A mixed-method systematic review of the perspectives of young people, carers and professionals on psychiatric diagnosis in childhood and adolescence.

PROBLEM: The significance and complexities of a psychiatric diagnosis have been well-documented in existing literature. Despite the reliability and accuracy of such diagnoses, the impact and use of diagnostic labelling on young people remains unclear. METHODS: A systematic review was conducted using six databases, identifying 13 studies that explored psychiatric diagnosis experiences in professionals, caregivers, and young people. FINDINGS: This review focuses on three main themes related to psychiatric diagnosis in young people. The first theme is diagnostic subjectivity, which explores the accuracy, usefulness, potential harm and alternatives (e.g. psychological formulation) to psychiatric diagnosis in this population. The second theme is the utility of psychiatric diagnosis, which considers whether it helps young people access appropriate support and gain a better understanding of themselves and their presenting issues. The third theme is stigma, which examines the negative experiences and discrimination that young people may face due to their psychiatric diagnosis. CONCLUSIONS: There is relatively limited literature which discusses the experience of psychiatric diagnosis in young people, caregivers and professionals. The available literature is difficult to compare due to discrepancies between methodologies and services, and there are several gaps i.e. a limited focus on the experience of young people themselves. Different views and experiences of psychiatric diagnosis among professionals, caregivers, and young people could impact young people's quality of life, access to healthcare, and identity development. The current literature needs to be more comprehensive to draw firm conclusions about young people's experiences with psychiatric diagnosis.

Fear of clowns: An investigation into the aetiology of coulrophobia.

Introduction: Fear of clowns or coulrophobia is a little understood phenomenon despite studies indicating that it has a high prevalence in the general population. There have been no previous investigations into the aetiology of this fear, although several plausible hypotheses from the wider literature can be generated; the fear stems from media portrayals of scary clowns, from the unusual physical appearance or the unpredictable behaviour displayed, or it derives from an unpleasant personal experience. Methods: The current study reviews the literature in this area and also pilots a new questionnaire (Origin of Fear of Clowns Questionnaire; OFCQ) to explore the causes of the fear of clowns in a sample of 528 participants who reported such a fear. Results: Our findings suggest that uncertainty of harmful intent, media influences and unpredictability of behaviour play an important role in the origins of coulrophobia. There are also multiple features of clown appearance which produce a negative experiential state and a sense of a direct threat. Discussion: We conclude that the origins of clown fear are multi-factorial and primarily relate to aspects of their facial appearance, their behaviour, and how they have been portrayed in the media. Surprisingly, fear derived from personal experience was not one of our main findings. Further research is focused on looking at associations between the level of fear and each aetiological category.

Physical activity interventions for the mental health of children: A systematic review.

OBJECTIVE: This systematic review explored the effectiveness of using physical activity (PA) interventions to enhance psychological well-being and reduce psychological ill-being (e.g., anxiety and depression) in children aged six to 11 years old from the general population. METHODS: Electronic databases were searched for studies published between January 2005 and June 2020: Web of Science, ProQuest Psychology Journals, PsycINFO, Pub Med, ASSIA, CINHAL PLUS, SPORTDiscus, EMBASE and Wiley Online Library. Search terms included 'physical activity intervention', 'psychological well-being' and 'child*'. After removing duplicates, 11 390 studies were independently screened by two authors based on inclusion/exclusion criteria and assessed for risk of bias. RESULTS: A total of 23 studies were narratively synthesized and categorized into four domains: Quality of Life (QOL), body image, self-esteem and psychological ill-being. Evidence was provided for the impact of PA interventions in improving QOL, body image and self-esteem. Despite the positive effect on psychological well-being, evidence for a reduction in the frequency and severity of symptoms associated with psychological ill-being in children is less clear. CONCLUSIONS: Reviewed studies support the use of PA interventions in enhancing the psychological well-being of children in school and community settings. More research is warranted to understand the impact of PA interventions on reducing psychological ill-being in children from the general population.

