bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Bridging the Gap': Do Psychiatry Core Trainees Feel Prepared to Deal With Acute or Emergency Physical Health Conditions?
Authors: Holdridge Sian
Published: June 2022

Aims

In many cases there are several years between a trainee finishing foundation training and covering inpatient psychiatric wards on call. However, being resident on-call and covering psychiatric wards involves dealing with acute medical as well as psychiatric emergencies. Anecdotally trainees say that they often feel unprepared for this, and that the types of medical emergencies seen in psychiatric wards have rarely been come across in foundation training. The views of the psychiatric core trainees in the Maudsley Training Programme were audited with the aim of finding out how confident they feel in this area.

Methods

30 Maudsley core trainees were sent a questionnaire which included questions such as “how confident do you feel when dealing with physical health issues, particularly when on call?” and “how rusty do you feel on your physical health medicine from med school?” using a Likert scale.

Following the results of this initial audit an intervention was introduced which was the delivery of a monthly 10 minute slot at local teaching called “Bite-Sized Medicine”. This was a 10 minute power-point presentation on acute physical health issues.

Post-intervention there was a re-audit. Trainees were sent another questionnaire (Likert scale) asking follow-up questions to determine if the intervention had improved their confidence.

This project was approved by the South London and the Maudsley Information Governance team and did not require ethical approval.

Results

10 core trainees responded during the pre-intervention audit and 13 during the post-intervention audit.

Mann Whitney U tests were used to compare the means Q1vs Q3 (confidence), and Q2 vs. Q4 (rustiness) pre and post intervention.

Both were significant on this output (P < 0.0005).

This shows that there is a significant difference in the mean scores pre and post intervention, with the post-intervention scores being higher. This indicates that the intervention helped trainees to feel more confident and less rusty in terms of dealing with acute physical health issues.

Conclusion

In this small survey, core psychiatry trainees expressed that the introduction of “Bite-Sized Medicine” was useful in helping them feel more confident and prepared when dealing with acute and emergency physical health issues. This is reflected in the statistical analysis, albeit with small sample sizes. Comments were made such as “there are a range of physical health issues that are common in psychiatric care that trainees won't have seen much of in their foundation training. This is a very useful intervention for bridging that gap”.
Postgraduate Psychiatry Training Programme in Morocco
Authors: Salihi Imane , Loo Jiann Lin
Published: June 2022

Aims

The field of psychiatry in Morocco has grown significantly since the 1970s, from less than 10 psychiatrists to the current number of around 400. The increased number of practising psychiatrists has enabled the expansion of local residency training programmes, which has been set up since 1974 to cater for the population needs of more than 36 million population of Morocco. This study is aimed to describe the current medical educational approach of the Moroccan postgraduate psychiatry training programme.

Methods

This descriptive medical educational study was based on official training documents and interviews with local faculty members involved in the training.

Results

The entry requirement of the four-year Moroccan postgraduate psychiatry residency programme includes the completion of 1 year of foundation training and passing the entrance examination consisting of psychiatric semiology and pharmacology. The postgraduate residency programme is run by the local universities in collaboration with the Ministry of Health and accredited by the Moroccan government. Trainees have the option of taking up a voluntary or contractual position with the government or University Hospitals. All trainees will go through 34 months of general adult outpatient and inpatient, while liaison psychiatry training starts from the second year until the end of the training. On top of the core rotation, a trainee can opt for two months in old age and neuropsychiatry postings. Child and adolescent rotation is currently not available. Addiction psychiatry training is optional and can be done through a university diploma. The 4th year is a 12-month elective posting in any discipline that is relevant to psychiatry, which can be done either locally or abroad. Teaching methodologies involve lectures, seminars, ward rounds, case conferences, journal clubs, and skill training workshops. Formative assessments included case-based discussions and mini-clinical evaluation exercise. There are multiple high stakes summative assessments at year 1, year 2, year 3, and year 4. The summative assessment strategies includes modified essay question, clinical short case and long case. Viva voce is used to assess competency in research. Different mandatory skill competencies include electroconvulsive therapy, psychotherapy, and research.

Conclusion

The advancement of local postgraduate psychiatry residency training in Morocco has improved the access of local trainees to quality training. Similar to other developing countries, Morocco requires more psychiatrists to improve the psychiatrists to population ratio so that the mental service can become more accessible to the local population.
Physician Associates in the Frame: Developing a National Competence Framework for Physician Associates Working in Mental Health
Authors: Mahajan Pranav , Crimlisk Helen , Wildbore Ellie , Tatt-Smith Paris , Roth Tony
Published: June 2022

Aims

Physician associates (PAs) are becoming more commonplace in psychiatric services in the UK to help address long term workforce difficulties. The 2019 NHS Long Term Plan detailed a commitment to transforming mental health care in England recognising that services were not meeting current or future increase in demand. Health Education England's (HEE) report, Stepping Forward to 2020/21: The Mental Health Workforce Plan for England, described a longer-term strategy to expand the mental health workforce, including recruiting 5,000 people into ‘new roles’ including physician associates. The NHS Mental Health Implementation Plan 2019/20–2023/24 stated an aim of recruiting 140 PAs to the workforce over five years in addition to the requirements specified in the HEE report. Competence frameworks make the link between evidence and practice and can be a valuable basis for training, an agenda for supervision and a guide for self-monitoring and personal development for people working in the role.

