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Children and adolescents who present to hospital following self-harm have an increased future risk of suicide compared with other children and adolescents, which may persist for several years, according to an observational study of more than 9,000 children and adolescents aged 10-18 years who presented to five English hospitals for non-fatal self-harm.
Adolescent hope and optimism: A scoping review of measures and their psychometric properties.
UNLABELLED: There is much research examining adolescent hope and optimism, but there is limited information on the available measures, particularly the most frequently used measures and their psychometric properties. We conducted a scoping review to: (1) identify measures of hope and optimism for use among adolescents; (2) determine the most frequently used measures of adolescent hope and optimism; (3) document the psychometric properties of the identified measures. We searched five bibliographic databases and Open Grey for relevant articles published from database inception to 03 May 2023. The search included the key terms 'adolescents', 'optimism', 'hope' and 'measures'. We targeted adolescents aged 10-19 years without country or gender restrictions. We identified 86 measures of optimism and 64 measures of hope for use among adolescents from 803 eligible studies. Most of the included studies (n = 341, 42.5%) originated from North America. We identified 22 most frequently used measures used across 603 (75.1%) of the included studies, with 509 (84.4%) of them providing their psychometric properties. The reported validity of the tools included face, content, construct, criterion, convergent, discriminant, predictive validity and measurement invariance. There are several measures of adolescent hope and optimism. The most frequently used measures of these constructs demonstrated sound psychometric properties, especially reliability. However, most of the evidence originates from high-income countries. There is a need for development, cross-cultural adaptation and validation of these tools to other settings. CONTRIBUTION: Hope and optimism are character strengths that have been consistently linked to positive health outcomes in adolescents. Based on increasing research on adolescent hope and optimism, there have been measures developed to assess these constructs but there is no study summarising the available measures, particularly regarding the most frequently used measures and their reliability and validity across contexts. This study aimed at filling this gap. Information on this will be useful to various stakeholders to make evidence-informed choice on selection of the most relevant instrument for use in adolescents in their contexts.
Guided visual search is associated with target boosting and distractor suppression in early visual cortex.
Visual attention paradigms have revealed that neural excitability in higher-order visual areas is modulated according to a priority map guiding attention towards task-relevant locations. Neural activity in early visual regions, however, has been argued to be modulated based on bottom-up salience. Here, we combined Magnetoencephalography (MEG) and Rapid Invisible Frequency Tagging (RIFT) in a classic visual search paradigm to study feature-guidance in early human visual cortex. Our results demonstrate evidence for both target boosting and distractor suppression when the participants were informed about the task-relevant and -irrelevant colour (guided search) compared to when they were not (unguided search). These results conceptually replicated using both a magnitude-squared coherence approach and a General Linear Model based on a single-trial measure of the RIFT response. The present findings reveal that feature-guidance in visual search affects neuronal excitability as early as primary visual cortex, possibly contributing to a priority-map-based mechanism.
The future of community engagement with the trans+ community
This essay reflects on ethical and inclusive research practices with the trans+ community, particularly young people, and the challenges posed by discrimination in doing such research. The essay centres the importance of trust, lived experience, and the wellbeing of researchers and research partners in creating meaningful community engagement in research.
Death and the Doctor: the museum as a tool for understanding the needs of the dying
Over the past several years, the Ashmolean Museum at Oxford has been part of a multi- disciplinary team examining the question of how we train medical students to deal with those parts of their profession which are concerned primarily with the humanity of their patients. In collaboration with colleagues from Neuroscience, Psychiatry, History and Theology, the Museum has participated in an ongoing teaching experiment in which medical history, ethics and the visual arts are brought to bear on an understanding of medical professionalism - what it means to be a doctor and how to be a better one. Bringing together museum professionals, Expert Patient Tutors and doctors in curriculum planning and delivery, the work has been delivered online, using images from the museum’s collections, and live, using the Ashmolean galleries as spaces for the consideration of issues around death, dying and end-of-life care. This article and its preface reflect broadly on a decade of medical collaboration at the Ashmolean and specifically on the processes of both making and delivering teaching on dealing with death, in a cross-disciplinary, non-medical context, asking not only what the Museum can do for medical education but why medical education needs the museum.
Temporal Dynamics of Subtle Cognitive Change: Validation of a User-Friendly Multidomain Digital Assessment Using an Alcohol Challenge.
