bluuebunny/crossref_metadata_2025 huggingface dataset:
Site downsizing: a blessing or a curse?
Authors: Waterhouse Benjamin , Attwood Ben
Published: June 2021

Aims

To measure staff wellbeing and morale, which in 2015 was described by CQC as 'low', following a downsizing of premises.

Background

In 2019, due to loss of mental health funding, Camden & Islington NHS Foundation Trust controversially sold the much-loved Queen Anne-style mansion Lyndhurts Gardens. The Rehab & Recovery team caring for those with serious mental illness were relocated to one floor of the much smaller Daleham Gardens. It was hypothesed by the authors that this would impact negatively on the already unhappy workforce.

Method

The same staff wellbeing survey was used as in in 2015 (following CQC's description of 'poor' morale), nearly 5 years on and following the site relocation. All clinical, managerial and administrative staff members were encouraged to participate by posting their survey anonymously in a make-shift postbox. Sweet treats were used to encourage participation within the busy team.

Result

Qualitative and quantitative data were collected from the team (response rate 44%). Exact tables will be shown but in summary; in the new building there was an increase in the number of staff who felt they could use initiative at work, make improvements at work, looked forward to going into work and felt enthusiastic about their job. Improvement cited were 'increased socials after work' and consequent 'wellbeing', in addition to 'good team atmosphere', 'good team work' and 'good relationships' in the new space. Further ideas were generated for additional improvements going forward.

Conclusion

Whilst caseloads and workloads are often cited as the cause of burnout, and indeed other changes in the 5 years could act as confounders, the design of work buildings is not to be underestimated. Contrary to what the authors had suspected, 'bigger' was not necessarily 'better' and a more condensed working environment made for greater togetherness amongst the team. In this age where economically desperate NHS trusts are forced to sell off their prized assets, observations that this is not always at the detriment of staff morale will provide some cause for optimism.
Increasing participation in the 2019 UK general election amongst patients on a high intensity rehabilitation ward
Authors: Wood Aaron , Shetty Amrith
Published: June 2021

Aims

To increase participation in the 2019 UK general election amongst inpatients on a high intensity rehabilitation ward, by supporting patients to both register to vote (RTV) and vote.

Background

In 2000, the franchise was extended to those under section 2 or 3 as well as informal inpatients. Unfortunately, voting rates remain low: studies of the 2010 general election show voting rates amongst psychiatric inpatients to be 14%, compared to 65% for the general population. Engaging patients in the democratic process is not only just, it has been shown to be an effective avenue for rehabilitation through increasing social capital. The 2019 UK general election represents a singular opportunity for biopsychosocial rehabilitation.

Method

In the three weeks up until 26/11/19 – the deadline to RTV – visual displays and verbal information were used to notify patients of:

The election

Their eligibility

The need to RTV before casting a ballot

The registration deadline

Voting methods (in person, by post, by proxy)

We gathered patients’ intention to RTV and offered impartial, personalised support to register online or by paper, and to apply for a postal or proxy ballot if wished. Patients with no fixed abode were supported to use the ward as their declared place of residence.

Result

Of the 17 patients on the ward there were:

Four informal patients

11 patients under section 3

One patient each under a section 37 and a section 37/41, both ineligible to vote

Of the 15 eligible patients, one (6.7%) had already registered, six patients (40%) wanted to register and eight (53.3%) stated they did not want to register. Those wanting to register were supported according to individual patient preference. Of the registered seven, five (33.3%) reported voting, one (6.7%) reported not having voted and one (6.7%) declined to say. Two (13.3%) voted in person and five (33.3%) voted by postal ballot.

Conclusion

Our intervention corresponded with an increase in number of patients registering – from one patient (6.7%) to seven (46.7%), with 5-6 (33.3-40%) casting their ballot. While the causal relationship should not be overstated, the uptake of assistance supports the intervention's efficacy.

Good rehabilitation increases a person's social capital, empowering them to actively participate in societal life. Registering to vote is a tacit assertion of this principle. Our study shows that brief interventions that are easily incorporated into everyday care are a simple, effective and ultimately necessary tool in holistic mental health rehabilitation.
Impact of community treatment orders on inpatient bed usage in assertive outreach team
Authors: Al-Uzri Mohammed , Harvey Zena , Noushad Fabida , Iheonu Chinyere , Abbas Mohammed
Published: June 2021

Aims

To examine the impact of using Communty Treatment Orders (CTO) of the Mental Health Act on use of inpatient care in Assertive Outreach team.

Background

Currently there is little evidence of the efficacy of community treatment orders (CTOs), and in particular with patients who use the Assertive Outreach service. One large randomised controlled study found no impact on use of inpatient care while a naturalistc study found significant impact.

Method

Our primary outcome was the number of admissions with and without a CTO comparing each patient with themselves before CTO and under CTO(“mirror-image”). Our secondary outcomes were the number of bed days, and the percentage of missed community visits post-discharge. We also looked at the potential cost savings of a reduction in inpatient bed usage.

