bluuebunny/crossref_metadata_2025 huggingface dataset:
Irritability and Risk-Taking Behaviour on the Cambridge Gambling Task (CGT) in Adolescents With a Family History of Depression
Authors: Srinivasan Ramya , Lewis Glyn , Roiser Jon , Rice Frances
Published: August 2024

Aims

Irritability is a common symptom in children and adolescents, often resulting in referral to mental health services and is associated with depression. Depression in adolescents and adults at familial risk of, and with depression, is associated with reduced risk-taking on the Cambridge Gambling Task (CGT) particularly when the chance of winning is high. However, little is known about risk-taking in irritability. This study tests the hypothesis that increased irritability is longitudinally associated with later risk-taking behaviour on the CGT; specifically, that increasing irritability is associated with lower risk-taking when the chance of a favourable outcome is high.

Methods

We conducted a longitudinal study of the biological offspring of parents of children with depression (n = 337). Irritability, the exposure, was measured at wave one using the Child and Adolescent Psychiatric Assessment (CAPA). The primary outcome was risk-taking to obtain reward at varying probability ratios (6:4, 7:3, 8:2 and 9:1) measured by the Cambridge Gambling Task (CGT) at waves two and three. We investigated the longitudinal association between irritability at wave one and average risk-taking at each ratio across waves two and three using multi-level models. The extent to which risk-taking according to probability ratio varied with irritability was tested with interaction terms. We ran univariable models and then multivariable models.

Results

In univariable (n = 207; Coef. 0.006, 95%CI −0.011–0.023, p = 0.470), and fully adjusted (Coef. 0.011, 95%CI −0.007–0.029, p = 0.213) models there was no evidence of a main association between irritability and risk-taking on the CGT. There was evidence of an interaction between irritability and risk-taking ratio (p = 0.019). In fully adjusted models including the interaction, a one-point increase in irritability was associated with relatively higher risk-taking at the less favourable ratios (6:4 – 0.018 (95%CI −0.002–0.037) and 7:3 – 0.015 (95%CI −0.005–0.035)) relative to the more favourable ratios (9:1 – 0.001 (95%CI −0.019–0.021) and 8:1 – 0.011 (95%CI −0.008-0.031)).

Conclusion

We found no evidence of relationship between irritability and subsequent risk-taking on the CGT overall. However, there was some evidence that those with higher irritability were relatively more risk-taking when less likely to win compared with when a favourable outcome was more likely. These findings warrant further investigation of the association between prior irritability and later depression in a larger community cohort. If prior irritability and depression are both associated with risk-taking, this strengthens the case for focussing on risk-taking as a potential target for preventive intervention.
The Prevalence of Attention-Deficit Hyperactivity Disorder in Functional Neurological Disorder: An Integrative Literature Review
Authors: Staunton Catriona , Rudrappa Roopa , Rathnaiah Mohanbabu
Published: August 2024

Aims

Functional Neurological Disorders (FNDs) affect motor or sensory functions without a detectable underlying disease. FNDs encompass a range of presentations including non-epileptic seizures, cognitive changes, weakness, and sensory symptoms. The prevalence of FND as a diagnosis is increasing rapidly. Following our clinical observations of a high prevalence of Attention-Deficit Hyperactivity Disorder (ADHD) in people referred with a previous diagnosis of FND to our tertiary Neuropsychiatry pilot service in Derbyshire, we conducted an integrative literature review with the aim to investigate the prevalence of ADHD in people diagnosed with FND.

Methods

We conducted an integrative literature review using a systematic approach. A literature search was performed on two databases, PubMed and ScienceDirect. The keywords ‘Functional Neurological Disorder’, ‘Attention-Deficit Hyperactivity Disorder’, ‘Non-Epileptic Seizures’, ‘Functional’ were used. Databases were searched for initial search on 31 November 2023 and the search was repeated on 31 January 2024. Only articles in English language were included. Studies were eligible if reporting the prevalence of ADHD in FND populations. Studies involving adults and children were included. A further search was conducted on reference lists from the selected articles.

Results

Database searches on PubMed and ScienceDirect had 298 and 11,837 results, respectively. Only seven studies were identified that explored the prevalence of ADHD in individuals diagnosed with a FND and were included. In the adult population an association between a FND diagnosis, and ADHD traits identified on screening, or a final ADHD diagnosis was identified. The findings also demonstrate an increased incidence of comorbid ADHD and FND with the presence of another co-existing neurodevelopmental disorder such as Autism Spectrum Disorder. Furthermore, results indicated that the prevalence of an ADHD diagnosis in children with a FND was higher compared with adults. The literature suggests that, in both adults and children with FND-related functional seizures there is an increased prevalence of comorbid ADHD.

