Aims: In this systematic review, the effectiveness and safety of viloxazine ER in the treatment of ADHD in children and adolescents aged between 6–17 years will be assessed.

Methods: This review identified articles through a systematic approach using PubMed, EMBASE, and the Cochrane Library. Randomized controlled trials with viloxazine ER in an active comparator condition versus placebo or other stimulant/non-stimulant ADHD drugs were included.

The first set of outcomes for assessing efficacy was a decrease in the severity of ADHD symptoms as measured by the ADHD-RS-5 and CGI-I scales. Safety outcomes comprised comparability in the rates of adverse events and treatment discontinuation rates.

Results: A meta-analysis showed that viloxazine ER is effective in managing ADHD symptoms compared with placebo at 10–12 weeks. Very few side effects were reported with this medication and those reported were mostly mild to moderate in nature. Mild side effects were noted to be decreased appetite, somnolence, and headache. The rates of treatment disappearance were similar compared with other oral ADHD drugs.

Conclusion: The research implies that viloxazine ER may be useful to paediatric patients with ADHD as a new treatment approach. We hypothesize that its profile of being an NRI and 5-HT2B antagonist may be beneficial for patients who have not shown sufficient improvement with more common treatments. The use of once daily dosing of the extended release formulation may enhance compliance compared with drugs taken more than once per day.

In a general manner, viloxazine ER seems to be a safe and efficacious therapy in children and adolescents affected by ADHD. Because it has a unique mechanism of action and can be taken once daily, it complements other ADHD medications well. More prospective, multicentre trials of longer duration are, therefore, required to determine the success and risks of the technique in the long run.

Aims: People with Severe Mental Illness (SMI) have a reduced life expectancy of 15–20 years compared with the general population. This disparity is largely due to preventable health conditions like cardiovascular disease and diabetes. Certain antipsychotics (APs) can contribute to this increased burden due to their association with cardio-metabolic side-effects. Despite the availability of lower-risk APs, risperidone, olanzapine, and quetiapine remain the most prescribed APs in the UK. Switching to improve cardio-metabolic side-effects is rarely implemented in clinical practice. Improving the physical health of people with SMI is a key NHS priority. We conducted a qualitative study to explore the perceptions and experiences of patients and their caregivers surrounding switching APs for physical health benefits to inform the development of an educational intervention for clinicians to support switching APs.

Methods: Semi-structured interviews were conducted with patients who have experienced AP-induced cardiometabolic side-effects (ascertained by the treating clinician) and their caregivers. Participants were recruited through two NHS trusts and primary care. Interviews were by telephone or online and transcripts were thematically analysed using NVIVO. A patient advisory group contributed to all phases of the study.

Results: Seventeen interviews (16 one-on-one and one dyadic) were conducted with thirteen people with SMI (Bipolar Disorder [9], Schizophrenia [2], Psychosis [2]) and five caregivers.

We will present two themes:

(1) Managing the dual challenge of mental and physical health conditions: Managing this challenge can be overwhelming and impact their everyday life; patients often normalise side-effects of medication as a necessary trade-off for mental health stability.

(2) Enabling a change in medication: The possibility of medication changes was met with optimism as well as apprehension. Past experiences of medication adjustments, fear of relapse and concerns about new side-effects were important from both patient and caregiver perspectives; addressing these requires inviting patients and caregivers into decision-making. Carers play a crucial role in supporting patients, and recognising their contributions can ease the transition. Improving collaboration at the system level is equally important.

Conclusion: The study highlights the complex interplay between mental and physical health; patients and caregivers often face significant challenges in balancing mental and physical health. Switching medication is a challenge for patients and their caregivers. Addressing patients’ concerns like fear of relapse, lack of support, and clear communication would help foster confidence in switching. Recognising the importance of caregivers is essential for effective patient support. Improving overall collaboration can foster a more patient-centred approach to managing the switching process.

