bluuebunny/crossref_metadata_2025 huggingface dataset:
Why is hitting A&E time targets so hard?: using Nudge theory and modelling to improve response times
Authors: Svedberg Kaj
Published: June 2021

Aims

To improve the one hour response times to referrals made to psychiatric Liaison in A&E without adding or changing available resources.

Method

Response time data of referrals made to the Homerton University Hospital psychiatric liaison service was collected dating back from August 2016 to October 2019 (n = 10225).

A nudge was introduced in the form of a large display showing referrals arriving in real time in the staff office.

Data was then collected over a period of 5 weeks (n = 436) to measure if any change had occurred in response times.

Result

Response times appear to follow a Poisson like distribution curve. The average referral was responded to within 6 minutes (n = 1577) prior to the nudge, and 6 minutes (n = 88) after. Prior to the nudge the 95% referral envelope fell within 134 minutes (n = 9728) and was 122 minutes (n = 414) after the intervention. Significant statistical difference is observed upon considering response in the first 240 minutes.

Conclusion

Nudge interventions could be a useful resource-sparing method to improve services. The average referral to the HUH liaison team was quickly responded to within 6 minutes and yet hitting the 1 hour 95% target appears ever-elusive. Hitting targets of 95% responses within 1 hour may prove very difficult if we are not considering natural distributions, such as Poisson, occuring in the backgroung which ultimately may require a change in approaches to how we set performance targets.
Confidentiality at the interface of an adolescent psychotherapy service
Authors: Thomas Rhianne , Congdon Lawrence , Habel Sheva
Published: June 2021

Aims

Aims included to explore how, within a London trust, staff at the interface between patients, relatives and access to services view their understanding of confidentiality, and to determine ways to improve knowledge if needed.

Background

Confidentiality is essential to the trust and development of clinician-patient relationships. National policies set guidance on how confidential information should be recorded, secured and shared. However, confidentiality breaches are reportedly common within health professions. Working with adolescent patient groups brings additional issues regarding confidentiality. Care-givers who contact services, often desiring containment, may experience a sense of uncertainty when confidentiality policy prevents details being shared about a young person's clinical experience.

Method

Stakeholders were identified from the multidisciplinary team, with a collaborative rather than ‘top-down’ approach. Administrators in patient-facing roles were surveyed to ascertain current understanding and frequency of involvement in confidentiality issues. Based on feedback, a flowchart prompt was designed, ensuring it reflected best practice. Qualitative and quantitive data were collected before and after a two month implementation period.

Result

All respondents (n = 10) dealt with confidentiality issues at work, with 50% experiencing issues daily. 33% respondents did not feel confident dealing with confidentiality queries at work. The majority (60%) had received confidentiality training, but all respondents thought extra information would be useful. Of possible interventions, 70% supported a flowchart. Following an implementation period, 100% respondents re-surveyed agreed they felt confident dealing with issues related to confidentiality at work. The majority of respondents had used the flowchart and found it useful (83%). Qualitative data gathered suggested rolling-out the project elsewhere.

Conclusion

A lack of confidence surrounding issues with confidentiality, including information sharing, was identified. This can negatively impact patient engagement and delivery of care. The introduction of the confidentiality flowchart demonstrated improved understanding of, and confidence in, patient confidentiality issues. The small sample size means there are limitations in extrapolating findings to wider contexts. However, it is likely that more confidentiality training and practical information for NHS staff at the interface between patients, clinicians and services would reduce the risk of confidentiality breaches and reinforce positive relationships with services.
Improving physical health form completion on a general inpatient adult ward
Authors: Wong Brandon , Vekaria Anjna
Published: June 2021

Aims

The government's Five Year Forward View Plan for Mental Health has set a target for 280,000 people with severe mental health problems to be offered screening and appropriate intervention based on physical health risk stratification, including obesity, diabetes and heart disease. As such, physical health review for patients on a general inpatient adult psychiatry ward includes routine blood tests for cholesterol levels and HbA1c. They are recorded together in a Physical Health (PH) Form in the patient's electronic record and used to stratify cardiovascular risk factors and risk of diabetes. If a patient declines these blood tests it should be recorded on the PH form.

This study aims to improve the completion of Physical Health forms to ≥95% by within a 4-month period on a general adult inpatient psychiatric ward.

Method

PH form completion was measured using Tableau Software for a 4-week period as a baseline then fortnightly during the study. PH form completion required HbA1c and cholesterol levels to be inputted, or to be marked as declined where the patient had declined these tests. Potential interventions were discussed by clinicians and implemented using PDSA cycles with iterative changes tested and analysed. PH form completion was re-audited monthly for a 6-month period.

