bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Interventions Implemented and Subsequent Outcomes Following a Moderate and High Score on the Dynamic Appraisal of Situational Aggression Risk Assessment Tool
Authors: Challinor Alexander , Briggs Patrick , Brennan Faye , Daniels Charles
Published: July 2023

Aims

The Dynamic Appraisal of Situational Aggression (DASA) is one of a few instruments designed for the prediction of violence specifically for inpatient populations. It is important that risk assessment tools demonstrate clinical utility, and that barriers to successful implementation are addressed. If successful, the tool should not only predict risk, but lead to the utilisation of interventions intended to manage and reduce risk. The aim of this study is to learn more about the acceptability of the tool (adherence), it's outputs (nursing interventions), and the outcomes (inpatient aggression and violence). Understanding more about the relationship and processes between an intervention and its outcomes is a key step in intervention evaluation.

Methods

Data were collected over a three-month period within a medium secure forensic hospital. A total of 43 patients were included for analysis.

Categories of nursing intervention were coded and content analysis of electronic health records analysed. Incidents of aggression/violence to others was recorded as aggression to patient and aggression to staff. Data were gathered on the completion of the DASA score for all patients for each 24-hour period. A DASA score of 2–3 for moderate risk and ≥4 for high risk was used. The change in DASA score (before and after intervention) and frequency of incidents was calculated for each intervention implemented.

Results

The average adherence of the DASA tool was 58.82% (Range 1.09% - 90.02%). The most frequent intervention following a moderate and high DASA score was that no interventions were provided. The second most frequent outcome following a high score was a focussed discussion with the patient, the use of increased monitoring and the use of seclusion. For those patients that recorded a high score on the DASA tool, eight of those scores were followed by an incident of aggression (n = 8 / 50%). There was no statistically significant difference between the change in DASA scores between interventions implemented, for both high and moderate scores.

Conclusion

The ultimate goal of risk assessment is the management and prevention of risk. Thus, if a high score does not result in strategies for intervention, it renders the assessment process worthless. A recommendation for future clinical practice would be the systematic recording of interventions and risk management strategies when in receipt of a high score on the DASA. Greater operationalisation of risk management strategies and their ability to reduce aggression is needed to enhance risk assessment research and clinical practice.
Does ECT Work? the Impact of ECT on Depression
Authors: Collins Dawn
Published: July 2023

Aims

The aim of this project was to evaluate the impact of ECT on depression and mood symptoms.

Methods

50 patients who were treated with ECT within NSFT (2020–22) were assessed using extended Hamilton Depression Rating Scale (HDRS, observer rated depression scale). This rates depression out of a possible 40, with higher scores indicated more severe depression: under 7 indicating no depression, 8–16 mild depression, 17–23 moderate depression and over 24 as severe depression. Cognition was also assessed (using Mini Ace) .

HDRS was carried out at the start, mid point (session 6–8) and end of ECT, and scores were then evaluated.

Results

All patients showed a significant drop in HDRS scores and an improvement in depressive symptoms (even the ones who were no being primarily treated for depression). This effect was most notable between start and mid point of ECT.

Mean scores at start of ECT were 24/40 (range 11–36), mean at mid point was 11 (range 4–25) and mean at end of treatment was 7 (range 0–14).

Conclusion

This Project would seem to reflect the findings from functional neuroimaging: that the greatest impact of ECT on neurophysiology and anatomy (including on brain structures) occurs in about the first 6- 8 sessions. This positive effect continues with subsequent treatment but at a reduced gradient. The effect is noted to be statistically significant for this project/sample.

In Conclusion: all 50 patients started ECT depressed (again, even those who were not being primarily treated for depression) and all patients improved with ECT. At the end of ECT, only 7 patients scored over 7 on HDRS and none over 14 (i.e. only 7 (14%) of patients were assessed as having mild depression compared with 50 (100%) at the start of ECT treatment).

This project would further support that ECT is a highly effective treatment for depression, especially when a rapid response is required due to severity or threat to life (such as catatonic or not eating/drinking, as was the case 6 patients seen) or for psychotic depression (12 patients). It is notable that all patients had a reduction in depressive symptoms, even those not presenting with depression or marked mood symptoms.
Assessment of Knowledge About Frailty Syndrome Among Doctors and Its Intervention: A Literature Review
Authors: Loo Jiann Lin , Simiyon Manjula , Thomas Catrin , Ginty Shona , Gajdhar Wamiqur Rehman , Griffiths Sioned Mai , Hassan Ibrahim Mohammed Ibrahim
Published: July 2023

Aims

Under-detection of frailty syndrome or sarcopenia can result in significant mortality and morbidity among elderly patients, especially in old-age mental health settings. Therefore, it is crucial to ensure doctors are equipped with the competency of early identification and management of frailty syndrome. To date, there is limited information about any systematic approaches to assess and improve the knowledge, attitude, and practice of doctors about frailty syndrome. This literature review is aimed to identify the tools used to assess the knowledge of doctors about frailty syndrome and the available educational intervention to improve doctors’ knowledge.

