Childhood bullying is a public health priority. We evaluated the effectiveness and costs of KiVa, a whole-school anti-bullying program that targets the peer context.

A two-arm pragmatic multicenter cluster randomized controlled trial with embedded economic evaluation. Schools were randomized to KiVa-intervention or usual practice (UP), stratified on school size and Free School Meals eligibility. KiVa was delivered by trained teachers across one school year. Follow-up was at 12 months post randomization. Primary outcome: student-reported bullying-victimization; secondary outcomes: self-reported bullying-perpetration, participant roles in bullying, empathy and teacher-reported Strengths and Difficulties Questionnaire. Outcomes were analyzed using multilevel linear and logistic regression models.

Between 8/11/2019–12/02/2021, 118 primary schools were recruited in four trial sites, 11 111 students in primary analysis (KiVa-intervention: n = 5944; 49.6% female; UP: n = 5167, 49.0% female). At baseline, 21.6% of students reported being bullied in the UP group and 20.3% in the KiVa-intervention group, reducing to 20.7% in the UP group and 17.7% in the KiVa-intervention group at follow-up (odds ratio 0.87; 95% confidence interval 0.78 to 0.97, p value = 0.009). Students in the KiVa group had significantly higher empathy and reduced peer problems. We found no differences in bullying perpetration, school wellbeing, emotional or behavioral problems. A priori subgroup analyses revealed no differences in effectiveness by socioeconomic gradient, or by gender. KiVa costs £20.78 more per pupil than usual practice in the first year, and £1.65 more per pupil in subsequent years.

The KiVa anti-bullying program is effective at reducing bullying victimization with small-moderate effects of public health importance.

The study was funded by the UK National Institute for Health and Care Research (NIHR) Public Health Research program (17-92-11). Intervention costs were funded by the Rayne Foundation, GwE North Wales Regional School Improvement Service, Children's Services, Devon County Council and HSBC Global Services (UK) Ltd.

Pediatric Bipolar Disorder (BPD) is a chronic psychiatric disorder that alters normal and psychological development processes among patients. Although cognitive deficits in BPD have identified in recent studies, little is known about the developmental trajectory of these deficits. DMDD is a newly defined diagnosis included in the DSM-V. Since it added a new dimension to the clinical spectrum but few studies conducted on DMDD, there are some conflicting discussions in the literature about how to distinguish this disorder from other childhood psychiatric disorders and how to treat it.

The aim of this study was to determine the phenomenological and neuropsychological differences between children and adolescents with a diagnosis of BPD (Pediatric Bipolar Disorder), DMDD (Disruptive Mood Dysregulation Disorder), and children and adolescents who are genetically at high risk for Bipolar Disorder (BD), and healthy controls (HCs) who do not have any psychiatric diagnosis, to investigate endophenotypes that may be predictive for BD.

Our study sample consists of four groups, the BPD group (n=30), the Risk group (n=25), the DMDD group (n=36), and the Healthy Control group (n=29). All participants were evaluated by the “Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Now and Lifetime Pattern (K-SADS-PL)”. “Young Mania Rating Scale/Parent Form (YMRS-ABF), Conner’s Parent Rating Scale (CPRS-48), Child and Adolescent Behavior Rating Scale (CBCL)” scales were filled by parents, and “Child Depression Inventory (CDI), Youth Self-Report Form for 11-18 Years Olds (YSR)” scales were filled by children and adolescents. Neurocognitive test battery was applied to each participant: Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), Stroop Color and Word Test (SCWT), Trait Making Test A and B sections (TMT-A/B), California Verbal Learning Test-Child version (CVLT-C).

While it was determined that the cases in the BPD and DMDD groups performed significantly worse in CPT, SCWT, CVLT-C, TMT A/B tests compared to healthy controls, it was found that the subjects in the Risk group performed worse at the CPT test than healthy controls. In addition, the cases in the BPD, Risk and DMDD groups reported more clinical and behavioral problems than the healthy controls.

