Within psychiatry, relationships between doctors and patients with psychosis are significant determinants of attitudes, adherence, and therapeutic outcomes. Current research focuses on communication within psychiatrist-patient interactions with limited evaluation of the patient's perspective. Understanding the components underpinning the patient's relationship with their doctor could help improve outcomes for individuals with psychosis.

Eight participants, recruited through advocacy programmes, were interviewed. All had a diagnosis of psychosis or its subtypes. Interviews lasted between forty and eighty minutes. Thematic analysis of semi-structured interviews allowed exploration of important themes within doctor-patient relationships. Ethical procedures were implemented in accordance with British Psychological Society guidelines.

Participants’ narratives identified three salient themes perceived to influence doctor-patient relationships. Participants explored ‘Interactions with Medical Professionals’, focusing on communication and discussion styles. Doctors were not perceived as empathic, open listeners, reducing trust and limiting conversation during interactions. Participants described reduced engagement due to perceived misunderstanding and highlighted the impact of time constraints, guidelines, and limited medical training on relationships.

Secondly, participants discussed the ‘Diagnostic Process’, suggesting it had a negative influence on the relationship due to delivery methods.

Finally, participants explored ‘Treatment’, highlighting an overwhelming reliance on medication, lack of explanations, and lack of psychological therapies, which contradicted with patients’ preferences.

The narratives describe a relationship in which patients feel misunderstood, furthering patient disengagement and resulting in a vicious cycle of dissonance that limits health outcomes. Findings suggest a need to incorporate psychological therapies into doctor-patient interactions to allow increased communication and understanding.

Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) effects 0.5–3.28% of children. NICE guidance recommends Activity Management, Graded Exercise Therapy or Cognitive Behavioural Therapy for fatigue (CBT-f). Approximately 15% of patients do not achieve full recovery within one year with current treatments. Acceptance and Commitment Therapy (ACT) is an effective treatment in many chronic illnesses. There are no studies investigating ACT for paediatric CFS/ME. This feasability study aimed to assess if ACT is a feasible and acceptable alternative treatment when current treatment has not led to recovery.

This feasability cohort study aimed to enrol a minimum of 12 participants aged 11–18 yearswith CFS/ME attending the Royal United Hospitals Bath NHS Foundation Trust Specialist Paediatric CFS/ME Service, who were still symptomatic after 12 months or 12 sessions of standard treatment and were offered six to 12 sessions of ACT. Retention and recruitment data were analysed. Participants were asked to complete questionnaires before, during and after treatment. A selection of participants and their parents were interviewed about their experience of the study. Interviews were analysed using thematic analysis.

19 participants (95% of those approached) were recruited. Only 4 participants of this hard-to-reach group did not complete treatment.

In almost all sessions participants reported that they felt ‘totally’ listened to in post session questionnaires (31/33 sessions).

Preliminary interviews (n = 12) indicate acceptability of ACT, with all young people and their parents stating that they thought ACT should be offered to this population. Participants particularly commented that the absence of thought challenging (used in CBT-f) was a positive element of ACT. Participant's openness to try new approaches and altruistic desire to be in a study was noted.

Recruitment data indicate that it is feasible to recruit and retain 11–18-year-olds with CFS/ME to a study offering ACT. Interviews with participants and parents were broadly positive suggesting ACT is an acceptable treatment in this population.

Results indicated that it is both feasible and acceptable to offer ACT to 11–18-year-olds with CFS/ME using this protocol, supporting the prospect of an RCT in this area.

Early-life interpersonal stress, particularly childhood maltreatment (CM), is associated with neurobiological abnormalities. However, few studies have investigated the neural effects of peer victimisation (PV). This study examines the common and specific associations between CM, PV and brain structural alterations in healthy youths.

Grey matter volume (GMV) and cortical thickness (CT) data were collected from 105 age-and gender-matched healthy youths (34 CM, 35 PV and 36 controls). Region-of-interest (ROI) and whole-brain analyses were conducted.

