bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal immune activation generates anxiety in offspring: A translational meta-analysis
Authors: Matos Ursula , Quagliato Laiana Azevedo , Nardi Antonio Egidio
Published: June 2021

Aims

Maternal immune activation (MIA) during pregnancy is recognized as an etiological risk factor for various psychiatric disorders, such as schizophrenia, major depressive disorder, and autism. Prenatal immune challenge may serve as a “disease primer” into an altered trajectory of fetal brain development that, in combination with other genetic and environmental factors, may ultimately result in the emergence of different psychiatric conditions. However, the association between MIA and the offspring's chances of developing anxiety disorders is less clear. To examine the effect of MIA on offspring anxiety, a systematic review and meta-analysis of the preclinical literature was conducted.

Method

A systematic search of the PubMed, Web of Science, PsycINFO, and Cochrane Library electronic databases was performed using the PRISMA and WHO methodologies for systematic reviews. Studies that investigated if MIA during rodent's pregnancy could cause anxiety symptoms in offspring were included.

Result

Overall, the meta-analysis showed that MIA induced anxiety behavior in offspring. The studies provide strong evidence that prenatal immune activation impacts specific molecular targets, synapse formation and function, and a disbalance in neurotransmission that could be related to the generation of offspring anxiety. Future research should further explore the role of MIA in anxiety endophenotypes.

Conclusion

According to this meta-analysis, MIA plays an important role in the pathophysiological mechanisms of anxiety disorders and provides a promising therapeutic target.
Mindfulness based cognitive therapy for recurrent depressive disorder
Authors: McLoughlin James , Martin Paula , McCarthy Geraldine , Piong Chee Lin
Published: June 2021

Aims

Mindfulness-based therapies have been demonstrated to be effective in reducing anxiety, stress and depressive symptoms in adults. Depression is a chronic relapsing condition. Major depressive disorder is one of the most common causes of ill health and functional impairment.

Our goal was to assess the real world clinical effectiveness of Mindfulness Based Cognitive Therapy (MBCT) for Recurrent Depressive Disorder in three domains:

-Depression, anxiety and stress levels

-Mindfulness level

-Self-compassion level

Method

Patients with a diagnosis of Recurrent Depressive Disorder (primary or secondary diagnosis) were referred by their community mental health team to participate in an 8-week educational MBCT programme. Participants completed the Depression, Anxiety and Stress (DASS), 5-Facet Mindfulness and Self Compassion self-rated scales prior to commencing and at the end of the course. They were also invited to give qualitative feedback at the end of the course.

Data were collected from four groups who completed the course over a period of twelve months. A paired samples test was used to compare pre and post intervention scores to determine effect size.

Result

We had complete data for 19 participants out of a cohort of 34. Pre intervention scores were similar for both groups.

The mean age of the cohort was 47 years (SD of 10 years), 3 male, 16 female.

Patients showed a clinically significant reduction of symptoms in depression, anxiety and stress, with respective reductions of 48%, 26% and 43% post intervention. Results were statistically significant for depressaion and stress p <0.001 but not for anxiety p = 0.130.

Positive trends were seen in all domains of the 5-Fact Mindfulness and Self Compassions scales, with mean improvements of 28.2% and 35.3% respectively. All results were statistically significant.

We also collected anonymized qualitative feedback which highlighted themes of empowerment, skill acquisition and improved coping.

Conclusion

Numerous studies have demonstrated poor compliance with antidepressant treatments commonly prescribed in Recurrent Depressive Disorder. This small scale study demonstrates a statistical and clinical benefit of MBCT for these patients, supporting greater use of such novel non-pharmacological therapeutic options as treatment strategies..
Are drug consumption facilities an effective intervention to reduce drug related mortality? A critical review of the literature
Authors: Melvin Holly
Published: June 2021

Aims

To critically appraise the literature regarding the effect of Drug Consumption Facilities in reducing overdose mortality

Drug consumption facilities (DCF) are places where people can use illicit drugs in the presence of medically trained staff, they aim to reduce fatal overdose risk, reduce risky injecting practices, and to serve as a bridge for users into mainstream treatment, healthcare and social services. Increasing numbers of fatal overdoses due to illicit drug use are a significant public health concern. The UK's statutory independent advisory body (the Advisory Council on the Misuse of Drugs) has recommended DCFs as a mechanism to reduce fatal overdoses due to illicit drugs. However, current UK legislation prohibits their provision.

Method

Systematic extraction of relevant literature from PubMed, using a search string with a focus on observational cohort studies with fatal overdose as the outcome. Appraisal of identified papers using the CASP tool

Result

184 papers were identified, two of these met the inclusion criteria. Quality was fair/good. Neither demonstrated a clear effect of DCFs in reducing overdose mortality

Conclusion

It is difficult to draw firm conclusions due to design weaknesses and potential confounding variables. Robust design is difficult in this research area, due to lack of suitability for RCTs. Despite the lack of a clear effect on overdose mortality, DCFs may exert other positive effects and are a pragmatic and humane response to reducing risk in this target population
Using electronic clinical records to investigate service use and in-patient care of adults with intellectual disability and/or autism spectrum disorder
Authors: Mutch Jennifer , Sheehan Rory , Marston Louise , Werbeloff Nomi , Osborn David , Hassiotis Angela
Published: June 2021

Aims

To describe characteristics of adults with intellectual disability (ID) and/or autism spectrum disorder (ASD) accessing care in one mental health Trust.