There is a significant deterioration in the areas of continuous attention, processing speed, cognitive flexibility, response prevention, verbal memory and working memory in the BPD and DMDD groups, and in the continuous attention area in the Risk group compared to healthy controls. Prospective follow-up and imaging studies using larger samples and a larger neurocognitive test battery in the future will better reveal the neuropsychological characteristics of the BPD, Risk and DMDD groups.

None Declared

A growing body of evidence has shown the association between autoimmune thyroiditis and mental illness (Rege et al. AUS N J S Psychiatry 2013; 300 141-154). Identifying the neuropsychiatric features associated with thyroid antibody positivity could have significant implications for diagnostic and therapeutic strategies. However, the link between anti-thyroid antibodies and precise underlying pathophysiology requires future research.

The aim of the present study was to conduct a retrospective evolution in patients diagnosed with schizophrenia spectrum disorder and affective disorder who were screened for anti-thyroid antibodies at the time of their hospitalization and to investigate neuropsychiatric features of anti-thyroid antibody-positive patients.

A total of 143  inpatients diagnosed with schizophrenia spectrum disorders and affective disorders between 2021 and 2023 were screened for anti-thyroid antibodies such as thyroid peroxidase (TPO) and thyroglobulin (TG). All patients were women. In order to elucidate the subsequent neuropsychiatric clinical features of individuals with positive anti-thyroid antibodies, the retrospective examination was conducted based on Neuropsychiatric Invetory-Q (NPI-Q) and DSM-V diagnostic criteria utilized at the time of hospitalization.

The main age of the patients was 48.2 (SD 10.4). A total of 143 inpatients with schizophrenia spectrum disorders and affective disorders were screened for anti-thyroid antibodies at the time of their hospitalizations. %23.1 (n=33) tested positive for at least one of the anti-TG or anti-TPO. All patients were euthyroid. The neuropsychiatric diagnoses are shown in Table 1. The most common neuropsychiatric features assessed by NPI-Q are shown in Table 2. 12.1% (n=4) of all patients were treated with IV steroid Pulse therapy.Table 1.

Neuropsychiatric syndrom-level diagnostic patterns according to DSM-V

In particular, in a subset of schizophrenia spectrum disorder or affective disorder patients with positive anti-thyroid antibodies may indicate autoimmunity, especially in cases where catatonic symptoms dominate the clinical presentation.

None Declared

Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic.

By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions.

A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021.

Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.

A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls.

This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate.

ES-SCZ was associated with the GAF dimensions in patients (symptom: B = −1.53, p-value = 0.001; disability: B = −1.44, p-value = 0.001), siblings (symptom: B = −3.07, p-value < 0.001; disability: B = −2.52, p-value < 0.001), and healthy controls (symptom: B = −1.50, p-value < 0.001; disability: B = −1.31, p-value < 0.001). The results remained the same after adjusting for PRS-SCZ. The degree of associations of ES-SCZ with both symptom and disability dimensions were higher in unaffected siblings than in patients and controls. By analyzing an independent dataset (the Genetic Risk and Outcome of Psychosis study), we replicated the results observed in the patient group.

Our findings suggest that ES-SCZ shows promise for enhancing risk prediction and stratification in research practice. From a clinical perspective, ES-SCZ may aid in efforts of clinical characterization, operationalizing transdiagnostic clinical staging models, and personalizing clinical management.

Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene–environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum.

The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components).

Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene–environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions.

The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.

The relationship between substance use disorders and aggression is complex and not only limited to direct effect of the drugs. Aggression increases the likelihood of substance abuse and is suggested to be a long term individual characteristic which is probably in association with personality traits preexisting before the substance use.

The aim of this study was to evaluate the relationship of personality dimensions with aggression among heroin dependent inpatients and to control the effect of psychiatric symptom severity on this relationship.

