bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of psychiatry school on attitudes towards psychiatry in medical students and junior doctors in Pakistan
Authors: Ahmed Raja Adnan , Moledina Sanaa , Asad Usama
Published: June 2021

Aims

To assess the impact of Psychiatry School on the attitudes towards psychiatry in Pakistani medical students (MS) and junior doctors (JD).

Method

Inspired by the Royal College of Psychiatrists’ ‘Choose Psychiatry’ campaign, an online event by the name of ‘Psychiatry Autumn School Pakistan’ was held on the 1st of November 2020. The event was promoted through social media and medical students and junior doctors from across Pakistan were invited to attend. Moreover, a panel of British and Pakistani psychiatrists belonging to different sub-specialties was invited to deliver talks. The attendees were provided an insight into psychiatry as a viable career option and were introduced to the training pathways, research opportunities, and the various sub-specialties present within the field.

Participants were requested to complete the 'Attitudes Towards Psychiatry' (ATP-30) questionnaires before and immediately after the event. Individual scores on the questionnaire can range from 30 to 150 and a high score indicates a positive attitude. Statistical analysis was performed using a paired t-test.

Result

41 attendees (MS = 30, JD = 11) completed the pre-and post-school survey. The respondents were majorly female (76%) and from public sector universities (76%), with an average age of 23 years. The mean ATP score before the course was 119 (MS = 117, JD = 121) which increased by 9 points to 128 (MS = 126, JD = 131) after the event. When the two samples were compared using a paired t-test, the difference was statistically significant p < 0.005.

Conclusion

We conclude that a psychiatry school can positively influence attitudes towards psychiatry in medical students and junior doctors and our findings are consistent with similar studies done in other countries.

In Pakistan, unfortunately, only 2–4% of undergraduate students opt for a career in psychiatry owing to insufficient knowledge and awareness about the available treatment modalities and advancement in the field. Hence, such an intervention can greatly enhance recruitment within the profession as it makes psychiatry more accessible and visible as a career choice, generates awareness about the effectiveness and evolution of psychotherapeutic practices, and eradicates misconceptions about the field that prevail among young doctors.

This was the first psychiatry school held in Pakistan and the findings of the study as well the feedback received from the participants and the speakers motivate us to continue campaigning for ‘Choose Psychiatry.’
The association between obesity and depression in adults: a meta-review
Authors: Musa Abdi Malik , Cortese Samuele , Bloodworth Olivia
Published: June 2021

Aims

Obesity and depression are increasing in prevalence and have become key issues in the public health of the modern day. We performed a meta-review to summarise the association between obesity and depression in adults.

Method

A systematic literature search was undertaken on MEDLINE, PsychINFO, EMBASE and Web of Science for systematic reviews (SRs) with or without meta-analyses (MA) on the association between obesity and depression in adults (>18 years) published before 18 September 2018. Any approach to define depressive disorders (e.g. via structured interview or code in medical file) was accepted. Likewise, any method to assess obesity was accepted. Screening, data extraction and quality assessment was completed by two reviewers independently, with a third reviewer to arbitrate any disagreement. AMSTAR 2 tool was used to assess the methodological quality and risk of bias of the pertinent SRs/MAs.

Result

After duplicate removal, we identified 6007 potentially pertinent citations. Following, title, abstract and full-text screening, 10 studies were included in the review; nine SRs with MAs and one SR. A statistically significant association between obesity and depression was reported in all nine SRs with MAs, with odds ratios ranging from 1.18 (95% CI = 1.11-1.26) to 1.57 (95% CI = 1.53-2.01). Increased severity of obesity (body mass index over 40) was associated with a greater odds of becoming depressed. Odds of developing depression were greater for obese females, compared to obese males, but this difference was not statistically significant. Depression was shown to be a significant risk factor for future obesity in all four relevant MAs with odds ratios ranging from 1.18 (95% CI = 1.13-1.23) to 1.40 (95% CI = 1.14-1.71) . Depressed adolescent females had the highest odds of becoming obese, significantly more so than depressed adolescent males and depressed adults. The quality of the included studies were mixed with five scoring moderate quality, three low quality and two critically low quality.

Conclusion

The findings suggest a reciprocal association between depression and obesity, which may be modulated by age and gender. Future research should assess the potential effect of obesity and depression severity more carefully while also exploring the underlying mechanisms. These results warrant the investigation of the effect of obesity or depression intervention on the outcomes of the other.

