bluuebunny/crossref_metadata_2025 huggingface dataset:
Professional training and case-load mix within a community mental health team
Authors: Walsh Richard , Fahy Rebecca , Abdelgadir Ala , Walsh Elizabeth , Patel Sonn
Published: June 2021

Aims

Community Mental Health Teams (CMHTS) are now the cornerstone of modern mental health care and play a central role in assessment, diagnosis and care coordination. CMHTs vary widely in their service provision and composition. Within teams there is latitude for variation of professional roles but the extent to which different disciplines undertake generic and profession-specific work is poorly defined. This cross-sectional study aims to establish how professional training influences the distribution of case-load mix within a general adult CMHT

Method

The GR1 CMHT provides care to a mixed urban/rural population of 25,000 in Galway city and Connemara. A review was conducted of multi-disciplinary case notes for all patients actively registered with the team for a period of one year. Name, age, gender, whether referred or admitted in the past year, medication and day hospital attendance were recorded. Clinical diagnoses were recorded but, where missing, verified with a relevant team member. The team consultant reviewed and verified the 1CD-10 primary clinical diagnosis for all patients. Evidence of clinical input by multidisciplinary team members was recorded from clinical files with the final electronic database being checked by each professional for accuracy. We examined any input over the past year rather than

frequency of input. Patient characteristics and diagnosis by professional discipline were examined using descriptive statistics.

Result

Of a total of 246 patients registered to the team, 37.8% (N = 93) saw one, 34.6% (N = 85) saw two and 24.4% (N = 60) saw 3 or more team members. Of those who saw three or more team members, psychotic disorders represented the majority diagnoses (40%, N = 24) followed by personality disorders (25%, N = 15) and affective disorders (15%, N = 9). Patients were most commonly seen by a doctor (91.5%, N = 225) followed by community mental health nurses (CMHNs) (52.8%, N = 130). Doctors saw 85% or more of all patients grouped by ICD-10 diagnoses. The majority of social work and occupational therapy case-mix comprised psychotic disorders (SW = 44.2%, OT = 34.2%) followed by personality disorders (SW = 25.6%, OT = 23.7%). Of psychology case-mix, the highest was personality

disorders at 41.6% (N = 13) followed by anxiety and related disorders at 25% (N = 8). CMHN case-mix was highest for psychotic disorders at 44.6% (N = 58) followed by 21.5% mood disorders (N = 28).

Conclusion

This cross sectional survey informs how we currently target our specialist resources. We will now develop this to include frequency of contact to inform resource allocation and skill mix.
GP Trainees' perceptions and experiences of the training placement in Psychiatry - A qualitative study
Authors: Ahmed Raja Adnan , Saeed Rugiyya , Tombs Michal
Published: June 2021

Aims

This qualitative study aims to explore the leaning needs of the GP trainees for their psychiatry placements.

Method

In this qualitative study, semi-structured interviews of eight former GP trainees were conducted. Data were transcribed and analysed using thematic analysis. Triangulation through multiple analysts” was used to improve the validity of the study

Result

This study identified six key areas of learning needs for GP trainees during their psychiatry placement. i) the on-call experience which enabled the participants to learn how to manage acutely unwell patients in psychiatry, ii) learning the self-harm and suicidal risk assessment which is an important skill for a GP practising in primary care, iii) training in relation to psychiatric medication which enabled GPs to prescribe more confidently in the community, iv) exposure to the community psychiatry which was helpful in getting exposure to community-based clinical practice, v) learning from formal teaching activities which can be tailored to cover the relevant primary care related clinical topics and finally, vi) getting the opportunity to improve the communications skills during the psychiatry placement which is useful for all doctor in training.

Conclusion

We recommend that detailed induction of the service setup is required before GP trainees start on-calls and a well-defined support network should be provided and explained to the training doctors. Risk assessment teaching should be delivered by formal training, regular supervision and discussions. Training on psychiatric medication especially in the context of GP prescribing should be considered as part of formal teaching experience. Opportunities to work with community mental health teams and outpatient clinics should be generated and offered to the trainees. Formal teaching sessions should be set up with an understanding of the GP training curriculum and their learning needs. Improvement of communications skills with exposure to difficult communication scenarios under supervision during psychiatric placement should be identified as an important area of learning for the GP trainees.
Psychological impact of COVID-19 pandemic on frontline health care workers in Bangladesh: A cross-sectional study
Authors: Ahmed Suman , Ahsan Mohammad Shamsul , Khan Rubaiya , Hasan Mahbubul , Ferdous Fahmida , Shahjahan Humayra , Hossain Murin , Kar Ananya , Hossain Kamrul
Published: June 2021

Aims

Frontline health care workers exposed to COVID-19 patients could be at increased risk of developing psychological issues. The study aimed to estimate the prevalence of mental health-related problems, specifically depression, anxiety, post-traumatic stress disorder (PTSD), and insomnia among health care professionals during the COVID-19 pandemic in Bangladesh and to compare these between medical and allied health care professionals.