Result

All the 63 patients studied over period of 6 years had a severe and enduring mental illness. The use of a CTO was linked to a significant reduction in the number of admissions (mean difference = 0.89, 95% CI = 0.53–1.25, P < 0.0001) and bed days (mean difference = 158.65, 95% CI = 102.21–215.09, P < 0.0001) There was no significant difference in the percentage of missed community visits post-discharge. Looking at the costs, an average cost for an inpatient Assertive Outreach bed per day in the local Trust was £250, and there were 8145 bed days saved in total, making a potential saving of just over £2million, during the study period.

Conclusion

This study suggests that the implementation of CTOs using clinical judgment and knowledge of patients can significantly reduce the bed usage of Assertive Outreach patients. The financial implications of CTOs need to be reviewed further, but this study does suggest that the implementation of CTOs is a cost-effective intervention and is economically advantageous to the local Trust.
Relationship between bullying victimisation and post-traumatic stress disorder among public junior secondary school students in Abeokuta, Nigeria
Authors: Awhangansi Sewanu , Salisu Titilayo , Akanji Oluwayemisi , Okewole Adeniran , Sowunmi Oladipo , Amosu Sunday , Adeosun Increase , Owoeye Olugbenga
Published: June 2021

Aims

To determine the relationship between bullying victimization and PTSD among students attending public Junior Secondary Schools in Abeokuta. The Prevalence of Bullying victimization and PTSD as well as some socio-demographic correlates were also assessed.

Method

About 411 junior students from five randomly selected public secondary schools were approached for the study and given consent forms to take home to their parents/guardians. Those who subsequently returned signed consent forms and who gave assent to participate in the study were administered the Socio-demographic questionnaire and the Multidimensional Peer Victimisation Scale (MDPVS). They were thereafter interviewed with the PTSD module of the MINI KID.

Result

A total of 351 students completed the study to yield a response rate of 85.4%. The age range of the respondents was 9–17 years with mean (SD) of 12.48 (1.50) years. The gender distribution was 49.3% males and 50.7% females. 68.7% of the respondents were from a monogamous home, 22.2% had divorced parents, 74.3% lived with both parents, and 6% reported being an only child. 14.8% of the respondents reported having experienced higher levels (moderate & high) of victimization by peers. The mean score of the overall bullying victimization level was 9.6 (±6.5). Verbal victimization subscale had the highest mean score of 3.2 (±2.0), while physical victimization had the lowest mean of 1.9 (±2.1). Seventy (19.9%) students admitted to the experience of a significant traumatic event, with only 7.1% of these meeting the current diagnosis of PTSD in the past month. There was no statistically significant association between bullying victimization and PTSD (χ2 = 2.666; df = 2; p = 0.261). Traumatic event experience was however significantly associated with high levels of bullying victimization experience (χ2 = 4.266; p = 0.039). None of the assessed socio-demographic, familial or self-perceptual factors was found to be significantly associated with either bullying victimization or PTSD.

Conclusion

The experience of bullying victimization among secondary school students remains a prevailing problem in our local setting, as it is across the globe. Verbal bullying is the most common while physical bullying is the least common peer victimization experience in this study. The study points out that PTSD among high school students in our environment may be more prevalent than had previously been reported. Given the high rates of peer victimization experiences reported by students, there is a need for policy changes to make the school environment safer for students, thereby promoting their mental health.
Evaluation of self-esteem in adolescents of secondary school level
Authors: Begum Farhana , Zubair Usama , Afridi Iqbal , Toufique Fatima , Dars Jawed , Lal Chunni
Published: June 2021

Aims

To assess the frequency of low self-esteem among adolescents of secondary school level in private schools of Karachi

Method

It was a cross-sectional descriptive study done in ten private schools of Karachi for a period of 6 months. The proposal of the study was accepted by ethical committee of Jinnah Postgraduate Medical Centre, Karachi (called Institutional Review Board or IRB).The subjects fulfilling inclusion criteria were enrolled after obtaining informed consent by their parents. A semi-structured Performa was used to assess students’ particulars and included Rosenberg Self-esteem Questionnaire as a part of Performa. The data were analysed using SPSS version 17.0. Frequencies & percentages were generated for the level of self-esteem.Stratified analysis was done with a p value <0.05 taken as significant.

Result

Out of the 246 students, 39.8% were of 14yrs of age, 36.2% were 15 years of age, while only 24% of adolescents were 16 years of age. Majority (64.2%) of the students were males while females were 35.8%. 70.3% of the students had normal level of self-esteem, whereas 28.9% of students had low self-esteem and only 0.8% of students had high self-esteem. Relationship of all the variables was found to be non-significant except that of educational level (p-value 0.047).

Conclusion

Self-esteem was found to be normal in most of the adolescents of secondary school level but still more than 1/4th of the study participants had low self-esteem which if assessed and addressed early may save the individuals from mental health issues as well as problems at work and home life.Having a better understanding of self-esteem, can help us to identify the adolescents who have low self-esteem and are predisposed to develop mental health difficulties in future.It can lead to not only early intervention and reducing the burden of disease but also help in developing programs to help improve self-esteem in adolescents,hence increasing their overall motivation and productivity.
Impairments in theory of mind following traumatic brain injury: a systematic review
Authors: Chikramane Radhika
Published: June 2021

Aims

To assess the nature and extent of Theory of Mind (ToM) impairments post-TBI.