Participants were consecutively admitted male heroine (n=78) dependent inpatients. Patients were investigated with the Buss–Perry Aggression Questionnaire (BPAQ), the Temperament and Character Inventory (TCI) and the Symptom Checklist-Revised (SCL-90-R).

Character dimensions self-directedness (SD) and cooperativeness (C) were negatively and self-transcendence (ST) and severity of psychiatric symptoms were positively correlated with severity of aggression and its dimensions. Low SD and C, which are indicative of a personality disorder, were predictors of aggression. Other predictors for aggression in heroin dependents were higher persistence (P) and ST. Severity of psychiatric symptoms predicted aggression together with low C, and high P.

Aggression was more closely related with character dimensions rather than temperament dimensions. Nevertheless, low C and high P predicted the severity of aggression even when the severity of psychopathology was controlled. The careful evaluation of patients for the comorbid psychiatric disorders such as depression, anxiety and personality disorders are needed to handle aggression in heroin dependents which may be related with poor treatment outcome.

Aggression is suggested to be a predictive factor for alcohol use but the casual relationship between aggression and alcohol dependence is complex. Early aggressive acts are a risk factor for early onset alcohol dependence and aggression is suggested to be a long term individual characteristic which is probably in association with personality traits preexisting before the alcohol use.

The aim of this study was to evaluate the relationship of personality dimensions with aggression among alcohol dependent inpatients and to control the effect of psychiatric symptom severity on this relationship.

Participants were consecutively admitted male alcohol (n=94) dependent inpatients. Patients were investigated with the Buss–Perry Aggression Questionnaire (BPAQ), the Temperament and Character Inventory (TCI) and the Symptom Checklist-Revised (SCL-90-R).

Character dimensions self-directedness (SD) and cooperativeness (C) were negatively and severity of psychiatric symptoms was positively correlated with severity of aggression and its dimensions. Low SD and C, which are indicative of a personality disorder, were predictors of aggression. When severity of psychiatric symptoms was included in analyses as an independent variable, it became the main predictor.

Consistent with the hypothesis that aggression is an expression of poor character development, aggression was found to be more closely related with character compared to temperament dimensions. Nevertheless, our findings also suggest that the relationship between the aggression and character dimensions may be indirect through psychopathology. Therefore, when the aggression is the main problem, it is important to evaluate alcohol dependents for the personality dimensions and severity of psychiatric symptoms.

It was suggested that impulsivity is a temperamental risk factor for alcohol use and may be a fundamental mechanism in both the onset of excessive alcohol use and the relapse to alcohol use. Aim of this study was to evaluate the changes in impulsivity scores among alcohol dependents 12 month after inpatient treatment.

Among 78 consecutively admitted male alcohol dependents, 58 were examined by face to face interview 12 months after discharge from hospital. Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11) (10) both at the baseline and at the end of 12 months.

Among 58 alcohol dependent inpatients 61.8% (n=32) were considered as relapsed to heroin use during 12 month follow-up. Sociodemographic variables did not differ between the groups. Mean impulsivity scores did not differ between remission and relapsed groups at baseline, whereas only non-planning impulsivity was higher in relapsed group at follow-up. Impulsivity score decreased during 12 month follow-up in remission group, whereas increased in relapsed group. Among dimensions of impulsivity non-planning impulsivity decreased in remission group, whereas attentional impulsivity increased.

Results of the present study may suggest that while attentional impulsiveness may be the cause of alcohol use, non-planning impulsiveness may also be a vulnerability factor for alcohol dependency and relapse.

The aim of this study was to evaluate the changes in impulsivity scores among those who are still using buprenorphine as maintenance substitution treatment and those relapsed to heroin use in heroin dependent inpatients at the end of 12 month follow-up. We also controlled depression and trait state anxieties on the relationship between impulsivity and relapse.

Among 78 consecutively admitted male heroin dependents, 52 (66.7%) were examined by face to face interview 12 months after discharge from hospital. Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11), Beck Depression Inventory and State-Trait Anxiety Inventory at the end of 12 months.

