bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare Needs of an Older Adult Population Referred for Psychiatric Assessment in the Emergency Department of a University Hospital
Authors: Hoare Fiona , O'Donoghue Ann , Sweeney Colm , Tan Darlene , Alabdulrahman Meshari
Published: August 2024

Aims

It is estimated that approximately 15% of adults over 60 years old suffer from a mental disorder. Self-harm and suicidal ideation are associated with a range of mental disorders, and high rates of suicide. The aim of this project is to identify the characteristics of older people who present with self-harm and suicidal ideation to an emergency department (ED) in a university hospital. In examining the variables associated with self-harm we may be better able to identify the characteristics of older adults who are at highest risk.

Methods

We conducted a cohort study of older adults (aged 65 years+) who presented to the Mater Misericordiae University Hospital with a mental health problem from 2008–2022 (a 15-year cohort). Data were extracted from the Electronic Patient Records including all patients who presented to the ED in that time period with a mental health triage code. We examined this cohort to collect detailed information on the characteristics of those older people presenting with self-harm and suicidal ideation.

Results

We identified 30,941 ED attendances with a mental health triage code between 2008 and 2022. Of these, 946 (3.1%) were older adults. One-fifth (20%) presented with self-harm, a further 21% reported suicidal ideation. Of these, 8% reported previous self-harm and 32% had previously been reviewed by psychiatry. Over one-third (38%) were admitted. Of those, the majority (78%) were admitted to a medical or surgical ward, 16% to a psychiatric ward and 5% to critical care.

Of those presenting with self-harm 37% were admitted to hospital – 32% to a medical or other ward and 5% to psychiatric unit. There was a significant difference in those who were admitted with self-harm versus suicidal ideation (p < 0.001).

Conclusion

Our results demonstrate key insights into older adults who presented to the ED with self-harm and suicidal ideation. These patients were more likely to be admitted to a medical ward than a psychiatric unit, and those with self-harm were more likely to be admitted medically compared with those with suicidal ideation.

Possible reasons for these results include the higher rate of medical co-morbidity in older adults and the potential high lethality of self-harm in this cohort. Another explanation could be the scarcity of acute psychiatric beds necessitating medical admission. There is a need for further exploration of this high-risk population.
Drift in Depression Prevalence Disorder in Gulf Cooperation Council (GCC) Countries Over 30 Years
Authors: Al Balushi Mitha , Al Maskari Fatima , Javaid Syed , Ahamd Amar
Published: August 2024

Aims

Depression disorder is a major public health problem and a serious medical illness which negatively affects people's daily life. The WHO's International Classification of Diseases (ICD–10) defines this set of disorders ranging from mild to moderate to severe. Estimated annual percentage change (EAPC) is a useful statistic that is used to measure trends in rates over time-period.

The aim of this study was to compute the drift in depression prevalence disorder using the EAPC of the prevalence of depression disorder between 1990 to 2019 with corresponding 95% confidence intervals (95% CI) across the GCC countries.

Methods

Prevalence of depression disorder data for the GCC countries were downloaded from “Our World in Data” https://ourworldindata.org/mental-health#depression. We computed the drift of depression over 30 years between the 6 GCC countries using the statistical software R.

Results

The greatest decrease was seen for Bahrain which is (–5.2%) followed by Qatar (–3.2%) and United Arab Emirates (–3%). However, the largest increase was observed for Saudi Arabia (2.7%), followed by Kuwait (1.1%) and Oman (0.7%). The reduction in the prevalence of depression disorder seen in Bahrain, Qatar and United Arab Emirates shows a significant achievement in mental health diagnosis, prevention, and treatment.

Conclusion

However, further studies are required to better understand the drifts in the GCC countries. Furthermore, governmental funding for academic and research mental health programs is highly recommended.
Depression and the Risk Factors Among Elderly Residents in Gyeongsangbuk-Do
Authors: Lee M.D. Kwang Hun
Published: August 2024

Aims

The purpose of this study is to analyze the prevalence and factors of depression among the elderly population, a significant issue in Korea's aging society. By doing so, we aim to provide basic indicators for improving mental health and quality of life while efficiently managing healthcare costs.

Methods

From February to December 2021, a study was conducted on a population of 19,158 elderly individuals aged 65 and above residing in Gyeongsangbuk-do province. The severity of depression was evaluated using the Korean version of the Patient Health Questionnaire (PHQ)-9, which was adapted for use as a depression screening tool in clinical settings. In addition, demographic information such as place of residence, age, gender, and education level was collected to analyze factors that may influence depression. The data were analyzed using cross-analysis, two independent sample t-tests, one-way ANOVA, multiple regression analysis, and Scheffe's post-hoc analysis.

