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Background: A third of people with epilepsy are drug resistant. People with drug-resistant epilepsy (DRE) have a higher risk of mortality and physical injuries than those who respond to anti-seizure medication (ASM). This study describes patient characteristics, comorbidities, and mortality in people with DRE in the UK. Methods: The Clinical Practice Research Datalink was utilised to select people with DRE prescribed a third ASM between 1 January 2011 and 31 March 2021. Annual incidence and prevalence of DRE, patient characteristics, comorbidities, and mortality rates were analysed. Subgroup analysis was performed by age, sex, presence of intellectual disabilities and time from epilepsy diagnosis to DRE. Results: A total of 34,647 people with DRE were included (mean ± SD age 42.68 ± 23.59 years, 52.6% females). During the study period, annual DRE incidence ranged from 1.99% to 3.12%. As of 31 March 2021, DRE prevalence was 26.6% (95% confidence interval [CI] 26.3%–26.8%). A greater proportion of people with DRE resided in the most deprived regions, with 21.1% and 16.7% in the top two quintiles of the Index of Multiple Deprivation respectively, compared to < 15% in the three less deprived regions. All-cause mortality ranged from 3,687 to 4,802 per 100,000 persons with DRE, four times higher than that in the general population in the UK. Variations existed across subgroups. Conclusions: Considerable disease burden was observed in people with DRE in the UK. The findings emphasise the importance of early DRE diagnosis and appropriate disease management in people who develop DRE. [ABSTRACT FROM AUTHOR]

Epilepsy is one of the most common neurologic conditions. Its clinical manifestations are not restricted to seizures but often include cognitive disturbances and psychiatric disorders. Prospective population-based studies have shown that people with epilepsy have an increased risk of developing mood disorders, and people with a primary mood disorder have an increased risk of developing epilepsy. The existence of common pathogenic mechanisms in epilepsy and mood disorders may explain the bidirectional relation between these two conditions. Recognition of a personal and family psychiatric history at the time of evaluation of people for a seizure disorder is critical in the selection of antiseizure medications: those with mood-stabilizing properties (e.g., lamotrigine, oxcarbazepine) should be favoured as a first option in those with a positive history while those with negative psychotropic properties (e.g., levetiracetam, topiramate) avoided. While mood disorders may be clinically identical in people with epilepsy, they often present with atypical manifestations that do not meet ICD or DSM diagnostic criteria. Failure to treat mood disorders in epilepsy may have a negative impact, increasing suicide risk and iatrogenic effects of antiseizure medications and worsening quality of life. Treating mood disorders in epilepsy is identical to those with primary mood disorders. Yet, there is a common misconception that antidepressants have proconvulsant properties. Most antidepressants are safe when prescribed at therapeutic doses. The incidence of seizures is lower in people randomized to antidepressants than placebo in multicenter randomized placebo-controlled trials of people treated for a primary mood disorder. Thus, there is no excuse not to prescribe antidepressant medications to people with epilepsy. [ABSTRACT FROM AUTHOR]

Purpose: This commentary explores the challenges and themes enumerated by the associated article "Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England". This commentary broadens and outlines the research's background, premise and potential impact. This paper aims to critically examine the evidence on this subject. Design/methodology/approach: This commentary considers the attitudes to inpatient care for people with learning disabilities in the past decade and outlines a possible compact for the future. Findings: Contrary to popular and emotive beliefs that using specialist inpatient psychiatric settings for people with learning disabilities is universally a poor practice, there are defined occasions when such settings are needed and imperative in the clinical pathway. If people with learning disabilities can access inpatient settings at the right time for the right reason, psychiatric outcomes could be improved. Timely discharge is imperative and currently lacking due to a lack of suitable engagement mechanisms between inpatient settings and the community. Thus, evidence-based outcome tools are essential to facilitate appropriate discharge. Originality/value: There is an ongoing debate on the value and utility of specialist inpatient psychiatric units for people with learning disabilities. This commentary provides a balanced, evidence-based insight into this discussion. [ABSTRACT FROM AUTHOR]

SUMMARY: Almost a quarter of people with intellectual disabilities have epilepsy. This life-long condition adversely affects their health, safety and well-being and carries an increased risk of sudden unexpected death in epilepsy (SUDEP) in this population. This commentary considers what not only health and social services but also communities and people with intellectual disabilities themselves can do to improve outcomes. [ABSTRACT FROM AUTHOR]

Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) for the management of adults with DRE. A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print, Embase, and the Cochrane library databases. Outcomes examined included reduction in seizure frequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs). Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy. Four RCTs and six comparative observational studies were identified for inclusion. Against comparators, individuals treated with VNS had a significantly better odds of experiencing a ≥ 50% reduction in seizure frequency (OR: 2.27 [95% CI 1.47, 3.51]; p = 0.0002), a ≥ 75% reduction in seizure frequency (OR: 3.56 [95% CI 1.59, 7.98]; p = 0.002) and a reduced risk for increased ASM load (risk ratio: 0.36 [95% CI 0.21, 0.62]; p = 0.0002). There was no difference in the odds of discontinuation or the rate of SAEs between VNS versus comparators. This meta-analysis demonstrated the benefits of VNS Therapy in people with DRE, which included improvement in seizure frequency without an increase in the rate of SAEs or discontinuations, thereby supporting the consideration of VNS Therapy for people who are not responding to ASMs and those unsuitable or unwilling to undergo surgery. [ABSTRACT FROM AUTHOR]

Background: Antipsychotic medications are used among 19%–58% of adults with intellectual disabilities to manage challenging behaviour against the NICE guideline recommendations. Studies show that it is possible to completely withdraw antipsychotics in about one third of adults with intellectual disabilities and a dose reduction of 50% or more in another third. Method: In Cornwall, over three years the present authors developed a structured pathway to withdraw antipsychotics among adults with intellectual disabilities which involved people with intellectual disabilities and their carers, GPs, community learning disability team members and pharmacists. Results: The present authors managed to withdraw antipsychotics totally among 46.5% (33/71) and reduced over 50% of dosage in another 11.3% (8/71) of adults with intellectual disabilities. At three months follow‐up no one required hospital admission or change in placement. Conclusion: It is possible to withdraw/reduce antipsychotics in a high proportion of adults with intellectual disabilities if a concerted effort is made involving all stakeholders from the outset. [ABSTRACT FROM AUTHOR]

