bluuebunny/crossref_metadata_2025 huggingface dataset:
Rates of cervical screening amongst females admitted to the psychiatric inpatient hospital in Jersey, Channel Islands
Authors: Wright Jade
Published: June 2021

Aims

Patients with enduring mental health conditions are known to have higher morbidity and mortality rates than the general population. It has been identified that this is due to lifestyle risk factors, medication side effects and barriers to receiving physical health care. National screening programmes; including cervical screening, save lives, however depends upon patient engagement. We hypothesised that due to the factors stated above, psychiatric inpatients are more at risk of cervical cancer and less likely to engage in cervical screening. This study aimed to assess the cervical screening history of patients discharged from the psychiatric inpatient hospital in Jersey, Channel Islands.

Method

Using computerised laboratory records, the cervical smear history of female patients discharged from the paychiatric inpatient hospital was analysed. Inclusion criteria were: being aged between 25–64 years and having a cervix in situ. Exclusion criteria were total hysterectomy. Cervical smear history was compared to the national guidelines of having routine smears every 3 years for women aged 25–49 and every 5 years for women aged between 50–64 years.

Result

In the period 1 December 2019–1 December 2020 there were 45 females discharged from the psychiatric inpatient hospital that fit the inclusion criteria. 26 (58%) were up to date with their cervical smears in accordance with national guidelines. 12 (27%) had previously had a smear but were not up to date. 19 smears were done at the GP, 13 at the sexual health clinic and 6 at gynaecology clinic. 7 (16%) had never had a cervical smear. Of these 7 patients it was identified that one patient was in a same sex relationship and one was a victim of sexual assault.

Conclusion

58% of women discharged from the psychiatric inpatient hospital were up to date with their smears. This is down from the 72.2% coverage rate of the general population. Although this was a small study, it highlights that engagement with cervical screening amongst psychiatric inpatients is less than the general population. Admission presents a crucial contact between patients and healthcare services and this could be utilised to engage patients in physical health screening. Cervical screening history could be checked upon admission and patients not adequately screened, assisted to make an appointment on discharge.
Implementing out of hours MDT safety huddles at the Ladywell Unit, Lewisham, South London and the Maudsley (SLAM) NHS Foundation Trust
Authors: Yeoh Su , Babayeva Natavan , Williams Hugh , Jones Emma
Published: June 2021

Aims

•

For 100% of patients admitted OOH (Friday 5pm – Sunday 9am) to have a multi-disciplinary review of their treatment

•

For 100% of patients with deteriorating physical and mental health to be discussed

•

To improve multi-disciplinary team (MDT) morale, working relationships and team cohesiveness OOH

Background

In most specialties, the standard of best practice is that patients admitted to the ward out of hours (OOH) receive a senior review over the weekend. However this does not usually take place in Psychiatry, and patients routinely wait until Monday to be seen by the ward team. This has been highlighted as problematic in cases where patients are agitated and not receiving any treatment for > 24 hours.

We trialled a weekend teleconference safety huddle in Lewisham involving the on call consultant, registrar (SpR), core trainee (CT) and duty senior nurse (DSN).

Method

The weekend huddles were through a teleconference line, with participants dialling in at 9.45am.

Issues discussed:

1)

Management plan for newly admitted patients OOH.

2)

Plan for patients with deteriorating mental health or escalating level of aggression.

3)

Plan for patients with deteriorating physical health.

Feedback was collected from CTs, SpRs and consultants focusing on whether the huddle made any difference to the speed of care, cohesiveness of the OOH team, and whether it was generally helpful or not.

Result

54% of CTs (n = 11) felt that patients admitted OOH had an MDT review, and 90% felt that patients with deteriorating mental and physical health were discussed and a plan put in place. 80% of CTs, 63% of SpRs (n = 8) and 67% of consultants (n = 6) agreed it improved team cohesiveness. 90% of DSNs felt safer and more supported in decision-making OOH.

80% of CTs, 63% of SpRs and 83% of consultants found weekend huddles helpful.

Data were also collected on violent incidents OOH, and there was a slight reduction in the number of violent incidents in the weeks following introduction of the huddle.

Conclusion

Introducing safety huddles in Lewisham has facilitated the prompt discussion of the management of patients admitted OOH, and of those with deteriorating mental and physical health. It has also fostered a greater sense of cohesiveness in the MDT team.

In light of this feedback, safety huddles have now been established as part of the weekend schedule in Lewisham, and are being rolled out to other boroughs within SLaM.
Skin Deep? : A scoping literature review of the psychological impact of Acne Vulgaris on patients and the role of the Psychiatrist
Authors: Adeyemi Stephanie
Published: June 2021

Aims

This literature review aims to assess existing scientific literature on the psychological impact of Acne Vulgaris on adolescents and adults and the role that Psychiatrists can play in supporting these patients. The hypothesis of this literature review is that all patients with Acne Vulgaris should have their quality of life assessed in order to identify those who require additional support.

