bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring of Inter-Dose Intervals for Long-Acting Injectable Antipsychotics: A Proposed Protocol for the MIDILIA Trial
Authors: O'Neill James , Crowther George J.E. , Cardno Alastair G.
Published: July 2023

Aims

Service users taking long-acting injectable antipsychotics (LIAs) may experience recurrence of symptoms as they approach trough levels within a steady-state cycle. Limited research exists around symptom variation between peak-to-trough plasma concentrations of LIA inter-dose intervals. Different LIAs have variable rates of change in dopamine receptor occupancy during this peak-to-trough variation due to differing elimination half-lifes. It is unclear what rate of change in D2 blockade is tolerated by patients at present, which this trial aims to determine through observing symptom severity differences during peak-to-trough variation.

Methods

A real-world observational longitudinal cohort study is proposed. Inclusion criteria would be working-age adults (18–65 years) who have received five consecutive and timely LIA administrations of a consistent drug and dose. The study would exclude anyone with significant hepatic or renal impairment, anyone on concurrent oral antipsychotic medication or anyone deemed not to yet be within steady-state plasma levels of their LIA medication.

Serum assays for drug level will be obtained at both peak and trough concentrations during an LIA cycle. Expected timings for peak levels will be determined by derived tmax values from existing pharmacokinetic literature for individual drugs. Trough levels will be taken within 24 hours of the next LIA administration being due. Plasma drug concentrations will then be used to calculate expected striatal D2 blockade using EC50 values and maximal occupancy for individual drugs derived from existing PET scan data.

Symptom severity will be assessed by completing Positive and Negative Symptom Scores (PANSS) questionnaires with service users at the time of both peak and trough plasma concentrations of LIA. The difference in these scores will then be plotted alongside the difference in expected D2 blockade derived from plasma drug concentrations.

Results

We hypothesize that the rate of D2 occupancy change would correlate with symptom severity differences in an exponential manner, in that drugs with shorter elimination half-life would have greater difference in symptom severity between peak and trough. We expect that service users would be able to tolerate such change to a degree without significant emergence of symptoms; the trial aims to determine the threshold for what most service users can tolerate, which may then assist in guiding how to effectively reduce and discontinue medications.

Conclusion

This outlines a research protocol to monitor response to pharmacokinetic variation within inter-dose intervals of LIA medication, which may ultimately aid service users in reducing and discontinuing antipsychotics.
Evaluation of Films That Depict People With Dementia
Authors: Jibril Arwa , Overshott Ross
Published: July 2023

Aims

Films are known to influence the public's perception about mental health conditions. Dementia's prevalence in society has been increasing due to the ageing population. Cinema has long struggled with its depiction of mental health as seen with the depiction of schizophrenia, autism and psychosis in many blockbusters and award winning films. However, the depiction of dementia in films has not been as widely explored. The aim of this paper is to evaluate the depiction of dementia in films to assess its clinically accuracy.

Methods

A systematic search of keywords related to dementia was completed on the Internet Movie Database. The search was conducted in May 2022. Non-foreign language feature films were used in this paper. Films from 2000 and onwards were used. The films were analysed on the type of dementia they portrayed. 8 themes and tropes were assessed for each film. The portrayal of healthcare was also assessed. Each film was measured against the Neuropsychiatric Inventory-Questionnaire.

Results

42 films were used from an initial sample of 1,320. Alzheimer's was found to be the most frequently portrayed cause of dementia. Time-shifting was the most common theme. There was a predominantly negative portrayal of care homes with a positive portrayal of carers. The films, measured against the NPI-Q, produced on average a lower severity of neuropsychiatric symptom score and carer distress score.

Conclusion

The depiction of dementia was mild in comparison to dementia's clinical manifestation. Films showed a positive portrayal of healthcare workers which can be considered rare when looking at cinema's history with psychiatry. Overall, films did not accurately portray the clinical aspect of dementia as they tended to focus more on the early stages of the diagnosis. However, films were realistic in their depiction of the emotional challenges that comes with a diagnosis of dementia. Film's powerful role in influencing the public's perception could be used to help reduce stigma and misunderstanding. Filmmakers could work with clinicians to help produce accurate portrayals of dementia. Patients experience the emotive aspect of their diagnosis but also equally experience the symptomatic aspects and cinema should be able to embody that. An accurate portrayal can still maintain the appeal of cinema and at the same time help with reducing misunderstanding and stigma held by the public about dementia which can help improve health outcomes.
Health Care Professionals’ Perspectives of Early Intervention in Psychosis Services: A Qualitative Study
Authors: Rickett Michelle , Kingstone Tom , Gupta Veenu , Shiers David , French Paul , Lennox Belinda , Chew-Graham Carolyn
Published: July 2023

Aims

An Early Intervention in Psychosis (EIP) service offers treatment in the community to people with a first episode of psychosis. EIP is meant to be given for three years; after this time, those who are well are discharged to their GP, while those with ongoing symptoms and care needs are transferred to a general community mental health team. People can become unwell at this time of change and might benefit from longer treatment with EIP. We also know that some people who are well could possibly have been discharged back to their GP earlier. The EXTEND programme aims to develop a more tailored approach to EIP services based on the needs of each individual and understand the health, social, and cost-benefits of this approach.