Conclusion

In conclusion, the findings from this review demonstrate a lack of evidence looking into the prevalence of Attention-Deficit Hyperactivity Disorder in complex presentations being labelled as Functional Neurological Disorder. However, the existing literature indicates there is an association between FND and ADHD. These findings highlight the importance of considering potential ADHD comorbidity in the assessment and management of FND, potentially informing targeted treatment approaches for affected individuals. Further research could explore the efficacy of ADHD medication and similar dopamine modulating molecules in treating sub-cohort of people with FND.
A Pilot Study to Assess Suicidal Risk in Women Reporting Domestic Violence to a Law Enforcement Agency in South India
Authors: Thatavarthi Lakshmi Keerthana , Chintala Hari Priya
Published: August 2024

Aims

In a recent national study in India, 35% of women reported experiencing domestic violence. The association between domestic violence and mental health outcomes especially suicidal risk has been less studied in Asia especially in India. With this context in mind, we aimed to establish a preliminary prevalence of suicidal risk in women reporting domestic violence using self-injurious thoughts and behaviors as proxy measures. We also wanted to probe the feasibility of assessing suicidal risk in a community center for vulnerable women with limited access to referral care and to determine the acceptability of safety plans as well as referral to a hospital setting for women with increased suicidal risk.

Methods

A single center cross-sectional pilot study was conducted among 50 females who have officially reported Domestic Violence. The participants had reported this domestic violence to a ‘SHE Teams’ center in Telangana state, India, which is a women safety surveillance initiative launched by the state government. HARK (Humiliation, Afraid, Rape, Kick) questionnaire to assess the type of domestic violence experienced and SITBI (Self Injurious Thoughts and Behaviors Interview) questionnaire to evaluate the type of self-harm in victims were used.

Results

It was found that 100% of the study population experienced emotional abuse, 50% sexual abuse, 74% physical abuse and 80% of them were afraid of their partners. It was also found that 64% had suicidal ideation, 40% had made a suicidal plan, 22% made suicidal gestures, 34% have attempted to commit suicide at least once. 12% had thoughts of Non-Suicidal Self Injury and 10% have committed Non-Suicidal Self Injury. Women who were unemployed and those who were harassed for dowry/endowment by the spouse or spouse's family had a statistically significant association with elevated suicidal risk. 17 participants were referred to a psychiatrist in the nearby hospital and 32 requested for shelter in fear of future violence.

Conclusion

Domestic violence is a risk factor for poor mental health among women and suicide is one of the main causes of premature death in this population. To prevent more suicides in women, identifying risk and referral of domestic violence victims should be an essential part of health care systems apart from adequate legal support. This pilot study provides preliminary data for a future study of risk factors mediating suicidal risk in women who are victims of domestic violence and to develop targeted interventions as well.
Increases in Daily Defined Doses of Incident Benzodiazepine Prescriptions in the Netherlands During the Second and Third COVID-19 Lockdowns
Authors: Visser Damian , Everaerd Daphne , Tendolkar Indira , Zinkstok Janneke , Schellekens Arnt
Published: August 2024

Aims

The aim of this study is to investigate incident and total benzodiazepine prescribing in the Netherlands during the COVID-19 pandemic, including the impact of lockdown periods.

Methods

A national Dutch pharmacological registry was used, investigating extramural psychiatric drug prescriptions, between March 2020 and March 2022. Data included incident and total prescriptions as well as daily defined doses (DDDs) of benzodiazepines. The data covered 96% out of a total Dutch population of 17.5 million people. This was compared with the previous calendar year as a reference expressed as a monthly risk ratio (RR) and was corrected for population growth. Changes over time will be discussed if the RR was above 1.1 or below 0.9.

Results

A total of 13.4 million prescriptions over a period of three years were included of which 5.8% were incident prescriptions. Three lockdown periods were identified during pandemic.

When analysing the total benzodiazepine prescription group, prescriptions and DDDs remained mostly stable throughout the pandemic. A brief relative increase in prescription DDD amounts was found during the second lockdown (RR: 1.11). When viewing the incident benzodiazepine prescriptions, there was a short period between the first and second lockdown when both prescription numbers and DDDs decreased (RR: 0.86 and RR: 0.83 respectively). The DDDs of incident prescriptions increased sharply during the second and third lockdown period and remained elevated between both, with an average RR of 1.13.

Conclusion

Total monthly benzodiazepine prescriptions and DDDs remained mostly stable during the COVID-19 pandemic in the Netherlands. COVID-19 related lockdowns seem to have mainly influenced incident benzodiazepine DDDs dispensed during the second and third lockdown. Increased incident DDDs, but not prescription numbers, imply that new patients on average received larger benzodiazepine prescriptions. The increase in incident prescription DDDs could be indicative of decreased accessibility to (psychiatric) healthcare. It could also have been driven by an increase of the incidence and/or severity of sleep and anxiety symptoms during the second and third lockdown. A better understanding of exact causes and mechanisms behind these changes is relevant in order to limit the psychiatric repercussions of future (inter)national emergencies.
A Systematic Review of Recruitment and Retention Within Randomised Controlled Trials of Adults With Down Syndrome
Authors: Wilkinson Aimee , Realpe Alba , Rai Dheeraj
Published: August 2024

Aims

Adults with Down syndrome (DS) face significant health inequalities and are at increased risk of numerous health concerns. Despite the need, there is a lack of high-quality randomised trial evidence and clinical interventions for people with DS are largely based on consensus guidelines or clinician preferences. As life-expectancy of those with DS increases, the research gap continues to widen.

