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The Green et al., Paranoid Thoughts Scale (GPTS) - comprising two 16-item scales assessing ideas of reference (Part A) and ideas of persecution (Part B) - was developed over a decade ago. Our aim was to conduct the first large-scale psychometric evaluation. In total, 10 551 individuals provided GPTS data. Four hundred and twenty-two patients with psychosis and 805 non-clinical individuals completed GPTS Parts A and B. An additional 1743 patients with psychosis and 7581 non-clinical individuals completed GPTS Part B. Factor analysis, item response theory, and receiver operating characteristic analyses were conducted. The original two-factor structure of the GPTS had an inadequate model fit: Part A did not form a unidimensional scale and multiple items were locally dependant. A Revised-GPTS (R-GPTS) was formed, comprising eight-item ideas of reference and 10-item ideas of persecution subscales, which had an excellent model fit. All items in the new Reference (a = 2.09-3.67) and Persecution (a = 2.37-4.38) scales were strongly discriminative of shifts in paranoia and had high reliability across the spectrum of severity (a > 0.90). The R-GPTS score ranges are: average (Reference: 0-9; Persecution: 0-4); elevated (Reference: 10-15; Persecution: 5-10); moderately severe (Reference: 16-20; Persecution:11-17); severe (Reference: 21-24; Persecution: 18-27); and very severe (Reference: 25+; Persecution: 28+). Recommended cut-offs on the persecution scale are 11 to discriminate clinical levels of persecutory ideation and 18 for a likely persecutory delusion. The psychometric evaluation indicated a need to improve the GPTS. The R-GPTS is a more precise measure, has excellent psychometric properties, and is recommended for future studies of paranoia.

Compulsory supervision outside hospital has been developed internationally for the treatment of mentally ill people following widespread deinstitutionalisation but its efficacy has not yet been proven. Community treatment orders (CTOs) for psychiatric patients became available in England and Wales in 2008. We tested whether CTOs reduce admissions compared with use of Section 17 leave when patients in both groups receive equivalent levels of clinical contact but different lengths of compulsory supervision. OCTET is a non-blinded, parallel-arm randomised controlled trial. We postulated that patients with a diagnosis of psychosis discharged from hospital on CTOs would have a lower rate of readmission over 12 months than those discharged on the pre-existing Section 17 leave of absence. Eligible patients were those involuntarily admitted to hospital with a diagnosis of psychosis, aged 18–65 years, who were deemed suitable for supervised outpatient care by their clinicians. Consenting patients were randomly assigned (1:1 ratio) to be discharged from hospital either on CTO or Section 17 leave. Randomisation used random permuted blocks with lengths of two, four, and six, and stratified for sex, schizophrenic diagnosis, and duration of illness. Research assistants, treating clinicians, and patients were aware of assignment to randomisation group. The primary outcome measure was whether or not the patient was admitted to hospital during the 12-month follow-up period, analysed with a log-binomial regression model adjusted for stratification factors. We did all analyses by intention to treat. This trial is registered, number ISRCTN73110773. Of 442 patients assessed, 336 patients were randomly assigned to be discharged from hospital either on CTO (167 patients) or Section 17 leave (169 patients). One patient withdrew directly after randomisation and two were ineligible, giving a total sample of 333 patients (166 in the CTO group and 167 in the Section 17 group). At 12 months, despite the fact that the length of initial compulsory outpatient treatment differed significantly between the two groups (median 183 days CTO group vs 8 days Section 17 group, p<0·001) the number of patients readmitted did not differ between groups (59 [36%] of 166 patients in the CTO group vs 60 [36%] of 167 patients in the Section 17 group; adjusted relative risk 1·0 [95% CI 0·75–1·33]). In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients' personal liberty. National Institute of Health Research.

