2019). Hospitalisation and length of hospital stay following first-episode psychosis: Systematic review and metaanalysis of longitudinal studies. Psychological Medicine. https://doi. AbstractBackground: Reducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in hospital during follow-up.Methods: Studies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted. Results: 81 longitudinal studies encompassing data for 23280 FEP patients with an average follow-up length of 7 years were included. 55% (95%CI=50.3-60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95%CI=95.1-138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS. Conclusion: One in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest. Key words: First episode psychosis / schizophrenia / hospitalisation / length of stay / inpatient / follow-up / outcome R.M.M. has received honoraria from Janssen, Astra-Zeneca, Lilly, and BMS. A.S.D. has received honoraria from Janssen and Roche Pharmaceuticals. F.G. has received honoraria for advisory work and lectures from Roche, BMS, Lundbeck, Otsuka and Sunovion and has a family member with professional links to Lilly and GSK. The other authors (O.A., B.S., J.L., E.F.) have no conflict of interest to declare. References Agius M, Hadjinicolaou AV, Ramkisson R, Shah S, Haq SU, Tomenson B, Zaman R. (2010). Does early intervention for psychosis work? An analysis of outcomes of early intervention in psychosis based on the critical period hypothesis, measured by number of admissions and bed days used over a period of six years, the first three in an early intervention service, the second three in a community mental health team. Psychiatria Danubina 22, s72-84. (2017) Patterns of illness and care over the 5 years following onset of psychosis in different ethnic groups; the gap-5 s...

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Background: A proportion of people with treatment-resistant schizophrenia fail to show improvement on clozapine treatment. Knowledge of the sociodemographic and clinical factors predicting clozapine response may be useful in developing personalised approaches to treatment. Methods: This retrospective cohort study used data from the electronic health records of the South London and Maudsley (SLaM) hospital between 2007 and 2011. Using the Least Absolute Shrinkage and Selection Operator (LASSO) regression statistical learning approach, we examined 35 sociodemographic and clinical factors’ predictive ability of response to clozapine at 3 months of treatment. Response was assessed by the level of change in the severity of the symptoms using the Clinical Global Impression (CGI) scale. Results: We identified 242 service-users with a treatment-resistant psychotic disorder who had their first trial of clozapine and continued the treatment for at least 3 months. The LASSO regression identified three predictors of response to clozapine: higher severity of illness at baseline, female gender and having a comorbid mood disorder. These factors are estimated to explain 18% of the variance in clozapine response. The model’s optimism-corrected calibration slope was 1.37, suggesting that the model will underfit when applied to new data. Conclusions: These findings suggest that women, people with a comorbid mood disorder and those who are most ill at baseline respond better to clozapine. However, the accuracy of the internally validated and recalibrated model was low. Therefore, future research should indicate whether a prediction model developed by including routinely collected data, in combination with biological information, presents adequate predictive ability to be applied in clinical settings.

Highlights Antidepressant gender disparity less in type 2 diabetes than general population No evidence of ethnic disparity in antidepressant prescribing in type 2 diabetes No evidence of disparity in antidepressant prescribing for insulin users Considerable evidence gaps for antidepressant prescribing in type 2 diabetes

Background Researchers use both subjective self‐report and objective measures, such as official records, to investigate the impact of childhood adversity on psychopathology. However, it is unclear whether subjective and objective measures of childhood adversity (a) show agreement, and (b) differentially predict psychopathology. Method To address this, we conducted a pre‐registered meta‐analysis to examine the agreement between subjective and objective measures of childhood adversity, and their prediction of psychopathology. We searched in PubMed, PsycINFO and Embase for articles with both subjective measures (self‐reports) and objective measures of childhood adversity (comprising official records, or reports from multiple informants unrelated to the target individual), and measures of psychopathology. Results We identified 22 studies (n = 18,163) with data on agreement between subjective and objective measures of childhood adversities, and 17 studies (n = 14,789) with data on the associations between subjective and objective measures with psychopathology. First, we found that subjective and objective measures of childhood adversities were only moderately correlated (e.g. for maltreatment, r = .32, 95% CI = 0.23–0.41). Second, subjective measures of childhood adversities were associated with psychopathology, independent of objective measures (e.g. for maltreatment, r = .16, 95% CI = 0.09–0.22). In contrast, objective measures of childhood adversities had null or minimal associations with psychopathology, independent of subjective measures (e.g. r for maltreatment = .06, 95% CI = −0.02–0.13). Conclusions Our findings suggest that the effects of childhood adversity on psychopathology are primarily driven by a person's subjective experience. If this is the case, clinical interventions targeting memories and cognitive processes surrounding childhood adversity may reduce the risk of psychopathology in exposed individuals.