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How does stigma impact acts of compassion among people with borderline personality disorder
No full textBorderline personality disorder (BPD) is a highly stigmatised mental disorder. A variety of research exists highlighting the stigma experienced by individuals with BPD and the impacts of such prejudices on their lives. Similarly, much research exists on the benefits of engaging in compassionate acts, including improved mental health recovery. However, there is a notable gap in understanding how stigma experienced by people with BPD acts as a barrier to compassion and by extension recovery. This paper synthesises these perspectives, examining common barriers to compassionate acts, the impact of stigma on people with BPD, and how these barriers are exacerbated for individuals with BPD due to the stigma they face. The synthesis of perspectives in the article highlights the critical role of compassion in supporting the recovery of individuals with BPD, while also revealing the significant barriers posed by stigma. Addressing these challenges requires a comprehensive understanding of the intersection between compassion and stigma, informing the development of targeted interventions to promote well-being and recovery for individuals with BPD.https://www.cambridge.org/core/journals/irish-journal-of-psychological-medicine/article/abs/how-does-stigma-impact-acts-of-compassion-among-people-with-borderline-personality-disorder/3FA5FBF3140B1D54AB0F41B314CB8D2
Women and mental health symposium
No full textThis symposium will delve into critical topics addressing gender-specific mental health challenges. The first speaker will discuss updated MHRA guidelines for prescribing sodium valproate, a widely used medication for epilepsy and bipolar disorder. Historically, risks associated with valproate have focused on women of childbearing age, with 11% of babies exposed in utero developing birth defects and 30–40% facing developmental issues. Emerging data now indicate a potential risk of neurodevelopmental disorders in children conceived by men on valproate up to three months before conception, raising questions about its future prescription for men. The Indian perspective on this issue will also be explored. The second speaker will highlight SHAPER’s “Breathe Melodies for Mums” initiative, a Wellcome-funded £2.6 million research programme investigating group singing as an intervention for postnatal depression. Findings from this randomized control trial will provide insights into how arts-based social interventions can address mild to moderate postnatal depression. The third speaker will focus on ADHD in young girls, a condition often overlooked due to its atypical presentation, leading to challenges in self-esteem, development, and long-term mental health as women. Early recognition and intervention will be emphasized. The fourth speaker will share her leadership journey as a woman of Indian origin forging a successful career in the UK, mentoring international graduates, and contributing to psychiatry. The symposium promises to offer enriching discussions on these timely issues.https://journals.lww.com/indianjpsychiatry/fulltext/2025/01001/ancips_2025___symposia.15.asp
Mentalisation-based treatment for antisocial personality disorder in males convicted of an offence on community probation in England and Wales (Mentalization for Offending Adult Males, MOAM): A multicentre, assessor-blinded, randomised controlled trial
No full textBACKGROUND: Antisocial personality disorder is a major health and social problem, but scepticism about its treatability has restricted development of the evidence base for psychological treatments. Mentalisation-based treatment (MBT) tailored for antisocial personality disorder (MBT-ASPD) can address problematic behaviours by improving the ability to understand and regulate the negative effects of thoughts and feelings. This study aimed to evaluate the clinical and cost-effectiveness of MBT-ASPD compared with probation as usual in reducing aggressive behaviours from baseline to 12 months of follow-up. METHODS: The Mentaliziation for Offending Adult Males (MOAM) trial was a multicentre, two-group, pragmatic, assessor-masked, randomised controlled superiority trial in England and Wales. Eligible participants were male, aged 21 years or older, convicted of an offence and under National Probation Service supervision at one of 13 sites, identified through the Community Personality Disorder Pathways Service, met DSM-5 criteria for antisocial personality disorder, and scored at least 15 on the Overt Aggression Scale-Modified (OAS-M). After a three-stage screening process, consenting participants were randomly allocated (1:1), stratified by site, age, probation order type, and remaining probation duration, to either MBT-ASPD plus probation as usual, or probation as usual alone. Participants