BackgroundBehavioural and cognitive interventions remain credible approaches in addressing loneliness and depression. There was a need to rapidly generate and assimilate trial-based data during COVID-19.ObjectivesWe undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trial ISRCTN94091479). We also assimilate these data in a living systematic review (PROSPERO CRD42021298788) of cognitive and/or behavioural interventions.MethodsParticipants (≥65 years) with long-term conditions were computer randomised to behavioural activation (n=47) versus care as usual (n=49). Primary outcome was PHQ-9. Secondary outcomes included loneliness (De Jong Scale). Data from the BASIL-C19 trial were included in a metanalysis of depression and loneliness.FindingsThe 12 months adjusted mean difference for PHQ-9 was −0.70 (95% CI −2.61 to 1.20) and for loneliness was −0.39 (95% CI −1.43 to 0.65).The BASIL-C19 living systematic review (12 trials) found short-term reductions in depression (standardised mean difference (SMD)=−0.31, 95% CI −0.51 to −0.11) and loneliness (SMD=−0.48, 95% CI −0.70 to −0.27). There were few long-term trials, but there was evidence of some benefit (loneliness SMD=−0.20, 95% CI −0.40 to −0.01; depression SMD=−0.20, 95% CI −0.47 to 0.07).DiscussionWe delivered a pilot trial of a behavioural intervention targeting loneliness and depression; achieving long-term follow-up. Living meta-analysis provides strong evidence of short-term benefit for loneliness and depression for cognitive and/or behavioural approaches. A fully powered BASIL trial is underway.Clinical implicationsScalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.

BackgroundAvailable prediction models of cardiovascular diseases (CVDs) may not accurately predict outcomes among individuals initiating pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD).ObjectiveTo improve the predictive accuracy of traditional CVD risk factors for adults initiating pharmacological treatment of ADHD, by considering novel CVD risk factors associated with ADHD (comorbid psychiatric disorders, sociodemographic factors and psychotropic medication).MethodsThe cohort composed of 24 186 adults residing in Sweden without previous CVDs, born between 1932 and 1990, who started pharmacological treatment of ADHD between 2008 and 2011, and were followed for up to 2 years. CVDs were identified using diagnoses according to the International Classification of Diseases, and dispended medication prescriptions from Swedish national registers. Cox proportional hazards regression was employed to derive the prediction model.FindingsThe developed model included eight traditional and four novel CVD risk factors. The model showed acceptable overall discrimination (C index=0.72, 95% CI 0.70 to 0.74) and calibration (Brier score=0.008). The Integrated Discrimination Improvement index showed a significant improvement after adding novel risk factors (0.003 (95% CI 0.001 to 0.007), p<0.001).ConclusionsThe inclusion of the novel CVD risk factors may provide a better prediction of CVDs in this population compared with traditional CVD predictors only, when the model is used with a continuous risk score. External validation studies and studies assessing clinical impact of the model are warranted.Clinical implicationsIndividuals initiating pharmacological treatment of ADHD at higher risk of developing CVDs should be more closely monitored.

Improving child and adolescent mental health requires the careful development and rigorous testing of interventions and delivery methods. This includes universal school-based mindfulness training, evaluated in the My Resilience in Adolescence (MYRIAD) trial reported in this special edition. While discovering effective interventions through randomised controlled trials is our ultimate aim, null or negative results can and should play an important role in progressing our understanding of what works. Unfortunately, alongside publication bias there can be a tendency to ignore, spin or unfairly undermine disappointing findings. This creates research waste that can increase risk and reduce benefits for future service users. We advocate several practices to help optimise learning from all trials, whatever the results: stronger intervention design reduces the likelihood of foreseeable null or negative results; an evidence-informed conceptual map of the subject area assists with understanding how results contribute to the knowledge base; mixed methods trial designs aid explanation of outcome results; various open science practices support the dispassionate analysis of data and transparent reporting of trial findings; and preparation for null or negative results helps to temper stakeholder expectations and increase understanding of why we conduct trials in the first place. To embed these practices, research funders must be willing to pay for pilot studies and ‘thicker’ trials, and publishers should judge trials according to their conduct and not their outcome. MYRIAD is an exemplar of how to design, conduct and report a trial to optimise learning, with important implications for practice.

In this study, we compared the accuracy of the rate of myocardial glucose use (rMGU) measured using PET and 1-¹¹C-glucose with the rate measured using PET and the more conventional tracer ¹⁸F-FDG. <b>Methods:</b> PET measurements of myocardial tracer uptake (K, in mL/g/min) and rMGU (in nmol/g/min) were obtained with 1-¹¹C-glucose and ¹⁸F-FDG in 21 dogs using kinetic modeling and the Patlak graphical method, respectively. Eighteen dogs were studied during hyperinsulinemic-euglycemic clamp performed either at rest or combined with phenylephrine, dobutamine, intralipid infusion, or intralipid infusion and dobutamine. Three dogs were studied during intralipid infusion alone under resting conditions. Arterial-coronary sinus sampling was performed to measure the K of both tracers (<i>n</i> = 14) and rMGU by the Fick method (<i>n</i> = 21). <b>Results:</b> PET-derived values for K from either 1-¹¹C-glucose or ¹⁸F-FDG correlated closely with directly measured tracer K values (glucose: y = 0.98x + 0.01, <i>r</i> = 0.79, <i>P</i> &lt; 0.001; ¹⁸F-FDG: y = 0.74x + 0.03, <i>r</i> = 0.77, <i>P</i> &lt; 0.001). In contrast, correlation with K values of unlabeled glucose measured directly was better for 1-¹¹C-glucose (y = 0.92x + 0.02, <i>r</i> = 0.96, <i>P</i> &lt; 0.0001) than for ¹⁸F-FDG (y = 0.66x + 0.05, <i>r</i> = 0.72, <i>P</i> &lt; 0.01) (<i>P</i> &lt; 0.001 for comparison of correlation coefficients). As a consequence, PET-derived values for rMGU correlated more closely with Fick-derived measurements of unlabeled glucose using 1-¹¹C-glucose (y = 0.82x + 168, <i>r</i> = 0.97, <i>P</i> &lt; 0.0001) than with ¹⁸F-FDG (y = 0.81x + 278, <i>r</i> = 0.79, <i>P</i> &lt; 0.001) (<i>P</i> &lt; 0.001 for comparison of correlation coefficients). <b>Conclusion:</b> Over a wide range of conditions, PET-derived measurements of rMGU are obtained more accurately with 1-¹¹C-glucose than with ¹⁸F-FDG.

