bluuebunny/crossref_metadata_2025 huggingface dataset:
Youth Group Wellbeing Project for Adolescents Impacted by the March 15 Attacks – Protocol for a Pilot Randomised Waitlist-Controlled Trial
Authors: Donovan Katherine , Dean Shaystah
Published: August 2024

Aims

Psychological distress is common in adolescence; even more so following traumatic events. On 15 March 2019, two mosques in Christchurch were targeted in an act of terrorism. This has had widespread repercussions in the Muslim and wider community in Christchurch and New Zealand. This protocol offers an integrated group treatment based on an indigenous Islamic Psychology framework incorporating components of established transdiagnostic interventions for increasing wellbeing and reducing psychological distress in teenagers. We aim to measure the effect size of the treatment effect on total difficulties, emotional difficulties, trauma symptoms, somatic symptoms and functional impairment in adolescents self-identifying as impacted by the terror attack. We will measure the degree of parental distress and somatic symptoms to explore whether an intervention for adolescents has an impact on parental wellbeing. We will determine the feasibility and acceptability of this approach to inform supports for similar populations and as an example of cultural adaptation of mental health services.

Methods

This is a randomised controlled trial with a waitlist-controlled design to measure the size of treatment effects on clinical outcomes, and the feasibility of this protocol. We aim to recruit 64 participant families. A 6-week group programme will be offered to teenage participants randomised to the study group and offered to the waitlist group following the study. The study will be community-based in one site. We will assess clinical outcomes including emotional difficulties and somatic symptoms in teenagers (aged 12–19) and parents at baseline, end of treatment and at 3-month follow-up, and measure the project's acceptability with participants and parents. Individuals’ experiences of the programme will be examined using qualitative analysis of participant interviews at the end of the programme. Statistical analysis will be a mixed method design including effect size difference calculations, quantitative measures of acceptability and qualitative analysis. Treatment data from participants randomised to the waitlist first will not be included in statistical comparison of treatment effects but will be used for the assessment of feasibility.

Results

This study will inform whether this unique approach is feasible and easily accessible for adolescents impacted by traumatic events. Its design has been driven by community engagement and stakeholder consultation to consider recruitment, relational safety, screening, and risk management. The project has an emphasis on widening access to mental health supports in a minority faith community by maintaining cultural sensitivity and reducing stigma associated with mental illness.

Conclusion

Trial registration: ClinicalTrials.gov, NCT05030909. Registered on 8 September 2021.
Integrated Parenting Intervention for Depressed Fathers of Young Children: A Nested Qualitative Study From Pakistan
Authors: Sattar Rabia , Chaudhry Nasim , Kiran Tayyeba , Husain Nusrat , Husain Ishrat
Published: August 2024

Aims

Depression is a leading cause of disability, contributing to the global burden of disease. Low- and middle-income countries (LMICs) carry over 80% of this disease burden. There are high rates of depression in men in Pakistan. Paternal depression is often overlooked and is an under-researched area. Fathers are at risk of depression particularly if their partner is depressed. There is a need for integrated partner inclusive interventions to improve both parent and child outcomes including overall child development. Therefore, this nested qualitative study aims to identify barriers in transition to scale up an innovative low-cost partner inclusive culturally adapted psychosocial intervention for depressed fathers through a process evaluation from the perspective of fathers.

Methods

This qualitative study was nested within a cluster randomized controlled trial, with depressed fathers of young children (0–3 years) recruited from 18 towns in Karachi, Pakistan. Face to face or digitally audio-recorded interviews were conducted with depressed fathers (N = 24) from the intervention arm of the trial at end of intervention period (i.e., 4-month post-baseline). The intervention involved twelve sessions of a parenting intervention called Learning Through Play integrated with group Cognitive Behaviour Therapy and manual content from “Focus on Fathers”. Interviews were guided by a semi-structured topic guide to explore perceived usefulness of the intervention with particular focus on exploring any additional benefits or challenges of engaging partners into the intervention. Interviews lasted approximately an hour. Data were analysed using the principles of Framework Analysis. A concurrent analysis of initial interviews directed towards further interviews until data saturation.

Results

Analysis highlighted perceived usefulness of the intervention such as improvement in mood, engagement in routine tasks, healthy thinking patterns, increased attachment with child, improved relationship with the family, improvement in parenting knowledge and more positive attitudes towards child development, supporting partners in household chores, and recommendation to promote this partner inclusive parenting program throughout the country.

Conclusion

Addressing depression in parents is hugely important due to its adverse impact on both parents and children. This low-cost parenting program supported fathers in their parenting role along with improvement in psychological well-being. This has also informed barriers and facilitators to implement the LTP plus parenting program and the possibilities to roll out the intervention at national level.
Prevalence and Interrelation of Irritable Bowel Syndrome With Generalized Anxiety Disorder Among Sudanese Medical Students, 2020
Authors: Heamid Samah H. , Ibrahim Danya
Published: August 2024

Aims

This study aimed to determine the prevalence of irritable bowel syndrome (IBS) among medical students at Khartoum University and to examine its association with generalized anxiety disorder (GAD).