'When you have the adrenalin pumping, it kind of flushes out any negative emotions': a qualitative exploration of the benefits of playing football for people with mental health difficulties.

BACKGROUND: Physical activity is a factor by which mental health can be improved. However, the association between mental health and physical exercise, in a "team-based sport" setting within the community, remains unclear. AIMS: The current paper aims to provide an evaluation of a football programme, implemented by Time to Change Wales, funded by the Welsh Government, to improve mental health. METHODS: Participants attended weekly 90-120 minute football sessions, held in local community venues across Wales, UK, with no requirement on the number of sessions that participants had to attend. A qualitative method was employed to explore the experiences of those who took part. RESULTS: Individuals who participated in the programme reported psychosocial and physical benefits, such as improved physical and mental health, improved social confidence and having a sense of purpose added to their day-to-day living. Factors affecting participation were also identified within the data, such as environmental barriers. Conclusion: The findings provide both support and contextual extension to previous research in this area; demonstrating the positive effects of sport-based therapy for those with mental health difficulties. Implications and conclusions should be used to inform future research into developing community sport-based programmes to improve mental health.

Review: Physical activity interventions for the mental health and well-being of adolescents - a systematic review.

BACKGROUND: Rates of physical activity decline throughout adolescence, and evidence indicates that this has an adverse impact on psychological health. This paper aims to synthesise available evidence for physical activity interventions on the mental health and well-being of young people (11-19 years) from the general population. METHOD: Nine databases were searched to identify studies published between January 2005 and June 2020: Web of Science, ProQuest Psychology Journals, PsycINFO, Pub Med, ASSIA, CINHAL PLUS, SPORTDiscus, EMBASE and Wiley Online Library. Key search terms included 'physical activity intervention', 'mental health' and 'adolescen*'. Eligible studies were independently screened by two authors based on inclusion/exclusion criteria. RESULTS: Twenty-eight interventions were narratively synthesised in four categories: Quality of Life (QOL), self-esteem, psychological well-being and psychological ill-being (e.g. depression, stress). A large proportion (67.9%) of interventions were multicomponent and combined physical activity with other features such as health education (e.g. nutrition). However, only a limited number (N = 5) specifically addressed mental health. Findings suggest that interventions are useful in improving psychological well-being and QOL, yet evidence for self-esteem is mixed. CONCLUSIONS: Although effectiveness in improving well-being is evident, evidence for a reduction in the frequency and severity of mental health problems is less clear. A summary of the overall impact of physical activity interventions on the mental health of young people is presented.

Priority setting in research: user led mental health research.

PLAIN ENGLISH SUMMARY: Involving people in health research is increasingly recognised as being important to make sure that research is focused more on the needs of people who use health services. At present, ideas about what should be researched most often comes from researchers and/or health professionals like doctors and nurses rather than people with a lived experience of mental illness. In this study, we will talk with this group of people from across Wales to explore what they think research into their health services should focus on. The findings from this work will help to influence the work of the National Centre for Mental Health Research Partnership Group; as well as` researchers and health professionals and others who concentrate on mental health research. The Research group is a partnership between people with a lived experience of mental ill health and professionals with an interest in mental ill health. The group plan to take forward the ideas that came from this research and some of the ideas have already been used to increase funding in the area of mental health research. ABSTRACT: Background This paper is the result of continued collaboration between members of the Service User and Carer Research Partnership, based in Wales and supported by the National Centre for Mental Health, Health and Care Research Wales, and Hafal. The aim of this study was to explore the research priorities of people with experience of mental health services which include people with a lived experience of mental ill health, their carers, and professionals. Method A nominal group technique was used to gather data. A one-day workshop 'Getting Involved in Research: Priority Setting' was held to gather the ideas and suggestions for research priorities from people who have experience of mental health services. Results Twenty-five participants attended the workshop. 5 were mental health professionals, 20 had a lived experience of mental ill health, (of which 3 were also carers). 11 were male and 14 were female. 120 research ideas were generated across 6 'Ideas Generating Workstations'. Participants took part in a 3 stage vote to narrow down the ideas to 2 main research priorities. Conclusion The two main research priority areas that were identified:'Developing the knowledge of mental health issues amongst school-aged children' as a vehicle to overcome stigma and discrimination, and to support young people to manage their own mental health.'Developing education as a tool for recovery', for example by peer support. In addition, participants engaged in a notable discussion over the research priority: 'How are carers supported during the recovery of the person for whom they care?'

