bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining the Levels of Violence in Mental Health Trusts
Authors: Dinkel Charlotte , Hassanally Khalil
Published: June 2022

Aims

A recent NICE report stated that there were 68,683 assaults reported by NHS staff between 2013 and 2014. 69% of these were in the mental health or learning disability setting. We sought to explore the number of violent incidents within mental health trusts across England and to understand whether the levels of violence against staff have increased, decreased, or remained the same between the years 2014 to 2019. We also looked at whether a change in bed numbers correlated with the levels of violence experienced.

Methods

Mental Health Trusts in England were identified, and Freedom of Information requests were sent to them. We asked for the numbers of sexual and physical violence between the years 2014 and 2020, broken down by outpatient and inpatient setting. Using bed data from NHS England we looked at whether there was a correlation with violence.

Results

Out of the 53 trusts we approached with freedom of information requests, 43 returned responses with data that could be used for analysis. Data sets were often incomplete, especially for the earlier years requested. The total number of violent incidents from the 43 trusts was 24,393, in the year 2014. There was an increase to 37,907 by the year 2019, which may, in part, be explained by more complete data. Over the same time period, there was a decrease in bed numbers. Average number of episodes of violence per bed increased over 2014 to 2019 from 2 to 2.5, but the increase was not statistically significant. From our data, a correlation between the decrease in bed numbers and increase in rates of violence cannot be drawn.

Conclusion

The high number of violent incidents within the mental health setting remain troubling, particularly when taking into account that this analysis represented only a partial data set. This limitation, together other data robustness issues, including the probability of under reporting by staff mean that firm conclusions cannot be drawn. This remains an area where urgent further research is needed, both to identify the extent of the problem, and to probe the impact violence has on staff and patients.
Transcranial Direct Current Stimulation in the Treatment of Post-Laminectomy Syndrome: A Clinical Trial
Authors: Faria Fernanda , Oliveira Marília , Júnior Demosthenes , Olmos Ana , Cosmo Camila , Filho Gerardo
Published: June 2022

Aims

To evaluate the effectiveness of Transcranial Direct Current Stimulation (tDCS) in treatment of post-laminectomy syndrome.

Methods

Twenty-four patients were randomized in three groups to receive active or sham anodic stimulation (1.5 mA, 20 minutes for five consecutive days, with 25cm2 electrodes) in two different areas (primary motor cortex (M1) vs. dorsolateral prefrontal cortex (DLPFC), according to lateralization of pain. Brief Pain Inventory (BPI) and Visual Analogue Scale (VAS) were instruments used to assess pain, while Clinical Global Impression Scale (CGI) was applied to measure severity disease and clinical response. Additionally, the quality of life assessment was based on World Health Organization Quality-of-Life Scale (WHOQOL-BREF). In order to identify psychiatric comorbidities, Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) tests were applied. Comparisons between groups were performed using one-way ANOVA, ANOVA-Welch, Kruskal-Wallis, Man-Whitney, and Fisher's test.

Results

It is observed that there was a statistically significant difference (difference 0,15† [95% CI, 7,07 ± 1,39]) in the way individuals assess their quality of life and the improvement in pain intensity by VAS, especially in M1. The assessment of quality of life among those who showed improvement was higher than those who did not improved.

Conclusion

Application of tDCS in primary motor cortex (M1) produced an improvement in pain pattern in patients with post-laminectomy syndrome. Our data suggest that tDCS - a low-cost, technically simple and highly tolerable technique, is a promising technique for management chronic pain in disorders such as post-laminectomy syndrome.
Development of a mHealth Intervention (TechCare) for First Episode Psychosis: A Focus Group Study With Mental Health Professionals
Authors: Gire Nadeem , Mohmed Naeem , McKeown Mick , Duxbuy Joy , Husain Nusrat
Published: June 2022

Aims

Research in the area of mHealth, has shown much promise in the development of mobile phone interventions which look at the assessment and treatment in real-time of psychiatric disorders. Within the context of Severe Mental Illnesses (SMI), such as psychosis, communication and understanding between health professionals and service users in the reporting of distress and reoccurrence of symptoms is essential in reducing the chances of relapse. An alternative pathway which uses mobile technology to engage with services, may hold the key to gaining a deeper understanding of the lived experiences of those with mental health difficulties, in particular experiences of recovery from SMI's. AIM: The aim of the study was to explore the perspectives and opinions of health professionals on the development and refinement of the TechCare App for psychosis. A qualitative approach was adopted for data collection, which provided an understanding of factors in relation to the development of the intervention.

Methods

A total of two focus groups were held with health professionals to elicit their views on optimising the utility of the TechCare App. The total sample size for the focus groups was n = 16 with a total of 6 males and 10 females. This qualitative study was part of a feasibility study, investigating a novel intervention (TechCare) (Husain et al., 2016; Gire et al., 2021) which monitored participants symptoms and provided a tailored psychosocial response in real-time. Data obtained from the focus groups was transcribed. Framework analysis were used to analyse the data for emerging themes, focusing on feasibility, acceptability and further development.

