bluuebunny/crossref_metadata_2025 huggingface dataset:
A cross-sectional study exploring attitudes of first year medical students towards psychiatry and factors they identified that would help stimulate their interest
Authors: Mark Isabel , De Las Heras Victoria Fernandez Garcia
Published: June 2021

Aims

Psychiatry has had long standing recruitment difficulties. Many efforts have been made to explore strategies that encourage interest in the specialty, with early university experience being an important factor in ultimate career choice. The Royal College of Psychiatrists ‘Choose Psychiatry’ guidance for medical schools outlines four key areas of focus: teaching excellence, placement quality, leadership and enrichment activities, with other research reporting similar conclusions. The aim of this study was to assess attitudes towards psychiatry amongst first year medical students, examine what input they would welcome from psychiatrists at this stage of their career and consider if their wishes are in keeping with the ‘Choose Psychiatry’ guidance.

Method

All first-year medical students at St George's University of London were approached in October 2019 and offered the opportunity for early psychiatry exposure. 60 students were recruited. Data were collected in November 2019 via an online questionnaire comprising of baseline demographics, the 30-item Attitudes Towards Psychiatry questionnaire (ATP-30) and a free-text question asking what students would like from psychiatry at this stage of their education. Quantitative data were analysed using Excel, whilst qualitative data were analysed thematically.

Result

The mean ATP-30 score was 113.83 (SD 12.57, range 70-135). Gender, ethnicity and religious background were not associated with a change in ATP score. Undergraduates’ attitudes were more positive than those of postgraduates (independent t-test revealed a p-value of 0.087). Seven themes were identified outlining what students wanted from psychiatry, the most prominent being: (a) learning about the lifestyle of a psychiatrist and finding a role model, (b) exploring the patient perspective, (c) exploring the interaction between psychiatry and specialities and (d) having an opportunity to develop communication skills.

Conclusion

The findings demonstrate higher ATP-30 results than previous literature has reported, potentially due to mental health awareness campaigns in recent years. As undergraduates were found to have a higher mean score, targeting them for additional psychiatry contact may be beneficial. Themes identified by students in this study support ‘Choose Psychiatry’ guidance, whilst also highlighting the potential for combining some psychiatry with other specialties in the curriculum. Integration with communication skills teaching might help engage those not initially psychiatry-inclined. Further study will be required to establish whether implementing the suggested strategies can lead to improvement in student ATP-30 scores and ultimately increased recruitment rates.
Psychoeducation for the Frontline: Ealing Liaison Psychiatry Service (ELPS) pilot training day for London Ambulance Service (LAS)
Authors: McLean Emma , Alexander Mariam
Published: June 2021

Aims

To host the first ELPS training day specifically for LAS staff to improve their knowledge and understanding about mental health issues and the role of ELPS.

On average 13,000 calls are received by LAS relating to mental health issues every month. Many patients seen by ELPS will have multiple interactions with LAS. ELPS has previously held training for the Emergency Department team but this innovative day was designed to extend this training commitment to pre-hospital clinicians

Method

LAS training needs were initially assessed by a bespoke questionnaire and ELPS attending another LAS training event held by the new mental health joint response car team.

We then developed a training programme to match the identified training needs and which utilised the specific expertise of individual ELPS staff.

14 members of the local LAS stations attended including both Paramedics and Emergency Ambulance Clinicians. The presentations covered mental state examination, suicide, risk assessment, substance misuse, legal frameworks and then a ‘challenging cases’ session to bring it all together.

Pre and post course questionnaires were completed by participants, exploring attitudes and knowledge.

Result

There was a statistically significant improvement in the average self-ratings for all of the categories assessed including attitudes to mental health, confidence in assessment and knowledge relating to the process the patient will experience in the emergency department.

The knowledge about the pathway and role of liaison psychiatry showed the greatest improvement with an average 4.25 increase in pre and post course rating.

Almost all participants (9.2/10) would recommend this training day to a colleague

Conclusion

We met our objective of improving LAS staff knowledge and understanding about mental health issues and the role of ELPS. We plan to build on this successful pilot and expand our training programme for LAS with the ultimate aim of improving patient care.
Peer mentoring in psychiatry: a trainee-led initiative
Authors: Moore Zoe , Irwin Linda , Brown Stuart , Anderson Julie , Moore Stephen
Published: June 2021

Aims

Our aim was to establish a Peer Mentoring Network within Psychiatry Training in Northern Ireland.

Recognising that starting a new job can be a stressful time in any junior doctor's career, we wanted to ensure that new Core Trainees (CT1s) joining our Specialty Programme were well supported through this transition.

Although Clinical and Educational Supervision is well established in providing a support structure for trainees, we believed that a peer mentoring relationship, (with allocation of a Higher Psychiatry Trainee as mentor), would be of additional benefit.

