bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic Effects of Antidepressants; Is It Time to Change the Conversation?
Authors: Patel Anjali , Shanthakumaran Yathorshan , Rasheed Reshma , Nazir Imaduldin
Published: June 2022

Aims

The incidence of depression has risen both nationally and internationally. The mainstay of management remains referral to IAPT and treatment with SSRI and SNRIs and the rates of prescribing are rising exponentially. During the COVID-19 pandemic, more people faced mental health challenges. In the last ten years, the incidence of SSRI prescribing rose from 6.8% to 100%. A known side effect of antidepressant medication is weight gain, dyslipidemia, increasing risk of impaired fasting glycaemia and diabetes. Our study was conducted to assess the actual risk incurred in our population from the point of starting therapy till date.

Methods

Patients were identified from the GP clinical system (SystmOne) to identify those with a current prescription of antidepressants and antipsychotics. A retrospective analysis of 591 patients' case records was undertaken. Body weight, BMI, fasting glucose, HbA1c, fasting lipids and Q risk were analysed at the time of prescription initiation, post treatment and any rise in cardiovascular risk over a period of years. The data were analysed to see the trajectory of deterioration in metabolic risk. All patients were assessed to ensure they had been signposted and referred to weight management services.

Results

The data show a positive correlation between the onset of antidepressant and antipsychotic prescribing, worsening of BMI, increase of cardiovascular and metabolic risk. The data show an exponential rise in BMI and metabolic risk (cardiovascular Q risk, dyslipidemia, imparied fasting glycaemia, diabetes and ischaemic heart disease) for patients taking SSRI and SNRI within 12 months. This effect continues for the length of the prescribing interval. We also found that with the rise of BMI dose, escalation was common due to reduced effectiveness. The average rise in cardiovascular Q risk average was 14.05% over three years. Patients need careful counselling at the outset and need regular reassessment of metabolic risks at each medication review. Informed consent must be obtained - risks of SSRI, SNRI and antipsychotic risk should be stated.

Conclusion

A known iatrogenic risk of antidepressant medication is weight gain, dyslipidemia, increasing risk of impaired fasting glycaemia and diabetes. Careful counselling and metabolic risk assessment is required when initiating these medications. Throughout the length of prescribing patients need re-assessment of their cardiovascular and diabetes risk with timely referral to weight management services to counterbalance metabolic risks.
A Mixed Method Study of Indian Mothers Assessing Impact of Lockdown in the Understanding and Burden of ADHD in Their Child
Authors: Patkar Prajakta
Published: June 2022

Aims

To study the impact of the lockdown (pandemic) in the mother's understanding of the child's disorder (ADHD) and the burden faced by her.

Methods

A mixed method design with a combination of a qualitative and quantitative approach. An in depth in-person semi structured interview with the participant mother was conducted as the qualitative part and the quantitative part of the study consisted of burden assessment by the Zarit Caregiver burden scale pre and post pandemic. The responses were transcribed and themes were identified

Results

As far as understanding of the disorder was concerned, the major themes identified were “Knew about the child's problems from teachers but online schooling made me see the child's issues in person” and “Knew about the illness but more time led to more bonding and more understanding”. When questioned about the burden faced, the major themes that evolved were “Increased burden as I felt exhausted taking care of child 24/7” and “Increased burden as I felt angry and irritated with my child, the school and family”. The Zarit caregiver questionnaire revealed a statistically significant difference in the burden before and after pandemic with more number of mothers falling in the mild to moderate & severe category of burden after the commencement of the pandemic.

Conclusion

COVID-19 pandemic increased the caregiver burden for Indian mothers of children with ADHD. They understood a lot more about their child's disorders by spending more time and devised different ways and means of helping their child in academic and other areas.
Associated Mortality Risk of Atypical Antipsychotic Medication in Individuals With Dementia (AMRAAD): A Clinical Cohort Study
Authors: Phiri Peter , Engelthaler Tomas , Carr Hannah , Delanerolle Gayathri , Holmes Clive , Rathod Shanaya
Published: June 2022

Aims

Antipsychotic medications such as risperidone, olanzapine and aripiprazole are used to treat psychological and behavioural symptoms among dementia patients. Current evidence indicate prescription rates for antipsychotics vary and wider consensus to evaluate clinical epidemiological outcomes is limited. This study aims to investigate the potential impact of atypical antipsychotics on the mortality of patients with dementia.

Methods

A retrospective clinical cohort study was developed to review United Kingdom Clinical Record Interactive Search system based data between January 1, 2013 to December 31, 2017. A descriptive statistical method was used to analyse the data. Mini Mental State Examination (MMSE) scores were used to assess the severity and stage of disease progression. A study specific cox proportional hazards model was developed to evaluate the relationship between survival following diagnosis and other variables.

