Clarifying terminology and definitions in education services for mental health users: A disambiguation study.

In the wake of the mental health crisis in children and adolescents, the coordination of education and mental health services has become a global priority. However, differing terminologies and classifications across sectors, hinder effective comparison. The classification in education focuses mainly on outputs like qualifications or throughputs like teaching programs. This proof-of-concept study tested the applicability of a standard classification of health services, the Description and Evaluation of Services and DirectoriEs (DESDE), to evaluate education services for mental health users in the context of Spain and The Netherlands. It was conducted alongside the PECUNIA project, that sought to develop methods for the assessment of mental health costs and outcomes in different sectors. The study followed an ontoterminology approach involving: 1) identification of services from a predefined list of 46 resource-use items, 2) disambiguation of identified services with the DESDE, and classifying them as accurate, ambiguous, vague or confuse; and 3) external validation by an expert panel. The analysis was conducted at the level of type of resource, target population and care provision. From the initial list, only ten of the resources could be categorized as services using DESDE, and not activities, interventions or professionals. Only four of them (8,65%) were accurate across all disambiguation categories. Experts were unaware of terminology problems in classification of service provision in the education sector. Classifications and glossaries can clarify service naming, description and costing allowing comparative effectiveness analysis and facilitating cross-sectoral planning. This should be grounded in common methodologies, tools, and units of analysis.

[The Hungarian adaptation of the Mental Health Quality of Life Questionnaire (MHQoL)]. / A Mentális Egészséggel Összefüggo Életminoség Kérdoív (MHQoL) magyar adaptációjának bemutatása.

Our study presents the Hungarian adaptation of the Mental Health Quality of Life Questionnaire (MHQoL). BACKGROUND: In recent decades, there has been a shift in the field of healthcare, with a notable change in the ultimate goal of health interventions. Rather than merely reducing symptoms and prolonging life, the objective of health interventions is now to improve quality of life. A number of measures of quality of life have been developed, but the majority of these focus exclusively on physical health and do not fully cover the dimensions that are relevant to the quality of life of people with mental health problems. Van Krugten et al. have developed the Mental Health Quality of Life (MHQoL) questionnaire, which covers the seven most important dimensions of mental health-related quality of life. OBJECTIVES: Our research had the following two main aims. Firstly, it aimed to develop and test a Hungarian adaptation of the Mental Health Quality of Life (MHQoL) questionnaire. Secondly, it aimed to compare the results of healthy individuals and those with diagnosed psychiatric disorders. METHODS: A total of 189 individuals participated in the survey, with 157 classified as psychiatrically healthy and 32 diagnosed with a mental disorder, of which 20 were in acute psychiatric care and 12 were in outpatient care. The data were analysed using confirmatory factor analysis, reliability analysis and independent samples t-test. RESULTS: Our confirmatoriy factor analysis indicated that all items show a good fit with the model. The factor weights for each item were observed to range from 0.45 to 0.79. The Cronbach's α index obtained in our reliability analysis of the MHQoL demonstrated exceptional internal reliability: an index value of 0.81, with individual item- specific reliability coefficients ranging from 0.7 to 0.81. Independent samples t-tests were conducted to assess the statistical significance of differences in mean scores between respondents with and without a psychiatric diagnosis. The results indicated that there were significant differences in the means of the two groups for items pertaining to future vision, mood, relationships and physical health, as well as when comparing the mean scores of the MHQoL total score and the mean scores of psychological well-being. The majority of variables exhibited statistically significant differences from each other, with medium effect sizes. CONCLUSIONS: The results thus far indicate that the Hungarian version of the MHQoL is an effective instrument for differentiating between individuals with and without mental illness, based on psychometric indicators. Furthermore, it provides valuable insights into the domains in which psychiatric illnesses have the greatest impact on patients' quality of life. The objective of our future research is to further validate the MHQoL questionnaire in order to contribute to the concept of healthcare that focuses not only on eliminating symptoms but also on improving quality of life.

A community case detection tool to promote help-seeking for mental health care among children and adolescents in Ugandan refugee settlements: a stepped wedge cluster randomised trial.

