bluuebunny/crossref_metadata_2025 huggingface dataset:
Working Towards a Greener NHS: Exploring Psychiatrists’ Attitudes Towards the Climate Crisis
Authors: Hall David , Romeu Daniel , O'Donohoe Hannah , Srinivasaraghavan Gayathri , Nightingale Sharon
Published: July 2023

Aims

The primary aim of this project was to explore the attitudes of doctors employed by Leeds and York Partnership NHS Foundation Trust (LYPFT) towards climate change and sustainability issues. Secondary aims were to ascertain psychiatrists’ knowledge of current efforts to mitigate the impact of healthcare on the climate, and to identify barriers to action against the climate crisis.

Methods

This was a cross-sectional study using a self-completed questionnaire designed by the team on an online platform (Survey Monkey, www.surveymonkey.co.uk). It was open from 23 August to 19 September 2022 and shared via email with doctors of all grades employed by LYPFT (n = 211). Likert-scale and multiple-choice responses were analysed using descriptive statistics and two-sided t-tests. Free-text responses were analysed independently by four researchers (DH, DR, HO, GS) using thematic analysis. Participants were required to agree to an online consent statement before proceeding. The study was carried out in accordance with University of Leeds ethical protocols.

Results

66 doctors completed the questionnaire (31.3% response rate) of whom 24 (36.3%) were consultants and 42 (63.6%) were junior doctors. 57 (86.3%) respondents agreed that climate change is harmful to mental and physical health. 42 (63.6%) indicated that the climate emergency was relevant to their role, and 46 (69.7%) felt that climate and sustainability issues should be included in educational curricula for all healthcare professionals. Only 4 (6.1%) were aware of the Trust's strategies to mitigate its impact on the climate, and 7 (10.6%) were familiar with the remit and content of the Greener NHS Plan. There were no statistical differences in responses to these questions between consultants and junior doctors.

The most commonly perceived barriers to reducing the Trust's impact on the climate were a lack of willingness to change current practice (n = 28, 42.4%), poor awareness of the impact of the healthcare industry on the climate (n = 16, 24.2%), and an absence of guidance on sustainable practice (n = 15, 22.7%). Three themes emerged among free-text responses to this question: clinical priorities taking precedent, extensive use of pharmaceuticals and a lack of appropriate infrastructure and resources.

Conclusion

LYPFT doctors appreciated the significance of the climate crisis and its relevance to their role as healthcare professionals. However, there is a lack of awareness of local and national efforts to mitigate the impact of healthcare on the climate. Future work should raise awareness of the association between planetary and human health and encourage stakeholders to prioritise sustainability issues.
Improving a Psychiatry Teaching Programme for Junior Doctors on Placement in a Mental Health Trust
Authors: Williams Verity , Ajiteru Tonye , Hussein Abigail , Daly Rachel , Fry Lydia , Maczka Luke , Pendleton Angela , Pickard Max
Published: July 2023

Aims

Foundation Programme and GP trainees on psychiatry placement within Kent and Medway attend a teaching programme on core topics. The GP training and new Foundation Programme curricula require key mental health content to be covered. This quality improvement project (QIP) aimed to improve the delivery of mental health teaching to Foundation and GP trainees on psychiatry placement.

Methods

The existing teaching programme was fortnightly, full-day teaching, online via zoom. Drivers for change included: reduction in duplication of teaching; new curricula; changes to training patterns, including GP trainees moving to Integrated Training Posts (ITP); and promoting sustainability.

The project team included Medical Education team members, trainee representative and clinical staff involved in education. In the first QIP cycle between March and August 2022, a Medical Education Working Group reviewed teaching content for congruence with GP and Foundation curricula and to reduce duplication with other training settings. Medical education teams from other local mental health trusts were contacted to gather examples of best practice, and teachers and trainee supervisors were consulted. Qualitative trainee feedback for teaching between December 2020 and April 2022 was evaluated. Teaching delivery was revised to half a day fortnightly, and session length standardised to 75 minutes. After the new programme commenced in August 2022, a second QIP cycle evaluated trainee qualitative feedback and there was further engagement with teachers.

Results

First cycle trainee feedback revealed several themes: teaching was too long; content was useful, especially focus on primary care; presenters were engaging. Suggestions for improvements included using interactive teaching tools such as online polls or quizzes, increasing case-based teaching, and small group breakout sessions. Shortening the teaching day preserved clinical exposure, especially for ITP trainees. Online format reduces travel time and expense, promotes sustainability, and reduces impact on clinical experience. Second cycle trainee feedback identified some sessions could be shortened. Consultation with education teams from neighbouring acute trusts identified schedule overlap with other mandatory training, so teaching was condensed to one 75-minute session weekly. Delivering teaching more efficiently releases time for direct patient care.