Methods

The competence framework was developed by the National Collaborating Centre for Mental Health (NCCMH). The work was overseen by an expert reference group, comprising experts in training PAs in mental health, PAs, researchers and experts by experience, all selected for their expertise in research, training and service delivery. The completed framework was then sent to relevant stakeholders including the Faculty of Physician Associates and patient groups for comment and adapted accordingly.

Results

The completed framework has been arranged into seven domains: Knowledge of Mental Health, Professional/Legal Issues, Engagement and Communication, Diagnostic Assessment and Treatment Planning, Interventions, Team Working and Metacompetences. This reflects the expected roles and responsibilities of PAs working in mental health.

Conclusion

The Competence Framework for PAs will help those involved in mental health care services who wish to deepen their understanding of the PA role, and will be useful to team members working with PAs, to their managers and to commissioners. It will support the work of PA supervisors and peer coordinators, and those delivering education and training to them. It also brings a level of standardisation of the role. More work will be needed to adapt the Competence Framework for PAs for specialist contexts, such as in dementia care or children and young people's services.
Junior Doctor Mentors: Enhancing Medical Student Psychiatry Training
Authors: Ruddock Kenneth , Neil Catriona
Published: June 2022

Aims

Increased clinical contact during undergraduate psychiatry placements has been shown to both increase the likelihood of students considering a career in psychiatry and reduce mental-health related stigma. It can be challenging to provide medical students with a valuable clinical experience, a problem which has been further exacerbated by the coronavirus pandemic. We aimed to develop a junior doctor mentoring scheme to increase clinical exposure and teaching for students.

Methods

Within NHS Lanarkshire, groups of 4–6 University of Glasgow medical students are accommodated for their five-week clinical psychiatry blocks, during which they have a varied structured timetable, providing an overview of different psychiatric specialties. As such, students meet a wide range of clinicians, which can unfortunately mean there is little continuity in their training throughout the block.

We developed a mentoring scheme to help address this issue. Enthusiastic trainee doctors – including foundation year two doctors, GP trainees and psychiatry core trainees – were invited to participate. Medical students are paired with a mentor for the duration of their block, during which they meet informally on a weekly basis. Mentors provide students with ward shadowing opportunities and bedside teaching, as well as completing work-place based assessments (WPBAs), discussing case reports and providing an additional perspective for end-of-block reports.

Results

The mentoring scheme has been running successfully for every five-week student placement since October 2020. Student feedback has been collected via an anonymous electronic questionnaire. Students were asked what they enjoyed the most about their placement, with students frequently highlighting the support from their mentor.

Examples from free-text comments included, “having an assigned mentor was really useful as someone to touch base with and go through clinical cases” and, “having a mentor was invaluable – it is crucial to have a friendly face on the wards and a contact to complete WPBAs”.

Informal feedback from mentors has also been positive with trainees enjoying the opportunity to develop their teaching skills and support student training. Mentors also highlighted the role's benefit for their portfolios and specialty applications.

Conclusion

This simple and cost-free intervention has had resoundingly positive feedback from medical students and trainees. Medical students enjoy having consistent informal teaching, support and feedback. Our mentoring scheme will continue for all medical students in NHS Lanarkshire and we would encourage other areas to consider a similar project. By increasing clinical exposure we hope to further reduce mental health stigma amongst students and inspire the psychiatrists of tomorrow.
What Do Medical Students Think About Incorporating VR Into Psychiatry Education and Training?
Authors: Sidhu Manu , Dulai Vikram
Published: June 2022

Aims

The authors hypothesised that medical students may be receptive to incorporating Virtual Reality (VR) within the psychiatric curriculum as a technological adjunct to existing teaching methods. Therefore, the aim was to evaluate medical students’ attitudes towards the role of VR in psychiatry education and training.

Methods

In this descriptive cross-sectional online survey, 76 medical students from all year groups across 10 medical schools in the UK answered a questionnaire consisting of 13 items regarding their views on the role of VR in psychiatry education and training, each on a 5-point Likert scale.

Results

96.1% of respondents had received some level of education and training in psychiatry. 57.9% had never undertaken a VR experience before, yet 79.0% ‘agreed/strongly agreed’ that they would feel comfortable using VR at medical school.

