Background Clozapine is the antipsychotic of choice for people with treatment-resistant schizophrenia (TRS) but is associated with the uncommon but potentially life-threatening adverse effect of myocarditis. However, there are no criteria for diagnosing clozapine-associated myocarditis (CAM) or global guidelines on detection and risk reduction, or for restarting clozapine after CAM.Aims To develop

Background Sleep problems are common among people with psychosis. Research suggests poor sleep is causally related to psychosis, anxiety and depression.Aims This review investigates the effectiveness and acceptability of cognitive–behavioural therapy (CBT) in targeting sleep problems in people with and at risk of psychosis.Method Four databases were searched in line with PRISMA guidelines. Eligible

Attention-deficit hyperactivity disorder (ADHD) is commonly considered a neurodevelopmental disorder, with symptoms present before 12 years of age. Increasingly, adults who have no evidence of impairment in childhood are seeking treatment for ADHD. In this Editorial, we propose that psychiatry considers conceptual changes to better understand impairment and distress caused by inattention and disorganisation

Although treatments for depression are effective, many patients do not respond. Many new innovations are currently being developed, claiming to substantially improve outcomes. We propose a new method to assess the strength of these innovations. Based on response rates of current treatments, we can estimate how many treatments are needed in total to realise response in >99% of patients if they were

Background Natural remission from common mental disorders (CMDs), in the absence of intervention, varies greatly. The situation in India is unknown.Aims This study examined individual, village and primary health centre (PHC)-level determinants for remission across two rural communities in north and south India and reports natural remission rates.Method Using pre-intervention trial data from 44 PHCs

People with intellectual disability experience significant health inequality, and consequently poor health outcomes. Although research can facilitate change, there is a risk of researchers propagating inequity by selecting methods that exclude people with some forms of intellectual disability. We argue for participatory research methods that enable inclusion.

Background Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.Aims To describe the prevalence of, and patient

Online platforms and activities, including smartphones, computers, social media, video games and applications involving artificial intelligence, have become a regular part of daily life and offer individuals a wide range of benefits. The purpose of this document is to increase psychiatrists’ awareness of the frequency and potential risks associated with excessive internet use, and to emphasise the

Background Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacological treatment for obsessive–compulsive disorder (OCD). However, insufficient response is common and it remains unclear whether specific patient-level factors influence the likelihood of treatment response.Aims To determine the efficacy and acceptability of SSRIs in adult OCD, and to identify patient-level modifiers

Background It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.Aims To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.Method Randomised trials comparing psychological

Background Current approaches to identifying individuals at risk for psychosis capture only a small proportion of future psychotic disorders. Recent Finnish research suggests a substantial proportion of individuals at risk of psychosis attend child and adolescent mental health services (CAMHS) earlier in life, creating important opportunities for prediction and prevention. To what extent this is true

Approximately one in three people who use anabolic-androgenic steroids (AASs) develop dependence, characterised by both psychiatric and somatic symptoms. Despite this, AAS use disorder (AASUD) is not distinctly recognised in the latest versions of either the ICD or DSM, impeding both clinical care and research progress. It is clear that AASUD shares many features and correlates with substance use disorders

Background Electroconvulsive therapy (ECT) is the most effective treatment of major depression, but autobiographical memory loss may limit its use. Despite previous attempts to synthesise the literature, the nature of autobiographical memory loss after ECT is still debated.Aims To provide an overview of the effect of ECT on autobiographical memory in patients with depression and explore whether the

Background Understanding the effects of ketamine on depressive symptoms could help identify which patients might benefit and clarify its mechanism of action in both the early (≤1 day post-infusion) and late (e.g. 2–30 days post-infusion) post-infusion periods. Symptom network analyses could provide complementary information regarding relationships between symptoms.Aims To identify the effects of ketamine

Background In the past decade, no meta-analytical estimates of the prevalence of post-traumatic stress disorder (PTSD) among children and adolescents have been published, despite a host of new prevalence studies and updated DSM-5 criteria.Aims We set out to estimate the prevalence rates of PTSD in trauma-exposed children and adolescents on the basis of DSM-IV and DSM-5 criteria, and investigate differences

Real-world studies provide valuable insights into long-term outcomes across diverse populations. Here, we contextualise recent findings on the association between antipsychotic use and breast cancer risk in women with schizophrenia. We discuss clinical implications and the strengths and limitations of real-world studies in psychiatry. We conclude with future perspectives.