There is a perception that randomised controlled trials (RCTs) involving people with DS may be hard to carry out due to difficulties in recruitment and retention of participants. However, there is no scientific literature exploring this topic. This systematic review aimed to assess planned vs actual recruitment and retention in RCTs involving adults with DS, and to summarise reported facilitators and barriers to participation of adults with DS in relevant trials.

Methods

The MEDLINE, PsycINFO, EMBASE databases were searched systematically to retrieve all RCTs involving adults with DS aged 16 years or older published from 01.11.1961 to 15.12.2023. Ongoing RCTs were identified from trial registries and searches were supplemented by review of reference lists. Data extraction is ongoing but seeks to elicit details of trial design; planned and achieved recruitment sample size; planned and achieved retention rate, and any specific recruitment or retention strategies described. Risk of bias analysis was not relevant to the research question and so not performed. The review was prospectively registered on Prospero (CRD42023447126).

Results

The database searches retrieved 1,825 results. Post deduplication, 1,518 articles underwent title and abstract screening, of which 82 full texts were reviewed. 53 papers were included in the final analysis, reflecting 47 RCTs involving 1,772 individuals. Commonly studied interventions included exercise programmes for physical fitness and pharmaceuticals that may augment neuropsychological function. Studies typically reported small sample sizes at the point of randomisation (mean = 38.5, SD = 49.6), with over half reporting a sample size of n < 50. A significant number of studies reported difficulty recruiting and retaining participants (detailed data will be available in the poster). Of the minority of articles that reported power calculations, several reported failure to meet target sample size.

Conclusion

Initial results point to a paucity of high-quality, large-scale RCTs involving adults with DS and challenges related to recruitment of participants. The results may aid development of strategies that allow clinical trial teams to overcome challenges in recruitment and retention in RCTs, and may eventually contribute to the improved health and wellbeing of adults with DS.
Caregiver Mental Health, Quality of Life, and Coping Following a Child's Diagnosis of Autism: A Follow-Up Study After 4–6 Years
Authors: Wong Chui Mae , Lian Sylvie Yiting , Ong Amily Yi Lin , Ang Lui Yee , Magiati Iliana
Published: August 2024

Aims

Caregivers of autistic children may experience greater stress and reduced mental well-being compared with caregivers of typically developing children or children with other neurodevelopmental conditions. Less is known about earlier child and family predictors of later caregiver stress, as most studies have been cross-sectional. This study aimed to examine how caregiver (coping strategies and appraisal of their child's autism) and child factors (behavioural difficulties and adaptive functioning) were related to mental health and quality of life in caregivers of 2–7-year-old autistic children over 4–6 years.

Methods: At Time 1 (T1), 119 caregivers completed the Coping Health Inventory for Parents (CHIP), Family Impact of Childhood Disability (FICD), Centre for Epidemiology Studies Depression Scale (CES-D), Autism Treatment Evaluation Checklist (ATEC), and Scales of Independent Behavior-Revised (SIB-R). Of those, 50 completed the same measures 4–6 years later (Time 2-T2). Demographic data at T1 and the World Health Organization Quality of Life (WHOQOL) questionnaire at T2 were also collected. The relative contributions of T1 caregiver and child factors in predicting T2 caregiver self-reported depression and quality of life were analysed with multiple regressions.

Results

Caregivers’ depressive symptoms remained generally stable across 4–6 years (30% at T1 and 38% at T2 scoring at or above the CES-D cut-off), and earlier caregiver depression predicted later caregiver depression. At T2, child adaptive functioning significantly improved compared with T1, while mean child behavioural difficulties (e.g., behaviours disruptive to others, damaging to property, socially offensive or inappropriate) remained generally stable. Caregiver appraisal of the impact of child's autism on the family also did not change much over time, but higher T1 negative caregiver appraisals of their child's diagnosis predicted poorer later social quality of life on the WHOQOL. There were mixed findings regarding the helpfulness of coping patterns assessed by the CHIP, with our findings suggesting that family integration and optimism could be helpful in improving caregiver mental well-being.

Conclusion

Modifiable predictors of longer-term caregiver adaptation indicate that in addition to providing early supports for children's adaptive functioning and social communication, caregivers’ appraisals of autism, caregiver and family coping strategies, and earlier caregiver depressive symptoms also need to be targeted.
Royal College of Psychiatrists (RCPsych) Dean's Grand Rounds – an Innovative Medical Education Tool to Bridge the Education-Practice Gap
Authors: Krishnan Deepa Bagepalli , Mullins Elizabeth , Dave Subodh
Published: August 2024

Aims

RCPsych Dean's Grand Rounds focuses on understanding a problem or an opportunity for change in clinical practice using a patient story, academic evidence, and contextual data in this area to bridge the evidence-practice gap using a quality improvement approach. The Dean's Grand Rounds aims to embed the lived experience in clinical practice and use data to drive change.