Results

A total sample size of 1692 patients were identified using natural language processing of which, 587 were prescribed olanzapine, quetiapine, or risperidone (common group) whilst 893 (control group) were not prescribed any antipsychotics. Patients prescribed olanzapine and Risperidone showed similar risk of death [hazard ratio (HR) = 1.32; 95% confidence interval (CI): 1.08–1.60; P < 0.01], (HR = 1.35; 95%CI: 1.18–1.54; P < 0.001). Patients prescribed Quetiapine showed no significant association (HR = 1.09; 95%CI: 0.90–1.34; P = 0.38). Factors associated with a lower risk of death were elevated MMSE score at diagnosis (HR = 0.72; 95%CI: 0.62–0.83; P < 0.001) along with other demographic factors such as women (HR = 0.73; 95%CI: 0.64–0.82; P < 0.001) and being of a Caucasian British group (HR = 0.82; 95%CI: 0.72–0.94; P < 0.01).

Conclusion

A significant mortality risk was identified among those prescribed olanzapine and risperidone which contradicts previous findings although the study designs used were different. Comprehensive research should be conducted to better assess clinical epidemiological outcomes associated with diagnosis and therapies to improve clinical management of these patients.
Comparison of Prevalence of Psychiatric Disorders Among the Adult Population in Bangladesh, Before and During the COVID-19 Lockdown
Authors: Radwan Rifat Binte , Mallik Chiro Islam , Pike Grace
Published: June 2022

Aims

The aims were to determine and compare the prevalence of possible psychiatric disorders among Bangladeshi adults before and during lockdown. It was hypothesized that prevalence of possible psychiatric disorders would increase during the lockdown. In Bangladesh, lockdown was implemented in response to the COVID-19 pandemic resulting in conditions where those prone to developing psychiatric disorders were more vulnerable in an environment where the mental healthcare infrastructure is already lacking. Although many studies outlined the devastating impact on mental health that the lockdown measures created, this unique study specifically uses a World Health Organization developed research instrument for a lower-middle-income country.

Methods

This was a cross-sectional, descriptive, comparative study with one stage design to determine possible psychiatric cases. Initially, 603 adults were randomly contacted using Facebook messenger & groups and email. Questionnaires including the validated Self Reporting Questionnaire (SRQ)-20 in Bangla, for screening psychopathology of the cases, and a structured questionnaire containing socio-demographic and other related variables, were inputted into Google Forms and hyperlinks were distributed. Eventually, 570 participants, from 18 to 77 years, with Internet access, who completed the questionnaires, were included in the study through purposive and consecutive sampling. The SRQ variables were divided into four categories: (1) depressive/anxious; (2) somatic symptoms; (3) reduced vital energy; and (4) depressive thoughts. Using IBM SPSS Statistics, paired sample t-tests were used during data analysis.

Results

The mean age of cases was 34.69 ± 13.02 years; male: female = 1.41:1. The prevalence of possible psychiatric disorders was 43.9% during lockdown compared to 23.3% before lockdown (t = 19.497, P = 0.000). Before lockdown, sex and employment status were significant factors for the SRQ positive cases. After lockdown, in the SRQ positive cases, sex, educational status, COVID-19 positive cases and death due to COVID-19 among family members were highly significant (p = 0.0001) factors. Somatic symptoms and depressive thoughts were approximately double in prevalence among the SRQ positive cases during lockdown compared to before lockdown.

Conclusion

There was a significant impact on mental health where a reduction in psychological and socioeconomic support occurred. These findings are in line with those in the literature where somatic symptoms have been identified as most commonly experienced during the pandemic. Increased depressive thoughts are associated with increased feelings of possible impending death and fear of an uncertain situation. Clearly, the mental health infrastructure of Bangladesh is in even greater need of rapid change to ensure resilience to the survivors of the lockdown.
The Provision of Mental Health Care for Service Users With Complex Needs Who Are at Risk of Suicide
Authors: Saini Pooja , Balmer Anna , Sambrook Laura , Roks Hana , McIntyre Jason , Martin Antony , Tait Jackie , Ashley-Mudie Peter , Shetty Amrith , Nathan Rajan
Published: June 2022

Aims

Individuals presenting with complex behavioural and mental health needs may not receive the provision of care needed. Those presenting with a more complex clinical presentation may have a history of self-harm and suicide attempts. A common risk factor for preceding suicide is previous self-harm, suicide attempts or discharge from inpatient units. Understanding the descriptive symptom domains for inpatients and those treated in the community and the relationship between them could inform suicide prevention. The aim of this study was to explore the extent of self-harm and suicidal behaviours in individuals with complex mental health needs across inpatient and community settings.

Methods

A cohort study design of in-depth written medical notes (n = 80) for people who were known to have complex mental health needs across inpatient and community settings. Data were extracted from medical records onto a coproduced questionnaire. As well as demographic data, information was collated about previous self-harm, suicide planning, suicide attempts, and support seeking regarding suicidal thoughts. The study will include a quantitative in-depth description and inferential analysis of the demographic clinical characteristics of the patient group.

Results

Medical case notes were reviewed for 80 service users with complex mental health needs. Across both groups, approximately three-quarters of participants had previously self-harmed (76%), or planned suicide (n = 73%), and/or attempted suicide (63%). Self-harm (83% vs. 70%) and suicide attempts (72% vs. 65%) were more prevalent in the inpatient group compared to the community group. Social support was received more by community patients than inpatients (70% vs. 50%), even though inpatients were more likely to sough help when experiencing suicidal thoughts compared to people cared for in the community (38% vs. 30%). In both groups, there were often multiple suicide plans and attempts made over their timeline of contact with services.