Background

The link between Psychiatry and Dermatology is becoming increasingly recognised. Resources on the British Association of Dermatologists’ website are often distributed to patients by Dermatologists in order to assess the impact that a skin condition has had on a patient's life. Acne Vulgaris is a psychophysiological skin condition that impacts up to 95% of people to some extent from the ages of 11 to 30 years old. Due to its prevalence it is essential that the psychological burden of Acne Vulgaris on patients is understood.

Method

Literature written since 2011 was searched identified from: PsychINFO, MEDLINE, EMBASE, CINAHL and PUBMED. The search strategy key words were: acne vulgaris, mental health, psychiatry, anxiety and depression. Arksey and O'Malley's framework was utilised to conduct a scoping literature review. Data were collated and summarized thematically.

Result

A total of 72 studies were included representing over 14,000 adults and adolescents with Acne Vulgaris from the following countries: Egypt, Nigeria, Turkey, India, Lithuania, UK, USA, Iran, Pakistan and Spain.

Screening tools such as the Global Acne Grading System (GAGS), The Acne Quality of Life Scale (AQLS), the Cardiff Acne Disability Index (CADI), and the State Trait Anxiety Index STAI (Y-1) form were utilised in order to identify the impact of Acne Vulgaris on patients’ quality of life and mental health. The data clearly showed the significant psychological burden that patients with Acne Vulgaris can experience. There was a clear trend of low self-esteem, lack of self-confidence, social withdrawal, depression (ranging from 23.1% to 62% of study participants), anxiety (ranging from 38.4% to 51%) and even suicidal ideation (ranging from 12.9% to 20.1%). Literature also suggested a higher prevalence of Body Dysmorphic Disorder in patients with Acne Vulgaris which should be considered and screened for.

Conclusion

This scoping literature review has highlighted the significant psychological burdensome acne patients can experience. Given the prevalence of the condition Psychiatrists do have a role in working with Dermatologists to ensure appropriate screening tools are utilised and patients are able to access appropriate support.
A state hospital survey of movement disorders including intention tremor
Authors: Bark Nigel , Kim Sung-Ai , Eapen George
Published: June 2021

Aims

In a survey of movement disorders in patients in a State Hospital the finger-nose test was included because of increasing interest in the cerebellum in schizophrenia. It was expected that this would reflect the pathobiology of schizophrenia and be unrelated to the type of medication.

Background

Abnormalities of movement and involuntary movements have gone from being considered part of schizophrenia to side-effects of medication to now demonstrably present in those who have never taken anti-psychotic medication. Soft neurological signs (SNS) are increased in schizophrenia, unrelated to medication, considered not to indicate brain localization, yet often include the finger-nose test which localizes to the cerebellum.

Method

All available patients in a State Hospital were examined for movement disorders. They were rated on the following scales: Abnormal Involuntary Movement Scale (AIMS) for Tardive Dyskinesia (TD), Simpson-Angus Neurological Rating Scale for Parkinsonism (SANRS), Barnes Akathisia Scale (BAS), a Dystonia scale and the finger-nose test.

Result

250 patients were included, 174 were examined or observed for movement disorder: 120 had no missing data, 54 refused part of the exam. Their mean age was 47, 62% male, 53% black, 26% Hispanic, 17% white.

Medication: First Generation Antipsychotic (FGA) 35 (mean CPZ equivalent dose:1177mg), Second Generation Antipsychotic (SGA) 159 (734mg), both FGA and SGA 56 (1907mg), no antipsychotic 3; anticholinergic or amantidine: FGA 57%, SGA 16%, both FGA and SGA: 50%.

Tardive Dyskinesia: all 23%, FGA 36%, SGA 25%, both 7%

Parkinsonism: all 38%, FGA 43%, SGA 33%, both 34%

Akathisia: all 3%, FGA 0%, SGA 4%, both 3%

Pseudo-akathisia: FGA 11%, SGA 4%, both13%

Dystonia: all 10%, FGA 13%, SGA 11%, both 8%

Intention Tremor: all 16%, FGA 0%, SGA 21%, both 16%

Half of those with Intention Tremor had Parkinsonism, a third had TD and a half were on anti-Parkinson medication.

None of these differences were statistically significant at p = 0.05 though intention tremor did show a trend (p = 0.08). The difference between FGA and SGA only became significant when all movement disorders were added together with those on anticholinergics with no movement disorder.

When compared with rates in similar State Hospitals in the 1970s tardive dyskinesia was now half the rate and Parkinsonism about the same.

Conclusion

Overall rates of movement disorder are not very different between FGA and SGA. The surprise was that intention tremor only occurred with SGAs. Why?
Bournewood in Belfast: who's ready?
Authors: Bowes Hayley , Kane Joseph , McPherson Gillian
Published: June 2021

Aims

We aimed to determine doctors’ confidence in completing capacity assessments and reports associated with new Deprivation of Liberty Safeguards (DoLS), and the impact that these would have on practice. We hypothesised that psychiatrists would have greater confidence in completing the requisite assessments and would anticipate a greater impact on practice than doctors in other specialties.