Results

In the PHQ-9 screening, the average score of the elderly population was 3.65. The results showed that 13,705 individuals (71.5%) were in the normal group with scores ranging from 0 to 4, 3,683 individuals (19.2%) were in the mild group with scores ranging from 5 to 9, 1,575 individuals (8.2%) were in the moderate group with scores ranging from 10 to 19, and 195 individuals (1.0%) were in the severe group with scores of 20 or higher. It was found that place of residence, education level, type of housing, top two difficulties in daily life, subjective economic status, desired services, subjective mental health, past and current history of mental health treatment, and medication for physical illness had statistically significant (*p < 0.05) effects on depression.

Conclusion

Various factors were found to have a significant impact on depression among the elderly population in Gyeongsangbuk-do. Proactive prevention and treatment tailored to the population characteristics of the region may be necessary.
Unravelling the Complex of Substance Use and Suicide: Insights From a Qualitative Study in Pakistan
Authors: Asif Muqaddas , Shahzad Salman , Chaudhry Imran B. , Memon Rakhshi , Husain Nusrat
Published: August 2024

Aims

Suicide and substance use all contribute significantly to the global burden of mortality and morbidity. While existing evidence establishes the association between substance use and suicidal behaviour in Lower- and Middle-Income Countries (LMICs), only a few studies illustrate how substance use affected deceased people's lifestyles and suicide attempts. The study addresses this gap by exploring the role of substance use (particularly, alcohol and drug use) in overall lifestyles and suicides of deceased with substance use in Pakistan – an underexplored and under-researched country regarding suicide and substance use.

Methods

We conducted in-depth qualitative interviews (N = 11) with close relatives and friends of those who died by suicide and have a history of substance use. The topic guide was comprised of a narrative part exploring the circumstances that surrounded the suicidal death of the deceased and a problem-focused part collecting comprehensive details about the deceased's personal, family, psychological, and social context and the role of substance use in the lifestyles and the suicide of the deceased.

Results

The content analysis of interviews revealed five key themes: 1) Reasons for suicide, 2) Personality traits, 3) Psychological distress, 4) Initiation of substance use, and 5) Suicidal tendencies. Most of the participants reported the reason for their loved one's suicide was either an overdose of drugs or alcohol, family dynamics, or societal attitudes such as difficulty in building trust and finding acceptance within the family or society. Deceased individuals were perceived as impulsive with low control over their emotional states. Participants highlighted the underlying psychological distress in the deceased, emphasising the complexity of mental health and substance use problems. Participants reported that the deceased initiated drugs at an early age; had suicidal ideations; and overdosed themselves as a means of suicide.

Conclusion

This study provides valuable insights into the role of substance use in suicide. The findings highlight the need for a holistic approach to understanding the multifaceted factors that may influence suicidal behaviours in individuals with substance use. Understanding these factors can help develop targeted suicide prevention and intervention strategies, particularly in low-resource settings such as Pakistan.
Systematic Review of Cultural Expressions of Depression in African Communities; Implications for Service Provision
Authors: Ozidu Victoria , Dourado Hani
Published: August 2024

Aims

This review delves into the understanding of depression within African communities, extending its scope to nations with significant African populations, aiming to enhance service provision for these patients. While focusing on cultural experiences of depression that transcend geographical boundaries, it builds upon existing literature predominantly centred on sub-Saharan African countries.

Methods

A comprehensive literature search was conducted across multiple databases, yielding 13 relevant articles after applying stringent criteria. Following Cochrane guidelines, search terms encompassed population (Africa, Africans, African communities), exposure (Depression, Depressive disorder, Dysphoria, Dysthymia, Low mood), and outcomes (Cultural expressions, Cultural variations, Somatization, Cultural framework, Cross-cultural research, Service provision).

Results

Analysing selected articles through the CASP checklist, a narrative synthesis of qualitative studies over the past twelve years elucidated diverse perceptions and expressions of depression in African communities compared with Western contexts. Three major themes emerged: Expressions of depression (with subthemes: Attitudes towards depression), Perceptions of depression (including Stigmatization), and culturally acceptable forms of treatment (including Barriers towards treatment).

Conclusion

The review underscores the significance of integrating culturally acceptable treatment methods into psychological therapy for improved healthcare delivery. Collaboration between clinicians and patients is pivotal, with religious assistance emerging as a culturally acceptable treatment avenue. Establishing therapeutic alliances with religious communities could enhance treatment effectiveness. Further research is warranted to explore the impact of religious activity on depression symptoms and progression, as well as the influence of mental health providers' religious backgrounds on treatment dynamics. This holistic approach is crucial for addressing the unique cultural nuances surrounding depression in African communities and optimizing patient care.
Do AI Chatbots Incite Harmful Behaviours in Mental Health Patients?
Authors: Patel Harikrishna , Hussain Faiza
Published: August 2024

Aims

The contribution of mental illness towards total Disability Adjusted Life Years is increasing according to the Global Burden of Disease study. As the need for mental health services increases, technological advances are being deployed to improve the delivery of care and lower costs.

