bluuebunny/crossref_metadata_2025 huggingface dataset:
P300 event-related potentials in people with epilepsy: clinico-neurophysiologic study
Authors: Hasan Lina Abdulelah , Hamdan Farqad Bader , Al-Mahdawi Akram
Published: July 2023

Background

There is increasing evidence that prolonged or recurrent seizures can cause or exacerbate cognitive impairment (CI) in memory, attention, orientation, and visuospatial and abstraction disabilities, all of which can jeopardize educational progress and achievement throughout life. The objectives of our study are to assess the cognitive functions in people with epilepsy (PwE) using P300 event-related potentials (ERPs), and correlate each P300 components with six explanatory variables (epilepsy type, seizure type, NHS3 score- seizure severity, disease duration, age at first seizure, and the number of anticonvulsant medications).

Methods

One hundred and two PwE [52 with focal epilepsy and 50 with generalized epilepsy, as classified by the International League Against Epilepsy in 2017]. They underwent electroencephalography (EEG) and P300. The Montreal Cognitive Assessment (MoCA) scale was used to assess baseline cognitive functions.

Results

Epileptic patients showed significant latency prolongation and amplitude reduction of P300 as compared to non-epileptic population. Longer P300 latency and lower amplitude were seen in patients with abnormal EEG records. P300 latency was longer in patients using poly-therapy. P300 components correlated well with age at presentation and disease duration but not with NHS3. According to epilepsy type, 50.98% of PwE had focal epilepsy and 49.02% had generalized epilepsy, 85.29% of them had abnormal EEG recording. Considering seizure type, 47.06% had a generalized tonic–clonic seizure, 38.24% had a focal to bilateral tonic–clonic seizure, 20.59% had a myoclonic seizure, 12.75% had a focal with impaired awareness seizure, 3.92% had a focal aware seizure, and 2.94% had an absence seizure. Seventy-seven PwE had one type of seizure, while 25 had more than one type of seizure. The NHS3 score was higher in those with a single seizure type than in those with multiple seizure types.

Conclusion

All seizure types had an abnormal P300 component, indicating cognitive function deficits. P300 may be a promising objective method for assessing cognitive function in PwE. The number of antiepileptic drugs used, the presence of EEG abnormalities, the age at presentation, and the duration of the disease are the factors that best correlate with cognitive impairment (CI).
Maximizing mushroom residues benefits to produce vermicompost for Fusarium Oxysporium resistance in maize
Authors: Ali El Sayed A. E. , Amer Mariam A. , Saad AbdelGawad , Eid Hend T.
Published: July 2023

Background

Since the ecosystem is the first link in the food chain for all living things, including humans, animals, and plants, restoring it has become a global priority in recent years, particularly in agricultural soils by expanding the trend of fertilization and biological control instead of relying more on the use of chemical pesticides. Therefore, this study aims to maximize and enhance the advantages of mushroom residues (MR) to make vermicompost that can resist Fusarium Oxysporium (FO) in maize. This study was conducted in three stages: compost preparation, composting, and planting.

Results

The mixing process of vermicompost with the soil was improved by the lowest CV. The highest productivity was achieved by using a plastic rotary drum composter which had a patching size of 60 kg at a speed of 15 rpm for 8 min. In addition, the production of vermicompost from (MR) was improved by adding the aqueous extraction of licorice residue (LR), where helped to increase the vermicompost's pH and the amount of dissolved Cu and Zn. The wilt illness disease caused by FO in maize crop was decreased by adding the mixture of vermicompost (MR and LR) to the soil infested with Fusarium, as compared to the control.

Conclusions

The combination of 25% vermicompost (MR + LR) and 75% agri-soil proved to be the most effective treatment for wilt disease control, with a disease severity score of 1.90. It was discovered that treated maize roots produced more peroxidase and polyphenol oxidase activity compared to the control.
The many faces of intracranial tuberculosis: atypical presentations on MRI—a descriptive observational cohort study
Authors: Kumar Ishan , Shekhar Shashank , Yadav Tanya , Aggarwal Priyanka , Singh Pramod Kumar , Shukla Ram C. , Verma Ashish
Published: July 2023

Background

Atypical MRI findings of cranial tuberculosis can lead to prolonged delay in diagnosis resulting in high costs to evaluate for alternative diagnoses. The aim of this study was to describe a series of cranial tuberculosis patients with spectrum of MRI features, other than hydrocephalus, parenchymal tuberculomas, and leptomeningeal thickening. The final diagnosis was made based on CSF findings, clinical findings, and/or marked improvement after antitubercular treatment.

Results

A total of 39 patients met the inclusion criteria and were diagnosed with vasculitis (n = 15), tubercular abscess (n = 5), miliary tuberculosis (n = 3), tubercular cerebritis (n = 9), sellar and parasellar tuberculosis (n = 7), mass forming tuberculosis (n = 1), choroid plexitis (n = 2), and intraventricular tuberculomas (n = 1).

