Human papillomavirus (HPV) infection has a negative impact on quality of life (QoL) and sexual function, mainly owing to increased levels of anxiety and distress.

To examine the potentially moderating effects of general psychological health on the relationships between (a) HPV-related psychosocial burden and QoL and (b) HPV-related psychosocial burden and sexual function.

The HPV Impact Profile, Female Sexual Function Index, General Health Questionnaire-28 and Life Satisfaction Inventory questionnaires were completed by 151 women.

HPV-related psychosocial burden and general psychological health accounted for 23.2% of QoL variability. There was not strong evidence for a moderating effect of general psychological health on the relationship between HPV-related psychosocial burden and QoL. Higher HPV-related psychosocial burden predicted worse sexual function on average. However, HPV-related psychosocial burden accounted for only 4.1% of sexual function variability.

Higher HPV-related psychosocial burden is associated with lower QoL as well as worse sexual function. General psychological health predicts changes in QoL over and above HPV-related psychosocial burden; thus, a deep understanding of emerging mental health issues soon after diagnosis is crucial to improve counselling and enhance women’s mental empowerment to achieve a better psychological response.

Mental health difficulties affect the well-being of doctors and compromise the delivery of healthcare. However, large-scale data on doctors’ mental health needs are limited.

Describe patterns of self-referrals for mental health support among doctors in England and explore associations with demographic factors, speciality, neurodevelopmental and mental health indicators.

Observational study using data from doctors who self-referred for mental health difficulties to a national service in England over a 4-year period. Logistic regression was used to explore associations between speciality and mental health indicators.

Of the 16 815 doctors who self-referred during the study period, 80% were under the age of 49 and 70.6% were female with the two largest ethnicities being 65.1% White and 22.7% Asian. Women were more likely to report higher scores for depression (odds ratio 0.90, 95% CI = 0.84 to 0.97), anxiety (odds ratio 0.78, 95% CI = 0.72 to 0.84) and psychological distress (odds ratio 0.78, 95% CI = 0.70 to 0.87), but males were more likely to screen positive for attention-deficit hyperactivity disorder (ADHD) symptoms. Doctors in general practice accounted for 46.3% of referrals. Compared with them, doctors in most other specialities had higher odds of elevated mental health scores across all measures, including ADHD.

The findings highlight a significant mental health burden among self-referring doctors, particularly for females and doctors in non-general practice specialities. Tailored and easily accessible support strategies that account for both demographic and professional contexts are essential to address the diverse mental health needs of the medical workforce.

As guided by the General Medical Council and the Royal College of Psychiatrists, the inclusion of experts by experience is a required component of British undergraduate medical education and postgraduate psychiatry training. However, this has not been formally applied to the training of Mental Health Tribunal (MHT) and Special Educational Needs and Disability (SEND) Tribunal members who are advised on reasonable adjustments for patients and appellants through the Equal Treatment Bench Book, including guidance on Autism Spectrum Disorder (ASD).

This study aims to evaluate the impact of expert-patient input on tribunal members’ understanding of ASD following a dedicated training programme. We hypothesise that the training day will increase participants’ confidence regarding reasonable adjustments for patients with ASD and will be perceived as novel and valuable.

A multidisciplinary training day was delivered to MHT and SEND Tribunal members in England, jointly by clinicians and experts by experience. The training offered a multimodal overview of ASD and its treatment, and how reasonable adjustments can be made in tribunal hearings.

To evaluate the session, data was collected via online post-session feedback questionnaires. Items were selected to assess participants’ confidence with regard to the training’s learning outcomes, the perceived novelty and value of expert-by-experience involvement, and participants’ willingness to receive a follow-up email six weeks post-training to support consideration of reasonable adjustments.

The training programme was attended by 54 MHT and SEND Tribunal members, of which 24 were judges, 13 were consultant psychiatrists, and 17 were other specialists involved in the care of patients with ASD.