The emergence of Artificial Intelligence (AI) technology in mental health and companionship is an evolving topic of discussion. There have been increasing debates about the use of AI in managing mental health problems. As the AI technology and its use grows, it is vital to consider potential harms and ramifications.

There are very limited discussions about the use of chatbots and relevant AI by humans to commit crime especially in those suffering from mental illness. AI can potentially serve as an effective tool to misguide a vulnerable person going through a mental health problem e.g. encourage someone to commit a serious offence. There is evidence that some of the most used AI chatbots tend to accentuate any negative feelings their users already had and potentially reinforce their vulnerable thoughts leading to concerning consequences.

The objective of this study is to review existing evidence for harmful effects of AI chatbots on people with serious mental illness (SMI).

Methods

We conducted a review of existing evidence in five databases for relevant studies. The search sources were 4 bibliographical databases (PsycINFO, EMBASE, PubMed, and OVID), the search engine “Google Scholar” and relevant grey literature. Studies were eligible if they explored the role of AI and related technology in causing harm in those with SMI.

Results

Initial searches constrained the scope of review to the harmful effects of AI use in mental health and psychiatry and not just the association with crime due to very limited existing data.

Conclusion

Whilst current AI technology has shown potential in mental healthcare, it is important to acknowledge its limitations. At present, the evidence base for benefits of AI chatbot in mental healthcare is only just getting established and not enough is known or documented around the harmful effects of this technology. Nevertheless, we are seeing increasing cases of vulnerable mental health patients negatively influenced by AI technology. The use of AI chatbots raises various ethical concerns often magnified in people experiencing SMI. Further research will be valuable in understanding the ramifications of AI in psychiatry. This will also help guide the developers of this important and emerging technology to meet recognised ethical frameworks hence safeguarding vulnerable users.
Patterns of Psychiatric Help Seeking Behaviour Among Patients With Psychotic Illness, Presenting at Mental Health Institute in Pakistan
Authors: Kumar Rajesh , Roy Rahul , Devi Priyanka
Published: August 2024

Aims

To identify the patterns of psychiatric help seeking behaviour among patients with psychotic illness presenting to mental health institute in Pakistan.

Methods

This Descriptive, Cross-Sectional Design comprised of a sample of 103 patients with psychotic diseases, chosen via non-probability – consecutive sampling at Outpatient Department of Sir Cowasjee Jehangir Institute of Psychiatry, Hyderabad. The relatives of psychotic patients who were between 18 and 65 years of age with either gender and living with at least one family member were interviewed after taking informed written consent. An anonymous self-structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, psychiatric diagnosis and disease particulars, pattern of help seeking and time and reasons for delay.

Results

The mean age of the sample stood at 32 years (±9.5 SD). 1/3 of the sample comprised of male patients while only 24% were comprised of female population. The mean time elapsed after first episode psychosis till interview was 82 ± 32 months (7 years) while mean delay in help seeking to any helper was reported to be 41 ± 17 months (3.5 years). Majority of the patients approached first to faith healers (Aamil Baba, Witch Doctor, Pir, Religious Leader, Molvi, Imam or Religious Cleric) while only 1/5 of the patients approached to psychiatrists for treatment of first psychotic episode. The mean time duration to approach to psychiatrist after first episode psychosis was reported to be 73 ± 38 months (around 6 years).

Conclusion

The study showed that most frequent source of health care for psychiatric patients were faith healers (Aamil Baba, Witch Doctor, Pir, Religious Leader, Molvi, Imam or Religious Cleric) as compared with one-third who went to qualified healthcare providers like psychiatrists or physicians. There is a huge delay in proper help seeking among psychiatric patients. Health education aiming at increasing awareness among general population regarding treatment options for psychiatric illness is recommended to improve the quality of life of people living in our locality.
Real-World Impact of Research Feedback Reports on CYP Mental Health for Families of Children With Rare Genetic Disorders and Intellectual and Developmental Disability
Authors: Housby Harriet , Srinivasan Ramya , Skuse David , Wolstencroft Jeanne ,   IMAGINE ID Consortium
Published: August 2024

Aims

Children and young people (CYP) with intellectual and developmental disabilities (IDD) of known genetic origin experience complex physical and mental health problems; IMAGINE-ID has followed a national UK cohort from childhood to early adulthood. Parents completed structured online psychiatric assessments on repeated occasions. From these assessments, semi-automated personalised reports were generated summarising each child's strengths and difficulties, in collaboration with IMAGINE ID participants and the charity UNIQUE.