It was hoped that the scheme would prove mutually beneficial to both mentee and mentor.

Method

We delivered a presentation at CT1 induction and sent out follow-up emails to encourage participation. Higher trainees were also sent information via email and asked to complete a basic application form if interested in becoming a mentor. Prospective mentors then attended a one-day training session.

Two lead mentors, (also higher trainees), were allocated to oversee the scheme, with additional supervision from two lead Consultants. Mentor-Mentee matches were made based on information such as location, sub-specialty affiliations and outside interests.

Matched pairs were advised about the intended frequency and nature of contacts. Check-in emails were sent halfway through the year and feedback evaluations completed at the end.

Result

95% of trainees who completed the evaluations said they would recommend the scheme to colleagues.

Mentees reported benefits in terms of personal and professional development, whilst mentors reported improved listening, coaching, and supervisory skills.

A small number of trainees highlighted that 6 monthly rotations impacted on ability to maintain face to face contacts.

Recruitment and engagement have improved annually. We are currently running the third year of the scheme and have achieved 100% uptake amongst CT1s and are over-subscribed with mentors, (19 mentors to 13 mentees).

Conclusion

The majority of feedback received has been positive and interest in the scheme continues to grow.

Potential issues relating to location of postings has been overcome, at least in part, by recent changes to ways of working and the use of alternative forms of contact, such as video calling.

Having exceeded demand in terms of mentor recruitment, we hope to extend the scheme to include trainees of other grades, and particularly those who are new to Northern Ireland.

We are excited to see where the next stage of our journey takes us and hope that others will be inspired to embark on similar schemes within their areas of work.
Quantitative and qualitative analysis of feedback from The Psychiatry Teaching Programme for Foundation Year doctors rotating through Pennine acute trust from 2010 to 2020
Authors: Namuddu Angel , Gani Margaret , Burlinson Sarah
Published: June 2021

Aims

To monitor the year on year trend of feedback scores regarding content, presentation and relevance of sessions delivered as part of the programme by analysing the average Likert scales. To review the confidence post topic from FY feedback. To review qualitative data on the written feedback annually using a word cloud.

Method

Collated data from teaching programme from the various teaching sessions from the past decade and analysed previous teaching reports completed by previous ST leads.

Result

Finding: Relevance: Improvement in the average score year on year, highest in 2018/19 at 4.8/5

Content: Improvement in the average score year on year, highest in 2018/19 at 4.6/5.

Delivery: Improvement in the average score year on year, highest in 2018/19 at 4.6/5.

Qualitative analysis showed that the common themes that were commented on as positives for the session were: interactive, relevant and interesting, for areas for improvements the common themes were: more interaction, split into shorter sessions, faster pace and the need practical advice

Conclusion

Recommendations: teaching for FYs should aim to be interactive, relevant and interesting and include practical advice, be shorter and faster paced. Teaching programme organisers to contine to use the foundation year feedback to improve the teaching programme including advising future trainees and organising different topics.
Demystifying the pathway of assessment and treatment for bipolar disorder – utilising co-production and algorithms to personalise the approach
Authors: Nicholls-Mindlin Jessica , McLellan Angus , Gee David , Fuzi Lauren , Taylor Matthew , Quested Digby
Published: June 2021

Aims

To develop an evidence based, patient centred treatment pathway for people experiencing symptoms of bipolar disorder (BD), modifiable to include local resources.

Method

This project was developed in line with current approaches to service development such as coproduction, with patient and public involvement (PPI) and enhancing personalisation of treatment in medicine. As part of a local initiative, a multi-disciplinary team was brought together to understand and analyse the current local pathway for those affected by BD. It was found that the approach to assessment and management was not consistent between locality teams. Two experts by experience who have a diagnosis of BD were invited to become involved with the development of the pathway. Meetings were set up to enable coproduction and elicit information from those with the diagnosis. The responses provided insight into the effectiveness of different approaches used nationally to inform the methods and resources that are most helpful and appropriate to comprehensively support those with the illness.

NICE guideline evidence was used to create two algorithms to streamline the care of those with BD in both primary and secondary care. These algorithms include pharmacological, psychological and social approaches. It also considers the junctions at which referrals should be made and the criteria on which decisions are based.

Result

One algorithm was designed for use in primary care and will be distributed to local GPs to clarify the initial steps for assessment and management of BD and the criteria for referral. A second decision tree will be made available to all doctors working in mental health services with detailed medication options, when they are appropriate and whether additional psychological intervention should be considered e.g. post-discharge groups. Other specialist options such as Early Intervention for Psychosis and Perinatal Mental Health Services were also included. An information pack was created to be offered to all those with a diagnosis or possible diagnosis of BD. This contains useful resources such as skills and exercises that patients may find of benefit, external resources and websites regarding additional support and further information on BD, its nature and management.