Conclusion

We used a quality improvement approach to improve a teaching programme offered to GP and foundation trainees in Kent and Medway. Our outcome delivers an efficient teaching strategy, responding to trainee feedback, which meets curriculum objectives more efficiently, preserving time for direct patient care and to implement learning. Additional learning is the importance of liaison with medical education teams in acute trusts to optimise teaching.
Examination of Medical Students’ Expectations of Psychiatry Prior to Placement: A Qualitative Study
Authors: Mark Isabel , Edgerley-Harris Georgina , Hutchinson Julia , O'Brien Aileen
Published: July 2023

Aims

There is limited literature regarding medical students’ expectations of psychiatry placements, although studies focussing on nursing students reveal fear and anticipation of aggression and violence to be prominent factors. Anecdotally, authors have been aware of medical students having reported impressions of psychiatric wards which were at odds with the reality. This study aims to explore what medical students specifically imagine and expect from psychiatric wards and psychiatric intensive care units prior to their placement. Psychiatric intensive care, arguably the most intense experience students will have in psychiatry, was used as a specific focus to highlight the full extent of their preconceptions.

Methods

Students undertaking their psychiatry attachment between July and December 2021 were invited to complete a semi-structured questionnaire, deemed to be more preferable to interviews as it was thought that anonymity would encourage more students to participate, provide open and honest responses, thereby exposing the full scope of presumptions. Question content was designed by 2 psychiatrists, with modifications after consultation with 2 student advisors. Questions explored student emotions regarding their visits to psychiatric wards and psychiatric intensive care, as well as expectations of the ward atmosphere, layout, activities, where patients would be, what they would be doing and how they would be managed. 37 responses were received. Analysis followed the well-recognised six stages of thematic analysis. Two authors read and coded all text independently, before discussing any discrepancies and then defining and refining themes with involvement from all authors, in a process of several reviews.

Results

Five themes emerged from the data: 1) Mixed feelings about the placement (with anxiety being prominent), 2) Mixed views about patient behaviour with many assumed to be violent, 3) Caring and holistic-minded staff, 4) A restrictive and locked environment, 5) Assumed similarities to acute general hospital care. Some of the expectations of students were markedly different to the realities of psychiatric inpatient and intensive settings, with students reporting ideas of patients in locked rooms, physically restrained, sedated and attached to ventilators.

Conclusion

This study offers a unique insight into what medical students expect from their psychiatry placement, a key issue of which all educators and clinicians who supervise students should be aware. Results can inform better student preparation and placement supervision, leading to more meaningful learning and improved well-being.
Psychodynamic Psychiatry Education and Training for Health Care Staff in the Acute Hospital Setting
Authors: Bo Lorna , FitzGerald James , Arends Fraser , Peters Pamela
Published: July 2023

Aims

Psychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that healthcare staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for healthcare staff in the Cambridge University Hospitals (CUH) NHS Foundation Trust, and to evaluate the perceived benefits of attending in terms of personal and professional development.

Methods

Convenience sampling was used to recruit CUH doctors, nurses, and healthcare assistants at all stages of training as part of their in-house teaching schedule. Sessions were delivered via an online format or in person. The evaluation period was between October 2021 and July 2022. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessions

Results

Thirty-three participants responded to our survey, with the sample consisting of gastroenterology (n = 4), acute medicine (n = 6), and emergency medicine doctors (n = 10). The sample also included emergency department nurses (n = 8) and health care assistants (n = 5). included. Most respondents (>90%) described the experience of the sessions including the material covered as ‘Positive’ or ‘Very Positive’. All participants felt they were able to express themselves in the session and the majority (>97%) felt that the sessions were relevant to their training needs and focused on the right issues. Notably, most participants (>88%) felt the sessions enhanced their ability to recognise the importance of the therapeutic relationship, the emotional significance of symptoms as well as the impact of group dynamics on patient's presentations.

Conclusion

Our findings suggest that these psychodynamic psychiatry training seminars provide an effective, safe, non-judgemental space for experimentation and interdisciplinary discussion to support healthcare staff management of complex patients. Our results support the expansion of this low-cost, high-value intervention for both the well-being and professional development of healthcare staff.
Targeted Approach to Providing Child and Adolescent Mental Health Education to GPs
Authors: Foster Michael , Sherratt Anna , Hawcroft Victoria , Maqsood Hamid
Published: July 2023

Aims

The aim of this project was to construct and deliver an educational session for general practitioners (GPs) in local Primary Care Networks on challenging child and adolescent mental health conditions. It was hypothesized that delivering targeted teaching sessions, supported by the same quiz applied before and after, would demonstrate an effective and repeatable method of improving GPs’ knowledge about these conditions. Since the COVID-19 pandemic, demand on both Child and Adolescent Mental Health Services (CAMHS) and GPs has reached unprecedented levels. Compounding this load, half of all referrals written by GPs to CAMHS are rejected, which prolongs the time a young person is under GP care, delaying specialist intervention. Unfortunately, during GP training exposure to CAMHS is limited and dedicated teaching is often insufficient. As a step towards addressing this challenge, a comprehensive teaching session combining didactic and socratic methods was devised and tested.