Methods

This qualitative study sits within a larger programme of work. Ethics and HRA approvals gained. Semi-structured interviews were conducted with health care professionals from primary and specialist care, managers and commissioners, to understand why and how decisions about duration of EIP care are made. Interviews have been transcribed and thematic analysis using principles of constant comparison is being conducted. Patient and public involvement is key to all stages of the study.

Results

Five interviews with General Practitioners and twelve interviews with EIP healthcare professionals, managers and commissioners have been conducted. Initial analysis suggests that access to EIP services can be challenging. Initial engagement is needed before therapy can begin. Decisions about duration of care can depend upon availability of access to Community Mental Health teams. Discharge planning rarely involves communication between primary and specialist care, and this can be a difficult transition, particularly when discharge is back to primary care. The pathway back into mental health care following discharge can be difficult. Trusting relationships between service users and EIP professionals are key to the success of EIP care. Healthcare professionals would value - and in some cases are given - flexibility to extend EIP care beyond 3 years.

We have developed a model to illustrate the patient journey through the EIP service which will be presented for the first time at the conference.

Conclusion

This research provides a framework to understand decision-making around duration of care, discharge planning and practices, and post-discharge support for EIP service users. The next phase of the study will be interviews with service users and carers to explore their experiences of EIP services, duration of care and discharge planning.
Comparative Effects of Antipsychotics on Metabolic and Endocrine Function in Children and Young People With Schizophrenia: A Systematic Review and Network Meta-Analysis
Authors: Rogdaki Maria , McCutcheon Robert , Howes Oliver , Pillinger Toby
Published: July 2023

Aims

Antipsychotic treatment is associated with metabolic disturbance, with clear differences observed between drugs in the adult population. However, the degree to which metabolic alterations occur with different antipsychotics in children and adolescents is unclear. As such, we aimed to compare and rank antipsychotics based on their metabolic and endocrine side-effects when used in the treatment of schizophrenia in this age population.

Methods

We searched MEDLINE, EMBASE, and PsycINFO from inception until October 30, 2022. We included double blinded, randomised controlled trials comparing 12 antipsychotics and placebo in acute treatment of schizophrenia in individuals aged <18 years. We performed random-effects network meta-analyses to investigate treatment-induced changes in body weight, BMI, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose, and prolactin concentrations. We performed meta-regressions to examine the relationship between metabolic/endocrine change and age, sex, and ethnicity

Results

Of 6697 citations, we included 15 randomised controlled trials, consisting of 2501 patients. Antipsychotics included in analyses were aripiprazole, asenapine, blonanserin, clozapine, haloperidol, lurasidone, molindone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. Median treatment duration was 6 weeks (IQR 6-12). Mean age was 15.13 (SD 0.94) years. Mean differences for weight gain compared with placebo ranged from -2.04 kg (95% CI -4.24 to 0.17) kg for molindone to 4.11 kg (-0.55 to 8.77) for clozapine; for BMI from -0.55 kg/m2 (-1.37 to 0.27) for molindone to 1.92 kg/m2 (0.16 to 3.68) for quetiapine; for total cholesterol from -0.14 mmol/L (-0.70 to 0.41) for risperidone/paliperidone to 0.46 mmol/L (0.00 to 0.90) for quetiapine; for LDL cholesterol from -0.32 mmol (-0.76 to 0.12) for aripiprazole to 0.24 mmol/L (-0.15 to 0.63) for olanzapine; for HDL cholesterol from 0.10 mmol/L (-0.05 to 0.26) for aripiprazole to -0.23 mmol/L (-0.52 to 0.06) for risperidone/paliperidone; for triglycerides from -0.01 mmol/L (-0.21 to 0.34) for molindone to 0.62 mmol/L (0.04 to 1.2) for clozapine; for glucose from -0.33 mmol/L (-0.64 to -0.02) for ziprasidone to 0.81 mmol/L (0.28 to 1.34) for clozapine; for prolactin from -1.92 ng/mL (-15.37 to 11.53) for aripiprazole to 28.10 ng/mL (16.23 to 39.96) for risperidone/paliperidone. Higher baseline age predicted by greater increases in body weight (p = 0.014).

Conclusion

We found significant differences between antipsychotics in terms of metabolic and endocrine side-effects when used in children and adolescents. Treatment guidelines should be updated to reflect our findings. However, the choice of antipsychotic should be made on an individual basis, considering the clinical circumstances and preferences of young people, carers, and clinicians.
Understanding Pre-Hospital Care for Self-Harm: Views and Experiences of Yorkshire Ambulance Service Clinicians
Authors: Romeu Daniel , Guthrie Elspeth , Mason Suzanne
Published: July 2023

Aims

Self-harm is a common presentation in emergency services, and ambulance clinicians are often the first professionals involved. The aims of this study were to explore the experiences of Yorkshire Ambulance Service (YAS) clinicians of caring for people who self-harm, and to seek their views of the care provided to this group in the pre-hospital setting.