Method

This cross-sectional survey was conducted using Google Form then subsequent telephone interview between June and August 2020. Using random sampling, a total of 479 health care professionals participated in the study. We collected data on demographics. Anxiety and depression were measured using 4 items Patient Health Questionnaire-4 (PHQ-4), PTSD was measured using 4 items Primary Care (PC)-PTSD-Screen, and insomnia was measured by using a 7-item Insomnia Severity Index (ISI). A multivariable logistic regression analysis was performed to assess risk factors associated with mental health symptoms.

Result

Overall, 17.6% of frontline health workers had symptoms of anxiety, 15.5% had depression symptoms, 7.6% had PTSD symptoms and 5.9% had symptoms of insomnia. Compared to allied health professionals (n = 113, 24%), doctors (n = 366, 76%) had significantly higher prevalence of anxiety: 21.1% vs 06%, (OR = 4.19; 95% CI = 1.88–9.35; p-value <0.001); depression: 18% vs 6.8%, (OR = 2.99; 95% CI = 1.40–6.42; p-value 0.005); PTSD: 9.4% vs 1.7%, (OR = 5.96; 95% CI = 1.41–25.11; p-value 0.015) and insomnia: 7.4% vs 0.9%, (OR = 9.22; 95% CI = 1.24–68.4; p-value 0.03). Logistic regression analysis showed that pre-existing medical illness has significantly more risks of developing symptoms of anxiety (adjusted OR = 2.85; 95% CI = 1.71–4.76; p-value <0.001) and depression (OR = 2.29; 95% CI = 1.39–3.77; p-value 0.001). Having a postgraduate degree (adjusted OR = 6.13; 95% CI = 1.28–29.28; p-value 0.023) and working in secondary care setting (adjusted OR = 3.08; 95% CI = 1.18–8.02; p value 0.021) have significant predictors of developing anxiety symptoms among health workers. Those who had worked more than 6 weeks in COVID-19 dedicated hospitals had risk of developing symptoms of PSTD (OR = 2.83; 95% CI = 1.35–5.93; p value 0.006) and insomnia (OR = 2.63; 95% CI = 1.15–6.02; p value 0.022).

Conclusion

Our study demonstrated a high prevalence of symptoms of depression, anxiety, PTSD, and insomnia among Bangladeshi frontline health workers (particularly among doctors) during the COVID-19 pandemic. There is an urgent need to address the mental health needs of frontline health workers.

Funding: Medical Research Council, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Preconception interventions and resources for women with serious mental illness: a rapid evidence review
Authors: Atmore Katie , Howard Louise , Easter Abigail
Published: June 2021

Aims

There is little research into evidence-based preconception interventions for women with serious mental illness (SMI). Women with SMI will have specific needs around preconception due to the complexities of the teratogenicity of medications, risk of mental illness relapse and higher levels of stigma around motherhood. If effectively delivered preconception care could mitigate these difficulties and improve outcomes for mother and baby. The aim of this research was therefore to determine to identify and describe studies evaluating preconception interventions for women of child-bearing age who have an existing SMI through searches of the peer-reviewed literature.

Method

A rapid review was conducted to search MEDLINE and PsychINFO databases from the year 2000 onwards for peer-reviewed articles describing preconception interventions/resources delivered prior to a pregnancy to women of child-bearing age with a pre-existing existing serious mental illness (including schizophrenia, bipolar and eating disorders).

Result

A total of 592 results were returned from the searches and 576 of these remained after the removal of duplicates. 11 studies were included in the final narrative synthesis describing the following intervention types: Health warning (1), Health screening (1), Teratogen phone service (2), Psychiatric consultation (5), Family planning information (1) and Peripartum management plan (1). Interventions were delivered in Australia, UK, Italy, Germany, Netherlands, USA and Nigeria.

Conclusion

Though the included studies indicated that some efforts have been made globally to meet the preconception needs of women with SMI the numbers included in the studies tended to be low and reflective of small-scale service provision. Future studies utilising a randomised controlled trial design would lower the risk of bias and provide more generalisable evidence of effectiveness for these interventions. The results of this review were used to inform the development of a number of resources to aid the planning of healthy pregnancies in both women with SMI and the health professionals working with them.
Taking leadership over psychopathogenic environments
Authors: Cockburn Alastair , Morris Jane
Published: June 2021

Aims

Do psychiatrists believe children are growing up in psychopathogenic environments that significantly contribute to mental ill- health? If so, do they feel empowered to change those environments? If not, how can psychiatrists be given a role where they can create meaningful change? Finally, how much responsibility can psychiatry usefully take for changing psychopathogenic environments?