BackgroundThe availability of specialist psychotherapies for treating borderline personality disorder (BPD) is limited by costs associated with training, resourcing and treatment duration. Developing a programme that incorporates effective strategies from a range of evidence-based specialist treatments, concentrates their delivery and uses a group-based format will improve treatment access.ObjectiveTo assess the short-term clinical efficacy, acceptability and feasibility of a bespoke manualised programme for the treatment of BPD. This 10-week group-based outpatient programme was delivered 2 days per week in 4 hour sessions; participants received 80 hours of treatment in total.MethodsForty-three participants, many having severe BPD symptomatology, were assessed before and after the 10-week programme using a range of validated self-report questionnaires and a self-appraisal feedback form. The primary outcome measured was BPD symptom severity.FindingsStatistically significant improvements were measured in BPD symptom severity, depression, trait anxiety, emotional regulation, general health, hopefulness, self-compassion and anger, several with moderate to large effect sizes. Many of these improvements remained at 4–6 months post treatment. More than 90% of surveyed participants expressed a moderate or high level of satisfaction with the programme.ConclusionsThis integrated treatment programme delivered in a highly concentrated format demonstrated short-term efficacy across many BPD-relevant endpoints; its acceptability was endorsed by most clients.Clinical implicationsIncorporation of key aspects of evidence-based treatment using a time-intensive group format could greatly enhance the capacity of mental health services to meet the needs of people who experience BPD within a population-based mental health service framework.

Almost 70 years ago, Eysenck1 stirred up the community of psychotherapists by postulating that psychotherapies—at that time predominantly psychoanalytic—are not effective in the treatment of psychological disorders. This led to a massive surge of empirically evaluated psychotherapy research and promoted particularly the rise of cognitive behavioural therapy. Today, we know that a range of psychotherapies work across a wide variety of mental disorders and numerous meta-analyses of randomised controlled trials prove that Eysenck’s conclusion is no longer relevant. However, despite ample evidence that psychotherapy is generally efficacious, only 30% of patients achieve remission while as many as 65% leave treatment without a measurable benefit or even with deterioration.2 Therefore, psychotherapy researchers face the challenge to improve the effectiveness of their interventions. …

IntroductionAlthough several systematic reviews (SRs)/meta-analyses (MAs) on the association between specific mental disorders and specific somatic conditions are available, an overarching evidence synthesis across mental disorders and somatic conditions is currently lacking. We will conduct an umbrella review of SRs/MAs to test: 1) the strength of the association between individual mental disorders and individual somatic conditions in children/adolescents and adults; 2) to which extent associations are specific to individual mental and somatic conditions .Methods and analysisWe will search a broad set of electronic databases and contact study authors. We will include SRs with MA or SRs reporting the effect size from individual studies on the association between a number of somatic and mental conditions (as per the International Classification of Diseases, 11th Revision). We will follow an algorithm to select only one SR or MA when more than one are available on the same association. We will rate the quality of included SRs/MAs using the AMSTAR-2 tool. We will assess to which extent mental disorders are selectively associated with specific somatic conditions or if there are transdiagnostic, across-spectra or diagnostic spectrum-specific associations between mental disorders and somatic conditions based on the Transparent, Reporting, Appraising, Numerating, Showing (TRANSD) recommendations.DiscussionThe present umbrella review will shed light on the association between mental health disorders and somatic conditions, providing useful data for the care of patients with mental health disorders, in particular for early detection and intervention. This work might also add insight to the pathophysiology of mental health conditions, and contribute to the current debate on the value of a transdiagnostic approach in psychiatry.

BackgroundWhile there are numerous mental health apps on the market today, less is known about their safety and quality. This study aims to offer a longitudinal perspective on the nature of high visibility apps for common mental health and physical health conditions.MethodsIn July 2019, we selected the 10 top search-returned apps in the Apple App Store and Android Google Play Store using six keyword terms: depression, anxiety, schizophrenia, addiction, high blood pressure and diabetes. Each app was downloaded by two authors and reviewed by a clinician, and the app was coded for features, functionality, claims, app store properties, and other properties.ResultsCompared with 1 year prior, there were few statistically significant changes in app privacy policies, evidence and features. However, there was a high rate of turnover with only 34 (57%) of the apps from the Apple’s App Store and 28 (47%) from the Google Play Store remaining in the 2019 top 10 search compared with the 2018 search.DiscussionAlthough there was a high turnover of top search-returned apps between 2018 and 2019, we found that there were few significant changes in features, privacy, medical claims and other properties. This suggests that, although the highly visible and available apps are changing, there were no significant improvements in app quality or safety.