To explore factors associated with in-patient admission/risk of re-admission within 12 months of discharge.

Background

There is concern that adults with intellectual disability and those with autism spectrum disorder are frequently admitted to mental health hospitals. The evidence from NHS datasets suggests that this remains a significant issue and is associated with personal, social and economic costs.

Method

Adults (≥ 18 years) with ICD-10 diagnosis of “mental retardation” and/or autism who had accessed care in the Camden and Islington Foundation Trust were identified using the Clinical Record Interactive Search (CRIS). The identification process was validated through cross checking of free text in the electronic clinical notes. We compared demographic and clinical characteristics and service use, including length of admission, of 315 individuals with ASD and 339 with ID (with or without ASD). Logistic regression was used to explore factors associated with in-patient admission and re-admission within 12 months of discharge.

Result

A greater proportion of adults with ID (with or without ASD) had a diagnosis of psychosis, substance misuse, or dementia whereas diagnosis of anxiety disorder was greater in those with ASD. Antipsychotics and other psychotropics were twice as likely to be prescribed for the ID ± group. Admission to psychiatric in-patient care was greater in those with ID ± ASD (adjusted OR 4.00, 95% confidence interval (CI) 2.41-6.63), men (aOR 2.28, 95%CI 1.39-3.75), younger adults (aOR 0.98, 95%CI 0.97-1.00), and in those with a diagnosis of schizophrenia spectrum disorder (aOR 5.08, 95%CI 3.00-8.61), affective disorder (aOR 2.23, 95%CI 1.29-3.83), personality disorder (aOR 1.94, 95%CI 1.02-3.68), and record of previous inpatient admission (aOR 2.18, 95%CI 1.17-4.05). Having ASD alone was associated with a greater risk of re-admission within one year of discharge, although this difference was not statistically significant (aOR 0.70, 95% CI 0.32-1.52). Comorbid diagnoses of affective disorder or personality disorder were the only significant associations with re-admission (aOR 3.11, 95%CI 1.34-7.23 and aOR 8.28, 95%CI 2.85-24.04, respectively).

Conclusion

These findings provide the first longitudinal investigation into the acute care pathway for adults with ID and/or ASD in the NHS. Replication in other trusts is now needed to inform “at risk of admission” registers and guide targeted interventions to prevent admission.
Length of hospital stays in patients with psychosis before and after starting on lurasidone
Authors: Nguyen Uyen , Das Debasis
Published: June 2021

Aims

This study looked at the differences in the length of hospital stays in number of days, 12 months before and after starting on Lurasidone, in patients with psychosis.

Method

A retrospective review of medical records between 2016 and 2019 of patients with psychosis due to all causes at a First Episode Psychosis service in the United Kingdom was performed. Most common side effects, duration of Lurasidone treatment and reasons for stopping Lurasidone were recorded. The length of hospital stays (in number of days) before and after being started on Lurasidone of those had taken Lurasidone for at least 12 months were compared using a paired t-test.

Result

43 (n = 43) patients had taken Lurasidone at some point during the study period with a mean age of 30.48 years and a male: female ratio of 1.4:1. The average duration of treatment was 327 days. The most common reported side effects were sedation (16%), nausea (7%) and tardive dyskinesia (7%). Among these 43 patients, 19 patients (44%) tolerated and were on Lurasidone for at least 12 months with a mean age of 30.42 and a male: female ratio of 0.42:1. Of these 19 patients, the total number of days of hospital stays within 12 months before and after Lurasidone initiation was 1179 days (mean = 62.05) and 242 days (mean = 16.47) respectively. The paired t-test showed a significant reduction in the average length of hospital stays in these patients within 12 months after Lurasidone initiation (p = 0.0466).

Conclusion

Patients with psychosis who were on Lurasidone had a statically significantly reduction in the length of hospital stays within 12 months of medication initiation; up to 44% tolerance rate, with better tolerance in female patients and the most common side effects being sedation, nausea, tardive dyskinesia.
Using qualitative methods, what factors do child & adolescent higher trainees and new consultants (within 1 year of appointment), report in choosing their higher training subspecialty?
Authors: Parker Mary , Boylan Jim , Wolstenholme Nicholas
Published: June 2021

Aims

This Research aims to identify factors reported by recent and current trainees in choosing Child & Adolescent (C&A) Psychiatry for their higher training/career path. The hypothesis is that via thematic analysis prominent factors will emerge to inform future recruitment and retention.