Method

Electronic databases searches included PubMed/MEDLINE, PubMed Central, Scopus, PsychArticles, PsychINFO, Web of Science, ProQuest Central, and Wiley Online Library databases. Only studies conducted on adult patients with TBI compared with healthy controls published in English in peer-reviewed journals were considered. Reference lists were manually checked for additional studies. 19 studies were identified.

Result

Marked moderate-to-severe ToM deficits in adults post-TBI were observed across all severities of injury and chronicity. ToM deficits were documented across tasks and reflected a hierarchy where performance worsened significantly as tasks progressed in complexity. Despite supportive factors, certain aspects of ToM impairment, such as ability to detect and interpret non-literal speech and judge appropriateness of context remained affected in the subjects.

Conclusion

ToM deficits represent a robust finding in adults with TBI. The chronicity of TBI requires a long-term view and is complicated by the fact that ToM deficits are invisible and difficult to understand. Perceptive-taking deficits faced by TBI sufferers has bio-socio-economic implications. This review also discusses implications for basic and clinical neuropsychology and rehabilitation efforts. Further research is needed, particularly in the form of large, longitudinal studies that mimic day-to-day interactions, to inform/support rehabilitation programs.
Coping with a modern pandemic-an online survey of Anesthesiologists in India during COVID-19
Authors: Chockalingam Punitha , Balakrishnan Kalpana , Natarajan Priyadarshini , Veeraiah Surendran , Rajagopal Revathy , Elumalai Vinodh Kumar
Published: June 2021

Aims

In 2020, India was one of the worst affected countries by COVID-19. As the pandemic spread, creating undue pressure on health care workers (HCWs), there was an urgent need for the development of appropriate interventions to protect their mental health. This study aims to study the effect of COVID-19 on the mental health of anaesthesiologists in India and factors that influence their coping behaviour.

Method

The study was designed as a semi-structured, descriptive, cross-sectional, online open survey and conducted on Google forms between 21st May and 20th June 2020, among practicing anaesthesiologists across India. The participants were recruited by sending messages to their emails and through social media platforms. It created a small number of international respondents, who were also included (India = 301, rest = 23). The self-designed questionnaire had 30 questions in the form of multiple choices, checkboxes, linear scales and short comments. Informed consent was recorded at the outset. Details such as demographic characteristics, place and nature of work, pandemic related changes in duration or pattern of work, psychological symptoms during and after working hours, fears about quarantine, were collected in the survey. Statistical Analysis was performed using Statistical Package for Social Sciences (SPSS Statistics for Mac Version 21.0 IBM Corp., USA)

Result

Among the 324 participating anaesthesiologists, a prevalence rate of 64.8% for stress, 51.2% for anxiety and 65.7% for depression was noted, which was double the rate from pre-pandemic studies. Those between the ages of 30 and 50 (p = 0.010 OR:2.191) and working in government run (p = 0.045 OR:2.564) COVID-19 hospitals in India (p = 0.002 OR:2.018), were particularly stressed (33.3%) and anxious (38%) than the rest. Increased workload, contracting the virus and becoming an infectious source to their family (88.6%) were their prime concern. Formulating standard operating procedures (SOP) (66.7%) and procuring personal protective equipment (PPE) (56.2%) were some of the challenges faced at work. Most of them recommended a congenial workplace (68.8%) and family support (60.8%) to help them work through their anxiety and fear, while a few reported considering leaving their career (34.8%) from fear of monetary loss and burn out (53.8%).

Conclusion

COVID-19 has changed the professional and personal life of anaesthesiologists in India. Irrespective of their workplace, their fears and challenges remain universal. Early identification of anxiety and depression and providing appropriate psychological support will prevent deep and enduring damages to the lives of these professionals.
The effect of schizophrenia-associated CNVs on other psychiatric disorders
Authors: Farakish Lily
Published: June 2021

Aims

Schizophrenia is a highly heritable disorder, sharing genetic roots with other psychiatric disorders from both common and rare genetic variants. Copy number variants (CNVs) are one of the rare causes which increase the risk of a variety of psychiatric, medical and physical phenotypes. The role of schizophrenia-associated CNVs is becoming of increasingly scientific and clinical importance in the field of psychiatry, with new CNV-phenotype relationships opening perspectives for understanding the aetiology of psychiatric disorders. This paper aims to investigate whether 13 schizophrenia (SZ)-associated CNVs or any SZ-CNV-carrier status increase the risk for 9 psychiatric phenotypes, reduce levels of happiness, change duration of sleep, and increase the index of multiple deprivation.