For the ROI, the CM group had smaller GMV than controls in left IFG, bilateral anterior insula, postcentral and lingual regions, which were associated with higher emotional abuse, along with smaller insular GMV than the PV group. The PV group had smaller left lingual GMV than controls, which was positively associated with age of bully onset. At the whole-brain level, both CM and PV groups had smaller GMV than controls in a cluster comprising left post/pre-central, inferior frontal, insula, superior parietal and supramarginal gyri. The PV group alone had increased CT in a cluster comprising left superior frontal, anterior cingulate and medial orbitofrontal gyri, which was related to greater cyberbullying.

Early-life interpersonal stress from carers and peers is associated with common structural alterations of the inferior frontal-limbic, sensory and lingual regions involved in cognitive control, emotion and sensory processing. The findings of a CM-specific reduced anterior insular GMV and a PV-specific increased CT in the left medial prefrontal cluster is intriguing and underscores the unique negative effects of CM and PV, particularly cyberbullying.

Social cognition is impaired in a variety of psychiatric conditions; evidence for impairment in individuals with PTSD is increasing. Mentalization is one domain of social cognition that refers to the capacity to understand other people by ascribing mental states to them. The STOMP task (Spontaneous Theory of Mind Protocol) involves an individual watching two minutes of a silent video and describing what they see. As part of a wider project examining social cognition in PTSD, we aimed to find out whether mentalization in the STOMP task differs between patients with PTSD compared to controls.

171 individuals undertook the task: 30 patients were recruited from centres in Cardiff and Bristol at the start of their psychological therapy; 141 controls were recruited through Prolific website. Participants watched a 2-minute silent video and were asked to write 7–10 sentences about the clip. Qualtrics software selected the video and collected the texts. The verbs of the texts were coded and given a score by PM using the Mental-Physical Verb Norms (MPVN) method. MVPN was developed by Orr et al. 2019, to give a value to 250 commonly used verbs based on their mental or physical attributes (the higher the value, the more ‘mental’ the verb). The total score of each text was divided by the number of verbs scored to produce an average that reflects how much mentalization was used. An unpaired t-test was used to calculate the significance in difference between the means of the two groups.

The overall average score of individuals with PTSD was higher than the controls (38.5 vs. 33.5, p value 0.0047). The median score of individuals with PTSD was 37.95 compared to 31.60 with an actual difference of -6.350 and a Hodges-Lehmann difference of -4.650. These results do not support the hypothesis that mentalization is impaired in patients with PTSD.

This case-control study suggests that mentalization could be enhanced in patients with PTSD compared to controls. These results should be interpreted as part of a wider project being undertaken on the topic of social cognition in PTSD. Further studies with more participants from the population of interest and larger sample sizes could produce more reliable results, together with an expansion of the number of verbs coded in the MPVN method.

To estimate the prevalence of depression, anxiety and stress among Sudanese medical students and investigate the relationship and impact of closure periods on depression.

A cross-sectional analytical study was conducted. Data were collected from 1676 enrolled students from 10 medical schools in the capital of Sudan - Khartoum- who faced complete lockdown and agreed to participate in online google form. A self-administered questionnaire containing depression anxiety and stress scale (DASS-42) and socio-demographic inquires was used.

The chief responders were females 1158 (69.1%) while males were 518 (30.9%). The prevalence of stress symptoms was the highest (51.9%), followed by depression symptoms (49.8%) and anxiety symptoms (28.8%). 96 students attempted suicide (6%) and about 5 folds have suicidal ideation (27%). According to multiple binary logistic analyses, college closure time was significantly associated with decreasing chances of getting depression symptoms (OR: 0.39, 95% C.I: 0.21–0.70, p = 0.002), while being a female, COVID-19 patient or having a family history of depression appeared to elevate depression, anxiety and stress levels. The impact of university closure on stress and anxiety is non-significant.

Depression, stress, and to a lesser extent anxiety are widespread among Sudanese medical students and suicidal ideation is noteworthy. All of these require serious and expeditious interventions. Controversially, our findings suggest that university closure serves as a protective factor, relieving depression in medical students but not exaggerating it.