Background

The need to attract more doctors into Psychiatry has been identified by NHS, Royal College of Psychiatrists and the Media; Health Education England figures show core psychiatry had lowest fill rates of any specialty in 2016,17 &18.

Some subspecialties experience particular difficulties e.g. C&A. Royal College of Psychiatry analysis of workforce in March 2018 showed the numbers of C&A psychiatrists of all grades have fallen by 6.3% in four years and for consultants alone the decrease was 6.9% over the same period.

However, very little research has been completed investigating why trainees might choose C&A Psychiatry with a literature search revealing only one report of C&A trainees views in the UK in 2006.

Method

A qualitative design was chosen to provide insight into the factors affecting participants in choosing their career.

The theoretical framework supporting the study relates to capturing experience via a case study approach, aiming to explore reported issues in a real life context and considering similarities in the cases to inform future recruitment.

The Research was approved by The Health Research Authority and local Research & Development departments.

Purposeful sampling was used with voluntary participation following informed consent and non-identifiable demographic data were collected and analysed quantatively.

Semi-structured interviews to saturation were conducted with fourteen (N = 14) participants asked questions exploring their subspecialty choice. Responses were recorded and transcribed verbatim prior to thematic analysis, including triangulation via a co-coding process to check areas were not over-represented and/or subject to researcher thoughts and possible unconscious biases.

Result

Semi-structured interviews included all North-East C&A trainees and 3 recently qualified Consultants.

Demographics results included 5 male and 6 female participants and 6 non-UK graduates.

Emergent themes were analysed into key findings including:

–

interest in children/specialty

–

specialty experience

–

supportive supervisors/team

–

work-life balance

–

opportunity to impact/intervene early.

Limitations include study of a single geographical area and possible researcher bias.

Conclusion

This Research provides novel findings re factors influencing career choice of C&A Psychiatry to inform future recruitment and retention. Clear themes have emerged re important recruitment/retention factors and the study highlights need for more research to investigate reasons why C&A is not chosen.
Comparison of hospitalizations in patients on first generation versus second generation long acting injectable (LAI) antipsychotics
Authors: Rasool Seemab , Venan Paster
Published: June 2021

Aims

There is limited data on the comparison of efficacy between first and second antipsychotic LAIs. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics, significantly reduce hospitalizations as compared to conventional depots.

Our aim was to compare hospitalizations in patients on first and second generation LAI antipsychotics.

Method

A retrospective observational study was done by reviewing the records of all the depot clinics in South Essex, United Kingdom. A list of patients enrolled and receiving LAI antipsychotics was obtained from the 6 depot clinics. Data were collected by going through the electronic records of the patients on the depot clinic lists and taking down the demographics, diagnosis and the hospital admissions. Other variables like comorbid drug abuse were also recorded.

Result

Amongst a total of 346 patients 223 (64 %) were males and 123 (36%) were females. Average age was 50.3 (range 21 to 88 years) and 290 (83%) patients were single. An overwhelming majority of patients 299 (87 %) were not in employment. Regarding the diagnosis, the majority, 237 patients were diagnosed with Paranoid Schizophrenia, 49 patients were diagnosed with Schizoaffective disorder, 38 patients were diagnosed with Bipolar affective disorder, 20 patients had a diagnosis of Delusional disorder and only 2 patients had a primary diagnosis of Mental and Behavioral disorders due to substance abuse. Of the total 346 only 17 patients were on a Community treatment Order.

Risperidone was the most commonly used second generation LAI at 26%,Aripiprazole in 10% and Paliperidone was used in 5% patients. Olanzapine LAI was only used in 2 patients. Amongst first generation LAIs Zuclopenthixol, Fluclopentixol were both used in 24%, and Haloperidol in 10% patients. 21 % of patients were reported to be actively abusing drugs.

65 (32.6%) of the total 200 patients on Ist Generation LAIs had hospital admissions

55 (39.8%) of the total 138 patients on 2nd Generation LAIs had hospital admissions

This difference was not statistically significant (Z test)- P value of 0.082427

Conclusion

The results in our observational study are equivocal, both LAIs providing equitable decrease in the hospital admissions albeit with a slightly favourable outcome (not statistically significant though) attributable to the first generation LAIs. There was a high incidence of unemployment and drug abuse in our cohort of patients, thus targeted interventions can be established in rehabilitation of such individuals.
A randomised controlled trial to investigate the effectiveness of sustained photoprotective behaviour in xeroderma pigmentosum after intervention
Authors: Searle Tamara , Walburn Jessica , Norton Sam
Published: June 2021

Aims

This study aimed to investigate whether an intervention designed to improve photoprotective behaviours is effective at changing behaviour and whether any change could be maintained.

Background

Xeroderma Pigmentosum (XP) is a rare condition in which patients are at risk of malignancies when exposed to ultra-violet radiation (UVR). Sufferers must take extra precautions to protect themselves from UVR. They must apply sunscreen to exposed skin, wear thick clothing, gloves, and a UVR-protective visor. Treatments include preventative photoprotective measures; the use of sunscreen and protective clothing. Additionally, frequent eye and skin examinations are required and swift removal of any premalignant lesions.