Result

Baseline data showed 61.54% of patients had physical health forms completed (n = 26; 61.54% with HbA1c, 76.92% with cholesterol completed). Iterative changes and improvements included; (i) paper list to track PH form completion, (ii) table on Microsoft Word, (iii) Excel spreadsheet, and (iv) a conditionally formatted Excel spreadsheet. The conditionally formatted Excel spreadsheet was colour-coded to show completed elements as green and incomplete elements as red.

Paper lists increased PH completion to 84.85% (n = 33). Word table increased PH completion to 96.43% (n = 28). Excel spreadsheet had PH completion of 96.67% (n = 30). Colour coded excel spreadsheet increased PH completion to 100% (n = 28). This was used as standard practice with sustained 100% completion in November (n = 34) and December (n = 39). The improvement was sustained to January 2021, although there was a decrease to 97.7% (n = 30).

Conclusion

It was hypothesised an intervention to track completion of PH forms would improve completion rate. The use of a colour-coded conditionally formatted Excel spreadsheet improved PH form completion to 100% within an 8-week period and a sustained increase of >95% 6 months after the study began. This study recommends the use of such an electronic record keeping system to assist with PH form completion.
Quality improvement project: delirium awareness and training in coventry memory services
Authors: Yahya Nurul , Saad Karim
Published: June 2021

Aims

By way of Quality Improvement, this project aims to identify awareness levels, deliver a brief training and thus increasing the confidence of Memory Assessment Clinicians in detecting delirium.

Background

People with dementia are at greater risk of delirium, and the acute confusion associated with delirium may be mistaken as part of their dementia. Despite having an estimated prevalence in care homes of 14.2% in the UK, delirium is under-recognised. Memory Assessment Clinicians may have low confidence in identifying and have low awareness of delirium despite being tasked with a triage and diagnostic role in dementia assessment. NICE has recently updated the guidelines on Delirium in March 2019 with recommendations on prevention and treatment of Delirium.

Method

We delivered a survey pertaining:

(a)

Awareness of Delirium NICE Guidelines

(b)

Confidence in spotting Delirium

We used convenience sample of Memory Assessment Clinicians in Coventry. Overall, this survey was uptake by 17 clinicians. The pre training survey was done in early October 2019 and the post training survey was done shortly after the training, at the end of October 2019.

A brief training comprising NICE Guidelines and using Confusion Assessment Method (CAM) was delivered. The survey is repeated post training and differences in result of level of confidence is done to measure changes. The survey assessed knowledge, beliefs, practices and confidence level regarding delirium detection.

Result

Pre training:

17 clinicians took part in the survey. 59% was aware that there is a delirium NICE guidelines. 12% felt strongly agree, 41% agree and 47% felt neutral in their confidence of detecting delirium.

Post training:

10 clinicians took part in the survey. 50% felt strongly agree and 50% agree that they are confident in detecting delirium.

Overall, the mean difference is 2 and the p value is 0.92034. we used Mann- Whitney Test to measure the difference in pre and post training which showed not significant at p < 0.05.

Participants felt that the training was useful and relevant to practice.

Conclusion

This study showed our clinicians have a good basic knowledge in detecting delirium. As a result of this study, we have created ‘Delirium checklist’ and Confusion Assessment Method (CAM) to be used during duty work. We also feel that the majority of delirium cases referred to us comes from the community base, thus our next step of the project will be to involve educational work with the community care home.
Factors associated with mental health outcomes among medical residents exposed to COVID-19
Authors: Khoodoruth Mohamed Adil Shah , Ouanes Sami , Smida Malek , Al-Salihy Zerak , Nuaimi Saleem Al , Khoodoruth Widaad Nuzhah Chut-kai , Ghaffar Adeel , Mohammed Mohammed Faisal Hamad
Published: June 2021

Aims

The aims of our study were to assess and to examine i. the psychological impact of the COVID-19 pandemic on medical residents working on the front and second line, ii. the association between coping strategies, resilience and optimism and different mental health outcomes like stress, anxiety, and depression among the medical residents’ workers during the COVID-19 pandemic, and iii. the coping strategies used on the same sample with consideration of different factors like seniority, frontliner, gender and coping style.