To see the neuromodulatory effects of adjunctive HD-tDCS on white matter connectivity by using Diffusion Tensor Imaging (DTI) in schizophrenia patients with Auditory Verbal Hallucinations (AVH)

This was a randomized, double blind, sham controlled study. 40 patients of schizophrenia with prominent auditory verbal hallucinations and 10 age sex matched healthy controls were selected. The patients were randomly assigned to 2 groups and were given active or sham adjunctive HDtDCS (Active Treatment = 10 sessions of 2 mA current applied for 20 minutes, twice daily for 5 days, at left temporo-parietal Junction (TPJ); Sham treatment = 10 sessions of 1 mA current, twice daily for 5 days was applied for 30 sec at left TPJ). Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed and severity of schizophrenia symptoms and auditory hallucinations were rated on PANSS and PSYRATS-AH at baseline, after 1st week (i.e. end of HDtDCS sessions) and 4 weeks after the end of the HDtDCS sessions). Patients received stable dose of antipsychotics for the total study duration (equivalent to or more than 400 mg of chlorpromazine) to eliminate confounding bias. Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed in healthy controls. DTI data were analysed by DSI Studio software. Statistical analysis was done by SPSS version 25.

1. 1. Both the patient groups were comparable with regard to socio-demographic variables and baseline clinical variables.

2. 2. There was no significant difference in the values of Fractional Anisotropy in Left Arcuate Fasciculus among the patients and healthy controls at baseline.

3. 3. The group receiving active adjunctive HDtDCS, showed significant improvement in the frequency domain of AVH over time, in time*group comparison by repeat measure ANOVA with Mauchly's test of sphericity and Greenhouse-Geisser correction [p = 0.011 and partial eta square = 0.129].

4. 4. There was no significant difference in change in the Fractional anisotropy of the left arcuate fasciculus noted between the groups over time.

5. 5. Application of HDtDCS was not associated with significant side effects, minor itching and mild burning sensation being the only reported side effects

Adjunctive active HD-tDCS to the left temporo-parietal junction showed a statistically significant improvement in frequency of auditory verbal hallucinations (AVH) in schizophrenia patients, when compared to sham stimulation.

To examine the relationship between self-reported level of workplace support (WS) and various mental health outcomes in HCPs and non-HCPs at different time-points during the COVID-19 pandemic, and to examine whether improved WS is associated with improved mental health outcomes over time. Lastly, to identify what support healthcare professionals (HCPs) perceive to be most helpful.

Cohort survey study at baseline (July-September 2020) and follow-up (approximately four months later).

Setting

HCPs working in primary or secondary care, from UK and other countries, and non-HCP controls from primarily London-based universities.

Participants

1574 HCPs and 147 non-HCPs (academic and research staff at London-based universities). The inclusion criteria for the study were: 1) aged 18 or older, 2) electronic consent given, and 3) identified as HCP or non-healthcare academic staff or self-declared non-HCPs.

Main outcome measures

Presence of generalized anxiety disorder (assessed using the GAD-7), clinical insomnia (ISI), major depressive disorder (PHQ-9), well-being (SWEMWBS), and burnout (emotional exhaustion and depersonalization; EEDP2Q). Qualitative data exploring what support HCPs perceive as most useful was gathered using free-text inputs.

At baseline and follow-up, consistently, compared to those who felt unsupported, those who felt supported had significantly reduced risk (odds) of generalized anxiety disorder (baseline: 59% [95% CI of OR, 0.29 to 0.57], follow-up: 41% [0.38 to 0.92]), clinical insomnia (51% [0.34 to 0.69], 66% [0.20 to 0.55]), major depressive disorder (58% [0.31 to 0.58], 54% [0.31 to 0.74]), emotional exhaustion (65% [0.26 to 0.46], 61% [0.27 to 0.56]) and depersonalization (58% [0.28 to 0.61], 68% [0.21 to 0.50]).

At follow-up, self-reported improved WS (vs. baseline) was associated with significantly improved GAD-7 (adjusted difference. −1.73 [-2.54 to −0.91]), ISI (-0.96 [-1.88 to −0.04]), PHQ−9 (-1.32 [-2.16 to −0.49]), SWEMWBS (0.97 [0.37 to 1.57]) and EEDP2Q (burnout) (-1.30 [-1.82 to −0.79]) scores, independent of baseline level of support.

Five themes were identified constituting WS: ‘managerial support’ was the largest sub-theme.