Method

In this randomised controlled trial, 16 participants with XP were given questionnaires at 4 time points; baseline, post-intervention, 5 months and 9 months post-intervention. The intervention involved 7 one-on-one counselling sessions, as well as telephone consultations. Counselling sessions encouraged photoprotection adherence, self-efficacy and discussions of any barriers to improving photoprotective behaviour. This study focused on psychosocial variables, attitudes and photoprotection. Questionnaires included the photoprotection self-efficacy questionnaire, Self-Reported Behavioural Automaticity Index, Short Warwick-Edinburgh Mental Wellbeing Scale, Quality of Life and Brief Photoprotection Adherence Questionnaire.

Result

The intervention was shown to have no significant effect on participants’ questionnaires scores. Univariate ANCOVA revealed a group effect between follow-up 1 (FU1) and follow-up 2 (FU2); η2 = 0.422 for self-efficacy in wearing photoprotective clothing. A group effect was identified from BL to FU1 and FU1 to FU2; η2 = 0.343 and η2 = 0.378 respectively in how often participants reapplied sunscreen to their face when outside for longer periods. Univariate ANCOVA revealed no group or time effect for the other outcome variables; for example, sunscreen self-efficacy.

Conclusion

The intervention had no significant effect on photoprotective behaviour questionnaire scores. Future research could focus on recruiting more participants globally to generate more statistically powered results. Research should focus on producing a maintainable intervention so that any positive change would produce better long-term health outcomes. This study lays the foundations for future XP research, which will be vital to improve understanding and enhance photo protective behaviour.
How does self-report of anxiety symptoms compare with observer assessments after acquired brain injury?
Authors: Seelochan Alex , Paramlall Mark , Tyagi Himanshu , Kandasamy Rohan , Bakar Ida , Holloway Cameron , Harding Samantha , Gadhvi Anna
Published: June 2021

Aims

Comorbid anxiety and mood disorders occur in 30% and 60% of individuals post-ABI (acquired brain injury), respectively (Juengst et al, 2014). The presence of psychiatric symptoms correlate to poorer outcomes in post-stroke rehabilitation, worsened quality of life (QoL), and deficits in memory, attention, and processing speed that persists years following the index event. Despite this, it is unclear whether to what degree anxiety impacts cognition. Furthermore, the literature on this topic is inconsistent when comparing subjective and clinician measurements. This study seeks to ameliorate this gap in literature by analyzing how clinicians’ measures of anxiety and cognitive performance correlate with subjective assessments of patient's own anxiety symptoms.

Method

Individuals with an ABI who were seen in a clinical neuropsychiatry outpatient clinic between 2019 and 2020 completed a GAD-7 (Generalized Anxiety Disorder-7) questionnaire (patient's self-report of the severity of anxiety symptoms) and an observer completed a Neuropsychiatric Inventory Questionnaire (NPIQ) including a subscale for anxiety (NPIQ-A). Participants also underwent a formal cognitive examination with the Montreal Cognitive Assessment (MoCA). A total of 24 ABI patients (depressed ABI and non-depressed ABI) were analyzed for variation, statistical agreement and correlation. Here, total anxiety scores (using GAD-7 scores), anxiety severity (correlating category based on total GAD-7 score) were compared against the objective measures for anxiety (NPI-QA) and cognition (MoCA). In order to standardize MoCA scores, z scores were used in the statistical analysis.

Result

The patient's subjective raw scores of anxiety were statistically significantly different from the corresponding scores from objective observers on Wilcoxon-Rank Sum tests (p < 0.01), however, there was a statistical correlation between GAD (categorized by severity level) and NPI-QA (p = 0.75). Spearman Rank Correlation did show positive, but, statistically insignificant correlation between dyads of these independent variables (including GAD7/NPIQ-A, GAD 7 categorised/NPIQ-A, GAD7/MoCA, GAD 7 categorised/MoCA).

Conclusion

These findings indicate (1) self-reported measures of anxiety (GAD7) in ABI were inconsistent with objective measures of anxiety in this cohort, (2) anxiety measures did not demonstrate significant correlation when compared to objective measures for cognitive function, and (3) ABI patients did not display good insight into the severity of their anxiety symptoms as measured by the GAD7. Further research should focus on utilizing other subjective measurement tools for anxiety and/or clinician evaluation tools with NPIQ-A.
Before the light fades, who blows the whistle? : a narrative review on sports dementia
Authors: Sodiya Olusegun , Edafegwotu Ovwigho , Jeje Jide
Published: June 2021

Aims

Traumatic brain injury is a leading risk factor for degenerative conditions. Although in the past this was believed to affect mostly boxers, recent studies have expanded the at-risk population to include American football players, rugby players, hockey players and other athletes involved in contact sports. Hence, there has been growing interest in the media and the public at large on the short and long term impacts of head trauma in sportspersons. The aim of this study is provide an overview of the impact of traumatic brain injury in contact sports and the link to early onset dementia.