BackgroundClinical trials in neurological and psychiatric indications are hampered by poor measurement fidelity in currently used "standardized" rating scales. Digital, repeatable tests that can be remotely administered offer a more fine-grained understanding of the patient's clinical trajectory. Several such tools are being developed, but only a few have been validated in terms of their ability to discern and describe change over time-a critical element of clinical trials.ObjectiveFour cognitive tasks from a digital battery (delivered via tablet) are administered at high frequency following an alcohol challenge to assess sensitivity to change. The tasks are novel, repeatable, and self-administered implementations of classic neurobehavioral paradigms.MethodsThirty healthy younger adults were assessed on 2 separate days, once under the influence of alcohol and once under a placebo, with order counterbalanced. Each day included 8 assessments. The tasks comprised novel, engaging implementations of the Digit Symbol Substitution Task (DSST), reaction time, N-back working memory, and visual associative/episodic memory, and were compared with benchmark measures. In-laboratory assessments were preceded by massed practice (3 sessions), and blood alcohol concentration was monitored throughout using a breathalyzer and a Visual Analog Scale.ResultsAlcohol-related impairment was observed across multiple measures, followed by a return to baseline as blood alcohol concentration declined. A slight practice effect was noted between the first and second sessions for the digital DSST, along with a longer-term effect across the 2 days. Moderate to strong correlations between digital and benchmark measures were observed at peak intoxication.ConclusionsUnder alcohol challenge, this battery, along with benchmark standardized tests, demonstrates sensitivity to subtle changes in cognitive performance over time. Practice effects are minimal within this condensed protocol. Patient-friendly, repeatable tests administered via a digital platform, such as those in the current battery, warrant further investigation in the context of remote clinical studies that require methodological approaches capable of discerning and describing small changes over time. The availability of validated single tests or test batteries as sensitive tools that can be easily and frequently administered (eg, daily) would address a critical gap: the lack of descriptors with sufficient sensitivity, specificity, and reliability to detect cognitive changes over time in clinical trials of new therapies for neurological and psychiatric conditions.
The Adoption of Digital Games Among Older Adults
The revolution of technology brings many benefits towards diverse population. Digital game is one of the digital technologies that has potential to facilitate older adults’ daily routine. However, some of them faces challenges to adopt the usage of digital games in their daily lives, one of which is that most commercial games are not suitable for older people. This paper discusses the investigation into the challenges associated with the older adults’ adoption of digital games, their interaction, and experiences with digital games and specifically explores the andragogical perspectives, and game design attributes. A set of questionnaires consisted of open-ended and close-ended questions were distributed, targeting the older adults across Malaysia, using online and non-probability sampling technique. 81 respondents were recruited, and 56 respondents (n=56) were eligible in this study. Four participants were recruited for informal interview session. The analysis of the results indicates that the older adults’ perception of digital games and game design aspects are the major factors influencing their digital game adoption. Game designs are important to attract many older adults to experience and interact with digital games
Antidepressant Switching as a Proxy Phenotype for Drug Nonresponse: Investigating Clinical, Demographic, and Genetic Characteristics.
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are a first-line pharmacological therapy in major depressive disorder (MDD), but treatment response rates are low. Clinical trials lack the power to study the genetic contribution to SSRI response. Real-world evidence from electronic health records provides larger sample sizes, but novel response definitions are needed to accurately define SSRI nonresponders. METHODS: In the UK Biobank (UKB) (N = 38,813) and Generation Scotland (N = 1777) datasets, SSRI switching was defined using ≤90-day gap between prescriptions for an SSRI and another antidepressant in primary care. Nonswitchers were participants with ≥3 consecutive prescriptions for an SSRI. In the UKB, clinical, demographic, and polygenic score (PGS) associations with switching were determined, and the common-variant heritability was estimated. RESULTS: In the UKB, 5133 (13.2%) SSRI switchers and 33,680 nonswitchers were defined. The mean time to switch was 28 days (interquartile range, 17-49). Switching patterns were consistent across the UKB and Generation Scotland (n = 498 switchers). Higher annual income and educational levels (odds ratio [OR] [95% CI] for a university degree, 0.73 [0.67-0.79] compared with no qualifications) were associated with lower levels of switching. PGSs for nonremission, based on clinical studies, were associated with increased risk of switching (OR, 1.07 [1.02-1.12], p = .007). MDD PGSs and family history of depression were not significantly associated with switching. Using genome-wide complex trait Bayesian, the single nucleotide polymorphism-based heritability was approximately 4% (SE 0.016) on the observed scale. CONCLUSIONS: This study identified SSRI switching as a proxy for nonresponse, scalable across biobanks with electronic health records, capturing demographics and genetics of treatment nonresponse, and independent of MDD genetics.
