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Co-designing a peer support programme for carers of people treated under the Mental Health Act: views from stakeholdersBackground Relatives/friends (carers) of people who are involuntarily admitted to a psychiatric hospital report high levels of stress, feelings of isolation and exclusion from their patient’s care. One-to-one peer support is widely implemented for patients, facilitating mental health recovery. Preliminary evidence reports that peer support may benefit carers too, but a one-to-one peer support programme to help carers when their relatives/friends are in hospital has not been developed. Objective To explore carers’, patients’, and professionals’ views on what an accessible, feasible and helpful one-to-one peer support intervention should consider for carers of patients treated under the Mental Health Act (MHA) in England. Method Nineteen one-to-one interviews were conducted online with five carers, four patients, four clinicians, four independent mental health advocates and two behaviour change experts. Participants had experience of either being treated or supporting someone treated under the MHA within the last 10 years. Audio recordings of the interviews were transcribed, and data were analysed using thematic analysis. Results Five themes were identified: (a) carer availability and awareness; (b) peer support flexibility; (c) early promotion of peer support; (d) appropriate training and support for peers, and; (e) anticipated impact of peer support. Carers’ lack of time and awareness of support were reported as key barriers to accessing peer support. To address this, participants emphasised the need for early introduction of support following patients’ hospitalisation and flexible delivery through various communication channels. They also highlighted the need for robust, interactive training for peer supporters. Expected benefits included improved carer and peer supporter wellbeing and increased carer knowledge and empowerment. Conclusions These findings highlight the need for structured training for peer supporters and a flexible, accessible peer support programme for carers. The findings can inform evidence-based co-production of a carer peer support programme for use in England, which could improve carer wellbeing, knowledge and empowerment.
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Assessment of the Impact of Schizophrenia on Healthcare Resource Use Among Patients with Cardiometabolic Conditions in England: Insights from Big Data AnalysisObjectives Having schizophrenia increases the risk of developing cardiometabolic conditions, increasing costs and complicating management. This retrospective cohort study among patients with cardiometabolic conditions in England aimed to determine the impact of comorbid schizophrenia on primary and secondary healthcare use, and on the costs of nonelective inpatient admissions, as well as whether this burden is influenced by the number of a patient’s cardiometabolic conditions. Methods Primary and secondary healthcare use data were collected from the Clinical Practice Research Datalink and Hospital Episode Statistics databases, respectively. Adults with ≥1 cardiometabolic condition(s) were grouped according to the conditions, and whether they had schizophrenia. Healthcare resource use, and costs of nonelective admissions were calculated for patient with/without schizophrenia and any, 1, 2, 3, or 4 cardiometabolic condition(s). Results were adjusted for age and sex. Abstract Results Patients with comorbid schizophrenia had 68% more GP appointments (18.09 versus 11.07 appointments/patient/ year), 19% more prescriptions (4.20 versus 5.06 prescriptions/ patient/year), 21% more outpatient appointments (7.94 versus 6.60 appointments/patient/year), 189% more A&E attendances (2.31 versus 0.80 attendances/patient/year), and 127% more nonelective inpatient admissions (1.69 versus 0.77 admissions/patient/year) than those without. The higher number of nonelective admissions represented £1,420.36 increased spending/patient/year, translating into a potential spend of more than £31M annually. Schizophrenia was associated with higher secondary care resource use after adjusting for the number of cardiometabolic conditions. Conclusions Among patients with cardiometabolic conditions, comorbid schizophrenia is associated with higher primary and secondary healthcare resource use and cost, even after adjusting for the number of cardiometabolic conditions.
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Improving physical healthcare provided to psychiatric inpatients at an acute mental health trustPsychiatric patients are at high risk of developing physical health complications. This is due to various factors including medications prescribed, life style choices and diagnostic overshadowing. Admission to a psychiatric unit provides a prime opportunity to review a patient's physical healthcare. We noticed prior to the commencement of this project that this opportunity was not always being used in the inpatient unit, with one in four patients at baseline data collection having no physical health checks. This is despite clear guidance laid out in the trust policy 'Physical Examination of Service Users during Admission to Hospital'. We aimed to improve compliance with these checks to 100%. A number of prior audits in this area had failed to sustain improvement. Therefore, we proposed a quality improvement approach involving a series of plan do study act cycles, in order to test and review processes prior to implementation. The first cycle involved simplification of the paper-based documentation used for physical health checks, which resulted in minimal improvement by 5%. The second cycle involved combining this documentation with the history taking proforma resulting in an overall improvement in compliance to 90%. We learnt that a move away from the more widely used audit towards a more holistic approach of quality improvement allowed an informed continuum of change to take place which likely led to sustained improvement. Post implementation data collected at 1 month revealed compliance remained at 90%. Our initial 100% target was perhaps unrealistic, as there are also longstanding underlying cultural issues around physical healthcare in psychiatric patients that are complex to address and beyond the scope of this project.