Conclusion

The approach and resources collated here will help to streamline the management of those with bipolar disorder whilst also ensuring a more consistent approach. The involvement of experts by experience and the incorporation of NICE guidelines ensures a well-rounded and comprehensive set of documents that will be helpful to both clinicians and patients.
An audit on prescribing practice and risk of serotonin syndrome among patients with chronic pain
Authors: Rai Salakan , Yusof Aizad
Published: June 2021

Aims

To determine the incidence of prescribing practice with associated risk of serotonin toxicity among patients with chronic pain conditions.

Background

Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity, usually from drug interactions. Concurrent use of antidepressants is strongly linked to serotonin syndrome, with recent data revealing record numbers of NHS prescribed antidepressants in 2019. Antidepressant medications are also used in chronic pain management for their anti-neuropathic pain properties. However, it is well-recognised that a significant number of chronic pain patients suffer from anxiety and depression. This cohort of patients is therefore vulnerable to being exposed to multiple concurrent antidepressant agents, and thus at relatively higher risk of serotonin syndrome compared to other patient groups. Additionally, these patients are likely to be exposed to the concurrent use of antidepressants and certain analgesic agents particularly phenylpiperidine derivatives which increases serotonin toxicity risk.

Method

Medications of patients presenting to a secondary care pain clinic within the last year were looked into. Patients were selected at random by pain management secretaries. Concurrent use of multiple antidepressant agents including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Noradrenaline Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) or Tetracyclic Antidepressant (TeCA) was noted. Additionally, concurrent use of any of these antidepressant agents and phenylpiperidine derivatives such as Fentanyl and Tramadol was noted.

Result

Data on medications of 97 patients were collected. A total of 28 patients (28.8%) were observed to have at-risk medication combinations. Out of these, five patients were on both SSRI and TCA. Two patients were on both TCA and TeCA. Four other patients were on either a combination of SSRI and SNRI, SNRI and TCA, SSRI and TeCA, or TCA and TCA. Three patients were on both Fentanyl patches and an antidepressant. Fourteen patients were on both an antidepressant and Tramadol. None of these patients were diagnosed with serotonin syndrome; however, it is unclear as to whether these patients experienced milder symptoms of the syndrome.

Conclusion

A considerable number of patients in this group were on medication combinations putting them at risk of serotonin syndrome. Despite no documented patient harm, there is an urgent need for an increased awareness among prescribers on drug interactions which may lead to this syndrome and a subsequent change in prescribing practice.
Bedside teaching: an invaluable tool in undergraduate medical education
Authors: Ruddock Kenneth
Published: June 2021

Aims

Bedside teaching is one of the most important modalities in medical education. Sir William Osler stated, “Medicine is learned by the bedside and not in the classroom”. Despite this, the use of bedside teaching in the undergraduate curriculum has been declining, potentially due to changes in course design, increasing clinical workloads and reducing inpatient numbers. In my role as a Clinical Teaching Fellow (CTF), I have aimed to maximise bedside teaching and promote it as the primary approach for student learning.

Method

As a CTF, I deliver teaching to students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. Weekly teaching is provided to groups of 2-4 students, with around 50% of sessions delivered ‘at the bedside’.

Within psychiatry, there is a vast range of potential bedside teaching topics. Given the length of time required to conduct a full psychiatric history and mental state examination (MSE), teaching sessions instead focus on one specific component of the patient interview, for example, assessing perceptual abnormalities or delusions, conducting a substance use history or exploring social circumstances and the functional impact of illness. This approach allows for more focussed feedback and teaching. Session structure is based upon Cox's model of bedside teaching, which I have modified slightly for the psychiatry setting.

Student feedback has been collected via an anonymous electronic end-of-block questionnaire.

Result

Qualitative feedback reveals that students in NHS Lanarkshire value bedside teaching, with one student describing it as “informative, comprehensive and relevant for upcoming exams and clinical practice”.

There are a number of potential barriers to consider when delivering bedside teaching in psychiatry. These include issues identifying suitable patients who can provide informed consent to participate and the ethical concerns regarding exploring difficult subjects such as suicide risk assessment with patients for purely educational purposes.

These issues can be overcome; in inpatient units, there is usually a small cohort of patients who are able to consent and engage in student teaching, and difficult subjects can alternatively be addressed during role-play or simulation sessions.