Method

The study includes 421,268 participants of British or Irish descent (aged 40–69 years), containing 418,036 controls and 3232 schizophrenia-associated CNV carriers. The data are secondary from the UK Biobank, an online resource containing data on array-genotyped participants with their specific phenotypic information. Prior to analysis, CNV selection led to the exclusion of any CNV with less than 5 hits in the UK Biobank population. Incidence of each phenotype was based on self-reported diagnoses, questionnaires or hospital ICD-10 diagnoses, with a minimum of 500 cases. Both binary logistic and linear regression were used to assess the incidence of these phenotypes in relation to the CNVs, adjusted for age, sex, and ethnicity as potential cofounders.

Result

Overall, 12/13 CNVs were nominally associated with at least one phenotype, including 114/168 possible associations and 54 undetectable associations as not every CNV carrier displayed one of the chosen phenotypes. 41 associations were statistically significant (p < 0.05) and 13 survived Bonferroni Correction (p < 2.98 × 10-4). All significant associations met the expected change except 15q11.2 deletion and any CNV carrier status which showed a decrease in likelihood of addiction.

Conclusion

These findings suggest schizophrenia-associated CNV can affect range of psychiatric phenotypes. By building on existing reports, understanding the widespread effects of CNVs in the aetiology and pathogenicty of psychiatric disorders may overtime aid in strengthening our search for more targetted, effective treatments.

Many thanks to Professor George Kirov for supervising and supporting this project.
The impact of rTMS on patients with dual diagnosis of depressive disorder and substance use disorders
Authors: Foad Wael , Alhawi Rami , Altamimi Samer , Hussain Zahid , Moselhy Hamdy , Fayek Mohamed
Published: June 2021

Aims

We aim to investigate the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) in reducing consumption and craving among patients with Substance Use Disorder (SUD) and comorbid depressive disorder.

Background

Dorsolateral prefrontal cortex (DLPFC) is greatly involved in SUD evolution (1). Research has turned to targeting this brain area with rTMS; a non-invasive brain stimulation technique that modulates cortical excitability by sending pulsatile electromagnetic fields through the skull and into the brain (2). rTMS is an FDA approved and safe treatment option for treatment-resistant depression (TRD) (3).

Method

Fifty-four patients were admitted over six-month period of time (June 2019- December 2019) to the inpatient unit of Erada center for treatment and rehabilitation of SUD in Dubai. All patients who fulfilled ICD-10 diagnoses of Depressive disorder and SUD were screened for further assessment.

Positive drug screen was confirmed through urine analysis. Hospital Anxiety and Depression Scale (HADS) and Brief Substance Craving Scale (BSCS) were applied to all participants. Patients were contracted for 5-times weekly High frequency (10 Hz) rTMS for 4 weeks (total of 20 treatments). Those who managed to complete their contracted TMS sessions were matched for age and sex with similar number of patients who received standard treatment as usual (TAU). Stimulation was as per FDA clearance for rTMS application in TRD.

Result

Eight patients were excluded (previous head trauma). A total of 46 patients had TMS mapping; nine of whom completed 20 sessions.

Opioids was the most commonly used drug in almost 52% of patients (n = 14), followed by amphetamines in almost 30% (n = 8) and Cannabis in 18.5% (n = 5).

Among those who completed 20 rTMS sessions; HADS scores on anxiety and depression fell by 85% and 78% respectively. BSCS score fell by 98%. Relapse rate (defined by positive drug screen) at 3 months was 33%.

For those who completed 10 sessions; there was only 50% reduction on BSCS scores and 66% relapse rate. There were no data available on their HADS scores (only collected at baseline and at completion of 20 sessions).

Those who only had TAU; there were no reduction in their BSCS (average score of 7 at both baseline and after 2 weeks).

Conclusion

Our findings suggest that rTMS may be an effective and safe treatment for both depressive disorder and craving for SUD which is supported by other studies (3,4).

Our study is probably the first of its kind within Middle East population with addiction problems.
Person centred approaches to learning hold a potential for a mature depth of understanding and engagement as opposed to the traditional 'transmission of knowledge' approach to learning
Authors: Hayes Catherine , Heald Adrian
Published: June 2021

Aims

Do students experience a person-centred experiential (PCE) approach to learning in a university context differently to transmitted knowledge learning from prior education, and if so, how?

Background

The person-centred approach, as defined and developed by Carl Ransom Rogers, remains on the margins of practice in the UK. The approach sustains a non-medical stance. All of the Improving Access to Psychological Therapies Person Centred Experiential Counselling (APT PCEC) workforce require a qualification in person-centred experiential counselling. In order to attune to Roger's hypothesis regarding the conditions required in order to facilitate psychological growth, person-centred learning is a principle stance.

Researching experiences of PCE learning through anonymous feedback from students attending different levels of training (BA, MA and post qualification PCE-Counselling for Depress (CfD) License) is an initial test of the hypothesis .

Counselling education in the UK is increasingly highly standardised and driven by competency frameworks. This work begins to uncover person-centred students’ evaluation of undertaking person-centred qualifications. Modules and continuing professional practice were constructed to facilitate a person-centred learning environment wherein the curriculum was designed by students or the experiential aspect of the learning drove the agenda

Method

The sample was made up of (N = 30) students. 8 students were studying for a Master's degree in person-centred experiential psychotherapy, 10 students were studying a BA in humanistic psychotherapy, 12 students were attending a mandatory IAPT Continuous Professional Development (CPD) training in PCE therapy. The evaluation responses were subject to a thematic analysis.