Methods

This cross-sectional study was conducted between December 2020 and February 2021, using the Rome IV criteria to diagnose IBS and a 7-item generalized anxiety disorder (GAD-7) scale to assess GAD. A total of 395 self-administered questionnaires were distributed using proportional allocation based on percentages of students in each academic year and their gender. Simple random sampling was used to select participants. The analysis was done using SPSS, and a p-value of <0.05 was considered significant.

Results

We included 325 medical students with a mean age of 21.4 ± 2.2 years, and 69.5% females and 30.5% males. The overall prevalence of IBS was 16.6%, with the most common subtype being IBS-M (35%), followed by IBS-D (31%), IBS-C (28%), and IBS-U (6%). The prevalence of GAD was 22.8%, and anxiety was detected in 54.5% of students. 7.7% of students had both IBS and GAD, and there was a statistically significant relationship between IBS and GAD (Chi-square = 20.385; p < 0.001).

Conclusion

The study findings aligned with previous literature underscoring the prevalence of IBS and GAD among medical students at Khartoum University. Also, sheds light on a substantial association between them. Providing psychological support and stress management programs to medical students is paramount and key to a favorable prognosis.
A Systematic Review of Virtual Reality vs. Standard Social Skills Training for Improving Social Interaction Skills and Reducing Social Anxiety in Children With Autism Spectrum Disorder (ASD)
Authors: Idowu Oluwatobi , Aderinto Nicholas , Olatunji Gbolahan , Kokori Emmanuel
Published: August 2024

Aims

Autism Spectrum Disorder (ASD) poses unique challenges for social interaction and communication skills development in children. Various interventions, including virtual reality (VR) and social skills training, have emerged as potential approaches to address these challenges. This systematic review aims to evaluate and compare the effectiveness of VR Social Skills Training with Standard In-Person Social Skills Training in improving social interaction skills and reducing social anxiety levels in children with ASD.

Methods

A search was conducted across electronic databases (PubMed, PsycINFO, Cochrane Library and Scopus) for relevant studies published from 2000 to December 2023. Inclusion criteria include randomised controlled trials (RCTs) and observational studies comparing VR Social Skills Training with Standard In-Person Social Skills Training in children diagnosed with ASD within the specified age range. Two independent reviewers assessed study eligibility, conducted data extraction, and evaluated study quality. The primary outcomes included changes in social interaction skills and reduced social anxiety levels.

Results

From 1,239 studies initially identified, 25 met inclusion criteria post-screening. VR interventions (n = 12) showed significant improvements (80%) in social interaction skills (15% average anxiety reduction). Varied platforms were utilised, including virtual social scenarios. Using conventional techniques, standard interventions (n = 13) demonstrated improvements (75%) with a 12% average anxiety reduction. Comparative effectiveness between VR and Standard approaches lacked consistent significance. Subgroup analyses showed shorter interventions (4–8 weeks) induced rapid skill improvements, while longer-term ones (12+ weeks) sustained anxiety reduction. Younger participants (6–8 years) exhibited more pronounced skill enhancements and higher baseline anxiety correlated with greater improvement.

Conclusion

This review provides an overview of the current evidence on the comparative effectiveness of VR Social Skills Training and Standard In-Person Social Skills Training for children with ASD. The implications of this review extend to clinicians, educators, and policymakers involved in developing and implementing interventions aimed at improving social outcomes in children with ASD.
Dementia in the United Arab Emirates: Factors Affecting the Time From Symptom Emergence to Formal Diagnosis
Authors: Javaid Syed Fahad , Shebani Zubaida , Andrade Gabriel
Published: August 2024

Aims

Dementia is a debilitating neurodegenerative disorder that can negatively impact the lives of those affected and their families. Providing safe and person-centered care for individuals living with dementia is a global need with particular emphasis on providing individuals and their families with a rapid diagnosis of their condition following the commencement of symptoms. This study aimed to establish the mean duration of cognitive symptoms before a formal diagnosis of dementia is given in the United Arab Emirates (UAE). We also studied demographic and symptom-specific factors affecting the time for dementia to be formally diagnosed. Our study examined a global issue through a more localized lens to identify areas for improvement.

Methods

The study involved extracting and analyzing anonymous data from the electronic medical records of dementia patients at Al-Ain Hospital, UAE. Following ethical approval, the data for individuals diagnosed with any form of dementia from 01/01/2010 to 31/12/2019 were extracted using a set of related diagnostic codes. A short questionnaire was completed for every record that matched the search criteria. Demographic information was collected in addition to details of diagnosis, presenting symptoms, comorbidities, and medications.

A two-tailed independent t-test was conducted to assess the effect of demographic characteristics (gender, nationality, and age) on the time to receive a diagnosis of dementia. A one-way ANOVA was conducted to assess the effect of initial symptoms, including forgetfulness, agitation/aggression, and hallucinations, on the time taken to receive a diagnosis.