Methods

We held five virtual Dean's Grand Rounds with this format from June 2022 to January 2024. The sessions included a variety of medical professionals, carers and expert patients presenting on the chosen theme, followed by a panel discussion. The sessions were then made available for on-demand viewing via the RCPsych website for those unable to attend the live session. Qualitative and quantitative feedback helped us improve the sessions iteratively.

Results

The sessions have enabled discussion of broader issues facing staff and patients, facilitating the exchange of ideas between professionals from divisions of the RCPsych from around the world. Participants globally attended these sessions, with over 1,000 registrations for the Grand Rounds on memory clinics and catatonia. The feedback for the sessions was overwhelmingly positive, with many participants praising the involvement of patients and carers and the opportunity to come together at the RCPsych level for learning. Many were attracted to the sessions because of the themes discussed, with 68.5% having excellent overall experience. Over 92% of the feedback participants thought the Grand Rounds had improved their professional practice. The majority of the feedback participants strongly agreed that lived experience is an important element in understanding the evidence-practice gap (4.4 on a Likert scale of 1, strongly disagree; 5, strongly agree) and that the Grand Rounds had enhanced their understanding of academic evidence and contextual data in the area (4.4, 4.39 respectively on a Likert scale of 1, strongly disagree; 5, strongly agree). The themes that stood out in the feedback were that participants liked the Grand Rounds format and were grateful to hear from patients, with suggestions to allocate more time for questions and answers. Learning from the feedback, we set up a resources page for each Grand Rounds to enable further learning.

Conclusion

In their revitalised format, these sessions are proving highly effective in bringing the worldwide RCPsych community together to improve patient care and deliver educational and informative interactive content available on demand.
From Virtual to In-Person Teaching After COVID – Face-to-Face Simulation Gives Greater Improvement in Confidence and Satisfaction
Authors: Di Francesco Daniel , Colombo-Sansom Alexandra
Published: August 2024

Aims

To adapt a virtual simulation training session for junior doctors, developed during COVID, to an in-person format.

To compare self-reported differences in knowledge and usefulness of the session across the two formats.

Methods

Initially a virtual simulation training session was developed and run in the induction program for junior doctors rotating onto psychiatry. This involved a series of 10-minute simulations tackling 5 emergency scenarios:

Using section 5(2); Acutely agitated patient and rapid tranquilisation; Neuroleptic malignant syndrome; Alcohol withdrawal and detoxification; ligature injury.

Written briefs were constructed and standardised actors delivered the content through a video call with the doctors. A facilitator was able to provide key data, including NEWS scores and exam findings. This was followed by a ten minute debrief, giving feedback on communication, and discussion around the key learning points.

After COVID restrictions were eased, this programme was adapted to a face-to-face format. New, Trust-specific, resources were developed – paper NEWS charts, drug charts, alcohol detoxification pro-forma, and section 5(2) paperwork, which were made available to the candidate during the scenario.

Self-reported scores were collected in the virtual (N = 117) and face-to-face (N = 19) sessions across several domains: in the usefulness and relevance, improvement in knowledge, and overall benefit of the teaching programme, as well as free-text feedback.

Results

Scores were collected on a 5-point Likert scale, (from 1 - strongly disagree, to 5 - strongly agree) and a mean score was calculated, and p value calculated with a two-tailed Mann Whitney U test. The scores showed improved ratings in the face-to-face sessions across all domains - improvement in knowledge (from 4.2 to 4.6; p = 0.0005), and overall satisfaction (from 4.18 to 4.63; p = 0.00036), usefulness and relevance (from 4.06 to 4.68; p = 0.053, though this last domain did not reach statistical significance).

Free text feedback highlighted the positive aspects of the pacing, organisation and delivery of feedback from actors and facilitators.

There were also suggestions for improvement - to adapt the scenarios to better capture the wide variation in doctors' previous experience of psychiatry, and to reduce the group sizes.

Conclusion

A simulation teaching session developed during COVID was successfully transitioned to a face-to-face format. This allowed a higher-fidelity environment with trust specific scenario materials and enabled more realistic communication with the actors. The face-to-face session was found to deliver higher improvement in self-reported knowledge and satisfaction, compared with the virtual session.
A Novel Model for Student-Led Justice, Equity, Diversity and Inclusion Training at a UK Medical School
Authors: Gallier-Birt Isabelle , Reid Emily Róisín , Webster George , Bowley Mary
Published: August 2024

Aims

It was identified that at Warwick Medical School (WMS) there was no provision for in-person, student-led Justice, Equity, Diversity, and Inclusion (J, E, D&I) training for both staff and students. A novel approach using case-based studies and group discussions was developed through a student-staff collaboration with the aim of participants gaining a greater understanding of the impact of various institutional practices, from the perspective of students with first-hand experience of the subject matter. The training aimed to promote a greater understanding of intersectionality, and how institutional practices can disproportionately disadvantage students depending on their identity, experience, and background. Participants were encouraged to reflect upon the cumulative effects of systemic disadvantages in higher and medical education. The subsequent impact upon academic attainment, mental health and wellbeing was a further focus.