71.1% ‘agreed/strongly agreed’ that experiencing the first-person perspectives of psychiatric patients in VR would enable them to develop greater empathy. 81.6% ‘agreed/strongly agreed’ that managing dangerous patient interactions in VR would increase their confidence in managing such interactions in real-world clinical settings. However, students were most ‘unsure’ about whether VR would reduce their anxiety (30.3%) and improve their interpersonal communication (27.6%) in real-world clinical settings.

The majority of students ‘agreed/strongly agreed’ that VR would make educational experiences more engaging (80.3%), improve understanding of content (63.1%), and better prepare them for clinical practice (64.4%).

Most significantly, 81.6% ‘agreed/strongly agreed’ that learning in VR would enhance experiential learning in ways that existing teaching methods outside of clinical settings cannot, and 84.2% ‘agreed/strongly agreed’ that they would rather learn from a mixture of VR plus existing methods over existing methods alone.

Conclusion

These findings demonstrate that medical students believe VR would improve engagement, understanding, and preparation for clinical practice.

VR holds the greatest potential in developing empathy for patients with mental illness and preparing students for dangerous patient interactions. However, further investigation is required to evaluate how educational experiences in VR translate to performance in real-world clinical settings.

In times of restricted access to clinical care, such as during the COVID-19 pandemic, VR could play a vital role in teaching psychiatry. The preference for VR to be added to existing teaching methods was the strongest held and most relevant belief to the aim of this study, indicating the readiness of medical students to accept VR into psychiatry education and training.
Co-Production of an Online Medical Student Conference: Inspiring Interest in Psychiatry
Authors: Harris Georgina Edgerley , Rudra Sonya , Swain Rachel , Swerdlow Abigail
Published: June 2022

Aims

The aim of this project was to create a Pan-London event to increase awareness and enthusiasm of medical students for Psychiatry as a specialty. In addition to a longer term goal of ultimately increasing recruitment to the specialty once students qualify, this event aimed to bring Mental Health to the forefront of the minds of future doctors.

Methods

Psychiatry Teaching Fellows from different trusts created a virtual educational event targeted at medical students in all years across London universities. It was co-produced with the student Psychiatry Societies across the London Universities. This encouraged student engagement from the ground level and fostered an environment of collaboration between students and Doctors. The event was free to attend and was supported by the Royal College of Psychiatry, London Division. The conference programme showcased the various facets Psychiatry has to offer from a global perspective, including Women's Mental Health, Forensic Psychiatry, research and volunteering around the world.

Results

The conference welcomed 263 attendees. 92 of the attendees completed a feedback questionnaire at the end of the session. The majority of respondents were from London universities and fairly evenly distributed amongst medical school year groups. 99% of those completing the questionnaire found the session interesting (scoring 3 or more out of 5 on a 5 point Likert scale). 98% of respondents reported that they found the session widened their view of Psychiatry. 78% were already considering a career in Psychiatry. 96% felt more likely to pursue a career in Psychiatry following the conference (scoring 3 or more out of 5 on a 5 point Likert scale). Open-text feedback indicated that attendees had found the sessions interesting and particularly valued the range of topics.

Conclusion

Extra-curricular events are a fantastic chance to broaden medical students’ views of the specialty of Psychiatry. A virtual platform creates opportunities for audiences to hear from a vast array of expert speakers, which might not otherwise be possible in person, and creates a community of like-minded students in a safe environment. Whether or not students go on to pursue the field themselves later on in their training, events such as this bring awareness of Psychiatry and its impacts to the foreground. It is hoped that, in future, further co-produced events between the Royal College of Psychiatry and university Psychiatry societies, can continue to inspire medical students.
Improving the Response Rate of Teaching Feedback by Introducing Exam Practice Questions – a Quality Improvement Project
Authors: Tamilson Bruce , Swerdlow Abigail , Rudra Sonya
Published: June 2022

Aims

Aim: The quality improvement (QI) project aimed to improve the response rate of teaching feedback from medical students at Queen Mary University of London (QMUL). Background information: Universities and health care settings use students' feedback to improve the teaching and other services. The feedback is a valuable source to evaluate a service delivery and improvement. Following the COVID-19 pandemic a large majority of teaching switched to being held online. Feedback plays an important role in evaluating these new methods of teaching. However, response rates were noted to be low. This QI project aims to improve the response rate from students.

Methods

The project was registered on LifeQI and carried out during the psychiatric teaching for 4th year medical students at QMUL. The team emphasized the importance of feedback to students and produced online feedback forms which are mobile-friendly and concise. These were provided to students immediately after lectures and in an email reminder. As a change idea, five multiple choice practice questions from the topics of the day were included as a follow-on activity from the feedback form, with the expectation that this would motivate the students to complete the feedback. The response rate was calculated as a percentage (number of responses/number of attendees x 100%) and compared before and after the change was introduced using the independent t-test.