Methods

The teaching session comprised the presentation, diagnosis, and first steps in management of four challenging conditions in children: autism, eating disorders, depression, and emotional dysregulation. A quiz with multiple-choice answers was administered before and after the presentation, addressing each of the four conditions. The data collection took place between December 2022 and January 2023. A total of 29 pairs of quizzes were completed by GPs. Due to the type and size of data collected, a non-parametric bootstrap resampling method was used to compare the before-and-after scores for each topic and overall score.

Results

For the 29 pairs of quizzes, mean differences and 95% confidence intervals (CIs) were calculated between before-and-after scores, for each topic and for the total. All 4 topics showed statistically significant mean improvements: autism 1.3 CI: [0.9 , 1.8 ], eating disorder 1.8 CI: [1.4 , 2.3 ], depression 1.4 CI: [1.0 , 1.7 ] and emotional dysregulation 1.7 CI: [1.4 , 2.0 ]. The total mean improvement was 6.2 CI: [5.5 , 6.8 ] out of a maximum 16 points.

Conclusion

These targeted educational sessions suggest it is possible to make reliable improvements in GP knowledge across a variety of topics. With child and adolescent mental health demands at record levels, a more focused approach of the kind considered here may offer a model for training elsewhere. As an indication of the impact of this approach, further sessions on other topics have been requested by the GP teaching leads.
Gogledd Cymru-Peer Supervision in Psychotherapy (GC-PSP): What Are Lessons Learned After Two Years?
Authors: Loo Jiann Lin , Simiyon Manjula , Sambhi Rajvinder Singh
Published: July 2023

Aims

Core trainees in psychiatry (CT) must attain competencies in at least two psychotherapy modalities before they are allowed to sit for the final Royal College of Psychiatrists’ membership exam. The common training approaches in the United Kingdom include regional training workshops, weekly Balint groups, and access to individual supervision. Some CTs express their wish to have extra opportunities to practice psychotherapeutic skills and discuss cases in order to enrich their experience in learning psychotherapy. Therefore, the peer-led GC-PSP, i.e. Gogledd-Cymru (North Wales) Peer Supervision in Psychotherapy is conceptualised as a quality improvement project (QIP) for North Wales CTs. This article aims to illustrate the lessons learned after two years of GC-PSP.

Methods

A baseline survey was done to identify trainees’ ideas, concerns, and expectations in psychotherapy training and weekly one-hour supervision sessions were set up in May 2021. Sessions were facilitated by a speciality trainee (ST) in psychiatry with experience in psychotherapy. The agenda was determined on the day based on the specific issue or expectation brought up by trainees which could include: clarification of psychotherapeutic concepts and knowledge learned elsewhere, skill training through role-playing, case formulation of clinical encounters, discussions on suitable intervention, and any topics that were relevant to psychotherapy or combination. Subsequent written and verbal feedback was gathered.

Results

A total of 48 sessions had been conducted in two years, with 37.5% covering knowledge teaching, 45.83% skills training, and 39.58% case-based discussions. The top five modalities requested by CTs included: cognitive behavioural therapy (32.35%), psychodynamic therapy (20.59%) acceptance and commitment therapy (17.65%), motivational interview (11.76%), and behavioural activation (8.82%). The overall attendance had been inconsistent, ranging from no attendees and the highest of eight attendees comprising medical students, foundation year trainees, core psychiatry trainees, general practitioner specialist trainees, and specialist registrars.

Conclusion

Although inconsistent attendance results in the repetition of discussions and topics, all trainees feel the extra sessions support their learning in psychotherapy in a safe space as they feel the small group discussion allows more active participation and they are able to learn from others on top of their individual supervision (positive Kirkpatrick level 1 reaction). All trainees wish to have this initiative continued and prefer a semi-structured rather than totally flexible agenda so that they can plan for their attendance, which can be a consideration for future implementation.
Mentorship Scheme at Surrey & Borders NHS Foundation Trust
Authors: Majid Zafrina , Cremin Patrick , Mudunkotuwe Jeremy
Published: July 2023

Aims

To establish a mentorship programme for all grade of Psychiatrists working within Surrey and Borders Partnership Trust.

Methods

RSPsych guidance was used to establish a mentoring programme within Surrey and Borders Partnership Trust.

A core leadership team was identified and established, this included the Director of Medical Education, a Higher Specialist Trainee, and a Core Trainee.

The decision was made to structure the programme to involve all grades of doctor within the trust, with pairing of Mentor and Mentees tailored to mentee needs. Support from the core team will also be offered to both Mentees and Mentors on a regular and drop in basis, as well as support groups for each group.

The programme was then advertised using a trust email list and training days were held via Microsoft Teams and delivered by the West Midland Mentoring Team RCPsych.

The programme is due to launch in February 2023 with expected widespread engagement, followed by evaluation survey.