A consistent association was observed between level of WS and the mental health of HCPs and non-HCPs. Improved WS was associated with improved mental health scores over a four-month period during the pandemic.

To examine links between Adverse Childhood Experiences (ACE) categories and diagnosis of antisocial personality disorder (ASPD) in this population; it is predicted that there will be a positive association between number of ACEs and ASPD. The effectiveness of high secure hospital admission and treatment in reducing number of risk incidents was also examined. ACEs are known to impact significantly on the development of the personality and future psychiatric risk. Currently, research into links between distinct ACE categories and the diagnosis of ASPD in the high-secure inpatient population is limited.

Data were collected from a sample (n = 221) including all patients in the Mental Health, Personality Disorder and Women's Services at a high-secure hospital. Records were examined for evidence of abuse/neglect during childhood, and a number of markers of household dysfunction. The statistical relationship between each ACE category and subsequent diagnosis of ASPD was examined through paired t-tests. Frequency of incident reports (IR1s) involving violence was compared in the first, third and fifth years post-admission.

Significant associations with adult diagnosis of ASPD were seen in categories of childhood physical abuse, sexual abuse, divorced/separated parents, Looked After Child (LAC) status and parental substance misuse, and total number of ACE categories present overall. Significant reductions in frequency of IR1s were seen in all services between first- and fifth- year post admission.

A significant association between ACEs in specific domains and ASPD in adulthood was found. The importance of detailed exploration of childhood circumstances in this group is highlighted, as well as the need for further investigation of the psychological and social mechanisms underlying.

Compared with the general population, people with mental health disorders are at increased risk of negative physical and mental health outcomes following SARS-CoV-2 infection. In the UK, all adult mental health in-patients were offered COVID-19 vaccination as a priority group. Patients admitted to medium secure care have greatly increased mortality compared with the general population. Understanding COVID-19 vaccine uptake, and reasons for refusal, in patients in medium secure hospitals is important given the high prevalence of chronic physical health comorbidities such as obesity and diabetes, as these conditions are also associated with poor clinical outcomes in COVID-19 disease. Aims: To assess the proportions of patients who accepted or declined the COVID-19 vaccine, and explore their reasoning. To examine vaccine uptake between White and Black Asian minority ethnic (BAME) patients, and between younger/older patients.

The study took place at a medium secure hospital with male and female inpatients. All patients were offered a COVID-19 vaccine, and had a capacity and physical health evaluation completed by their Consultant Forensic Psychiatrist.

Data regarding capacity to consent to the vaccine, acceptance/refusal, and demographics were retrospectively collected from the clinical records. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent.

A similar proportion of patients aged under and over 40 years old consented. Those from a BAME background were more likely to decline than White British patients. The reasons for capacitous refusal appeared similar to the general population.

COVID immunisation was broadly acceptable for patients in medium secure hospitals. The prevalence and reasoning of capacitous refusal appears similar to the general English population.

The indication that BAME patients were more likely than White patients to decline the vaccination echoes the findings of research conducted in the Leicester general hospital. Further consideration needs to be given to how the uptake of COVID-19 vaccination can be improved in people with BAME ethnicity, especially as this group is also overrepresented in secure hospital settings.

The study demonstrates that similar services should be able to approach the vaccination process with confidence. As many people with severe mental disorder also have high physical comorbidity that would increase the risk of a poor clinical outcome if they contracted COVID-19, protecting this vulnerable population through vaccination must be a priority for mental health services.

To explore mental health in-patient's perceptions and aspirations in employment and to produce a lay document on employment

Employment is beneficial, it improves mental health and betters social integration. Different interventions exist to support mental health patients into employment. However, patients experience many obstacles, including the characteristics of their condition and stigma.

Literature review was undertaken, using a search string on PubMed focusing on mental health and employment.

Developed and used a 17-question questionnaire exploring patients’ perceptions and aspirations in employment

Created lay document containing information on benefits of employment, employment rights and accessing employment.

100% of patients interviewed were interested in employment. 90.9% believed employment would improve their mental health and 100% believed it would improve their connection to their community. 100% felt there is a stigma around mental health problems which makes finding employment harder.