Results

Introducing practice MCQs at the end of the feedback form resulted in a significant improvement: the response rate increased from 22.3% to 50%, more than doubled. The independent t-test found a significant increase in the number of feedback forms returned from the original rates (M = 13.8, SE = 3.0) to rates after practice questions were introduced into feedback (M = 30.6, SE = 1.7), t= -4.9 p = 0.001.

Conclusion

Students’ motivation to complete feedback plays a major role in the response rate of medical students’ feedback at QMUL. Adding five MCQs on the topics of the day to the feedback form has significantly increased the response rate of 4th year medical students at QMUL. This project was limited to 4th year medical students who received online psychiatric lectures. It is important to try other change ideas in future in order to compare the outcomes.
“Transition to CAMHS SPR” – a Simulation Induction Course Provided for Newly Appointed Child and Adolescent Mental Health Service (CAMHS) Higher Trainees (HTs)
Authors: Tiley Claire , Cuhraja Alina , Saunders Aleks , Virk Kiran , Schilderman Marcela , Baxey Emma , Fisher Megan
Published: June 2022

Aims

The transition between Core Psychiatry Training (CPT) and Psychiatry HTs is often anxiously anticipated by trainee psychiatrists, in view of the heightened responsibility and increased demand faced by trainees. The author wrote and delivered a one-day simulation induction course for newly appointed CAMHS HTs across London. The aim of this course was to improve participant's confidence, skills and knowledge in managing a range of conditions and challenging scenarios in children and young people (CYP) presenting to CAMHS. The course was also designed to improve HT's confidence in supporting junior colleagues and in managing conflict resolution. There was also an overarching aim of increasing human factor skills by focusing on these within the scenarios and debriefs.

Methods

The simulation training was delivered online and consisted of five scenarios commonly faced by CAMHS SPRs based in a variety of settings. Themes within the scenarios included eating disorders and deliberate self-harm, as well as managing risk, multiple demands, and the psychosocial factors contributing to mental illness. Professional actors, plants and virtual backgrounds were used to enhance fidelity of the scenarios. Platform orientation and an introduction to simulation were initially provided followed by “ice breaker” activities, which were used to promote psychological safety amongst participants. Each scenario lasted approximately 10 minutes. Following each scenario, participants were supported to engage in a debrief using the Maudsley Debrief model. Pre- and post-course evaluation questionnaires were given to participants to complete and comparative analysis was conducted.

Results

Seven participants completed both the pre- and post- course evaluation questionnaires. The mean sum score for course specific questions was 51.86 (SD = 9.56) pre course, and 68.00 (SD = 10.08) post course, showing a 31.12% increase in knowledge, skills, and confidence across the course specific domains.

The mean sum score for the Human Factors Skills for Healthcare Instrument (HFSHI) was 76.67 (SD = 17.26) pre course, and 86.50 (SD = 16.54) post course, showing a 12.82% increase in human factors skills.

Conclusion

This simulation course demonstrated it is an effective and innovative way to help with induction for HT, resulting in an increase in knowledge, skills and confidence in trainees transitioning from CPT to HT, both in terms of factors specific to managing CYP's care and in relation to broader human factor skills.
Smartphone Addiction and Its Associated Factors Among Tehran University Students
Authors: Kheradmand Ali , Amirlatifi Elhamsadat
Published: June 2022

Aims

Smartphone addiction is a new concern due to its progressive global usage. Since this phenomenon occurs in adolescents and young people, especially in students, causing many problems in interpersonal relationships, occupational and educational performances, evaluation of smartphone addiction in this population seems to be necessary. Accordingly, this study aimed to examine the prevalence of smartphone addiction in Tehran university students for determining the risk factors associated with this issue.

Methods

This analytical cross-sectional survey was carried out on university students in Tehran between 2016–2018. A study sample of 382 students from various faculties of Tehran universities was chosen by random multi-stage cluster sampling. The participants simultaneously completed a researcher-made questionnaire on demographic characteristics and risk factors, the Smartphone Addiction Scale (SAS), and Young's Internet Addiction Test (IAT). After checking the smartphone addiction questionnaire, smartphone-addicted individuals were identified, and a comparison with the non-addicted group was performed in terms of risk factors.

In this study, the participants were given written consent forms. Questionnaires were anonymous and the information was kept confidential. This study was registered at the Ethics Committee of Shahid Beheshti University of Medical Sciences with a code of 1395,309.