Ninety-four per cent of respondents reported feeling confident after the training session, an increase from retrospectively reported pre-session confidence of 50% (n=18). Over half had no prior exposure to expert-by-experience training (55%, n=47), while a large majority thought MHT and SEND tribunal training should include more input from experts by experience (89%, n=46). 68% of participants (n=45) opted to receive an email six weeks post-training to be prompted to continue to make reasonable adjustments for patients with ASD.

The findings reinforce the effectiveness of expert-by-experience input and highlight its lack of incorporation to date in tribunal training. The willingness of participants to receive a follow-up email six weeks post-training suggests an openness to reflection. Further work should explore how such involvement can be sustainably embedded within tribunal training to support awareness of mental health conditions, including ASD, and the implementation of reasonable adjustments in hearings.

Anhedonia (loss of pleasure) is a core feature of both depression and psychosis and yet the experience is not well understood. This limits our ability to effectively target it with psychological or pharmacological interventions.

The aim of this study was to explore the experience of anhedonia, for the first time from a transdiagnostic perspective.

Semi-structured interviews, co-facilitated by lived-experience experts, were conducted among 17 adults with a diagnosis of depression or psychosis and who were experiencing anhedonia. Reflexive thematic analysis was employed to generate themes.

Six themes were identified: (a) no longer experiencing pleasure or joy in previously enjoyable activities; (b) grieving for the joyful times that have been missed; (c) the dilemma before trying an activity again; (d) the significant social impact of anhedonia, and the power of lived-experience connections; (e) uncertainty around what causes anhedonia; and (f) the lack of acknowledgement or support from services around this experience. The words disconnection and frustration were those most used to describe what people felt when experiencing anhedonia.

The results highlight the negative impact of expectation and social pressure on joy, and the importance of the anticipatory period prior to trying an activity again. The clinical implications highlight the importance of discussing anhedonia with patients: by not doing so is contributing to stigma. This is the first study to directly explore anhedonia in adults, with lived-experience input throughout, and the findings support further work adopting a wider transdiagnostic approach.

Emergency department mental health practitioners (MHPs) decide onward care for individuals presenting with self-harm or suicidal ideation. However, their experiences and practices in making these decisions remain underexplored.

To synthesise research on MHPs’ experiences and practices in making decisions about onward care for patients presenting to emergency departments with self-harm or suicidal ideation.

We searched six databases (inception to July 2024) for empirical studies of MHPs making care decisions for self-harm or suicidal patients in emergency departments. We used a segregated mixed-methods design, applying narrative synthesis of quantitative data and thematic synthesis of qualitative data.

Eleven studies were included (one quantitative, one mixed-methods, nine qualitative). Narrative synthesis of quantitative data produced two themes: (a) subjective decision-making and variability among MHPs and (b) impact of the institutional mandate to discharge within 4 h on referral outcomes. Thematic synthesis of qualitative data generated five themes: (a) risk-centric culture is anti-therapeutic and shapes defensive practice, scepticism toward patients and burnout; (b) time and environmental pressures impact therapeutic potential of assessments; (c) ‘battling’ to access services: gatekeeping, cycles of repeat attendances affecting patient safety and staff moral injury; (d) strategies to facilitate access and extending care to overcome challenges in the emergency department and (e) potential for training to counter negative attitudes and stereotypes.

Intersecting institutional, systemic and emotional pressures shape MHPs’ practices, undermining assessment quality and access to care. System-level reforms and training should promote relational, compassionate care. Limited quantitative evidence restricted integration, and the review reflects high-income Western settings.

Depression screening in primary care has been widely discussed, but its economic implications have remained largely unexplored. The GET.FEEDBACK.GP randomised controlled trial evaluated feedback interventions after depression screening in primary care. The study arms were (a) feedback provided to the general practitioner; (b) feedback to both the patient and the treating general practitioner; and (c) a control group without feedback. Analysis of clinical effectiveness revealed that feedback interventions were not associated with decreased depression severity. Their economic implications were the subject of this study.