Preventing Suicide and Self-Harm.

BACKGROUND: Telephone helplines are considered to play an important role in preventing suicide and self-harm among callers in distress. However, inconsistency in the methods of evaluating such services has limited the firm conclusions that can be drawn. AIMS: To evaluate the efficacy of a UK-based helpline from a service user and helpline worker perspective. METHOD: Callers were asked about their mental state at the beginning and end of the call with a short questionnaire. Helpline workers were surveyed about their experiences of using the questionnaire as part of routine service provision. RESULTS: The helpline was successful at reducing suicidal and self-harming ideation. The short questionnaire method was also successfully integrated into routine practice. CONCLUSION: Evaluating the efficacy of helplines can be successfully achieved using the short questionnaire method.

Noticing spiders on the left: Evidence on attentional bias and spider fear in the inattentional blindness paradigm.

Attentional biases in anxiety disorders have been assessed primarily using three types of experiment: the emotional Stroop task, the probe-detection task, and variations of the visual search task. It is proposed that the inattentional blindness procedure has the ability to overcome limitations of these paradigms in regard to identifying the components of attentional bias. Three experiments examined attentional responding to spider images in individuals with low and moderate to high spider fear. The results demonstrate that spider fear causes a bias in the engage component of visual attention and this is specific to stimuli presented in the left visual field (i.e., to the right hemisphere). The implications of the results are discussed and recommendations for future research are made.

The effects of physical activity on psychological well-being for those with schizophrenia: A systematic review.

This paper systematically reviews the existing evidence of the effects of physical activity on psychological well-being for those with schizophrenia. A search of 15 databases including for example, PsycINFO, SportDiscus, and Science Direct was conducted to identify studies investigating the effects of physical activity on psychological well-being for those with schizophrenia. The included studies were then assessed, extracted, and synthesized. Fifteen studies met the inclusion criteria: 12 quantitative and 3 qualitative. The physical activity interventions lasted between 3 and 20 weeks and included a wide range of physical activities. The instruments used to measure psychological well-being varied across all studies, this along with the variety of study designs made statistical analysis impossible. The findings of this systematic review however, suggest that physical activity has a beneficial effect on some attributes associated with psychological well-being in individuals with schizophrenia.

Physical activity and mental health in a student population.

BACKGROUND: A growing body of literature indicates that physical activity can have beneficial effects on mental health. However, previous research has mainly focussed on clinical populations, and little is known about the psychological effects of physical activity in those without clinically defined disorders. AIMS: The present study investigates the association between physical activity and mental health in an undergraduate university population based in the United Kingdom. METHOD: One hundred students completed questionnaires measuring their levels of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and their physical activity regime using the Physical Activity Questionnaire (PAQ). RESULTS: Significant differences were observed between the low, medium and high exercise groups on the mental health scales, indicating better mental health for those who engage in more exercise. CONCLUSIONS: Engagement in physical activity can be an important contributory factor in the mental health of undergraduate students.

Employer and employment agency attitudes towards employing individuals with mental health needs.

