bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Change in the 2007 English Law on Mental Health Act Detentions
Authors: Beezhold J. , Mosa G. , Pandey A. , Pandey S. , Dyer M. , Kitromilidou C.
Published: June 2017

Background

The Mental Health Act (MHA) 2007 made some significant changes from the Mental Health Act 1983, including the fact that detention is now only allowed if an appropriate medical treatment is available to the patient at the time [1]. There was considerable concern at the time that the 2007 Act would lead to an increase in detentions.

Objective

The primary objective is to assess how the change in the English law with the MHA 2007 has affected the number of detentions under the MHA.

Methods

A retrospective, observational and noninterventional study used anonymised and routinely collected data regarding 11,509 people who were formally assessed under the Mental Health Act during the period of 2001–2011 in the county of Norfolk. This included 7885 assessments before the 2007 MHA and 3620 done after implementation.

Results

The proportion of people detained following assessment decreased from 53.2% before the 2007 MHA to 42.9% after implementation (P = .000). The total proportion of patients admitted (whether informally or detained) also decreased from 63.3% before the 2007 MHA to 52.8% thereafter (P = .000).

Conclusion

These results show a significant decrease in the rate of detentions under the MHA since the 2007 Act became law.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Symposium: Mental Health Law Differences and Coercive Measures Over Four Countries
Authors: Noorthoorn E. , Lepping P. , Steinert T. , Flammer E. , Massood B. , Mulder N.
Published: June 2017

In 2008, the UNHCR issued a convention on the rights of persons with disability. Since then, many countries were visited by the High Commissioner for Human Rights. In a number of countries, for example Germany and the Netherlands, mental health legislation was considered unsatisfactory and either regional variations in procedures or new legislation was drafted. In Germany, the final decision after different admission procedures is always made by a judge. In the Netherlands, detention on mental health ground with involuntary admission is decided by a Governmental administrator working for the local Major. In England and Wales, it is decided by three medical/psychiatric professionals. Currently, the Netherlands is drafting a law following the main principles of the Anglo-Saxon law. In Germany, all federal states are currently adopting their mental health laws to fulfil requirements of the Constitutional Court, which decided that coercive treatment is only admissible under very strict conditions after a judge's decision. Studies show the Dutch legislation is associated with higher seclusion rates, in numbers, and duration. Moreover, recent German findings show in a recent period when involuntary medication was not admissible, inpatient violence and coercive measures increased significantly. In this symposium, we discuss the several laws and regulations of four countries (Wales, Ireland, Germany, Netherlands), now and in the near future. Each presentation of a certain countries’ regulations is followed by a description of standard figures of the country, first by an expert in the respective country's law, and consequently by an expert in nationwide or regional figures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicidal Ideation Among International Medical Students Studying Medicine in Romania
Authors: Buzoianu A.D. , Popescu C.A.
Published: June 2017

Background

The burden of mental health impairment in medical students is an important research subjects. Evidence shows that medical students have a higher prevalence of symptoms of depression and anxiety than the general population. A number of studies regarding suicidal ideation among medical students have been carried out, but this topic has largely been ignored in regard to international medical students coming from Western European countries studying medicine in Eastern European countries. Suicidal ideation is the early symptom of suicidal actions. The students are the most vulnerable and easily influenced by cases of suicide, especially in a closed group with little connections with the general population like the international students.

Objectives

Following 2 suicides in our university, we aim to measure the prevalence of suicidal ideations in international students.

Methods

Overall, 150 medical students from the French section studying at the University of Medicine and Pharmacy “Iuliu Hatieganu”, Romania, were evaluated for symptoms of depression using BDI and for suicide ideation using Beck HS.

Results

Suicidal ideation was present in 28.57% of the French international medical students. Depression and the lack of social support had a significant relationship with suicidal ideation.

Conclusions

Suicide is a serious issue that has to be dealt with immediately. It is important to assist medical students who are considering the possibility of committing suicide, so that they overcome their difficulties. There is a need to identify the prevalence of suicidal ideation among medical students and for student counselling.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Paradoxical Effect of Two Different Emotion Regulation Processes in the Association Between Shame and Depression
Authors: Mendes A.L. , Ferreira C. , Marta-Simões J.
Published: June 2017

