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Objective: Younger-onset dementia accounts for about 5–10% of all dementias in Australia. Little data is available on neuropsychiatric symptoms in people with younger-onset dementia compared to those with older-onset dementia. This study aims to compare the types of neuropsychiatric symptoms and their clinico-demographic characteristics of people with younger-onset dementia and older-onset dementia who are referred to a specific dementia support service. Methods: A 2-year retrospective observational cross-sectional analysis was undertaken on referrals with neuropsychiatric symptoms from Dementia Support Australia programmes. Neuropsychiatric symptoms were measured using the Neuropsychiatric Inventory total severity scores and distress scores. Contributing factors to neuropsychiatric symptoms for dementia groups were examined. Logistic regression was used to examine the relationship between individual neuropsychiatric symptoms and having older-onset dementia vs younger-onset dementia. Results: Of the 15,952 referrals, about 5% ( n = 729, mean age: 60.7 years, standard deviation = 5.4) were individuals with younger-onset dementia. Referrals with older-onset dementia were more likely to be female (56%), whereas referrals with younger-onset dementia were more likely to be male (54%). There was a four times greater rate of frontotemporal dementia for those with younger-onset dementia (16.0%, n = 117) compared to those with older-onset dementia (2.8%, n = 427), χ2 (1) = 366.2, p Conclusion: Clinico-demographics of referrals with younger-onset dementia differ from those with older-onset dementia. There were some differences in the characteristics of neuropsychiatric symptoms between younger-onset dementia and older-onset dementia. Our findings have implications for service provision and support for people with dementia at different ages.

Context Pain is linked to behaviors and psychological symptoms of dementia (BPSD); however, it often remains underrecognized in this population. Objectives We aimed to investigate the prevalence and intensity of pain in people living in aged care homes with BPSD and by dementia subtypes and the association between pain intensity and BPSD. Methods A 1-year retrospective cross-sectional analysis was conducted on BPSD and the presence of pain in referrals to a national BPSD support service using the Neuropsychiatric Inventory and PainChek®, respectively. Referrals were categorized into two groups: pain group and no pain group. Results Of the 479 referrals (81.9 ± 8.3 years old) included in the analysis, two-thirds (65.6%) had pain identified, with almost half (48.4%) of these categorized as experiencing moderate-severe pain. Pain was highly prevalent (range: 54.6-78.6%) in all subtypes of dementia, particularly in mixed dementia and dementia with Lewy bodies. Compared with the no pain group, the pain group had 25.3% more neuropsychiatric behaviors, 33.6% higher total severity of these behaviors, and 31.4% higher total distress caused to caregivers. For all results, effect sizes were small to medium (η²p = 0.04-0.06). Despite a high prevalence of aggressive or agitated behaviors across the entire group, the pain group was 3.8 times more likely to experience these behaviors than referrals not in pain. Conclusion There is a strong need to consider the possibility of pain as a contributor to behavioral changes in aged care residents living with dementia.

Key points The aetiopathogenesis of behaviours and psychological symptoms of dementia (BPSD) is often subjective, complex and multifaceted, produced by an array of contributing factors, including biomedical, psychological, environmental and/or social factorsAlongside other contributing factors, organic aetiology of BPSD should be considered when devising therapeutic management plansAlthough considered last resort, time‐limited antipsychotic treatment (≤3 months) may have a vital adjunct role in managing intractable, refractory, distressing and/or life‐threatening BPSD, such as delusions and hallucinations; but only after person‐centred psychosocial interventions are exhausted and fail to deliver any therapeutic responseIf prescribed, careful monitoring of therapeutic responses and adverse effects of antipsychotics with de‐prescribing plans should be a top priority, as these agents have limited efficacies and serious adverse outcomes (e.g., mortality)

SUMMARY Most patients with dementia have behavioural and psychological symptoms. The first-line treatments for these symptoms are not drugs, but behavioural and psychological interventions Antipsychotic drugs are widely prescribed for people living with dementia. This is despite a high adverse effect burden and limited evidence of efficacy Most behavioural and psychological symptoms will subside spontaneously within six months. Trials of deprescribing are therefore recommended Behaviours should be seen as symptoms that have an underlying cause. Treatment should target these causes, rather than the resultant behaviours

