bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-harm on a specialist adult eating disorder unit: a retrospective cohort study of patient characteristics and outcomes
Authors: Holm-Mercer Leah , Kohler Douglas , Ayton Agnes
Published: June 2021

Aims

Deliberate self-harm (DSH) is common but rarely studied among inpatients with eating disorders. We sought to investigate the frequency of DSH among inpatients in a specialist adult eating disorders unit, and the association of DSH with comorbidities and treatment outcomes. We also investigated changes in these parameters during the pandemic.

Method

We included the records of 70 patients consecutively admitted to Cotswold House in Oxford between April 2018 and November 2020. Data were analysed using Microsoft Excel using descriptive statistics. For comparisons, student T-tests were used for continuous variables and Chi-square tests used for categorical variables.

Result

99% of patients were female; their ages ranged from 17 to 67 years (mean 30.7). 81% had a primary diagnosis of anorexia nervosa, and 67% had a history of DSH prior to admission. There was a total of 100 incidences of DSH, of which 12% required transfer to a general hospital for medical treatment.

Frequency of self-harm decreased with time throughout admission (17% self-harming on admission, vs 7% at discharge, p = 0.043).

Compared to those with no history of DSH, patients who self-harmed during admission were more likely to be detained under the Mental Health Act (45% vs 17.4%, p = 0.003), and to have psychiatric comorbidities (85% vs 35%, p = 0.001). Patients whose self-harm required transfer for general hospital treatment had a lower mean discharge BMI (18.18kg/m2 vs 20.23kg/m2, p = 0.039), longer admission (105.9 days vs 78.1 days, p = 0.037), and gained weight at a slower rate (0.26kg/m2/week vs 0.43kg/m2/week, p = 0.048) than those who did not require transfer.

During the pandemic, the frequency of DSH doubled on the ward. Overall outcomes were similar, however mean length of admission was lower during the pandemic (67.83 vs 89.94 days, p = 0.046), and patients regained weight more rapidly (0.43kg/m2/week vs 0.28kg/m2/week, p = 0.003) than prior to it.

Conclusion

Self-harm during admission was seen in 29% of patients and was associated with the presence of comorbid psychiatric diagnoses. The frequency of DSH much reduced between admission and discharge, suggesting a beneficial effect of treatment. Medical transfer for DSH, considered as a proxy measure for severity, predicted poorer outcomes in weight restoration. We also noted an increase in rates of DSH during the pandemic, which may have resulted from a combination of increased psychosocial stressors and a reduction in admission capacity in eating disorder units.
The perception of behaviour associated with dementia in the acute hospital
Authors: Jawaid Zumer , Crowther George , Ashar Syeda
Published: June 2021

Aims

General hospital based Health Care Professionals (HCPs) use very varied language to describe behaviour in dementia. Lessons from medicine and other professions tell us that non-uniform communication is a source of error and subsequent poor decision making. Knowing how HCPs communicate behaviour in dementia in a hospital setting may help better understand these potential sources of communication error and identify training needs.

Background

Around 25% of hospital beds occupied with people living with dementia. Hospitalised patients with dementia have a high prevalence of distressing symptoms (pain 70%, delirium 66%, depression 35%, anxiety 34%, hallucinations 14% delusions 11%). These symptoms often displayed as behaviour can be challenging for HCPs to interpret. Variations in communicating behaviour may lead to inconsistent understanding of the need, with the potential for missing treatable conditions that drive the behaviour. Standardizing communication and documentation have the potential to improve the quality of information handed over between HCPs which may improve the quality of care and patient outcomes.

Method

Qualitative methodology including photo elicitation was used. A purposive sample of 59 HCPs was selected. This was identified from a range of professional backgrounds, experience levels and medical specialities. They were presented with a photograph and case vignettes depicting 4 behaviours associated with distress (aggression, depression, delirium and psychosis). HCPs were asked to respond to the scenarios as if they were handing over to colleagues or documenting in the medical record. Data were analysed by thematic analysis.

Result

59 HCPs were interviewed with photo-elicitation. Participants recorded their responses in limited time to reflect time constraints in a busy ward environment. 2 HCPs declined to participate in research.

When describing behaviour associated with aggression and depression HCPs were consistent with the language used (49/57). When presented with a delirium less consistency was observed (31/47). While describing psychosis each HCP chose either paranoia or suspiciousness among other descriptions.