Methods

A literature search was performed in Google Scholar, PubMed, SCOPUS, Ovid, and EMBASE using the keywords of “frailty syndrome” AND “knowledge” AND “doctors”. Data collected included the assessment tool used to understand the knowledge level and the intervention used to improve the knowledge. The inclusion criteria were: studies published in English in the last 10 years which assessed the knowledge of doctors about frailty syndrome.

Results

There were five studies fulfilling the inclusion criteria after the title and abstract screening, two from the Americas, two from Europe, and one from Australia.

The target group of studies involved general practitioners and doctors working in the primary healthcare setting (three), orthopaedic surgeons (one), and doctors working in the trauma setting (one). Two of the studies included non-medical healthcare practitioners as their participants.

One study used qualitative semi-structured individual interviews, two used a self-report questionnaire, one combined knowledge testing and self-report questionnaire, and one study compared the clinical assessment with a validated tool.

Only one study provided an educational intervention, i.e., a single-day training course conducted by three geriatricians.

Conclusion

Despite a comprehensive search, there were limited studies identified on this topic. The methods used to assess doctors’ knowledge about frailty syndrome are heterogeneous and no standardised tool has been identified in the process. There is only one study using educational intervention to improve knowledge, which was found to be effective and sustainable based on the change in self-perception, i.e. Kirkpatrick Level 1 of evaluation. There is a need to develop systematic assessment approaches or tools and training modules to improve the knowledge of doctors about frailty syndrome. Nevertheless, this review is limited only to studies published in English.
Who Is Calling: A Change in the Profile of the Callers of a Crisis Phone Line During the First Three Waves of the COVID-19 Pandemic
Authors: Gutnisky David , Ortega Licenciate Maria Soledad , O'Connor Horacio Rodriguez , Taboada Licenciate Sandra Garcia , Kugler Licenciate Victoria , Alul Florencia
Published: July 2023

Aims

‘Mental Health Answers’ [Salud Mental Responde] is a Crisis Telephone Line that was developed during the first months of the COVID-19 pandemic in the Autonomous City of Buenos Aires, Argentina. It is also a Point of Entry to Mental Health services, providing assisted referrals to the appropriate level of care. The aim of this paper is to evaluate the profile of the callers to the line during the first three waves of COVID-19.

Methods

Retrospective case analysis of calls made to the telephone line throughout the different COVID-19 waves under study. For this analysis, the time frame for the first three waves was as follows. First wave: from 1 August to 30 of November 2020; second wave: 15 of March to 30 of July 2021; third wave: from 20 of December 2021 to 25 January 2022.

Results

The first wave lasted 122 days. 4,601 calls were recorded, 27 calls were discarded for missing data. Women's mean age 51.79, SD 17.3, n = 3355. Men's mean age 43.29, SD 15.52, n = 1219. Significant differences were found in age, being men younger (T=−15.764, p < 0.000). Women made the majority of calls (72.9%). Fear and anxiety represented 45.1% of calls, depression 27.3% and psychosis 9%.

The second wave lasted 138 days and there were 4051 calls. Again, most of calls were made by women (71.5%). There were significant differences in age, being men younger (T = 14.450, p < 0.000). Women's mean age 46.68, SD = 18.72, n = 2872; men's mean age 38.05, SD = 16.34, n = 1138. The three most common detected problems were fear and anxiety 53.3%, depression 14.9% and psychosis 18.3%.

The third wave lasted 36 days; it had 1117 calls. Most calls made by women, 70.5%. Men were younger and this difference was significant (women's mean age 46.09, men's mean age 42.54; T = 3.233, p = 0.001). Problems detected, fear and anxiety 37.6%, depression 4.5% and psychosis 32.7%.

Conclusion

There was a change in the caller profile throughout the studied period, the callers from the first wave were older than the ones from the second and third waves. There was a change in the motivation to call, the most noticeable changes the drop in the number of calls related to depression (from 27.3% to 4.5%) and the increase in calls related to psychotic problems (from 9% to 32.7%). This last change might be related to the shift in the use of the Phoneline, from a Crisis Line to a Point of Entry to Mental Health Services.
Stigma, Secrecy and Masculine Norms: A Systematic Review of How Perinatal Mental Illness in Men and Their Partners Is Experienced by Males
Authors: Harding Rebecca , Hassoulas Athanasios , Smith Susan
Published: July 2023

Aims

Background: In recent years, fathers have become increasingly involved in pregnancy and childcare and the concept of paternal perinatal mental illness (PMI) has gained research interest. There has been increased recognition of the impact of parenthood on the mental health of males, particularly in first time fathers where feelings of helplessness and marginalisation are common. Prevalence of paternal PMI is thought to be 10–16%, with higher risk demonstrated when their partner too experiences PMI. The importance of this topic was highlighted in the NHS long term plan, which recognised the disparity in service provision between males and females and the need to address this. Aim: To conduct a systematic review to establish the knowledge, beliefs, and experiences of males with PMI and whose partners had PMI, and to understand the barriers associated with help-seeking for paternal PMI.