Mercury is a toxic environmental pollutant emitted into the atmosphere by both natural and anthropogenic sources. In Australia, previous estimates of anthropogenic mercury emissions differ by up to a factor of three, with existing inventories either outdated or inaccurate and several lacking Australia-specific input data. Here, we develop a twenty-year inventory of Australian anthropogenic mercury emissions spanning 2000-2019 with annual resolution. Our inventory uses Australia-specific data where possible and incorporates processes not included in other Australian inventories, such as delayed release effects from waste emissions. We show that Australian anthropogenic mercury emissions have decreased by more than a factor of two over the past twenty years, with the largest decrease from the gold production sector followed by brown coal-fired power plants and commercial product waste. Only the aluminium sector has shown a notable increase in mercury emissions. Using a global 3-D chemical transport model (GEOS-Chem), we show that the reduction in emissions has led to a small decrease in mercury deposition to the Australian continent, with annual oxidised mercury deposition ∼3-4% lower with present day emissions than with emissions from the year 2000. We also find that Australian emissions are not accurately represented in recent global emissions inventories and that differences between inventories have a larger impact than emissions trends on simulated mercury deposition. Overall, this work suggests a significant benefit to Australia from the Minamata Convention, with further reductions to Australian mercury deposition expected from decreases in both Australian and global anthropogenic emissions.

Objective: The objective of this study was to perform a clinical and risk audit of private hospital inpatients who had been readmitted within 28 days of a preceding admission. Method: Of 118 readmissions within 28 days in 2017 (7% of all admissions), 50 were randomly selected for audit. Characteristics, illness severity and clinical risk profiles were ascertained at discharge from the index admission and at readmission. Results: Cases were 64% female, age 49.9 ± 18.2 years (range 19–89), 40% in relationships and 24% on disability support. At readmission, 88% posed danger to self due to effects of illness, 46% had high suicide risk and 40% had high physical risk. Illness was rated as severe in 58%, while 40% were rated markedly ill. Relapse or exacerbation of major depression was a cause of readmission in 78%, relapse of alcohol/substance use requiring readmission in 22% and relapse of psychosis in 20%. Index admission length of stay of cases did not differ from that of all hospital admissions. Conclusion: Most readmitted patients were suffering severe exacerbation of depression, were acutely suicidal and were otherwise at high risk of harm. If these patients had been denied readmission on the basis of insurer funding disincentives, catastrophic outcomes may well have occurred.

Objective: To compare inpatients who had been readmitted within 28 days of discharge with patients not readmitted within the same period in a private psychiatric hospital. Method: Of 118 readmissions within 28 days in 2017 (7% of admissions), 50 were randomly selected and matched by age and gender with control patients who had not been readmitted within 28 days. Differences in demographics, diagnosis, length of stay and number of admissions in the previous 12 months were examined. Results: Readmitted cases were 64% female, were aged 49.8 ± 18.2 years (range 19–89), 40% were in relationships and 24% were receiving disability support. Most patients were suffering an episode of depression. Cases had higher rates of multiple psychiatric diagnoses ( p < .001) and physical disorders ( p < .05). There were no significant differences between cases and controls on psychiatric diagnoses. Cases had a longer length of stay in their previous admission ( p < .01) and a higher number of admissions in the preceding 12 months ( p < .05) compared to controls. Conclusion: This study indicates that inpatients readmitted within 28 days of discharge were more likely to have multiple diagnoses, physical co-morbidity and relapsing conditions than patients who were not readmitted.

Glia in the central nervous system engulf neuron fragments during synapse remodeling and recycling of photoreceptor outer-segments. Whether glia passively clear shed neuronal debris, or actively remove neuron fragments is unknown. How pruning of single-neuron endings impacts animal behavior is also unclear. Here we report that adultC. elegansAMsh glia engulf sensory endings of the AFD thermosensory neuron. Engulfment is regulated by temperature, AFD’s sensory input, and tracks AFD activity. Phosphatidylserine (PS) flippase TAT-1/ATP8A, functions with glial PS-receptor PSR-1/PSR and PAT-2/α-integrin to initiate engulfment. Glial CED-10/Rac1 GTPase, acting through a conserved GEF complex, executes phagocytosis using the actin-remodeler WSP-1/nWASp and the membrane-sealing factor EFF-1 fusogen. CED-10 levels determine engulfment rates, and engulfment-defective mutants exhibit altered AFD-ending shape and thermosensory behavior. Our findings reveal a molecular pathway underpinning glia-dependent phagocytosis in a peripheral sense-organ, and demonstrate that glia actively engulf neuron-fragments, with profound consequences on neuron shape and animal behavior.