Results

Our findings indicated that the frequency of smartphone addiction was 28.8%. The frequency of smartphone addiction in women (32.5%) was higher than that in men (23%) (p = 0.04). The highest incidence of smartphone addiction occurred in the age range of less than 20 while the lowest was found above the age of 40. (P = 0.001). The prevalence of smartphone addiction in the single population was 34.1% Vs 16.1% in married. (P = 0.000) The most prominent educational field of smartphone addicts was technical and engineering. (P = 0.007). Smartphone addiction was significantly more in internet service and social networking users. (P = 0.025) There was a significant relationship between the history of psychiatric illness and smartphone addiction. (P = 0.035) The most common psychiatric diseases were found to be obsessive-compulsive disorder (41.7%), followed by anxiety disorders. (33.3%)

Conclusion

Smartphone addiction has a significant frequency among university students in Tehran, associated with access to internet services and social networking. It was more common in women, single adults, and younger ages. There was a significant relationship between the history of psychiatric illness and smartphone addiction. The highest frequency of psychiatric illnesses in the addiction group was obsessive-compulsive disorder and anxiety disorders. No relationship was found between smartphone addiction and history of substance use, as well as smoking and alcohol.
Experience and Reflection From Inpatient Staff at an Intellectual Disability Hospital During COVID-19
Authors: Malhotra Rahul , Azhar Zeenish
Published: June 2022

Aims

The COVID-19 pandemic and the associated impact on the NHS led to particular challenges for Intellectual Disability (ID) inpatient hospitals across the country. The aim of this Research Project is to gather the experience of Inpatient staff in our local ID Hospital following the first wave of COVID-19 pandemic in July 2020.

Methods

We gathered data by means of survey from inpatient staff including ‘staff nurses’ and ‘health care support workers’ from 2 cute assessment and treatment units and 1 rehabilitation unit over the preceding 3 months. We obtained 15 responses. We gathered quantitative data via a questionnaire on the views of staff regarding the service provision for patients and staff during COVID-19. We also gathered qualitative data on learning points and how things would have been done differently in hindsight.

Results

The responses were anonymised, directly transcribed, coded and grouped into themes. 67% of staff stated appropriate type and quantity of Personal Protective Equipment was available. 60% of staff stated it was ‘easy’ to access a General Practitioner for patient reviews. 60% of staff stated, there was a change in arrangements for Do Not Resuscitate/Escalation plans during COVID-19. 47% of staff stated there was availability of virtual or face-to-face clinical training support. 67% of staff did not take sickness leave due to symptoms or contact with a COVID-19 patient. 67% of staff did not receive or found it difficult to access a COVID-19 test. 47% of staff reported a negative impact of the pandemic on their physical and mental health well being. 13% of staff found the Counselling/emotional Support helpful.

Some of the key themes that emerged in the qualitative data analysis included the importance of being grateful for personal health and well being, move lives could be saved if earlier and more frequent testing was available during the first wave, delays in the arrival of PPE in the hospital and ideas to mitigate risk by designating members of staff to a fixed work area to reduce mixing.

Conclusion

A wide range of reflections, suggestions and feedback were obtained during the research project which will be helpful to plan and organise services moving forward should future waves of COVID-19 emerge.
Evaluation of Physical Health in an In-Patient Psychiatric Rehabilitation Setting
Authors: Cockburn Alastair , Watson Andrew , Mountain Debbie , Lawrie Stephen
Published: June 2022

Aims

The mortality gap between patients with serious mental illness (SMI) and without is around 15–20 years. This has multiple contributing factors including poor physical health, side effects of antipsychotic medications and sub-optimal medical management. Presented here is a detailed cross-sectional study of physical health measures in an in-patient rehabilitation population in Scotland. Results are compared to national averages and clinical guidelines with the aims to a) benchmark physical health in this population and b) where possible improve physical health.

Methods

Physical health data including observations, blood tests, and investigations was collected ahead of detailed structured interviews and physical exams performed by a post-foundation doctor. These results were compared to recommendations for physical health monitoring from numerous national and government guidelines (SIGN, NICE, Scottish Government, Maudsley). Data were collected in 4 domains, 1) Indicators of physical health, 2) Engagement with physical health, 3) Concordance with guidelines and 4) Outcomes of reviews.

Results

Data were collected from 57 of all 62 in-patients. 34 reported being generally happy with their health vs 15 unhappy. 42% were obese (compared to 28% of the general population), 84% were smokers (vs 16% in the local population) 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK >10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed cancer screening uptake compared to the Scottish population was low; Cervical (30% vs 71%), Bowel (8% vs 59%), Breast (23% vs 72%), AAA (0% vs 84%). Patients were generally up to date in terms of recorded weight (100%), BP (98.2%), HR (98.2%) and lipids (89.4%), but not ECG's (61.4%) and Diabetes screening (59.6%). 17 referrals were made to medics/surgeons, 29 to MDT's, 24 medications started, 9 stopped and 27 changed, most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients).

