Atypical eating behaviours in adults with obsessive-compulsive disorder (OCD) are often overlooked or misdiagnosed, possibly due to some eating difficulties being synonymous with their associated OCD. This study explored eating experiences from the perspective of eleven females with OCD, aged between 20 and 45 years. A series of semi-structured interviews were conducted and analysed using reflexive thematic analysis. Three central themes were generated from the data: the hidden burden; the importance of control; the detrimental impact of OCD on eating. These themes encapsulated how prevalent atypical eating difficulties were among the females with OCD, often emerging in response to heightened states of emotions, the need for control and/or as a reflection of their OCD symptoms. Whilst the reported eating behaviours did not always meet the diagnostic threshold for an eating disorder, participants described them as posing significant challenges to their daily functioning, as well as negatively affecting those around them. The current findings suggest that individuals with OCD often perceive their eating behaviours to be directly associated with their OC symptoms, highlighting the need to acknowledge these challenges in clinical practice. A better understanding of the broader implications of OCD, particularly on eating behaviours, is warranted to facilitate tailored interventions and prevent additional complications associated with eating behaviours in this group.

AIM:Numerous studies have now shown that those with eating disorders have statistically higher rates of obsessive-compulsive disorder (OCD). However, much less is known about the eating behaviours of adults with OCD. This scoping review aimed to identify and synthesise the existing literature describing pathological eating behaviours in adults with OCD and/or obsessive-compulsive (OC) symptoms. METHOD:The databases PubMed, Scopus, ScienceDirect and PsychNet were searched in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS:Fifty-nine studies met the eligibility criteria and were included in this review. There was a high occurrence of eating disorders identified in both adults with a diagnosis of OCD and in those with elevated OC symptoms. The literature appears inconclusive as to which eating disorders most commonly co-occur alongside OCD. Furthermore, it was noted that a number of adults with OCD and those with elevated OC symptoms showed high levels of eating behaviours falling below clinical thresholds, including behaviours synonymous with avoidant-restrictive food intake disorder and orthorexia nervosa. CONCLUSIONS:Future research needs to identify underlying factors for these problematic eating behaviours in OCD to adapt current treatment modalities to meet this group's needs. Addressing particular subsets of adults with OCD and/or OC symptoms, such as those with co-occurring anxiety and mood disorders, may be key to understanding who are most at risk. TRAIL REGISTRATION:The scoping review was registered on OSF: https://osf.io/s8kan.

Aims and method Patients prescribed clozapine are increasingly living into old age. However, there is a lack of studies to guide prescribing in this age group. We sought to identify all clozapine patients in Hertfordshire Partnership NHS Foundation Trust over a 5-year period and review side-effect burden and co-prescribing in all patients aged over 65 years. Results We identified 69 patients. The majority (61%) were stable in terms of mental state; 94% of cases had experienced a side-effect within the past year, with constipation occurring most commonly (65% of cases). Clinical implications Our findings reveal a significant side-effect burden, particularly in relation to constipation. Clozapine-induced gastrointestinal hypomotility (CIGH) can be fatal; however, increasing age has not been a recognised risk factor for constipation in clozapine patients to date. This raises questions about increasing risk to physical health as patients age and adds to concerns about the lack of monitoring for CIGH.

Background Research into paranormal beliefs and cognitive functioning has expanded considerably since the last review almost 30 years ago, prompting the need for a comprehensive review. The current systematic review aims to identify the reported associations between paranormal beliefs and cognitive functioning, and to assess study quality. Method We searched four databases (Scopus, ScienceDirect, SpringerLink, and OpenGrey) from inception until May 2021. Inclusion criteria comprised papers published in English that contained original data assessing paranormal beliefs and cognitive function in healthy adult samples. Study quality and risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) and results were synthesised through narrative review. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was preregistered as part of a larger registration on the Open Science Framework (https://osf.io/uzm5v). Results From 475 identified studies, 71 (n = 20,993) met our inclusion criteria. Studies were subsequently divided into the following six categories: perceptual and cognitive biases (k = 19, n = 3,397), reasoning (k = 17, n = 9,661), intelligence, critical thinking, and academic ability (k = 12, n = 2,657), thinking style (k = 13, n = 4,100), executive function and memory (k = 6, n = 810), and other cognitive functions (k = 4, n = 368). Study quality was rated as good-to-strong for 75% of studies and appears to be improving across time. Nonetheless, we identified areas of methodological weakness including: the lack of preregistration, discussion of limitations, a-priori justification of sample size, assessment of nonrespondents, and the failure to adjust for multiple testing. Over 60% of studies have recruited undergraduates and 30% exclusively psychology undergraduates, which raises doubt about external validity. Our narrative synthesis indicates high heterogeneity of study findings. The most consistent associations emerge for paranormal beliefs with increased intuitive thinking and confirmatory bias, and reduced conditional reasoning ability and perception of randomness. Conclusions Although study quality is good, areas of methodological weakness exist. In addressing these methodological issues, we propose that authors engage with preregistration of data collection and analysis procedures. At a conceptual level, we argue poorer cognitive performance across seemingly disparate cognitive domains might reflect the influence of an over-arching executive dysfunction.