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Underlying biological mechanisms of emotion dysregulation in Bipolar DisorderDifficulties with emotion regulation (ER) are a key feature of Bipolar Disorder (BD) contributing to poor psychosocial and functional outcomes. Abnormalities within emotion processing and regulation thus provide key targets for treatment strategies and have implications for treatment response. Although biological mechanisms and ER are typically studied independently, emergent findings in BD research suggest that there are important ties between biological mechanisms and the disturbances in ER observed in BD. Therefore, in this narrative review, we provide an overview of the literature on biological mechanisms underlying emotional dysregulation in BD including genetic and epigenetic mechanisms, neuroimaging findings, inflammation, hypothalamic-pituitary-adrenal (HPA) axis dysfunction, neuroplasticity and brainderived neurotrophic factor (BDNF), and circadian rhythm disturbances. Finally, we discuss the clinical relevance of the findings and provide future directions for research. The continued exploration of underlying biological mechanisms in ED in BD may not only elucidate fundamental neurobiological mechanisms but also foster advancements in current treatment strategies and the development of novel targeted treatments.
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The Roles, Responsibilities and Tasks of Peer Support Workers in Coventry and Warwickshire Partnership Trust (CWPT): A Service ReviewBackground: Peer support worker roles were introduced into the Coventry and Warwickshire Partnership Trust (CWPT) workforce in January 2021. A subsequent review highlighted concerns among peer support workers and their employers around the lack of clarity regarding the roles, responsibilities, and tasks of peer support workers. Aim: The aim of this service review was to explore the similarities and differences between the role of peer support workers and their multi-disciplinary team colleagues, and the extent to which there was clarity around peer support worker roles. Additionally, the service review aimed to investigate the broader impact of peer support workers beyond their formal roles, responsibilities and tasks. Methods: A qualitative approach was used, involving semi-structured interviews and focus groups with peer support workers, multi-disciplinary team colleagues, and service users. Data were audio-recorded, transcribed, and analysed thematically. The service review was coproduced, involving peer support workers at all stages. Results: Three focus groups and six individual interviews were conducted with sixteen participants. Thematic analysis revealed similarities between peer support worker and multi-disciplinary team colleagues’ roles, as well as key differences in the use of lived experience and the unique approach of peer support workers. Role clarity improved with increased exposure to peer support workers and better access to role-related information, however, the need for further role clarity was emphasised. Additionally, peer support workers were found to have a significant impact beyond their formal roles, specifically through shaping team culture and providing authentic, person-centred and recovery focused support to service users. Conclusions: This review highlights the ongoing development of peer support worker roles, responsibilities and tasks in CWPT. Recommendations to further develop peer support worker roles include improving role clarity, emphasising the value of lived experience, and supporting effective collaboration between peer support workers and multi-disciplinary team colleagues to improve service delivery.
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Depression and obesity: can the cycle be broken?Obesity and depression are conditions that have been linked through a great number of interesting mechanisms. To fully understand the implications of treatment choices it is necessary to continue to investigate the physiology of these two conditions. By examining the background of these problems and considering factors such as stress response, neurological change and systemic inflammation, we propose a cycle linking depression and obesity. With reference to this cycle, we discuss management options, focusing particularly on prescribing choices and current guidelines. An assessment of the medication options is provided demonstrating that prescribing choices can have a significant impact on ongoing physical health. The aim of this discussion is to raise awareness of current research and progress and to see whether the cycle of depression and obesity can be broken. LEARNING OBJECTIVES • Update knowledge of the mechanisms linking depression and obesity • Understand the impact of medication on the cycle linking the two • Consider how we can improve outcomes for patients with depression and/or obesity
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Non-contact monitoring to support care in acute inpatient mental healthBackground: Averting incidents of patient self-harm is an ongoing challenge in acute inpatient mental health settings. Novel technologies that do not require continuous human visual monitoring and that maintain patient privacy may support staff in managing patient safety and intervening proactively to prevent self-harm incidents. Aim: To assess the effect of implementing a contact-free vision-based patient monitoring and management (VBPMM) system on the rate of bedroom self-harm incidents. Methods: A mixed methods non-randomized controlled before-and-after evaluation was conducted over 24 months on one female and one male acute inpatient mental health ward with the VBPMM system. The rates of bedroom self-harm, and of bedroom ligatures specifically, before and after implementation were investigated using quantitative methods. Qualitative methods were also used to explore the perceived effectiveness of the system and its acceptability. Results: A -44% relative percentage change in bedroom self-harm incidents and a -48% relative percentage change in bedroom ligatures incidents were observed in the observational wards with the VBPMM system. Staff and patient responses gave insights into system acceptability and the ways in which these reductions may have been achieved. Conclusion: The results indicate that using the VBPMM system helped staff to reduce self-harm incidents, including ligatures, in bedrooms.