Conclusion

Cardiovascular disease indicators were notably raised, uptake of screening was very poor and there were areas where the service didn't meet national guidelines. The number of referrals and medication changes suggest an unmet need within such services. The findings, if generalisable across similar populations, suggest that more can be done to address ongoing poor physical health in populations with SMI and indeed patient readiness to comply with physical health screening. Screening for key physical health parameters needs to be augmented by working to engage patients and following up with management plans for abnormalities found.
Understanding the Developmental Pathways and Onset of Bipolar Disorder and Borderline Personality Disorder in Young People: A Systematic Review of Reviews
Authors: Durdurak Buse Beril , Upthegrove Rachel , Altaweel Nada , Marwaha Steven
Published: June 2022

Aims

There is still an ongoing debate on the nosological position of Bipolar Disorder (BD) and Borderline Personality Disorder (BPD). Identifying the unique and shared risks and developmental pathways in emerging BD and BPD could help the field refine aetiological hypotheses of these disorders. The study aims were to systematically synthesise the available evidence from systematic reviews and meta-analyses concerning environmental, psychosocial, biological, and clinical factors leading to the emergence of BD and BPD to identify the main differences and common characteristics between the two disorders to characterise their complex interplay whilst highlighting remaining evidence gaps.

Methods

A literature search was conducted PubMed, PsychINFO, EMBASE, Cochrane, CINAHL, MEDLINE, and ISI Web of Science as the data sources. 19 systematic reviews and meta-analyses involving 217 prospective studies met eligibility criteria.

Results

Results demonstrated that family history of psychopathology, affective instability, attention deficit hyperactivity disorder, anxiety disorders, depression, sleep disturbances, substance abuse, psychotic symptoms, suicidality, childhood adversity and temperament dimensions were common predisposing factors across both disorders. There are also many distinct variables that could be found early in the course of both disorders. Most of the factors should be considered as a general, nonspecific precursor signs and symptoms of both BPD and BD, apart from subsyndromal depression, subsyndromal hypomania, cyclothymia disorder, psychotic symptoms, age at onset of major depression and frequency and loading of affective symptoms.

Conclusion

Although the findings of this review may lead to support the view of BD and BPD as two distinct disorders, there is not sufficient data to either indicate that BD and BPD are separate nosological entities or that BPD should be considered as an extension of BD disorders. Future research is required to increase our understanding of the aetiology of BD and BPD onset and their complex interplay by conducting prospective studies which concurrently examine multiple measures including biological, environmental, psychosocial and clinical factors in BD and BPD at-risk populations. Large, multilevel data sets will enable deep phenotyping and distinguish pathophysiological pathways.
Is Cannabis Abstinence Related to Subsequent Reduced Risk of Psychosis? a Nested Retrospective Case Control Hierarchical Survival Analysis
Authors: Gafoor Rafael
Published: June 2022

Aims

There is strong evidence from systematic reviews and meta-analyses that cannabis use is related to an elevated risk of developing a subsequent psychotic illness. It is less clear if the length of cannabis abstinence is related to the risk of developing a psychotic episode. We explore the relationship between length of cannabis abstinence and subsequent risk of a psychotic episode.

Methods

We included patients aged 18–64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We excluded all patients who reported no past history of cannabis use. We carried out hierarchical survival analyses on probability weighted data to examine the relative hazards of cessation of cannabis abstinence between cases and controls. Data on cannabis abstinence were collected retrospectively by participant recollection. We controlled for ethnicity, age, length of education and history of cigarette smoking. Proportionality assumptions were verified using Kaplan Meier plots, log-log plots and scaled Schoenfeld residuals. There was some evidence of non-proportional hazards and the assumptions of proportionality were relaxed by introducing caseness as a time varying co-variate with time specified as its natural log.

Results

We included 506 cases and 482 controls with a mean age of 30.12 years (sd = 9.97). Cases had an elevated hazard ratio of cannabis use versus cannabis abstinence in controls (HR = 6.11 [SE = 1.43; p = <0.001]). There was no evidence of a difference associated with ethnicity (p = 0.198) but there were statistically significant differences at the 5% level between age groups. Ages 23–27 had a hazard ratio of 0.528 (SE = 0.064; p <0.001) versus those 18–22 years old. For ages 28–32, 33–44 and 43 to 64, the hazards ratios were 0.311, 0.110 and 0.100 (all statistically significant; p<-0.001) respectively.

Conclusion

Abstinence of cannabis use is related to a reduced hazard of having a subsequent psychotic episode. The magnitude of the hazards for a subsequent psychotic illness is highest in those 18–22 years old and decreases with increasing age. Cannabis cessation maintenance therapies may have greater impact if targeting younger rather than older cannabis users who are at an elevated risk of developing a psychotic illness.
Diabetes Care in the Psychiatric Inpatient Setting: A National Survey of Mental Health Professionals Knowledge, Attitudes and Skills
Authors: Goff Zoe , Varvari Ioana , Sharma Vishal
Published: June 2022

Aims

People with Severe Mental Illness (SMI) are at increased risk of developing diabetes. There is currently a lack of monitoring and standardisation of diabetes care in the NHS psychiatric inpatient setting. This presents as a missed opportunity, as inpatient admission could be used to improve diabetes care for this population. We surveyed the multi-disciplinary teams in psychiatric inpatient units across England to develop understanding of current diabetes care in this setting.