Conclusion

A significant number of patients of cranial tuberculosis can have variable presentations and may be misdiagnosed. This analysis helps to reinvestigate the spectrum of MRI findings.
Qualitative and quantitative parameters of dynamic contrast-enhanced (DCE) MRI as a diagnostic determinant of soft tissue tumor malignancy: a study from Indonesia
Authors: Rosida Yulia Rosa , Sukmaningtyas Hermina , Imawati Sukma , Prajoko Yan Wisnu , Sadhana Udadi
Published: July 2023

Background

Soft tissue tumors encompass a large variety of benign and malignant lesions which are classified histologically based on the components. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a non-invasive technique that is used in differentiating benign from malignant lesions by observing the differences in the enhancement rates, index of lesion vascularity and perfusion. Therefore, this research aimed to evaluate the diagnostic efficacy of qualitative and quantitative parameters of DCE-MRI in the malignancy of soft tissue tumors.

Methods

The type of time-intensity curve (TIC), Ktrans, Kep, and Ve values were obtained from 30 soft tissue tumor (17 malignant and 13 benign) from patients who performed the DCE-MRI examination. The obtained values were then statistically analyzed to get the cutoff point, sensitivity, and specificity in determining the malignancy of soft tissue tumors.

Results

TIC, Ktrans, and Kep values were significantly differentiated into benign and malignant soft tissue tumors except for Ve. The TIC for benign soft tissue tumors was predominantly by type 2, while type 3, 4, and 5 were predominantly malignant. The AUC of the ROC curve demonstrated a diagnostic potential of Ktrans (0.873) and Kep (0.889). Furthermore, the cutoff point for Ktrans and Kep was 0.2905 and 0.3365 with a sensitivity of 88.2% and 94.1%, specificity of 84.6%, PPV of 88.2% and 88.9%, and NPV of 84.6%, and 91.7%.

Conclusions

Qualitative and quantitative parameters of DCE-MRI helped diagnose soft tissue tumor malignancy with a cutoff point for Ktrans 0.2905 and Kep 0.3365.
MRI features of myelin oligodendrocyte glycoprotein antibody disease: a descriptive study—how it differs from neuromyelitis optica spectrum disorders and multiple sclerosis
Authors: Tom Mishael J. , Sandeep S. , George Arun , Philip Babu , Deepalam Saikanth
Published: July 2023

Background

Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a novel inflammatory demyelinating disease of the central nervous system. This study aims to characterize the MRI features of MOGAD and contrast our results with the findings previously described in the literature and its close differential diagnoses.

Results

Most of the abnormal findings are in the brainstem followed by supratentorial deep/subcortical white matter and optic nerves. Brain lesions in MOGAD tend to show a pattern that is different from multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Orbital MRIs show features of bilateral longitudinally extensive optic neuritis predominantly involving the anterior segments. The spinal cord is the least affected and mostly shows longitudinally extensive lesions in the dorsal spine.

Conclusions

We could identify numerous characteristic radiological features that could help distinguish MOGAD from NMOSD and MS. We hope this study helps clinicians systematically evaluate and manage patients with clinical features of neuroinflammatory diseases.
Significance of peak oxygen pulse in patients with chronic obstructive pulmonary disease
Authors: Mohamed Mai Hassan , Shahin Mostafa Mahmoud , Hoshy Mona Said El , Gharraf Heba Said
Published: July 2023

Background

Patients with chronic obstructive pulmonary disease (COPD) are more likely to develop cardiovascular comorbidities, such as pulmonary hypertension or heart failure. COPD patients are frequently adversely affected by compromised cardiovascular function. Oxygen pulse (O2P) serves as a proxy for stroke volume. However, studies concerning O2P, health-related quality of life (HRQL), and exercise capacity in COPD patients are lacking. Our objective was to verify the association between O2P, exercise capacity, and severe COPD exacerbation.

Materials and methods

Fifty COPD patients were evaluated using spirometry, echocardiography, and a cardiopulmonary exercise test (CPET) for this study. Hospitalizations and emergency department visits due to COPD, as well as cardiovascular co-morbidities, were tracked. Patients with normal peak O2P and those with impaired peak O2P were compared for these measures. Peak oxygen consumption (O2P) was correlated with cardiopulmonary exercise testing (CPET) and lung function by simple linear regression.

Results

Higher exercise capacity (peak oxygen uptake and work rate) and fewer hospitalizations due to COPD were observed in patients with normal peak O2P. Forced expiratory volume in one second (FEV1) was found to have a statistically significant correlation with arterial oxygen pressure (O2P) in a linear regression model.

Conclusion

Hospitalization due to COPD and exercise ability are both significantly affected by peak O2P. Peak O2P is strongly correlated with FEV1. The severity of COPD can be measured in part by the patient's peak O2P.
Off-Piste or Just Usual Prescribing in CAMHS? an Audit of Prescriptions and the Guidelines That Support Them
Authors: Roberts Claire , Brown Jenny
Published: July 2023

Aims

The aim of this audit was to review the prescriptions in one community Child and Adolescent Mental Health Service (CAMHS) and to see whether these prescriptions were licenced for the prescribed indication and if the prescription was supported by national guidelines.

