Palliative care services are unavailable for the vast majority of children in Bhutan. Children’s palliative care has not been incorporated into training programs for health professions, leading to limited knowledge and awareness of how best to support children facing serious or life-threatening conditions.

To describe the impact of the Project ECHO children’s palliative care course on participants’ knowledge, comfort, and attitudes and to evaluate the overall acceptability of an online training to support palliative care training in Bhutan.

Before-and-after surveys of program participants were conducted, assessing changes in knowledge, comfort, and attitudes. Participants’ overall experiences and acceptability of the learning program were assessed through an end-of-program survey.

Participants were primarily nurses (49%) or physicians (34%). Most participants (68%) worked in pediatric and/or neonatal care. Participants’ knowledge of core palliative care concepts improved significantly between the beginning and end of the course. Participants’ comfort and attitudes toward palliative care also improved, with significance effect sizes in most domains (11/18). Satisfaction with the program was high, with 100% of participants agreeing that the training was applicable to their clinical practice. Although most participants (56%) identified a personal need for additional clinical training to support practice change.

Project ECHO can be used to deliver palliative care education, with improved palliative care knowledge, comfort, and attitudes among program participants. A short online training program can generate interest in palliative care, which can be leveraged to further develop palliative care services in settings where palliative care is currently unavailable.

Explore humanitarian healthcare professionals’ (HCPs) perceptions about implementing children’s palliative care and to identify their educational needs and challenges, including learning topics, training methods, and barriers to education.

Humanitarian HCPs were interviewed about perspectives on children’s palliative care and preferences and needs for training. Interviews were transcribed, coded, and arranged into overarching themes. Thematic analysis was performed using qualitative description.

Ten healthcare workers, including doctors, nurses, psychologists, and health-project coordinators, were interviewed. Participants identified key patient and family-related barriers to palliative care in humanitarian settings, including misconceptions that palliative care was synonymous with end-of-life care or failure. Health system barriers included time constraints, insufficient provider knowledge, and a lack of standardized palliative care protocols. Important learning topics included learning strategies to address the stigma of serious illness and palliative care, culturally sensitive communication skills, and pain and symptom management. Preferred learning modalities included interactive lectures, role-play/simulation, and team-based case discussions. Participants preferred online training for theoretical knowledge and in-person learning to improve their ability to conduct serious illness conversations and learn other key palliative care skills.

Palliative care prevents and relieves serious illness-related suffering for children with life-threatening and life-limiting conditions; however, most children in humanitarian settings are not able to access essential palliative care, leading to preventable pain and suffering. Limited palliative care knowledge and skills among HCPs in these settings are significant barriers to improving access to palliative care. Humanitarian HCPs are highly motivated to learn and improve their skills in children’s palliative care, but they require adequate health system resources and training. These findings can guide educators in developing palliative care education packages for humanitarian HCPs.

Postpartum depression (PPD) is a serious illness where patients (pts) experience depressive symptoms that start during or after pregnancy. Concurrent anxiety symptoms in PPD are common and are associated with poorer outcomes. The Edinburgh Postnatal Depression Scale (EPDS) is a patient-reported instrument used for PPD and may be used concurrently with the clinician-administered Hamilton Rating Scale for Anxiety (HAM-A). Zuranolone (ZRN) is an investigational oral positive allosteric modulator of synaptic and extrasynaptic GABAA receptors and neuroactive steroid for the treatment of PPD and major depressive disorder in adults. The phase 3, double blind, randomized, placebo (PBO)-controlled SKYLARK study evaluating the efficacy and safety of ZRN 50 mg (ZRN50) in pts with severe PPD met its primary endpoint of change from baseline (CFB) in the 17-item Hamilton Rating Scale for Depression (HAMD-17) total score at Day (D)15 (−15.6 vs −11.6 for placebo; p<0.001). The percentages of pts achieving HAMD-17 response (≥50% CFB in HAMD-17 total score) and remission (HAMD-17 total score ≤7) were higher in the ZRN group vs PBO. We report a post hoc analysis of the EPDS and HAM-A response and remission rates to assess the effects of ZRN50 on depressive and anxiety symptoms in the SKYLARK study.

Adults aged 18-45 years with severe PPD (baseline HAMD-17 ≥26) were randomized 1:1 to oral once-daily ZRN50 or PBO for 14 days and followed through D45. EPDS and HAM-A response (≥50% CFB in EPDS or HAM-A total score, respectively) and remission (EPDS total score <10 or HAM-A total score ≤7) rates were recorded at D3, D8, D15, D21, D28, and D45. Response and remission rates were modeled using generalized estimating equations for binary responses. Statistical testing was not adjusted for multiplicity; p values and statements of significance are considered nominal. D15 and D45 results are reported.