Background

On the 2ndDecember 2019 DoLS became the first part of the Mental Capacity Act (Northern Ireland) 2016 to be implemented, believed to apply to 7500 individuals across Northern Ireland (NI). As arguably the most significant change in mental health legislation in NI since 1986, the Department of Health commissioned training for all clinicians.

Method

We conducted a cross-sectional survey among doctors working within psychiatry, general medicine, anaesthetics and surgery in Belfast Health and Social Care Trust prior to implementation. The survey comprised seven questions with a 10-point Likert scale. Statistical analysis included Pearson'sχ2and Spearman's rank tests.

Result

79 doctors in psychiatry and 25 in other medical specialties completed the survey.Respondents were moderately confident in completing capacity assessments (median 6 (3-9)) and medical reports (median 5 (1-9)). Those that had completed training (n = 86; 83%) were significantly more confident in capacity assessment (median 7 (2-10) vs 4 (1-7); χ2(18) = 36.8, p <0.01) and medical report completion (median 5 (1-9) vs 1 (1-5); χ2(16) = 27.2, p =.04) than those that had not (n = 18; 17%). Psychiatrists had greater confidence in conducting capacity assessments (median 7(2-10)) than other doctors (median 5(1-9); χ2(9) = 18.2, p = 0.04). No significant differences were observed between the two groups with respect to medical report completion, or anticipated impact on practice.

Respondents who most frequently conducted capacity assessments as part of their current practice anticipated higher degrees of impact on their individual practice (rs = 0.51, p < 0.01) and their service (rs = 0.50, p < 0.01)

Conclusion

Engagement with the commissioned training was encouraging. Respondents were, on average, relatively confident in conducting capacity assessment, but considerable variation in confidence, and a lower confidence in completing medical reports. This might suggest that some may require further training. A poor response rate among non-psychiatrists indicates potential respondent bias in favour of those already more cognisant of capacity in routine practice. A correlation between more practiced assessors and anticipated impact on service provision could suggest that some clinicians may be underestimating the potential impact of DoLS; the same groups should therefore be resurveyed after DoLS implementation.
A systematic review of comparative time to all cause discontinuation of antipsychotic medications in first episode psychosis
Authors: Brooke Alice , Whale Richard , Bucur Mihaela
Published: June 2021

Aims

Prompt treatment with medication and intensive psychosocial support are interventions that have been shown to improve function and prognosis in patients with First Episode Psychosis. NICE guidelines state that patients with a first episode of Psychosis should remain on an antipsychotic medication for 1–2 years to reduce risk of relapse, yet most patients stop long before 2 years. This systematic review explores the comparative time to all cause discontinuation of antipsychotics, often used as a marker of real-world treatment effectiveness, in First Episode Psychosis patients.

Method

A literature search was performed across multiple healthcare databases from 1980 to present day in the English Language. Inclusion criteria covered patients with a First Episode of Psychosis aged 14 years and over, and studies that were randomised controlled trials or observational in nature. The primary outcome measure was time to discontinuation of antipsychotic medication. Bias was assessed using the GRADE approach.

Result

11 studies and 3840 patients were included in the review. Seven studies were randomised clinical trials; three were blinded, and four open-label. The remaining four were observational studies. All but one of the studies had a minimum follow-up period of one year (with a maximum of three years). Due to significant methodological heterogeneity across studies, it was not possible to perform meta-analysis. Narrative analysis of the results showed that Olanzapine performed ranked best, and wasbeing taken for the longest time period by patients, followed by Risperidone.

Conclusion

Multiple reviews exist on the efficacy of antipsychotics in First Episode Psychosis, but this is the first one to focus on time to discontinuation as a distinct outcome measure. The review encompasses a large sample size across North America, Eastern Asia and Europe. The interaction of time to discontinuation of antipsychotics with associated symptom levels and medication doses remains an area for further research. The review highlighted the significant differences in statistical methodology across studies in this emerging field, and the need for standardisation in ongoing research. Whilst effectiveness may therefore be greatest for olanzapine, this is outweighed in current guidance by its least favourable metabolic adverse effects profile.
Who wants to be a psychiatrist? Northern Ireland foundation doctors (2006 - 2018) positive towards psychiatry as career choice
Authors: Doris Michael , Grimason Amy , Hughes Damien , Parks Lorraine , Carragher Angela
Published: June 2021

Aims

Recruitment into psychiatry remains a major issue nationally despite recent progress with the #choose psychiatry scheme. Here we look to establish why Northern Ireland (NI) has been able to have 100% fill rates by speaking to the people who have work in the frontline of psychiatry. What is done differently in NI and are there lessons that could benefit other regions?

Background

NI presents itself as an anomaly – In a region that only attracts 31.8% of F2s to enter into any training programme, Core psychiatry has been consistently oversubscribed for many years. One difference is the allocation of trainees in the Foundation programme. NI offers psychiatry placements to 33% of F2 doctors with none in the F1 year.

Method

All doctors of any grade working in psychiatry who had been through the Foundation programme since 2006 were asked to complete a survey on their foundation experience and reasons for choosing a career in psychiatry using SurveyMonkey technology. Qualiative and quantiative data was collected and analysed.