Result

The emerging themes parallel each other and indicate that degree students were very aware of the difference from their previous learning experience in education.

68% of MA Students experienced psychological maturation through the process of training.

83% of BA students became more agentic in their approach to learning.

83% IAPT therapists noticed the nurturing, compassion and humane approach to the learning, despite the mandatory nature of the offer and empowered them in regards to their non-medical stance within an NHS context.

Conclusion

Our findings point to the significance and impact of person-centred learning for person-centred psychotherapists’ development during and post-qualification. Implications can be drawn in regards to engaging with person-centred learning in public sector and health contexts.

Person centred approaches to learning hold a potential for a mature depth of understanding and engagement as opposed to the traditional ‘transmission of knowledge’ approach to learning.
Reduced motivation to work for financial reward associated with harmful alcohol use in a community sample of young adults
Authors: Henry Jessica , Ersche Karen , Lim Tsen Vei
Published: June 2021

Aims

Neuroimaging research suggests that alcohol dependency is associated with impairments in anticipating monetary rewards, but not aversive or alcohol-related cues.

We sought to investigate if reinforcement sensitivity is altered in young adults, who regularly consume harmful levels of alcohol, using a monetary incentive reinforcement (MIR) task. In light of previous research suggesting reduced motivation to obtain reward, we hypothesized that young alcohol users would show reduced motivation for monetary gain, but unimpaired loss avoidance behaviour.

Method

We recruited 46 volunteers from the local community in Cambridge (UK), half of whom reported consuming alcohol at harmful levels, as reflected by the Alcohol Use Disorder Test. Participants completed a number of personality questionnaires, including the Barratt Impulsivity Scale (BIS-11) and Sensation-Seeking-Scale (SSS-V) and performed the MIR task, which measures participants’ efforts in avoiding punishment and gaining rewards. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25 (IBM, Chicago IL). Analysis of co-variance (ANOVA) were used to explore group differences in demographics, personality traits and task performance; age and gender were included as co-variates.

Result

The groups were well-matched in terms of socioeconomic status and education levels. As the alcohol group was significantly younger than the control group and dominated by females, age and gender were statistically controlled for. Alcohol users reported significantly higher levels of impulsivity (F1,41 = 6.0, p = 0.019) and sensation-seeking traits (F1,42 = 36.7, p < 0.001) and demonstrated normal sensitivity to monetary value (F1,41 = 1.07,p = 0.307). However, when challenged to on the MIR task to gain reward or avoid punishment, alcohol users were as equally motivated as control volunteers to take action to avoid financial loss (F1,41 = 2.6,p = 0.112) but showed less motivation to work towards financial reward (F1,41 = 4.7,p = 0.036). Especially for small rewards, alcohol users exerted significantly less efforts, as reflected by a reduced accuracy rate (F1,41 = 6.6,p = 0.014) and a significant increase in late responses (F1,41 = 7.7,p = 0.008). The lack of motivation to work for reward was negatively associated with the severity of alcohol use, as reflected by the AUDIT score (r=−.48,p < 0-05).

Conclusion

We observed reduced motivation to obtain financial reward, but not avoid loss in a community sample of heavy drinkers. As the observed effect was directly related to alcohol use severity, it may suggest changes in reinforcement sensitivity occur at an early stage of chronic alcohol use. Future research may want to monitor reward motivation in alcohol users longitudinally to evaluate whether it would be a suitable target for early intervention.
Inflammatory mechanisms of mental illness: brain inflammatory response to interferon stimulation
Authors: Herron James , Cavanagh Jonathan
Published: June 2021

Aims

We hypothesise that peripheral IFN stimulation results in a brain inflammatory response via pathways of neuroimmune communication which in turn results in sickness-behaviour and depressive phenotype. We aim to determine if peripheral IFN stimulation results in brain inflammatory response including upregulation of inflammatory cytokines and chemokines.

Background

There is increasing interest in the role of dysregulated immune function and inflammation in the pathogenesis of psychiatric disorders including mood disorders and dementias. Immune mechanisms offer a new approach to investigating mechanism in addition to offering hope for new avenues of treatment.

Interferon (IFN) therapy in humans is known to be associated with a significant risk of developing depression, both during therapy and increasing risk of relapse in the years following exposure, yet the mechanism remains unclear. IFN stimulation in animal models may offer insights into this phenomenon, in addition to furthering our understanding the role of immune mechanisms in the development of psychiatric phenotypes.

Method

Mice (n. 42) were exposed to either IFN-alpha, IFN-gamma or vehicle control using either osmotic pump or intraperitoneal injection over the course of 7 days. Mice were scarificed, brains were dissected and RNA extracted. Inflammatory gene transcription within the brain was determined using real time quantitative polymerase chain reaction (RTqPCR). Absolute quantification was achieved using standard curves and reference gene. Statistical significance was determined using Mann-Whitney or ANOVA/Kruskal-Wallis depending on normality of data and number of groups.

