Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

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admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Impact of COVID-19 pandemic on mental health in the general population: A systematic review.

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Applied Longitudinal Data Analysis Modeling Change And Event Occurrence

Background
During the COVID-19 pandemic general medical complications have received the most attention, whereas only few studies address the potential direct effect on mental health of SARS-CoV-2 and the neurotropic potential. Furthermore, the indirect effects of the pandemic on general mental health are of increasing concern, particularly since the SARS-CoV-1 epidemic (2002–2003) was associated with psychiatric complications.

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COVID-19 pandemic and mental health consequences: Systematic review of the current evidence.

Introduction The sudden changes in daily routine due to the containment measures adopted for facing the COVID-19 pandemic have had an impact on the mental health of the general population. In particular, young adults are exposed to a higher risk compared to the general population to suffer from the consequences of the pandemic, in terms of anger and irritability, depressive symptoms and somatic complaints, insomnia, lack of motivation and loneliness. In particular, loneliness can be particularly pronounced during young adulthood. Objectives This study aimed to describe the levels of loneliness in a sample of Italian young people during the national lockdown in 2020, evaluating clinical and socio-demographic differences and the role of coping strategies and levels of resilience. Methods A sub-analysis of a sample of adults aged 18-34 years has been drawn on a larger cross-sectional observational national trial (COMET, 2020) in which, among other psychopathological dimensions, the levels of loneliness have been assessed by the UCLA scale short version. Results Levels of loneliness were particularly severe in a third of cases (risk factors: unemployment, low income and vulnerability in mental health), in association with depression, anxiety, stress, OCD symptoms, higher rates of suicidal ideation, sleep disturbance and excessive use of Internet. Levels of loneliness tended to increase over time. Conclusions Overall, during the Italian COVID-19 lockdown young people have experienced quite high levels of loneliness: this dimension could represent a useful domain to assess in routine clinical practice. Disclosure No significant relationships.