Result

in total 67 doctors from CT1 to Consultant and SAS doctors responded, including over 60% of all current trainees, providing a huge amount of information. Remarkably, 45% of psychiatry doctors working in NI surveyed hadn't considered a career in psychiatry until their foundation placement. NI is the only region in the UK that does not have an F1 placement in Psychiatry. Over 80% of doctors here feel that this is a positive. White space answers revealed other aspects of training that positively influenced them to choose psychiatry including a reputation for high quality training, as well as close links between the local medical school, the local brach of the Royal College of Psychiatrists and the NI deanery.

Conclusion

This study is the first to examine the reasons behind psychiatry's success in NI. The quality of the training scheme locally and presence of an excellent training to service provision balance were also mentioned. This study supports the presence of psychiatry in the F2 year only.
Long-term trajectory of cognitive performance in people with bipolar disorder and controls: 6-year longitudinal study
Authors: Sparding Timea , Joas Erik , Clements Caitlin , Sellgren Carl M. , Pålsson Erik , Landén Mikael
Published: June 2021

Background

Cross-sectional studies have found impaired cognitive functioning in patients with bipolar disorder, but long-term longitudinal studies are scarce.

Aims

The aims of this study were to examine the 6-year longitudinal course of cognitive functioning in patients with bipolar disorder and healthy controls. Subsets of patients were examined to investigate possible differences in cognitive trajectories.

Method

Patients with bipolar I disorder (n = 44) or bipolar II disorder (n = 28) and healthy controls (n = 59) were tested with a comprehensive cognitive test battery at baseline and retested after 6 years. We conducted repeated measures ANCOVAs with group as a between-subject factor and tested the significance of group and time interaction.

Results

By and large, the change in cognitive functioning between baseline and follow-up did not differ significantly between participants with bipolar disorder and healthy controls. Comparing subsets of patients, for example those with bipolar I and II disorder and those with and without manic episodes during follow-up, did not reveal subgroups more vulnerable to cognitive decline.

Conclusions

Cognitive performance remained stable in patients with bipolar disorder over a 6-year period and evolved similarly to healthy controls. These findings argue against the notion of a general progressive decline in cognitive functioning in bipolar disorder.
Metabolic profiles differences of overweight patients on olanzapine, clozapine and risperidone
Authors: Liew Siew Fai , Bhanu Gupta , Lee Jimmy , Chee Kok Seng , Neo Li Qi , Tang Charmaine
Published: June 2021

Aims

We set out to examine the differences in metabolic profiles of at risk (overweight) patients across commonly used atypical antipsychotics (Olanzapine, Risperidone, Clozapine). We hypothesized that Olanzapine and Clozapine group will have more metabolic abnormalities compared to Risperidone.

Background

Cardiovascular diseases remain the leading cause of morbidity and mortality among people with schizophrenia. Since the introduction of atypical antipsychotics, there is cumulative evidence of their association with metabolic abnormalities. Clozapine and Olanzapine are known to constitute the highest metabolic risks amongst atypical antipsychotics.

Method

This study is based on the data of 67 subjects recruited into a 12-week open-labelled trial looking at the effects of adjunctive Aripiprazole in atypical antipsychotics for weight reduction and improvement in metabolic profile. Metabolic profiles including weight, waist circumference, fasting blood glucose, HbA1c, serum total, HDL and LDL cholesterol levels and triglycerides were measured at baseline. The measurements were then compared across the different subgroups of atypical antipsychotics. The definition of metabolic syndrome proposed by the Third Report of the National Cholesterol Education Program Expert Panel (Adults Treatment Panel III) was used.

Result

The atypical antipsychotics were grouped into Olanzapine (n = 27), Risperidone (n = 24) and Clozapine (n = 16). More than 50% of clozapine-treated and Olanzapine-treated overweight patients were demonstrated to have metabolic syndrome at baseline. There was a statistically significant difference in serum triglycerides (p = 0.012), LDL (p = 0.046) and HbA1c (p = 0.045) across the three groups as demonstrated by one-way ANOVA. A Tukey post hoc test showed that both the Olanzapine (p = 0.032) and Risperidone (p = 0.013) groups demonstrated statistically significant lower serum triglycerides when compared to Clozapine. Interestingly, the mean serum HbA1c was significantly lower in Clozapine when compared to Olanzapine group (p = 0.045), perhaps reflecting the closer monitoring of fasting blood sugar in clozapine patients. When controlled for age and BMI, the significant differences in serum triglycerides remain between Clozapine and Risperidone groups [but not for serum HbA1c]. There were no statistically significant differences across the groups with respect to other metabolic parameters.