Result

IFNγ stimulation is associated with a significant brain upregulation of a number of inflammatory cytokines and chemokines including Il1β, Tnfα, Il10, Ifnγ, Ccl2, Ccl5, Ccl19, Cxcl10 and Ccr5. However, unexpectedly we did not find IFNα stimulation to associate with brain inflammatory transcriptional changes.

Conclusion

This work demonstrates a brain inflammatory response to peripheral IFNγ stimulation. The inflammatory profile, including upregulated chemokines, suggests that recruitment of leukocytes across the blood brain barrier may be part of the immune response. Further experiments using existing tissues will explore if there are structural/cellular changes within the brain parenchyma. Further experiments within the group will seek to demonstrate if IFN treatment associates with sickness behaviour in order to determine if this is a clinically meaningful model. Suprisingly, we did not see similar changes in the IFNα treated group, which requires further investigation.

Funding: University of Glasgow, The Sackler Trust
Stealth-vaping: a new era of illicit substance misuse? a systematic review and meta-analysis of the prevalence of electronic nicotine delivery systems for the consumption of illicit substances
Authors: Hicks Tim , Arrowsmith Rebecca , Keill Susannah , Papadakou Eleni
Published: June 2021

Aims

To estimate the prevalence of using Electronic Nicotine Delivery Systems (ENDS) for the consumption of illicit Substances (illegal under UK Law). We hypothesised that this is an increasingly common mode of delivery.

Background

Using ENDS to consume nicotine is increasing in popularity worldwide with a prevalence in the UK of 6% and in the USA 4%-6%. Existing studies have reported that people are switching to vaping because it is felt to be safer than smoking.

However there is also emerging evidence that this mode of consumption is increasingly being used as it is discreet and much less easy to detect, hence sometimes referred to as stealth-vaping. This appears to be driving a switch to vaping to administer substances other than nicotine, notably, but not exclusively cannabis, including concentrated forms of Tetrahydrocannabinol (THC) and synthetic cannabinoids. Anecdotally this practice is known to be occurring in psychiatric inpatient settings.

This is against a backdrop of the uncertain long-term effects of vaping and the emergence of case reports of the death of otherwise healthy young persons after using ENDS to consume cannabis.

Method

Search strategy: MEDLINE , EMBASE, Cochrane Database of Systematic Reviews, Grey Literature using Medical Subject Headings (MeSH), text words relating to vaping of drugs and hand searching journals.

Statistical methods: Synthesis of data was performed using inverse variance with double arcsine transformation in MetaXL. Heterogeneity was assessed with the Cochran's Q and I2.

Result

From 970 abstracts, 61 papers were selected for full text review, 18 met the inclusion criteria. The total study population for the outcome of ENDS nicotine users who also use ENDS for the consumption of illicit substances was 9098. There was significant heterogeneity with a random effects model prevalence of 17% (95%CI 7%-32%). The total study population for the outcome of cannabis users who use ENDS to consume cannabis was 52708. There was significant heterogeneity with a random effects model prevalence of 23% (95%CI 12%-37%).

Conclusion

The use of ENDS to consume illicit substances is concerning as it appears to be relatively common practice. This was most notable in studies of existing cannabis users, younger people and medical marijuana users.

Given the uncertainty of long term health consequences and poor understanding of sudden death in some users, this study highlights an emerging and substantial public health concern.

Currently there is a paucity of primary studies to elucidate the impact on health.
Post traumatic growth during COVID-19: unity in diversity
Authors: Lakha Meena Afzal , Bhowmik Anindya , Bisht Sneha , Shrestha Suzani , Gajanan Kantappa , Shah Samir
Published: June 2021

Aims

This poster reflects how the experience of staying with people of diverse nations and cultural background helped the stranded IMGs cope with this agony in a foreign land during an unprecedented tumultuous situation. The aim is to show that despite diversity among people, the hard times made them unite and overcome countless difficulties.

Background

The COVID 19 pandemic has been a period of global health crisis and has exponentially affected mental health issues in the world population. In these difficult times, several International Medical Graduates (IMGs), who had come to the UK to attend their PLAB exams, were left stranded as the exams were postponed, flights cancelled and borders sealed. Faced with huge uncertainty their mental health was of great concern.

At this time the British Association of Physicians of Indian Origin (BAPIO) came forward to help this cohort of stranded doctors in terms of accommodation, finances, mental health support, preparation for exams to the extent of liaising with General Medical Council (GMC) and Home Office. The virtual support group provided a platform for IMGs from different nations and cultures to get in touch with each other helping overcome mental burden and stress.

The stories presented in the poster show how unity in diversity helped these young doctors deal with mental trauma amidst the Pandemic.

Method

276 doctors from 27 countries were looked after by BAPIO. From those excerpts taken from 26 IMGs, personal narratives was used as a method for qualitative assessment.

The percentage of IMGs clearing their exams and getting jobs in the NHS has been used for quantitative assessment.