in the MBT-ASPD group were offered 12 months of weekly 75-min group therapy sessions and monthly 50 min individual sessions. Probation as usual lasted up to 12 months, after which participants continued under National Probation Service supervision for the remainder of their term. Investigators and data collectors were masked to treatment allocation. The primary outcome was aggression measured by the OAS-M at 12 months after random allocation. Data were collected by a hybrid team of traditional researchers and researchers with lived experience of the criminal justice system. The primary analysis was conducted in the intention-to-treat population using a linear mixed-effects model, adjusted for baseline at each follow-up timepoint (months 3, 6, 9, 12, 15, 18, 21, and 24). This trial is registered with ISRCTN (ISRCTN 32309003), and all pre-planned follow-ups are complete. FINDINGS: Between Jan 2, 2016, and Aug 31, 2018, 1946 individuals were referred to the study; after the screening process, 313 participants were randomly allocated (156 [50%] to probation as usual and 157 [50%] to MBT-ASPD plus probation as usual). Participants had a mean age of 34·2 years (SD 9·3); the majority of participants (247 [79%]) identified as White British, Irish, or White Other; followed by Black British (Caribbean, African, or Other; 30 [10%]) or Mixed (29 [9%]). At 12 months after random allocation, mean OAS-M scores were significantly higher in the probation as usual group (mean score 186 [SD 153]) than in the MBT-ASPD group (90 [126]), with an adjusted mean difference between groups of -73·5 (95% CI -113·7 to -33·2); p<0·0001, with a medium-to-large effect size of 0·74. During the trial, seven participants died, and one presumed death occurred, all in the probation as usual group after random allocation, with none of the deaths deemed related to trial procedures. INTERPRETATION: MBT-ASPD holds promise as an effective intervention for individuals with antisocial personality disorder within a forensic population. Future research should explore these findings' generalisability and the sustainability of treatment gains. FUNDING: National Institute for Health Research Health Technology Assessment programme.https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00445-0/abstrac
At the peak: a review of current diagnostic and therapeutic concepts surrounding tibial plateau fractures
No full textTibial plateau fractures are complex injuries commonly resulting from high-energy trauma in younger patients or low-energy falls in the elderly. They significantly impair knee function and overall quality of life, often leading to complications such as post-traumatic osteoarthritis and knee stiffness. This review looks at current diagnostic modalities, epidemiological data, anatomical considerations, and therapeutic strategies for managing tibial plateau fractures, highlighting advancements in treatment and outcomes. The well-established Schatzker and AO/OTA systems of classification have evolved alongside emerging frameworks like the three-column classification and ten-segment concepts that utilize three-dimensional imaging technologies. Tibial plateau fractures have an estimated incidence of 10.3 per 100,000 people, with males affected more frequently than females. The incidence increases with age, particularly among women in their seventh decade. The management of tibial plateau fractures can involve either non-operative or operative interventions. While minimally displaced fractures may be treated conservatively, more complex cases typically require surgical procedures such as open reduction and internal fixation or arthroscopically assisted techniques. Recent improvements in rehabilitation protocols and surgical techniques aim to enhance recovery and minimize complications. Long-term assessments indicate that functional deficits and complications persist in many patients following tibial plateau fractures. Factors such as age, fracture type, and soft tissue integrity significantly influence recovery trajectories. Effective management of tibial plateau fractures requires a multi-faceted approach that utilizes imaging techniques, judicious surgical intervention, and patient-tailored rehabilitation. Further research is needed to refine treatment protocols and establish standardized methods for evaluating functional outcomes.https://www.orthopaedicsandtraumajournal.co.uk/article/S1877-1327(25)00005-3/abstrac
Age-dependent phenotypes of cognitive impairment as sequelae of SARS-CoV-2 infection
Full text link© 2025 Gonzalez Aleman, Vavougios,
Tartaglia, Uvais, Guekht, Hosseini, Lo Re,
Ferreccio, D’Avossa, Zamponi, Figueredo
Aguiar, Yecora, Ul Haq Katshu, Stavrou,
Boutlas, Gourgoulianis, Botero, Gonzalez ´
Insua, Perez-Lloret, Zinchuk, Gersamija, ´
Popova, Bryzgalova, Sviatskaya, Russelli,
Avorio, Wang, Edison, Niimi, Sohrabi,
Mukaetova Ladinska, Neidre and de Erausquin.