Methods

Five databases including EMBASE, Web of Science, Ovid MEDLINE, Scopus and PsycINFO were searched for qualitative studies investigating the experiences of males affected by PMI personally or through their partner's illness. The research question and inclusion criteria were determined using the PICOSS (population, intervention, comparison, outcome, setting, study design) method. 11 studies met criteria for inclusion and were appraised for quality using the Critical Appraisal Skills Programme and Joanna Briggs Institute Qualitative checklists. Evidence was synthesised using thematic analysis and study quality and risk of bias were assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) checklist and Risk of Bias in Systematic Reviews (ROBIS) too.

Results

5 main themes and 17 sub-themes were identified, and demonstrated lack of knowledge and preparation for fatherhood, and distress and isolation experienced by males with PMI. Males were reluctant to seek help, and factors including stigma and lack of awareness regarding PMI and available support services were identified as barriers. The option to remain anonymous, flexibility of appointments and an emphasis on peer support were considered facilitators to engagement.

Conclusion

Unhelpful and potentially damaging stereotypes regarding masculinity and PMI still exist, prohibit help-seeking for PMI and promote the marginalisation of males in perinatal settings. Support for males with PMI is warranted but lacking, and effective communication and education regarding paternal PMI for both professionals and the public is needed to allow successful expansion of services to include males.
Weight Change Following Diagnosis With Psychosis: A 25 Year Perspective in Greater Manchester, UK
Authors: Heald Adrian , Hassan Lamiece , Firth Joseph , Livingston Mark , Gibson Martin , Daly Christopher
Published: July 2023

Aims

Weight gain in the months/years after diagnosis/treatment severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased cardiometabolic risk in people treated with antipsychotic agents. There is limited data on the longer term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a 25-year perspective on weight change post-SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on a history of psychosis vs bipolar affective disorder.

Methods

We undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) also bipolar disorder = BPD). We analysed body mass index (BMI) change in the period before and after first prescription of anti-psychotic medication.

Results

We identified 9125 people with the diagnoses above. NAP (n = 5618; 37.5% female) mean age 49.3 years; BPD (n = 4131; 63.3% female) mean age 48.1 years. Follow-up period was up to 25 years. 27.0% of NAP were of non-white ethnicity vs 17.8% of BAP individuals.

A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for BPD. There were no significant differences in baseline BMI profile but mean HbA1c in those 2103 people where available was higher in NAP at baseline at 40.4mmol/mol vs 36.7mmol/mol for BPD.

At 5-year follow-up 53.6% of those NAP with a normal healthy BMI transitioned to obese / overweight BMI vs 55.6% with BPD. 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7 % with BPD. At 5-year FU for NAP, 83.1% of those with BMI ≥30kg/m2 stayed in this category vs 81.5% of BPD.

At 5-year follow-up there was similarity in the overall % NAP in the obese ≥30kg/m2 category (42.4%) vs BPD (44.1%).

Conclusion

The results of this 25-year real world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, highlighting the importance of regular physical health monitoring in all people with SMI.

Using longitudinal population data in this way has the potential to open up new avenues of research in psychiatry in terms of physical and mental health outcomes.
How Do Patients, Carers and Mental Health Nurses Experience Their Contact With the Forensic Multidisciplinary Team in a Medium-Secure Unit? a Thematic Analysis
Authors: Jack Alexander , Parkinson Eleanor , Malik Talhah , Hemblade Stephen , Hynes Fiona
Published: July 2023

Aims

Clinical teams oversee the care of patients within secure psychiatric inpatient settings. They are made up of a number of professions, including psychiatrists, psychologists, occupational therapists, social workers and nurses. The effective collaboration of the different members of the clinical team is vital for its functioning. However, so is the team's interface with other key stakeholder groups, namely nursing teams, service users and carers. Understanding the needs and priorities of these groups regarding their relationships with the clinical team is also important to recognise and in the provision of good quality care. To understand the experiences, priorities and needs of stakeholder groups in their relationship with the clinical team. Gaining feedback from multiple sources (service users, carers, nurses) will help facilitate functioning of the clinical team in the delivery of excellent care to service users.