Results

The key themes that emerged from the data were; access and usage of digital technologies, implications for clinical practice, challenges & barriers to delivery and development and refinement considerations for the TechCare App.

Conclusion

Results of the focus group with health professionals provided a unique perspective of conducting mHealth research within an EIS context, and the differing challenges professionals anticipated facing in delivering the TechCare App intervention. The main finding of the focus group was that professionals saw the potential for the TechCare App to increase access to digital technologies, providing service users with an alternative medium to communicate with EIS health professionals. However, the participants felt that despite mHealth Apps being a useful platform to deliver interventions, face-to-face contact should remain an important aspect of routine care.
Breast Feeding Experiences of NHS Staff Returning to Work From Maternity Leave: A National Study
Authors: Hearfield Hollie , Collier Jennie , Paize Fauzia
Published: June 2022

Aims

Anecdotally, NHS staff feel unsupported in breastfeeding when returning to work from maternity leave. The NHS provides clear guidance to employers about provisions required for breastfeeding employees (clean lockable room, adequate time, clean fridge). We aimed to establish if these provisions were provided for NHS staff, and to further explore the difficulties reported.

Methods

We conducted a pilot study of NHS doctors, exploring their experiences of feeding on returning to work. The results highlighted difficulties for many of the 519 cases. We extended the study to encapsulate the experiences of all NHS professionals.

The survey was distributed via various professional social media accounts.

Results

We received 1201 responses.

•

79% of women were breastfeeding when they returned to work. 59% wished to continue on return.

•

78% of women were unaware of the local breastfeeding policy. Of those that were, only 7% were informed of the policy by their employer.

•

90% of women were unaware that they needed to inform their employer of their intention to breastfeed.

•

Only 6% of women had a breastfeeding risk assessment on their return to work.

•

Basic requirements were not consistently met (50% did not have access to a lockable room, 51% to a fridge, 69% to adequate time).

•

55% were interrupted whilst expressing.

•

23% of women expressed in changing rooms; 32% in toilets; 25% in their cars; 15% in cupboards.

•

88% of women did not have their duties adapted. 91% regularly held the bleep whilst expressing.

•

52% of women reported embarrassment and humiliation at work. 60% reported stress directly due to their difficulties expressing, with a further 15% experiencing mental health problems. 10% of women felt their experiences negatively affected their bond with their child.

Conclusion

Only 1% of UK mothers continue to breastfeed at six months. There is a huge NHS drive to improve this statistic. 76.7% of NHS staff are women. These women are also NHS patients. NHS breastfeeding guidelines are not being consistently followed within the organisation. There is a direct impact on mother and child, and on patient care.

We must support our NHS family, create a positive breastfeeding culture, and lead UK change.

“I was ridiculed… it set me apart from my colleagues.”

“Resigning was my only option.”

“Subject to eye rolls and whispers… rude, unsupported and unkind.”

“He unlocked the door and walked in while I shouted “stop”.”
What Does Current Literature Tell Us About the Mental Health of Looked After Children?
Authors: Herwig Katie
Published: June 2022

Aims

Looked after children (LAC) are one of the most vulnerable groups in our society. Often, after experiences of neglect and abuse, they are more likely to experience poor mental health, attachment difficulties and problems in educational progress. This review aims to explore literature published over the past decade which addresses the mental health needs and management of LAC within CAMHS in the UK.

Methods

A literature review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 structure. Selection criteria was used. The total number of papers identified after this initial search was thirty-six across the database.

Literature titles and abstracts were then screened to exclude papers with an irrelevant focus. Full-texts of the remaining twenty-two papers were then assessed for relevant and conclusive information. The total number of full papers included in the research was thirteen.

To analyse the literature identified, a framework of three themes has been highlighted. These include:

•

the mental health needs of LAC,

•

factors relevant to the assessment of LAC in mental health services

•

considerations associated with the management of LAC with mental health conditions.

Results

Mental health needs of LAC included numerous emotional, behavioural and social problems. These were largely focused around substance misuse, emotional disorders and poor relationships with peers.

The main themes which have come out of research in relation to the treatment of LAC include:

•

the importance of supporting healthy social relationships with primary care-givers, peers and teachers

•

maximising the informal support of family, friends and pets

•

the provision of early, holistic and flexible mental health services, rather than disjointed agencies

Conclusion

The literature published over the past decade has indicated the great number of adverse outcomes amongst LAC and has made useful suggestions for the assessment and treatment of these children within a CAMHS setting.

Through targeted support into residential placements, offering intensive and direct psychological input at an early stage and continuing even after they have been adopted, as well as, working alongside schools to promote peer interaction could significantly reduce the adverse outcomes of LAC.

