bluuebunny/crossref_metadata_2025 huggingface dataset:
Virtual reality exposure therapy in panic disorder: a pilot study
Authors: Faria Clara Gitahy Falcão , Santos Veruska Andrea , Muniz Marcos Fidry , do Cabo Mariana Costa , Nardi Antonio Egidio , da Rocha Freire Rafael Chistophe
Published: June 2021

Aims

To ascertain if virtual reality exposure therapy (VRET) is an effective add-on tool in the treatment of Panic Disorder (PD).

Background

The exposure to virtual stimuli has been studied as a useful treatment for PD. However, the studies with PD are still scarce and use dissimilar protocols, with effectiveness varying according to the protocol applied.

Method

Eight PD patients received VRET as an add-on treatment to pharmacotherapy. The treatment protocol consisted of eight sessions. The first session is for the patient to understand the treatment and to answer the questionnaires. The second and third sessions were to prepare the patients for exposures with breathing training using diaphragmatic breathing and others breathing techniques to manage anxiety. From the fourth to eighth sessions, the patients followed a hierarchy of tasks during virtual reality exposure. Clinicians rated the Clinical Global Impression Scale (CGI) and the Panic Disorder Severity Scale (PDSS). The patients rated the Diagnostic Symptom Questionnaire (DSQ); the Mobility Inventory (MI), the Anxiety Sensibility Index (ASI-R), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the WHOQOL-BREF before and after the protocol. After all exposures, the Igroup Presence Questionnaire (IPQ) was applied to measure the sense of presence experienced in the virtual environment. The virtual environment simulated the subway of Rio de Janeiro.

Result

There were no statistically significant improvements in the CGI-S, PDSS, BAI, MI or WHOQOL. There was a significant improvement in the BDI scores (P = 0.033). There was a trend towards improvement of anxiety measured by the ASI-R (P = 0.084) and of panic symptoms measured by the DSQ (P = 0.081) scores. There was also a significant improvement of sense of presence (IPQ – general presence) through the exposure sessions.

Conclusion

Our study demonstrated that VRET as an add-on to pharmacological therapy could benefit PD patients. Despite the lack of significant differences in the means, the dispersion of PDSS and BAI scores were smaller after treatment compared to before treatment, suggesting that patients with more severe anxiety, panic and agoraphobia symptoms benefited more of the VRET protocol so, at the end of the treatment, differences were found in important measures of panic. Randomized controlled clinical trials are warranted to confirm the efficacy of VRET.

This study was funded by the Brazilian National Council for Scientific Development (Cnpq). The authors report no conflicts of interest.
ECT practice in England from 2012/13 to 2018/19: a retrospective analysis
Authors: Gondhalekar Mohan , Chaplin Robert , Rogers Sinead , Delgado Oriana
Published: June 2021

Aims

The purpose of this study was to look longitudinally at ECT practice in England over the past 7 years: namely over the following key time periods; 2012/13, 2014/15, 2016/17, 2017/18, and 2018/19. A previous study by Chaplin et al, published in 2016, found that there had been a striking decline observed in the number of courses of ECT prescribed to patients from 2006 to two time points i.e. 2012/13 and 2014/15.

In this study we investigated whether or not this trend had continued. Hence we looked at the change in frequency of ECT use, the length of ECT courses, patient demographics and clinical outcomes; between 2012/13 and 2018/19.

Background

Electroconvulsive therapy (ECT) is an effective treatment for Major Depression, Treatment-Resistant Depression, Catatonia, and Clozapine-resistant psychosis. There have been regular improvements in the administration of ECT, over the past two decades. Increases in the volume of the hippocampus and the amygdala have consistently been observed in ECT studies. Stigma has been the major barrier to patients receiving ECT in a timely fashion. The Royal College of Psychiatrists (RCPsych) Centre for Quality Improvement (CCQI) established the ECT Accreditation Service (ECTAS) back in 2006. ECTAS had the aim of standardising ECT practice through the production of evidence-based standards that all member ECT Clinics could use to support their practice.

Method

We looked at the minimum dataset of information collected from ECTAS Members within England for the following years; 2012/13, 2014/15, 2016/17, 2017/18, 2018/19. In 2012/13, 2325 adjusted courses of ECT treatment were given to patients in England. In 2014/15 it was 2302.

Result

Between 2012/13 and 2018/19; two thirds of ECT patients continue to be female. The modal age of patients has also remained the same at 70 years. The number of patients detained under the Mental Health Act 1983 receiving ECT has gone up by 12%; suggesting that the patients receiving ECT were more clinically unwell. After treatment, CGI scale scores (i.e. the very much improved and much improved scores) slightly reduced by 6% from 2012/3 to 2018/19.