FUNDING

This research received no financial sponsorship.
Perspectives on implementing HIIT interventions for service users in inpatient mental health settings: a qualitative study investigating patient, carer and staff attitudes
Authors: Martland Rebecca , Onwumere Juliana , Gaughran Fiona , Stubbs Brendon
Published: June 2021

Aims

High intensity interval training (HIIT) may improve a range of physical and mental health outcomes among people with severe mental illnesses (SMI). However, there is limited data on patients’ reported attitudes towards HIIT and its implementation within inpatient settings, and there remains an absence of data on attitudes towards HIIT from informal family carers of service users and healthcare professionals, who both have key roles to play in facilitating recovery outcomes in service users. This study sought to qualitatively investigate, in inpatients with SMI, carer and staff groups, perspectives on implementing HIIT interventions for patient groups in inpatient settings.

Method

Seven focus groups and one individual interview were conducted. These included three focus groups held with inpatients with SMI (n = 12), two held with informal carers (n = 15), and two held with healthcare professionals working in inpatient settings (n = 11). An additional individual interview was conducted with one patient participant. The focus group schedule comprised open- ended questions designed to generate discussion and elicit opinions surrounding the introduction of HIIT on inpatient mental health wards. Data were subject to a thematic analysis.

Result

Two key themes emerged from the data, across all participants, that reflected the ‘Positivity’ in the application of HIIT interventions in psychiatric inpatient settings with beliefs that it would help patients feel more relaxed, build their fitness, and provide a break from the monotony of ward environment. Moreover, the short length of HIIT sessions was deemed appealing to mitigate against difficulties that many inpatients can experience with motivation, interest and attention, and was considered to be more appealing than more lengthy forms of exercise, which may require greater physical exertion. The second theme related to ‘Implementation concerns’, that reflected subthemes about i) low patient motivation, particularly with older participants, those administered many medications, and for those with less positive memories of exercise ii) patient safety, including concerns surrounding the intensity of HIIT and inclusion of patients with physical health comorbidities and iii) practical logistical factors, including having access to the right sports clothing and staff availability to supervise HIIT.

Conclusion

HIIT for inpatients with SMI was actively endorsed by patients, carers and healthcare professionals. Patient safety and baseline motivation levels, and practical service considerations were all noted as potential barriers to successful implementation and are worth considering in preparation for trialing a new intervention.
Association of COVID 19 pandemic with new onset Obsessive-Compulsive Disorder (OCD) symptomology in the medical students – A cross sectional study
Authors: Mazhar Khadija , Khaliq Fatima , Arshad Daneyal
Published: June 2021

Aims

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder, which is the sixth largest contributor to non-fatal health loss globally. Coronavirus disease (COVID-19) pandemic, aside from its impact on physical health, has also had its effects on mental health. This study aimed to explore the frequency of new onset OCD symptomology in medical students amidst COVID-19 pandemic and its association with potential sociodemographic parameters.

Method

This cross-sectional study was conducted among medical students studying in Pakistani medical colleges. Data were collected after ethical approval from 1st January 2020 to 20th January 2020 during the second COVID-19 wave. Participants with a history of diagnosed psychiatric illness such as OCD, bipolar disorder, depression, anxiety and those taking relevant medications were excluded from the study. The online questionnaire included Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Revised Padua Inventory-Contamination Subscale (PI-CS), which were used to assess OCD symptoms and aversion for contamination respectively. Participants filled Y-BOCS twice, once for pre-pandemic score (based on self-recall), and a second time during 2nd wave of COVID-19. Data were analysed using IBM SPSS v23.0 (Armonk, N.Y., USA).

Result

The study included 711 participants (Males: 29.8%, Mean age: 21.59 ± 1.52 years) from over 46 medical colleges and over 44 cities of Pakistan. The mean pre-pandemic and mid-2nd wave Y-BOCS scores were 11.86 ± 6.02 and 15.61 ± 7.41 respectively. The mean PI-CS score was 17.27 ± 9.17. Twenty five percent (n = 176) of students developed new onset OCD symptomology during pandemic, while seventy percent (n = 497) suffered from worsened Y-BOCS score during pandemic. New onset OCD symptomology was associated with age less than 20 years (p = 0.02), higher PI-CS score (p = 0.001) and studying in preclinical years (p = 0.002). Worsening of YBOCS score had significant association with female gender (p = 0.02), attending pandemic related awareness seminar (p = 0.027), studying in preclinical years (p < 0.001) and age less than 20 years (p < 0.001). High Padua scorers (16 and above) showed significant association with increase in YBOCS score (p < 0.000), age less than 20 years (p = 0.005), preclinical years (p = 0.001), frequency of engagements in pandemic related discussions (p = 0.001) and change in YBOCS score (p < 0.001).

