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The article focuses on the role of moods, affects, meaning and emotions to understand one's self and others and to justify the reasons for a person's actions. It notes that moods function as reflexive evaluators which connect the sophisticated cognitive roles of the autobiographical self to the irrational and pre-reflective core self. It conveys that moods are required in the study of philosophy, which contain emotional tonality and coloring as a form of adjustment to the world.

Psychiatric interviewing highlights the apparent tension between psychiatry's quest for objectivity and its aim to chart the particular experiences and values of individuals. Neo-Kantian philosophy can help to shed light on this apparent tension. There need be no conflict between an exploration of individual values and scientific inquiry, not least because values play a central role in the selection of facts in scientific observation in general and psychiatric history taking in particular. [ABSTRACT FROM AUTHOR]

In this paper, recent publications in the field of psychiatric nosology, classification, and diagnosis are reviewed. An attempt is made to group such writings into three broad themes: "essentialist/realist," "anti-essentialist/pragmatic," and "eliminative." The conceptual nature of these groupings is explored, and similarities between some elements of biological psychiatry and phenomenological psychiatry are outlined. The paper attempts to undercut current ways of thinking about psychiatric disorders by drawing i n John McDowell's criticism of the idea of a value-free objective standpoint, and further relates our difficulties in thinking about mental disorders to McDowell's wider diagnosis of problems in contemporary philosophy. [ABSTRACT FROM AUTHOR]

Can delusions, in the context of psychosis, enhance a person’s sense of meaningfulness? The case described here suggests that, in some circumstances, they can. This prompts further questions into the complexities of delusion as a lived phenomenon, with important implications for the clinical encounter. While assumptions of meaninglessness are often associated with concepts of ‘disorder’, ‘harm’ and ‘dysfunction’, we suggest that meaning can nonetheless be found within what is commonly taken to be incomprehensible or even meaningless. A phenomenological and value-based approach appears indispensable for clinicians facing the seemingly paradoxical coexistence of harmfulness and meaningfulness. [ABSTRACT FROM AUTHOR]

Background: Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP.Methods/design: The current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14-18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants' usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions.Discussion: This is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences.Trial Registration: Current controlled trial with ISRCTN, ISRCTN80567433 . Registered on 27 February 2017. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Neuroprogression in schizophrenia" by J. Davis, S. Moylan and B. Harvey published in the 2014 issue.

Sleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP. [ABSTRACT FROM AUTHOR]

Background: Cannabis use is a global public health issue associated with increased risks of developing mental health disorders, especially in young people. We aimed to investigate the relationships between cannabis exposure and risks of receiving mental illness diagnoses or treatment as outcomes. Methods: A population based, retrospective, open cohort study using patients recorded in 'IQVIA medical research data', a UK primary care database. Read codes were used to confirm patients with recorded exposure to cannabis use who were matched up to two unexposed patients. We examined the risk of developing three categories of mental ill health: depression, anxiety or serious mental illness (SMI). Results: At study entry, the exposed cohort had an increased likelihood of having experienced mental ill health [odds ratio (OR) 4.13; 95% confidence interval (CI) 3.99–4.27] and mental ill health-related prescription (OR 2.95; 95% CI 2.86–3.05) compared to the unexposed group. During the study period we found that exposure to cannabis was associated with an increased risk of developing any mental disorder [adjusted hazard ratio (aHR) 2.73; 95% CI 2.59–2.88], also noted when examining by subtype of disorder: anxiety (aHR 2.46; 95% CI 2.29–2.64), depression (aHR 2.34; 95% CI 2.20–2.49) and SMI (aHR 6.41; 95% CI 5.42–7.57). These results remained robust in sensitivity analyses. Conclusion: These findings point to the potential need for a public health approach to the management of people misusing cannabis. However, there is a gross under-recording of cannabis use in GP records, as seen by the prevalence of recorded cannabis exposure substantially lower than self-reported survey records. [ABSTRACT FROM AUTHOR]

Background Individuals with an “Attenuated Psychosis Syndrome” (APS) have a 20–40% chance of developing a psychotic disorder within two years; however it is difficult to predict which of them will become ill on the basis of their clinical symptoms alone. We examined whether P50 gating deficits could help to discriminate individuals with APS and also those who are particularly likely to make a transition to psychosis. Method 36 cases meeting PACE (Personal Assessment and Crisis Evaluation) criteria for the APS, all free of antipsychotics, and 60 controls performed an auditory conditioning–testing experiment while their electroencephalogram was recorded. The P50 ratio and its C–T difference were compared between groups. Subjects received follow-up for up to 2 years to determine their clinical outcome. Results The P50 ratio was significantly higher and C–T difference lower in the APS group compared to controls. Of the individuals with APS who completed the follow-up (n = 36), nine (25%) developed psychosis. P50 ratio and the C–T difference did not significantly differ between those individuals who developed psychosis and those who did not within the APS group. Conclusion P50 deficits appear to be associated with the pre-clinical phase of psychosis. However, due to the limitations of the study and its sample size, replication in an independent cohort is necessary, to clarify the role of P50 deficits in illness progression and whether this inexpensive and non-invasive EEG marker could be of clinical value in the prediction of psychosis outcomes amongst populations at risk. [ABSTRACT FROM AUTHOR]