Purpose: People with Intellectual disability (ID) are likely to be prescribed psychotropic medication particularly antipsychotics without a clear clinical indication. This has given rise to a national initiative in the UK to stop overprescribing medication in this vulnerable population. While the goals are simple it is unclear if specialist ID services or primary care services in the UK should look to lead. Further, it is uncertain if primary care practitioners (GPs) can be systematically educated of the latest good practice developments and concerns in this specialised area. This study surveyed the knowledge level of a sample of GPs in Cornwall UK (county of 538,000) post a structured tutorial on psychotropic medication and people with ID. Methods: A 21 item questionnaire was delivered in meetings organised for all the county GPs a year after a talk given to the same demographic. The questionnaire conducted an assessment of the knowledge of national guidance on use of psychotropic medication in ID based on the subjects covered in the tutorial. Results: Of the 60 expected GP participants the tutorial was attended by 44 GPs (73%) and the follow up meeting by 42 (70%). Ninety percent GPs in the follow up meeting filled the questionnaire. For 16 questions, more than 80% GPs gave correct responses whereas five questions attracted a correct answer from less than 80%. Majority of the GPs felt psychotropic medication management in people with ID should be specialist led. Conclusions: GPs’ knowledge of issues relevant to prescribing in people with ID benefitted from the tutorial. However a clear need for the psychotropic medication management to be delivered via specialist care emerged. This raises issues of resource allocation and debate on whether people with ID require specialist provision due to lack of ability in main stream primary care to manage their needs. [ABSTRACT FROM AUTHOR]

Purpose: One quarter of people with epilepsy have an intellectual disability (ID) and one fifth of people with an ID have epilepsy. Both conditions are associated with higher levels of morbidity, stigma and premature mortality. There have been calls for action to promote more research in this group. We examined if this group are represented adequately in current research. Methods: The proportion of research output in epilepsy conferences and publications relevant to ID and the proportion in ID conferences and publications on epilepsy for 2015–2016 were identified. As the percentage of children in the population with epilepsy is 17%, research output of this group was compared with the ID group. Recognised material was classified based on whether it applied to general epilepsy/ID research, children with epilepsy or people with epilepsy and ID. Data was analysed to determine the proportion of presented research specifically identifying people with epilepsy and ID. Results: Fewer than 2% of presentations at epilepsy conferences specifically related to the ID and epilepsy group compared to 15% relating to children with epilepsy. Similarly only 1.4% of the research presented at major ID conferences related to those with people with epilepsy and ID. About 5% of published research in the field of epilepsy related to those with ID as compared with 24% for children with epilepsy. Twelve percent of published research in ID specifically identified epilepsy. Conclusion: Publications and conference presentations, on the population with epilepsy and comorbid ID is under-represented. Increased research in this area might assist in improving the quality of care for this relatively neglected group. [ABSTRACT FROM AUTHOR]

Background Psychiatric and behavioral side effects (PBSEs) are a major cause of antiepileptic drug (AED) withdrawal. Levetiracetam (LEV) is a recognized first-line AED with good seizure outcomes but recognized with PBSEs. Eslicarbazepine (ESL) is considered to function similarly to an active metabolite of the commonly used carbamazepine (CBZ). Carbamazepine is used as psychotropic medication to assist in various psychiatric illnesses such as mood disorders, aggression, and anxiety. Aim The aim was to evaluate the psychiatric profile of ESL in people who had LEV withdrawn due to PBSEs in routine clinical practice to see if ESL can be used as a possible alternative to LEV. Methods A retrospective observational review was conducted in two UK epilepsy centers looking at all cases exposed to ESL since its licensing in 2010. The ESL group was all patients with treatment-resistant epilepsy who developed intolerable PBSEs to LEV, subsequently trialed on ESL. The ESL group was matched to a group who tolerated LEV without intolerable PBSEs. Psychiatric disorders were identified from case notes. The Hamilton Depression Scale (HAM-D) was used to outcome change in mood. Clinical diagnoses of a mental disorder were compared between groups using the Fisher's exact test. Group differences in HAM-D scores were assessed using the independent samples t -test (alpha = 0.05). Results The total number of people with active epilepsy in the two centers was 2142 of whom 46 had been exposed to ESL. Twenty-six had previous exposure to LEV and had intolerable PBSEs who were matched to a person tolerating LEV. There was no statistical differences in the two groups for mental disorders including mood as measured by HAM-D (Chi-square test: p = 0.28). Conclusion The ESL was well tolerated and did not produce significant PBSEs in those who had PBSEs with LEV leading to withdrawal of the drug. Though numbers were small, the findings suggest that ESL could be a treatment option in those who develop PBSEs with LEV and possibly other AEDs. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic club foot is primarily treated by Ponseti technique of serial manipulation and casting. Ponseti recommended evaluation of club foot by palpation, but it is subjective, dependent on clinical experience and limited by inter-observer variability. Aim: To assess the deformities and amount of correction achieved after the treatment using radiographs obtained before and after treatment. Materials and Methods: A non-randomized, interventional study was done among patients with idiopathic club foot treated by Ponseti method. Radiographs including the anteroposterior and lateral projections in maximum dorsiflexion of foot were taken at presentation and after completion of treatment. Five parameters, i.e., the Anteroposterior (TCA-AP) and Lateral Talo-Calcaneal Angle (TCA-LT), Anteroposterior Talo-First Metatarsal Angle (TMT-AP), Lateral Tibio-Calcaneal Angle (TiC-LT) and Talo-Calcaneal Index (TCI) were measured and analysed. The Student's paired t-test was used to compare the variables before and after treatment and a p-value of less than 0.05 was considered significant. Results: There was a statistically significant improvement in the mean values of the five parameters after treatment when compared with the values on presentation. The Anteroposterior Talo-Calcaneal Angle (TCA-AP) before treatment had a mean value of 21.4 and after treatment had a mean value of 33.82° (p-value <0.05). The TMT-AP had a mean value of 29.07° & 2.14° following treatment (p-value <0.05). The TCA-LT had a mean of 18.05° prior to treatment & 34° after correction (p-value <0.05). The TCI had a mean of 39.41° before treatment & 67.82° after treatment (p-value<0.05). The TiC-LT at presentation had a mean value of 102.95° & 64.31 after treatment (p-value <0.05). Conclusion: Analytical radiology of club foot is a reliable method of evaluation of the treatment and tends to be more objective and critical when multiple parameters are considered. [ABSTRACT FROM AUTHOR]

Background: The general public regard mass media as their main source of information about mental illness. Psychiatrists are reluctant to engage with the media. There is little understanding of why this is the case. Aims: The paper looks to explore attitudes of mental health clinicians and the media towards one another. Method: Media and mental health clinicians in the southwest of England completed self-report surveys. Results: Of 119 questionnaires returned 85 were mental health clinicians and 34 media professionals. Both groups agreed that stigma is a major issue and clinicians have a key role influencing media portrayal of mental illness. The media view their reporting to be more balanced than clinicians and lack awareness of clinician mistrust towards them. Those clinicians with media training (13%) felt significantly more comfortable talking to media and significantly less mistrustful of them. Clinicians who had experience of working with media felt more comfortable doing media work. Only 15% of media professionals had received mental health awareness training. Conclusions: Media training and experience are associated with an increased willingness of mental health professionals to engage with the media. Reciprocal awareness training between media and mental health professionals may be a simple intervention worth pursuing. [ABSTRACT FROM AUTHOR]