Objective Squalor affects 1 in 1000 older people and is regarded as a secondary condition to other primary disorders such as dementia, intellectual impairment and alcohol abuse. Squalor frequently is associated with hoarding behaviour. We compared the neuropsychological profile of people living in squalor associated with hoarding to those presenting with squalor only. Methods This study is a retrospective case series of hospital inpatient and community healthcare services of 69 people living in squalor (49 from aged care, 16 from aged psychiatry, 3 from acute medical and 1 from a memory clinic). Forty per cent had co-morbid hoarding behaviours. The main outcomes were neuropsychologists' opinions of domain-specific cognitive impairment. Results The squalor–hoarding group (M age 75.8, SD = 6.9,) was significantly older (p

Insufficient supply of selenium to antioxidant enzymes in the brain may contribute to Alzheimer’s disease (AD) pathophysiology; therefore, oral supplementation may potentially slow neurodegeneration. We examined selenium and selenoproteins in serum and cerebrospinal fluid (CSF) from a dual-dose 24-week randomized controlled trial of sodium selenate in AD patients, to assess tolerability, and efficacy of selenate in modulating selenium concentration in the central nervous system (CNS). A pilot study of 40 AD cases was randomized to placebo, nutritional (0.32 mg sodium selenate, 3 times daily), or supranutritional (10 mg, 3 times daily) groups. We measured total selenium, selenoproteins, and inorganic selenium levels, in serum and CSF, and compared against cognitive outcomes. Supranutritional selenium supplementation was well tolerated and yielded a significant (p

Background:Domestic squalor has been associated with alcohol misuse but little work has explored this. Executive dysfunction is commonly observed in squalor and is also associated with alcohol misuse. Hoarding can accompany squalor, but it is unclear whether hoarding is also linked with alcohol misuse. This study compared neuropsychology and hoarding status of individuals living in squalor with and without a history of alcohol misuse.Methods:A subgroup analysis was conducted on a series of 69 neuropsychological reports of people living in squalor. Data on cognitive profiles, basic demographics, alcohol use, and hoarding were extracted and analyzed.Results:Alcohol misuse was reported in 25 of the 69 participants (36%). Alcohol misusers were significantly younger (mean age 66.2 years, SD = 10.7) than non-misusers (mean age 75.6 years, SD = 10.3) (p< 0.00) and significantly more likely to be male (p= 0.01). No significant differences between the two subgroups were found for estimated premorbid intellectual functioning, Mini Mental State Examination (MMSE) scores, or individual neuropsychological domains. Alcohol misusers were more likely to be living in squalor without hoarding than squalor with hoarding (p= 0.01).Conclusions:Alcohol misusers living in squalor were less likely to hoard than non-misusers. This finding suggests that alcohol misuse may be a risk factor for squalor via failure to maintain one's environment rather than through intentional accumulation of objects. The similar cognitive profile among those with and without a history of alcohol misuse could represent a common pattern of executive dysfunction that predisposes individuals to squalor regardless of underlying alcohol misuse diagnosis.

Objective: To discuss common pitfalls and useful tips in designing a quantitative research study, the importance and process of ethical approval, and consideration of funding. Conclusions: Through careful planning, based on formulation of a research question, early career researchers can design and conduct quantitative research projects within the framework of the Scholarly Project or in their own independent projects.

Objectives: Research can seem daunting, especially for trainees and early career researchers. This paper focuses on how to formulate and begin a research project such as the RANZCP Scholarly Project. Methods: We outline an approach to framing a research question, developing theses and hypotheses, choosing a supervisor and conducting a literature review. Conclusions: Through systematic planning early career researchers and other clinicians can plan and conduct research suitable for the Scholarly Project or other research activity.