Method

An electronic survey was sent to all medical residents in Qatar. Depression, anxiety and stress were assessed by the Depression, Anxiety and Stress Scale – 21 Items. Professional quality of life was measured by the Professional Quality of Life measure. The coping mechanisms were assessed with the Brief-COPE, resilience by the Brief Resilience Scale, and optimism by the Revised Life Orientation Test (LOT-R).

Result

Of the 640 medical residents contacted, 127 (20%) responded. A considerable proportion of residents reported symptoms of depression (42.5%), anxiety (41.7%) and stress (30.7%). Multivariate analysis of variance showed significant effects of seniority in residency, with junior residents having poorer outcomes. In addition, there was a statistically significant interaction effect with moderate effect sizes between gender and working on the front line, as well as gender, working on the front line and seniority, on mental health outcomes. The most commonly used coping strategies were acceptance, religion, and active coping. The least reported coping strategies were substance use and denial. Avoidant coping style scores were higher among junior residents (p = .032) and non-COVID-19 frontliners (p = .039). Optimism LOT-R score was higher in senior than in junior residents (p < .001). Another important finding is that optimism and resilience were associated with better mental health outcomes. In addition, we find that avoidant coping style is highly associated with depression.

Conclusion

The COVID-19 pandemic may have a negative impact on junior residents’ mental health. Preventive measures to reduce stress levels and easy access to professional mental health services are crucial. This study also raises awareness among residency programs on the psychological and coping responses and strategies of medical residents.
The relationships between Big Five Personality dimensions, harmful psychoactive substance use and academic motivation among undergraduates in Nigeria
Authors: Awolaran Busola , Babalola Emmanuel , Onifade Peter
Published: June 2021

Aims

The aim of this study was to determine the relationships between personality traits, stress perception, academic motivation and harmful use (use related harmful consequences) of alcohol, tobacco and cannabis among undergraduates in Southwestern Nigeria.

Method

The study is a descriptive cross-sectional study conducted among students of randomly selected tertiary institutions in south western Nigeria. Ethical approval was obtained from the Research and Ethics Commitee of the Federal Neuropsychiatric Hospital Abeokuta Ogun State Nigeria. Permission to carry out the study was sought from the University authorities. A multi-stage cluster sampling selection of 850 respondents was done. Consenting students were administered socio-demographic questionnaire, WHO student's drug use questionnaire, the Big Five Personality Inventory (BFI-44), perceived stress scale-10 and academic motivation inventory.

Result

Seven hundred and eighty one completed questionnaires were analysed yielding a response rate of 92%. There were 51% males and 49% females with a mean age of 23.3 years (SD = ±2.29), from monogamous family setting 591(75%) and high socio-economic class (65.8%). Of the respondents, 24.8% reported experience of use related harmful consequences such as engaging in quarrel or argument, unprotected sex and sex regretted the next day. There were significant associations between male gender (p=<0.001), urban residence (p = 0.028), polygamous family setting (p = 0.002), high socioeconomic status (p = 0.026) and use related harmful consequences.

Multiple logistic regression showed that the odds of experiencing harmful consequences was less than 1 for agreeableness (OR = 0.515, df = 1, p = <0.001) and openness (OR = 0.634, df = 1, p = <0.028) but greater than 1 for extraversion (OR = 1.525, df = 1, p = <0.036) personality dimensions. This implies that for a unit increase in agreeableness and openness scores, there were decreased odds (8.6% and 79% respectively) of experiencing harmful consequences while there was increased odd (86%) of experiencing harmful consequences from a unit increase in extraversion score.

Both binary and multiple regression analysis revealed that the odds of experiencing harmful consequences is greater than 1 for perceived stress score (OR = 1.079, p = <0.001) and less than 1 for academic motivation (OR = 0.975, p = <0.001). This means that perceived stress is positively associated with substance use and experience of harmful consequences while academic motivation is negatively associated with substance use and experience of harmful consequences

Conclusion

There were associations between certain socio-demographic factors, personality dimensions, stress perception and academic motivation with substance use and experience of harmful consequences. Thus, clinicians and researchers should consider these factors when designing preventive and treatment strategies.
Mental health, physical impairment and violence among FSWS in North Karnataka, South India: a story of intersecting vulnerabilities
Authors: Beksinska Alicja , Beattie Tara S , Platt Lucy , Bhattacharjee Parinita , Prakash Ravi , Ramanaik Satyanarayana , Dibbadahalli Kavitha , Collumbien Martine , Gafos Mitzy , Davey Calum , Watts Charlotte , Isac Shajy , Jewkes Rachel
Published: June 2021

Aims

This study examines the prevalence and associations between recent violence experience, mental health and physical health impairment among Female Sex Workers (FSWs) in north Karnataka, India.