Conclusion

Our findings indicate that the prevalence of OCD symptomology increased during the COVID-19 pandemic as demonstrated by increased Y-BOCS scores.Femal medical students and students in preclinical years are more likely to suffer from psycological impact of COVID-19 pandemic and heightened concerns and fear for contamination.
Prevalence of DSM-V mental disorders in a cohort of young adults in Ireland
Authors: McGrane Josen , Carey Eleanor , Power Emmet , Dooley Niamh , Madden Sean , Coughlan Helen , Campbell Donal , Clarke Mary , Cannon Mary
Published: June 2021

Aims

To estimate the prevalence of DSM-V mental disorders in a population of Irish emerging adults

Background

Mental disorders are the leading cause of years lived with disability in youth worldwide. Few studies use gold standard of face to face semi-structured standardized interview tools, and this is a limitation in the estimates of prevalence rates of mental disorder in the extant literature.

Method

Briefly, we recruited a representative sample of 212 adolescents and followed them up over ten years. In this wave of the adolescent brain development study, 103 of the initial 212 participants took part, 50 males and 53 females, with a mean age of 20.87 years (SD = 1.3). Psychopathology was assessed in all participants by trained research psychologists and mental health professionals using the Structured Clinical Interview for DSM-V (SCID).

Result

52.4% of participants had one lifetime mental disorder, the prevalence rates were highest for Major Depressive Episode (25.3%), Social Anxiety (12.6%) and Generalized Anxiety (8.7%). 50.5% had a history of a mental disorder. 27.2% had 1 lifetime diagnosis, 15.5% had 2 and 7.8% had >2.

Conclusion

Rates of mental disorder rapidly increase during emerging adulthood. In a similar Irish study, 55% of young adults met the criteria for lifetime mental disorder. Whilst the rates of mental disorder are high in young people, previous longitudinal research has suggested that many common mental disorders remit by the late twenties. We suggest a need for further research investigating the comparative later functional and economic outcomes of these young people. Research to date is supportive of a need to expand capacity of youth friendly services for prevention and treatment.

Ethical Approval

Ethical approval for the study protocols, including interviews and assessments, along with informed consent documents, was granted by the Beaumont Hospital Medical Ethics Committee in 2016.

Acknowledgements:

1. European Research Council Consolidator Award and Health Research Board Ireland Award to Mary Cannon

2. Health Professionals Fellowship from the Health Research Board Ireland to Helen Coughlan.
How effective is clinical simulation in improving medical students' confidence when interviewing patients with mental health problems?: a comparison of pre-COVID and post-COVID medical student experiences
Authors: Mitchell Philippa , Varnish Ella , Das Arthita
Published: June 2021

Aims

Clinical Simulation sessions were started in April 2020 to supplement reduced patient contact for medical students at the University of Sheffield due to COVID-19 restrictions. These were run by Foundation Trainees in psychiatry with supervision and oversight from a senior psychiatrist. This study aims to review current literature on remote teaching as a learning resource and will evaluate the effectiveness of clinical simulation as an alternative to patient contact, with the focus being on improving students’ confidence as well as developing clinical interview skills.

Method

Feedback surveys were developed, focussing on confidence undertaking difficult aspects of psychiatric interviews, and distributed amongst two cohorts of medical students at the University of Sheffield. One cohort completed their face-to-face psychiatry placement in full pre-COVID, the other undertook placements consisting of virtual simulation sessions alongside reduced patient contact. Responses were collected online over 6 weeks between February and March 2021. As two medical students who completed face-to-face psychiatry placement prior to the pandemic, we have additionally submitted personal reflections as a comparator to current student experiences.

Result

A total of 8 students in the clinical simulation cohort, and a total of 13 students from the face-to-face teaching cohort completed the questionnaire. 62.5% of students that responded were female and the remaining percentage identified as male. Students in the face-to-face cohort reported being more confident in 6 out of 7 aspects of our feedback surveys determining confidence undertaking clinical interview skills in comparison to the virtual simulation cohort. Students attended varying numbers of simulation sessions and ultimately the main restrictions and barriers to the simulation teaching reported by students are the time constraints during the sessions, and unstable internet connection.

Conclusion

Overall confidence levels in medical students are undoubtedly higher in students that completed full face-to-face placements in comparison to those with combined teaching. Based on student responses and review of current literature, clinical simulation appears to serve as a useful adjunct to students with reduced face-to-face contact in psychiatry, particularly for increasing confidence when interviewing more challenging patients. Immediate facilitator feedback and exposure to more difficult patient scenarios seem to be the most beneficial aspects. We would not advocate it as an exclusive form of teaching for medical students, but it may be a useful resource post-pandemic for providing students with extra learning opportunities, specifically targeted at developing confidence and skills in more difficult situations which will hopefully benefit them in their later careers.
The effects of the first wave of the COVID-19 pandemic on the presentation of adolescents to acute mental health services in NHS Lanarkshire
Authors: Nagiub Youstina , Hegde Rekha
Published: June 2021

Aims

This project aimed to assess the effects of COVID-19 on the mental health of adolescents, reflected through their presentations to A&E departments in NHS Lanarkshire.

