bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Rare Copy Number Variants on Real-World Functional Outcomes in Individuals With Psychosis
Authors: Kendall Kimberley
Published: August 2024

Aims

Individuals with psychosis experience impairments in real-world functional outcomes such as employment and health. Rare copy number variants (CNVs) are established risk factors for psychosis, neurodevelopmental disorders and cognitive impairment. However, little is known about their effect on real-world functional outcomes in individuals with psychosis.

I aimed to establish the effect of rare neurodevelopmental CNVs on real-world functioning in individuals with psychosis.

Methods

I identified 1,932 individuals with psychotic disorders (ICD–10 F20–F29) in the UK Biobank using first-occurrence data (from primary care, hospital inpatient and death register records and self-reported conditions). I mapped UK Biobank data to two domains of real-world functional outcomes – health deficits and vocational outcomes. We previously called CNVs using PennCNV, annotating them with 53 CNVs associated with autism spectrum disorder and developmental delay. I conducted regression analyses with neurodevelopmental CNVs as the predictor, real-world functioning as outcomes and with relevant covariates (e.g. age and sex).

Results

Out of 1,932 individuals with psychotic disorders, 2.5% (n = 49) carried a neurodevelopmental CNV.

Health Deficits

I used first-occurrence diagnosis data to establish comorbid psychiatric diagnoses. I summed these diagnoses and dichotomised them into one or more comorbid diagnoses versus no comorbid psychiatric diagnoses. I conducted a logistic regression analysis – neurodevelopmental CNV carrier status was associated with having at least one psychiatric diagnosis in addition to a psychosis diagnosis (OR 2.1, 95% CI 1.1 - 4.1, p 0.034). Post-hoc analyses revealed an increased rate of dissociative and conversion disorders in CNV carriers (OR 4.5, 95% CI 1.26 - 15.99, p 0.021).

I used first-occurrence physical health diagnosis data to establish the burden of the 20 most prevalent chronic non-cancer illnesses. Neurodevelopmental CNV carrier status was associated with chronic physical health multimorbidity in individuals with psychosis (59.2% vs 43.5%, OR 2.30, 95% CI 1.27–4.17, p 0.006), defined as the presence of two or more chronic physical health conditions.

Vocational Outcomes

I conducted an ordinal regression analysis, establishing that among individuals with psychosis, CNV carriers had a lower likelihood of achieving a higher qualification (OR 0.45, 95% CI 0.27–0.77, p 0.003).

Conclusion

Neurodevelopmental CNVs are associated with important real-world functional outcomes in individuals with psychosis. This work provides information that can guide the assessment and management of individuals with both psychosis and neurodevelopmental CNVs.
Phenomenology of Mood Disorders in Children and Adolescents
Authors: Khadanga Poornima , Moktan Sherina , Sharma Eesha , Vijaysagar Kommu John
Published: August 2024

Aims

Psychiatrists frequently diagnose mood disorders in children. However, there is a limited understanding of clinical history and phenomenology of mood disorders in these phases of lifespan, and phenomenological variations in those with and without neurodevelopmental disorders (NDD). The primary objective of the study was to study, comparatively, the phenomenology in children clinically diagnosed with mania, depression and mixed affective disorder. The second objective was to study the phenomenological differences in diagnosed cases of mood disorder children with and without neurodevelopmental disorders.

Methods

We conducted a semi-qualitative study of the clinical history and phenomenology in 120 children recruited from a tertiary care child and adolescent psychiatry service. Children with current diagnosis of depression, mania or mixed affective state, age less than 18 years, and appropriate consent/assent were included. Children with comorbid neurological disorders, any underlying organicity, or those currently in remission from their mood episode were excluded. Descriptive summaries were calculated for socio-demographic, clinical and phenomenological data. Chi Square test was used to examine statistical differences in prevalence of various phenomena across the clinical diagnostic groups.

Results

The most common clinical diagnosis was depression (58.3%) followed by mania (25.8%) and mixed affective state (15%). Irritable mood and emotional dysregulation were equally distributed among the three diagnostic groups. With a high prevalence of comorbid NDDs in the sample, we compared phenomena between groups with and without NDDs. In cases of depression, suicidal ideas and guilt feelings were expressed in 61% and 80% of these participants without comorbid NDD (n = 45) respectively, which was significantly high as compared with those with NDD (n = 67). The symptoms of disinhibition (78.9%), impulsivity (84.2%) and emotional dysregulation (10.5%) were more frequently seen in participants with neurodevelopmental disorder. Dissociative and obsessive phenomena were present in about a quarter of our study sample, similarly across mania, depression and mixed state.

Conclusion

Mental status examination of mood disorders in children suggests considerable phenomenological overlap with irritable mood, emotional and behavioural dysregulation, dissociative symptoms, obsessive symptoms, sleep disturbances, nightmares and hyperarousal seen in mania, depression and mixed states. These phenomena may, therefore, not be suitable in differentiating these clinical diagnoses. Children with NDDs may report lesser cognitive phenomena of depression, and the clinician may have to rely on the affective and behavioural manifestations of depression in clinical decision-making.
A Qualitative Analysis of Contributory Factors to Serious Incidents Involving Adults With Learning Disabilities Receiving NHS Mental Healthcare
Authors: Khodabux Nusra , Kiani Reza
Published: August 2024

Aims

This study aimed to analyse contributory factors to serious incidents (SIs) involving adult patients with intellectual disabilities receiving NHS care in a mental health trust. People with intellectual disabilities face considerable preventable harm and disparities in care. In-depth analysis of contributory factors to incidents involving adults with an intellectual disability, using human-factors based frameworks is lacking. Individual SI reports contain useful data, but learning is often limited without aggregated analysis.