Methods

Around 350 students and staff from across WMS attended the training sessions over 6 months. These sessions were led by a team of student facilitators who possessed subject expertise in topics related to J, E, D&I, in addition to representing the communities that were discussed in terms of inclusion. The content was delivered in the form of case-based scenarios and small and wider group discussions. Content was based on discussions surrounding racism, classism, ableism, homophobia, sexism, Islamophobia, and transphobia. Discussion was encouraged and facilitated to promote reflection on personal practices and acknowledgement of where future efforts to improve practice should be directed.

Results

Results indicate statistically significant shifts in participant knowledge and confidence levels in pre-post survey data, with qualitative feedback emphasising the strength of the student-led format. Faculty and students commented on the benefit of student-lead case-based teaching and student facilitator reflections highlight personal growth and the challenges of navigating power dynamics.

Conclusion

Overall, this project illustrates the efficacy of a student-led change initiative in fostering inclusivity and positive change within educational environments and provides an original model to explore for future partnership-working across the medical school. The student-led approach facilitated mutual learning between staff and students, bringing greater focus to how student attainment and wellbeing can be impacted by institutional practices.
One-Off Focused Teaching Can Improve Trainee Confidence, Knowledge and Skillset in Understanding and Therapeutically Engaging People With a Diagnosis of Personality Disorder
Authors: Lau Sil-Jun , Meek Daniel
Published: August 2024

Aims

To design, deliver and evaluate teaching for psychiatry trainees on personality disorder (PD) with the following objectives: to promote understanding and empathy for people with a diagnosis of PD; to equip trainees with skills they can immediately use for therapeutically engaging patients with PD; to introduce the evidence-based treatments that underpin these techniques; and to increase confidence in offering therapeutic clinical encounters for patients with PD.

Methods

A single teaching session was designed and delivered to core psychiatry trainees in three components. First, an interactive lecture was delivered on the theory of personality disorder as understood by two evidence-based psychotherapies: Mentalization-Based Treatment (MBT) and Transference-Focused Psychotherapy (TFP). Second, techniques from both were introduced as skills they can readily apply to clinical practice. Lastly, role-play scenarios with original scripts were worked through to highlight theory and techniques. Evaluation was conducted through anonymous participant-rated scores matched to learning objectives pre- and post-delivery of teaching.

Results

20 participants (n = 20) completed the evaluation. 90% of respondents agreed/strongly agreed that they frequently encountered patients with PD. There was high pre-existing confidence in recognising PD in clinical practice; this was little changed by the teaching. Before the teaching, 45% of respondents agreed/strongly agreed with the statement saying they are confident offering clinical encounters for patients with PD; this changed to 90% post-delivery. Pre-delivery, 45% agreed/strongly agreed they possessed skills they could use clinically for PD; this increased to 75% post-delivery. Pre-delivery, 60% agreed/strongly agreed that they can generally empathise with people with PD; this increased to 90% post-delivery. Self-rated knowledge of evidence-based treatments for PD increased for both MBT (20% pre-delivery to 85% post-delivery) and TFP (15% to 75%). 95% of respondents agreed/strongly agreed that they will try out new skills learnt from the session. 100% of respondents agreed/strongly agreed that the teaching was overall useful.

Conclusion

This study shows it is possible to make positive effects on trainee confidence, knowledge and skill in relation to PD in a short and one-off timeframe. Future efforts should include attempts to replicate these findings on larger numbers of participants, across different training and non-training medical grades and in non-medical staff. Future evaluation should also observe if positive changes are sustained across time or lead to improvements in clinical outcomes and patient satisfaction.
Consult, Connect, Collaborate: Cross-Sector Approach to Recruitment and Retention in Psychiatry
Authors: MacKenzie Nina , Cook Alastair
Published: August 2024

Aims

Mental ill-health is one of Scotland's most pressing challenges, with an expectation of increased workload for health services. There are substantial vacancies in psychiatry specialties. Fill rates for core psychiatry training in Scotland have improved dramatically, filling at 100% since 2020. However, higher training fill rates have remained lower, with 68% filled in 2022. In response, the Scottish Government established a working group to examine the issues, both common and unique, to the whole psychiatry pipeline from training through to the consultant workforce, over two phases. The group aims to:

•

Set out the current landscape.

•

Consider the factors which influence recruitment and retention.

•

Collate and analyse quantitative and qualitative evidence.

•

Develop a set of recommendations.

Methods

A representative group was convened, including SG Health Workforce and Mental Health Directorates, NHS Education for Scotland (NES), the Royal College of Psychiatrists Scotland, Health Board representatives (Associate Medical Directors, Clinical Directors, Directors of Medical Education) and trainee doctors. Representatives offer first-hand experience of training and working in psychiatry, knowledge and expertise in training programme management, workforce modelling data analysis, experience of a range of approaches to improve health workforce recruitment (including the use of financial incentives). The group has met 4 times since May 2023, with SG Health workforce directorate providing secretariat support.

