bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio-Demographic and Clinical Characteristics of First-Ever Admitted Psychiatric Inpatients in Palestine: A Cross-Sectional Study
Authors: Marzouqa Nizar , Alhroob Thaer , Alnammourah Wala , Oweina Layth , Awwad Asala
Published: August 2024

Aims

Bethlehem Psychiatric Hospital is the only psychiatric hospital in the West Bank. Epidemiological data on mental health in Palestine is very limited due to the lack of research in this area. This study aims to evaluate the socio-demographic characteristics and clinical outcomes of first-time admitted patients at Bethlehem Psychiatric Hospital over a year period.

Methods

A retrospective cross-sectional study was conducted at the Bethlehem Psychiatric Hospital, reviewing the medical records of patients admitted for the first time between October 2022 and October 2023. Data collection was conducted manually by residents through an Excel sheet. Next, demographic characteristics (socioeconomic and demographic measures), relevant history (past medical, psychiatric, and forensic), presenting episode characteristics, and current hospitalization (admission, hospital stay, and discharge) were studied descriptively.

Results

Of the 140 patients admitted for the first time to the psychiatric hospital between October 2022 and October 2023, the mean age was 32.6, a majority (70%) were male, more than half were single, around two-thirds finished high school, and 13.6% had a university degree. Only 41.4% of patients were referred from a medical or legal source. The overwhelming majority of the patients had poor prior outpatient follow-up.

Substance use was common (Tobacco: 63.8%, alcohol: 16.1%, and other substances: 26.4%). Family history of psychiatric illness was found in 40% of the cases, and prior imprisonment in 42%.

The most common presenting complaints included: sleep disturbances (84.3%), and physical aggression (73.6%). Delusions were elicited in 72.9% (most commonly persecutory-paranoid, and least commonly grandiose and reference delusions). Hallucinations were present in 38.6% of admissions, auditory hallucinations were the most common. 15.4% had depressed mood, and 22.1% had current suicidal ideations.

Involuntary admissions constituted 62.1% of all admissions. A third of urine drug tests, conducted in 68.6%, came back positive. Patients stayed a mean of 17.8 days. A diagnosis was reached in 82.1% of patients, the most common established diagnosis was Schizophrenia spectrum (42.9%). Around a third were discharged against medical advice.

Conclusion

This is the first study conducted on Palestinian psychiatric inpatients. The results of this study suggest that most patients who are admitted had poor outpatient care. Delusions were elicited in the majority of patients, amongst different final diagnoses.

There is a need for more research on Palestinian psychiatry, integrative social services, and better mental health regulations to protect the rights of mental health patients.
Real World Effectiveness of rTMS in Depression and Anxiety
Authors: Thanki Milind , Briley Paul , Ottahal Sarah , Lankappa Sudheer , Ul Haq Katshu Mohammad Zia
Published: August 2024

Aims

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation recommended by NICE for treatment of depression with minimal side-effects and a high patient acceptability. Our aim was to assess the effectiveness of rTMS in real world clinical service in alleviating symptoms of depression and anxiety.

Methods

All patients receiving rTMS in our Centre for Neuromodulation Services (CNS) received 5 daily treatment sessions a week for a period of 5 weeks (25 sessions in total). All patients routinely completed PHQ-9, BDI-II and GAD-7 measures before and after the course of treatment. The scores on these measures were retrospectively analysed using paired-sample t-test.

Results

All 15 patients completed the PHQ-9 and GAD-7 scales while 10 patients completed BDI-II. Eleven patients (73%) had improved PHQ-9 scores post-treatment with average improvement of 5.5 points which was statistically significant [paired-sample t-test: t(14) = 3.019, p = 0.009]. Nine patients (90%) had improved BDI-II scores post-treatment with average reduction of 36% from baseline which was statistically significant [t(9) = 3.681, p = 0.005]. Eleven patients (73%) had improved GAD-7 scores post-treatment, with average reduction of 4 points. This reduction was also statistically significant [t(14) = 3.038, p = 0.009]. Improvement in all measures was also of a level that would be considered clinically significant for these measures. All patients tolerated the treatment well with no patients dropping out due to side effects.

Conclusion

With the limitation of relatively small sample size, our initial analysis indicates that rTMS treatment offered in real world clinical service is effective in treating symptoms of depression. Although our protocol was not intended to treat anxiety, our patients had remarkable improvement in anxiety symptoms as well.
Understanding Issues Faced by West Midlands’ International Medical Graduates (IMG) Psychiatry Trainees and How to Support them
Authors: Dastidar Supriya , Ogunsina Oluwadamilola , Javed Asma
Published: August 2024

Aims

The GMC 2023 workforce report indicates that doctors with primary medical qualification (PMQ) outside United Kingdom (UK) made up 62% of new additions to the register in 2022, with international medical graduates (IMGs) from outside the European Economic Area accounting for a further 10%. In 2023, 49.8% of psychiatry trainees in West Midlands were IMGs.