The barriers mental health patients seeking employment face are varied and complex. Most wish to seek employment, and should be encouraged, as the health benefits are clear. Professionals need to acknowledge individual barriers patients face including different mental health characteristics, ethnicity, gender and personal circumstances and find a way to create a bespoke service tailored to patients’ needs in order to secure employment.

Transmission of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic. Many studies are underway to ascertain the mental health impact of this seismic event, however no study has investigated its effect on psychosis incidence. We hypothesise that the overall crude incidence rates of first episode psychosis (FEP) will be higher during the pandemic when comparing the same area of South London in defined pre-pandemic and pandemic time periods.

Clinical records for all patients aged 18 to 64 years presenting to early intervention in psychosis services in the London boroughs of Southwark and Lambeth between July 1st 2019 to December 31st 2019 (pre-pandemic period) and July 1st 2020 to December 31st 2020 (pandemic period) were extracted from the Clinical Record Interactive Search (CRiS), an online database containing anonymised patient records. All patients were manually screened using the Screening Schedule for Psychosis to confirm FEP, with 104/235 cases meeting criteria for FEP in the pre-pandemic period compared with 158/376 in the pandemic period. Crude, age-standardised, and sex-standardised incidence rates and ratios were calculated for interpretation.

The crude incidence rate of FEP was significantly higher in the pandemic period (68.3, 95% CI:[57.6 ; 78.9]) than the pre-pandemic period (44.9, 95% CI:[36.3 ; 53.6]). The crude incidence ratio was 1.52 (95% CI:[1.28 ; 1.77]), indicating that the overall crude incidence of FEP in the pandemic period was significantly higher (52%) than in the pre-pandemic period. The directionality and statistical significance of this ratio was unperturbed by standardisation for age (SIR = 1.45, 95% CI[1.23 ; 1.70]) and sex (SIR = 1.56, 95% CI[1.33 ; 1.83]).

Our results suggest that the COVID-19 pandemic has had a significant impact on the incidence of FEP in the South London boroughs of Southwark and Lambeth. Further research is required to elucidate the factors contributing to this increase to inform targeted interventions and prevent deterioration in at-risk patients.

Workplace Bullying (WPB) is a severe stressor that can negatively impact an individual's physical and psychological health. WPB, a type of occupational violence, is the third leading cause of death in the workplace worldwide. This study delivers an estimated prevalence of bullying among healthcare practitioners in the Syrian graduate medical education system and to explore its prevalence within socio-demographic subgroups.

A cross-sectional study was conducted in Damascus, during the Syrian war crisis. A total of 478 residents and fellows fully completed the survey. Respondents completed questions regarding socio-demographic information and workplace bullying.

Of 478 respondents, 267 (55.9%) were males. The majority (89%) reported being subjected to workplace bullying, and (92%) of them witnessed their colleagues being bullied. Supervisor/attendings (45%), and peer/resident (40%) were the most frequent source of perceived bullying followed by supervisor/consultant (34.5%), and Patients (33.5%). Attempts to belittle and undermine work 434 (90.7%) was the most frequently reported bullying behavior. Specific bullying behaviors were more reported by males, ＜170 cm height, ≥ 25 BMI kg/m2, and postgraduate year 1 (PGY) participants. Credible published national data regarding the number of Syrian medical residents are not available to evaluate the representativeness of our sample.

Many participants reported experiencing bullying in the Syrian graduate medical education programs. Enforcing anti-bullying policies, closely monitoring work environments, and encouraging anonymous reporting of workplace bullying, is crucial to eliminate these behaviors in the healthcare system. A longitudinal study should be conducted to gain more knowledge and insight into workplace bullying among healthcare practitioners.

We aimed to compare the NAS in neonatal exposed to antidepressants to unexposed neonates.

A prospective cohort study was carried out comprising of women in 3rd trimester of pregnancy, data were collected on women exposed and unexposed to antidepressants. Approval from the Rotunda Hospital REC was obtained.

Hospital records were used to collect pre-, peri- and postnatal information which was relevant to the study Aim. Neonatal Abstinence Score was completed within 0–48 hours of the birth, Moderate-Severe abstinence was defined as eight points or higher (on a scale with maximum 40 points), mild abstinence as 4 points or higher. Paediatric records were reviewed where the baby required NICU admission. Women were recruited between 2019–2021

221 women in total were recruited,138 pregnant women were on no psychotropic medication (Control group) and 83 pregnant women were on antidepressant medication (exposed group).