Method

The psychiatry liaison database was searched for referrals of 17 year olds and under from April until August 2020.

All referrals to all acute hospital sites in Lanarkshire received from any source were included. The only exclusion criteria applied were age over 17 and unavailable assessment information.

The sources searched for information were: patient's electronic notes, Mental Health Assessment forms, Mental Health Risk Assessment forms and electronic letters. The following information was gathered:

–

patient's age

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date, source and reason for referral

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hospital site of assessment

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outcome of assessment

Result

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Between April and August 2020, the number of CAMHS A&E referrals increased every month except in July.

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The age range of CAMHS patients presenting to A&E were 12-17 years, with 17 being the most common age seen.

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87% of referrals were from A&E.

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The two most common reasons for referrals were drug overdose and suicidal ideation.

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The most common outcome of assessment was a CAMHS referral.

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COVID-19 was a trigger for an adolescent's presentation to A&E in 31% of cases, the most common cause being struggling with the lockdown/restrictions.

Conclusion

The mental health charity YoungMinds carried out several surveys throughout the COVID-19 pandemic's first wave. They demonstrated a detrimental effect on young people's mental health in the UK.

YoungMinds surveys revealed that 32% and 41% of young people experienced “much worse” mental health due to COVID-19. The findings of NHS Lanarkshire were similar, with 31% of adolescents presenting to A&E as a result of COVID-19.

No adolescent included in this review had contracted COVID-19 at any point. Their mental health was therefore impacted by the indirect effects of COVID-19 rather than the direct effects of infection. For the 31% of CAMHS presentations to A&E which were due to COVID-19, most young people struggled with the lockdown/restrictions.

The number of presentations to A&E increased every month between April and August 2020 except for July. This could be due to people's initial fear of coming to hospital and catching COVID-19. However, as infection and death rates decreased towards the summer, people may have regarded hospitals as safer. The general increase in referrals every month may also be a reflection of the worsening of young people's mental health the longer the pandemic extended.
Evidence base for psychological treatment of personality disorder – a narrative review
Authors: Shuilleabhain Caoimhe Ni
Published: June 2021

Aims

This review critically appraises the up-to-date evidence base for psychological treatment of PD.

Background

The prevalence rate of any personality disorder (PD) in the general population has been estimated to be as high as 12% rising to over 70% in prison settings. PD is known to carry significant psychosocial and health burdens with increased mortality, increased suicide, increased substance misuse, increased crime, reduced capacity to work, poorer outcomes for comorbid mental disorders, dysfunctional engagement with services, and high economic costs through a high utilisation of healthcare systems. In the 1990s several manualised treatment strategies emerged, specifically for borderline PD. These include dialectical behaviour therapy, cognitive therapy, cognitive analytic therapy, mentalization-based therapy, transference-focused psychotherapy, and schema-focussed therapy.

Method

Using relevant search criteria, literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the current evidence base for psychological treatment of PD.

Result

The DSM-V defined Cluster B borderline PD has received the majority of attention. Increasing attention has been paid in recent years to the Cluster B antisocial PD. Cluster A (Paranoid, Schizoid, Schizotypal) and Cluster C PDs (Avoidant, Dependent, Obsessive Compulsive) have received relatively little attention with few studies to draw upon regarding the effectiveness of therapy. The remaining Cluster B personality disorders (Narcissistic and Histrionic) have been criticised as having poor construct validity, with a lack of rigorously designed treatment trials.

A number of treatment protocols have gained empirical support. However, of those that have empirical support, there appears to be little demonstrable evidence to suggest superiority of any one of the evidence-based interventions over another. While specialised therapies are more efficacious than “treatment as usual” or treatment delivered by expert clinicians, when specialised therapies are compared with well-specified manualised general psychiatric care tailored to personality disorder, the results are different, with little consistent evidence demonstrating the superiority of specialised therapies.

Conclusion

Current evidence suggests that individual therapies do not differ substantially from each other or from structured clinical care that relies on generic change factors. This is in keeping with established psychotherapy outcome literature. Current evidence would indicate that common features across the proven treatment strategies should be emphasised and implemented well. There may be justification for added interventions from specific treatment modalities targeted to specific patient problems.
Quality of sleep and burnout among undergraduate medical students at the university of Nairobi, Kenya
Authors: Nyamute Linda , Mathai Muthoni , Mbwayo Anne
Published: June 2021

Aims

The main objective was to determine whether quality of sleep is associated with burnout among undergraduate medical students at the University of Nairobi.

The null hypothesis in our study population was; 'There is no significant association between poor sleep quality and burnout'.

Background

In a pressure prevailing environment, medical students find themselves in a vicious cycle of cutting down on sleep in attempts to cope and adjust to increasing workloads. Students with poor sleep quality have been found to perform worse in their board exam and have strained social engagements. Ultimately, this chronic sleep deprivation may lead to burnout which may cause diminished sense of accomplishment and impaired professional conduct, that may be carried on to the career as a physician. High levels of burnout have been associated with suicides.