Conclusion

Overall there has been consistency in describing the distress experienced by the patient even though HCPs came from very different roles and specialities. Doctors, Nurses, CSWs and dieticians all described the behaviour alike. Newer staff were more accurate which could be due to dementia training within National Dementia Action Alliance.
Course and outcome of comorbid mood disorders in children and adolescents with intellectual disability [IDD]
Authors: Velusamy Arul Jayendra Pradeep , Girimaji Satish Chandra , Kommu John Vijay Sagar
Published: June 2021

Aims

The primary objective of the study is to assess the clinical course and functional outcome of comorbid mood disorders in children and adolescents with Intellectual Disability [IDD]

Method

53 children and adolescents with varying levels of severity of IDD presenting with comorbid mood disorders diagnosed using Kiddie Schedule for Affective Disorder and Schizophrenia-DSM-5 version [KSADS] were recruited by convenient sampling with the exclusion of autism spectrum disorders. Vineland Social Maturity Scale [VSMS] is used to quantify the severity of ID. Developmental Behaviour Checklist-Parent [DBC-P] version is used to measure psychopathology, Clinical Global severity of illness [CGI-S] to quantify the clinical improvement, and Developmental Disabilities Children's Global Assessment of Severity [DD-CGAS] to assess functional improvement. Prospective naturalistic follow-up was done with assessment points at baseline, 1, 3- and 6-month timeline.

Result

40 patients were followed up for 6 months period. Overall significant improvement is observed in the dependent variables like CGI, DDCGAS, and DBC-P from baseline to 3 months and then a plateau of improvement from 3 to 6 months. The diagnostic breakup of mood disorders is mania [N = 19], Depression [N = 12], and mixed affective state [N = 9]. Patients with mania had significant improvement in DBC score [F = 12.69, p < 0.001 in repeated measures ANOVA], DDCGAS [p < 0.001], and CGI score [p < 0.03] with an overall remission rate of 42.10% over 6 months period. Patients with depression had significant improvement in DBC score [F = 15.48, p < 0.001], DDCGAS, and CGI score [p < 0.001] with an overall remission rate of 41.7%. None of the patients with mixed affective states had clinical remission with no significant improvement observed in any of the dependent variables measuring course and outcome.

Conclusion

Comorbid psychiatric disorders in children and adolescents with IDD have a guarded prognosis compared to mood disorders in neurotypical children. Comorbid ADHD and caregiver stress majorly influenced the course and outcome in the current study.
Battered woman syndrome and PTSD in women who kill their abusing partner: a study in medical jurisprudence
Authors: Lagunathan Sharmilaa
Published: June 2021

Aims

The aim of the study was to identify any symptoms or features of Battered Woman Syndrome (BWS) or Post-traumatic Stress Disorder (PTSD) that may be associated with, or explain, abused women killing their abuser; and the extent to which such identified symptoms or features have been deemed, or are potentially relevant, to past and now reformed partial defences to murder in English law. Hence two sub-studies were completed.

Method

The first sub-study identified mental symptoms of BWS or PTSD apparent in battered women who kill their abuser; achieved by identifying relevant research papers, through applying a ‘rapid review’ approach to three databases: PubMed, PsychInfo and PsychArticles. The second sub-study identified by legal research reported Court of Appeal (CA) judgments on women appealing their conviction of the murder of their abusive partner. It then analysed the legal approach taken towards evidence of the effects of abuse upon these women before and after relevant statutory law reform (although no CA cases were identified post-reform).

Result

The first sub-study identified and reviewed six symptoms or features, within three quantitative and three qualitative studies, that appeared to be associated with, or described by, abused women killing their abuser. These included helplessness, symptoms associated with PTSD, plus fear, isolation, experience of escalation of violence and cycle of violence. From the CA cases the perpetrators of killings that occurred prior to 04.10.2010 (the date of law reform) were usually successful in having their conviction overturned based upon diminished responsibility; but not provocation, because of the requirement of ‘sudden loss of self control’. ‘Loss of control’, which replaced provocation, appears highly likely to be capable of reducing murder to manslaughter based upon symptoms of BWS, or PTSD. However, the amended defence of diminished responsibility is likely to exclude evidence of BWS, but allow evidence of PTSD, because of its requirement of the defendant suffering from ‘a recognised medical condition’.

Conclusion

This study demonstrated particular symptoms or features of BWS or PTSD associated with abused women killing their abusers plus their very different relevance to two partial defences to murder, pre and post law reform.
Development of a co-produced tool for monitoring and supporting the mental health of young people
Authors: MacKeith Joy , Good Anna , Burns Sara
Published: June 2021

Aims

The aims were to develop and validate a tool for monitoring and supporting the mental health of young people. Based on extensive experience of developing similar tools, the hypothesis was that a user-friendly tool could be produced with sound psychometric properties.