Among 196 pts randomized and dosed, 170 completed the 45-day study. Significantly greater percentages of pts treated with ZRN achieved EPDS response (52.7% vs 33.7%; p=0.0178) and remission (49.5% vs 33.7%; p=0.0192) at D15 vs PBO and achieved HAM-A response (54.3% vs 37.8%, p=0.0338) and remission (34.8% vs 15.6%; p=0.0050) at D15 vs PBO. Numerically greater percentages of pts achieved EPDS response (57.1% vs 50.6%; p=0.3020) and remission (56.0% vs 47.1%; p=0.0812) at D45 with ZRN vs PBO and achieved HAM-A response (65.5% vs 60.0%; p=0.3066) and remission (44.0% vs 37.6%; p=0.3662) at D45 with ZRN vs PBO.

ZRN50 was associated with improvements in both depressive and anxiety symptoms, which commonly co-occur in individuals with PPD. These results suggest treatment with ZRN may lead to improvements in measures of both depression and anxiety and support the potential role of ZRN as a novel, oral, rapid-acting, 14-day treatment course for PPD.

Sage Therapeutics, Inc. and Biogen Inc. Medical writing and editorial support were provided by Meditech Media, Ltd. and Parexel, and funded by Sage Therapeutics, Inc. and Biogen Inc.

Free school meals (FSM) are a crucial form of support for families. This study aimed to investigate whether the FSM allowance can provide what is perceived to be, healthy, sustainable and satisfying food.

A mixed methods study incorporating co-production, citizen science and participatory approaches was conducted. Citizen scientists were given a daily budget equivalent to the FSM allowance and asked to purchase a ‘tasty, healthy and sustainable’ school lunch for a week. Alongside keeping records of available and purchased foods, young people engaged in focus groups to capture information on perceptions of food offered and FSM allowance adequacy.

Secondary schools in Yorkshire, UK.

Citizen scientists (n 42) aged 11–15 years across seven schools.

Obstacles were faced in obtaining sustainable and healthful meals when restricted to an FSM allowance. Reasons included restrictions in what could be purchased due to costs, limitations in the use of allowances that restricted breaktime purchases leading to hunger, inadequate portion sizes, systemic barriers like hurried lunch breaks that encourage ‘grab and go’ options and broken water fountains that led students to purchase bottled drinks. Findings were reinforced by descriptive food record data.

Our findings suggest that schools would benefit from national policies to address the lack of funding, infrastructure issues and capacity to support optimal provision of food to those on FSM as well as provide greater flexibility in how pupils use their allowance. Young people verified these findings, which they presented to policymakers at a parliamentary event.

Publicly funded cancer services face significant financial and capacity challenges. It is estimated that 40 percent of medicines used to treat cancer are outside their marketing authorization or “off-label.” These uses are usually outside the remit of health technology assessment (HTA) groups. Accessing emerging off-label uses is mostly through individual patient requests, which are resource intensive, delay patient treatment, and produce inequity.

A program providing national HTA review of off-label and off-patent cancer medicine uses has been established by Healthcare Improvement Scotland. Processes include horizon scanning, support for proposing clinicians, and engaging patient groups. Relevant published and unpublished clinical and cost-effectiveness information—identified through systematic literature searches, engagement with pharmaceutical companies, academic and health service data groups—supports independent appraisal and decision-making. Where cost-effectiveness information is unavailable, a value-judgment framework, including magnitude of clinical benefit, uncaptured benefits, and budget and service impact, is utilized to standardize review. The decision-making Council includes public partners, and advice is shared across NHSScotland.

From July 2022 to October 2023, the program has published advice on nine proposals—eight off-label uses and one on-label off-patent use. Health economic models from a pharmaceutical company and an academic group supported decision-making on two proposals, value-judgment frameworks for two proposals, and real-world evidence for one proposal. Eight proposals were supported, and one was not supported. Each supported proposal slowed cancer, prolonged life, or reduced toxicity compared to standard treatment options. Four were cost-saving and three had a low medicines budget impact. Three were service-saving and three had no significant impact on services.

Novel HTA programs can address gaps in medicines governance to improve patient outcomes and support sustainability. Clinical connections, patient group engagement, health economic collaborations and linkage to national cancer data teams and academics have facilitated bespoke approaches to evidence-gathering despite limited resources. Our agile and adaptive approach has enabled robust review and decision-making on varied and impactful proposals.

Higher specialist trainees (HSTs) in psychiatry in Ireland were recruited to complete a 21-item online questionnaire anonymously. Questions were designed to establish the research experience of HSTs in various years of training, identify perceived barriers to participation and generate potential strategies to overcome these barriers.

Of 165 HSTs surveyed, 50 (30%) responded. Most respondents (58%) were in the second or third year of HST. Most (72%) were training in general adult psychiatry. Themes that emerged from analysis of the qualitative data were ‘collaborative research culture’, ‘guidance’, ‘choice’ and ‘access to resources’. Participants felt they needed more structured guidance and regular supervision, and expressed a desire for more networking and collaboration.

The need for a supportive, collaborative research culture within psychiatry was predominant among responses. Structured research programmes and access to resources may facilitate a more positive research culture and should be considered as part of the training curriculum.