We have enough evidence to show that IMGs experience significant differential attainment in both training and exams. They also have an added burden of adjusting to a new country, language, culture, and society, not to mention adapting to a novel medical system and work culture. Attempts have been made to address this through induction, clinical supervision, etc.

This survey aims to understand the challenges faced by West Midlands psychiatry IMG trainees and to identify how best to support their needs.

Methods

A questionnaire survey was designed using the Microsoft forms platform and disseminated via the West Midlands School of Psychiatry in October 2023 to all trainees whose PMQ was outside UK. The survey gathered feedback on quality of inductions received, clinical supervision, difficulties experienced in training/examinations and awareness of available IMG-specific resources.

Results

36 trainees with PMQ from 14 countries outside the UK completed the survey. 31% of the respondents were CT1 trainees. 17% had less than a year of NHS experience. All respondents had attended their current job induction. 64% rated their workplace induction as ‘Good’ or above, 50% rated trust and deanery induction at ‘Good’ or above. Only 17% of respondents had received IMG-specific induction. Many felt that induction was an information overload in a short space of time. 83% received weekly, hourly supervision. 69.4% rated support from their supervisor as ‘Very good’ or above. Respondents reported difficulties in immigration, finances, systemic racism, cultural and language adaptation. Other difficulties include portfolio, research experience and audits. MRCPsych exam difficulties were reported in 46% respondents especially around study materials and preparation. Trainees wanted IMG specific induction and supervision, pastoral care, portfolio support, MRCPsych exam support, mentoring, guidance around career progression and research.

Conclusion

The survey results show that IMG trainees do not receive appropriate and necessary IMG-specific induction and supervision even though they make up nearly half of the trainee cohort. The Deanery, NHS trusts and clinical supervisors can utilize the results of this survey to inform strategies to support IMGs better. Focus groups are due to be held shortly to get further qualitative feedback.
The Expert Patient Clinic (QI Project): A Meaningful New Community Psychiatry Training Experience for Medical Students
Authors: Holdcroft-Long Jason , Dean Natalie , Rayner Meg , Mullins Elizabeth
Published: August 2024

Aims

Psychiatry is predominantly a community specialty, but large medical school cohorts and limited outpatient learning opportunities mean students report a lack of experience in community mental healthcare. They describe clinicians lacking time to teach in busy clinics, or patients declining student presence. Consequently, many Foundation Doctors will first experience working with outpatients when they sit down to their first clinic! Our aim, quite simply, was to remedy this gap.

Methods

The Psychiatry Teaching Unit at Derbyshire Healthcare is in the vanguard of patient involvement, with a large group of Expert Patients (EPs) having extensive lived experience of inpatient/outpatient psychiatric care, and medical education delivery.

We co-produced an Expert Patient Clinic to replicate a psychiatric outpatient clinic, with students acting as psychiatrists, reviewing Expert Patients. Students work in groups, taking turns as doctor/observer. Each ‘appointment’ is followed by tailored feedback.

The tasks are themed as follows:

Patient-specific review: a more ‘technical’ task e.g. reviewing medication changes and side effects, or using measurement tools to assess signs and symptoms.

Psychosocial review: considering social circumstances, activities of daily living and personal functioning.

Current mental health review: assessing mental state, subjective and objective signs and symptoms of mental health problems, and concerns, ideas and expectations for care and intervention.

Sessions are facilitated by a psychiatrist, Lived Experience Facilitator (EPs formally employed as educators) and a senior clinical nurse educator.

Pre- and post-session we ask students to assess/rate their confidence and competence in reviewing outpatients, discussing risk, and planning care, in an outpatient appointment.

Results

Results so far are overwhelmingly positive with both written and numerical feedback acknowledging a significant improvement in student confidence and self-rated competence across the board. A chart in our poster shows the large increases in self-rated Likert scales measuring aspects outlined above. Qualitative verbal feedback outlines the value of having a session with real patients where they can try consultation techniques and receive instant feedback, and learning through discussing with EPs their individual stories and clinical histories. Accounts from EPs document their own learning from the sessions and development of skills in giving feedback.

Conclusion

The EP Clinic provides an opportunity for students to experience clinical responsibility and practise in a safe environment with real patients. It provides valuable, realistic and high quality experience in community psychiatry without the disappointments often unavoidable in live clinical services.
“Boys Will Be Boys” - the Medicolegal Implications of Gender Disappointment
Authors: Jayarajah Chrishanthy
Published: August 2024

Aims

Gender disappointment can be defined as the subjective feelings of sadness when discovering the sex/gender of their child is the opposite to what the parent had hoped or expected. Wanting a boy (or “son preference” as referred to in some of the literature) has been noted for generations in many cultures, particularly in South and East Asian communities, however, is now becoming more recognised in the UK, Europe and North America.

This article aims to improve understanding of gender disappointment, as well as discuss the ethical, political and medico-legal implications of such potentially high-risk cases in clinical, forensic and social care practice.