The association of early life adversities and psychosis symptoms is well documented in clinical populations; however, whether this relationship also extends into subclinical psychosis remains unclear. In particular, are early life adversities associated with increased levels of schizotypal personality traits in non-clinical samples? We conducted a systematic review and meta-analysis of associations between early life adversities and psychometrically defined schizotypal traits in non-clinical samples. The review followed PRISMA guidelines. The search using PubMed, Web of Science and EBSCO databases identified 1,609 articles in total. Twenty-five studies (N = 15,253 participants) met eligibility criteria for the review. An assessment of study quality showed that fewer than half of all studies were rated as methodologically robust. Meta-analyses showed that all forms of childhood abuse (emotional, physical and sexual) and neglect (emotional and physical) were significantly associated with psychometric schizotypy. The association of schizotypy traits with childhood emotional abuse (r = .33: 95%CI .30 to .37) was significantly larger than for all other form of abuse or neglect. Meta-regression analyses showed that the physical abuse-schizotypy relationship was stronger in samples with more women participants; and the sexual abuse-schizotypy relationship was stronger in younger samples. The current review identifies a dose-response relationship between all forms of abuse/neglect and schizotypy scores in non-clinical samples; however, a stronger association emerged for emotional abuse. More research is required to address the relationship of trauma types and specific symptom types. Future research should also address the under-representation of men.

The exponential growth in international student mobility since the 1990s brings issues of travel health preparedness in overseas students and the impact of studying in a foreign country on their health to the fore. The direction of travel for much 'education first' educational tourism is from less- to more-economically developed countries, yet the existing literature tends to focus on the health-related expectations, precautions and behaviours of students travelling in the other direction. We explore the health implications of the international sojourn for students in UK higher education from various developing countries, and attendant risks such as the translocation of disease (a concern elevated by the COVID-19 pandemic). Drawing on, fusing and extending ideas from research on education and health mobilities, we examine students' experiences beyond the much-discussed first few weeks after arrival which is typically understood in terms of culture shock. Using narrative research and interviews with a purposive sample of students from ten countries/territories to establish their travel health preparations and perceptions, we reveal that they made extensive use of non-medical sources of advice including family and friends, the internet and study abroad agents. When they did become ill it was an isolating, distressing and frustrating experience due to delays in obtaining a doctor's appointment and the lack of social support away from home. Of some concern, these students perceived a low risk to traveling to and studying in the UK, and had given little thought to the possibility of inadvertently transmitting disease across borders. These findings will inform our understanding of international students' health, and have the potential to shape related policy and practice in origin and destination countries alike.