Methods

Ethical approval was granted by the host NHS trust. Between October 2019 and October 2021, three focus groups were conducted using a semi-structured interview to gather responses from carers, nurses and service users (6 participants in each group) respectively. The interviews were recorded and transcribed. Thematic analysis was used to code each transcript and themes were drawn from the coded data.

Results

Dominant themes emerged from the three data sets. Consistent themes between groups included communication, hierarchy/power and representation. There were also differences in themes identified, with the carer group bringing the theme of education/ knowledge, and nursing group raising the value of human relationships, including compassion. The theme of transparency emerged strongly for the service user group.

Conclusion

This study offers an interesting perspective on what distinct stakeholder groups want and value in their relationship with the clinical team. Gaining feedback from multiple sources (service users, carers, nurses and members of the MDT) can better inform a team about its functioning and help improve performance. Developing a tool to aid the systematic collection of multi-source feedback is the next step of this project, facilitating the voices of key stakeholder groups to be heard.
The Impact of Emotional Intelligence and Resilience on Adolescents’ Mental Health in Sudan 2022
Authors: Ibrahim Danya , Abdelgafour Rania
Published: July 2023

Aims

The study aimed to determine the level of Emotional intelligence and resilience in relation to the mental health of adolescents in Khartoum locality, Khartoum state, Sudan 2022.

Methods

This study is a descriptive cross-sectional study. A total of 392 high school students participated from four different high schools chosen using the multistage cluster sampling. An anonymous self-administered questionnaire was filled by the students including both Arabic and English versions consisted of the 30-item trait Emotional Intelligence Questionnaire- short form (TEQ-SF) for emotional intelligence measurement, Brief Resilience Scale-6 (BRS-6) as a brief measure for resilience, and Patient Health Questionnaire-4 (PHQ-4) for anxiety and depression screening as a measure for mental health. Data were analysed using SPSS 25, Pearson correlation test, and linear regression analysis were used to measure the associations between the variables.

Results

In a sample of 392 Sudanese high school students, the emotional intelligence score was high (mean 131.53 ± 22.16). While Psychological resilience was normal (mean 3.20 ± 0.51). Students had mild to moderate degrees of anxiety, and depression at 89%, and 78% respectively. There was a strong positive association between emotional intelligence and psychological resilience (r = .272, p < .0005). Emotional intelligence had no direct significant relationship with anxiety and depression. Resilience was positively correlated with anxiety scores to a small extent (r= .105) i.e., the more resilient an adolescent is, the more anxious he/she is. There was no association between resilience and depression. Anxiety had a strong positive correlation with depression (r = .540) and a significant negative association with academic performance (r = -.102) indicating students’ suffering from anxiety had poorer academic scoring.

A significant unique contributor to the prediction of the resilience levels was the parents’ status, p value = 0.011 with an unstandardized beta coefficient of .368 i.e., if the parents were separated, a student has higher resilience and vice versa.

Conclusion

It is crucial to investigate the causes of the reported levels of anxiety and depression in secondary school students. Rapid detection will potentiate the possibility to provide suitable care, prevention from psychiatric morbidities and improvement of students’ academic performance by means of comprehensive psychological programs for screening, educating and training students including emotional intelligence training boosting their happiness, mental stamina and success.
Qualitative Study of the Impact of Relationships With Other Patients During Inpatient Treatment for Anorexia Nervosa
Authors: Jackson Elizabeth , Bould Helen
Published: July 2023

Aims

We aimed to interview people who had received inpatient treatment for anorexia nervosa, to explore their perspectives on the impact their interactions with other patients during their admission had on their recovery, including short term and longer term effects.

Methods

We recruited people who had experienced inpatient admission for treatment of anorexia nervosa, and who had been recovered from anorexia nervosa for at least 12 months. We conducted semi-structured, one-to-one interviews, with nine individuals specifically exploring the helpful and unhelpful aspects of peer relationships during inpatient treatment for anorexia nervosa. Interviews were transcribed and analysed using thematic analysis.

Results

We interviewed nine individuals. Five themes were indentified: comparison and justification, learnt unhelpful behaviours, dealing with distress, new-found compassion, and role-modelling. All participants expressed conflicting feelings about their relationships with peers, but generally described more resilience in resisting negative effects as they got closer to recovery. Positive effects, such a new-found compassion, appeared to hold significance long term in participants’ ‘recovered’ lives.

