To describe and compare psychoactive substance misuse help-seeking among transgender (trans) and cisgender (cis) participants from a large multi-national cross-sectional survey.

Trans people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cis participants from a large multi-national cross-sectional survey.

Over 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey (GDS) - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1,857 non-binary people) were compared, using Chi-square and z-tests with Bonferroni correction, on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this. Respondents from GDS 2018 were also assessed for substance dependence. Binary logistic regression was used to compare gender groups on self-reported substance dependence to frame the help-seeking analyses.

Trans respondents (n = 1,710) to GDS 2018 were significantly more likely than cis respondents to report use of illicit substances (OR = 1.66-2.93) and dependence on cannabis (OR = 2.39), alcohol (OR = 3.28) and novel psychoactive substances (OR = 4.60). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2,579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, non-binary people and trans women were most likely to want help to achieve this.

Trans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.

In a modified case–control association study we tested the assumption that two polymorphisms (A118G in exon 1 and IVS2+31 in intron 2) of the human μ-opioid receptor gene (OPRM1) confer susceptibility to opioid dependence.

In contrast to classical case–control studies both groups, opioid dependent cases and non-opioid dependent controls were recruited from individuals who have had access to drugs including opioids and who had been sentenced for violation of the “Dangerous Drugs Act” in Germany.

For the two allelic variants of OPRM1 under study we did not find evidence for association with opioid dependence.

Despite absence of association we think that this recruitment approach introduced here, is useful since it putatively offers a more adequate matching for case–control association studies of opioid dependent individuals.

To examine the impact of determinants of incident dementia in three different old age groups (75–79, 80–84, 85+years) in Germany.

Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals.

Primary care medical record registry sample.

General practitioners’ (GPs) patients aged 75+years at baseline.

Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset.

Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups.

This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.

After reading this article you will be able to:

• • describe the ways in which reflective practice is beneficial to clinical work

• • describe the basic structure of the interpersonal dynamics consultation, including the four interpersonal perspectives

• • recognise the types of cases where interpersonal dynamics consultation might be most useful.

None.

Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.

To confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.

The sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.

In the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.

This meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.

Subjective cognitive decline (SCD), the potentially earliest notable manifestation of preclinical Alzheimer's disease and other dementias, was consistently associated with lower quality of life in cross-sectional studies. The aim of this study was to investigate whether such an association persists longitudinally – particularly with health-related quality of life (HRQoL) in older individuals without cognitive impairment.

Data were derived from follow-up 2–6 of the prospective Germany Study on Ageing, Cognition and Dementia in Primary Care (AgeCoDe) covering a total six-year observation period. We used linear mixed effects models to estimate the effect of SCD on HRQoL measured by the EQ-5D visual analogue scale (EQ VAS).

Of 1,387 cognitively unimpaired individuals aged 82.2 years (SD = 3.2) on average, 702 (50.6%) reported SCD and 230 (16.6%) with SCD-related concerns. Effect estimates of the linear mixed effects models revealed lower HRQoL in individuals with SCD (unadjusted: –3.7 points on the EQ VAS, 95%CI = –5.3 to –2.1; SE = 0.8; p < 0.001; adjusted: –2.9 points, 95%CI = –3.9 to –1.9; SE = 0.5; p < 0.001) than in individuals without SCD. The effect was most pronounced in SCD with related concerns (unadjusted: –5.4, 95%CI = –7.6 to –3.2; SE = 1.1; p < 0.001; adjusted: –4.3, 95%CI = –5.8 to –2.9, SE = 0.7; p < 0.001).

SCD constitutes a serious issue to older cognitively unimpaired individuals that is depicted in persisting lower levels of HRQoL beyond depressive symptoms and functional impairment. Therefore, SCD should be taken seriously in clinical practice.

Most of the previous studies attempted to disentangle the relationship between disability and depressive symptoms were limited to observation periods of only few years. Moreover, evidence is missing regarding the complex co-occurrence of disability and depressive symptoms in old age in Germany. In order to close the research gap, we aimed at disentangling the complex co-occurrence of disability and depressive symptoms in old age in Germany over a longer time frame.

Based on data from a representative survey of the German general population aged 75 years and older, the course of disability as well as depressive symptoms was observed every 1.5 years over six waves. While disability was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale, the Geriatric Depression Scale was used to measure depressive symptoms. Taking into account the complex co-occurrence of depressive symptoms and disability, a panel vector autoregressive model was used. By taking the first differences, unobserved heterogeneity was taken into account.

In the total sample and in both sexes, we revealed a robust positive association between an initial change in depressive symptoms and subsequent changes in disability. No robust association between an initial change in disability and a subsequent change in depressive symptoms was detected.

Our findings highlight the importance of changes in depressive symptoms for future changes in disability in old age.

This paper provides nationally representative data on how current and past mental disorders are related to functional disability and health-related quality of life (QoL).

