South London and Maudsley NHS Foundation Trust, is an NHS foundation trust based in London, England, which specialises in mental health. It comprises three psychiatric hospitals (Bethlem Royal Hospital, Lambeth Hospital and the Maudsley Hospital), the Ladywell Unit based at University Hospital Lewisham, and serves the boroughs of Lambeth, Lewisham, Croydon and Southwark. The Trust also provides drug and alcohol services and 50 high-quality, national specialist services for people with complex needs.The Trust employs around 6,300 members of staff (including bank and agency staff) and serves a population of 1.3 million people. The Trust has 268 community, inpatient and outpatient services including 52 inpatient wards.The Trust launched a new strategy, Aiming High; Changing Lives 2021-2026 built on the feedback of hundreds of staff, service users, carers and partners with the support of many community organisations. The strategy comprises five key ambitions: Deliver outstanding mental health care; Be a partner in prevention; Be a catalyst for change; Build a culture of trust together; Become effective and sustainable.South London and Maudsley forms part of the institutions that make up King's Health Partners, an academic health science centre.The Trust collaborates with Oxleas NHS Foundation Trust and South West London and St George's Mental Health Trust to provide more sustainable healthcare to more than 3.6 million people in south London through the South London Mental Health and Community Partnership (SLP).In its most recent inspection of the Trust, the CQC gave SLaM a 'good' rating overall.
Dopamine agonists (DAs), such as cabergoline (CAB), are first-line treatments for hyperprolactinaemia but have been associated with impulse control disorders (ICD). This observational study aimed to investigate the prevalence, severity, and clinical characteristics of ICD in CAB-treated patients compared with controls, using a combined clinician-administered and multimethod self-report assessment. A total of 126 participants were included: 63 patients with prolactin-secreting pituitary adenomas receiving cabergoline (CAB) and 63 controls (CG). ICD were evaluated using the Parkinson’s Impulse Control Scale (PICS) as the reference diagnostic measure, alongside self-report questionnaires assessing ICD-related behaviors. Psychiatric comorbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and general psychopathology using the Brief Symptom Inventory-53 (BSI-53). ICD were identified in 15.9
OBJECTIVES:This World Federation of Societies of Biological Psychiatry (WFSBP) consensus paper aims to summarise and evaluate the published study results on objectively measurable biological markers associated with anorexia nervosa (AN). METHODS:The relevant literature was reviewed by the WFSBP Task Forces on Eating Disorders and on Biological Markers, and a consensus regarding the significance of the published evidence was reached. RESULTS:Candidate biological markers that have been associated with AN include clinical (e.g. body weight), molecular (e.g. genetic, epigenetic, hormonal, immunological, metabolomic), cellular (e.g. leukocytes), neuroimaging (e.g. structure, function, connectivity), digital, cardiac and neurophysiological parameters. Some clinical and laboratory parameters are risk markers in clinical practice. Biological markers have pathophysiological relevance in understanding the biological and metabolic pathophysiology of AN and its physical health consequences. Few studies have examined pharmacogenetics or therapeutic drug monitoring as tools to monitor and guide the treatment of AN. CONCLUSIONS:Biological markers will hopefully soon enable clinicians to intervene earlier in a more targeted manner to mitigate treatment resistance. However, the current scientific basis for most biological markers are group comparisons only. Studies on sensitivity, specificity and the prognostic value of these markers are lacking.
Objective A proof-of-concept study aimed at designing and implementing Visual & Interactive Engagement With Electronic Records (VIEWER), a versatile toolkit for visual analytics of clinical data, and systematically evaluating its effectiveness across various clinical applications while gathering feedback for iterative improvements.Materials and Methods VIEWER is an open-source and extensible toolkit that employs natural language processing and interactive visualization techniques to facilitate the rapid design, development, and deployment of clinical information retrieval, analysis, and visualization at the point of care. Through an iterative and collaborative participatory design approach, VIEWER was designed and implemented in one of the United Kingdom's largest National Health Services mental health Trusts, where its clinical utility and effectiveness were assessed using both quantitative and qualitative methods.Results VIEWER provides interactive, problem-focused, and comprehensive views of longitudinal patient data (n = 409 870) from a combination of structured clinical data and unstructured clinical notes. Despite a relatively short adoption period and users' initial unfamiliarity, VIEWER significantly improved performance and task completion speed compared to the standard clinical information system. More than 1000 users and partners in the hospital tested and used VIEWER, reporting high satisfaction and expressed strong interest in incorporating VIEWER into their daily practice.Discussion VIEWER provides a cost-effective enhancement to the functionalities of standard clinical information systems, with evaluation offering valuable feedback for future improvements.Conclusion VIEWER was developed to improve data accessibility and representation across various aspects of healthcare delivery, including population health management and patient monitoring. The deployment of VIEWER highlights the benefits of collaborative refinement in optimizing health informatics solutions for enhanced patient care.