Conclusion

Despite its challenges, bedside teaching can be an enjoyable and rewarding approach in undergraduate medical education, with feedback revealing it is positively received in NHS Lanarkshire. By utilising Cox's model and focussing on specific aspects of MSE and history-taking, bedside teaching is more accessible and an invaluable tool for psychiatric teaching. Clinicians and educators are encouraged to keep the patient at the centre of student learning.
GMC training survey and missing trainees in psychiatry
Authors: Schmidt Martin , Leung Timothy
Published: June 2021

Aims

To investigate the extent of misattributed responses in the General Medical Council (GMC) National Training Surveys (NTS).

Background

As part of its role in quality assurance of medical training, the GMC conducts an annual survey of trainers and trainees. Benchmarking of trusts’ performance is indicated by red flags denoting outlying poor performance. The validity of this depends on the correct attribution of responses to trusts. We have previously found that responses for Foundation Year One (FY1) trainees undertaking psychiatry placements were misattributed to trainees’ affiliated acute trusts (AT), even though the mental health trusts (MHT) were providing the training placements.

Method

Data from the online reporting tool were used to calculate the numbers of FY1, Foundation Year Two (FY2), and General Practice Speciality trainees (GPST) on psychiatry placements attributed to ATs and MHTs in 2019. A range is provided for the data, as results for trusts with one or two trainees are not reported. The data were analysed by training level and the 13 Health Education England (HEE) regions to give a proportion of trainees missing from the MHT data (% missing), an indication of response misattribution.

Result

296-302 FY1s were attributed to MHTs and 114-148 to ATs, giving a % missing of 27.4-33.3%. 261-275 FY2s were attributed to MHTs and 89-125 to ATs, giving a % missing of 24.4-30.0%. 507-511 GPSTs were attributed to MHTs and 49-73 to ATs, giving a % missing of 8.8-12.6%.

Across the three training levels, all HEE regions were affected by data misattribution. The regions most affected were South London, Kent Surrey Sussex, and North West London, with missing % of 51.6-54.3%, 33.9-40.7% and 29.9-32.5% respectively. The HEE regions least affected were East Midlands, North Central and East London, and East of England, with missing % of 4.3-6.0%, 5.6-8.1% and 5.5-10.4% respectively.

Conclusion

Response misattribution for psychiatry placements in the NTS is rife, with the greatest impact on FY1s. While this issue affects all HEE regions, wide variation exists. Response misattribution means that the calculation of outliers is based on incomplete data, threatening the validity of the results. By liaising with our local HEE office to ensure correct attribution of our trainees, Surrey and Borders Partnership NHS Foundation Trust reduced our % missing from 50.0-56.8% in 2018 to 5.4-10.1% in 2019, thus proving that it is possible to remedy the situation on a local level.
Core Trainees' study budget and study leave: a survey exploring trainees' needs and understanding of local processes in place within the North West
Authors: Shroff Chirag
Published: June 2021

Aims

Health Education England launched a new system for study leave and study budget on 1st April 2018, in response to trainees' concerns regarding the previous system. According to this, Health Education England would manage the study leave budget through its local offices, making the process of accessing study ‘more transparent, equitable and streamlined' for all trainees. At the RAP Oversight Committee meeting of the North West Deanery in 2019, trainees' uncertainties over the process was discussed by the local reps. It was aimed that there was a need to gather information on trainees' needs and understanding of local processes in place by the deanery to access study leave and study budget

Method

A cross sectional survey was sent out to all the trainees by the Core Trainees year 1 RAP rep. A total of 6 relevant questions were designed and sent out to the trainees, allowing them 2 weeks’ time to respond. There were a total of 66 trainees who were sent the survey. The guidance mentioned in the 2016 Gold guide was used for reference to ensure the questions are relevant.

Result

Of the total of 66 trainees who were sent the survey, there were 48 respondents. The results indicated that all 48 responders preferred study budget and leave process explained at induction. 47 of 48 respnders sought access to their study budget, 46 of 48 responders sought use of budget for external course and exam fees fudning, 27 of the 48 responders struggled to get study leave and 27 of 48 responders felt the current leave process was not satisfactory with 14 opining that there was scope for improvemement.

Conclusion

The responses were collated by the trainee rep as a PowerPoint presentation containing graphical representation of trainees’ views regarding their study leaves and budget access. The survey results were made aware to the local board at the subsequent RAP Oversight Committee meeting to seek response and new guidance. There is a new system in place for study leave and study budgets, overseen by Health Education England. Overall, the survery attempted to understand and collate trainees' wants and needs, in effect improving trainee experiences.
‘What is psychiatry?’ – an exploration of the effect of a psychiatry summer school on school students’ attitudes towards psychiatry, through the medium of word clouds
Authors: Wyke Clementine , Jones Charlotte Wilson , Chivers James
Published: June 2021

Aims

To explore if attending a psychiatry summer school would change the understanding of school students as to what the word ‘Psychiatry’ represents.