Background Police mental health street triage is an increasingly common intervention when dealing with police incidents in which there is a suspected mental health component. We conducted a systematic review of street triage interventions with three aims. First, to identify papers reporting on models of co-response police mental health street triage. Second, to identify the characteristics of service users who come in to contact with these triage services. Third, to evaluate the effectiveness of co-response triage services. Methods We conducted a systematic review. We searched the following databases: Ovid MEDLINE, Embase, PsycINFO, EBSCO CINAHL, Scopus, Thompson Reuters Web of Science Core Collection, The Cochrane Library, ProQuest National Criminal Justice Reference Service Abstracts, ProQuest Dissertations & Theses, EThoS, and OpenGrey. We searched reference and citation lists. We also searched for other grey literature through Google, screening the first 100 PDFs of each of our search terms. We performed a narrative synthesis of our results. Results Our search identified 11,553 studies. After screening, 26 were eligible. Over two-thirds (69%) had been published within the last 3 years. We did not identify any randomised control trials. Results indicated that street triage might reduce the number of people taken to a place of safety under S136 of the Mental Health Act where that power exists, or reduce the use of police custody in other jurisdictions. Conclusions There remains a lack of evidence to evaluate the effectiveness of street triage and the characteristics, experience, and outcomes of service users. There is also wide variation in the implementation of the co-response model, with differences in hours of operation, staffing, and incident response.

Dissociative experiences occur across a range of mental health disorders. However, the term 'dissociation' has long been argued to lack conceptual clarity and may describe several distinct phenomena. We therefore aimed to conceptualise and empirically establish a discrete subset of dissociative experiences and develop a corresponding assessment measure. First, a systematic review of existing measures was carried out to identify themes across dissociative experiences. A theme of 'Felt Sense of Anomaly' (FSA) emerged. Second, assessment items were generated based on this construct and a measure developed using exploratory (EFA) and confirmatory (CFA) factor analyses of 8861 responses to an online self-report survey. Finally, the resulting measure was validated via CFA with data from 1031 patients with psychosis. 'Felt sense of anomaly' (FSA) was identified as common to many dissociative experiences, affecting several domains (e.g. body) and taking different forms ('types'; e.g. unfamiliarity). Items for a novel measure were therefore systematically generated using a conceptual framework whereby each item represented a type-by-domain interaction (e.g. 'my body feels unfamiliar'). Factor analysis of online responses found that FSA-dissociation manifested in seven ways: anomalous experiences of the self, body, and emotion, and altered senses of familiarity, connection, agency, and reality (Χ2 (553) = 4989.435, p<0.001, CFI = 0.929, TLI = 0.924, RMSEA = 0.052, SRMR = 0.047). Additionally, a single-factor 'global FSA' scale was produced (Χ2 (9) = 312.350, p<0.001, CFI = 0.970, TLI = 0.950, RMSEA = 0.107, SRMR = 0.021). Model fit was adequate in the clinical (psychosis) group (Χ2 (553) = 1623.641, p<0.001, CFI = 0.927, TLI = 0.921, RMSEA = 0.043, SRMR = 0.043). The scale had good convergent validity with a widely used dissociation scale (DES-II) (non-clinical: r = 0.802), excellent internal reliability (non-clinical: Cronbach's alpha = 0.98; clinical: Cronbach's alpha = 0.97), and excellent test-retest reliability (non-clinical: ICC = 0.92). Further, in non-clinical respondents scoring highly on a PTSD measure, CFA confirmed adequate model fit (Χ2 (553) = 4758.673, CFI = 0.913, TLI = 0.906, RMSEA = 0.052, SRMR = 0.054). The Černis Felt Sense of Anomaly (ČEFSA) scale is a novel measure of a subset of dissociative experiences that share a core feature of FSA. It is psychometrically robust in both non-clinical and psychosis groups.

Correspondence to Dr Andrew Molodynski; andrew.molodynski@oxfordhealth.nhs.uk Implications for practice and research This study shows that across a diverse range of first responders in Australia, levels of trauma and of subsequent mental health symptoms are high. Methods This study is a scoping review of available peer-reviewed literature relating to the experience of trauma and mental health in first responders in Australia between 2003 and 2023. The other study reported that 50% of volunteer firefighters had accessed mental health support outside work in the 12 months following bush fires. 16 studies reported on the effects of trauma.