Conclusion

Self-harm, suicide planning, and suicide attempts were prevalent for people treated across both inpatient and community settings. Self-harm and suicide planning was indicative of a later suicide attempt within both settings. In those experiencing suicidal thoughts, few had sought help, suggesting the importance in staff training to enable then to recognise and identify patterns of self-harming and suicidal behaviours in individuals with complex mental health needs. Social support needs for inpatients should be increased, particularly when they sought help for suicidal thoughts. This may help to reduce length of stays in hospital or future readmissions to hospital; thus, reducing the cost implications for the NHS mental health services.
Effectiveness of Single Therapeutic Project in Adolescents With Attempted Suicide And/or Self-Harm
Authors: de Almeida Junior José Robson Samara Rodrigues , Konno Yoichi Takaki , Santos Nágila Batista Lúcio , Parreira Gabriel Silveira , Cenedesi Loíse Maria Tiozzo , Fernandes Bianca Besteti , Carvalho Pedro Henrique Ferreira
Published: June 2022

Aims

Brazil is the eighth in number of suicides in the American continent, and 4th in the number of suicides in Latin America. From 2011–2016, there were 33,269 cases in women and 14,931 in men, with 24.1% and 17.2% in populations aged 10–19 years, respectively. Regarding self-harm, there were 116,113 cases (25.9%), and 60,098 cases (19.6%). And in both, the recurrence rate was high, with 25.3–33.1%. Properly employed, the Singular Therapeutic Project (STP) can prevent further events and even completed suicide. In this way, there is a reduction in stigma in this population and for family members, adequacy of mental health services, in addition to lower public spending on hospitalizations. We analysed the effectiveness of the STP in cases of suicide attempt and self-harm, in an outpatient setting, through the comparison of a group of patients with more adherence with the STP, in relation to the group with less adherence in a multidisciplinary context.

Methods

It was a retrospective cohort, with adolescents aged 12 to 18 years, from the south of Sao Jose do Rio Preto (Brazil), during the period of 2015–2019, with follow-up for more than 3 months.

To analyze the behavior of numerical variables, descriptive statistics, boxplot plots and the specific test for Kolmogorov-Smirnov will be considered. Comparisons of continuous variables between two independent groups will be performed using Student's t test or Mann-Whitney test; comparisons of categorical variables with Pearson's chi-square test or Fisher's exact test.

Results

The study sample consisted of 88 patients, 79.5% of whom were girls, 1.1% were illiterate, 34.2% were referred from the health unit, 29.5% from the hospital emergency. Patients with new episodes of suicide attempts accounted for 14.7% (1 attempt −10.2%, 2–1.1%, 3–3.4%), and self-harm 23.8% (1–12.5%, 2–2.3%, 4–4.5%, 5–2.3%, 6–1.1%, 7–1.1%).

There was no statistical significance between the group with adherence to STP and without adherence in relation to new suicide attempts (p = 1.0) and recurrence of self-harm (p = 0.309). In addition, both outcomes were not statistically significant with sociodemographic data, psychoactive substance use, and negative life events.

Conclusion

The adolescents' adherence on STP was not associated in recurrence of suicide attempts and self-harm. We hypothesized that the sample size may have influenced the power of the statistical analysis. This pilot study is the first phase of the still ongoing study on all city.
Do Chronotypes Influence Problematic Mobile Phone Use and Sleep Quality Among the Doctors? – a Cross-Sectional Study From India
Authors: Gopalakrishnan Prathyusha , Simiyon Manjula , Mani Manikandan , Thilakan Pradeep
Published: June 2022

Aims

This study aimed to determine the prevalence of problematic mobile phone use and its association with the chronotypes among the doctors of a medical college hospital in Puducherry, India. It also aimed to assess the feasibility of the University of Rochester Modified CAGE Questionnaire as a brief screening tool for problematic mobile phone use.

Methods

This cross-sectional study was conducted at a tertiary care teaching hospital in South India. After obtaining the Institutional ethics committee approval, doctors including consultants, higher trainees, core-trainees, and junior doctors working in various departments were approached and requested to participate in the study. Those who agreed were provided with the participant information sheet and written informed consent was obtained. Part-A of the questionnaire contained requests for personal and professional details and part B had the following questionnaires to assess problematic mobile phone use, chronotypes, phantom ringing and vibration and, sleep quality.

•

Problematic use of mobile phone scale (PUMP)

•

Reduced Morningness Eveningness Questionnaire (r MEQ)

•

Questionnaire for Phantom ringing and Phantom vibration

•

The Pittsburgh Sleep Quality Index (PSQI)

•

University of Rochester Modified CAGE Questionnaire

•

Data were analysed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). Nonparametric tests were used as the data were skewed. The data were summarized by frequencies and percentages for categorical variables and median and interquartile range for continuous variables. The chi-square test was used to find the association between two categorical variables. Kruskal Wallis test was used to compare the chronotype with the continuous variables such as CAGE total, PUMP, and PSQ score. Correlation between different continuous variables was studied by using Spearman rank correlations. Kappa statistics were used to evaluate the concordance between PUMP and the University of Rochester Modified CAGE questionnaire.