Experiential avoidance, considered a main process of psychological inflexibility, has been defined as the unwillingness to be in contact with particular unwanted inner experiences and the effort to control or avoid its form, frequency and the context in which they occur. On the other hand, decentering, conceptualized as the ability to deal with feelings, thoughts and emotions as subjective and ephemeral events, which occur in the mind, is considered an important protective process against psychopathology. The present study aimed to explore the moderator effect of two different emotional regulation processes, decentering and experiential avoidance, on the association between external shame and depression. The sample comprised 421 participants (131 males and 290 females), aged between 18 and 34-year-old. Results from two independent path analysis revealed that decentering abilities and experiential avoidance showed a significant moderator effect on the association between external shame and symptoms of depression. In fact, these findings allow to verify that decentering abilities were negatively linked to symptoms of depression. Through a path analysis, the buffer effect of decentering was confirmed. On the contrary, performed tests demonstrated that experiential avoidance exacerbates shame's impact on the severity of depressive symptoms. Taken together, these findings emphasize the importance of targeting maladaptive emotion regulation processes (such as experiential avoidance), and developing adaptive strategies (e.g., decentering abilities), as strategies to diminish depressive symptomatology in prevention and intervention programs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression Among Tunisian Young Mothers
Authors: Zerriaa O. , Moula O. , Ben Saadi S. , Chebli S. , Ghachem R.
Published: June 2017

Introduction

In the Tunisian cultural context, the mother is in charge of childcare, housekeeping and the well-being of the whole family, which can lead to exhaustion and depression.

Objective

To estimate the frequency of depression among mothers aged between 20 and 40 years, its consequences and the possible solutions.

Method

Transversal study using an anonymous questionnaire of 26 questions published through social media sites to mother with young aged children.

Results

Three hundred and twenty-seven mothers participated in the study: 20% of them aged between 20 and 30 years and 80% between 30 and 40. Ninety-seven percent of the participants were married; 96% of them had university education. Seventy-nine percent of them were working mothers and 50% of them did not get any help in childcare. Forty-two percent of the participants had only 1 child, 49% had 2 children, 8% 3 children and only 1 mother had 4 children. Depressive symptoms were present in 73% of the participants and were significantly higher among mothers aged between 30 and 40. However, depression was certain in only 36% of them and there was no significant difference between the two age groups. Eighteen percent of the participants noticed an increase in consummation of cigarettes, 31% resorted to tranquilizers, 25% needed sick leaves, and 2% resorted to alcohol use. Less working hours was suggested as a solution in 36% cases, sharing house chores in 30% cases.

Conclusion

Depression among young mother is a public health problem in Tunisia. It is underestimated and not always treated, which can have a serious impact on the whole family well-being.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Increased Prevalence of Major Depressive Disorder in Patients who Get Admitted with Atrial Fibrillation with Worse Outcomes
Authors: Mansuri Z. , Patel S. , Patel P. , Jayeola O. , Das A. , Shah J. , Gul M.H. , Ganti A. , Karnik K. , Patel R.
Published: June 2017

Objective

To determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing major depressive disorder(MDD).

Background

While post-AF MDD has been extensively studied, contemporary studies including temporal trends on impact of pre-AF MDD on AF and post-AF outcomes are lacking.

Methods

We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AF and MDD as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).

Results

We analyzed total of 3,887,827 AF hospital admissions from 2002 to 2012 of which 6.78% had MDD. Proportion of hospitalizations with MDD increased from 4.93% to 14.19% (P-trend < 0.001). Utilization of atrial cardioversion was lower in patients with MDD (34.37% vs. 40.52%, P < 0.001). In-hospital mortality was significantly lower in patients with MDD (aOR0.749; 95% CI 0.664–0.846; P < 0.001) but discharge to specialty care was higher (aOR 1.695; 95%CI 1.650–1.741; P < 0.001). In addition, median length of hospitalization (2.5 vs. 2.13 days; P < 0.001) and median cost of hospitalization (28,246 vs. 22,663; P < 0.001) was higher in hospitalizations with MDD.

Conclusions

Our study displayed an increasing proportion of patients with MDD admitted due to AF in the last decade with lower mortality but higher morbidity post-AF. In addition, there was significantly less utilization of atrial cardioversion in this population along with higher median length and cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and atrial cardioversion utilization in order to improve post-AF outcomes in this vulnerable population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Temporal Trends in Drug Abuse in Adults with Acute Myocardial Infarction Show Worse Outcomes
Authors: Mansuri Z. , Patel S. , Patel P. , Jayeola O. , Das A. , Shah J. , Gul M.H. , Karnik K. , Ganti A. , Patel R.
Published: June 2017

Objective

To determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults.

Background

DA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking.

Methods

We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR).

Results

We analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA.

Conclusions

We demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Intensive Case Management (ICM) Project in Eastern Lower Austria: A Description
Authors: Ramirez Gaite M. , Gundendorfer-Mag. FH E. , Hrubos W.
Published: June 2017

Introduction

Our ICM Project was implemented in 2012, with the primary objective of preventing hospitalizations and unburdening services. Here, we present a description.

Objectives

ICM is a type of multi-professional assertive community treatment (ACT) and case management, although our concept has a stronger focus on social work than ACT and uses less resources. It aims at patient's stabilization at home, better life quality, less inpatient/residential treatments, and more access to crisis intervention.