Background Long-term feeding by percutaneous endoscopic gastrostomy tube (PEG) is uncommon but can present significant issues when both nutrition and medication have to be fed down the same tube. This is especially important in people with epilepsy where the dose and bioavailability of antiepileptic drugs are critical to maintain adequate seizure control. This group with long-term PEG tubes is particularly vulnerable and dependent on their carers to provide high standard of care. Indeed, approximately half of the people with long-term feeding tubes suffer from severe intellectual disability which requires careful coordination of all members of the multidisciplinary team. It is all the more important when consideration is given that around 50% of people with severe ID have seizures, mostly treatment resistant. Method A detailed literature review was conducted with the focus on the numerous factors that can affect medication delivery and absorption with the potential to destabilize seizure control in people with PEG. Issues concerning the site of drug absorption, excipients and dilution, interaction between antiepileptic drugs and the nutritional feed, bioavailability, and problems with the PEG tube are considered. Results There is limited research in this area and the studies are often based on small numbers, healthy volunteers or in vitro findings. Conclusion In the absence of sound research data, seizure control in each patient with a PEG needs to be considered on an individual basis. Establishing a baseline by measuring the serum levels prior to the tube insertion may be helpful, followed by checking the levels after PEG insertion. [ABSTRACT FROM AUTHOR]

Status epilepticus (SE) has a high mortality rate and is associated with complications such as neurological deficit and cognitive decline. Buccal midazolam is the recommended emergency rescue medication in the UK to reduce the duration of a seizure and SE. It should be administered by an appropriately trained person. There are agreed guidelines on training standards for its administration in the UK produced by the Joint Epilepsy Council of the United Kingdom and Ireland. Training should provide an overview of epilepsy to facilitate safe, person-centered care and appropriate administration of rescue medication to people with epilepsy (PWE). Unfortunately the current guidelines do not assure satisfactory practice. An investigation was conducted to quantify the nature and degree of the problem in Cornwall, UK (population 550,000). To address the identified inconsistencies, a web-based test was developed using a focus group of experts and stakeholders. Over 800 carers for PWE took the test at different intervals of its development. A consistent 20% failure rate was noted. Over 90% of participants felt it kept PWE safer. The test was incorporated into routine clinical practice and has contributed to reduction of primary epilepsy deaths. The e-test is a cost-effective solution to help harmonize practices across different settings and can be easily adopted by other countries. [ABSTRACT FROM AUTHOR]

Attendance at UK Emergency Departments (EDs) for people with epilepsy (PWE) following a seizure can be unnecessary and costly. The characteristics of PWE attending a UK rural district ED in a 12-month period were examined to foster better understanding of relevant psycho-social factors associated with ED use by conducting cross-sectional interviews using standardized questionnaires. Of the total participants (n = 46), approximately one-third of the study cohort attended ED on three or more occasions in the 12-month study period and accounted for 65% of total ED attendances reported. Seizure frequency and lower social deprivation status were associated with increased ED attendance while factors such as knowledge of epilepsy, medication management, and stigma were not. Similarities in frequency of repeat attendees were comparable to a study in urban population but other factors varied considerable. Our findings suggest that regular ED attendees may be appropriate for specific enhanced intervention though consideration needs to be given to the fact that population characteristics may vary across regions. [ABSTRACT FROM AUTHOR]

This review looks at the strategies that may help to reduce the risk of sudden unexpected death in epilepsy beyond that of trying to achieve seizure cessation, which is not possible for up to 30% of patients with epilepsy. These strategies include seizure safety checklists, mobile phone technology, telehealth and various devices currently available or in development. We highlight interventions where there is evidence of benefit, and draw attention for the need both to involve patients with epilepsy in risk reduction and to improve communication with those at risk. [ABSTRACT FROM AUTHOR]

Our objectives were to compare people with epilepsy (PWE) who died of sudden unexpected death in epilepsy (SUDEP) with live controls using the risk factor items of the SUDEP and Seizure Safety Checklist. All 48 SUDEPs of 93 epilepsy deaths which occurred in Cornwall UK 2004-2012 were compared to 220 live controls using the SUDEP and Seizure Safety Checklist, an evidenced based tool used to communicate person centered risk of SUDEP to PWE. The odds ratio for having a specific factor in those who died was compared to controls and ranked according to P value using a sequential Bonferroni correction for multiple comparisons. Of the 17 modifiable and non-modifiable risk factors analyzed 9 were statistically significant of which 7 are potentially modifiable. Well known modifiable factors such as nocturnal monitoring, compliance and sleeping position featured prominently in the risk association. This is the first case control study exploring the risk factors for SUDEP since 2009. The findings are compared to the current considered risk factors as identified in a major recent review. The study further validates certain SUDEP risk factors. It highlights that the majority of risk factors strongly associated with SUDEP are potentially modifiable. There is an emerging profile to rank the risk factors. It furthers the evidence to use structured risk assessment and communication tools such as the SUDEP and Seizure Safety Checklist in daily clinical practice. It highlights key areas for a person centered discussion to empower PWE to mitigate risk. [ABSTRACT FROM AUTHOR]

The Winterbourne View inquiry highlighted issues about people with learning disabilities who are placed in hospitals. Although most people with learning disabilities are in residential care, they remain at risk of the abuses seen at Winterbourne View. The housing costs in certain areas and non-person centred commissioning has led to many vulnerable people being placed in facilities far away from their communities. Aim To devise a structured, evidence-based tool to facilitate the safe transfer of vulnerable people with learning disabilities between agencies across the UK. Methods A literature review was conducted to determine the need for the tool. A focus group of experts identified relevant good practice to develop the checklist. The draft document was considered by the Royal College of Psychiatrists' intellectual disabilities faculty executive and the Learning Disability Professional Senate. Findings When piloted on new transfers, the checklist identified existing gaps in service provision. The placing authorities found the tool useful to reflect on the expectations of the receiving services, and it was deemed to be an example of good practice that needed to be shared across services. Conclusion The use of out of area placements continues without proper consideration of good practice. The interagency transfer document described in this article ensures basic standards of care can be met. [ABSTRACT FROM AUTHOR]