Commentary Although this study was from the USA, the findings and quotes from staff would be similar in A+E departments up and down the UK.2 The pressure of trying to do the best for people with mental health problems in stressful, cramped and noisy departments with endless pressure to ‘get through’ large numbers of waiting patients resonates. Inadequate services and treatment gaps for people with mental health problems are prevalent worldwide.3 Austerity here in the UK has stripped away many of the traditional supports for people in distress and National Health Service mental health services are battered daily by ever increasing demand and a dwindling trained workforce. There is robust evidence for community-based approaches to help people with mental health and substance misuse difficulties—greater investment in them could and should release some of the pressure on busy A+E departments.

Background Mental health problems among medical students are highly prevalent internationally. There have been very few studies however in Nepal. This study aimed to assess the frequency of mental health problems and burnout in Nepalese medical students. Results A total of 169 students responded to the questionnaire. Half (50%) of the surveyed students had some form of mental health problem according to the GHQ-12, while the OLBI showed that 85% students were disengaged and 65% were exhausted. The CAGE screening tool was positive in 14%, and 11% described illicit drug use. Sixty-four percent of students identified their academic studies as their major source of stress. Conclusions Timely recognition of mental health problems is imperative to avert psychiatric illness. Training on early identification and management of stress would be helpful. Further studies are required to identify the factors associated with poor mental health.

Background Medical students in India face multiple challenges and sources of stress during their training. No nationally representative survey has yet been undertaken. We undertook a cross-sectional national survey to assess substance use, psychological well-being, and burnout using CAGE, Oldenburg Burnout Inventory (OLBI), and the short General Health Questionnaire (GHQ-12). The survey was open to all medical students in India. Descriptive statistics along with chi square tests and Spearman’s correlation were performed. Results Burnout was reported by 86% of respondents for disengagement and 80% for exhaustion. Seventy percent had a score of more than 2 on the GHQ-12, indicating caseness. Conclusions This study reveals that medical students are going through exceptional stress when compared to their age-matched peers. More nationally representative studies must be conducted on a large scale to quantify the problem and to help design new interventions.

The unprecedented SARS-2 COVID-19 pandemic has had a profound impact on individuals, families, and societies worldwide. The impact of the illness does not only directly relate to poor health on infection but also social and political determinants of health. As such, the secondary effects of the pandemic have been profound. Mental health and well-being have been one such area of concern, with the causal links thought to occur in three ways. First: the impact on general population, particularly vulnerable groups such as BAME individuals; Second: the impact on people with pre-existing psychiatric disorders; Third: mental health of COVID patients and those who have recovered and their careers. There are lessons to be learnt from previous pandemics and the impact on mental health. There are high levels of anxiety, depression, substance use (particularly alcohol), posttraumatic stress symptoms, and survivor guilt. Within this context, there is a need to consider the differential impact on underprivileged populations. Vulnerable groups include women, children, elderly, minority racial and ethnic groups, LGBT + individuals and the poor. It is noted that these classifications are met with challenges related to definition, and there is significant heterogeneity within the groups and the focus on race, gender, and poverty must be seen through an intersectional lens.

There is no doubt that practice of medicine is an extremely stressful profession. Not surprisingly, training and education in medicine also creates a degree of pressure. In the past 50 years, more attention is being paid to the mental health and well-being of doctors. However, recently focus has shifted to the mental health and well-being of medical students. A series of studies have shown that the rates of mental ill-health among doctors and medical students are exceptionally high and appear to be getting worse. In studies across 12 countries with over 3600 responses, it has been shown that rates of burnout among medical students vary and have been reported to be over 90% of respondents in Hong Kong. Explanations for these high rates vary according to cultural factors which include parental expectations, financial and housing problems, and relationship difficulties. It is crucial that institutions make every effort at looking after the mental health needs of medical students and their medical staff.