Institute of Mental Health

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression and anxiety, yet response rates remain suboptimal. Clinically accessible predictors of treatment outcome are therefore needed to guide decision-making in routine care. In this analysis, we examined data from a prospective hospital-based cohort of 92 outpatients with depression who initiated escitalopram monotherapy guided by therapeutic drug monitoring. The objective was to determine whether early levels of perceived stress predict subsequent treatment outcomes. Psychometric assessments included the clinician-rated Hamilton Depression (HAMD) and Anxiety (HAMA) Rating Scales and the self-rated Perceived Stress Scale (PSS), collected at baseline, week four, and week eight. Treatment outcomes were defined as absolute and relative changes in HAMD and HAMA scores at week eight, as well as response (≥50% HAMD reduction) and remission (HAMD <8). The week-4 PSS score predicted improvement in depression symptoms at week eight across all measures, independent of demographics, baseline PSS, and symptom severity at baseline or week four. Patients with low week-4 PSS scores (PSS<16) had markedly higher remission rates (22/27) compared to those with high scores (PSS>25), where remission was rare (1/21). The week-4 PSS score was also associated with improvement in anxiety symptoms, although less robust after adjustment for concurrent anxiety severity. Early perceived stress may represent a promising and accessible predictor of SSRI treatment outcomes. As an exploratory analysis, these findings should be considered hypothesis-generating and require replication before clinical implementation. The PSS is adaptable for digital platforms and may support future remote monitoring.

Introduction: This study aims to investigate the access to leadership development opportunities among European psychiatric trainees and early career psychiatrists (ECPs) and their perceptions and needs related to leadership skills training.

Assessment and management of dry eye disease (DED) in the UK is increasingly taking place outside of specialist ophthalmology settings. While comprehensive, evidence-based international guidance exists, much of it does not reflect the realities of practice in the UK. A panel of experts was brought together to identify areas of consensus on assessment, management, and appropriate referral of DED in the UK National Health Service (NHS). A questionnaire was circulated to a panel consisting of 15 optometrists, ophthalmologists, and corneal specialists with experience and expertise in DED. Based on their responses, consensus statements were developed and underwent two rounds of voting, in which respondents indicated to what extent they agreed with each statement. A core steering panel of seven experts discussed the results and provided further context for the statements. Strong or very strong consensus was reached for 57/62 statements. Statements with very strong consensus included guidance on the minimum symptoms and signs to be assessed on initial presentation and simple guidance for grading the severity of the disease. Statements regarding initial treatment were divided by setting (primary and secondary care), and a strong or very strong consensus was reached on 17/20 statements relating to treatment options in these settings. Statements specific to referral included approximate target timelines, where possible, as well as guidance on key supporting information to help improve the efficiency of patient care. This consensus provides a UK-focused resource to support consistent and effective care for patients with DED within the NHS.

Abstract Background: Cervical cancer is the second-most common cancer among Indian women and has a high mortality rate. Its primary cause is persistent human papillomavirus infection, with additional risk factors such as early sexual activity, multiple partners, poor immunity, and smoking. Women with psychiatric illnesses are especially vulnerable due to impaired insight, reduced self-care, disinhibited behavior, disability, and substance use, all of which reduce their likelihood of undergoing cervical cancer screening. Aims and Objectives: This study aimed to identify factors associated with cervical cancer awareness among married women attending a psychiatry outpatient clinic. Materials and Method: A prospective cross-sectional study was conducted on 108 married women aged 30–65 years seeking mental health care at a tertiary psychiatric center. Participants were educated about cervical cancer, and their awareness and subsequent actions were recorded during follow-up. Results: Only 23 women (21%) were aware of cervical cancer, whereas 85 (79%) were unaware. Awareness varied by diagnosis: Women with psychosis NOS (F29) showed higher awareness (50%) compared to those with Schizophrenia (F20), with statistical significance ( P = 0.033). Despite forming the largest group ( n = 40), women with somatoform disorders (F45) showed low awareness (15%). Socioeconomic predictors – education ( P = 0.0005) and income ( P = 0.003) – were stronger determinants of awareness than clinical variables. Menopausal women were particularly vulnerable, with risks more likely to go unnoticed. A prevention paradox was observed: Even when aware, many patients failed to modify risk factors such as tobacco use or access screening. Conclusion: In conclusion, sociodemographic barriers, attitudinal resistance, systemic issues, and illness-related factors contribute to low awareness. Counseling about menopause, integrating screening reminders into mental health care, and improving screening accessibility may help address these preventable risk.

