioning in children and adolescents. Included sources of evidence report that future research should include larger, longitudinal evaluations, multi-informant data, and evaluate the utility of assessment tools across different clinical, demographic, geographical, and cultural settings.

Evaluate whether neuroimaging can predict response to cognitive behavioural therapy in those between ages 6–60 years with a diagnosis of major depressive disorder (MDD) and its use in a more personalised treatment plan.

A literature review was conducted using Ovid database (Medline, Embase, Emcare) and Google Scholar. Relevant studies were identified using a broad search which were then systematically screened. Inclusion criteria were participants aged 6–60 years with MDD, the use of neuroimaging and electrophysiological techniques as biomarkers pretreatment, and assessment of those biomarkers. Eligible literature included randomised controlled trials, cohort, case-control studies, systematic reviews, and meta-analyses published in English. Exclusions were studies with other comorbidities, non-CBT interventions, or combined CBT and pharmacotherapy without separate analyses. Out of 649 identified studies, only nine met the inclusion criteria. The findings were grouped by neuroimaging modality.

Evidence identified fronto-limbic and thalamo-cortical networks as key predictors of CBT response across the nine studies. Task-based fMRI studies showed lower pretreatment activity in subgenual anterior cingulate cortex which predicted superior outcomes. Siegle et al. demonstrated over 75% accuracy in classifying responders and 70% accuracy in remitters (R²=0.29) amongst 49 unmedicated adults. In 22 adults, Richy et al. found greater pretreatment ventromedial prefrontal and anterior temporal activation predicted symptom reduction with post treatment normalisation of fronto-limbic function. Feurer et al. found that greater rostral and subgenual anterior cingulate engagement predicted larger symptom improvement across psychotherapy modalities in 72 adults (B=−0.39, p=0.002).

Dunlop et al. showed subcallosal cingulate connectivity differentiated CBT vs antidepressant responders with 72–78% accuracy for remission and up to 89% accuracy for non-responders in 122 treatment-naive adults. In 30 adolescent participants, Tymofiyeva et al. demonstrated using structural diffusion imaging that greater thalamo-cortical connectivity predicted CBT response with 83% accuracy. Using Neurochemical imaging Dunlop and Mayberg showed that lower anterior insula metabolism predicted CBT response compared to subgenual anterior cingulate hypermetabolism which predicted non-response in 63 adults with MDD. Feurer et al. in 2 separate studies showed that in 112 adolescents with MDD, electrophysiological studies demonstrated that reduced reward positivity, increased late positive potential during reappraisal, and enhanced neural differentiation during self-referential processing predicted CBT outcomes more reliably than self-report measures. A systematic review by Fonseka et al. confirmed consistent involvement of anterior cingulate, prefrontal, insular and limbic regions.

Neuroimaging and electrophysiological biomarkers show promise for predicting CBT response in depression, particularly within anterior cingulate, prefrontal, insular, and thalamo-cortical neural circuits. Despite this, heterogeneity and limitation in replication restrict clinical translation. Larger, prospective, multimodal studies are needed to validate the use of biomarkers in psychotherapy for MDD.

To evaluate the impact of sleep interventions on sleep quality, duration, and efficiency in adults with psychotic disorders, and to assess secondary effects on psychotic symptoms, daytime functioning, and mental health stability.

A systematic review of studies published in the past 10 years was conducted, including meta-analysis, randomized and non-randomized trials, and observational studies. Eligible studies involved adults (≥18 years) with psychotic disorders and documented sleep disturbances. Interventions included pharmacological agents (melatonin, Z-drugs, antipsychotics), psychological therapies (CBT-I), and other complementary therapies (light, relaxation).

Twenty-three studies met inclusion criteria. Cognitive Behavioural Therapy for Insomnia (CBT-I), was the most frequently studied and consistently effective intervention across delivery formats. Pharmacological agents offered variable short-term benefits but raised concerns about side-effects, tolerance, and dependency. Adjunctive therapies such as music therapy, relaxation and exercise, light-dark rhythm modulation etc. demonstrated promise in specific subpopulations. Common limitations included methodological heterogeneity, small samples, and limited long-term follow-up.

CBT-I, adapted for psychotic disorders, appears the most robustly supported intervention. Integrated approaches combining psychological, pharmacological, and adjunct therapies may optimise outcomes. Large-scale, long-term studies and pathways for routine care integration are warranted, with inclusion in national guidelines.