Background:Squalor is an epiphenomenon associated with a range of medical and psychiatric conditions. People living in squalor are not well described in the literature, and prior work has indicated that up to 50% do not have a psychiatric diagnosis. Squalor appears to be linked with neuropsychological deficits suggestive of the presence of impaired executive function. We present a case series of people living in squalor that examines their neuropsychological assessment and diagnosis.Methods:Clinicians from local health networks were invited to submit neuropsychological reports of patients living in squalor. These selected reports were screened to ensure the presence of squalor and a comprehensive examination of a set of core neuropsychological domains. Assessments were included if basic attention, visuospatial reasoning, information processing speed, memory function, and executive function were assessed.Results:Sixty-nine neuropsychological reports were included. Sixty-eight per cent of the group underwent neuropsychological assessments during an inpatient admission. For participants where it was available (52/69), the mean Mini-Mental State Examination score was 25.29 (SD = 3.96). Neuropsychological assessment showed a range of cognitive impairment with nearly all the participants (92.75%) found to have frontal executive dysfunction. One person had an unimpaired neuropsychological assessment. Results indicated that dorsolateral prefrontal rather than orbitofrontal functions were more likely to be impaired. Vascular etiology was the most common cause implicated by neuropsychologists.Conclusions:Frontal executive dysfunction was a prominent finding in the neuropsychological profiles of our sample of squalor patients, regardless of their underlying medical or psychiatric diagnoses. Our study highlights the importance of considering executive dysfunction when assessing patients who live in squalor.

Residents in aged care facilities are among our most frail and vulnerable citizens. In a humane society, they should be afforded comprehensive, high-quality care that explicitly addresses the known high prevalence of dementia with BPSD. This high-quality individualised care is likely to be predicated upon systematic changes in the RACF environment that go well beyond calls for a reduction in the use of psychotropic medication. Potential proposals for systemic improvement may include: • the provision of services for prompt assessment of residents with mental illness, such as consultation-liaison mental health services, GPs, nurses/appropriately supervised nurse-practitioners, psychologists, pharmacists and allied health professionals visiting RACFs; • GP and specialist collaborative care with nurses/appropriately supervised nurse-practitioners, psychologists, pharmacists and allied health professionals visiting RACFs; • the use of telemedicine and innovative technology approaches in support of the above; • education and up-skilling of care staff to collaboratively implement personalised psychosocial/nonpharmacological interventions (including the health student teaching in RACFs and RACFs as teaching environments); • training in the use of assessment instruments (observation scales/ questionnaires) for common mental health problems by skilled care staff; • changes in the design and organisational culture of RACFs towards improving the mental well-being of residents; • the investigation and development of sustainable funding models for provision of care (Hilmer and Gnjidic, 2013) to allow improved remuneration for RACF personnel, including nursing staff and GPs; • coordination of all of the above, preferably via strong links between primary care and specialist services. Comprehensive systemic review and reform of the provision of mental health care for BPSD within RACFs is needed to address the problem of potential overuse of psychotropic medication.

Most patients with dementia have some behavioural and psychological symptoms. While aggression and agitation are easily recognised, symptoms such as apathy may be overlooked. Behavioural and psychological symptoms should be managed without drugs whenever possible. Although there is little evidence to support their use, antipsychotic drugs are often prescribed to people with dementia. Before prescribing it is important to exclude other causes of altered behaviour, such as pain or infection. Some symptoms may be artefacts of memory loss rather than psychosis. Patients with dementia who are prescribed antipsychotic drugs have an increased risk of falls, hospitalisation and death. They should be regularly monitored for adverse effects. If the patient's symptoms resolve with drug treatment, reduce the dose after two or three months. Stop the drug if the symptoms do not return.

BACKGROUND There is increasing interest in targeting hyperphosphorylated tau (h-tau) as a disease modifying approach for Alzheimer's disease (AD). Sodium selenate directly stimulates the activity of PP2A, the main enzyme responsible for h-tau dephosphorylation in the brain. OBJECTIVE This study assessed the safety and tolerability of 24-week treatment with VEL015 (sodium selenate) in AD. Investigating the effects of VEL015 on cognitive, CSF, and neuroimaging biomarkers of AD were secondary, exploratory objectives. Data were used to identify biomarkers showing most promise for use in subsequent efficacy trials. METHODS A 24-week, multicenter, Phase IIa, double-blinded randomized controlled trial. Forty patients aged ≥55 y with mild-moderate AD (MMSE 14-26) were randomized to supranutritional (VEL015 10 mg tds [n = 20]) and control (VEL015 320μg tds [n = 10] or placebo [n = 10]) groups. Patients were regularly monitored for safety, adverse events (AEs), and protocol compliance. Exploratory biomarkers included cognitive tests, neuroimaging (diffusion MR), and CSF (p-tau, t-tau, and Aβ1-42). RESULTS Thirty-six (90%; [supranutritional n = 18, control/placebo n = 18]) patients completed the trial. There were no differences in the incidence of specific AEs between groups. Only one secondary biomarker, diffusion MR measures, showed group differences, with less deterioration in the supranutritional group (p