Brain network architecture is anticipated to influence future grey matter loss in individuals at Clinical High Risk (CHR) for psychosis. However, existing studies on grey matter structural network properties in CHR are scarce and constrained by small sample sizes. Here, we examined network topology differences comparing a) CHR versus healthy controls (HC); b) CHR who transitioned to psychosis (CHR-T) versus those who did not (CHR-NT); and c) different subsyndromes. We included structural scans from 1842 CHR individuals and 1417 HC individuals from 31 sites within the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) consortium. At the global level, CHR individuals exhibited lower structural covariance (q < 0.001; Cohen's d = 0.164) and less optimal structural network configuration than HC (lower global efficiency and clustering coefficient, d = 0.100,0.087, qs <= 0.027). Though no global difference between CHR-T and CHR-NT, network distinctiveness of the frontal and temporal surface area networks was higher in CHR-T than CHR-NT (d = 0.223,0.237) and HC (d = 0.208,0.219) (qs < 0.001). Network distinctiveness of the frontal cortical thickness network was lower in CHR-T (d = 0.218, q < 0.001) than CHR-NT and HC (d = 0.165, q < 0.001). Importantly, higher network distinctiveness was associated with worse positive symptoms in CHR-NT (frontal surface area, q = 0.008, R2 = 0.013) and at trend with worse negative symptoms in CHR-T (frontal thickness, q = 0.063, R2 = 0.049). Further, the brief intermittent psychotic syndrome subgroup showed more severe network alterations. Together, brain structural networks inform symptoms and the risk of transition to psychosis in CHR individuals.

Previous studies of antidepressant prescribing patterns largely were limited to a single location or time, and very few involved Asia. This Asian Psychotropic Prescription Patterns Consortium study investigated pharmacoepidemiologic trends and factors associated with use and dosing of newer antidepressants across 12 Asian sites in 2003, 2013, and 2023. Data from each site included demographic, treatment setting, clinical features, and type and dosage of antidepressants prescribed. Sociodemographic and clinical variables were examined using univariate methods, followed by multivariable logistic and linear modeling. Of 8357 adult participants (59.8% female), 82.8% received at least one modern antidepressant. Use of these drugs was strongly associated with more recent year, younger age, inpatient status, and affective or anxiety-related disorders. Higher daily antidepressant doses were associated with inpatient status, male gender, more recent year, and younger age. This large, multisite study provides a two-decade overview of evolving antidepressant-prescribing patterns in 12 Asian sites and highlights patient characteristics associated with prescription of newer antidepressants and their dosage. Needed are further studies of psychotropic prescribing practices related to specific illness subtypes and their impact on psychosocial functioning over time among Asian patients.

Reducing unplanned 30-day readmission is imperative across health systems; particularly if they result from clinical failings, avoidable harms and are associated with unnecessary expenditure. This study aimed to identify interventions capable of reducing avoidable 30-day readmission after fragility fracture of the hip in an area of high socio-economic deprivation in the United Kingdom (UK) and understand how these interventions could be informed by behaviour change theory. A qualitative study was undertaken in the Midlands region of the UK in the National Health Service. Observational fieldwork of healthcare staff meetings, interviews with patients following hip fracture, carers and staff, and a theoretical mapping exercise were undertaken to examine patient’s journeys and factors affecting service delivery that might impact readmission risk. Observations were documented using electronic field notes. Semi-structured interviews explored experiences of the admission/readmission, transitions in care, readmission risks and interventions capable of reducing avoidable readmission. Analysis was conducted in four parts: 1) Inductive thematic analysis of interview and observational data explored patient journeys 2) Dyadic interviews analysis examined agreement/divergence within accounts 3) Deductive analysis identified readmission risk factors and candidate interventions 4) Candidate interventions were mapped with the constructs of the Theoretical Domains Framework. UK REC and HRA approval was obtained 3/WM/0242. Eleven non-participant observations were conducted in healthcare staff meetings in community (3) and acute (8) settings. Twenty-Four interviews were completed with 11 staff (five occupational therapists, three physiotherapists, one doctor, one trainee nurse practitioner, and one physiotherapy assistant), eight patients and five of the patients’ carers during July-September 2024. Three high level themes were identified – perceived burden, communication challenges and the health and social care system. Twenty-two candidate interventions relating to four challenges were identified: 1) adequacy of information, 2) individualised care, 3) access to services and 4) the hip fracture pathway. This study identified interventions which staff, patients and carers proposed might reduce avoidable readmission after hip fracture in an area of high deprivation. Further work is needed to refine and rank the proposed interventions followed by an implementation plan to explain mode of delivery and who needs to do what differently.

