Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.

The attitudes toward genomics and precision medicine (AGPM) measure examines attitudes toward activities such as genetic testing, gene editing, and biobanking. This is a useful tool for research on the ethical, legal, and social implications of genomics, a major program within the National Institutes of Health. We updated the AGPM to explore controversies over mRNA vaccines. This brief report examines the factor structure of the updated AGPM using a sample of 4939 adults in the USA. The updated AGPM’s seven factors include health benefits, knowledge benefits, and concerns about the sacredness of life, privacy, gene editing, mRNA vaccines, and social justice.

This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.

State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team’s larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians.

The ideal anxiolytic drug would be effective in all anxiety disorders, with a rapid onset of action, across all symptom domains and the spectrum of severity, in achieving remission and minimising disability, in preventing relapse, and in treating comorbid depression. Ideally, the drug would be suitable for once-daily dosage, would have minimal adverse effects or cause minimal interference with everyday life, not lead to the development of tolerance, have no discontinuation symptoms, be suitable in physically ill patients and free from interactions, and be safe in overdose.

But there are no ideal anxiolytic drugs. Response rates to initial treatment can be disappointing, it is not possible to reliably predict likelihood of response; a substantial proportion of patients experience unwanted effects; many will relapse despite treatment adherence; comparatively little is known about further management after initial non-response; and discontinuation symptoms can be troublesome.

Hence there is much room for improvement in identifying those patients who are most likely to benefit from treatment; in choosing between drug and psychological treatments; in choosing the right drug for the right patient groups; in optimising medication dosage to achieve maximum effectiveness whilst minimising adverse effects; in combining drug treatments to enhance efficacy; and in treating over the long term to prevent relapse and recurrence.

Panic disorder is a common condition. Epidemiological studies throughout the world consistently indicate that the lifetime prevalence of panic disorder (with or without agoraphobia) is between 1.5% and 3.5%. Panic disorder shows substantial comorbidity with other forms of mental illness. Major depressive disorder occurs in 50 to 65% of individuals with panic disorder and there is considerable cross-sectional and longitudinal comorbidity with recurrent brief depression and dysthymia. Phobic anxiety disorders, most notably social phobia and generalised anxiety disorder, commonly occur with panic disorder, especially in individuals with more severe agoraphobia. Approximately 35 to 50% of individuals with panic disorder in community settings also have agoraphobia. Panic disorder also shows significant comorbidity with physical illness. Compared with individuals without or with some other psychiatric diagnosis, patients with panic disorder have an increased risk of suffering from multiple medically unexplained symptoms and are associated with high use of medical services and increased mortality from both cardiovascular and cerebrovascular disease.

Anxiety disorders are common, have an early onset, run a long course, cause substantial distress, impair overall function, reduce quality of life and impose a major economic burden, and therefore represent an important public health problem. Many patients do not present or are not recognized, the standard of care is often sub-optimal, and the effectiveness of interventions in real-world practice can be disappointing: there is considerable room for improvement in recognition, care and treatment.

The causes remain largely unknown and this hinders accurate diagnosis, prediction of prognosis, and development of refined treatment approaches. There is much co-morbidity between the disorders and with conditions such as bipolar disorder, depressive illness and physical illness. Research findings in patient samples without co-morbidity may have limited applicability to wider practice, and there is a need to undertake research in fully representative groups. Little is known about determinants of non-response, or next steps in management after the failure of first-line interventions, and there is a clear need for research in the substantial proportion with ‘treatment-resistant’ conditions.

The unmet public health, clinical and research needs could therefore be addressed by developing an independent collaborative European Anxiety Disorders Research Network. This would facilitate harmonization of research and clinical databases and refinement of research methodologies. It should contribute to greater accuracy when predicting clinical outcome, and encourage the evaluation of innovative interventions, particularly in important groups such as in the early stages of illness, those with comorbid disorders, and those who have not responded to initial treatment approaches.

Current evidence-based guidelines for generalized anxiety disorder (GAD) tend to recommend initial treatment with either a selective serotonin reuptake inhibitor or a serotonin-noradrenaline reuptake inhibitor, although there is also good evidence for the efficacy of pregabalin and quetiapine. NICE guidelines recommend that cognitive behaviour therapy is reserved for patients not responding to initial interventions based on self-help and psychoeducation. The findings of a mixed treatment comparison and meta-analysis demonstrate the difficulty in establishing the relative efficacy and tolerability of pharmacological treatments. It is hard to predict which patients will respond well to pharmacological treatment, but response to antidepressants or pregabalin is unlikely if there is no onset of effect within four weeks. The value of combining pharmacological with psychological interventions is uncertain. The small number of relapse prevention studies causes uncertainty about optimal duration of treatment after a satisfactory initial response, but continuing treatment for at least twelve months is advisable. However many patients will not respond well to current interventions, and there is much room for improvement in the development of more effective and better tolerated treatments. Challenge studies in healthy volunteers, involving the inhalation of air ‘enriched’ with 7.5% CO2 provide a robust experimental medicine model of GAD and are being used to evaluate novel pharmacological and psychological interventions. In addition, advances in understanding of the potential role of neuroinflammatory factors in GAD also suggest other potential targets for pharmacological treatment.