Background

We define psychopathogenic environments as environments that predispose to mental ill-health. It is the psychological environment we live in - including income, the way we interact with others (e.g. social media, bullying), what we do with our free time, pressures at school and expectations of our peers. It is not discrete events (e.g. trauma) and stretches beyond life at home (where many ACE's occur).

Self-harm presentations to medical professionals amongst teenagers are on the rise, Universities report a fivefold increase in disclosure of mental health conditions in the last decade. Here we consider if psychopathogenic environments are part of the cause of these changes.

Method

A 10-item questionnaire distributed to Child and Adolescent Psychiatrists in NHS Lothian, NHS Grampian and Manchester University NHS Trust via a consultant in each Trust.

Result

All 14 respondents said psychopathogenic environments are “very important” contributors to mental ill-health. 13/14 say the environments have got worse in the last 10 years. 13/14 responded negatively about whether psychiatrists could change them. When given white space to tackle the problem they suggested changes were needed from Government including against poverty / inequality, education, public health nudges, more resources, MDT working and better access to leisure facilities. Given specific choices, 11/14 identified influencing Government as a major way forward.

Conclusion

This group of psychiatrists believe psychopathogenic environments are; 1) a very important contributor to mental ill-health 2) getting worse but 3) feel largely powerless to tackle it. It is a problem they think is important and want to engage in, but lack time, resources and struggle with the complexity of the problem. How therefore, can psychiatrist show leadership in this area? The two perspectives to consider how to empower psychiatrists to help create change are 1) how they can influence the environment for individual patients, 2) how they can influence public policy and government to make wider changes.

Is this the job of psychiatrists? Not alone, but as agents they have a unique insight and authority as both a lens for and director of these environments.
Prevalence and correlates of substance use among transgender adults: a systematic narrative review
Authors: Connolly Dean , Gilchrist Gail
Published: June 2021

Aims

To understand the prevalence, patterns and correlates of substance use among transgender adults.

Background

Minority stress theories suggest that the increasing rates of discrimination experienced by transgender people are precipitants of substance use. This is likely exacerbated by an inadequate provision of trans-inclusive substance misuse services. However, the exclusion of transgender people from the general substance misuse literature makes it difficult to determine the extent to which gender minority status influences substance use. A systematic review was undertaken to better understand the prevalence, patterns and correlates of substance use among this group.

Method

In accordance with the PRISMA guidance, a literature search was conducted to 29th May 2019 on PubMed, PsycINFO, EMBASE and Global Health databases. Primary quantitative studies, published in the English language, that reported the prevalence, patterns or correlates/risk factors of substance use by trans people were included, with no restriction on methodological design.

Result

651 unique records were identified by the search and 40 studies were included in the synthesis. While there was some suggestion of excess risk of substance use among trans people, there was insufficient evidence to estimate prevalence or quantify the risk of substance use among transgender people, relative to a cisgender population. However, this review identified several gender minority related correlates of substance use which are of relevance to clinicians working with transgender patients, including transphobic discrimination or violence, unemployment and sex work, gender dysphoria, high visual gender non-conformity and intersectional sexual minority status.

Conclusion

There are currently significant gaps in the trans substance use literature, relating to the disproportionate investigation of transgender women with multiple intersectional disadvantages, who are not representative of the wider trans community. However, there is sufficient evidence to recommend screening for substance use when individuals report high levels of gender minority stress and to consider the use of integrated trauma-informed psychosocial interventions when managing problematic substance use in the transgender adult.
A clinical inventory of moderators of tic severity in Tourette's Syndrome
Authors: Conti Francesca , Tyagi Himanshu
Published: June 2021

Aims

Changes in the severity of tics in Tourette's syndrome (TS), as seen with variations in the intensity or frequency of tics, can be moderated by a variety of independent factors such as external or internal stimuli. Identifying such moderators has important clinical implications as it can aid clinicians in adjusting interventions. Hence, based on our previous review of tic-severity moderators, we developed a clinical inventory of moderating variables for motor and vocal tics for inclusion in the new version of the Queen Square Proforma for Tourette's Syndrome to aid initial assessments in the National Tourette Syndrome Service's Outpatient Clinic for Adults.

Method

A review of tic-severity moderators was previously carried out by the authors to investigate the kinds of moderators and their worsening, improving or neutral effects on tic severity. Based on this a semantic thematic analysis of the identified moderators was carried out and themes were developed based on appropriate and relevant MeSH terms in order to create the categories and items of the clinical inventory.

Result

Seventy-three different tic severity moderators were identified, the most common being exercise, sleep, peer victimisation, psychosocial stress, watching TV, academic activities and distraction. Twenty-nine themes emerged from the thematic analysis which were then used to update the clinical inventory of tic severity moderators. The review also highlighted the subjectivity of these moderators’ effects on tic severity as some moderators were tic-worsening in some individuals and tic-improving or neutral in others, which is contrary to the current dichotomous understanding.