Results

Neither type (NT) was the most common chronotype (41.5%), followed by morning type (38%) and evening type (20%). Eight (5.6%) doctors had problematic mobile phone use, and 38(26.8%) had poor sleep quality. Evening chronotype (p-value- 0.002), being a female (p-value- 0.014), working in a clinical department (p-value 0.017) and experiencing phantom ringing (p-value- 0.001) had significant association with higher PUMP score. Even though females had a higher median PUMP score, problematic mobile phone use was more among males. University of Rochester Modified CAGE Questionnaire had a sensitivity of 81.73% (73–88.6%), and a specificity of 28.95% (15.4–45.9%).

Conclusion

Doctors should be aware of their mobile phone usage. This study has reiterated the predilection evening chronotype has for behavioral addictions and doctors of evening type should be extra cautious.
Assessing the Impact of Pre-Existing Mental Health and Neurocognitive Disorders on the Mortality and Severity of COVID-19 in Those Aged Over 18 Years: A Systematic Review and Meta-Analysis
Authors: Thomas Catrin , Williams Laura , Dhandapani Asha , Bhattacharyya Sarmishtha
Published: June 2022

Aims

Since the coronavirus disease 2019 (COVID-19) pandemic began, evidence suggests that people with underlying mental health disorders have worse outcomes from COVID-19 infection. Our aim was to assess the impact of COVID-19 infection on people with pre-existing mental health or neurocognitive disorder including COVID-19 related mortality and severity.

Methods

We conducted systematic searches of PubMed, EMBASE, and Cochrane library for articles published between 1 December 2019 and 15 March 2021. The language was restricted to English. We included all case control, cohort and cross sectional studies that reported raw data on COVID-19 associated mortality and severity in participants aged 18 years or older with a pre-existing mental health or neurocognitive disorder compared to those without. Three independent reviewers extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Methodological quality and risk of bias were assessed using the 9-star Newcastle-Ottawa Scale. We calculated the odds ratio as the summary measure along with the corresponding 95% confidence intervals. The random effects model was used to calculate the overall pooled risk estimates. COVID-19 related mortality was the primary outcome measure. The secondary outcome measure was COVID-19 related severity, defined as intensive care unit admission or use of mechanical ventilation.

Results

Fifteen studies were included in the meta-analysis comprising of 8,021,164 participants. There was a statistically significant increased risk of mortality for participants with a pre-existing mental health or neurocognitive disorder compared to those without (OR = 2.18, 95% CI = 1.63–2.90, P < .00001). Increased mortality risk was found on subgroup analysis for participants with pre-existing schizophrenia (OR = 2.55, 95% CI = 1.38–4.71, P = .003) and dementia (OR = 3.83, 95% CI = 2.42–6.06, P < .00001). There was no statistically significant difference in the severity of illness when comparing the two groups. There was a statistically significant increase in the number of participants with comorbid diabetes and chronic lung disease in those with a pre-existing mental health or neurocognitive disorder compared to those without.

Conclusion

The results show that people over 18 years with a pre-existing mental health or neurocognitive disorder have an increased risk of mortality from COVID-19 and are more likely to have comorbid diabetes and chronic lung disease. These results highlight the need for better physical health monitoring and management for this group of people and better integration of mental and physical health services, as well as adding to the evidence that they should be prioritised in the ongoing COVID-19 vaccination schedules worldwide.
Microbiome Modulators and Mood Disorders: Using a Multi-Strain Probiotic - Bio-Kult® Advanced - in Patients With Low Mood
Authors: Aswani Deepti , Day Richard , Vijayakumar Vineetha , Naghibi Malwina , Wolstenholme Nicola , Barker Grace
Published: June 2022

Aims

The aim of this proof-of-concept study was to understand the effect of daily intake of a 14-strain probiotic on mood, reward learning and emotional and cognitive processing in adults with low mood in the absence of prescribed medication. Salivary cortisol was measured as a marker for physiological stress.

Methods

In this parallel-group double-blind, placebo-controlled trial, 80 healthy adults with self-identified low mood were randomised to receive either the 14-strain probiotic or placebo for a duration of 4 weeks. Data were collected from participants at baseline (week 0) and post-intervention (week 4).

Results

Probiotic intake significantly reduced depression scores (by 50%) compared to baseline, as measured by the Patient Health Questionnaire-9 (PHQ-9) scale (p < 0.05). Analysis of individual items in the PHQ-9 revealed that participants taking probiotics reported improved concentration relative to baseline (+ 51%, p < 0.05) and felt less tired compared to placebo (−21%, p < 0.01).

Regarding emotional processing, the probiotic group was more accurate at recognising facial expressions compared to those receiving placebo (facial emotion recognition test, +12%, p < 0.05). Furthermore, the probiotic group performed less well at the reward learning task relative to the placebo group (probabilistic instrumental learning task, p < 0.05) and was less vigilant to emotional cues compared neutral cues (dot-probe unmasked test, −8%, P < 0.05). The probiotic group also showed increased susceptibility to emotional interference during a cognitive learning task, relative to placebo (auditory visual learning task, −18% p < 0.05).