AimsObsessive Compulsive Disorder is a disabling and difficult-to-treat condition, new treatment options are needed to improve health outcomes. Transcranial Direct Current Stimulation, a non-invasive form of neurostimulation, has shown positive results in a small number of studies as a safe and potentially efficacious treatment for OCD. There nevertheless remains uncertainty about the optimal stimulation protocol, magnitude and duration of effect, acceptability, tolerability and practicality of applying tDCS clinical settings. As existing data are inadequate to support a full-scale trial, we will deliver a feasibility study to address key research questions and knowledge gaps to enable the design and the development of the most efficient, cost effective, definitive trial.MethodWe designed Feasibility And Acceptability Of Transcranial Stimulation In Obsessive Compulsive Symptoms (FEATSOCS), a double-blind, sham-controlled, cross-over randomised multicentre study in 25 adults with OCD. We will stimulate the two most promising cortical sites, the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated, given in counterbalanced order. Each course comprises four 20 minutes-stimulations, delivered over two consecutive days, separated by at least four weeks’ washout period. Blinded raters will regularly assess clinical outcomes before, during and up to four weeks after stimulation using validated scales. We will include relevant neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning.ResultFEATSOCS trial is currently underway and recruiting. Owing to the impact of COVID-19, a recruitment extension has been granted. At the study end, we will analyse the feasibility outcomes, magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure to estimate effect size, and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, the impact on their overall quality of life and their views on the potential of tDCS as home based-intervention.ConclusionFurther evidence is needed to establish whether tDCS could join the treatment armamentarium of OCD. The clinical outcomes in FEATSOCS will enable to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the tDCS in OCD in a full scale trial.The funder for this study is the National Institute for Health Research Programme, Research for Patient Benefit (RfPB) [Ref. no PB-PG-1216-20005]. Extra funding to allow study extension was provided by Orchard OCD. This study has received full ethics committee approval and protocol amendments approval form the Cambridge and Hertfordshire NHS Research Ethics Committee, IRAS Project ID 254507, REC ref: 19/EE/0046.

Abstract Background Obsessive–compulsive disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches. Transcranial direct current stimulation (tDCS), a noninvasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatment for OCD in a small number of trials. The two most promising stimulation sites are located above the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). Methods The aim of this feasibility study is to inform the development of a definitive trial, focussing on the acceptability, safety of the intervention, feasibility of recruitment, adherence and tolerability to tDCS and study assessments and the size of the treatment effect. To this end, we will deliver a double-blind, sham-controlled, crossover randomised multicentre study in 25 adults with OCD. Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated and given in counterbalanced order. Each course comprises four 20-min stimulations, delivered over two consecutive days, separated by at least 4 weeks’ washout period. We will collect information about recruitment, study conduct and tDCS delivery. Blinded raters will assess clinical outcomes before, during and up to 4 weeks after stimulation using validated scales. We will include relevant objective neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning. Discussion We will analyse the magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure, to estimate effect size and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Additionally, qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, as well as the impact on their overall quality of life. These clinical outcomes will enable the project team to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the treatment in a full-scale trial. Trial registration ISRCTN17937049. (date applied 08/07/2019). Recruitment (ongoing) began 23rd July 2019 and is anticipated to complete 30th April 2021.

Background This study describes the construction and validation of a new scale for measuring belief in paranormal phenomena. The work aims to address psychometric and conceptual shortcomings associated with existing measures of paranormal belief. The study also compares the use of classic test theory and modern test theory as methods for scale development. Method We combined novel items and amended items taken from existing scales, to produce an initial corpus of 29 items. Two hundred and thirty-one adult participants rated their level of agreement with each item using a seven-point Likert scale. Results Classical test theory methods (including exploratory factor analysis and principal components analysis) reduced the scale to 14 items and one overarching factor: Supernatural Beliefs . The factor demonstrated high internal reliability, with an excellent test–retest reliability for the total scale. Modern test theory methods (Rasch analysis using a rating scale model) reduced the scale to 13 items with a four-point response format. The Rasch scale was found to be most effective at differentiating between individuals with moderate-high levels of paranormal beliefs, and differential item functioning analysis indicated that the Rasch scale represents a valid measure of belief in paranormal phenomena. Conclusions The scale developed using modern test theory is identified as the final scale as this model allowed for in-depth analyses and refinement of the scale that was not possible using classical test theory. Results support the psychometric reliability of this new scale for assessing belief in paranormal phenomena, particularly when differentiating between individuals with higher levels of belief.

We present data on outcomes associated with COVID-19 in a time-limited sample of 1181 patients who were receiving treatment within secondary care services from a mental health and learning disabilities service provider. Unfortunately, 101 (9%) died after contracting COVID-19, though the real death rate is probably lower due to mild, unreported cases. Those who died were more likely to be male, of older age (75.7 vs. 42.7 yrs) and have a diagnosis of dementia (57% vs. 3.4%). We examined Health of the Nation Outcome Scale (HoNOS) scores as possible predictors for COVID-19 outcomes. Although the deceased group had higher HoNOS scores (17.7 vs. 13.2), the differences disappeared when examining only cases of dementia in 65+ age-group, suggesting that diagnosis is key. There has been little information published about people with severe mental health problems within secondary care. Although our sample is small, it does highlight some important inequalities that would benefit from further research.