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these terms.Cognitive changes associated with PASC may not be uniform across populations. We conducted individual-level pooled analyses and meta-analyses of cognitive assessments from eight prospective cohorts, comprising 2,105 patients and 1,432 controls from Argentina, Canada, Chile, Greece, India, Italy, Russia, and the UK. The meta-analysis found no differences by country of origin. The profile and severity of cognitive impairment varied by age, with mild attentional impairment observed in young and middle-aged adults, but memory, language, and executive function impairment in older adults. The risk of moderate to severe impairment doubled in older adults. Moderately severe or severe impairment was significantly associated with infection diagnoses (chi-square = 26.57, p ≤ 0.0001) and the severity of anosmia (chi-square = 31.81, p ≤ 0.0001). We found distinct age-related phenotypes of cognitive impairment in patients recovering from COVID-19. We identified the severity of acute illness and the presence of olfactory dysfunction as the primary predictors of dementia-like impairment in older adults.https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2024.1432357/ful
Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial
Full text linkWei Shen Lim is a member of the RECOVERY Collaborative Group.BACKGROUND: Lopinavir-ritonavir has been proposed as a treatment for COVID-19 on the basis of in vitro activity, preclinical studies, and observational studies. Here, we report the results of a randomised trial to assess whether lopinavir-ritonavir improves outcomes in patients admitted to hospital with COVID-19. METHODS: In this randomised, controlled, open-label, platform trial, a range of possible treatments was compared with usual care in patients admitted to hospital with COVID-19. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus lopinavir-ritonavir (400 mg and 100 mg, respectively) by mouth for 10 days or until discharge (or one of the other RECOVERY treatment groups: hydroxychloroquine, dexamethasone, or azithromycin) using web-based simple (unstratified) randomisation with allocation concealment. Randomisation to usual care was twice that of any of the active treatment groups (eg, 2:1 in favour of usual care if the patient was eligible for only one active group, 2:1:1 if the patient was eligible for two active groups). The primary outcome was 28-day all-cause mortality. Analyses were done on an intention-to-treat basis in all randomly assigned participants. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. FINDINGS: Between March 19, 2020, and June 29, 2020, 1616 patients were randomly allocated to receive lopinavir-ritonavir and 3424 patients to receive usual care. Overall, 374 (23%) patients allocated to lopinavir-ritonavir and 767 (22%) patients allocated to usual care died within 28 days (rate ratio 1.03, 95% CI 0.91-1.17; p=0.60). Results were consistent across all prespecified subgroups of patients. We observed no significant difference in time until discharge alive from hospital (median 11 days [IQR 5 to >28] in both groups) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 0.98, 95% CI 0.91-1.05; p=0.53). Among patients not on invasive mechanical ventilation at baseline, there was no significant difference in the proportion who met the composite endpoint of invasive mechanical ventilation or death (risk ratio 1.09, 95% CI 0.99-1.20; p=0.092). INTERPRETATION: In patients admitted to hospital with COVID-19, lopinavir-ritonavir was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death. These findings do not support the use of lopinavir-ritonavir for treatment of patients admitted to hospital with COVID-19. FUNDING: Medical Research Council and National Institute for Health Research. Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.https://doi.org/10.1016/s0140-6736(20)32013-
Subthreshold Autism and ADHD: A Brief Narrative Review for Frontline Clinicians.