Additionally, by referring patients along with their carers for psycho-education can be extremely beneficial. Alongside this, the young people ought to be directed to support groups with other LAC to meet peers who are in similar situations as themselves.
Service User Involvement in Recovery-Oriented Care Planning: A Realist Synthesis
Authors: John Thomas , Billings Jenny , Wilson Patricia
Published: June 2022

Aims

Service user involvement (SUI) in recovery-oriented care planning (ROCP) warrants more sophisticated theorisation and explanation to support practice improvement. This study investigated which changes to practice work best, in what circumstances, and to what extent, to embed an active role for service users’ involvement in ROCP during the acute inpatient mental health care pathway.

Methods

A realist synthesis, combined with qualitative methods, was conducted to theoretically explore the causal mechanisms that underlie SUI in ROCP and how contextual factors influence the link between these causal mechanisms and outcomes. The study was conducted in three stages: theory-gleaning, theory-refinement and theory-consolidation. Initial programme theories were developed in the theory-gleaning stage. Theories were refined iteratively in the theory-refinement stage, using evidence from a realist review and interview data. With stakeholder involvement, refined programme theories were finely tuned using ‘if-then’ statements in the consolidation stage.

Results

Five programme theories relating to the acute care pathway were identified following the realist synthesis:

1)

‘Provider-controlled care transition’ (admission to acute inpatient mental health units), referring to limitations to service users’ active involvement. The focus of care and access to acute inpatients units should be needs-led, rather than resource-led or demand-driven;

2)

‘Care plan as a recovery tool?’ – addressing infrastructural and organisational limitations to active SUI in care-plan formulation. The use of multidisciplinary meetings as a forum for care-plan formulation can create a cohesive approach and facilitate shared ownership;

3)

‘Ward rounds as a non-inclusive arena for shared decision making’, highlighting their unfulfilled potential for shared decision making about treatment. Professionals should focus on preparing service users for the ward-round process. Opportunities and access for service users to build therapeutic relationships with treating doctors are vital components;

4)

‘Peer support worker intervention' as a key factor in service users’ recovery’, concerning their positive impact. Their presence in ward rounds and care-planning meetings might create a more user-friendly atmosphere for service users; and

5)

‘Provider-controlled care transition’ (discharge from acute inpatient mental health units), increasing focus on preparing service users for transition into the community, and constraints on resources should not dictate or anticipate decisions on discharging service users.

Conclusion

The study identified practices required to embed an active role for service users to be involved in ROCP, namely multi-contextual interventions at various levels (macro, meso and micro) of the mental health system. The study uncovered barriers that restrain SUI in ROCP, impacting desirable outcomes.
Insight to Psychological Aspects of Cancer
Authors: Kunhikkandy Ashkar Ali
Published: June 2022

Aims

The baseline of this study

1)

What is the type of psychiatric disturbances in oncology settings?

2)

Is there any importance in cancer education?

3)

How to manage psychiatric disturbances?

Methods

As of lockdown concerning COVID-19, this study is conducted online among 20 cancer patients. This is a cross-sectional study where Each patient has explained the purpose of the study, procedures, and consent was taken from patients then a questionnaire was given, and this was assessed. Among the profile of the study population, 50% were males and 50% were females of the total study population, 60% were married and 40% were unmarried, Participants were aged between 22 and 63 years. The study population also consists of 20% are breast cancer, 25% lung cancer,10% lung cancer, and the rest are other types of cancers. Patient details are collected from the Facebook groups for cancer patients. Assessment has 2 parts, one is based on CES-D Test where each individual was each patient answered 20 question and next part is based on 5 questions regarding Financial Depression, Behavioral changes, Feelings, Education about cancer and Psychiatric support.

Results

It is found that 60% population are normal, 25% had mild Depression, 10% have moderate Depression followed by 5% with severe depression.

Among associations between marital status and various disorders, it was found that psychological disturbances are 2 times fold more in married people while compared to unmarried. There is also an association between treatment modalities are observed, in that anxiety is prevalent with people who had chemotherapy. Based on education and financial status, those who are with less education about cancer and less financially stable have also prominent disturbances.

Conclusion

The study was based on other research study related to the spectrum of psychological disturbance based on treatment stage, financial status, awareness of cancer among patients, and role of marital status among individuals Offering mental health services to patients with cancer is becoming an integral part of oncologic treatments because psychological problems harm cancer management. The most common psychiatric disorders in cancer patients are depression, anxiety disorders, and adjustment disorders. Psychiatrists should be involved in the multidisciplinary treatment team that works with cancer patients. Further research is needed to determine the effectiveness of different psychological and psychopharmacological interventions in psycho-oncology and palliative medicine
Journey From Acute In-Patient to Community-Based Mental Health Rehabilitation: Outcome of Ayu-Psychiatry Care Initiative
Authors: Sharma Neha , Voegeli Maël , Joshi Venkata , Lakshmanan Skanthesh
Published: June 2022

Aims

In developing countries specially in sub-urban or rural areas, most patients with psychiatric crisis phase don't access intensive care. In India, AYUSH system of medical care is widely used, including crisis resolution and community treatment. However, evidence to support their effectiveness has remained very low. Present study is designed as community based participatory research, where Ayurveda management from acute in-patient care to a community-focused treatment and rehabilitation was studied.