Background

Multi-morbidity, in particular the overlap between physical and mental health problems, is an important global health challenge to address. FSWs experience high levels of gender-based violence, which increases the risk of poor mental health, however there is limited information on the prevalence of physical health impairments and how this interacts with mental health and violence.

Method

We conducted secondary analysis of cross-sectional quantitative survey data collected in 2016 as part of a cluster-RCT with FSWs called Samvedana Plus. Bivariate and multivariate analyses were used to examine associations between physical impairment, recent (past 6 months) physical or sexual violence from any perpetrator, and mental health problems measured by PHQ-2 (depression), GAD-2 (anxiety), any common mental health problem (depression or anxiety), self-harm ever and suicidal ideation ever.

Result

511 FSWs participated. One fifth had symptoms of depression (21.5%) or anxiety (22.1%), one third (34.1%) reported symptoms of either, 4.5% had ever self-harmed and 5.5% reported suicidal ideation ever. Over half (58.1%) reported recent violence. A quarter (27.6%) reported one or more chronic physical impairments. Mental health problems such as depression were higher among those who reported recent violence (29%) compared to those who reported no recent violence (11%). There was a step-wise increase in the proportion of women with mental health problems as the number of physical impairments increased (e.g. depression 18.1% no impairment; 30.2% one impairment; 31.4% ≥ two impairments). In adjusted analyses, mental health problems were significantly more likely among women who reported recent violence (e.g. depression and violence AOR 2.42 (1.24–4.72) with rates highest among women reporting recent violence and one or more physical impairments (AOR 5.23 (2.49–10.97).

Conclusion

Our study suggests multi-morbidity of mental and physical health problems is a concern amongst FSWs and is associated with recent violence experience. Programmes working with FSWs need to be mindful of these intersecting vulnerabilities, inclusive of women with physical health impairments and include treatment for mental health problems as part of core-programming.

Samvedana Plus was funded by UKaid through Department for International Development as part of STRIVE (structural drivers of HIV) led by London School of Hygiene and Tropical Medicine and the What Works to Prevent Violence Against Women and Girls Global Programme led by South African Medical Research Council
The impact of the March 2020 lockdown on the cardiometabolic risk factors of male forensic and rehabilitation patients
Authors: Dodough Nicholas , Phull Jaspreet , Singh Jaswant , Sendell Jackie
Published: June 2021

Aims

To explore the impact of the March 2020 lockdown restrictions on the cardiometabolic risk factors of male forensic and rehabilitation inpatients in one NHS trust in the United Kingdom.

Method

Retrospective data from September 2019 to September 2020 (six months before and after the 23 March 2020 lockdown) was collected by evaluating the health records of male patients in a low secure forensic ward and two rehabilitation units.

Result

The number of patients with BMI values within the study period was 34 while the number of patients with blood results was 26. This study showed that the average BMI six months before the start of the March lockdown was 29.8 kg/m2 while the average BMI at the end of six months after the lockdown was 31.8 kg/m2.

The results from the 6-month interval before the March 2020 lockdown (M = 0, SD = 0) and the 6- month interval after the March 2020 lockdown (M = 0.9, SD = 4.16) indicate that the March 2020 lockdown resulted in an increase of BMI, t (5) = 2.42, P = 0.036. The result is significant at p < 0.05

8.8% of patients had an increase in their doses of antihypertensive agents after the lockdown whereas no patients had an increase of dose before the lockdown. 7.7% of patients had an HBA1c of more than 48 mmol/L after the lockdown compared to 3.8% before the lockdown. The serum triglycerides and total cholesterol levels also increased after the lockdown with an average increase of 0.17 mmol/L and 0.25 mmol/L respectively. The average serum HDL levels decreased after the lockdown with an average decrease of 0.06 mmol/L.

Conclusion

There appears to be a positive correlation between the onset of the March 2020 lockdown and an increase of BMI, worsening of blood pressure, glycemic control and lipid metabolism.

Limitations

(1)

Waist circumference was not measured during the study period preventing us from examining all of the features of metabolic syndrome.

(2)

This study did not look at the levels of physical activity (such as access to section 17 leave) and dietary habits before and after the March 2020 lockdown which may explain the results found.