Paranoia is the erroneous idea that people are targeting you for harm, and the cognitive model suggests that symptoms increase with emotional and relational distress. A factor potentially associated with paranoia is mistrust, a milder form of suspiciousness. This study investigated the longitudinal course of non-clinical paranoia in a sample of 739 students (age range 10–12 at baseline assessment, 12–14 at second assessment) using data from the Social Mistrust Scale (SMS) and the paranoia subscale of the Specific Psychotic Experiences Questionnaire (SPEQ). Prevalence of mistrustful and high paranoia children was 14.6 and 15% respectively. Independently, baseline internalizing symptoms (b = 0.241, p < 0.001) and mistrust (b = 0.240, p < 0.001) longitudinally predict paranoia after controlling for confounders. The interaction of mistrust and internalizing symptoms at T1 increases the possibility of the onset of paranoia at T2. Therefore, the effect of mistrust on paranoia is more marked when internalizing symptoms are higher. Our results confirm the role of mistrust as a factor involved in the developmental trajectory of paranoia in adolescence, enhanced by the presence of internalizing symptoms. The implications of these results are both theoretical and clinical, as they add developmental information to the cognitive model of paranoia and suggests the assessment and clinical management of mistrust and internalizing symptoms in youth may be useful with the aim of reducing the risk of psychotic experiences. [ABSTRACT FROM AUTHOR]

Background: Reducing bullying is a public health priority. KiVa, a school-based anti-bullying programme, is effective in reducing bullying in Finland and requires rigorous testing in other countries, including the UK. This trial aims to test the effectiveness and cost-effectiveness of KiVa in reducing child reported bullying in UK schools compared to usual practice. The trial is currently on-going. Recruitment commenced in October 2019, however due to COVID-19 pandemic and resulting school closures was re-started in October 2020.Methods: Design: Two-arm pragmatic multicentre cluster randomised controlled trial with an embedded process and cost-effectiveness evaluation.Participants: 116 primary schools from four areas; North Wales, West Midlands, South East and South West England. Outcomes will be assessed at student level (ages 7-11 years; n = approximately 13,000 students).Intervention: KiVa is a whole school programme with universal actions that places a strong emphasis on changing bystander behaviour alongside indicated actions that provide consistent strategies for dealing with incidents of bullying. KiVa will be implemented over one academic year.Comparator: Usual practice.Primary Outcome: Student-level bullying-victimisation assessed through self-report using the extensively used and validated Olweus Bully/Victim questionnaire at baseline and 12-month follow-up.Secondary Outcomes: student-level bullying-perpetration; student mental health and emotional well-being; student level of, and roles in, bullying; school related well-being; school attendance and academic attainment; and teachers' self-efficacy in dealing with bullying, mental well-being, and burnout.Sample Size: 116 schools (58 per arm) with an assumed ICC of 0.02 will provide 90% power to identify a relative reduction of 22% with a 5% significance level.Randomisation: recruited schools will be randomised on 1:1 basis stratified by Key-Stage 2 size and free school meal status. Process evaluation: assess implementation fidelity, identify influences on KiVa implementation, and examine intervention mechanisms. Economic evaluation: Self-reported victimisation, Child Health Utility 9D, Client Service Receipt Inventory, frequency of services used, and intervention costs. The health economic analysis will be conducted from a schools and societal perspective.Discussion: This two-arm pragmatic multicentre cluster randomised controlled trial will evaluate the KiVa anti-bullying intervention to generate evidence of the effectiveness, cost-effectiveness and scalability of the programme in the UK. Our integrated process evaluation will assess implementation fidelity, identify influences on KiVa implementation across England and Wales and examine intervention mechanisms. The integrated health economic analysis will be conducted from a schools and societal perspective. Our trial will also provide evidence regarding the programme impact on inequalities by testing whether KiVa is effective across the socio-economic gradient.Trial Registration: Trials ISRCTN 12300853 Date assigned 11/02/2020. [ABSTRACT FROM AUTHOR]

Abstract: Background: Individuals with an “At Risk Mental State” have a 20–30% chance of developing a psychotic disorder within two years; however it is difficult to predict which individuals will become ill on the basis of their clinical symptoms alone. We examined whether mismatch negativity (MMN) could help to identify those who are particularly likely to make a transition to psychosis. Method: 41 cases meeting PACE criteria for the At Risk Mental State (ARMS) and 50 controls performed a duration-deviant passive auditory oddball task whilst their electroencephalogram was recorded. The amplitude of the MMN wave was compared between groups using linear regression. The ARMS subjects were then followed for 2years to determine their clinical outcome. Results: The MMN amplitude was significantly reduced in the ARMS group compared to controls. Of the at-risk subjects who completed followed up (n=41), ten (24% of baseline sample) subsequently developed psychosis. The MMN amplitude in this subgroup was significantly smaller across all three recording sites (FZ, F3 and F4) than in the ARMS individuals who did not become psychotic. Conclusion: Among those with the ARMS, MMN amplitude reduction is associated with an increased likelihood of developing frank psychosis. [Copyright &y& Elsevier]