Background

The Outcomes Star is a suite of collaboratively completed, strengths-based tools with the dual roles of both supporting and monitoring change. Service users are empowered through their active involvement in identifying their strengths and creating their care plan. Triangle, the creators of the Outcomes Star was approached by a number of organisations to develop a version of the Star for young people with mental health issues in early intervention services and also to support young people in managing a diagnosed mental illness.

Method

Using a series of focus groups and an iterative process of refinement we gathered data from practitioners and service users on the domains in which they wish to create change, and the steps of the change process. A draft version of the new tool was piloted in two organisations by 67 workers and 177 young people over six months. The pilot data were analysed to assess the psychometric properties of My Mind Star (acceptability, skew, factor structure, internal consistency, item redundancy and responsiveness).

Result

The resulting tool, My Mind Star consisted of seven domains: Feelings and emotions, Healthy lifestyle, Where you live, Friends and relationships, School, training and work, How you use your time and Self-esteem. Almost all young people and practitioners (94%) agreed that their completed Star was ‘a good summary of my life right now’ and that it gave a better idea of service users’ support needs. Psychometric analyses indicated a unidimensional structure with good internal consistency (α = .76) and no item redundancy. My Mind Star was responsive to change between the first and second readings, with medium and small-medium effect sizes.

Conclusion

Initial findings suggest that My Mind Star has good psychometric properties and is perceived as acceptable and useful by young people and practitioners, Further research is planned to conduct a full validation of the psychometric properties of this Star including inter-rater reliability and predictive validity.

Financial sponsorship of the study: Action for Children
Exploring the mental health impact on private flat owners in residential buildings with external combustible cladding
Authors: Martin William
Published: June 2021

Aims

To explore the mental health of private flat owners in residential buildings with external combustible cladding, which require remediation following the 2017 Grenfell tower fire.

The speed at which the fire at Grenfell spread, killing 72 people, is largely attributed to external combustible cladding. It is increasingly suspected that there are ongoing profound effects on the mental health of people living in flats with external combustible cladding like Grenfell both in the UK and abroad. The issue has left flat owners facing severe financial hardship, the threat of bankruptcy and concerns about safety in their own homes.

Method

An exploratory ‘Google Forms’ online mental health survey comprising multiple choice and free text questions over 47 sections was distributed to flat owners in affected buildings. The survey remained open for 6 weeks to allow response. 550 individual responses were studied.

Result

550 individuals completed the survey, from 143 buildings across 45 UK councils.

As a direct result of external combustible cladding:

89.5% said their mental health had deteriorated,

22.5% reported having suicidal feelings or a desire to self-harm,

71.1% reported having difficulty sleeping,

93.8% said they were suffering from worry and anxiety,

59.6% used coping strategies to deal with their situation,

35.1% said that existing physical and mental health conditions had been exacerbated,

84.1% said they cannot move on with their lives and

57.9% of people had concerns about seeking help or treatment for mental/physical health problems caused by their situation during the pandemic.

In addition, free text responses reflected feelings of anxiety and low mood attributed to the constant fear of fire, and an inability to plan families and future homes. One person said, “I have been left utterly broken by this. My mental and physical health has worsened, I have severe anxiety, depression and PTSD. I struggle each day to keep myself alive.”

Conclusion

Safe housing is a basic human right. The results show the current situation is having a detrimental impact on flat owners’ mental health and makes a strong case for the provision of specific services offering support - particularly given it is 3.5 years since Grenfell and a viable solution for all is yet to be found.
A systematic review to evaluate the effectiveness of mental health literacy interventions implemented in schools and communities in low- and middle- income countries
Authors: McGuckin Niamh , Leavey Gerard
Published: June 2021

Aims

Mental health literacy campaigns have received increasing attention as a useful method of reducing the burden of mental disorders, by promoting public awareness and improving attitudes surrounding mental disorders. However, despite the wealth of research into the effectiveness of mental health literacy interventions in high-income countries, there is an absence of evaluations of these interventions in low-middle-income countries (LMICs). This systematic review aims to pool the evidence on effectiveness of these interventions in LMICs.

Method

MEDLINE(OVID), PyschInfo, Scopus and reference lists of included studies were searched. Studies that quantitively measured the effectiveness of mental health literacy interventions amongst schools and communities in LMICs were included, regardless of study design. The included papers were not limited to a particular population demographic, ethnicity or educational level. Studies were included if conducted in LMICs according to the World Bank Classification. Each study was critically assessed according to CASP critical appraisal checklists.