Methods

Thirty anonymized serious incident reports (2014–2023) from an NHS mental health Trust's intellectual disability service were analysed qualitatively using the Yorkshire Contributory Factors Framework, followed by reflexive thematic analysis (RTA) to identify patterns across the data. This enabled nuanced themes to emerge across errors at the sharp end and systems-level factors at the blunt-end.

Results

Across 30 reports, 606 discrete factors were identified. Situational factors such as behavioural escalations and staff competency gaps were most frequent (n = 187, 31%). Other factors included active failures, such as slips, lapses, mistakes, violations (n = 109, 18%), organisational influences (n = 107, 18%), communication breakdowns (n = 75, 12%), unfavourable working conditions (n = 62, 10%), cultural factors such as reluctance to voice safety concerns (n = 51, 8%), and external system factors (n = 15, 2%).

Using RTA, we identified recurring themes across incidents involving interactions between sharp-end human and blunt-end system factors, with broader issues shaping frontline performance. Patient marginalisation, excessive workloads, lack of resources, and cultures tolerant of shortcuts aligned to permit errors. Deficient coordination across fragmented healthcare systems and overdependence on non-permanent workers and bank staff obstructed comprehensive incident reviews. Failure to adequately probe cultural influences and external pressures further reflect the limited extent of investigational efforts.

Conclusion

Adults with intellectual disabilities are subject to serious incidents caused by interacting human and system-level factors, including organisational, cultural and external factors. Addressing under-resourcing and improving investigation quality are paramount to enhancing safety of care for people with intellectual disabilities.
Two Years Beyond COVID-19: Unveiling the Persistence of Neuropsychiatric Symptoms and Risk Factors in a Cross-Sectional Study
Authors: Laha Poulami , Gowda Guru S , Reddi V Senthil Kumar , T Harish , Moirangthem Sydney
Published: August 2024

Aims

The neuropsychiatric morbidities associated with post-COVID status are important public health issues. The range and severity of morbidity varies with the type of clinical setting and time of assessment. There are limited studies on the long-term persistence of the post-COVID neuropsychiatric symptoms (PCNS). Hence, this study aims to determine the proportion of persistent PCNS after approximately 2 years of COVID and to find any risk factors for persistent PCNS.

Methods

This study was a cross-sectional study of randomly selected 2,281 individuals aged 18–60 years, currently living in the community, who were RT-PCR positive for COVID-19 from the National Institute of Mental Health and Neurosciences (NIMHANS) laboratory (at least 4 weeks before intake) from a period of 1 June 2020 to 31 March 2022. Among them, 927 individuals who met the study criteria were screened for PCNS through telephone interviews using a validated PCNS screening tool comprising sociodemographic details, life events inventory and 20 questions to assess for PCNS. 196 individuals who came positive for PCNS were further evaluated by in-person or web-based interviews with Structured Clinical Interviews for DSM–5-Research Version and World Health Organization-Post-COVID Case Report Form for persistent PCNS. Descriptive statistics, Chi2 test, Mann–Whitney U Test, and Binary logistic regression analysis were used for data analysis. The Institutional Ethics Committee approved this study.

Results

The median age of study participants was 34 years, and 51.3% were female. 68 out of 196 participants (34.7%) had persistent PCNS approximately 2 years (23.84 months) after COVID-19 infection. Chronic fatigue (10.2%), depression (6.1%), cognitive symptoms (4%), hyposmia (3.6%), hypogeusia (3.6%), anxiety (2.5%), panic disorder (2.5%) and insomnia (2%) are the main persistent symptoms. The median age of the participants with persisted PCNS (40 years) is higher compared with the median age of the participants without persisted PCNS (34 years) [Mann–Whitney U = 5,225.0, P = 0.021]. Even though significant associations were found between the development of PCNS after 4 weeks of COVID and female gender, symptomatic COVID-19, severity of COVID-19 (oxygen supplementation), hospital admission, total number of times of COVID-19, and presence of life events, this association were not found with persistence of PCNS at 2 years.

Conclusion

This study revealed that one-third of the individuals with PCNS had persistent symptoms after 2 years. Chronic fatigue is the most common persistent PCNS. Middle-aged and above age groups were found to be a risk factor for persistent PCNS.
Nature and Prevalence of Long-Term Conditions in People With Intellectual Disability, a Study That Combines the Powers of AI, Big Data and Lived experience
Authors: Lewin Gemma , Kousovista Rania , Abakasanga Emeka , Shivamurthy Rishika , Cosma Georgina
Published: August 2024

Aims

Individuals with intellectual disability (ID) exhibit elevated health needs when compared with the general population. There is a higher vulnerability to long-term conditions. A scoping review identified that individuals with ID exhibit a distinct pattern of multiple long-term conditions (MLTC) that is different to the general population. Findings highlight health challenges faced by individuals with ID, emphasising the need for targeted and early interventions to address their unique healthcare needs.

