Investigations into health and social care services offered to people who have died by suicide or who have committed a homicide have the potential to facilitate improvements in future practice. Such improvements are, however, dependent on the operationalizability of the recommendations of these investigations. Operationalizability in this context means the potential of the recommendations to alter the thinking/actions of practitioners involved in the areas of practice to which the recommendations relate. Critically, the proposed learning must make sense to practitioners in a multiplicity of single instance episodes of practice when the future is unknown. Although common content themes identified by investigations have been reported, no study has yet specifically examined how the framing of recommendations in investigation reports affects their operationalizability.

Primary objective: to pilot a novel approach to the thematic analysis of investigations into serious incidents which focuses on the operationalizability of recommendations for day-to-day practice. Secondary objective: to explore the operationalizability of the specific recommendations arising from a recent UK review of child homicides.

A publicly available UK national review of child homicides by parents under social care services was subjected to a two-stage thematic analysis (firstly, to identify the types of thinking/acting that were scrutinised; and secondly to characterise the ways in which these thoughts/actions were appraised). The frame of reference for the thematic analysis was that of a practitioner involved in typical instances of practice where there is uncertainty about outcomes (i.e. real-life practice).

Stage 1 - Four types of thinking/acting were identified: (i) information gathering, (ii) interpretation, (iii) judgement formation, and (iv) decision to act (figure 1).Stage 2 - The thoughts/actions were appraised according to three key themes: (a) occurrence of thoughts/actions at a pivotal moment, (b) erroneousness of thoughts/actions, and (c) thoroughness of thoughts/actions.

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With regard to the specific report analysed, the recommendations were found to have differing degrees of operationalizability. For instance, examples of ‘erroneous thinking/acting’ were more readily applicable to future practice (since they can be operationalised in terms of general principles). However, the notion of ‘pivotal moments’ is less useful, since the labelling of moments as ‘pivotal’ is dependent on a knowledge of the outcome and therefore would not have been readily identified contemporaneously in these cases (or, by extension in future similar cases prior to any serious incident). This pilot demonstrates that the novel approach used is a feasible way to examine not just the content, but also the utility, of investigation recommendations.

None Declared

Mental health remains key comorbidity in the transgender population. There are more grave consequences on mental health if there is long-term incarceration history of a transgender person. 21% of transgender women are incarcerated in their lifetime, compared to <3% of the US general population. Incarcerated, transgender women are typically at risk for verbal, physical, and sexual assault that has been cross-sectionally linked to poor mental health in transgender patients. Childhood traumas and Adverse childhood experiences like sexual abuse may attribute to gender dysphoria as well as the externalizing and internalizing behaviors of the child in later part of life.

Better understand Gender Dysphoria and Incarceration.

A case report and review of the literature.

X is a 56-year-old transgender female, admitted for Major Depressive disorder with Psychotic features, and substance abuse disorder. She was disoriented to person place, or time, believing she was at the “Federal Penitentiary.” She was also selectively mute and socially isolative as well as unable to perform ADL’s. She has an extensive legal history, which started in 1985 when she burglarized a pharmacy store for estrogen. Patient was started on Sertraline, Mirtazapine, and Risperidone. She was still socially withdrawn but was soon oriented to person place, and time and was able to complete her daily tasks.

In this poster we discuss the challenges of managing an acute patient with extensive legal and substance abuse history, while also addressing the features of gender identity disorder and highlighting the difficult path of both the patient and physician in managing these challenges.

No significant relationships.

To examine demographic and dietary correlates of consumption of a variety of fruits and vegetables (FV) among Texas adolescents. Different types of FV are needed for adequate dietary intake of vitamins and phytochemicals for proper development and functioning throughout the lifespan.

Cross-sectional analysis from the Texas Surveillance of Physical Activity and Nutrition (Texas SPAN) data comparing consumption of a variety of fruit and vegetables by gender, race/ethnicity and region (Texas-Mexico border/non-border).

Middle, high schools in Texas.

8th, 11th grade Texas adolescents (n 9056 representing n 659 288) mean age 14·8 years.

Within this sample, mean fruit and vegetable variety scores (0–7) ranged from 2·47 to 2·65. Boys consumed a significantly greater variety of fruit than girls (mean = 1·12 compared with 1·04). Adolescents in non-border regions consumed a greater variety of vegetables and FV compared with those in border regions. FV variety was associated with healthier eating in the full sample, particularly in the highest socio-economic status (SES) tertile. Within the highest SES tertile, a one-unit increase in variety of fruit, vegetable and FV was associated with significant increases (P < 0·001) in a healthy eating measure, the SPAN Healthy Eating Index: Fruit variety (β = 1·33, se = 0·29), vegetable variety (β = 0·90, se = 0·28) and FV variety (β = 0·81, se = 0·19).