Results

Through the formation of this group, several areas affecting recruitment and retention were, and continue to be, addressed: enhanced exposure to psychiatry via FY1 simulation training, and increased number of FY2 psychiatry placements; the design and recruitment of clinical development fellow doctors; flexibility of training posts and the expansion of run through training programmes; using data to better support workforce modelling; trainee support, including tailored IMG support; the use of attraction campaigns and incentives in other devolved nations/specialties; alternative ways to provide clinical supervision; examining diversification of the MH workforce; international and domestic recruitment options.

Conclusion

Several actions have been identified and progressed as the work of the group develops. Work is ongoing, and its impact will take time to emerge. This cross-functional group encouraged connectivity, conversation and network-building, striving to amplify differences and reduce power differentials, challenging traditional views. However, as with groups of this nature, there could be internal conflict where members fight strongly for ‘their corner’. Such a broad membership affects the development of a cohesive identity. Membership is largely voluntary, and so competing demands from the members’ existing responsibilities adds time pressure and stress, impacting commitment and productivity.
Case Based Learning in Psychiatry: Use of Interactive Presentation Software and Fictional Narrative
Authors: McGuigan Gareth , Barr Scott , Robertson Megan , Ghouri Syeda , Doris Ayemyat
Published: August 2024

Aims

Undergraduate Psychiatry placements often struggle to provide the bedside teaching familiar to students from other specialties. Efforts to reproduce this experience in tutorials can be impaired by lack of interactivity, high student-to-teacher ratio, and use of mostly didactic pedagogy. Psychiatry trainees have provided weekly tutorials in ‘Clinical Skills' to University of Glasgow students on Psychiatric placement for several years. Unfortunately, these tutorials suffered from poor attendance, poor engagement, and difficulty recruiting facilitators. We created an afternoon of teaching structured around three presentations of a fictional patient in a narrative fashion aimed at solving these issues and providing excellent experience for students.

Methods

Together with Glasgow University tutors, we selected Learning Objectives that would benefit from additional formal teaching. We then created a fictionalised patient narrative incorporating presentations of self-harm, delirium and postnatal depression. Teaching materials were created using mentimeter.com to allow for maximal engagement and interactivity. The content included brief summary slides, groupwork, Word-Clouds, anonymous quizzes, and simulated clinical encounters/roleplay. Custom illustrated vignettes accompanied each scenario to increase verisimilitude. The day is delivered by three Psychiatry trainees to up to forty students in their penultimate week of placement. Feedback is gathered digitally and anonymously on the day.

Results

77/80 students invited attended. 71 (92%) completed feedback: 100% ranked the day positively - either “very helpful” (85.9%) or “somewhat helpful” (14.1%). Students advised it was “extremely useful” preparation for both clinical placements (73.2%) and exams (88.7%). All attendees provided free-text remarks; quotes include “One of the best teaching days I've been to” and “Best teaching of the block”. 84.5% felt “very involved” in the day and the word “interactive” was used 30 times in freetext. When asked on what could be improved, the most common response was “another session” (34%).

Conclusion

Recruitment to Psychiatry relies on positive experiences during placement. Retention of Psychiatrists relies on providing rewarding and varied working experiences. Our hope is that successful events like this support both aims. The creative use of narrative, illustrated vignettes, roleplay and interactive questions afforded excellent engagement and enjoyable experiences for student and facilitator, as reflected in the feedback.

Going forward, we plan to refine this case and develop another. We are seeking review and design input from patient representatives and EDI experts. Comparison of students' exam outcomes and feedback from the replaced tutorials is also planned. Use of this format across other specialties is also being pursued.
Home Is Where the Health Is: Developing Medical Students’ Understanding of Homeless Health
Authors: Pereira-Greene Lauren
Published: August 2024

Aims

Mental and physical ill-health are both causes and consequences of homelessness. As the cost-of-living crisis forces more people out of their homes, it is imperative that medical students are informed and prepared for this health crisis. Discussions with or about homeless populations are largely absent from the current medical school experience, and are rarely accompanied by homelessness-specific on-the-ground exposure. This project aims to use contemporary literature and the personal experience of a UK medical student to formulate suggestions on how the curriculum can better address homeless health.

Methods

A literature search was performed, including recent work on medical education, inclusion health, and homelessness. Reflection on the author's personal experience at medical school was conducted and compared with existing literature to ascertain validity.

Results

Whilst many students will walk past rough-sleepers on their way into university/hospital, homelessness is a seldom-addressed topic at medical school. In the author's personal experience, there can be a cognitive disconnect between the theoretical principles (e.g. social determinants of health, inclusion health) covered in lectures, and the on-the-ground realities of the isolation, discrimination, and violence that homeless populations face. Since medical students disproportionately come from privileged socioeconomic backgrounds, this disconnect may be due to a lack of exposure underpinned by the assumption that homelessness will never directly affect them.