In the exposed group, 46% (38/83) were on Sertraline,19% (16/83) fluoxetine, 17% (14/83) Escitalopram and 17% (14/83) on other SSRI/SNRI.

Six infants (3%) expressed signs of severe abstinence and 38 (28%) had mild abstinence symptoms in exposed group whereas in control group 10 (7%) of infants were observed to have mild abstinence which was seen in infants with low birth weight, poor feeding and poor sleep after feed. Neonatal hypoglycaemia in infants prenatally exposed to antidepressant was seen in 10% compared to 1% of control group.

Severe abstinence in infants prenatally exposed to antidepressants was found to be (3%) and mild abstinence in 28% this is in keeping with international findings. Low one minute APGAR sores and greater rates of hypoglycaemia were also noted.

While neonatal withdrawal with all antidepressants are usually mild and self-limiting it is important to make the obstretric and neonatal teams aware of the mothers medication and mothers should be advised that their baby may need a review by neonatology after delivery.

We endeavoured to ascertain if using a specific tool rating insight adds benefit over and above the insight ratings on violence risk assessment or recovery based tools currently in use and to see if they may be helpful in guiding clinical decision making.

A cross sectional study of 104 forensic in-patients was completed. All current inpatients were rated for self-rated and clinician-rated insight using the VAGUS tool, a validated and reliable measure of insight into psychotic symptoms. All participants completed the self-rated scale independent of the clinician to avoid bias. Patients were also rated with the HCR-20, the Dundrum-3 and Dundrum-4, and the PANSS measures. Patients’ scores on the VAGUS tool and the other tools were compared to ascertain if any correlations could be identified.

Higher scores on the VAGUS tool were associated with a greater degree of insight into psychotic symptoms. Clinician and self-ratings of insight on the VAGUS tool were different from but complimentary to the ratings for insight on the HCR-20 (r = 0.480, p = <0.001), the DUNDRUM-3 (r = 0.491, p = <0.001) and DUNDRUM-4 (r = 0.265, p = 0.041). An inverse relationship between the VAGUS scores and the scores on the PANSS measures (r = 0.452, p = <0.001) was found, correlating lower levels of insight with a higher degree of positive and negative psychotic symptoms. There was also a correlation between greater insight and progress through the care pathway to lower secure wards.

Using a specific tool to rate insight adds benefit over and above the insight ratings on other tools currently in use and may be helpful in guiding clinical decision making in the forensic setting.

Frailty is a medical syndrome that is strongly associated with mortality risk, and an emerging global health burden. Mental disorders are associated with reduced life expectancy and elevated levels of frailty. In this study, we examined the mortality risk associated with frailty in individuals with a lifetime history of mental disorders compared to non-psychiatric controls.

The UK Biobank study recruited >500,000 adults, aged 37–73 years, between 2006–2010. We derived the two most common albeit distinctive measures of frailty, the frailty phenotype and frailty index. Individuals with lifetime depression, bipolar disorder or anxiety disorders were identified from multiple data sources. The primary outcome was all-cause mortality. We have also examined differences in frailty, separately by sex and age.

Analyses included up to 297,380 middle-aged and older adults with a median follow-up of 12.19 (IQR = 1.31) years, yielding 3,516,706 person-years of follow-up. We observed higher levels of frailty in individuals with mental disorders for both frailty measures. For key comparisons, individuals with a mental disorder had greater all-cause mortality hazards than their controls. The highest hazard ratio (3.65, 95% CI 2.40–5.54) was observed among individuals with bipolar disorder and frailty, relative to the non-frail controls.

Our findings highlight elevated levels of frailty across three common mental disorders. The increased mortality risk associated with frailty and mental disorders represents a potentially modifiable target for prevention and treatment to improve life expectancy.

This study aims to assess the stigmatization of Moroccans towards substance and nonsubstance addictions, as well as to explore its relationship with both demographic factors and addiction familiarity.