Method

For the purpose of this study we conducted a literature search using PubMed electronic base and Google scholar. The search was made in February 2021 and using the following keywords ‘early onset dementia’, ‘presenile dementia’, ‘traumatic brain injury’, ‘contact sports’, ‘sportsmen’, and ‘athletes’. The search words were used individually and in combination to gather relevant articles. Types of studies included were case reports, case series, cohorts, cross-sectional, editorial and newspaper articles.

Result

Most of the published studies have shown significant associations between repeated head trauma and brain morphological changes evidenced by the presence of myelinated axons, astrocytosis, perivascular neuroinflammation and formation of phosphorylated Tau proteinopathy. These contribute significantly to alterations in axonal functioning and synaptic transmissions which sets the stage for neuronal degeneration. These changes affect both the macroscopic and microscopic structures with consequent neurochemical disturbances and functional deficits which, manifest primarily as executive dysfunction.

Conclusion

Current evidence supports an association between participation in contact sports and neurodegenerative disease, despite the protective aspects of sporting activities. Overall the studies reviewed have shown that brain injury remains a potent risk factor for the early onset dementia seen in sportspersons. Consequently, it is prudent for more proactive and precautionary measures to be put in place to reduce impacts of head injury and to better identify and manage brain injury in sports.
Establishing prevalence of diagnosis of personality disorder across high secure forensic services using the ICD 10 and ICD 11 classification
Authors: Soni Anju , Sengupta Samrat , Treasaden Ian
Published: June 2021

Aims

There has been an increasing recognition of the lack of clinical validity of different types of ICD10 personality disorder.

The prevalence was established among patients in a high secure hospital in England of those with either a primary or secondary diagnosis of personality disorder and its recorded type according to ICD10 and then ICD11.

The new ICD11 classification increased the validity of diagnosis of personality disorder as well as its severity.

Background

ICD 11 has proposed the dropping of the classification of personality disorder based on particular types of personality disorder and instead adopting a diathesis model based on 2 dimensions: presence of personality disorder and three levels of severity (Mild, Moderate and Severe) and the option of specifying one or more prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality, and Anankastia) and also specify a Borderline Pattern qualifier.

Method

The electronic medical records were used to establish the presence and type of personality disorder using the criteria of ICD10 and ICD11.

The researchers assured reliability by rating some vignettes using the Schedule for Personality Assessment from Notes and Documents (SPAN-DOC) before rating actual cases.

Result

From a total population of 208 patients, 64(30.8%) were classified as having either a primary or secondary diagnosis of personality disorder according to the ICD 10.

30 (47%) had dissocial personality disorder (DSPD), 19(30%) emotionally unstable personality disorder (EUPD) and 8(13%) paranoid personality disorder. 20 (31%) had a comorbid diagnosis of mental illness and about a tenth had diagnoses of multiple personality disorders. These types of personality disorder diagnosed by the researchers using ICD 10 did not always match the types of personality disorder diagnosed by clinicians at the hospital.

All patients met the criteria of personality disorder under ICD 11 but the number with a borderline specifier was greater than those with an ICD10 diagnosis of EUPD. Using the trait domain qualifiers in ICD 11, patients with ICD 10 diagnoses of EUPD or DSPD showed dissociation and disinhibition, with those with a DSPD showing low and those with EUPD high negative affectivity.

Conclusion

The results confirm that while psychiatrists in a high secure hospital reliably diagnose the presence of a personality disorder, they are much less able to make an accurate diagnosis as to the actual type of personality disorder. The new ICD 11 classification will increase the clinical validity of the diagnosis of personality disorder and its severity.
How can automated linguistic analysis help to discern functional cognitive disorder from healthy controls and mild cognitive impairment?
Authors: Beavis Lizzie , O'Malley Ronan , Mirheidari Bahman , Christensen Heidi , Blackburn Daniel
Published: June 2021

Aims

The disease burden of cognitive impairment is significant and increasing. The aetiology of cognitive impairment can be structural, such as in mild cognitive impairment (MCI) due to early Alzheimer's disease (AD), or in functional cognitive disorder (FCD), where there is no structural pathology. Many people with FCD receive a delayed diagnosis following invasive or costly investigations. Accurate, timely diagnosis improves outcomes across all patients with cognitive impairment. Research suggests that analysis of linguistic features of speech may provide a non-invasive diagnostic tool. This study aimed to investigate the linguistic differences in conversations between people with early signs of cognitive impairment with and without structural pathology, with a view to developing a screening tool using linguistic analysis of conversations.