Methods

This preliminary cross-sectional study involved a self-completed questionnaire using an online platform (Online Surveys, www.onlinesurveys.ac.uk). The questionnaire was designed by the research team, piloted by four academic paramedics, and shared with ambulance clinicians employed by YAS via social media and email bulletins. Multiple-choice answers were analysed using descriptive statistics, and two researchers (DR, EG) independently analysed free-text responses thematically. Participants could only proceed to the questionnaire if they agreed to an online consent statement. Ethical approval was granted by the University of Leeds.

Results

26 clinicians responded to the questionnaire (1.0% response rate), of whom 17 (65%) were female and 16 (62%) were paramedics. 17 (65%) indicated that they had not received specific mental health training in their roles. Only nine (35%) respondents felt comfortable caring for this group, and four (15%) thought that their training had adequately prepared them.

Respondents identified the following as facilitators to high-quality clinical care for people who have self-harmed: previous clinical experience, training in mental health and injury management, availability of mental health advice and services, good communication skills, relevant online resources, and support from senior colleagues. Barriers identified included patient factors, a lack of mental health pathways, services and support and a lack of training and education in mental health. Suggested improvements to emergency services for self-harm were alternatives to emergency departments, greater availability of mental health support, more staff, mental health training for ambulance clinicians, and guidance for the management of patients declining to attend hospital.

Conclusion

Respondents generally felt unconfident and unprepared when called to assess and manage people who have harmed themselves. Improvements in mental health training for ambulance clinicians and greater availability of mental health services are needed to improve pre-hospital care for people who self-harm. Although the study was limited by a low response rate, it has begun to address the literature gap in paramedic care for self-harm. Questionnaire responses corroborate NICE recommendations that alternative services to emergency departments, where appropriate, could improve patient satisfaction and the quality of clinical care. This should be considered by commissioners and policymakers.
Oral Health in Mentally Ill Patients Attending the Outpatient Clinic of Taha Baasher Psychiatric Hospital, Khartoum
Authors: Serebel Areej , Mussab Ahmed
Published: July 2023

Aims

Mental illness has been very common lately and the mentally ill are a special population with their own particular set of needs and challenges. In general physical health of the mentally ill is poorer than that of the general population and oral health is especially neglected hence the desire to quantify this.

Methods

This study was a cross-sectional hospital based study conducted in the outpatient clinic of Taha Basher Psychiatric teaching hospital. The sample (90) was selected randomly from among the adult patient attendants who agreed to participate in the study.

Results

The mean DMF was 4.91 +/-4.46 . It was positively correlated to age and duration of illness. It was higher in females and the greatest proportion was due to missing teeth and the smallest proportion was the filled teeth. There were no dentures used by any of the patients.

Conclusion

Those involved in the study reflect the poor level of oral health among the mentally ill population and this deficiency is unfortunately not receiving enough attention of care givers or mental health professionals. The dental community ought to establish a professional referral system with such facilities to facilitate patient care.
Experience of Differential Attainment in Psychiatry Trainees at Surrey and Borders Partnership NHS Foundation Trust (SABP)
Authors: Shaheed Sidra , Mudunkotuwe Jeremy , Jenkinson Josie
Published: July 2023

Aims

Differential attainment is a term used to describe variation in the achievement of groups of doctors based on certain characteristics. Evidence suggests that international medical graduates (IMGs) in the UK struggle at different stages of training in many specialties including psychiatry. This project aims to explore the experience of psychiatry trainee doctors and their trainers at SABP to understand this issue and identify areas for quality improvement.

Methods

This was an exploratory study using a mixed methods approach. Qualitative data were collected via semi-structured interviews and focus groups conducted with trainees and trainers. Interviews and focus groups were recorded and transcribed, then analysed for themes. Quantitative data were collected via an online survey sent to trainees and trainers and were analysed using descriptive statistics. Informed consent was obtained from all participants. This project received approval from the Health Education England research governance committee and was conducted in accordance with British Educational Research Association (BERA) guidelines.

Results

The online survey had a good response rate of 60.4% for trainees (26 out of total 43 trainees) and 64.7% for trainers (22 out of total 34 trainers). Challenges identified by the participants both in qualitative and quantitative data mirrored the national picture. Five main themes that were identified from semi-structured interviews and focus groups were: 1) the impact of professional and informal support, 2) challenges faced by IMGs in adjusting to the new system, 3) communication barriers, 4) Stress and burnout impacting trainees’ performance and 5) unconscious bias during recruitment, exams, and ARCP on the training experience of IMGs.

Conclusion

This project was used to generate ideas for quality improvement with regard to the experience of trainees and the reduction of differential attainment within the trust. Findings from this research have guided SABP in the development of interventions to support IMGs and trainers, particularly regarding professional and non-professional support. These interventions include an induction booklet for doctors joining the trust, an IMG support network, and a mentorship scheme for all the trainees. We aim to explore the experience of IMGs trainees and trainers using a similar method in the future to evaluate the success of these interventions. Our findings will have an impact on other organisations providing postgraduate training in psychiatry and other specialties.
The Effect of Clozapine on Violence / Aggression in Adults With Mental Illness and Personality Disorders: A Systematic Literature Review
Authors: Shaheen Manar
Published: July 2023

Aims

Violence is not uncommonly seen in patients with mental illness and personality disorders. Various medications have been used to control aggression including antipsychotic medications. Clozapine has proven effectiveness in the treatment of resistant schizophrenia. Recently studies tried to explore its effectiveness as anti-aggression medication. The aim of the review is to explore the efficacy of Clozapine in controlling violence in adults with mental illness and personality disorders.