527 Moroccans anonymously participated in a cross-sectional study via an online survey that was distributed on social media. Participants were randomly assigned 2 vignettes describing either substance (Alcohol and Cannabis) or non-substance (Gambling and Social Media) addictions, followed by the Social Distance Scale and the Familiarity Scale.

A total of 527 individuals answered our online questionnaire. The median age of respondents was 27.6 years (std = 15.66). 56% were females and 44% were males. Among the participants 45% were married and 50% were medical students or health professionals.

Using ANOVA and a series of student t-tests, that yielded a p < 0.05, the following results were obtained:

A moderate level of stigma was found towards all addictions, except for social media where no stigma was found (p < 0.05). In contrast, the familiarity level was high with social media addiction and low with the other addictions (p < 0.05).

The women in our study showed higher stigmatization of all addictions, whereas older people (>43 years) showed higher stigmatization of substance addictions only.

Different levels of stigmatization were observed towards the 4 types of addiction; the highest being cannabis addiction and the lowest being social media addiction.

Regarding familiarity with addiction, males were more familiar with all types of addiction. Whereas, younger individuals (<23 years) were the least familiar with substance addiction.

Moroccans’ familiarity levels with different types of addiction were significantly different. Familiarity with social media addiction was the highest whereas familiarity with gambling addiction was the lowest.

Using the Pearson correlation, we found that stigma and familiarity concerning substance addiction were negatively correlated (r=−0,30, p < 0.01). A stronger, yet moderate relationship was found between stigma and familiarity regarding cannabis (r=−0,36, p < 0.01).

It seems that Moroccans stigmatize against most addictions, which was found to be influenced by multiple factors including familiarity level, age, and sex. These findings can be used as a base to create a targeted educational campaign to tackle addiction in our society. No significant conclusions were made concerning whether or not the academic level or the health professional background influenced stigmatization, which raises concerns about the Moroccan academic and medical curricula's representation of addiction.

The National Autism Service for Adults receives over 600 referrals annually and with an extensive waitlist, COVID-19 restrictions on in-person assessments were a challenge for service delivery. We aimed to adapt the Autism Diagnostic Observation Schedule (ADOS) for online delivery and investigate whether it is comparable to the in-person ADOS in predicting Autism Spectrum Disorder (ASD) diagnostic outcome. We also aimed to obtain qualitative feedback from service users and clinicians regarding experiences of the online ADOS.

A working group of staff who administer ADOS and representatives from psychiatry, psychology and management reached consensus that an online version of ADOS module 4 was feasible based on experience that a lot information required for coding is obtained verbally and some tasks were adaptable for online delivery. After the pilot, it was agreed all algorithm items could be coded except ‘unusual eye-contact’. Subsequently, 163 service users attended an online ADOS between August 2020 and February 2021. A matched-comparison group consisted of 198 service users seen for an in-person ADOS between May 2014 and February 2020. Algorithm scores were recorded and ASD diagnosis was made by a trained clinician. Qualitative feedback regarding the online ADOS was collected from 46 service users and 11 clinicians.

The working group agreed the online and in-person ADOS were closely matched regarding administration and coding. Mean scores for service users who received an ASD diagnosis were comparable for the online and in-person ADOS groups (7 and 8 respectively). This was also shown for those who were not diagnosed with ASD (3 and 4 respectively). A two-sample t-test showed no significant difference in total scores between the online and in-person ADOS (p = 0.38). Qualitative feedback suggested good service user and clinician satisfaction; only 27% of service users indicated they would have preferred an in-person assessment; 88% of clinicians reported there were gains from offering an online alternative. Although the online and in-person ADOS perform similarly, clinicians reported relying more on qualitative reports over scores from the online version to inform diagnostic decision.

To our knowledge, this is the first study to examine using an online ADOS within an adult diagnostic service. Due to its comparable performance, the online-ADOS is a viable alternative option for service delivery when in-person assessments are not possible. As this clinic group has high rates of comorbid mental health difficulties, the applicability of online assessments could generalise to other services and have an impact beyond the pandemic.

Major depressive disorder (MDD) is the most prevalent mental health condition among adolescents. Current treatments have limited effectiveness, accessibility and questionable safety profiles. Exercise is becoming a more widely recognised intervention for MDD in adults. However, evidence and research for its effectiveness in adolescents is lacking. This review aimed to establish if exercise is effective at reducing MDD symptoms and severity in adolescents, and thus its first-line treatment potential.