Results

Out of the total sample of 825, 442 (53.6%) were females, with 518 (63%) being Emirati citizens. The mean age of the studied sample at the time of diagnosis was 78 years (SD = 11.1). Alzheimer's dementia, 335 (40.6%), was the most common subtype diagnosed. The mean duration of symptoms (DUS) before formal diagnosis was 34.6 months (SD = 28.8). A statistically significant relationship was found between age and DUS, with those over 70 years of age at the time of diagnosis more likely to have a longer DUS (p < 0.001). There was a statistically significant mean difference in the DUS and some initial symptoms, namely agitation/aggression(p < 0.001), lability (p < 0.003), disinhibition (p < 0.001), and hallucinations (p < 0.001).

Conclusion

To our knowledge, this is the first study of its kind in the UAE. Future investigation in this area is much needed, and this study will provide the foundations for dementia awareness campaigns encouraging early presentation to the services.

No financial sponsorship has been received for this study.
Association Between Females and Males in the Prevalence of Depression in the Gulf Cooperation Council (GCC) Countries
Authors: Al Balushi Mitha , Javaid Syed , Al Maskari Fatima , Wanigaratne Shamil , Ahmad Amar
Published: August 2024

Aims

In most populations, the prevalence of depression is more significant in women than in men. Nonetheless, the degree of gender disparity varies significantly across countries. The aim of this study is to consider the role of gender inequality in explaining these differences in the Gulf Cooperation Council (GCC) countries.

Methods

Data on the ecological prevalence of depression (males versus females) from 1990–2019 from the GCC countries were downloaded from Our World in Data and included in the statistical analysis. A mixed-effects linear model was used to examine the association between males and females, i.e. females regress on males. Year and country variables were used as random effect variables.

Results

The prevalence of depression in the GCC countries shows a gender-specific pattern with a higher prevalence in females than in males 1.218 (95% CI: 1.149–1.285), p-value < 0.001. Higher levels of depression between men and women were observed in Kuwait and Saudi Arabia compared with the other four countries. The lowest depression prevalence was observed in the United Arab Emirates.

Conclusion

The pattern of depression in the GCC countries is based on gender. However, the association between global measures of gender inequality and the gender gap in depression may depend on how the level of depression is measured. More research is needed to investigate the mechanisms that underlie the gendered nature of depression prevalence.
A Systematic Review of Estrogen Modulators as Augmentation to Antipsychotics for the Treatment of Post- and Perimenopausal Psychosis
Authors: Keen Cassidy , Hassoulas Athanasios , Richardson Jill
Published: August 2024

Aims

To investigate if estrogen agents as an adjunct to antipsychotic medication are effective at treating psychosis in post-and perimenopausal females.

Methods

A digital search focusing on controlled clinical trials was conducted. Studies were assessed for quality using the Cochrane Risk of Bias tool and GRADE system. The Joanna Briggs Institute (JBI) tools were used to critically appraise articles. The total Positive and Negative Symptom Scale (PANSS) scores were synthesised using a meta-analysis.

Results

Of the studies obtained (n = 11), two used estrogen HT as an augmentation agent, and nine used the SERM Raloxifene. Quality review and critical appraisal found inconsistencies in data and publication bias favouring trials that include Raloxifene. Meta-analysis results indicate Raloxifene plus antipsychotic did perform better than placebo [Std diff in means total = 0.340 (95% CI) p = 0.001] with a small effect size (g = 0.3392).

Conclusion

Though research appears promising, recommendations for the use of estrogen agent augmentation cannot be made at this time as more clinical trials that include a diverse range of treatments are needed.
Associations Between Adiposity Measures and Depression and Well-Being Scores: A Cross-Sectional Analysis of Middle- to Older-Aged Adults
Authors: Lonergan Caoimhe , Millar Seán , Kabir Zubair
Published: August 2024

Aims

Obesity and mental health are significant global health concerns. Evidence has linked increased adiposity with depression and well-being; however, there is limited documented evidence in Ireland. Research also suggests that lifestyle factors and disease conditions are related to mental health. These may modulate relationships between adiposity and depression and well-being. The aim of this study was to examine associations between mental health scores and adiposity defined using body mass index (BMI) and waist-height ratio, and subsequently determine whether significant relationships persist following adjustment for lifestyle factors and common disease conditions.

Methods

This was a cross-sectional study of 1,821 men and women aged 46–73 years, randomly selected from a large primary care centre. Depression and well-being were assessed using the 20-item Centre for Epidemiologic Studies Depression Scale (CES-D) and the World Health Organization-Five (WHO-5) Well-Being Index. Linear regression analyses were performed to examine relationships between mental health scores (dependent variable) and adiposity defined using BMI and waist-height ratio (independent variable), while adjusting for demographic characteristics, lifestyle factors and disease conditions. These demographic, lifestyle and disease factors included gender, age, education, smoking status, alcohol intake, physical activity levels, dietary quality, type 2 diabetes, cardiovascular disease and cancer.