This paper describes an interdisciplinary integration of the concept of environmental identity into cognitive behavioural approaches to facilitate psychotherapy interventions for climate distress. Environmental identity encompasses one’s sense of self in relation to the natural world and other species, and is an important sub-identity analogous to gender, sexual and other forms of self and social identity recognized in psychotherapy. We provide a background on the construct of environmental identity as developed in social and environmental psychology and share culturally responsive methods for mental health practitioners and the public to evoke and explore their own environmental identity. We then discuss steps to create environmental identity-based therapy interventions using cognitive and behavioural approaches for climate distress. We highlight the potential for acceptance and commitment therapy to foster mindfulness and values-based action, dialectical behaviour therapy to support emotional regulation, and radically open dialectical behaviour therapy to mitigate perfectionism and over-controlled coping styles. We also describe a composite case study of environmental identity-based cognitive behavioural therapy for an LGBTQ+ client.

1. (1) The paper presents new opportunities and techniques for adapting cognitive behavioural interventions in a climate conscious manner, with insights and observations from the authors based on clinical practice, which informs research into psychotherapy best practices in the context of environmental and climate issues.

2. (2) Readers will become familiar with the empirical basis of environmental identity drawn from theory and research in social and environmental psychology; how environmental experiences and values intersect with other forms of personal and social identity addressed in mental health practice; and culturally responsive ways to elicit environmental identity on the part of practitioners and those they serve.

3. (3) Readers are guided through examples of environmental identity-based cognitive and behavioural interventions including (1) promoting values-based action using acceptance and commitment therapy, (2) addressing emotional dysregulation using dialectical behaviour therapy, and (3) modifying over-controlled or perfectionistic coping styles using radically open dialectical behaviour therapy.

4. (4) A composite case study provides an example of environmental identity-based cognitive behavioural therapy for a 20-year-old LGBTQ+ person experiencing climate distress.

Diagnosis of autism falls under the remit of psychiatry. Recognition that psychiatrists could be autistic is recent. Psychiatrists are the second largest specialty group in Autistic Doctors International, a peer support group for autistic doctors.

To explore the experiences of autistic psychiatrists in relation to recognising themselves and others as autistic.

This was a qualitative study using loosely structured interviews and an interpretive phenomenological analysis.

Eight autistic senior psychiatrists based in the UK participated. One had a childhood diagnosis, two had been diagnosed in adulthood and the remainder self-identified as autistic as adults. Recognition of autism followed diagnosis of their children or encounters with autistic patients. Barriers to self-recognition included lack of autism training, the deficit-based diagnostic criteria and stereotypical views of autism. Recognising that they were autistic led to the realisation that many colleagues were also likely to be autistic, particularly in neurodevelopmental psychiatry. All participants reported the ability to quickly recognise autistic patients and to develop a good rapport easily, once they were aware of their own autistic identity. Difficulties recognising patients as autistic occurred before self-recognition when they shared autistic characteristics and experiences. ‘If we don't recognise ourselves as autistic how on earth can we diagnose patients accurately?’

Autistic psychiatrists face multiple barriers to recognising that they are autistic. Lack of self-recognition may impede diagnostic accuracy with autistic patients. Self-recognition and disclosure by autistic psychiatrists may be facilitated by reframing the traditional deficit-based view of autism towards a neurodiversity-affirmative approach, with consequent benefits for autistic patients.

The aim of this study is to assess General Practitioner (GP) trainees’ training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland.

An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants’ training experiences and confidence levels in key areas of child and adolescent mental health in primary care.

Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders.

The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.

Tuberculosis is a bacterial infectious disease caused by Mycobacterium tuberculosis. This disease predominately affects the lungs but also affects other parts of the body, including the central nervous system. According to the the World Health Organization (2023), tuberculosis has an incidence of 6.4 million people in 2022, with 1.5 million deaths attributed to this disease. Psychosis describes a group of disorders that affects a person’s thought process and perception. It is a serious disorder that can have a profound impact on a person’s mental and physical health. As a result, psychosis symptoms and its treatment can complicate the management of tuberculosis.

The aim of this systematic review is to explore the association between tuberculosis and psychosis. It has been shown that up to 70% of patients with tuberculosis also have comorbid mental illness, this is likely to include psychosis. There are also shared risk factors between tuberculosis and psychosis, including poverty and homelessness, substance abuse, HIV positive serology and isolation. Tuberculosis medication, including isoniazid and rifampicin have been shown to have adverse psychiatric effects and we will examine if this includes psychosis.

A systematic review was pre-registered with PROSPRO and performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, OVID and PsychINFO databases were searched from beginning of records to September 2023. This included hand-search of relevant reference lists. Observational and epidemiological studies were included along with population based registries.

Over one thousand (1,154) articles were identified and screened. There was significant heterogenity in results and over half of studies were from Asia and Africa. Many studies reported cases of drug-induced psychosis from anti-tubercular agents. Studies also discussed the increased risk of TB incidence among patients with psychosis and other psychiatric disorders.

This study identifies the importance of training healthcare workers in rapid detection of co-morbid psychosis in patients with tuberculosis, along with neuropsychiatric side effects of antitubercular agents. Integration of psychiatric and medical care of these patients would be of benefit to improve outcomes in this patient population. More research is needed on co-morbidity of tuberculosis and psychosis.

None Declared