Stroke results in various cognitive and motor impairments. The most frequent cognitive problem is spatial and non-spatial attention, typically caused by unilateral brain lesion. Attention is typically assessed with several different paper-and-pencil tests, which have long been criticized for their lack of theoretical basis, their limited ecological validity to deficits experienced in daily life, and their lack of measurement sensitivity (Appelros et al., 2004; Azouvi, 2017). Here, our global aim was to develop an innovative integrative serious game in an immersive environment. The REASmash, combines the evaluation of spatial attention, non-spatial attention, and motor performance. We present the spatial and non-spatial cognitive attention evaluation results.

Eighteen first stroke individuals and 40 age-match healthy controls were assessed on the REASmash. They were instructed to find a target mole presented amongst distractor moles. The stimulus array consisted of a grid of 6 columns and 4 rows of molehills, from which the target and 11, 17 and 23 distractors moles could randomly appear, in two search conditions (single feature condition and saliency condition). Responses were made with the ipsilesional hand for individuals with stroke and with the dominant hand for the healthy controls. Participants were evaluated also with two standardized clinical tests of attention; the hearts cancellation task of the Oxford Cognitive Screen, and the visual scanning subtest of the Test for Attentional Performance.

Validation results showed significant and strong correlations between the REASmash and the two reference tests, with the REASmash showing high sensitivity and specificity (i.e., the correct identification of the post-stroke vs. control individuals). The REASmash also showed significant and strong test/re-test reliability. We additionally evaluated user experience using the UEQ, and the results showed excellent attractiveness and novelty, and good stimulation and efficiency.

In conclusion, the REASmash is a novel immersive virtual environment serious game that is valid, sensitive, and usable. It provides a new diagnosis measure spatial and non-spatial attention impairment.

Executive functions (EFs) refer to a set of top-down cognitive processes that are fundamental for the control of goal directed behaviours (Lezak et al., 2004). Inhibition (the capacity to ignore irrelevant information) and selective attention (the capacity to selectively focus on relevant information) are considered as the core components of EFs (Barkley, 2001; Veer et al., 2017). EFs can be impaired following brain damage (Chung et al., 2013) and they are traditionally assessed individually, using paper-and-pencil tests that have long been criticized for their ecological and sensitivity limitations (Dugbartey et al., 1999; Miyake et al., 2000). Here we developed a serious game in immersive virtual reality to measure inhibition and selective attention based on the go/no-go paradigm and the D2 Test.

Sixty healthy participants were asked to perform a series of tasks, where in each task, the target was a mole wearing a coloured helmet. In task A, either the target or a distractor bomb was presented. The participants had to respond to the target and inhibit a response to the bomb. In task B, the target was presented with distractor moles wearing different coloured helmets. The two tasks could also be combined, task AB, where the target was presented with distractors (as in task B) versus the bomb was presented with distractor moles. All the stimuli appeared from four molehills aligned to sagittal axis (near to far from the participant). Responses were made with the dominant hand in task A and with both tasks in tasks B and AB. The participants were instructed to hit the target with a virtual hammer.

Response time analysis showed that in tasks A, B and AB, participants were slower to respond to the far compared to near targets. In task B and AB, participants were additionally slower to respond to the left compared right targets. Significant interactions between laterality and proximity for tasks B and AB showed that the participants were significantly slower to response to left vs right target in both far and near conditions. All participants were able to inhibit responses to the bomb and distractor stimuli.

In conclusion, we have developed a novel serious game in immersive virtual reality for the assessment of inhibition and selective attention, both as individual tests and as a combined test. Future studies will test patients with executive dysfunction to test the validity of this new serious game.

Psychosis is a major mental illness with first onset in young adults. The prognosis is poor in around half of the people affected, and difficult to predict. The few tools available to predict prognosis have major weaknesses which limit their use in clinical practice. We aimed to develop and validate a risk prediction model of symptom non-remission in first-episode psychosis.

Our development cohort consisted of 1027 patients with first-episode psychosis recruited between 2005 to 2010 from 14 early intervention services across the National Health Service in England. Our validation cohort consisted of 399 patients with first-episode psychosis recruited between 2006 to 2009 from a further 11 English early intervention services. The one-year non-remission rate was 52% and 54% in the development and validation cohorts, respectively. Multivariable logistic regression was used to develop a risk prediction model for non-remission, which was externally validated.