Assessing personality pathology in adolescence is crucial for early identification of issues that may manifest in adulthood. While adolescence involves typical “storm and stress”, some adolescents exhibit personality pathology beyond normative developmental challenges. Early assessment and intervention are key during this pivotal developmental period. The Shedler–Westen Assessment Procedure–Adolescent Prototypes (SWAP-AP) offers a promising clinical tool for assessing personality functioning. This study aimed to examine the construct validity of the SWAP-AP Emotionally Dysregulated prototype.

Adolescents and their parents (N=121) from a Long Island, NY suburban adolescent psychiatry outpatient clinic consented to participate in an assessment and treatment outcome study. Participants completed admission packets, including the BeckYouth Inventory (BYI), Inventory of Interpersonal Problems-32 (IIP-32), Youth Outcome Questionnaire (YOQ), and Youth Self-Report (YSR), prior to psychiatric evaluation. Intake psychiatrists independently completed SWAP-AP ratings based on clinical evaluation, before reviewing self-report or parent report data. Each SWAP-AP prototype describes a personality configuration in “experience-near” language, with clinicians rating the match on a 1–5 scale (5=prototypical example).

The sample included 52% male participants, 35% Caucasian, 32% African American, 23% Hispanic, 3% Asian, and 7% “other”, with an average age of 17.77 years (SD=3.23). Forty-five SWAP-AP ratings were completed by clinicians, paired with available patient and parent data. The Emotionally Dysregulated prototype significantly correlated with: BYI scales of self-concept (r =−0.33, p=0.03), anxiety (r=0.36, p=0.01), and depression (r=0.50, p <0.001); IIP-32 self-sacrificing (r=0.42, p=0.03) and intrusive/needy (r=0.37, p =0.05) scales; YOQ social isolation (r=0.48, p=0.01) and depression/anxiety (r=0.41, p=0.03); and YSR anxious/depressed (r=0.48, p <0.01), withdrawn/depressed (r=0.43, p <0.01), and social problems (r=0.41, p =0.01).

These results provide strong support for the construct validity of the SWAP-AP Emotionally Dysregulated prototype, which characterizes borderline personality pathology in adolescents. The observed correlations between clinician-rated SWAP-AP and patient self-reports align with theoretical expectations, indicating the prototype’s utility in capturing relevant psychopathology. Future research should investigate the predictive validity of the prototype matching approach and its sensitivity to treatment-related change.

Gender differences are hypothesized to influence the reporting of attachment styles and psychological symptoms. Culturally, masculine characteristics are often linked with physical and aggressive tendencies, while feminine characteristics are associated with internalizing problems such as depression and anxiety. Some theoretical perspectives suggest that attachment styles may reflect different gender-specific mating strategies. This study investigated gender differences in self-reported adult attachment and psychological symptoms within a sample of patients from a cardiology outpatient clinic.

A total of 186 patients awaiting consultation at a private outpatient cardiology clinic completed a packet of self-reports. The sample comprised 55.7% males (one participant did not report gender) and 85.5% Caucasian individuals, with an average age of 66.2 years. We analysed gender differences in adult attachment using the 12-item Experiences in Close Relationship-Short Form (ECR-SF) and scores on the SPECTRA: Indices of Psychopathology, a broadband self-report measure of psychopathology.

Males scored significantly higher than females on several measures. Specifically, males reported higher ECR-SF attachment anxiety [t(139)=2.12, p=0.03], and higher scoreson SPECTRA’s severe aggression scale [t(120)=2.21, p=0.03], antisocial tendencies [t(120)=2.51, p=0.02], externalizing spectrum [t(120)=2.48, p=0.01], grandiose ideation [t(119)=2.93, p<0.01], and reality impairing spectrum [t(119)=3.00, p<0.01].

Our findings indicate that males reported higher scores on several psychological symptom scales, many of which align with theoretically externalizing strategies (e.g. aggression). More surprising findings included higher male scores on grandiose ideation and the reality impairing spectrum of the SPECTRA. Additionally, males exhibited higher attachment anxiety, which is unexpected given that females typically score higher on this dimension in most samples, with the exception of some Asian populations. Future research is warranted to further investigate these findings and enhance our understanding of gender differences in self-reports.