Methods

In this evaluation study, we trace the journey of Ayu-Psychiatry Care project, set up as community based mental health rehabilitation program in rural and sub-urban areas of Rajasthan, India, from acute in-patient care to a community-focused treatment and rehabilitation.

Results

While receiving Ayu-Care and promoting early treatment and rehabilitation, community-based treatment demonstrated considerable improvement in maintaining family relationships and employment. Increased treatment adherence, improved self-efficacy, and reduced stigma were all made possible because to this community-based strategy.

Conclusion

The connection between UK and Indian organisations is also explored during the journey. The findings of the study and the principles of long-term international cooperation are laid out by the authors.
Psychosis and the Dissonance in the Doctor-Patient Relationship; a Thematic Analysis
Authors: Lawton Aimee
Published: June 2022

Aims

Within psychiatry, relationships between doctors and patients with psychosis are significant determinants of attitudes, adherence, and therapeutic outcomes. Current research focuses on communication within psychiatrist-patient interactions with limited evaluation of the patient's perspective. Understanding the components underpinning the patient's relationship with their doctor could help improve outcomes for individuals with psychosis.

Methods

Eight participants, recruited through advocacy programmes, were interviewed. All had a diagnosis of psychosis or its subtypes. Interviews lasted between forty and eighty minutes. Thematic analysis of semi-structured interviews allowed exploration of important themes within doctor-patient relationships. Ethical procedures were implemented in accordance with British Psychological Society guidelines.

Results

Participants’ narratives identified three salient themes perceived to influence doctor-patient relationships. Participants explored ‘Interactions with Medical Professionals’, focusing on communication and discussion styles. Doctors were not perceived as empathic, open listeners, reducing trust and limiting conversation during interactions. Participants described reduced engagement due to perceived misunderstanding and highlighted the impact of time constraints, guidelines, and limited medical training on relationships.

Secondly, participants discussed the ‘Diagnostic Process’, suggesting it had a negative influence on the relationship due to delivery methods.

Finally, participants explored ‘Treatment’, highlighting an overwhelming reliance on medication, lack of explanations, and lack of psychological therapies, which contradicted with patients’ preferences.

Conclusion

The narratives describe a relationship in which patients feel misunderstood, furthering patient disengagement and resulting in a vicious cycle of dissonance that limits health outcomes. Findings suggest a need to incorporate psychological therapies into doctor-patient interactions to allow increased communication and understanding.
Why Should ACT Work When CBT Has Failed? a Study Assessing Acceptability and Feasibility of Acceptance and Commitment Therapy (ACT) for Paediatric Patients With Chronic Fatigue Syndrome/myalgic Encephalomyelitis (CFS/ME)
Authors: Leveret Jamie , Starbuck Jen , Chapple Kate , Gubb Sam , Kwuo Hannah , Burge Sarah , Li Morain , Clery Philippa , Crawley Esther
Published: June 2022

Aims

Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) effects 0.5–3.28% of children. NICE guidance recommends Activity Management, Graded Exercise Therapy or Cognitive Behavioural Therapy for fatigue (CBT-f). Approximately 15% of patients do not achieve full recovery within one year with current treatments. Acceptance and Commitment Therapy (ACT) is an effective treatment in many chronic illnesses. There are no studies investigating ACT for paediatric CFS/ME. This feasability study aimed to assess if ACT is a feasible and acceptable alternative treatment when current treatment has not led to recovery.

Methods

This feasability cohort study aimed to enrol a minimum of 12 participants aged 11–18 yearswith CFS/ME attending the Royal United Hospitals Bath NHS Foundation Trust Specialist Paediatric CFS/ME Service, who were still symptomatic after 12 months or 12 sessions of standard treatment and were offered six to 12 sessions of ACT. Retention and recruitment data were analysed. Participants were asked to complete questionnaires before, during and after treatment. A selection of participants and their parents were interviewed about their experience of the study. Interviews were analysed using thematic analysis.

Results

19 participants (95% of those approached) were recruited. Only 4 participants of this hard-to-reach group did not complete treatment.

In almost all sessions participants reported that they felt ‘totally’ listened to in post session questionnaires (31/33 sessions).

Preliminary interviews (n = 12) indicate acceptability of ACT, with all young people and their parents stating that they thought ACT should be offered to this population. Participants particularly commented that the absence of thought challenging (used in CBT-f) was a positive element of ACT. Participant's openness to try new approaches and altruistic desire to be in a study was noted.