Background: The number of people with learning disabilities and significant health needs who have been placed in Cornwall from outside the county by other local authorities was estimated along with its effects on the individuals concerned and the health service. Materials and methods: Electronic health records of the local NHS trust for adults with learning disabilities were compared with the council’s social services learning disabilities register to screen for out-of-county placements. Records of individuals placed from outside the county over the previous three years were scrutinised to identify the reason for placement, capacity to consent, quality of transition and cost to local services. Results: A total of 155 of the 703 clients were from outside Cornwall, and 17 of the 155 had been resident in the county for no more than three years. All 17 lacked capacity to consent to placements at their places of residence. No close family members had acted as advocates for any of them. The cost to local learning disabilities specialist health services to provide unmet needs was found to be £117,000 per year. Conclusions: UK national guidance advocates the placement of individuals with learning disabilities close to their homes, yet out-of-area placements continue without proper consideration of good practice or the cost implications. Service users who do not have close family members to advocate for them appear to be especially vulnerable to this practice. [ABSTRACT FROM AUTHOR]

Background: The number of people with learning disabilities and significant health needs who have been placed in Cornwall from outside the county by other local authorities was estimated along with its effects on the individuals concerned and the health service. Materials and methods: Electronic health records of the local NHS trust for adults with learning disabilities were compared with the council’s social services learning disabilities register to screen for out-of-county placements. Records of individuals placed from outside the county over the previous three years were scrutinised to identify the reason for placement, capacity to consent, quality of transition and cost to local services. Results: A total of 155 of the 703 clients were from outside Cornwall, and 17 of the 155 had been resident in the county for no more than three years. All 17 lacked capacity to consent to placements at their places of residence. No close family members had acted as advocates for any of them. The cost to local learning disabilities specialist health services to provide unmet needs was found to be £117,000 per year. Conclusions: UK national guidance advocates the placement of individuals with learning disabilities close to their homes, yet out-of-area placements continue without proper consideration of good practice or the cost implications. Service users who do not have close family members to advocate for them appear to be especially vulnerable to this practice. INSET: Case study. [ABSTRACT FROM AUTHOR]

Aim To improve the treatment, care and monitoring of women with learning disabilities who receive oral contraceptive pills and long-term anti-epileptic drugs. Method A questionnaire based on standards from national and good-practice guidelines was devised and sent to all GP surgeries in Cornwall. The questions concerned: The rationale for birth control and/or behaviour management in the client group. Whether anti-epileptic drugs interactions and adverse effects were being considered. Whether clients demonstrate sufficient mental capacity to make informed choices about birth control and, if not, whether best-interest processes are being followed. Results All 67 surgeries in Cornwall were asked to answer the questionnaire and 29 did so. Results showed a significant paucity of understanding of the relevant legal issues, including the Mental Capacity Act 2005; communication issues, such as use of pathways and easy-read documents; and clinical issues, for example concerning the interactions and long-term effects of medications. Conclusion Copies of an easy-read leaflet for women with learning disabilities and a flowchart describing the best way to manage such patients were sent to GPs around Cornwall to ensure that they follow a single process in securing the consent of women with learning disabilities to birth.control, and thereby avoid any associated physical, financial and legal problems. [ABSTRACT FROM AUTHOR]

Aim To improve the treatment, care and monitoring of women with learning disabilities who receive oral contraceptive pills and long-term anti-epileptic drugs. Method A questionnaire based on standards from national and good-practice guidelines was devised and sent to all GP surgeries in Cornwall. The questions concerned: The rationale for birth control and/or behaviour management in the client group. Whether anti-epileptic drugs interactions and adverse effects were being considered. Whether clients demonstrate sufficient mental capacity to make informed choices about birth control and, if not, whether best-interest processes are being followed. Results All 67 surgeries in Cornwall were asked to answer the questionnaire and 29 did so. Results showed a significant paucity of understanding of the relevant legal issues, including the Mental Capacity Act 2005; communication issues, such as use of pathways and easy-read documents; and clinical issues, for example concerning the interactions and long-term effects of medications. Conclusion Copies of an easy-read leaflet for women with learning disabilities and a flowchart describing the best way to manage such patients were sent to GPs around Cornwall to ensure that they follow a single process in securing the consent of women with learning disabilities to birth.control, and thereby avoid any associated physical, financial and legal problems. [ABSTRACT FROM AUTHOR]

There is evidence that mass-media campaigns can educate the public, influence health behaviour and may reduce stigma. In this article, the authors describe how they initiated a new local radio phone-in programme covering different mental health problems and evaluated the benefits to members of the public who called the programme. [ABSTRACT FROM AUTHOR]

Some people with Asperger syndrome process their sensory impressions in different or impaired ways from most people, and so may be unable to engage productively in conventional environments. It is important that such people are provided with the information, skills and time they need to adjust to sensory input in these conditions. As a result of the public's ignorance of, and failure to meet, the needs of people with Asperger syndrome, these individuals may fail to reaching their full potential in their personal lives and in society as a whole. [ABSTRACT FROM AUTHOR]

Some people with Asperger syndrome process their sensory impressions in different or impaired ways from most people, and so may be unable to engage productively in conventional environments. It is important that such people are provided with the information, skills and time they need to adjust to sensory input in these conditions. As a result of the public's ignorance of, and failure to meet, the needs of people with Asperger syndrome, these individuals may fail to reaching their full potential in their personal lives and in society as a whole. [ABSTRACT FROM AUTHOR]

This case study describes a method of separating and clarifying the impact that a client's concomitant learning disability, personality disorder, bipolar affective disorder and post-traumatic stress each had on her capacity to make decisions and take responsibility. This information was then used to plan an effective management strategy. [ABSTRACT FROM AUTHOR]

This case study describes a method of separating and clarifying the impact that a client's concomitant learning disability, personality disorder, bipolar affective disorder and post-traumatic stress each had on her capacity to make decisions and take responsibility. This information was then used to plan an effective management strategy. INSET: Case study. [ABSTRACT FROM AUTHOR]