Method

In this explorative, cross-sectional study, we recruited 25 people with MCI considered likely due to AD, (diagnosed according to Petersen's criteria and referred to as PwMCI), 25 healthy controls (HCs) and 15 people with FCD (PwFCD). Participants’ responses to a standard questionnaire asked by an interactional virtual agent (Digital Doctor) were quantified using previously identified parameters. This paper presents statistical analyses of the responses and a discussion of the results.

Result

PwMCI produced fewer words than PwFCD and HCs. The ratio of pauses to speech was generally lower for PwMCI and PwFCD than for HCs. PwMCI showed a greater pause to speech ratio for recent questions (such as ‘what did you do at the weekend?’) compared with the HCs. Those with FCD showed the greatest pause to speech ratio in remote memory questions (such as ‘what was your first job?’). The average age of acquisition of answers for verbal fluency questions was lower in the MCI group than HCs.

Conclusion

The results and qualitative observations support the relative preservation of remote memory compared to recent memory in MCI due to AD and decreased spontaneous elaboration in MCI compared with healthy controls and patients with FCD. Word count, age of acquisition and pause to speech ratio could form part of a diagnostic toolkit in identifying those with structural and functional causes of cognitive impairment. Further investigation is required using a large sample.
Exploring evidence of fatigue in survivors of paediatric brain tumours: a systematic review
Authors: Wood Jennifer , Verity Sarah
Published: June 2021

Aims

As the number of survivors of childhood brain tumor grows, fatigue is being increasingly recorded as a long-term consequence of both the cancer itself and the treatment received. Survivors of childhood brain tumour report more significant fatigue than children with other cancers, often impacting all aspects of life, including academic attainment, self-concept and social relationships with peers, leading to reduced health-related quality of life.

This study aimed to systematically evaluate the evidence for fatigue in paediatric brain tumour survivors.

Method

A systematic search using EMBASE, MEDLINE and PsycINFO identified 20 papers meeting the inclusion criteria. Scientific rigor was used throughout by following Scottish Intercollegiate Guidelines Network (2015) guidance for systematic reviews. Quality Assessment of Evidence Rating tool - Fatigue (QAERT) was developed with substantial inter-rater agreement found.

Result

19 of the 20 studies reviewed showed conclusive evidence of fatigue in survivors of paediatric brain tumour. One study offered adequate evidence that there was no difference in levels of fatigue in paediatric cancer survivors, including survivors of paediatric brain tumour, when compared to healthy controls. Three studies found that fatigue was worse in survivors of paediatric brain tumour when compared to survivors of other paediatric cancers

Conclusion

This review provides evidence for the presence of fatigue in survivors of paediatric brain tumour. However, the construct of fatigue was poorly defined throughout, with fatigue associated with physical effects of treatment and fatigue associated with long-term cognitive impairment not distinguished. This poor construct validity, coupled with a lack of comparison groups in 12 of the 20 studies, reduces the generalizability of the data and its usefulness for developing effective psychological interventions. Further research is needed, built on a clear fatigue construct definition, and including well defined exclusion criteria, to provide a sound basis for improving the quality of life of these children.
Waiting list eradication in serious mental illness (SMI) “secondary care” psychology: addressing an NHS blind spot
Authors: Airey Nicola , Iqbal Zaffer , Brown Sophie
Published: June 2021

Aims

The poster focuses on the reduction, and eventual eradication, of waiting times within a community-based NHS psychology service in the North East of England. The poster aims to demonstrate the effectiveness of strategies implemented within a secondary care psychology service whilst examining patterns of help-seeking behaviour and treatment compliance in those waiting for therapy, and also the care needs of this cohort following a wait for services.

Background

Secondary care waiting lists for psychological therapy, as highlighted by a recent British Medical Association audit, remain a so-called ‘blind-spot’ in mental health care provision and a national problem. Tackling waiting lists within this sector has been stated as a priority within the Five Year Forward View, however “core ingredients” of waiting list eradication methodologies and the components leading to such, have yet to be disseminated.

Method

A historical audit and follow-up of clinical data were utilised to gather and analyse data of 208 individuals who were seen by the psychology service between October 2014 and March 2016.

Result

No significant differences were found between individuals who successfully completed therapy compared to those who disengaged in regard to demographic or epidemiological variables, or mental health service input. Despite lengthy waiting times of up to 3.69 years, waiting time did not significantly impact whether someone engaged with psychological services. Any form of input from psychological services led to a significant reduction in distress, as measured by the CORE-OM. No individuals who completed therapy were re-referred for psychological input at 12-month follow-up.