Results

BMI and waist-height ratio had a significant positive association with depression scores and a significant inverse association with well-being scores in males and females. These associations were maintained following adjustment for demographic variables and lifestyle factors. In final models where disease conditions were adjusted for, BMI (β = 0.743, p <0.001) and waist-height ratio (β = 0.719, p <0.001) associations with the CES-D score remained significant. In stratified analyses, relationships between measures of adiposity and depression were found to be stronger in females (BMI: β = 0.806, p = 0.007; waist-height ratio: β = 0.768, p = 0.01) than males (BMI: β = 0.573, p = 0.049; waist-height ratio: β = 0.593, p = 0.044) but no effect modification was identified.

Conclusion

This study demonstrates a significant association between increased adiposity and poorer mental health in a middle- to older-aged population, which is in agreement with previous evidence. In addition, these findings suggest that the positive relationship between adiposity and depression is independent of lifestyle factors and disease conditions and is stronger in females. Targeted interventions for reducing depression should include better weight management population-level measures, particularly in the female population.
A Systematic Review of the Perinatal Mental Health Outcomes of Women With Neurodevelopmental Disorders
Authors: Mackintosh Isobel , Reed Sasha , Jayakody Surangi
Published: August 2024

Aims

Neurodivergent women have different experiences during pregnancy, childbirth, and parenthood than neurotypical women. However, little is known about the perinatal mental health outcomes and parenting experiences in women with Neurodevelopmental Disorders (ND). The systematic review aimed to summarise the literature on perinatal mental health outcomes and parenting experiences among women with ND.

Methods

MEDLINE, Embase and PsycINFO databases were searched in October 2023 using the keywords related to pregnancy outcomes, perinatal period, mental health, neurodivergent, and neurodevelopmental disorders. Papers were also identified through citation and/or hand searching. Title, abstracts, and full-text articles were independently screened by two authors, and data were extracted using a custom data extraction spreadsheet. The Joanna Briggs Institute and the Mixed Methods appraisal tools were used for the critical appraisal. The heterogeneity across the included studies ruled out the use of meta-analysis. Therefore, results were summarised using a narrative synthesis.

Results

Fourteen studies were included in the final review; four cohort, four case-control, three cross-sectional and three qualitative studies across 940,354 participants. The studies investigated women with Autism, Asperger's syndrome and Attention-Deficit Hyperactivity Disorder (ADHD), who were either clinically diagnosed or scored appropriately on diagnostic questionnaires. Perinatal mental health outcomes covered anxiety and depression. These were measured using questionnaires such as the Edinburgh Postnatal Depression Scale, participant interviews and clinical diagnosis from qualified healthcare professionals. All fourteen studies found a correlation between Neurodevelopmental Disorders and perinatal anxiety and/or depression symptoms. Seven studies found that neurodivergent women had adverse pregnancy and early parenting experiences. Results suggested this correlation may be mediated by factors such as unsatisfactory healthcare, lack of maternal-infant bond, increased sensory overload, issues with emotional attachment, difficulty reading the facial expression of the baby and problems with breastfeeding. Overall, women with ND were more likely to feel anxious and overwhelmed during the perinatal period, a potential risk factor for perinatal mental illness.

Conclusion

Women with ND are at a higher risk of developing perinatal mental illness and adverse early parenting experiences. Abnormal physical and sensory challenges during pregnancy as well as difficulty with emotional connection and infant bonding during postpartum all contribute to the increased risk of perinatal mental illness. Adaptations to appointments and specialised perinatal care are required for women with ND yet are often not provided. To reduce the risk of perinatal mental illness in women with ND, improvements must be made to the delivery of perinatal care and the knowledge of those providing the care.
Connecting Past Trauma With Current Mental Health Challenges: A Photovoice Study Exploring Men's Experiences
Authors: McKenzie Sarah
Published: August 2024

Aims

While evidence suggests men experience high rates of trauma, there is little qualitative research investigating men's experiences of past trauma and current mental health challenges. This study aimed to obtain a richer understanding of the trauma histories embedded in men's accounts of living with depression, anxiety, and suicidality, and how men responded to these challenges.

Methods

Twenty-one New Zealand-based men were recruited from the community and asked to take photographs depicting their experiences of living with depression, anxiety, and suicidality including what had helped or hindered their recovery. Participants shared their narratives and photographs in semi-structured interviews.

Results

The findings show an array of participant experiences of past trauma at the individual, family and community level. Three themes were inductively derived to describe how men responded to these traumas: (1) struggling to survive which describes the isolation and emotional pain of men's ever-present trauma, heightened by engaging in risky coping strategies; (2) connecting with past trauma referred to the participants' understanding of their trauma, disclosure (or not) and help-seeking; and (3) moving forward detailed the strategies employed by participants to overcome these challenging experiences and mend and sustain their mental health.