Method

The sample size obtained was 384 and participants were selected by a mixed sampling method. Data collection was through self-administered questionnaires. Scales used for this study were the Pittsburg Sleep Quality Index(PSQI) and the Oldenburg Burnout Inventory(OLBI).

Ethical considerations were adhered to and approval obtained from the Kenyatta National Hospital-University of Nairobi(KNH-UON) Ethics Board. Data entry and analysis was by SPSS v23. Data from 336 questionnaires were deemed fit for analysis.

Result

With a response rate of 87.5%, the prevalence of poor sleep quality and burnout were 69.9% and 74.7% respectively. There was a significant positive association between poor sleep quality and female gender, clinical years of study, living with family, poorly perceived socio-economic state and poor subjective academic performance. In addition, being female, younger, pre-clinical years, living independently off-campus and poor subjective academic performance were significantly associated with higher levels of burnout.

Burnout had a significant correlation with poor sleep quality. Daytime functioning, a component of sleep quality had the highest correlation with components of burnout, disengagement and exhaustion. Overall, 57% of the respondents had both poor sleep quality &burnout, while only 12% were good sleepers with no burnout. Furthermore, having poor sleep increased the risk of having burnout by 2.8times. It is crucial that students adopt better sleeping habits to reduce the risk of burnout.

Conclusion

With the high prevalence of poor sleep quality and burnout, peer-support groups and peer-led mentorship programs are recommended within this population to help deal with expectations, challenges and difficulties encountered within the course of medical education, in addition to preparing for the early future careers.
Admission patterns in a psychiatric intensive care unit in Ireland: a longitudinal follow-up
Authors: Raaj Shaeraine , Navanathan Sujesha , Matti Basil , Bhagawan Anisha , Twomey Pauline , Lally John , Browne Roy
Published: June 2021

Aims

This observational study aims to describe the course of the admission and clinical characteristics of admissions to the PICUs in the Phoenix Care Centre, Dublin, Ireland. The authors hypothesised that the length of stay (LOS) would be shorter in male patients as compared to females.

Method

This retrospective cohort study was carried out at the Phoenix Care Centre Dublin, Ireland. Informed consent was not sought as this was a retrospective chart study involving anonymised clinical data which was collected as part of routine clinical care and no items of information were reported that would enable the identification of any subject. We described primary outcomes using frequencies, percentages, mean and standard deviations, median and interquartile ranges (IQR). Between groups comparisons were made using x2 tests for categorical variables; t-tests, ANOVA tests, or Kruskal-Wallis tests, for continuous variables; All analyses were two-tailed, and a P-value ≤ 0.05 was considered statistically significant

Result

Over the study period from Jan 2014 to Jan 2017 inclusive, there were 96 admission episodes to the PICU. The mean age of admitted cases was 37.1 (SD = 11.3) years (range 18–63 years). The mean length of stay (LOS) was 59.3 (SD = 61.0) days (median 39.5 days). All patients were admitted under the Mental Health Act legislation. We identified assault as the primary risk factor for pre-admission 62% (n = 62) to the PICU. Antipsychotic polypharmacy was used in 61% (n = 55) of the admission. The mean daily antipsychotic dosage was 139.4 % (SD = 65.1) of BNF maximum daily dose. A diagnosis of acute psychotic disorder (B= -1.027, p = 0.003, 95% CI: –1.691 to –0.363) was associated with reduced LOS in PICU. Majority of admissions 43% (n = 39) had a diagnosis of schizophrenia, followed by Bipolar affective disorder BPAD 21% (n = 21), schizoaffective disorder 18% (n = 18), and acute psychotic disorder 9% (n = 9).

Conclusion

Psychiatric Intensive Care Unit is an essential service for the severely ill psychiatric patients and is a progressively developing sub-speciality. An important finding from our study describes the cohort of patients admitted being predominantly male, younger-aged, single, with a diagnosis of schizophrenia, legally detained, and from an Irish background. The primary indication for a referral is the risk of assault, showing the need for the intensive and secure treatment model that a PICU can provide.
Substance use determinants in Jamaican under-25s: family, peers, spirituality and maltreatment (literature review)
Authors: Sargent Oliver , Omar Mayeh
Published: June 2021

Aims

Jamaica is undergoing rapid change in its attitudes and laws regarding substance use; understanding the reasons why under-25s use substances will help inform future interventions and policy decisions. This review will investigate the determinants of substance use in under-25s in Jamaica, aiming to identify key sub-groups to target with interventions, and propose topics for further research.