We aimed to discover whether providing a structured summary of our mental health and behavioural assessments would be beneficial to families of children with rare genetic conditions and IDD.

Methods

574 of the CYP's caregivers completed an online ‘impact’ survey, five years after receiving their initial report, comprising four areas of potential benefit: Quality of Care (whether the report led to an improvement in the child's quality of mental and/or physical health care); Social Impact (whether the report was used as evidence to support an EHCP, disability benefits etc.), Psychological Impact (whether it led to any change in understanding of the child's condition), and Referrals (whether the report led to a referral for Autism/ADHD etc.). We also invited qualitative feedback.

Results

82% of respondents rated the reports as helpful. 35% reported they had led to an improvement in their CYP's quality of care, 24% reported social impact using the report as supporting evidence, 99% reported a psychological impact – a change in their understanding of the child, and 17% used the report to initiate a referral for an assessment of ADHD and/or autism. In our qualitative analysis, families who found the report helpful mentioned it led to ‘reflection’ on their child's condition and that it provided ‘access to benefits’. For those who did not find the report helpful, issues such as ‘it lacked professional input’ and ‘forgetting the contents’ of the report were identified.

Conclusion

Personalised summary reports, based on a structured assessment of their child's behavioural, social and emotional adjustment, are valued by families of children with rare genetic conditions and IDD and can bring about tangible benefits to the child and the family's access to resources.
Ethical Challenges in the Use of Digital Tools for Screening of Depression in India: A Scoping Review
Authors: Townsend Francesca , Waqas Ahmed , Rahman Atif
Published: August 2024

Aims

Depression poses a significant public health concern globally, characterized by prolonged periods of sadness, loss of interest, and impairment in daily functioning. With over 800,000 annual deaths attributed to suicide, it stands as the second leading cause of mortality among 15–29-year-olds worldwide. To address this growing crisis, various digital methods are being increasingly developed for screening depression efficiently in large populations. However, the ethical implications surrounding the use of these tools remain debated. This scoping review aims to explore the landscape of research on digital screening methods for depression in India, elucidating ethical challenges and identifying research gaps.

By synthesizing available evidence, this study seeks to contribute to the discourse surrounding the ethical use of digital tools for depression screening in India, ultimately striving for improved mental health outcomes in the population.

Methods

Using a pre-tested search strategy in January 2024, we searched PubMed and Google Scholar for studies regarding digital divide in the use of digital technology for mental health. Relevant studies were selected using a two phased screening process. Studies included in the review were synthesised qualitatively using a thematic synthesis approach.

Results

Out of 379 titles identified in our database search, only four were included in the qualitative synthesis. Two of these were cross-sectional, followed by a qualitative study and a pre-post evaluation. These studies were conducted in remote villages in the state of Andhra Pradesh, urban slums of Delhi, pan-Indian national survey and rural and under resourced urban areas.

The studies examined diverse aspects of the digital divide in India, revealing profound socio-economic disparities and gender inequities. Disparities in ownership of digital devices and usage were stark, with less educated, lower-income, and lower-caste groups facing marginalization due to limited access and skills. There were gender discrepancies in mobile phone ownership and internet access, with females significantly less likely to possess these technologies compared with males. However, there is a strong potential of mobile technology in increasing mental health service utilization in rural areas, fostering community awareness and stigma reduction.

Conclusion

Collectively, these findings illuminate the multifaceted challenges of the digital divide in India, emphasizing the urgent need for targeted interventions to promote equitable access to technology and bridge socio-economic gaps.
Project Whiteboard: A Quality Improvement Project Enhancing Patient Flow in an Acute Mental Health Setting
Authors: Handa Ashu , Harper Terry , Wong Brandon , Abbas Kisa , Odeyemi Olanrewaju
Published: August 2024

Aims

We are a 17 bedded acute mental health ward in a busy inner-city hospital. A handover of all patients, with the multi-disciplinary team, takes place every morning (Whiteboard round). The clinical team felt that the information provided during this meeting needed a review, to ensure relevant patient information is being disseminated, and right clinical decisions are being made in a timely manner.

The team decided to focus on improving links with Community Mental Health Hubs (CMHH) to ensure continuity of care. The challenge the inpatient team faced is the need to interface with community mental health teams from two London boroughs, as the unit became the main admission hospital for Kensington & Chelsea and Westminster (KCW) patients.