Conclusion

The use of ECT in England notably declined from 2006 to 2012/13 and 2014/15. However, from 2012/13 to 2018/19, ECT use has remained relatively stable; suggesting that it is currently being used appropriately on patients, who are amongst the most severely unwell. The clinical effectiveness of ECT remains high however, it has slightly dipped by 6%.
Does food responsiveness change in people with first episode psychosis (FEP) over a period of 6 months after commencing antipsychotics? Preliminary results
Authors: Heald Adrian , Shakespeare Mark , Williamson Kevin , Close Adrianne , Phillipson Adrian , Higgs Suzanne
Published: June 2021

Aims

We here present preliminary results from our study to understand better the changes in people’ s experience of food in the months after diagnosis with first episode psychosis (FEP). Weight gain often occurs in the weeks/months after diagnosis and is related to an increase in appetite and food intake. Many drugs that are effective in treating psychosis are associated with changes in the way that people experience reward when they eat.

The aim of this project is to increase our understanding of exactly why this happens in terms of an individual's experience of food reward and reduced satiety – and therefore how we can help people with FEP to keep their weight down. At this stage we are looking at the feasibility of applying currently available evaluation tools to people in this situation.

Method

A convenience sample was used to recruit 10 service users from RDaSH NHS FT Early Intervention Services. This is a feasibility study which will provide data to underpin a fully powered, larger trial.

Rating scales applied were:

Power of food questionnaire: measures responsiveness to the food environment.

Intuitive Eating Scale: measures an individual's tendency to follow their physical hunger and satiety cues.

The loss of control over eating scale (LOCES): measures a global sense of whether individuals experience LOC over eating.

Dutch Eating Behaviour Questionnaire (DEBQ): measures restrained eating, emotional eating and external eating.

Result

The ages of the participants ranged from 17-26 years. All were started on Olanzapine at the dose of 5 or 10 mg daily.

Baseline total scores for the Power of Food (2.47-3.80)/5 (higher score = more responsiveness) and Intuitive Eating scales (2.10-2.62)/5 (higher score = greater tendency to follow hunger and satiety cues) were in the mid-range, while the LOCES scores varied widely from 1.50-2.38/5.

The DEBQ restrained subscale score range was 2.40-2.80/5 (higher indicates greater restraint with food) while the DEBQ external subscale ranged from 2.70—3.00/5 (higher = greater tendency to overeat) and the DEBQ emotional subtotal score was 1.92-1.94/5, in keeping with a relatively low emotional drive to eat.

Conclusion

Our preliminary results reveal at the beginning of antipsychotic treatment a moderate responsiveness to food and tendency to follow hunger/ satiety cues, with scores for Loss of Control of eating in the low to moderate range and a low emotional drive to eat. The difference between these and the follow-up eating behaviour scores will provide important clues as to the precise changes in eating behaviour with anti-psychotic treatment in FEP.
Placebo response in treatment resistant depression: a systematic review and meta-analysis of multiple treatment modalities
Authors: Jones Brett D M , Weissman Cory R. , Karbi Jewel , Vine Tya , Mulsant Louise S. , Mulsant Benoit , Brunoni Andre , Husain M. Ishrat , Razza Lais B. , Blumberger Daniel , Daskalakis Zafiris J
Published: June 2021

Aims

The placebo response in depression clinical trials is a major contributing factor for failure to establish the efficacy of novel and repurposed treatments. However, it is not clear as to what the placebo response in treatment-resistant depression (TRD) patients is or whether it differs across treatment modalities. Our objective was to conduct a systematic review and meta-analysis of the magnitude of the placebo response in TRD patients across different treatment modalities and its possible moderators.

Method

Searches were conducted on MEDLINE and PsychInfo from inception to January 24, 2020. Only studies that recruited TRD patients and randomization to a placebo (or sham) arm in a pharmacotherapy, brain stimulation, or psychotherapy study were included (PROSPERO 2020 CRD42020190465). The primary outcome was the Hedges’ g for the reported depression scale using a random-effects model. Secondary outcomes included moderators assessed via meta-regression and response and remission rate. Heterogeneity was evaluated using the Egger's Test and a funnel plot. Cochrane Risk of Bias Tool was used to estimate risks.

Result

46 studies met our inclusion criteria involving a total of 3083 participants (mean (SD) age: 45.7 (6.2); female: 52.4%). The pooled placebo effect for all modalities was large (N = 3083, g = 1.08 ,95% CI [0.95-1.20)I 2 = 0.1). The placebo effect in studies of specific treatment modalities did not significantly differ: oral medications g = 1.14 (95%CI:0.99-1.29); parenteral medications g = 1.32 (95%CI:0.59-2.04); ayahuasca g = 0.47 (95%CI:-0.28-1.17); rTMS g = 0.93 (95%CI:0.63-1.23); tDCS g = 1.32 (95%CI:0.52-2.11); invasive brain stimulation g = 1.06 (95%CI:0.64-1.47). There were no psychotherapy trials that met our eligibility criteria. Similarly, response and remission rates were comparable across modalities. Heterogeneity was large. Two variables predicted a lager placebo effect: open-label prospective design (B:0.32, 95%CI: 0.05-0.58; p:0.02) and sponsoring by a pharmaceutical or medical device company (B:0.39, 95%CI:0.13-0.65, p:0.004)). No risk of publication bias was found.