To evaluate the economic impact of general-practitioner- and patient-targeted feedback following depression screening for adults in German primary care.

A cost-effectiveness analysis from a societal perspective of feedback interventions after depression screening with a time horizon of 12 months was conducted. Direct and indirect costs were estimated. Quality-adjusted life years were calculated on the basis of the EQ-5D-5L, and incremental cost-effectiveness ratios and cost-effectiveness acceptability curves based on the net monetary benefit were constructed. Sensitivity analyses and post hoc explorative subpopulation analyses were performed. Trial registration: ClinicalTrials.gov, NCT03988985.

In total, 987 participants who screened positive for at least moderate depression were included. Feedback provision was not significantly associated with changes in costs or quality-adjusted life years during follow-up. Cost-effectiveness probabilities of feedback interventions were lower than 50% compared with no feedback. Higher cost-effectiveness probabilities were observed in patients whose suspected depression was confirmed 1 month post-screening and in those with previous depression.

The analysed feedback interventions cannot be considered to be cost-effective for the investigated population. Patient-targeted feedback was potentially cost-effective for subpopulations, particularly patients with a later confirmed depression diagnosis; this requires further research.

South Asians are the largest ethnic minority group in the UK. Despite having an elevated incidence of psychotic disorders compared to the European-ancestry majority, this group remains underrepresented in genomic research.

The heritability of schizophrenia (SCZ) is high, with around one quarter attributable to common genetic variants. Polygenic risk scores (PRS) summarise their combined contribution. The NHS 10-year plan prioritises implementation of population-based PRS to facilitate early identification of common diseases. PRS are derived from largely European-ancestry genome-wide association studies (GWAS), raising questions about the transferability of the SCZ PRS in ethnic minority populations.

This study aimed to examine the association between SCZ PRS, SCZ diagnosis, and antipsychotic prescribing in a South Asian cohort. Additionally, it aimed to compare PRS between individuals prescribed any antipsychotic and those prescribed injectable antipsychotics or clozapine as proxies for illness severity.

We analysed data from Genes & Health, a community-based cohort with linked genetic and electronic health records for over 65,000 Pakistani and Bangladeshi individuals in the UK. PRS were derived from summary statistics from a largely European-ancestry SCZ GWAS. We examined associations between PRS, SCZ diagnosis, and antipsychotic prescribing, with secondary analyses of clozapine or injectable antipsychotic use.

SCZ PRS was associated with SCZ diagnosis (OR=1.51 per SD). However, SCZ PRS showed only a weak association with antipsychotic use in the full sample (OR=1.04 per SD).

SCZ diagnosis was strongly associated with antipsychotic prescribing (OR=28.4). Among those with SCZ, there was a stronger association between PRS and antipsychotic use (OR=1.45 per SD). Quintile analyses showed a pronounced extreme-risk pattern, with individuals in the highest PRS quintile having higher odds of antipsychotic use compared with those in the lowest quintile (OR=3.4). The PRS–antipsychotic association was modified by SCZ diagnosis (p=0.048). Among individuals with a diagnosis of SCZ and prescribed an antipsychotic, a higher PRS was associated with increased odds of clozapine or injectable antipsychotic use (OR=1.37 per SD).

SCZ PRS derived from European-ancestry GWAS is associated with a diagnosis of SCZ in a South Asian ancestry cohort and higher PRS scores were associated with antipsychotic prescriptions. In those with a diagnosis of SCZ, higher PRS scores were also associated with clozapine or injectable antipsychotic use. The absence of directly comparable European-ancestry dataset limits inferences about relative performance across ancestries. The next stage will address this through UK Biobank analyses.

Functional neurological disorder (FND) is characterised by disabling motor, sensory and/or seizure symptoms. Contemporary models highlight the possible involvement of altered affective and autonomic regulation and interoceptive processing in FND. However, accessible, mechanism-informed interventions remain limited.