Squalor affects 1 in 1000 older people and is regarded as a secondary condition to other primary disorders such as dementia, intellectual impairment and alcohol abuse. Squalor frequently is associated with hoarding behaviour. We compared the neuropsychological profile of people living in squalor associated with hoarding to those presenting with squalor only.This study is a retrospective case series of hospital inpatient and community healthcare services of 69 people living in squalor (49 from aged care, 16 from aged psychiatry, 3 from acute medical and 1 from a memory clinic). Forty per cent had co-morbid hoarding behaviours. The main outcomes were neuropsychologists' opinions of domain-specific cognitive impairment.The squalor-hoarding group (M age 75.8, SD = 6.9,) was significantly older (p 0.05) than the squalor-only group (M age 69.9 years, SD = 13.1), significantly more likely to have vascular or Alzheimer's type neurodegeneration (p 0.05) and significantly less likely to have alcohol-related impairment (p 0.05). Chi-square analyses revealed significantly greater rates of impairment for the squalor-only group (p 0.05) in visuospatial reasoning, abstraction, planning, organisation, problem solving and mental flexibility, compared with the squalor-hoarding group. Logistic regression analysis indicated that impaired mental flexibility was a significant predictor and strongly indicated squalor only (odds ratio = 0.07; 95% confidence interval: 0.01-0.82).Preliminary evidence suggests that squalor associated with hoarding may have distinct neuropsychological features compared against squalor only. Future work should be conducted using a larger sample and a common neuropsychological battery to better understand the deficits associated with hoarding-related squalor. Copyright © 2016 John WileySons, Ltd.

Objective: To assess the perceptions of psychiatry registrars of their training experience in Psychiatry of Old Age (POA), and whether factors such as clinical exposure and stage of training correlate with these perceptions. Method: Royal Australian and New Zealand College of Psychiatrists (RANZCP) registrars were surveyed in September 2009. Demographic information, POA exposure and responses to 14 statements related to registrar experience were collected. Results: From 978 surveys sent, 226 responses were complete enough to be analysed. Themes that emerged included a high level of enjoyment of a POA rotation, favourable views of supervision, the challenging nature of managing medical co-morbidities and concerns regarding the teaching of cognitive assessment. In general, type or duration of POA exposure and demographic variables were not correlated with a significant difference in perceptions of the field. Conclusion: These data may be useful in addressing a shortfall of trainees in POA, which has implications for the health of older Australasians. It may inform service providers and the RANZCP of factors that could be modified or optimised to encourage registrars to consider subspecialty training in the area.

The aim of this study was to measure a range of psychological factors identified as important in the literature (resilience, psychological distress, feelings of hopelessness, personal and interpersonal control) among community-dwelling elderly women (N = 31) who had suicidal intentions or attempted suicide. The target group was matched to a control group on age within 5 years. The target group reported lower resilience, personal and interpersonal control but higher psychological distress and feelings of hopelessness compared to the control group. Women who had suicidal ideation or attempts in the last 12 months reported higher personal and interpersonal control. This suggests that although suicide among older women is strongly linked to psychological factors, it warrants further investigation.

