BackgroundAntisocial personality disorder (ASPD) is an under-researched mental disorder. Systematic reviews and policy documents identify ASPD as a priority area for further treatment research because of the scarcity of available evidence to guide clinicians and policymakers; no intervention has been established as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment which specifically targets the ability to recognise and understand the mental states of oneself and others, an ability shown to be compromised in people with ASPD. The aim of the study discussed in this paper is to investigate whether MBT can be an effective treatment for alleviating symptoms of ASPD.MethodsThis paper reports on a sub-sample of patients from a randomised controlled trial of individuals recruited for treatment of suicidality, self-harm, and borderline personality disorder. The study investigates whether outpatients with comorbid borderline personality disorder and ASPD receiving MBT were more likely to show improvements in symptoms related to aggression than those offered a structured protocol of similar intensity but excluding MBT components.ResultsThe study found benefits from MBT for ASPD-associated behaviours in patients with comorbid BPD and ASPD, including the reduction of anger, hostility, paranoia, and frequency of self-harm and suicide attempts, as well as the improvement of negative mood, general psychiatric symptoms, interpersonal problems, and social adjustment.ConclusionsMBT appears to be a potential treatment of consideration for ASPD in terms of relatively high level of acceptability and promising treatment effects.Trial registrationISRCTN ISRCTN27660668, Retrospectively registered 21 October 2008

Aims There has been a surge in child mental health literacy training programmes for non‐mental health professionals. No previous review has examined the effectiveness of child mental literacy training on all professionals in contact with children. Methods Studies were identified through a systematic literature search of the Cochrane, EMBASE, Medline, and PsycINFO databases in February 2019. The review included studies that delivered training to professionals who have regular contact with young people aged 0 to 19 in the context of their role and at least one component of mental health literacy; (a) knowledge, (b) attitudes, (c) confidence in helping, (d) intention to help and (e) actual helping behaviour. The quality of papers was reviewed using the Cochrane revised Risk of Bias Tool for randomized controlled trials (RCTs) and the Integrated Quality Criteria for the Review of Multiple Study Designs for non RCTs. Results Twenty‐one studies met eligibility criteria (n = 3243). There was some evidence that global and specific child mental health literacy training improved professionals' knowledge and stigma‐related attitudes towards mental health. Few studies investigated the impact of training on actual helping behaviour. Conclusion There may be value in providing child mental health literacy training to professionals in contact with children, however there is a need for studies to evaluate the long‐term impact of such training, particularly on subsequent access to appropriate support. Findings raise concerns about the quality of the studies reported in the systematic review and recommendations are made for future studies.

Aging is associated with increased hyperglycemia, insulin resistance and dysregulation of the immune system, but the causative factors underlying their association remain unknown. We show that IR is induced by activated innate 4-1BBL+ B1a (4BL) cells that accumulate as a response to age induced changes in gut microbial composition and subsequent decrease in beneficial microbial metabolites. The loss of the commensal bacterium Akkermansia muciniphila impairs intestinal integrity, causing leakage of bacterial products such as endotoxin, which activate CCR2+ monocytes in an environment with reduced butyrate concentration. These CCR2+ monocytes infiltrate in the omentum where they induce 4-1BBL expression on B1a cells. The cascade continues with 4BL cells inducing IR, presumably by triggering 4-1BB receptor signaling as in obesity-induced metabolic disorders. This pathway and IR are reversible, as manipulation of gut microbiota can restore normal insulin response in aged mice and macaques. In addition, treatments that target monocytes or 4BL cells had the same effect on IR. These results underscore the pathological function of B1a cells and suggest that the microbiome-monocyte- B cell axis could potentially be targeted to reverse age-associated IR.

Background: Children with chronic physical health conditions are up to six times more likely to develop a mental health condition than their physically well peers. Frontline pediatric hospital staff are in a good position to identify mental health problems and facilitate appropriate support for patients. To date, no evaluation of mental health literacy training has taken place with this professional group to enable early identification of difficulties. It is also not known whether face-to-face or digital training is more effective or preferable in this setting. To improve the skills of frontline hospital staff, a face-to-face and digital mental health literacy training course was delivered using MindEd content and evaluated in a randomized controlled trial.Method: Two-hundred and three frontline staff across different professions from a tertiary pediatric hospital were randomized to a face-to-face (n = 64), digital (n = 71), or waitlist control group (n = 68). Face-to-face training was two and a half hours and digital training took ~1 h. The effects of training were evaluated pre- and post-training and at two-week follow-up. Questionnaires assessed mental health knowledge, stigma, confidence in recognizing concerns and knowing what to do, actual helping behavior, as well as training delivery preference, completion rate, and satisfaction.Results: Both face-to-face and digital training increased mental health knowledge, confidence in recognizing mental health problems and knowing what to do compared to waitlist controls. Digital training increased actual helping behavior relative to the waitlist controls and stigma decreased across all groups. Staff were satisfied with both delivery methods but preferred face-to-face training.Conclusions: The results provide promising findings that digital content is an effective way of improving mental health literacy in frontline pediatric hospital staff. Providing digital training could be a time-efficient way of upskilling non-mental health professionals to identify mental health needs in a pediatric population and facilitate access to appropriate care.