Methods

Presently we have 118 spots. Target groups are persons with severe psychiatric conditions at high risk for institutionalization or already institutionalized, including heavy users of mental health services. An initial eligibility assessment is required. At least 3 workers are providing a minimum of 2 h face-to-face contact per week per person. Care is offered predominantly at home environment and anchored in: careful distance-closeness ratio, structured and restructuring, autonomy enhancing, respectful, non-judgmental, confidential, regularity and commitment. Each treatment plan is individualized and based on two axes: intensive assistance and day-structure. It comprises comprehensive psychiatric treatment, counselling, assistance in everyday life, support groups, crisis management and interdisciplinary organizational meetings.

Results

The program was evaluated in 2014 using the CANSAS and FLZ scales and its effectiveness was validated. Most significant improvements were found in day-structure, housing, social contacts and performance, nutrition, and psycho-education. Life satisfaction improvement was found mostly in areas of general health, performance, relaxation and autonomy.

Conclusions

Since its implementation ICM has steadily expanded. Further research tools are currently being developed. Results will be presented in future publications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association Between ADHD and Psychopathology Among Prison Inmates
Authors: Machado A. , Rafaela D. , Silva T. , Cerejeira J.
Published: June 2017

Introduction

Several studies showed that among people with ADHD, the prevalence of psychiatric comorbidities is the rule, both in general population and in perpetrators.

Objectives

To analyze the relationship between ADHD and other psychiatric symptoms among prison inmates from a high security male prison in Portugal.

Methods

A total of 101 subjects aged 18–65, with at least 4 years of formal education, were interviewed for socio-demographic data and completed the ASRS-v1.1 (Adult ADHD Self-Report Scale) and the BSI (Brief Symptom Inventory). Subjects were divided into ADHD positive or negative according to their score on ASRS-v1.1, and then compared regarding BSI scores using Student's t-test.

Results

Seventeen subjects scored positive for ADHD. They significantly differed from the non-ADHD group in the total BSI score (t = −4.27, P < 0.001). When looking into the different subscales of BSI, the groups differed in the subscales of obsessions/compulsions (t = −4.05, P < 0.001), interpersonal sensibility (t = −3.47, P 0.001), hostility (t = −6.71, P < 0.001), paranoia (t = −3.17, P 0.002) and psychotism (t = −3.20, P 0.002), with the ADHD group scoring higher in all the mentioned subscales. No significant differences were found between the groups in the subscales regarding anxiety, depression or somatization.

Conclusions

In line with previous work, our study showed a higher prevalence of psychopathology in prison inmates with ADHD, then in non-ADHD subjects. However, while higher prevalence of depressive and anxiety symptoms in ADHD subjects is mentioned in other studies, we found no differences between the two groups concerning those subscales. The subscales that significantly differed, point to higher prevalence of disfunctional relationships and a higher tendency for violent behaviour in the ADHD group.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Risk Factors Related to Homicide in Moroccan Patients with Schizophrenia
Authors: Kachouchi A. , Majda D.S. , Said D.S. , Imane P.A. , Fatiha P.M. , Mohamed P.A. , Fatima P.A.
Published: June 2017

Background

The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link.

Objectives

The objectives of this study were to describe the characteristics of homicide in Moroccan patients suffering from schizophrenia and to determine the correlated socio-demographic, clinical and toxic variables.

Methods

The study included two groups of patients with a DSM-IV diagnosis of schizophrenia who attended the “Ibn Nafis” university psychiatric hospital of Marrakech in Morocco. The first group was composed of 30 patients hospitalized for homicide in the forensic unit between the first January 2005 and the 31st of August 2015. The second group included 90 patients without any criminal record. These two groups have been matched according to age and gender. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups.

Results

The mean of age in the first group was 37.03 and in the second group was 31.4. No significant difference was found between the two groups regarding the different socio-demographic variables and the age of onset of disease. Significant difference was found between the two groups regarding: personal antecedents of attempt of homicide a (P < 0.003), personal antecedents of attempt of suicide (P < 0.001), a history of previous violence (P = 0.005), untreated psychosis before the act (P < 0.001) poor medication compliance and a low familial support (P < 0.001), antisocial behavior (P < 0.001), addictive behavior (P = 0.007).

Conclusion

Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Eating Disorders in Schizophrenia
Authors: Sallemi R. , Hentati S. , Feki I. , Masmoudi J. , Moala M.
Published: June 2017

Background

Due to their frequency and negative impact on quality of life, eating disorders in schizophrenia need to be considered and highlighting.

Objective

To identify the risk of eating disorders (ED) and its correlates among mental patients.