Methods

The poster reviews the key statutory literature and legal guidance in England, USA and South-East Asia specifically affecting women and girls around discussions on gender equality and reproductive rights. It also discusses high profile cases (e.g. Supreme Court decision to overturn the Roe vs Wade case) and the potential implications on reproductive health and mental well-being.

The poster also discusses the international practices influencing birth rate (such as the one child policy in China, and concerns of the dropping fertility rate in countries such as Japan), and how this, combined with deep-rooted cultural beliefs around sex and gender for preference of a son, may influence the wider socio-political discourse.

Finally the poster discusses the medico-legal and perinatal-forensic interface of gender disappointment if left unnoticed during the perinatal period, namely the risk of the possible immediate consequences of unwanted pregnancy (such a late termination, pregnancy denial and neonaticide), and the longer term risks of being an “unwanted girl” - such as violence against women and girls, forced marriage and domestic violence.

Results

Gender Disappointment is a common but often missed presentation in multicultural populations. Although at present it is not identified as a distinguishable ICD-11 Diagnosis, it has the potential to impact on one's mental health during the perinatal period, and may also influence ethical and medico-legal decision making, such as in complex cases of requests for late termination of pregnancy.

Conclusion

In conclusion, there is little dialogue surrounding gender disappointment which has led to misunderstanding and the potential for serious political and medico-legal repercussions and risk. My hope is that this article may act as the catalyst for a more nuanced discussion on gender issues in mental health, in collaboration with obstetric, social, forensic and criminal justice services to tackle this complex subject.
Leadership Development as a Medical Educational Fellow in Psychiatry: Reflection After Two Years
Authors: Loo Jiann Lin , Taylor-Clutton Andrea
Published: August 2024

Aims

The disruptive force of the COVID pandemic has highlighted the importance of leadership for all medical educationists to prepare the future workforce with the ever-changing healthcare practice. Early career medical educators must attain leadership skills as early as possible. The only way to learn leadership is through experiential learning, i.e. learning while leading. Therefore, this self-study is aimed to share the reflection on the journey of a psychiatrist specialist trainee from North Wales in leading different psychiatric educational projects.

Methods

This is self-study research on the reflective experience of working as a medical educational fellow while undergoing specialist training in psychiatry from January 2022 to December 2023. The data reflected were sourced from publications, end-of-project reports, meeting minutes, participant and peer feedback, personal records, educational portfolios, and appraisals.

Results

Nine psychiatric educational quality improvement projects (QIPs) had been conceptualised and implemented, i.e. three series of mock exams (Special Preparation in CASC Exam), continuous coaching and mentoring in portfolio-based learning (Café of RCPsych Portfolio), continuous mentorship in academic writing (Mini North Wales-Academic and Research Clinic), continuous peer supervision in psychotherapy (Gogledd Cymru-Peer Supervision in Psychiatry), mock interview for job application, digitalisation of departmental induction, psychopathology training (3P: Psychopathology for Postgraduate Psychiatrists Trainee), and two international collaborative educational programmes (Perinatal Psychiatry Perinatal and Infant Psychiatry Educational Programme of Wales, Tanzania, and Malaysia; and Bhutan Old Age Psychiatry Educational programme). Five peer-reviewed publications had been completed while the other academic writings were ongoing. Three of the projects (33.3%) were expanded from a Welsh initiative to the whole United Kingdom and a bigger team was formed to ensure sustainability could be achieved. Two projects (22.2%) started as an international collaborative project. All projects provided opportunities for the members of the QIP to obtain workplace-based assessments and evidence for yearly appraisal while improving the educational experience of trainees and professionals in the field of mental health.

Conclusion

All challenges come with the opportunities to be innovative in problem-solving. Communication skills and people management are crucial for resource gathering and conflict resolution. Lastly, talent development is required as part of the effort to sustain all the projects.
To Improve Higher Trainees' Experience With Out of Hour (OOH) Working Through Local Induction Programme
Authors: Miller Ting , Natarajan Chandrashekar , Laher Ismail
Published: August 2024

Aims

Out-of-hours (‘on-call') work can be perceived as daunting by junior doctors. When psychiatry trainees progress from core trainee to higher trainee, what entails ‘on-call' work often shifts dramatically. Current allocation policy in Yorkshire and Humber Deanery means most of the higher trainees (HTs) begin their first on-call as a HT in a trust where they have never worked before. This frequently entails navigating an unfamiliar patient record system and various OOH care pathways in a new work environment, which can make the first few on-call shifts extremely stressful and potentially increase the risk of clinical errors.

We aim to evaluate the on-call experiences among higher trainees, collect feedback on ways of improving induction programme relating to OOH work and re-evaluation after the interventions implemented in the latest induction.

Methods

•

A short survey using Likert scale was designed to capture HTs' experience and knowledge in relation to OOH work plus free text feedback at the end of each question.

•

An online survey link was disseminated by email in May 2023 among HTs who joined LYPFT between August 2022 to Feb 2023.

•

Interventions: a) A face to face induction in August 2023 to replace the online induction; b) ‘A walkabout tour at Crisis office’ led by Crisis consultant as part of the induction programme.