Conclusion

The updated clinical inventory of tic severity moderators invites researchers and clinicians to be more aware of the existence, variability and subjective effects of these tic severity moderators in individuals with TS, as these have been previously looked in a dichotomous way. By better identifying tic-severity moderators and their worsening, improving or neutral effects on tic severity this clinician rated inventory will have potentially important, direct implications for the management and treatment of tics.
Differentiated white blood cell count measures as a predictor of weight in anorexia nervosa
Authors: Cross Benjamin , Cahill Matthew
Published: June 2021

Aims

To explore the relationship between weight, BMI and differentiated white cell count in patients with anorexia nervosa that have commenced refeeding protocols.

Hypotheses:

1. Weight and BMI will be positively correlated with differentiated white blood cell measures.

2. Regression analyses will indicate that differentiated white blood cell measures can predict weight and BMI.

Background

Anorexia nervosa is a serious mental illness with the highest psychiatric mortality rate. It is characterised by an extreme overvaluation of body image and a preoccupation with weight loss that is achieved through calorie restriction, purging or laxative abuse. The eventual malnutrition that is as a result of self-starvation causes significant negative physical sequelae. One such consequence is the detrimental effect that starvation has on the immune system, leading to bone marrow suppression and cytopenias. In obesity, weight loss has been shown to cause reductions in differentiated white blood cell counts, which are often reduced in anorexia. No studies to date have explored whether weight is related to white blood cell count in anorexia, despite being a common finding in patients.

Method

All subjects were inpatients or ex-inpatients on an eating disorder unit in the Wirral, NW England. Subjects were assessed according to an inclusion criterion. 12 consecutive weekly weights, BMIs and differentiated white blood cell measures were collected for analysis in SPSS. Correlational and regression analyses were then performed to examine the relationship between variables.

Result

302 data points from 26 individuals were used in the final analysis. Weight and BMI both moderately positively correlated with white cell count, r = 0.364 p < 0.001 N = 302 and r = 0.521 p < 0.001 N = 302, respectively. Weight and BMI also moderately positively correlated with all differentiated measures of white blood cell count. Linear regression revealed a significant regression equation between weight, BMI and white blood cell count: (F (1,301) = 22.482, p < 0.001) R2 = 0.69 and (F (1,301) = 112.244 p < 0.001) R2 = 0.272, respectively.

Conclusion

We have demonstrated that there is a moderately positive relationship between weight, BMI and differentiated white blood cell measures. Furthermore, in line with our hypotheses, differentiated white blood cell measures have some power to predict weight and BMI. This further implicates the effect that starvation and anorexia nervosa have on the immune system. It also highlights the possibility that it might be possible to use immunological markers in order to deduce whether weights have been falsified by those with anorexia nervosa.
Anxiety levels among health care workers within Irish mental health services during COVID-19: a survey
Authors: Elimam Ibrahim , McCarthy Mary , Cooney Roisin , Dumitrescu Alin
Published: June 2021

Aims

The aim of this survey was to assess any fluctuations in anxiety levels experienced by mental health workers during the COVID-19 pandemic and the association between these changes and variables of information dissemination, risk management, and managerial support.

Method

A survey was created to assess variables of information dissemination, risk management, and managerial support. The GAD-7 was employed as measure for anxiety during and pre the pandemic The survey was conducted online via an anonymised questionnaire and disseminated by management through the heads of various disciplines within the mental health work force, using the local email portal in the Cork region. It was made available for research participation for a period of one month(JULY).

Following this stage, the reported data were analysed utilizing paired samples t-test, Pearson's correlations, and a hierarchical regression. Demographic variables were controlled for during analysis.

Result

102 mental health healthcare workers participated in the survey (81.2% Female, 18.8% Male). The mean GAD-7 total scores for Pre-COVID-19 doubled in the during COVID-19 condition. The largest effect can be seen on the GAD-7 facet of “feeling afraid as if something awful might happen” with pre-COVID-19 GAD-7 mean scores more than quadrupling during COVID-19 conditions.

Managerial support had a moderate negative relationship with GAD-7 scores during the COVID-19 pandemic. Information dissemination total scores also had a moderate positive correlation with managerial support total scores and perceived risk/safety total scores. There was no correlation found between the GAD-7 total scores during COVID-19 pandemic and Information dissemination total scores nor Risk/safety total scores. Childcare was a concern for 64% of staff that it was applicable to; 45% of these staff considered altering work hours; 17% reported issues from management regarding these requests.

Conclusion

Mental health workers have seen a dramatic increase in anxiety since the COVID-19 pandemic, particularly in the context of expecting something bad to happen. Managerial support appears to be a protective factor for increased anxiety levels in this population. Childcare has been a predominant concern and altering working hours to accommodate this has been problematic for almost 1 in 5 mental health workers. Staff satisfaction with information dissemination positively affects perceived managerial support and perceived risk management.