The main aim is that 80% of KCW patients' CMHH (including new referrals) will be contacted within 24 hours of them being admitted onto the ward by April 2024.

Methods

As part of this QI project, weekly meetings were commenced, with a team comprising doctors, nursing staff (both inpatient and from local community team) and an Expert by Experience (EbE). A questionnaire was produced and circulated to ward colleagues about their views on the quality of whiteboard. A more focused questionnaire was then sent out around CMHH involvement in a patient's admission journey. We took a deep dive into the structure of the local community teams (at least 10 identified) and how referral processes work, as it was evident that staff were unclear at times on who/how to refer.

From this, the first change idea was formed: “information sheets” were produced showing which GPs correspond to which teams, and that patients can be referred this way. The Plan Do Study Act (PDSA) was applied to make these sheets visible to all staff. The outcome measure used was how many patients had CMHH referral/contact within 24 hours.

Results

Data is being collected daily, by reviewing patients notes to see if CMHHs have been contacted. Since commencement of the first PDSA cycle in December 2023, of the twenty-three patients admitted, nineteen have been eligible. Of these nineteen patients, fifteen patients (79%) have had contact or referrals made to their CMHH within 24 hours.

Conclusion

Results suggest that the aim is on the way to being met. Our next change idea is to obtain formal feedback from staff and patients on this process.
Promoting Post-Restraint Patient Debriefing in an Acute Psychiatric Inpatient setting
Authors: Jackson Harry , Quraishy Munzir , Mendoza Maya , Berry Alex
Published: August 2024

Aims

Controlled physical restraint is a commonly used, but controversial practice in inpatient psychiatric settings, at times bringing psychiatric practice into potential conflict with accepted medical ethical standards for preserving autonomy and bodily-integrity. However, physical restraint can produce high levels of patient distress, re-traumatise those who have experienced physical or sexual abuse, and may lead to inadvertent bodily injury, and even death on rare occasions. There is an international consensus to attempt to reduce restrictive practices, including physical restraint, as demonstrated in the World Health Organization's Quality Rights Initiative. Post-restraint patient debriefing can promote recovery, prevent future restraint, and promote a more ethical and humanising care environment.

We aimed to audit the frequency of restraint events, and post-restraint debriefs offered to patients in a single, London-based, male acute psychiatric ward.

Methods

In the pre-intervention sample, data was extracted from the records of patients admitted over a six-month period (n = 75), to identify the number of patients who had undergone restraint and the number who had been debriefed. The search terms “restrain”, “PMVA”, “response team” and “debrief” were used. After each restraint event, the notes for the following two weeks were reviewed to see if a debrief was delivered.

The intervention consisted of a single description and dissemination of the results in a ward business meeting, with instruction that all staff members within the ward multidisciplinary team can help provide debrief if appropriate to do so. Where a patient was known to have been restrained, debriefs were offered during subsequent ward round reviews as appropriate.

In the post-intervention sample, we collected data from patients admitted over a 10-month period (n = 89).

We used Chi-Squared testing to compare categorical variables pre- and post-intervention.

Results

Pre-intervention, 15 patients underwent restraint and of these, 8 patients (53.33%) were debriefed. Post-intervention, 21 patients underwent restraint and of these, 10 patients (47.62%) were debriefed. There was no statistical difference in the proportion of patients offered a psychological debrief (p = 0.735).

Conclusion

Following a single intervention there was not a sustained difference in the proportion of post-restraint debriefs offered. It is likely more sustained interventions would bring about more substantive practice change. Incorporating the need for post-restraint debriefs in daily ward safety-huddles, or in structured “ward round proformas”, may increase the proportion of patients offered post-restraint debriefing. It is possible that the note review strategy did not capture all debriefs delivered.
Evaluating a Process for Offering Psychiatry Inpatients a Novel Onsite Sexual and Reproductive Health Clinic
Authors: Moss-Lawton Francesca , Pathak Anushka , Giles Emily , Nuttall Norman , Needham Nicole
Published: August 2024

Aims

1.

For all eligible general adult psychiatry and substance misuse inpatients at the Royal Edinburgh Hospital (REH) to be offered appointments at a pilot onsite sexual and reproductive health (SRH) clinic.

2.

To evaluate the need for this novel service using eligibility rates and attendance levels.

Methods

Eligibility of all inpatients on a substance misuse ward considered at admission, and a space in the clinic offered if appropriate. Reminder added to the clerking proforma.

Eligibility of general adult psychiatry (GAP) inpatients considered by their multidisciplinary team (MDT) weekly. Team 1 to trial this at ward round, and team 2 to trial it at rapid rundown.

A patient leaflet was created to explain the clinic.

