bluuebunny/crossref_metadata_2025_split huggingface dataset:
An audit assessing the monitoring of SSRIS after initiation in children and adolescents
Authors: McGowan Ella 
Published: June 2021

AimsTo identify children and adolescents started on SSRIs to see if they are being followed up in accordance to NICE and Maudsley guidelinesObjectivesHas the patient been followed up after a week to check for adverse effects or improvement in their mental state?Has the patient been re-evaluated every 4-6 weeks, if not is there an alternative plan?If there is no improvement has the dose been increased?If there is an adverse effect has the dose been lowered or the medication stopped?MethodPaper case notes including clinic letters and handwritten notes were reviewed on the 19/10/2020. The following data were collected anonymously.AgeGenderDate seen / Date medication startedName of medicationDate medication startedDate of Follow-upMonitoring of improvementMonitoring of adverse effectsOutcome of monitoringResultA total of 18 sets of cases were identified.Follow-up occurred in 17 of the 18 cases.The one case that had not been followed up had started the medication 8 weeks before the audit. The median follow-up time was 42 days (6 weeks). No cases were followed up within a week.Monitoring of improvement was recorded in 88% of case notes reviewed.Monitoring for adverse effects occurred in 36% of case notes and none of these patients had reported any side effects. 53% of cases did not have monitoring of adverse effects documented. There were two patients (11%) who did not take the medication as prescribed. One out of choice and one their parent had not collected it.The medication dose was increased in 22% of patients without clear documentation of monitoring for adverse effects.ConclusionAfter discussion with the clinical lead it was decided it is impractical to follow up patients a week after starting medication. However, patients and their carers should be informed of the side effects and advised to contact CAMHS if adverse effects occur.The area of practice that can be improved is the documentation of adverse effects at follow-up.Recommendations:All patients to be informed of the common side effects of the medication before it is initiated and advised to contact the CAMHS team if they have concernsAll CAMHS patients started on SSRIs should be followed up within 4-6 weeksAt follow-up any adverse events and clinical response should be discussedAn accurate record of the exchanges of the above information should be documented in the notesRe-audit
The utility of the Brief Edinburgh Depression Scale (BEDS) in assessing severity of depression in advanced cancer patients
Authors: Meyer Zeryab , Shiels Christopher , Dowrick Christopher , Lloyd-Williams Mari 
Published: June 2021

AimsWhen using an assessment tool, brevity and validity are essential. Although brief depression inventories exist, they rely heavily on the inclusion of somatic symptoms. This can be problematic in advanced cancer populations; weight loss and sleep disturbance are for the most part ubiquitous in these patients and may not necessarily be indicative of depression.The Brief Edinburgh Depression Scale (BEDS) is a 6-item shortened version of the Edinburgh Depression Scale which has been validated for use in patients with advanced cancer and is used internationally. The BEDS cut off threshold of 6/18 indicates that depression may be present. However, the BEDS currently provides no information regarding severity. The aim of this study is to establish severity thresholds for the BEDS by comparing it to another depression scale: the commonly used, rigorously validated, Patient Health Questionnaire (PHQ-9).Method284 advanced cancer patients attending hospice day services in the North West of England completed both the PHQ-9 and the BEDS. Mean participant age was 66.7 (Standard Deviation = 13.2) and the sample contained both males (n = 102, 36%) and females (n = 182, 64%). BEDS severity thresholds with the highest Sensitivity (Sn) and Specificity (Sp) were selected based on their ability to predict PHQ-9 categories.ResultA BEDS score of 4 to 6 was selected to indicate ‘mild depression’ (Sn = 81.7, Sp = 65); 7 to 8 ‘moderate depression’ (Sn = 74.8, Sp = 78.7); 9 to 11 ‘moderately severe depression’ (Sn = 82, Sp = 82.9) and 12 or more ‘severe depression’ (Sn = 63.2, Sp = 92.8). A linearly weighted kappa (with s weighting) showed a moderate level of agreement (0.47, 95% Confidence Interval: 0.40-0.54).ConclusionThe BEDS is a simple and brief tool used to screen for depression in advanced cancer patients. It is administered throughout the UK and multiple translation studies have enabled its global a (including in resource poor countries). The severity thresholds calculated here are derived from a large sample of patients with advanced cancer attending hospice services and demonstrate acceptable sensitivity and specificity in relation to the PHQ-9, a thoroughly validated reference standard. We conclude that the generated BEDS thresholds support use of the BEDS in determining the presence and severity of depression in advanced cancer populations.
Improving facilitation of ECT treatment for patients in an acute medical hospital
Authors: Mishra Vatsala , Fai Lam Chun Chiang Sin , Calcia Marilia , McMullen Isabel 
Published: June 2021