This study is limited by the utilization of a novel self-created measure for examining variables specific to the COVID-19 pandemic and to the employment of a retrospective measure to obtain baseline anxiety scores of staff members before the pandemic.
What can be found in the spam folder? a self-study from junior researchers in psychiatry
Authors: Shankar Nikhil Gauri , Selvakumar Jashan , Loo Jiann Lin , Ohn May Honey , Chua Sze Hung , Dhandapani Asha , Simiyon Manjula , Raja Jawad
Published: June 2021

Aims

Thriving on the pressure of “publish or perish” experienced by academicians, the industry of predatory publishers with dubious quality has mushroomed and gained their notoriety. The battle of uncovering predatory publishers, including Beall's list, has proven to be tough given the huge monetary gain generated by the predatory publishers. It may be difficult for an inexperienced junior researcher to identify those predatory publishers’ soliciting emails, which may disguise as a reputable journal's article-commissioning process. To date, there is a limited systematic approach to identify such emails. Hence, this research is aimed to describe the common features of soliciting emails from publishers which appeared to be predatory.

Method

This self-study involved reviewing the content of emails in the spam folder of authors, a team of junior researchers in psychiatry, for a month. Emails included in this study were soliciting emails relevant to publications and the following were reviewed: types of solicitation, sentences used, strategies used, and information available in the public domain of their webpages. Informative types of emails were excluded.

Result

The solicitation could include: 1) request for a manuscript to be published a journal article, 2) request for a thesis to be published as a book, 3) request to write for a book chapter, 4) invitation to be an editorial member or a reviewer with the offer of free publishing, 5) invitation to be a speaker for a conference, and 6) proofreading services. The publisher may cite a published article of the author from another journal, which was the source where they identified the author's email. Common strategies used for solicitation included: 1) promising a fast-tracked and guaranteed publication, 2) using compliments that appeared to be inappropriate, 3) repetitive emails, and 4) using argumentum ad passiones to induce guilt. The common features of the webpages of those publishers included: 1) open access publishing as the only option, 2) extensive list of indexing services excluding well-established indexing agencies, and 3) the publisher has a huge collection of journals in different disciplines.

Conclusion

It is hoped that these findings will help junior researchers in psychiatry to stay vigilant to avoid falling into the trap of predatory publishers, which may result in financial loss and loss of work to plagiarism. Total eradication of those predatory soliciting emails is unlikely despite the advancement of spam filtering technology, which necessitates a more united effort from different stakeholders to come out with a probable solution.
“Prevalence of orthorexia nervosa in a sample of patients attending Sligo/Leitrim mental health services with a diagnosis of eating disorder”
Authors: Graffeo Ignazio , Harron Mary , O'Mahony Edmond
Published: June 2021

Aims

The main aim of this study is to investigate its presence in a sample of patients already diagnosed with a canonical eating disorder and also to understand eventual overlaps with other clinical disorders in order to optimize treatment and follow-up. The ORTO-15 questionnaire, developed by an Italian team of researchers in 2005, was used to achieve the above aims: it is a tool comprehensive of 15 questions that assesses eating habits perceived as healthy. Really interesting and fascinating is to comprehend if people with a diagnosis of eating disorder present orthorectic behaviour and how this emerging reality fits in the Irish society with its peculiarities and uniqueness.

Method

Every patient was asked to complete a demographic grid (elaborated by the researchers, which includes information regarding: age, gender, race, weight, height, hours of weekly exercise, years of education, employment situation, medical illnesses, smoking habits, type of diet, average weekly alcohol intake) and the Orto-15 questionnaire

Result

The Point Prevalence obtained is 17.9%.

Conclusion

The results obtained from this study give a clear indication of the profile of the orthorexic patient, considered that the sample was obtained from a population of people with a diagnosis of Eating Disorder:

Caucasian woman in her 30s

Exercising 5 hours per week

Secondary education

Unemployed

Non-smoker

Diagnosis of Anorexia Nervosa

No other comorbid psychiatric illnesses

Standard pattern of eating

Minimal or absent alcohol consumption

Normal range BMI

According to previous Italian studies (Ramacciotti et al. 2011), the expected rates of Orthorexia Nervosa in the general population are between 6.9% and 57.6%, with a peak of 81.8% in specific populations, fact that places our examined sample in the lower side of the prevalence previously considered. It is very difficult to comprehend and explain the reasons behind this fact and probably this is due to an overshadowing of symptoms with the major eating disorders. It is also significant the absence of correlation found between OCD and ON and also the fact that ON is more linked to Bulimia Nervosa in our sample rather then Anorexia Nervosa.
Evaluating participant experience in Balint online sessions held during the COVID-19 pandemic – lessons learnt and moving forward
Authors: Handa Nikhita , Garbutt Romy , Chudley Sylvia
Published: June 2021

Aims

From the outset of the COVID-19 global pandemic and the lockdown that subsequently ensued, a challenge was posed to reshape previously face-to-face meetings in all walks of life. One area that rose to this, with quick introduction of online sessions, was the Balint Group. We aimed to take a snapshot of the effect virtual Balint sessions have had and analyse the themes that members of virtual Balint groups have been identifying about their online group experience at this particularly challenging time for healthcare workers. We hope this will inform both leaders and participants of future online groups of the benefits and pitfalls found by these members reflecting on their first experiences of virtual Balint.