Background

The Institute of Psychiatry, Psychology and Neuroscience (IoPPN) and the local mental health trust, South London and Maudsley NHS Foundation Trust (SLaM) ran a free five-day summer school for 16-year-old school students, who had just completed their GCSE exams, from state and private secondary schools within South-East London.

Method

We asked all 26 student attendees to anonymously write down as many single words relating to ‘Psychiatry’ as they could think of. They were given approximately 5 minutes to complete this and they were asked to do this at the beginning of the first day and at the end of the final day of the summer school. These words were then transcribed with the number of times each word was submitted being documented. This information was then formatted into a word cloud, with the size of the word varying according to how many times it had been submitted.

Result

At the start of the summer school, the students submitted a total of 208 words which included a total of 94 distinct words. Of these, the 2 most common were brain (n = 15) and mental (n = 10). At the end of the summer school, the students submitted a total of 199 words which included a total of 100 distinct words. The 2 most common were psychosis (n = 12) and forensic (n = 8). Of the words submitted pre-summer school, there were 8 distinct words that described positive attributes of psychiatry – such as ‘helping’. This increased to 17 distinct positive words post-summer school.

Conclusion

We note from our outcomes that the number of words submitted by the students pre and post the summer school were similar but the words submitted most frequently differed. The most common words submitted post the summer school were more consistent with medical terminology than those submitted pre the summer school, which suggests that their knowledge of this had increased. The increase in the number of distinct positive words submitted at the end of the summer school implies that the students had a more positive view of psychiatry following the summer school.
Collaborative development of course feedback with students for Psyched Up. Put more in, get more out
Authors: Zac-Williams Lois , Cannon Alistair , Saunders Chloe , Zhang Shuo , Kohara Sae
Published: June 2021

Aims

To develop a responsive and sustainable template for long-term course evaluation for PsychED Up

To obtain rich, meaningful and specific feedback across multiple domains which can be translated into course improvements

To work collaboratively with students interested in medical education having previously participated in the course

To empower current students with the knowledge that their input is valuable

Background

PsychED Up is an innovative extra-curricular course for 3rd year medical students at King's College London delivered by psychiatry trainees, senior students and actors. It is in its second year of running and focuses on the hidden curriculum in medicine, exploration of holistic care and communication skills at the mind-body interface. Input from people with lived experience is used to shape teaching.

Method

Embedded evaluation in course development sessions thus engaging the entire faculty in evaluation processes at the start of the new term

Decided evaluation focus

Face-to-face discussions

Survey for faculty to determine what specific feedback content would be most useful

Finalised the questionnaire

Collaborative design and refinement of questions, confirmed sub-sections and scope of questionnaire

Result

Revised questionnaire:

Included rationale at the start

Tailored questions so faculty have more useful responses

Greater quantity of prompted questions

Specific questions for large group presentation, small group teaching, actors’ performances and students’ reflections

Thoughtful combination of quantitative ratings and open-space questions

Reduced time between course sessions and obtainment of feedback

Quality and quantity of feedback

High response rates: 32/30 (2 duplicates) mid-term, 29/30 end-of-term

High-quality filling of open-space feedback allowed consolidation of themes to improve the course

Conclusion

Co-designing the feedback form with previous students from the course and faculty brought focus to the questions. They were more specific and were organised into sub-sections for different domains. This led to responses that were relevant, enriched with depth and breadth and provided faculty with richer, more personalised responses. More detailed reflections in feedback were thought to be due to better student understanding of the rationale for questions, and knowledge that their input would help improve the course. We have set up a robust system for collecting long-term feedback for PsychED Up. We will continue to make iterative amendments, and supplement questionnaire feedback with focus groups.
Comparison between the efficiency of pharmacotherapy and cognitive behavioral therapy in reducing captagon (fenethylline) dependence and relapse prevention
Authors: Binnwejim Mohammed , Alhumade Atheer , Hosny Deiaaeldin , Alhabib Mohamed
Published: June 2021

Aims

To examine the therapeutic efficacy and effectiveness of cognitive behavior therapy and pharmacotherapy in the treatment of Major Captagon (Fenethylline) Dependence.

Method

A 41 outpatients males selected for the study, diagnosed as they are suffering from Captagon Dependence according to the DSM-5, with mean age 34.58 ± 5.11. The sample was divided into three experimental groups, (A) (N = 14) treated by cognitive behavior therapy (CBT) and pharmacotherapy in combination. (B) (N = 13) treated by CBT alone. (C) (N = 14) treated by pharmacotherapy alone. All groups were assigned to four measurements, one for the baseline before any treatment interventions, one post-treatment evaluation and two for follow-up within a short and long time. Non-parametric statistics were used to analyze the data collected by SPSS.