Results

We received a good response from all grades of doctors targeted in the Mentorship Scheme.

Following this a prelaunch meeting, facilitated by the core leadership team, was organised for all those involved in the scheme.

This meeting outlined the aims of the scheme and support available to both Mentors and Mentees.

The Mentors and Mentees have now been paired and the scheme will be launching in February 2023.

Conclusion

Burnout is a significant and highly prevalent phenomenon within the Psychiatric community.

Mentorship is shown to reduce rates of burnout as well as improving staff well-being, productivity and retention.

Following RCPsych guidance this project aims to establish a mentorship programme for all psychiatrists within the Surrey and Borders NHS Trust.

The Surrey & Borders Mentorship Scheme will launch in February 2023.
Supporting Well-being and Resilience: Delivering Interactive Workshops for Psychiatry Core Trainees
Authors: Ruddock Kenneth , Neil Catriona , Galloway Suzanne , Hegde Rekha
Published: July 2023

Aims

Stress and burnout is increasingly recognised as an issue for doctors in training. The 2022 General Medical Council (GMC) National Training Survey revealed that 39% of respondents were suffering from burnout to a ‘high’ or ‘very high’ degree. 51% felt their work is emotionally exhausting. There are multiple sources of stress for psychiatry trainees, including clinical demands, adverse events, the impact of emotional labour and moral injury. The Royal College of Psychiatrists recognises the importance of supporting trainees’ well-being; this has been reflected with the inclusion of personal well-being-focussed key capabilities in the new Core Psychiatry Training curriculum.

Methods

To meet these needs, we developed and delivered two interactive face-to-face workshops for Year 1 Core Psychiatry Trainees (CT1s) in the West of Scotland. Training is embedded within the CT1 educational programme and facilitated by higher trainees. The sessions cover key aspects of well-being, including the physiology of stress, risk factors for burnout and the evidence base for developing resilience. We explore the impact of errors on doctors and the health service, relevant clinical governance systems and regulatory policies, focussing on psychiatry training issues. Feedback was obtained immediately after each session via anonymous questionnaire with a mixture of Likert scale and free text responses.

Results

There were 27 responses for workshop one and 21 for workshop two. 14 respondents felt the teaching should be mandatory for core training. There was mixed opinion regarding the overall benefit and optimum timing of the sessions within the training year. Overall, CT1s valued group discussions and wanted more time for this with less focus on GMC policy. There was also split opinion on the value of discussing institutional responses to errors, including significant adverse event reviews and Datix reporting.

Conclusion

Our feedback showed differing opinions on which topics should be covered during the training and their level of detail. Overall, the opportunity for group discussion – in order to share experiences with peers – appeared to be valued most. We feel the sessions provide new CT1s with an opportunity to explore problems they may encounter in a safe and supportive environment.

We aim to provide trainees with a ‘toolkit’ to support their personal well-being within the workplace, as well as demystifying clinical governance systems. We plan to further develop our course materials based on our feedback, and deliver the workshops again in 2023.
Improving Emergency Psychiatric Training Experience for Core Trainees in Southwest London
Authors: Scanlon Hannah , Vamathevan Divya
Published: July 2023

Aims

To improve emergency psychiatry experience for Core Trainee doctors in Southwest London in accordance with the Royal College of Psychiatrists curriculum requirements.

Methods

A scoping questionnaire was sent to all core trainees over a 3-month period (February 2022-March 2022) regarding on-call commitments. This incorporated evaluation of emergency psychiatry experience which was provided through Crisis Assessment Team (CAT) on-call shifts. Direct responses were utilised in conjuncture with the feedback from the Junior Doctor Forum and engagement with trust senior management to promptly identify and implement alternative provision of this training need. This resulted in On-call Core Trainee emergency cover being changed from CAT to the Liaison service.

A second questionnaire was then sent over a further 3-month period (November 2022-January 2023) to trainees participating in liaison shifts to evidence outcome.

Results

From the initial questionnaire a total of 93 responses were collected, with 19 from CAT shifts. Of these, 42.1% indicated they found it was useful in meeting the training need of emergency experience. 47.3% reported no assessments or admissions to the unit over the shift.

From the second questionnaire a total of 22 responses were collected from liaison shifts. 77.3% reported the shift to have been useful in meeting the training need of emergency experience. 100% of respondents reported exposure to a wide range of emergency psychiatric presentations over their shift. 63.6% also reported feeling their confidence had improved in managing emergency psychiatric scenarios independently in the future.

Overall, this showed a 35.2% increase in trainee satisfaction that their emergency psychiatric training need was being met following the change to on-call arrangements.