Recommendations

To raise metabolic awareness of the impact of the lockdown restrictions on cardiometabolic risk in people with SMI and the general public.
Impact of COVID-19 on the mental health of healthcare workers in different regions of the world
Authors: Islam Mahfuja , George Philip , Sankaran Sindhu , Su Hui Janet Leu , 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.
Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study
Authors: Jomaa Sami , Kakaje Ameer , Zohbi Ragheed Al , Alyousbashi Ayham , Abdelwahed Rawan N K , Aldeen Osama Hosam , Alhalabi Mohammad Marwan , Ghareeb Ayham , Latifeh Youssef
Published: June 2021

Aims

The Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria.

Method

This is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters.

Result

This study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lower PTSD scores but was associated with a worse physical component of HRQL.

Conclusion

This is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.
Reducing aggression and improving offending outcomes in youth with conduct disorder, results of a systematic review
Authors: McEwan Craig , Dunn Lauren , Harvey Jake
Published: June 2021

Aims

The aim of this literature review was to determine what interventions are effective in reducing aggression and offending behaviour in under 18's with conduct disorder.

Null hypothesis: There is no difference in aggression or offending behaviour in under 18's with conduct problems in spite of interventions offered

Background

Mental health services for children and adolescents who are aggressive or who have come into contact with the Youth Justice System are sparse and often under resourced. Conduct disorder (CD) is one of the most frequently diagnosed conditions in adolescents, particularly in young offenders (Kenny et al 2007). The most effective prevention programs for youth at risk of persistent delinquency has previously been found to be a multi model program focussing on the family context. However, this has not taken in to consideration the extent and prevalence of mental disorder, including conduct disorder, within the target population.

Method

A systematic literature search was undertaken on medline and psychoinfo between January and December 2018. Identified papers were then screened by two independent researchers against pre-agreed inclusion and exclusion criteria. Relevant papers were assessed for bias and results summarised.

Result

From an initial data set of 526 papers, 9 were included for review. 4 focussed on psychopharmacology (1 aripiprazole, 1 risperidone, 1 risperidone vs clozapine, 1 clozapine), 1 family centred feedback, 1 Mode Deactivation Therapy and 3 were multi modal (combinations of Mode Deactivation Therapy, Stop Now and Act Programme, CBT, Didactic sessions, 1:1 counselling). None of the multi-modal interventions were standardised or comparable to each other. End points varied from 8 weeks (aripiprazole) to 15 months (multimodal SNAP programme). Settings varied from community programmes to secure inpatient settings. Whilst one risperidone study reported it to be effective in reducing aggression, it was not significant. One SNAP (multimodal) programme failed to show significant effect. All other 7 interventions, across various methods, demonstrated significant reductions in aggression, violence or other antisocial behaviour.

Conclusion

Few papers were identified that assessed interventions for youth with conduct disorder. The papers that were identified were significantly heterogeneous in their intervention, sample selection, methodology and outcome measures. Unfortunately, this leads to an inability to compare any interventions for this demographic. Despite the rise in Forensic Child and Adolescent Mental Health Services, there is a weak and poorly understood evidence base for supporting and managing young people with conduct disorder.
Prevalence and correlates of depression and quality of life among primary caregivers of patients with schizophrenia attending a Nigerian Tertiary Hospital
Authors: Akinfala Akinloye , Sowunmi Oladipo , Sakeeb Imam
Published: June 2021

Aims

To determine the prevalence and correlates of depression and quality of life and their relationship among primary caregivers of patients with schizophrenia in a psychiatry specialist hospital.

Method

A total of 138 caregivers of patients diagnosed with schizophrenia attending the outpatient clinic of the Neuropsychiatric Hospital Aro, Abeokuta were recruited. Sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI-PLUS) (depressive module) and World Health Organization Quality of Life-Bref (WHOQOL-Bref) were administered on the caregivers while Brief Psychiatric Rating Scale (BPRS) was used to measure symptoms severity in the patients.

Result

The mean (±SD) age of respondents was 48.3 years (±14.7), 53.6% were females and 33.3% were without partners. The prevalence of depression among the caregivers who participated in the study was 13.8%. Female gender (χ2 = 5.68, df = 1, p = 0.02), hailing from a minority tribe (χ2 = 9.78 df = 1, p < 0.01), and Previous treatment for mental illness (χ2 = 8.24 df = 1, p < 0.01) were associated with depression. Female gender (ß = 1.35, OR = 3.86, p = 0.03), minority tribe (ß = 1.95, OR = 7.03, p < 0.01), and previous treatment for mental illness (ß = 3.19, OR = 24.21, p = 0.01) were independently predictive of depression in the caregivers.