Health factors such as diabetes, severe obesity and chronic kidney disease are all associated with a more severe outcome following coronavirus disease 2019 (COVID-19) infection. However, there has been little exploration into the impact of mental and behavioural disorders on outcomes associated with COVID-19. We investigated outcomes for older people who used mental health services. Those who had a COVID-19-associated death had previously rated worse across a range of health and social problems, including mental health related problems. Our findings evidence the need to urgently explore whether mental and behavioural disorders should also be considered a health risk factor for a more severe outcome from COVID-19 infection in older people.

HoNOS is one of the most widely used clinician rated outcome measures in mental health services. A commonly encountered problem is that one or more of the 12 individual HoNOS items is left uncompleted (missing data rates of up to 25% have been reported), which affects the degree to which organisations can rely on the accuracy of historical HoNOS data. In this brief paper we outline a simple statistical method of predicting missing item scores for HoNOS, both in general adult and 65+ populations. The method accounts for the average pattern of responding being non-uniform across items: i.e., some HoNOS items consistently elicit higher scores than others. By calculating individual item weights based on a very large sample of fully completed HoNOS assessments, we were able to accurately predict the value of missing items in a new sample. We contrast the accuracy of this approach with two other simple statistical procedures, and show that the weighted means model returns a much lower error rate. Although this is not the only method of predicting missing items, it carries the advantages of being: (i) free of charge, (ii) easily applicable to large datasets using a spreadsheet and (iii) unreliant on the availability of previous assessment data for the same patients. We hope this method will be of use to other organisations that are processing large volumes of HoNOS data.

Aims and method The Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017–2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire. Results Analysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances. Clinical implications An integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services. Declaration of interest None.

Recruitment to target is a major challenge for randomised controlled treatment trials (RCTs) in psychiatry. Strong patient preference may hamper recruitment of protocol-eligible participants, thereby compromising statistical power and limiting the external validity and generalisability of study findings to target populations. The Optimal Treatment in OCD (OTO) is a UK non-placebo feasibility trial of CBT and sertraline (two standard treatments) and their combination, randomly allocated, designed to ascertain the optimal community-based treatment for OCD. OTO aims to provide information about relevant design issues, to optimise feasibility of the definitive trial. To identify the factors influencing recruitment to the RCT. The study was approved by the relevant NHS ethics committee. Adult OCD outpatients were recruited at three UK centres. They were identified from routine referrals, primary healthcare services, community mental health clinics, other clinics attracting high levels of OCD, trust databases of patients likely to be suffering with OCD and the use of promotional materials. Patients subjected to screening were given detailed information about the treatments. Flexible and responsive clinical support was offered for the trial duration. Those eligible candidates declining to consent to participate were asked for their reasons. We report the data from one centre. 86 individuals satisfied the trial eligibility criteria. Of these, only 24 (27.9%) agreed to participate in the study. Of the remaining 62 (72.1%) who refused to participate, 35 (56.5%) gave treatment-related reasons. The commonest treatment-related reason was refusal to take pharmacological treatment (N=17; 27.4% all refusers). 12 of these individuals refused medication in general, while 5 refused sertraline. Another 8 (12.9% all refusers), showed a clear preference for CBT. However, 10 (16.1% all refusers) declined because they were reluctant to discontinue ongoing medication prior to randomisation. Treatment–related preferences constituted a major obstacle to the recruitment of UK OCD patients to a non-placebo RCT of standard pharmacotherapy and CBT, to the extent that only 27.9% eligible patients were actually randomised. Over 40% (40.3%) of those refusing to enter the study gave as the reason a reluctance to receive pharmacotherapy or a bias toward receiving CBT, while 16.1% refused washout. These choices occurred despite patients being informed of the current evidence suggesting equivalent clinical effectiveness for CBT and SSRI and being offered clinical support during the washout phase. Trial designs that account for patient preference e.g. ‘patient-preference RCT’ ‘or ‘comprehensive cohort’ designs (Brewin & Bradley, 1989) or omit washout may increase recruitment but have methodological limitations. RCTs should gather information on the effect of pre-randomisation preference on outcomes to inform better trial design (Torgerson, Klaber-Moffett & Russell, 1996). New approaches to overcome public prejudice toward psychopharmacology are also needed to support robust trial design in psychiatry.