This study utilises a professional advisory panel (PAP) and patient and public involvement (PPI) group to form a consensus on relevant long-term conditions for people with ID. Machine learning algorithms are employed to identify long-term conditions in a large, population-based data repository covering the whole of Wales revealing a comprehensive range and prevalence of long-term conditions in a sample of 13,361 adults with ID.

Methods

A consensus on relevant long-term conditions for people with ID was formulated through iterative review followed by revision by PAP and PPI group. PAP comprised a multidisciplinary team with relevant expertise including General Practitioners, a Consultant Psychiatrist, nurses, pharmacists, and data analysts. The PAP worked in collaboration with a PPI group, comprising three groups of experts by experience: people with ID, family or informal carers of people with ID, and professional carers of people with ID.

This study utilises machine learning algorithms in the Secure Anonymised Information Linkage (SAIL) databank to identify the range and prevalence of long-term conditions in ID. SAIL is an anonymised, population-based data repository, comprising billions of anonymised records across Wales. This study included 13,361 ID adult patients.

Results

Following iterative review and revision by the PAP and PPI group, a consensus of 40 long-term conditions relevant for people with ID was identified. Prevalence rates for each condition were calculated. Ten most prevalent conditions were recorded as mental illness, reflux disorders, epilepsy, chronic airway diseases, hypertension, thyroid disorders, chronic arthritis, chronic kidney disease, diabetes, and anaemia.

Conclusion

Consensus on relevant long-term conditions for the general population developed through previous studies is not relevant for the ID population. This is the first effort at creating a full range of long-term conditions for individuals with ID, utilising a population-based data repository. It is possible to do this in partnership with PAP and PPI groups. Along with prevalence, impact of ageing and gender, and hospitalisation as outcome data, this study describes challenges associated with interpreting data captured by Read Codes and ICD–10 codes.
Risk Factors for Burnout Among Doctors in a Tertiary General Hospital
Authors: Lim Leslie , Loh Louis , Chan Yiong-Huak , Eng Leonard , Fam Johnson
Published: August 2024

Aims

To study the risk factors for burnout among doctors in a tertiary general hospital in Singapore. We hypothesized that burnout would be associated with singles, young age, females, foreign born staff who had recently moved to this country unaccompanied by family, and those showing less resilience. We hypothesised perceived support and satisfaction with leisure would mitigate against burnout.

Methods

An anonymised survey was carried out, with questionnaires sent to all staff via email. Survey instruments included the Oldenburg Burnout Inventory, Connor Davidson Resilience Scale, Brief Form of Perceived Social Support Questionnaire, Patient Health Questionnaire-4 items (PHQ-4), Leisure Time Satisfaction Survey and the Demand Control Support Questionnaire (DCSQ). Descriptive statistics for normally-distributed numerical variables were presented as mean (SD or standard deviation), and for categorical variables, median and n (%). One-way ANOVA was performed to determine differences in total burnout scores across categorical variables and simple linear regression was used to assess for binary and numerical outcomes in terms of resilience, PHQ, DSCQ, satisfaction with leisure time and perceived social support, with significance set as p < 0.05.

Results

A total of 129 doctors responded to the survey. Over half were male, and nearly 70% were married. Nearly half were below age 40 and only about 5% had no immediate family living in Singapore.

Burnout was associated with young age (p < 0.004) and those with anxiety 2.39 (2.13 to 2.64) p = 0.038, and depressive symptoms 2.71 (2.44 to 2.97) p < 0.001. Psychological demand was positively associated with burnout (1.52 (1.32 to 1.71) p < 0.001; whereas decision latitude −0.69 (−0.85 to −0.52), social support at work −1.35 (−1.49 to −1.21), and high resilience −0.56 (−0.63 to −0.48), were negatively associated (all p < 0.001).

Satisfaction with leisure time was negatively correlated with burnout (p < 0.001). Contrary to hypothesis, singlehood, gender, overseas staff recently joined with no accompanying family were not associated with burnout (p > 0.05). In addition, perceived social support from outside work did not mitigate against burnout (p > 0.05).

Conclusion

Young age, anxiety and depression, and psychological demands were risk factors, whereas resilience, decision latitude, satisfaction with leisure, and social support at work were protective factors against burnout. Reducing workload, improving work schedules, promoting self-management, teaching physical, mental, and emotional self-care, and other stress management activities are among the effective techniques shown to reduce burnout. Interventions should be made available for all staff, but specifically focusing on those at greatest risk.
Modelling Clozapine Levels to Identify Safe Titration Targets and a Method for Precise Dose Adjustment
Authors: Meyer Zeryab , Simpson Gemma , Drake Richard J
Published: August 2024

Aims

A precision medicine approach to clozapine dosing aims to personalise it in two ways: i) during titration, and ii) for succeeding dose adjustments. This requires valid models of dose/concentration relationships, but cross-sectional models suffer from population-level artefacts and individual problems due to poor adherence or stopping smoking. Longitudinal data sets from two mental health trusts allowed poor adherence and smoking cessation to be identified. We then modelled dose/concentration relationships to construct personalised targets for i) and ii).