AimsA Quality Improvement Project aiming to streamline facilitation of electroconvulsive therapy (ECT) treatment for psychiatric patients at a general acute hospital and reduce cancellation rates via the use of a checklist.ECT treatment is an essential aspect of psychiatric care for patients with severe depression or treatment-resistant psychosis. Facilitation of ECT treatment is an uncommon task for liaison psychiatry and the medical and nursing teams responsible for patients’ medical care. Between August-October 2019, this liaison psychiatry team had 3 patients undergoing ECT treatment a total of 13 times, with treatment being cancelled on 4 occasions. After engagement with stakeholders from the acute medical teams, the liaison team and the ECT suite team, key areas requiring intervention were identified to help reduce the rates of cancellation. Areas identified included a lack of ownership on the logistic and operational aspects of ECT amongst staff, a lack of knowledge of what the process involved and a lack of confidence in managing said patients. Difficulties in communication between teams and accurate documentation may contribute to errors and cancellation of ECT sessions, which in turn would delay treatment and impact on patient safety and clinical outcomes.MethodThe first author, a Foundation Year 1 doctor, developed a 10-point checklist to be referred to when arranging ECT for patients, to ensure errors were not made which could lead to missed treatment and delayed recovery. The tasks and responsibilities of each key member of the team were clearly identified. This checklist was included in all ECT patients’ files and teaching was provided to staff involved. Feedback was obtained from staff involved regarding the clarity of information and their confidence in managing such cases.ResultIn the month following initial intervention the liaison psychiatry team organised 12 ECT sessions. The checklist was pasted into notes the day before each ECT session and 0 sessions were missed for avoidable reasons. Feedback from staff showed all teams felt more confident co-ordinating ECT treatment as a result of the checklist.ConclusionCreating a 10-point checklist for the facilitation of ECT treatment in patients at a medical hospital was beneficial in reducing avoidable errors from 16% to 0%. The liaison psychiatrists, medical doctors, and nurses involved reported greater confidence in managing patients undergoing ECT and described the checklist as enhancing the feeling of teamwork and communication within the multi-disciplinary team, and felt it had improved patient safety and clinical outcomes.
Contribution of birth weight to mental health, cognitive, and socioeconomic outcomes: a two-sample Mendelian randomisation
Authors: Orri Massimiliano , Pingault Jean-Baptiste , Turecki Gustavo , Nuyt Anne-Monique , Tremblay Richard E , Côté Sylvana M , Geoffroy Marie-Claude 
Published: June 2021