Method

A literature search was performed with Ovid on three databases, using wildcards and synonyms to increase the number of hits. This search produced 379 results, of which 41 remained after inclusion/exclusion criteria were applied. Additional sources were utilised as the review was written.

Result

Strong family relationships are protective against illicit substance use for under-25s, with conflicting results for licit substance use. Healthy peer relationships protect against substance use, particularly in the academically-stressful university environment. All Jamaican under-25s appear to be susceptible to peer pressure, which increases the likelihood of substance use. Spirituality is protective against substance use, although male Rastafarians are more likely to use cannabis. Certain forms of childhood maltreatment make use of particular substances more likely. University students and under-18s brought up in single-parent families are key sub-groups to target with interventions. Further research on mechanisms by which these determinants work, particular religions and which determinant has the greatest effect is recommended.

Conclusion

Various factors can protect against or predispose substance use in Jamaican under-25s. This review, and future research, can help inform policy decisions and intervention design for the key sub-groups found.
Psychological morbidity and associated factors among perinatal patients referred for psychiatry assessments at a tertiary care centre in Sri Lanka
Authors: Senanayake Saumya Madhri , Perera Iresha , Galhenage Janith , Hanwella Raveen
Published: June 2021

Aims

Our objective was to study the psychological morbidity and associated risk factors among antenatal and postnatal patients referred for the psychiatric assessment at University Psychiatry Unit of National Hospital of Sri Lanka.

Method

All the Clinic records of perinatal referrals from 1st January 2019 to 31st December 2019 were assessed. Sociodemographic details, delivery details, health of the newborn, past and present psychiatry illness related details were obtained using a questionnaire. Data were analysed using SPSS.

Result

Total of 161 perinatal referrals were studied. Mean age of the mothers were 28.7 years (SD = 6.60). About 18 (11.8%) were not legally married, partner passed away or estranged. Above Ordinary level education was having 34.5% of participants. Majority were postnatal mothers (61.5%). Some mothers (32.3%) have reported the pregnancy was unexpected whilst 20(32.3%) and 49(30.8%) have experienced delivery complications and neonatal illnesses respectively. Past mental illnesses were found among 31(20.7%) of mothers. Out of whole perinatal referrals maternity blues (28.9%) was the commonest current psychiatry diagnosis. Among antenatal mothers, adjustment disorder (28.8%) and depressive disorder (17.3%) were the commonest. Schizophrenia, Schizophreniform disorder and bipolar illness were found among 8(5%), 6(3.7%) and 3(1.9%) mothers respectively. Major psychoactive substance use disorder was found among 4 (2.5%) mothers. Presence of pregnancy related complications were significantly associated with postpartum metal illnesses(p = 0.008).

Conclusion

Commonest perinatal mental illness was the maternity blues. Depressive disorder was the commonest major mental illness and neonatal complications were associated with psychological morbidity in postnatal mothers.
Attitudes surrounding the disclosure of mental illness
Authors: Sengupta Brishti , Dasgupta Pritha
Published: June 2021

Aims

To survey the effect of COVID-19 on mental health of both medical professionals and the general population, as well as attitudes surrounding the disclosure of mental illness.

Method

An online survey comprised of two questionnaires, one for medical professionals and one for the general population, were conducted via social media. Both questionnaires asked respondents of the effect of COVID-19 on their mental health, and the former asked respondents about the effect of COVID-19 on their patient group's mental health. The questionnaires went on to ask respondents about their attitudes to mental health disclosure in various scenarios, to varying groups of people. The general population group was also asked how they would react if someone else disclosed their mental illness to them.

Result

The questionnaire for the medical professionals gained 62 respondents and the one for the general population had 122 respondents, with responses from multiple nations. Overall, COVID-19 has affected everyone's mental health to a degree, and all groups had reservations about disclosing their mental health issues to others. The medical professionals were especially reluctant to disclose mental illness to their patients, but were more comfortable when it came to disclosing mental illness to colleagues. The general population, however, was much more reluctant to disclose mental health issues to their colleagues. The general population were, on the whole, willing to listen to and help anyone who came to them with mental health concerns. Both groups surveyed showed reluctance toward disclosure to the wider community.

Conclusion

COVID-19 appears to significantly affect not only physical health, but mental health as well. There is at least some degree of stigma surrounding the disclosure of mental health issues. While most would be happy to help anyone who came to them with their mental health problems, there seems to be an attitude shift when people must contend with mental health issues of their own.
Staff survey on using the new clinical risk assessment framework for teams (CRAFT) tool
Authors: Swift Pamela , Gillatt Brian , Drysdale Emma , Walker Hollie , Johnston Pamela , Jackson Emma
Published: June 2021

Aims

Risk assessment and management are crucial elements of clinical practice in mental health. Healthcare Improvement Scotland identified risk management as a key area for change, with risk tools identified as one necessary component. In NHS Greater Glasgow and Clyde (GG&C) the CRAFT tool replaced the Glasgow Risk Screen (GRS) in October 2019. The CRAFT tool is a 2 page document that comprises a broad risk screen, details of historical risk events and prompts for family and carer involvement. The aim of this study was to assess staff attitudes to the CRAFT, 12 months after it had been rolled out. Looking at whether the CRAFT tool is used to inform decision making about risk in clinical settings and if patients were involved in the risk management process.

