Eating disorders and psychotic disorders represent two of the most serious psychiatric conditions. Emerging lines of evidence from genetic and epidemiological studies suggest that these disorders may commonly co-occur. This systematic review investigated the association between these disorders across community and clinical populations.

A systematic review was preregistered (CRD42021231771) and conducted according to PRISMA guidelines. Web of Science, PsycINFO and Medline were searched for articles on the association and comorbidity between psychosis and eating disorders up to the 26th February 2024. A random effects meta-analysis was conducted for studies reporting comorbidity of eating disorders and psychotic disorders based on clinical diagnosis or interview measures, to estimate prevalence of the comorbidity between these disorders. A narrative synthesis was conducted for all other studies and grouped by sample (general population, eating disorders or psychotic disorders).

In total 43 studies met inclusion criteria for the systematic review and 16 were included in the meta-analysis. Findings suggest substantial comorbidity between eating disorders and psychotic disorders, with a pooled comorbidity prevalence of 8% (CI: 3, 14) based on clinical diagnosis or interview measures. Studies using self-report questionnaires also highlight the association between eating disorders and psychosis across clinical and community populations.

Eating disorders and psychotic disorders frequently co-occur. Further research should investigate the temporal order of symptom development and consider the need for novel interventions targeted at overlapping psychotic and eating disorder symptoms and associated phenomena.

Cognitive remediation (CR) can reduce the cognitive difficulties experienced by people with psychosis. Adapting CR to be delivered remotely provides new opportunities for extending its use. However, doing so requires further evaluation of its acceptability from service users’ views. We evaluate the acceptability of therapist-supported remote CR from the perspectives of service users using participatory service user-centred methods.

After receiving 12 weeks of therapist-supported remote CR, service users were interviewed by a service user researcher following a semi-structured 18-question interview guide. Transcripts were analysed using reflexive thematic analysis with themes and codes further validated by a Lived Experience Advisory Panel and member checking.

The study recruited 26 participants, almost all of whom reported high acceptability of remote CR, and some suggested improvements. Four themes emerged: (1) perceived treatment benefits, (2) remote versus in-person therapy, (3) the therapist’s role, and (4) how it could be better.

This study used comprehensive service user involvement methods. For some participants, technology use remained a challenge and addressing these difficulties detracted from the therapy experience. These outcomes align with existing research on remote therapy, suggesting that remote CR can expand choice and improve access to treatment for psychosis service users once barriers are addressed. Future use of remote CR should consider technology training and equipment provision to facilitate therapy for service users and therapists.