Summary Duration of untreated psychosis (DUP) is commonly used as a prognostic marker in first-episode psychosis (FEP), but it does not capture symptom persistence following antipsychotic initiation. We examined whether DUP, duration to remission ((DTR) time from antipsychotic initiation to first remission) and duration of active psychosis ((DAP) time from symptom onset to first remission, i.e. DUP + DTR) predict 10-year clinical and functional outcomes in a Chinese FEP cohort ( n = 142). Both duration (months) and severity (area under the curve) indices were generated. DTR emerged as the most consistent and robust predictor, with longer and more severe post-initiation symptom persistence associated with greater symptom severity and poorer functioning. In contrast, DUP and DAP showed limited predictive value. These findings suggest that persistence of active psychosis after treatment initiation may be more clinically informative than treatment delay alone, highlighting early treatment response as a key target for improving long-term outcomes.
Background Acute behavioural disturbance (ABD) is a contested term describing severe agitation and behavioural dysregulation, often preceding sudden death. Concerns regarding diagnostic clarity, racial bias and law enforcement restraint have been raised, and its clinical and forensic utility have been questioned. Aims To characterise fatal ABD cases following substance use to inform clinical management, forensic interpretation and policy. Method Fifty-one deaths consistent with ABD were identified from the National Programme on Substance Use Mortality (NPSUM) using textual screening and Royal College of Emergency Medicine and Faculty of Forensic & Legal Medicine criteria. Results All cases met Royal College of Emergency Medicine criteria and most met Faculty of Forensic & Legal Medicine (84.3%) criteria. Agitation was the most frequently observed sign (86.3% of cases). Stimulants, particularly cocaine and amphetamines, were also detected in 86.3% of cases, but not necessarily in the same cases, and the rate of stimulant detection was almost three times higher than that in in the broader NPSUM cohort (32.1%). Cocaine concentrations were higher in ABD cases than in all NPSUM cocaine-related deaths (0.848 mg/L v . 0.105 mg/L). Compared with the NPSUM cohort, ABD decedents were significantly younger (30.2 ± 7.5 v . 40.5 ± 13.4) and more likely to be male (92.2 v . 73.4%), from racially minoritised backgrounds (21.7 v . 3.9%) and living in deprived areas (87.0 v . 75.9%). Conclusions Variability in diagnostic criteria highlights a need for clearer ABD definitions. Toxicology testing may assist in refining the ABD construct, but its results must be interpreted within broader clinical and social contexts. These findings support avoiding use of ABD as a stand-alone cause of death but retaining it as a clinical descriptor prompting urgent treatment, monitoring and reduced reliance on prolonged restraint.
Background International guidance recommends that long-acting injectable (LAI) antipsychotics be considered for routine management of first-episode schizophrenia. Reliable national estimates of utilisation are lacking for most countries, including Ireland. Aims To determine the prevalence of LAI antipsychotic prescribing in Ireland between 2014 and 2024 and explore the effects of age, sex and socioeconomic status on prescribing trends. Method The annual prescribing prevalence was calculated per 1000 individuals with schizophrenia aged 15–69 using the national pharmacy claims database. The effects of year, age, sex, socioeconomic class and antipsychotic medication on LAI antipsychotic prescribing trends were examined using log-linear regression. Results The prevalence of LAI antipsychotic prescribing decreased from 327/1000 in 2014 to 281/1000 in 2024, with an average annual change in prescribing rate of −1.49% [95% CI −1.98, −0.79]. In 2024, paliperidone LAIs were most commonly prescribed (40.2%). Prescribing prevalence increased with age, with the lowest prescribing prevalence occurring among those aged 15–24 years (79/1000) and the highest among those aged 65–69 years (434/1000). The prescribing prevalence increased significantly among those aged 25–34 years only (+2.7% [95% CI 1.7, 4.3]). Prescribing rates decreased across all ages between 45 and 69 years; the largest decrease occurred among those aged 65–69 years (−4.3% [95% CI −5.7, −2.9]). Higher rates of prescribing were seen in male compared with female patients across all age bands, with the highest male-to-female ratio (2.94) occurring among those aged 25–34 years. Conclusions Approximately 28% of Irish individuals with schizophrenia are prescribed an LAI antipsychotic. Prescribing rates have decreased by 14% since 2014. Priorities for future research include implementation science studies to identify strategies that can effectively increase LAI antipsychotic prescribing.
Summary Lithium is a first-line maintenance treatment for bipolar disorder yet delays in diagnosis and lithium initiation remain common. This retrospective cohort study examined whether time to bipolar disorder diagnosis and lithium initiation differ by ethnicity, gender or age among 88 patients at South London and Maudsley National Health Service Foundation Trust. Delay outcomes were non-normally distributed and log-transformed before analysis. No demographic characteristic was significantly associated with time to lithium initiation. Ethnicity was significantly associated with diagnostic delay, with individuals from minority ethnic groups experiencing longer delays than White individuals (median 556 v . 50.5 days; IQR [89.8, 1342] v . [6.25, 222]), which persisted after adjustment for age, gender, substance use and illness severity, and remained robust to outlier removal. Although social deprivation was not accounted for, these findings suggest possible systematic diagnostic inequities in bipolar disorder, calling for culturally informed diagnostic practices and further investigation in larger, multi-site samples.
Background The 7 October 2023, terrorist attack at the Nova Festival in southern Israel caused deaths, injuries, hostage-taking and prolonged life-threatening exposure, creating an urgent need for early interventions to reduce post-traumatic morbidity. Although prolonged exposure is an established post-traumatic stress disorder (PTSD) treatment, its feasibility and benefit during ongoing threat remain unclear. Aims This preliminary study evaluated a war-adapted brief prolonged exposure protocol (WBPE) delivered shortly after trauma in Nova Festival survivors with acute stress disorder. Method Forty survivors completed the WBPE and were assessed at baseline and immediately post treatment. A subsample of 27 WBPE completers and 18 untreated wait-list controls was reassessed after 5 months. Outcomes were PTSD (PDS-5), depression (PHQ-9) and anxiety (GAD-7) symptom severity. Results WBPE was associated with significant reductions in PTSD, depression and anxiety immediately after treatment. At 5 months, WBPE participants showed greater reductions in PTSD and depressive symptom severity and lower PTSD and depression symptom scores than controls, with large effect sizes. Anxiety symptoms improved in both groups, consistent with possible natural recovery. Clinically significant depressive symptoms (48.15 v . 77.78%) and anxiety symptoms (37.04 v . 72.22%) were less frequent in WBPE participants than controls, whereas probable PTSD rates did not differ significantly. Substance use during the study period was associated with poorer outcomes and smaller symptom reductions. Conclusions WBPE appears feasible and potentially beneficial under wartime conditions, with meaningful improvements in PTSD and depression despite persistent threat. Substance use was linked to poorer recovery and should be systematically assessed in post-trauma care.