• First study of use of oromucosal midazolam maleate (OMM) in adults in community. • Oromucosal midazolam maleate is safe to use by trained non-clinical carers. • 10-mg dose of OMM is effective for cessation of seizure in adults at status risk. • Oromucosal midazolam maleate is an effective rescue medication in adults with epilepsy in community settings. Oro-mucosal midazolam maleate (OMM) with suitable training to family and carers is being increasingly recognized as the treatment of choice to mitigate the development of status epilepticus in non-hospital community settings. There are no studies to describe the use, effectiveness, and suitable dosing of OMM in adults with epilepsy in community settings. To describe the use, effectiveness, and dosing of OMM in the emergency treatment of epileptic seizures in community settings. A retrospective observational study (2016–17) design was used with participant recruitment from four UK NHS secondary care outpatient clinics providing epilepsy management. Study sample was of adult people with epilepsy (PWE) having had a recent seizure requiring OMM. Data on patient demographics, patient care plans, details of a recent seizure requiring emergency medication, and dose of OMM were collected from medical records. Study data from 146 PWE were included. The mean age of PWE was 41.0 years (SD 15.2) and mean weight was 64.8Kg (SD 18.2). Fifty-three percent of PWE were recorded as having intellectual disability. The most frequently used concomitant medications were lamotrigine (43%). The majority of seizures occurred at people's homes (n = 92, 63%). OMM was most often administered by family/professional care-givers (n = 75, 48.4%). Generalized (tonic/clonic) seizures were recorded in most people (n = 106, 72.6%). The most common initial dose of OMM was 10 mg (n = 124, 84.9%). The mean time to seizure cessation after administration of this initial dose was 5.5 minutes (SD = 4.5, Median 5.0, IQR 2.1–5.0). Only a minority of seizures led to ambulance callouts (n = 18, 12.3%) or hospital admissions (n = 13, 9%). This is the first observational study describing the use and effectiveness of OMM in adults in community settings. Minimal hospital admissions were reported in this cohort and the treatment was effective in ending seizures in adults in community settings. [ABSTRACT FROM AUTHOR]

Genetic factors contribute to the aetiology of epilepsy in >50% of cases, and information on the use of antiseizure medications in people with specific aetiologies will help guide treatment decisions. The PERMIT Extension study pooled data from two real-world studies (PERMIT and PROVE) to investigate the effectiveness and safety/tolerability of perampanel (PER) when used to treat people with focal and generalised epilepsy in everyday clinical practice. This post-hoc analysis of PERMIT Extension explored the use of PER when used to treat individuals presumed to have epilepsy with a genetic aetiology. Assessments included retention rate (evaluated at 3, 6 and 12 months), effectiveness (responder and seizure freedom rates; evaluated at 3, 6, 12 months and the last visit [last observation carried forward) and tolerability (adverse events [AEs]). Of the 6822 people with epilepsy included in PERMIT Extension, 1012 were presumed to have a genetic aetiology. The most common genetic aetiologies were idiopathic generalised epilepsy (IGE; 58.2%), tuberous sclerosis (1.1%), Dravet syndrome (0.8%) and genetic epilepsy with febrile seizures plus (GEFS+; 0.5%). Retention rates at 3, 6 and 12 months in the total genetic aetiology population were 89.3%, 79.7% and 65.9%, respectively. In the total genetic aetiology population, responder rates at 12 months and the last visit were 74.8% and 68.3%, respectively, and corresponding seizure freedom rates were 48.9% and 46.5%, respectively. For the specific aetiology subgroups, responder rates at 12 months and the last visit were, respectively: 90.4% and 84.4% (IGE), 100% and 57.1% (tuberous sclerosis), 100% and 71.4% (Dravet syndrome), and 33.3% and 20.0% (GEFS+). Corresponding seizure freedom rates were, respectively: 73.1% and 64.6% (IGE), 33.3% and 22.2% (tuberous sclerosis), 20.0% and 28.6% (Dravet syndrome), and 0% and 0% (GEFS+). The incidence of AEs was 46.5% for the total genetic aetiology population, 48.8% for IGE, 27.3% for tuberous sclerosis, 62.5% for Dravet syndrome, and 20% for GEFS+. Tolerability findings were consistent with PER's known safety profile. PER was effective and generally well tolerated when used in individuals with a presumed genetic epilepsy aetiology in clinical practice. PER was effective across a wide range of genetic aetiologies. • Perampanel was evaluated in people with epilepsy with different genetic aetiologies. • At 12 months, 75% of participants responded to treatment and 49% were seizure free. • Perampanel was effective across a wide range of genetic aetiologies. • Perampanel was generally well tolerated with no new or unexpected adverse events. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Discussion Sudden unexpected death in epilepsy (SUDEP) is a leading cause of epilepsy mortality. All international guidance strongly advocates for clinicians working with people with epilepsy (PWE) to discuss SUDEP. Clinician views working with PWE in the UK and Norway on SUDEP counselling are compared.A cross‐sectional online mixed methodology survey of 17 Likert and free‐text response questions using validated themes was circulated via International League against Epilepsy/Epilepsy Specialist Nurses Association in the UK and International League against Epilepsy/Epilepsinet in Norway using a non‐discriminatory exponential snowballing technique leading to non‐probability sampling. Quantitative data were analysed using descriptive statistics and Mann–Whitney, Kruskal–Wallis, chi‐squared and Fisher's exact tests. Significance was accepted at p < 0.05. Thematic analysis was conducted on free‐text responses.Of 309 (UK 197, Norway 112) responses, UK clinicians were more likely to have experienced an SUDEP (p < 0.001), put greater importance on SUDEP communication (p < 0.001), discuss SUDEP with all PWE particularly new patients (p < 0.001), have access and refer to bereavement support (p < 0.001) and were less likely to never discuss SUDEP (p < 0.001). Significant differences existed between both countries’ neurologists and nurses in SUDEP counselling with UK clinicians generally being more supportive. UK responders were more likely to be able to identify bereavement support (p < 0.001). Thematic analysis highlighted four shared themes and two specific to Norwegians.Despite all international guidelines stating the need/importance to discuss SUDEP with all PWE there remain hesitation, avoidance and subjectivity in clinicians having SUDEP‐related conversations, more so in Norway than the UK. Training and education are required to improve communication, engagement and decision making. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance This study was undertaken to validate a set of candidate biomarkers of seizure susceptibility in a retrospective, multisite case–control study, and to determine the robustness of these biomarkers derived from routinely collected electroencephalography (EEG) within a large cohort (both epilepsy and common alternative conditions such as nonepileptic attack disorder).The database consisted of 814 EEG recordings from 648 subjects, collected from eight National Health Service sites across the UK. Clinically noncontributory EEG recordings were identified by an experienced clinical scientist (N = 281; 152 alternative conditions, 129 epilepsy). Eight computational markers (spectral [n = 2], network‐based [n = 4], and model‐based [n = 2]) were calculated within each recording. Ensemble‐based classifiers were developed using a two‐tier cross‐validation approach. We used standard regression methods to assess whether potential confounding variables (e.g., age, gender, treatment status, comorbidity) impacted model performance.We found levels of balanced accuracy of 68% across the cohort with clinically noncontributory normal EEGs (sensitivity =61%, specificity =75%, positive predictive value =55%, negative predictive value =79%, diagnostic odds ratio =4.64, area under receiver operated characteristics curve =.72). Group level analysis found no evidence suggesting any of the potential confounding variables significantly impacted the overall performance.These results provide evidence that the set of biomarkers could provide additional value to clinical decision‐making, providing the foundation for a decision support tool that could reduce diagnostic delay and misdiagnosis rates. Future work should therefore assess the change in diagnostic yield and time to diagnosis when utilizing these biomarkers in carefully designed prospective studies. [ABSTRACT FROM AUTHOR]