Conclusion

Recruitment data indicate that it is feasible to recruit and retain 11–18-year-olds with CFS/ME to a study offering ACT. Interviews with participants and parents were broadly positive suggesting ACT is an acceptable treatment in this population.

Results indicated that it is both feasible and acceptable to offer ACT to 11–18-year-olds with CFS/ME using this protocol, supporting the prospect of an RCT in this area.
Examining Grey Matter Structural Abnormalities in Young People Exposed to Childhood Maltreatment and Peer Victimisation
Authors: Lim Lena
Published: June 2022

Aims

Early-life interpersonal stress, particularly childhood maltreatment (CM), is associated with neurobiological abnormalities. However, few studies have investigated the neural effects of peer victimisation (PV). This study examines the common and specific associations between CM, PV and brain structural alterations in healthy youths.

Methods

Grey matter volume (GMV) and cortical thickness (CT) data were collected from 105 age-and gender-matched healthy youths (34 CM, 35 PV and 36 controls). Region-of-interest (ROI) and whole-brain analyses were conducted.

Results

For the ROI, the CM group had smaller GMV than controls in left IFG, bilateral anterior insula, postcentral and lingual regions, which were associated with higher emotional abuse, along with smaller insular GMV than the PV group. The PV group had smaller left lingual GMV than controls, which was positively associated with age of bully onset. At the whole-brain level, both CM and PV groups had smaller GMV than controls in a cluster comprising left post/pre-central, inferior frontal, insula, superior parietal and supramarginal gyri. The PV group alone had increased CT in a cluster comprising left superior frontal, anterior cingulate and medial orbitofrontal gyri, which was related to greater cyberbullying.

Conclusion

Early-life interpersonal stress from carers and peers is associated with common structural alterations of the inferior frontal-limbic, sensory and lingual regions involved in cognitive control, emotion and sensory processing. The findings of a CM-specific reduced anterior insular GMV and a PV-specific increased CT in the left medial prefrontal cluster is intriguing and underscores the unique negative effects of CM and PV, particularly cyberbullying.
A Case-Control Study Measuring Mentalization in Individuals With PTSD Compared to Controls Using the STOMP Task
Authors: MacInnes Poppy , Wiseman Chantelle
Published: June 2022

Aims

Social cognition is impaired in a variety of psychiatric conditions; evidence for impairment in individuals with PTSD is increasing. Mentalization is one domain of social cognition that refers to the capacity to understand other people by ascribing mental states to them. The STOMP task (Spontaneous Theory of Mind Protocol) involves an individual watching two minutes of a silent video and describing what they see. As part of a wider project examining social cognition in PTSD, we aimed to find out whether mentalization in the STOMP task differs between patients with PTSD compared to controls.

Methods

171 individuals undertook the task: 30 patients were recruited from centres in Cardiff and Bristol at the start of their psychological therapy; 141 controls were recruited through Prolific website. Participants watched a 2-minute silent video and were asked to write 7–10 sentences about the clip. Qualtrics software selected the video and collected the texts. The verbs of the texts were coded and given a score by PM using the Mental-Physical Verb Norms (MPVN) method. MVPN was developed by Orr et al. 2019, to give a value to 250 commonly used verbs based on their mental or physical attributes (the higher the value, the more ‘mental’ the verb). The total score of each text was divided by the number of verbs scored to produce an average that reflects how much mentalization was used. An unpaired t-test was used to calculate the significance in difference between the means of the two groups.

Results

The overall average score of individuals with PTSD was higher than the controls (38.5 vs. 33.5, p value 0.0047). The median score of individuals with PTSD was 37.95 compared to 31.60 with an actual difference of -6.350 and a Hodges-Lehmann difference of -4.650. These results do not support the hypothesis that mentalization is impaired in patients with PTSD.

Conclusion

This case-control study suggests that mentalization could be enhanced in patients with PTSD compared to controls. These results should be interpreted as part of a wider project being undertaken on the topic of social cognition in PTSD. Further studies with more participants from the population of interest and larger sample sizes could produce more reliable results, together with an expansion of the number of verbs coded in the MPVN method.
Exploring Mental Health Patient's Perceptions and Aspirations in Employment
Authors: Melvin Holly , Akinola Adeola
Published: June 2022

Aims

To explore mental health in-patient's perceptions and aspirations in employment and to produce a lay document on employment

Methods

Employment is beneficial, it improves mental health and betters social integration. Different interventions exist to support mental health patients into employment. However, patients experience many obstacles, including the characteristics of their condition and stigma.

Literature review was undertaken, using a search string on PubMed focusing on mental health and employment.

Developed and used a 17-question questionnaire exploring patients’ perceptions and aspirations in employment

Created lay document containing information on benefits of employment, employment rights and accessing employment.