Conclusion

The overall placebo effect in TRD studies was large (g = 1.08) and did not differ among treatment modalities. A better understanding of the placebo response in TRD will require: standardizing the definition of TRD, head-to-head comparisons of treatment modalities, an assessment of patient expectations and experiences, and standardized reporting of outcomes.
Experiences of children who have been separated from a parent due to military deployment:a systematic review of reviews
Authors: Kent Jennifer , Taylor Pamela , Argent Sarah , Kalebic Narasha
Published: June 2021

Aims

To conduct a systematic review of reviews to investigate how military deployment of a parent affects his/her child, and the extent to which the child's own perspectives have been documented.

Background

Lengthy but finite disruptions to parenting in any form may affect child development and mental and physical health.

Military deployment means weeks or months of separation from one parent.

2016 figures for the U.S. military showed that 40.5% of military personnel have children, and of these 1.7 million children the largest percentage are aged between 0–5 years (37.8%).

Method

Seven databases were searched: AMED, Web of Science, Scopus, EMBASE 1947, Joanna Briggs Institute EMP database, Ovid MEDLINE 1946 and PsycINFO 1806 from the inception of each electronic database until 31st March 2018.

Inclusion criteria:

Child and young adults aged 0–24 years

English language papers only

All papers being systematic reviews or meta-analyses

A focus on documenting the effects on child outcomes

Data extracted included the review methods and child outcomes reported, including educational attainment; physical symptoms; mental illnesses or disorders; changes to behaviours, and effects on peer and parental relationships.

Result

The eight reviews identified included 32 common and relevant studies.

Across the various studies, only about 20% of data came directly from children.

Five papers extracted from the reviews identified parental deployment as having a negative effect on school attainment.

Nine studies extracted from the review papers found a positive correlation between having a deployed parent and a greater chance of experiencing depressive symptoms and feelings of anxiety.

Strong correlations of increased prevalence of both externalising & internalising behaviours were conclusively found in 7 of the reviews.

Increased resilience was detailed in only one study featured in multiple reviews.

Just one study featured across the reviews reported on physiological measures - adolescents with deployed parents had higher blood pressures and significantly higher heart rates and stress scores than civilian children.

Conclusion

More research obtaining the viewpoint of the child directly and observation of such children is required to properly understand the effects on children with a deployed parent, without the interference of parent or teacher reporting bias. Additionally, with only one study reporting on increased offspring resilience there has been limited exploration of potential positive correlates, so further research regarding these is important.
Landscape of childhood and adolescent depression in Pakistan: experience from a tertiary care hospital in Karachi, Pakistan
Authors: Khan Maria , Raja Mohummad Hassan Raza , Gauhar Fatima , Nadeem Tania
Published: June 2021

Aims

Depression is highly prevalent in children and adolescents in Pakistan, yet, factors affecting depression have not been widely studied. This study aims to assess the demographic and clinical characteristics of depression in children and adolescents and identify associations between parental marital status and confounding factors for depression.

Method

A descriptive retrospective study was undertaken at the Aga Khan University Hospital in Karachi, Pakistan. Patient records of children and adolescents (aged under 18 years), presenting to the psychiatry clinic with depression from 2015-2019 were reviewed. The diagnosis of clinical depression was made based on clinical assessment according to international guidelines. Patients whose medical records had missing information were excluded. Data were analysed using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA). Continuous data are presented as mean +/- standard deviation, whereas categorical data are presented as percentages (%). Pearson Chi-square test of association has been used to assess the association between parental factors and confounding factors. In instances where Pearson's Chi-square test could not be applied, Fisher's exact test is used instead. Associations at p <0.05 (95% confidence limit) are considered statistically significant.

Result

A total of 133 participants were included, of which 78 (58.6%) were female, and 55 (41.4%) were male, with a mean age of 15.5 +/- 2.4 (Range: Ages 4–18). The population had a 50.4% prevalence of suicidal ideation, 21.1% of self-harm, 15% of substance abuse and 14.3% of suicide attempts. Academic stress (54.9%), inter-parental conflict (30.1%) and child abuse (29.3%) were the most common confounding factors reported. Other confounding factors include a family history of depression (20.3%), experience of bullying (16.5%) witnessing domestic violence (16.5%), substance abuse (15.0%) and experiencing sexual abuse (6.0%). There is a statistically significant association between children having parents with non-intact marriages and experiencing sexual abuse (p < 0.001, Odds Ratio (OR) = 21.48), having a family history of depression (p < 0.001, OR = 7.04), child abuse (OR = 3.78). Children of non-traditional (not living with both parents) families were more likely to witness domestic violence (p < 0.001, OR = 4.28), have a family history of depression (p < 0.001, OR = 3.44), abuse substances (OR = 3.20) and experience child abuse (OR = 2.48).