Electronic databases were searched for randomised control trials studying effects of exercise in adolescents, clinically diagnosed with MDD. Trials were excluded if participants’ depression was secondary to another disorder or health condition. The primary outcome measure was depression symptom severity, assessed by a validated depression symptom scale. Six trials met the eligibility criteria and were included in this review.

Four trials found reduced depression scores in the exercise intervention group compared to control immediately post-intervention; of the four trials which included follow-up data, all reported higher rates of remission in the exercise intervention group compared to control. The length of exercise intervention programme seems important, needing to be greater than 6-weeks for a therapeutic effect. The type of exercise doesn't appear critical.

Given the small sample sizes and methodological limitations presented by the trials, it is difficult to draw definitive conclusions. Further and larger-scale studies are needed before exercise can become a recognised and readily recommended treatment for MDD in adolescents; but thus far, it seems to have a promising therapeutic potential in both short and long term.

To provide a fresh insight into the extent digital phenotyping methods have been employed to measure or detect social behaviour in patients with SMIs; with a closer look at those used in Bipolar Disorder (BD); to give findings on the validity, reliability, acceptability and tolerability of these digital phenotyping methods.

Using specified search terms relating to digital phenotyping metrics and terms related to SMIs, a thorough literature search strategy for studies was employed across the following electronic databases: PubMed, Embase, and PsychINFO - from inception to July 2021.

Included studies employed digital phenotyping methods, collecting either passive, active or mixed-modal data, which in principle reported metrics representing social behaviour on patients with an SMI. Here we present a preliminary analysis of studies reporting results for patients with BD, with a particular focus on tolerability and acceptability.

Of 4,646 records initially screened, a subgroup of 9 studies (n = 474) directly focusing on patients with BD are reported here. Across the studies, we find a modest adherence rate towards these applications by patients, ranging from 72.6% to 89.2%. Methods used by the studies include the frequency of phone calls and text messages, and self-reported and observer ratings of social and interpersonal functioning. The collection of such digital phenotyping data appears tolerable and acceptable to participants with BD, with patients reporting them to be supportive and only mildly intrusive.

Our preliminary analysis suggests that digital phenotyping of social behaviour may be acceptable and tolerable to participants with Bipolar Disorder. In an increasingly digital world, digital phenotyping methods of social behaviour may assist physicians with clinical assessment and prediction of clinical outcomes including relapse. Future analyses will assess the reliability and validity of the data that such methods yield, and their potential therapeutic value.

Clinical teams oversee the care of patients within secure psychiatric inpatient settings. They are made up of a number of professions, including psychiatrists, psychologists, occupational therapists, social workers and nurses. The effective collaboration of the different members of the clinical team is vital for its functioning. However, so is the team's interface with other key stakeholder groups, namely nursing teams, service users and carers. Understanding the needs and priorities of these groups regarding their relationships with the clinical team is also important to recognise and in the provision of good quality care. This study aims to understand the experiences, priorities and needs of stakeholder groups in their relationship with the clinical team. Gaining feedback from multiple sources (service users, carers, nurses) will help facilitate functioning of the clinical team in the delivery of excellent care to service users.

Ethical approval was granted by the host NHS trust. Between October 2019 and October 2021, three focus groups were conducted using a semi-structured interview to gather responses from carers, nurses and service users (6 participants in each group) respectively. The interviews were recorded and transcribed. Thematic analysis was used to code each transcript and themes were drawn from the coded data.

Dominant themes emerged from the three data sets. Consistent themes between groups included communication, hierarchy/power and representation. There were also differences in themes identified, with the carer group bringing the theme of education/ knowledge, and nursing group raising the value of human relationships, including compassion. The theme of transparency emerged strongly for the service user group.

This study offers an interesting perspective on what distinct stakeholder groups want and value in their relationship with the clinical team. Gaining feedback from multiple sources (service users, carers, nurses and members of the MDT) can better inform a team about its functioning and help improve performance. Developing a tool to aid the systematic collection of multi-source feedback is the next step of this project, facilitating the voices of key stakeholder groups to be heard.