Conclusion

The detailed exploration of themes in this study provides a deeper understanding of the complex nature of peer relationships amongst people experiencing inpatient treatment for anorexia nervosa. This could aid clinical decision making when choosing appropriate treatment settings for individual patients as well as informing clinical practice in inpatient units.
The Effects of Trait Extraversion on University Student Mental Health and Well-being During Lockdown: A Systematic Review
Authors: James Oliver , Hassoulas Athanasios , Umla-Runge Katja
Published: July 2023

Aims

Personality traits such as extraversion and neuroticism are associated with mental health and well-being with trait extraversion positively associated with resilience, and negatively associated with a plethora of mental disorders including depression. Resilience was likely a useful trait during the COVID-19 pandemic which studies have shown negatively impacted the mental health of several different population groups, particularly university students. Mental health may also have been impacted differentially based on trait extraversion, with some evidence finding the mental health of extraverts was negatively impacted by lockdown. This review aimed to investigate whether trait extraversion was protective to university student mental health and well-being, operationalised by different symptom domains including stress and anxiety, during lockdown. We hypothesised that due to an extravert's proclivity to seek out and enjoy social interaction and the restriction of these very activities during lockdown, trait extraversion would no longer have a protective effect on mental health and well-being.

Methods

Six databases (EMBASE, MEDLINE, PSYCHINFO, SCOPUS, Web of Science and Cardiff University Full Text Journals) were consulted, and forty-five studies identified. Briefly, the eligibility criteria were studies of university students that had trait extraversion measured using either the Big Five or Eysenck's Personality Questionnaire in addition to a measure of mental health or well-being. Furthermore, at least 50% of the study must have been conducted under lockdown conditions with cross-sectional and longitudinal studies eligible for inclusion. After data screening, three longitudinal and seven cross-sectional studies were identified as eligible for inclusion. Following data extraction, a qualitative narrative synthesis was applied to the extracted data.

Results

Significant results were found for positive affect, negative affect, life satisfaction, quality of life enjoyment and satisfaction, anxiety and depression which suggested extraversion was protective. Non-significant results were also found for anxiety, depression, mental health, global quality of life, perceived stress, COVID-19 student stress and coronavirus anxiety.

Conclusion

The hypothesis that extraversion would be protective for mental health and well-being was accepted unanimously for life satisfaction and tentatively for anxiety. Furthermore, the hypothesis was rejected for depression and stress whose relationship with trait extraversion differed from pre-pandemic findings. The review recommended that extraverted university students should be mindful of the increased risk of depression and stress during lockdown. Additionally, further research should be carried out on extraversion's relationship with stress, an important factor in mental health, and also look at interactions of trait extraversion with other personality traits such as neuroticism.
A Systematic Review of Cognitive Behavioural Therapy as a Non-Pharmacological Intervention for School Aged Children With ADHD
Authors: Journeaux Aoife
Published: July 2023

Aims

The aim of this poster is to illustrate a systematic review exploring Cognitive Behavioural Therapy (CBT) as a Non-Pharmacological Intervention for School Aged Children with Attention Deficit Hyperactivity Disorder (ADHD). CBT is a common behavioural intervention in several child and adolescent psychopathologies as reported by Ramsay (2010); Solanto et al. (2010); Ramsay (2012); and Lopez et al. (2018). It is recommended as a non-pharmacological intervention alongside parent training, in school-aged children with a moderate severity of ADHD symptoms (National Institute for Health Care and Excellence [NICE] 2018b). This systematic review aimed to evaluate the effects of CBT as an intervention for ADHD in school-aged children. The research objective was to assess the effects of CBT in reducing the core symptoms of ADHD.

Methods

A search strategy was developed and a search of four databases initially yielded 1100 results. The search was then limited to randomised controlled trials (RCT) which evaluated the efficacy of CBT compared with treatment as usual, no treatment, and waitlist, in school-aged children. Inclusion criteria included participants who were diagnosed by a medical professional, and participants under the age of 18 in full-time, mainstream education. Those with co-morbid autism or tic disorder and those with an intellectual disability were excluded.

Results

Six RCTs met the inclusion criteria. The age range of participants was 8–18 years. The medication status of participants varied across the included studies. A narrative synthesis of the results included assessment of methodological quality and risk of bias. Jadad scores were used alongside the Cochrane Risk of Bias Tool (RoB 2) for RCTs, to assess the quality of evidence. The studies all included different modalities of CBT intervention and a variety of measurement tools.

Conclusion

The findings support the use of CBT as a non-pharmacological intervention to reduce the severity of ADHD symptoms in adolescents. However, as there were no available studies that included children aged under 8 years, the findings cannot support the use of CBT in the reduction of severity of ADHD symptoms in this group. Methodological issues within the study designs mean the findings need to be treated with caution. Future research is warranted that includes larger sample sizes and younger children with longer follow-up periods. Different modalities of CBT should be explored with and without pharmacological interventions. There is also a case for exploring modalities of CBT that are suitable for targeting in the younger age range of children.
Findings of Recruitment and Retention Survey – Consultants’ Perspective
Authors: Mahmood Sajid , Kunigiri Girish
Published: July 2023

Aims

Recruitment and retention of medical staff is a national issue. Low level of staff means challenges in provision of adequate and efficient patientcare. There is a lack of flexibility for clinicians to get time for Supported Programmed Activity (SPA). Burn out of existing clinicians and loosing good will is common which increases patients’ complaint and potential risk of near misses and serious incidents. Leicestershire Partnership NHS Trust (LPT) has significant challenge like many other neighbouring Trusts in term of recruitment and retention of consultant psychiatrists. The aim of this research was to find out proportion of consultant psychiatrists satisfied with current job and to explore their views on current difficulties and ways to support and retain them within their current Trust.

