De-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness.

To conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training.

The review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis.

A total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and de-escalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results.

It is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects.

The relationship between well-being and mental ill health is complex; people may experience very low levels of well-being even in the absence of overt mental health problems.

This study tested the hypothesis that anxiety, depression and well-being have different causal determinants and psychological mediating mechanisms.

The influence of causal and mediating factors on anxiety, depression and well-being were investigated in a cross-sectional online questionnaire survey hosted on a UK national broadcasting website.

Multivariate conditional independence analysis of data from 27 397 participants revealed different association pathways for the two constructs. Anxiety and depression were associated with negative life events mediated by rumination; low levels of subjective well-being were associated with material deprivation and social isolation, mediated by adaptive coping style.

Our findings support the ‘two continua’ model of the relationship between psychological well-being and mental health problems, with implications for both treatment and prevention.

Research on mental well-being is relatively new and studies of its determinants are rare.

To investigate whether the socioeconomic correlates of mental well-being mirror those for mental illness.

Using logistic regression analyses, the independent odds ratios of high and low mental well-being, compared with middle-range mental well-being, were estimated for a number of sociodemographic variables known to be associated with mental illness from 13 983 participants in the 2010 and 2011 Health Surveys for England.

Independent odds ratios for low mental well-being were as expected from studies of mental illness with increased odds for the unemployed (OR = 1.46, 95% CI 1.01–2.10) and those aged 35–54 years (OR = 1.58, 95% CI 1.35–1.84) and reduced odds for the married (OR = 0.78, 95% CI 0.62–0.97). A linear trend was observed with education and equivalised income. Odds ratios for high mental well-being differed from those for low mental well-being with regard to age (55+ years: OR = 1.48, 95% CI 1.23–1.79); employment status where there was an association only with retirement (OR = 1.35, 95% CI 1.09–1.69); education where there was no association; and equivalised income for which the association was non-linear.

Odds ratios for low mental well-being mirrored those for mental illness, but not those for high mental well-being, suggesting that the socioeconomic factors associated with positive mental health are different from those associated with mental illness.

Durkheim's seminal historical study demonstrated that religious affiliation reduces suicide risk, but it is unclear whether this protective effect persists in modern, more secular societies.

To examine suicide risk according to Christian religious affiliation and by inference to examine underlying mechanisms for suicide risk. If church attendance is important, risk should be lowest for Roman Catholics and highest for those with no religion; if religiosity is important, then ‘conservative’ Christians should fare best.

A 9-year study followed 1 106 104 people aged 16–74 years at the 2001 UK census, using Cox proportional hazards models adjusted for census-based cohort attributes.

In fully adjusted models analysing 1119 cases of suicide, Roman Catholics, Protestants and those professing no religion recorded similar risks. The risk associated with conservative Christians was lower than that for Catholics (HR = 0.71, 95% CI 0.52–0.97).

The relationship between religious affiliation and suicide established by Durkheim may not pertain in societies where suicide rates are highest at younger ages. Risks are similar for those with and without a religious affiliation, and Catholics (who traditionally are characterised by higher levels of church attendance) do not demonstrate lower risk of suicide. However, religious affiliation is a poor measure of religiosity, except for a small group of conservative Christians, although their lower risk of suicide may be attributable to factors such as lower risk behaviour and alcohol consumption.

Despite growing interest in men's perinatal mental health, we still know little about whether becoming a new father is associated with increases in psychological distress.

To use prospective longitudinal data to investigate whether becoming a first-time expectant (partner pregnant) and/or new father (child <1 year) is associated with increases in depression and anxiety.

Men were aged 20–24 years at baseline (n = 1162). Levels of depression and anxiety were measured at four time points over 12 years. Over this time, 88 men were expectant fathers, 108 men were new fathers and 626 men remained non-fathers.

Longitudinal mixed models showed no significant increase in depression or anxiety as a function of expectant or new fatherhood, as compared with pre-fatherhood levels.

Our findings suggest that, generally, expectant and new fathers are not at greater risk of depression or anxiety. Future epidemiological research should continue to identify men who are most (and least) at risk to focus resources and assistance most effectively.

Alterations of cortical thickness have been shown in imaging studies of schizophrenia but it is unclear to what extent they are related to disease phenotype (including symptom profile) or other aspects such as genetic liability, disease onset and disease progression.

To test the hypothesis that cortical thinning would vary across different subgroups of patients with chronic schizophrenia, delineated according to their symptom profiles.