Methods

A 13-item questionnaire was designed to assess the knowledge, attitudes and skills relating to diabetes care. This was piloted via think out loud interviews with 5 staff at a Forensic unit. Amendments were then made to the questionnaire to improve the validity prior to national roll-out.

Site coordinators working within General Adult, Old Age, Rehabilitation and Forensic inpatient services were recruited via medical education and academic links. This included 19 inpatient sites within 11 NHS Mental Health Trusts across England. Site coordinators circulated the questionnaire, primarily via electronic survey. A small number of paper responses were also collected.

Results

156 responses were collected via the national survey (electronic = 136, paper = 20). 6 responses were excluded due to missing professional role information or roles not involving physical healthcare. Respondents included within the analysis comprised 43 Doctors, 55 Nurses and 52 Allied Healthcare Professionals.

93% of respondents agreed that addressing physical health needs was an important part of the mental health team's role, although only 28% had received physical healthcare training within the last 12 months.

68% agreed that they had adequate skills and knowledge to manage diabetes safely on the ward. 69% agreed that the diabetic care on the ward was of an acceptable standard according to National Institute for Health and Care Excellent (NICE) guidelines. This reflects a need for appropriate training and guidance to help improve this aspect of care.

Additionally, only 51% agreed that they felt able to refer a patient with diabetes to the most appropriate diabetes service based on type of diabetes and medication prescribed. This highlights an important issue, as cohesive shared-care and clear referral pathways are key when considering effective diabetes management.

Conclusion

Psychiatric inpatient admission could be used opportunistically to improve the healthcare disparities for people with comorbid diabetes and SMI. This national survey highlights key areas that would need to be addressed to standardise and optimise diabetes care in this setting. This includes appropriate training, clear guidelines and cohesive shared-care pathways.
A Narrative Review of Defensive Medical Practice in Psychiatry
Authors: Hassanally Khalil
Published: June 2022

Aims

Defensive medical practice has become an increasingly global phenomenon and encompasses all medical specialties. In the UK it was defined in the case of Sidaway v Board of Governors of the Bethlem Royal Hospital [1985] UKHL 1 (21 February 1985) as “the practice of doctors advising and undertaking the treatment which they think is legally safe even though they may believe that it is not the best for their patient”. This narrative review surveys the literature to establish the forms in which defensive practice may manifest itself within psychiatry.

Methods

In this narrative review, various terms pertaining to defensive medical practice in psychiatry were searched in both medical and legal databases.

Results

Though the literature in psychiatry compared to other medical specialties is more limited, some common themes occur across all jurisdictions surveyed. Defensive psychiatric practice included admitting the patient even though they may be managed within the community (as reported by 21% of psychiatrists surveyed in the North of England) and employing more coercive practice, either using the mental health legislation or implied or actual threats. Once hospitalised, defensive practice manifests itself by placing patients on higher levels of nursing observations than necessary.

Across inpatient and outpatient settings between one and two thirds of psychiatrists reported altering the way they document to attend to medicolegal considerations. Prescribing habits were also altered due to fears of litigation; an Israeli study found that almost half of psychiatrists surveyed reported they prescribed smaller doses of medication than what they felt was required to pregnant woman and ninety percent reported the same when it came to the treatment of elderly patients.

When looked at by seniority it was felt that junior doctors were more prone to admitting patients defensively than consultants. In this respect, psychiatry differs from most other medical specialties as, in general, the evidence suggests that increased seniority is more likely to lead to admission.

Conclusion

Defensive practice in psychiatry appears to be widespread and takes a number of different forms. However, the research in psychiatry is limited and does not explore key areas common to other medical specialties such as clinician avoidance of certain cases or increased use of diagnostic tests. Furthermore, there is little examination of how psychiatrists may utilise mental health legislation within their defensive practice.
Psychiatric Morbidity Among the Patients of First Ever Ischaemic Stroke
Authors: Inam Muhammad Sayed
Published: June 2022

Aims

To evaluate psychiatric morbidity among the patients of first ever ischemic stroke

Methods

This sectional comparative study was carried out in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1st July 2013 to 30th June 2014. Sixty six ischaemic stroke patients of first attack between 2 weeks to 2 years of stroke, aged above 18 years irrespective of sex and 66 accompanying healthy person of the patients and other patients without any kind of stroke matching age and sex fulfilling inclusion and exclusion criteria were taken in Group-A and Group-B respectively. Diagnosis of ischaemic stroke was made in these patients by the consultant neurologists reviewing the history, clinical examination and accompanying investigations reports specially CT scan of brain. Psychiatric assessment was done using General Health Questionnaire (GHQ12) as screening tool. All GHQ12 positive cases were evaluated using mental state examination and recorded in a MSE sheet. Diagnosis of psychiatric disorders of all respondents was confirmed by psychiatrist according to DSM-5 criteria.

