Elevated non-high-density lipoprotein cholesterol (non-HDL-C) is a significant risk factor for atherosclerotic cardiovascular diseases, particularly in individuals with metabolic syndrome (MetS) and major psychiatric disorders (MPDs), who may experience metabolic side effects of psychopharmacological treatments. We evaluated the cholesterol-lowering effects of an experimental pasta characterized by a high content of phytosterols, arabinoxylans, polyunsaturated and monounsaturated fatty acids, and vitamin E in individuals with MetS, with and without MPDs.

In a double-blind, randomized trial, 298 participants with MetS were assigned to consume either experimental or conventional pasta for 3 months. Non-HDL-C levels were measured at baseline and follow-up. A polygenic risk score for hypercholesterolemia (TC-PRS) was calculated to assess any genetic influence on the intervention’s efficacy. The cholesterol-lowering effect of the experimental pasta was also tested in vitro by exposing human hepatocarcinoma cells, which developed lipid storage alterations due to olanzapine (OLZ) exposure, to an extract of the flour mixture used to prepare the experimental pasta.

The participants who consumed the experimental pasta exhibited a significantly greater reduction in serum non-HDL-C levels compared to the control group (p = 0.001). No significant interaction between pasta variety and the TC-PRS on non-HDL-C changes was found. The extract from the experimental flour mixture significantly reduced both the number and size of lipid droplets in HepG2 cells treated with OLZ.

These results indicate that a low-impact lifestyle intervention may offer a practical strategy for improving the cholesterol profile and mitigating cardiovascular risk in patients with MetS, with and without an MPD.

Although social anxiety remains prevalent, conventional exposure therapy faces limitations such as limited accessibility, high cost, and low ecological validity. These barriers highlight the need for alternative, scalable methods that can effectively simulate social evaluative contexts.

This study aims to evaluate the anxiety-inducing effects of videoconferencing exposure, measured through heart rate variability (HRV), using a fully online-based methodology.

A total of 31 participants who reported social anxiety were recruited online and engaged in a simulated videoconference task, where they interacted with multiple audience members’ emotional faces on a 3 × 3 split screen. Their video recordings were analysed using imaging photoplethysmography to obtain HRV data. Baseline anxiety levels were assessed using validated self-report questionnaires, including the State Anxiety Scale (STAI-X1), Trait Anxiety Scale (STAI-X2), Social Interaction Anxiety Scale, and Social Phobia Scale.

Pearson correlation analysis revealed that STAI-X1 scores negatively correlated with high-frequency normalised units (HFnu) changes and positively correlated with low-frequency high-frequency (LF–HF) ratio and low-frequency normalised units (LFnu) changes. Similar patterns were observed for STAI-X2. These findings suggest that higher levels of trait and state anxiety are associated with greater reductions in parasympathetic activity and increased sympathetic activation during online videoconferencing.

This study underscores the clinical potential of online videoconferencing as a scalable and accessible exposure therapy for the digital era, eliminating spatial and logistical constraints associated with traditional in-person exposure therapy.

Easily accessible, impactful, evidence-based resources are needed to assist mental health workers to best support voice-hearers in managing and living well with voices. Let’s Talk About Voices (LTAV) is an innovative suite of resources designed for mental health workers to use in supporting voice-hearers.

This study aimed to assess the impact of LTAV on mental health workers’ self-reported capacity to work with voice-hearers.

A randomised, controlled crossover design was used, with assessment at three time points. The assessment measure was co-developed by researchers, clinicians, peer workers and voice-hearers based on the aims of LTAV and the Theory of Planned Behaviour. Participants were randomised into two groups. The immediate group received access to LTAV following the first assessment; the delayed group received access following the second assessment. In total, 256 mental health workers commenced the study, with 120 completing all assessments.

Between-group comparisons for change between times 1 and 2 found a significant difference with a large effect size (F = 40.2, P < 0.001, ηp2 = 0.19). Significance remained on intention-to-treat analysis (F = 22.9, P < 0.001, ηp2 = 0.08). Pairwise repeated-measures comparisons found a significant increase in scores for both groups following access to LTAV, which was sustained at follow-up. Fourteen of 24 individual items showed significant change. Changes were consistent across professions, work settings and experience working with voice-hearers, but those with less confidence in working with voice-hearers on intake showed significantly stronger improvements.

This research indicates that LTAV has the potential to substantially improve mental health workers’ attitudes and confidence in supporting voice-hearers.

Improving Access to Psychological Therapies (IAPT), an NHS England service providing talking therapies, is meeting its target recovery rate of 50%. However, engagement in treatment, as well as recovery rates, may be lower for some groups.

To assess variation in treatment completion and recovery rates by demographic and socioeconomic group and to describe rates of further referrals for patients to IAPT and secondary mental health services.

Using 121 548 administrative records for 2019–2020 and 2022–2023 for the Norfolk and Waveney area, we estimated associations of age, gender, ethnicity and deprivation with the likelihood of treatment completion and recovery using logistic regression modelling. We also described rates of further referrals.

Younger people and those living in deprived areas were less likely to recover or complete treatment, with those aged 16–17 years (n = 735) having the lowest adjusted odds for recovery (adjusted odds ratio = 0.5, 95% CI: 0.5–0.6) compared with those aged 36–70 years, and those aged 18–24 years (n = 23 563) having the lowest rate of completion (adjusted odds ratio = 0.5, 95% CI: 0.5–0.6). Further referrals before April 2022 were recorded for 45.4% of 6513 patients who had completed treatment and 68.8% of 9469 who had not completed treatment, and for 39.4% of 2007 recovered patients in 2019–2020 and 53.1% of 1586 who had not recovered. Non-completers had relatively more further referrals to secondary mental health services compared with completers (43.6% v. 22.8%; P < 0.01).