AimsLow birth weight is associated with adult mental health, cognitive, and socioeconomic problems. However, the causal nature of these associations remains difficult to establish due to confounding. We aimed to estimate the contribution of birth weight to adult mental health, cognitive, and socioeconomic outcomes using two-sample Mendelian randomisation, an instrumental variable approach strengthening causal inference.MethodWe used 48 independent single-nucleotide polymorphisms as genetic instruments for birth weight (N of the genome-wide association study, 264 498), and considered mental health (attention-deficit hyperactivity disorder [ADHD], autism spectrum disorders, bipolar disorder, major depressive disorders, obsessive-compulsive disorder, post-traumatic stress disorder [PTSD], schizophrenia, suicide attempt), cognitive (intelligence), and socioeconomic (educational attainment, income, social deprivation) outcomes. We performed a two-sample Mendelian randomisation using the random-effect Inverse Variance Weighing method as primary analysis, supplemented by a wide range of sensitivity analyses, including Egger regression, weighted median, and Pleiotropy Residual Sum and Outlier. Results were considered statistically significant after accounting for multiple testing using False Discovery Rate (q = 0.05).ResultAfter correction for multiple testing, we found evidence for a contribution of birth weight to ADHD (OR for 1 SD-unit decrease [~464 grams] in birth weight, 1.29; CI, 1.03–1.62), PTSD (OR = 1.69; CI = 1.06–2.71), and suicide attempt (OR = 1.39; CI = 1.05–1.84), as well as for intelligence (β= –0.07; CI= –0.13; –0.02), and socioeconomic outcomes, ie, educational attainment (β=−0.05; CI= –0.09; –0.01), income (β=−0.08; CI= –0.15; –0.02), and social deprivation (β=0.08; CI = 0.03; 0.13). However, no evidence was found for a contribution of birth weight to the other examined mental health outcomes. Results were consistent across main and sensitivity analyses.ConclusionThese findings support that birthweight could be an important element on the causal pathway to mental health, cognitive and socioeconomic outcomes. Early interventions targeting birth weight may therefore have a positive impact on promoting mental health and improving socioeconomic outcomes.This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 793396
It's a risky business: use of the QCovid risk calculator in a psychiatric rehabilitation population to enhance prevention
Authors: Patel Jinal , Scott Fraser , Mohan Rajesh 
Published: June 2021

AimsSerious mental illness (SMI) is now accepted as a significant risk factor for contracting COVID-19, increasing the rates of adverse outcomes, including hospitalisation and mortality. Risk assessments are the cornerstone of protecting vulnerable groups of individuals. The QCovid risk calculator is a newly developed tool to predict the risk of death or hospitalisation from COVID-19. It has not been applied in SMI populations. We aimed to use the QCovid risk calculator in an inpatient rehabilitation setting to identify and mitigate risk for people with SMI with personalised COVID-19 prevention plans.MethodClinical and sociodemographic characteristics were obtained for 22 inpatients. Firstly, the QCovid risk calculator was used to ascertain the absolute and relative risks to patients (Odds Ratios (OR) of mortality and/or hospitalisation) from COVID-19. Patients were stratified as high (OR > 10), moderate (OR 5-10) and low (OR < 5) risk. Secondly, personalised COVID-19 prevention plans were coproduced by patients and clinicians addressing 1) risk factors contributing to increased QCovid risk, 2) patient's personal goals, concerns, and preferences 3) maximizing patient engagement in COVID-19 infection prevention strategies. Finally, uptake of personalised COVID-19 prevention plans was evaluated after four weeks using a customised patient feedback questionnaire.ResultOf the 22 inpatients (68% male), 14 patients (64%) had schizophrenia and 3 patients (14%) had schizoaffective disorder as primary diagnosis. 13 (59%) patients were prescribed clozapine. QCovid risk stratification showed 10% of patients as high risk, 29% as moderate risk, and 61% as low risk. Apart from SMI in all 22 inpatients, the most common QCovid risk factors were increased body mass index (64%, n = 14; 23% overweight and 41% obese), diabetes mellitus type 1 or 2 (27%, n = 6) and epilepsy (n = 4, 18%). 19 of the 22 patients provided feedback on their personalised COVID-19 prevention plans. Most patients (79%) felt they had “contributed significantly” to their COVID-19 prevention plans, and their individual goals and concerns were valued. 79% were “satisfied” with their COVID-19 prevention plans. Subjective perception of safety from COVID-19 was high, with 95% of patients feeling “safe and well-protected from COVID-19”.ConclusionComprehensive assessment of COVID-19 risks in vulnerable groups enables personalised risk mitigation, both at an individual and service level. Our findings show the importance of applying current knowledge to protect vulnerable patients with SMI through personalised prevention plans. This approach can be scaled up to understand risks for services and teams, while allowing clinicians to adapt their use for individualised COVID-19 prevention.
Sexual and reproductive health needs assessment & interventions in a female psychiatric intensive care unit
Authors: Rose Elizabeth , Covshoff Elana , Blake Lucy , Bolade Adenike , Rathouse Robert , Wilson Aleshia , Cotterell Arthur , Pittrof Rudiger , Sethi Faisil 
Published: June 2021