This study sought to examine the feasibility, acceptability and possible benefits of tailored somatic yoga for people with FND, aiming to directly target altered emotional and bodily regulation in this group.

This single-site, two-arm randomised feasibility trial allocated adults with FND to 6 weeks of either somatic yoga (weekly remote sessions plus home practice manual) or a music-based relaxation control. Feasibility outcomes included recruitment, retention, adherence and acceptability. Secondary outcomes, assessed at baseline, week 3, week 6 and 3-month follow-up, included FND symptom burden, psychological symptoms (anxiety, depression, dissociation), general functioning, health-related quality-of-life, interoceptive awareness and autonomic symptoms.

Seventy-six enquiries were received. Thirty participants consented (100%), 27 were randomised (90%), 23 commenced the trial (77%) and 21 completed it (70%). Recruitment and retention targets were met, with 100% retention in the yoga arm. Adherence was high across both groups, although digital logging of home practice posed usability challenges. Exploratory analyses indicated large effect sizes for self-reported FND symptom improvement and interoceptive awareness in the yoga group, with effects sustained at follow-up.

Individually delivered somatic yoga was found to be feasible, acceptable and safe for people with FND. Our results also suggest potential benefits of somatic yoga for FND symptom improvement and interoceptive awareness, supporting progression to a fully powered trial.

Patients with major depressive disorder (MDD) are known to be at a heightened risk of suicide. Research indicates that comorbid anxiety may further elevate this risk. However, studies specifically examining the prevalence of anxiety and its associated factors among patients with MDD and history of a recent suicide attempt (RSA) remain limited.

To investigate the prevalence of anxiety and the factors associated with its severity in patients with MDD.

A total of 1718 patients with MDD were included. Hypothesis testing and binary logistic regression were employed to examine differences in anxiety severity and clinical factors between patients with and without an RSA, as well as the association between anxiety severity and RSA. Subsequently, patients with MDD were categorised into three subgroups based on anxiety severity. One-way analysis of variance and multivariate logistic regression were then conducted to identify factors associated with anxiety symptoms.

Anxiety severity was identified as an independent correlate of RSA. Compared with patients with anxiety, patients with MDD and significant or severe anxiety had a 2.9-fold and 11.8-fold increased risk of RSA, respectively. Furthermore, Hamilton Rating Scale for Depression score, Positive and Negative Syndrome Scale positive subscale score, and thyroid function indices (free triiodothyronine and thyroid-stimulating hormone levels) were also determined to be independent correlates of anxiety severity.

Anxiety is associated with risk of RSA in patients with MDD, and depressive symptoms, positive psychotic symptoms and thyroid function may be related factors for severity of anxiety.

Studies have shown that klotho, a neuroprotective protein, plays a crucial role in neurodevelopment. However, its association with attention-deficit hyperactivity disorder (ADHD), the most prevalent neurodevelopmental disorder, remains uncertain.

To elucidate klotho levels in adolescents with ADHD and to clarify its association with executive function.

The present study enrolled 92 adolescents (mean approximate age 14 years) diagnosed with ADHD and 80 age-matched healthy adolescents. All participants had their klotho levels measured and underwent the Wisconsin Card Sorting Test (WCST); their parents fulfilled the Swanson, Nolan and Pelham IV (SNAP-IV) scale and the Child Behavior Checklist-Dysregulation Profile (CBCL-DP).

Results from generalised linear models (GLMs), with adjustments for age, gender, body mass index, clinical symptoms (SNAP-IV and CBCL-DP scores) and ADHD medication use, indicated that adolescents with ADHD had significantly lower klotho levels (P = 0.044) and performed worse on WCST (P = 0.027) compared with healthy adolescents. The GLMs further indicated a negative association between klotho levels and the percentage of non-perseverative errors on WCST (P = 0.002).