BACKGROUND: The positive benefits of paid employment for individuals with mental health needs are well known yet many still remain unemployed (Perkins & Rinaldi, (2002). Unemployment rates among patients with long-term mental health problems: A decade of rising unemployment. Psychiatric Bulletin, 26(8), 295-298.). AIMS: Attitudes of employers and employment agencies that may provide short-term contracts to individuals with mental health needs are important to understand if these individuals are to be given access to paid employment. METHODS: A mixed methods approach was used to investigate this phenomenon comprising of interviews and a follow-up survey. Interviews were conducted with 10 employment agencies and 10 employers. The results of these interviews then informed a follow-up survey of 200 businesses in Gloucestershire. RESULTS: The findings demonstrated that employment agencies would consider putting forward individuals with previous mental health needs to employers. However, employers had a high level of concern around employing these individuals. Employers reported issues of trust, needing supervision, inability to use initiative and inability to deal with the public for individuals with either existing or previous mental health needs. CONCLUSIONS: The findings of this research suggest a need for employers to have more accurate information regarding hiring individuals with mental health needs.

Awareness of everyday executive difficulties precede overt executive dysfunction in schizotypal subjects.

Much evidence indicates that schizophrenic patients exhibit deficits on tests of executive functioning. It is therefore hypothesized that individuals with high schizotypal personality traits that may have a predisposition to schizophrenia, are also likely to exhibit impairments in neuropsychological tests of executive function. The sample consisted of 65 healthy controls that were divided into high and low scorers on the Schizotypal Personality Questionnaire (SPQ-B: Raine et al., 1995). Participants completed a battery of executive tasks (category and letter fluency, the Hayling test, Zoo map); however, a MANOVA revealed no significant differences between high and low SPQ scorers. Nevertheless, high SPQ scorers scored significantly higher on the Dysexecutive Questionnaire (DEX) self-rating scale of everyday executive problems; and these self-ratings correlated significantly with the disorganisation and cognitive-perceptual features of the SPQ-B, but not with the interpersonal features. This suggests that perceived executive dysfunction is pre-morbidly present and may become evident in test performance only with the onset of schizophrenia itself.

Attention and executive function in people with schizophrenia: Relationship with social skills and quality of life.

Objective. Executive function and attention are highly complex cognitive constructs that typically reveal evidence of impairment in people with schizophrenia. Studies in this area have traditionally utilised abstract tests of cognitive function and the importance of using more ecologically valid tests has not been extensively recognised. In addition, there has been little previous examination of the relationship between these key cognitive abilities and social functioning and quality of life in this population. Methods. Thirty-six schizophrenic patients and 15 controls were assessed on the Behavioural Assessment of the Dysexecutive Syndrome (BADS) test, three subtests from the Test of Everyday Attention (TEA), a measure of social functioning and a quality of life measure. Results. Analysis of subtest scores revealed that patients were impaired on all attentional measures, but only one BADS subtest score in addition to the BADS profile score. However, 23 patients demonstrated no impairment in their BADS profile scores whilst being impaired on at least one attentional measure. Only the BADS profile score predicted social functioning and quality of life. Conclusions. Ecologically valid tests of attention and executive function can play an important role in defining the cognitive deficits in schizophrenia and how such deficits relate to social function and quality of life.

Cognitive function and social abilities in patients with schizophrenia: relationship with atypical antipsychotics.

Although atypical antipsychotics have been associated with improvements in cognitive function in schizophrenia, the neurochemical basis for such effects is not well understood. Candidate neurotransmitter systems primarily involve dopamine and serotonin. The current study explored this issue by examining the cognitive abilities, social function and quality of life in patients with schizophrenia who were medicated with atypical antipsychotics. Comparisons were done for matched schizophrenia patients who were on antipsychotics with (i) an affinity for multiple receptors (olanzapine, clozapine, quetiapine) versus those that have preferential affinity for dopamine receptors (risperidone, amisulpride); and patients on medication with (ii) a high affinity for serotonin (5HT-2A) receptors (risperidone, olanzapine, clozapine) versus those with a low (or no) affinity for 5HT-2A receptors (quetiapine, amisulpride). No differences emerged between groups on any cognitive or social variable when the groups were compared for the dopaminergic properties of antipsychotic medication. By contrast, differences did emerge when patients were compared on the 5HT-2A affinity of their antipsychotic medications. Patients on low 5HT-2A-affinity antipsychotics exhibited a better performance on a measure of selective attention and adjustment to living. These findings accord with the notion that serotonergic mechanisms are important determinants of both the cognitive and the social effects of the atypical antipsychotics.