Conclusion

Emergency Psychiatric experience is a curriculum requirement and is vital in preparing for higher training. Consultation with trainees has been used to drive change with evidence of improved exposure to emergency psychiatry, increased trainee satisfaction and enhanced clinical confidence. This has highlighted the benefit of involving trainees in devising provision of training opportunities in this trust and would be recommended in training schemes nationally.
Attachment to Parents and Childhood Trauma in Adolescent Patients With Non-Suicidal Self-Injurious Behaviour
Authors: Abdelhafez Nessma , El-Bakry Azza , Fakher Walaa
Published: July 2023

Aims

To explore the phenomenon of non-suicidal self-injury (NSSI) in adolescent patients and to assess adolescent-parent attachment and childhood trauma in relation to NSSI behaviour through a case control comparison between adolescents with and without NSSI.

Methods

NSSI group included 30 adolescent patients presenting to psychiatry outpatient clinic with history of NSSI. Controls were 30 non-psychiatric adolescent patients recruited from other specialties outpatient clinics. Tools applied were: Semi-structured Psychiatric Interview, Structured Clinical Interview for Diagnostic and Statistical Manual (DSM IV-TR) Axis I and II Disorders (SCID-I and II), Brief Non-Suicidal Self-Injury Assessment tool (BNSSI-AT), Inventory of Parent and Peer Attachment (IPPA)-Parent form, Parental Bonding Instrument (PBI) and Childhood Trauma Questionnaire (CTQ). Patient-rated tools were translated into Arabic language.

Results

Self-cutting was the primary method of NSSI in 86.7% followed by interference with wound healing in 73.3%. Of NSSI group, 60% met the criteria for diagnosis of borderline personality disorder (BPD) while 16.7% showed only traits. Moreover, 40% were diagnosed with depressive disorders. While 93.3% used NSSI to deal with anger, 80% used it to cope with uncomfortable feelings or to relieve stress and pressure. In addition, 73.3% reported self-injuring because of their self-hatred. The main motivation for initial NSSI was negative feelings such as being upset (90%), being angry at oneself (73.3%) or at someone else (53.3%). Also, 36.7% reported seeing it in media or reading about it while 40% of the motivations were found related to peer pressure. NSSI group scored significantly lower than controls in their attachment to parents (particularly to mothers). A positive correlation was found between perceived parental care and attachment to parents (mainly trust and communication). A statistically significant difference was found between both groups regarding severity of childhood trauma experiences. In NSSI group, emotional neglect was reported in 80%, emotional abuse in 63.3%, sexual abuse in 50% and physical abuse in 46.7%. Perceived emotional neglect was positively correlated with sense of alienation from fathers and negatively correlated with trust in mothers.

Conclusion

Females constituted 80% of the NSSI group, primarily with the diagnosis of BPD. The most common method of NSSI was “self-cutting”. A significantly high percentage of adolescents with NSSI described their attachment to parents as insecure. The majority of NSSI patients perceived their relationship to both parents as “affectionless control”. A significant correlation was found between perceived parental care and security of attachment. Results also suggest that different types of child maltreatment might predict later NSSI.
Barriers to Choosing Psychiatry as a Career in Pakistani Medical Students and Junior Doctors – Survey Study
Authors: Ahmed Raja Adnan , Zahid Samrah , Shahab Bisma
Published: July 2023

Aims

In a majority of low and middle-income countries, the mental health system is weakened due to poor resources as well as poorer recruitment and retention rates in psychiatry among junior doctors. The present study utilizes a mixed-methods approach to explore the factors associated with low recruitment and retention of junior doctors in Psychiatry.

Methods

This study utilized an online survey administered among medical students and postgraduate trainees in psychiatry in Pakistan. The survey was open for 5 weeks for data collection from Nov 21st to Dec 31st, 2022. The survey was distributed conveniently using social media platforms and supplemented by snowball sampling procedures. This survey explored common myths about mental illness and psychiatrists using close-ended questions. Open-ended questions were asked to probe the participants on solutions to improve recruitment into psychiatry be improved.

Results

A total of 103 responses were received on the online survey, with the majority (83, 80%) of respondents being females. A majority (66, 64%) of respondents were medical students and 37 (36%) were junior doctors. Most responses were received from the two largest government sector medical universities in Karachi Pakistan, Jinnah Sindh Medical University (67%) & Dow University of Health Sciences (23%).

A total of 62 (60%) respondents reported a lack of exposure to Psychiatry in medical students, to make it a career choice. A larger proportion 57 (55%) felt working in Psychiatry can affect their own mental health. A total of 43 (40%) were not sure if Psychiatry is fulfilling enough as a career and 58 (56%) felt that job satisfaction in psychiatry is difficult to achieve. Around 60% were concerned that mental health conditions are chronic and enduring psychiatrists may not have many options for treatment. In open-ended responses, several common themes emerged. Most respondents commented about their lack of exposure to psychiatry as medical students, which accounts for their reluctance to choose Psychiatry.