Methods

comprehensive psychiatric literature review was conducted. Screening of the relevant articles in the national and international databases covering the period between 1973 and 2012. Multiple data sources searched. The author used the Cochrane Library, Ovid on line and NHS Evidence journals and databases to access health care databases advanced search to find articles on EMBASE, MEDLINE, AMED , CINAHL ,PsycINFO, Health Business Elite and HMIC. The studies narrowed down following a flowchart, based on the PRISMA statement. Studies including patients with brain injury, moderated/ severe learning disabilities were excluded. Quality assessment of literature completed.

Results

52 robust studies were retrieved showing consistent evidence to support the use of Clozapine as anti-aggressive medications in patients with schizophrenia and schizoaffective disorders. Studies has shown that a dose of 500 mg daily has a superior effect on controlling aggression, A serum Clozapine level of 0.35 mcg/l can exert anti aggression effect. Some studies noted that its anti-aggression effect could be observed from 5 weeks onwards after treatment is initiated.

The evidence supporting its use in individual with personality disorders has been little. Neither randomized controlled trial nor prospective case controlled trials were conducted to support its anti-aggressive effect in this group. However, few studies reported some reduction in the aggressive behaviour when small dose of 100 mg daily was used in patients with emotionally unstable personality disorder.

Conclusion

There is sufficient evidence to support the use of Clozapine in controlling aggression and violence in patients with schizophrenia and schizoaffective disorders. Its use in personality disorders needs further exploration and support by robust studies. Studies has found anxiety disorders very common in borderline personality disorders, 88% of personality disorder patients involved in a study had co morbid Anxiety disorder. It is possible that the sedative effect of clozapine; may have lowered anxiety levels and subsequently contributed to the reduction in impulsivity and aggression.
Exploration Heuristics During Anxiety – an Online Study
Authors: Tertikas Georgios , Dubois Magda , Hauser Tobias U. , Campbell-Meiklejohn Daniel K. , Critchley Hugo D.
Published: July 2023

Aims

Every day, we may choose something new randomly (random exploration) or select something new with no prior information (de-novo exploration). The link between exploration and anxiety has only been studied using trait-like anxiety questionnaires, but an experimental manipulation of anxiety could have different results. Individual differences (e.g., sex or novelty-seeking (NS) trait) also impact specific exploration strategies. Thus, we examined if anxiety manipulation in a task would influence different exploration strategies while also looking at sex, NS bias and trait anxiety.

Methods

117 healthy subjects (58 female) completed online questionnaires (novelty-seeking dimension of the Cloninger's Tridimentional Personality Questionnaire (TPQ-NS), trait anxiety questionnaire (STAI)) and performed the Maggie's farm task. This task allows to review different exploration strategies, promoting exploration via the number of available choices (horizon). The threat of aversive stimuli (loud noises appearing at random times) was used to emulate anxiety, in a between-subject design. Comparing computational models of exploration, the best-fitting model (evaluated by Bayesian Information Criterion) in our data was a Thompson model with an ε-greedy element (random exploration) and a novelty bonus η (de-novo exploration). We used repeated-measures ANOVA, comparing the effect of horizon on the ε and η parameters with the anxiety category as a between-subject factor. We used partial Pearson's correlations of ε and η derivatives (mean and standardised-difference (SD) across horizon) with STAI and TPQ-NS measures correcting for participant's reported stress levels and anxiety category. Partial correlations analyses were repeated after splitting the data by sex.

Results

There was no between-subject effect of anxiety category on the horizon of either ε (F(1,1) = 0.253, p = 0.6) or η (F(1,1) = 0.305, p = 0.58). SD of ε was negatively correlated with TPQ-NS (r = −0.184, p = 0.050) but no other partial correlation was significant. When splitting by sex, SD of ε was negatively correlated with the STAI score (r = −0.341, p = 0.01) in females and the TPQ-NS score in males (r = −0.275, p = 0.038). The mean η positively correlated with the STAI score (r = 0.318, p = 0.016) in males.

Conclusion

While the experimentally modulated anxiety did not affect the exploration parameters, individual differences in NS and trait anxiety are suggested to affect random and de-novo exploration in a sex-dependent manner. Imaging research, or research into anxiety population could help further solidify these results in the future.
Patterns of Insomnia and Its Treatment in North Central London: Using Primary Care Data to Establish Unmet Needs and Health Inequalities
Authors: Waterman Lauren , Harrison Fleur , Osuagwu Uche , Dougan Sarah
Published: July 2023

Aims

There is robust research evidence that insomnia is highly prevalent in the general population, with a significant adverse impact on physical and mental health and quality of life. There is also strong evidence of the cost-effectiveness of cognitive-behavioural therapy for insomnia (CBT-I), the first-line treatment for insomnia recommended by the UK's National Institute for Health and Care Excellence. However, data from primary care records has not been used in the UK to establish real-world impact, including local prevalence, treatment rates and inequalities. This study's aim was to establish these in North London.