Results

General adult psychiatry: In team 1, 82% (120/147) of patients were considered by the MDT over 20 weeks, and in team 2, 65% (53/82) over 10 weeks. Of all GAP patients considered, 48% (83/173) were deemed eligible. Of those, 70% (61/83) were asked if they wished to attend, usually by the junior doctor leading the QI project. Thirty-six percent (22/61) of those booked into the clinic, of which 82% attended.

Substance misuse ward: Over 15 weeks, 85% (82/97) of patients admitted to the substance misuse ward were considered, deemed eligible and offered a space in the clinic at admission, of whom 15 accepted and 4 attended.

Conclusion

Nearly half of GAP inpatients were eligible to attend, with the total likely to be higher over time, as mental state improved. A high level of demand was demonstrated for SRH services in this population, where research also suggests a higher level of need and lower levels of access.

During weeks when the QI leads were absent, it was not recorded that any patients were considered at ward rounds or rapid rundowns. It was difficult to implement a process for this whilst the clinic was still at the pilot stage. The incorporation of a reminder into the ward round template would ensure that this is always considered.

A very high proportion of substance misuse patients were eligible for this clinic, highlighting higher levels of capacity. The main challenges for attendance were a high discharge rate, presence of withdrawal symptoms, and extensive passes off the ward.
Over-Referred and Badly Served – Patient Journeys in Attention Deficit Hyperactivity Disorder at a Community Mental Health Team
Authors: Brooks Samuel , Annear Delia
Published: August 2024

Aims

To measure the proportion of Attention Deficit Hyperactivity Disorder (ADHD) referrals that result in a positive diagnosis and medication prescription at a community mental health team (CMHT) in Cardiff.

To compare patient journeys from referral to diagnosis – documenting the use of GP mental health liaison, private psychiatrists, questionnaires and CMHT appointments.

To measure the proportion of patients with a pre-existing private diagnosis of ADHD that subsequently received a positive diagnosis by the CMHT.

Methods

230 referrals were made to Pendine CMHT in 2022 for consideration of ADHD. Patient e-records were manually reviewed over a 12-month period following initial referral.

We recorded whether a patient had a pre-existing private diagnosis and whether they were subsequently diagnosed with ADHD by the CMHT. It was also recorded if medication was prescribed or if an alternative diagnosis was suggested.

We recorded whether the patient was asked to see GP mental health liaison team, fulfil an ADHD questionnaire, or attend a doctor appointment before a diagnosis of ADHD was made or refuted.

For positive diagnoses, patient records were reviewed to record whether this diagnosis was later changed on subsequent appointments.

Results

Of 230 referrals, 32 received a CMHT diagnosis of ADHD (14%) and 25 were prescribed medication for ADHD (11%).

Of the 25 patients who received a positive diagnosis and medication, 4 had the diagnosis changed on a subsequent appointment and medication stopped.

21 patients had a pre-existing private sector diagnosis of ADHD, of which 9 (43%) were given a positive diagnosis by CMHT and 8 (38%) were prescribed medication.

Of 230 total referrals, 33 were asked to see their GP mental health liaison team for information gathering before re-referral to the CMHT. 112 were asked to complete a questionnaire before an appointment would be considered. 87 were given a consultant psychiatrist appointment at CMHT.

When ADHD was not diagnosed, the most common alternative diagnoses suggested by the CMHT were anxiety, substance misuse or emotional dysregulation (36, 23 and 9 patients respectively).

Conclusion

Referrals to the CMHT for ADHD assessment result in a low rate of positive diagnosis and even lower rates of medication prescription, even for those with an existing private diagnosis.

Patient journeys vary markedly, which we propose reflects the variable quality of referrals and pressure on the CMHT to protect clinic time.

Future work to create ADHD referral guidance is needed to ensure better patient experience and proper utilisation of secondary mental health resource.
Review of Equity of Access to Treatment for Gambling Harms in Racial and Ethnic Minority Populations: A Mixed Methods Study
Authors: Davidson-Hine Deborah , Lloyd Helen , Close James , Ioannidis Konstantinos , King Mat
Published: August 2024

Aims

The NHS Southern Gambling Service (SGS) is a service providing evidence-based assessment and treatment for people affected by Gambling Disorder (GD) across the South-East of England. This service evaluation aimed to ascertain whether SGS was offering equality of access to treatment and suitable provision of treatment to ethnic minority communities, and whether there were barriers making it difficult for people from ethnic minority communities to access and engage in treatment for gambling harms.

Methods

Quantitative ethnic origin demographic data was obtained from 120 referrals to SGS between September 2022 and October 2023. These were statistically compared with the ethnic origin demographics of the general population in the same geographical area, as identified by Office of National Statistics (ONS) Census 2021 data. Qualitative data was collected through interviews with three participants from ethnic minority populations who were engaged in treatment with the service. Relevant themes in the qualitative data were identified using thematic analysis.