Are the cognitive effects of atypical antipsychotics influenced by their affinity to 5HT-2A receptors?

It is well documented that atypical antipsychotics have an influence on cognitive function in patients with schizophrenia, although the neurochemical basis for this effect is not well understood. One suggestion is that the effects are exerted through action on 5HT-2A receptors, which leads to changes in the level of dopamine in the prefrontal cortex. The following study explored this hypothesis by comparing the cognitive effects of the atypical antipsychotics which have a high affinity for 5HT-2A receptors, with those that have little or no affinity to these receptors. Forty-four patients with a DSM-IV diagnosis of schizophrenia were recruited within 6 weeks of starting one of the atypical antipsychotics: clozapine, olanzapine, risperidone, quetiapine, or amisulpride. The patients were divided into two groups according to the 5HT-2A affinity of the individual medications (high 5HT-2A affinity--clozapine, olanzapine, risperidone vs. low 5HT-2A affinity--quetiapine, amisulpride). Patients were tested on a broad range of neuropsychological measures after 9 months and 18 months of treatment. The high 5HT-2A affinity group showed a decrement in performance on tests of visual recognition memory and planning ability. In contrast, the low-5HT-2A affinity group showed improvements on these measures in addition to others. The 5HT-2A affinity of the atypical antipsychotics is an important determinant of their cognitive effects.

The Rivermead Behavioural Memory Test can predict social functioning among schizophrenic patients treated with clozapine.

OBJECTIVE The aim of this study was to find out whether clinical symptoms, such as positive and negative symptoms, or cognitive problems, such as impairment in memory, are predictive of social outcome among patients with schizophrenia and treated with clozapine in the long-term. METHODS Twelve subjects with a DSM-III-R diagnosis of schizophrenia treated with clozapine were recruited from an inpatient rehabilitation psychiatry unit. Subjects were assessed at baseline, and 6, 12 and 24 months, using symptoms measures, the Social Behaviour Scale (SBS) and the Rivermead Behavioural Memory Test (RBMT), which tests episodic memory. Three multivariate stepwise regression models were created with SBS at 6, 12 and 24 months score as dependent variable, and the other measures at baseline as independent variables. RESULTS The only significant contribution on social functioning in each model was made by the RBMT, which was therefore the only significant predictor of social functioning in all models. CONCLUSIONS The authors discuss the importance of episodic memory in the prediction of social functioning.

Stability of set-shifting and planning abilities in patients with schizophrenia.

Patients with schizophrenia have deficits in executive function that involve attentional set-shifting and planning ability. It is unclear, however, whether such deficits are stable during the course of the illness or if they fluctuate in response to medication effects or symptom changes. Patients with a DSM-IV diagnosis of schizophrenia (n=28) and healthy control subjects (n=17) were tested on computerised measures of attentional set-shifting and planning at baseline and 9-month follow-up. The measures used were the Intra/Extradimensional Shift test (ID/ED) and the Stockings of Cambridge test (SoC) from the Cambridge Automated Neuropsychological Testing Battery (CANTAB). On both tests, the patients were poorer than controls at baseline; however, there was no evidence of change over the 9-month follow-up. Additionally, there was little evidence of a relationship between executive test performance and medication or length of illness. This study accords with the presence of executive processing deficits in schizophrenia that are stable across time.

Conventional antipsychotic prescription in unipolar depression, II: withdrawing conventional antipsychotics in unipolar, nonpsychotic patients.

