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Background: The Black Country (BC) is an area of the United Kingdom covering Dudley, Sandwell, Walsall, and Wolverhampton. The area is ethnically, culturally and religiously diverse. One-fifth of the total population is in the lowest socioeconomic quintile, with an uneven distribution of wealth. The area manifests unmet needs and as perceived underserved community groups. Objectives and Methods: To better understand the situation and inform future provision, listening events were organised across the BC to engage with local underserved communities. A mixed-methods design was employed, using collaborative workshops. The workshops enabled stakeholders to explore priorities, perceived barriers and solutions to mental health services' access within the BC. Results: Sixty participants verbally consented and signed in to attend the three workshops. There were nine groups that provided 247 statements on the topic, yielding a total of 12 codes and six themes (priorities). The top identified priorities were inappropriate periodisation of accessible funded healthcare needs (n = 42, 18.03%), barriers to appropriate healthcare (n = 49, 21.03%) and limited resources for training, health promotion, preventative care and support networks (n = 62, 26.61%). Conclusions: Addressing the identified priorities will require location and community-specific solutions to establish those communities' trust and engagement. Cultural stigma should not be viewed as the only barrier to access healthcare but should be considered in combination with the population's reluctance to reach out to healthcare services due to loss of trust between community groups and lack of co-design of culturally and religiously appropriate services for the community.

This systematic review compared the efficacy and tolerance of oral antipsychotics (APDs) used in the treatment of schizophrenia following the PRISMA-P© statement ( n = 21). The primary outcomes of interest were clinical response measured with symptoms' improvement, tolerance to side effects and discontinuation reasons. There was better individual patients' response to aripiprazole vs. ziprasidone and quetiapine ((CDSS p = 0.04), BPRS p = 0.02, YMRS p = 0.001) and ziprasidone vs. quetiapine (CGI p = 0.02, CDSS p = 0.02). Aripiprazole was more tolerated than risperidone, ziprasidone and quetiapine ( p < 0.05). Quetiapine was more tolerated than aripiprazole, ziprasidone and risperidone ( p < 0.05). Ziprasidone was more tolerated than quetiapine haloperidol and olanzapine ( p < 0.05). Risperidone was more tolerated than olanzapine ( p = 0.03) and haloperidol was more tolerated than olanzapine and quetiapine ( p < 0.05). Olanzapine caused less discontinuation than quetiapine; quetiapine caused less discontinuation than ziprasidone, aripiprazole and haloperidol; ziprasidone caused less discontinuation than quetiapine, aripiprazole and haloperidol; aripiprazole caused less discontinuation than quetiapine, ziprasidone and olanzapine and olanzapine caused less discontinuation than ziprasidone and haloperidol ( p < 0.05). It was concluded that individual patient clinical response, tolerance to side effects and life-threatening side effects remain the most reliable basis for selecting and continuing the use of APD.

The aim of this survey of psychiatrists from the UK and India was to compare their opinions on antipsychotic medication choice and their experiences of such medications' effectiveness and tolerability in patients who were newly diagnosed with acute schizophrenia. Following ethical approval, a cross-sectional online survey of psychiatrists from the UK and India was conducted. Ninety-five responses were received from each country. The most selected first-line APDs in both countries were olanzapine (47.5%), risperidone (42.8%) and aripiprazole (25.3%). A total of 60% of psychiatrists from India (60%) and 48% from the UK (48%) selected 'medication efficacy' as the main factor in their choice. Reassessment and consideration to switch most often took place within 4-6 weeks (53.7%) and 3-6 months (11.6%). The major reasons for switching antipsychotic medications were poor clinical efficacy (69%) and lack of tolerability (45%). Nonadherence was the most common reason for relapse (90% of UK psychiatrists and 70% of Indian psychiatrists), followed by illicit drug use (27.6%). The most commonly reported side effects that led to nonadherence were weight gain (10.8%), drowsiness (10.4%), erectile dysfunction and movement disorders (equally 8.7%). It was concluded that olanzapine, risperidone and aripiprazole are the most commonly selected as the initial treatment choice by psychiatrists from India and the UK. They are perceived as widely effective and well tolerated.

Background: A limited number of studies have explored patients' experience with home parenteral (injectable) therapy (HPT) in the UK., Aim: To explore the immediate-, short-, and long-term experience of patients with self-management of any home parenteral therapy with the intention for developing a guideline for service development in the United Kingdom., Methods and Design: An interview-based study of patients receiving HPT. Invitations were posted to all patients on the hospital HPT register. The sessions were conducted by telephone for all consenting patients. The interviews were recorded, transcribed, and analysed thematically. Participants completed the 'Health Education Impact Questionnaire' (heiQ) before and after the education session., Results: Of the 640 patients invited to participate in the study, 45 (7%) patients completed the interviews and the education session. An interview analysis revealed that the patients' experiences of HPT were generally positive, but the levels of training and support received showed wide individual variations. The patients had experienced periods of doubt and uncertainty, where they would have appreciated quick access to professional advice to alleviate their concerns. There was a reliable positive change (10.5-18.4%) from before and after the education sessions in six out of the eight domains on the heiQ questionnaire (health-directed behaviour, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, and emotional distress) and moderate change in two domains (5.3% in positive and negative engagement in life, and 2.6% in health services navigation)., Conclusion: Self-administered parenteral therapy at home is a valuable option, but training and preparation standards should be optimised across hospitals and the wider NHS.