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While there is evidence that mental health problems are more prevalent in people with borderline intellectual functioning (BIF) compared to the general population, it is not known to what extent this has varied or changed over time and whether there have been changes in access to services. This paper compares the prevalence rates of psychiatric disorders and monitors trends in treatment and services in this population compared to the general population. We conducted secondary analysis on the Adult Psychiatric Morbidity Surveys carried out in England in 2000, 2007 and 2014. The total sample analysed included 21,796 participants, with 12.8% of individuals identified with BIF (n = 2786). Regression models were used to examine trends in psychiatric disorders, treatment and service use across the three datasets. People with BIF had significantly higher odds of developing mood and anxiety disorders, psychosis, drug dependence and suicidal behaviour than the general population, increasing at each subsequent timepoint. They received significantly more pharmacological treatments than the general population but have had increasingly more access to general practitioners, community care and daycare services over time. This study shows increasing prevalence rates of several mental disorders in people with BIF. Access to day-care, community care and healthcare services has increased over time for this group but not formal psychiatric care. These changes over time underline some of the problems this population faces, emphasizing a need to recognize that this is a population often overlooked in research and clinical practice.

BACKGROUND People with intellectual disability (ID) are more likely to experience chronic depression compared with the general population, which may be compounded by loneliness and lower levels of social support. Befriending aims to provide social support and promote engagement in community activities. No randomised controlled trials have examined whether befriending improves symptoms of depression and social outcomes in people with ID. The aim of this pilot trial was to assess the feasibility and acceptability of a future larger trial of one-to-one befriending by volunteers in people with ID and depressive symptoms. METHODS Participants were adults with mild or moderate ID with a score of 5 or more on the Glasgow Depression Scale for People with Learning Disabilities (GDS-LD). They were randomised to the intervention arm (matched to a volunteer befriender for 6 months) or the control arm (usual care). Volunteers received training and supervision provided by two community befriending schemes. The main outcomes were feasibility of recruitment (minimum target n = 35), retention rate of participants, adherence (minimum 10 meetings), acceptability of the intervention, changes in depressive symptoms (assessed at baseline and 6 months) and feasibility of collecting data for a health economic analysis. RESULTS Recruitment was challenging, and only 16 participants with ID and 10 volunteers were recruited. Six participants were matched with a volunteer and no participants dropped out (except for two volunteers). Four participants completed 10 meetings (mean 11.8). Befriending was thought to be acceptable, but modifications were suggested. An exploratory analysis suggested that GDS-LD score was lower in the intervention group compared with the control group after adjusting for baseline scores, but not significant (adjusted mean difference: -4.0; 95% confidence interval: -11.2 to 3.2). CONCLUSIONS A large trial would not be feasible based on the recruitment strategies employed in this study. A further feasibility study addressing these challenges or the use of other study designs should be considered.

Aims and methodMental health services have changed the way they operate during the COVID-19 pandemic. We investigated the challenges and innovations reported by staff working in services for people with intellectual disability and/or autism in National Health Service (NHS) and non-NHS sectors, and in in-patient and community settings.ResultsData were drawn from 648 staff who participated in a UK-wide online survey. Issues around infection risk and mitigation were more important to those working in the NHS and in-patient settings. Community staff were more likely to express concern about the practicalities of a rapid shift to remote working and engaging patients remotely. Qualitative data revealed support for maintaining remote staff working and remote service provision post-pandemic.Clinical implicationsGiven the current emphasis on community support for people with intellectual disability and/or autism, the focus of research and clinical practice should be the development of accessible and effective models of remote service provision.

Background: People with intellectual disability are among the most stigmatised groups in society. There is a paucity of studies reporting on how stigma is experienced in low- and middle-income countries. This study aims to explore the experience of stigma among adults with mild/moderate intellectual disability and the extent of their inclusion in Indonesian society. Method: Fifteen adults with mild/moderate intellectual disability were purposively recruited from three service providers and were interviewed using a semi-structured interview schedule. The data were analysed using thematic analysis. Results: The findings suggest that adults with intellectual disability experience stigma in multiple settings (family, school, community), have limited access to social activities, and internalised the experienced stigma. Conclusion: This study adds to the international understanding of stigma experienced by adults with mild/moderate intellectual disability in daily life and their inclusion in society in a middle-income country.