Results

The patients with ischaemic stroke and control subjects were similar in age [57.6 (SD ± 5.5) years vs 57.1 (SD ± 4.5) years; p > 0.130] and sex [48 (72.7%) male and 18 (27.3%) female vs 45 (68.2%) male and 21 (31.8%) female; p = 0.567]. Comorbid psychiatric disorder was found in 23 (34.8%) patients of ischaemic stroke and 9 (13.6%) control subjects. The comorbid psychiatric disorder was significantly higher in patients of ischaemic stroke than that of control g subjects (p = 0.004). Comorbid specific psychiatric disorders were generalized anxiety disorder in 9 (13.6%) and major depressive disorder in 14 (21.2%) in stroke group; while comorbid specific psychiatric disorders were generalized anxiety disorder in 2 (3.0%) and major depressive disorder in 7 (10.6%) respondents in control group (p < 0.013).

Conclusion

Comorbid psychiatric disorders are quite common among patients with first ever ischaemic stroke in the form of major depressive disorder and generalized anxiety disorder. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients’ emotional stress and personal suffering, which could improve their neurological outcome.
Investigating the Role of Ethnicity and Religion or Spirituality on the Risk of Self-Harm in Children and Adolescents: A Systematic Literature Review
Authors: John Lin
Published: June 2022

Aims

Around the world rates of self-harm vary, placing immense strain on health services. Approximately 20% of children and adolescents are thought to engage in self-harm. The systematic review aims to explore the characteristics, risks and protective factors of ethnicity and religion on self-harm in comparison to the general population. Better identification of risk factors can help professionals and local authorities develop intervention programs to mitigate the incidence of self-harm.

Methods

The Population, Exposure, Outcome, Study design and setting (PEOS) was used as a framework to formulate the question for this systematic review. A literature search was conducted using EMBASE, MEDLINE and APA PsycInfo databases and all English articles published between 2010 and 2020 were screened against the inclusion and exclusion criteria.

Results

Fourteen studies which met the criteria were identified and appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist.

Unintentional injuries, sexual behaviours, adverse childhood experiences, health status and poverty alongside racial discrimination were associated with self-harm and or suicidal ideation in ethnically diverse populations. In African Americans, Hispanics and Whites, violence or physical altercation, illicit substance misuse, sadness and hopelessness increased the risk of self-harm and or suicidal ideation. The association of subtle forms of discrimination and suicidal ideation was noted to be statistically significant for African Americans, whereas for Latinx this was only marginally increased. Low mood and hopelessness in African American girls, substance misuse in American Indian youths, and aggression in the Caribbean cohort were also noted to present with increased self harm.

Adolescent's religiosity and parental monitoring had both a direct and an indirect role for suicidal ideation reduction. Religious importance and attendance at religious services by offspring and parents decreased self-harm in female adolescents more than males.

There was a wide heterogeneity in the population and factors reviewed in the different studies, hence pooling of data for meta-analysis of the quantitative studies was not appropriate to estimate prevalence or association between factors and characteristics of the population.

Conclusion

This narrative synthesis provides evidence that minority ethnic groups have unique factors, which can increase the rate of self-harm. Religion or spirituality favours a protective role in self-harm or suicide but not for suicidal ideation, although there were only a limited number of articles exploring this.

Future studies should focus on defining the ethnic groups further and exploring this and religious factors on a wider scale using standardised parameters.
Afghanistan and the Global Heroin Trade
Authors: Kinally Eamonn
Published: June 2022

Aims

In 2020, Afghanistan supplied around 85% of the world's heroin. The recent Taliban takeover and political upheaval seems highly likely to impact the supply chain, but how? This literature review aims to explore the background of heroin production and possible consequences of the recent conflict, both for suppliers and for end users.

Methods

In addition to recent mainstream media news articles on the Afghanistan conflict, PubMed search terms “heroin adulteration” were used to find 202 results. Only results published from the year 2000 onwards were examined for relevance, leaving 160 results. These were reviewed for relevance and led to suggestions of similar PubMed articles to arrive at the final 23 sources used.

Results

Studies of previous heroin shortages in Australia and the UK are discussed to gain insight into the potential effects of a future shortage. A reduction in heroin exports from Afghanistan would cut down the supply to most nations excluding North and South America. Sources of evidence for our current understanding of the supply chain are examined. Specific US and UK policy failure which led to the current situation is also provided for context.

Methods of production in Afghanistan and smuggling routes are also examined to help predict impending changes.

Conclusion

Given the number of factors involved it is difficult to anticipate with much certainty how the Taliban takeover of Afghanistan will affect the global heroin trade, but based on the available literature it seems more likely that this will cause shortages rather than an increased supply.

Clinicians should be aware that in line with previous shortages, this may cause a shift towards increased rates of polysubstance use in regular heroin users. We may also see a rise in incidents of harm from heroin adulteration with substances other than the currently widespread paracetamol and caffeine.