Results

Quantitative data results indicated no significant statistical differences in most ethnic origin categories between the proportion of referrals to SGS from the ethnic origin and the recorded proportion of this ethnic origin in the general population. There was a greater difference for the “other ethnic group” category (chi square p,0.05, uncorrected), which was likely due to a difference in categorisation of ethnicity between SGS and ONS in 2021 Census.

The qualitative review identified themes of value of money, stigmatisation, different cultural attitudes towards gambling, and experiences of healthcare. GPs were identified as the first step towards seeking help for gambling.

Conclusion

These results suggested that SGS was offering equality of access to treatment for people from ethnic minority populations and that there were not significant barriers preventing people from ethnic minority populations accessing treatment. The reported positive experiences of participants' referral to and treatment with SGS indicates that for these participants suitable provision of treatment had been offered by our service.

With the thematic analysis identifying GPs as the first step towards seeking help for their gambling, this study indicates the importance of the gambling service working closely with primary care for the equitable access to treatment from gambling harms on a regional level.

These preliminary findings are based on a limited, small sample. Further research using a larger, more diverse sample to gain a deeper knowledge would be advised to further shape the service offer to ensure equity of access.
Audit on Management of Behavioural and Psychological Symptoms Among Dementia Patients in Humber Older People's Mental Health Services
Authors: Adeoye Sunday
Published: August 2024

Aims

Up to 75% of dementia patients will experience behavioural (non-cognitive) symptoms in their lifetime. Therefore, it is important to ensure delivery of high level of quality care to these set of patients.

The NICE guideline recommends that:

1.

Non-pharmacological method should be used before pharmacological method in the management of behavioural symptoms.

2.

When antipsychotics are used, they should be started at low dose and increased slowly.

3.

Those started on antipsychotics should have follow up at least 6 weeks after commencement.

Aim: The audit aims to compare the care we give dementia patients with behavioural symptoms against the NICE guideline.

The objectives are:

1.

To assess use of non-pharmacological method before pharmacological method in the management of behavioural symptom in dementia patients.

2.

To assess antipsychotic prescriptions in the management of behavioural symptoms in dementia patients.

3.

To assess if patients started on antipsychotics were properly followed up.

Methods

Electronic records of 34 patients who met the inclusion criteria were assessed and information related to the objectives were extracted. Data was stored securely in the trust laptop. Analysis of the information was done using Microsoft Excel version 2022. Results were presented in charts.

Results

The result showed that the commonest behavioural symptoms reported was agitation and verbal aggression which accounted for 34% and 29% respectively. About 24% of the patient were commenced on medication for their symptoms without trial of non-pharmacological methods. Out of the patient that were on medications, risperidone was the commonest medication prescribed accounting for 37%. Other medications prescribed included quetiapine, amisulpride and lorazepam. The result also showed that those started on medication were properly followed up according to the NICE guideline.

Conclusion

The audit showed that the NICE guideline is not fully followed, adherence to the guideline is around 75% overall. Efforts should be geared toward enlightening professionals about the need to follow the NICE guideline in managing this condition. It would be worthwhile to re-audit in 12 to 24 months.
Health Notes Audit
Authors: Golding Charlotte , Sud Neeti
Published: August 2024

Aims

To assess whether patients admitted to the forensic secure rehabilitation ward are transferred with their physical health notes.

Most patients admitted to secure rehabilitation do not have an open GP record due to last registration with primary care having been many years previous as a result of a lengthy prison/hospital stay. Additionally, patients may be referred from an out of area prison or hospital. A comprehensive psychiatric history paperwork is obtained at referral. This audit was to assess how many patients currently on the rehabilitation ward arrived with complete physical health notes. We defined a complete set of physical health notes to mean:

1.

Records from medical consultations linked to physical health during time in prison or psychiatric hospital.

2.

Any physical health history prior to current incarceration/admission episode from primary and secondary care.

3.

Complete prescription of physical health related medications including allergies, doses, regime, and indication.

Methods

Retrospective review of patient electronic records sent by discharging institution when the patient was transferred to the rehabilitation ward.

Data collected: List of documentation of patient's physical health records around transfer time. Identification of the contents of the records provided by the transferring ward.

We then compared the information available to our criteria for complete physical health notes.

Participants: All current residents of the male secure rehabilitation ward (n = 12) were included.

Results

7 out of the 12 patients included were transferred to the secure ward with notes that fulfilled the criteria as set by audit team.