Methods

I reviewed the treatment of 77 patients who were assessed by the consultant psychiatrist in one CAMHS team between January 2020 and August 2022.

For each prescription I gathered

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The name of the medication

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The Indication

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Child or young person's comorbidities

I then compared this with the licenced use on the Summary Product Characteristics (SPC), as well as the guidance available from (National Institute for Health and Care Excellence (NICE), British Association of Psychopharmacology (BAP) and British National Formulary for Children (BNFc)).

Results

In total there were 177 prescriptions for a variety of medication including antidepressants, antipsychotics, sedatives, and medication to treat ADHD.

It was found that 25% of all prescriptions were prescribed according to the medication's licensed use, with 42%, 62% and 67% compatible with NICE guidelines, BAP guidelines and BNFc respectively. However, 12% deviated entirely from these guidelines, including prescriptions for mirtazapine (1), melatonin (9), quetiapine (6), risperidone (1) and olanzapine (4). These prescriptions were also associated with increased comorbidity with each child having at least one comorbid mental health problem.

There was an 81% agreement between NICE and BAP guidelines, a 75% agreement between NICE and BNFc and 66% agreement between BAP guidelines and BNFc.

Conclusion

This audit demonstrated that only a quarter of prescriptions were prescribed according to a licenced use, with the vast majority falling outside the product licence. This is important because the Joint Standing Committee on Medicines preference “an appropriate licenced preparation” over unlicenced prescribing.

Furthermore, the defensibility of unlicenced prescriptions is increased when they are supported by published clinical guidelines which was the case in 88% of prescriptions that were reviewed. This leaves 12% of prescriptions that were not supported by either licencing or BAP, NICE or BNFc guidelines. There may be multiple causes for this, but it is likely that the high number is aggravated by the lack of NICE guidelines for common conditions such as anxiety as well as high levels of comorbidity in this population group which is not always reflected in clinical trials and guidelines.
Balint Group Sessions for Medical Students: A Pilot Study
Authors: Cowell Victoria , Ayalogu Chukwunwike , Ros Annette , Brown Harvey , Shittu Bayode , Akella Anusha , Lasisi Adeolu , Bancroft James , Whitcroft Holly , Surendran Indu , Bu Christopher , Older Abby , Gaynor Eleanor , Sullivan Kathia
Published: July 2023

Aims

The issue of health and well-being amongst the National Health Service (NHS) workforce has never been so prominent. Balint groups are facilitated discussion sessions aiming to help clinicians reach a better understanding of the emotional content of the doctor-patient relationship. Evidence suggests participation decreases rates of burnout and increases empathic ability. A Balint group pilot scheme for medical students was launched within Cheshire and Wirral Partnership NHS Foundation Trust (CWP), facilitated by both core and higher trainees in psychiatry, and supervised by a consultant psychotherapist. Feedback from both participants and facilitators was collected to gain a greater understanding of how these groups can shape our clinical interactions, and benefit the mental well-being of both patient and doctor.

Methods

We approached the University of Liverpool School of Medicine, who did not have a formal Balint programme, and proposed a pilot scheme with 4th year medical students rotating through psychiatry in CWP.

Sessions were conducted in four week blocks, during a student's psychiatry rotation, and were facilitated by two psychiatry trainees. At the end of each block, anonymised feedback was collected, and small alterations were made to the programme during the course of the pilot in response to attendance rates, punctuality and feedback.

Results

143 students participated in the programme in the first 11 cohorts, between September 2021 and December 2022, and 72 (50.3%) submitted feedback forms.

98.6% agreed that the programme helped them reflect more on their interactions with patients, and that it helped them gain insight into how others think and feel when caring for patients.

91.7% enjoyed the groups and 97.3% would use the skills learnt in Balint group in the future.

100% of students gave a positive response when rating their overall experience of the programme.

Facilitators reported increased confidence in their psychotherapeutic knowledge, and an improvement in leadership and communication skills.

Conclusion

The student experience of the Balint programme was positive for the vast majority, and from a facilitator perspective, we have found involvement to be very rewarding.

Psychiatry trainee group facilitation was well received by students, allowed a greater number of groups to run, and is beneficial for trainees’ professional development.

Before this pilot, approximately only 1/3 of University of Liverpool medical students had the opportunity to attend a Balint group.

However, our findings have contributed to a decision by the University of Liverpool to extend the scheme to all 4th year students on psychiatry placement from August 2023.
Great Northern Psychiatry Summer School - a New Online 3 Day Conference
Authors: Cranshaw Thomas , Evans Evelyn
Published: July 2023

Aims

Over the past two years, and continuing in 2023, we have developed a new three day online conference ‘Great Northern Psychiatry Summer School’ aimed at medical students and junior doctors interested in training in psychiatry in the North of England. This poster seeks to elaborate on our successes designing and providing a conference that contributes to the ongoing success of the RCPsych 'Choose Psychiatry' recruitment initiative and addresses regional disparities in core training fill rates.

