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Background: Psychological morbidity in inflammatory bowel disease is common with significant impact on quality of life and health outcomes, but factors which predict the development of psychological morbidity are unclear.\ud \ud \ud \ud Aim: To undertake a systematic literature review of the predictors of psychological morbidity in patients with inflammatory bowel disease.\ud \ud \ud \ud Methods: Electronic searches for English-language articles were performed with keywords relating to psychological morbidity according to the Diagnostic and Statistical Manual of Mental Disorders IV and subsequent criteria, and inflammatory bowel disease; in MEDLINE, PsychInfo, Web of Science and EMBASE for studies published from January 1997 to 25 January 2019.\ud \ud \ud \ud Results: Of 660 studies identified, seven met the inclusion criteria. All measured depression, with three also measuring anxiety. Follow-up duration was variable (median of 18 months range 6–96 months). Risk factors identified for development of psychological morbidity included physical factors: aggressive disease (HR 5.77, 95% CI 1.89 to 17.7) and greater comorbidity burden (OR 4.31, 95% CI 2.83 to 6.57) and psychological risk factors: degree of gratitude (r=−0.43, p

Objective. When considering psychosis, the concept of narrative insight has been offered as\ud an alternative to clinical insight in determining individuals’ responses to their difficulties, as\ud it allows for a more holistic and person-centred framework to be embraced within\ud professional practice. This study aims to explore the validity of the narrative insight construct\ud within a group of people who have experienced psychosis.\ud \ud Design. Inductive qualitative methods were used to explore how eight participants utilised\ud spiritual or religious explanatory frameworks for their experiences of psychosis, and to\ud consider these in relation to the construct of narrative insight.\ud \ud Methods. Semi-structured interviews were undertaken with individuals who identified\ud themselves as interested in spiritual or religious ideas, and whose self-reported experiences\ud which were identified as akin to psychosis by experienced academic clinicians.\ud Transcriptions from these interviews were subject to Interpretative Phenomenological\ud Analysis within a broader research question; a selection of themes and data from the resultant\ud phenomenological structure are explored here for their relevance to narrative insight.\ud \ud Results. Participants discussed spiritual and biological explanations for their experiences, and\ud were able to hold alternative potential explanations alongside each other. They were\ud reflective regarding the origins of their explanations, and would describe a process of testing\ud and proof in relation to them.\ud \ud Conclusions. These findings suggest that the narrative insight construct has the potential to\ud be a valid approach to understanding experiences of psychosis, and challenge the dominance\ud of the clinical insight construct within clinical practice.

Background: Sleep and mental health go hand-in-hand, with problems sleeping being associated with a variety of mental health difficulties. Recently, insomnia has been linked with the experience of paranoia, a relationship that is likely to be mediated by negative affect. Given these links, the present research aimed to test whether a self-help intervention designed to improve sleep can also improve negative affect and paranoia.\ud \ud \ud \ud Method: Participants were recruited from a mailing list of University staff and were randomly allocated to one of three conditions; a wait-list control group, an active control group who completed a sleep diary each day for 6 weeks, and an experimental group who received an online self-help intervention targeting sleep problems alongside the same sleep diary. Levels of insomnia, negative affect, and paranoia were measured at baseline, immediately post-intervention, and 4- and 18-weeks post-intervention.\ud \ud \ud \ud Results: There were no significant differences between the groups on levels of insomnia, negative affect, and/or paranoid thinking at post-intervention, 4-weeks, or the 18-week follow-up. However, a relatively large number of participants dropped out of the study, particularly in the intervention group, which meant that the primary analysis was underpowered.\ud \ud \ud \ud Conclusion: Due to a high level of participant dropout, the findings from the present research are inconclusive, and suggest that retaining participants in trials of online interventions is a significant challenge that needs to be addressed in future research.

BACKGROUND: A growing body of evidence points to relationships between insomnia, negative affect, and paranoid thinking. However, studies are needed to examine (i) whether negative affect mediates the relation between insomnia and paranoid thinking, (ii) whether different types of insomnia exert different effects on paranoia, and (iii) to compare the impact of objective and self-reported sleeping difficulties. METHOD: Structural equation modelling was therefore used to test competing models of the relationships between self-reported insomnia, negative affect, and paranoia. n = 348 participants completed measures of insomnia, negative affect and paranoia. A subset of these participants (n = 91) went on to monitor their sleep objectively (using a portable sleep monitor made by Zeo) for seven consecutive nights. Associations between objectively recorded sleep, negative affect, and paranoia were explored using linear regression. RESULTS: The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia. There was no evidence of a direct association between delayed sleep onset or sleep maintenance problems and paranoia. CONCLUSIONS: Taken together, the findings point to an association between perceived (but not objective) difficulties initially falling asleep (but not maintaining sleep) and paranoid thinking; a relationship that is fully mediated by negative affect. Future research should seek to disentangle the causal relationships between sleep, negative affect, and paranoia (e.g., by examining the effect of an intervention using prospective designs that incorporate experience sampling). Indeed, interventions might profitably target (i) perceived sleep quality, (ii) sleep onset, and / or (iii) emotion regulation as a route to reducing negative affect and, thus, paranoid thinking.