Result

Ten studies met the inclusion and exclusion criteria, including 6 case series, 3 controlled before and after studies and 1 cross sectional study. Most of the studies claimed significant improvement of knowledge, attitudes and coping skills following the intervention. However, the overall the methodological quality of the studies was rated as fair to poor.

Conclusion

The review found that mental health literacy interventions may have promising effects, however the pooled evidence of the effectiveness in LMICs was inconclusive. Further research into the effectiveness of these interventions would benefit from using a RCT design, or controlled-before and after studies, with careful control of confounding variables in order to further establish effect. This study provided insights into the barriers to effective implementation of these programs and examined the contextual appropriateness of such interventions. The review provides recommendations for policy makers for the development of future interventions.
Management of medically unexplained symptoms (MUS): a stepwise integrated model between primary and secondary caremanagement of medically unexplained symptoms (MUS): a stepwise integrated model between primary and secondary care
Authors: Al-Dahash Zaineb S Y , Loveday William , Law Naomi , Qureshi Mutahira , Gallagher Paul , Turton Daniel , Polledri Luca
Published: June 2021

Aims

Description of a model to improve care for patients with Medically Unexplained Symptoms (MUS) by small targeted investment and maximisation of existing resources.

Background

Treatment of MUS presents several challenges including a lack of clarity on the best models of care and limited service provision. Patients typically present with a physical complaint to physical health outlets: here limited confidence in professionals around how to address these often leads to poor patient/doctor experience, inappropriate use of resources and repeated attendance. Evidence shows that integration of care, psychological interventions and upskilling physicians in interventions such as positive communication, can significantly improve outcomes. Psychiatric Liaison Teams (PLT) are positioned at the interface of mental and physical health services and can play a crucial role for these patients, when provided with the right skill-mix.

Method

1FTE Clinical Psychologist specialising in MUS was integrated into the PLT. Pathways to triage between primary, secondary psychology and the new service were agreed, alongside channels of communication and supervision. The job plan included integrated sessions in Gastroenterology, Rheumatology and PLT. The activities included: assessments, formulations and discharges; brief psychological interventions; group sessions for patients; one-day long courses to GP trainees and physicians, and input in specialities MDTs. Clinical outcomes, numbers of patients seen and signposted, teaching sessions and simulation training delivered were collected.

Result

Over 20 months the service was able to process 237 referrals, 35 were managed over the phone. Referral sources: Gastroenterology 32%, Rheumatology 37%, Psychiatric liaison 28%.

116 patients attended 315 face to face appointments and 21 phone contacts were made. Core-10 data show reduction from moderately severe to mild psychological distress in a sample of patients. 58% of patients were referred on for continuing care. The service ran 8 patient groups including sessions on pain management and joint sessions with Rheumatology. It ran 9 one-day long courses for GP and physician trainees, training a total of 120 doctors: feedback showed increased confidence in managing and recognising MUS. Attendances to Emergency Departments covered by Barking Havering and Redbridge and Bart's Health Trusts combined (5 sites) reduced by 22%, saving an estimated £19,200, while ambulance usage in the cohort dropped by 29%, saving an estimated £9072.

Conclusion

The integration of a specialist psychologist with a mix of educational, advisory and clinical role to a PLT can provide an effective and efficient stepped-up model to increase the provision of care for patients with MUS
Use and understanding of functional cognitive disorder terminology in United Kingdom clinical practice - a survey
Authors: Nash Alexandra , Stone Jon , Carson Alan , Ritchie Craig , McWhirter Laura
Published: June 2021

Aims

This study aimed to explore the terms used by old-age psychiatrists and psychologists to describe subjective and mild cognitive impairment and functional cognitive disorders (FCD) in clinical practice.

Method

Participants were selected from across the United Kingdom based on their clinical involvement in the assessment of cognitive complaints. 9 old-age psychiatrists and 4 psychologists were interviewed about their use of terminology in clinical practice and their awareness and understanding of FCD terminology via semi-structured interview questions and case vignettes. Interviews were conducted between December 2020 and February 2021 using online platforms Zoom and Microsoft Teams. Participants were recruited by email and Twitter. All questions were asked verbally; however, the four case vignettes were displayed via screen-share. All discussions and answers were transcribed and transcripts were coded manually using the exploratory case study methodology in order to identify themes in participants’ responses.