Methods

Participants were recruited by advertising online (including social media), circulating information by medical schools and by integrating advertising into undergraduate educational provision.

Innovative teaching methods including online workshops were used to introduce attendees to the breadth of roles available within psychiatry and the work-life balance available within the North. Experienced and charismatic psychiatrists within subspecialties were invited to present their area of work. Practical sessions including interactive discussion of video scenarios introducing attendees to the working lives of psychiatrists.

Results

In the poster we summarize feedback received from attendees including a potential positive influence on psychiatric recruitment. The conference was popular to the point of being oversubscribed and having to limit numbers.

In 2022, 100% of attendees (n = 56) described the conference as either ‘very well’ or ‘reasonably well’ organized including a comment that it was ‘The most to-schedule online event I've attended’. 55% ofattendees suggested that the conference should remain virtual in the future. 90% of attendees indicated they were either ‘very likely’ or ‘likely’ to apply for psychiatry training. 70% of attendees responded that they were ‘very likely’ or ‘likely’ to apply for psychiatry training in the North as a result of attending the conference.

Conclusion

We have designed and hosted a successful 3 day online conference aimed at recruiting high quality and motivated candidates to the North of England, an area traditionally but no longer considered hard to fill. We have used feedback to improve the conference year to year and are hosting a 2023 conference online given previous positive experiences with this mode of delivery.
Improving Trainee Knowledge of Raising Concerns: A Trainee-Led Session at Induction for Postgraduate Doctors in Training
Authors: Davies Sian , Ibbett Vicki , Hubbard Katherine , Kulman Ella , Pantall Shay-Anne , Scally Ruth
Published: July 2023

Aims

As part of a wider Quality Improvement Project aiming to improve trainees’ experiences with ‘Raising Concerns’ in a large mental health trust, we sought to improve induction processes to make information on raising concerns more accessible when starting a new post. Based on change ideas generated from our driver diagram, peer-delivered information was identified as a useful tool, so a trainee-led session was introduced to the induction programme.

Methods

A 60-minute trainee-led session was integrated into the induction programme for Postgraduate Doctors in Training in August 2022. The session included sections on raising concerns, on-call advice and rota information. Following the induction, as part of our “Plan, Do, Study, Act” (PDSA) cycle, we sent a questionnaire to gather data from trainees, which covered quantitative measures, including overall helpfulness of the session and effectiveness of information on ‘raising concerns’, and qualitative feedback for how to improve the session. The session was replicated at both the December 2022 and February 2023 inductions, incorporating the feedback from each previous session.

Results

On a 1-5 scale (5 = strongly agree), the average response for how helpful the trainee-led induction session was 4.5 from both the August and December 2022 inductions. 4 out of 6 responders from the August 2022 induction specifically mentioned the information on raising concerns as being particularly helpful. There was also feedback on improvements that could be introduced, such as increasing the amount of time for the session to allow for more questions. When asked to rate the helpfulness of the ‘raising concerns’ section, the average response was 4.83 and 4.50 for August and December 2022 inductions, respectively. Following the feedback from August 2022, we implemented changes to increase the duration to 90 minutes and include trainee reps in a separate ‘Question and Answer’ session. Unfortunately, there were only 2 responders to the December 2022 questionnaire due to a small intake, so we will evaluate data from February 2023 induction to analyse the effectiveness of changes made to the session and assess the need for further improvements.

Conclusion

Overall, the response to our trainee-led induction session has been positive, with good feedback both for the whole session and specifically relating to ‘raising concerns’. It has highlighted trainees’ appreciation for peer-delivered information and the need for more time in this session. The questionnaire from February 2023 induction will give more data on whether our improvements have been effective and provide ideas for future PDSA cycles.
Examination of Kubler Ross Model of Grief From the Perspective of Bollywood Cinematic Media
Authors: Dawar Aditi , Dara Praneeth , Sule Akeem
Published: July 2023

Aims

Bollywood cinema is one of the largest entertainment industries, catering to a population of more than 1.4 billion people across the world. Social psychiatry faces a challenging relationship with pop culture and understanding such portrayals of mental health culture could be valuable to public mental health. "Goodbye" is a fictional movie depicting various stages of Kubler Ross model of grief following a bereavement.

Methods

AS, AD and PD had structured discussions to analyse themes, social determinants and psychiatric correlations following bereavement in a Bollywood movie called "Goodbye".

Results

“Goodbye” is a well acclaimed Bollywood movie. The story revolves around a family responding to a sudden bereavement of their loved one.

This story clearly depicts individual responses to the incident based on their attachment and psychosocial circumstances. It demonstrates varied responses depending upon their own perception of the processes following bereavement.

In the movie each individual is observed coping with their own roller coaster of emotions and at the same time struggling to fit into the complex demands of the moment.

Even though each individual responded differently it clearly demonstrates each of them going through Kubler Ross stages of grief reaction. It focuses on the psychodynamic makeup of each individual and their response mechanisms.