Methods

Demographics and co-prescribed medication were recorded for 137 patients from Greater Manchester Mental Health (GMMH) Trust who had two or more successive plasma levels and doses from 2016–2018. 412 patients from Pennine Care Foundation Trust (PCFT) who had successive plasma levels and doses from 2009–2023 were also recorded. In each sample, adherent patients (88 from GMMH and 371 from PCFT) were identified after excluding: > two-fold variation between blood samples in clozapine/norclozapine ratios, > two-fold variation in dose/concentration ratios, a clozapine/norclozapine ratio > 3, or a dose/concentration ratio > two standard deviations from the sample mean. Those whose smoking status (smoker vs non-smoker) changed between samples were excluded.

To identify i) titration targets, we used raw data in first samples (checked with logistic regression) to identify dose thresholds which produced most levels above 0.35 μg/ml (therapeutic) and no levels greater than 1 μg/ml (toxic). To model ii) effective dose adjustment, we used the equation Dt = Dc(Ct/Cc) to identify the most effective dose for the second samples. Dt was target dose, Dc current dose, Ct target level (0.45 μg/ml), and Cc current level.

Results

First sample dose/concentration ratio in adherent patients correlated r > 0.75 with second samples’ dose/concentration. >84% of plasma levels were within 20% of the mean across both samples.

i.

The GMMH dataset titration targets were 325 mg, 300 mg, 225 mg, and 175 mg daily for male smokers, female smokers, male non-smokers, and female non-smokers, respectively. In PCFT, data suggested corresponding targets of 375 mg, 325 mg, 225 mg and 175 mg. Targets avoided toxicity and gave therapeutic levels in > 50% of cases.

ii.

Target dose, ascertained using the equation, and actual second dose were compared: in adherent cases, toxicity only occurred when actual doses were 1.5-fold greater than target dose, and above target all plasma levels exceeded 0.35 μg/ml in GMMH. PCFT data appeared similar.

Conclusion

Relatively safe and effective titration targets for smokers and non-smokers from both sexes were identified. A simple equation would improve precision and effectiveness of dose adjustment thereafter.
Cognitive Behavioural Therapy Versus Psychodynamic Therapy for Medically Unexplained Symptoms: A Retrospective Study of Healthcare Utilisation and Cost Analysis
Authors: Naylor Rory
Published: August 2024

Aims

Patients experiencing Medically Unexplained Symptoms (MUS) are some of the costliest in both primary and secondary care. Psychotherapy is one of the most efficacious ways of treating them although the most superior modality is unclear. Cognitive Behavioural Therapy (CBT) has the greatest evidence base, but a growing number of studies have investigated the role of Psychodynamic Psychotherapy (PPT). This is the first study to compare the two modalities concerning their impact on healthcare utilisation and cost to the NHS.

Methods

Patients referred to the Oxford Community Psychological Medicine Service in 2021 and who went on to complete a course of psychotherapy for MUS were included. 78 patients were referred, 66 patients were assessed, 16 patients began treatment and 9 patients completed treatment. 4 received CBT and 5 received PPT based on a ‘best fit’ assessment. Their healthcare utilisation (GP appointments, health investigations, A&E attendances, inpatient admissions and outpatient appointments) was assessed during the 6 months prior to their initial assessment and compared with the 6 months after therapy had ended using data from ‘Health Information Exchange’.

Results

Overall, psychotherapy reduced primary care use but our data was insufficiently powered for this to be statistically significant. There was a significant reduction in outpatient appointments after psychotherapy, mostly representing mental health consults.

Significant differences between pre-therapy and post-therapy were only observed for the number of health investigations in the PPT group which, surprisingly, increased with a large effect size (d = 1.19 95% CI 1.12–2.88, P = 0.03). The same trend towards increased utilisation were observed for every outcome measure in PPT besides outpatient appointments. Conversely, all outcome measures showed an improvement after CBT apart from the number of health investigations which marginally increased.

CBT significantly decreased GP appointments at 6 months follow-up compared with PPT with a large effect size (η2 = 0.5, p < 0.05). A similar trend was seen for total cost (η2 = 0.5, p < 0.06) with each PPT patient costing £790 more on average than their CBT counterparts during the 6 months after therapy.

Conclusion

Whilst CBT appears to be efficacious in the short-term, PPT caused significantly increased healthcare utilisation compared with CBT in the 6 months after therapy. This aligns with similar studies that demonstrate a ‘sleeper effect’ in which patients who receive PPT, but not CBT, deteriorate before improving over long-term follow-up.

Additional research is needed to correlate this data with symptoms and capture the long-term benefits of these psychotherapies for MUS.
The Effects of Developmental Stress on Dopaminergic Function in Adulthood: A Systematic Review and Meta-Analysis
Authors: Noar Alexander , Chapman George , Chang Tinya , Payne-Gill James , Bloomfield Michael
Published: August 2024

Aims

Exposure to traumatic experiences during childhood and adolescence is a significant risk factor for the development of psychiatric disorders in adulthood. An estimated 50% of the worldwide incidence of depression and anxiety can be attributed to childhood maltreatment (Li et al., 2016). In addition, approximately one-third of psychotic experiences are attributable to a history of developmental trauma (McGrath et al., 2017). It is thought that long-lasting, trauma-induced adaptive changes in neurobiological function may lead to a predisposition towards pathophysiology (McCrory and Viding, 2015). However, the precise mechanisms through which developmental trauma exposure alters brain function on cellular and circuit levels remain poorly elucidated.