Methods

It was a descriptive and analytic study. It included 53 inpatients with DSM-5 diagnoses of schizophrenia or schizoaffective disorder, followed in the department of Psychiatry at the Hedi Chaker University Hospital of Sfax in Tunisia, during the three months of August, September and October 2016. Data collections were conducted using questionnaire exploring sociodemographic and medical data. The SCOFF (sick, control, one, fat, food) Questionnaire was used to screen ED. A total score of ≥ 2 was used as a cutoff point to select persons at risk of ED.

Results

The average age of our patients was 30.47 ± 9.5 years old. The majority of our patients was male (71.7%) and single (71%). The mean of extra Body mass was 27.9. The mean duration of disease was 9.9 ± 8.1 years and patients were mostly (54%) in atypical neuroleptics. According to the SCOFF Questionnaire, 35.8% had a risk of ED. Female gender and treatment with atypical neuroleptics were significantly associated to ED risk with respectively P = 0.02 and P = 0.038.

Conclusion

Eating disorders remain underestimated among patients suffering from schizophrenia. Yet, its screening prevention and management are crucial and must be multidisciplinary for optimal care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
How Dissociation, Temperament and Character Influence at the Eating Disorders
Authors: Muñoz Martínez V. , Rodriguez Cano T. , Beato Fernández L. , Jimenez Londoño G.A. , Mata Saenz B. , Asensio L. , Nuevo Fernandez L. , Mella L.
Published: June 2017

Objectives

Dissociation has been related to emotional dysregulation and eating psychopathology. Dissociation may interfere with the learning process, affecting at the therapy negatively. The aim of the study is to analyse if at the eating disorders (ED), dissociation is linked to temperamental traits or also to character traits, which are susceptible to be modulated during the therapeutic process.

Methods

We studied 119 females that started an outpatient program for their ED. We used the Dissociative Experience Scale (DES), Temperament and Character Inventory (TCI), Eating Attitudes Test (EAT-40), and the State Trait Anxiety Inventory (STAI). We used multiple regression analysis.

Results

Dissociation was associated with high scores on the EAT-40, even controlling the effect of anxiety traits, which also was related to dissociation. The temperament dimension “searching for novelty”, has been related in an opposite way to the DES. Also, the “dimension of transcendence “character and “self determination” influenced on the DES.

Conclusions

This study confirms the importance of improving Self Determination levels at ED therapy, which influence on a lot of prognostic aspects, such as protecting from dissociation, which is related to anxiety and alimentary psychopathology and can interfere with the therapeutic progress.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Microstructural Changes in Patients with Parkinson's Diseases and REM Sleep Behavior Disorder: Depressive Symptoms Versus Non-Depressed
Authors: Mohammadi Jooyandeh S. , Aarabi M.H. , Rahmani F.
Published: June 2017

Introduction

REM sleep behaviour disorder (RBD) is associated with psychiatric symptoms, such as anxiety and depression. RBD is characterized by loss of normal skeletal muscle atonia during rapid eye movement (REM) sleep with prominent motor activity and dreaming and is a usual symptom of the early stages of Parkinson's disease (PD). Diffusion MRI connectometry was used to carry out group analysis between age and gender matched PD patients with RBD in with and without depression to characterize possible depression-related white matter microstructural changes in the Parkinson patients with RBD.

Method

DWI images were obtained for 15 PD-RBD with depression and 27 PD-RBD without depression. This dataset was acquired on a 3 Tesla Siemens scanner, producing 64 DWI at b = 1000 s/mm2 and one b0 image. Diffusion MRI data were corrected for subject motion, eddy current distortions, and susceptibility artefacts due to the magnetic field inhomogeneity. Diffusion MRI connectometry was conducted in a total of 27 subjects using percentage measurement.

Results

PD-RBD Patients with depressive symptoms showed decreased anisotropy (FDR < 0.05) in the fornix bilaterally, right cingulum, inferior longitudinal fasciculus bilaterally, right corticospinal tract and Genu of corpus callosum compared to PD-RBD patients without depression.

Conclusion

Since RBD is considered to be an early symptom of PD and also a marker of progression to PD, these results might PD-RBD patients with depression may progress dementing processes and visuospatial dysfunction earlier since fornix, cingulum and ILF have proven to be associated with these cognitive dysfunctions respectively.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Light as an Aid for Recovery in Psychiatric Inpatients: A Randomized Controlled Effectiveness Pilot Trial
Authors: Okkels N. , Jensen L.G. , Arendt R. , Blicker A.B. , Hjortdal J. , Jennum P. , Straszek S.
Published: June 2017

Introduction

Electric indoor lighting can disturb sleep and increase depressive symptoms; both common complaints in psychiatric inpatients.

Aims

To improve quality of sleep in patients using an indoor hospital lighting environment simulating nature in intensity, color, and circadian timing.

Methods

Investigator-blinded parallel group randomized controlled effectiveness trial supplied with qualitative interviews in an inpatient psychiatric ward with fully automatic and adjustable lighting. Admitted patients received a room with a naturalistic lighting environment (intervention group) or lighting as usual (control group). The primary outcome was the Pittsburg Sleep Quality Index and secondary outcomes included the Major Depression Inventory and WHO-five Well- Being Index.