Aims: Peripheral Arterial Disease (PAD) is linked to vascular cognitive impairment and vascular depression due to concurrent cerebrovascular disease. Cognitive impairment and mental health disorders in surgical patients lead to poorer recovery and rehabilitation. Awareness of these diagnoses in this population is important when considering suitability for surgical input – especially high-risk procedures such as limb revascularisation. In the UK population, evidence suggests that 33–42% of cognitive impairment and 26.5% of anxiety and depressive disorders remain undiagnosed. In this high-risk PAD population, this is likely an underestimate. We aim to determine the prevalence of cognitive impairment and anxiety and depressive disorders within this group while controlling for possible confounders.

Methods: 100 unselected PAD patients were identified pragmatically from a Vascular outpatient setting at Addenbrooke’s Hospital. Inclusion criteria required patients to be >65, and have radiological or clinical evidence of PAD. Written consent was obtained for assessment. Patients came from a wide area in the East of England with a catchment of 1.8 million people, demonstrating significant socio-geographical variety for a single centre study. The assessment pack included the 6-CIT screening tool for cognitive impairment, HADS for anxiety and depression, 4AT for delirium, SASQ for alcohol use, and a brief clinical history covering memory, attention, visuospatial skills, speech, and personality.

Results: 100 patients were assessed over 6 months. 20.5% met the 6-CIT cut-off for memory clinic referral (mean score 12). The estimated general prevalence of cognitive impairment including dementia in those over 65 is 7.1%. 26.8% met the HADS cut-off for anxiety or depression (mean score 15). The prevalence of anxiety and depression in the general over 65 population is estimated to be around 9% and 12.5%, respectively. Hence, there appears to be a significant increase in possible prevalence of both diagnoses, compared with a general age matched population. No significant age or gender differences were found between those scoring above the cut offs and those not (p=0.79).

Conclusion: Cognitive impairment and anxiety/depression appear more prevalent in PAD patients. Given these conditions impact surgical outcomes, raising awareness of underdiagnoses is crucial. Future follow up will include memory clinic assessment, cerebral and peripheral imaging, and exploring surgical outcomes. Cost-effectiveness analyses are needed to assess the benefits of pre-operative screening.

Aims: In 2021–2022, 10.5% of UK citizens provided unpaid informal care, saving the government £162 bn annually. Many carers reside in high-deprivation areas, where access to appropriate health and social care services is limited. Previous studies indicate that carers are more prone to depression, anxiety, and physical symptoms, and these negative outcomes are higher among socio-economically disadvantaged carers. The shift of some health and social care services online, combined with ‘digital poverty’ (having no suitable electronic devices with Internet access or limited access or skills concerning the Internet), may exacerbate difficulties with accessing health and social care support, potentially increasing unmet needs and burdens among socioeconomically disadvantaged carers. The aim is to understand how informal carers with marginalised socioeconomic status (SES) access existing health and social care services and how this impacts their mental health. The second aim of the project is to explore how potential digital poverty may shape a carer’s mental health outcomes.

Methods: A systematic literature review will identify barriers and facilitators of accessing health and social care by informal carers, the impact of access/non-access on mental health, stratified by carer SES and care-recipient’s health conditions. Followed by a qualitative photovoice study to explore carers’ experiences of accessing health and social care and the effects of digital poverty, analysed through critical discourse analysis. Thirdly a survey (N >300) examining how factors underpinning access to health and social care are related to informal carers’ mental health as moderated or mediated by the caregiver SES, carers’ perceptions of access to health and social care and of digital poverty analysed by structural equation modelling.

Results: We will identify if and how informal carers with a marginalised socioeconomic background access health and social care services. Which will allow us to develop an evidence-based health promotion model.

Conclusion: This study will offer us a unique opportunity to develop an evidence-based health promotion model for these carers that shows how to mitigate existing pathways of health inequalities. Based on key findings, recommendations will be generated and shared with researchers, clinicians, and policymakers via academic publications, conferences, exhibitions of carers’ photographs, and carer forums with NHS Trust(s).

Aims: A handful of studies argue that ED treatment would benefit from a network analysis of social influences, particularly in girls and young women pressured by socio-culturally prescribed beauty standards, and reinforced by peers and family. The study’s aim was to investigate the impact of social network density on a person’s acquisition, perpetuation, and recovery from an eating disorder (ED). It was hypothesized that one’s connectedness within dense social networks of others with EDs would increase the likelihood of an ED diagnosis and resistance to treatment and recovery.