•

Re-survey link was sent out in October 2023 to HTs who joined in August 2023.

Results

1st Survey: 11 out 16 new HTs completed the survey. 5 out of 11 had never worked in LYPFT.

2nd Survey: 11 out of 19 new HTs completed the survey. 8 out of 11 had never worked in LYPFT.

2nd Survey showed significant improvement in HTs' level of familiarity to on-call office environment, awareness of the multi-agency S136 pathway and local policy as well as alternative local crisis provisions other than hospital admission, and the relevant referral procedures. HTs' confidence of navigating OOH local care pathway was markedly enhanced.

Overwhelming positive feedback were received regarding the ‘Walkabout tour' as part of the Induction programme.

Conclusion

•

Simple interventions at Induction programme can significantly improve HTs' confidence for OOH work.

•

HTs valued high on practical support such as the ‘Walkabout tour at Crisis office' and would like it to be expanded to other OOH services such as Seclusion unit and Acute Liaise Psychiatry Service.
Improving Information Distribution and Education Within Memory Clinic
Authors: Alhadi Rashed , Harley Isabella , McDonald Cara
Published: August 2024

Aims

The aims of this project were to improve patient education and overall information distribution within the Memory Clinic within the Old Age Psychiatry department, based at Kingsway Care Centre, Dundee.

Methods

This project originated, after there were concerns raised from relatives of a patient who had recently been assessed in the Memory Clinic. A suggested area for improvement included distributing information to patients, highlighting any potential tests or topics of conversation that may be explored during a Memory Clinic appointment. In response, our team engaged in a thorough collaboration with our colleagues in Psychiatry and the Post-Diagnostic Services (PDS). As a result of this partnership, a summary sheet was compiled, highlighting the spectrum of cognitive testing and assessments that may be conducted, potential medicinal treatments and other significant considerations, including driving and Power of Attorney statuses. To ensure these resources were both accessible and informative, they were systemically distributed to patients. The materials were paired with feedback forms to capture patient experiences and insights, to be later collected by the PDS.

Results

Whilst this project remains in the data gathering stages, provisional data has been very promising in showing improvement in clarity of information delivered to patients (both in current and future assessments), explanation to patients regarding medication and treatment options, and overall patient satisfaction.

Conclusion

Optimising educational resources for both patients and families attending the Memory Clinic through summary documentation can be utilised to improve overall patient satisfaction. Aiding patients’ understanding of their diagnosis and further management of this, allows them and their families to feel more included in their care and optimises the delivery of holistic care within Psychiatry of Old Age.
Monitoring of Clozapine-Induced Gastrointestinal Hypomotility
Authors: Ansari Saba , Spence Elizabeth
Published: August 2024

Aims

Clozapine, a second-generation antipsychotic licensed for treatment-resistant schizophrenia, has a well-documented side effect profile, the most common of which is decreased gastrointestinal motility. Clozapine-induced constipation occurs more frequently than blood dyscrasias and can lead to severe complications such as paralytic ileus and intestinal blockage; in extreme cases, it can be fatal, with a fatality rate of 20–30%. The risk of gastrointestinal hypomotility is most pronounced during the initial four months of treatment; hence, weekly assessments are imperative during this period. According to Lanarkshire's local guidelines, bowel habits should be assessed at baseline, during routine blood sampling, and ideally at every clinical interaction. Our audit aims to determine the frequency of bowel habit monitoring in inpatient settings and to ascertain the prevalence of laxative prescriptions among these patients.

Methods

Data were collected retrospectively from psychiatric inpatient wards in Lanarkshire for patients on Clozapine therapy. The review focused on electronic medical records to evaluate the regularity of bowel habit screening. Additionally, we examined the Hospital Electronic Prescribing and Medicines Administration (HEPMA) system to gather information on laxative prescriptions.

Results

The audit revealed that bowel habit monitoring, which should be a standard practice at each clinical encounter, was found to be inconsistent. Regular assessments were documented for only 40% of patients. Monitoring was most thorough in rehabilitation wards, where patients on Clozapine had their gastrointestinal function assessed routinely through screening questionnaires. Furthermore, 80% of the surveyed patient population was documented as having been prescribed laxatives.

Conclusion

The documentation of bowel movements for inpatients on Clozapine was suboptimal, leading to the potential oversight of critical side effects. The audit highlights a discrepancy in adherence to national and Lanarkshire's local guidelines for the monitoring of inpatients treated with Clozapine. To rectify this, we recommend the implementation of a standardized screening protocol to assess constipation risk systematically. Proactive monitoring should be incorporated into regular clinical evaluations for patients on Clozapine, ensuring that this assessment occurs at every clinical interaction. This approach is crucial not only for patient safety but also for enhancing treatment efficacy and patient quality of life. Moreover, these measures will likely lead to improved documentation and compliance with established guidelines, thereby reducing the incidence of preventable complications associated with Clozapine-induced constipation.
Audit to Determine the Incidence of Did Not Attend (DNA) Rates at First Assessment in the NHS Northern Gambling Service (NGS) by Assessment Modality
Authors: Barker John , Marriott Benjamin
Published: August 2024

Aims

Non-attended appointments can lead to adverse outcomes for a service and its users, including reduced service efficiency; increased waiting times; and impaired patient care. The audit objective was to explore whether DNA rates vary between the current modalities of face-to-face; virtual; and telephone. It was hoped that this would enable the service to better understand the reasons for patients not attending initial assessments and determine whether the modality may present a barrier.