The study also revealed a downward trend in salivary cortisol in the probiotic group over 4 weeks.

Together, these results suggest that probiotics may work via a different psychological mechanism to that of conventional antidepressants. In other words, probiotics may work by reducing emotional salience across all emotions whereas conventional antidepressants are thought to work by increasing bias to positive emotional cues and decreasing bias to negative ones.

Conclusion

These data suggest that intake of Bio-Kult® Advanced has an effect on mood and that this is achieved in ways distinct from the effects of pharmacological antidepressants. While more research is needed, these results suggest that certain probiotics could form part of an ‘early intervention’ strategy for people experiencing low mood. A second randomised controlled trial (currently recruiting) will provide data on this intervention in patients with a formal diagnosis of depression undergoing concurrent pharmacological treatment.

ClinicalTrials.gov Identifier: NCT03801655
Genetic Polymorphisms Are Differentially Associated With Affective Outcomes in Adolescents With and Without ADHD
Authors: Welker Tünde É. , Angyal Nóra , Nemoda Zsófia , Pászthy Bea , Réthelyi János , Bunford Nora
Published: June 2022

Aims

Various genetic polymorphisms have been associated with attention-deficit/hyperactivity disorder (ADHD), and some of these have also been implicated in individual differences in affective processing. Yet, no studies to date have examined the complex interrelations across these genetic polymorphisms, ADHD, and affective processing. Several variables (e.g., age, ethnicity, sex) have been shown to affect whether a given genetic variant confers risk. Our aim was to examine whether relevant genetic variants differentially confer risk for negative affectivity (NA) and/or emotion dysregulation (ED), depending on ADHD status.

Methods

Participants were n = 297 adolescents (Mage=15.30 years; SD = 1.06; 60.27% boys) with (n = 83) and without (DSM-5) ADHD. ADHD- and affective processing-related dopaminergic and serotonergic polymorphisms were genotyped (i.e., DRD2/ANKK1 TaqIA (rs1800497), dopamine receptor DRD4 exon-3 48 bp VNTR, and serotonin transporter linked polymorphic region 5-HTTLPR including the rs25531). Affectivity and ED were measured via parent- and/or self-report.

Results

We first calculated bivariate correlations between polymorphisms, affectivity, and ED then compared the obtained (Fisher's r to z-transformed) values between with and without ADHD groups. There were no correlations that were significant – but several differed – across groups. In youth without ADHD, carrying the DRD2 rs1800497 T-allele was negatively associated both with negative affectivity (pcorr=.033) and with self-rated ED (pcorr=0.039). In youth with ADHD, carrying the DRD4 VNTR 7-repeat allele was positively associated with self-rated ED (pcorr=0.008), and carrying the L'L’ relative to the low-expression S’ serotonergic allele was also positively associated with parent-rated ED (pcorr=.042)

Conclusion

Differences across with and without ADHD groups with regard to correlations between genetic polymorphisms - previously implicated in both ADHD and affective processing - and negative affectivity and emotion dysregulation indicate that certain genetic variants may differentially confer risk for affective outcomes, given ADHD status. These results have implications for targeted prevention of adolescent affective outcomes, which will be discussed during the presentation. That findings held across different indices of affective processing (dispositional affectivity and certain emotion dysregulation components) suggest these results may be robust.
Religiosity and Psychotic Experiences: A Large Community-Based Study From Qatar
Authors: Woodruff Peter , Khaled Salma , Brederoo Sanne , Alabdulla Majid , Sommer Iris
Published: June 2022

Aims

We wished to explore associations between intrinsic religiosity, extrinsic (non-organizational (ENORG) and organizational (EORG)) religiosity and hallucinations phenomenology in a non-clinical Muslim population.

Methods

We selected full-time students at Qatar University using systematic random sampling and administered the Questionnaire of Psychotic Experiences online. We modelled the effects of sociodemographic variables, anxiety, depressive symptoms, and religiosity measures, delusions on hallucinations severity and distress/impact in the past week, using structural equation modelling.

Results

Direct-effects models supported ENORG religiosity's protective role against experiencing distress or negative impact on daily function from hallucinations. Intrinsic religiosity had positive indirect-effects on hallucinations distress/impact through depression, anxiety, and through EORG but negative (suppression) indirect-effects on hallucinations distress/impact through ENORG. Younger and married from lower socio-economic class participants had comparatively more severe hallucinations and more distress from them.

Conclusion

We present evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and past week distress/impact of hallucinations.

Our data support the importance of alignment between religious education and mental health and well-being education.
Gray's Impulsivity Is Differentially Associated With Amygdala-Insula Functional Connectivity in Adolescents, Depending on ADHD Risk Status
Authors: Ágrez Kristóf , Bunford Nóra
Published: June 2022

Aims

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with alterations in both reinforcement sensitivity and affective processing but the nature of the associations of these characteristics is yet to be examined. We hypothesized that individual differences in the sensitivity of the Behavioral Approach System (BAS) would exhibit differential relations with affective network connectivity – involved in emotional regulation and salience monitoring – in youth at-risk for, relative to youth not at-risk for, ADHD.