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Distinct alterations in probabilistic reversal learning across at-risk mental state, first episode psychosis and persistent schizophreniaWe used a probabilistic reversal learning task to examine prediction error-driven belief updating in three clinical groups with psychosis or psychosis-like symptoms. Study 1 compared people with at-risk mental state and first episode psychosis (FEP) to matched controls. Study 2 compared people diagnosed with treatment-resistant schizophrenia (TRS) to matched controls. The design replicated our previous work showing ketamine-related perturbations in how meta-level confidence maintained behavioural policy. We applied the same computational modelling analysis here, in order to compare the pharmacological model to three groups at different stages of psychosis. Accuracy was reduced in FEP, reflecting increased tendencies to shift strategy following probabilistic errors. The TRS group also showed a greater tendency to shift choice strategies though accuracy levels were not significantly reduced. Applying the previously-used computational modelling approach, we observed that only the TRS group showed altered confidence-based modulation of responding, previously observed under ketamine administration. Overall, our behavioural findings demonstrated resemblance between clinical groups (FEP and TRS) and ketamine in terms of a reduction in stabilisation of responding in a noisy environment. The computational analysis suggested that TRS, but not FEP, replicates ketamine effects but we consider the computational findings preliminary given limitations in performance of the model.
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The Association Between Trajectories of Self-reported Psychotic Experiences and Continuity of Mental Health Care in a Longitudinal Cohort of Adolescents and Young AdultsBackground and hypothesis: Young people (YP) with psychotic experiences (PE) have an increased risk of developing a psychiatric disorder. Therefore, knowledge on continuity of care from child and adolescent (CAMHS) to adult mental health services (AMHS) in relation to PE is important. Here, we investigated whether the self-reported trajectories of persistent PE were associated with likelihood of transition to AMHS and mental health outcomes. Study design: In this prospective cohort study, interviews and questionnaires were used to assess PE, mental health, and service use in 763 child and adolescent mental health service users reaching their service's upper age limit in 8 European countries. Trajectories of self-reported PE (3 items) from baseline to 24-month follow-up were determined using growth mixture modeling (GMM). Associations were assessed with auxiliary variables and using mixed models. Study results. At baseline, 56.7% of YP reported PE. GMM identified 5 trajectories over 24 months: medium increasing (5.2%), medium stable (11.7%), medium decreasing (6.5%), high decreasing (4.2%), and low stable (72.4%). PE trajectories were not associated with continuity of specialist care or transition to AMHS. Overall, YP with PE reported more mental health problems at baseline. Persistence of PE or an increase was associated with poorer outcomes at follow-up. Conclusions: PE are common among CAMHS users when reaching the upper age limit of CAMHS. Persistence or an increase of PE was associated with poorer mental health outcomes, poorer prognosis, and impaired functioning, but were less discriminative for continuity of care.
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Designing and implementing a physical exercise intervention for people with first episode psychosis using experience-based co-design: A pilot study from Chennai, IndiaBackground: Physical exercise can improve outcomes for people with first-episode psychosis (FEP). Co-designing physical exercise interventions with end users has the potential to enhance their acceptability, feasibility, and long-term viability. This study's objective was to use experience-based co-design (EBCD) methodology to develop a physical exercise intervention for FEP, and pilot test it. Methods: The study was conducted at the Schizophrenia Research Foundation's FEP program in Chennai, India. Participants(N=36) were individuals with FEP and their caregivers, mental health professionals (MHPs, and physical training experts. EBCD methodology included one-to-one interviews, focus group discussions, joint conferences, and co-design workshops. Two instructional videos were developed. Twelve FEP patients engaged in physical exercise with help of the videos over three months. They were followed up through weekly phone calls and in-person interviews to capture data on regularity, frequency, location of exercise, and comfort levels. Results: Several touch points emerged from the interviews, focus groups, and joint meetings including lack of motivation, knowledge about physical exercise; differing perspectives about physical exercise; limited resource, and time constraints. Two instructional videos demonstrating activities for participants incorporated strategies that addressed these touch points. Pilot data indicated that participants engaged with the physical exercise intervention over 3 months. Conclusion: This was the first study to use co-design methodology to design a physical exercise intervention for first-episode psychosis. The intervention may have therefore been responsive to stakeholder needs and preferences. Results of this study highlight the potential of co-design in designing and adapting interventions. There is need for rigorous testing with larger samples.