The movie begins with the daughter getting the news of her mother's death and immediately going into shock/denial. It is followed by anger which she directs towards her father for following the rituals around death in a Hindu culture. She challenges the practice of lighting the funeral pyre only by the sons. She reminisces telling her mother that once she dies she will get all her jewellery and displays guilt around this, leading to significantly low mood and bargaining as well. Once they are in the process of finishing all the rituals she comes to terms with her mother's death and reconciles with her father, showing acceptance.

The cultural milieu plays a strong role in various responses to bereavement. The family follows various Hindu rituals for 13 days, which helped them stick to each other's side and reach the stage of acceptance following the death of a daughter, a sister, a wife and a mother.

Conclusion

This movie beautifully exemplifies how grief is a universal concept even in various socio-cultural backgrounds. It is a good study for anyone interested in understanding grief through a cultural medium. It demonstrates the importance of support network in tiding over significant life events.
Treating Through “The Sopranos”: A Biopsychosocial Approach
Authors: Hamour Omer , Sule Akeem
Published: July 2023

Aims

Television is a medium through which an audience can gain insight into the nuances of psychiatric practice. Nonetheless, the psychoeducational benefits are dependent on accurate portrayals. “The Sopranos” has received critical acclaim from various professional psychiatric bodies for its artistic depiction of psychoanalysis and the psychotherapeutic relationship. The series follows Tony Soprano, a middle-aged Italian-American male engaged in organized crime. He is referred to his psychiatrist, Dr Melfi, by his family physician after suffering debilitating panic attacks. Melfi accepts the referral despite Tony's chequered past, employing a holistic approach to his care. We aimed to analyse the psychotherapeutic relationship between Tony Soprano and his psychiatrist, using a biopsychosocial approach.

Methods

Season 1 of “The Sopranos” was identified by a facilitator and utilized for discussion. The season was viewed individually and virtual case-based dialogues took place between the author and facilitator examining the psychotherapeutic relationship using the biopsychosocial model.

Results

The Sopranos coincided with the popularity of the serotonin theory of depression in the US, promoted by the pharmaceutical industry. Tony Soprano is pharmacologically treated for panic attacks, anxiety and depression. This sparked thematic discussion around symptom control, medication efficacy and adverse effects. Melfi balances the application of medication alongside understanding the psychological roots of symptoms, deprescribing when necessary.

Themes pertaining to conflict between Freud's id, ego and superego persisted, manifesting cognitive dissonance most prominently in relation to Tony's line of work. Symbolism of ducks guided understanding of Tony's biggest fear – losing his family. Projective testing was explored, alluding to the Rorschach test. Scenes depicting transference and countertransference were present, the former representing Tony's unmet needs from female figures in his life. Eventually, Tony's distress induces internally generated pseudohallucinations.

Tony's tender treatment of his children offsets his volatile relationship with his parents, particularly his mother who habitually antagonizes her son. His personal and professional life are intertwined, with mental health stigma evident in both realms as Tony seeks help surreptitiously to maintain his credibility.

Conclusion

“The Sopranos” depicts the psychotherapeutic relationship between a man suffering from mental illness and his therapist. This layered and accurate portrayal can provide a case-based reference for psychoeducational discussion, and give rise to further discussions of psychiatric themes within film and television.
Learning From Serious Incidents - Support Programme for Trainees
Authors: Rao Prathibha , Harris Jennifer , Paisley Emma
Published: July 2023

Aims

A significant number of Psychiatrists will experience a serious incident (SI) whilst in training. CNTW Trainee Led Implementation Committee (TLiC) felt that the trust SI reporting process and support offered for trainees was inconsistent, anxiety provoking and at times insensitive. We decided to review existing processes to support trainees through SIs and develop a programme that addresses these areas.

Aims of programme

Improve trainers’ confidence in supporting a trainee involved in SI. Establish robust mechanisms to support trainees involved in SI

Methods

The SI medical education quality team with a trainee representative, set up a comprehensive programme to address above objectives.

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Process: System for weekly notifications of incidents from trust safety team and producing a useful algorithm to decide thresholds for reporting to Live flow (Health Education North East). Trainee notification of incidents via their named Clinical and Educational supervisors.

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Trainers support: Produced a template that would form basis of discussion with trainee covering educational and governance areas, resources and support offered- uploaded to trainee's portfolio/form R for ARCP review. Workshop conducted for trainers to enhance their knowledge in supporting trainees.

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Trainee support: Rolling training programme for trainees-sessions from trust SI team, trainee sharing personal experience of involvement in SI, Coroners Inquest by trust Legal department and Interactive Human factor approach-based case studies. Ongoing support from trust safety team- immediate (team debriefing, after action reviews) and long-term support (SI panel and legal representation) offered to all trainees. Learning opportunities offered - observing coroners and joining SI panels.

Results

We have run 5 trainee days since 2019- attended by 79 trainees in total.

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All sessions rated excellent. Sessions of trainee's perspective, legal perspective and case study discussions being rated the best.