Methods

Adolescents (n = 125; Mage=16.24 years, SD = 1.09 years; 61.6% boys) were recruited as part of The Budapest Longitudinal Study of ADHD and Externalizing Disorders. Forty-nine were classified as at-risk for ADHD (Mage=16.15 years; SD = 1.21 years; 77.6% boys), defined as exhibiting ≥4 parent-rated symptoms of either domain on the ADHD Rating Scale-5. Participants completed a 10-minute resting-state functional Magnetic Resonance Imaging session, during which they were asked to focus their attention on a fixation cross, as well as various self-report assessments, including the Reinforcement Sensitivity Theory of Personality Questionnaire (RST-PQ).

Results

Functional Network Connectivity analyses indicated an interaction effect between the RST-PQ BAS impulsivity subscale and at-risk status on functional connectivity between four affective network region-pairs (ps < .05, False Discovery Rate [FDR] corrected) within a cluster based on functional similarity (p = .014, FDR-corrected). Follow-up OLS linear regressions showed higher impulsivity scores predicted stronger functional connectivity between the (1) left amygdala-right insula (F(6, 117) = 3.298, p = .005, adjusted R2=.101), (2) left amygdala-left insula (F(6, 117) = 2.2, p = .048, adjusted R2=.055), (3) right amygdala-right insula (F(6, 117) = 3.833, p = .002, adjusted R2=.121), and (4) right amygdala-left insula (F(6, 117) = 3.064, p = .008, adjusted R2=.092) in at-risk youth, whereas an inverse relationship was apparent in not at-risk youth.

There was no main effect of group status on BAS impulsivity scores (t(122)=−1.167, p = .246) or on functional connectivity ((1) t(122) = .383, p = .702; (2) t(122) = .195, p = .846; (3) t(122)=−.107, p = .915; (4) t(122)=−.206, p = .837).

Conclusion

The amygdala-insula connection has been shown to be involved in trait impulsivity, however, available ADHD-focused studies targeted emotional functioning. To our knowledge, we are the first to demonstrate that Gray's impulsivity – reflecting trait reward sensitivity – is predictive of amygdala-insula functional connectivity at rest and that this relation differs given ADHD risk. Results have conceptual and practical implications (e.g., early identification) as the role of the amygdala-insula connection in reward sensitivity appears especially relevant for a developmental phase and a diagnostic group linked to increased risk taking.
Improving the Quality of Old Age Inpatient Ward Rounds During COVID-19 in NHS Lanarkshire, Scotland
Authors: Ambardar Prerna , Chatterji Indrajit
Published: June 2022

Aims

To provide a structured Multidisciplinary team (MDT) checklist to improve the quality of ward rounds in Ward 3, Wishaw General hospital. Ward rounds normally involved patient and electronic documentation review during MDT. Feedback from medical and nursing staff indicated inconsistencies in finding up to date Do not resuscitate cardiopulmonary resuscitation (DNACPR)forms/Treatment escalation plans, treatment forms, care plans, thromboembolism prophylaxis during ward rounds. Discussions about who will update the family, make social work referrals needed clear documentation in order to follow up efficiently post MDT. Food, fluid, and weight charts although done regularly there was no single place to keep them together. These charts to be kept in a separate folder for finding easily during ward rounds. The Royal College of Psychiatrists sets standards that managers and practitioners have agreed standards for ward rounds. Structured ward rounds and check lists have shown to prevent omissions in care and improve patient safety.

Methods

Discussions with Ward 3 team, nursing colleagues and ward Quality improvement group were held. A Standard MDT Quality improvement Checklist was devised and used as a Pilot in W3, WGH.

This was first introduced in August 2021. Plan, do, study, act (PDSA) cycle was carried out.

Plan: Trial MDT checklist at Ward 3 ward Round

Do: Use Initially for two Consultant ward rounds

Study: Ask all MDT staff members for feedback on the form

Act: Reformat the checklist for the following ward rounds and distribute among all consultants.

Repeated Revisions of MDT checklist done after feedback from ward staff and final version devised and results audited in Nov 2021 and Jan 2022.

Food, Fluid, and weight charts were put in separate folders.

Results

Before MDT Checklist nil up to date MDT checklist information available, 10% individual food and fluid charts and 0% folders.

After MDT checklist in November 2021, 73% increase in up-to-date checklist items, 100% increase in finding charts in folders.

In January 2022 decrease to 44% of up-to-date MDT checklist items, 100% food and fluid charts in folders.

Conclusion

MDT Checklist provided robust structure to our Ward rounds along with the regular electronic record and has been incorporated in our shared drive. The results in January for up-to-date checklist were down because of staff sickness due to new Omicron variant and less people available to keep documentation up-to-date.
Antipsychotic Monitoring Within the Home Treatment Team in the Southern Trust, a Quality Improvement Project
Authors: Andress Cedar , Coulter Paul , Watson Leah
Published: June 2022

Aims

The Royal College of Psychiatrists has a specialist group called the Home Treatment Accreditation Scheme (HTAS) that has published a set of best practice recommendations for Home Treatment Crisis Response (HTCR) teams across the UK. As of yet, the HTCR team in the Southern Trust is not accredited. We decided to focus our project on antipsychotic monitoring. SMART aim: All patients (100%) within the HTCR team commenced on antipsychotics are receiving an appropriate level of blood and physical monitoring as recommended by guidelines and these are being documented correctly within 10 days of discharge.