We present detailed data on the efficacy and safety profile of paliperidone palmitate once-monthly long acting injectable (PP1M-LAI) in the treatment of schizophrenia in an elderly Caucasian woman. PP1M-LAI was initiated with starting doses of 150 and 100 mg on treatment days 1 and 8, respectively. Subsequent 100 mg doses of PP1M-LAI were then administered at 4-weekly intervals. The primary efficacy variable was the change in Positive and Negative Syndrome Scale (PANSS) total score from baseline. Safety assessment variables included assessment of treatment emergent adverse events, clinical laboratory tests, vital sign measurements, ECG, Calgary Depression Scale for Schizophrenia (CDSS), mini-mental status examination, Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Rating Scale (BARS), Simpson-Angus Scale for the Assessment of Extrapyramidal Side Effects (SAS) and WHO Quality of Life–BREF (WHO-QOL-BREF). The aforementioned variables were all monitored for changes from baseline over a period of 28 weeks. A reduction of PANSS total score was noted over the 28 weeks, demonstrating the efficacy of PP1M-LAI for the treatment of schizophrenia in our patient. Improvements were also noted in the BARS score, SAS score and WHO-QOL-BREF. Negative findings were observed with regard to several pre-established safety variables such as blood glucose levels, prolactin levels, QTC intervals and weight. Overall, the addition of PP1M-LAI to the treatment regime improved the control of psychotic symptoms. However, iatrogenic consequences arising from the use of PP1M-LAI need to be considered and balanced against the primary efficacy of the medication.

Objective The aim of the study was to determine whether depressed aged inpatients treated with brief pulse unilateral electroconvulsive therapy (ECT) differed from those treated with bilateral (bitemporal or bifrontal) ECT with respect to numbers of treatments, length of hospital admission, changes in scores on depression and cognitive scales, and serious adverse effects. Methods An audit of routinely collected data regarding 221 acute ECT courses in 7 public aged psychiatry services in Victoria, Australia. Results Patients given unilateral, bifrontal, and bitemporal treatments were similar with respect to personal, clinical, and treatment characteristics. Most treatments were administered in line with local clinical guidelines and were rated as effective. Psychiatrists preferred unilateral ECT in the first instance with stimulus dosing based on patients' seizure thresholds. Approximately a quarter of unilateral courses were switched later to bitemporal placement, most probably because of insufficient progress. Bilateral treatments were associated with a larger number of treatments, less improvement in scores on mood and cognitive scales, and more refusals to continue treatment than unilateral-only ECT. Discussion Brief pulse unilateral ECT proved more effective than bitemporal and bifrontal ECT for most aged patients, especially when coupled with stimulus dosing based on seizure threshold.

References Conclusions Primary: Evaluate the maximum tolerated dose of ANAVEX2-73. Secondary: Dose response, bioavailability, exploratory cognitive efficacy using electroencephalographic (EEG) activity, including event-related potentials (EEG/ERP), Mini Mental State Examination (MMSE), Cogstate and evaluation of ADSC-ADL and add-on therapy to donepezil, the current standard of care. PART B is an open-label extension for an additional 26 weeks, with daily oral dosing so as to establish a longer drug effect.

Background Advance care planning (ACP) provides a framework for discussion and documentation of future care preferences when a person loses cognitive capacity. It can assist people in the early stages of dementia to document their preferences for care at later stages of the illness. Method A three-stage project introduced ACP to clients with mild cognitive impairment (MCI) or recently diagnosed dementia and their families through a specialist memory clinic. Over 8 months, all English-speaking clients (n = 97) and carers (n = 92) were mailed a survey assessing completed documentation for future care; understanding of the principles of ACP and willingness to get further information about ACP (Stage 1). Participants wanting more information were invited to a seminar introducing the ACP program and service (Stage 2). Participants wanting to complete ACP documentation could make an appointment with the ACP clinicians (Stage 3). Results Forty-eight (52.2%) carers and 34 clients (35.1%) responded to the survey. Most clients (62.1%) and carers (79.1%) expressed interest in ACP, and 78.6% of clients and 63.6% of carers believed that clients should be involved in their future medical decisions. Nine clients (26.5%; diagnoses: MCI = 5; AD = 3; mixed dementia = 1) and 9 carers (18.8%) attended the seminars, and 2/48 (4%) carers and 3/34 (8.8%) clients (diagnoses: MCI = 2; AD = 1) completed ACP. Conclusion Despite initial interest, ACP completion was low. The reasons for this need to be determined. Approaches that may better meet the needs of people newly diagnosed with MCI and dementia are discussed.

Background: We aimed to assess why carers seek participation for their relatives in clinical trials of Alzheimer's disease (AD) medications, and to assess carer impressions of the value of trial participation. Method: A retrospective questionnaire was sent to 31 carers of participants in clinical trials for AD conducted at the Mental Health Research Institute and the National Aging Research Institute between January 1997 and December 1999. Results: Twenty-five questionnaires (81%) were returned, completed to an extent to permit analysis. Helping a relative feel better, contributing to medical science, and hoping for a cure were the main reasons for trial participation. In general, carers found the regular consultation with research staff supportive and would recommend trial participation to others. Conclusion: A greater understanding of the motivations of carers may aid the recruitment and retention of participants in clinical trials.