Klotho may serve as a novel biomarker of ADHD and play a key role in ADHD-related executive dysfunction.

Psychiatry is a rewarding career which has grown in popularity in recent years. Despite psychiatry training posts recently achieving high fill rates, the specialty has consistently faced long-standing recruitment difficulties, with associated negative perceptions and low interest from medical students. Exposure to extracurricular enrichment programmes has been suggested as a potential method to improve student attitudes, increase engagement, and encourage early career interest in psychiatry. Extracurricular enrichment programmes offer medical students the opportunity to engage with psychiatry beyond the mandatory curriculum, such as through summer schools, special study modules and mentoring schemes. This systematic review aims to evaluate the current literature on extracurricular psychiatry enrichment programmes for undergraduate medical students.

The review was registered with PROSPERO (CRD420251025990) and followed PRISMA guidelines. Four databases were searched (Embase, Ovid MEDLINE, APA PsycInfo and ERIC) using pre-determined search strings. Records were screened and data extracted independently by two authors. Extracted data included programme characteristics, student experiences, attitudes towards psychiatry and mental illness, career intentions and eventual specialty outcome. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Due to heterogeneity in study designs and outcomes, findings were synthesised narratively to identify patterns and themes.

Of 731 articles screened, 65 full reports were assessed for eligibility and 27 were included. These studies were conducted across 10 countries, most commonly the USA and UK. Programme duration and format varied from single-day events (n=2) to longitudinal mentoring schemes spanning medical school (n=5). Summer schools were most common (n=10). Other schemes included mentoring, elective courses, special study modules, student-led clinics and film/media-based activities. Student feedback was positive, particularly for mentoring and film/media initiatives. Most studies reported improved attitudes towards psychiatry and mental illness, with several reporting statistically significant improvements using validated tools. Of 18 studies assessing career intentions, 16 reported increased interest in a career in psychiatry, and six studies reported higher subsequent match rates into psychiatry specialty training.

Although potential self-selection bias may arise from programmes that are both voluntary and extracurricular in nature, the available literature suggests that these programmes provide positive student experiences, and foster improved attitudes and early interest in psychiatry through meaningful learning opportunities. However, longitudinal research is needed to clarify the long-term impact, particularly on those without prior interest. Despite study heterogeneity, this review highlights the importance of enrichment programmes to support recruitment, provided inclusivity and accessibility are considered during programme development.

Mental health issues are prevalent among children and young people (CYP) with chronic conditions like epilepsy, yet few access evidence-based psychological therapies. Evidence from the Mental Health Intervention for Children with Epilepsy (MICE) trial supports the effectiveness of a personalised modular psychological intervention, but cost-effectiveness is unknown.

To assess the cost-effectiveness of the MICE intervention compared with assessment-enhanced usual care at 12-months follow-up, taking a health and social care perspective.

We conducted a within-trial economic evaluation. Outcomes were the Strengths and Difficulties Questionnaire (SDQ; primary) and quality-adjusted life years (QALYs; secondary) for CYP, caregivers, and CYP and caregivers combined. Sensitivity analyses examined missing data and intervention-costing assumptions.

Cost-effectiveness results for the SDQ indicated that MICE had a higher probability of being cost-effective compared with control at a willingness to pay ≥£368 per unit improvement. For QALYs, MICE had a lower probability of being cost-effective for CYP compared with control (35 to 42%) across the £20 000–£30 000 per QALY threshold range. However, at the upper threshold this finding was reversed in sensitivity analyses with missing data imputed (45 to 58%) and with MICE costed at 75%, assuming the intervention partly substituted standard services (46 to 55%). Furthermore, MICE had a higher probability of being cost-effective for caregiver QALYs (52 to 63%) and combined CYP and caregiver QALYs (62 to 75%).

MICE appears to be cost-effective compared with assessment-enhanced usual care when considering QALYs for CYP and caregivers combined, though uncertainty exists across willingness-to-pay thresholds.

