Scalable assessment tools for precision psychiatry are of increasing clinical interest. One clinical risk assessment that might be improved by such approaches is assessment of violence perpetration risk. This is an important adverse outcome to reduce for some people presenting to services for first-episode psychosis. A prediction tool (Oxford Mental Illness and Violence (OxMIV)) has been externally validated in these services, but clinical acceptability and role need to be examined and developed.

This study aimed to understand clinical use of the OxMIV tool to support violence risk management in early intervention in psychosis services in terms of acceptability to clinicians, patients and carers, practical feasibility, perceived utility, impact and role.

A mixed methods approach integrated quantitative data on utility and patterns of use of the OxMIV tool over 12 months in two services with qualitative data from interviews of 20 clinicians and 12 patients and carers.

The OxMIV tool was used 141 times, mostly in new assessments. Required information was available, with only family history items scored unknown to any notable degree. The OxMIV tool was deemed helpful by clinicians in most cases, especially if there were previous risk concerns. It was acceptable practically, and broadly for the service, for which its concordance with clinical judgement was important. Patients and carers thought it could improve openness. There was some limited impact on plans for clinical support.

The OxMIV tool met an identified clinical need to support clinical assessment for violence risk. Linkage to intervention pathways is a research priority.

The literature on cortical excitability, inhibitory and facilitatory properties of the brain in patients with primary dystonia is not well elucidated. We aimed to study the changes in these neurophysiological parameters in patients with dystonia using transcranial magnetic stimulation (TMS).

Patients with primary dystonia of presumed genetic etiology (n = 36) and an equal number of healthy controls (HC) (n = 36) were recruited from May 2021 to September 2022. TMS was done using single and paired pulse paradigms. The left motor cortex was stimulated, and responses were recorded from the contralateral first dorsal interosseus muscle. Resting motor threshold (RMT), central motor conduction time, contralateral silent period (cSP), ipsilateral silent period (iSP), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were recorded. All patients underwent whole exome sequencing.

The mean age of patients was 36.6 ± 13.5 years. There was a significant reduction of cSP (79.5 ± 33.8 vs 97.5 ± 25.4, p = 0.02) and iSP (42.3 ± 13.5 vs 53.8 ± 20.8, p = 0.003) in patients compared to HC. SICI was significantly enhanced in patients (0.38 ± 0.23) compared to HC (0.51 ± 0.24, p = 0.006). RMT was higher (42.1 ± 7.9 vs 37.1 ± 6.4%, p = 0.032) with enhanced SICI (0.36 ± 0.21 vs 0.56 ± 0.25, p = 0.004) in patients with generalized dystonia (n = 20) compared to HC. The genetically determined subgroup (n = 13) had significantly enhanced SICI compared to HC (0.23 ± 0.15 vs 0.51 ± 0.23, p = 0.001).

Patients with primary dystonia have altered cortical excitability and inhibition with significantly reduced silent period and enhanced intracortical inhibition suggestive of impaired GABAergic neurotransmission.

The study assessed the interactions and the impact of specialist mobile community care teams (assertive outreach teams or AOTs) implemented in the mental health (MH) system of Bizkaia (Spain) using a methodology derived from an ecosystem perspective.

First, the experts assessed the system’s services and codified them according to an international classification system. Second, following an iterative methodology for expert-knowledge elicitation, a clients’ flow diagram showing the inter-dependencies of the system’s components was developed. It included variables and their relationships represented in a causal model. Third, the system elements where the AOTs had a major impact (stress nodes) were identified. Fourth, three scenarios (variable combinations representing the ‘stress points’ of the system) were modelled to assess its relative technical efficiency (technical performance indicator).

The classification system identified the lack of fidelity of the AOTs to the original assertive community treatment model, categorizing them as non-acute low-intensity mobile care. The causal model identified the following elements of the system as ‘stress nodes’ in relation to AOT: users’ families; social services (outside of the healthcare system); acute hospitals; non-acute residential facilities and, to a lesser extent, acute hospital day care services. When the stress nodes inside the healthcare system were modelled separately, acute and non-acute hospital care services resulted in a large deterioration in the system performance, while acute day hospital care had only a small impact.