Methods

PLAN

HTAS standards were reviewed alongside NICE guidelines on antipsychotic monitoring and a pro forma created. We collected baseline data on patients commenced on treatment dose antipsychotics in the HTCR team and assessed completion of bloods/ECGs/physical parameters and documentation.

DO

Our intervention for PSDA cycle 1 was to educate members of the multi- disciplinary team (MDT) via a presentation after the baseline data were analysed. We looked at correct documentation and how to fix common mistakes identified. We asked staff for their input on how to improve outcomes. Posters were printed off for guidance. We collected data after this intervention using the same pro forma.

STUDY

We analysed the results from PSDA cycle 1, comparing them to baseline results.

ACT

Our next step in PDSA cycle 2 would be to focus on continuing to improve poorer results such as prolactin levels and ECGs, with input from the MDT.

Results

Baseline data showed between a 14% and 59% completion rate for various baseline bloods, 68–72% completion rate for heart rate (HR)/blood pressure (BP)/weight and a 36% completion rate for ECGs.

Following PDSA cycle 1, this improved to between a 55–100% completion rate for baseline bloods, a 91% completion rate for HR/BP/weight and a 64% completion rate for ECGs.

Baseline documentation of these parameters was correctly recorded between 9–68% of the time. This overall improved after PSDA cycle 1 to 18–73%.

Conclusion

Our intervention from PDSA cycle 1 improved completion of bloods, physical parameters and ECGs in the HTCR team. Documentation also improved in all domains.

Our next step in PDSA cycle 2 would be to focus on continuing to improve poorer results, looking at altering practicalities that may have affected those areas.
Audit Reviewing Consent for Electro Convulsive Therapy
Authors: Ansari Saba , Maiya Sujatha
Published: June 2022

Aims

The National Institute for Health and Clinical Excellence (NICE) recommends that valid consent be sought for Electro Convulsive Therapy (ECT) in all instances where the individual has the capacity to provide or deny consent. Individuals should get comprehensive information on the general risks and potential advantages of ECT. When informed consent and decision-making are not possible, advance directives are fully considered, and the individual's advocate and caregiver are consulted. Additionally, patients should be informed that they can discontinue treatment at any moment. The purpose of this audit is to determine whether we are adhering to the NICE-recommended standards and recommendations.

Methods

This is a retrospective audit looking at case notes from the last 30 individuals who received ECT at University Hospital Wishaw. Individuals' electronic and paper light notes were analysed for data.

In informal patients, the aspects reviewed were:

1.

Documentation about adequate information given.

2.

Documentation of risks and benefits explained.

3.

Documentation of information given about withdrawing consent.

In Formal patients the aspects reviewed were:

1.

Number of cases who received urgent ECT under Mental Health Act (Scotland) with Record of notification on T4 form.

2.

Number of cases who received ECT under Mental Health Act (Scotland) with Certificate of the designated medical practitioner completing T3A form.

3.

Number of cases who regained capacity to consent for ECT during the course of treatment and had appropriate informed consent with Certificate of consent to treatment completed on T2 form.

4.

Did any of the cases have Advance Statement either for or against having ECT as a treatment option for them?

Results

Observations of the data collected revealed that over 30% of cases lacked the documentation proposed by NICE standards. Only 25% of cases with complete documentation were informal patients, whereas the remaining 75% received ECT under the Mental Health Act Scotland.

Conclusion

Based on the observations, this audit establishes that our results do not meet generally accepted standards. The full results will be disseminated with appropriate recommendations to the prescribing Consultant Psychiatrists. This Audit process has also prompted us to redesign the ECT booklet to include the required documents in accordance with standards.
Improving Continuity of Care of Patients Transferred Between Medical and Psychiatry Wards During the COVID-19 Pandemic and the Increasing Demands on Core Trainees to Manage Medical CoMorbidity
Authors: Beaumont Paula
Published: June 2022

Aims

An existing transfer document at FVRH recognised that patients presenting to one specialty may require transfer to another depending on the changing needs of that patient. This document was not often used prior to the COVID-19 pandemic however demands for medical beds resulting in prompt return of patients to psychiatry highlighted the need to adhere to a safe transfer process. Unlike many psychiatry units where physically unwell patients are taken to ED, the MHU for Forth Valley is attached to the general hospital. This results in the view that physically unwell patients can be managed for longer before requiring transfer. Despite the proximity to the medical wards however, the unit is not equipped to manage physically deteriorating patients. This QI project aimed to improve communication between psychiatry and medical staff to improve patient safety.

Methods

Patients transferred during their admission between the MHU and medical or surgical wards in May 2020, or in Oct-Dec 2021 were identified from 5 psychiatry wards. Electronic and paper notes were checked for a transfer form for each stage of transfer. Medications prior to transfer, on return and changes during admission were cross checked on Hepma, ECS and care partner as well as within documentation from medicine/surgery.