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Almost all trainees felt that the session would have a significant impact on their clinical practice- in particular contemporaneous documentation reflecting decision making. Many felt the need for an informal peer support group that they could access.

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Workshop for trainers was also rated good/excellent

Conclusion

Creating a culture which supports reporting concerns around safety and focuses on learning is crucial. Trainers often feel ill equipped to support a trainee. Our programme which now includes a peer support group provides a comprehensive and systematic package to help address all these areas and promote a culture of openness with quality and safety being the top priorities, right from a grass root level.
Provision of Climate Emergency Teaching for Psychiatry Trainees: A Deanery Wide Quality Improvement Project
Authors: Roberts Rosa , Etter Olivia
Published: July 2023

Aims

In 2021, The Royal College of Psychiatrists declared a climate emergency, stating that “The disruption to life posed by climate and ecological degradation is a crisis which presents an unprecedented threat to human health”. In 2022 the College released an updated curriculum for both Core Trainees and Higher Trainees, which included the requirement that trainees “demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice”. We aimed both to understand whether Core Psychiatry Trainees (CTs) are meeting the new sustainability curriculum requirements and to increase awareness of the connections between the climate crisis and mental health.

Methods

We used an electronic questionnaire to survey CTs baseline understanding of the climate emergency and sustainable practices in psychiatry, with reference to clauses included in the 2022 curriculum and Silver Guide. An educational module on the climate emergency was planned and delivered to CTs in 2022 and 2023. Content included sustainable practices in psychiatry and the relevance of the climate crisis to mental healthcare. Feedback was gathered afterwards.

Results

The questionnaire showed 44% of CTs surveyed disagreed or felt neutral that they could demonstrate an understanding of the principles of sustainability and 56% disagreed or strongly disagreed that they understand how the mental healthcare system can work to reduce potential negative impacts of healthcare on the environment. Feedback from the initial teaching day in 2022 included the following suggested improvements 1) Highlighting the relevance to psychiatry 2) Holding the day in person 3) Avoiding sessions with too many facts. These suggestions were incorporated into the second teaching day, along with the new College Silver guide curriculum requirements. 32 CTs attended the second teaching day (16 in person and 16 online), with some overlap in attendees from the previous year. Feedback from the second day was very positive. Respondents particularly found the session on young people and eco-distress useful, and reported finding the day ‘educational’, ‘insightful’, ‘practical’ and ‘accessible’. Further suggested improvements were to incorporate a nature based intervention into the day.

Conclusion

Our findings showed psychiatry trainees find educational sessions on the climate crisis and psychiatry necessary and useful for their practice. This project gives an insight into how to provide this teaching in way that is reflective of the scale and urgency of the issue whilst also providing practical advice, optimism and active hope for the future.
The Association of Black Psychiatrists-UK Culture Club: The Experience So Far and Proposed Future Directions
Authors: Talabi Olufemi , Shonibare Oluwafunminiireayomi , Ogundalu Abisola , Akanle Olukemi , Fapohunda Mosun , Sule Akeem , Omojuwa Toyin , Kwentoh Mona-Lisa , Nwokolo Isioma , Edwards Allison , Orimoloye Olamide , Ofovwe-Onwusi Fejiro , Ijete Elohor , Medubi Adeyinka , Obinwa Chinwe
Published: July 2023

Aims

Media coverage and representations in popular culture can positively and negatively impact wider social attitudes to mental health and illness.In the light of the George Floyd and Tyre Nichols murders and the discussion about racism and its legacy on Black mental health, it has become especially important to discuss the effect of popular culture on Black mental health and vice-versa. The Culture Club was formed in 2021 as an offshoot of the Association of Black Psychiatrists-UK (ABP-UK) with the aim of analysing popular culture and black mental health with a view towards finding recurring themes about Black mental health and our lived experiences of racism and racial trauma. The Culture Club comprises doctors at all levels and medical students affiliated with ABP-UK. We initially started off reviewing films as the cinema offers an accessible and enjoyable way to explore the link between popular culture and mental health. The proposed future direction is to further incorporate other media to offer a more holistic experience and to further support public education efforts.

Methods

Media from across the world featuring the intersection of racial trauma and black mental health are selected. The feature is watched individually, with a club discussion occurring virtually. Discussions are centred on the plot, characters, mental health correlations, and themes relative to our own lived experiences. We then note major or recurring themes for further exploration.

Results

To date, we have discussed “Thirteenth”, a documentary by Ava DuVernay, “Da Five Bloods” by Spike Lee, “Red, White and Blue” by Steve McQueen, The Nollywood blockbuster series “Blood Sisters” created by Temidayo Makanjuola and “Queen and Slim” by Melina Matsoukas.

The emerging critical themes from the screenings and our lived experiences are systemic racism, differential attainment, vicarious trauma, stigma and its impact on mental health, and the law.

Conclusion

Key themes underpin black mental health and racial trauma. These themes, if studied further, could potentially be targeted to improve the lived black experience and, in turn, black mental health.

Popular culture remains an important tool in understanding Black mental health.