Background Despite the high prevalence of social and performance anxiety, current treatments do not meet the full needs of patients. Development of novel anxiolytics with rapid onset of action for on-demand treatment of social and performance anxiety is an active area of clinical research.Aims To examine the anxiolytic effect of VQW-765, an α7-nAChR agonist, in subjects with performance anxiety.Method

Background Assessment of regional glucose metabolism by [18F]fluorodeoxyglucose position emission tomography ([18F]FDG PET) serves as a biomarker for differential diagnosis of dementia. Conversely, depressive cognitive impairment shows no abnormalities on cerebral [18F]FDG PET.Aims This study validates the diagnostic value of [18F]FDG PET in addition to clinical diagnosis in a real-life gerontopsychiatric

Background The duration of undiagnosed or untreated bipolar disorder (DUBD) has become a focus of research interest. However, its relationship with clinical characteristics and outcomes remains poorly understood.Aims The objective of this systematic review and meta-analysis was to examine DUBD and explore its relationships with clinical characteristics and outcomes in bipolar disorder.Methods We conducted

Background Cognitive–behavioural therapy (CBT) is a first-line treatment for depressive disorders, but research on its neurobiological mechanisms is limited. Given the heterogeneity in CBT response, investigating the neurobiological effects of CBT may improve response prediction and outcomes.Aims To examine brain functional changes during negative emotion processing following naturalistic CBT.Method

Background Cannabis use is linked to treatment non-adherence and relapses in psychotic disorders. Antipsychotic medication is effective for relapse prevention in primary psychoses, but its effectiveness after cannabis-induced psychosis (CIP) remains unclear.Aims To examine the effectiveness of antipsychotic medication for relapse prevention following the first clinically diagnosed CIP.Method A cohort

Background One-third of schizophrenia patients show a lack of response to conventional antipsychotic drugs because of adverse effects and limited efficacy. Emerging treatments target muscarinic and nicotinic receptors, leveraging cholinergic dysfunction implicated in the pathophysiology of schizophrenia.Aims To evaluate the efficacy and safety of cholinergic modulators in schizophrenia.Methods Reviewers

Background The identification of early warning signs is of great importance for identifying individuals at risk for mental disorders. Especially in the case of bipolar disorder, these research endeavours are imperative considering that the frequently delayed diagnoses and longer illness duration are associated with symptom exacerbation and lower recovery rates.Aims To multimodally investigate associations

Ableist culture stigmatises psychiatric and psychological conditions, which perpetuates misconceptions about them and can discourage people from seeking appropriate treatment for mental conditions. This editorial examines how pejorative use of diagnostic terms contributes to stigmatisation, identifies its discriminatory impact and explores its connection to fears about becoming disabled.

Summary Recent changes in US government priorities have serious negative implications for science that will compromise the integrity of mental health research, which focuses on vulnerable populations. Therefore, as editors of mental science journals and custodians of the academic record, we confirm with conviction our collective commitment to communicating the truth.

Background The Kahramanmaraş earthquakes in February 2023 represented a disaster within a disaster, as northwest Syria had been affected by years of war. Literature on the immediate psychological impact of such natural disasters in high-adversity populations is lacking.Aims To examine prevalences, longitudinal trajectories and cognitive predictors of post-traumatic stress disorder (PTSD), depression

Background Having a relapse of schizophrenia or recurrent psychosis is feared by patients, can cause social and personal disruption and has been suggested to cause long-term deterioration, possibly because of a toxic biological process.Aims To assess whether relapse affected the social and clinical outcomes of people enrolled in a 24-month randomised controlled trial of antipsychotic medication dose

Background Dog-assisted interventions (DAIs) to improve health-related outcomes for people with mental health or neurodevelopmental conditions are becoming increasingly popular. However, DAIs are not based on robust scientific evidence.Aims To determine the effectiveness of DAIs for children and adults with mental health or neurodevelopmental conditions, assess how well randomised controlled trials

Background There is a significant mortality gap between the general population and people with psychosis. Completion rates of regular physical health assessments for cardiovascular risk in this group are suboptimal. Point-of-care testing (POCT) for diabetes and hyperlipidaemia – providing an immediate result from a finger-prick – could improve these rates.Aims To evaluate the impact on patient–clinician

Background Traumatic experiences can trigger post-traumatic stress disorder (PTSD) and influence one’s future perspective, which can change over time with the sense of control.Aims We measured changes in predictions about the future among individuals who experienced a traumatic event, with or without PTSD, according to their sense of control, and its relationship with post-traumatic change (post-traumatic

Background There are 117.3 million people forcibly displaced because of war, conflict and natural disasters: 40% are children. With growing numbers, many high-income countries have adopted or are considering increasingly restrictive policies of immigration detention. Research on the impact of detention on mental health has focused on adults, although recent studies report on children.Aims To synthesise

Background Previous studies investigating the effectiveness of augmentation therapy have been limited.Aims To evaluate the effectiveness of antipsychotic augmentation therapies among patients with treatment-resistant depression.Method We included patients diagnosed with depression receiving two antidepressant courses within 1 year between 2009 and 2020 and used the clone-censor-weight approach to address

Geriatric (old age) psychiatry faces growing challenges amid Europe’s ageing population. This editorial emphasises the need for specialised training, mentorship and subspecialty recognition to attract young psychiatrists. By addressing structural gaps and fostering innovation, the field offers a rewarding career in enhancing older adults’ mental healthcare and quality of life.