BACKGROUND: Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents. METHODS: This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780. FINDINGS: 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use. INTERPRETATION: The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services. FUNDING: Sint Antonius Stichting Projects. TRANSLATIONS: For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

Food Addiction Screening, Diagnosis and Treatment: A Protocol for Residential Treatment of Eating Disorders, Substance Use Disorders and Trauma-Related Psychiatric Comorbidity.

Food addiction, or ultra-processed food addiction (UPFA), has emerged as a reliable and validated clinical entity that is especially common in individuals seeking treatment for eating disorders (EDs), substance use disorders (SUDs) and co-occurring psychiatric disorders (including mood, anxiety and trauma-related disorders). The clinical science of UPFA has relied on the development and proven reliability of the Yale Food Addiction Scale (YFAS), or subsequent versions, e.g., the modified YFAS 2.0 (mYFAS2.0), as well as neurobiological advances in understanding hedonic eating. Despite its emergence as a valid and reliable clinical entity with important clinical implications, the best treatment approaches remain elusive. To address this gap, we have developed and described a standardized assessment and treatment protocol for patients being treated in a residential program serving patients with psychiatric multi-morbidity. Patients who meet mYFAS2.0 criteria are offered one of three possible approaches: (1) treatment as usual (TAU), using standard ED treatment dietary approaches; (2) harm reduction (HR), offering support in decreasing consumption of all UPFs or particular identified UPFs; and (3) abstinence-based (AB), offering support in abstaining completely from UPFs or particular UPFs. Changes in mYFAS2.0 scores and other clinical measures of common psychiatric comorbidities are compared between admission and discharge.

Towards effective screening for paternal perinatal mental illness: a meta-review of instruments and research gaps.

Background: Paternal perinatal mental illness (PPMI), which affects around one in 10 fathers, is under-recognised despite increasing awareness of men's mental health in the perinatal period. Social stigma and men's reluctance to seek help exacerbate this gap. Neglecting the mental health needs of new fathers not only puts them at increased risk for mental illness themselves, but also has a profound and long-lasting impact on their families, children and their own self-esteem as they navigate their new role in the family dynamic. Objective: This meta-review systematically identifies instruments assessing PPMI symptoms, evaluates their psychometric properties and applicability, presents key findings from studies using these tools, and identifies gaps and limitations in the literature on PPMI symptom assessment. Methods: A systematic literature review was conducted using search strategies applied to PubMed, PsycNet APA, Cochrane, and Web of Science, supplemented by hand searches. Relevant information was extracted from each included study. Extracted data were analysed narratively to address the research questions. Results: Findings identified limitations and gaps in current screening practices. While the Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for both fathers and mothers, it inadequately captures atypical depressive symptoms in men. Cutoff scores lack consensus, and instrument sensitivity varies significantly due to cultural and sociodemographic factors. A number of other screening tools have been identified, most of which are more general and not specifically designed for perinatal mental health. Conclusion: This meta-review broadens perspectives on PPMI screening instruments, highlighting key themes, patterns, and differences across the included reviews. While a variety of screening tools are used, the review underscores the necessity for tools specifically tailored to fathers during the perinatal period.

Neurological and Psychiatric Clinical Manifestations of Sjögren Syndrome.

PURPOSE OF REVIEW: Sjögren Syndrome is a systemic autoimmune disorder that presents mainly with sicca symptoms, but frequently affects other body systems which can lead to a wide variety of manifestations. Understanding the neurological and psychiatric manifestations of Sjögren Syndrome can help with an earlier diagnosis of this disease and leads to better clinical outcomes. RECENT FINDINGS: We provide an updated overview of the central neurological manifestations, peripheral neurological manifestations and psychiatric manifestations and their diagnosis when associated with primary Sjögren Syndrome. The epidemiology and clinical features of the neurological and psychiatric manifestations are derived from different cohort studies and review articles that were selected from PubMed searches conducted between January 2024 and March 2024. The absence of diagnostic criteria and the scarcity of large, robust studies makes the recognition of the neurological and psychiatric manifestations of Sjögren Syndrome more difficult. Maintaining a high index of suspicion in clinical practice and a close collaboration between the Neurologist and the Rheumatologist will facilitate the diagnosis and management of these patients.