Methods

A sample was obtained including all first assessment appointments between March 2022 and March 2023 (n = 386). Data included the modality for each initial appointment. Matched to this data, was whether the patient attended each appointment, creating a frequency of DNAs for each appointment modality across the year. Data analysis was conducted using Microsoft® Excel®. Beyond frequency and percentages, a chi-square test was used to assess for a statistical difference in appointment attendance between modalities.

Results

For this one-year sample the overall attendance rate was 77%: with 299 appointments attended, and 87 ‘DNAs’. The DNA rates across the one-year sample were face-to-face (24%); virtual (22%); and telephone (23%).

The chi-square value produced when analysing the DNA rates between modalities was 0.92 (critical value 5.99). Hence, there was no statistically significant difference in DNA rates by modality.

Conclusion

Despite the absence of variation in DNA rates between modalities, the findings can be viewed as reassuring. The move to include multimedia alternatives to assessments does not appear to be impacting attendance when compared with assessments that continue to occur face-to-face. Balanced against this increased geographical inclusion afforded by remote appointments, is the competing equity issue of digital exclusion, highlighting the need for face-to-face appointment provision to remain accessible across the service.

This audit did not collect demographic data that may have provided insight into whether certain factors may have impacted attendance and could have acted as confounders, for example geographical location.

Introduction of a supportive reminder letter for patients, to bridge the wait between patient's referral and their initial assessment, was an outcome recommendation that was implemented by the service.
Co-Producing and Quality Assuring Multi-Modal Psychoeducation to Enable Early Engagement in Guided Self-Help for People With Functional Neurological Disorder
Authors: Dahir Tahani , Lapitan Stephanie , Mohamud Adna , Saxena Anushka , Williams Verity
Published: August 2024

Aims

People with Functional Neurological Disorder (FND) exhibit diverse symptoms, ranging from motor and sensory issues to non-epileptic attacks, potentially causing reduced functioning and quality of life. East Kent Neuropsychiatry Service developed written and video resources to educate patients about FND. We aim to improve patient education on FND through increasing resource options and identifying optimal implementation of the materials within the care pathway.

Methods

We implemented an existing symptom self-management psychoeducation booklet and novel video resources as part of a quality improvement project (QIP). The first QIP cycle trialled the resources across different treatment pathways using three groups, each of seven patients. Group 1 received the booklet first, then the video two weeks later. Group 2 received the video first, then the booklet after two weeks. Group 3 received both resources at the same time. After 4 weeks, patient feedback was collected by 4 medical students by telephone. Qualitative and quantitative data was obtained from 8 patients. Quantitative feedback was obtained using a 5-point Likert scale. In the second QIP cycle, 10 patients received both resources simultaneously, with improvements made to resource accessibility and readability.

Results

The first QIP cycle highlighted that the videos were helpful in explaining FND, with 75% of patients rating the videos the same or higher than the booklet. Qualitative responses commented that videos were more personal and easier for family members to understand. Across both video and booklet resources, 67% of patients agreed or strongly agreed the resources were useful for explaining FND and their experience. One patient, in group 1, stated the resources improved their symptoms. 54% of patients agreed that they received the resources at the appropriate time; a common theme across all groups was the desire to access the resources earlier within the pathway. In the second QIP cycle (8 patients, 25% response rate), all agreed the resources improved FND understanding and self-management strategies.

Conclusion

Our study highlights that video resources are a valuable addition to FND psychoeducation, with benefits for patients, carers and family members. Both booklet and video resources were helpful in improving patient education on FND. Our findings emphasise the need for early integration of psychoeducation in the care pathway. Future developments could include collaborating with other specialties involved in the care of FND patients, such as neurology and emergency departments, to enable early integration of psychoeducation resources, empowering clinicians to effectively communicate about FND and enhancing patient psychoeducation.

Additional authors: Mr Alan Dunlop, Ms Wendy Collison and Professor Rafey Faruqui.
Clinical Supervisors' and (Junior) Doctors' Experiences of Breastfeeding Risk Assessment, and Where We Go From Here
Authors: Gourley Erin , Parsons Megan
Published: August 2024

Aims

With recruitment and retention of NHS doctors an increasingly topical issue, the facilitation of a supported Return To Work (RTW) following a period of leave is particularly important. That the support provided takes a holistic approach to the wellbeing of the individual and their family unit is necessary if it is to be of the greatest success, especially with regards to new parents. The World Health Organization recommends breastfeeding until 2 years of age but in the UK just 0.5% of parents are breastfeeding at 1 year and, perhaps more significantly, 90% of breastfeeding parents stop before they would like to. Under the 2010 Equality Act, breastfeeding is a protected characteristic and legally, upon RTW, a breastfeeding parent must have a Breast-Feeding Risk Assessment (BFRA). The Health and Safety Executive have set out factors to be considered when completing BFRAs which enable the identification, mitigation or removal of risks that threaten breastfeeding, often via impacting the physical and mental health of the parent and child.