Result

There is no significant intra-group differences were found in terms of baseline assessment. There was no significant discrepancy between the first and the second group except in the term of reducing Captagon craving, as it was clearer in the first group in comparison with other groups. There was a clear significant discrepancy between the first and third groups, for all the study variables and it is phases of assessment especially follow-up. There was a clear degree of differences among the second and the third group, through the different phases of post-assessment, which refers to the great efficacy and effectiveness of CBT in Treating Captagon Dependence CBT was proved to be more effective than pharmacotherapy in the treatment of Captagon Dependence. The combination of CBT and pharmacotherapy was more effective than each other alone in the treatment of Captagon Dependence and Relapse Prevention.

Conclusion

Available evidence suggests that cognitive–behavioral therapy is an effective intervention method for psychological aspects of automatic thoughts, depression, negative health beliefs, craving, and relapse prevention, although its efficacy in reducing Captagon (Fenethylline) dependence.
The links between the amount of antipsychotic medication prescribed at GP practice level, local demographic factors and medication selection
Authors: Heald Adrian , Stedman Mike , Farman Sanam , Davies Mark , Gadsby Roger , Taylor David
Published: June 2021

Aims

To examine the factors that relate to antipsychotic prescribing in general practices across England and how these relate to cost changes in recent years.

Background

Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses(SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia.

Since 2014 many antipsychotic agents have moved to generic provision. In 2017_18 supplies of certain generic agents were affected by substantial price increases.

Method

The study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care and considered if price change affected agent selection by prescribers.

The NHS in England/Wales publishes each month the prescribing in general practice by BNF code. This was aggregated for the year 2018_19 using Defined Daily doses (DDD) as published by the World Health Organisation Annual Therapeutic Classification (WHO/ATC) and analysed by delivery method and dose level. Cost of each agent year-on-year was determined.

Monthly prescribing in primary care was consolidated over 5 years (2013-2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice.

Result

Description

In 2018_19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. We included 5,750 GP Practices with practice population >3000 and with >30 people on their SMI register.

Effect of price

In 2017_18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018_19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the increase in drug price in 2017/18.

Regression

Demographic factors

The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density(urban), and comorbidities e.g. chronic obstructive pulmonary disease(COPD). Higher %younger and %older populations, northerliness and non-white (Black and Minority Ethnic (BME)) ethnicity were all independently associated with less antipsychotic prescribing.

Prescribing Factors

Higher DDD/general practice population was linked with higher %injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol. Less DDD/population was linked with general practices using higher %risperidone and higher spending/dose of antipsychotic.

Conclusion

Higher levels of antipsychotic prescribing are driven by social factors/comorbidities. The link with depot medication prescriptions, alludes to the way that antipsychotics can induce receptor supersensitivity with consequent dose escalation.
Adjunct pharmacotherapy for psychotherapy
Authors: Lochtenberg Jessica , Kirshenbaum Ari , Johnson Matthew
Published: June 2021

Aims

A variety of pharmacotherapies have been used to assist the psychotherapy process as “adjunctive therapies.” These drugs are used in an acute, targeted fashion, such that they are explicitly delivered in the context of psychotherapy for anxiety, mood and substance-dependence disorders (SUDs). Our narrative review highlights the potential of medically-assisted psychotherapy by outlining the current state of research on few of these medications and describing the basic science that supports their use.

Method

Firstly, we researched an assortment of medications that have been used off-label to enhance psychotherapy, and selected a few that have received the most empirical attention in preclinical and clinical-trial settings. Our review of clinical trials focused on three of the most common psychiatric ailments. For all studies reviewed, we identify the strengths and weaknesses of the data supporting the use of the medications for the three aforementioned disorders.

Result

D-cycloserine: accelerates the process of associative emotional learning, enhancing exposure therapy in the treatment of various anxiety disorders, including obsessive-compulsive disorder and posttraumatic stress disorder. Limited studies are available on efficacy in treating SUDs.

Intranasal oxytocin: accelerates memory retrieval-extinction procedures used in posttraumatic stress disorder, and promotes prosocial cognition and behaviour, facilitating a therapeutic alliance. Sufficiently powered studies and safety studies are required before strong conclusions can be made.

Propranolol: interrupts the reconsolidation of memories (leading to maladaptive learned responses) involved in posttraumatic stress disorder during memory-reactivation therapy sessions, but there is little evidence that this drug can be used for depression or SUDs.

Psychedelics: may effect the brain's default mode network, engendering a transformative experience that is often followed by a reduction in psychiatric symptoms. 3,4-methylenedioxymethamphetamine may additionally modulate the amygdala response in a way that allows for reprocessing of traumatic memories, and improves the therapeutic alliance. Anxiety, mood, and SUDs appear to be positively influence by traditional and non-traditional (ketamine) psychedelics.