Results

100% of patients interviewed were interested in employment. 90.9% believed employment would improve their mental health and 100% believed it would improve their connection to their community. 100% felt there is a stigma around mental health problems which makes finding employment harder.

Conclusion

The barriers mental health patients seeking employment face are varied and complex. Most wish to seek employment, and should be encouraged, as the health benefits are clear. Professionals need to acknowledge individual barriers patients face including different mental health characteristics, ethnicity, gender and personal circumstances and find a way to create a bespoke service tailored to patients’ needs in order to secure employment.
The Impact of the COVID-19 Pandemic on the Incidence of First Episode Psychosis in South London
Authors: Meyer Zeryab , Azlan Aryn , Spinazzola Edoardo , Quattrone Diego , Murray Robin
Published: June 2022

Aims

Transmission of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic. Many studies are underway to ascertain the mental health impact of this seismic event, however no study has investigated its effect on psychosis incidence. We hypothesise that the overall crude incidence rates of first episode psychosis (FEP) will be higher during the pandemic when comparing the same area of South London in defined pre-pandemic and pandemic time periods.

Methods

Clinical records for all patients aged 18 to 64 years presenting to early intervention in psychosis services in the London boroughs of Southwark and Lambeth between July 1st 2019 to December 31st 2019 (pre-pandemic period) and July 1st 2020 to December 31st 2020 (pandemic period) were extracted from the Clinical Record Interactive Search (CRiS), an online database containing anonymised patient records. All patients were manually screened using the Screening Schedule for Psychosis to confirm FEP, with 104/235 cases meeting criteria for FEP in the pre-pandemic period compared with 158/376 in the pandemic period. Crude, age-standardised, and sex-standardised incidence rates and ratios were calculated for interpretation.

Results

The crude incidence rate of FEP was significantly higher in the pandemic period (68.3, 95% CI:[57.6 ; 78.9]) than the pre-pandemic period (44.9, 95% CI:[36.3 ; 53.6]). The crude incidence ratio was 1.52 (95% CI:[1.28 ; 1.77]), indicating that the overall crude incidence of FEP in the pandemic period was significantly higher (52%) than in the pre-pandemic period. The directionality and statistical significance of this ratio was unperturbed by standardisation for age (SIR = 1.45, 95% CI[1.23 ; 1.70]) and sex (SIR = 1.56, 95% CI[1.33 ; 1.83]).

Conclusion

Our results suggest that the COVID-19 pandemic has had a significant impact on the incidence of FEP in the South London boroughs of Southwark and Lambeth. Further research is required to elucidate the factors contributing to this increase to inform targeted interventions and prevent deterioration in at-risk patients.
Frailty in Individuals With Mental Disorders: Longitudinal Analyses of All-Cause Mortality
Authors: Mutz Julian , Dregan Alexandru
Published: June 2022

Aims

Frailty is a medical syndrome that is strongly associated with mortality risk, and an emerging global health burden. Mental disorders are associated with reduced life expectancy and elevated levels of frailty. In this study, we examined the mortality risk associated with frailty in individuals with a lifetime history of mental disorders compared to non-psychiatric controls.

Methods

The UK Biobank study recruited >500,000 adults, aged 37–73 years, between 2006–2010. We derived the two most common albeit distinctive measures of frailty, the frailty phenotype and frailty index. Individuals with lifetime depression, bipolar disorder or anxiety disorders were identified from multiple data sources. The primary outcome was all-cause mortality. We have also examined differences in frailty, separately by sex and age.

Results

Analyses included up to 297,380 middle-aged and older adults with a median follow-up of 12.19 (IQR = 1.31) years, yielding 3,516,706 person-years of follow-up. We observed higher levels of frailty in individuals with mental disorders for both frailty measures. For key comparisons, individuals with a mental disorder had greater all-cause mortality hazards than their controls. The highest hazard ratio (3.65, 95% CI 2.40–5.54) was observed among individuals with bipolar disorder and frailty, relative to the non-frail controls.

Conclusion

Our findings highlight elevated levels of frailty across three common mental disorders. The increased mortality risk associated with frailty and mental disorders represents a potentially modifiable target for prevention and treatment to improve life expectancy.
How Does an Observational Assessment Adapted for Online Delivery Perform Compared to an In-Person Assessment? Learning From the National Autism Service for Adults
Authors: Blackmore Charlotte , Nolan Alexandra , Stoencheva Vladimira , Greenwood Natalie , Liu-Thwaites Natasha , Maltezos Stefanos , McAlonan Grainne
Published: June 2022

Aims

The National Autism Service for Adults receives over 600 referrals annually and with an extensive waitlist, COVID-19 restrictions on in-person assessments were a challenge for service delivery. We aimed to adapt the Autism Diagnostic Observation Schedule (ADOS) for online delivery and investigate whether it is comparable to the in-person ADOS in predicting Autism Spectrum Disorder (ASD) diagnostic outcome. We also aimed to obtain qualitative feedback from service users and clinicians regarding experiences of the online ADOS.