Methods

A systematic literature search and meta-analysis was performed to establish how dopaminergic functioning in adulthood is affected by developmental stress in rodents. Three databases, Medline®, Embase®, and PsycINFO®, were systematically searched initially on 2nd December 2023. Terms for three superordinate concepts (‘childhood’ terms, ‘trauma’ terms, and ‘dopamine’ terms) were combined. Cohen's d statistic was used for effect sizes. This protocol is pre-registered on PROSPERO® (ID: CRD42018106382).

Results

A total of 104 studies met our inclusion criteria. Meta-analysis indicated that developmental stress exposure leads to complex and long-lasting effects in basal and post-amphetamine extracellular dopamine concentrations in the medial prefrontal cortex, amygdala, and nucleus accumbens. In addition, there is a significant downregulation of D1 receptors and upregulation of D2 receptors in prefrontal and striatal regions involved in threat and reward processing. Effect sizes ranged from 0.36 to 1.55.

Conclusion

These findings strongly suggest that dopaminergic dysfunction is a mechanistic link between developmental trauma and vulnerability towards mental illness in adulthood.
Modelling Co-Occurring Mental Health Conditions Among Autistic Individuals Using Polygenic Scores
Authors: Okewole Adeniran , Bourque Vincent-Raphael , Jacquemont Sebastien , Warrier Varun , Baron-Cohen Simon
Published: August 2024

Aims

This study investigated the relationship between common genetic variation and co-occurring mental health conditions among autistic individuals.

Methods

The study was conducted with the Simons Foundation Powering Autism Research (SPARK) dataset, V9 release, and included probands [n = 17,582] with confirmed diagnosis of autism, who were also in the SPARK iWES1 array genotyping dataset. Six co-occurring mental health conditions (attention deficit hyperactivity disorder or ADHD, bipolar disorder, depression, schizophrenia, anxiety disorder and disruptive behaviour disorders) were analysed. Polygenic scores (PRS) were generated with PRScs software, using summary statistics from the most recent genome wide association studies (GWAS) for autism, ADHD, schizophrenia, bipolar disorder, depression, anxiety, neuroticism, p-factor, intelligence, educational attainment and hair colour (negative control). General linear models (GLM) and Cox proportional hazards models were computed, with age at registration, sex, cognitive impairment and genetic principal components included in both sets of models. Multiple testing correction was done using the Benjamini-Yekutieli method. Results were calculated using odds ratios (OR), 95% Confidence Intervals (CI) and corrected p values (p).

Results

There were similar patterns of association and interaction for both GLMs and Cox models. Polygenic scores for educational attainment were significantly lower for those with co-occurring ADHD (GLM: OR=8.85E-01, 95% CI=8.48e-01–9.23e-01, p = 2.91E-07; Cox: OR=8.94E-01, 95% CI=8.66e-01–9.22e-01, p = 4.76E-11), bipolar disorder (GLM: OR=7.45E-01, 95% CI=6.54e-01–8.49e-01, p = 2.40E-04; Cox: OR=7.25E-01, 95% CI=6.39e-01–8.23e-01, p = 3.96E-05), depression (GLM: OR=8.63E-01, 95% CI=8.04e-01–9.26e-01, p = 5.13E-04; Cox: OR=8.56E-01, 95% CI=8.03e-01–9.12e-01, p = 2.80E-05), schizophrenia (GLM: OR=6.94E-01, 95% CI=5.71e-01–8.42e-01, p = 3.99E-03; Cox: OR=6.67E-01, 95% CI=5.52e-01–8.05e-01, p = 1.41E-03), anxiety disorder (GLM: OR=8.77E-01, 95% CI=8.37e-01–9.20e-01, p = 9.88E-07; Cox: OR=8.81E-01, 95% CI=8.49e-01–9.15e-01, p = 1.46E-09) and disruptive behaviour disorders (GLM: OR=7.10E-01, 95% CI=6.63e-01–7.60e-01, p = 3.22E-21; Cox: OR=7.10E-01, 95% CI=6.67e-01–7.57e-01, p = 1.35E-24).

Conclusion

Polygenic scores for educational attainment were associated with the co-occurrence of several mental health conditions among autistic individuals.
How Are Inpatient Psychiatric Ward Rounds Understood in Research Literature? A Scoping Review
Authors: Williams Benjamin , Olagunju Oluwatomilola , Richardson Siobhan , Jameson Georgia
Published: August 2024

Aims

Ward rounds are complex clinical interactions crucial in delivering high-quality, safe, and timely patient care. They serve as a platform for the multidisciplinary team to collaboratively assess a patient's condition and actively involve the patient and their caregivers in shared decision-making to formulate a care plan. Ward rounds involve an intersection of factors worthy of consideration separate from the wider literature on inpatient experience and multidisciplinary team meetings. With this review our primary aim is to systematically identify what methods and perspectives researchers are using to understand ward rounds.

