Examining the Associations Between Substance Misuse and Suicide Bereavement.

Focusing on the understudied question of substance misuse among suicide bereaved adults we investigated patterns of binge drinking and non-prescribed drug use among a recently bereaved sample (n = 1,132). Comparing our respondents to the non-bereaved, those in the 2022 National Survey of Drug Use and Health (n = 71,369), we did not find heightened problematical substance misuses among our respondents. With t-tests and multiple regression analyses we examined whether binge drinkers and non-prescribed drug users had heightened levels of grief difficulties, PTSD, self-blaming and depression compared to others not bingeing or using non-prescribed drugs. Results showed binge drinkers had more of all these grieving problems when important confounding variables were also considered. Analysis of the demographic correlates of bingeing showed them dimly aware of their own additional grieving and substance misusing problems. Since 75% indicated being under the care of counseling professionals, this represents an important opportunity for psycho-educational helping.

Detection of and response to gender-based violence: a quality improvement project across three secondary mental health services in London.

AIMS AND METHOD: Our team of core and higher psychiatry trainees aimed to improve secondary mental health service detection of and response to gender-based violence (GBV) in South East London. We audited home treatment team (HTT), drug and alcohol (D&A) service and in-patient ward clinical records (n = 90) for female and non-binary patients. We implemented brief, cost-neutral staff engagement and education interventions at service, borough and trust levels before re-auditing (n = 86), completing a plan-do-study-act cycle. RESULTS: Documented enquiry about exposure to GBV increased by 30% (HTT), 15% (ward) and 7% (D&A), post-intervention. We identified staff training needs and support for improving GBV care. Up to 56% of records identified psychiatric symptoms related to GBV exposure. CLINICAL IMPLICATIONS: Moves to make mental healthcare more trauma-informed rely on services first being supportive environments for enquiry, disclosure and response to traumatic stressors. Our collaborative approach across clinical services increased GBV enquiry and documentation. The quality of response is more difficult to measure and requires concerted attention.

Living with Psychosis without Mental Health Services: A Narrative Interview Study.

OBJECTIVES: Little research has looked at how people who do not use mental health services experience psychosis. Thus, the present study aimed to explore the experiences and views of people with psychosis who have neither sought nor received support from mental health services for at least 5 years. DESIGN: A narrative interview study. Thematic analysis was used to analyse the data. SETTING: England. PARTICIPANTS: Twenty-eight participants with self-defined psychotic experiences were asked to provide a free narrative about their experiences. RESULTS: Five themes were identified: (1) Perceiving psychosis as positive; (2) Making sense of psychotic experiences as a more active psychological process to find explanations and meaning; (3) Finding sources of strength, mainly in relationships and the environment, but outside of services; (4) Negative past experiences of mental health services, leading to disengagement and (5) Positive past experiences with individual clinicians, as an appreciation of individuals despite negative views of services as a whole. CONCLUSIONS: Perceiving psychosis as something positive, a process of making sense of psychotic experiences and the ability to find external sources of strength all underpin-in addition to negative experiences with services-a choice to live with psychosis outside of services. Future research may explore to what extent these perceptions, psychological processes and abilities can be facilitated and strengthened, in order to support those people with psychosis who do not seek treatment and possibly also some of those who are in treatment.

Postpartum smoking relapse--a thematic synthesis of qualitative studies.

BACKGROUND AND AIMS: Many women quit smoking during pregnancy, but relapse after the baby is born. To understand why and identify ways of preventing this, this study reviewed the qualitative literature on women's experience of postpartum smoking relapse. METHODS: A systematic review of qualitative studies and process evaluations of trials. We undertook a thematic synthesis of published qualitative data. RESULTS: We screened 1336 papers. Twenty-two papers reporting on 16 studies were included, reporting on the views of 1031 postpartum women. Factors affecting relapse and barriers and facilitators to relapse prevention were identified around the key themes of beliefs, social influences, motivation, physiological factors and identity. Women's beliefs about smoking as a means of coping with stress and the need for social support, especially from a partner, emerged as important. Extrinsic motivation to quit during the pregnancy (for the health of the fetus) appeared to be a factor in prompting relapse after the baby was born. During the immediate postpartum period women believed that physiological changes influence cigarette cravings. The stress of caring for a newborn, sleeplessness and adjusting to a new mothering identity were also reported to be important. CONCLUSIONS: Among women who quit smoking during pregnancy, those who relapse postpartum talk commonly about no longer needing to protect the baby and the effects of stress. Partner support and a sense of changed identity are cited as factors preventing relapse.

Is Rafflesia an endothermic flower?

• The giant flowers of the parasitic Rafflesia occur in the shade of the forest understorey. They present several characteristics in common with the related species, Rhizanthes lowii, which is a strongly endothermic flower. The possible existence of endothermy in Rafflesia tuan-mudae was investigated here. • The internal and surface temperature of the flowers were continuously monitored with fine thermocouples while radiation fluxes and microclimatic variables were recorded. A computational fluid dynamic model was used to predict the concentrations of CO2 inside the diaphragm of the flower. • It was found that the internal parts of the flower were maintained a few degrees (1-6 K) above air temperature. It was not possible to account for this temperature rise without postulating a significant internal source of heat. It was concluded that R. tuan-mudae is an endothermic flower that generates a maximum of 50-60 W m-2 of heat in the centre of the column. • The possible role of endothermy, CO2 and volatiles as elements in the mimicry of the flower to attract pollinating blowflies is discussed and compared with the related species Rhizanthes lowii.