Conclusion

Although the efficacy of the medically-assisted psychotherapies reviewed is still under investigation, we propose that these novel treatment approaches may be preferred over traditional psychopharmacological treatments due to the presence of fewer chronic side effects, as well less toxicity and abuse potential. Furthermore, these adjunctive pharmacotherapies may help to reinforce the psychotherapeutic alliance and may ultimately yield better long-term treatment outcomes. If at least some of the adjunctive pharmacotherapies outlined in this review are found to be clinically efficacious and safe, patients will benefit from having more treatment options available to them in the future.
National video consultation service- changing the way we deliver future care
Authors: Ahuja Alka , Johns Gemma , Khalil Sara , Ogonovsky Mike
Published: June 2021

Aims

In March 2020, when the COVID-19 outbreak emerged, Technology Enabled Care (TEC) Cymru went into partnership with the Welsh Government and CWTCH Cymru to offer a safe solution to protect the NHS and the public by developing and rolling-out a National Video Consulting (VC) Service on an All-Wales basis.

The aim was to quickly develop and roll-out an NHS-approved communication platform (Attend Anywhere) to all primary, secondary and community care services, and into care homes, prisons, dentistry, optometry and pharmacy to offer video consultations to patients.

Method

The NHS Wales Video Consulting (VC) Service used a robust mixed methodology of surveys and interviews with patients, families and professionals. The real-time quality improvement approach was invaluable to the team as findings continually informed the approach and direction.

Result

Based upon 10,000 survey responses from patients and professionals, and more than 300 interviews the results demonstrate that video consulting is consistently high in satisfaction, clinical suitability and acceptability across a wide range of patient demographics and clinical specialties in Wales. The key findings are

Very high in patient and clinician satisfaction (slightly higher in patients).

Clinically suitable across a wide range of specialties, care sectors and Health Boards.

Very high in patient and clinician satisfaction (slightly higher in patients).

High acceptability of VC, which is believed to be associated to the ‘Welsh Way’ of digital implementation processes.

Consistent data patterns across patient demographics (age, gender, urban/rural location).

Consistent data patterns across clinical settings and Health Boards.

Conclusion

There is large appetite for VC in Wales, with high potential of sustainability and long-term use beyond COVID-19. The service is now working with clinicians, patients, carers and policy makers to explore the long-term use and sustainability of video consultations in Wales
A quality improvement project to increase patient feedback in the psychotherapy department, Tavistock Clinic
Authors: Almyroudi Avgoustina , Baban Alan , Sidhu Sukhjit
Published: June 2021

Aims

A rigorous and systematic patient feedback system is important for identifying gaps, improving the quality of care and encouraging patient involvement in service delivery. In the Adult Complex Needs Service of the Tavistock Clinic, a tertiary psychotherapy centre, only 5% of patients have provided feedback when requested. This Quality Improvement (QI) project aimed at improving the return rates of the Experience of Service Questionnaire (ESQ) and the CORE Outcome Measure by 10% within a year.

Method

The QI methodology was used to help identify factors contributing to the low response rate, including views amongst stuff about how such feedback, and the method of its delivery, might affect a psychoanalytically-informed treatment. Previously these forms were posted or handed out in person. In the first Plan-Do-Study-Act (PDSA) cycle, the method of distribution was changed by sending out the questionnaires to patients electronically, using an online survey platform. In the second PDSA cycle, the CORE-34 questionnaire was replaced with a shorter version, the CORE-10. This was in order to test our hypothesis that a shorter questionnaire would result in an increase in the response rates.

Result

In the first cycle of change, 197 patients were emailed for both the CORE-34 and ESQ and a total return rate of 31% was achieved. This signified an increase of 26% in the response rate. Overall more ESQ forms were completed (35% uptake) compared to CORE-34 forms (28% uptake). In the second cycle 199 patients were emailed with the CORE-10 and ESQ forms. The response rate was 21% and 18% respectively. Although the response rates decreased slightly in the second PDSA cycle the results indicated that this method of distribution was capturing a greater range of patients who had not previously provided the service with this sort of feedback.

Conclusion

Sending out the outcome measures electronically and adopting shorter versions of the CORE questionnaire increased the feedback response rate significantly, and provided the service with useful data as to patients' experience of their treatment journey here.
Audit of baseline cardiometabolic monitoring for patients prescribed or advised dose increase of antipsychotic medication by the knowsley assessment team
Authors: Behera Debakanta , Metcalf Joanna , Adnan Aaliya
Published: June 2021

Aims

To ascertain whether baseline monitoring of cardiometabolic health parameters was undertaken for patients prescribed dose increases of, antipsychotic medications in an outpatient setting. Whether results from baseline tests were taken into consideration when prescribing antipsychotic medications.