This study aimed to explore key professionals’ attitudes towards people with intellectual disability (ID) and inclusion of said people in the community. Eighteen participants from three professional groups, comprising health practitioners (medical doctors, psychologists), mainstream/special education teachers, and religious leaders (Islam, Catholicism, Protestantism, Hinduism, and Buddhism) were recruited. Semistructured interviews, aided by two vignettes depicting mild and severe ID, were conducted. Thematic analysis was used to analyse the data. Seven themes were identified exploring: perceived causes; use of terminology; attitudes towards people with ID; attitudes towards inclusion, religion and ID; family-centric support; and challenges faced by people with ID in a wider context. Perceived capabilities of persons with ID were found to influence attitudes towards people with ID and their inclusion. Availability and accessibility of good quality services were also found to influence attitudes towards the inclusion of people with ID. Cultural factors related to attitudes towards ID are discussed.

Background Loneliness is linked to a number of adverse health outcomes in the general population. There is a lack of evidence on the prevalence and impact of loneliness in people with borderline intellectual impairment. Methods Data from the 2014 Adult Psychiatric Morbidity Survey, a national survey of England, was analysed using Weights-adjusted regression analyses to compare the prevalence of loneliness and the association between loneliness and socio-demographic and clinical variables in people with borderline intellectual impairment and the general population. Results Data from 6877 participants were included. Ten percent (n = 671) of the sample had borderline intellectual impairment and their prevalence of loneliness was 24.5% compared to 18.4% in the general population. This difference was explained by exposure to social disadvantages. Associations were found in both groups between loneliness and being single, unemployed, low income, lower social support, feeling unsafe and discrimination in the past year. Loneliness was associated with lower wellbeing and higher rates of common mental disorders, suicidal thoughts and chronic physical disorders in both groups. Intellectual functioning moderated the relationship between loneliness and income (OR 1.82; 95%CI 1.06 to 3.11) and suicidal thoughts in the last week (OR 0.13; 95% CI 0.02 to 0.93). Limitations IQ was measured using the National Adult Reading Test (NART), which is only valid for English speakers and loneliness was measured using a single item. Conclusion Loneliness is more prevalent in people with borderline intellectual impairment. Interventions targeting social disadvantages (e.g. low income) may lead reduce loneliness and vulnerability to mental health problems.

To understand the pathogenesis of specific neuronal circuit dysfunction in Alzheimer’s disease (AD), we investigated the fate of three subclasses of “modulatory interneurons” in hippocampal CA1 using the AppNL-F/NL-F knock-in mouse model of AD. Cholecystokinin- and somatostatin-expressing interneurons were aberrantly hyperactive preceding the presence of the typical AD hallmarks: neuroinflammation and amyloid-β (Aβ) accumulation. These interneurons showed an age-dependent vulnerability to Aβ penetration and a reduction in density and coexpression of the inhibitory neurotransmitter GABA synthesis enzyme, glutamic acid decarboxylase 67 (GAD67), suggesting a loss in their inhibitory function. However, calretinin (CR) interneurons—specialized to govern only inhibition, showed resilience to Aβ accumulation, preservation of structure, and displayed synaptic hyperinhibition, despite the lack of inhibitory control of CA1 excitatory pyramidal cells from midstages of the disease. This aberrant inhibitory homeostasis observed in CA1 CR cells and pyramidal cells was “normalized” by blocking P2Y1 purinoreceptors, which were “upregulated” and strongly expressed in CR cells and astrocytes in AppNL-F/NL-F mice in the later stages of AD. In summary, AD-associated cell-type selective destruction of inhibitory interneurons and disrupted inhibitory homeostasis rectified by modulation of the upregulated purinoreceptor system may serve as a novel therapeutic strategy to normalize selective dysfunctional synaptic homeostasis during pathogenesis of AD.