Results

In this ongoing trial, we included 28 patients (16 treated and 12 controls). Patients in the intervention group reported higher subjective sleep quality and sleep efficiency, lower use of sleep medication (mean difference, 4.68 mg; 95% CI, 0.54; 53.5), fewer depressive symptoms (mean difference, 5; 95% CI,–2; 13), but lower well-being (difference,–4 percentage points; 95% CI,–20; 16), compared with the control group. At discharge, fewer patients in the intervention group had experienced use of involuntary treatment. Qualitative data indicated no side effects apart from issues in performing indoor leisure activities in dim light.

Conclusions

A naturalistic lighting environment was safe and improved sleep and mood in our small patient sample. The trial integrated well with routine clinical care and our sample reflected the heterogeneity of the target population (Funded by Region Midtjylland and others; Clinicaltrials.gov number, NCT02653040)

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Risk of Suicide Mortality Among Cancer Patients: A Meta-Analysis of Observational Studies
Authors: Calati R. , Di Mattei V. , Courtet P.
Published: June 2017

Introduction

Suicide rates among patients with cancer are higher than ones in the general population.

Objective

This meta-analysis aims to estimate the suicide risk in patients with cancer.

Methods

We searched Medline, PsycINFO, and the Cochrane library to identify articles published before July 1, 2016, examining the association between suicide [death (SD), attempt (SA), ideation (SI)] and any form of diagnosed cancer.

Results

We initially identified 4880 records and after unsuitable studies were removed, our search yielded 102 publications of which 14 were used in the meta-analyses. Patients with cancer had higher risk of SD (seven studies, 247.869 participants; odds ratio [OR] = 1.52, 95% CI = 1.22–1.89, P = 0.0002) compared with those without cancer (among case-control studies focused on SD versus living controls). Among studies focused on SD versus other deaths, patients with cancer had higher risk of SD (two studies, 23.839 participants; OR = 1.53, 95% CI = 1.03–2.27, P = 0.03). No difference has been detected for risk of SA (four studies, 8.147.762 participants) and for SI (two studies, 37.879 participants).

Since publication bias was detected, the “trim and fill” method was applied. The majority of the included studies have a high quality at the STROBE statement.

Conclusion

The assessment of suicide risk in this population is crucial.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Workplace Assessment in Crisis? – The Way Forward
Authors: Al-Taiar H.
Published: June 2017

Introduction

A recent Royal College of Physicians’ (RCP) study on assessment raises serious questions for workplace assessment. To address these, a system that bridges the gap from competence to performance and integrates supervised learning events (SLEs) that are formative in purpose with summative assessment of performance by entrustable professional activities (EPAs) is recommended.

Aims and objectives

As a working group on assessment in psychiatry, we were interested in the RCP findings which represent a significant milestone in studies of workplace assessment. The RCP aims were to evaluate the feasibility, validity and educational value of using existing WPBA tools but for different assessment purposes and processes.

Results

These were based on the General Medical Council (GMC) working party on assessment. The RCP revised its assessment processes to differentiate between assessments of development and performance. The former are formative and aim to identify a trainee's areas of strength and development; the latter are summative and aim to determine fitness to progress. Of note is that the same workplace based assessment (WPBA) tool can be used for each type of assessment; the assessment's purpose is the discriminating factor.

Conclusions

Initial design of the requisite EPAs requires value judgments by trainers and trainees alike on what represent core units of work. EPAs can contribute directly and more meaningfully to ARCP progression decisions.

Recommendations

Inclusion of the required level of supervision as part of SLE feedback enables future decisions on meeting performance standards.

Trainee/trainer

Interaction in this educational process.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Psychiatry Trainee Burnout in the United Kingdom: The BoSS Study
Authors: Beezhold J.N. , Beezhold K. , Malik A. , Lydall G. , Podlesek A. , Jovanovic N.
Published: June 2017

Introduction

Burnout syndrome is defined by three domains: emotional exhaustion, cynicism and reduced professional efficacy. Junior doctors have a high susceptibility to burnout reflected in the high prevalence identified in previous work. This is a significant issue as burnout has measurable effects on work performance. There has been limited research conducted on burnout in psychiatry trainees in the United Kingdom.

Aim

This paper takes a step towards addressing this gap by extracting the data concerning UK psychiatric trainees collected in the international burnout syndrome study (BoSS), which aimed to assess the prevalence and contributing factors of burnout among psychiatric trainees from over 20 countries, and presenting the findings concerning UK trainees.