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The psychosis risk timeline: can we improve our preventive strategies? Part 3: primary common pathways and preventive strategiesPsychosis is a recognised feature of several psychiatric disorders and it causes patients significant distress and morbidity. It is therefore important to keep knowledge of possible risk factors for psychosis up to date and to have an overview model on which further learning can be structured. This article concludes a three-part series. It gives a review of evidence regarding common pathways by which many risk factors come together to influence the development of psychosis and finalises our suggested overview model, a psychosis risk timeline. The three primary pathways considered are based on the major themes identified in this narrative review of recent literature and they focus on neurological, neurochemical and inflammatory changes. We link each back to the factors discussed in the first and second parts of this series that alter psychosis risk through different mechanisms and at different stages throughout life. We then consider and summarise key aspects of this complex topic with the aim of providing current and future clinicians with a model on which to build their knowledge and begin to access and understand current psychosis research and implications for future preventive work.
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The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthoodCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.
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Ruminative response scale for eating disorders: bifactor model and measurement invariance in a Portuguese community sampleThe Ruminative Response Scale for Eating Disorders (RRS-ED) measures ruminative thought content specifically related to eating disordered themes, assessing two domains of rumination, brooding and reflection. This study aims to examine the factor structure of the RRS-ED in a Portuguese community sample, using correlated two-factor models, unifactorial and bifactor models and test for invariance across sex. A sample of 535 adults (179 male; 356 female) filled out the RRS-ED. A subsample (n=347) answered additional measures of repetitive negative thinking and eating psychopathology. The bifactor model of the RRS-ED provided the best fit, demonstrating a reliable general rumination factor. Also, the bifactor model of the RRS-ED was invariant across sex. RRS-ED showed moderate to strong correlations with negative perseverative thinking and eating psychopathology. Both domain-specific factors of RRS-ED were associated with higher levels of eating psychopathology. Findings indicate that RRS-ED is a reliable and valid measure to assess the ruminative response from the general population in Portugal, showing initial evidence that supports the use of a total score of RRS-ED as an overall measure of rumination, while specific factor scores should be reported with caution. Future studies are needed to replicate the findings and further corroborate the unidimensionality of the RRS-ED.
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Effectiveness of online social networking interventions on social isolation and quality of life of people with psychosis: A systematic reviewBackground: Social isolation is frequent in people with psychosis, contributing to negative health outcomes. Interventions including online social networking (OSN) may overcome some psychosis-related barriers and facilitate social interactions. However, evidence is currently sparse and needs to be collated in a systematic review to better understand effectiveness. Method: Following PRISMA guidelines, this review yielded 9835 results. Eleven publications, reporting data from five RCTs and six non-controlled studies, met the inclusion criteria. Two independent reviewers undertook data extraction and quality assessment, with results narratively synthesised. Results: This review looked broadly at interventions including either purpose-build platforms for peer-to-peer interactions or existing OSN tools. Yet, we only identified interventions utilising purpose-designed platforms. Early small-scale studies suggested OSN interventions reduced social isolation, but larger effectiveness studies did not confirm these effects. No improvements in quality-of-life outcomes were identified. Conclusion: Higher quality and longer-term studies did not support effectiveness of current OSN interventions in reducing social isolation or improving quality of life of people with psychosis. These interventions used purpose-built platforms and encouraged OSN between selected individuals, which may explain these outcomes. Future research may explore promoting safe use of mainstream OSN platforms to expand the social networks of individuals with psychosis.