Young and lonely? Results from the COMET study

Severe mental disorders are leading causes of disability and significant risk factors for premature mortality worldwide. It has been estimated that more than 800 million people are suffering from any mental disorder and its related burden is steadily increasing (Collins, 2020). Moreover, the COVID-19 pandemic is adding further impairment on mental health of the general population, thus contributing to increased prevalence of mental disorders (Greenberg & Rafferty, 2021; Un€ utzer et al., 2020). In fact, it is anticipated that the mental health consequences of the pandemic will be even worse in the near future and are not expected to reduce in the aftermath of this international health, economic and social crisis (Adhanom Ghebreyesus, 2020; Wang et al., 2021). According to the most recent estimates of the global burden of diseases (Arias et al., 2022; Knapp & Wang 2020), at least 16% of global DALYs can be attributable to mental disorders, with economic loss of 5 USD trillion. Therefore, patients suffering from mental disorders need to be adequately and timely identified, diagnosed, and managed with appropriate personalised treatment plans. The starting point for an optimal management of patients with severe mental disorders is the clinical characterisation of each individual case (Maj et al., 2020, 2021; Stein et al., 2021), which include the following clinical factors: symptom profile (Tanner et al., 2019), clinical subtypes and severity of the disorder (Wu et al., 2022), level of functioning and quality of life (Mollon et al., 2021), personality traits (Mulder, 2021; Santesteban-Echarri et al., 2021), antecedent and concomitant psychiatric conditions (Balachander et al., 2022; Erzin et al., 2021; Silove, 2021; van der Wal et al., 2020; Glover, 2020), physical comorbidities (Luciano et al., 2022; Plana-Ripoll et al., 2020), family history (Ayerbe et al., 2020; Duarte et al., 2020), and the presence of protective factors (Feldman, 2020). All these aspects are transdiagnostic and are too often overlooked, especially by younger generation of trainees and early career psychiatrists, which prefer to search for the exact number of diagnostic criteria to be satisfied. Recent data have confirmed that the transdiagnostic approach is useful for identifying risk and protective factors of mental disorders (Heckers & Kendler, 2020; Pettersson et al., 2020). For example, common risk factors such as childhood adversities or being exposed to stressful events are mostly involved in the early neurodevelopmental period for all mental disorders (Arango et al., 2021). Another aspect which needs to be taken into consideration is related to the reciprocal influence of environment on genes, particularly pollution, climate change and urbanicity, which are common risk factors for several physical (e.g. cancer, infectious diseases) and mental disorders (e.g. psychosis, affective disorders). The personalised approach to mental disorders is necessary in order to achieve patient’s recovery (Reynolds, 2020; Swift et al., 2021). Unfortunately, recovery rates for patients with severe mental disorders are still far to be satisfying. In the case of patients with major depressive disorders, full recovery happens only in 30% of patients, with the remaining 70% having residual symptoms (Salzer et al., 2018), treatment-resistance (Fonseca de Freitas et al., 2022; Kadra-Scalzo et al., 2022; Zhdanava et al., 2021) and functional impairment (Karpov et al., 2017). It appears mandatory to identify innovative treatment strategies to promote recovery in patients with severe mental disorders. A recent innovation is represented by telepsychiatry and telemental health, which gives patients the ability to meet with mental health professional without having the necessity to leave their home. It improves the availability of mental healthcare, reducing delays in care that can lead to emergency room trips or the need for expensive inpatient care. A further innovation in telepsychiatry is represented by the adoption of digital tools for youth mental health, as discussed by Orsolini et al. (2022). In order to introduce innovative approaches, it is necessary to rethink the ethiopathogenesis of mental disorders and searching for new determinants of mental health. In this special issue, the role of noise pollution has been evaluated as a possible innovative determinant for mental health and mental health problems, which has been a neglected topic in psychiatry for many years. Another important innovation in mental health is the discovery of the gene-environment interaction in the development of mental disorders, which has been highlighted by Fusar-Poli et al. (2022). Other innovations summarised in this issue include the topic of community psychiatry (Carr a et al., 2022), clinical psychiatry (Carmassi et al., 2022; Demyttenaere, 2022; Jovanovi c et al., 2022; Provenzani et al., 2022), clinical decision making (Luciano et al., 2022),

Innovations in psychiatry: challenges and future directions

Effect of affective temperament on illness characteristics of subjects with bipolar disorder and major depressive disorder.

Introduction Bipolar disorder (BD) is associated to high personal and social burden, impaired social functioning and high levels of disability. Recent studies have showed that relapse rates are significantly reduced in those patients whose families receive psychoeducational interventions. Even though most of available evidences are related to the short-term efficacy of psychoeducational family interventions (PFI). No evidence is available on medium and long-term efficacy. Objectives This study aims to assess the efficacy after one and five years of PFI in BD in terms of: 1) improvement of patients’ symptoms and global functioning; 2) improvement of relatives’ objective and subjective burden and coping strategies. Methods A multicenter, controlled, outpatient trial has been conducted in BD patients and their key relatives, recruited in 11 Italian mental health centers. Patient’s clinical status, social and personal functioning, burden of illness, and relative’s burden and coping strategies were assessed with specific instruments at baseline, after 1 year and after 5 years. Results 137 families were recruited, 70 allocated to the experimental intervention. After one year, an increasing positive effect on patients’ clinical status, global functioning and objective and subjective burden was found. Moreover, were observed a reduced number of relapses and of hospitalizations after five years, compared to the control group. A reduction in the levels of family burden and an improvement of their coping strategies were also observed. Conclusions Positive effects of the experimental intervention persist over the mid and long-term period. PFI should be provided in mental health centres to patients with BD and their relatives. Disclosure No significant relationships.

Andrea Fiorillo

Papers

Young and lonely? Results from the COMET study

Innovations in psychiatry: challenges and future directions

Effect of affective temperament on illness characteristics of subjects with bipolar disorder and major depressive disorder.

Psychoeducational family intervention for bipolar I disorder: medium and long-term efficacy

Coercive Measures and Involuntary Hospital Admissions in Psychiatry