Developing a transdiagnostic Ecological Momentary Assessment protocol for psychopathology.

OBJECTIVES: The network approach to psychopathology posits that mental disorders emerge from dynamic interactions among psychopathology-relevant variables. Ecological Momentary Assessment (EMA) is frequently used to assess these variables in daily life. Considering the transdiagnostic nature of the network approach to psychopathology, this study describes the development of a transdiagnostic EMA protocol for psychopathology. METHODS: First, 96 clinicians completed an online survey, providing three EMA constructs for up to three disorders they specialize in, and three EMA constructs relevant across disorders (transdiagnostic constructs). Second, 12 focus groups were conducted with clinical experts for specific types of diagnoses (e.g., mood disorders, anxiety disorders). Finally, a selection of items was reached by consensus. Two raters independently coded the online survey responses with an inter-rater agreement of 87.3%. RESULTS: Jaccard indices showed up to 52.6% overlap in EMA items across types of diagnoses. The most frequently reported transdiagnostic constructs were mood, sleep quality, and stress. A final set of EMA items is created based on items' frequency and informativeness, ensuring completeness across diagnoses and minimizing burden. CONCLUSIONS: The described procedure resulted in a feasible EMA protocol to examine psychopathology transdiagnostically. Feasibility was helped by the overlap in mentioned symptoms across disorders. Such overlap raises questions about the validity of DSM categories.

The evaluation of the General Health Questionnaire (GHQ-12) reliability generalization: A meta-analysis.

BACKGROUND: The General Health Questionnaire (GHQ-12) is widely used for detecting psychiatric disorders, but its reliability across different populations remains to be determined. OBJECTIVE: This meta-analysis aims to evaluate the reliability of GHQ-12 across varied cultural and demographic settings. METHOD: This meta-analysis evaluates the reliability of General Health Questionnaire [GHQ-12]' across diverse populations, employing a systematic search strategy and rigorous inclusion criteria. This meta-analysis evaluates the General Health Questionnaire (GHQ-12) using a pre-registered protocol (CRD42023488436) to ensure unbiased results. Data from 20 studies published between 2016-2023 were analysed using a random-effects model, with quality assessment guided by COSMIN Risk of Bias and QUADAS-2. This study enhances our understanding of GHQ-12's psychometric properties. RESULTS: For the GHQ-12 subscales, Cronbach's alpha coefficients were 0.72 (90% CI [0.68, 0.75]) for anxiety and depression, 0.82 (90% CI [0.79, 0.86]) for social dysfunction, and 0.72 (90% CI [0.68, 0.76]) for loss of confidence. However, the analysis showed substantial heterogeneity (I2 = 90.04%), with significant variability in reliability estimates across different studies. The overall Cronbach's alpha was 0.84 (95% Cl [0.810, 0.873]) with SE = 0.016 (90% CI [0.68, 0.82], p < .05), indicating moderate to high internal consistency. Quantifying heterogeneity revealed a substantial level (se = 0.0016, I2 = 96.7%), signifying considerable variability in the reliability estimate among the studies. Results further show Cronbach's alpha coefficients range from 0.82 to 0.85 (95% Cl [0.77, 0.86 to 0.81, 0.90]) for the GHQ 12 items. CONCLUSION: While reaffirming the GHQ-12's utility in mental health assessment, our findings urge a more cautious and context-aware application of the questionnaire. The substantial heterogeneity and variability in reliability scores indicate a need for further research. Future studies should explore the reasons behind this variability, focusing on cultural, socio-economic, and methodological factors that might influence the GHQ-12's reliability. This critical analysis underscores the need for a deeper understanding of the GHQ-12's applicability and the importance of tailoring mental health assessment tools to specific population characteristics.

Diagnóstico y formulación de casos en terapia psicodinámica: una revisión sobre herramientas actuales.