Purpose Fidelity data in clinical trials are not only necessary for appraising the internal and external validity, but also could provide useful insights how to improve the application of an intervention in everyday settings. The purpose of this paper is to understand the current literature of fidelity measurements in complex interventions for people with intellectual disabilities (ID) and behaviours that challenge. Design/methodology/approach The electronic databases MEDLINE, Embase, PsycINFO, Web of Science and CINAHL Plus were searched for studies published between 1990 to 2017 that have mentioned fidelity in randomised controlled trials of complex interventions for people with ID and behaviours that challenge based on positive behaviour support or applied behaviour analysis principles. The authors also searched the grey literature and reference lists. Findings Five randomised controlled trials were included in the review. The authors found variable and inconsistent fidelity measurements reported in the studies. The most frequently provided fidelity elements found in four out of five studies were adherence of implementation, dose and some aspects of quality of delivery. Research limitations/implications Research recommendations for a standardised approach of measuring fidelity in such studies are suggested. Originality/value The first review of such type that confirms the paucity of research measuring fidelity in complex interventions in this population.

Background There is a wealth of literature exploring the experiences of family caregivers of people with severe mental illness (SMI) in western countries, however, this topic has been neglected in the Middle East, despite families being the main source of caregiving in this context. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis to explore the experiences of family caregivers living in countries in the Middle East caring for a relative with severe mental illness. Methods A systematic review and meta-synthesis were conducted, to comprehensively gain a thorough and detailed overview of what is known about family caregivers’ experiences from published qualitative research in the Middle East geographical area from inception to May 2021. The review protocol was pre-registered with PROSPERO (Ref: CRD42020165519). Results The review identified twelve qualitative studies that explored caregivers’ experiences of caring for relatives with SMI in Middle East countries. Family caregivers’ experiences were captured under seven overarching themes. The participants across all studies reported negative consequences of providing care, increased burden and emotional distress. Many experienced issues with family/marital relationships and stigmatizing attitudes and behaviours from their communities. Caregivers expressed the need for increased support which was perceived to have a critical role in improving family caregivers’ experiences. Conclusions The meta-synthesis revealed many challenges and issues that affect caregivers of people with SMI in the Middle East. Family caregivers experienced distress and burden, and reported significant impact on their psychological well-being. Their experiences highlight the urgent need to provide more support for family caregivers in Middle East countries.

To examine the feasibility, acceptability and fidelity of individual Cognitive Stimulation Therapy (iCST) in people with intellectual disability (ID) and dementia.We aimed to recruit forty dyads (carer and individual with dementia and ID) who were randomised to iCST or a waiting list control group. Both groups received treatment as usual. Family and paid carers delivered the manualised intervention (40 sessions over 20 weeks). Recruitment and retention of participants, intervention adherence, fidelity and acceptability were assessed. Outcome measures of cognition, adaptive functioning, quality of life (QoL) and carer outcomes were collected at baseline, midpoint (11 weeks) and at 21 weeks. Qualitative interviews were conducted with six carers about their experience of iCST.Forty dyads were recruited over 10 months from 12 National Health Service trusts. One dyad dropped out and 87.5% and 97.5% completed the midpoint and end-point assessments respectively. Assessment of fidelity indicated that the correct session structure was not followed; 70% completed at least 20 sessions and there was a high level of satisfaction with iCST. QoL was significantly higher in the iCST arm at 21 weeks (adjusted mean difference: 3.11; 95% CI: 0.64 to 5.58). There were no differences in the other outcome measures.The intervention was feasible and acceptable. A full-scale trial is warranted but some modifications are needed, including improved training and supervision for carers to improve fidelity.