Method

Data collected included demographic data and information related to working hours, bullying, harassment and stalking, supervision, suicidal ideation, depression (PHQ−9), and a personality trait assessment. Burnout syndrome was measured using the Maslach burnout inventory (MBI-GS). A total of 3964 psychiatry trainees in the UK were invited, of which 1187 (30%) responded including 811 (20%) providing complete responses for MBI-GS.

Results

The mean age was 33 years, and 49.1% of respondents were male. Gender distribution of participants was the same as non-participants. Mean scores were 2.6 for exhaustion, 2.1 for cynicism and 4.5 for professional efficacy; and severe burnout was found in 309 (38%).

Conclusion

Three factors were positively associated with severe burnout: long working hours, lack of clinical supervision and not having regular time to rest.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Psychiatric Morbidity and Mortality Teaching Conference to Improve Patient Safety: Lessons Learned at the Massachusetts General Hospital
Authors: Freudenreich O. , Smith F. , Wozniak J. , Fava M. , Rosenbaum J.
Published: June 2017

Introduction

A morbidity and mortality (M&M) conference is a time-honored educational format in surgery and medicine to review bad patient outcomes and learn from mistakes made. However, despite the value of learning together as peers from difficult cases with unexpected outcomes, most psychiatric departments in the United States do not have an M&M conference. Several years ago, the department of psychiatry at Massachusetts's general hospital in Boston began a monthly M&M conference.

Objectives

Describe our department's experience with the M&M format as an educational vehicle to teach patient safety and improve care in an increasingly complex care environment.

Aims

Introduce the M&M format that we have developed at our department and obstacles encountered.

Methods

We reviewed the content of our four years of M&M conferences; the feedback received from participants after each conference; and changes introduced to improve the conference.

Results

Our department has successfully implemented and sustained a monthly psychiatric M&M conference that is well attended and valued. A critical decision was mandatory involvement of residents to prepare cases in conjunction with a dedicated faculty member. A structured presentation using a root cause analysis framework to guide the discussion in order to harness the wisdom of the group allows for a more comprehensive understanding of factors leading to bad outcomes, including systems-based problems.

Conclusions

A psychiatric M&M conference can teach individual clinicians about patient safety. Developing a departmental mechanism to apply lessons learned in the conference to improve hospital systems is the next task.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
How Satisfied are Undergraduate Students with Interprofessional Training? Meta-analysis of a Pilot Study
Authors: Lazzari C. , Masiello I.
Published: June 2017

Introduction

Learning to work in an interprofessional team entails satisfaction in working with others.

Objective

Contextual assessment of the degree of satisfaction of undergraduate healthcare students (doctors, nurses, occupational therapists and physiotherapists) during interprofessional education (IPE).

Aims

Meta-analysis of degree of satisfaction contextually assessed during major interprofessional learning moments.

Methods

Thirty-six undergraduate health care students (medical students, nursing students, occupational therapy students) answered questions on a 5-point Likert scale (from “Very satisfied” to “Very dissatisfied”). A meta-analysis with Tau2 (t2), Cochrane's Q, and I2 analyzed IPE activities: self-reflection after daily training, interactions with teachers, discussion of clinical cases during ward rounds and patient care as a team.

Results

Meta-analysis reported significant heterogeneity in the degrees of satisfaction (Fig. 1): 47.2% being “satisfied” with reflection after IPE, {t2 = .011; Q (5df) = 30.03; I2 = 83%, P < .0001}; 45% being “satisfied” during interactions with their teachers {t2 = .01; Q (5df) = 25.74; I2 = 80%, P < .001}; 31.4% being “satisfied” about the discussion of a clinical case during ward rounds {t2 = .009; Q (5df) = 22.61; I2 = 77.89%, P < .001}; and 44.4% being “satisfied” about patient care with the interprofessional team {t2 = .009; Q (5df) = 22.99; I2 = 78.25%, P < .001}.

Conclusions

Undergraduate students show satisfaction with IPE activities. This helps improve the quality of care and teamwork in the busiest wards.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Parental Causal Explanations and Treatment Seeking in Attention Deficit Hyperactivity Disorder: Perspectives From a Developing Nation Based on Process Theory
Authors: Shah R. , Sharma A. , Grover S. , Chauhan N. , Jhanda S.
Published: June 2017

Introduction

Cultural factors have an important role in causal model of symptoms, threshold for treatment seeking and acceptability of professional help in ADHD.

Objectives and aims

To explore causal explanations and treatment seeking amongst parents of children with ADHD and understand these in context of a largely collectivistic culture as in India.

Methods

In-depth semi-structured interviews were conducted with 27 consenting parents; data interpreted using process theory.