Younger people and those living in deprived areas have lower recovery and completion rates. Those who have completed treatment and not recovered have higher rates of further referrals.

Children born very preterm (VPT; ≤32 weeks’ gestation) are at higher risk of developing behavioural problems, encompassing socio-emotional processing and attention, compared to term-born children. This study aimed to examine multi-dimensional predictors of late childhood behavioural and psychiatric outcomes in very preterm children, using longitudinal clinical, environmental, and cognitive measures.

Participants were 153 VPT children previously enrolled in the Evaluation of Preterm Imaging study who underwent neuropsychological assessments at 18–24 months, 4–7 years and 8–11 years as part of the Brain Immunity and Psychopathology following very Preterm birth (BIPP) study. Predictors of late childhood behavioural and psychiatric outcomes were investigated, including clinical, environmental, cognitive, and behavioural measures in toddlerhood and early childhood. Parallel analysis and exploratory factor analysis were conducted to define outcome variables. A prediction model using elastic-net regularisation and repeated nested cross-validation was applied to evaluate the predictive strength of these variables.

Factor analysis revealed two key outcome factors in late childhood: externalising and internalising-socio-emotional problems. The strongest predictors of externalising problems were response inhibition, effortful control and internalising symptoms in early childhood (cross-validated R2=.256). The strongest predictors of internalising problems were autism traits and poor cognitive flexibility in early childhood (cross-validated R2=.123). Cross-validation demonstrated robust prediction models, with higher accuracy for externalising symptoms.

Early childhood cognitive and behavioural outcomes predicted late childhood behavioural and psychiatric outcomes in very preterm children. These findings underscore the importance of early interventions targeting cognitive development and behavioural regulation to mitigate long-term psychiatric risks in very preterm children.

People with opioid use disorder (OUD) have substantially higher standardised mortality rates compared with the general population. However, lack of individualised prognostic information presents challenges in personalisation of addiction treatment delivery.

To develop and validate the first prognostic models to estimate 6-month all-cause and drug-related mortality risk for people diagnosed with OUD using indicators recorded at baseline assessment in addiction services in England.

Thirteen candidate prognostic variables, including sociodemographic, injecting status and health and mental health factors, were identified from nationally linked addiction treatment, hospital admission and death records from 1 April 2013 to 1 April 2022. Multivariable Cox regression models were developed with a fractional polynomial approach for continuous variables, and missing data were addressed using multiple imputation by chained equations. Validation was undertaken using bootstrapping methods. Discrimination was assessed using Harrel’s C and D statistics alongside examination of observed-to-predicted event rates and calibration curve slopes.

Data were available for 236 064 people with OUD, with 2427 deaths due to any cause, including 1289 due to drug-related causes. Both final models demonstrated good optimism-adjusted discrimination and calibration, with all-cause and drug-related models, respectively, demonstrating Harrell’s C statistics of 0.73 (95% CI 0.71–0.75) and 0.74 (95% CI 0.72–0.76), D-statistics of 1.01 (95% CI 0.95–1.08) and 1.07 (95% CI 0.98–1.16) and calibration slopes of 1.01 (95% CI 0.95–1.08) and 1.01 (95% CI 0.94–1.10).

We developed and internally validated Roberts’ OUD mortality risk, with the first models to accurately quantify individualised absolute 6-month mortality risks in people with OUD presenting to addiction services. Independent validation is warranted to ensure these models have the optimal utility to assist wider future policy, commissioning and clinical decision-making.

Virtual reality (VR) may improve psychological treatments for psychotic disorders. We investigated the effects of VR-based cognitive behavior therapy for paranoid ideation (VR-CBTp) compared to standard CBTp.

We conducted a pragmatic, single-blind, randomized clinical trial in seven mental health centers across the Netherlands and Belgium. A total of 98 participants with a psychotic spectrum disorder and paranoid ideation were randomized to a maximum of 16 sessions of VR-CBTp (n = 48) or CBTp (n = 50). The primary outcome was momentary paranoia, measured with the experience sampling method (ESM) at posttreatment. Secondary measures, assessed at baseline, posttreatment, and 3-month follow-up, included symptoms (paranoia, hallucination, depression, cognition, and anxiety related), social functioning, self-esteem, and schemes.

Both groups showed reductions in momentary paranoia between baseline and posttreatment (n = 56, b = −15.0, effect size [ES] = 0.65), but those were greater for VR-CBT (interaction b = 8.3, ES = 0.62). Reductions remained at follow-up (n = 50, b = −10.7, ES = 0.57) but not the interaction. Limited ESM compliance resulted in data loss; however, secondary paranoia measures did confirm improvements (ES range = 0.66–1.15, n = 78–81), but not the interaction. Both groups improved in symptoms, self-esteem, and social functioning. Interaction effects in favor of VR-CBTp were found for safety behavior, depression, and self-esteem at posttreatment, and self-esteem and anxiety at follow-up. For VR-CBTp, 37.5% did not complete treatment; for CBTp, this was 24.0%. Completers, on average, received 12.7 (VR-CBTp: standard deviation [SD] = 3.9) and 15.1 (CBTp: SD = 2.5) sessions.

Both CBTp and VR-CBTp are efficacious treatments for paranoid ideation, but VR-CBTp may be somewhat more effective. Limitations concern missing primary outcome data and a lower sample size than anticipated.