Neurocognitive disorders constitute the primary clinical deficits in cognitive functioning, which represent a decline on such functioning levels. Conducting neurocognitive assessments in people with intellectual and developmental disabilities (IDD) who are suspected of dementia may be challenging due to multiple physical health comorbidities and varying baseline cognitive functioning. In this chapter, the principles, and recommendations regarding the assessment of cognitive decline are highlighted. Key issues that should be considered when conducting neuropsychological assessments and instruments that are commonly used in the assessment process, are discussed. Reference is made to a case study demonstrating how the assessment process has been implemented in one region in Italy.

BackgroundVery little is known about the impact of previous epidemics on the care of people with intellectual and developmental disabilities, particularly in terms of mental health services. The COVID-19 pandemic has the potential to exacerbate existing health inequalities as well as expose gaps in service provision for this vulnerable population group.MethodsWe investigated the responses of 648 staff working in mental healthcare with people with intellectual disabilities and/or developmental disabilities. Participants contributed to a UK-wide online survey undertaken by the National Institute for Health Research Mental Health Policy Research Unit between 22nd April and 12th May 2020. Recruitment was via professional networks, social media and third sector organisations. Quantitative data describing staff experience over three domains (challenges at work, service user and carer problems, sources of help at work) were summarised and differences between groups explored using Chi square tests. Content analysis was used to organise qualitative data focusing on service changes in response to the pandemic.ResultsThe majority of survey respondents worked in the NHS and in community mental health services. One third had managerial responsibility. Major concerns expressed by mental healthcare staff were: difficulties for service users due to lack of access to usual support networks and health and social care services during the pandemic; and difficulties maintaining adequate levels of support secondary to increased service user need. Staff reported having to quickly adopt new digital ways of working was challenging; nevertheless, free text responses identified remote working as the innovation that staff would most like to retain after the pandemic subsides.ConclusionsUnderstanding the experiences of staff working across different settings in mental healthcare for people with intellectual and developmental disabilities during the COVID-19 pandemic is essential in guiding contingency planning and fostering service developments to ensure the health of this vulnerable group is protected in any future disease outbreaks.

IntroductionPeople with intellectual disability (ID) are more likely to experience loneliness and have smaller social networks, which increases vulnerability to depression. Befriending may reduce depressive symptoms in other populations, but randomised controlled trials (RCTs) have not been carried out in this population. This pilot study aims to assess the acceptability and feasibility of carrying out a full RCT of one-to-one befriending by volunteers for people with ID, compared with an active control group.Methods and analysisThe trial aims to recruit 40 participants with ID. Participants in the intervention arm will receive weekly visits from a volunteer over 6 months. Community befriending schemes will recruit, train, supervise volunteers and match them to individuals with ID. Both groups will receive a booklet about local activities and have access to usual care. Health and social outcomes will be measured at the end of the intervention and 6 months’ follow-up. The following outcomes will be assessed: (1) recruitment and retention of individuals with ID and volunteers in the trial, (2) adverse events related to the intervention, (3) the acceptability of the intervention, (4) whether the intervention is delivered as intended, (5) changes in health and social outcomes and (6) the feasibility of carrying out a cost-effectiveness analysis in a full trial. Qualitative data from participants, volunteers, staff and carers will identify barriers and facilitators of a future full trial.Ethics and disseminationThe study has been approved by the London City and East Research Ethics Committee (reference 18/LO/2188). The findings will be presented at conferences and published in a peer-reviewed journal and in the National Institute of Health Research journals library. A public engagement seminar will be held at the end of the study aimed at key stakeholders.Trial registration numberNCT63779614.

Since late January 2020, the world has been trying to deal with the coronavirus pandemic and its impact on populations and societies. Whilst no one is exempt from contracting COVID-19 as a result o...