BACKGROUND: In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 patients were identified as taking a redundant conventional antipsychotic with no apparent diagnostic indication. Concerns regarding these patients' polypharmacy, duration of treatment, and risk of long-term or undetected side effects led to their being contacted with a view to the discontinuation of conventional antipsychotic treatment. METHOD: All case notes were scrutinized to validate, as far as possible, the diagnosis of unipolar depression without psychotic features. Patients were invited for a review of their medication. Ratings of symptoms (Brief Psychiatric Rating Scale), depression (Hamilton Rating Scale for Depression), motor side effects (Abnormal Involuntary Movement Scale), and personal function (Independent Living Skills Survey) were made before and after conventional antipsychotic discontinuation. The study was conducted Autumn 1999-Spring 2000. RESULTS: None of the 55 patients were deemed to present comorbid depression secondary to any other diagnosis. One patient could not be contacted; 14 patients, who tended to be older, refused the review. Of the remaining 40 who were seen, 25 had already discontinued antipsychotic treatment; their chronicity of illness was half that of the 15 patients continuing antipsychotic treatment. However, only 11 of these 25 patients had their medications discontinued under consultant psychiatrist supervision following the audit; 14 patients had stopped medication of their own volition, or for unclear reasons. Of the remaining 15 patients, 13 had their conventional antipsychotic discontinued by us. There were clinically and statistically significant improvements in symptoms and side effects after antipsychotic treatment was discontinued, and a statistically significant improvement in personal health care function. CONCLUSION: In this small sample, discontinuation of nonindicated conventional antipsychotic treatment was associated with clear benefits. Conventional antipsychotics should be used with caution in nonpsychotic depressed patients, particularly in the long term. Reluctance to discontinue medication in more chronic patients may be misplaced.

Conventional antipsychotic prescription in unipolar depression, I: an audit and recommendations for practice.

BACKGROUND: Despite narrow indications for conventional antipsychotics in depression, recent reports confirm a suspicion that they are widely prescribed in nonpsychotic depressive conditions. METHOD: Data from the case notes of over 510 patients with unipolar depression (unvalidated clinical diagnoses) were collected between June 1997 and January 1998 from community and acute units in 1 National Health Service (NHS) Trust. The aim of this audit was to assess the extent and pattern of antipsychotic prescription in this sample. RESULTS: More than a quarter (N = 138) of the sample (N = 494) were currently prescribed an antipsychotic; 40% of these received an antipsychotic without any recognized indication. The mean time on antipsychotic therapy was 3 years. Patients on antipsychotic therapy were, on average, taking twice as many total medications as those not on antipsychotic therapy. Patients with psychotic depression were taking an average of nearly twice the antipsychotic dose of nonpsychotic patients. CONCLUSION: Current clinical guidelines commend careful antidepressant choice in preference to polypharmacy. A number of drug choices for specific depressive presentations are summarized from recent sources.

Early development and unstable genes in schizophrenia: preliminary results.

BACKGROUND: Trinucleotide repeats have been associated with schizophrenia, but the evidence, based on cross-sectional clinical information, is equivocal. AIMS: To examine the relationship between genomic CAG/CTG repeat size and premorbid development in schizophrenia. METHOD: Early development and premorbid functioning of 22 patients with DSM-IV diagnosis of schizophrenia were assessed by parental interviews. Repeat expansion detection (RED) technique was used to measure genomic CAG/CTG repeat size, and PCR for CAG repeat size at the ERDA-1 and CTG 18.1 loci. RESULTS: There was an inverse association between CAG/CTG size and perinatal complications. Patients with speech and motor developmental delay had larger repeats. The results were not due to expansion in the ERDA-1 and CTG 18.1 genes. CONCLUSIONS: CAG/CTG repeat expansion is associated with speech and motor developmental delay in schizophrenia. We propose that the developmental model may be useful for research into the genetics of schizophrenia.