This paper highlights systemic research and clinical deficiencies in addressing eating disorders among males and men, focusing on societal stigma, gender-biased diagnostics and barriers to care. It advocates for comprehensive reforms, including addressing systemic underfunding, closing research gaps, improving clinician training and tailored interventions to reduce disparities and improve outcomes

Background Antidepressants are effective for depression, but most evidence excludes individuals with comorbid physical conditions.Aims To assess antidepressants’ efficacy and tolerability in individuals with depression and comorbid physical conditions.Methods Systematic review and network meta-analysis of randomised controlled trials (RCTs). Co-primary outcomes were efficacy on depressive symptoms

Background The methodology and impact of independent inquiries of homicides by people in care of mental health services have been questioned.Aims To analyse characteristics of patients who committed homicide, their victims and inquiries published in England between 2010 and 2023.Method Documentary and thematic analysis of 162 mental health homicide inquiries. We compared characteristics of perpetrators

Background Involuntary treatment for patients with anorexia nervosa is common and lifesaving, but also highly intrusive. Understanding how morbidity patterns relate to involuntary treatment can help minimise its use.Aim We estimate the relative risk of involuntary treatment according to morbidity profiles in patients with anorexia nervosa.Method This register-based cohort study included all individuals

Bupropion is not licensed as an antidepressant in the UK, limiting its use. We highlight bupropion’s distinct pharmacological profile and its potential benefits in treatment-resistant depression and people experiencing selective serotonin reuptake inhibitor-induced sexual dysfunction. The National Health Service repurposing medicines programme could improve equity of access for UK patients.

Background Evidence suggests the crucial role of dysfunctional default mode (DMN), salience and frontoparietal (FPN) networks, collectively termed the triple network model, in the pathophysiology of treatment-resistant depression (TRD).Aims Using the graph theory- and seed-based functional connectivity analyses, we attempted to elucidate the role of low-dose ketamine in the triple networks, namely

Background People with dementia (PwD) and their carers often consider maintaining good quality of life (QoL) more important than improvements in cognition or other symptoms of dementia. There is a clinical need for identifying interventions that can improve QoL of PwD. There are currently no evidence-based guidelines to help clinicians, patients and policy makers to make informed decisions regarding

Background Late-life affective disorders (LLADs) are common and are projected to increase by 2050. There have been several studies linking late-life depression to an increased risk of dementia, but it is unclear if bipolar affective disorder or anxiety disorders pose a similar risk.Aims We aimed to compare the risk of LLADs progressing to all-cause dementia, and the demographic and clinical variables

Background Self-harm, self-poisoning or self-injury, irrespective of the motivation, is a central risk factor for suicide. Still, there is limited knowledge of self-harm among patients with substance use disorders (SUDs) who die by suicide.Aims We aimed to describe the prevalence of a history of self-harm and identify the factors associated with self-harm, comparing individuals who died by suicide with

Background While cognitive impairment is a core feature of psychosis, significant heterogeneity in cognitive and clinical outcomes is observed.Aims The aim of this study was to identify cognitive and clinical subgroups in first-episode psychosis (FEP) and determine if these profiles were linked to functional outcomes over time.Method A total of 323 individuals with FEP were included. Two-step hierarchical

Background We rely heavily on cut-off points of brief measures of psychological distress in research and clinical practice to identify those at risk of mental health conditions; however, few studies have compared the performance of different scales.Aim To determine the extent to which the child- and parent-report Strength and Difficulty Questionnaire (SDQ), Revised Children’s Anxiety and Depression

Summary Within the medical model, ‘impairment’ is required for a diagnosis of autism. However, the diagnostic manuals provide limited guidance as to how to interpret impairment, which can impact diagnostic rates and the provision of support. Impairment is discussed within the context of the medical model and current sociocultural landscape.

For over four decades, isotretinoin has shown unparalleled efficacy in the management of severe recalcitrant acne. However, controversies exist about its psychiatric safety profile. This editorial discusses the alleged causal role of isotretinoin in the development of psychiatric adverse events in light of the best available evidence.

Background Researchers explore the biology of painful experiences not primarily felt in the body (‘non-physical pain’), sometimes referred to as mental, social or emotional pain. A critical challenge lies in how to operationalise this subjective experience for biological research, a crucial process for translating findings into clinical practice.Aims To map studies investigating biological features

In the post-COVID-19 pandemic era, a ‘digital-first’ agenda is being adopted in health/social care services, while digital exclusion has not been fully addressed. People with severe mental illness face profound inequalities at many levels (i.e. social, financial and health). Digital exclusion may further exacerbate some of these inequalities.

Autism spectrum disorder is defined by the presence of sustained problems in areas of social cognition and social understanding alongside repetitive and/or restricted patterns of behaviour. Behavioural presentations and developmental trajectories in autism are highly heterogeneous. For most, characteristics variably continue across the lifespan, and, for many, they overlap with numerous overrepresented

There has been substantial recent renewed interest and investment to assess the therapeutic potential of psychedelic compounds in addiction disorders. This editorial discusses the available evidence from randomised trials and future research directions in the field, together with potential implications for patients, professionals and the wider addiction treatment system.