The minimal clinically important difference (MCID) is relevant in the estimation of improvement in a patient outcome.To determine the MCID on the Aberrant Behaviour Checklist-Irritability (ABC-I), widely used to measure the effects of intervention for aggressive challenging behaviour in people with intellectual disabilities.We utilised distribution and anchor based methods to estimate the ABC-I MCID. We extracted data from 15 randomised controlled trials (RCTs) for meta-analysis. We conducted three online workshops with family carers and professionals to consider meaningful change in case vignettes of increasing severity of aggressive challenging behaviour.We did not find overlap in the range of values between the two approaches. The meta-analysis indicated a range of MCID on the ABC-I (0.05, 4.94) whilst the anchor-based estimation indicated a larger change (6.6, 16.6).The MCID is essential in interpreting the results from intervention studies. The present work was undertaken as part of a wider programme on the development and testing of a psychosocial intervention for aggressive challenging behaviour, and it is of interest to researchers in justifying how they choose and determine the MCID on the outcome of interest.

Background: Epilepsy and challenging behaviour are both highly prevalent in the intellectual disability (ID) population and it is thus crucial to understand any possible associations between the two.Method: PsycINFO, MEDLINE, Embase, CINAHL and Web of Science were searched for quantitative data about epilepsy and any forms of challenging behaviour in adults with ID.Results: A total of 25 articles were included in the review. Overall the evidence suggests that while epilepsy is not a good explanatory variable for the presence of challenging behaviour; the relationship is complex. However, for some people with epilepsy and for certain types of challenging behaviour a link may exist.Conclusions: Given the possible link between epilepsy-related factors such as seizure type and specific subgroups of challenging behaviour, investigating these relationships further and particularly exploring how to best measure challenging behaviour in people with epilepsy could be of great clinical benefit.

Introduction Cognitive stimulation therapy (CST) is a psychosocial intervention for dementia. Group CST is effective in reducing cognitive decline and improving quality of life in patients with dementia. There is some evidence that individual CST (iCST) may be beneficial in reducing cognitive decline. People with intellectual disability (ID) have an increased risk of dementia. However, there are no published studies of CST in people with ID and dementia. This protocol describes the feasibility and acceptability of a randomised controlled trial of iCST delivered by carers to people with ID and dementia, compared with treatment as usual (TAU). The results of this study will inform the design of a future definitive randomised controlled trial. Methods and analysis The iCST intervention has been adapted for this trial. Forty dyads (individuals with ID and their carer) will be randomised to either iCST or TAU. The manualised intervention comprises 40 iCST sessions delivered by a carer for 30 min, twice a week, over 20 weeks. The primary outcome will be process measures assessing the feasibility and acceptability of the intervention and trial procedures. The secondary outcome will be changes in the scores of outcome measures (cognition, functional ability and quality of life in individuals with ID, and caregiver burden, competence in managing dementia, and anxiety and depression in carers). Data will be collected at baseline, 11 weeks and at 21 weeks. A process evaluation will examine adherence to iCST and will include qualitative interviews with participants to identify aspects of the intervention that were or were not successful. Ethics and dissemination The study has received ethical approval. The results of the study will be presented at conferences and submitted to a peer reviewed journal. Trial registration number ISRCTN18312288; Pre-results.

Purpose The aim of this study was to investigate whether socio-demographic variables and physical disability (e.g. sensory impairment and mobility problems) were associated with self-reported stigma in people with intellectual disabilities (ID), and to examine whether age, sex and ethnicity modified the relationship between severity of intellectual disability and self-reported stigma. Methods 229 participants with mild or moderate intellectual disabilities were recruited from 12 centres/sites in England from community intellectual disability services, day centres, supported housing schemes, voluntary organisations and invitation letters. Information on physical disability and socio-demographic variables were obtained using a structured data collection form. Self-reported stigma was measured using a validated questionnaire. Results Age was associated with self-reported stigma, with older adults reporting more stigmatising experiences. Participants with moderate intellectual disabilities were more likely to report being treated differently such as being made fun of and being treated like children. Physical disability such as sensory, mobility and speech problems were not associated with self-reported stigma. Gender modified the relationship between severity of ID and self-reported stigma as participants who were male and had moderate ID were more likely to report stigma compared to females with moderate ID. Categorical age also modified the relationship between severity of ID and self-reported stigma as older participants who had moderate ID were more likely to report stigma compared to younger people with moderate ID. Conclusions Older adults and those with moderate ID are potentially at higher risk of being targets of public stigma or are more likely to report stigma. Interventions to help individuals cope with stigma could be targeted to this group.