Result

This study has highlighted the variable use of terms used to describe and diagnose patients presenting with symptoms of cognitive disorders. The terms ‘mild cognitive impairment’, ‘subjective cognitive decline’ and ‘functional cognitive disorder’ were used most commonly amongst participants, though the terms ‘subjective cognitive impairment’ and ‘pseudodementia’ were also presented. This theme of language discontinuity is underscored by participants’ varying use of terminology when describing or presenting their diagnoses for the case vignettes. The data also reveals a sub-theme of variability in application of the term FCD. Whilst all participants gave similar definitions for this term, the application of FCD as a diagnosis in practice was inconsistent. Six participants described FCD as associated with or secondary to other functional or psychiatric conditions, four participants viewed FCD as an isolated diagnosis, and one participant considered FCD to be either part of another illness or a separate diagnosis. Two participants neither used nor recognised the term FCD.

Conclusion

It is evident that there is varied use of terms describing or diagnosing forms of cognitive symptoms. The findings of this study highlight the need for a clear, adoptable definition of FCD in practice as well as implementable management plans for FCD patients. This is critical in order to avoid misdiagnosis and mismanagement, which may have harmful effects on patients living with debilitating cognitive symptoms.
A survey into the influence of dopaminergic drug exposure on ‘sense of presence’ symptoms in patients with parkinson's disease
Authors: Padfield Emma , Potticary Hannah , Segal Tim
Published: June 2021

Aims

The first objective was to estimate prevalence of sense of presence (SoP) experiences in patients with Parkinson's Disease (PD), including whether onset was prior to or after commencing dopaminergic medication. The second objective was to explore the relationship between frequency of SoP experiences and dopaminergic drug, drug dosage and length of drug exposure. The experimental hypothesis was that SoP symptoms in PD would present more frequently in patients treated longer and with higher dopaminergic drug doses.

Background

PD is a debilitating neurodegenerative disorder. Psychiatric symptoms are common and associated with impaired quality of life and higher treatment costs. PD psychosis often starts with ‘minor hallucinations’, the most common being a false ‘sense of presence’ (SoP), the vivid sensation that someone else is nearby when nobody is there. SoP symptoms typically do not cause significant distress but may act as a prognostic marker for future severe psychosis and may prompt alteration of treatment or reduction in dopaminergic drug dosage. This study aimed to extend prior research by characterizing SoP further and investigating the link with dopaminergic medication.

Method

This was a retrospective, cross-sectional study. Twenty-one patients diagnosed with PD completed a questionnaire to identify presence of SoP symptoms, duration of symptoms, timing of onset related to dopaminergic treatment and the frequency of symptoms in relation to current levodopa equivalent dose (LED). Descriptive frequencies were compared using a two-tailed t-test. Multiple regression analysis was conducted to assess the relationship between frequency of SP experiences, levodopa equivalent dose and length of drug exposure.

Result

Sixteen of twenty-one patients reported experiencing SoP symptoms. Patients who had not experienced SoP symptoms had a significantly lower LED than those who had experienced these symptoms. There were no other significant differences between the groups. No statistical significance was shown on regression analysis; however our study was not adequately powered for the regression analysis as the number of participants was too low.

Conclusion

This study confirms that SoP symptoms are common among patients with PD and supports a correlation between the total daily equivalent dose of levodopa and SoP symptoms. It does not provide evidence for a temporal relationship between onset of SoP symptoms and duration of dopaminergic treatment. The study was insufficiently powered and a larger study is required to investigate further.
A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants
Authors: Soni Anju , Walters Pamela
Published: June 2021

Aims

Electronic medical case files of male prisoners in a category B prison in London was studied to establish a prevalence during an 8-month period of the use of and the reasons for prescribing gabapentinoids in prison.

In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination.

Method

A retrospective, SystmOne electronic case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1500 prisoners; Average turnover of prisoners up to 6000 per year), including to establish practice standards related to the prescription of Gabapentinoids in the prison and determine the compliance with these.

Result

In total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. Half of the cases were co-prescribed gabapentinoids with an opioid substitute and 17% with antidepressants. Only in 22% of the cases there was documentation of discussion with the prisoner about the potential risks of co-prescribing with these medications. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners.

Conclusion

For those prescribed gabapentinoids in prison, the indications for such use especially if off label should be reviewed and their use minimised where relevant.

The initiation of gabapentinoids in prison should be avoided.

For patients who are also receiving antidepressants and opioid substitutes or are abusing opiates, consideration should be given as to whether it is safe to continue on gabapentinoids, given the risks of misuse and death.

Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well.