Our aim was to explore the experiences of both JDs and clinical supervisors in accessing and completing BFRAs in order to identify whether further work was required on this subject.

Methods

A survey was sent to psychiatry JDs across the West Midlands inviting those who had RTW whilst breastfeeding to share their experiences. Another survey was sent to leads and supervisors across the region, exploring their confidence with BFRAs and their recommendations.

Results

20 JDs responded. 16% received a BFRA with 5% being undertaken prior to RTW (best practise). For most of those who received one, it was a positive experience and 81% of those who did not receive one reported that they would have liked to but were either unaware that they existed or that they apply to children over 1 year.

36 consultants responded. 31% were aware of BFRAs with 9% feeling confident in completing one and none having had any training to do so. There was a strong sense that BFRAs should have a multi-disciplinary approach which contrasted with what occurred in reality.

Conclusion

Identifying a lack of knowledge, as well as doctors’ need and desires regarding BFRAs, has resulted in a multifactorial approach to raising awareness of their existence, content and potential impact. Sessions for JDs and supervisors have been organised regionally and locally and there has been engagement with each trust in order to create a more uniform breastfeeding policy.
Genetic Screening of Inpatients With Intellectual Disabilities: A Service Development Project to Widen Access to Up-to-Date Genetic Screening in Adults With an Intellectual Disability
Authors: Monaghan Shauna
Published: August 2024

Aims

Problem:

Around 10% of patients with an intellectual disability have a clinically relevant copy number variant in their DNA detected using microarray analysis. Adults with an intellectual disability may not have had access to genetic screening during their patient journey, or they may have had previous screening with now outdated technology.

Aim: to offer up-to-date genetic screening to adults with intellectual disability in an inpatient setting.

Methods

Strategy for change:

In collaboration with the clinical genetics department, confirm local capacity for genetic screening by microarray testing, and create a pathway for referral with a screening tool for detection of “high risk” patients. Develop processes and resources for consenting patients with capacity, and for acting in best interests with family agreement for those without.

Measurement of Improvement:

Increase in the number of patients with up-to-date genetic screening.

Results

Effects of change:

This project has detected previously unknown genetic abnormalities in current inpatients, two of which were felt to be clinically significant. Further testing is underway and clinical discussions are ongoing regarding the implication of these findings for current patient care and management.

Conclusion

Discussion:

Patients with capacity, families and multidisciplinary healthcare professionals were overwhelmingly supportive of this project with the aim of improving understanding and ultimately the care of each individual. With further discussion and assistance, this project could be widened to the community setting to benefit a greater number of patients and their families.
Fantastic Lists and Where to Find Them: Implementation of Centralised Jobs Lists Into Psychiatric Workplaces
Authors: Sain Samriddhi , Charalambous Christos
Published: August 2024

Aims

This quality improvement project aims to address the current gaps in safe handover between doctors on psychiatric wards by implementing a “live jobs list” that can be remotely accessed and edited by all members of the ward medical team. It should create accountability between different members of the medical team and allow colleagues to track which jobs have been started, completed or are not yet assigned; avoiding duplication or noncompletion of outstanding ward tasks.

Methods

Qualitative surveys were sent out to junior doctors working within inpatient psychiatric wards. The survey focussed on identifying the opinions of doctors about jobs lists and their views regarding collaborative vs. individualised lists. The survey was sent out prior to creating ward-specific online channels with collaborative task lists that could be accessed by the whole team. The survey was then repeated after 4 months of this system being implemented to see how it had changed the opinions of the doctors using it.

Results

Of 21 participants, 95.2% had used individualised jobs lists (IJLs) with 52.4% having negative experiences of these. Only 76.2% of participants had used centralised jobs lists (CJLs) and 42.9% had negative experiences with these. Overall, 61.9% of participants preferred CJLs.

Negative experiences with IJLs focused on lack of accountability, duplication of tasks and unsafe handover. The negative experiences of CJLs revolved around colleagues not correctly using the platform and the process being time-consuming compared with IJLs due to preference of layout and user interface.

The MS Teams CJL was then implemented into multiple wards within an inpatient psychiatry setting. After 4 months of use, the majority of participants (80.9%) were in favour of CJLs; this could be categorised into three main reasons: 1) reduced risk of overlooking or duplicating tasks, 2) safer handover within the team especially due to shift patterns and sickness, 3) accountability within the wider team for clinical tasks. Those who preferred IJLs stated that the newer system was “difficult to adapt to” and that they lacked senior input on how to incorporate it.