Methods: One thousand participants, largely from North America and Europe, completed an online survey of ED social networks. Respondents were asked whether they had an ED diagnosis, and if so, the diagnosis/typology, whether they knew others with an ED, whether they were in recovery, and, if so, the extent of social supports. Indices and latent structural equation model (SEM) variables were constructed from respondents’ identification of siblings, peers, friends, parents, other relatives, spouses, and neighbours with an ED. Similar indices were constructed for others identified as supportive of recovery. Social media influence was measured by asking if pro-anorexic or recovery websites were viewed. Data were analysed using bivariate statistics and Lavaan’s SEM R program.

Results: Social network density (knowing others with EDs) was highly predictive of ED diagnosis, including multiple EDs. Internet media was equally impactful. Same-sex siblings and peers had the greatest influence, exceeding parents or other relatives/friends. Networks of supportive others were highly predictive of recovery, outweighing negative ED models and media.

Conclusion: Our results were highly revealing of dense networks of family and peer models of EDs as well as supportive networks for recovery. The density/richness of social networks of others with an ED was highly predictive of an ED diagnosis, particularly of multiple EDs. Same-sex peers and siblings with an ED were especially strong influences. “Rich” day-to-day networks of multiple social contacts with EDs were associated with multiple ED diagnoses. Media appeared to complement these social contacts. However, only dense networks of supportive others were significantly predictive of recovery. Effective ED treatment requires a careful consideration of social influences who may model ED attitudes and behaviours; same-sex siblings and peers are especially critical. ED treatment and recovery might be compromised if these significant others model and reinforce a patient’s ED attitudes and behaviours.

Aims: Forests are important for planetary and human health, but deforestation is increasing. Poor mental health is increasingly affecting the world’s population. This study aims to investigate the association between forestry area, deforestation and mental health, at country level, worldwide.

Methods: Forestry area in each country was sampled in 2006 and 2016; the country prevalence of mental health disorders or substance abuse was sampled in 2006 and 2016; and the relative disability-adjusted life years (DALYs) in 2010 and 2016. Crude and multivariate linear regression analyses were run, adjusting for peace index, wealth and inequalities, and urbanisation at country level. A sensitivity analysis including sanitation and food security was run. Interaction with country gross domestic product per capita was assessed.

Results: Based on data for 230 countries, country forestry area is negatively associated with the prevalence of mental health disorders in 2016 (β −0.02 (195% C.I. −0.04/−0.01). This association was maintained in sensitivity analyses, and found mainly in lower- and upper-middle income countries. Change in forestry area is not associated with mental health prevalence nor estimated DALYs due to mental health.

Conclusion: This is the first study showing that forestry area at country level is associated with a lower prevalence of mental health disorders. If these results are replicated at individual level, this would suggest that public health implications should play a strong role in weighting ecological decisions, such as optimising forestry area coverage.

Aims: Gambling Disorder is a mental health condition in which people experience impaired ability to control or stop gambling behaviours despite adverse consequences. It is associated with psychiatric co-morbidities and risk factors for physical health conditions. There is growing exploration into physical health conditions associated with gambling disorder and this study sought to further contribute towards understanding that association. The first aim was to describe rates of physical health conditions. The second aim was to explore potential associations between physical health conditions and individuals’ sociodemographic characteristics.

Methods: Dataset one comprised aggregated anonymised subject-level data from clinical trials conducted in participants with gambling disorder (n=423). Dataset two comprised aggregated anonymised patient data from the NHS Southern Gambling Service (n=352). Descriptive characteristics of people with versus without physical health co-morbidities were presented. Statistical tests were undertaken to compare those with versus without physical health co-morbidities, independent t-tests were utilised to compare continuous variables whereas Chi Square or Fisher’s Exact test were utilised when comparing categorical variables.

Results: In dataset one 42.9% reported one or more physical health condition, the most frequent reported physical health conditions were musculoskeletal, cardiovascular, and endocrine and metabolic conditions. People in dataset one with physical health condition(s) versus without had significantly older age. In dataset two 27.1% reported one or more physical health condition, with respiratory, musculoskeletal, and endocrine and metabolic being the most reported. The presence of physical health conditions, musculoskeletal conditions, and endocrine and metabolic conditions was associated with significantly older age and female sex.