Methods

Pseudonymised data were extracted from primary care records across three North London boroughs for 765,035 patients (aged 15+ years). Insomnia prevalence was determined by identifying patients with a code for insomnia in previous five years, sleeping tablet prescription in previous three months, or code for insomnia treatment. Data were aggregated upon extraction and analysed using descriptive statistics.

Results

Insomnia prevalence was 4.3%. Prevalence increased steadily with age, being highest in those aged 85–90 years (10.8%). There was significant variation by ethnic group and deprivation quintile, with highest prevalence in the most deprived quintile (5.2%) and those of Bangladeshi ethnicity (7.3%). Variation in insomnia prevalence, diagnosis and treatment occurred between GP practices. Prevalence was significantly higher in patients with comorbidities, including those with chronic obstructive pulmonary disease (17.5%), diabetes mellitus (11.8%), severe mental illness (16.6%), and depression (14.1%). 0.3% of people with an insomnia code had been referred for CBT-I.

Conclusion

Insomnia was found to be as common as other illnesses that receive high levels of focus and resourcing in the UK. Prevalence estimates were likely underestimates since patients were only counted as having insomnia if this could be identified from coded data or prescription information. Significant variation in prevalence and treatment rates by factors such as ethnicity and deprivation quintile may represent health inequalities. Additionally, insomnia was particularly common among patients with certain comorbid illnesses and of advancing age, meaning that those groups should be actively screened for insomnia. Concerningly, referral rates for CBT-I were extremely low. It is vital that clinicians receive training in diagnosing insomnia and local treatment pathways, and that culturally appropriate services are commissioned to address this unmet need and ensure equitable access. Although this study included data from only one locality, it is consistent with international research findings. Therefore, prevalence and unmet need is likely to be high in many other areas and should be investigated locally.
Esketamine Nasal Spray Improves Rate and Time to Remission Versus Quetiapine Extended Release in Subgroups of Patients With Treatment Resistant Depression and Two or Three Plus Prior Treatment Failures: Results From ESCAPE-TRD, a Randomised Phase IIIb Trial
Authors: Young A.H. , Cubała W.J. , Nielsen R.E. , Popova A. , Ito T. , Mulhern-Haughey S. , Pirotte N. , Rive B. , Thilakarathne P. , Usankova I. , Godinov Y.
Published: July 2023

Aims

For patients with depression, the likelihood of remission decreases with each subsequent treatment failure. Per European Medicines Agency guidance, treatment resistant depression (TRD) is defined as nonresponse to ≥2 consecutive treatments at adequate dosage and duration in the current depressive episode. In ESCAPE-TRD (NCT04338321), esketamine nasal spray (NS) increased the probability of achieving remission and remaining relapsefree, compared with quetiapine extended release (QXR) in patients with TRD. Here, we report the efficacy of esketamine NS vs QXR in patient subgroups with 2 or ≥3 consecutive prior treatment failures (PTFs).

Methods

ESCAPETRD was a phase IIIb trial comparing the efficacy of esketamine NS with QXR in patients with TRD. Patients (N = 676) were randomised 1:1 to esketamine NS (n = 336; 56/84 mg; twice weekly, weekly, or every 2 weeks [wks]) or QXR (n = 340; 150–300 mg daily, both in combination with an ongoing selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor. Randomisation was stratified by age (18-64 years; 65–74 years) and PTFs (2; ≥3).

The primary endpoint of remission (Montgomery-Åsberg Depression Rating Scale total score ≤10) at Wk8 and the secondary endpoint of remaining relapse-free through Wk32 after remission at Wk8, were analysed in PTF patient subgroups and compared between study arms, with treatment discontinuation considered as a negative outcome. The effect on time to remission was assessed using hazard ratios (HR) from a Cox regression model.

Results

Of the randomised patients, 415 (61.4%; esketamine NS: 204, QXR: 211) had experienced 2 PTFs and 261 (38.6%; esketamine NS: 132, QXR: 129) had experienced ≥3.

Of patients with 2 PTFs, 54/204 (26.5%) esketamine NS-treated patients and 46/211 (21.8%) Q-XR-treated patients achieved remission at Wk8 (p = 0.267). Of patients with ≥3 PTFs, 37/132 (28.0%) and 14/129 (10.9%) patients achieved remission at Wk8 in esketamine NS and Q-XR arms, respectively (p < 0.001). Of patients with 2 and ≥3 PTFs, 49/204 (24.0%) and 24/132 (18.2%) of esketamine NS-treated patients and 38/211 (18.0%) and 10/129 (7.8%) of Q-XR-treated patients achieved remission at Wk8 without relapse to Wk32 (p = 0.133 and p = 0.013), respectively.

Esketamine NS significantly improved time to remission, with a greater effect in the ≥3 PTF subgroup (2 PTFs: HR = 1.547 [95% confidence interval (CI) 1.210–1.976]; p < 0.001 vs ≥3 PTFs: HR = 2.066 [95% CI 1.469–2.907]; p < 0.001).