From 1 April 2019, gabapentinoids have been classed as Class C controlled drugs in the UK.
Psychiatric liaison referrals: a thematic analysis during peak COVID-19
Authors: Svedberg Kaj , Hancox William , Grant-Peterkin Hugh
Published: June 2021

Aims

With the advent of the COVID-19 Pandemic the NHS long term Plan commitments of January 2019 to improve crisis care nationwide became all the more pressing. The aim of this study was to thematically investigate what mental health crisis presentations might be diverted from the Emergency department to external crisis hubs in order to reduce the COVID-19 contamination risks.

Method

All referrals made to the Homerton University Hospital (HUH) mental health liaison service were looked at between 1/3/20-11/6/20 (n = 846), coinciding with the first peak of the COVID-19 Pandemic.

Referral data was anonymised and sorted independently into naturally emerging thematic classes by two junior liaison doctors.

Cases that did not clearly fit any of the 14 themes generated were further looked into to determine outcome of referral and discussed to try and match to an appropriate class.

Result

14 frequent themes for mental health crisis referrals were identified. The distribution of these ranged from most common (suicidality) to neurocognitive presentation and identified shifts in themes over the course of the pandemic peak such as increases of low mood, anxiety and intoxication requiring medical attention over the three month period.

Conclusion

Although themes for presentations may be identified in acute referrals to mental health liaison services it is problematic determining how these may be parsed safely to crisis hubs without risking overlooking cases that may require medical attention. The most common theme that was identified and remained throughout the first wave of the COVID-19 Pandemic was acute suicidal presentation. The remaining themes would require careful consideration around risk thresholds for what a service may wish to accept in devolving the emergency department liaison and balance these against future risks of repeat COVID-19 waves.
Medical comorbidities of patients presenting to an adult neurodevelopmental new case clinic in Singapore
Authors: Tan Ho Teck , Moon James Patrick , Tan Giles Ming Yee
Published: June 2021

Aims

To describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.

Background

Medical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.

Method

A retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.

Result

319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.

58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.

Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.

Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.

In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.

Conclusion

Patients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.
Exploring unusual bodily experiences, basic self disturbances and multimodal hallucinations in the non-clinical population: a cross-sectional study
Authors: Thomas Lucretia , Reniers Renate , Torregrossa Lénie , Humpston Clara
Published: June 2021

Aims

Psychosis research has largely focused on symptoms which are easier to define. Symptoms which are challenging to detect and articulate, including disturbances in the basic- and bodily-self, may not be volunteered by patients, despite causing significant distress. Increased understanding of such symptoms, which may present in the prodromal phase of psychosis and persist following the remission of positive symptoms, may allow patients who experience these to be better supported.

This study aims to explore how disturbances in the basic- and bodily-self relate to multimodal hallucinations. Through sampling a non-clinical population, this study takes the continuum approach to psychosis, where individuals experience sub-clinical psychotic symptoms which do not cause distress or functional impairment.

It is hypothesised that individuals with greater hallucination proneness will exhibit greater severity of ambiguous and imprecise mapping of bodily experiences, and will report greater levels of basic and bodily-self disturbance. This project also aims to evaluate Audiograph as a newly developed tool for creating representations of visual hallucinations.

Method

This is a two-stage cross-sectional study. In stage one, participants completed the Multi-Modality Unusual Sensory Experiences Questionnaire to assess hallucination-proneness. In stage two, all participants were invited to complete seven further validated questionnaires which assessed basic- and bodily self-disturbances alongside co-variates including anxiety and depression symptoms, delusion-proneness and loneliness. Participants also completed emBODY, a computer-based task which allows participants to map the bodily sensations they experience during 13 different emotional states. Participants with high-hallucination proneness also completed the Audiograph task. Hierarchical linear regression, conducted using Stata, will be used to model the influence of hallucination proneness on measures of basic- and bodily-self disturbance. MATLAB will be used to generate topographical maps of the data from emBODY; maps will be compared between different emotional states using linear discriminant analysis, and between high and low hallucination proneness groups using Spearman's test.

Result

Currently, 50 of the 104 stage one participants have completed stage two.

Since this project comprises a compulsory component of the presenting author's intercalated degree, data collection will cease on the 29th of March in advance of their poster and write-up submission deadlines in May.

Conclusion

Although basic- and bodily-self disturbances have been assessed in previous studies using various techniques, no single study has assessed these alongside multimodal hallucinations to link these concepts together as a whole, especially not in a general population sample. The added value of this project is to precisely address this gap in knowledge.
Telemedicine in addictions feasibility RCT – staff and patient qualitative satisfaction
Authors: Treloar Dominic , Mayet Soraya
Published: June 2021

Aims

Opioid dependence has high risks. Opioid substitution treatment (OST) improves outcomes. Addiction specialist prescribers prescribe OST and monitor safety, but nonattendance may lead to worse outcomes. Telemedicine can reduce travel and improve attendance at appointments. Before COVID-19, we started a telemedicine in addictions trial to see if this helped in addictions. We present the qualitative patient and staff experience results.