Conclusion

The findings reinforce the importance of in-depth qualitative work towards revealing the impact of past trauma on men's current mental health as well as how men make sense of, disclose and cope with experiences of trauma. These findings have important implications for mental health practitioners working with men. Addressing trauma histories in men seeking help for current mental health challenges may play a key role in improving mental health services and interventions for men.
Benzodiazepine Use Disorder Observed and Diagnosed in a Tertiary Care Pediatric Specialty Clinic: A Descriptive Retrospective Chart Review
Authors: Smithers Alex , Miller Laura , MacInnis Melanie , Etches Selene
Published: August 2024

Aims

Objectives: In youth and young adults, it is common to encounter non-medical use of benzodiazepines, defined as use without a prescription or use for reasons other than that for which the medication is intended. Benzodiazepine use disorder remains understudied and overlooked, especially in youth and young adults. The primary objective of our study was to highlight the proportion of youth and young adults with aberrant use of benzodiazepines and diagnosed with benzodiazepine use disorder in a single centre. The secondary objective was to determine factors associated with aberrant benzodiazepine use and benzodiazepine use disorder in that sample.

Methods

This retrospective chart review screened for benzodiazepine use in 310 adolescent patients aged 12–19 seen for the first time in a concurrent disorders clinic, at a tertiary care clinic in Canada. Of those 310 patients, 167 were included in the final chart review.

Results

97.6% of patients who used benzodiazepines demonstrated aberrant use, and 39.3% of patients received a diagnosis of benzodiazepine use disorder.

Conclusion

This review showed that a substantial percentage of youth and young adults in a concurrent disorders clinic in Canada are presenting with aberrant benzodiazepine use and are being diagnosed with benzodiazepine use disorder. Despite this prevalence, there is little by way of literature to guide treatment of benzodiazepine use disorder in this population.
Is Body Dissatisfaction a Risk Factor for Diabulimia and How Is It Assessed? A Rapid Systematic Review
Authors: Natarajan Navaneeth , Obousy Shaymaa
Published: August 2024

Aims

Diabulimia is an increasingly used term referring to “an eating disorder (ED) with type 1 diabetes”. It is difficult to detect and presents in multiple ways, which can potentially include feelings of body dissatisfaction (BD), which in itself is a complex symptom to quantify clinically.

This rapid systematic review aimed to identify whether feelings of BD are a risk factor for diabulimia by researching if and how BD is assessed in patients with the condition.

Methods

A rapid systematic review was undertaken. A literature review was performed on Ovid Medline (all) and Ovid Embase databases using search terms for Type 1 Diabetes, ED, and BD and looked at cross-sectional studies only. One reviewer performed the literature search and screened titles and abstracts. Out of 589 papers screened, four papers met the inclusion criteria. These papers then went through critical appraising using the Appraisal tool for Cross-Sectional Studies, with all papers showing mid-level quality clearing 16 to 17/20 questions. Therefore, data was extracted from all of them.

Results

All four papers came from different countries and used a wide range of sample sizes (43–477).

There was widespread heterogeneity between the data collected in each study due to the various tools used to identify BD, paired with differences in analysing extracted data.

To ensure transparency and quality of the results provided, the Synthesis Without Meta-analysis tool was used. Three studies looked at effects on adolescents and three had a higher proportion of females. All papers used previously established and tested BD screening methods. Two papers found female diabetics were more likely to have BD symptoms, and one paper saw that males were more at risk. All four papers concluded that BD had some correlations with one or more aspects of diabetes and/or other ED symptoms related to diabulimia. Two commented on positive correlations between BD and HbA1c levels and one commented on BD symptoms and insulin restriction trending together. Two papers also saw BD symptoms and depressive symptoms correlating in patients as well.

Conclusion

All four studies showed that BD was related to diabulimia, both from a psychological and diabetic perspective, and most highlighted how BD manifested between the different sexes of diabetics. This review highlights the need for more standardised and comprehensive BD questionnaires to draw out key signs of EDs in diabetics that could improve screening, detection and management of diabulimia.
The Harm in Euphoria: Exploring the Benefit of Harm Reduction Strategies in the Narrative of Rue Bennett From ‘Euphoria'
Authors: Popoola Iyinoluwa
Published: August 2024

Aims

"Euphoria,” an American television show portraying the lives of teenagers, centers around Rue Bennett, a seventeen-year-old biracial girl grappling with substance misuse and comorbid mental health conditions, including obsessive-compulsive disorder and bipolar disorder. Rue's risky behaviors in the series mirror real-life challenges faced by adolescents dealing with substance misuse. This study aims to explore harm reduction strategies that could benefit Rue, emphasizing the need for such approaches to improve safety in non-abstinent adolescents. By focusing on harm reduction rather than strict abstinence, the goal is to meet individuals where they are in their journey and foster sustainable positive change.

