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People with psychosis have a reduced life expectancy of 10–20 years, largely due to cardiovascular disease. This trial aimed to determine the effectiveness of a modular health promotion intervention (IMPaCT Therapy) in improving health and reducing cardiovascular risk in psychosis. A multicentre, two arm, parallel cluster RCT was conducted across five UK mental health NHS trusts. Community care coordinators (CC) were randomly assigned to training and supervision in delivering IMPaCT Therapy or treatment as usual (TAU) to current patients with psychosis (cluster). The primary outcome was the physical and mental health subscales of the Short form-36 (SF-36) questionnaire. Of 104 care coordinators recruited, 52 (with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with 193 patients) randomised to TAU. Of 406 patients, 318 (78%) and 301 (74%) attended 12- and 15-month follow-up respectively. IMPaCT therapy showed no significant effect on the physical or mental health component SF-36 scores versus TAU at 12 or 15 months. No effect was observed for cardiovascular risk indicators, except for HDL cholesterol, which improved more with IMPACT therapy than TAU (Treatment effect (95% CI); 0.085 (0.007 to 0.16); p = 0.034). The 22% of patients who received >180 min of IMPACT Therapy in addition to usual care achieved a greater reduction in waist circumference than did controls, which was clinically significant. Training and supervising community care coordinators to use IMPaCT therapy in patients with psychosis is insufficient to significantly improve physical or mental health quality of life. The search for effective, pragmatic interventions deliverable in health care services continues. The trial was retrospectively registered with ISRCTN registry on 23/4/2010 at ISRCTN58667926 ; recruitment started on 01/03/2010 with first randomization on 09.08.2010 ISRCTN58667926 .

Background: Novel Psychoactive Substances (NPS) are a heterogeneous class of synthetic molecules including synthetic cannabinoid receptor agonists (SCRAs). Psychosis is associated with SCRAs use. There is limited knowledge regarding the structured assessment and psychometric evaluation of clinical presentations, analytical toxicology and clinical management plans of patients presenting with psychosis and SCRAs misuse. Methods: We gathered information regarding the clinical presentations, toxicology and care plans of patients with psychosis and SCRAs misuse admitted to inpatients services. Clinical presentations were assessed using the PANSS scale. Vital signs data were collected using the National Early Warning Signs tool. Analytic chemistry data were collected using urine drug screening tests for traditional psychoactive substances and NPS. Results: We described the clinical presentation and management plan of four patients with psychosis and misuse of SCRAs. Conclusion: The formulation of an informed clinical management plan requires a structured assessment, identification of the index NPS, pharmacological interventions, increases in nursing observations, changes to leave status and monitoring of the vital signs. The objective from using these interventions is to maintain stable physical health whilst rapidly improving the altered mental state. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

Objectives: High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has proven antidepressant effects, but the optimal frequency of sessions remains unclear. Methods:We conducted a 3-week, sham-controlled trial to assess the antidepressant efficacy of 1 active HF-rTMS session per day (A1 group) compared with 2 per day (A2 group) and equivalent sham sessions (once a day, S1 group; twice a day, S2 group) in patients with treatmentresistant major depression with a subsequent 2-week follow-up period. One hundred seventy-seven patients were screened, of whom 105 met eligibility criteria and 98 consented and were randomized. The HF-rTMS (20 Hz) was targeted to the left prefrontal cortex in sessions of approximately 40 trains (2 seconds each) at 100% resting motor threshold with an intertrain interval of 1 minute. Treatment response was defined as a 50%or greater decrease in the Hamilton Depression Rating Scale (HDRS) score and/or Clinician Global Impressions-Severity of Illness (CGI-S) score of 3 or less. Remission was defined as HDRS score less than 8 and/or CGI-S score of 2 or less. Results: Practically none of the subjects in either sham groups achieved remission. Increased odds of remission were present for CGI-S by stimulating twice rather than once per day (odds ratio [OR] = 1.5, P = 0.018), whereas there was a marginal result for HDRS (OR = 3.9, P = 0.066). Patients who had lower baseline HDRS (OR = 0.75, P = 0.014) and CGI-S scores (OR = 0.18, P = 0.001) were more likely to achieve remission. Conclusions: Twice per day active HF-rTMS might be more effective than once per day active HF-rTMS or sham stimulation. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Since 1993 geodetic data obtained by different techniques (GPS, EDM, SAR, leveling) detected a consistent inflation of the Mount Etna volcano. The inflation, culminated with the 1998-2001 strong explosive activity from summit craters and recent 2001 and 2002 flank eruptions, may be interpreted by magma ascent and re-filling of the volcanic plumbing system and reservoirs. Our purpose is to model the 1993-97 GPS and EDM data by pressurized sources simulating the magma reservoir using a 3D Finite Element modeling coupled to a Neighbourhood Algorithm inversion. The power of this technique, if compared with analytical inversions, is that sources can be placed in complex media (heterogeneous, with topography, inelastic, etc.) so that the inversion result is not influenced by the usual approximations of elastic, homogeneous half-space. We model the inflation by a deep volcanic source, considered as point source. The source intensity is given by its stress tensor, identifying an ellipsoidal pressure source. The FE model of Mt. Etna is characterized by a regular mesh below the volcanic edifice, and by arbitrarily distorted brick elements elsewhere. The potential point sources are contained in a cubic volume located below the summit craters, between 4 km and 8 km b.s.l.. For each potential source we compute the deformation and elongation at GPS and EDM observation points. The solution is a weighted combination of displacements (one for each stress component) computed for each of the potential sources. The best source parameters search is performed by the Neighbourhood Algorithm inversion technique. Good results from synthetic tests and previous inversions with only GPS data confirm the robustness of the method. We consider four classes of models characterized by: i) homogeneous medium and flat free surface; ii) homogeneous medium with topography of Mt. Etna; iii) heterogeneous medium with flat free surface; iv) heterogeneous medium with topography. Results from data inversion show evidence for a vertically elongated body. This result is a robust feature of the inversions, since it is common to models with/without topography and with/without rigidity contrasts. Differences in the location and dimension of the ellipsoid are due to the presence of the rigidity contrasts and topography. Solutions are compared also with those derived by inversions of analytical forward models in the homogeneous medium with flat free surface, showing good agreement.

Both substance use and poor medication adherence are associated with poor outcome in psychosis. To clarify the contributions of substance use and poor medication adherence to poor outcome in the year following a first episode of psychosis, 205 patients were evaluated for use of tobacco, alcohol, cannabis and stimulants at their psychosis onset, and in a 1-year follow-up. Data on medication adherence and symptom remission were also collected. Patients had high rates of overall substance use before (37-65%) and after psychosis onset (45-66%). 44% showed poor medication adherence and 55% did not reach remission from psychosis. Nicotine dependence and cannabis use after psychosis onset significantly predicted both poor medication adherence and non-remission, and poor medication adherence mediated the effects of these substances on non-remission. In conclusion, medication adherence lies on the causal pathway between nicotine dependence and cannabis on the one hand and non-remission on the other.