Conclusion

This study identifies factors that may put children at an increased risk of developing depression and performing high-risk behaviours. The findings can help develop better screening programs and counselling for children and adolescents, allowing prevention and ensuring early diagnosis and care.
Survey of remote consultations in psychiatry during the SARS-CoV-2 outbreak
Authors: Khodabux Nusra , Gangadharan Satheesh , Tromans Samuel , Hiremath Avinash
Published: June 2021

Aims

To compare the usage of remote consultations before and after the first wave of the SARS-CoV-2 outbreak and explore mental health workers’ views on the usage of telemedicine.

Method

An online questionnaire survey was developed, and disseminated to mental healthcare professionals via e-mail and social media. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using Braun and Clarke's six step procedure for thematic analysis.1

Result

There were 40 responses from mental healthcare professionals of varying grades from different sub-specialties, predominantly from the UK. Compared to before the SARS-CoV-2 outbreak, there was an increase in usage of telephone (9(22.5% to (29)72.5%) and video consultations (4(10%) to 17(42.5%)). Respondents reported an increase in virtual MDTs (35(87.5%) during the pandemic, 9(22.5%) pre-pandemic).

Based on a 5-point Likert scale, the mean technical quality of telephone consultations was 3.56/5 (Range 2-5), with 75% rating telephone consultations as not being as good as face-to-face consultations. The mean technical quality of video consultations was 3.58/5 (Range 2-5), with 63% rating video consultations as not being as good as face-to-face consultations. 25 (62.5%) respondents felt comfortable using telephone consultations during the pandemic, 20(50%) felt comfortable using video consultations. Recurring themes identified from the qualitative data regarding reasons for the technical quality ratings were: connection issues, poor infrastructure and security concerns.

Nine (23%) respondents felt that using video conferencing consultations had a detrimental impact on the mental health of patients while 14(35%) felt that telephone consultations had a detrimental impact on patients’ mental health. Recurring themes for health practitioners’ perceived effect of the use of telemedicine on patients’ mental heath were the loss of personal touch and reduced patient engagement.

Conclusion

There was a substantial increase in usage of remote consultations during the first wave of the SARS-CoV-2 pandemic among mental healthcare professionals. The results reported in the present study suggest there are numerous barriers to the use of telemedicine in psychiatry, which require future exploration, ideally through interview or ethnographic studies.
Glucose transporters in Alzheimer's disease
Authors: Kyrtata Natalia , Dickie Ben , Emsley Hedley , Parkes Laura
Published: June 2021

Background

Physiological brain function depends on tight glucose regulation, including transport and phosphorylation, the first step in its metabolism. Impaired glucose regulation is increasingly implicated in the pathophysiology of Alzheimer's disease (AD). Glucose hypometabolism in AD may be at least partly due to impaired glucose transport at the blood-brain barrier (BBB). Glucose transporters (GLUTs) are an integral component of the BBB. There is evidence of a significant reduction in vascular and non-vascular forms of GLUT1 and GLUT3 in AD brains compared to age-matched controls. Glucose transport, as well as phosphorylation, appears to be a rate limiting step for glucose metabolism in the brain. We have reviewed the literature on glucose transport abnormalities in AD and the effect such abnormalities have on the brain.

Method

Published literature between 1st January 1946 and 1st November 2019 was identified using EMBASE and MEDLINE databases and titles and abstracts were scanned. Human studies (autopsy and imaging) and data from animal models were included while reviews, letters and cellular or molecular studies were excluded from the search.

Result

Autopsy studies in AD patients show significant reductions in GLUT3 in areas of the brain closely associated with AD pathology. Patients with AD and diabetes showed greater reductions of GLUT1 and GLUT3. A longitudinal study showed significant reductions in GLUT3 levels which correlated with greater amyloid-β (Aβ) and neurofibrillary tangle pathological burden in participants with AD pathology at post-mortem but without evidence of cognitive dysfunction in their lifetime. Some studies showed increased GLUT1, with others showing reduced GLUT1, levels in AD brain. A newly recognised GLUT12 appears to be increased in AD. Animal studies showed similar results with GLUT1 and GLUT3 knockout animal models exhibiting AD pathology, while overexpression of GLUT1 or treatment with metformin decreased Aβ toxicity in a Drosophila model of AD. GLUT2 levels were increased in both human AD brain and in an animal model of AD. Imaging studies using fluorodeoxyglucose [18F]FDG with positron emission tomography (FDG-PET) in AD subjects show reductions in glucose transport and glucose metabolism in areas most affected in AD. A small randomised control trial showed anti-diabetic medications improved the glucose transport in AD subjects.