Studies have investigated the experiences of courtesy stigma and affiliate stigma in family members of individuals with intellectual and developmental disabilities (IDD) without a clear distinction between the two. This systematic literature review aimed to evaluate the findings of studies that examined the experiences of stigma in families of individuals with intellectual disabilities and/or autism. A systematic search of PsycINFO, ERIC and Scopus identified relevant articles published between 2012 and 2016, to expand on an earlier review on this topic published in 2012. Ten articles pertaining to eight studies were identified. They revealed that family carers do experience stigma and various consequences related to these, with family culture influencing these experiences. This review identifies a number of psychosocial variables that are associated with the development of courtesy stigma, affiliate stigma and their consequences. It highlights protective factors and strategies family carers use to cope with stigma, and a lack of clarity in distinguishing the concepts of courtesy stigma and affiliate stigma in family members.

Background Studies have shown that individuals with intellectual disability (ID) are aware of stigma and are able to describe experiences of being treated negatively. However, there have been no cross-cultural studies examining whether self-reported experiences of stigma vary between ethnic groups. Method Participants with mild and moderate ID were recruited from a number of different settings in Cape Town, South Africa. Self-reported experiences of stigma in three ethnic groups were measured using the South African version of the Perceived Stigma of Intellectual Disability tool, developed by the authors. One-way anova was used to test whether there were differences in the total stigma score between the ethnic groups. Regression analysis was performed to identify factors associated with stigma. Results A total of 191 participants agreed to take part; 53 were Black, 70 were of mixed ethnicity and 68 were Caucasian. There were no differences in the levels of stigma reported by the three groups but the Black African ethnic group were more likely to report being physically attacked and being stared at, but were also more likely to report that they thought they were ‘the same as other people’. There was an interaction effect between ethnicity and level of ID, with participants with mild ID from the Black African group reporting higher levels of stigma compared with those with moderate ID. Younger age was the only factor that was associated with stigma but there was a trend towards ethnicity, additional disability and socio-economic status being related to stigma. Conclusion Interventions should target the Black African community in South Africa and should include the reduction of both public stigma and self-reported stigma.

SummaryChallenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.LEARNING OBJECTIVES•Understand the aetiological basis of challenging behaviour.•Understand the role of functional analysis.•Appreciate the evidence base in relation to the psychological and pharmacological treatment of challenging behaviour.

INTRODUCTION: Focal therapy may reduce the toxicity of current radical treatments while maintaining the oncological benefit. Irreversible electroporation (IRE) has been proposed to be tissue selective and so might have favourable characteristics compared to the currently used prostate ablative technologies. The aim of this trial is to determine the adverse events, genito-urinary side effects and early histological outcomes of focal IRE in men with localised prostate cancer. METHODS: This is a single centre prospective development (stage 2a) study following the IDEAL recommendations for evaluating new surgical procedures. Twenty men who have MRI-visible disease localised in the anterior part of the prostate will be recruited. The sample size permits a precision estimate around key functional outcomes. Inclusion criteria include PSA ≤ 15 ng/ml, Gleason score ≤ 4 + 3, stage T2N0M0 and absence of clinically significant disease outside the treatment area. Treatment delivery will be changed in an adaptive iterative manner so as to allow optimisation of the IRE protocol. After focal IRE, men will be followed during 12 months using validated patient reported outcome measures (IPSS, IIEF-15, UCLA-EPIC, EQ-5D, FACT-P, MAX-PC). Early disease control will be evaluated by mpMRI and targeted transperineal biopsy of the treated area at 6 months. DISCUSSION: The NEAT trial will assess the early functional and disease control outcome of focal IRE using an adaptive design. Our protocol can provide guidance for designing an adaptive trial to assess new surgical technologies in the challenging landscape of health technology assessment in prostate cancer treatment.