Result

Qualitative: The personal narratives of the IMGs show how they were positively impacted by staying together albeit different nationalities and cultural background.

Quantitative: A total of 21 IMGs out of the 26 cleared their PLAB 2 exams and got registration under General Medical Council giving a percentage of 81.7%. 20 IMGs have successfully joined the NHS in various posts giving a job success rate of 95.2%.

Conclusion

The experience of living and sharing housings with people from different nationalities, has increased appreciation and also prepared them to work in the NHS which has a diverse work force. This learning experience has been integral for all of us in shaping our life in the UK making everyone more compassionate.
Treatment of anorexia nervosa in young people with autism: a literature review
Authors: Karim Aneesa
Published: June 2021

Aims

The purpose of this review was to review existing literature relating to treatment of anorexia nervosa in young people with a diagnosis of autism. Hypothesis was that there would be a limited amount of literature in this age group.Previous research has suggested that there is over-representation of autistic traits in anorexia nervosa. There are implications for treatment outcomes for young people with anorexia nervosa and autism. Young people with autism may find it more difficult to engage in psychological treatments for anorexia nervosa, due to cognitive and behavioural inflexibility, or communication difficulties. Researchers are therefore looking at other options for treatment.

Method

This is a narrative review. Search was conducted in January 2020. Keywords used were “anorexia nervosa” combined with “autism” combined with “treatment”. Only published, peer-reviewed, full articles in English were included. Search of OVID (for MEDLINE, PsycINFO, EMBASE and ERIC databases) gave a result of 222 articles. 9 articles met the inclusion criteria. Search of CINAHL gave a result of 12 articles; 3 articles met the inclusion criteria but had been reviewed following OVID search.

Result

Themes identified for discussion were: cognitive remediation therapy; improving emotional identification; adaptations to communication; dietary, sensory and environmental considerations; recognising the role of autism; and pharmacological therapies.

Conclusion

Literature suggests that treatment targeting cognitive features, common to anorexia nervosa and autism, can be effective. There has been interest in the use of cognitive remediation therapy (CRT) and cognitive remediation and emotion skills training (CREST). However, more research is required in younger patient groups. Use of medication is in experimental stages, with studies considering a role for oxytocin from age 16. Qualitative studies provide information on modifications to treatment which could be helpful. The review highlights the need for a standardised, evidence-based treatment pathway for this patient group.
Attitudes of medical students towards choosing psychiatry as a career
Authors: Ahmad Mohammad , Dabbagh Marwan , Dabaliz Alawwab , Obeidat Akef
Published: June 2021

Aims

Our aim is to study factors influencing attitudes of medical students towards pursuing Psychiatry as a career. We hypothesise that the minimal exposure and/or importance given to Psychiatry during medical school is insufficient to let a student truly experience and appreciate the specialty.

Background

Studies report an annual decline in Psychiatry Trainees in many parts of the world. This deficiency is projected to create gaps between mental health service needs and providers. Studies have also explored the crisis in recruitment and the positive impact a short course can have in promoting engagement in Psychiatry by students.

Method

An anonymous questionnaire was distributed amongst medical students, from years 1 to 5, in the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Factors assessed in the survey included demographics, specialty ranking, acceptance ratios, role models and personal experiences, among others. Those who didn't express interest were asked about the lack of exposure to Psychiatry during medical school along with other influential factors that have been studied elsewhere, including those that we hypothesise to be of significance in our study population.

Result

A total of 153 students responded. Positive views towards Psychiatry increased linearly by year (50% in Year 1 to 90% in Year 5). 33% of students selected psychiatry as a top 3 choice with the most significant factors being a unique patient-doctor relationship (P < 0.05), and the challenges faced in the specialty (95%).

Of the 67% of students who did not prefer Psychiatry, insufficient exposure to ward experiences and the specialty as a whole were unanimously agreed upon factors. Other deterring factors included lack of instant gratification when treating a psychiatric patient (72%), and an underestimation by the non-medical community of a Psychiatrists role (26%).

Conclusion

Our findings give an optimistic view towards the future of Psychiatry in the region, given the large number of students (33%) who consider it in their top 3 choices for a career. However, a larger number of students continue to have a negative view towards Psychiatry, especially due to the lack of exposure to the specialty during medical school. The factors identified in our study should be tackled by medical schools or curriculum provision authorities, as this has shown to be of benefit in studies in other parts of the world.
Attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment
Authors: Kaur Darpan , Verma Rishab , Ghildiyal Rakesh
Published: June 2021

Aims

The aim of the study was to assess the attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.

The hypothesis of the study was there are significant problems in the domains of attitude and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.

Background

Parents are an important stake holder in child and adolescent psychiatry and mental health care service models. There is scarce literature from developing countries regarding attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.

Method

This study was conducted at the Child and Adolescent Psychiatry Clinic, Department of Psychiatry at a Tertiary Care Institution. Eligibility criteria comprised of parents of children and adolescents who had come for consultation. The parents were provided information of the study and those willing to participate were included in the study. A convenience sample of 100 parents was considered for the study. The parents were interviewed using a specially designed survey comprising 30 questions with Yes/No response developed by the authors for the purpose of the study. Informed consent and Institutional Ethics Committee Clearance was obtained. Data were analysed using SPSS.