Full text linkBackground: Epidemiological studies have shown that neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are more prevalent in the general childhood population, compared to cases that are formally diagnosed in clinical cohorts. This suggests that many children and youths have NDD which are never diagnosed clinically, causing impairments in some domains of their daily life. There is increasing recognition of the concept of a “subthreshold” condition, sometimes used to describe the presence of potentially impairing variations in the neurodevelopmental profile that do not meet criteria for a diagnosis. The aim of this narrative review is to appraise the published literature about common themes regarding subthreshold conditions in relation to autism and ADHD, identifying any practical lessons that may be applicable to frontline neurodevelopmental clinicians. Methods: We searched electronic databases including PMC and PubMed using various combinations of keywords, including “Subthreshold”, “subclinical”, “neurodevelopmental”, “childhood”, “ADHD” and “ASD”. Results: The identified themes include definitions, prevalence, assessment tools, lifetime impairments, NDD classification models, management, raising public awareness, and future research directions. Conclusions: The authors propose that a “subthreshold condition” should be recorded when NDDs do not meet current diagnostic criteria if there is evidence of significant, persisting impairment in at least one setting.https://www.mdpi.com/2036-7503/17/2/4
British Thoracic Society clinical statement on aspergillus-related chronic lung disease
No full texthttps://doi.org/10.1136/thorax-2024-22256
Systematic review of the efficacy of pharmacological and non-pharmacological interventions for improving quality of life of people with dementia
Full text link© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly citedBackground People with dementia (PwD) and their carers often consider maintaining good quality of life (QoL) more important than improvements in cognition or other symptoms of dementia. There is a clinical need for identifying interventions that can improve QoL of PwD. There are currently no evidence-based guidelines to help clinicians, patients and policy makers to make informed decisions regarding QoL in dementia. Aims To conduct the first comprehensive systematic review of all studies that investigated efficacy of any pharmacological or non-pharmacological intervention for improving QoL of PwD. Method Our review team identified eligible studies by comprehensively searching nine databases. We completed quality assessment, extracted relevant data and performed GRADE assessment of eligible studies. We conducted meta-analyses when three or more studies investigated an intervention for improving QoL of PwD. Results We screened 14 389 abstracts and included 324 eligible studies. Our meta-analysis confirmed level 1 evidence supporting the use of group cognitive stimulation therapy for improving QoL (standardised mean difference 0.25; P = 0.003) of PwD. Our narrative data synthesis revealed level 2 evidence supporting 42 non-pharmacological interventions, including those based on cognitive rehabilitation, reminiscence, occupational therapy, robots, exercise or music therapy. Current evidence supporting the use of any pharmacological intervention for improving QoL in dementia is limited. Conclusions Current evidence highlights the importance of non-pharmacological interventions and multidisciplinary care for supporting QoL of PwD. QoL should be prioritised when agreeing care plans. Further research focusing on QoL outcomes and investigating combined pharmacological and non-pharmacological interventions is urgently needed.https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/systematic-review-of-the-efficacy-of-pharmacological-and-nonpharmacological-interventions-for-improving-quality-of-life-of-people-with-dementia/A766AB11F8A7141D7762F47185E4A3D
Systematic review of differentially abundant proteins in people with lewy body dementia
Full text linkThis is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
© The Author(s), 2025. Published by Cambridge University Press on behalf of Scandinavian College of NeuropsychopharmacologyObjectives: Dementia with Lewy Bodies (DLB) and Parkinson's Disease Dementia (PDD) are collectively called as Lewy body dementia (LBD). Despite the urgent clinical need, there is no reliable protein biomarker for LBD. Hence, we conducted the first comprehensive systematic review of all Differentially Abundant Proteins (DAP) in all tissues from people with LBD for advancing our understanding of LBD molecular pathology that is essential for facilitating discovery of novel diagnostic biomarkers and therapeutic targets for LBD. Method(s): We identified eligible studies by comprehensively searching five databases and grey literature (PROSPERO protocol:CRD42020218889). We completed quality assessment and extracted relevant data. We completed narrative synthesis and appropriate meta-analyses. We analysed functional implications of all reported DAP using DAVID tools. Result(s): We screened 11,006 articles and identified 193 eligible studies. 305 DAP were reported and 16 were replicated in DLB. 37 DAP were reported and three were replicated in PDD. Our meta-analyses confirmed six DAP (TAU, SYUA, NFL, CHI3L1, GFAP, CLAT) in DLB, and three DAP (TAU, SYUA, NFL) in PDD. There was no replicated blood-based DAP in DLB or PDD. The reported DAP may contribute to LBD pathology by impacting misfolded protein clearance, dopamine neurotransmission, apoptosis, neuroinflammation, synaptic plasticity and extracellular vesicles. Conclusion(s): Our meta-analyses confirmed significantly lower CSF TAU levels in DLB and CSF SYUA levels in PDD, when compared to Alzheimer's disease. Our findings indicate promising diagnostic biomarkers for LBD and may help prioritising molecular pathways for therapeutic target discovery. We highlight ten future research priorities based on our findings.https://www.cambridge.org/core/journals/acta-neuropsychiatrica/article/systematic-review-of-differentially-abundant-proteins-in-people-with-lewy-body-dementia/23706982EB0DEB020D6936FE75930A3