Conclusion

Amongst inpatient psychiatry doctors, the use of a CJL has shown to be preferable due to improvements in efficiency, safety and accountability. Although there are barriers to overcome, namely regarding the initial implementation of the system and lack of customisation to individual preferences, this can be explored in the future with the aim to further increase the appeal to doctors working within a ward team.
A Quality Improvement Project to Investigate How Addenbrooke's Cognitive Examination-III (ACE-III) Training Improves the Accuracy of ACE-III Scoring in an Older Adult Community Mental Health Team
Authors: Tyson Zara
Published: August 2024

Aims

Aims – An Audit in the Older Adult Community Mental Health Team identified that there were inaccuracies in the Addenbrooke's Cognitive Examination-III (ACE-III) scoring used to help diagnose dementia. The aim of this Quality Improvement Project was to determine if ACE-III training delivered by a neuropsychologist would improve the accuracy and reliability of ACE-III scores used by the team to help diagnose dementia.

Methods

ACE-III surveys completed over a 6 month period were analysed to determine if they followed the ACE-III scoring guidelines provided by the ACE-III Administration and Scoring Guide (2012). ACE-III surveys were completed by different members of the multidisciplinary team. Following identification of inaccuracies and inconsistencies in scoring we delivered ACE-III training via a neuropsychologist to determine if this would improve ACE-III scoring (as per the ACE-III Administration and Scoring Guide) in the following 6 month period after the training was received.

Results

Following ACE-III training delivered by a neuropsychologist in how to complete the ACE-III survey, surveys were analysed using the Administration and Scoring Guide (2012). ACE-III scores were more accurate in the 6 months following the ACE-III training delivered by a neuropsychologist to the team.

Conclusion

ACE-III training improved the accuracy of ACE-III scores in the multidisciplinary CMHT. This finding would advocate for ACE-III training to become part of our roles within Older Adult Psychiatry in order to improve service delivery to the patient.
Enduring Benefits of Widespread TMS Implementation: Analysis of Data in Pennine Care NHS Foundation
Authors: El-Nemr Donia , Murch Stephanie , Kurkar Micheal , Stanescu Andi , Haque Syed
Published: August 2024

Aims

Transcranial Magnetic Stimulation (TMS), characterized by its non-invasiveness and absence of recovery time, emerges as an optimal intervention for treatment-resistant depression. Operating through the induction of a time-varying electric field in the brain, TMS elicits action potentials in cortical neurons, leading to long-term neural inhibition and excitation, fostering neuroplasticity. Despite its efficacy, TMS remains available in a limited number of National Health Service (NHS) hospitals. This study aims to evaluate the use of TMS for treatment resistant depression and its impact upon service utilisation within Pennine Care NHS Foundation Trust.

Methods

A retrospective analysis was conducted on 76 patients diagnosed with treatment-resistant depression. Responders (n = 54) and non-responders (n = 22) were identified based on baseline, midpoint and endpoint assessments using HDRS, Beck's Inventory, PHQ-9, and GAD anxiety questionnaires. Patient data was extracted from PARIS, the Electronic Patient Record system of Pennine Care NHS Foundation, encompassing NHS service utilisation pre- and post-TMS treatment.

Results

Comparison between 12 months pre and post-TMS treatment revealed noteworthy findings:

12 responders (22%) were admitted to hospital in the year prior to starting treatment with a total of 1134 and mean of 94.5 days. In comparison to post-TMS where 11 (20.4%) patients had total of 913 and mean of 83 days.

8 non-responders (36.4%) were admitted to hospital in the year prior to starting treatment with a total of 285 and mean of 36.5 days. In comparison to post-TMS where 3 (13.6%) patients had a total of 276 and mean of 92 days.

Outpatient appointments reduced by 15.4% for responders and 27.2% for non-responders.

Number of A&E admissions reduced by 79.3% for responders and 65.5% for non-responders.

Admissions to Home Treatment Team (HTT) decreased by 62.7% for responders and 86.7% for non-responders.

Post-TMS discharge from services was 25.9% for responders and 18.2% for non-responders.

Conclusion

This study underscores a reduction in service utilisation among treatment-resistant depression patients following TMS treatment, with some indication that a greater reduction is seen for responders to treatment. While there was limited benefit seen when analysing outpatient appointments and HTT involvement, a greater reduction was seen when evaluating A&E attendance and days spent in hospital. In addition to exploring the possibility of late response to treatment and how this affects non-responder data, future studies are needed to compare results with patients who did not have TMS. These studies will require larger study numbers to better analyse the enduring benefits of widespread TMS implementation within the NHS.
Outcomes Used for the Evaluation of Mental Health Helplines: A Systematic Review
Authors: Mahmood Sajid , Chari Damodar , Hamid Mohamed , Khan Rashid , Pannilavithana Pam
Published: August 2024

Aims

Helplines and crisis lines are a standard component of a public health approach which appear to be intuitively supportive and useful to a population in acute distress and prevent severely adverse outcomes i.e., suicide. These services exist in different formats throughout the world. They have the advantage of being widely accessible, approachable, and bypass the waiting times and bureaucracies of referral systems for accessing secondary mental health services. The authors set out to study the range of outcomes used to evaluate mental health helplines and crisis lines. The focus was not simply to explore whether mental health helplines were effective or not. Rather the authors wanted to investigate what outcomes were being considered as evidence.