Result

We found that the majority of parents were from urban area (72%) and mothers comprised 68%. We found that 46% of parents did not want a psychiatric diagnosis and 35 % parents felt stigmatized for seeing a psychiatrist for their child. Sixty nine percentage of parents preferred counseling as the first line of treatment and 31% preferred medicines as the first line of treatment. We found that 33 % felt additional psychological tests could be useful and 54% of parents felt brain imaging and blood tests could be useful for their child. Majority of parents expected basic improvement for their child within 1 week(32%) and expected full improvement by 1 month(82%). Fifty three percent of parents had searched online information prior to consulting and found useful information. However, 38% of the parents felt confused after reading online information and 69 % of parents were more worried about giving medications after referring online information.

Conclusion

Our study provides useful key insights from parent's perspective in child and adolescent psychiatric services. Implications exist for future research as well as policy perspectives on the role, attitudes and expectations of parents as vital stake holders in child and adolescent psychiatry.
Transient musical hallucinations in a young adult male associated with alcohol withdrawal
Authors: Lim Mao , Blackman Graham , David Anthony , Mannan Fahmida
Published: June 2021

Aims

We present the case of a 25-year-old male who presented to A&E with isolated musical hallucinations, in the absence of audiological or neurological disease.

Background

Musical hallucinations (MH) are a form of complex auditory hallucinations whereby an individual experiences an instrumental and/or vocal melody in the absence of auditory stimuli.

Result

The patient had a history of recreational drug use and a family history of psychosis. Hallucinations, which were preceded by discontinuation of alcohol and re-initiation of citalopram for depression, resolved spontaneously after three days.

Conclusion

Aetiological factors are discussed alongside the existing literature. Whilst the underlying mechanisms underpinning musical hallucinations remains elusive, the case illustrates the potential role of alcohol withdrawal, serotonin toxicity, recreational drug use and genetic vulnerability.
Autism in girls and the pre-referral environment
Authors: Nussbaum Peter
Published: June 2021

Aims

This literature review sought to identify and highlight any sex specific factors in the diagnosis of autism spectrum conditions during the pre-referral period which might affect diagnosis rates in ASD in girls. The null hypothesis was that there are no sex specific factors that affect referral and diagnosis of ASD in girls.

Background

Historically, boys are diagnosed with ASD more than girls but rates vary depending on clinical population characteristics. Diagnosis trends continue to demonstrate a large male excess. The concept of autism as a predominantly male condition has been challenged and there is increased focus on females with high functioning autism who are not being detected as easily.

Various theories exist as to why this is the case.

There are high rates of suicidality in ASD and risk of death by suicide is higher in ASD women (the reciprocal of the suicide rates in general population where more men complete suicide). Women with high functioning autism represent an at risk group. Undetected autism in females may be complicated by ‘camouflaging’ or masking of symptoms which puts a large strain on individuals functioning and mental health. Costs to society and the individual are large.

However, early identification and intervention improves outcomes such as activities of daily living and social behaviours.

Method

An electronic literature search was completed using MEDLINE, PsycINFO and EMBASE in November 2018. Key terms were: (‘child*’ OR ‘adolescent’ OR ‘young pe*’) AND (‘ASD’ OR ‘autism’ OR ‘asperger*’ OR ‘high functioning*’ OR ‘PDD’ OR ‘Pervasive developmental*’) AND (‘girl*’ OR ‘sex’ OR ‘gender’). Papers were excluded on a number of grounds.

Result

11 papers were included in the review from an initial 2823 abstracts.

Conclusion

A number of papers highlighted important learning points. Some of the more original conclusions included that we require more studies comparing populations of girls with ASD to high risk, high functioning girls and female controls to clarify features particular to the ‘female phenotype’. Delays in diagnosis in girls appears to pre-date assessment so further thought on how to educate and support referral sources (caregivers and schools) on how to identify girls with autism is recommended and would be informed by further research focus on the previous point. Active case ascertainment should be considered in future research and follow-up of girls who do not receive a diagnosis at initial assessment were additional learning points that came from the review.
Towards peak experience - exploring the influence of wilderness on conscious awareness
Authors: Purnell Oli
Published: June 2021

Aims

This study examines what effect wilderness has on our conscious awareness, and by extension of that meta-cognition; our physical, mental and spiritual health. It reviews available scientific and artistic literature and integrates this with interviews in order to generate original grounded theory. It was found that intensity of wilderness experience varied proportionally with four mediators; Challenge, Immersion, Beauty and Time. With these maximised, experiences broadly within four themes occurred; Increased Awareness, Confidence, Perspective and Connectedness. When sufficiently intense, these four experiences amalgamated to elicit what Maslow described as 'Peak Experience'. As such, this thesis unexpectedly provides a pragmatic recipie towards peak experience, and a map of one's potential psychological journey, in the context of wilderness.