Conclusion

GLUTs play a significant role in AD pathology with evidence suggesting that GLUT3 reductions may precede the onset of clinical symptoms, while GLUT2 and GLUT12 may have a compensatory role. Repurposing anti-diabetic drugs shows promising results in both animal and human studies of AD.
To what extent does the COVID-19 pandemic impact patients with anorexia nervosa?
Authors: Mehta Krishna
Published: June 2021

Aims

This systematic review aims to discuss the extent to which the measures undertaken to control the COVID-19 pandemic in several countries have affected those with Anorexia Nervosa (AN). The coronavirus pandemic is still raging on in many countries and its effects will still be felt years from now and previous studies have shown that it has impacted other mental illnesses. AN cases are on the rise and the nature of the illness has deadly consequences, therefore it is paramount to discuss the relationship between the COVID-19 measures and symptomatology of AN to ensure appropriate services are in place to deal with potential outcomes.

Method

Systematic search of the PubMed database gave thirty-three total results with seven of these used in this review. These studies met the inclusion criteria; examples include primary studies and use of the English Language. The exclusion criteria involved literature reviews, studies with less than ten participants and studies not separating AN from other eating disorders.

Result

Many studies were cross sectional in nature except two longitudinal studies. Anorexic symptomology increased in the majority of papers in this review. Specifically restricting intake has increased compared to before lockdown measures. Physical activity has varied on an individual level in most studies potentially due to compensatory behaviours. Co-morbid psychopathologies were also noted during these studies. There are many factors behind these changes such as food insecurity, the effect of media and social media, uncertainty and the lack of social interaction. A number of participants across the studies were dissatisfied with treatment services during lockdowns. Variability in study results may be due to the differences in measures between countries and the use of self-reported cases compared to those contacted through care services. Limitations of this review are largely due to the how current the topic is and recommendations for the future include reviewing new studies that are published and to review the situation once the full impact of COVID-19 is known.

Conclusion

Patients with AN have struggled more due to the COVID-19 measures and the true effect of the pandemic is yet to be felt. Further studies and reviews should be conducted. The appropriate services should be put into place to ensure patients are supported effectively.
Prognostic evaluation of suicidality and development of risk factors in victims of physical and emotional child abuse and emotional/psychological neglect
Authors: Miah Latif
Published: June 2021

Aims

To evaluate the effects of childhood maltreatment, specifically physical and emotional abuse and emotional/psychological neglect on the development of suicidal ideation, depressive symptoms and self-harm. It is hypothesised that there will be a strong causal link between the aforementioned types of maltreatment with suicidality, depression and self-harm.

Background

Child abuse is a major public health issue with profound developmental and mental health consequences towards victims and their contributions to society as a whole. The impact of sexual abuse is well-established, however non-sexual child maltreatment and its sequelae are not as well understood or studied.

Method

A literature search was carried out using the Pubmed, Cochrane, Scopus and Google Scholar databases. Articles were appraised according to set criteria and manually screened for relevance to the review.

Result

The results of this review demonstrate that there are statistically significant, potentially causal links between emotional and physical abuse, and emotional/psychological neglect with suicidal ideation, depressive symptoms and self-harm. More research is still required to elucidate the role of polyvictimisation in mental health outcomes and to further confirm these links between abuse and development.

Conclusion

Child maltreatment remains a large public health issue with major impact on the economy of the world. It has profound, potentially lifelong consequences on victims and is something that needs to lose its stigma so that it can be identified earlier and potential damage prevented as far as possible. The future may lie in working to remove the stigma surrounding it, standardise how it is studied and thus learn to recognise the signs earlier – ideally leading to implementation of policy to get victims to safety, preventing unncecessary harm.
Age-related changes in physiology in individuals with lifetime bipolar disorder
Authors: Mutz Julian , Lewis Cathryn M
Published: June 2021

Aims

Individuals with bipolar disorder have reduced life expectancy and may experience accelerated biological ageing. In individuals with lifetime bipolar disorder and healthy controls, we examined differences in age-related changes in physiology.

Method

The UK Biobank study recruited >500,000 participants, aged 37–73 years, between 2006–2010. Generalised additive models were used to examine associations between age and grip strength, cardiovascular function, body composition, lung function and bone mineral density. Analyses were conducted separately in males and females with bipolar disorder compared to healthy controls.

Result

Analytical samples included up to 272,462 adults (mean age = 56.04 years, SD = 8.15; 49.51% females). We found statistically significant differences between bipolar disorder cases and controls for grip strength, blood pressure, pulse rate and body composition, with standardised mean differences of up to -0.238 (95% CI -0.282 to -0.193). There was limited evidence of differences in lung function, heel bone mineral density or arterial stiffness. Case-control differences were most evident for age-related changes in cardiovascular function (in both sexes) and body composition (in females). These differences did not uniformly narrow or widen with age and differed by sex. For example, the difference in systolic blood pressure between male cases and controls was -1.3 mmHg at age 50 and widened to -4.7 mmHg at age 65. Diastolic blood pressure in female cases was 1.2 mmHg higher at age 40 and -1.2 mmHg lower at age 65.