Results

Initial reaction to psychiatric referral revealed themes of disbelief/surprise, feeling confused/offended and lag of 6–36 months to consultation. Parents most commonly attributed causality to psychosocial reasons (lack of motivation/volitional, inadequate disciplining), while few gave one or more biomedical explanations (epilepsy, brain damage, low birth weight, nutritional deficiency, maternal ill health, low intelligence) alone or with a psychosocial reason. Despite the initial reaction, all but 1 parent was relieved with medical explanation, accepted diagnosis, and perceived need for treatment. Most parents were willing to start/continue medication if doctor suggested so as “he/she would know the best”. All parents expressed that counseling was needed.

Conclusions

Initial reactions and delay in treatment seeking is understood in light of cultural attitudes towards mental illnesses and psychiatric consultation in developing nations. More importantly, despite initial reluctance, most parents accepted biomedical explanation and treatment. The doctor patient relationship modeled on a guru-chela relation of complete trust in authority can explain this process change. We conclude that cultural attitudes not only influence causal models and initial treatment seeking, but also modify process of help seeking.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trajectories of depression and anxiety symptoms in coronary heart disease strongly predict health care costs
Authors: Palacios J. , Khondoker M. , Mann A. , Tylee A. , Hotopf M.
Published: June 2017

Introduction

There is little information describing the trajectories of depression and anxiety symptomatology in the context of coronary heart disease (CHD), and their comparison according to sociodemographic and disability measures, cardiac risk factors, and health care costs.

Methods

Using a primary care cohort of 803 patients with a diagnosis of CHD, a latent class growth curve model was developed to study the distinct trajectories of depression and anxiety symptoms (using the hospital anxiety and depression scale) over a 3-year period comprised of 7 distinct follow-up points. Multinomial regression analysis was then conducted to study the association between latent classes, baseline risk factors, and total health care costs across time.

Results

The 5-class model yielded the best combination of statistical best-fit analysis and clinical correlation. These classes were as follows: “stable asymptomatic” (n = 558), “worsening” (n = 64), “improving” (n = 15), “chronic high” (n = 55), and “fluctuating symptomatology” (n = 111). The comparison group was the “stable asymptomatic” class. The symptomatic classes were younger and had higher proportion of women, and were also associated with non-white ethnicity, being a current smoker, and having chest pain. Other measures of disease severity, such as a history of myocardial infarction and comorbidities, were not associated with class membership. The highest mean total health care costs across the 3 years were the “chronic high” and “worsening” class, with the lowest being the “improving” and “stable low” classes. The total societal costs for patients in the “chronic high” and “worsening” class were significantly higher, as compared to the “stable low” class.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effects of brain stimulation with direct electrical current in the treatment of resistant obsessive-compulsive disorders
Authors: Najafi K. , Fakour Y. , Zarrabi H. , Khalkhali S.M.R. , Ramezanghorbani N. , Najafi T. , Shabafrouz S.
Published: June 2017

Introduction

Direct brain stimulation with electrical currents is an effective treatment for depression and considering is an effective supplementary treatment of resistant obsessive-compulsive disorder.

Aim

Assess the effects of brain stimulation with direct electrical current in the treatment of resistant obsessive-compulsive disorders.

Methods

The present study is a paired clinical trial conducted in a group of 42 patients diagnosed with treatment resistant obsessive-compulsive disorder in the province of Rasht. Direct brain stimulation with electrical current was performed according to the protocol throughout the 15 treatment sessions. The effectiveness of the first, fifth, tenth and fifteenth session(s) of treatment were evaluated based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and results were analyzed using Repeated Measure ANOVA, Spearman Correlation and Pearson Correlation software SPSS version 22.

Results

All 42 participants stayed throughout the study. Mean age of patients was 10.14 ± 29.10. Mean test scores of Yale-Brown Obsessive Compulsive Scale in the first, fifth, tenth and fifteenth session of treatment was 6.78 ± 28.4, 4.58 ± 22.8, 6.3 ± 16.4 and 5.37 ± 10.8,respectively which is significantly lower (P-value = 0.00, F = 80.12). No significant correlation was observed between the participant's age, sex, education level, marital status and employment status and in any of the test scores of Yale-Brown Obsessive Compulsive Scale in the first, fifth, tenth and fifteenth session of treatment (P-value > 0.05).

Conclusion

In order to attain a sustainable long term effects of the proposed treatment, it is recommended that patients be reminded on their next schedule of treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Paroxetine concentrations in obsessive-compulsive disorder: Support for a therapeutic interval
Authors: Humble M.B. , Reis M.
Published: June 2017

Introduction

Previous studies of concentrations of serotonin reuptake inhibitors (SRIs) versus therapeutic efficacy have yielded inconsistent results. Even if the relationships between the individual's serotonergic system and the clinical symptoms of obsessive-compulsive disorder (OCD) are poorly understood, the SRIs are consistently effective in OCD. However, studies on SRI concentrations in OCD treatment are rare.

Objectives/aims

To identify possible links between paroxetine concentrations and anti-obsessive response.