Results are based on a nationally representative sample (DEGS1-MH; n = 4483 aged 18–79). Respondents were examined by clinical interviewers with the DSM-IV Composite International Diagnostic Interview (DIA-X/M-CIDI). Functional disability, i.e. number of disability days in the past 4 weeks, and QoL, i.e. mental (MCS) and physical (PCS) component scale of the SF-36V2, were examined in subjects with 12-month mental disorders (= active cases [AC]) and compared to (a) subjects who never met diagnostic criteria (= unaffected individuals [UAI]), and (b) those with a history of mental disorders but not meeting the diagnostic criteria in the past 12 months (= non-active cases [NAC]; partially or fully remitted).

In comparison to UAI (mean: 1.9), AC reveals a 2–3 fold disability days/month (5.4, P < .001) and a substantially reduced MCS (UAI: 52.1; AC: 43.3, P < .001). NAC had a similar number of disability days as UAI, but significantly reduced MCS scores (49.9; P < .001). Disability days and QoL decrements were highest in internalizing disorders including somatoform disorders and most pronounced in comorbid cases.

By and large, findings of a previous study were confirmed and extended for this nationally representative German sample. 12-month mental disorders, particularly internalizing, including somatoform disorders, are associated with high levels of disability and increased health-related QoL decrements. Partial or complete remission of the mental disorders is associated with a normalization of the numbers of disability days.

Obesity has been shown to be associated with depression and it has been suggested that higher body mass index (BMI) increases the risk of depression and other common mental disorders. However, the causal relationship remains unclear and Mendelian randomisation, a form of instrumental variable analysis, has recently been employed to attempt to resolve this issue.

To investigate whether higher BMI increases the risk of major depression.

Two instrumental variable analyses were conducted to test the causal relationship between obesity and major depression in RADIANT, a large case–control study of major depression. We used a single nucleotide polymorphism (SNP) in FTO and a genetic risk score (GRS) based on 32 SNPs with well-established associations with BMI.

Linear regression analysis, as expected, showed that individuals carrying more risk alleles of FTO or having higher score of GRS had a higher BMI. Probit regression suggested that higher BMI is associated with increased risk of major depression. However, our two instrumental variable analyses did not support a causal relationship between higher BMI and major depression (FTO genotype: coefficient −0.03, 95% CI −0.18 to 0.13, P = 0.73; GRS: coefficient −0.02, 95% CI −0.11 to 0.07, P = 0.62).

Our instrumental variable analyses did not support a causal relationship between higher BMI and major depression. The positive associations of higher BMI with major depression in probit regression analyses might be explained by reverse causality and/or residual confounding.

Passing the MRCPsych Clinical Assessment of Skills and Competencies (CASC) is a significant challenge for trainee psychiatrists. We describe the process of setting up a new educational intervention of a simulated CASC examination incorporating peer observation, and report the findings from these events.

The training events involved a series of simulated scenarios followed by personalised feedback from examiners. Peer observation was a fundamental part of the events and was viewed positively by the trainees with perceived improvements in knowledge and skills. Differences in self-rated and examiner-rated competence were observed more often in those who subsequently failed the CASC.

Simulated CASC examination as a training event with a strong focus on observing and learning from peers provides a useful learning experience and supports trainees who are preparing for the CASC examination.

To generate a list of topics for ‘core curriculum’ that can be used as a guide for trainees and trainers carrying out workplace-based assessments (WPBAs). A three-stage Delphi consultation was carried out.

Generation of a list of topics for WPBA appropriate for each year of core training with a mean rating of importance in curriculum.

In the absence of formal guidance, the list generated can serve as an informal guide.

To improve the level of insight (measured using standardised instruments) using a video interview and self-observation. Changes in levels of insight were measured using the Schedule for Assessing Insight (SAI) at the time of admission, at the time of discharge (both prior to and following the viewing of the videotape) and at follow-up a few months later.

The comparison of the SAI scores indicated a significant improvement in insight at the time of discharge (P < 0.005), with a further significant improvement after watching the video (P < 0.006). This appeared to be sustained at 3- to 6-month follow-up.

Video self-observation is a simple, inexpensive procedure that can be used to improve insight in psychosis. This study provides further support for the clinical utility of video self-observation in improving client's insight.

People in a putatively late prodromal state not only have an enhanced risk for psychosis but already suffer from mental and functional disturbances

To evaluate the acute effects of a combined supportive and antipsychotic treatment on prodromal symptoms

Putatively prodromal individuals were randomly assigned to a needs-focused intervention without (n=59) or with amisulpride (n=65). Outcome measures at 12-weeks effects were prodromal symptoms, global functioning and extrapyramidal side-effects

Amisulpride plus the needs-focused intervention produced superior effects on attenuated and full-blown psychotic symptoms, basic, depressive and negative symptoms, and global functioning. Main side-effects were prolactin associated

Coadministration of amisulpride yielded a marked symptomatic benefit. Effects require confirmation by a placebo-controlled study