Conclusion

At baseline, metabolic dysregulation was demonstrated in all subgroups of overweight patients. As hypothesized, patients on Olanzapine and Clozapine groups fared worse than Risperidone. Further studies examining long term effects of atypical antipsychotics in a larger sample of patients are warranted to confirm these findings. These findings have clinical significance in terms of choosing the first antipsychotic for drug naïve patients or where there is no clinically significant difference in efficacy.
Evaluation of a mental health first aid workshop for healthcare professionals
Authors: Abou Sherif Sara , Patel Sachin
Published: June 2021

Aims

Annually, 1 in 4 people in the UK will experience a mental health problem. Alongside the approach of increasing awareness of the issue amongst the general population, there is a drive to deliver training and education on the recognition and management of mental health crises. Limited resources exist to aid healthcare professionals in delivering mental health first aid (MHFA), with the vast majority focussing on lengthy training courses. Small group problem-based learning (PBL) is utilised widely in medical education and this modality offers advantages in deliverability, audience participation and experiential learning. Our aim was to deliver and explore the effectiveness of a PBL MHFA workshop to various healthcare professionals.

Method

As part of an Emergency Medicine Mental Health Education day, we delivered four 30-minute PBL MHFA workshops. These involved an introduction to MHFA, followed by an interactive discussion of 4 mental health simulated cases, whereby participants anonymously answered a range of questions using the web-based platform Mentimeter. We devised a simple MHFA A,B,C,D,E acronym to bring structure to problem solving. Pre- and post-workshop questionnaires were used to assess outcomes using Likert scales to measure various aspects of MHFA (1 = strongly disagree and 5 = strongly agree). Statistical significance was calculated using T-Test with P < 0.05 defining statistical significance.

Result

A total of 28 professionals attended the workshops, 20 (72%) completed both the pre and post workshop questionnaire. 19 (76%) were nurses (5 Registered Mental Health Nurses and 14 Registered General Nurses), 3 (12%) were doctors, 2 (8%) were HCA's and 1 was a policeman. 15 (75%) of the participants reported historically having had the need to deliver MHFA but only 3 (15%) had previously received training. After the workshop, participants reported significantly increased understanding [3.0 to 4.3 (p < 0.05)] and confidence in delivering MHFA [3.05 to 4.30 (p < 0.05)]. There was significantly improved confidence in assessing risk [3.03 to 4.05], calling for appropriate help [3.45 to 4.35] and de-escalation techniques [3.05 to 4.15].

Conclusion

To our knowledge this is the first mini PBL-based MHFA workshop. We have demonstrated that the PBL workshop setup is an effective means to deliver training on MHFA. We recognise the importance of MHFA training reaching a larger audience and its potential value if incorporated into national healthcare training programmes and made available to the general public.
What happens to frequent attenders when they attend psychiatric liaison services? a clinical and demographic profile
Authors: Grose Frederick , Lee Tennyson , Canlas Richelle , Phung William , Albert Rikke , Ahmet Alana , Song Jia
Published: June 2021

Aims

We aimed to describe the demographic and clinical profile, and management of frequent attenders to a psychiatric liaison service.

Background

Frequent Attenders to emergency departments contribute significantly to the burden on health services and by definition are subjectively highly stressed. It is therefore important that mental health services develop effective responses to this group of patients. A systematic literature search indicated a paucity of information on this group of patients.

Method

We conducted a case series of 49 frequently attending patients to the Psychiatric Liaison service in Tower Hamlets, East London NHS Foundation Trust.

We defined frequent attenders as seeing the Psychiatric Liaison Service 5 or more times in 2018. We excluded 4 patients aged <18 years or >65 years.

For each patient we collected data regarding their demographics; the details of each attendance to the Psychiatric Liaison Service; and their use of other psychiatric services.

We then conducted a multivariate analysis, including stratification of patients based on number of attendances to identify correlation between frequency of attendance and the other information.

Result

Demographic: The 45 patients reviewed had a mean age of 37 and a mean of 7 attendances during the study period.

Clinical: 89% had a history of emotional trauma, 71% of substance misuse, and 49% of any personality disorder. Only 9% of the patients were under the care of the locality Personality Disorder Service.

73% of the patients were under the care of any other psychiatric service. There was no correlation between being under other services and the frequency of attendance.

Only 31% had contact with the locality Frequent Attenders Service during the study period, as this was established recently.

Conclusion

Psychiatric Frequent Attenders have complex needs, which do not fit neatly into existing psychiatric diagnoses and services.

The high frequency of emotional trauma, substance misuse and personality disorder indicates a need for training of clinicians in these services to manage these patients, as well as planning for referral pathways for this group of patients who provide services with major challenges in appropriate pathways to care and follow-up
How do people with dementia present to the services, and why do they present late? A descriptive study in a Tertiary Care Hospital in Sri Lanka
Authors: Gunathilake Malsha , Suraweera Chathurie
Published: June 2021

Aims

To assess how patients with dementia present to services and reasons for delayed presentation among patients with dementia in Sri Lanka.

Method

A descriptive cross-sectional study was conducted among 83 newly diagnosed patients with dementia and their caregivers at the University Psychiatry Unit, National Hospital of Sri Lanka. They were interviewed using a semi-structured pre-tested questionnaire. Statistical Package for the Social Sciences (SPSS) was utilized for data analysis.