Consumption of a greater variety of FV appears to be associated with a healthier overall diet. Associations of FV variety with healthy eating were most significant in the highest SES tertile. These findings support the need to further examine consuming a variety of FV within healthy eating behaviour.

Surgery is the recommended treatment for resectable T4a laryngeal and hypopharyngeal carcinoma. Non-surgical treatment is an option in a select few patients.

This retrospective study was undertaken to assess the treatment outcomes in patients with resectable T4a carcinoma of the larynx and hypopharynx who received either surgical or non-surgical treatment at our institute and to assess factors influencing these outcomes.

A total of 120 patients were included in the study. They were divided into groups A, B and C based on the presence of extralaryngeal spread through laryngeal membrane, cartilage or both. The overall survival was better among patients who received surgery than those who received non-surgical treatment in the three groups. The factor influencing overall survival was the treatment given in the form of surgical versus non-surgical treatment.

Surgery is the preferred treatment for T4a laryngeal and hypopharyngeal carcinoma, even in patients with extralaryngeal spread without cartilage erosion.

Exercise has been found to be important in maintaining neurocognitive health. However, the effect of exercise intensity level remains relatively underexplored. Thus, to test the hypothesis that self-paced high-intensity exercise and cardiorespiratory fitness (peak aerobic capacity; VO2peak) increase grey matter (GM) volume, we examined the effect of a 6-month exercise intervention on frontal lobe GM regions that support the executive functions in older adults.

Ninety-eight cognitively normal participants (age = 69.06 ± 5.2 years; n = 54 female) were randomised into either a self-paced high- or moderate-intensity cycle-based exercise intervention group, or a no-intervention control group. Participants underwent magnetic resonance imaging and fitness assessment pre-intervention, immediately post-intervention, and 12-months post-intervention.

The intervention was found to increase fitness in the exercise groups, as compared with the control group (F = 9.88, p = <0.001). Changes in pre-to-post-intervention fitness were associated with increased volume in the right frontal lobe (β = 0.29, p = 0.036, r = 0.27), right supplementary motor area (β = 0.30, p = 0.031, r = 0.29), and both right (β = 0.32, p = 0.034, r = 0.30) and left gyrus rectus (β = 0.30, p = 0.037, r = 0.29) for intervention, but not control participants. No differences in volume were observed across groups.

At an aggregate level, six months of self-paced high- or moderate-intensity exercise did not increase frontal GM volume. However, experimentally-induced changes in individual cardiorespiratory fitness was positively associated with frontal GM volume in our sample of older adults. These results provide evidence of individual variability in exercise-induced fitness on brain structure.

Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.

To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.

Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.

Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.

AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.

In 2005 Elizabeth Parker and fellow researchers described the first case of Hyperthymestic Syndrome, a woman going by initials AJ. Thereafter, a handful more of such cases have emerged. Older descriptions of extraordinary memory in medical literature mainly considered semantic and working memories. Jorge Luis Borges in his 1930s short story ‘Funes, his Memory’ writes about his, presumably fictitious, encounter with a man named Ireno Funes who possessed an extraordinary memory and a knack for keeping track of briefest of passing moment. Among many qualities that Funes and AJ share are their extraordinary memories, obsession for keeping track of time, and their problems with abstraction. After describing his extraordinary memory, Borges says of Funes, ‘I suspect nevertheless, that he was not very good at thinking. To think is to ignore (or forget) differences, to generalize, to abstract.’ Similarly, AJ has been described to have impaired abstraction, hypothesis formation and conceptual shifting. Moreover, both Funes and AJ see their capability as a burden rather than a gift. “My memory, sir, is like a garbage heap.” Says Funes.

A brief exploration of Jorge Luis Borges’ works in the context of autobiographical memory.

The comparisons between Borges’ description of his character’s autobiographical memory and findings of modern research techniques will be done qualitatively.

Effort is made to undersatnd Borges philosophy in context of mordern memory research.

An in depth look into Borges’ philosohies linking perception of time, coding of memory, abstration and language can inform further line of research regarding autobiographical memory.

No significant relationships.

As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan–Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation.

COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016.

During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder.

COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.