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Admissions and re-admissions for inpatient care for anorexia nervosa have been increasing. The aim of this study was to examine whether the transition from inpatient care to the community could be facilitated by supplementing usual treatment with ECHOMANTRA (transition interventions) for both patients and carers. A case series study was employed using a mixed-methods approach to measure the feasibility and efficacy of augmenting intensive hospital treatment with ECHOMANTRA. A consecutive series of consenting patients (n = 31) and carers (n = 21) were assessed on admission, discharge, and at 3 months follow-up. These outcomes were compared with audit data (n = 152) previously collected (2007–2017). The length of stay for the ECHOMANTRA intervention group was 4.5 weeks less than the comparison group, and weight gain was 0.11 kg per week higher. Improvements in patient symptomology were sustained at follow-up. Thematic analysis of the feedback from both patients and carers suggests that the intervention is valued. Carer burden was reduced and their skills improved (both moderate size changes). In conclusion, both the acceptability and efficiency of inpatient care for anorexia nervosa may be improved by augmenting treatment to prepare for transition from inpatient care by giving support to both patients and their carers. [ABSTRACT FROM AUTHOR]

Background: Postgraduate medical education has, in recent years, become a dynamic field with the increasing availability of innovative and interactive teaching techniques. Anecdotal evidence suggests that the current focus of psychiatric training on the acquisition of scientific and clinical knowledge is inadequate to address the multidimensional nature of psychiatry. Supplementary teaching tools may be usefully applied to address this need. Methods: A group of trainees at the Maudsley Hospital and Institute of Psychiatry (UK) pioneered the use of a book group as an innovative teaching tool to enhance the psychiatric training experience by, amongst other aspects, facilitating dialogue between peers on fundamental epistemological issues raised by critical engagement with seminal psychiatric texts. Results: Feedback from members suggested that participation in the book group broadened the overall learning potential and experience of psychiatry. The key ingredients were identified as: (i) collaborative peer-to-peer learning; (ii) the use of ‘flipped classroom’ model; and (iii) joint ownership. Conclusion: The book group has demonstrated real potential to facilitate direct trainee engagement with the multi-faceted nature of psychiatry as a complex humanistic discipline within an informal learning space. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented in response to the article "A Systematic Review and Meta-Analysis of the Association Between Depression and Insulin Resistance" by C. Kan and colleagues in a 2013 issue.

Depression is more frequent among individuals exposed to traumatic events. Both trauma exposure and depression are heritable. However, the relationship between these traits, including the role of genetic risk factors, is complex and poorly understood. When modelling trauma exposure as an environmental influence on depression, both gene-environment correlations and gene-environment interactions have been observed. The UK Biobank concurrently assessed Major Depressive Disorder (MDD) and self-reported lifetime exposure to traumatic events in 126,522 genotyped individuals of European ancestry. We contrasted genetic influences on MDD stratified by reported trauma exposure (final sample size range: 24,094-92,957). The SNP-based heritability of MDD with reported trauma exposure (24%) was greater than MDD without reported trauma exposure (12%). Simulations showed that this is not confounded by the strong, positive genetic correlation observed between MDD and reported trauma exposure. We also observed that the genetic correlation between MDD and waist circumference was only significant in individuals reporting trauma exposure (r g  = 0.24, p = 1.8 × 10 -7 versus r g  = -0.05, p = 0.39 in individuals not reporting trauma exposure, difference p = 2.3 × 10 -4 ). Our results suggest that the genetic contribution to MDD is greater when reported trauma is present, and that a complex relationship exists between reported trauma exposure, body composition, and MDD.