Conclusion

Differences in ageing trajectories between bipolar disorder cases and healthy controls were most evident for cardiovascular and body composition measures and differed by sex.
Falling through the cracks’ – the role of assertive alcohol outreach teams in treating comorbid mental health problems in people with addictions
Authors: Naomi Smith E. , Finch Emily , Drummond Colin
Published: June 2021

Aims

Input from Assertive Alcohol Outreach Teams (AAOTs) reduces the ‘burden’ on already overstretched community mental health teams (CMHTs).

AAOTs are specialist addictions services. This project focuses on an AAOT based in the London, which engages with people with severe alcohol and illicit substance misuse problems.

Previous research has shown that input from AAOTs reduces hospital admissions. This project examined the impact of AAOT input on reducing the ‘burden’ on CMHTs.

Method

The full caseload of the Southwark-based AAOT was reviewed, including mental health records, general practitioner notes, hospital notes and discharge summaries. We collected data on diagnoses and previous hospital admissions. Patients were assessed to determine whether they met criteria to be open to a CMHT (the presence of complex or serious mental health problems, in addition to addictions).

Result

The caseload was made up of 39 patients, 85% of patients were deemed to meet criteria for being under the care of a CMHT. Only 15% of patients are currently under the care of a CMHT. 87% of patients had at least one comorbid psychiatric diagnosis. 72% of patients had had at least one emergency department or medical hospital admission due to mental health-related problems. 39% had previous admissions to mental health wards. 21% of patients has been admitted under Section of Mental Health Act.

Conclusion

The majority of AAOT patients have severe mental health problems in addition to addictions. The patients are complex and often have a history of disengagement from standard mental health services. Formal diagnosis and treatment of comorbid mental health problems is challenging in the presence of protracted drug and alcohol misuse. AAOT input appears to address a serious ‘gap’ in supporting patients with complex mental health needs who are often ineligible for CMHT input or disengage from CMHT support.
What is the prevalence of self-harming and suicidal behaviour in under 18s with autism spectrum disorder, with or without an intellectual disability?
Authors: Oliphant Rosalind , Smith Eleanor , Grahame Victoria
Published: June 2021

Aims

The aims of this systematic review are to summarise data on the prevalence of suicidal behaviours and self-harm in under 18s with Autism Spectrum Disorder (ASD) and consider the impact of Intellectual Disability (ID). It was hypothesised that the prevalence of these behaviours may be higher in under 18s with ASD than in the general population.

Background

In the general population, rates of self-harm and suicide in under 18s are of increasing concern. Whilst there is an emerging evidence base considering suicidality in autistic adults, less in known about the experience of under 18s. There has been very little research focused on how self-harm seen within the general population presents in the context of ASD and whether it continues to be a predictor of future suicidal behaviour. This may be partly due to self-harm being considered alongside Self-Injurious Behaviours (SIB), which have long been recognised as part of the clinical presentation of ASD and may have other functions (e.g. fulfilling sensory stimulation needs).

Method

A systematic literature search was conducted in line with PRISMA guidelines. For this review, all papers that included data on prevalence of self-harm and/or suicidal behaviours in under 18s with ASD were included. Studies that only reported on the prevalence of the broader entity of SIB (characterised as stereotypic or habitual) were excluded.

Result

338 papers were initially identified and 9 met eligibility criteria. There was considerable variation in how different aspects of self-harm and suicidal behaviours were addressed between groups and also between population samples, making it difficult to generalise the findings. The prevalence of self-harming and suicidal behaviours ranged from 7% to 73%, indicating that this is a clinically significant problem for this patient group. The only study that considered the impact of co-existing ID did not identify significant differences between groups (ID vs no ID).

Conclusion

There was variation in the reported prevalence rates but results suggested that rates of both self-harm and suicidal behaviour may be elevated in under 18s with ASD compared to the general population. This is in keeping with literature relating to autistic adults but in contrast to conclusions of a previous systematic review. This review highlights the need for further research to explore the experience of self-harm and suicidal behaviour in autistic children and young people.
A two-year mirror-image study of the effect of treatment with paliperidone and aripiprazole long-acting injections on need for inpatient care and home treatment intervention
Authors: Pantall Shay-Anne , Pilsbury Joseph , Gan Le , Brownell Lisa
Published: June 2021

Aims

To evaluate the effect of the use of aripiprazole and paliperidone long acting injections on healthcare resource use

Background

Long acting injections of second-generation antipsychotics such as paliperidone and aripiprazole have become more commonly prescribed over the past decade. They have much higher acquisition costs when compared to first generation depot antipsychotics. It is therefore essential to demonstrate their tolerability and cost-effectiveness.