Schizophrenia and psychosis have high twin heritability (approximately 80%), but these general estimates may hide aetiological variation. This can be investigated by using syndromes based on key psychotic symptom combinations.

To investigate concordance, and heritability where calculable, of psychotic syndromes in multiple schizophrenia and psychosis twin samples.

We investigated concordance for positive, negative and disorganised psychotic syndromes, based on lifetime symptom ratings, in three classical schizophrenia twin samples (Fischer, Kringlen and Slater) and two psychosis samples (Maudsley register and non-register), the first four being systematically ascertained (total 317 monozygotic and 145 dizygotic probandwise pairs). We assessed concordance differences with logistic regression in generalised linear mixed models, and heritability from twin-modelling in the Maudsley register sample.

The positive syndrome, comprising delusions plus hallucinations, had 37.7–41.4% monozygotic and 6.0–6.3% dizygotic concordance, and heritability of 0.81 or 81% (95% CI 0.58–0.88), with similar results for negative and disorganised syndromes. In the systematically ascertained samples, delusions and hallucinations occurring without disorganised symptoms had nominally lower monozygotic twin concordance than when disorganised symptoms were also present (in the three schizophrenia samples: 89 pairs, odds ratio 3.47 (95% CI 1.04–1.54), p = 0.043; and the Maudsley register psychosis sample: 70 pairs, odds ratio 7.68 (95% CI 1.49–39.70), p = 0.016).

In schizophrenia and psychosis, the syndrome of delusions plus hallucinations has high twin heritability overall. Positive symptoms without disorganised symptoms may indicate relatively high environmental influences, and positive symptoms with disorganised symptoms, relatively high familial and probably genetic influences, but further confirmation is needed.

To examine how musicians express mood states through music and how these expressions are interpreted by media narratives, and how cultural analysis can be used as an educational tool to enhance psychiatric understanding of mental state, stigma and patient engagement.

A qualitative analysis was conducted using a comparative cultural analysis approach. Publicly available materials related to four artists (Amy Winehouse, Kurt Cobain, Stormzy and Florence Welch) were used. These artists were selected to reflect variation across genres, eras, genders and cultural contexts. Materials, such as song lyrics, interviews and media reporting, were thematically analysed using the Braun and Clarke framework. Patterns in emotional expression, representations of mental distress, and media framing were found. Identified themes were mapped to core psychiatric training domains, including mental state variations, stigma and culturally informed care. As no primary clinical data were collected and all materials were in the public domain, ethical approval was not required.

Three consistent themes were identified. First, musicians frequently expressed emotional distress and vulnerability using metaphors, tone and narrative rather than explicit clinical language. This suggests music can provide insight into subjective emotional states and serves as a tool for understanding the meaning and the context of an experience or emotion. Second, media portrayals often simplified or moralised these expressions, particularly in relation to substance abuse, reinforcing stigma and overshadowing the complexity of co-occurring mental health challenges. Third, disparities were observed in how distress was framed, dependent on gender, race and genre, with some artists’ experiences pathologised to a greater extent, whilst others were relatively contextualised or minimised. These findings demonstrate how cultural material can be used in education to show the limitations of symptom-only interpretation and the importance of contextual formulation – including social environment, occupational pressures and media influence. This pedagogical approach aligns with the RCPsych curriculum by enhancing reflective practice and improving cultural competence, pivotal for managing complex presentations in diverse populations.

Music and media analysis offers a potentially useful framework to augment psychiatric training by highlighting how emotional distress is expressed, interpreted and socially constructed. While music cannot be used to diagnose mental illness, it can enhance engagement and facilitate conversations around stigma, identity and help-seeking. Incorporating culturally relevant case analyses through simulated formulation workshops into education may improve recognition of non-verbal expressions of distress, encourage reflective engagement with stigma and media narratives, and promote culturally informed practices.