The authors aimed to conduct a systematic review of evidence for mental health outcomes of service users of helplines and crisis lines.

The research question was, ‘What outcomes are evidenced in published literature for mental health helplines and/or crisis lines in terms of efficacy, effectiveness or efficiency?’

Methods

This was a systematic review of literature using the PRISMA-2020 statement. Literature searches of Web of Science, Ovid (PsycINFO, Medline, EMBASE), PubMed and Scopus were conducted in December 2022. Relevant information from eligible studies was extracted by using a structured data extraction form. Mixed Methods Appraisal Tool (MMAT) was used to assess quality of the included studies. While the heterogeneity of studies prevented a meta-analysis, it provided a rich landscape for exploring the topic through a thematic analysis.

Results

Eighteen studies finally met the inclusion and exclusion criteria. The projects studied used both trained professionals and volunteers trained to offer crisis intervention. Both qualitative and quantitative outcomes were evaluated across the studies. Outcomes were frequently subjective assessments of service users and/or the personnel delivering the intervention. Studies evaluated outcomes in various ways. Anonymity of the callers made long-term follow-up difficult in most cases, though it is understandable that anonymity might have contributed to the helpline being more accessible and less intimidating to the callers. MMAT scores showed the papers have a range of methodological soundness.

Conclusion

There is lack of consensus and uniformity regarding what outcomes can evidence the efficacy, efficiency, and effectiveness of mental health helplines. Before more investment in helplines, there needs to be discussion, planning and understanding among policy makers and service developers in deciding what they want to achieve from a mental health helpline. This will help researchers focus on relevant outcomes to evaluate mental health helplines. Services need clarity regarding what difference they are trying to make when such helplines are set up.
Benzodiazepine Prescribing Within a Community Mental Health Team Setting
Authors: Farooq Azra
Published: August 2024

Aims

Current guidelines provide for short-term relief of symptoms using benzodiazepines, but patients, including those with complex emotional disorders often seek these medicines for longer. The current audit aims to review clinical practice in respect of benzodiazepine prescribing against national and local guidelines.

Methods

Retrospective analysis of all benzodiazepines prescriptions during the study period (March–December 2021 and January–December 2023). Data was assessed against National Institute for Health and Care Excellence, British National Formulary and local Trust guidelines using a proforma and spreadsheet. The study authors separately reviewed prescribing for separate years of the study.

Results

In the 2021 subsample, (9/15) 60% of patients received a benzodiazepine for less than one month. All of these patients had a psychotic disorder diagnosis. 6/15 (40%) received a benzodiazepine for more than 4 weeks, with an average duration of 5 months. Of these, only one patient had a diagnosis of a Personality Disorder. 7 patients in total (46%) were offered psychological interventions. Patients receiving benzodiazepines for more than 4 weeks were offered a tailored management plan to address their use.

In the 2023 re-audit, 10/51 (20%) patients received a benzodiazepine for greater than one month. The common indications were agitation, anxiety and crisis management. The commonest diagnoses were Personality Disorder, Post-Traumatic Stress Disorder and Schizoaffective Disorder. 4/10 (40%) patients with a Personality Disorder were prescribed a benzodiazepine for more than 4 weeks. The average duration of benzodiazepine prescribing was 11 weeks.

Conclusion

Although benzodiazepines continued to be commonly used for a range of conditions, the proportion of patients not compliant with the one month, recommended duration for prescribing was reduced by half. There was a general reduction in the overall duration of prescribing but patients with a Personality Disorder continued to receive benzodiazepines for longer than recommended.
Evaluation of the Clinical Significance of Assessing Previous Gambling Problems Before Initiating Antipsychotic Treatment: An Audit
Authors: Farthing Evelyn
Published: August 2024

Aims

This audit aims to address the critical link between antipsychotics and impulsive behaviors, particularly pathological gambling, by emphasizing the importance of assessing patients' gambling history before initiating antipsychotic treatment. The focus is on patients under the care of the Bolton Early Intervention in Psychosis (EIT) service, with the aim of meeting the standard set by NICE guidelines, ensuring that 100% of patients started on antipsychotics are asked about their previous gambling history.

Methods

Data was collected from prescription and shared care protocol lists for patients prescribed antipsychotics in the last six months. The PARIS progress notes and clinical correspondence were then searched to determine if patients had been asked about gambling.

Results

The audit revealed a significant gap in the practice, with minimal adherence to NICE guidelines regarding assessing gambling history before prescribing antipsychotics. Out of 35 patients, only one was asked about gambling history.

Conclusion

The recommendations for improvement include incorporating a gambling prompt into the medical review proforma, educating the team about the importance of this assessment, and adding the Problem Gambling Severity Index to the initial review by EIT.