Independent predictors of lower quality of life (QOL) were: Parents/siblings relationship for social relationship domain (ß = −7.076, p = 0.037) and spending more than 35 hours per week for Environmental domain (ß = −5.622, p = 0.028).

Finally, a significant correlation was also found between Depression and Psychological Domain of QOL (t = 3.048, p < 0.01) and Social Domain of QOL (t = 2.154, p = 0.03).

Conclusion

This study shows that primary caregivers of patients with schizophrenia have high prevalence of depression and poor quality of life. There is need to pay attention to the psychological wellbeing and quality of life of caregivers who come in contact with psychiatric services, and not just the patients they accompany.
Diversion and liaison services in England and Wales for mentally disorder offenders – a narrative review
Authors: McLaughlin Patrick
Published: June 2021

Aims

To critically examine the development of L&D services in England and Wales and critically appraise their evidence base.

Background

High levels of morbidity across the criminal justice pathway are well established. Although the strongest evidence has emerged from prison studies, the court literature also confirms these high levels. In acknowledgment of this, there have been a range of initiatives to improve access to services for mentally ill individuals involved with the criminal justice system. Once such initiative has been the development of court liaison and diversion services (L&D).

Method

Relevant literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the development of L&D services and their evidence base.

Result

The provision of L&D services has increased substantially since their first introduction in England and Wales in 1989. Early L&D services were largely small-scale, unfunded local schemes, and were dependent upon the energy and interest of clinicians who chose to lead in this area. This led to geographical variations in provision and variations in L&D model delivery. The Bradley Report (2009) recommended that a national L&D model be created. The roll-out of a national L&D model meant that half the population of England was covered by 2015, with funding assured for a final wave of L&D services to provide for total population coverage.

Where implemented, L&D services have been shown to lead to increased numbers of local team referrals. They may reduce court adjournments and the overall amount of time spent attending court. There is also some evidence of an association with improved mental health among both adults and young people, with reductions in re-conviction rates amongst the later. There remain deficiencies in the evidence base with regards to the economic impact of L&D services. The majority of economic assessments of L&D services have been performed in the United States with fewer studies in the UK.

Conclusion

Although there is evidence that liaison and diversion can produce benefits, there is a general recognition that a higher standard of evidence is required, including experimental work and assessment of economic impact. L&D services carry a financial burden, but this may be offset by incorporating the value of the health improvements that may be brought in those who might otherwise not have received treatment.
Do reality distortions contribute to an increased risk of violent offending in schizophrenia? – a narrative review
Authors: McLaughlin Patrick
Published: June 2021

Aims

To critically examine the factors that drive an increased risk of violence in the schizophrenic population, with emphasis on the role played by reality distorted symptoms.

Background

A multitude of studies have reported a positive association between schizophrenia and violence. Many of the risk factors for violence among the non-mentally disordered population, such as substance use, childhood conduct problems and victimisation, are the same as for persons with schizophrenia. There remains controversy however as to whether reality distorted symptoms themselves contribute to the increased risk of violence.

Method

Relevant literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the current evidence base for the role of reality distorted symptoms in violence in schizophrenia.

Result

Studies ascertaining the contribution of reality distorted symptoms in violent behaviour have produced contradictory results. At a population level, several epidemiological surveys have found little or no contribution for reality distorted symptoms. Such studies frequently show that violence can be accounted for almost entirely by other factors such as substance use and victimisation. However studies investigating relationships between clinical diagnoses and population-wide violence may be unable to detect association at the symptom level. A number of studies have found strong associations between schizophrenia and violence which was not explained by comorbid substance use and have shown strong associations between specific reality distorted symptoms (in particular persecutory delusions accompanied by anger) and violent behaviour.

Conclusion

There is heterogeneity in the relationship between schizophrenia and violence. Factors that are associated with increased risk of violence among the schizophrenic population are also pertinent to those without mental disorders. With regards to the pathways to violence in schizophrenia the following conclusions may be drawn: there is an well-established increased risk of violence associated with schizophrenia which has been replicated in many studies; this risk is driven largely by substance use but other factors such as victimisation are also important; there is evidence that reality distorted symptoms, particularly persecutory symptoms, play a role in violent behaviour in some patients, particularly when co-occurring with anger; finally, there may be shared aetiological links between schizophrenia and antisocial behaviour.
The haematological side effects of clozapine: literature review and meta-analysis
Authors: Munshi Tariq , Naeem Farooq , Ayub Mohammed , Farooq Saeed , Khachatryan Davit , Asmer Selim , Wang Peter , Premji Shahista , Winssen Christine Van , Lau Felix , Fairbairn Jonathan
Published: June 2021

Aims

This review and meta-analysis aim to estimate the cumulative incidence of clozapine induced agranulocytosis and leukopenia the impact of the associated factors such as dose of clozapine, duration of follow-up, gender and race on the cumulative incidence.