We welcome further ideas towards improving the culture club experience.
Foundation Doctors and the New Mental Health Curricula: What They Think and What They Want
Authors: Varvari Ioana , Dewhurst Tom , Jones Corinne , Haslam Richard
Published: July 2023

Aims

The new United Kingdom Foundation Programme Curriculum was implemented in 2021 and emphasizes the importance of Foundation Trainees (FTs) acquiring mandatory core skills and knowledge in mental health. The primary aim of our study was to enquire if the FTs perceive the new psychiatry competencies to be important and relevant to their needs. Secondarily we compared what the curriculum is offering with what FTs wished to have been offered.

Methods

A hybrid questionnaire was delivered online via Google forms to all foundation doctors before and after their psychiatry rotation. Data collection took place between August 2021 and March 2023 from a sample of 85 FTs. The quantitative data were elicited via 5-point Likert scales that mapped FTs' perception of importance across areas of required knowledge and core psychiatric skills from ‘not at all’ important to ‘extremely’ important. The data were imported into Microsoft Excel and analysed via descriptive statistics. The qualitative component of eliciting what FTs want by using open-ended questions was analysed using content analysis.

Results

The entry survey data show a combined median perceived importance of 4 (Very important) for recognizing, assessing, and managing mental health conditions. Out of these, personality disorder rated lowest with a median answer of 3 (Fairly important). These scores have seen a significant improvement in the exit survey with an overall combined median result of 5 (Extremely important). But not all areas have seen improvement, for example, eating disorders and Somatisation disorders remained unchanged with a median of 4. Interestingly, the median perceived importance of practicing core skills and managing clinical scenarios has not shown an improvement, but a slight decrease over a few categories, going from a median answer of 5 to 4. The qualitative data show that FTs would have liked to learn more about Child and Developmental Psychiatry, Bereavement, and acute health context teaching. They also wanted to learn communication skills and about psychiatry career paths and academic opportunities.

Conclusion

The overall baseline perceived importance of psychiatry competencies was satisfactory, with most conditions being rated as very important. Post placements there was a shift in responses, with the same conditions being rated as extremely important. Supraspecialised areas continue to be perceived as least important and curiously, FT's importance perception of practicing core skills in the acute setting decreased. Future research should qualitatively look at why their perceptions changed and how we can improve context teaching in a heterogeneous group.
Medical Students’ Perceptions of Factors Associated With Their Mental Health and Psychological Well-being
Authors: Hawsawi Aisha Ali , Nixon Neil , Stewart Emily , Nixon Elena
Published: July 2023

Aims

In light of growing evidence suggesting that medical students are particularly susceptible to stress and ill health, the need to enhance their psychological well-being has been highlighted as a priority concern in medical education and policy. However, only a few studies have comprehensively addressed both positive and negative contributors to medical students' psychological well-being. Therefore, this study aims to provide a more holistic understanding of medical students' psychological well-being, the coping strategies they use and any barriers they face in seeking support, as well as outline potential areas of improvement within provisional well-being support.

Methods

This qualitative study involves semi-structured interviews with 25 medical students to gain in-depth insight into their experiences and perspectives on the factors influencing their psychological well-being during their medical training. The interviews were transcribed and analysed using thematic analysis.

Results

The study's results revealed that positive and negative factors influence medical students' psychological well-being. Positive factors such as study-life balance, academic achievement, meaningful relationships with staff and peers and time spent with close friends or family positively influenced students’ psychological well-being; while adverse educational, organisational and cultural factors negatively impacted students' well-being. Additionally, COVID-19 had negatively affected students’ academic, personal and social lives. Medical students mainly used active coping strategies, including planning, acceptance, positive reframing, and seeking support. However, some students reported facing barriers in seeking support, such as fear of stigma, lack of time/support, confidentiality concerns, and difficulty in accessing support. At the same time, there was an expressed need to improve well-being services or resource provision. Students have recommended various solutions to improve mental health support in schools, including addressing cultural and organisational changes within schools, increasing access to resources, reducing the stigma surrounding mental health, and promoting positive factors that support psychological well-being.

Conclusion

The findings highlight the importance of adopting a holistic approach that considers a variety of contributing factors affecting positively as well as negatively medical students’ well-being. It also highlights the need to provide a supportive and nurturing environment in medical schools and offer appropriate support and resources to help students cope with the stress and challenges of medical training.
Optimising a Digital Micro Intervention to Support Parenting Skills Using Agile Sprints
Authors: Hodson Nathan , Woods Peter
Published: July 2023

Aims

To adapt a digital micro intervention, the Pause: Smart Parent Timer app, to support evidence-based parenting skills programs, which are first line for disruptive behavioural disorders. 77% of parents use time out but 85% use it in ways contrary to evidence. This project aimed to optimise the app to support time out and related approaches across a diverse range of parenting programs.

Methods

Working with parenting program providers across the Midlands, the app was updated through an iterative process of agile sprints. The process drew on the EAST behavioural insights framework with a focus on consistency between parenting programs and the app.