Method

We undertook an observational, retrospective two-year mirror study for all patients who started treatment with paliperidone long acting injection between January and June 2016 (n = 47) or aripiprazole long acting injection between April 2014 and July 2017 (n = 93). Clinical notes were examined to determine the number of admissions, inpatient days, home treatment episodes and number of home treatment days, in the 12 months preceding and following the commencement of the long acting injection.

Result

70% remained on paliperidone and 62% remained on aripiprazole at the end of the one-year period.

There was a significant reduction in occupied bed days in those treated with paliperidone from 78.2 days in the year before this treatment was started to 25.4 days in the year after (p = 0.002). There was a significant reduction in occupied bed days in those treated with aripiprazole from 66.51 days to 32.7 days (p = 0.0006).

There was no significant reduction in days spent under the care of home treatment teams for individuals treated with either of these medicines.

Conclusion

Treatment with either paliperidone or aripiprazole long-acting injection was associated with a reduction in admissions and occupied bed days of a magnitude that delivered an overall cost-saving despite the high drug acquisition costs. It remains to be determined how these reductions compare with other second-generation long-acting injections and first-generation depot antipsychotics.
Prevalence and correlates of depressive symptoms among professional drivers in Saudi Arabia: a cross-sectional study
Authors: Alnaser Adnan Raed , Zitoun Osama A. , Rajab Tawfik , Khojah Abdullah , Saquib Juliann , Saquib Nazmus
Published: June 2021

Aims

Due to the nature of their work, professional drivers face a considerable risk of developing depression and other mental illnesses. We sought to assess the prevalence and the factors influencing depressive symptoms among professional drivers in Saudi Arabia.

Method

Using convenience sampling, we have conducted an interviewer-administered survey on 324 professional drivers in Qassim Region in Saudi Arabia using Depression subscale from the Depression, Anxiety and Stress Scale 21 (DASS-21). Participants were interviewed in their native language, and responses were outlined directly into an online form in English. Data were then extracted and analyzed using SPSS software.

Result

Participants’ mean age was 38.6 years, and mean driving hours per day were 9.86 hours/day. The mean DASS-21 depression score among the professional drivers was 2.88. Overall, 21.9% of the included drivers had variable degrees of depressive symptoms, with 7.4% suffered from extremely severe symptoms. Depressive symptoms were influenced by the driver's nationality, educational level, vehicle type, driving years, BMI, presence of chronic medical conditions, physical activity, and sexual activity. Moreover, poor sleep quality increased the risk of developing depressive symptoms among the drivers by 31.9 times (OR: 31.9, CI: 9.03–112.63, P < 0.001).

Conclusion

Nearly one-fifth of professional drivers in Saudi Arabia (Qassim region) suffer from depressive symptoms. Unhealthy lifestyle practices (i.e. being obese and physically inactive) have been closely related to depressive symptoms. Education, sexual activity, type of driven vehicle, and the number of chronic conditions were also associated with depressive symptoms. Also, poor and fair sleep quality was strongly associated with the development of depressive symptoms as compared with excellent sleep quality. As drivers are always on the move and hardly reachable, we would propose psychological support and counseling to be administered via telemedicine services. Future research is needed to better comprehend the needs of this vulnerable population.
Prevalence of mental disorders in prisons in the UK: a systematic review and meta-analysis
Authors: Rebbapragada Nivedita , Furtado Vivek , Hawker-Bond George William
Published: June 2021

Aims

To report pooled prevalence of all mental disorders among the general prison population in the United Kingdom (UK). This includes individuals in Young Offender Institutions (YOI), youth custody and adult prisons across all categories. A secondary aim explores possible sources of heterogeneity by performing subgroup and meta-regression analysis across certain covariates (e.g. sex of prisoner). We hypothesise that contemporary estimates of mental disorders are higher than the general population.

Background

Prevalence of mental health problems among prisoners are considerably higher than the general population; this poses an important public health concern. Individuals who require diversion to appropriate psychiatric services are becoming embroiled in the revolving door of the criminal justice system. However, there are no up-to-date reviews assessing prevalence of mental disorders across the general prison population in the UK. This study aims to address this gap.

Method

We conducted a systematic search of PsycINFO (1923 – October 2019), MEDLINE (1946 – October 2019), EMBASE (1947 – October 2019) and Web of Science (all years) of articles reporting prevalence of mental disorders in UK prison populations (PROSPERO registration number: CRD42019132685). The Joanna Briggs Institute (JBI) Appraisal Checklist for Studies Reporting Prevalence Data assessed study quality and bias. Pooled prevalence of each mental disorder was calculated using Stata statistical software 16.0 via the metaprop command. Forest plots present prevalence estimates with study weights and associated 95% confidence intervals (CI). Overall, 20 studies satisfied inclusion criteria, comprising of 12,335 prisoners across England, Wales and Scotland.