Cannabis Withdrawal and Psychiatric Intensive Care
ImportanceCannabis use is common in people with severe mental illness and its adverse effects on outcomes are well established. However, adverse outcomes may also result from cannabis withdrawal syndrome (CWS). CWS includes symptoms such as agitation, irritability, and aggression, and typically peaks after 3 to 5 days of abstinence.ObjectiveTo assess whether cannabis use prior to admission is associated with an increase in the risk of transfer to a psychiatric intensive care unit (PICU) during the cannabis withdrawal risk period.Design, Setting, and ParticipantsThis retrospective cohort study used clinical data from a secondary mental health care database and took place at 4 psychiatric hospitals in London, United Kingdom, between January 2008 and December 2023. Patients included adults admitted to general psychiatric wards and PICUs. Data were analyzed from June 2023 to February 2025.ExposureCannabis use was determined from clinical records, using natural language processing and manual review.Main Outcomes and MeasuresThe primary outcome was transfer from a general ward to PICU during the cannabis withdrawal risk period (3 to 5 days after presentation to the hospital). Secondary outcomes included admission to PICU at any time point. Outcomes were analyzed according to cannabis use status with multivariable models, which adjusted for age, gender, ethnicity, diagnosis, tobacco use, stimulant use, comorbid alcohol or substance use disorder, and admission year.ResultsThere were 52 088 hospital admissions identified, of which 4691 involved admission to a PICU (9.0%). Cannabis users were more likely to be admitted to a PICU than nonusers (adjusted odds ratio [aOR], 1.44; 95% CI, 1.33-1.55; P < .001). There were 1236 admissions where the patient was transferred to PICU after initial admission to a general ward (mean [SD] age, 33.4 [10.4] years; 810 male [66%] and 426 female [34%]). At 3 to 5 days postpresentation (the risk period for cannabis withdrawal), transfer from a general ward to a PICU was more common in cannabis users (31.0%) than nonusers (24.2%) (aOR, 1.36; 95% CI, 1.01-1.81; P = .04). The association was particularly evident in women (aOR, 2.03; 95% CI, 1.22-3.39; P = .007) and in those older than 35 years (aOR, 2.53; 95%CI: 1.52-4.21; P < .001).Conclusions and RelevancePeople with severe mental illness who are cannabis users may develop cannabis withdrawal syndrome shortly after hospital admission, and this can exacerbate their mental state.
The effect of D-cycloserine on brain connectivity over a course of pulmonary rehabilitation - A randomised control trial with neuroimaging endpoints.
Combining traditional therapies such as pulmonary rehabilitation with brain-targeted drugs may offer new therapeutic opportunities for the treatment of chronic breathlessness. Recently, we asked whether D-cycloserine, a partial NMDA-receptor agonist which may enhance behavioural therapies, modifies the relationship between breathlessness related brain activity and breathlessness anxiety over pulmonary rehabilitation. However, whether any changes are supported by alterations to underlying brain structure remains unknown. Here we examine the effect of D-cycloserine over a course of pulmonary rehabilitation on the connectivity between key brain regions associated with the processing of breathlessness anxiety. 72 participants with mild-to-moderate COPD took part in a longitudinal study in parallel to their pulmonary rehabilitation course. Diffusion tensor brain imaging and clinical measures of respiratory function were collected at three time points (before, during and after pulmonary rehabilitation). Participants were assigned to 250mg of D-cycloserine or placebo, which they were administered with on four occasions in a randomised, double-blind procedure. Following the first four sessions of pulmonary rehabilitation (visit 2), during which D-cycloserine was administered, improvements in breathlessness anxiety were linked with increased insula-hippocampal structural connectivity in the D-cycloserine group when compared to the placebo group. No differences were found between the two groups following the completion of the full pulmonary rehabilitation course 4-6 weeks later (visit 3). The action of D-cycloserine on brain connectivity appears to be restricted to within a short time-window of its administration. This temporary boost of the brain connectivity of two key regions associated with the evaluation of how unpleasant an experience is may support the re-evaluation of breathlessness cues, illustrated improvements in breathlessness anxiety. Trial registration ClinicalTrials.gov (NCT01985750).
Collaborative risk assessment and management planning in secure mental health services in England: protocol for a realist review.
INTRODUCTION: Secure mental health pathways are complex. They are typically based around secure hospitals, but also interface with justice agencies and other clinical services, including in the community. Consideration of risk is fundamental to clinical care and to decisions relating to a patient's stepwise journey through the pathway. Patient autonomy and involvement in decision-making are policy priorities for health services. However, improving collaboration in risk-related decisions in secure services is complicated by potential issues with insight and capacity and the necessary involvement of other agencies. In addition, although some collaborative approaches are feasible and effective, their impact, mechanisms and the contexts in which they work are not well understood. Therefore, using realist methodology, this review will outline what works, for whom, why and under what circumstances in terms of collaborative risk assessment and management in secure services. METHODS AND ANALYSIS: The review will consist of four stages: (1) Development of an initial programme theory to explain how and why collaborative risk assessment and management works for different groups of people, (2) search for evidence, (3) data selection and extraction and (4) evidence synthesis and development of a final programme theory. Our initial programme theory will be informed by an informal search of the literature and consultation with experts and patient and public involvement and engagement representatives. Following this, our formal literature search will include both the published and unpublished literature. During full text screening, each document will be assessed according to the principles of rigour and relevance and, if included, data will be extracted and synthesised to refine the programme theory. ETHICS AND DISSEMINATION: This protocol is for a review of published literature and so does not require ethical approval. The main output will be the final programme theory. Remaining gaps will inform planned future work to further refine the theory using mixed methods. Our dissemination strategy will be codeveloped with our public and patient involvement group and will include publishing findings in a peer-reviewed journal and presenting findings at relevant professional conferences, as well as engaging patient, carer and clinician groups directly.