Immune dysfunction is implicated in the pathophysiology of schizophrenia. The 18 kDa translocator protein (TSPO), expressed by various cell types, including microglia and astrocytes, is widely used as a marker for neuroinflammation and can be quantified in vivo using PET. However, findings from TSPO PET studies in recent-onset psychosis have been inconsistent, and it remains unknown whether TSPO levels can be modified in schizophrenia. We addressed these questions with a baseline case-control comparison of patients with a first-episode psychotic disorder who were symptomatic despite antipsychotic treatment and healthy volunteers, and a longitudinal study testing the effects of natalizumab (a monoclonal antibody previously shown to reduce TSPO levels in neuroinflammatory conditions) on TSPO levels and symptoms in patients. Baseline and 3-month follow-up brain imaging was carried out using 18F-DPA-714 TSPO PET, quantified as the distribution volume ratio (DVR) in total, frontal lobe and temporal lobe grey matter. A total of 103 volunteers (62 patients and 41 healthy controls) received baseline brain imaging, and 47 patients completed follow-up imaging after receiving natalizumab (n = 31) or placebo (n = 16) infusions. Natalizumab was well tolerated, with no serious treatment-related adverse events. The patient group also received clinical assessments with the Positive and Negative Syndrome Scale at baseline and follow-up. At baseline, DVR was significantly higher in patients relative to controls in total (eta(2) = 0.04) and temporal lobe (eta(2) = 0.06) grey matter. However, there was no significant change in DVR across these regions following natalizumab or placebo treatment. Mean +/- standard deviation (SD) CSF levels of natalizumab after treatment were 10.7 +/- 27.2 ng/ml, indicating that the monoclonal antibody crossed the blood-brain barrier. Patients receiving natalizumab showed a modest but statistically significant improvement in Positive and Negative Syndrome Scale total scores (mean +/- SD change: -3.7 +/- 9.1, Cohen's d = 0.40, P = 0.017), although there was no relationship between change in DVR and change in symptom severity (P > 0.05). These findings are consistent with elevated grey matter TSPO levels in first-episode psychosis relative to healthy controls. Although natalizumab treatment was associated with a modest reduction in symptoms, the absence of corresponding changes in DVR suggests that higher grey matter TSPO might reflect expression by non-microglial cells. The lack of significant changes in the placebo group indicates that it is a stable trait biomarker. Further work is needed to clarify the functional relevance and cellular specificity of TSPO alterations in psychosis.
BACKGROUND:Men are underserved in research on eating, exercise and body image psychopathology (EEBIP), and remain underrepresented within healthcare settings despite growing clinical need. One barrier to men's help-seeking for EEBIP-related concerns is that public-facing healthcare information/resources often appear unwelcoming to them, suggesting the need for more inclusive, gender-sensitive resources that engage men and address their specific needs. This study aimed to explore men's perspectives on the design of inclusive EEBIP resources, to inform the iterative co-design of guidance for future resource development. METHODS:This study employed a lived experience-led approach, integrating a modified nominal group technique with participatory research methods, as part of an iterative co-design of a guidance document. Six men with lived experience of EEBIP ranked their preferred features of male-inclusive resources from a broader list of content and format ideas generated through a survey of 42 men. Interview and focus group discussions followed, exploring the underlying reasons why the men with EEBIP experience believed these content and format ideas would support men's help-seeking for EEBIP. Finally, a draft guidance document, underpinned by the results of the discussions, was designed and iteratively edited, following feedback from healthcare organisation representatives, academics, and men with lived experience. RESULTS:Thematic analysis of the discussions identified five themes to inform the development of future resources. The five themes are titled: (1) Designing accessible resources that navigate men's readiness; (2) Authentic voices: inclusive, conversation-led outreach; (3) Self-realisation: refraining from labelling men as 'unhealthy' or 'disordered'; (4) Purpose and progress driven resources; (5) Images: the line between helpful and harmful isn't always clear. These themes are discussed alongside EEBIP and men's mental health help-seeking literature. CONCLUSIONS:This is the first study to centre men's experiential knowledge to explore how healthcare organisations can facilitate men's help-seeking for EEBIP-related concerns via public-facing resources. The themes generated in this study reflect findings of studies exploring the facilitation of men's general mental health help-seeking, whilst contributing novel EEBIP-specific findings. The results of this study can support EEBIP healthcare organisations to develop public-facing resources that are more inclusive of men.