Conclusion: Increased age in individuals with gambling disorder is a crucial sociodemographic factor regarding physical health morbidity. In dataset two being female was identified as a risk factor for having physical health morbidity. Implementation of treatments targeting these risk factors may reduce the public health and individual health burden of gambling disorder.

Aims: Changes in body biomechanics – that is, changes in gait, posture, and balance – have been identified during episodes of major depressive disorder (MDD). Whilst biomechanical changes are related to the level of disability experienced by people with MDD, such changes are rarely asked about by clinicians or addressed directly by interventions. As part of a project studying whether interventions that target biomechanics might be helpful for MDD, we are conducting an initial non-patient study quantifying biomechanics, mood and anxiety, before and after physiotherapist-directed interventions.

Methods: Twenty young people (aged 19–21) from a higher education setting have completed baseline measurements so far. The baseline protocol consists of questionnaire measures, a happy–sad emotional bias task, and a comprehensive biomechanical assessment including walking tasks, static and dynamic balance tasks, and postural measures.

The baseline walking-task metrics described here were collected using a force plate flush with the floor of a 10-metre walkway. Participants were asked to walk at a comfortable pace across the walkway six times. Walking speed was recorded, and the plate measured reaction forces from which were derived peak/mean forces in three dimensions, as well as variability in these forces across the six repetitions. There were no exclusion criteria for baseline analyses, other than physical disability preventing completion of key measures.

Results: In the fifteen participants (13 male) for whom baseline analyses are complete, mean PHQ-8 (self-reported depressive symptoms) ranged from 0–11 (none to low-moderate), and mean GAD-7 (self-reported anxiety) ranged from 0–25 (none to severe). One participant was taking sertraline, the others reported no mental health medications. Ratings of pain and mobility difficulties were low (EQ-5D domains, scored 1–5: fourteen participants scored 1, one participant scored 2).

Whilst there were no significant relationships between PHQ-8 total score and baseline gait metrics, mean reaction time to sad faces on the emotional bias task was correlated with variability in vertical and horizontal walking forces (28–50% variance explained, r2, across individual metrics, p=0.042–0.003). Greater GAD-7 total score was associated with greater walking speed and mean vertical and horizontal force (32–39% variance explained, p=0.029–0.012).

Conclusion: Gait variability was associated with a sensitive mood marker (average reaction time to sad faces), in this non-patient sample with low levels of self-reported depression. Self-reported anxiety was associated with average walking force and speed. Ongoing work is examining changes in metrics following physiotherapist-directed interventions and adapting the approach, with lived experience experts, for clinical studies.

Aims: The objective of this scoping review is to understand the extent and type of evidence in relation to psychotherapeutic interventions for older adults with depression and/or anxiety.

Methods: Prior to undertaking this scoping review, a preliminary search of the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, PubMed, CINAHL and American Journal of Psychiatry was conducted and no identical current or underway systematic reviews or scoping reviews on the topic were identified. The terms ‘old age psychiatry’ and ‘psychotherapy’ were used, and results were filtered for reviews and systematic reviews only. The scoping review will be conducted in accordance with the JBI methodology for scoping reviews. An electronic search for articles will be conducted using PubMed, American Journal of Psychiatry, Cambridge Core (BJPsych,) PsychInfo and Open Journal of Psychiatry. The databases will be searched for the following components: Older person’s mental health (using terms geriatric psychiatry, older person’s mental health, old age psychiatry.) AND Psychotherapy (using terms psychotherapy, talking therapies, cognitive behavioural therapy, cognitive analytical therapy, interpersonal therapy, group therapy, dialectical behavioural therapy, mindfulness, self help, psychodynamic therapy, psychoanalytical therapy, brief intervention, motivational interviewing.) AND Depression (using terms depression, loneliness, suicide, low mood) OR anxiety (using terms anxiety, panic disorder, generalised anxiety) using the title and abstract.