Method

Seven members of virtual Balint groups across the UK were randomly selected for interview from a pool of volunteers facilitated by the UK Balint Society after the first 6 months of their first virtual Balint experience. Interviews were conducted by two academic foundation doctors who were not members of the Balint groups. Qualitative thematic analysis was then conducted on these interview transcripts. Going forward, as Balint groups continue online, the researchers plan to interview further group members and leaders to look for change and development in the primary themes identified.

Result

Key positive themes identified when discussing virtual Balint were ease of access, increased anonymity, attention to facial expressions and interaction with participants from different parts of the country. The most common drawback themes were a lack of socialising and different group dynamic as well as the expected technical and environmental challenges. Interestingly all participants reported that ‘silence’ and ‘sitting/stepping back’ were still used in their online sessions. Core theme analysis indicates the virtual Balint descriptions draw out sentiments of safe, open and structured sessions. In these early sessions a frequent theme was the increased role of the leader.

Conclusion

All participants interviewed so far have felt their online experiences have had many positive aspects. They highlight areas they feel virtual Balint could develop to better replicate the original sessions. The fact some interviewees would prefer to maintain online Balint groups even when ‘in person’ options resume makes it likely this will not be a transient rise in virtual Balint and that the style may be here to stay. Based on this, the role for feedback and constant evaluation and improvement will be central to virtual Balint evolution.
Reducing fatigue-related symptoms in Long COVID-19: finding an intervention that works
Authors: Heald Adrian , Riste Lisa , Walther Andreas , Stedman Mike , Mukherjee Annice , Perrin Ray
Published: June 2021

Aims

In the early days of the first global wave of the COVID-19 pandemic, the potential for a post-viral syndrome to manifest following COVID-19 infection was highlighted.

It was pointed out that an early intervention applying management techniques used in patients with CFS/ME appeared to help reduce the fatigue related symptoms of Long COVID.

Here we present an analysis of a consecutive case series of the first twenty patients’ data collected. Our aim was to evaluate the potential of this mode of treatment for Long COVID.

Method

Face to face treatment sessions with the practitioners occurred once a week, involving effleurage and other manual articulatory techniques.

The individuals being treated also undertook a daily self-massage along with gentle mobility exercises and alternating warm and cool gel packs on the upper spine, to encourage a reduction of spinal inflammation and further aid lymph drainage of the brain and spine.

Symptom severity was recorded using the self-reported 54-item Profile of Fatigue Related States (PFRS).

Result

The mean age of the men was 41.8 years with a range of 29.1-53.1 years with the corresponding mean age for women being 39.3 years with a range of 28.3-50.4 years.

The average time interval between onset of Coronavirus symptoms and start of treatment for Long COVID was just over 20 weeks. The average number of treatment sessions was similar at 9.7 in men and 9.4 in women.

The change in Profile of Fatigue Related States (PFRS) score was similar in men with a significant decrease (-45%) as in women (-52%) (F 4.8, p < 0.001).

None of the individuals had any prior diagnosis of chronic fatigue syndrome.

All were new attendees to the clinic at the time of initial assessment.

Conclusion

Our findings indicate that this intervention based on massage and mobility exercises significantly reduced fatigue related to Long COVID.

It may be that early intervention and supportive treatments at the end of the acute phase of COVID-19 can help overcome acute phase symptoms and prevent them becoming chronic/enduring.
Impact of COVID-19 on the mental health of healthcare workers in different regions of the world
Authors: Islam Mahfuja , George Philip , Sankaran Sindhu , Hui Janet Leu Su , Kit Tzun
Published: June 2021

Aims

The global health system is facing a serious challenge after the recent outbreak of COVID-19 coronavirus infection which was first identified in Wuhan, China in November 2019 and declared as a pandemic in March 2020 by WHO. There is a wide consensus that this pandemic has negative psychosocial consequences as well as unforeseeable provision of mental health care services and just not on physical health alone. The aim of this research study is to determine the prevalence of psychological distress and to identify the sociodemographic variables with the main attributable factors associated with the psychological distress among healthcare workers and suggestions on how to reduce the impact on the mental health of healthcare workers during the COVID-19 pandemic in different regions of the world.