Methods

A working group of staff who administer ADOS and representatives from psychiatry, psychology and management reached consensus that an online version of ADOS module 4 was feasible based on experience that a lot information required for coding is obtained verbally and some tasks were adaptable for online delivery. After the pilot, it was agreed all algorithm items could be coded except ‘unusual eye-contact’. Subsequently, 163 service users attended an online ADOS between August 2020 and February 2021. A matched-comparison group consisted of 198 service users seen for an in-person ADOS between May 2014 and February 2020. Algorithm scores were recorded and ASD diagnosis was made by a trained clinician. Qualitative feedback regarding the online ADOS was collected from 46 service users and 11 clinicians.

Results

The working group agreed the online and in-person ADOS were closely matched regarding administration and coding. Mean scores for service users who received an ASD diagnosis were comparable for the online and in-person ADOS groups (7 and 8 respectively). This was also shown for those who were not diagnosed with ASD (3 and 4 respectively). A two-sample t-test showed no significant difference in total scores between the online and in-person ADOS (p = 0.38). Qualitative feedback suggested good service user and clinician satisfaction; only 27% of service users indicated they would have preferred an in-person assessment; 88% of clinicians reported there were gains from offering an online alternative. Although the online and in-person ADOS perform similarly, clinicians reported relying more on qualitative reports over scores from the online version to inform diagnostic decision.

Conclusion

To our knowledge, this is the first study to examine using an online ADOS within an adult diagnostic service. Due to its comparable performance, the online-ADOS is a viable alternative option for service delivery when in-person assessments are not possible. As this clinic group has high rates of comorbid mental health difficulties, the applicability of online assessments could generalise to other services and have an impact beyond the pandemic.
Digital Phenotyping Methods to Measure or Detect Social Behaviour in Patients With Serious Mental Illness (SMI): A Systematic Review. a Closer Look at Bipolar Disorder
Authors: Pandey Samyak , Azlan Aryn , Gillett George
Published: June 2022

Aims

To provide a fresh insight into the extent digital phenotyping methods have been employed to measure or detect social behaviour in patients with SMIs; with a closer look at those used in Bipolar Disorder (BD); to give findings on the validity, reliability, acceptability and tolerability of these digital phenotyping methods.

Methods

Using specified search terms relating to digital phenotyping metrics and terms related to SMIs, a thorough literature search strategy for studies was employed across the following electronic databases: PubMed, Embase, and PsychINFO - from inception to July 2021.

Included studies employed digital phenotyping methods, collecting either passive, active or mixed-modal data, which in principle reported metrics representing social behaviour on patients with an SMI. Here we present a preliminary analysis of studies reporting results for patients with BD, with a particular focus on tolerability and acceptability.

Results

Of 4,646 records initially screened, a subgroup of 9 studies (n = 474) directly focusing on patients with BD are reported here. Across the studies, we find a modest adherence rate towards these applications by patients, ranging from 72.6% to 89.2%. Methods used by the studies include the frequency of phone calls and text messages, and self-reported and observer ratings of social and interpersonal functioning. The collection of such digital phenotyping data appears tolerable and acceptable to participants with BD, with patients reporting them to be supportive and only mildly intrusive.

Conclusion

Our preliminary analysis suggests that digital phenotyping of social behaviour may be acceptable and tolerable to participants with Bipolar Disorder. In an increasingly digital world, digital phenotyping methods of social behaviour may assist physicians with clinical assessment and prediction of clinical outcomes including relapse. Future analyses will assess the reliability and validity of the data that such methods yield, and their potential therapeutic value.
An Observational Study of the Mental Health Burden in Frail and Elderly Patients
Authors: Shanthakumaran Yathorshan , Rasheed Reshma , Patel Anjali
Published: June 2022

Aims

Psychiatric illnesses are common among older adults and are associated with increased mortality and physical comorbidities. It is suggested that patients with frailty have a higher prevalence of depressive symptoms. (1) The eFI (electronic Frailty Index) is a tool used to assess the severity of frailty in elderly frail patients using a cumulative deficit model based on routine interactions with their GP.

Methods

Patients were selected for annual frailty assessments by searching the electronic clinical system (SystmOne) using the eFI tool. Patients were assessed using the Comprehensive Geriatric Assessment (CGA) framework. In addition, all patients were screened for coexisting anxiety and depression using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaire.

Results

Of the 118 patients who ranged from mild to severe frailty, we found there was a positive correlation of the frailty severity eFI scores with increased rates of anxiety and depression evidenced by higher scores on the PHQ-9 and GAD-7 scoring tools. We found a positive correlation of the eFI with the PHQ-9 depression scores of (r = 0.819 p < 0.001). Within the same data set, we found correlation coefficients of eFI and anxiety GAD-7 scores (r = 0.651 p < 0.001). Increasing frailty was found to be associated with a higher rate of depression and anxiety.