INTRODUCTION: Sleep and mental health go hand-in-hand, with many, if not all, mental health problems being associated with problems sleeping. Although sleep has been traditionally conceptualised as a secondary consequence of mental health problems, contemporary views prescribe a more influential, causal role of sleep in the formation and maintenance of mental health problems. One way to evaluate this assertion is to examine the extent to which interventions that improve sleep also improve mental health. METHOD AND ANALYSIS: Randomised controlled trials (RCTs) describing the effects of interventions designed to improve sleep on mental health will be identified via a systematic search of four bibliographic databases (in addition to a search for unpublished literature). Hedges' g and associated 95% CIs will be computed from means and SDs where possible. Following this, meta-analysis will be used to synthesise the effect sizes from the primary studies and investigate the impact of variables that could potentially moderate the effects. The Jadad scale for reporting RCTs will be used to assess study quality and publication bias will be assessed via visual inspection of a funnel plot and Egger's test alongside Orwin's fail-safe n. Finally, mediation analysis will be used to investigate the extent to which changes in outcomes relating to mental health can be attributed to changes in sleep quality. ETHICS AND DISSEMINATION: This study requires no ethical approval. The findings will be submitted for publication in a peer-reviewed journal and promoted to relevant stakeholders. PROSPERO REGISTRATION NUMBER: CRD42017055450.

BACKGROUND: Psychological morbidity in young people aged 10-24 years, with inflammatory bowel disease (IBD) is increased, but risk factors for and impacts of this are unclear. AIM: To undertake a systematic literature review of the risk factors for and impact of psychological morbidity in young people with IBD. METHODS: Electronic searches for English-language articles were performed with keywords relating to psychological morbidity according to DSM-IV and subsequent criteria; young people; and IBD in the MEDLINE, PsychInfo, Web of Science and CINAHL databases for studies published from 1994 to September 2014. RESULTS: One thousand four hundred and forty-four studies were identified, of which 30 met the inclusion criteria. The majority measured depression and anxiety symptoms, with a small proportion examining externalising behaviours. Identifiable risk factors for psychological morbidity included: increased disease severity (r(2) = 0.152, P < 0.001), lower socioeconomic status (r(2) = 0.046, P < 0.001), corticosteroids (P ≤ 0.001), parental stress (r = 0.35, P < 0.001) and older age at diagnosis (r = 0.28, P = 0.0006). Impacts of psychological morbidity in young people with IBD were wide-ranging and included abdominal pain (r = 0.33; P < 0.001), sleep dysfunction (P < 0.05), psychotropic drug use (HR 4.16, 95% CI 2.76-6.27), non-adherence to medication (12.6% reduction) and negative illness perceptions (r = -0.43). CONCLUSIONS: Psychological morbidity affects young people with IBD in a range of ways, highlighting the need for psychological interventions to improve outcomes. Identified risk factors provide an opportunity to develop targeted therapies for a vulnerable group. Further research is required to examine groups under-represented in this review, such as those with severe IBD and those from ethnic minorities.

BACKGROUND: General practitioners (GPs) are being encouraged to treat more drug users but there are few studies to demonstrate the effectiveness of primary care treatment. AIM: To determine whether patients retained on methadone maintenance treatment for one year in a modern British primary care setting, with prescribing protocols based on the new national guidelines, can achieve similar harm reduction outcomes to those demonstrated in other settings, using objective outcome measures where available. DESIGN OF STUDY: Longitudinal cohort study. SETTING: The Primary Care Clinic for Drug Dependence, Sheffield. METHOD: The intervention consisted of a methadone maintenance treatment provided by GPs with prescribing protocols based on the 1999 national guidelines. The first 96 eligible consenting patients entering treatment were recruited; 65 completed the study. Outcome measures were current drug use, HIV risk-taking behaviour, social functioning, criminal activity, and mental and physical health, supplemented by urinalysis and criminal record data. RESULTS: Frequency of heroin use was reduced from a mean of 3.02 episodes per day (standard deviation [SD] = 1.73) to a mean of 0.22 episodes per day (SD = 0.54), (chi 2 = 79.48, degrees of freedom [df] = 2, P < 0.001), confirmed by urinalysis. Mean numbers of convictions and cautions were reduced by 62% (z = 3.378, P < 0.001) for all crime. HIV risk-taking behaviour, social functioning, and physical and psychological wellbeing all showed significant improvements. CONCLUSION: Patients retained on methadone maintenance treatment for one year in a primary care setting can achieve improvements on a range of harm reduction outcomes similar to those shown by studies in other, often more highly structured programmes.