Conclusion

If imposed appropriately over a suitable time-frame evidence-based, effective and efficient needs-led psychological input can be provided whilst eradicating a waiting list and still remaining flexible, formulation-based and person-centred.
Predicting risks of physical health deterioration in a place of safety
Authors: Berry Alex , Dalton Florence , Dunning Michael , Johansson Freddie
Published: June 2021

Aims

Healthcare triage for those subject to section 136 powers (MHA 1983/2007) remains challenging. Camden and Islington NHS Foundation Trust opened a dedicated Health-Based Place of Safety (HBPOS) in 2020, situated separately from an emergency department (ED). There was concern that this may lead to physical health problems going unrecognised. We aimed to design a simple, efficient algorithm to be used by non-medically-trained staff to identify those who are subject to s.136 powers who would benefit from medical clearance before being admitted to the HBPOS

Method

We chaired a consensus meeting with nursing staff, police and emergency medicine consultants when designing the algorithm. Case notes of those presenting under s.136 to the POS over 1 calendar-month in 2019 were reviewed, and the proportion of those who the algorithm would have diverted for medical clearance was calculated. We then reviewed the proportion of cases sent for medical clearance during a single calendar month in 2020, after the HBPOS had opened, to see whether there was a significant difference.

Result

37 patients were admitted to the ED-based POS in July 2019, of which 36 records were analysed. 9 patients (25%) were referred for medical clearance, with 2 (6%) requiring medical admission. 8.6% were identified as needing medical clearance when the algorithm was applied retrospectively (positive predictive value 66%, negative predictive value = 79%).

Review of records over 1 calendar-month after the HBPOS was established showed 30.6% of patients had been diverted for medical clearance prior to entering the HBPOS. Of the 65 patients, 1 (2%) required transfer to ED within 48 hours of entry. No statistical difference in the proportion of patients sent for medical clearance was observed since the formation of the HBPOS away from the ED (Chi-squared = 0.549, p = 0.458), suggesting the algorithm successfully identified those patients who needed medical clearance prior to admission.

We observed high rates of intoxication amongst those admitted (30–40%).

Conclusion

The algorithm showed high specificity and negative predictive value, allowing for a degree of confidence when admitting those deemed at low-risk of physical deterioration, though it does not eliminate the need for clinical judgement. Interpretation of the results is complicated by the COVID19 pandemic in 2020, which was not accounted for in the algorithm, which possibly led to deviations from the algorithm in real-world clinical practice.
Polypharmacy and potentially inappropriate medications (PIMS) in older adults referred to a liaison psychiatry service
Authors: Akpan Anietie , Longe Omolade
Published: June 2021

Aims

The older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and being under the care of several specialists. Adverse drug events and reactions account for a significant number of acute hospital presentations in this population group with increased risks of delirium, lasting cognitive impairment, falls and death.

Medications are not routinely reviewed or rationalised in the elderly, often contributing to preventable harm.

We sought to estimate the prevalence of polypharmacy and potentially inappropriate medications, anticholinergics in particular, in patients (65 years and older) referred to the St Mary's Hospital Liaison Psychiatry Department over a 3-month period.

Method

Between 01/06/2019 and 31/08/2019 all referral forms (from in-patient wards and A&E) for patients aged 65+ years were screened for medications currently prescribed and administered. The medications were confirmed via the St. Mary's Hospital electronic records, pharmacists’ completed Medicines Reconciliation and GP Summary Care Records. Polypharmacy was defined as patients prescribed 5 or more medications. Drugs with anticholinergic properties were considered as an example of Potentially Inappropriate Medication (PIMs) using the Anticholinergic Burden Scale. 77 patients were referred in the time period. 9 were excluded due to incomplete/unreconciled medication information.

Result

77.94% (n = 53) were prescribed 5 or more medications.

38.24% (n = 26) were prescribed over 10 medications.

10.29% (n = 7) prescribed over 15 medications.

69% of (n = 47) prescribed an anticholinergic.

42.65% (n = 29) prescribed more than 1 anticholinergic.

Conclusion

Polypharmacy and potentially inappropriate prescribing remain widespread within the older adult population.

Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.

Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.

Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.

Pharmacovigilance, collaborative working, regular and systematic medication reviews, and on-going training are needed across services providing care for the older adult.
Utilisation of mental health transfer checklist proforma from acute physical health hospitals (Liverpool University Hospitals NHS Foundation Trust) to mental health hospitals (Mersey Care NHS Foundation Trust)
Authors: Al-Bazz Dalal , Anwar Fareeba , Javed Qaiser
Published: June 2021

Aims

Testing the compliance and completion rate of a transfer checklist (proforma) created in accordance with local hospital policies.

Background

The proforma was developed following serious incidents where medically unstable patients were inappropriately discharged to mental health hospitals, requiring readmission to acute medical hospitals. Frequently these events reported an inadequate handover from medical to mental health teams and patients were often prematurely deemed medically fit with evidence to the contrary.

Although parity of esteem between mental and physical health has been a high profile political issue in the UK since 2011, evidence indicates that parity is far from being achieved. This first ever checklist was designed to improve safety of patient transfer from acute physical health hospitals to mental health hospitals by ensuring patients are medically fit and better communication between the two trusts.

Method

Data were collected retrospectively over a six-month period between August 2018 and January 2019 and retrieved from patient notes available at relevant trusts. Electronic notes were obtained from medical wards, accident and emergency and Mersey Care electronic systems. Notes were specifically scrutinised for presence of the proforma, quality of completion and, number and reasons for readmission from mental health hospitals to acute physical health hospitals following their medical optimization. Readmissions were considered as admissions to physical health hospitals up to one month following discharge with evidence of ongoing concerns.