A review of literature highlighted several worldwide initiatives aiming to develop medical students’ understanding of homelessness. Programmes involved students in health screening, education programmes, and street psychiatry placements. These have been shown to reduce bias and improve student preparedness.

Based on the overlap between literature and the author's own experiences, three focuses for curriculum improvement are proposed: supported exposure, compulsory education, and advocacy. Supported exposure would involve students having formal face-to-face contact with homeless populations, supported by supervision and debriefing. To prepare for these interactions and their potential challenges, students should receive trauma-informed training alongside teaching on inclusion health and social determinants of health. This should be emphasised by medical schools as mandatory, rather than a ‘special-interest’ topic that many students will not engage with. Finally, students should be encouraged to advocate for vulnerable patients both within the clinic, and on a broader systemic level.

Conclusion

This project stresses the urgent need for addressing homelessness within medical education. The proposed focuses aim to cultivate a deeper understanding among medical students about the health challenges faced by homeless populations, fostering empathy and competence in future healthcare professionals.
INSIGHT: Integrating Social Determinants of Health in Medical Education During Psychiatry Prison Placements
Authors: Nafees Sadia Bashir , Matusiak Jakub , Taylor-Clutton Andrea , Newman Simon , Poole Rob
Published: August 2024

Aims

Background. The importance of the social determinants of health (SDOH) is increasingly recognised. However, medical students are taught about them as epidemiological facts. We established a programme in North Wales involving prison placements for medical students, accompanied by specific teaching to contextualise SDOH to individual patients’ mental health problems. This is being evaluated over a four-year follow-up. We report findings of qualitative evaluation of the second-year cohort.

Methods

Individual interviews with students and free text data from questionnaires were analysed thematically.

Results

Previous teaching about SDOH:

•

“You do not understand until you see it in your own life. Lectures do not always deliver a point.”

•

“Mentioned but not very explicit session like here.”

Baseline knowledge and attitudes to SDOH

•

“I knew mental health and social determinants are a lot intertwined, but I would not have thought of it in such depth before coming here.”

•

“I knew what SDOH were, but I have not seen it on this scale.”

•

“Some students related the teaching to their personal experience of hardship.”

Prison placement

“I think the prison placement has given invaluable teaching about psychiatric conditions.”

“I…think it helps widen experiences in medicine, seeing a different perspective of healthcare.”

“I enjoyed the prison experience. It gave me the social aspects of health, and especially in the prison, it is clear and visible.”

Impact of the placements

“Humbling experience. A lot of patients I saw had some sort of childhood trauma.”

“Maybe I will be treating someone that is not as privileged or someone who's been in prison, so it's important…”

“Learned to have confidence when taking patient history. Do not feel awkward when asking medical questions such as suicide.”

SDOH incorporation into medical education

“Introducing the modules in medical school would be good before the students meet the patients, as the social aspect is a big part of the history.”

“These sessions need to be integrated throughout the module rather than at one point as social determinants also play a role in other specialities, not only psychiatry.”

Conclusion

In previous publications, we reported positive responses to prison placements. By integrating a module about SDOH, students can develop a broader understanding of health and gain the awareness needed to address these factors in clinical practice.
Enhancing On-Call Preparedness Among Junior Doctors in Psychiatry: A Comprehensive Bootcamp Approach
Authors: Santosh Ananya , Kumar Praveen , Brown Susan
Published: August 2024

Aims

The Psychiatry Bootcamp at a psychiatric hospital was developed to address the unique and diverse challenges faced by new trainees, including Foundation Year Doctors, General Practitioner Specialty Trainees, Core Psychiatry trainees and Broad-Based Trainees, during their rotations in psychiatry in the Highlands, Scotland. The aim was to enhance their core skills and confidence levels, ensuring they are well-prepared for their first on-call shift. This initiative seeks to complement the existing induction program, specifically targeting areas of acute medical and psychiatric emergencies and care, that are critical for on-call duties.

Methods

Since its launch in 2022, the Psychiatry Bootcamp has been conducted quarterly, aligning with new doctor rotations. Held at the Medical Education Centre/Psychiatry Hospital, this one-day intensive training accommodates an average of 10 participants per session. The program, delivered by consultants, specialist nurses, and senior trainees, comprises tutorials, practical skills sessions, and simulated scenarios, focusing on key areas like the Mental Health Act, psychiatric risk assessment, wound management, resuscitation guidelines, and rapid tranquilisation.

A pre-test is administered to gauge participants' baseline knowledge and skills. Feedback is also collected immediately after the session and 3–4 months later. This ongoing feedback, systematically gathered since 2022, has been pivotal in continuously refining the curriculum and teaching methods, ensuring they remain up-to-date and effective.