Background

Clozapine is the only medication licensed for treatment-resistant schizophrenia. There has been a renewed interest in the role of Clozapine in the treatment of Schizophrenia based on strong evidence that favours its efficacy and safety. Despite the evidence that Clozapine has superior efficacy and has been recommended for treatment-resistant cases by the national guidelines, the drug is underutilised.

Method

We included all studies in which clozapine was used for a psychotic illness. We included studies which provided data on two primary indices; Leucopenia or agranulocytosis and neutropenia; defined according to the cut off used by CPMS for total WBC and neutrophil count. Additionally we included studies reporting another blood dyscrasia or death due to agranulocytosis. Studies were identified by searching AMED, BIOSIS, CINAHL, EMBASE, MEDLINE, PsycINFO, PubMed, and registries of Clinical Trials and their monthly updates, hand searches, gray literature, and conference proceedings from the first available date until 2nd February, 2015. The search was updated on 15th March, 2017. The Protocol was initiated and then registered with PROSPERO International prospective register of systematic reviews University of York, Centre for Reviews and Dissemination.

Result

The cumulative incidence of the agranulocytosis in all studies was 00.32 % (CI 00.1-0.63). The cumulative incidence in all studies for different types of blood dyscrasia were following: leucopenia 00.96 % (CI 0.39-1.70), neutropenia 2.93 % (CI 1.49-4.72), other blood dyscrasias 4.64% (CI 2.34-7.52) and any blood dyscrasia was 2.23 (CI 1.46-3.12).

Conclusion

The limitations of this review are mainly due to the nature of evidence from the included studies. We adopted a broad inclusion criteria to include all the available evidence. Number of patients started on Clozapine may be withdrawn from the Clozapine on the earliest signs of blood dyscrasias since the introduction of Clozapine monitoring services. This means that the true incidence of agranulocytosis and neutropenia may be higher and this may be a major bias in finding the true incidence of Clozapine induced neutropenia.
The mental health of elite rugby players (a literature review)
Authors: Musgrave Kirk
Published: June 2021

Aims

Players are Rugby's key asset, what recent research has been conducted into the Mental Health of rugby players/former players?

Method

Initially a Literature Search using HDAS, Ebsco, Researchgate and Googlescholar followed by a Literature Review of relevant articles.

Result

A significantly higher prevalence of anxiety and depressive symptoms in Professional rugby players (compared to the general population) is something that authors agree on. This review considers some of the rugby specific variables not limited to injuries (including concussion), retirement from the sport and finally alcohol abuse.

In 2014, Sullivan looked at the role of potential mediators between concussion and later life depression. Sullivan suggested that the effects of concussion on later life depression may be directly neurological.

Chronic Traumatic Encephalopathy (CTE) is a neurodegeneration which is only definitively diagnosed by post-mortem examination of brain tissue at this time. Today, Chronic Traumatic Encephalopathy is a very controversial subject, for every piece of research which claims to prove CTE, there is another piece of research apparently disproving it.

Alcohol Misuse - Whilst it is well known in general adult psychiatry that alcohol has a significant negative impact on depression and anxiety in the general population, this review summarises findings from research into alcohol misuse in elite rugby players.

Conclusion

In addition to personal variables (which include personality, perfectionism, ability to cope with stress, optimism, pessimism, ability to utilise mental skills, burnout and career satisfaction) there are rugby specific variables which are not limited to injuries, retirement from the sport and finally alcohol abuse.

As mentioned in the paragraph on depression and anxiety, numerous recently published authors agree that a significantly higher prevalence of anxiety and depressive symptoms are seen in Professional rugby players (compared to the general population).

As alcohol misuse has already been researched, there would seem to be an opportunity for future research into the extent of illicit drug use by elite rugby players and potentially the effect of illicit drug use on depressive symptoms and anxiety. As mentioned in the paragraph on depression and anxiety, numerous recently published authors agree that a significantly higher prevalence of anxiety and depressive symptoms are seen in Professional rugby players (compared to the general population).

