The Maudsley Hospital is a British psychiatric hospital in south London. The Maudsley is the largest mental health training institution in the UK. It is part of South London and Maudsley NHS Foundation Trust, and works in partnership with the Institute of Psychiatry, King's College London. The hospital was one of the originating institutions in producing the Maudsley Prescribing Guidelines. It is part of the King's Health Partners academic health science centre and the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health.
IntroductionWomen nurses in the global north more likely to die by suicide than women in other occupations. Current suicide research is largely quantitative and individualises and pathologises nurses. Suicide prevention policy echoes this approach, focusing on individualised risk factors, thereby missing the opportunity to explore contextual, systemic and workplace factors that may contribute to suicide in women nurses. This critical policy analysis explores how distress, suicidality and suicide prevention in women nurses is positioned and constructed in policy and with what political, social and personal consequences.MethodsA critical intersectional feminist design was adopted to interrogate the data and draw out issues pertinent to women nurses. This work was co-produced with women nurses. Bacchi’s ‘What’s the problem represented to be?’ method of critical policy analysis to inform the data extraction and analysis. We employed a feminist perspective and adapted Lazar’s five principles of feminist discourse praxis. Documents were sourced from governmental and organisational websites and via search engines and were screened against our inclusion criteria. Data was extracted to inform an overview of included documents and for the critical analysis.ResultsNine documents met our inclusion criteria. We found some stark silences in the included documents regarding suicide in women nurses, and in the health services. Suicide is positioned as a problem of risky people, and as a workforce, rather than a workplace issue. Three narratives were developed to convey the core findings of the analysis: Invisible nurses and silenced suicide; People as risky; Responsibilising the workforce. Four themes sit within ‘Responsibilising the workforce’: Nurses as risky; Knowledge and means; Workforce problems; Workforce solutions.ConclusionCurrent policy documents engage a language of risk which pathologises and responsibilises individuals and minoritised groups as causing high rates of suicide within communities and health workplaces. The impact of socio-economic, political and systemic contexts is overlooked as shaping the lives of suicidal people.
The ANZJP 2026 schizophrenia guideline appropriately emphasises the importance of identifying treatment-resistant schizophrenia and the timely initiation of clozapine. However, despite clear guidance on when to commence clozapine, there remains comparatively limited direction regarding the systematic assessment and management of individuals who show an inadequate response to clozapine, commonly termed clozapine-resistant schizophrenia. The absence of consistent, operationalised guidance contributes to variability in clinical practice and uncertainty regarding optimal management strategies. In this perspective article, we summarise practical, evidence-informed recommendations to assist clinicians in the assessment and management of clozapine-resistant schizophrenia. Current evidence supports the early use of clozapine once treatment-resistant schizophrenia is established, with delayed clozapine use associated with poorer outcomes. In individuals with persistent symptoms despite clozapine treatment, systematic assessment is required to exclude pseudoresistance, including non-adherence, drug interactions, altered metabolism, and subtherapeutic plasma clozapine concentrations. Therapeutic drug monitoring is therefore a core component of care. Optimisation of clozapine should prioritise individualised adjustment of plasma concentrations guided by clinical response, adverse effects, and tolerability, rather than reliance on fixed concentration thresholds alone. Where an adequate trial of optimised clozapine has failed, augmentation strategies may be considered, with preference given to interventions supported by meta-analytic findings and real-world effectiveness data, while recognising the modest and inconsistent benefits observed across studies. Augmentation trials should be time-limited, systematically evaluated and if no meaningful improvement occurs, should be discontinued rather than continued indefinitely. Despite decades of research, no augmentation strategy has demonstrated consistent efficacy in clozapine-resistant schizophrenia. Future research should prioritise adequately powered, placebo-controlled trials and standardised definitions of treatment-resistant schizophrenia and clozapine-resistant schizophrenia to enable clearer treatment algorithms and more reliable clinical pathways for this patient group.
Background: Gastrointestinal symptoms (GIS) are prevalent in autistic adults, but little is known about their psychological predictors. This study examined general (anxiety, gastrointestinalspecific anxiety [GSA], neuroticism) and autism-specific (sensory over-responsivity [SOR], autism severity) psychological predictors of GIS in adults with varying levels of autistic traits. Methods: One hundred and fifty-five adults without a formal autism diagnosis were divided into high (AQ+, n = 72) and low (AQ-, n = 83) autistic trait groups based on a cut-off score of 32 on the Autism Quotient. Participants completed self-report measures of gastrointestinal symptoms, autistic traits, and psychological characteristics including anxiety, GSA, neuroticism and SOR. Group differences were assessed using analysis of variance, and hierarchical regression was used to identify independent predictors of GIS. Anxiety and GSA emerged as the only independent predictors and were entered as parallel mediators testing whether they explained the association between autistic traits and GIS. Results: The AQ+ group reported significantly greater GIS severity and frequency, particularly diarrhoea, constipation, and abdominal pain, together with higher anxiety, GSA, neuroticism, and SOR. In regression analyses, only anxiety and GSA independently predicted GIS. Mediation analysis indicated full mediation, with indirect effects via GSA (b = 0.0190, 95 % CI [0.0118, 0.0280]) and anxiety (b = 0.0089, 95 % CI [0.0040, 0.0148]). The model explained 50.4 % of variance in GIS severity. Conclusions: Anxiety, particularly GSA, plays a central role in explaining GIS severity in adults with elevated autistic traits. Interventions targeting these psychological factors may offer a promising route to reducing GIS in this population.
Purpose - Psychologically informed environments (PIEs) are increasingly being used within the homeless sector to meet the psychological needs of this population, with increasing evidence for their effectiveness. Reflective practice (RP) is one of the "pillars" of the PIE approach. The purpose of this paper is to explore the impact on staff following the delivery of RP in Centrepoint: a national homeless charity for young people (YP) aged 16-25 years, following its introduction and adaptation post COVID-19. Design/methodology/approach - A mixed method approach was adopted. Data collected on the frequency and uptake of RP across the organisation was analysed, including qualitative analyses of the themes emerging from the RP sessions and a staff survey to explore attendees' experience of RP. Findings - Overall, the majority of staff were satisfied with RP and found it helpful. Qualitative responses from the survey indicated that staff valued having a space to reflect on and speak about their work as well as a place to learn new psychological "tools" or approaches to working with the homeless YP. They also noted the "supportive" function of the sessions, which is particularly important given the stressful impact of the recent COVID-19 pandemic on "frontline" health and social care staff. Dissatisfaction was associated with a lack of access or insufficient frequency of RP sessions, suggesting more resources are required to allow for a greater provision of RP. Originality/value - To the best of the authors' knowledge, this paper is one of the first to explore RP in the homelessness sector, and the first within the COVID-19 pandemic.