Conclusion

Psychiatry forms a very limited part of the medical school curriculum and students' placements. Myths and stigma around mental illness can lead to low recruitment in Psychiatry and stigma can be challenged with more exposure to psychiatry during medical university years. Early medical study years have an influence on career choice and Psychiatry should be introduced relatively early as clinical placement. Psychiatry conferences, seminars and workshops on the local and national level can help in inspiring Medical students and junior doctors.
National Prescribing Patterns of Psychotropic Medications in Older Adults in Oman
Authors: Al-Shehhi Afaf , Al-Qamshooei Maryam , Al-Kaabi Laila , Al-Suqri Mahera , Al-Kalbani Yahya , Al-Kasbi Salim , Al-Saadi Sumaia , Al-Farsi Asma , Al-Busaidi Safiya , Al-Jahwari Latifa , Al-Hinai Azza , Al-Balushi Manal , Al-Shekaili Waleed , Al-Sinawi Hamed
Published: July 2023

Aims

High rate of psychotropic medications use in elderly people has been reported in the literature. Potentiality inappropriate prescriptions (PIPs) is very common as well. This issue has not been investigated in Oman previously. The aim of our study was to assess the patterns of psychotropic medications prescribed for older adults in the psychiatry clinics in Oman, screen for PIPs and plan for future actions to minimize inappropriate prescriptions.

Methods

This is a cross sectional descriptive study using the information in patient's medical records. It was conducted in 12 health care institutions which equally represent all Governorates of Oman. All patients who aged ≥ 60 years old who attended psychiatry clinics from January 2019 to June 2021 and were prescribed psychotropic medications were included. All psychotropic drugs were evaluated including: antidepressants, antipsychotics, Mood stabilizers and hypnotics. STOPP criteria were applied to detect PIPs.

Results

1409 patients (70%) out of 1995 elderly patients who attended the psychiatry clinics in the study period as a new case were prescribed psychotropic medications. Rate of polypharmacy in our study is 38.9%. The most common medications prescribed were risperidone (18.1%) from the antipsychotic category, citalopram (23%) from the antidepressant group and promethazine (30.1%) from the hypnotics group. Regarding the use of sedative medications,18.5% of the patients were prescribed a benzodiazepine and 35.6% of them were prescribed an antihistamine. When assessed the pattern of medications prescribed in healthy people compared to people with different categories of major medical morbidities, no differences were observed. We found 130 (9.3%) potentially inappropriate prescriptions in our study based on STOPP criteria which included use of long-acting benzodiazepine (Diazepam), prescription of anticholinergic medication to treat extrapyramidal side effects (procyclidine) and use of tricyclic antidepressants in specific categories of medical diseases.

Conclusion

The patterns of psychotropic prescriptions for older adults in the outpatient setting in Oman raise concerns about 2 main issues: psychotropic polypharmacy and high rate of benzodiazepines and antihistamines use. This warrants further investigation of these issues in separate studies to identify risk factors. We also recommend implementing certain actions to minimize inappropriate prescriptions including reviewing the availability of appropriate psychotropic medications for this age group in Oman, creating a national guideline for prescribing and providing continuous medical education to the physicians in the primary and secondary health care institutions regarding this aspect.
Alcohol Use and Associated Risk Factors Among Female Sex Workers in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Authors: Beksinska Alicja , Karlsen Oda , Gafos Mitzy , Beattie Tara
Published: July 2023

Aims

Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns.

Methods

The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021.

Inclusion criteria:

•

Any measure of prevalence or incidence of alcohol use among FSWs aged 18 years or older.

•

Countries defined as LMIC in accordance with the World Bank income groups 2019.

•

Study designs: cross-sectional survey, case–control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use.

Pooled prevalence estimates were calculated for:

1.

Any hazardous/harmful/dependent alcohol use

2.

Harmful/dependent alcohol use only, both overall and by region

3.

Daily alcohol use.

4.

Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use.

Results

In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31–51%), and of daily alcohol use was 26% (95% CI: 17–36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01–2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15–1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24–4.80), but not with HIV, violence or mental health problems.

Conclusion

We found a high burden of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with HIV risk factors such as inconsistent condom use, STIs and other drug use. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment
Using Evidence-Based Measures to Assess the Effectiveness of Residential Mental Health Rehabilitation for Adults With Dual Disabilities
Authors: Charles Rock , Bhandarkar Ritesh , Fulgoni Catherine
Published: July 2023

Aims

The Transitional Support Unit (TSU) is a unique 10-bed state-wide service and currently operates as one of two community-based long-term mental health services in Victoria. TSU is geared towards adults with complex mental health disorders in addition to a co-occuring intellectual disability or acquired brain injury--also referred to as a dual disability (DD). The aim of this project is to identify the benefits of this service to participants in order to improve the current structure and also to encourage development and expansion of similar services in Australia or globally.