Healthcare professionals (HCPs) face significant mental health challenges, yet barrierssuch as stigma, fear of professional repercussions, and systemic issues hinder help-seeking. At present, there is little evidence on how help-seeking in HCPs can be facilitated. Given the widespread prevalence and serious consequences of mental health difficulties among HCPs, this study aimed to explore the barriers and facilitators that help or hinder HCPs accessing and utilising mental health support and wellbeing provision within a mental health National Health Service (NHS) Foundation Trust. A further aim was to develop recommendations, informed by participants’ accounts and existing literature, to encourage uptake of mental health support and wellbeing provision and foster a culture of wellbeing across healthcare organisations.

Three focus groups were conducted with healthcare professionals (doctors and nurses) employed by a mental health NHS trust. Participants represented a range of roles, backgrounds, and genders. Focus group transcripts were analysed using Reflexive Thematic Analysis, following a six-phase, non-linear process. Analysis identified key workplace stressors, coping strategies, and mitigating factors that shaped whether and how participants engaged with wellbeing support. Recommendations were developed from participants’ accounts and extrapolated in the context of existing literature.

Analysis generated three overarching thematic domains: (1) workplace stressors, (2) coping strategies, and (3) mitigating factors influencing help-seeking. Core stressors included overwhelming workloads, exposure to clinical risk and responsibility for patient safety, operational pressures, and the impact of serious incidents and investigations. Coping strategies ranged from individual approaches (e.g. hobbies, informal support) to organisational supports (e.g. supervision, flexible working, counselling). Barriers to help-seeking were primarily organisational and relational, including limited awareness andaccessibility of services, cultures emphasising resilience and self-sacrifice, and trust- and manager-related dynamics that shaped perceptions of safety, authenticity, and confidentiality. Key recommendations focused on addressing system-level stressors, strengthening wellbeing-focused managerial training, and improving the accessibility, credibility, and authenticity of wellbeing services.

These findings demonstrate that help-seeking among HCPs is shaped less by individual reluctance and more by organisational culture, leadership practices, and system-level pressures. Addressing these factors may reduce burnout, encourage timely help-seeking, and enhance patient care. The study provides practical, transferable guidance for healthcare organisations seeking to develop effective interventions to support healthcare professionals’ wellbeing in the workplace.

Eating disorders (ED) are associated with high morbidity, mortality, and relapse, yet access to evidence-based care remains limited. Digital interventions have improved scalability but often lack responsiveness to individual symptom profiles and changing clinical risk. Artificial intelligence (AI) has been proposed as a means of enabling personalised andadaptive interventions. However, the feasibility and safety of AI-enabled approaches in ED care remain unclear. This review evaluated the feasibility and safety of AI-enabled personalised interventions for anorexia nervosa, bulimia nervosa, and binge eating disorder, and explored potential clinical applications and evidence gaps.

A systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, APA PsycInfo, and Global Health were searched alongside grey literature sources including ProQuest, OAIster, EthOS, and Overton for studies published between 2020 and 2025. Eligibility criteria were defined using the SPIDER framework to capture quantitative, qualitative, and mixed methods evidence. Included studies examined AI-based approaches such as machine learning, natural language processing, digital phenotyping, or conversational agents used to personalise ED interventions and report feasibility or safety outcomes. Methodological quality was assessed using the Mixed Methods Appraisal Tool, and findings were synthesised narratively.

Eight studies met inclusion criteria across four domains. The evidence suggests that AI-augmented approaches can feasibly support aspects of personalised ED care, although findings remain early and heterogeneous. Machine learning methods showed potential for individualised risk prediction, relapse monitoring, fidelity monitoring in digital therapies, and just-in-time adaptive interventions, with substantial variability in performance and limited generalisability. Sensor-based systems demonstrated promise for low burden, real-time behaviour detection, but were evaluated in very small samples. Conversational agents were generally acceptable and engaging, though safety and autonomy concerns were identified. Clinician and service user studies indicated cautious openness to AI use, alongside ongoing concerns regarding trust, transparency, empathy, and governance.

AI-enabled personalisation for ED is technically feasible and shows promise in enhancing risk monitoring, treatment augmentation, and continuity of care. However, clinical effectiveness and safety remain unestablished. Prospective trials, diverse samples, systematic monitoring of harms, and integration within ethically governed, AI-augmented, clinician-led models are required before routine clinical implementation.