Method

An electronic staff survey was distributed to all clinical staff within NHS GG&C Mental Health Services. Clinical staff includes the following professional groups: Medical, Nursing, Psychology, Occupational Therapists and Allied Health Professionals. Contact details were accessed via the relevant managers and surveys were sent via secure global address lists. Questions were focused around the following areas: time taken to complete/update/frequency of use/contact and ease of use, role in decision making, patient and carer involvement/knowledge, view on the impact of the CRAFT.

Result

There were 209 responses. This represents a response rate of approximately 10%. 89% of respondents had completed a CRAFT tool at some point but only 38% had received training. 15% reported that the CRAFT did not aid decision making about risk in clinical settings, whereas 37% said it did and 42% said it did sometimes. 46% report patients are consulted most of the time (34%) or always (12%). The qualitative impression was that the CRAFT was an improvement on its predecessor. However common themes from responders highlighted a lack of clinical relevance or impact decision making, lack of training in filling it out and cumbersome integration with the electronic case notes.

Conclusion

Staff perceptions of the CRAFT tool were generally negative with many feeling it was a box ticking exercise that had minimal real world impact on patient risk and its management. However many felt it was an improvement over the previous risk tool and the majority used it at some point to aid clinical decision making.
Disability and functional outcomes following STN, VC/VS, and combined deep brain stimulation in obsessive compulsive disorder
Authors: Tyagi Himanshu
Published: June 2021

Background

OCD severity scores mostly convey information within the domain of clinical conceptualisations. To capture the full impact of any new intervention it is crucial to measure its impact on disability. For this purpose we captured prospective data on changes in disability, function and impairments with multiple tools throughout the UCL-MRC trial of Deep brain stimulation (DBS) for Obsessive Compulsive Disorder (OCD) between 2013-2017. The clinical and cognitive outcomes from the trial have already been reported in 2019. We hypothesized a concomitant improvement in perceived and observed indicators of disability with clinical improvement in OCD symptoms. This is a preliminary report of the disability outcome data from the trial.

Method

Six patients with severe treatment resistant OCD were recruited for this study from the NHS England OCD Specialist Service. Eligible participants were offered lesion surgery (anterior cingulotomy) or entry to the DBS trial. OCD medication was kept constant throughout the trial. We tested the effects of DBS by comparing baseline, VC/VS, STN, both sites and CBT stages of trial on the following three assessments of function: GAF, SDS and CAOIC. An impairment focussed interview was done to quantify changes in function specific to OCD. Friedman's test was used to test for DBS effects during the double-blind crossover phases comparing baseline, amSTN and VC/VS. Post-hoc pair-wise Conover tests for significant effects were used with FDR corrections. All significant results are reported at P < 0.05.

Result

DBS had a significant effect across all phases for all above mentioned clinical measures. For all three measures of disability, there were significant improvements after both amSTN and VC/VS DBS. For all three measures of disability the effect of VC/VS DBS was significantly better that amSTN DBS. For all three measures of disability there was a non-significant trend (p = 0.058) for stimulation at both sites to have a better effect than stimulation of one site alone. For all three measures of disability, there were no significant difference between DBS alone and DBS and CBT.

Conclusion

This study is the first to have directly compared differential effects of STN versus VC/VS DBS stimulation in OCD patients whilst testing clinical, cognitive and disability outcomes. The results of this study indicate that although both sites are equally effective in reducing OCD, stimulating VC/VS leads to a significantly greater improvement on disability scores in severe OCD.
Social cognition and major depressive disorder: impact on psychosocial function and therapeutic opportunities
Authors: Weightman Michael , Baune Bernhard
Published: June 2021

Aims

This poster aims to examine the impact of social cognitive deficits on psychosocial functioning in depressed patients, as well as summarise the utility of various evidence-based therapeutic interventions employed to target these deficits. The stated hypotheses were twofold: (1) that social cognitive impairment in major depressive disorder will correlate with poorer psychosocial functioning; and (2) that these deficits will respond to existing anti-depressant therapies.

Background

Social cognition is an important adaptive trait that incorporates the identification, perception and interpretation of socially relevant information from the external world. It is frequently affected in major depressive disorder such that depressed patien

Method

A review of the existing literature was performed in order to test the stated hypotheses. Pertinent sources were identified via the MEDLINE, EMBASE, PsycINFO, PubMed, Scopus and Google Scholar databases. A total of 107 studies met inclusion criteria for review.