The 2008 UK government White Paper, published as part of the Managing Radioactive Waste Safety programme, identified benefits to disposing of all of the UK's higher activity wastes at the same site. That is, a single geological disposal facility (GDF) could be constructed that consists of a module for low- and intermediate-level waste, and a module for high-level waste and spent fuel.

A safety case for a co-located GDF will have to consider the extent to which evolving thermo-hydro-mechanical-chemical and gas (THMCG) conditions in and around one module may affect conditions in the other module, including the extent to which barrier performance and radionuclide migration behaviour could be altered. Several research projects have been undertaken on behalf of Radioactive Waste Management Directorate aimed at understanding and evaluating the THMCG interactions that might occur during the disposal facility operational and post-closure phases.

This paper describes research on THMCG interactions between disposal modules based on illustrative GDF designs for different host rock environments. Interactions were evaluated using simple analytical solutions and detailed three-dimensional models. The analyses demonstrated that interactions can be controlled by design constraints.

Intermediate-level wastes (ILW) include substantial quantities of fissile material and controls are required to ensure that its storage, transport and disposal does not present a nuclear criticality hazard. This paper describes the Radioactive Waste Management Directorate's research to develop package fissile material limits (in the form of screening levels) for four different categories of ILW, defined according to uranium or plutonium composition: (1) irradiated natural and slightly enriched uranium (uranium containing up to 1.9 wt.% 235U); (2) low-enriched uranium (uranium containing up to 4 wt.% 235U); (3) high-enriched uranium (uranium containing up to 100 wt.% 235U); and (4) separated plutonium (plutonium containing up to 100 wt.% 239Pu).

The derivation of package screening levels was supported by neutron transport calculations that addressed conditions during waste package transport to a geological disposal facility (GDF), during the GDF operational phase and after GDF closure. The analysis included consideration of combinations of events and processes that could result in fissile material accumulation and concentration after GDF closure, when waste packages have deteriorated sufficiently for fissile material to be mobilized. The results of the calculations have provided input to Radioactive Waste Management Directorate's decision making on setting waste package screening levels.

A geological disposal facility (GDF) will include fissile materials that could, under certain conditions, lead to criticality. Demonstration of criticality safety therefore forms an important part of a GDF's safety case.

Containment provided by the waste package will contributeto criticality safety during package transport and the GDF operational phase. The GDF multiple-barrier system will ensure that criticality is prevented for some time after facility closure. However, on longer post-closure timescales, conditions in the GDF will evolve and it is necessary todemonstrate: an understanding of the conditions under which criticality could occur; the likelihood of such conditions occurring; and the consequences of criticality should it occur.

Work has addressed disposal of all of the UK's higher-activity wastes in three illustrative geologies.This paper, however, focuses on presenting results to support safe disposal of spent fuel, plutonium and highlyenriched uranium in higher-strength rock.

The results support a safety case assertion that post-closure criticality is of low likelihood and, if it was to occur, the consequenceswould be tolerable.

Background: Evidence suggests that insomnia may be an important therapeutic target to improve mental health. Aims: Evaluating changes in symptoms of depression and anxiety after supported digital cognitive behavioural therapy (dCBT) for insomnia delivered via a community-based provider (Self Help Manchester) of the Improving Access to Psychological Therapies (IAPT) service. Method: Supported dCBT for insomnia was delivered to 98 clients (mean age 44.9 years, SD 15.2, 66% female) of Self Help Manchester. All clients received six support calls from an eTherapy coordinator to support the self-help dCBT. During these calls levels of depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7) were determined. Results: Depression (M difference-5.7, t(70) = 12.5, p < .001) and anxiety [Generalized Anxiety Disorder-7 (GAD-7), M difference-4.1, t(70) = 8.0, p < .001] were reduced following supported dCBT for insomnia. This translated into an IAPT recovery rate of 68% for depression and anxiety. Conclusions: These results suggest that dCBT for insomnia alleviates depression and anxiety in clients presenting with mental health complaints in routine healthcare.