Results

The app was improved over several stages to meet the needs and preferences of parenting program providers. Key gains included: a) improved graphics, b) improved UX, c) more options for parents to change timings, d) a wider range of timing protocols for different parenting programs, e) removing references to time out, f) added elements of mindfulness.

Conclusion

This process resulted in a single app which can be used to support any major parenting skills program. Future plans include extending parent feedback and evaluating usability in practice.
Prevalence of Psychiatric Disorders in Adolescents With Epilepsy Attending a Tertiary Care Centre in South India
Authors: Omanakuttan Geethu Parvathy , Devasia Mithun Pulichumakal , Williams Laura Jayne , Anil Kumar Thekkethayil Viswanathan
Published: July 2023

Aims

Epilepsy is one of the most common neurological disorders characterized by an enduring predisposition to generate seizures, which can affect all age groups. Prevalence of overall psychiatric disorders among persons with epilepsy is significantly higher, and children and adolescents with epilepsy were found to have even higher rate of disorders ranging from 35% to 50%. Along with anxiety and depressive disorders, attention deficit hyperactivity disorder (ADHD) is also a common psychiatric disorder in children and adolescents. This study was primarily aimed to estimate the prevalence of psychiatric disorders among adolescents diagnosed with epilepsy. It also looked for any association between such disorders with various sociodemographic and epilepsy related factors.

Methods

A cross sectional study was conducted among 117 adolescents aged 11 to 18 years diagnosed with epilepsy. Patients with intellectual disability were excluded. After taking written informed consent and assent from parents and participants, relevant sociodemographic and clinical data were recorded. Prediction of having a psychiatric disorder was made using multi-informant type of Strength and Difficulties Questionnaire (SDQ), with a total score in borderline range suggestive of possible and score in abnormal range suggestive of probable psychiatric disorder. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 22. Chi-square test was used to find association between categorical variables. For all statistical interpretations, p < 0.05 was considered the threshold for statistical significance

Results

Assessment with multi-informant type of SDQ has predicted that 64.1% of adolescents with epilepsy has possible (23.9%) or probable (40.2%) psychiatric disorder.

Prevalence of abnormal scores for hyperactivity subscale was 29.9%, conduct subscale was 29.1%, emotional symptoms subscale was 40.2% and peer-problem subscale was 27.4%.

88 % had high pro-social score suggestive of good social behaviors.

An abnormal or borderline total difficulty score on SDQ was significantly associated with inadequate seizure control (p = 0.029). No significant association was noted between a higher total difficulty score on SDQ with age, sex, sociodemographic status or disease related variables like age of onset, duration and type of epilepsy, monotherapy or polytherapy or family history of psychiatric illness.

Conclusion

A higher proportion of adolescents with epilepsy were identified to risk of having a psychiatric morbidity, which can possibly impair the quality of life and treatment outcome, particularly in Indian context.

Early identification of such disorders using screening tools and a multidisciplinary approach for managing them at the earliest can possibly improve the outcome, for which further research is recommended.
Caring for Women Going Through Care Proceedings in the Perinatal Period While in Prison
Authors: Streets Lulu , Pontvert Caroline , Pitfield Christy
Published: July 2023

Aims

This literature review aims to identify and understand the mental health needs of women in prison going through care proceedings in the perinatal period, in order for professionals to effectively care and support these women. Mental health difficulties in the perinatal period has been found to effect up to 27% of new and expectant mothers. The likelihood of experiencing these specific mental health issues is increased when there is past psychiatric and/or trauma history. Women in prison are more likely to have experienced childhood adversity and have psychiatric illnesses than the general population, which make them more susceptible to developing perinatal mental ill health. It has also been acknowledged that going through care proceedings can impact maternal mental health, which in prison brings specific and unique challenges. Therefore, the perinatal women in prison who are going through these proceedings have specific needs that have previously been overlooked, which this literature review aims to identify.

Methods

The databases searched for literature written since 2008 were: PubMed, PsychNet, Web of Science, Springer Link. Search strategy key words were: prison, perinatal, care proceedings and maternal mental health. Data were then collected and summarised thematically. 16 studies met the inclusion criteria.

Results

The negative effects of going through care proceedings during the perinatal period include: earlier rates of maternal mortality, increased trauma symptoms, lack of support and increase in shame and issues with self-esteem and identity. Additionally, literature that focused specifically on women in prison going through care proceedings, found additional effects such as increased self-harming behaviours and depressive mood symptoms.

In order to address these difficulties, the following interventions have been recommended: more trauma informed training for professionals, oppositional identity work, a focus on building Epistemic Trust and ensuring interventions are delivered within 18 months of removal as this has been identified as a window of opportunity to make meaningful impact.

Conclusion

Going through care proceedings in the perinatal period has been identified as a significant challenge for mothers, which has increased complexity for women in prison. This literature review highlights the need for specific trauma-informed support and specialist perinatal mental health interventions for this population. Future research should focus on identifying the needs of women in prison going through care proceedings further, as it has previously been overlooked.