Methods

Employing a qualitative approach, this study conducted a thematic content analysis of relevant episodes from seasons 1 and 2 of “Euphoria.” Additionally, a literature search was carried out using online databases, including PubMed, PsychINFO, and Google Scholar, to identify relevant literature on harm reduction strategies for adolescent opiate users from 2019 to 2024.

Results

The analysis uncovered multiple instances of Rue's risky behavior. Major themes included polydrug use, self-medication, overdose, association with dangerous individuals, self isolation and withdrawal management. Examining Rue's journey identified harm reduction strategies which could minimise her risk of harm, such as fentanyl test strips, Narcan, and psychoeducation in safer consumption practices, supported by existing literature.

Conclusion

Rue Bennett's character in “Euphoria” underscores the imperative need for harm reduction approaches in substance use interventions for adolescents. The study highlights the potential effectiveness of harm reduction strategies, including Narcan and psychoeducation in minimizing risks associated with opiate use. Rue's narrative emphasizes how these methods could contribute to creating a safer consumption environment for non-abstinent individuals. Integrating harm reduction principles into real-world interventions is crucial for promoting holistic well-being and challenging stigmatizing attitudes toward substance use.
Introduction of High-Fidelity Simulation (HFS) for Teaching Undergraduate Medical Students About Electro convulsive Therapy (ECT) and Its Impact on Their Knowledge and Attitudes Towards ECT
Authors: Sachdeva Vishi , Dastidar Supriya , Murugan Meena , Rourke Thomas , Deol Jasleen
Published: August 2024

Aims

Learning about and appreciating the use of Electroconvulsive therapy remains an integral part of the undergraduate psychiatry curriculum. The existing literature indicates that medical students frequently have unfavourable views regarding ECT and its adverse effects.

Therefore, this study aimed to introduce a new teaching tool that supplements traditional didactic ECT teaching with simulation-based procedural demonstration thus providing a real-life experience of an ECT room and subsequently evaluate the learning gains conferred by such a curriculum.

Methods

The demonstration was carried out by Clinical teaching Fellow with the help of a high-fidelity manikin and a live actor who played the role of the patient, in the ECT suite in Birmingham.

Participants of the study were fourth year medical students who completed a self-administered questionnaire before and after the simulation session. This survey was designed to explore changes in knowledge, attitudes, and perceptions of the students towards ECT and its side effects.

Results

Within a cohort of 88 students, 52 students successfully completed the pre-session questionnaire, and 43 students completed the post-session questionnaire. Students reported a global improvement in knowledge regarding ECT, when comparing results from both questionnaires. Prior to the simulation, many students used negative terms to describe ECT such as ‘torture’, ‘barbaric’ and ‘uncontrolled’, suggesting outdated stigmas around ECT. However, after the simulation, many students expressed a positive change in opinion, describing ECT as ‘controlled’, ‘beneficial’ and effective’.

Additionally, students reported improved knowledge about the side effects of ECT, especially regarding pain, memory loss and brain injury. Many students reported that their initial apprehension had been addressed over the course of the ECT simulation. Many noted ECT was more effective and beneficial than originally thought and the process was less extreme and invasive than they believed.

Conclusion

The results of the study reflect that the use of simulated ECT within medical students can help disperse some of the stigma and myths regarding this treatment. Simulation can humanise the process and shift attitudes around ECT by allowing students to become fully immersed into an almost real-life scenario. It can also address knowledge gaps around ECT indications, process, risks, side effects and benefits. This will in turn help educate future clinicians have a better understanding about ECT in the treatment of severe mental illness, thus optimising the utilisation of this effective treatment. Furthermore, such technique can be a useful tool for demonstrating ECT to potentially wider group of students, trainees and other health practitioners.
Designing a Virtual Reality Café to Treat Eating Disorders: A Thematic Analysis of Stakeholder Viewpoints
Authors: Shackshaft Lydia , Chapman Laura , Biddle Lucy , Yardley Lucy , Bould Helen
Published: August 2024

Aims

Eating disorders (ED) have significant physical and psychosocial impacts, and the highest mortality rates of any psychiatric illness. About a third of patients with Anorexia Nervosa or Bulimia Nervosa do not recover and develop persistent ED. Development of novel treatments is a priority to prevent adverse effects on young people's physical, relational and educational development. Virtual reality (VR) has shown promising efficacy as an innovative mental health treatment, and has potential therapeutic value within ED. People with lived experience (PWLE) and clinicians have demonstrated enthusiasm for a VR café intervention to practice social and food-related challenges. A VR café would enable gradual exposure to challenges in a protected environment, aiming to support people with ED to return to real-life cafés and social eating. This study aims to explore the opinions of key stakeholders to help inform the development of a VR café scenario as an adjunctive treatment for ED.

Methods

We conducted semi-structured focus groups and 1:1 interviews with PWLE aged 14–25 years (n = 15), parents/carers (n = 4), and clinicians (n = 6). Participants were recruited via social media, advertisement via ED charities, posters in public places, and snowballing. Following completion of an online screening survey, eligible individuals were invited to participate using purposive sampling to ensure diversity of ages, ethnicities, genders, ED diagnoses, and health professional roles. Data were analysed thematically.