Methods

The project was performed at the TSU. Participants included all previous and current residents of the TSU program (N = 24). Data were collected from three different evidence-based measures; the Health of the Nation Outcome Scales (HoNoS), Lifestar, and the Life Skills Profile (LSP). Each participant had these scales performed on admission, at time of discharge, and at 91 day intervals throughout their stay at TSU. The change in the measures were used to determine what clinical benefit, if any, resulted from undergoing engagement with the TSU program. Inclusion criteria was broad and encompassed any adult who had a DD and was admitted into TSU. Exclusion criteria was defined as any TSU resident with no completed discharge scales for comparison.

Results

On review, it was found that on average, there was an overall decrease in HoNoS scores from admission to discharge of 4 points. For the LSP, there was an average decrease of 10 points in TSU participants and the Lifestar was found to have an average increase of 20 points. Within Lifestar specifically, participants were found to have an average improvement between 1.64 and 2.94 in each individual category assessed. No TSU participants were observed to suffer from any decline or step back in categories related to how they spent their time, feeling good about themselves, or the people they knew.

Conclusion

TSU does appear to have notable benefit for adults with DD, particularly in improving overall mood, social interaction, and development of a routine as well as activities throughout the day. The least improvement was found in categories such as physical health and communication. The data were limited by participants who have not yet been discharged from TSU, therefore any discharge scales were unavailable for comparison.
Effect of Accelerated TMS vs Daily Sessions on Clinical Outcomes in Depression
Authors: Kennedy Eoin , Madan Rio , Neal Leigh
Published: July 2023

Aims

This study investigated the impact of accelerated Transcranial Magnetic Stimulation (aTMS) compared to daily sessions on outcomes in depression patients. While traditional TMS protocols involved daily sessions 4/5 times per week, this can be inconvenient for patients, particularly those travelling long distances to a TMS clinic. Recent well-designed studies have demonstrated that multiple sessions per day (aTMS) can be as effective as daily TMS. It was expected that these findings would be replicated in a clinical setting and that aTMS would be just as effective at reducing symptoms of depression as daily TMS.

Methods

A retrospective chart review of 240 patients (126 males, mean age = 42.36, range = 16–86) was analysed using multiple regression. Patients were treated for unipolar depression over the left Dorsolateral Prefrontal Cortex (LDLPFC) using TMS protocols that have been shown to deliver equivalent outcomes (Blumberger et al, 2018).

The aTMS intensity variable (aTMSiv) was calculated by dividing total number of TMS sessions by number of days between the first and last session (minimum of five days for inclusion). Therefore, a patient who had 30 sessions over 15 days would have an aTMSiv of 2. The mean number of sessions delivered was 24.46 (SD = 8.01, Range = 7–45) and the mean days between first and last treatment was 35 (SD = 20.21 Range = 6–105).

The main outcome variable was percentage reduction of PHQ-9 scores from baseline (mean = 17.89) to treatment completion (mean = 10.76). The mean reduction in PHQ-9 was 40%. The independent variables (IVs) included: aTMSiv, PHQ-9 baseline score, number of sessions, age and sex.

Results

Collectively the IVs predicted PHQ-9 reduction at a statistically significant level (F (5,234) =7.91, p = 6.70E-07, R2 = 0.14). Individual analysis of predictors revealed that aTMSiv did not significantly predict PHQ-9 reduction (F (1,238) = 0.05, p = 0.82, R2 = 0.0002). Only number of sessions significantly predicted PHQ-9 reduction in this model (t = 6.04, p = 5.88E-09).

Conclusion

As the aTMSiv did not predict the change in PHQ-9, this suggests the frequency at which TMS is delivered does not affect the outcome when treating depression. Thus, either daily sessions or aTMS can be utilised to best fit the schedule and lifestyle of the patient.
Stifled Screams: Experiences of Sexual Harassment Survivors at First Generation Universities in Southwest Nigeria
Authors: Mapayi Boladale , Oloniniyi Ibidun , Oginni Olakunle , Ukpong Morenike , Harrison Abigail
Published: July 2023

Aims

Sexual Harassment (SH) in colleges and universities in Nigeria is often shrouded in secrecy. Survivors rarely report the SH experience. This is often because of unequal power relations, fear of loss of status, marks, or job as retaliation, and the attendant stigma. The sexual harassment policy, implementation, and campus climate also have huge roles to play in reportage. This study aimed to investigate the experience of SH by men and women in heterosexual and same-sex situations in first-generation universities in South West Nigeria.

Methods

Students and staff who had survived SH were targeted for IDIs focused on the experience of SH from the perspective of the survivor including the consequences, reportage, outcomes, and whether justice had been served. A purposive approach was adopted in identifying respondents and a snowballing method guided the process across the three universities. The sensitivity of the topic and the stigma attached called for a recruitment strategy that ensured privacy, confidentiality, and freedom to share experiences without reservation. About four IDIs were conducted in each university. Interviews were held on several (face-to-face via telephone or Whatsapp calls) platforms. Analysis commenced with verbatim transcription of the audio recordings. The accuracy, integrity, and completeness of all transcriptions were verified. A thematic analysis was conducted and all transcripts were coded by three experts which were organized into categories. The most prominent and salient thematic findings were brought forward by merging codes while maintaining the integrity of the individual categories. A cluster analysis of code associations was also performed to facilitate pattern recognition in the data. NVivo Pro v.12 was used to facilitate the analysis. Themes were categorized into four distinct areas: experience of SH, consequences, reportage, and outcome.