We compared high-resolution magnetic resonance imaging data of 87 patients with DSM-IV schizophrenia with 108 controls to detect changes in cortical thickness across the entire brain (P<0.05, false discovery rate-adjusted). The patient group was divided into three subgroups, consisting of patients with predominantly negative, disorganised or paranoid symptoms.

The negative symptoms subgroup showed the most extensive cortical thinning, whereas thinning in the other subgroups was focused in prefrontal and temporal cortical subregions.

Our findings support growing evidence of potential subtypes of schizophrenia that have different brain structural deficit profiles.

Genetic testing in psychiatry promises to improve patient care through advances in personalised medicine. However, there are few clinically relevant examples.

To determine whether patients with a well-established genetic subtype of schizophrenia show a different response profile to the antipsychotic clozapine than those with idiopathic schizophrenia.

We retrospectively studied the long-term safety and efficacy of clozapine in 40 adults with schizophrenia, half with a 22q11.2 deletion (22q11.2DS group) and half matched for age and clinical severity but molecularly confirmed to have no pathogenic copy number variant (idiopathic group).

Both groups showed similar clinical improvement and significant reductions in hospitalisations, achieved at a lower median dose for those in the 22q11.2DS group. Most common side-effects were similarly prevalent between the two groups, however, half of the 22q11.2DS group experienced at least one rare serious adverse event compared with none of the idiopathic group. Many were successfully retried on clozapine.

Individuals with 22q11.2DS-schizophrenia respond as well to clozapine treatment as those with other forms of schizophrenia, but may represent a disproportionate number of those with serious adverse events, primarily seizures. Lower doses and prophylactic (for example anticonvulsant) management strategies can help ameliorate side-effect risks. This first systematic evaluation of antipsychotic response in a genetic subtype of schizophrenia provides a proof-of-principle for personalised medicine and supports the utility of clinical genetic testing in schizophrenia.

Numerous early intervention services targeting young people with psychosis have been established, based on the premise that reducing treatment delay and providing intensive treatment in the initial phase of psychosis can improve long-term outcome.

To establish the effect of extending a specialised early intervention treatment for first-episode psychosis by 1 year.

A randomised, single-blind controlled trial (NCT01202357) compared a 1-year extension of specialised early intervention with step-down care in patients who had all received a 2-year intensive early intervention programme for first-episode psychosis.

Patients receiving an additional year of specialised intervention had better outcomes in functioning, negative and depressive symptoms and treatment default rate than those managed by step-down psychiatric care.

Extending the period of specialised early intervention is clinically desirable but may not be feasible in lower-income countries.

A cognitive–behavioural therapy (CBT) programme designed for post-traumatic stress disorder (PTSD) in people with severe mental illness, including breathing retraining, education and cognitive restructuring, was shown to be more effective than usual services.

To evaluate the incremental benefit of adding cognitive restructuring to the breathing retraining and education components of the CBT programme (trial registration: clinicaltrials.gov identifier: NCT00494650).

In all, 201 people with severe mental illness and PTSD were randomised to 12- to 16-session CBT or a 3-session brief treatment programme (breathing retraining and education). The primary outcome was PTSD symptom severity. Secondary outcomes were PTSD diagnosis, other symptoms, functioning and quality of life.

There was greater improvement in PTSD symptoms and functioning in the CBT group than in the brief treatment group, with both groups improving on other outcomes and effects maintained 1-year post-treatment.

Cognitive restructuring has a significant impact beyond breathing retraining and education in the CBT programme, reducing PTSD symptoms and improving functioning in people with severe mental illness.

Anxiety is common and problematic in dementia, yet there is a lack of effective treatments.

To develop a cognitive–behavioural therapy (CBT) manual for anxiety in dementia and determine its feasibility through a randomised controlled trial.

A ten-session CBT manual was developed. Participants with dementia and anxiety (and their carers) were randomly allocated to CBT plus treatment as usual (TAU) (n = 25) or TAU (n = 25). Outcome and cost measures were administered at baseline, 15 weeks and 6 months.

At 15 weeks, there was an adjusted difference in anxiety (using the Rating Anxiety in Dementia scale) of (–3.10, 95% CI −6.55 to 0.34) for CBT compared with TAU, which just fell short of statistical significance. There were significant improvements in depression at 15 weeks after adjustment (–5.37, 95% CI −9.50 to −1.25). Improvements remained significant at 6 months. CBT was cost neutral.

CBT was feasible (in terms of recruitment, acceptability and attrition) and effective. A fully powered RCT is now required.