Method

We performed a cross-sectional study from September-November 2020. We used a self-administered survey tool which was distributed electronically to healthcare workers across the globe. The data were stored on an online database with password protected devices where survey responses were restricted to investigators exclusively.

Data collected were: 1) Socio-demographic data (age, gender, marital status, ethnicity, religion, role in the healthcare, region of practice); 2) Psychological General Well-Being Index (PGWBI) questionnaire which contains 22 standardized items. This is a subjective assessment to score the degree of psychological well-being by focusing on 6 domains: depression; anxiety; positive-well-being; self-control; vitality and general health; 3) Subjective assessment from respondents of the main attributable factors causing psychological distress and suggested methods to help reduce the impact on mental health on health care workers.

Result

Majority out of the 217 respondents were from a younger age group; females and married/domestic partnership, mainly from Western Pacific Region, South East Asian and the African Region. More than half the respondents were moderate-severely psychologically distressed and the three main attributable factors causing psychological distress were: fear of family/friends contracting COVID-19 followed by lack of PPE and discomfort caused by wearing PPE for long hours. Respondents suggested that the distress would be reduced if: more resources were provided in hospital; protocols and guidelines were implemented and counselling facilities with recreational activities were available to frontline workers.

Conclusion

This study showed that the COVID-19 pandemic has affected the mental health of healthcare workers and more support or strategies need to come in place to protect frontline workers at the time of crises.
A decade of community-based participatory research: from a tentative start to a fruitful approach in the field of mental health: a scoping review
Authors: Janmohamed Aoife M.
Published: June 2021

Aims

This scoping review aimed to identify and analyse studies utilising Community-Based Participatory Research (CBPR) to design and/or disseminate a mental health (MH) intervention with underserved communities around the globe. This was with the intention of updating the knowledge base on this area, and identifying both areas of promise in this field as well as any gaps for future work to fill.

Method

This scoping review was conducted using the Joanna Briggs Institute's Scoping Review Manual and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Three databases, Scopus, PubMed and Sage Journals, were searched to identify relevant studies, using the three terms ‘CBPR’, ‘underserved’ and ‘mental health’, and words to the equivalent.

Result

The search identified 607 English-language sources published between 1st January 2010 and 30th June 2020. Following duplicate removal, screening and bibliography scanning, 34 highly relevant studies remained. The studies were varied in their chosen context, MH gap, how they gave meaning to the participatory approach, how they defined their successes, and what strengths and challenges were encountered in CBPR's application to this field. Briefly, all bar one of the studies were focused on underserved communities within high-income countries (HICs); many focused solely on women and youth groups; and finally, the use of technology and talking therapies were noted to achieve particular success.

Conclusion

CBPR is commonly used to engage the underserved through long-term partnership building and equitable stakeholder involvement, shifting the dialogue from research on to research with communities. This unique, needs-oriented approach harbours mutual ownership of the research, empowering historically disenfranchised individuals to become actively involved in reducing identified health disparities. In the field of MH, this is of great importance and need in many underserved communities due to issues of access, heightened by a distrust in mainstream services as well as by the stigma attached to MH conditions.

As compared to studies in this field ten years ago, CBPR has become much more established, with this review noting a remarkable increase in MH projects utilising this approach. Furthermore, the addition of new technologies to this field was shown to offer significant promise in overcoming access barriers, hoping to ultimately narrow identified MH gaps. Nonetheless, further work on the prevailing gender and HIC biases, and for a review including relevant Spanish-language studies, are still required in order to form a more global overview of this field.
Mortality rates are higher in lewy body and parkinson's disease dementia compared to Alzheimer's dementia in patients referred into a secondary care mental health service. Why?
Authors: K Anne , O'Brien John , Price Annabel , Cardinal Rudolph , Moylett Sinead
Published: June 2021

Aims

We compared survival in four cohorts of dementia patients– Lewy body (LBD), Parkinson's (PDD), Vascular (VD) and Alzheimer's dementia (AD) - in patients referred into Cambridge and Peterborough NHS Foundation Trust (CPFT) mental health services.

Additionally, we investigated reasons for variation in survival in the four cohorts.

Method

Using electronic records we identified retrospective cohorts of patients referred into services from 2013 onwards. Cases of LBD and PDD were identified using text searches, and comparison cohorts with AD or VD identified using ICD10 diagnosis codes ((F00.*) or (F01.*) respectively).

We collected referral (date of referral and service referred into), demographic (date of birth and gender) and diagnosis data on the patients in the four cohorts. Dates of death were available, through central NHS reporting to Trusts.

We used date of first referral as start of the follow-up and end of follow-up, death or 31/12/19. We used Kaplan-Meier and Cox survival analysis to compare survival in the four cohorts.