Only primary research studies to be included. Once the articles have been retrieved, they will be saved to an Excel spreadsheet and uploaded to Rayyan. The articles will then be checked and any duplicates will be removed. Two reviewers will check the articles by abstract and either include, exclude. The included articles will then be read, and analysed and written up into the scoping review report.

Results: Preliminary search: This returned 570 articles: 109 of these were relevant to this topic. The results returned 855. Results: 121 were included and 734 excluded. Psychotherapy research is worldwide but the main areas for primary research are North America and Europe. The majority of papers were randomised controlled trials looking at short-form therapy such as randomised controlled trials.

Conclusion: This scoping review has provided a foundation for the current evidence base looking at psychotherapeutic interventions for older adults with anxiety and depression. It would be good to do a similar review for older adults with other mental disorders such as mild cognitive impairment. It provides the foundation for researchers to move on to systematic reviews.

Aims: Delusional misidentification syndromes (DMS) are characterised by a delusional belief of misidentification concerning familiar individuals, places or objects and by the conviction that they have been replaced or transformed. Violent behaviours towards the “impostor” are often observed and can take the form of verbal threats or physical assault. This review explores the specific factors that increase the risk of violence in individuals with DMS.

Methods: An initial search was conducted in PsycInfo, MEDLINE, PubMed and PsycArticles in May 2023, followed by a subsequent search in November 2024, to identify publications reporting severe violence (e.g. homicide, attempted murder, assault) in individuals with DMS. 13 papers comprising 16 case reports were included in the review.

Results: The majority of patients were male (N=15), aged 29–43 (i.e. early- to mid-adult years) (N=14) at the time of the offence and had a prior diagnosis of a psychiatric disorder (N=13) (i.e. psychotic disorder). In 13 of 16 cases, the DMS was Capgras syndrome. The violent act most commonly perpetrated was homicide (including uxoricide, matricide, patricide, parricide and filicide) (N=21). Victims were mostly acquaintances or strangers (N=16), followed closely by familiar individuals (N=13). In 13 cases, social behaviour of the patients prior to the offence was described as “hostile”, “aggressive”, “solitary” or involving “poor social interactions from a young age”. Only 3 patients were described as “lively” or “social”.

Conclusion: The current systematic review identified specific factors such as a prior psychiatric diagnosis (i.e. of psychotic disorders), as well as male gender, early- to mid-adulthood, the type of DMS (i.e. Capgras syndrome) and social behaviour marked by isolation and hostility prior to the offence as potential contributors to severe violence in individuals with DMS. However, the lack of available case reports and empirical studies makes it challenging to understand the psychopathology exhibited and its relationship with violent behaviour. Further research is needed to advance our understanding of the possible factors associated with and the possible causes underlying the severity of violence exhibited in DMS.

Aims: The North London Foundation Trust was established in 2024. The partnership has created a new clinical strategy for the next 5 years (2024–2029) and some of the main priorities are: “For all services to use a trauma informed approach”, “Service users must be involved in co-production and decision making”, “Value feedback from service users”, “Facilitate communication and information sharing with service users”.

For these priorities to be addressed there need to be forums in which service users are able to be heard and fed back to using a trauma informed approach. Currently there are community meetings on the inpatient wards for service users and staff to feedback on any issues within the ward environment. On my ward these are poorly attended by both staff and patients and feedback from patients is that they raise the same issues, but nothing gets acted on. There is no set policy/protocol for how these meetings should run and who should be in attendance. By formalising the structure of the community meetings using a trauma informed framework, my hope is that both patients and staff benefit from the shared space and that the learning can be shared with other wards.

Objectives: To develop an evidence-based protocol for running community meetings on an inpatient psychiatric ward that fits within a trauma-informed framework; Improved attendance from staff and patients at the ward community meeting; Improved satisfaction from staff and patients attending community meetings; Share learning with other wards in the partnership.

Methods: A literature search to establish current best practice for running community meetings.

Qualitative questionnaires/ structured interviews and thematic analysis of staff interviews.

Development of protocol for running community meetings on inpatient wards.

3 month pilot of the new community meetings.

Attendance records pre and post intervention.