Aim To assess a simple and immediate feedback tool. Method Service users' feedback was recorded using a simple push-button device. Results The cumulative results could be used as a trigger indicator. Discussion It is important to listen to the views of service users but feedback from people with significant learning disabilities can be difficult to elicit. Carers and people with learning disabilities were able to use the device under discussion. Conclusion The information obtained supplements that elicited with other feedback tools to give a broad view of the service. [ABSTRACT FROM AUTHOR]

Aim To assess a simple and immediate feedback tool. Method Service users' feedback was recorded using a simple push-button device. Results The cumulative results could be used as a trigger indicator. Discussion It is important to listen to the views of service users but feedback from people with significant learning disabilities can be difficult to elicit. Carers and people with learning disabilities were able to use the device under discussion. Conclusion The information obtained supplements that elicited with other feedback tools to give a broad view of the service. [ABSTRACT FROM AUTHOR]

Just Checking is an evidenced-based tool used in dementia care in many UK health authorities. It uses infrared sensors to produce 24-hour charts showing person-centred activity and staff intervention, and is invaluable for effective and efficient assessment and care planning. The authors used Just Checking as part of a study to screen for movements suggestive of nocturnal seizures in a vulnerable high-risk population who cannot provide reliable histories about their seizure activities. Members of the study group, who all live in the community, have learning disabilities and epilepsy. [ABSTRACT FROM AUTHOR]

Just Checking is an evidenced-based tool used in dementia care in many UK health authorities. It uses infrared sensors to produce 24-hour charts showing person-centred activity and staff intervention, and is invaluable for effective and efficient assessment and care planning. The authors used Just Checking as part of a study to screen for movements suggestive of nocturnal seizures in a vulnerable high-risk population who cannot provide reliable histories about their seizure activities. Members of the study group, who all live in the community, have learning disabilities and epilepsy. [ABSTRACT FROM AUTHOR]

Sudden unexpected death in epilepsy (SUDEP) is a tragic condition and, despite varied risk levels among the population with epilepsy, is the cause of significant premature mortality. In the last 20 years, though awareness of SUDEP has increased among epilepsy professionals, little has changed with regard to the death rates per se, in rates of informing people with epilepsy (PWE) of their person-centered SUDEP risks, or in the awareness levels of nonepilepsy clinicians, such as, primary care practitioners and hospital doctors. The challenges to make aware and inform PWE have been multifold, in particular, 'when', 'what', and 'how' to tell about SUDEP. Current guidance recognizes that to improve SUDEP rates, it is important to engage proactively with PWE. There is a need to bring shared responsibility between clinicians and PWE to help mitigate the risk of SUDEP. To enable this, a meaningful evidence-based person-centered conversation is essential. The SUDEP and Seizure Safety Checklist ("Checklist") was created to facilitate this. This paper showcases the background, concept, development, implementation, feasibility and validity studies undertaken, challenges, barriers, and limitations of the eight-year Checklist project, which has moved from a single clinic to an international presence. It outlines the need to further reform SUDEP risk communication recognizing the differences between a basic risk message at time of diagnosis as advocated by current good practice guidance and the need for a more person-centered discussion on a regular basis for which the Checklist can be a key catalyst. This article is part of the Special Issue "Prevent 21: SUDEP Summit - Time to Listen" • SUDEP is a significant cause of premature mortality in people with epilepsy (PWE). • Shared responsibility between clinicians and PWE to mitigate SUDEP risk is needed. • Enabling this meaningful evidence-based person-centered conversation is essential. • The SUDEP and Seizure Safety Checklist ("Checklist") was created to facilitate this. • The development, implementation, and validity studies for the Checklist are presented. [ABSTRACT FROM AUTHOR]

Background: Ictal hypoxaemia is a feature seen in epileptic seizures, characterized by low oxygen saturations, increasing seizure prolongation risk and possibly contributing to sudden unexpected death in epilepsy (SUDEP). High flow oxygen is recommended in the management of seizures by UK's National Institute of Health and Care excellence (NICE); however, the evidence supporting this recommendation is unclear. Aims: To identify the efficacy of oxygen in the seizure treatment. Method: A scoping review was conducted using PRISMA‐ScR guidance. PsycINFO, EMBASE and MEDLINE were searched along with the references section of identified literature. Articles were critically appraised for study, patient, seizure, oxygen therapy and outcome characteristics, summarized and quality‐assessed using Sackett's criteria. Results: Literature search identified 623 articles of which five met the pre‐criteria for full review. One animal study demonstrated favourable effects of oxygen administration. Three human studies also reported favourable effects of oxygen administration, while one reported outcomes that were not statistically significant. Study design concerns in all identified literature confounded the ability to assess efficacy. All five publications were assigned Sackett's score of 2b. Conclusion: There is a significant lack of evidence to support the efficacy of oxygen administration in epileptic seizures. Future research is needed. [ABSTRACT FROM AUTHOR]

Background: The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. Aim: To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. Methods: A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. Results: A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. Conclusion: Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised. [ABSTRACT FROM AUTHOR]

Background: Lithium is well described in managing certain mental illnesses including in people with intellectual disabilities (ID). It requires regular monitoring particularly of serum levels and relevant biochemistry. However, existing monitoring protocols do not provide ID-specific guidance leading to increased risk of poor-quality care. This study aims to construct a protocol to aid monitoring in primary care in this cohort. Need for a protocol is further explored by retrospectively auditing monitoring standards in people with ID in Cornwall, UK, and confirming gaps in current practice which may be minimized with clearer guidance. Methods: Protocol was developed drawing on existing guidance for the general population and considering challenges and best practice associated with monitoring in people with ID. The protocol was applied as an audit to all people with ID currently on lithium on the GP ID register across all GP practices in the county of Cornwall, UK, to explore current standards of monitoring to help elucidate whether increased guidance may be of use. Results: A novel protocol was developed and supplemented with additional information which is hoped to provide a useful reference guide in primary care. During audit, nine of the ten people with ID receiving prescriptions for lithium across the county were identified and data collected. Audit showed monitoring was to a reasonably high standard, though blood tests and annual health checks were not always performed within preferred maximum timeframes. Conclusions: This protocol represents the first ID-specific approach for monitoring lithium and associated health parameters in primary care. Auditing against the protocol showed gaps in current standards of care which may indicate a need for clearer published guidance. Some groupings of results highlighted particular areas of need. We hope that clear protocols, such as ours, may aid safe and timely monitoring of lithium treatment in future. [ABSTRACT FROM AUTHOR]