Method

Health Research Authority approval for randomized controlled feasibility trial of Telemedicine versus Face-to-Face (control) consultations at community addictions semirural service (2500km2) using a modified Hub-and-Spoke (outreach) model. Adult opioid dependent patients prescribed OST and attending outreach were recruited. Participants received two appointments in randomized group. Telemedicine was delivered using Skype-for-business videoconferencing. Patients attended outreach, saw keyworker for drug testing first, and telemedicine conducted via keyworker's laptop. Addiction prescribers located remotely at Hub. Post-trial research interview conducted assessing patient and staff experience of Telemedicine versus Face-to-Face consultations. Data transcribed, inputted to RedCap Cloud and free-text analysed using qualitative thematic analysis.

Result

Of fifty-nine patient participants, 58 completed a research interview. Patient participants reported similar levels of satisfaction between the Telemedicine and Face to Face groups. The themes generated in relation to Face-to-Face were no difference, easy, kind staff and liking being part of research. For Telemedicine, themes were less travel, good experience, easier to access, good communication, saves time and saves money. For instance, one patient stated ‘Clear, easy to access less travel’ and another patient stated ‘I struggle with travel. I found it easier’. Of 19 staff participant research interviews completed, Staff reported Good or Very Good experience with telemedicine which was equivalent for Face-to-Face consultations. Eleven staff had experience of telemedicine consultations during the trial. They reported similar themes to patients with telemedicine leading to less travel, beneficial to patient care, improves attendance and was innovative technology. One staff member reported satisfaction with telemedicine due to ‘Time, travel and money reduction’. When questioned on the downsides to telemedicine, technological issues were mainly related to connection issues and sound issues.

Conclusion

In the first known RCT of Telemedicine versus Face-to-Face consultations for patients with opioid dependence attending prescriber review, we found that both patients and staff were satisfied with telemedicine as compared to face-to-face consultations. Overall themes were reduced travel, saving time and more convenience. This will be very important given the impact of COVID-19 on access to addictions services.

Financial Sponsorship

East Riding CCG

Academic Health Science Network
Pharmacological management of tourette's syndrome comorbid with obsessive-compulsive disorder in adult patients
Authors: Tyagi Himanshu , Ogunbiyi Olabisi
Published: June 2021

Aims

Tourette's Syndrome (TS) is a neurodevelopmental disorder, which often presents in childhood and is hallmarked by motor and vocal tics. Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric condition characterised by intrusive thoughts and time-consuming repetitive behaviours. Research suggests that 15-20% of adult patients with TS will also meet the diagnostic criteria for OCD. Both illnesses appear to have neurobiological similarities but a differing course and clinical response to pharmacological treatments.

Despite this, research into optimal management of adults with co-occurring TS or other tic disorders and OCD remains sparse. Comorbidities, are known to be poor predictor of response to selective serotonin reuptake inhibitors (SSRI) monotherapy in OCD and are often associated with treatment-refractory OCD. Similarly SSRI monotherapy in patients with OCD and comorbid TS can sometimes worsen motor tics (1 in 2000) and fail to improve OCD symptoms. In this review, we aim to evaluate evidence on the management of patients with co-occurring TS and OCD and address an important knowledge gap in clinical practice.

Method

This review was conducted in accordance with PRISMA Guidelines. We performed a search using PubMed, Cochrane Library and PsychINFO using the following Boolean Input “Tourettic-OCD” OR “tic-related OCD” OR ((OCD OR “obsessive-compulsive” OR “obsessive compulsive”) AND (Tourette OR “Tourette's” OR Tourettes OR tic))”. The search was conducted until January 2020. We then screened the articles of systematic reviews to extract additional studies from their reference lists.

Result

1888 studies were identified, of which 15 clinical trials were included in our systematic review. The presence of tics in patients with OCD are a major predictor for treatment-refractory OCD and a lack of improvement following monotherapy with SSRIs. Dual therapy with an SSRI and antipsychotics (particularly risperidone) are associated with improved outcomes in OCD patients with tics and TS patients with obsessive-compulsive symptoms. However, conjoint therapy with neuroleptics and SSRIs was only investigated when OCD burden was unsatisfactory following SSRI monotherapy.

