Loneliness can affect people at any time and for some it can be an overwhelming feeling leading to negative thoughts and feelings. The current study, based on the Adult Psychiatric Morbidity Survey in England, 2007, quantified the association of loneliness with a range of specific mental disorders and tested whether the relationship was influenced by formal and informal social participation and perceived social support.Methods Using a random probability sample design,7,461 adults were interviewed in a cross-sectional national survey in England in 2007. Common Mental Disorders were assessed using the revised Clinical Interview Schedule;the diagnosis of psychosis was based on the administration of the Schedules of the Clinical Assessment of Neuropsychiatry, while loneliness was derived from an item in the Social Functioning Questionnaire.Results Feelings of loneliness were more prevalent in women (OR = 1.34, 95 % CI 1.20–1.50, P\0.001) as well as in those who were single (OR = 2.24, 95 % C I1.96–2.55, P<0.001), widowed, divorced or separated(OR = 2.78, 95 % CI 2.38–3.23, P<0.001), economically inactive (OR = 1.24, 95 % CI 1.11–1.44,P = 0.007), living in rented accommodation (OR = 1.73,95 % CI 1.53–1.95, P<0.001) or in debt (OR = 2.47,95 % CI 2.07–1.50, P<0.001). Loneliness was associated with all mental disorders, especially depression [corrected].

Established adverse prognostic factors in chronic lymphocytic leukemia (CLL) include CD38 expression, relative lack of IgV H mutation, and defects of the TP53 gene. However, disruption of the p53 pathway can occur through mechanisms other than TP53 mutation, and we have recently developed a simple screening test that detects p53 dysfunction due to mutation of the genes encoding either p53 or ATM, a kinase that regulates p53. The present study was conducted to examine the predictive value of this test and to establish the relationship between p53 dysfunction, CD38 expression, and IgV H mutation. CLL cells from 71 patients were examined for IgV H mutation, CD38 expression, and p53 dysfunction (detected as an impaired p53/p21 response to ionizing radiation). Survival data obtained from 69 patients were analyzed according to each of these parameters. Relative lack of IgV H mutation (less than 5%; n ‫؍‬ 45), CD38 positivity (antigen expressed on more than 20% of malignant cells; n ‫؍‬ 19), and p53 dysfunction (n ‫؍‬ 19) were independently confirmed as adverse prognostic factors. Intriguingly, all p53-dysfunctional patients and all but one of the CD38 ؉ patients had greater than 5% IgV H mutation. Moreover, patients with p53 dysfunction and/or CD38 positivity (n ‫؍‬ 31) accounted for the short survival of the less mutated group. These findings indicate that the poor outcome associated with having less than 5% IgV H mutation may be due to the overrepresentation of highrisk patients with p53 dysfunction and/or CD38 positivity within this group, and that CD38 ؊ patients with functionally intact p53 may have a prolonged survival regardless of the extent of IgV H mutation.

BackgroundPeople with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines’ monitoring.DesignPragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines’ monitoring versus usual care.SettingFive UK private sector care homesParticipants41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.InterventionNurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.OutcomesProblems addressed and changes in medicines prescribed.Data Collection and AnalysisInformation was collected from participants’ notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.ResultsFive of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57–4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78–8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80–235.90] and 5.12 [1.45–18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15–17.22).ConclusionThe WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.Trial Registration ISRCTN 48133332

The number of debts, source of the debt and reasons for debt are key correlates of suicidal ideation. Individuals experiencing difficulties in repaying their debts because they are unemployed or have had a relationship breakdown or have heavy caring responsibilities may require psychiatric evaluation in addition to debt counselling.

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