Background: Preventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis. Methods: Electronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively. Results: Searching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability (> 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty. Conclusions: Study findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is associated with premature mortality, partly through increased suicide rates.Aims: To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability).Method: We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset.Results: In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour.Conclusions: Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention. [ABSTRACT FROM AUTHOR]

• Longer-term physical activity improves mental health and cognition in youth. • Improvements coincide with altered fMRI and EEG parameters in frontal brain areas. • Physical activity is related to BDNF increases; associations with cortisol are more complex. • Physical activity interventions shall target lower fit and vulnerable youth. To investigate putative neurobiological mechanisms that link longer-term physical activity interventions to mental health and cognitive outcomes using randomised controlled trials in children, adolescents and young adults. A range of medical and psychological science electronic databases were searched (MEDLINE, EMBASE, Scopus, Web of Science, PsychINFO). Original research studies were selected, data were extracted and quality was appraised. Sixteen primary papers were included, ranging from healthy and community samples to subclinical and clinical populations across a variety of age ranges and using different neurobiological measures (e.g. magnetic resonance imaging, electroencephalography, cortisol, brain-derived neurotropic factor). The majority of studies report improvement in mental health and cognition outcomes following longer-term physical activity interventions which coincide with neurobiological alterations, especially neuroimaging alterations in activation and electrophysiological parameters in frontal areas. Future research should include measures of pre-existing fitness and target those who would benefit the most from this type of intervention (e.g. those with a lower level of fitness and at risk for or with mental health problems). [ABSTRACT FROM AUTHOR]

Abstract Background Bullying is a widespread phenomenon that has captured attention from mental health researchers. Several studies have assessed bullying prevalence with some methodological concerns. Objectives Preliminary, we analyzed the psychometric properties of two bullying scales for victimization (the multidimensional peer victimization scale – MPVS) and for perpetration (the bully subscale of the Illinois bully scale – IBS-B); then, we estimated bullying prevalence; finally, we evaluated the effect of gender and classroom on the phenomenon. Participants and setting 2959 students from the metropolitan city of Naples constituted the sample. Methods Data collection was obtained using a multi-assessment approach that included both single-item questions and intensity scales in order to compare the two methods. Results The two scales resulted valid and showed good reliability. The MPVS displayed a 1-factor second order model. The IBS-B had a mono-factorial structure. Both showed full invariance for gender and classroom. Prevalence of victimization was 37% whereas that for perpetration was 21%. As expected we obtained several bullying prevalence results depending on the specificity of questions and in particular repetitiveness of episodes. There was a good correspondence between results of single-item questions and multi-item scales. Finally results demonstrated several differences for gender and classroom attended. Conclusion In this epidemiological study the multi-assessment approach identified different but complementary features of bullying phenomena. The use of the two measurement approaches allowed us to obtain more precise and exhaustive information on bullying prevalence and compare it with previous findings. [ABSTRACT FROM AUTHOR]

Background: This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China.Methods: Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants' demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China.Results: A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models.Limitations: The cross-sectional study design and lack of follow-up data are limitations of this study.Conclusions: This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population. [ABSTRACT FROM AUTHOR]

Background: Affective instability (AI) is transdiagnostic, and associated with suicidality and healthcare use. It has rarely been compared between diagnoses or to controls. We investigated: whether AI differs between clinical cases and controls and between diagnoses; how different AI components are correlated; and whether AI is associated with functioning in clinical cases.Methods: Cases (N = 69) from psychiatric services had a diagnosis of borderline personality disorder, bipolar disorder, major depression or psychosis and were compared to primary care controls (N = 25). Participants completed the affective lability scale (ALS), affective intensity measure (AIM), affective control scale (ACS), scored mood fluctuation rate and the WHO-DAS.Results: There was a significant difference in affective lability between cases and controls and across diagnostic groups (p < 0.001). Compared to controls, cases showed lower affective control (p < 0.05). There were no differences in affective intensity between cases and controls or between diagnostic groups, or in mood fluctuation rate between groups. ALS score (p < 0.001), and total number of medications (p < 0.046), were associated with functioning, independent of diagnosis.Limitations: The sample size was modest. Cases were not in an acute illness episode and this could bias estimates of group difference towards the null.Conclusion: Individuals with mental disorder demonstrate higher levels of affective lability and lower affect control than those without mental disorder. In contrast affective intensity may not be useful in demarcating abnormal affective experience. Independent of diagnosis, affective instability, as measured by affect lability, adversely impacts day-to-day functioning. It could be an important target for clinical intervention. [ABSTRACT FROM AUTHOR]