Results: Attendance records show improved attendance of both staff and patients at the weekly community meetings. Prior to the intervention, thematic analysis showed that staff thought there was a lack of clarity about goals, diverse interpretations of community meetings, and mixed expectations about patient involvement. Post intervention, analysis revealed that community meetings were widely appreciated as a valuable initiative that enhanced the ward culture, patient recovery, and staff-patient relationships. Despite challenges, many participants felt these meetings brought significant benefits.

Conclusion: Having a trauma-informed, semi-structured proforma for running inpatient community meetings helps to improve attendance, satisfaction and positive outcomes from the meetings for both staff and patients.

Aims: We hypothesise that mental health impacts of flooding will be greater in India compared with the UK. Climate change is causing an increase in flooding due to the rising frequency of extreme weather patterns globally. The major impacts of flooding on mental health include displacement, financial hardship, and loss of access to healthcare. These can lead to conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD).

Methods: This study was conducted as a comparative analysis. Data was collected by a systematic search of peer-reviewed articles. Standardised tools were used to evaluate psychological outcome and mental health morbidities such as the Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), WHO-5 and the PTSD checklist (PCL-6). Data concerning the mental health consequences caused by the floods (specifically regarding anxiety, depression and PTSD), financial impacts and access to mental health services in both countries were extracted. Our findings were then thematically analysed to compare the patterns and disparities.

Results: In both countries, the research conducted on the effects of flooding on mental health has identified that the three main mental health morbidities that arose are depression, anxiety and PTSD. India has an average percentage of 43.2% depression, 32.19% anxiety and 36.46% PTSD amongst individuals affected by flooding, while the UK shows equivalent rates of 25.52% depression, 24.2% anxiety and 31.49% PTSD. These results suggest that socioeconomic differences and access to mental health resources play a significant role in post-flood psychological states. In both countries a larger financial impact links to higher rates of psychological stress.

Conclusion: Although effects are noted in both the UK and India, the prevalence of mental health conditions arising from flooding affect both the UK and India. However, our findings indicate that the mental health impacts are more severe in India, supporting our hypothesis. In disaster recovery, mental health funding is frequently deprioritised in favour of immediate concerns such as physical health and infrastructure.

Stigma surrounding mental health, particularly affecting developing countries, contributes to under-reporting and therefore the accuracy of assessments. To improve outcomes, a public health approach may destigmatise mental health, and enhance social support. Additionally, Psychological First Aid has set international foundations for psychosocial care following distressing events, a framework which supports people whilst respecting culture and abilities.

Aims: Extreme weather events refer to weather events that are dramatically different from typical patterns. These can be catastrophic, unexpected and pose a risk to the population. This review aims to examine whether sufficient evidence exists to demonstrate a link between extreme weather events and an increase in mental health conditions, specifically PTSD, anxiety, and depression.

Methods: We conducted a literature search across multiple electronic databases, including PubMed, Web of Science, Scopus, and PsycINFO, for articles published between January 2000 and January 2025. Keywords include Extreme weather; Mental health; Depression; Anxiety; Post traumatic stress disorder. From this we used four articles reporting quantitative data on the prevalence of mental health conditions in those exposed to extreme weather events. The selection of these four articles is justified based on the relevance to our research question. They provide figures which allow us to compare mental health prevalence before and after extreme weathers took place. Furthermore, they offer a vast array of data, from various populations to weather patterns, enabling us to conduct more thorough research.

Results: All four studies reported a rise in PTSD, anxiety, depression following extreme weather events like floods, heatwaves, and wildfires. A meta-analysis of surveys that targeted people who had been affected by floods in the previous 12 months found that the prevalence rates of anxiety (25.2%), depression (26.3%), and PTSD (30.4%) were generally higher in this group than in the overall population. The prevalence of anxiety (5.7%) and PTSD (7.8%) in the overall population was considerably lower than this. In contrast, depression did not experience such a large spike (20.6%). However, a cross-sectional analysis aiming to assess the relationship between flooding and psychological morbidity concluded that those experiencing cumulative and repeated exposure to extreme weather events such as flooding had a significant increased risk of developing depression but did not impact the levels of anxiety or PTSD. Two studies highlighted vulnerable groups including older adults and those with pre-existing mental health conditions are more susceptible to experience deteriorating symptoms.