Two patients were transferred with only the prescription of current medications. There was however, a brief physical health summary in care coordination notes sent earlier.

One patient was transferred with the prescription and a brief list of their past medical history.

The remaining 2 patients were transferred without any formal physical health documentation prior to transfer, however, they were transferred from an adjacent ward and therefore, all records were already on the electronic records. There was no formal verbal or written physical health handover.

Conclusion

It is important for our ward to ensure we have comprehensive and complete physical health summary for each patient on admission.

A proforma will be used at preadmission meetings from February 2024 to request specific information from discharging wards. We will re-audit in February 2025 to assess improvement in records requested and obtained.
An Evaluation of High Dose Antipsychotic Therapy Prescribing Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust
Authors: Hyland Declan , Singh Roopa , Dainton Kerry
Published: August 2024

Aims

High Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.

This evaluation aimed to determine the prescribing practice involved with HDAT across the 16 general adult inpatient wards and Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust.

Methods

A list of all inpatients on the 16 general adult inpatient wards and the PICU in the Trust between 17th and 20th of July 2023 was obtained. Each patient's electronic prescription record was scrutinised to determine whether the patient was prescribed HDAT. For each HDAT patient, the patient's electronic psychiatric record was reviewed to determine whether the decision to be prescribed HDAT was authorised by a Consultant, and whether there was evidence of this decision being discussed at a multi-disciplinary team (MDT) meeting and/or patient ward review. The authors also reviewed whether the clinical rationale for the patient to be prescribed HDAT was documented in the patient's clinical record and whether there was documentation of whether the patient had capacity to consent to being prescribed HDAT.

Results

Of the 29 HDAT patients identified, the decision to prescribe HDAT was authorised by a Consultant in 22 (76%) patients. In 14 (48%) patients, the decision to prescribe HDAT was discussed in an MDT meeting and/or patient ward review. The clinical rationale for being prescribed HDAT was documented in 15 (52%) patients. There was evidence of documentation of whether the patient had capacity to consent to being prescribed HDAT in only 8 (28%) patients.

Conclusion

The decision to prescribe HDAT should always be senior-led and involve MDT discussion, to enable input from medical, nursing and pharmacy staff. Current practice across the Trust's general adult inpatient wards and the PICU indicates that work needs to be done to ensure that, in every case of an inpatient needing to be subject to HDAT, the clinical rationale for this is documented. Capacity to consent to being prescribed HDAT must be documented for each HDAT patient as a matter of good clinical practice.
Clinical Audit of Rapid Tranquilisation in Mental Health Services for Older People (MHSOP)
Authors: Hern Daniel , Salim Tahir , Oduma Mabel , Langford Wren
Published: August 2024

Aims

Rapid Tranquilisation (RT) is the parenteral (intramuscular) administration of medication to calm or sedate an agitated, violent or aggressive patient in a timely and safe manner. This audit specifically looks at the clinical practice in the use of rapid tranquilisation in inpatient MHSOP against trust policy. The aim of this audit is to assess the effectiveness of RT and if other methods of de-escalation are being utilized first to provide better care for patients and utilize the least restrictive management options possible.

Methods

The audit was registered, and care was taken to uphold ethics, access patient information appropriately, and to ensure that data collected was both relevant and ensured confidentiality. All incidents of RT were identified across both wards of Auckland Park Hospital from the period of August to October 2023. DATIX numbers were identified to show incidents of RT from the specified period, these numbers were used to identify patient ID with liaison with relevant staff members. Patient ID was used to review the incident, specifically to investigate de-escalation techniques documented and effectiveness of RT. Only parenteral RT incidents were included to assess if appropriate measures were taken beforehand.

Results

A total of six Incident reports were identified over the three-month period. In all cases the choice and dose of the medication was within the current recommendations. 33% of incidents utilised promethazine 25mg while the other 66% utilised lorazepam either 1mg or 500mcg. All patients had baseline observations recorded on NEWS chart prior to the incident, however only 33% of incidents involved full recordings of observations at appropriate intervals on the NEWS chart. The reason for this in all cases was due to patient refusing observations which was documented. There were no documented side effects but 33% of incidents involved a raised NEWS score post RT. In all cases the NEWS score resolved spontaneously within the post RT monitoring period. In 100% of incidents de-escalation techniques were utilised and documented and evidence of post RT debrief with the patient was shown. 66% of incidents involved a medication review post RT as per recommendations.

Conclusion

Guidelines are being followed with good effect regarding RT in MHSOP. It is important to always undertake nonpharmacological de-escalation methods prior to considering RT which is reflected in the low numbers of RT during this period. Recommendations are made to follow local guidance as well as to exhaust nonpharmacological de-escalation methods to reduce the need for RT.