The prediction model showed good discrimination (C-statistic of 0.74 (0.72, 0.76) and adequate calibration with intercept alpha of 0.13 (0.03, 0.23) and slope beta of 0.99 (0.87, 1.12). Our model improved the net-benefit by 16% at a risk threshold of 50%, equivalent to 16 more detected non-remitted first-episode psychosis individuals per 100 without incorrectly classifying remitted cases.

Once prospectively validated, our first episode psychosis prediction model could help identify patients at increased risk of non-remission at initial clinical contact.

Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.

This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.

Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points.

A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine.

Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.

Anemia (and especially mild forms) is a frequent laboratory finding in the elderly and is usually regarded in our everyday practice in psychiatry as an incidental innocent finding.

However, the growing body of literature proves otherwise.

Recent literature shows that anemia in the elderly has serious negative impact on mortality, morbidity and quality of life in this age group.

Despite the importance of this topic in mental health care, there is paucity or even lack of studies aiming to examine the magnitude of this problem in psychiatric hospitals and to suggest potential solutions for it.

In this small study, we aim to examine the prevalence of anemia in an inpatient psychiatric hospital, the types of anemia found, the investigations done and if any treatment was given.

Inpatient case notes were examined retrospectively for patients admitted to the Julian hospital from June 2010 to December 2010.

Anemia was defined according to the WHO criteria1 as a hemoglobin concentration lower than 12 g/dL in women and 13 g/dL in men.

Based on WHO criteria, most of our elderly patients were found to be anemic, with a significantly higher frequency in men than in women. The prevalence of anemia increased with increasing age, both in men and in women.

Anemia in elderly is a frequent, underappreciated and potentially morbid condition accounting for significant morbidity and mortality in this population.

As mental health professionals, we must work with our colleagues in medicine to translate awareness into action.

Social disability is a hallmark of severe mental illness yet individual differences and factors predicting outcome are largely unknown.

To explore trajectories and predictors of social recovery following a first episode of psychosis (FEP).

A sample of 764 individuals with FEP were assessed on entry into early intervention in psychosis (EIP) services and followed up over 12 months. Social recovery profiles were examined using latent class growth analysis.

Three types of social recovery profile were identified: Low Stable (66%), Moderate-Increasing (27%), and High-Decreasing (7%). Poor social recovery was predicted by male gender, ethnic minority status, younger age at onset of psychosis, increased negative symptoms, and poor premorbid adjustment.

Social disability is prevalent in FEP, although distinct recovery profiles are evident. Where social disability is present on entry into EIP services it can remain stable, highlighting a need for targeted intervention.

Early intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice.

By analysing carers' accounts of their daily lives and affective challenges during a relative's FEP against the background of wider research into EIS, this paper explores relationships between carers' experiences and EIS.

Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS.

Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these user-focused engagements also emerge; they risk leaving carers' emotions unacknowledged and compounding an existing lack of help-seeking.

By focusing on EIS's engagements with carers, this paper draws attention to an urgent broader question: as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?

The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations.

The study population comprised 5606 healthy nulliparous pregnant women who participated in the international prospective Screening for Obstetric and Pregnancy Endpoints (SCOPE) study. Women completed the Perceived Stress Scale (PSS), the short form of the Spielberger State–Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at 15 ± 1 and 20 ± 1 weeks' gestation. SGA was defined as birthweight below the 10th customized percentile. Logistic regression was used for data analysis, adjusting for several potential confounders such as maternal age, body mass index (BMI), smoking, socio-economic status and physical exercise.

The risk of SGA was increased in relation to mild [adjusted odds ratio (aOR) 1.35, 95% confidence interval (CI) 1.07–1.71], moderate (aOR 1.26, 95% CI 1.06–1.49), high (aOR 1.45, 95% CI 1.08–1.95) and very high stress scores (aOR 1.56, 95% CI 1.03–2.37); very high anxiety score (aOR 1.45, 95% CI 1.13–1.86); and very high depression score (aOR 1.14, 95% CI 1.05–1.24) at 20 ± 1 weeks' gestation. Sensitivity analyses showed that very high anxiety and very high depression increases the risk of SGA in males but not in females whereas stress increases the risk of SGA in both males and females.

These findings suggest that prenatal stress, anxiety and depression measured at 20 weeks' gestation increase the risk of SGA. The effects of maternal anxiety and depression on SGA were strongest in male infants.

Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed.

To document the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). To model the likely impact on efforts to reduce DUP of targeted changes in the care pathway.

Data for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed.

A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP.

Community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS. Our methodology, based on analysis of care pathways, will have international application when devising strategies to reduce DUP.

None.