Objectives: To provide a guide for clinically-based psychiatrist supervisors of research projects for early career researchers. Methods: This paper will describe a mentoring framework for supervision, for psychiatrist clinical research supervisors and early career researchers. Results: The domains discussed include, across various aspects of a study: the role of the supervisor, project management, and where and when to seek advice. Conclusions: Supervision of clinical research can be a professionally rewarding experience for psychiatrists, as well as early career researcher supervisees.

Objectives: Systematic reviews are one of the major building blocks of evidence-based medicine. This overview is an introduction to conducting systematic reviews and meta-analyses. Conclusions: Systematic reviews and meta-analyses of randomised controlled trials (RCTs) represent the most robust form of design in the hierarchy of research evidence. In addition, primary data do not have to be collected by the researcher him/herself, and there is no need for approval from an ethics committee. Systematic reviews and meta-analyses are not as daunting as they may appear to be, provided the scope is sufficiently narrow and an appropriate supervisor available.

Objective: To describe the style of psychotherapy portrayed in the film Antwone Fisher. The rationale for this examination is that prospective patients often have little idea about what the process of psychotherapy may involve; depictions of therapy in popular films and on television serve to ‘prime’ our patients' expectations in this regard.Conclusions: The film in question shows a psychiatrist who might be readily perceived as unambiguously good by a lay audience, despite a number of clear therapeutic boundary violations occurring throughout the film. Although such positive depictions might enhance the public image of psychiatry, they have the potential to create unreal expectations within patients and to promote the acceptability of boundary violations.

We present detailed data on the efficacy and safety profile of paliperidone palmitate once-monthly long acting injectable (PP1M-LAI) in the treatment of schizophrenia in an elderly Caucasian woman. PP1M-LAI was initiated with starting doses of 150 and 100 mg on treatment days 1 and 8, respectively. Subsequent 100 mg doses of PP1M-LAI were then administered at 4-weekly intervals. The primary efficacy variable was the change in Positive and Negative Syndrome Scale (PANSS) total score from baseline. Safety assessment variables included assessment of treatment emergent adverse events, clinical laboratory tests, vital sign measurements, ECG, Calgary Depression Scale for Schizophrenia (CDSS), mini-mental status examination, Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Rating Scale (BARS), Simpson-Angus Scale for the Assessment of Extrapyramidal Side Effects (SAS) and WHO Quality of Life–BREF (WHO-QOL-BREF). The aforementioned variables were all monitored for changes from baseline over a period of 28 weeks. A reduction of PANSS total score was noted over the 28 weeks, demonstrating the efficacy of PP1M-LAI for the treatment of schizophrenia in our patient. Improvements were also noted in the BARS score, SAS score and WHO-QOL-BREF. Negative findings were observed with regard to several pre-established safety variables such as blood glucose levels, prolactin levels, QTC intervals and weight. Overall, the addition of PP1M-LAI to the treatment regime improved the control of psychotic symptoms. However, iatrogenic consequences arising from the use of PP1M-LAI need to be considered and balanced against the primary efficacy of the medication.

Background: We explored carer motivation for seeking participation for a relative in an Alzheimer's disease (AD) clinical drug trial, to assess impressions of the value of trial participation. We also surveyed the carers of patients who did not meet study entry screening criteria to see if our conduct of the screening visit was acceptable and ethical. Method: A retrospective questionnaire was sent to the carers of 36 randomized participants and 22 carers of patients who did not meet study entry screening criteria for an AD clinical treatment trial. Results: Twenty-nine (81%) of the trial participant carers and 15 (68%) of carers of the group who did not meet study entry criteria returned their questionnaires with sufficient information for analysis. The prime motivators in seeking trial participation were to help their relative feel better and live longer, to contribute to medical science, to improve the health of others, and the hope of a cure. Carers of both groups found research staff supportive and would recommend trial participatiion to others. Conclusions: Even though trial participation is onerous and patients were generally perceived by carers as not having improved, both the screening visit and participation in the trial itself were seen as positive experiences and the expectations of carers were met.