Background

People with Severe Mental Illness have a reduction in life expectancy of 15-20 years. Chief factors implicated in this rate are smoking, obesity, metabolic dysfunction from diabetes, hypertension and stroke. Antipsychotic medications themselves are associated with increased risk of adverse cardiometabolic effects. The CATIE Study of patients prescribed atypical antipsychotics found that men were 85%, and women 137% more likely to have metabolic syndrome than control. Relative risk for type 2 diabetes and CHD in patients with metabolic syndrome is 1.5-5 times that of the general population.

Method

The Team caseload was accessed between the 6/11/18-13/11/18. Chronologically the first 40 patients on the list who had been prescribed an antipsychotic or advised re a dose increase of antipsychotic chosen. Data were then retrospectively collected from informatics and progress notes, document uploads, initial assessments and the ICE bloods system to populate an excel spreadsheet which is currently in use within North West Boroughs.

Result

Of the 40 patients, 50% (20) attended for physical health review. All who did not attend initial appointment were offered a second appointment. 15% (6) did not attend 2 appointments. 35% (14) were not offered a physical health appointment. 1 patient had BP documented (from full physical review during previous episode within 12 m). 2 patients had BMI documented; Smoking, alcohol and drug use status was documented in 42.5%(17), 57.5%(23) and 67.5%(27) of patients, respectively. And 67.5% (27) of patients had an HbA1c result within past 12 months on ICE and 62.5% (25) had lipid profile. At least 10 of these bloods were not requested by our team. 7 patients were given a blood form but did not have bloods done. 57% (4 of 7) abnormal HbA1c's were acknowledged and 20% (1 of 5) lipid profiles.

Conclusion

This audit demonstrates that baseline cardiometabolic monitoring could be improved for patients under the Assessment Team who are prescribed antipsychotics. Only half of the audited patients had had a physical health review, despite being prescribed, or their GP being advised regarding an increase in dose of, antipsychotic medication. It is important to note that 15% of patients were offered but failed to attend an appointment for physical health review.
Hospital Anticipatory Care Planning for Inpatients of Organic Old Age Psychiatry Wards (NHS Lanarkshire)
Authors: Brennan Sarah , Routh Rajdeep
Published: June 2021

Aims

To improve practice of Hospital Anticipatory Care Planning for inpatients of Organic Old Age Psychiatry wards in NHS Lanarkshire.

Background

Hospital Anticipatory Care Plans (HACPs) are important components of care for inpatients with progressive and life-limiting conditions. HACPs provide guidance on treatment escalation and limitation for individual patients, in the event that they become acutely unwell. In the Old Age Psychiatry Department at NHS Lanarkshire, HACP standards are as follows:

HACP forms should be completed within 2 weeks of admission

HACP information leaflets should be provided to relatives/carers

HACPs should be discussed with relatives/carers

If a patient without an HACP becomes acutely unwell, an HACP should be made, and the responsible Consultant informed

HACP should be discussed within the multi-disciplinary team (MDT)

HACPs should be regularly reviewed

HACP and DNACPR forms should be kept at the front of the notes

Superseded HACPs should be marked as obsolete

Method

Inpatient notes were reviewed in October 2019 and compared against the above standards.

The findings were presented at the Clinical Governance Meeting and Old Age Psychiatry Teaching Group in December 2019.

An ‘HACP Checklist’ was also created to prompt good practice.

Inpatient notes were reviewed again in July 2020.

Data from both time periods were compared.

Result

There was an improvement in:

The proportion of patients who had an HACP - from 59% to 96%

The proportion of patients who had an HACP made within 2 weeks of admission - from 35% to 78%

Documentation of HACP discussions with relatives/carers - documented for 77% of patients (from 47%)

Timing of HACP discussions with relatives/carers - took place within 2 weeks for 52% of patients (from 29%)

Documentation of HACP discussion by MDT - documented for 73% of patients (from 29%)

HACP Information Leaflets were only distributed to one patient's relatives/carers across both time points

Medical emergencies for patients with no HACP were infrequent and so comparison could not be made

HACPs were reviewed less frequently in July 2020 than in October 2019

HACP forms and DNACPR forms were always filed appropriately

Superseded HACP forms were always appropriately marked as obsolete

Conclusion

HACP practice mostly improved from October 2019 to July 2020. This may have been due to increased awareness of HACP Standards, following the presentation of initial data to inpatient teams.

A much larger influence, however, was likely to be the COVID-19 pandemic and associated efforts to improve HACP practice throughout the Health Board.