Results

The experience of SH ranged from sexual assault to unsolicited physical touch and verbal harassment. In terms of consequences, survivors experienced low self-esteem, had problems in their relationships with others, became less trusting, and increased risk-taking behaviour. Most survivors were not aware of anti-SH policies in their institutions. None reported to law enforcement agents due to stigma, lack of financial means, and lack of trust in the system.

Conclusion

Institutions need to do more than develop adequate antisexual harassment policies. There is a need to interrogate the culture around implementation and training to improve prevention and raise awareness.
Staff Perspectives of Emergency Department Pathways for People Attending in Suicidal Crisis: A Qualitative Study
Authors: McCarthy Molly , Nathan Rajan , McIntyre Jason , Ashworth Emma , Saini Pooja
Published: July 2023

Aims

Background: The number of suicide-related presentations to emergency departments (EDs) has significantly increased over recent years; thus, making staff often the first point of contact for people in suicidal crisis. Despite this, staff receive minimal psychiatric training and few opportunities for education on the treatment and management of people presenting in suicidal emergencies. Understanding the needs of those who work within EDs is key to maximising the opportunity to reduce suicidal behaviour. Aims: To examine staff perspectives and experiences of working with people presenting to emergency departments in suicidal crisis.

Methods

Qualitative study guided by thematic analysis of semi-structured interviews with ED administrative, medical and mental health staff.

Results

Twenty-three staff participated. Three key themes were identified: (1) factors influencing staff decision-making; (2) quality of care for both staff and patients; (3) staff burnout, mental health and well-being. Staff described an overall lack of confidence and training related to asking patients about suicidal thoughts, which resulted in defensive practice and risk adverse decision-making. Quality of care for both patients and staff were discussed in relation to availability of resources, staffing pressures and team collegiality.

Conclusion

Staff felt inadequately equipped to deal with suicide-related presentations. Organisational support is lacking with increased staffing pressures, poor service availability and lack of beds. Negative staff attitudes often reflected an inherent unintentional use of language. Changing ED culture from top-down is imperative to address negative language and behaviours towards suicidal crisis and improve patient pathways and experience. Mandatory and ongoing training is needed to improve staff confidence, knowledge and attitudes.
Measuring the Permeability of the Blood-Brain Barrier in Alzheimer's Disease Using Dynamic Contrast Enhanced MRI
Authors: McCausland Beth , Huneke Nathan , Varatharaj Aravinthan , Gee Claire , Kunicki Amy , Darekar Angela , Teeling Jessica , Zetterberg Henrik , Holmes Clive , Galea Ian , Amin Jay
Published: July 2023

Aims

1) To compare blood brain barrier (BBB) permeability between AD and controls. 2) To examine the relationship between BBB permeability and cognitive decline in AD. 3) To examine the relationship between BBB permeability and peripheral markers of inflammation.

Methods

This pilot study combines the use whole brain DCE-MRI, with measures of peripheral inflammation in serum and urine. This is a clinical cohort study with longitudinal and cross-sectional arms, involving n = 15 AD and n = 17 age and gender matched controls. BBB permeability is measured using DCE-MRI and inflammation is measured by comparing serum cytokine and urine neopterin concentrations. AD participants attend three study visits over 12 months; control participants attend two over one week. Urinary neopterin analysis is being conducted in February 2023.The 12 month follow up visits complete in May 2023. Both neopterin and longitudinal cognitive assessment data will be included in the poster presentation in July.

Results

AD and control groups were well matched with no significant differences in demographics and multi-morbidity. We measured blood cytokine profiles for IL-6, IL-8, IL-2, IL-4, IL-1b, IL-10, IL13, IL-12p70-, TNF-alpha and INF-gamma. Only INF-Gamma was significantly different; higher in AD vs Controls (mean ± SD; 28.758 ± 90.226 AD, 3.773 ± 2.256 Control, P = 0.03). There were no significant differences in markers of neurodegeneration NfL and pTau-181, or vascular markers VCAM1, ICAM1, CRP and SAA between the groups. Ki is being calculated for overall whole brain, white matter, grey matter and hippocampus regions; an interim analysis showed no significant differences between the tissue categories, but analysis is ongoing.

Conclusion

There are currently no prognostic biomarkers that accurately predict decline in AD. We believe this pilot study will add to the literature about the utility and feasibility of DCE-MRI to measure BBB permeability. We hope that combining DCE-MRI with blood and urine biomarkers will further our knowledge of the pathophysiology of AD and help to develop minimally invasive biomarkers for identifying patients with AD, including those who are at risk of faster progression.