Purpose Irreversible electroporation has attractive attributes for focal ablation, namely nonthermal effect, precise demarcation of treatment and tissue selectivity. We report a prospective development study investigating focal irreversible electroporation. Materials and Methods A total of 20 men with certain characteristics were recruited for study, including a visible index lesion on anterior magnetic resonance imaging that was concordant with transperineal targeted and template prostate mapping biopsy, absent clinically significant disease noted elsewhere (University College London definition 2) and prostate specific antigen 15 ng/ml or less. Our primary objective was to determine the side effect profile at 12 months. Secondary objectives included the domain specific toxicity profile using patient reported outcomes and early disease control using magnetic resonance imaging targeted biopsy. Results A total of 19 patients with median age of 60 years (IQR 53–66) and median prostate specific antigen 7.75 ng/ml (IQR 5.5–10.03) were treated. Of the patients 16 were available for estimating the first outcome as 1 was lost to followup and 2 had received another form of treatment by study end. All 16 men had pad-free/leak-free continence at 12 months. The proportion of men with erection sufficient for penetration decreased from 12 of 16 (75%) to 11 of 16 (69%). No serious adverse events were recorded. There was a statistically significant improvement in urinary symptoms according to changes in UCLA-EPIC (UCLA Expanded Prostate Cancer Index Composite) and I-PSS (International Prostate Symptom Score) (p = 0.039 and 0.001, respectively). Erectile function remained stable according to the change in IIEF-15 (15-Item International Index of Erectile Function) (p = 0.572). Median prostate specific antigen significantly decreased to 1.71 ng/ml (p = 0.001). One man refused followup biopsy. No residual disease was found in 11 patients (61.1%). One man (5.6%) harbored clinically insignificant disease and the remaining 6 (33.3%) harbored clinically significant disease. Conclusions Focal irreversible electroporation has low genitourinary toxicity. Additional studies are needed to optimize patient selection and treatment parameters.

effects of combined “TURP+HIFU” for local radical ablation of high risk Prostate Cancer (hrPCa). METHODS: 480 hrPCa patients (T3-4 or initial PSA >20 or Gleason 8-10, N0, M0) were treated with TURP and consecutive transrectal complete HIFU Ablation with Ablatherm Integrated Imaging (EDAP-TMS, Lyon-France) and followed prospectively up to 17 years. “Disease progression” (failure) was defined as: Last PSA>initial PSA (PSAi) or M +/or onset of Salvage Therapy. RESULTS: In a high risk PCa patient cohort with a median follow up of 7 years (0.6-17.8) over all survival was 71.7%, metastasis free survival 91%, cancer specific survival 92.9% and progression free survival 63%. 30% needed adjuvant salvage ADT and 7% other salvage therapies in follow up after median 1.5 (0.1-12.5) years. Therapy induced side effects were: Stress Incontinence 7.9%, Obstruction: 3.7%, Fistula/Osteitis os pubis: 1.5%; UTI: 21.4%. CONCLUSIONS: Local radical prostate cancer ablation through transurethral resection (TURP) and transrectal complete High Intensity Focused Ultrasound (HIFU) with Ablatherm integrated imaging is a valid therapy even in high risk prostate cancer patients.

PurposeThe purpose of this article is to explore the current evidence base in understanding the relationship between mental health and challenging behaviour in people with intellectual disabilities.Design/methodology/approachThe article discusses how challenging behaviour is associated with psychiatric disorders. Common aetiological factors between challenging behaviour and psychiatric disorders and diagnostic issues are considered. The article ends with a review of the assessment and management of challenging behaviour within the context of mental health.FindingsSeveral studies have highlighted common aetiological factors that are responsible for challenging behaviour and psychiatric disorders in people with intellectual disabilities, and although there is an overlap in the symptoms, both are thought to be different phenomena. Treatment of the psychiatric disorder should ameliorate the challenging behaviour, although a functional analysis of the behaviour may still be required in order to understand the purpose of the behaviour. There is evidence for a range of different treatment approaches.Originality/valueThe article will assist professionals working with people with intellectual disabilities to understand the complex relationship between mental health and challenging behaviour. It also gives guidance on principles of management of people with complex mental health and behavioural needs.