Methods

It was a cross-sectional survey. The target population was consultant psychiatrists working in LPT. An online questionnaire was developed for data collection. Data were gathered through open (free text) and close (options provided) questions. Information was collected regarding job satisfaction, positive and negative of job, difficulties and challenges in current role, willingness to continue work within Trust and if they would recommend friends or colleagues to join LPT. Results are reported in percentages for descriptive statistics.

Results

About 34% of the responders (n = 38) were satisfied with their current job, whereas about 45% reported unsatisfied or very unsatisfied. Regarding quality of admin support, nearly 40% were unsatisfied. Similarly, about 1/3 of the responders reported un-satisfaction with available office and clinic space for clinical and admin activities. Nearly 2/3 reported not getting adequate time for SPA activities, instead 37.5% reported 5 or more hours per week spending over their contracted hours. Over 97% said, their job can be more rewarding by acknowledging their contribution, involving them in Trust activities, provision of adequate clinic space, reducing case load with enhance recruitment. Surprisingly 71.1% reported thought of leaving LPT in the last six months and only 28.9% clearly stated, they would stay within Trust and also recommend a friend or a colleague to join.

Conclusion

Majority of the consultant psychiatrists were unsatisfied with their current job and reported thought of leaving Trust in the last six months. There is an urgent need to address the highlighted challenges and early discussion with them in term of what local Trust can offer and support them to ensure their retention and enhance recruitment while they are being advocate for the LPT.
Correlates of Sexual Harassment Among Staff and Students in First Generation South West Nigerian Universities
Authors: Mapayi Boladale , Oginni Olakunle , Ukpong Morenike , Harrison Abigail
Published: July 2023

Aims

Sexual harassment (SH) is a widespread and recurring problem in educational settings. SH is not easy to define, partly because it does not involve a homogenous set of behaviours. There are gender variations in the experience and perception of SH. Risk factors for SH include female gender and gender inequality, same-sex attraction, poverty, poorly trained, underpaid, and understaffed educators. The study aimed to determine the prevalence rates and correlates of heterosexual and same-sex SH and to explore the social and mental health sequelae of SH among students and staff of first-generation universities in South-west Nigeria.

Methods

A cross-sectional survey was done in three first-generation universities in southwest Nigeria. A sample size of 550 participants per institution was estimated with a margin of error of 2.5%, a 95% confidence level. This gave a total sample size of 1650 respondents participants for the study. In each university, Students and staff were categorized by faculties into 3 clusters: science, social science, and arts. A proportionate sampling technique was used. Participants were assessed for SH, age, sexual orientation, gender, motivation for dressing, depressive symptoms, and suicidality. Associations were tested using Pearson correlations.

Results

SH was higher with age, among females, among lesbian, gay, and bisexual (LGB), participants with sexual motivation for dressing, high sexual desire, high suicidality, and low perception of campus safety. In terms of gender differences, correlation with age was slightly higher in females while correlations with lesbian/gay status was higher in males. In terms of sexual orientation, correlation with age was largest in LGB, association with dressing motivation, sexual desire, and depressive symptoms scores was greatest in heterosexual participants, association with suicidality scores was greatest with lesbian/gay status; and correlation with perception of campus as safe lowest among bisexual participants. Generally, the associations were weakest among staff compared to students.

Conclusion

There are certain demographics (heterosexual and bisexual females and gay men) that appear to be more vulnerable to SH in tertiary institutions. The correlates of SH also vary in the different sample groups. These should be considered when programming for prevention and response to SH in Nigerian tertiary institutions.
Association of Various Factors With Deliberate Self-Harm Among Patients of Bipolar Disorder
Authors: Mateen Yasir , Zubair Usama Bin , Hussain Hirra , Bokhari Sumira Qambar
Published: July 2023

Aims

Deliberate self-harm is one of the common psychiatric emergencies in medical practice, and bipolar disorder carries one of the highest risks for self-harm among various other psychiatric and physical disorders. The relationship between self-harm and bipolar disorder and its risk factors has not been sufficiently studied in Pakistan and remains an area of investigation elsewhere. The objective of our study was to determine the frequency and factors associated with deliberate self-harm in patients with bipolar disorder.