Conclusion: Overall, there is sufficient evidence to highlight the strong association between extreme weather leading to an increase in prevalence of mental health conditions. These findings emphasize the urgent need for mental health support and early intervention strategies for the communities affected.

Aims: A recently published systematic review studying the link between COVID-19 and new-onset dementia (NOD) concluded that COVID-19 infection is likely to be a risk factor for developing NOD in older adults at 12 months, but no increased risk was noted at 3 or 6 month post-infection. We present a case of an elderly gentleman ‘X’ with no prior history of any cognitive deficit, who developed behavioural problems and cognitive decline within 6 weeks of a COVID-19 infection.

Methods: X is a 70-year-old gentleman with no previous history of psychiatric illness prior to March 2020, when he contracted COVID-19. Within 6 weeks of a positive swab, there was an acute change in his behaviour and cognition, wherein he was noted to be more talkative, disinhibited, presenting with grandiose ideas, sleeping very little at night and displaying intermittent episodes of confusion. X had never complained of problems with his memory and the family had never previously raised concerns about the same. However, cognitive testing carried out at 3 months post-infection revealed a significant decline in cognitive ability (Montreal Cognitive Assessment 17/30).

X was referred to the neurology team, which carried out a battery of tests including MRI scans, DAT scan, cerebrospinal fluid analysis and antibody screens. These largely came back negative and no organic cause could be determined for X’s presentation. However, the screen for Neurofilament Light Polypeptide (NFL) was positive, which was reported to possibly indicate damage following COVID-19 infection. NFL is known to have links with Alzheimer’s disease pathology. Cognitive tests repeated in 2024 have returned a MOCA score of 16/30, indicating that X’s cognitive impairment continues to persist.

Results: A retrospective cohort study by Taquet et al. which looked at the association between COVID-19 infection and psychiatric disorder found that there was a two to three times increased risk of dementia after COVID-19 infection. A subsequent larger study by the same authors published in Lancet Psychiatry which looked at 6-month neurological and psychiatric outcomes following COVID-19 infection confirmed the link between COVID-19 and risk of NOD. The presentation of our patient X is consistent with this finding.

Conclusion: Our case study highlights the increased risk of cognitive decline and NOD following COVID-19 infection in older adults.

Aims: The prevalence of Alzheimer’s disease (AD) is increasing across the world, yet extensive research has not yielded effective curative treatment. Traditional Chinese Medicine (TCM) has shown benefits and potential in treating AD. However, there were no recent systematic reviews of the different TCM modalities in treating AD specifically. The primary aim of this systematic review (SR) was to investigate the effectiveness of TCM either as a standalone or adjunct treatment alongside conventional medication for AD. The secondary aim was to provide recommendations for treating AD by exploring the addition of TCM in clinical practice.

Methods: A systematic review with meta-analysis was performed, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search was performed on Medline, Allied and Complementary Medicine Database (AMED), Web of Science and Scopus, while grey literature was searched on Overton. There were no filters set on the date of publication, language, subject and author. The search terms of Traditional Chinese Medicine and Alzheimer’s disease were searched till 27 July 2024. The studies were screened to target patients with AD, therapies and herbs that have corresponding names in TCM and are randomised controlled trials (RCTs). This led to eleven included RCTs for narrative review and meta-analyses. Study Risk of Bias Assessment and quality assessment were performed. A random effects model was used in the meta-analysis to assess the efficacy of treatments.

Results: A total of 11 randomised controlled trials that comprise 1155 patients with AD were included. The included studies showed that TCM therapies of saffron, cistanches herba, MLC601, and Shenfu or Shenmai with Deproteinized Calf Blood Injection (DCBI) had therapeutic benefits as stand-alone therapy for improving cognitive function in patients with AD. Combined with results from the meta-analyses, bushenhuatanyizhi, Guilingji and Jiannao Yizhi formula also showed potential as stand-alone therapy in improving cognitive function and activities of daily living. Two studies supported adding Dengzhan Shengmai or Huanglian Jiedu decoction as an adjunct to conventional treatment. Hachimijiogan showed some effect in slowing cognitive decline as an adjunct therapy, while Yokukansan can help with managing behavioural and psychological symptoms of dementia.