En las últimas dos décadas, diversos grupos de trabajo de la comunidad psicoanalítica internacional se han interesado por el desarrollo de herramientas sistemáticas para el diagnóstico, la formulación de los casos y la planificación del tratamiento psicodinámico. Este tipo de manuales diagnósticos psicodinámicos son esfuerzos de integración sistemática de una enorme y rica cantidad de información históricamente parcializada y dispersa, pero que constituye el aporte sustancial del psicoanálisis al campo de la salud mental. El objetivo del presente artículo es ofrecer una revisión actualizada sobre esta clase de herramientas sistemáticas de diagnóstico, formulación del caso y planificación terapéutica, diseñadas para el campo de los abordajes psicodinámicos. A estos fines, se describe la estructura y los objetivos de: 1) el Manual Diagnóstico Psicodinámico 2 (PDM-2), 2) el Diagnóstico Psicodinámico Operacionalizado (OPD-2/OPD-3) y 3) el Diagnóstico Psicodinámico Operacionalizado Infanto-Juvenil 2 (OPD-IJ-2).Se discuten las contribuciones de estas herramientas actuales para la práctica clínica y la investigación empírica, así como la necesidad de difundir este tipo de instrumentos en nuestro contexto regional.

Exploratory rasch analysis of a static-99R clinical cohort assessment.

Modern test theory supplements the more prevalent classic methods for assessing test properties. However, such an assessment of the commonly used sexual recidivism risk assessment instrument, Static-99R, has yet to be attempted. This study evaluated the psychometric properties of said instrument using Rasch analysis. The clinical cohort assessed consisted of individuals with mental disorders convicted of a sexual offense (N = 146). Results showed that the original ten-item Static­99R did not meet the Rasch model requirements, and revisions of the instrument with seven and nine items each only marginally improved performance. More reliable results could likely have been obtained with a larger, non-clinical sample and a more randomized distribution of missing data. Despite the consistently poor performance of item 3 ("Index non-sexual violence") in all three analyses, reliability was slightly improved by dichotomizing the only two polytomous items in the Static-99R; items 1 ("Age at release from index offense") and 5 ("Prior sexual offenses"). These results may be of interest considering the significant change of splitting the formerly dichotomous item 1 into four different response categories in the revision of Static-99 to Static-99R.

The role of maternal and child healthcare providers in identifying and supporting perinatal mental health disorders.

BACKGROUND: Perinatal depression (PND) is underdiagnosed in the clinical setting. This study explores the role of obstetricians, and other primary care providers of maternal and child healthcare in detecting, screening, and referring women during the perinatal period identified as depressed, anxious, or exhibiting other symptoms of mental health disorders. METHOD: Information was gathered from obstetricians (n = 16), and other primary care providers (pediatricians, nurse practitioners, physician assistants) (n = 85), on identifying and supporting childbearing women with symptoms of perinatal depression using an online survey. RESULTS: Statistical comparisons across participant groups were adjusted for years of practice in the profession. Statistically significant differences were noted. Obstetricians inquired more about the mother's social support network (p = .011) and addressed mothers that appeared sad, upset, or unhappy (p = .044) compared to other primary care providers. Other primary care providers were more likely to refer patients to mental health support services (p = .005), provide PND-related information in their waiting rooms (p = .008), and use the Edinburgh Postnatal Depression Scale (EPDS) (p = .027). There was also a significant difference in positively identifying eight symptoms of PND between provider groups. Obstetricians had higher rates of identifying the following symptoms: excessive crying (p < .001), feeling little or no attachment to the infant (p < .001), little feeling of enjoyment (p = .021), feelings of failure (p < .001), hopelessness (p < .001), agitation with self and infant (p < .001), fear of being alone with the infant (p = .011), and fear that these symptoms would last (p < .001). CONCLUSION: Although certain screening practices were performed well, especially by the obstetrician group, screening deficits were noted within each group, and screening practices differed between groups. Training offered to maternal child health primary care providers on addressing perinatal mental health disorders may help improve provider screening practices and detection of PND symptoms in perinatal women. PND screening that combines face-to-face open-ended interviews with standardized screening tools can enhance patient-provider communication, potentially improving PND detection rates and follow-up care in perinatal women.