People with severe mental illness are often excluded from trials related to Eye Movement Desensitization and Reprocessing (EMDR) therapy. Principal concerns are that they may not tolerate treatment, might risk relapse or that psychotic symptoms may worsen. There is however building evidence of a traumatogenic etiology of psychotic disorder that may benefit therapeutically from EMDR. However, EMDR in this role is done mainly in specialist tertiary settings. To conduct a randomized exploratory trial of prospective treatment of EMDR for people with psychotic disorder and a history of trauma in an adult community mental health service. A randomized exploratory trial with a controlled pilot design was employed to conduct a prospective treatment and six-month follow-up study with an interim 10-week analysis in a rural county in the UK (population 538,000). We recruited participants with psychotic disorder who had a reported history of trauma and were interested in receiving trauma therapy. They were then randomized to either receive EMDR or treatment as usual (TAU). The primary instrument used was the Impact of Events Scale (IES) with secondary instruments of Positive and Negative Symptoms of Psychotic Disorder (PANSS), PTSD Checklist (PCL-C), and subjective Quality of Life (MANSA). IES scores showed significant improvements in the EMDR group (n = 24, age 42.0 SD (14.5), 42% male) compared to the TAU group (n = 12, age 34.4 SD (11.3), 50% male) at 10 weeks and at six months (p < 0.05). There were significant improvements in PCL-C and PANSS negative symptoms scores associated with treatment (p < 0.05). All other scales showed positive trends. This study demonstrates that EMDR can reduce the impact of traumatic events for patients with a psychotic disorder in a clinical setting in the UK. The improvements in psychotic disorder persisted for six months after treatment. ISRCTN43816889. • This is a 6 month prospective randomized study of EMDR for people with psychotic disorder. • This is the 1st study demonstrating EMDR effectiveness for this population in British routine psychiatric settings. • People with psychotic disorder are excluded from EMDR trials but our evidence suggests that they benefit therapeutically. [ABSTRACT FROM AUTHOR]

Background: Around 2% of the population have intellectual disabilities. Over one-third people with intellectual disabilities (PwID) present with 'challenging behaviour', which nosologically and diagnostically is an abstract concept. Challenging behaviour is influenced by a range of bio-psycho-social factors in a population, which is unable to suitably comprehend and/or communicate concerns. This predisposes to poor health and social outcomes. There is no evidence-based treatments for managing challenging behaviour. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are being trialled for a range of disorders, which are over-represented in PwID and provoke challenging behaviours, such as severe epilepsy, spasticity, post-traumatic stress disorder, social phobia, pain, etc. Methods: This perspective review explores the different conditions, which benefit from medicinal CBD/THC preparations, by analysing recent literature from neurobiological, pre-clinical and clinical studies related to the topic. The evidence is synthesised to build an argument of the therapeutic benefits and challenges of medicinal cannabis to manage severe challenging behaviour in PwID. Results: There is developing evidence of medicinal CBD/THC improving psychiatric and behavioural presentations in general. In particular, there is emergent proof in certain key areas of influence of medicinal CBD/THC positively supporting challenging behaviour, for example in children with neurodevelopmental disorders. However, there are significant challenges in employing such treatments in vulnerable populations such as PwID. Conclusion: Further clinical research for the considered use of medicinal CBD/THC for challenging behaviour management in PwID is needed. Strong co-production with experts with lived experience is needed for further testing to be done in this exciting new area. [ABSTRACT FROM AUTHOR]

Background: Approximately one quarter of people with an intellectual disability (PwID) have epilepsy of whom nearly three-quarters are pharmaco-resistant. There are higher reported neuropsychiatric side-effects to anti-seizure medication (ASM) in this group. Levetiracetam (LEV) is a first-line ASM with a stronger association with neuropsychiatric symptoms for PwID than other ASMs. Brivaracetam (BRV) is a newer ASM. Recent studies suggest a beneficial effect of swapping people who experience neuropsychiatric events with LEV to BRV. However, there is limited evidence of this for PwID. This evaluation analyses real world outcomes of LEV to BRV swap for PwID compared to those without ID. Methods: We performed a multicentre, retrospective review of clinical records. Demographic, clinical characteristics and reported adverse events of patients switched from LEV to BRV (2016–2020) were recorded at 3 months pre and 6- and 12-month post-BRV initiation. Outcomes were compared between PwID and those without and summarised using cross-tabulations and logistic regression models. A Bonferroni correction was applied. Results: Of 77 participants, 46 had ID and 52% had a past psychiatric illness. 71% participants switched overnight from LEV to BRV. Seizure reduction of > 50% was seen in 40% patients. Psychiatric illness history was predictive of having neuropsychiatric side-effects with LEV but not BRV (p = 0.001). There was no significant difference for any primary outcomes between PwID versus without ID. Conclusions: Switching from LEV to BRV appears as well tolerated and efficacious in PwID as those without ID with over 90% still on BRV after 12 months. [ABSTRACT FROM AUTHOR]

Background: The Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD) is an 18-item measure which provides a structured and standardized approach to rating various clinical and psychosocial outcomes and has been in use nationally since 2002. Aims: To revise and improve the HoNOS-LD's utility in contemporary intellectual disability (ID) services whilst retaining its original objectives and five-point severity ratings. Method: ID clinicians were invited to complete an online survey, rating each item on the existing measure for being fit for purpose, identifying issues and suggesting improvements based on their experience of using the HoNOS-LD in practice. Scales were then assessed and revised sequentially; survey responses were used to inform discussion and revisions to the HoNOS-LD by the Advisory Board. Results: A total of 75 individuals replied. Respondents had used HoNOS-LD for an average of 8.0 years (S.D. 5.28 years) and 88% found the scale to be useful in their practice. On average, respondents used HoNOS-LD ratings to inform care 42.4% of the time (S.D. 33.5%). For each scale there was a significant negative correlation between the percentage of positive/very positive respondent ratings and the number of changes proposed. Common changes included simplifying terms, reducing ambiguity and replacing anachronistic language. Conclusion: The changes outlined in this paper are based on the advisory group's expert consensus. These changes are intended to improve reliability and validity but now need empirical testing as well as review by service users. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities (PWID) are at six times higher risk of death due to COVID-19. To mitigate harm, as a high-risk group, significant social changes were imposed on PWID in the UK. Alongside these changes, the uncertainty of the pandemic influence, caused PWID and their carers to encounter significant stress. The evidence of the pandemic's psycho-social impact on PWID originates mainly from cross-sectional surveys conducted with professionals and carers. There is little research on the longitudinal psycho-social impact of the pandemic from PWID themselves. Aims: To examine the long-term psycho-social impact of the pandemic on PWID. Methods: A cross-sectional survey, following STROBE guidance, of 17 Likert scale statements (12 to PWID and 5 to their carers) to ascertain the pandemic's psychosocial impact was conducted. Every other PWID open to a specialist Intellectual Disability service serving half a UK County (pop:500,000) was selected. The same survey was re-run with the same cohort a year later. Descriptive statistics, Mann-Whitney, Chi-square and unpaired-t tests were used to compare responses. S ignificance is taken at p <.05. Comments were analysed using Clarke and Braun's approach. Results: Of 250 PWID contacted, 100 (40%) responded in 2020 and 127 (51%) in 2021. 69% (2020) and 58% (2021) reported seeking medical support. Carers, (88%, 2020 and 90%, 2021) noticed emotional changes in PWID they cared for. 13% (2020) and 20% (2021) of PWID had their regular psychotropics increased. 21% (2020) and 24% (2021) had their pro re nata (PRN) medication adjusted. PWID or carers demonstrated no statistically significant variation in responses between themselves from 2020 to 2021. PWID were more likely to report being upset/distressed compared to their carers' perceptions of them in both years (p <.001). Four themes were identified. Conclusion: This longitudinal study highlights the diverse psycho-social impact of the pandemic on PWID in the UK. The Pandemic's psycho-social impact has been significantly underestimated. [ABSTRACT FROM AUTHOR]