Methods

The databases searched were Medline, CINAHL, British Nursing Index, PsychInfo, and ASSIA as well as reference and citation checking. The search terms used were psychiatr* AND (ward round OR “multi disciplinary team meeting” OR “clinical team meeting”). Studies were included if they were peer reviewed, included primary research on psychiatric inpatient ward rounds in which patients are participants with no restriction on the type of ward or hospital, patient group, country or methodology.

Results

224 records were retrieved and screened from the database search and 10 from other sources. 35 full texts were reviewed for eligibility and 26 included in the review. 16 studies had no particular theoretical perspective, 2 were constructivist, 2 critical realist, 2 lean methodology, 1 systems research, 1 phenomenological, 1 trauma informed and 1 critical theory. 9 focussed on patient experience, 5 ward round structure, 3 on power relationships, 3 on efficiency, 2 on shared decision making and 4 had a unique focus. Though often not explicit, critical theory influenced discussion of power is common in papers focused on patient experience and ward round structure. Cross-sectional surveys, interviews, focus groups and audit cycles were the most common methods. Key themes which emerge are anxiety provoked by ward rounds, preparation and communication, and the negotiation of power structures. Key tensions identified include being multidisciplinary versus overcrowding, efficiency versus personalisation and reliability versus responsiveness.

Conclusion

For a central part of inpatient psychiatric practice there is a limited range of research on psychiatric ward rounds. The influence of critical theories’ focus on power was widespread with limited representation of other theoretical perspectives and concerns. There was no research using experimental methods, but there was some implementation research. Key tensions are highlighted which services may wish to consider when revisiting ways of working on inpatient psychiatric wards.
An Estimation of the Numbers of Patients Suitable for Lecanemab Treatment for Alzheimer's Pathology Within Mid and South Essex
Authors: Shanley Ivan , Pranay Piyush , Dilip Chitra , Hill Christopher St , Sebastian Feena
Published: August 2024

Aims

This paper sought to estimate the number of potential candidates per year, within the boundaries of the Mid and South Essex Integrated Care System, for the receipt of Lecanemab, a novel treatment of Alzheimer's pathology.

Methods

One of the four memory assessment services within the region was selected at random, following which all referrals to that service in January and February 2023 were retrieved from the electronic patient record system (n = 45). These records were then screened to assess whether the patient met the criteria for treatment with Lecanemab. The inclusion and exclusion criteria from the original CLARITY-AD phase 3 clinical trial (van Dyck et al., 2022) were combined with those of the Appropriate Use Recommendations released by the Alzheimer's Disease and Related Disorders Therapeutics Work Group (Cummings et al., 2023)1,2. Patients could not be identified as certainly suitable for treatment, but simply as potential candidates, as current practice does not include all the necessary investigations to receive the new drug, for example undergoing amyloid PET or CSF testing.

Results

11 of 45 referrals were potential candidates for novel therapeutics (24.4%). Of the 11, 3 were diagnosed with Alzheimer's disease (27%), and 8 with Mild Cognitive Impairment (73%). 8 were male, 3 female, with a mean age of 78 years (range 70 to 87). The mean score on the Addenbrooke's Cognitive Examination III was 82/100. Two patients had co-morbid mental illness, both mixed anxiety and depression, currently in remission. Extrapolating from this rate of eligibility for treatment, it is suggested that approximately 260 patients per year would be eligible for Lecanemab treatment within Mid and South Essex.

Conclusion

This paper estimates that approximately 260 patients per year would be eligible for Lecanemab treatment within Mid and South Essex based on the inclusion and exclusion criteria stated above. This estimate is given with caution, particularly as neither amyloid PET nor CSF testing was performed, and it is still not clear what other stipulations may be made by the UK regulatory bodies (for example the degree of vascular pathology permitted on neuroimaging). This paper does however provide a useful, early estimate of eligibility in order to facilitate planning for potential treatment pathways.
CONNEX, a Phase III Randomized Trial Program Assessing Efficacy and Safety of Iclepertin in Schizophrenia: Recruitment and Baseline Characteristics
Authors: Blahova Zuzana , Ikezawa Satoru , Falkai Peter , Krystal John H. , Rangan Tarun
Published: August 2024

Aims

Glutamatergic signalling deficits contribute to the neuropathology of cognitive symptoms in schizophrenia. Iclepertin (BI 425809), a glycine transporter-1 inhibitor, enhances N-methyl-D-aspartate receptor signalling in the brain by increasing synaptic levels of its co-agonist glycine. The Phase III CONNEX programme aims to assess the efficacy, safety and tolerability of iclepertin in improving cognition and functioning in schizophrenia.