Finally, given the limited recent published literature on suicide in elite rugby players and former elite rugby players, a significant research gap exists in this particular field.
The role of animal-assisted therapy in the management of people with dementia: a systematic literature review
Authors: Javaid Syed Nabeel
Published: June 2021

Aims

The aim of this systematic literature review was to determine the evidence-based effectiveness of animal assisted interventions and to look at the factors that limit implementation of this intervention.

Background

Dementia is a major health issue worldwide impacting not only on the people diagnosed with dementia, but also on their families and caregivers, and the healthcare professionals. The symptoms of dementia include cognitive impairment that can range from mild to severe, and behavioural and psychological symptoms which have debilitating effects on functional capacity and quality of life. A number of non-pharmacological interventions are being developed to help people with dementia. Animal assisted therapy is one of those interventions that has demonstrated positive effects on various aspects of dementia (Filan and Llewellyn-Jones, 2006). However, there are limitations to its use and feasibility of animal assisted therapy programmes is unclear.

Method

Only randomised-controlled trials (RCTs) were to be included to evaluate high quality evidence. A systematic literature search was carried out to find using the PubMed and Cochrane databases and a search of the NICE website. Literature was screened according to inclusion and exclusion criteria. Eight randomised-controlled trials were selected to be used in this systematic review to assess the effectiveness of animal-assisted therapy.

Result

The results regarding the effectiveness of animal assisted therapy were variable. There was some improvement demonstrated in symptoms of depression, agitation, behaviour and cognitive impairment. Quality of life and activities of daily living also demonstrated positive outcomes. There was a reduction in the risk of falls in people with dementia. However, the studies conducted demonstrated limited methodologies. The factors limiting the use of animal assisted therapy were found to be concerns around adverse events to animals, issues of animal welfare and economic feasibility of animal assisted therapy programmes.

Conclusion

Further research needs to be done using properly conducted randomised controlled trials with larger sample sizes to formally assess people's perceptions regarding therapy animals and develop clear guidelines and protocols for integrating these interventions in healthcare.
The feasibility and acceptability of a peer-support group for mental health in Filipino prisons
Authors: Platford Bethany
Published: June 2021

Aims

To assess the feasibility and acceptability of implementing and facilitating a peer-support group for mental health in Filipino prisons.

Objectives

To identify the logistical issues faced in implementing and facilitating healthcare in Filipino Prisons

To explore attitudes of potential participants towards the implementation of a peer-support group for mental health in the prisons

To provide logical recommendations from my findings to inform future mental health support for prisoners in the Philippines

Method

Ethical approval was granted by the University of Leeds prior to data collection. In-country ethical approval was granted through my host Dr Rachael Pickering. Data collection occurred through observations and semi-structured interviews. Participants recruited included six secure-environment healthcare workers, eight prisoners and six ex-prisoners. Both prisoners and ex-prisoners were identified through gatekeepers and informed consent was gained. Interviews were transcribed before coding and themes identified.

Result

Feasibility: Bureaucracy and corruption were the main barriers to the potential successful implementation of a peer-support group, which were emergent themes. Space, time and staff were all themes identified that may help facilitate the group.

Attitudes: It was noted that there is a significant lack of knowledge surrounding what mental health is and its causes. Stigma and discriminatory actions were also noted by many participants as barrier to the group. However, seven prisoners and five ex-prisoners said they would join.

Conclusion

The findings highlighted many barriers but with perservance and local cultural competence this peer-support group could be feasible and be accepted in Filipino prisons. It will be reducing a high unmet need for mental health services in these prisons and if ran successfully with positive effects, will be an example for other prisons across the Philippines and other low-middle income countries.
Exploring the influence of wilderness on conscious awareness
Authors: Purnell Oli
Published: June 2021

Aims

This study examined what effect wilderness has on our conscious awareness, and by extension of that meta-cognition; our physical, mental and spiritual health.

Background

Method

It reviews available scientific and artistic literature and integrates this with interviews in order to generate original grounded theory.

Result

It was found that intensity of wilderness experience varied proportionally with four mediators; Challenge, Immersion, Beauty and Time. With these maximised, experiences broadly within four themes occurred; Increased Awareness, Confidence, Perspective and Connectedness. When sufficiently intense, these four experiences amalgamated to elicit what Maslow described as 'Peak Experience'.

Conclusion

As such, this thesis unexpectedly provides a pragmatic recipie towards peak experience, and a map of one's potential psychological journey, in the context of wilderness.