The development of the expert-knowledge-based causal model from an ecosystem perspective was helpful in combining information from different levels, from nano to macro, to identify the components in the system likely to be most affected by a potential policy intervention, such as the closure of AOTs. It was also able to illustrate the interaction between the MH system components over time and the impact of the potential changes on the technical performance of the system. Such approaches have potential future application in assisting with service planning and decision-making in other health systems and socio-economic contexts.

One of the most effective treatments for social anxiety disorder (SAD) is cognitive behavioural therapy (CBT). Prior research indicates group cohesion is connected to treatment success in group CBT for SAD (CBGT). Videoconference CBGT delivery is now common following the COVID-19 pandemic; however, research investigating treatment outcomes and group cohesion in videoconference CBGT for SAD is limited.

The present study aimed to compare group cohesion in videoconference CBGT for SAD to group cohesion in both in-person CBGT for SAD and videoconference CBGT for other anxiety and related disorders. A secondary aim was to compare symptom reduction across all three groups.

Patients completed a 12-week CBGT program for SAD in-person (n=28), SAD via videoconference (n=46), or for another anxiety or related disorder via videoconference (n=100). At mid- and post-treatment patients completed the Group Cohesion Scale Revised (GCS-R), and at pre- and post-treatment patients completed the Social Phobia Inventory (SPIN, only in the SAD groups) and the Depression Anxiety Stress Scales (DASS-21).

Over the course of treatment, all three groups showed a significant increase in cohesion and a significant decrease in symptoms (ηp2 ranged from .156 to .562, all p<.001). Furthermore, analyses revealed no significant difference in cohesion scores between groups at both mid- and post-treatment.

These results suggest that videoconference CBGT for SAD is similarly effective in facilitating cohesion and reducing symptoms compared with in-person delivery. Limitations of the study and implications for treatment are discussed.

The notion of cognitive detachment (i.e. the capacity to treat thoughts as just thoughts, with no greater significance or importance) is introduced in this paper. Its link to similar established terminologies (e.g. distancing, decentering, defusion/deliteralisation, detached mindfulness), importance within cognitive behaviour therapies and place within an adapted cognitive-behavioural framework is highlighted. The use of metaphor to facilitate cognitive detachment is then the primary focus of the paper. An overview of how metaphor has typically been used within psychotherapy is presented and reflects mostly the use of therapist-generated metaphor for psychoeducational purposes. While the use of metaphor in serving a therapeutic cognitive detachment function is not new, developing idiosyncratic client-generated metaphors in this regard has been largely neglected, despite the widely held view that client-generated metaphors are more potent. Practical guidance on how clinicians can collaboratively assist clients to intentionally generate their own personalised cognitive detachment metaphor is provided, and specific ways to elaborate metaphors during therapy to enhance metaphor application and hence effectiveness in enabling cognitive detachment is considered. Finally, clinical examples are provided to illustrate the varied, creative and rich metaphors that can emerge from this process.

1. (1) To introduce the term cognitive detachment and understand this important therapy target within an adapted cognitive-behavioural framework.

2. (2) To appreciate the broader use of metaphors in therapy and frame metaphor as one method for facilitating cognitive detachment.

3. (3) To motivate therapists to pursue idiosyncratic client-generated metaphor.

4. (4) To provide an instructional script to support therapists to help clients develop a personalised cognitive detachment metaphor.

5. (5) To provide specific guidance to therapists regarding methods for metaphor elaboration.

Depression affects twice as many women as men. Risk factors for depression certainly impact this difference, but their strong interconnectedness challenges the assessment of standalone contributions. Network models allow the identification of systematic independent relationships between individual symptoms and risk factors. This study aimed to evaluate whether the extended networks of depressive symptoms, cognitive functions, and leisure activities in like-sex twins differ depending on gender or zygosity.

Twins, including 2,040 women (918 monozygotic and 1,122 dizygotic) and 1,712 men (730 monozygotic and 982 dizygotic), were selected from the Danish Twin Registry for having, along with their like-sex co-twin, completed measures of depressive symptoms, cognition, and leisure activities (physical, intellectual, and social). Network models were estimated and compared at three levels: co-twins to each other within groups defined by gender and zygosity; monozygotic to dizygotic twins within the same gender, and between genders.

No significant differences were observed when co-twins were compared to each other, regardless of the pair’s zygosity or gender, nor when monozygotic twins were compared to dizygotic twins within gender. However, the gendered networks differed significantly in global strength, structure, and partial correlations between specific depressive symptoms and risk factors, all indicating stronger connectedness in women relative to men.