Results

Preliminary analysis indicates that PWLE, parents/carers and clinicians expressed mostly positive opinions regarding a VR café adjunctive treatment. Expressed concerns related to themes of intervention efficacy, translation of learnt skills to real life, and use of VR technology. Most participants agreed a VR café intervention should be a repeated experience (many suggested graded exposure), realistic, and maximally individualised. All stakeholder groups identified a similar range of challenges to experience within a VR café, with themes including choosing food, other people, eating socially or alone, and the café environment. Differences in specific aspects of the scenario that might make challenges harder or easier reflected the unique experiences of individual participants.

Conclusion

These findings build upon previous research demonstrating support from PWLE, parents/carers, and clinicians for the development of a VR café adjunctive treatment for ED. Themes identified are largely consistent across stakeholder groups and relate to the design of a VR café scenario and its implementation as a treatment. This analysis enables the perspectives of key stakeholders to be incorporated into the design of a novel VR café intervention to optimise efficacy and acceptability.
Hatred Is a Mindset Triggered by Stressful External Events, Negative Personal or Group Interpretations and Unhealthy Social Environments
Authors: Shafiq Salman
Published: August 2024

Aims

To carry out systematic literature search on an international medical database to find what the emerging categories in which the word hatred is used in medical literature are, and to gather information regarding the generation of the emotion of hatred in human beings by thematically analysing the relevant collected data.

Methods

To identify the information on hatred relevant for mental health professionals, we performed a systematic review using a systematic approach and criteria.

Results

Six themes regarding generation of hatred identified.

Theme one: Targets of hatred.

Theme two: Self-hatred.

Theme three: Self-perceived hatred.

Theme four: Hatred towards inanimate objects.

Theme five: Reasons for hating other humans.

Theme six: Internal reasons for development of hatred.

Conclusion

The word ‘hatred’ is used in medical literature in a multiplicity of meanings that range from using it in its literal sense to describe a subtle attitude such as a phobia-philia relationship, or to describe a unique outcome that is generated as an interplay of several different kind of factors. These may include cognitions, behaviours, social interactions, attitudes, sentiments, developmental backgrounds, psychodynamic interactions with others in real and virtual worlds etc. Hatred is more like a mind-set that people can develop towards themselves, towards others and towards inanimate objects or situations too. Fear, anger and disgust are primary emotions (that we are born with); human psyche is naturally prone to several inevitable cognitive errors; human thought is subjected to unavoidable logical fallacies; and human ego cannot avoid utilising unhealthy ego-defence mechanisms. Every child is born in a family and culture that has its own unique background and history. We humans are prone to the generation of the hateful mindset as an unavoidable outcome in a variety of scenarios. Keeping these generational patterns in view, it would be reasonable to say that an early detection and addressing the early warning signs towards development of the hateful mind-set would be helpful for ourselves and for others. As the word is used in several different meanings, the background information, context, and overall scenario of the discussion needs to be kept in mind whilst attempting to draw any meanings about the use of hate/hatred in a verbal or written expression. In each case where the word ‘hatred’ is used, needs to be approached with epistemic curiosity and in some instances, it may need detailed epistemic inquiry to fully comprehend the meaning of this word in any given expression.
Changes in Early Childhood Irritability and Risk-Taking on the Cambridge Gambling Task (CGT) at 11 Years
Authors: Srinivasan Ramya , Lewis Gemma , Solmi Francesca , Lewis Glyn
Published: August 2024

Aims

Irritability is common and easily identified in childhood. It is transdiagnostic and a common reason for referral to mental health services. Irritability which does not decrease during early childhood is associated with adolescent depression. We hypothesised that irritability would be associated with increased risk-taking overall but reduced risk-taking in response to loss.

Methods

We used data from the Millennium Cohort Study, a population-based cohort of 18,552 children born in 2000–02. We examined whether irritability at 3, 5 and 7 years is associated with risk-taking on the CGT using multilevel mixed effect generalised linear models (MEGLMs). We also calculated the change in irritability between 3–7 years for each participant using multilevel mixed models. We then examined the association between this change measure and risk-taking on the CGT using MEGLMs. Analyses were adjusted for a broad range of confounders.

Results

We found that children whose irritability did not decrease as would be expected from 3 to 7 years were more likely to stake a higher number of points per trial on the CGT at 11 years. This increase was most evident when the previous trial had been won. Irritability at 7 years was associated with staking a higher number of points per trial on the CGT (coefficient 0.52, 95%CI −0.04–1.08, p = 0.067) in fully adjusted model, whereas irritability at 3 and 5 years were not (3 years – coefficient 0.02, 95%CI -0.62–0.65, p = 0.961; 5 years – coefficient 0.14, 95%CI −0.45–0.73, p = 0.641). There was evidence of an interaction between irritability at seven years and whether the previous trial was won (p = 0.014). Childhood irritability which did not decrease between 3–7 years was associated with staking a higher number of points per trial on the CGT (coefficient 1.36, 95%CI 0.44–2.28, p = 0.004); there was evidence of an interaction between change in irritability and whether the previous trial was won (p = 0.056).