Methods

CONNEX includes 3 randomised, double-blind, placebo-controlled parallel group trials in patients with schizophrenia from multiple centres across 41 countries in Asia, North and South America, Europe, and Asia Pacific Region (NCT04846868, NCT04846881, NCT04860830) receiving stable antipsychotic treatment. Each trial aims to recruit ~586 patients, 18–50 years old, treated with 1–2 antipsychotic medications (≥12 weeks on current drug; ≥35 days on current dose before treatment), who have functional impairment in day-to-day activities and interact ≥1 hour/week with a designated study partner. Patients with cognitive impairment due to developmental, neurological or other disorders, or receiving cognitive remediation therapy ≤12 weeks before screening will be excluded. Patients will be randomised 1:1 to once-daily oral iclepertin 10 mg (n = 293) or placebo (n = 293) for 26 weeks. Primary endpoint: change from baseline (CfB) in Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) overall composite T-score. Key secondary endpoints: CfB in Schizophrenia Cognition Rating Scale (SCoRS) total score and adjusted total time T-score in the Virtual Reality Functional Capacity Assessment Tool (VRFCAT).

Results

Trial completion is expected in Q1 2025. By 31/01/2024, there have been 811, 699 and 655 patients screened, 533, 474 and 458 randomised, and 320, 299 and 281 who have completed the trial medication for CONNEX-1, -2 and -3, respectively. Most patients are male (CONNEX-1: 69.3%, CONNEX-2: 69.0%, CONNEX-3: 63.3%) with similar age (mean [standard deviation; SD]) (CONNEX-1: 34.0 [8.9], CONNEX-2: 35.9 [8.4], CONNEX-3: 34.0 [8.8] years). For CONNEX-1, -2 and -3, mean (SD) duration of illness is 10.6 (8.3), 12.2 (7.9) and 9.6 (7.6) years and duration of previous schizophrenia treatment is 3.9 (4.6), 4.5 (4.9) and 3.3 (4.4) years. Baseline mean (SD) MCCB overall composite T-score (1: 28.4 [13.7], 2: 27.3 [13.8], 3: 29.7 [13.7]), SCoRS total score (1: 40.5 [11.1], 2: 39.9 [9.7], 3: 38.0 [10.0]) and VRFCAT adjusted total time T-score (1: 29.6 [22.3], 2: 30.7 [20.8], 3: 33.6 [18.1]) were similar across trials.

Conclusion

If successful, CONNEX will provide evidence for iclepertin as the first efficacious medication addressing cognitive impairments in schizophrenia.

Studies funded by Boehringer Ingelheim.
Impact of Covid-19 on Referrals to Paediatric Liaison Psychiatry at Children's Health Ireland (CHI) at Crumlin as the Pandemic Moved to Endemic Status
Authors: Sun Bohan , Adamis Dimitrios , McNicholas Fiona
Published: August 2024

Aims

Rates of acute mental health presentations in youth were rising pre-pandemic internationally. Longitudinal studies following Covid-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions.

This study aimed to examine whether the initial reported post-Covid-19 increase in mental health presentations persisted following the reclassification of Covid-19 to endemic status, which was accompanied by removal of most restrictions.

Methods

All referrals to paediatric liaison psychiatry (PLP) between Jan 2018–Dec 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis was conducted examining referrals with respect to different phases of Covid-19 and application of public health restrictions.

Results

1,385 referrals to PLP were received over the 5-year study time-period. There was a significant decrease in PLP referrals immediately post Covid-19, following a significant and sustained increase as the pandemic progressed. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals received. There was no effect of restrictions on other clinical profiles.

Conclusion

Increased referrals for youth with mental health difficulties, reported during the Covid-19 pandemic, persisted into the early endemic stage, after Covid-19 public health restriction have ceased. Potential impacts of restrictions on referrals of youth with suicidal ideation require further study. Investment in child and adolescent mental health services remain a priority, and future pandemic responses need to examine unintended consequences of any enforced public health measure.
IRAMP: Investigation of Risk Assessment and Management Processes Using Staff Focus Groups
Authors: Sunderland Kay , Drysdale Emma , Gillatt Brian , Mackenzie Alan , McCahon Paula
Published: August 2024

Aims

To investigate risk assessment and management processes across a health board in the context of the implementation of a new risk screening tool and policy through use of staff focus groups to identify how teams make decisions related to risk and gain an understanding of how the new CRAFT tool is used.

In mental health services, risk assessment and management are key responsibilities for clinical staff. A risk management tool that is structured and evidence-based aims to assist staff in managing risks including violence, self-harm, suicide and self-neglect.

It is not clear whether risk tools have clinical utility in influencing risk-related decision making and previous reviews within the health board indicated that risk policy was not being adhered to, prompting a review of the policy. Furthermore, policy recommends service user and carer collaboration with staff in all areas of mental health in Scotland but despite these recommendations there is little evidence to suggest they are routinely involved in risk assessment and management processes.

The present study is an opportunity to explore how teams think about and discuss risk management.

Methods

A qualitative analysis was carried out of data from two staff focus groups. These groups were identified by contacting interested teams by email. Groups comprised clinical staff from different disciplines within the MDT including medical and nursing staff. Staff were questioned about their understanding of risk, thoughts regarding risk assessment and their experience of being trained in and using the CRAFT tool.

Results

Themes emerging from the data indicate that staff felt the CRAFT had limited clinical utility or impact on their assessment of risk but may prove useful for communicating decisions about risk between staff and services. However, concerns were raised that the format of the tool made it difficult to complete and read, meaning that important information may not be adequately communicated. Staff reported feeling inadequately trained in the use of the CRAFT tool and felt there were inconsistencies in its use across the health board.