The cohorts were crossed with Hospital Episode Statistics (HES) data to extract hospital admission diagnoses. We extracted diagnoses of pneumonia due to aspiration and recurrent falls from hospital admissions data using ICD codes (J69.0 and R29.6 respectively). We calculated prevalence of these diagnoses in the dementia groups, in males and females separately.

Result

In Cox analysis (controlling for age at referral, gender and service referred into), the hazard ratio (HR) for death was highest for the PDD group (HR 2.0 (95% CI 1.7–2.4)), followed by LBD (HR 1.4 (95% CI 1.3–1.6)), then VD (HR 1.2 (95% CI 1.0–1.3)), with the AD group as reference. In the same analysis repeated separately for males and females, the highest HR was found in males with PDD (HR 2.3 (95% CI 1.8–2.8)).

Referrals to liaison psychiatry were associated with reduced survival compared to other mental health services (HR 1.7 (95% CI 1.5–2.0)).

The AD cohort showed the lowest rates of pneumonia due to aspiration and recurrent falls in males and in females. The highest rate of pneumonia due to aspiration was found in the male PDD group (27%).

Conclusion

In patients with dementia referred into mental health services, those with AD survive longer compared to other dementia groups, with PDD patients at highest risk of death. Physical frailty including risk of aspiration, is likely to account for some of this difference in survival.
Generalized anxiety disorder among diabetic patients visiting gharyan-polyclinic in Libya during COVID-19 pandemic
Authors: Khrwat Ahmed , Saadawi Abduraoof
Published: June 2021

Aims

To estimate the prevelance of Generalized anxiety disorder (GAD) in adult patients with diabetes mellitus (T1DM or T2DM) during COVID-19 pandemic.

Method

Random sample of 115 Adult Libyan patients (≥18 years) were drawn from 1200 Medical records of diabetic patients previously diagnosed in a primary care clinic (Gharyan polyclinic,South of Tripoli,West of Libya). Patients were recruited and diagnostically interviewed through outpatient visits and through Phone calls. Anxiety was assessed using Generalized Anxiety Disorder 7-item instrument (GAD-7), personal information, Co morbidities and History of COVID-19 infection within period of 3 weeks.

Result

The statistical analysis done by SPSS version 23, using ANOVA test. The GAD-7 scores ranged from 0 to 19 for the diabetic patient, 82 patients scores ranged from 0 to 4 with varying degrees of non-signifacant to subsyndromal symptopms of Generalized anxiety disorder, 24 patient with Mild GAD, 7 patients with moderate GAD and 2 patients with severe GAD. (P value = 0.000)

Conclusion

GAD is present in 28% of the patients who participated in the study. Additional epidemiological studies are needed to determine the prevalence of anxiety in the broader population of persons with diabetes.
Impact of online group studying for the MRCPsych A exam amongst international doctors logging-in from 7 countries
Authors: Kumar Praveen , Mohsen Sara , Zinchenko Oksana , Verde Philip , Breslin Kathleen , Judge Alice , Shanmugam Sridevi
Published: June 2021

Aims

Recently, global-remote group studying has been made possible via digital video conferencing platforms. In preparation for the December 2020 MRCPsych part A exam, a study group was formed comprising 30 International Medical Gaduates (IMG) logging-in from different countries via 3 hour Zoom-study sessions hosted daily from 28th September until 12th December 2020 (1800-2100 GMT time). This study demonstrates the impact of online group study in preparation for the MRCPsych A exam for s via data collected through questionnaires.

Method

The data of the study were collected through the questionnaires given to the group study members containing a total of 17 questions, 5 of which were open-ended.

The participants totalled 30 International Doctors who responded to an advertisement to form an online study group on Facebook. They logged-in for the sessions from seven different countries: Malaysia, India, Bangladesh, Ireland, Nigeria, Saudi Arabia, and the United Kingdom. The participants represented different working grades incuding experiences in psychiatry ranging from 0 to 5 years.

Data were analysed using percentage. The answers given to the open-ended questions were each examined using descriptive interpretation methods.

Result

Thematic analysis demonstrated that online group study made learning faster and easier. 96.6% support using online study sessions for future exams citing that they fostered cooperation, respect for diverse opinions and motivation for regular studying. 93.1% and partly 6.9% found the experience enjoyable and enabled the cultivation of different ideas. Indeed, 89.7% relied on it as a big part of their preparation with 26 saying it contributed to their passing of the exam success.

Almost three quarter of participants in the group also forged friendships and a sense of trust. It also became a platform for expressing opinions comfortably and developing communication and interpersonal skills.

Different working hours and time zones represented a challenge with most linking in at odd hours. Cultural differences were ultimately accepted including aspects of delivery of information which made a few participants appear abrupt.

Conclusion

With the ease in which social media connects us on a global scale, online study groups connecting IMGs from various backgrounds and diverse cultures not only makes exam preparations stimulating and easier to pass but also fosters interpersonal skills and connections that would be an asset in the long run.