Conclusion

We found in this study higher (eFI) electronic frailty indices are associated with higher rates of anxiety and depression. We would recommend annual frailty assessments in patients with high electronic frailty indices and this should include screening for mental health deterioration. Early detection of deterioration will enable patient centered supportive measures and targeted treatment strategies. Health maintenance programs should ensure patient centered holistic assessment of both physical and mental health needs for early identification to avoid deterioration of both physical and mental health.
COVID-19 Vaccine Hesitancy Among Health Care Professionals of Allied Hospitals of Rawalpindi Medical University: A Mediation Analysis
Authors: Saeed Sajeel , Rauf Abdul , Younas Waqar , Arish Muhammad , Sannan Abdul
Published: June 2022

Aims

This research assessed healthcare workers' vaccination practices for influenza, hepatitis, and pneumonia, as well as their desire to get COVID-19 vaccine when accessible, and investigated their 7C psychological antecedents (confidence, complacency, collective responsibility, compliance, calculation, constraints and conspiracy). Stress variables and vaccination intention for COVID-19 were also compared to see whether psychological stress had a meditative impact on the relationship.

Methods

An analytical cross-sectional survey was conducted among health care professionals including nurses and doctors of tertiary care hospitals of Rawalpindi. Data were collected from February to April 2021 to get the COVID-19 vaccination when it became available, and looked into their 7C mental forebears (confidence, complacency, collective responsibility, compliance, calculation, constraints and conspiracy). A total of 642 health care professionals voluntarily participated in our research. Demographic Details, questions like pneumonia vaccination, hepatitis vaccination, influenza vaccination and 7C questions were asked. Data were entered and analysed through SPSS 26.0 and Python. Correlation, linear and non linear regression, and mediation analysis were applied.

Results

The immunization rates for influenza, hepatitis, and pneumonia vaccines, as well as the percentage of those who received COVID-19 vaccination, were 43.4%, 65.2%, 42.8%, and 39.7%, respectively. Hepatitis vaccination was significantly associated with the 7C model, influenza vaccination with conspiracy, whereas pneumonia was significantly associated with compliance. confidence (r = 0.11), complacency (r = −0.19), constraints (r = −0.20), calculation (r = 0.08), collective responsibility (r = 0.18), and compliance (r = 0.19) were significantly corelated with the COVID-19 Vaccine Intention. Contrary to direct effect, the indirect effect of patient contact frequency (β = −0.01, ρ<0.05) and terrified of contracting virus (β = −0.05, ρ<0.05) via psychological stress on COVID-19 Vaccination intention were significant depicting full mediation.

Conclusion

For herd immunity, the probability for COVID-19 vaccination uptake among healthcare professionals was less than optimal. The 7C structures may help predict immunization against influenza, hepatitis, and pneumonia, but not vaccination against COVID-19.
A Qualitative Study Exploring the Experiences of Carers of Service Users With Complex Mental Health Needs
Authors: Saini Pooja , Roks Hana , Sambrook Laura , Balmer Anna , McIntyre Jason , Martin Antony , Tait Jackie , Ashley-Mudie Peter , Shetty Amrith , Nathan Rajan
Published: June 2022

Aims

Carers of individuals presenting with complex behavioural and mental health needs report that service users may not receive the provision of care they require, particularly when presenting following suicide attempts and self-harm. Carers are an integral part of the care system and often feel ignored and marginalised by services; there is a lack of involvement of carers and paucity of their views of support needs to be explored. The aim of the study is to understand carers’ experiences of caring for service users with complex mental health needs who self-harm and/or attempt suicide, and the support received from mental health care services.

Methods

Ten carers of service users with complex mental health needs were interviewed about their views on the psychiatric admission, treatment and discharge process for the people they were caring for. Data were gathered during semi-structured, one-to-one interviews remotely over the phone or online platforms. Interviews were audio-recoded and transcribed verbatim. A transcript-based conceptual analysis was conducted to identify and explore emerging themes.

Results

Carers identified both positive and negative aspects of the psychiatric admission and care within community settings. The following key themes emerged from the interviews: lack of control and information from mental health services, the importance of support from staff, or conversely its absence; concerns about service users’ vulnerability, negative staff attitudes and opportunities for involvement; negative experiences of generic psychiatric settings; positive experiences were encountered when there were supportive and caring staff, good information sharing and satisfactory discharge arrangements.

Conclusion

Important areas for service improvements are highlighted. Recommendations included: the need for support; information about suicidal behaviour and advice on managing further incidents at home; more support in coping with regular and escalating self-harming and suicidal behaviours, particularly, severe consequences of staff safeguarding errors and inappropriate discharge, and the importance of supportive and adept staff. These findings identify the need for tailored support for carers regarding the management of self-harm and suicidal behaviours in the community.