Background Little has been published regarding the views of family members of people with intellectual disabilities who are being cared for in out-of-area psychiatric hospitals. This study explores this area with specific reference to whether culturally appropriate services were being provided. Materials and Methods Sixteen family members were interviewed about their views on the care their relative or partner was receiving in an out-of-area hospital. Transcripts were then analysed by the study team and themes identified. Results Families expressed a wide range of views regarding out-of-area hospital care. Important themes identified were feelings of shame, concerns about safety, cultural needs not being met, lack of improvement and lack of involvement in care. Conclusions This study highlights areas of inpatient care that family members felt were important. Views on negative aspects of care should guide areas for quality improvement initiatives for inpatient services. © 2011 Blackwell Publishing Ltd.

Background This study reflects a growing concern with the placement of people with intellectual disabilities and complex mental health problems in out of area placements at a distance from their families and communities. Materials and methods We interviewed service users (n = 17) living in out of area in-patient psychiatric units using a semi-structured interview as part of a service user consultation process. The questions addressed safety and security, food, facilities, day time activities, education, opportunities for socialization, clinical, cultural and religious needs, carer involvement and access to information. Service users were also asked where they would prefer to live if they were to leave the hospital. Results Although there were some positive stories, service user responses suggested limited opportunities for engagement in therapeutic or educational experiences, for building supportive relationships with staff or other residents, for developing religious and cultural identities or for enhancing family relationships. Conclusions Whilst many of the issues raised by participants will be familiar to critics of institutional care, being placed at a distance from home is likely to put an additional strain on relationships with family members and limit opportunities to engage in practices valued by specific ethnic minorities. Commissioners and managers of community intellectual disability services should bear in mind the perspective of service users with complex mental health needs, and take seriously the drawbacks in placing individuals out of area.

This article highlights the most important principles of the Mental Capacity Act 2005 and some of the amendments to the Mental Health Act 1983 that are relevant to the general hospital setting. The article focuses on how capacity should be assessed and how best interest decisions for someone lacking capacity should be made. It also discusses the role of independent mental capacity advocates, advance decisions relating to refusal of treatment, the role of the Court of Protection, and the new deprivation of liberty safeguards that have been introduced to the Mental Capacity Act. Changes to the Mental Health Act that are likely to affect practice, such as changes to professional roles, are also discussed.

The new Mental Health Act 2007 substantially amends the Mental Health Act 1983. In this article, some of the most important changes are highlighted, including changes to the definition of mental disorder, the new professional roles of approved mental health practitioner and responsible clinician, and the new powers for Supervised Community Treatment. The likely impact of these changes for people with learning disability and professionals working with them is discussed.

International audience; Communication between neurons at chemical synapses is regulated by hundreds of different proteins that control the release of neurotransmitter that is packaged in vesicles, transported to an active zone, and released when an input spike occurs. Neurotransmitter can also be released asynchronously, that is, after a delay following the spike, or spontaneously in the absence of a stimulus. The mechanisms underlying asynchronous and spontaneous neurotransmitter release remain elusive. Here, we describe a model of the exocytotic cycle of vesicles at excitatory and inhibitory synapses that accounts for all modes of vesicle release as well as short-term synaptic plasticity (STSP). For asynchronous release, the model predicts a delayed inertial protein unbinding associated with the SNARE complex assembly immediately after vesicle priming. Experiments are proposed to test the model’s molecular predictions for differential exocytosis. The simplicity of the model will also facilitate large-scale simulations of neural circuits.