Result

The mean age of the patients was 71.53(SD = 7.595)years. The commonest type of dementia in the cohort was Alzheimer's disease(N = 49, 59%). The mean untreated duration before the first presentation was 16.33(SD = 16.13) months. A family member or the care-giver had initiated help-seeking in many (N = 65,78.3%). 84.33% of patients had behavioural and Psychological Symptoms of Dementia (BPSD) at first presentation. BPSD was the main reason for help-seeking in 40(48.2%) cases. Among them, psychosis(n = 18,45%), depression(n = 9,22.5%), disinhibition(n = 4,10%) and wandering(n = 3,7.5%) were common.

Lack of awareness on dementia (n = 70,93.3% and n = 68,86.1%) and considering cognitive impairment as a normal part of ageing (n = 39,52% and n = 43,54.4%)were the commonest reasons for delayed presentation reported by patients and care-givers respectively. Twelve patients misattributed the symptoms to their existing medical or psychiatric conditions. The mean untreated duration was significantly higher in the patient group with a family history of dementia (30.5 months) compared to those without a family history (12.8 months)(t = 3.818;p = 0.000). Similarly, the mean untreated duration was significantly higher when there is a family history of dementia among the care-givers (25.53months) compared to the group of care-givers without a family history (13.85 months)(t = 2.532;p = 0.013). Age, sex, education, occupation, income, knowledge on dementia of the patients and the caregivers, illness-related characteristics (type, severity, and presence of BPSD) or being in contact with medical services were not significantly associated with the timing of the first presentation.

Conclusion

There is a delay of more than one year for patients with dementia to present to services in Sri Lanka. The commonest reason for the presentation is BPSD. Lack of prior awareness of dementia and considering the cognitive impairment as a part of normal ageing by both patients and carers were the main reasons for delayed presentation. Patients with a family history of dementia present late than those without a family history. There is no significant association between the timing of presentation and the socio-demographic factors of the patients and care-givers, the presence of prior knowledge on dementia, illness-related characteristics, or contact with medical services.
The impact of the COVID-19 pandemic on symptom subtypes of obsessive-compulsive disorder: a cross-sectional study
Authors: Hassoulas Athanasios , Umla-Runge Katja , Adams Olivia , Scurlock-Green Madeline , Zahid Abeer , Hassoulas Antonia , Panayiotou Eliana
Published: June 2021

Aims

Since the COVID-19 outbreak was declared a global pandemic, public health messages have emphasised the importance of frequent handwashing in limiting the transmission of the virus. Whilst crucial in controlling transmission, such messaging may have an adverse effect on individuals with OCD. The primary aim of this study was to investigate any significant changes to handwashing behaviour, as well as other related hygiene behaviours, across all symptom dimensions of OCD. The frequency of engaging with pandemic-related media coverage was also considered across all symptom subtypes.

Method

A cross-sectional study was conducted, with a total of 332 participants recruited. Participants who scored above the optimal cut-off score on the Obsessive-Compulsive Inventory Revised edition (OCI-R) were included in the analysis (n = 254). Scores on the six subscales of the OCI-R were correlated with responses to a COVID-19 Impact measure.

Result

Factor analysis of the COVID-19 Impact measure revealed that items loaded on two components of the measure (handwashing and distress-avoidance). A significant correlation was revealed between the handwashing component and the OCI-R washing subscale (rs = 0.523, p = 0.0001), as well as between distress-avoidance and the OCI-R washing and ordering subscales (s = −0.227, p = 0.0001; rs = −0.159, p = 0.006). Content analysis revealed disruption to treatment delivery and worsening symptom severity in participants with contamination-related OCD.

Conclusion

The pandemic has had a significant impact on individuals with contamination-related OCD symptoms, in relation to symptom severity and treatment disruption. Consideration should be given to targeted support tailored to patients with this subtype of OCD.
Does my patient have sex ? - Mental health professionals’ understanding of sexual health issues among their patients
Authors: Hettiarachchi Nalin , Kumar Praveen , balasundaram vikramraj
Published: June 2021

Aims

To assess the level of understanding and difficulties encountered when obtaining sexual health details of their patients among mental health clinicians.

Background

People with mental health problems, especially those treated with psychiatric medication experience greater rates of sexual difficulties than those in the general population. Mental health practitioners need to examine personal beliefs and attitudes about sexuality among people with mental health problems. Providing information about sexuality and sexual practice benefits and enhances the quality of life of people with mental health problems. Therefore taking a sexual history should be an integral part of psychiatric assessment.

Method

An online survey consisted of 17 questions to cover 3 areas of objectives mentioned above was created using Survey Monkey. A link to the survey was emailed to all the clinicians who perform psychiatric assessments. Response collection and data analysis was performed by the trust IT team.

Result

Total of 54 clinicians participated in the survey representing nurses, junior, middle grade doctors and consultants. Almost all stated that mental health patients have capacity to make appropriate decisions about their sexual behaviour patterns. 43% thought people with mental health problems don't have similar patterns of sexual behaviour compared to people without mental health problems. 11% stated that people with mental health problems do not experience greater rates of sexual difficulties than those in the general population. Nearly a third did not believe that telling patients about potential sexual side effects may lead to poor compliance. Nearly 70% stated taking a sexual history should be an integral part of psychiatric assessment. 44% reported lack of knowledge and skills when talking about sexual health and 33% avoided asking about sexual health due to lack of knowledge. Half of the clinicians avoided asking about sexual health due to the fear of embarrassing or causing distress to patients while 16% avoided asking about sexual health due to self-embarrassment. 65% talk about sexual health issues only if patients brought them up.