Conclusion: This review adds support to the current literature of the potential of TCM therapies in treating AD. A search on the Chinese databases, investigating the mechanisms behind how these interventions work and using a combination of TCM therapies are potential future studies on alternate forms of treatment for patients with AD.

Aims: In obsessive-compulsive disorder (OCD), treatment non-response is common with recommended medications; hence there is a need to investigate the role of alternative agents. It was intended to evaluate the evidence base involving ondansetron as a treatment strategy for OCD in adults, considering its role as a 5-HT3 receptor antagonist primarily in the limbic system.

Methods: Various electronic databases (PubMed, CINAHL, EMBASE, PsycInfo, Cochrane, Clinical Trials Registers, and PROSPERO) were searched for articles with keywords of ‘ondansetron’, ‘obsessive-compulsive disorder’ or ‘OCD’, and ‘clinical trial’, in the English language, published up to October 2024.

Results: Nine studies were included in this systematic review. Studies used Yale–Brown Obsessive Compulsive Scale (YBOCS) scale for assessment and ondansetron mostly as an augmenting drug. More than half of the studies (five out of nine) had patients with treatment-resistant OCD, and serotonin reuptake inhibitors as the active drug. All trials reported improvement in OCD with ondansetron augmentation, except the study which involved chart review for treatment-resistant OCD. The improvement was observed as early as two weeks following ondansetron augmentation. The reported range of decrease in YBOCS score from baseline in various studies has been 23.2–55%. Treatment response was reported between 37–86.4%. Improvement was noticed in both OCD and treatment-resistant OCD groups. Discontinuation of ondansetron led to worsening of symptoms which was reported in two studies. Overall adverse effects of ondansetron were mild to moderate in degree, with no major clinical concerns, and were generally well tolerated. Commonly reported side effects were constipation, headache, diarrhoea, decreased appetite, dizziness, insomnia, anxiety, nervousness, sweating, dry mouth, muscle cramp and sexual dysfunction. Available studies have major limitations which are mostly small sample sizes and short duration of trials.

Conclusion: Current evidence suggests ondansetron may be beneficial in the treatment of OCD and treatment-resistant OCD, mostly as an augmentation agent; however the evidence is scarce to draw any firm conclusion. Further trials with adequate sample size and duration are required.

Aims: Could a hypothetical future Artificial General Intelligence (AGI) suffer from a mental illness? While this question may evoke differing intuitions, the following arguments propose that such an AGI could indeed experience mental pathology.

Methods: To prove that an AGI could suffer from a mental illness, the method of philosophical thought experiment using a priori deductive reasoning has been employed. The argument’s premises are justified by known principles of computer science and psychiatry.

Results: Though AGI systems do not yet exist, exploring their potential nature can offer valuable insights into conceptualising the pathogenesis of psychiatric illness. Consider the following deductive inference: Premise 1: People can suffer from mental illness. Premise 2: A future AGI will be a person, i.e. a conscious entity capable of generating new knowledge. Conclusion: An AGI will be a person and therefore can suffer from a mental illness.

Conclusion: From computer science and physics, we know in principle that AGI must be possible. The intuition that an AGI would be conscious, and therefore susceptible to mental illness, finds support from the Church–Turing–Deutsch principle. That is to say, any Turing-complete system, which includes all modern computers, can simulate any physical system, including the human brain. The human brain is a known structure that supports general intelligence, minds and consciousness. While brains are not isolated systems and have internal and external environmental inputs and outputs, these could also be computationally simulated. The key question is whether such a simulated brain would actually be conscious or merely simulate consciousness. It seems logically incoherent to “simulate” consciousness, as a successful attempt to simulate a conscious brain would necessarily result in the creation of a conscious being. Therefore, like a human mind, it seems consistent to suggest the mind of an AGI can suffer from mental illness.

Unlike humans, an AGI will not have a biological brain. Instead, its mind will presumably run on a silicon-based substrate. This suggests that brains are not fundamental to the pathophysiology of mental illness. Rather, we can speculate that information and its aberrant processing play a more central role in the emergence of mental disorders.