Results

In May 2020, no patients admitted from medical wards had a transfer form completed, 62.5% transferred to medicine and 57.1% returned from medical wards had forms. 20% of transfers had medication errors Identified. After making the transfer form electronic and following hospital wide changes to the Trakcare and Hepma systems, 27.8% of patients admitted from medical wards had forms, 75.9% transferred to medicine and 72% of those returned from medicine had forms. There were no further medication errors identified. During the timeframes studied only 1 patient was transferred due to COVID-19 but 29 transfers were carried out for other acute physical issues.

Conclusion

Changing the documentation process to make it as easy as possible for psychiatry juniors to document treatment plans for transferred patients improved continuity of care and decreased medication errors. This also ensured that patients were medically fit to return to psychiatry wards. The range of physical comorbidities that psychiatry trainees were expected to manage extends beyond caring for patients who contract COVID -19.
Developing Inpatient Management Strategies for Behavioural and Psychological Symptoms of Dementia (DIMS-BPSD)
Authors: Parker Jennifer , Beazley Ryan , De Souza Stephen
Published: June 2022

Aims

This project details the development of a Quality Improvement Project aiming to review and improve the management of behavioural and psychological symptoms of dementia (BPSD) on an old age psychiatry ward. BPSD refers to a constellation of non-cognitive symptoms and signs which arise in people with dementia, including disturbed perception, thought content, mood or behaviour. Examples include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and socially inappropriate behaviours. BPSD arise in 5/6 of people with dementia over the course of their illness and are associated with a deterioration in cognition and progression in dementia plus secondary harms such as falls and hospitalisation. Pyrland Two ward is a mixed gender specialised organic old age psychiatry inpatient unit serving the county of Somerset. Most patients have a diagnosis of dementia, are being cared for using either MHA or MCA legislation and exhibit one or more BPSD. There was no structured or formalised approach to the management of BPSD at inception.

Methods

1.

A point-in-time audit was conducted to produce baseline measurements of BPSD management on the ward, measured against NICE criteria.

2.

Plan-Do-Study-Act (PDSA) methodology was employed to incorporate incremental quality improvement interventions such as a ward-round checklist and staff education.

Results

•

Baseline: (n = 14) 4/14 formally diagnosed with BPSD. 6/14 were prescribed antipsychotic medications, of which 1/6 fully met NICE standards. 2/14 had structured assessment tools used.

•

Results following introduction of improvement methods: (n = 8) 8/8 formally diagnosed with BPSD. 7/8 were prescribed antipsychotic medications, of which 4/7 fully met NICE standards. 7/8 had structured assessment tools used.

Conclusion

It was possible to see modest improvements in the ward-based management of BPSD using quality improvement methodology, including more favourable psychotropic prescribing. However, total patient numbers are small and further interventions, such as more PDSA cycles, may add value and encourage sustainability.
Timeliness and Quality of Response to Referrals Received by a Psychiatry Liaison Service for Older Adults During a Pandemic
Authors: Beehuspoteea Nirja , Wilcha Robyn-Jenia , Edwards Amelia , Mbazira Agnes
Published: June 2022

Aims

To improve timeliness of response and provide a committed plan to referrals received by the liaison service for older adults in Croydon University Hospital. Background: A quality improvement project in 2019 aimed to evaluate effectiveness of the liaison referral pathway. A questionnaire distributed to ward staff revealed some comments regarding ‘non-committal advice’ given by the liaison team.

Methods

Data were collected from 44 referrals received by the liaison team in June 2021. Variables included referral date, reason for referral, date of first assessment, plan documented in the notes, date and details of committed plan of action.

Multi-disciplinary team (MDT) discussion identified that more committed advice could be provided by the following, which were implemented at the start of September 2021.

1.

Huddle at the start of each day to triage and allocate referrals to appropriate members of MDT.

a.

Prompt discussions with senior members of the team following assessment to discuss diagnosis and management.

b.

Team teaching sessions were organised once a week, in the form of case-based discussions and role play, to improve communication skills, confidence and history-taking.

Data were then collected from 48 referrals received in September and October 2021.

Results

Of the 44 patients in June, average time taken from point of referral to assessment was 1.27 days and to providing a concrete plan 1.80 days.

Of the 48 patients between end of September and October, average time to assessment was 1.31 days and to providing a concrete plan 1.88 days.

In June, 75% of patients were seen on same day or within one day and 50% had a concrete plan within one day.

In September/October, 65% of patients were seen on same day or within one day and 52% had a concrete plan within one day.

Conclusion

These results highlight that assessments by older adult liaison service require detailed collateral history, investigations and MDT discussions.

While ‘obtain collateral history’ may not seem as committed a plan as prescribing medication, it remains an important part of old age psychiatry.

Given the rapid turnover of patients and increased pressures during the pandemic, it is the responsibility of the liaison team to communicate effectively with the wards and offer a timeline for completion of plan.

Following above changes, another questionnaire has been sent to request feedback on effectiveness of the liaison team.