BackgroundAmbulatory assessment and mood monitoring are different methods that can use novel technology to deliver a more efficient, flexible, and usable method of clinical outcome assessment compared with established measures of behavior and mood. Concerns have been raised around attrition in and adherence to these new protocols, particularly over the medium to long term by people with mood disorders.ObjectiveThis systematic review and meta-analysis assessed attrition from and adherence to active and passive ambulatory assessment and mood monitoring protocols by people with bipolar disorder and depression over the medium and long term.MethodsRandomized controlled trials and nonrandomized studies were identified and rated for risk of bias. Adherence and attrition data were pooled to calculate effect sizes. We analyzed specific factors that we hypothesized a priori could affect the prevalences of attrition and adherence by means of subgroup meta-analysis or metaregression modeling.ResultsWe evaluated 77 mood tracking or ambulatory assessment studies including 17,123 participants. Pooled adherence was 0.64% (95% CI 0.59%-0.70%; P<.001), and pooled attrition was 0.28% (95% CI 0.22%-0.34%; P<.001). Three factors had a statistically significant subgroup difference for adherence: The presence of financial incentives increased adherence, and the presence of mood monitoring reminders and a higher study risk of bias decreased adherence. Four factors had a statistically significant subgroup difference for attrition: Digital mood monitoring decreased attrition versus analogue studies, but mood monitoring reminders, mood monitoring versus other protocols, and a high risk of study bias increased attrition. These analyses, however, were vulnerable to confounding by study design and protocol design. Attrition rates were not reported by 17 studies (17/77, 22%), and 20 studies (20/77, 26%) did not report adherence rates. Most studies had a low-to-moderate risk of bias, but heterogeneity was very high. Only 16 studies reported adherence systematically.ConclusionsReporting of attrition and adherence to ambulatory assessments was not systematic nor universal, and until it is, analyses are unlikely to demonstrate clear conclusions. We found very high heterogeneity and evidence of publication bias, and this limited the certainty of our conclusions. Financial incentives may increase adherence, and attrition may be lower in digital than analogue studies of mood monitoring. There was no statistically significant difference in adherence and attrition between studies of passive and active ambulatory assessments. Reminders of mood monitoring increased attrition and decreased adherence, but the results may be confounded by longer length of follow-up versus other studies.

BackgroundMood monitoring is widely used by people with depression and bipolar disorder (BD) to prevent relapse and improve insight into their condition, but it is unclear if these interventions have an impact on symptoms and for whom. As the capacity for passive mood monitoring increases, it is vital to improve our understanding of frequent mood assessment.ObjectiveThis systematic review and meta-analysis assessed the effect of mood monitoring interventions in people with depression and BD to decrease relapse risk and symptoms of depression and mania.MethodsWe conducted a systematic review and meta-analysis (PROSPERO, International Prospective Register of Systematic Reviews: CRD42023396473) and reported results according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Randomized controlled trials with clinically important follow-up periods were identified via multiple database searches and rated for risk of bias using the Cochrane Risk of Bias tool. The primary outcomes were symptoms of depression and mania. Available data were pooled to calculate standardized mean differences (SMDs) for the primary outcomes: severity of depression, bipolar depression, and mania/hypomania.ResultsWe included 8 trials of 1230 participants and 6 different mood monitoring protocols. In BD, meta-analysis found a small but not statistically significant effect of mood monitoring interventions on decreasing mania symptoms (6 comparisons, n=873; SMD 0.16, 95% CI−0.34 to 0.01; P=.06) and no effect on bipolar depression (6 comparisons, n=873; SMD −0.08, 95% CI −0.31 to 0.15; P=.02). In depression, we found a small effect in decreasing symptoms of depression of borderline statistical significance at 12 months (2 comparisons, n=262; SMD −0.25, 95% CI −0.49 to 0.00; P=.05) but not at 6 months (2 comparisons, n=268; SMD −0.21, 95% CI −0.54 to 0.12; P=.21). There was an absence of evidence on the effect of mood monitoring on decreased relapse rates or readmission rates. Studies had a low risk of bias. There was no evidence on mood monitoring through ecological momentary assessment.ConclusionsOverall mood monitoring interventions do not increase or decrease mood symptoms in people with BD, nor is there robust evidence of such effects in people with unipolar depression. Further research is merited on different forms of mood monitoring and to determine under what circumstances mood monitoring might have beneficial or adverse effects. These results initially suggest that ambulatory assessment does not induce large placebo effects or significantly negatively or positively affect mood, and thus that mood monitoring may be an appropriate outcome measure for research or for clinical practice.