Purpose of review Women are more impacted by Alzheimer's disease than men – they are at significantly greater risk of developing Alzheimer's disease, and recent research shows that they also appear to suffer a greater cognitive deterioration than men at the same disease stage. The purpose of this article is to review recent studies on examining sex differences in cognitive function in Alzheimer's disease. Recent findings We searched electronically for articles, reviews and meta-analyses published between 1/2016 and 12/2017 and identified 298 articles on sex differences in cognition in Alzheimer's disease. The key themes to emerge were sex differences in cognitive function, risk factors, resilience, and cognitive reserve. Summary Evidence is steadily and increasingly accumulating to confirm the poorer cognitive outcome for women than men with Alzheimer's disease. Although small in size, the effects occur across a broad range of cognitive domains including visuospatial, verbal, episodic memory, and semantic memory – some of which typically reveal a sex-related processing advantage for healthy women. Explanations have been linked to a variety of factors including differences in cognitive reserve, resilience, as well as genetics (apolipoprotein &egr;4) and functional and structural brain changes. Sex-related differences in risk factors, resilience, cognitive reserve, and rates of deterioration have implications for clinical practice.

Patients with psychosis report higher levels of adverse events in childhood. This relationship has not been extensively examined in healthy individuals who score highly on schizotypal personality traits. This study examined the association between different childhood traumas and psychosis-like traits in a general population sample, as well as differences in those links between men and women. Participants completed an online survey including measures of physical, emotional, and sexual abuse, and schizotypal personality traits. Results showed that the experience of emotional abuse was associated with a range of both positive and negative psychosis-like traits in both sexes. Sex differences emerged in the association between physical abuse and schizotypal personality traits. Although men reported more physical abuse in early life than women, this type of trauma was only associated with schizotypal traits in women and not in men. Additionally, women scored higher than men in sexual abuse; however, sexual abuse did not explicitly predict any schizotypal traits in the presence of the other two types of abuse. A simple linear or dose-response relationship between different types of trauma and psychosis-like traits was not supported. The importance of emotional abuse on schizotypy was highlighted in both sexes.

A significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties. The most effective treatments for these children are currently unknown, partly due to a lack of robust, controlled studies. Researchers have identified a number of obstacles to conducting well-designed research with this population, making the need to test the feasibility of a randomised controlled trial especially important.

Research on early intervention for young children (infants and toddlers) with fetal alcohol spectrum disorders (FASD), particularly children with comorbid maltreatment experiences, is limited. Existing research has primarily focused on structuring environments to be responsive to the needs experienced by children with FASD rather than improving their functioning. The purpose of this study is to present outcomes from an early psychosocial intervention with 10 adopted, maltreated young children diagnosed with FASD, aged 10–53 months (M = 35 months), and their adoptive parents. The potential for early, targeted interventions to improve developmental outcomes for children with prenatal alcohol exposure was examined, as well as improving the skills of and reducing stress experienced by their adoptive parents. Based on the outcomes of a neuro-developmentally informed assessment protocol, the 10 children whose data are presented were recommended to receive a range of regulatory, somatosensory, relational, and cognitive enrichments. As part of their treatment, children and caregivers received Child–Parent Psychotherapy (CPP), and caregivers (here, adoptive parents) also received Mindful Parenting Education (MPE). Related-samples Wilcoxon signed-rank tests indicated that scores of several measures of child developmental functioning improved from preto post-intervention and that parents’ caregiving skills improved while their caregiving stress decreased. Reliable change analyses indicated that change observed from preto post-intervention was reliable. The promise of using neuro-developmentally informed assessment strategies to sequence interventions for young children with diverse neurodevelopmental insults is discussed. Children’s drawings: self-perception and family function in international adoption Brittany L. Bannon, Linda G. Tirella and Laurie C. Miller Early Child Development and Care, Taylor & Francis, 2016, Volume 186 (8): 1285–1301. No comprehensive studies have examined the utility of family drawings within the context of international adoption. We examined the relationship of Kinetic Family Journal of Child Psychotherapy 279