Conclusion

There are clinical implications when a patient with OCD also has a chronic tic disorder. The findings indicate the need for further research, particularly in the form of a larger cohort in randomised controlled trials, to determine when it is best to initiate patients with OCD and comorbid tic disorders on a dual antipsychotic-SSRI management strategy. Further evidence should also be done to determine other characteristics that predict an improvement to conjoint SSRI/neuroleptic therapy for effective symptom reduction.
Review: Psychological & Behavioural Treatments of Nonepileptic Seizures in Children and Adolescents
Authors: Velani Hemma , Gledhill Julia
Published: June 2021

Aims

To systematically review Psychological and Behavioural treatments on NES in children and adolescents by reviewing the current literature.

Background

Non-epileptic seizures (NES) are associated with a high level of functional impairment for young people and their families. However, there are no UK guidelines for the management of NES in children and adolescents or adults. Though information from the limited studies in adults may be useful, the findings may not be generalizable to children and adolescents. To date, we are unaware of any published systematic review on this topic in children and adolescents.

Method

A systematic search of relevant electronic databases was conducted. Any study investigating the effectiveness of psychological and behavioural treatments on NES, in Children and Adolescents was included.

Result

Fifteen studies were identified, but only six studies had the primary aim of evaluating an intervention, and only one used a control group. The rest were observational studies that examined retrospective case notes.

CBT and psychoeducation were identified as the most common interventions. Eleven out of the fifteen studies used multiple treatments, four looked at one treatment only, three of these CBT and one was a natural history study.

Where individual therapy was provided, a common focus was management of anxiety, usually delivered in a flexible way, adapted to individual needs. Despite being identified as important in the literature, only one study demonstrated care that involved collaboration between physical and mental health teams.

Conclusion

It's difficult to conclude from this review that one treatment approach is superior to another. The findings of this review offer some insight into current practise and may help to inform future research in this area. CBT and psychoeducation with a focus on anxiety are frequently included in interventions for NES in young people, and further evaluation of these treatment modalities could be a helpful next step.
Aripiprazole as a risk factor for impulse control disorders: a systematic review
Authors: Williams Benjamin , Williams Benjamin , Neelam Kishen , Singh Saumya
Published: June 2021

Aims

Aripiprazole is an anti-psychotic medication widely used for bipolar affective disorder and depression. It's primary mechanism of action is as a partial dopamine agonist. Aripiprazole's effect on dopamine signalling in the mesolimbic and mesocortical pathways may lead to impulse control disorders, as seen with other dopamine agonist medications. Aripiprazole is often chosen by prescribers because of its favourable side effect profile. There is a need to synthesise the available epidemiological literature on the potential association between aripiprazole use and impulse control disorders. This is needed to inform patients and prescribers of the best available evidence regarding this potential association. Our aim is to conduct a systematic review of the available non case-study evidence on the potential association between aripiprazole and impulse control disorders.

Method

Databases were searched using MEDLINE, PsychINFO, EMBASE, Cochrane Clinical Trials and Web of science. All studies from no earliest date to December 2020 were included; adult patients with a severe and enduring mental illness prescribed antipsychotic medication were included. Cinician diagnosis, structured interview diagnosis, and interviewer or self-completion questionnaires were used to measure prevalence. The study designs included were experimental designs, cohort study, cross-sectional survey and administrative databases. Exclusion criteria being those with traumatic brain injury, psychosis secondary to autoimmune, iatrogenic, chromosomal or metabolic disorder, those with Learning disability or Autistic Spectrum disorders. studies with majority of participants <18yrs. Those who were on other antipsychotic medications in addition to Aripiprazole, were excluded. To ensure quality assurance, we used ROBINS-I tool and GRADE assessment to measure the risk of bias.

Result

240 records were retrieved, 187 after duplicates were removed. 8 full text articles were assessed for eligibility, of which 4 were included in the qualitative synthesis. 2 studies were analyses of spontaneous adverse drug reaction reporting systems and 2 of health insurance claims databases. All 4 studies found aripiprazole to be associated with greater risk of impulse control disorders. The single study which compared directly with other antipsychotics had a much smaller effect size. Study heterogeneity precluded meta-analysis. All studies were at high risk of bias. The quality of evidence is very low.

Conclusion

The available evidence is consistent with the existing warnings regarding increased risk of impulse control disorders in patients prescribed aripiprazole. Clinicians may wish to monitor for this adverse drug reaction. Further research which can account for potential confounders, examines specific impulse control disorders and which is less susceptible to detection and ascertainment biases is required.