Result

We identified higher rates of neurotic disorders (28.9%, 95% CI 0.71–74.7%), personality disorders (23.5%, 95% CI 13.6–35.2%), alcohol (22.7%, 95% CI 12.2–35.1%) and drug dependence (26.7%, 95% CI 15.0–40.4%). The lowest prevalence rates included schizophrenia (2.42%, 95% CI 0.78–4.84%), panic disorders (3.88%, 95% CI 3.17% – 4.64%), adjustment disorders (3.83%, 95% CI 1.19–7.84%) and intellectual disability (2.90%, 95% CI 0.90–5.80%). Meta-regressions for psychotic disorder and personality disorder revealed no significant differences across study year, sample size and gender.

Conclusion

Our prevalence estimates of mental disorders in prisons are higher than the general English population. However, we should acknowledge the influence of considerable heterogeneity. These findings demonstrate the need to quantify current prevalence of mental disorders amongst prisoners in the UK. We recommend for the government to consider performing an up-to-date census of psychiatric morbidity to facilitate service provision.
A clinical significance analysis of manualised psychological interventions for obsessive-compulsive disorder
Authors: Rigby Jake , Fisher Peter , Cherry Gemma , Stuart Taylor , Temple James
Published: June 2021

Aims

To conduct an individual patient data meta-analysis of randomised controlled trials (RCTs) of manualised psychological treatments for obsessive-compulsive disorder (OCD), and examine the differential efficacy of psychological treatments by treatment type and format.

Background

Previous meta-analyses conclude that efficacious psychological treatments for OCD exist. However, determining the efficacy of psychological treatments requires multiple forms of assessment across a range of indexes, yet most previous meta-analyses in OCD are based solely on effect sizes.

Method

We evaluated treatment efficacy across 24 RCTs (n = 1,667) by conducting clinical significance analyses (using standardised Jacobson methodology) and standardised mean difference within-group effect-size analyses. Outcomes were Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores, evaluated at post-treatment and follow-up (3-6 months post-treatment).

Result

Post-treatment, there was a large significant within-group effect size for treated patients (g = 1.28) and a small significant effect size for controls (g = 0.30). At follow-up, large within-group effect sizes were found for both treated patients (g = 1.45) and controls (g = 0.90). Clinical significance analyses indicated that treated patients were significantly more likely than controls to recover following an intervention, but recovery rates were low; post-intervention, only 32% of treated patients and 3% of controls recovered; rising to 38% and 21% respectively at follow-up. Regardless of allocation, only approximately 20% of patients were asymptomatic at follow-up. Across the different analysis methods, individual cognitive therapy (CT) was the most effective intervention, followed by group CT plus exposure and response prevention. Self-help interventions were generally less effective.

Conclusion

Reliance on aggregated within-group effect sizes may lead to overestimation of the efficacy of psychological treatments for OCD. More research is needed to determine the most effective treatment type and format for patients with OCD.
A systematic review of the prevalence of mental disorders, cognitive impairment and dementia amongst older adults populace in Egypt
Authors: Sabry Noha , Tadros George , Odejimi Opeyemi
Published: June 2021

Aims

This study aims to review current evidence of the prevalence of mental disorders amongst the elderly populace in Egypt. This will be achieved by estimating the current prevalence and then identifying any sociodemographic correlates with mental disorders.

Background

Mental disorders are the leading cause of disabilities amongst the older adult populace worldwide. The population of the older adult in Egypt is fast growing. According to the Egypt, latest national census in 2014, the population of individuals aged 60 years and above is 6.9% and this is expected to nearly double by the year 2031, with a projection of 11.5% forecasted. In fact, it has been estimated that cost per person of mental health diseases such as dementia in low-income countries is approximately £686 ($868) and £2456 ($3109) in lower-middle income countries like Egypt.

Method

Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PubMed) was carried from their date of inception. In addition, reference list scanning, key journal searching, citation searching and relevant internet resources were conducted. Papers were included, if they were published in English, point prevalence studies carried out on older adults Egyptians aged 60 years and above. In addition, mental disorders, cognitive impairment or dementia had to be ascertained using any validated diagnostic tools. Studies which did not meet any of the criteria detailed above were excluded.

Result

16 studies were included in this review. Four main mental disorders were identified, these are: depression, anxiety, cognitive impairment and dementia. Reported prevalence of Depression, anxiety, dementia and cognitive impairment are 23.7-74.5%, 14.2-72%, 3.66-39.2%, and 1.74 to 51.4% respectively. Anxiety and depression was positively correlated with female gender, increasing age and lower educational status. Also, cognitive impairment and dementia was positively correlated with age, illiteracy or low education. However, there appears to be inconsistencies in the diagnostic tools used.

Conclusion

This research brings to the forefront the scale of mental disorders amongst the elderly in Egypt. This may help ensure evidence-based initiatives are put in place and also priority is given to resource allocation for geriatric mental disorders in Egypt.