Result

Impaired social cognitive performance in depressed patients correlated with poorer psychosocial functioning across the key domains of general cognitive functioning and quality of life. Many current anti-depressant therapies were found to have a normalising effect on the social cognitive abilities of depressed subjects, both at a neural and functional level. Anti-depressant medications, in particular citalopram and reboxetine, appeared to correct facial affect recognition deficits, while a psychotherapeutic approach demonstrated improvements in theory of mind and negative interpretive bias. Data relating to other common treatments, such as electroconvulsive therapy, are limited.

Conclusion

The impact and treatment of social cognitive deficits in major depressive disorder is an important emerging field. The social cognitive deficits evident in depressed patients are sometimes subtle, but afford a significant functional impact. Additionally, it appears these impairments are at least partially reversible using anti-depressants or psychotherapy.
Are we meeting local and national guidelines for physical health assessment following admission to the meadows?
Authors: Abbasi Yasmin , Morgan Ruairidh , O'Docherty Alice
Published: June 2021

Aims

We audited practice at the Meadows Inpatient Unit regarding physical health assessment, against standards set by Surrey and Borders Partnership and NICE.

Background

SABP policy states that within 24 hours of admission to inpatient services, physical health assessment should be offered. It should be completed within 72 hours. Refusal should be documented.

These guidelines state that within 2 weeks of admission blood tests should be completed, and for specific individuals an ECG should be performed.

NICE guidelines state that “physical healthcare needs” should be discussed with newly admitted patients. NICE guidelines regarding physical health monitoring for individuals with psychosis or schizophrenia recommend that assessment includes “full physical examination to identify physical illness”.

NICE suggests use of antipsychotics for individuals with dementia who have severe distress, or are at risk of harming themselves or others. Those with behavioural and psychological symptoms of dementia (BPSD) should therefore be physically assessed to ensure safe use of antipsychotics may be implemented.

Method

All admissions to The Meadows over seven months were audited retrospectively. The clinical notes were accessed from Systm1.

Consensus medical opinion was reached that full examination should include: GCS/level of consciousness, cardiorespiratory, abdominal and neurological examinations.

Age, gender, diagnosis and prescriptions of psychotropic medication at time of admission were recorded.

The sample included 35 patients.

Result

55% of patients had a diagnosis of dementia.

63.8% of patients were prescribed antipsychotics on admission, more than other psychotropic medication. This may reflect that the most common diagnosis was dementia, commonly with associated BPSD.

97% of patients had a physical examination completed within 24 hours; most excluded neurological examination. 91% of patients had blood tests completed in two weeks, with the most commonly excluded tests being lipids and glucose. 86% of patients had an ECG in two weeks. In general, documentation of reason for not completing an examination was completed.

Conclusion

We found good compliance with recommendations for physical health assessment. Areas for improvement include better assessment of neurology and more thorough blood tests.

Recommended physical health examination for new admissions is not outlined in SABP policy. We recommend the following:

GCS/level of consciousness, cardiovascular, respiratory, abdominal, and neurological examinations, and baseline observations.

ECG should be a requirement of admission. In order to facilitate this, staff need to be trained to perform ECGs.

NICE guidelines refer to HBA1c rather than glucose, which should be reflected in SABP policy.
Audit cycle - VTE risk assessment in inpatient wards in mid Essex
Authors: Abdelkhalek Hesham , Elagawany Adel , McDowall Fiona , Leahy Matthew , Baker Emily , Penberton Nkechi
Published: June 2021

Aims

It is trust policy that the VTE risk assessment should be completed for every patient admitted to wards. The standard for this audit is therefore 100% completion. We completed the audit in October 2018 and closed the loop in September 2019.

Method

This was a cross-sectional study of all patients on all the wards according to patients’ list on the electronic system (Paris) on certain date. In the first audit we used an audit tool from a similar audit performed in another area in the trust. For the purpose of re- audit we designed an audit tool to reflect the changes made in the electronic form.

Result

In the re-audit, there was noticeable improvement in the completion rate compared to initial audit (95% vs. 82%); however, there was still under-performance. An interesting observation of the re-audit is that 74% percent of admissions had VTE risk assessments forms completed on same day of admission or next day compared to only 45% in previous audit.

Conclusion

When looking at the completion of individual components on the VTE forms there are still some room for improvement as well. For example, in 26% of the patients there was no documentation about the use of prophylactic anticoagulants before admission compared to 34% in our previous audit. Also in 7% of the patients there was no documentation about the outcome of the assessment compared to only 3% in previous audit.

This is an audit to assess the completion of electronic VTE forms as per trust policy. Following the initial audit we made recommendations to improve completion rate. In the re-audit there was an improvement in total completion rate but we have not met the goal of 100% yet.