Detection and disclosure of workplace mental health challenges: an exploratory study from India.

Workplace mental health challenges have emerged as a significant concern post-pandemic. Despite this, the pervasive stigma surrounding mental illness leads to the concealment of symptoms and reluctance to seek professional help among employees. This study aims to explore the perception of different stakeholders towards the 'Detection and disclosure' of workplace mental health challenges in the Indian context. Fifteen semi-structured interviews were conducted with human resource professionals, counselors, and employees who had previously experienced mental health challenge(s). Thematic analysis was done to identify recurring themes and sub-themes. Three critical pathways were identified: minimizing the inhibitory factors, including lack of awareness, denial, low self-efficacy, stigma, and underestimating organizational capability; maximizing the encouraging factors, including psychological safety, perceived social support, and communicating success stories; and implementing supportive organizational practices, including generating awareness and literacy, build the organizational capability, strengthen the role of managers, leadership advocacy, policies, and processes. By fostering a culture of support and prioritizing employee well-being, organizations in India can create healthier and more resilient work environments, benefiting both individuals and the larger society.

Measurement-Based Care for Pediatric and Adolescent Mental Health Disorders as a Decision-Making Support Paradigm for Clinical Practice: A Review.

This article makes a case to encourage pediatric/adolescent care providers and healthcare systems to implement measurement-based standardized assessments of patient's baseline and longitudinal health outcomes for mental disorders to help institute evidence-based treatments. The article discusses the current underutilization, challenges, barriers, and concerns from stakeholders with measurement-based care in clinical settings while also highlighting the advantages and importance of the aforementioned care model.

Enhancing the accuracy of register-based metrics: Comparing methods for handling overlapping psychiatric register entries in Finnish healthcare registers.

OBJECTIVES: Healthcare registers are invaluable resources for research. Partly overlapping register entries and preliminary diagnoses may introduce bias. We compare various methods to address this issue and provide fully reproducible open-source R scripts. METHODS: We used all Finnish healthcare registers 1969-2020, including inpatient, outpatient and primary care. Four distinct models were formulated based on previous reports to identify actual admissions, discharges, and discharge diagnoses. We calculated the annual number of treatment events and patients, and the median length of hospital stay (LOS). We compared these metrics to non-processed data. Additionally, we analyzed the lifetime number of individuals with registered mental disorders. RESULTS: Overall, 2,130,468 individuals had a registered medical contact related to mental disorders. After processing, the annual number of inpatient episodes decreased by 5.85%-10.87% and LOS increased by up to 3 days (27.27%) in years 2011-2020. The number of individuals with lifetime diagnoses reduced by more than 1 percent point (pp) in two categories: schizophrenia spectrum (3.69-3.81pp) and organic mental disorders (1.2-1.27pp). CONCLUSIONS: The methods employed in pre-processing register data significantly impact the number of inpatient episodes and LOS. Regarding lifetime incidence of mental disorders, schizophrenia spectrum disorders require a particular focus on data pre-processing.

Primary care physicians' perceptions of artificial intelligence systems in the care of adolescents' mental health.

BACKGROUND: Given that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs' challenges in addressing adolescents' mental health, along with their attitudes towards using AI to assist them in their tasks. METHODS: We used purposeful sampling to recruit PCPs for a virtual Focus Group (FG). The virtual FG lasted 75 minutes and was moderated by two facilitators. A life transcription was produced by an online meeting software. Transcribed data was cleaned, followed by a priori and inductive coding and thematic analysis. RESULTS: We reached out to 35 potential participants via email. Seven agreed to participate, and ultimately four took part in the FG. PCPs perceived that AI systems have the potential to be cost-effective, credible, and useful in collecting large amounts of patients' data, and relatively credible. They envisioned AI assisting with tasks such as diagnoses and establishing treatment plans. However, they feared that reliance on AI might result in a loss of clinical competency. PCPs wanted AI systems to be user-friendly, and they were willing to assist in achieving this goal if it was within their scope of practice and they were compensated for their contribution. They stressed a need for regulatory bodies to deal with medicolegal and ethical aspects of AI and clear guidelines to reduce or eliminate the potential of patient harm. CONCLUSION: This study provides the groundwork for assessing PCPs' perceptions of AI systems' features and characteristics, potential applications, possible negative aspects, and requirements for using them. A future study of adolescents' perspectives on integrating AI into mental healthcare might contribute a fuller understanding of the potential of AI for this population.