Environmental factors appear to best explain between-gender network differences. Women’s networks showed significantly stronger associations both among depressive symptoms and between depressive symptoms and risk factors (i.e., decreased cognition and leisure activities). Longitudinal research is needed to determine the causality and directionality of these relationships.

Increasing attention has been recently devoted to treatment-resistant depression (TRD); however, its clinical characteristics, potential risk factors, and course are still debated. Most recently, childhood trauma exposure has been correlated to TRD, but systematic investigation on the role of lifetime trauma is still lacking. The aim of this paper was to revise current evidence on early and recent trauma exposure in TRD.

A systematic search was conducted from the 1st of June to the 20th of February 2024 in accordance with the PRISMA 2020 guidelines and using the electronic databases PubMed, Web of Science, and Embase.

The primary database search produced a total of 1998 record, and finally, the search yielded a total of 22 publications, including 18 clinical studies, 3 case reports, and 1 case series, all from the period 2014 to 2024.

Limitations include a small sample size of some studies and the lack of homogeneity in the definition of TRD. Furthermore, we only considered articles in English, we excluded preprints or abstracts, and we included case reports.

This review highlights the role of early and recent trauma in TRD, even in the absence of a full-blown post-traumatic stress disorder (PTSD), highlighting the need for a thorough assessment of trauma in patients with TRD and of its role as a therapeutic target.

The COVID-19 pandemic has had a negative impact on the population’s mental health, particularly for individuals with health anxiety (HA) and obsessive compulsive disorder (OCD). This is in conjunction with a significant change in accessibility of face-to-face psychological services which have had to rapidly adapt to the remote delivery of therapy.

Using a single-arm open trial design, the study aimed to evaluate the effectiveness of evidence-based CBT interventions for HA and OCD delivered via a blend of online therapist consultations interspersed with self-study reading materials. A secondary aim was to evaluate remote training workshops provided to therapists.

Therapists attended three half-day remote workshops after which consecutive participants with HA or OCD were assigned to therapists for treatment. Monthly expert supervision was provided. Patients completed routine outcome measures at each session and an idiosyncratic measure of pre-occupation with COVID-19 at pre- and post-treatment.

Significant and comparable improvements were observed on measures of anxiety, depression and social adjustment from pre- to post-treatment in both the HA (n=14) and OCD (n=20) groups. Disorder-specific measures also showed significant improvements after treatment. The HA group showed greater levels of change on the COVID-19-specific questionnaire. The training workshops were well received by therapists, who valued the monthly supervision sessions.

The study provides support for the effectiveness of the online delivery of CBT for HA and OCD supported by the inclusion of additional self-study booklets.

Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of osteoporosis, and sertraline may be more potent than citalopram in this regard. Here, target trial emulation was used to investigate whether sertraline, citalopram and escitalopram (the S-enantiomer of citalopram) differentially affect the risk of osteoporosis. Subsequently, it was examined whether SSRIs increase the risk of osteoporosis in a dose-response-like manner.

Danish nationwide registers were used to identify all individuals that initiated treatment for depression with sertraline, citalopram, or escitalopram between January 1, 2007, and March 1, 2019. These individuals were followed until development of osteoporosis, death, or end of follow-up. Cox proportional hazards regression was used to adjust for relevant baseline covariates to emulate randomised treatment allocation to compare the rate of osteoporosis for individuals treated with sertraline, citalopram or escitalopram. Subsequently, the cumulative dose of sertraline, citalopram, and escitalopram was calculated, and Cox proportional hazards regression was used to assess dose-response-like relationships with osteoporosis.

We identified 27,280, 65,529, and 17,703 individuals initiating treatment with sertraline, citalopram, and escitalopram, respectively. There was no material or statistically significant differential risk of osteoporosis between these groups (adjusted hazard rate ratio, aHRR = 0.98 for citalopram versus sertraline and aHRR = 0.94 for escitalopram versus sertraline). The results were not indicative of the SSRIs having a dose-response-like effect on osteoporosis risk.

Sertraline, citalopram and escitalopram do not appear to differentially affect the risk of osteoporosis. The lack of clear dose-response-like relationships suggest that they do not have a causal effect on osteoporosis risk.