Among 52 heroin dependent patients that were avalible to examine by face to face interview 23 (44.2%) were considered as relapsed to heroin use during the last year, whereas 29 (55.8%) were still in the maintenance treatment. Relapsed group has less attended to polyclinic control, outpatient treatment, they did not change their social environment, continue to see their dependent friends and used other drugs during 12 monts. Mean impulsivity, depression and anxiety scores were higher in the relapsed group. State anxiety and impulsivity, particularly motor impulsivity determined the relapse in regression analyses.

Together with state anxiety, which may be mediated by craving, motor impulsivity predicted relapse. In response to stress or environmental cues, an individual with substance abuse could use the substance in a rapid unplanned action without regard to the consequences.

The aim of the present study was to evaluate relationship of impulsivity with severity of ADHD symptoms while controlling the effects of anxiety and depression in a sample of inpatients with alcohol use disorder.

Participants included 190 inpatients with alcohol use disorder. Participants were evaluated with the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Short Form Barratt Impulsiveness Scale (BIS-11-SF) and the Adult ADHD Self-Report Scale (ASRS).

Impulsivity predicted both severity of ADHD symptoms and inattentive and hyperactive/impulsive dimensions, even after controlling the effects of depression and anxiety in linear regression models. Types of negative affect that predicted dimensions of ADHD differed; similar with severity of ADHD symptoms, depression and trait anxiety also predicted inattentive dimension, whereas trait and state anxiety predicted hyperactive/impulsive dimension.

Impulsivity is related with severity of ADHD symptoms and dimensions of ADHD although negative affect that is related with dimensions may differ.

The authors have not supplied their declaration of competing interest.

Obesity is a major public health problem in the world and getting obesity under control is one of the most important goals of the World Health Organization. Cognitive behavioral therapy techniques are helpful for adjusting lifestyle to stay at a healthy weight range. Success of web-based programs which designed with evidence-based behavioral strategies has been proven with different studies. However, a web-based program suitable for Turkish culture and eating habits is still missing.

Primary objective of this project is to develop and test a web-based obesity behavioral treatment program in collaboration with experienced academicians from different disciplines.

The aim of this project is to develop a program which will help Turkish primary care physicians in treating and tracking obesity patients.

The web-based program will include a 12-week-long core behavioral program. Participants will be asked to record their daily dietary intakes and automatic feedback will be given by the system. Weekly behavioral training videos will be available during the core program. As participants watch the videos and record their daily intakes, they will get instant awards such as virtual diet-coin which they will be able to spend for gifts such as low calorie recipes. One hundred obese patients (with body mass index greater than 30 kg/m2) will be recruited to evaluate the effectiveness of the program. The changes in their blood pressures, body weights and waist circumferences will be recorded.

The authors have not supplied their declaration of competing interest.

Turkish version of the UPPS Impulsive Behavior Scale was previously validated in a sample of psychiatric inpatients. The aim of the present study was to evaluate psychometric properties of the sensation seeking subscale of this scale in a sample of inpatients with alcohol use disorder.

Participants (n = 190) were evaluated with the sensation seeking subscale of UPPS Impulsive Behavior Scale.

Sensation seeking subscale had two factors, which together accounted for 63.80% of total variance. As similar with original subscale internal consistency for the sensation seeking (coefficient α=0.859), factor 1 (α=0.862) and factor 2 (α=0.755) examined by Cronbach's alpa, were high. Factor 1 (r = 0.894) and factor 2 (r = 0.863) were highly correlated with total score, whereas moderately correlated (r = 0.544) with each other. Test-retest correlation for sensation seeking (n = 120) was mild (r = 0.460). Test-retest correlation for factor 1 was moderate (r = 0.518) and for factor 2 was mild (r = 0.431).

These findings support the Turkish versions of the sensation seeking subscale of the UPPS has good psychometric properties among inpatients with alcohol use disorder.

The authors have not supplied their declaration of competing interest.