During last 3 clinical encounters majority never asked about sexual difficulties, high risk behaviour and drug side-effects related to sexual difficulties. A significant proportion of clinicians never asked about contraception from their female clients.

Conclusion

Survey revealed majority of mental health clinicians lack understanding and skills about sexual health issues highlighting the importance of raising awareness among clinicians about sexual health issues.
A survey of Irish psychiatric trainees attitudes to balint groups
Authors: Jain Sudha , Adams Emma , Lee Alyson
Published: June 2021

Aims

1. To compare the experience of psychiatric trainees in Ireland of online Balint Groups (BG) in contrast to face to face groups.

2. To assess the general attitudes of trainees to BG using the Psychological Medical Inventory (PMI) (Ireton and Sherman, 1988) scale.

Method

An online survey comprising two sections: 1. A questionnaire exploring participants experience, effectiveness and obstacles to attending the two formats of BG with a free text box response. 2. General attitude of trainees towards BG using PMI scale.

An online cross-sectional survey using Survey Monkey. An invitation to participate in the survey was emailed to all trainees by the College of Psychiatrists in Ireland. All data were anonymised, and all data processing was conducted in line with GDPR. Statistical analysis was undertaken using Microsoft Excel. Thematic analysis was applied to the free-text box responses.

Result

16.49% (64/388) responded to the survey. Responses were uniform across all stages of training. 97% of respondents attended BG; 72% attended both formats, 25% attended only face-to-face and 3% online only. 65% of respondents preferred face to face compared to 18% online, whilst 11% stated no preference.

On thematic analysis, trainees asserted a preference for face-to-face, describing better group cohesion, feeling safer to share, increased ease of interpreting non-verbal communication, and that conversation was more fluid. They described greater ease of engagement with the group/facilitator and preferred direct social interaction with peers.

Conversely, most trainees acknowledged that online groups were convenient to attend, less time consuming & mitigated COVID risk associated with face-to-face meetings. Common themes against the use of online groups were: less psychotherapeutic in nature, technical issues, silences, unable to see participants faces and as though speaking “into the void”.

Regarding trainees' attitudes to attending BG, most of the trainees found BG had been beneficial in developing more interest and confidence in dealing with the psychological aspects of patient care. Trainees agreed that skills improved in developing an excellent doctor-patient relationship, recognising patients under stress/ in distress, systemically obtaining psychological information and making treatment decisions based upon psychological needs and psychotherapeutic engagement. They agreed that they could better understand the influence of doctors' emotions on the doctor-patient relationship.

Conclusion

This survey showed that most trainees find BG beneficial in developing better doctor-patient relationships, preferring face-to-face rather than online BG. However, they found online more convenient. A blended learning approach could provide trainees with the benefits of both formats of BG.
Mental disorder and PTSD in Syria during wartime: a nationwide crisis
Authors: Jomaa Sami , Kakaje Ameer , Al Zohbi Ragheed , Aldeen Osama Hosam , Makki Leen , Alyousbashi Ayham , Alhaffar Mhd Bahaa Aldin
Published: June 2021

Aims

Syria has experienced war since 2011, leaving over 80% under the poverty line and millions displaced. War and its retaliations have significantly impacted the mental health of Syrians. This study evaluates the post-traumatic stress disorder (PTSD), and the severity of the mental distress caused by war and other factors such as low social support. This study also evaluates other variables and compares the findings with those of multiple studies on Syria and refugees.

Method

This is a cross-sectional study that included people who lived in Syria in different governorates. Online surveys were distributed into multiple online groups and included the Kessler 10 (K10) scale which screens for anxiety and depression, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support, and questionnaires on demographic and war-related factors.

Result

Our study included 1951 participants, of which, 527 (27.0%) were males and 1538 (78.8%) between the age of 19 and 25. Among participants, 44% had likely severe mental disorder, 27% had both likely severe mental disorder and full PTSD symptoms, 36.9% had full PTSD symptoms, and only 10.8% had neither positive PTSD symptoms nor mental disorder on the K10 scale. Around 23% had low overall support. Half of the responders were internally displaced, and 27.6% were forced to change places of living three times or more due to war. Around 86.6% of the responders believed that the war was the main reason for their mental distress. Those with high SPTSS and K10 scores were found to take more days off from work or school due to negative feelings and having somatic symptoms. Moreover, the number of times changing places of living due to war, educational level, and being distressed by war noise were the most prominent factors for more severe PTSD and mental distress. No differences in PTSD and mental disorder prevalence were noted in participants living in different governorates or among different types of jobs. A strong significant correlation (r = 0.623) was found between SPTSS and K10 scores.