Results

The bootcamp demonstrated notable success in enhancing the preparedness of new psychiatry trainees for on-call duties. Post-course evaluations revealed an improvement in participants' confidence levels when managing psychiatric emergencies and various on-call situations. Through the practical and interactive nature of the training, trainees reported a deeper understanding of acute psychiatric care and an increased ability to apply theoretical knowledge in real-life scenarios. The hands-on experience with simulated scenarios was particularly effective in bridging the gap between classroom learning and clinical practice. Trainees expressed greater comfort in handling challenging situations, such as rapid tranquilisation and emergency detention under the Mental Health Act, which were previously areas of concern.

Conclusion

The Psychiatry Bootcamp represents a targeted and effective approach to preparing new psychiatry trainees for the demands of on-call duties. By focusing on key areas of need and employing a variety of teaching methods tailored to enhance practical skills and confidence, the bootcamp successfully addresses the gap between theoretical knowledge and clinical application. Preliminary feedback underscores the value of such programs in psychiatric education, suggesting that this model could be beneficial for similar settings seeking to improve trainee preparedness and overall patient care quality.
Audit of Patients Prescribed Psychotropic Medication in the Community Learning Disabilities Psychiatry Services of the Black Country Healthcare NHS Foundation Trust
Authors: Adetoki Adeniyi
Published: August 2024

Aims

Stopping Overmedication of People with a Learning Disability, Autism or Both (STOMP) is an initiative of NHS England. This was in response to concerns raised as a result of the Winterbourne View scandal related to the inappropriate use and insufficient arrangements for the review of the prescription of psychotropic medication.

33,000–35,000 individuals with an intellectual disability (ID) are prescribed psychotropic medication daily. 20–45% are on antipsychotic medication, of which 14–30% take these to control behaviour problems rather than for specified psychiatric conditions. Psychotropic medications can have side effects with the potential to significantly impair an individual's quality of life.

This audit is to observe current practice of the prescription of psychotropic medication, with a view to identifying changes to the compliance with recommendations and outlining areas for further improvement in line with the Stopping Overmedication of People with a Learning Disability, Autism or Both (STOMP) initiative.

Methods

Data was collected from electronic records for randomly selected patients, 20 from each of the 4 Community Learning Disabilities Locality Teams within the Trust. The patients who were not currently prescribed psychotropic medication were excluded from the randomly selected samples.

Results

There was good evidence that capacity, consent and best interests were considered, as well as multidisciplinary input. There was also good evidence of regular review of medication, side effects and treatment response. The results suggests that psychotropic medication continues to play a significant role in the management of patients presenting with behavioural problems, and more needs to be done to identify approaches that will help to reduce their use.

Conclusion

In this patient group it is sometimes the case that medication is prescribed legitimately for indications other than their British National Formulary (BNF) recommended use. However, the findings suggest that the rationale could be more clearly recorded. Close collaboration with primary care to provide a comprehensive medication history, the involvement of carers and family members in the active preparation for effective medication reviews and the involvement of the multidisciplinary team should continue to be encouraged and clearly recorded.
Improving Staff Awareness of Sensory Aid Needs and Dementia Status on an Old Age Ward
Authors: Arifaj Bekim , Nyam Limaro , Sansom-Ninnes Karen
Published: August 2024

Aims

The aim of our quality improvement project was to explore and improve care for patients who use sensory aids, with or without dementia, on an old age ward at King's College Hospital. We sought to do this by increasing the staff awareness of each patient's sensory needs and dementia status.

Guidelines state that sensory aids (glasses and hearing aids) are important in orientating patients with delirium and dementia, yet these devices frequently go missing during admission or are not being used appropriately. This could affect communication and therefore overall care, both physical and mental. It is widely understood that delirium and dementia are associated with increased morbidity and mortality. In this project we aimed to explore issues around sensory aid use and to identify and implement impactful changes.

Methods

2 Plan, Do, Study, Act cycles were conducted between October 2022 to February 2023. A driver diagram was created following staff interviews on the ward. The first cycle focused on increasing awareness of a form in electronic patient records (EPR) and the need for documenting each patient's sensory aid possessions and dementia status. This was done through bite-size teaching sessions to the team and monitoring of completion of this form. The second cycle included utilising a new laminated bedside checklist that is manually filled in and was aimed to serve as a visual cue of the patient's sensory impairment/dementia status. A survey was used at baseline and then repeated over the course of both cycles to evaluate awareness of staff (named nurse) of each patient's sensory impairment/dementia status on the ward.

Results

Baseline survey showed that staff were unsure of the sensory aid needs (glasses, hearing aids, dentures) of 25% of patients and 46.7% when it came to dementia status. EPR form completion increased by 14% between 14/12/22 and 25/01/23, however this was not statistically significant. 18% of bedside checklists were filled after 4 weeks. Overall, there was a statistically significant decrease in staff not knowing the sensory impairment status (by 32%) as well as dementia status (by 40%).

Conclusion

Whilst uptake of the forms and bedside checklist was slow, the project did show an improvement in awareness of staff and our hypothesis is that this leads to better use of sensory aids. The next step would be to assess whether this leads to better care through further PDSA cycles.