Methods

In a randomised, double-blind trial, comparing clomipramine, paroxetine and placebo in OCD treatment, serum paroxetine levels were measured after 1 week and after 4 weeks of treatment in 18 patients. Anti-obsessive response was assessed with Yale-Brown obsessive compulsive scale (Y-BOCS) and patients’ global evaluation (PGE), after 12 weeks of treatment.

Results

Serum paroxetine concentrations after 4 weeks suggested a therapeutic interval between 50 and 240 nmol/L (13–63 ng/mL). The mean Y-BOCS decrease was 54% inside versus 7% outside this interval (t = 3.96; P = 0.0011).

Conclusions

Paroxetine levels seemingly predicted clinical outcome. Studies with a greater number of patients are necessary in order to confirm this finding and to discern whether it is useful in clinical practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predictors of functioning in major depression
Authors: Serra-Blasco M. , Aguilar E. , Vicent M. , Navarra G. , Portella M.J. , Sánchez A. , Ros L. , Acebillo S. , Lahera G. , Palao D. , Cardoner N.
Published: June 2017

Introduction

Life functioning difficulties are a relevant but undervalued consequence of major depression. Mood symptoms and cognitive deficits have a significant, and somehow independent, impact on them. Therefore, cognitive difficulties should be considered a potential target to improve patients’ functioning.

Aims

To examine the degree in which objective and subjective cognition explain functional outcome.

Objectives

To assess objective cognitive function (CF) with a neuropsychological battery and to measure subjective CF using measures of cognitive perception.

Methods

Ninety-nine patients with depression were assessed by age, sex and level of schooling. Depressive symptoms severity was measured by Hamilton Depression Rating Scale (HDRS-17). Objective CF consisted in the following cognitive domains: memory, attention, executive functioning and processing speed. Subjective CF was assessed with Perceived Deficit Questionnaire-Depression (PDQ-D). Functioning Assessment Short Test (FAST) was used to evaluate life functioning, excluding the cognitive domain. All the listed measures were included in a multiple regression analysis with FAST scores as dependent variable.

Results

The regression model was significant (F1,98 = 67.484, P < 0.001) with an R of 0.825. The variables showing statistical power included (from higher to lower β-coefficient) HDRS-17 (β = 0.545, t = 8.453, P < 0.001), PDQ-D (β = 0.383, t = 6.047, P < 0.001) and DSST (β = −0.123, t = −1.998, P = 0.049).

Conclusions

The severity of depressive symptoms is the variable that best explains life functioning. Surprisingly, the second factor hindering it is the patients’ perception of their cognition. Current findings highlight the importance of correcting cognitive bias in order to improve functionality. However, results have to be taken cautiously as mood symptoms could partly explain the bias.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Aggression and violence towards healthcare workers in a psychiatric service in Italy. A retrospective questionnaire-based survey
Authors: Piacentino D. , Moser S. , Tosato S. , Bonetto C. , Conca A. , Bizzarri J.V.
Published: June 2017

Introduction

Violence at work is a major concern in healthcare services. Prevention programs have been implemented, albeit being scarce in Italy.

Objectives or Aims

The Bolzano psychiatric department adopted a de-escalation model developed by the Institut-für-Professionelles-Deeskalations-Management (ProDeMa®). It includes evaluation, prevention, and practical training aimed at preventing/reducing patients’ aggressive behavior toward healthcare workers.

Methods

In 2015, health professionals were interviewed by using a ProDeMa® 11-item questionnaire that assessed the type and frequency of endured patients’ aggressive behavior, as well as the conditions capable of producing or preventing it. One-way ANOVA with Tukey post-hoc test was used for comparisons.

Results

A total of 165/211 (78%) surveyed workers (mean age ± DE = 44.9 ± 7.7; females = 64.6%) completed the questionnaire, of whom 21% employed at the inpatients unit (INP), 37% at the outpatients unit (OUTP), 42% at the rehabilitation facility (REHAB). The one-year number of verbal aggressions (VA) was 9766, with INP (mean ± SD = 15.2 ± 29.6) vs. OUTP (mean ± SD = 6.2 ± 30.6) vs. REHAB (mean ± SD = 8.4 ± 26.1). The one-year number of physical aggressions (PA) was 1502, with INP (mean ± SD = 3.3 ± 12.2) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.7). The one-year number of injuries (IN) was 200, with INP (mean ± SD = 0.5 ± 1.9) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.2). ANOVA showed significant differences in terms of mean verbal/physical aggression and injuries among the three workplaces (P-values = 0.000), with post-hoc Tukey test showing a significant difference of INP vs. REHAB and OUTP. The most frequent risk factors identified by the staff for precipitating aggression included rigid rules (15.1%) and inadequate communication (9.1%).

Conclusions

The three types of violence are common in all facilities of our Department.

Disclosure of interest

The authors have not supplied their declaration of competing interest.