Conclusion

The conflict in Syria has left the population at great risk for mental distress which was higher compared to Syrian refugees elsewhere. Many measures with an emphasis on mental health are needed to help the people against a long-term avoidable suffering.
A retrospective observational study of vitamin D levels in patients within the Tameside and Glossop early intervention in psychosis team
Authors: Kaye Emily , Parker Pete , Fyall Thomas , Arrowsmith Katie , Hark Holly , Huda Samei Ahmed
Published: June 2021

Aims

Growing evidence indicates that Vitamin D deficiency is associated with psychotic symptoms. Although evidence suggesting a causal relationship is limited, theories regarding neuro-inflammatory modulation are promising. Alternatively, deficiency may signify chronic illness or poor functioning. Nevertheless, Vitamin D levels below 50nmol/L increase the risk of osteoporosis, muscle weakness, falls and fractures, thus identification and treatment are important.

The association between Vitamin D levels in patients within the Tameside Early Intervention in Psychosis Team (EIT) was studied, hypothesising a strong correlation.

Method

The records of all patients in the EIT as of 01/07/2020, over the age of 16 years old (n = 183), were studied. The first Vitamin D level taken while under the EIT and the CGI scores closest to the date of this level were recorded. Vitamin D levels of 25nmol/L and under were classified as deficient, levels of 25.1 - 50nmol/L were insufficient.

Result

45.90% (n = 84) of patients did not have their levels recorded. Of the 55% (n = 99) patients who had Vitamin D levels recorded, 49.50% (n = 49) were insufficient and 22.22% (n = 22) were deficient. Therefore, only 28.28% (n = 28) had either optimal or sufficient Vitamin D levels. The majority of Vitamin D levels were taken in Autumn (36.46% n = 36).

75.76% (n = 75) of patients had both vitamin D levels and CGI scores recorded, with an average of 35.65 days between date level and score recorded. A weak negative correlation between overall CGI scores and vitamin D level was calculated, producing Spearman R Correlation Coefficient of -0.15.

Conclusion

Almost 3/4 of the studied patients being assessed for psychotic symptoms had either insufficient or deficient levels of Vitamin D. The correlation between symptom severity and Vitamin D level was weak however. While we cannot comment on the causality of the relationship, it appears that there is an association between our studied patient group and Vitamin D insufficiency.

The evidence to suggest that supplementation can reduce psychotic symptoms is limited however, supplementation can reduce the risk of osteoporosis and falls, therefore would improve patient care. Only 55% of the patients within the EIT had their Vitamin D levels tested. As a result of this study, the authors recommend that all patients in the EIT have their Vitamin D levels tested as part of their psychosis assessment.

The study is limited due to low numbers of patients studied and the fact that recorded CGI scores were often recorded at a later date to Vitamin D levels.
The outcome of an attachment-based infant mental health therapeutic play programme on infant temperament, parent-infant relationship & maternal reflective functioning
Authors: Malinit Joy
Published: June 2021

Aims

In the Philippines, there is a need for preventive, early intervention programs for perinatal and infant mental health. This is the first local study that investigated an attachment-based, therapeutic play programme (Baby Bonding) on infant temperament, parent-infant relationship and maternal reflecting functioning.

Background

This study was an effort towards bridging the “10/90 gap in infant mental health research” wherein 90% of the world's infants are born in low- middle-income countries (Population Reference Bureau, 2013b) and “only 10% of the worldwide spending on health research is directed towards the problems that primarily affect the poorest 90% of the world's population (Tomlinson et al., 2014).

Method

Phase I involved local validation of the Parent-Rated Outcome Measures (PROM)- Infant Characteristics Questionnaire (ICQ), Mother Object Relations Scale (MORS) and Parental Reflective Functioning Questionnaire (PRFQ).Healthy mother-baby dyads, from the low socio-economic stratum, were screened using Parent Evaluation of Developmental Status (PEDS) and Hospital and Anxiety Depression Scale (HADS).

Phase II carried out randomized controlled design wherein mother-baby dyads were enrolled either in the usual care group or the 6-weekly Baby Bonding intervention.

Result

102 mothers answered the PROM. Their responses constituted the training set of the study tools. Baseline responses of the mothers from the usual care (N = 51) and intervention (N = 53) groups formed the evaluation set for the Filipino- translated instruments. In both the training and evaluation sets, if certain identified questions were to be removed from the PROM, better and acceptable Cronbach values were consistently generated.

There were no statistical differences on parent-infant relationship and reflective functioning between the usual care and intervention group. There was movement of the intervention group from high-challenging onto intermediate to low-levels of challenging temperament in the dull-dimension of the ICQ after 6 sessions. In comparison, infants in the control group remained in the high-challenging temperament after 6 weeks of usual care.

Conclusion

Linguistically validated study instruments (ICQ and MORS) provided accurate assessments of infant temperament and parent-child relationship. The Filipino-translated PRFQ has limited validity in evaluating parental reflective functioning (RF). “On-line” measures that video mother-baby interactions could have better captured changes in RF. As measured by the dull dimension of the ICQ, the Baby Bonding programme improved sociability of the infants (7 months or younger).