Methods

This cross-sectional study was conducted in the outpatient department of psychiatry of a tertiary care hospital in Lahore, Pakistan, from May 2020 to April 2021. A total of 165 patients living with bipolar disorder, between the ages of 15 and 65 years, were included in our study. The diagnosis was in accordance with the criteria in International Classification of Diseases 11th Revision (ICD-11). Deliberate self-harm was defined as a non-fatal act in which an individual deliberately causes self-injury or ingests a substance in excess of any prescribed or generally recognized dosage. This was assessed through history (during last 6 months) and physical examination performed by the psychiatrist.

Sociodemographic variables like age, gender, educational status, marital status and employment status, and the clinical variable of treatment compliance, were documented. The data were recorded and analysed using Statistical Package for the Social Sciences (SPSS) version 20. The association of above factors with the presence of self-harm in our study participants was then explored with Pearson Chi-Square test. The p-value of less than 0.05 was considered as significant.

Results

Out of 165 cases included in the study, 62.42% (n = 103) were male and 37.58% (n = 62) were females. The frequency of deliberate self-harm in bipolar disorder was 35.15%. In terms of association, only female gender was found to have a statistically significant relationship (p-value <0.001) with the presence of self-harm in our study.

Conclusion

We concluded that deliberate self-harm is a common finding in cases of bipolar disorder in Pakistan. Additionally, vulnerable subgroups, such as female patients in this study, should receive more clinical attention and safeguarding support.
Improve Coding Practices for Patients in Suicidal Crisis
Authors: McCarthy Molly , Saini Pooja , Nathan Rajan , Ashworth Emma , McIntyre Jason
Published: July 2023

Aims

The recording of suicidal ideation in emergency departments (EDs) is inconsistent and lacks precision, which can impede appropriate referral and follow-up. EDs are often the first point of contact for people experiencing suicide-related distress, but while data are available on attendances for self-harm, no comparable data exist for suicidal crisis.

Methods

Data were collected from six EDs across Cheshire and Merseyside (N = 42,096). Data were derived from presenting complaints, chief complaints and diagnosis codes for all suicidal crisis attendances (suicidal ideation, self-harm, suicide attempt) from January 2019 to December 2021.

Results

There was inconsistent coding within and between ED sites for people presenting in suicidal crisis. Attendances for suicidal ideation were often given the chief complaint code of ‘depressive disorder’ (12%). There was a high level of missing data related to the coding of suicide-related presentations (65%). Variation in coding was also reported for individual presentations; for example, 12% of attendances reported to be due to ‘self-inflicted injury’ were given a primary diagnosis code of ‘depressive disorder’ rather than ‘deliberate self-harm’. There was also high variability in the routinely collected data (e.g., demographic information, attendance source and mode, under the influence at time of arrival) both within and between EDs.

Conclusion

Accurate detection and documentation of suicidal crisis is critical to understand future risk and improve services. Research and development in monitoring systems for suicidal crisis should be a priority for health services, and a national data collection tool is urgently needed to maximise accuracy and utility. Better data could be used to inform crisis care policy and to target suicide-prevention resources more effectively.
TMS-EEG in the Investigation of Excitation-Inhibition Imbalance in Psychosis and Cognition
Authors: Michalopoulou Panayiota G , Chow Rachel TS , Farooq Nimra , Szentgyorgyi Timea , Mohammed-Akram Maryam , Rocchi Lorenzo , Shergill Sukhi S
Published: July 2023

Aims

Transcranial Magnetic Stimulation (TMS) is an in-vivo, non-invasive, and safe method that probes neurophysiological properties associated with cortical glutamatergic (excitatory) and GABAergic (inhibitory) neurotransmission. The combination of TMS with Electroencephalography (EEG) allows us to measure TMS-evoked cortical responses directly from brain activity and it is uniquely placed to elucidate in-vivo cortical Excitatory/Inhibitory processes. Schizophrenia has been associated with Excitation/Inhibition (E/I) imbalance. Cognitive impairment, which is almost ubiquitous in schizophrenia, has been linked with the E/I abnormalities observed in schizophrenia. Among the TMS-EEG evoked potentials (TEPs), the N100 is thought to reflect activation of inhibitory GABA-B cortical circuits and has been associated with attentional processes in healthy individuals, attention deficit hyperactivity disorder (ADHD) and depression. Our aim was to investigate the cortical processes related to the generation of N100 after motor cortex stimulation and its association with attention measures in patients with schizophrenia and healthy controls.

Methods

TEPs were recorded following application of 150 TMS pulses at 90% of resting motor threshold on two brain sites, i.e., left primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) in stable patients with schizophrenia (n = 9) and healthy controls (n = 9). Region of Interest (ROI) analysis was performed to calculate the regional average of the N100 peak amplitude in M1 and DLPFC based on previous literature. Attention was assessed with a Continuous Performance Task (CPT).