Conclusion

Esketamine NS demonstrated a significantly superior remission rate versus QXR at Wk8 in patients with ≥3 PTFs, and significantly shorter time to remission versus Q-XR in both subgroups.
Review of Consent to Treatment Documentation in University Hospital Wishaw Inpatient Psychiatry
Authors: Ansari Saba , Reid Kyle , Ahmad Fayyaz
Published: July 2023

Aims

To establish if the Mental Health Act Code of Practice was being followed in the mental health inpatient ward population in Wishaw General Hospital. Specifically, those who were subject to detention with a Compulsory Treatment Order (CTO) under the Mental Health Act and whether or not documentation of consent to treatment was being kept.

Methods

Over the course of one week beginning on 1st December 2022, we reviewed the inpatient population within acute psychiatric wards (Wards 1-3) at Wishaw General Hospital to determine the nature of patient admissions, informal or under detention, specifically Short Term Detention Certificate (STDC) or Compulsory Treatment Order(CTO). A total of 57 inpatient notes were evaluated, including those of 10 patients with STDC and 14 with CTO. From these 14 patients, we determined whether T2b(240) or T3b(240) forms were clearly documented in both paper and electronic records (MORSE).

Results

One of the three patients on Ward 1 who were subject to CTO had both electronic and physical documentation of the T3B form. In the physical notes of two patients, the T2B or T3B form, as well as the reason and specific treatment, were adequately described.

Seven of the eight patients subject to CTO in Ward 2 had adequate documentation of the cause and particular treatment, as well as clear documentation of the T2B or T3B form in their physical notes. None of these patient’' electronic notes contained any documentation. As the last patient was less than two months into CTO, they did not fit the criteria for the T2B or T3B consent forms.

All three patients subject to CTO from Ward 3 had clear documentation of T3B forms in their physical notes, as well as appropriate documentation of their cause and treatment. There was no documentation on these patient’' electronic notes.

Conclusion

Overall, the clinical documentation was accurate with strict adherence to mental health act code of practice. 100% of patients requiring consent to treatment documentation either via T2B or T3B form were completed and available for review in the paper notes. Of note however, only 1 patient had CTO documentation and consent to treatment documentation available on electronic records (MORSE) which would allow remote viewing.

We propose the practice to upload detention certificates and consent to treatment forms to Electronic data (MORSE within the “files” tab). This information will be shared with ward staff to encourage copy and filing of documentation within this section on MORSE (electronic records).
Evaluating a Pilot ‘Hearing Voices Group’ for People With Learning Disabilities
Authors: Bates Kirsty
Published: July 2023

Aims

Adults with learning disabilities have traditionally been excluded from psychosis research studies and intervention trials because of their learning disabilities. There is a distinct lack of knowledge about adults with learning disabilities and their lived experience of psychosis including specific symptoms such as voice hearing. Interventions such as Hearing Voices Groups (HVG) have been developed without thorough understanding of what these experiences mean for this population, I found one pilot study ran by South London and Maudsley (SLAM) in 2018 (1)

•

Understand more about voice hearing experiences in people with a learning disability

•

Evaluate whether an adapted HVG is acceptable and affective in this patient group

•

To obtain feedback in order to improve the group for future practice

Methods

We set up a hearing voices group for people under the Bristol Community Learning Disability Team (CLDT) who experience hearing voices which causes them distress. The sessions for the group were inspired by ideas from the book “People with Intellectual Disabilities Hear Voices too” published by Psychologist Dr John Cheetham, which we adapted into accessible session plans. The group consisted of 6 service users and was facilitated by me and 3 mental health nurses and ran for 8 weeks on a weekly basis for 1 hour 30 mins. Each participant worked through an accessible handout which we then collated at the end to create a take home workbook of all the material covered throughout the group, as well as individual feedback from the group facilitators.

We used CORE-LD 30 and World Health Organisation Quality of Life (WHOQOL-8) tool pre-group and post-group which are both validated tools for use in people with a learning disability. We also conducted an adapted Maastricht's interview with each service user to understand more about their voice hearing experiences and a post group feedback questionnaire.

Results

All participants had a reduction in their CORE-LD score with lower scores indicating fewer distressing symptoms and lower risk to self, with an average reduction in score of 39%. Themes of why they thought they heard voices included: bereavement, bad neighbours, doing something bad in the past. When asked what the voices say, they were mostly negative insults towards the service user or telling them to harm themselves. Feedback post group included: more sessions/more time, learnt ways of coping with voices, helped to speak about the voices, felt safe and less alone, enjoyed sharing experiences, understand voices.