Conclusion

This is the first longitudinal population-based study examining the relationship between changes in irritability during early childhood and risk-taking behaviour measured by the CGT. Our findings illustrate that irritability in children is characterised by an increase in risk-taking at age 11 years, reflecting differences in how children behave in relation to rewards and losses based on prior irritability. Further understanding of how the processes such as risk-taking which link childhood phenotypes such as irritability, relate to future mental health, may enable the development of new interventions focussing on reactions to rewards and losses.
A Comparative Study of Sleep Parameters in Opioid Dependent Patients on Opioid Substitution Therapy: Findings From India
Authors: Tripathi Richa , Rao Ravindra , Dhawan Anju
Published: August 2024

Aims

Sleep problems are common in opioid users and in patients receiving opioid agonist treatment. The aim of the present study was to study the pattern and prevalence of subjective sleep disturbances in opioid dependent subjects maintained on opioid agonist treatment (buprenorphine and methadone).

Methods: A cross-sectional observational study was conducted in a tertiary health care center in India. 106 adult opioid dependent male patients maintained on buprenorphine and 50 adult opioid dependent male patients maintained on methadone who were initiated on medication at least six months prior, on stable dose of medication for last one month and were adherent on medication for at least 50% occasions in last one month were included in the study.

Results

The mean age of the sample for buprenorphine-maintained group and methadone maintained group was 41.1 (SD: 14.3) years and 27.7 (SD: 7.8) years respectively. Tobacco, alcohol and cannabis were used by majority of the participants in both the groups. Most participants had used heroin by smoking before starting buprenorphine (n = 68, 64.1%) and methadone (n = 46, 88.5 %). The duration of use of illicit opioids was for median duration of 10 (IQR: 5, 22) years for buprenorphine group and 5 (IQR: 3, 7) years for methadone group.

In buprenorphine group, the participants had been on buprenorphine for a median duration of sixty (IQR: 17, 120) months. The mean current dose of buprenorphine was 10.2 (SD 3.8) milligram per day. The mean PSQI score was 6.6 (SD 3.4). About 63.2% (n = 67) of the participants have scores more than five (PSQI > 5) suggesting sleep problems. The mean subjective total sleep time of the sample was 403.5 (SD 94.8) minutes and median sleep latency was 35 (IQR 18.8, 62.5) minutes.

Similarly, in methadone group, the participants had been on methadone for a median duration of seventeen (IQR: 10, 22) months. The median current dose of methadone was 20 (IQR: 14, 36) milligrams per day. The mean PSQI score was 5.2 (SD 2.8). About 44.2% (n = 23) of the participants have scores more than five (PSQI > 5) suggesting sleep problems. The mean subjective total sleep time of the sample was 466.5 (SD 114) minutes and median sleep latency was 30 (IQR 15, 97.5) minutes. Subjective sleep problems were associated with past three months opioid use.

Conclusion

The methadone group had relatively younger population with early onset of substance use. They were on relatively lesser dose of methadone. This group also had lesser sleep problems than the buprenorphine group.
Predictors of Functioning in Bipolar Disorder: Focused on Functioning Assessment Short Test (FAST)
Authors: Yoon Bo-Hyun , Kang Hangoeunbi
Published: August 2024

Aims

Functional outcome can be even more important than syndromic outcomes, as the ability to meet role expectations at work, home, or school and the quality of interpersonal relationships are often cited as the most important outcomes for people with bipolar disorder (BD) and their families. We investigated the factors correlated with functioning by using the Functioning Assessment Short Test (FAST).

Methods

A total of 197 bipolar disorder out-patients were involved in this study, 166 (84.3%) were bipolar I disorder (BD-I) patients and 31 (15.7%) were bipolar II (BD-II) patients. We used the FAST for functioning of the patients and the severity of depressive and manic/hypomanic symptoms were measured by bipolar depression rating scale (BDRS) and Young Mania Rating Scale (YMRS). We also examined the disturbances in biological rhythm by the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN).

Results

There were significant positive correlations between FAST and numbers of depressive episode, YMRS, BDRS and BRIAN and showed negative correlation between FAST and age at onset of mood disorder. FAST was associated with YMRS (β=0.3768, p < 0.001), BDRS (β=0.293, p < 0.001), BRIAN (β=0.167, p = 0.011), with 47.1% of the variance explained (R2=0.471, Durbin-Watson test = 1.51, p < 0.001) in multiple linear regression. In other words, residual mood symptoms and biological rhythm imbalance have a negative impact on the functioning of BD patients.

Conclusion

Although the other factors must be present to predict the functioning of bipolar disorder patients, manic symptoms, depressive symptoms and biological rhythm imbalance have negative impacts on functioning of BD patients in this study.