Results

We found a significant negative correlation between the amplitude of N100 from M1 and CPT score in the patient group (rho = -0.73, p = 0.026). The N100 component from DLPFC in patients did not correlate with the CPT score (rho = -0.034, p = 0.93), which may suggest regional specificity of M1 inhibitory processes in attention in patients with schizophrenia.

Conclusion

N100 is considered to be related to cortical inhibitory processes influenced by cortico–striato–thalamo–cortical loops, with greater cortical inhibitory activity producing a larger N100 amplitude. Our preliminary results suggest association of the GABA-B-ergic TEP N100 with attentional processes in M1 and may represent cortical inhibition beyond motor inhibition in patients with schizophrenia. Overall, TMS-EEG offers the potential to investigate the state and dynamics of E/I imbalance in schizophrenia and cognition.
Mental Health and Contraception- Are We Doing Enough? a Study Exploring the Current Practice of Providing Contraceptive Advice by Mental Health Professionals
Authors: Mohamed Ashma , MacDonagh Emily , Giridhar Ramya
Published: July 2023

Aims

Contraception is of increased importance for women with mental health conditions. These women are more likely to experience unplanned pregnancies and are at a higher risk of sexually transmitted diseases. NICE (National Institute for Health and Care Excellence) guidelines recommend discussing the use of contraception with women of childbearing potential with mental health problems. Professionals should discuss how pregnancy and childbirth can impact a mental health problem and how a mental health problem and its treatment might affect the woman, the foetus or the baby. It is, therefore, important for professionals to feel confident when advising these women. In this study, we aim to examine the knowledge, practices and attitudes of mental health professionals in providing contraceptive advice to service users of childbearing potential.

Methods

An observational quantitative cross-sectional design study was utilised using a 12-item self-report questionnaire. Mental health professionals meeting the inclusion criteria, employed by Surrey and Borders Partnership NHS Foundation, were invited to complete the anonymised survey electronically. Responses were entered into the survey software (Qualtrics) and quantitative data analysis was conducted.

The study was approved by the North West Manchester Ethics Committee.

This is the first arm of the study, and the second arm focuses on service user experience and is currently in progress.

Results

76 professionals responded, including 24 consultants, 17 trainee doctors, 16 nurses, 8 non-trainee doctors, 7 psychologists, 3 social workers and 1 pharmacist. Of the 76 responses, 31% said they felt extremely/very familiar with the NICE guidelines. 38% of respondents said they were somewhat familiar, and 30% said they were not so/not at all familiar. Regarding confidence in discussing contraception and family planning 8% responded extremely/very, 28% responded somewhat and 64% responded not so/not at all. 68% said they would like to receive further training. A third of the professionals surveyed said they were not familiar with the NICE guidance. Two-thirds of respondents do not feel confident offering counselling around contraception, planning and spacing pregnancies. Over two-thirds would like further training

Conclusion

The survey showed a lack of confidence in offering reproductive advice and the need for training to improve knowledge. We aim to develop training in contraception advice to improve the care provided for female service users.
Gestational Factors in Mother – Infant Bonding Impairment Among Women With High Risk Pregnancies
Authors: Nachane Hrishikesh , Nayak Ajita
Published: July 2023

Aims

The present study aimed to study maternal bonding impairment among postpartum women at 6–8 weeks postpartum. We compared the severity of bonding impairment among women with high and low risk pregnancies. We also explored gestational factors related to maternal bonding impairment in these women.

Methods

Hundred women at six – eight weeks postpartum, without any significant physical or mental illness, were assessed for bonding failure using the Postpartum Bonding questionnaire. Their antenatal and postnatal records were reviewed to determine various gestational factors and subsequently classify them as high risk or low risk pregnancies. Unpaired t test and multiple regression analysis were used as appropriate for statistical analysis.

Results

7% of the mothers had significant impairment in bonding with their infants. The most prevalent type of bonding impairment was infant focused anxiety (1%) and incipient abuse (1%). Maternal bonding failure (d = 0.74) and rejection of infant (d = 0.45) were significantly higher in women with high risk pregnancies (P < 0.01). Not having a term delivery was the most significant factor associated with impaired maternal bonding (β = - 0.26, P = 0.02). Other factors in the model were maternal BMI, mode of delivery, having an emergency caesarean section, presence of congenital malformations in the baby and history of NICU admission. Overall adjusted R-squared for the model was low (0.07), indicating only 7% of variation can be accounted by the gestational factors in the model.

Conclusion

Women with high risk pregnancies have higher chances of an impaired bond with their infants. Preterm / post term delivery is the most important risk factor.