Conclusion

The NICE Guidelines 2017 Quality statement 4 states that we should be tailoring psychological interventions for people with learning disabilities. Previously there were specific interventions for people with a learning disability within the LD service. The evaluation of this group helps to support the effectiveness in adapting a well-established intervention and the value of offering this on a continued basis in the Bristol CLDT.
Use of an Information Pack to Improve Relative’', Friend’' and Carer’' Satisfaction With the Admission Process in an Older Adult Inpatient Service: A Quality Improvement Project
Authors: Baxter Luke , Zacharia Tharun
Published: July 2023

Aims

We performed a Quality Improvement Project in an inpatient Old Age Adult ward to increase patients’ relatives, friends and carers’ (RFCs’) knowledge about important aspects of hospital admission, through the provision of an information pack. By increasing this knowledge, we aimed to improve RFC satisfaction surrounding the admission process. Previously published evidence has shown that increasing the perception of involvement of RFCs in a patient's admission promotes greater satisfaction within this group. Adequate information provision is regarded as an important part of promoting perceived involvement; conversely, a lack of information provision and communication has been associated with dissatisfaction with hospital admissions among RFCs.

Methods

Using a survey directed towards members (n=9) of the ward MDT, we identified several topics relating to hospital admission that were regarded as high priority for inclusion in an information pack. MDT members were also asked about their perception of RFC satisfaction in the admission process. RFCs (n=8) were asked how well-informed they felt about these topics with a separate survey, and their level of satisfaction with the admission process. An information pack was created based on the results of these surveys and distributed to RFCs. The RFC survey was then repeated to assess improvements in RFC knowledge and satisfaction.

Results

Perceived RFC satisfaction among staff members prior to the publication of the information pack was lower than actual RFC satisfaction. RFC satisfaction with and knowledge about the admission process increased following the distribution of the care pack.

Conclusion

Admission information packs can be used on inpatient old age wards to improve patient family, friend and carer knowledge and satisfaction.
Lifestyle Factors and the Physical Health of Patients on Depot Antipsychotics in the Haywards Heath Catchment Area, Linwood ATS (Phase1, 2022)
Authors: Bucur Mihaela , McCabe Naoko , Ross-Skinner Emily , Kazmierow Hannah
Published: July 2023

Aims/Context

Patients with severe mental illness have reduced life expectancy, representing one of the most significant health disparities. Although the cause is multifactorial, cardiovascular disease & other comorbid chronic conditions play an essential role. Individuals with mental illness often face considerable barriers to accomplishing their health and well-being goals. As a result, there is a growing interest nationally and internationally and research evidence for the role of lifestyle interventions in managing mental health conditions. NICE guidelines now reflect this, recognizing the impact of physical health comorbidity and recommending monitoring of metabolic status and cardiovascular risk (using the Q-RISK3 tool) in the management of schizophrenia & bipolar. AIMS: -Phase 1: to identify & analyse lifestyle parameters contributing to patient’' health & leading to excessive disease burden and the QRISK3 calculations for patients in the Haywards Health catchment area on depot antipsychotics. -Phase 2: make recommendations focused on lifestyle factors interventions in addition to standard care-Phase 3: to re-assess following the recommendations from phase 2.

Methods

Phase 1 Steps:

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Identifying all patients on depot antipsychotics living in the defined catchment area.

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Data Collection from the electronic clinical record: diagnoses, gender, physical activity, alcohol intake, smoking, lipids, employment, BMI, blood pressure, QRISK3.

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Analyse results.

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Make Phase 1 Recommendations

Phase 2: Implement phase 1 recommendations

Phase 3: Use the electronic records to conduct a second analysis assessing the offer of intervention to patients, reassessing the lifestyle parameters and QRISK3 calculation

Results

Phase 1 Results: All patients identified (6) had a detailed overview of the lifestyle parameters assessed. None of the patients had the QRISK®3 calculation in phase 1.

Conclusion

A series of recommendations were made at the end of Phase 1 in view of initial results.

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Disseminate results locally, including in primary care

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Ascertain up-to-date information regarding physical health and lifestyle parameters in the OPC reviews; include in the letters to GP updates on the category of lifestyle parameters included in this project.

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Discussion with patients on the impact of lifestyle factors in the OPC reviews

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Signpost patients to resources they can use to support implementing positive lifestyle choices

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QRISK®3 measurement

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1:1 psychoeducational session focusing on improving lifestyle choices.

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Engage patients to engage in co-producing psychoeducational sessions aimed at improving lifestyle choices.

Phase 2: implement phase 1 recommendations (October 2022-September 2023)

Phase 3: re-assess in October 2023
Improving Allergy Status Documentation on Electronic Patient Records- a Trust-Wide In-Patient Quality Improvement Project
Authors: Cook Natalie , Prasanna Aparna , Mathews Rhea , Cabada Josh , Hebbar Meghnaa , Jaffar Shakeel
Published: July 2023

Aims

NICE guideline CG183 states that “both the drug and the description of the reaction must be documented on all forms of prescription and in a patient's medical records”. Black Country Partnership NHS Foundation Trust (BCPNFT) documents allergy status on both paper drug charts and the Electronic Patient Record“"Ri”" (EPR). Incomplete Allergy Status on EPR poses a significant patient safety risk, particularly in an era of hybrid working and out of hours input from remotely based clinicians. The standard for this audit is that 100% of drug charts and Rio notes should have allergy status documented. The BCPNFT is a collection of psychiatric services across four towns- Dudley, Walsall, West Bromwich and Wolverhampton. The aim was to ensure consistent practice and standards across all sites. Following the initial data collection, discussion of findings and Action Plan (AP), and to ensure consistent standards, it was agreed to expand the project to include all General Adult in-patient units.