Since much of our knowledge about the neurobiology of schizophrenia derives from the initial discovery that chlorpromazine was effective in treating psychosis, pharmacological research has mostly concentrated on dopamine-blocking agents. Here, the authors discuss the situation where there is no single pharmacological agent on the horizon that could serve as the 'holy grail' to address the full range of symptoms of schizophrenia and what the immediate future holds with the widespread use of polypharmacy. [ABSTRACT FROM AUTHOR]

There is a strong association between pain and depression, and the presence of pain negatively affects the recognition and treatment of depression. Here, Dr Cocksedge and colleagues' explore the neurobiology behind this relationship and propose a new screening tool to assess patients with either condition for the coexistence of the other, with the potential for significantly better diagnosis, referral and hence treatment. [ABSTRACT FROM AUTHOR]

Videoconferencing is not being widely used at present in mental health, however, it has the potential to be a useful resource if utilised alongside more traditional continuing professional development (CPD) to remain up-to-date within psychiatry. Dr Scott and Dr Shankar describe their literature search of the topic to undercover the benefits and limitations of videoconferencing as an educational tool. [ABSTRACT FROM AUTHOR]

Background: There is a bi-directional relationship between seizures and substance misuse, i.e., alcohol and recreational drugs. Seizures and substance misuse are recognised separately to influence increased emergency department (ED) admissions and early death. There is however no understanding of the cumulative influence of these matters on repeat ED attenders for seizures esp. as a third are likely to re-attend within the year. This case–control study compares the characteristics of people with substance misuse to those without substance misuse presenting recurrently with seizures to the ED. Methods: From a single ED serving a rural population in the Southwest of England, data of all people presenting more than once with a seizure over a 4-year period were examined. The diagnosis of alcohol or drug misuse, deaths, demographic characteristics, and service use were captured. Results: Of 450 repeat attenders, 95 had a recorded history of alcohol and/or drug problems. Those with substance misuse had double the mortality when adjusted for age and gender compared to those without. They were also more likely to be male, younger in age, have mental health issues, live in socially deprived neighborhoods, not take anti-seizure medications and not have had a specialist review in epilepsy services in the previous year. Nearly a quarter of those with addiction issues died in the 4-year period. Discussion: Service provision for this vulnerable group may need to be modelled along different lines to traditional approaches, such as an assertive outreach community-based service as provided for chronic psychiatric and addiction management. [ABSTRACT FROM AUTHOR]

Background: The media are an important source of information on mental health. They are often implicit in reinforcing negative stereotypes of people with mental health problems. There are no studies in German-speaking countries or Russia on media attitudes to mental health and mental health professionals' (MHP) attitudes to the media. Aims: This study explored journalists and MHPs attitudes to mental health media reporting in the German speaking countries of Switzerland, Germany, and Austria and in Russia. Methods: A cross-sectional online internet survey, of ten Likert scale statements to ascertain perceptions of stigma, role, and training needs following the STROBE guidance was conducted among journalists and MHPs via their professional organizations. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used. Descriptive statistics, Kruskal-Wallis, and a post hoc Dunn's multiple comparisons test using Bonferroni adjustment were used to analyze data. Results: A total of 106 German-speaking and 78 Russian journalists, 109 German-speaking, and 82 Russian MHPs fully answered the survey. Journalists felt the media were more balanced about mental health than MHPs, and MHPs were wary of engagement with the media. Small minorities of journalists had engaged with mental health training, similarly few MHPs had engaged with media training, but both groups were interested in doing so in the future. Significant differences between German and Russian speaking respondents were found on a range of issues (e.g. stigmatization, image about psychotherapy, the media/MHPs, and their own role in engaging with the media/MHPs). Russians were more likely to know specialized (media/mental health awareness) training compared to German-speaking MHPs and journalists. Conclusion: There are potential opportunities to engage journalists and MHPs in training about each other's worlds and reducing stigma toward mental illness through engaging MHPs with the media. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities (PwID) have a bidirectional relationship with epilepsy. Nearly 25% of PwID have seizures and 30% people with epilepsy are thought to have a significant intellectual impairment. Furthermore, 70% of PwID are thought to have treatment‐resistant epilepsy. In the United Kingdom, antiseizure medications (ASMs) are the second most widely prescribed psychotropic agent for PwID. However, it is unclear what the current evidence and patterns is on current prescribing of ASMs, including when and how a case is made to withdraw them. A narrative review along with an analysis of large‐scale NHS Digital published data (2015–2020) on several aspects of ASM prescribing by general practices for PwID was undertaken. The review results and data analysis are consolidated and presented as 11 themes to provide a comprehensive overview of the study topic. Recent studies estimate that one‐third and one‐fifth of PwID are prescribed ASMs. A history of epilepsy is seen as the primary prescribing reason; however, often it is a legacy, and the indication is no longer clear. The proportion receiving ASMs continues to rise with age. This pattern of use does not correlate well with seizure onset. There are limited data on de‐prescribing ASMs in PwID. The study population heterogenicity, associated polypharmacy, multimorbidity and higher sudden unexpected death in epilepsy risks are outlined. Suggestions are made from available evidence for improving prescribing practices for PwID and seizures, and key areas for further research in this complex clinical area are outlined. [ABSTRACT FROM AUTHOR]