Result

6597 referrals were made to liaison services from Liverpool University Hospitals, of which 5–6 % were admitted to inpatient mental health units. 31% of admissions from Liverpool University Hospitals were readmitted to a physical health hospital within one month of discharge indicating inappropriate and unsafe discharges. Of all those readmitted, 10% had ongoing acute medical concerns prior to admission to a mental health hospital. The proforma was filled in 13% of admissions from Liverpool University Hospitals. None of the forms were fully complete.

Conclusion

10% of patient admissions to mental health hospitals were identified as inappropriate due to ongoing acute medical concerns. The proforma served as structured guidance and evidence of medical fitness at time of transfer. However poor compliance was observed, which could be secondary to lack of awareness of the proforma and inadequate dissemination of the policy. Findings were shared and discussed with the appropriate teams both in acute physical health and mental health hospitals and steps will be taken to raise awareness of the proforma before completing a second audit.
The organization of a mental health phoneline in Buenos Aires City: its role to minimize the impact of mental health services disruption amidst COVID-19 pandemic
Authors: Gutnisky David Alejandro , Persano Humberto , Kugler Victoria
Published: June 2021

Aims

The main concern of this research is to evaluate the performance of a new Mental Health Phoneline Programme, developed to facilitate access to Mental Health Services and to lower the impact of Mental Health Services disruption due to COVID-19 lockdown. Crisis resolution, new referrals, and patients’ reconnection with their former Mental Health Teams were recorded.

Method

The data obtained from 11,406 calls made to the Mental Health Phone Line from April 14th, 2020 to March 1st, 2021 were analysed. Crisis resolutions, new referrals, and patients’ reconnection with their former Mental Health Teams were calculated.

Result

Of the 11,406 calls registered, 72.2% of them were made by women. Mean age was 50.13 years, SD 18.51; median: 50. There was a significant difference between gender regarding age (males: mean 43.91 years, SD 18.88; females: mean 52.48 years, SD: 15.9), being the males who used the phoneline younger (t:23.75; p <0.000). 54.2 % of the users lived with a significant other. Crisis resolution represented 12.6 % of the sample, request for information 34.4%, psychosocial interventions 47.6% and, reconnection with former Mental Health Team 4.3%. New referrals for treatment were 2.9% of the total calls. Two main negative affects the74.2% of the total affect reported. Anxiety-Fear accounts for 49.3% of reported feelings and depression a 24.9 %.

Conclusion
Characteristics and outcome indicators in a specialist inpatient intellectual disability unit: an independent sector experience
Authors: Apio Mike , Skalbania Witold , Khan Muhammad Aamer , Lotsu Bolanle
Published: June 2021

Aims

To elucidate critical elements for effective outcomes in patients with complex and challenging behaviours admitted to specialist inpatient ‘locked rehabilitation’ intellectual disability unit (LRU).

Background

People with intellectual disability of varying severity with or without associated mental disorder are at risk of deterioration presenting with problem behaviours at critical times of transition. In the context of their pre-set neurocognitive deficits, protective factors during early development include a robust psychosocial ‘parenting’ environment that optimises their strengths through nurturing and embedding a positive mind-set. Such environment is critical for the development of resilience as against reliance on external factors with high likelihood of change. The effect of early exposure to prenatal and or postnatal childhood adversities is a common denominator. The experience of abuse; from deprivation and neglect to physical violence and indeed sexual trauma predisposes to further perturbation and kindling effect on risks for early and later onset affective disorders. Specialist ID services become critical to the resetting of a distorted premorbid neuronal circuitry. A biopsychosocial approach to recreating a stable base and environmental enrichment may offer opportunities for enhancing neurocognitive remediation and enhance prosocial skills. Indicators for better outcomes may offer scope for focused intervention. This review highlights extent patients progress (response to treatment and symptom remission), length of Stay and discharge pathway could be predicated on their engagement with offered structured therapeutic activities.

Method

Using a mixed model approach, 12-months data regarding patient characteristics, elements from HoNOs LD, with patient's self-reported experience and utilization of therapy, progress of patients in the service were reviewed to elucidate factors that may predict improved outcomes..

Result

Of 48 patients, 18 females and 30 males identified in the 12-months from January 2019, 7 females were discharged/transferred with one stepped up to LSU and another side-moved to a LRU. 6 have identified places and 5 require ongoing care. Of the males, 8 were discharged and 5 have identified placements. 16 inpatients with support completed questionnaires (10 males, 6 females). Majority identified structured therapeutic activities as helpful in their progress. Data for length of stay ranged from 12 to over 120 months with a mean of 31 months ignoring potential discharges.

Conclusion

Findings suggest patients able to engage in structured therapeutic activities in conjunction with concordance to treatment are more likely to progress earlier in their care.