Methods

A data collection tool was designed collaboratively with the QI Department, to capture demographics, diagnosis, admission duration, legal status and allergy status both written and digital. This tool applied for all 96 older adult in-patients across the four localities within the trust on 03.10.22. The only exclusion criteria was admission within 24 hours of the data collection date.

Results

Data Collection: 100% of Paper Drug Charts had allergy status documented, only 70% have type or severity of allergic reaction documented. Despite 76% of in-patients admission of 4 weeks or longer, only 62% of patients had their allergy status documented on EPR, this varied from 30-100% across individual wards. EPR allergy status documented: Wolverhampton 93% West Bromwich 100% Dudley 33% Walsall 39%

Conclusion

The results from all four localities were presented at the respective locality post graduate teaching, the EPR configuration team meeting and the QI Group meeting to gain Multi-Disciplinary Team feedback for both low documentation rates and high variability across sites. Based on this feedback, the AP comprised of incorporating an Allergy Status prompt into the electronic clerking document, visual prompts of stickers and posters across all wards. Also, liaising with Pharmacy to request they also update the allergy status on EPR; and Ward Matrons who have added an Allergy Status alert onto their bed state view. Data will then recollected post AP interventions, across all older and working age adult inpatient wards- a sample size of around 300 patients. The second data collection is currently being undertaken.
Ecosia: Bringing a Greener Search Engine to the NHS
Authors: Cussans Amelia
Published: July 2023

Aims

The objective of this project was to switch the default search engine used on CNWL computers from Google/Bing to Ecosia. Both Google and Bing have poor ethical and environmental credentials. Ecosia, in contrast, is a not-for-profit, certified B-Corporation which funds tree planting and community projects around the world. Ecosia searches display ads (just like any other search engine) however it donates 100% of its profits towards high-impact agroforestry, tree planting and forest protection.

Methods

The first step was to pitch the proposal to the Trust's Sustainability Lead. Then, information governance and cyber security teams performed assessments and gave clearance. An ICT technician was allocated the task and they configured the switch for a pilot group of 38 staff, with the help of step-by-step guides produced by Ecosia. After a short trial, the pilot group completed a questionnaire. Following satisfactory feedback, the ICT technician switched the default search engine to Ecosia for the entire Trust staff group. A Trust-wide email informed staff of the change and provided opportunity for feedback to be given via an online survey.

Results

A CNWL tree count is sent monthly from Ecosia. Over the first four months, an estimated 32,872 trees were planted using the funding generated by CNWL.

The pilot survey showed 80% of participants agreed that CNWL should use Ecosia as its default search engine (0% = should not; 20% = undecided). 62% felt Ecosia performed the same as the previous search engine (14% = much better; 5% = somewhat better; 20% = somewhat worse; 0% = much worse). 86% said they would use Ecosia on their personal devices. Further comments included:“"This is a great initiative from the trust, who in many realms benefit private profit enterprises to the detriment of our planet.”;“"As a Trust, in addition to using Ecosia, we should look for other similar measures, on the grounds that every step towards sustainability makes a cumulative impact”"; “Google performs better than Ecosia”. It is noted that if an Ecosia search does not yield the required results, it can easily be switched to Google by clicking ‘More’ —> ‘Google’.

Conclusion

Switching to Ecosia is an achievable action that health organisations can take. Collectively we can fund the protection and regeneration of forests, which benefits people and the planet, and engages staff in climate action. The next step is for other Trusts to switch, with an ultimate goal of all NHS organisations using Ecosia.
Trainee Led Quality Improvement Addressing Lack of Transparency in Referral Processes for Psychiatric Reviews in the Maudsley Adolescent Mental Health Service
Authors: Dessain Amabel , Dionelis Karolos , Ingrassia Anto
Published: July 2023

Aims

The Specialist Adolescent Mental Health Service at the Maudsley Hospital provides multi-disciplinary mental health care to adolescents in London. There is currently no policy by which non-medical members of the multi-disciplinary team can request a psychiatric review for their patients. Staff feedback revealed problems with the medical review referral process to be a lack of clarity on how to make referrals, and a lack of transparency (e.g. referral outcome, approximate waiting time).This projected aimed to improve the clarity of the process for requesting psychiatric reviews and to develop skills in leadership as a future child psychiatrist.

Methods

We designed and introduced a referral form and integrated waiting list. Next we developed a policy document for making referrals. Finally we modified the referral form so that when submitted, it automatically updated the integrated waiting list. At the outset and after each intervention we resurveyed the staff.

Results

At the outset 71% of staff reported finding the process somewhat unclear, while 29% reported finding the referral process neither clear nor unclear. Following the final change 100% staff each reported finding the process very clear or somewhat clear.

Conclusion

The changes we implemented resulted in a clearer and more transparent referral process for medical reviews. We anticipate that this improved staff satisfaction will equally translate into some benefits for patient care, such as more clarity around when a medical review can be expected and what it might entail.