Neuropsychiatric Complications of Hypervitaminosis D: Diagnosis, Evaluation, and Treatment.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2024;26(3):23f03680. Author affiliations are listed at the end of this article.

Prevalence of mental, behavioural or neurodevelopmental disorders according to the International Classification of Diseases 11: a scoping review protocol.

INTRODUCTION: Due to a change in diagnostic prerequisites and the inclusion of novel diagnostic entities, the implementation of the 11th revision of the International Classification of Diseases (ICD-11) will presumably change prevalence rates of specific mental, behavioural or neurodevelopmental disorders and result in an altered prevalence rate for this grouping overall. This scoping review aims to summarise the characteristics of primary studies examining the prevalence of mental, behavioural or neurodevelopmental disorders based on ICD-11 criteria. The knowledge attained through this review will primarily characterise the methodological approaches of this research field and additionally assist in deciding which psychiatric diagnoses are-given the current literature-most relevant for subsequent systematic reviews and meta-analyses intended to approximate the magnitude of prevalence rates while providing a first glimpse of the range of expected (differences in) prevalence rates in these conditions. METHODS AND ANALYSIS: MEDLINE, Embase, Web of Science and PsycINFO will be searched from 2011 to present without any language filters. This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines.We will consider (a) cross-sectional and longitudinal studies (b) focusing on the prevalence rates of mental, behavioural or neurodevelopmental disorders (c) using ICD-11 criteria for inclusion. The omission of (a) case numbers and sample size, (b) study period and period of data collection or (c) diagnostic procedures on full-text level is considered an exclusion criterion.This screening will be conducted by two reviewers independently from one another and a third reviewer will be consulted with disagreements. Data extraction and synthesis will focus on outlining methodological aspects. ETHICS AND DISSEMINATION: We intend to publish our review in a scientific journal. As the primary data are publicly available, we do not require research ethics approval.

Severe psychiatric disorders are associated with increased risk of dementia.

BACKGROUND: Individuals with psychiatric disorders have an increased risk of developing dementia. Most cross-sectional studies suffer from selection bias, underdiagnosis and poor population representation, while there is only limited evidence from longitudinal studies on the role of anxiety, bipolar and psychotic disorders. Electronic health records (EHRs) permit large cohorts to be followed across the lifespan and include a wide range of diagnostic information. OBJECTIVE: To assess the association between four groups of psychiatric disorders (schizophrenia, bipolar disorder/mania, depression and anxiety) with dementia in two large population-based samples with EHR. METHODS: Using EHR on nearly 1 million adult individuals in Wales, and from 228 937 UK Biobank participants, we studied the relationships between schizophrenia, mania/bipolar disorder, depression, anxiety and subsequent risk of dementia. FINDINGS: In Secure Anonymised Information Linkage, there was a steep increase in the incidence of a first diagnosis of psychiatric disorder in the years prior to the diagnosis of dementia, reaching a peak in the year prior to dementia diagnosis for all psychiatric diagnoses. Psychiatric disorders, except anxiety, were highly significantly associated with a subsequent diagnosis of dementia: HRs=2.87, 2.80, 1.63 for schizophrenia, mania/bipolar disorder and depression, respectively. A similar pattern was found in the UK Biobank (HRs=4.46, 3.65, 2.39, respectively) and anxiety was also associated with dementia (HR=1.34). Increased risk of dementia was observed for all ages at onset of psychiatric diagnoses when these were divided into 10-year bins. CONCLUSIONS: Psychiatric disorders are associated with an increased risk of subsequent dementia, with a greater risk of more severe disorders. CLINICAL IMPLICATIONS: A late onset of psychiatric disorders should alert clinicians of possible incipient dementia.