Conclusion

Staff focus groups have identified challenges with the completion of the current CRAFT tool and expressed a need for better training in order to improve consistency of use across the health board. An update to the tool is due to be rolled out across the board in an effort to address these issues and improve risk assessment completion on the whole.
Assault Profile and Psychiatric Morbidity in Children With Sexual Abuse: A Community Based Cross- Sectional Study From an Urban Law-Enforcement Centre in India
Authors: Thatavarthi Lakshmi Keerthana , S Sireesha , M Aparna
Published: August 2024

Aims

The extent and nature of child sexual abuse (CSA) and its consequences with respect to psychiatric morbidity is still poorly described in children. This was a community based cross sectional study to describe the social demographic profile and identify psychiatric morbidity in children with CSA and to further examine the association between the sexual assault profile and the psychiatric illness present.

Methods

This study includes 100 children aged between 6–17 years ascertained as sexually abused at the time. The setting was BHAROSA centre, which is a society for protection of women and at-risk children with funding from the Department of Women and Child Development Telangana state, India. Simple random sampling was used to choose the participants and a pre-tested semi structured questionnaire was used to assess the sexual assault profile. The Developmental Psychopathology Checklist (DPCL) which is the Indian adaptation of Child behaviour checklist was used to understand the associated psychopathology. The prevalence of psychiatric morbidity was discerned by the Diagnostic Statistical Manual Text Revision (DSM V-TR).

Results

The average age for the first CSA encounter was 10.87 years. Most often the perpetrator was found to be an acquaintance (66%) of the child's family. ‘Vaginal/anal penetration’ (55%) was the most common form of abuse. In half of the cases there was a significant delay of two days-two weeks between the last episode of abuse and its discovery. 12% attributed themselves fully responsible for the abuse. 23% reported unsupportive reactions from the caregivers such as being dismissed or being blamed themselves for the abuse. More than half (53%) had at least one psychiatric disorder with post-traumatic stress disorder (PTSD) being the most common (28%) followed by conduct disorder (21%) and depression (17%). 28% had quasi psychotic symptoms and 25% non-specific somatic symptoms. 12% reported suicidal thoughts/ideation. 5 children tested positive for HIV and 2 were pregnant. Children who experienced ‘Vaginal/Anal penetration’ and those who pretended the act did not take place were found to have statistically significant rates of depression, PTSD and suicidality.

Conclusion

All children and adolescents who have been sexually abused must be evaluated for psychiatric morbidity regardless of their social demographic and abuse profiles. Additionally, all parents and caregivers should be sensitised on the fact that the majority of the perpetrators are acquaintances to the subjects. Coping strategies of the children especially self-blame and poor social support exert direct negative effects on victims’ adjustment.
Time From Referral to Discharge From High Secure Care: Challenges for Flow Through the Forensic Estate
Authors: Third Gavin , Rees Cheryl , Thomson Lindsay , McIntosh Lindsay Gilling
Published: August 2024

Aims

The Independent Forensic Mental Health Review (Scottish Government, 2021) highlighted an issue with timely transitions through and out of Scottish forensic inpatient services. Concerns were raised regarding the impact of transfer and discharge delays upon patients. As part of a wider service evaluation examining the pathways forensic mental health patients navigated through secure inpatient care, this study aimed to identify the requirements, processes and time-frames involved in transfer from The State Hospital (TSH), which provides male only, high secure care to Scotland and Northern Ireland.

Methods

Data for 69 patients noted on TSH transfer list (2017–2019) were collected. In addition to patient demographic, clinical and forensic variables, data was gathered about use of appeals against excessive security under section 264 and 265 of the Mental Health (Care and Treatment) (Scotland) Act 2003.

Results

Forty-nine (71.0%) patients were referred to medium secure care, 6 (12.2%) to low secure care and 14 (20.3%) for return to prison. Schizophrenia was the most common primary diagnosis (43, 62.3%), with 75.5% (37) of those referred to medium secure care vs 21.4% (3) returning to prison having received this diagnosis. There were statistically significant associations in terms of time between referral and transfer between individuals who had a primary diagnosis of Schizophrenia/Schizoaffective disorder (no 114, yes 388.5 days; Median) and whether they had lodged a section 264 appeal (no 109.5, yes 469.0 days; Median) or section 265 appeal (no 134.5, yes 517.0 days; Median) against excessive security. There were no significant differences in days from referral to transfer/discharge based on behaviour leading to admission or the number of formal attempts to transfer during current admission. Twenty (40.8%) patients referred to medium secure services made a successful section 265 appeal which resulted in a ruling that they should be transferred within three months. Seven (35%) of these patients were transferred inside three months.

Conclusion

Patients are waiting significantly variable lengths of time from referral to transfer depending on the service they are being referred to. The use of section 264 and 265 appeals against excessive security was implicated in a greatly increased length of time to transfer. Patients considered to have the most serious chronic mental health conditions are waiting the longest time for transfer with potential implications for their mental health. Patients’ human rights are potentially affected due to continuing to be placed in conditions of excessive security for more than a year following decision to refer.