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The development of the Compassion Focused Therapy Therapist Competence Rating ScaleObjectives Compassion-focused therapy (CFT) has shown promise as a treatment for a number of clinical presentations; however, existing studies have not adequately addressed issues of treatment fidelity. The aims of the present study were to identify initial candidate items that may be included in a CFT therapist competence rating scale and to develop the behavioural indicators to anchor these items. Design The Delphi method was used to develop and operationalize the competencies required for inclusion in a CFT therapist competence rating scale over five rounds. Methods Face-to-face meetings with two CFT experts were conducted in rounds one, two, and five, and these were used to define and operationalize the competencies. Nine other CFT experts were invited to complete online surveys in rounds two and four. An 80% consensus level was applied to the online surveys. Results The resulting Compassion Focused Therapy Therapist Competence Rating Scale (CFT-TCRS) consisted of 23 competencies which were separated into 14 ‘CFT unique competencies’ and nine ‘Microskills’. There was high agreement about the included ‘CFT unique competencies’ and ‘Microskills’; however, there were some differences in opinion about the specific content of some items. Conclusions This is the first study that has attempted to reach consensus regarding the competencies and behavioural anchors for a CFT therapist competence rating scale. The next stage of development for the CFT-TCRS is to establish whether the scale can be reliably and validly used to evaluate CFT practice.
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Oral health in Dementia: Clinical UpdateDementia is a progressive and debilitating neurodegenerative condition leading to a negative impact on older people’s quality of life and daily activities. Recently, there is interest in the bidirectional association between dementia and poor oral health. Research suggests higher incidence of gingivitis, plaque, periodontitis, mucosal lesions, reduced salivary flow and tooth loss in patients with dementia. Maintaining good oral health is visionary with disease progression and challenging behaviors. Good oral health could be achieved through appropriate oral care advice and education to carers/families with regular professional dental care. Standards of living are improving with increased life expectancy leading to an ageing population (1) which constitutes a risk factor for dementia, with a huge economic and social burden. Family members are negatively impacted, especially with disease progression and behavioral changes (2). Dementia is characterized by progressive cognitive impairment. Patients suffering from dementia usually present with dental conditions influenced by their impaired self-care, polypharmacy, co-existing morbidity, malnutrition, xerostomia, dysphasia, and dysphagia (2). Recent research suggested that dementia patients have higher incidence of caries, retained roots, and orofacial pain (3). There is increased risk of plaque, gingival bleeding, periodontal pockets, xerostomia, reduced salivary flow, stomatitis and oral lesions (3).
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Mental Health and Personality Functioning of People With Probable Personality Disorder Who Have Coexisting Complex Post Traumatic Stress DisorderThis paper examines the prevalence and comorbidity of complex post-traumatic stress disorder (CPTSD) and borderline personality disorder (BPD) among individuals with probable personality disorder, using baseline data from the Structured Psychological Support clinical trial. The clinical characteristics and personality functioning of participants are summarised and compared between those meeting criteria for BPD, CPTSD, both or neither condition. Among 292 participants, 97% reported significant trauma exposure, and over half met the criteria for CPTSD. Those with CPTSD exhibited higher levels of social dysfunction and depression compared with those with BPD, despite both groups showing elevated emotion dysregulation and anxiety. Comorbidity of CPTSD and BPD was high, with 50% of the sample meeting criteria for both conditions. Participants with comorbid CPTSD and BPD displayed poorer baseline scores across all measures of mental health and functioning than those who met criteria for BPD alone. No statistically significant differences were found in suicidal behaviour or treatment-seeking between groups. There were no significant differences in International Classification of Diseases-11 personality trait domains between participants with CPTSD and BPD, but people with comorbid CPTSD and BPD displayed higher levels of trait negative affectivity than those with BPD alone. The findings highlight the need for trauma-informed assessments in clinical settings and a better understanding of the impact of CPTSD on treatment outcomes for people with personality disorder, including how existing treatments may need to be modified to better meet the needs of people with these highly comorbid conditions. TRIAL REGISTRATION: Current controlled trials ISRCTN13918289 (registered 11/11/2022).
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Air Pollution: an environmental risk factor for psychiatric illness?No abstract is available for this article.
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Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trialObjective: To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia. Design: Multicentre, pragmatic, investigator masked, randomised controlled trial. Setting: National Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions. Participants: 494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm. Interventions: Usual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises. Main outcome measures: The primary outcome was score on the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention. Results: The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference -1.4, 95% confidence interval -2.6 to -0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer's disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m). Conclusion: A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.
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Interventions for mental health problems in children and adults with severe intellectual disabilities: a systematic review.Objective: Mental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects. Design: A systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers. Participants: Study samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities. Interventions: Eligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design. Outcomes: Symptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems. Results: We retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data. Conclusions: Mental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities.