AimsTo assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments/interventions in this setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and interventions in the PICU.MethodA retrospective analysis of fifteen months’ activity data found that only 25 SRH referrals had been made across 205 PICU admissions. This low referral rate of 12% likely reflected pathway barriers and was unlikely to represent the actual clinical need in female PICU patients. A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.ResultA quality improvement approach streamlined SRH assessments on the PICU and resulted in 42% of women being assessed and a 3.5-fold increase in uptake. At least 30% of the women in the PICU had unmet SRH needs identified and proceeded to a specialist appointment. This amounts to a minimum 2.5-fold increase in SRH unmet need detection.The most common SRH needs were complex gynaecological issues (such as period problems, pelvic pain, vaginal discharge), STI advice/testing and contraception advice/options. 21% of women initiated SRH interventions, and 14% completed all the interventions required for their needs. The most common interventions were in the areas of contraception advice/family planning and STI advice/testing.Staff confidence on assessing SRH topics was identified as a barrier to access with a positive shift noted after bespoke SRH training was implemented and a protocol introduced: on a scale of 0-10 (with 10 being high), 81.3% of staff rated their confidence 8 or above in relation to discussing contraception/sexually transmitted infections (pre-training: 25.0%), and 93.8% in relation to discussing risky behaviours (pre-training: 18.8%). All 11 patient and carer participants felt it was important to have a forum to talk about SRH and 8 (72.7%) agreed it was important in the PICU.ConclusionResults identify that SRH needs for PICU admissions are greater than previously realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient's individual risk profile considered. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.
Sleep and the risk of cognitive impairment and dementia: further insights from the Caerphilly Prospective Study
Authors: Selwood James , Coulthard Elizabeth , Bayer Antony , Fish Mark , Gallacher John , Ben-Shlomo Yoav 
Published: June 2021

AimsSleep disorders are highly prevalent with growing evidence that sleep problems may predict cognitive decline and dementia. A previous analysis of the Caerphilly Prospective Study (CaPS), a cohort of middle-aged men, found that daytime sleepiness predicted vascular dementia and cognitive impairment. We have re-examined this hypothesis with additional events based on further follow-up. The study aimed to examine the role of different sleep problems in predicting cognitive impairment not dementia (CIND) and dementia. Our hypothesis was that sleep problems in mid-life would predict CIND and dementia in later life.MethodCaPS is a population cohort of men born between 1920 and 1935 and resident in Caerphilly in South Wales, first seen between 1979–1983. Cognitive tests and a sleep questionnaire were introduced at Phase III (men aged 55–69 years). The questionnaire asked about daytime dysfunction, hypnotic use, insomnia, napping, nocturnal limb movements, sleep apnoea, sleep duration, sleep latency and snoring.At Phase V (men aged 68–82 years), poor performance on the Cambridge Cognition Exam (CAMCOG) was used to select men for detailed clinical assessment. Subjects were classified as having normal cognition, CIND or dementia. Cognitive disorders were sub-classified as vascular or non-vascular. At Phase VII (men aged 78–92 years), new cases were identified and survivors with existing diagnoses were reassessed.We initially conducted separate logistic regressions for vascular and non-vascular cognitive outcomes with the individual sleep measures, but where there was no evidence of heterogeneity, we combined these outcomes to enhance power. We also ran ordered logistic regression models to test for association of our sleep measures with CIND and dementia from any cause, with no cognitive problems as the reference group. All models were adjusted for potential confounders such as age and lifestyle variables.ResultThere were 256 cases of CIND, 155 dementia and 118 vascular cognitive disorders. 889 had normal cognition. Nocturnal limb movements strongly predicted vascular cognitive disorders (OR 2.59, 95% CI 1.34–4.98, p = 0.004). Poor sleep duration, defined as less than 6 or more than 8 hours, predicted all-cause CIND and all-cause dementia (OR 1.62, 95% CI 1.01–2.61, p = 0.045). The other sleep measures showed weak associations consistent with chance.ConclusionWe have provided further evidence that sleep problems predict cognitive decline, justifying the growing interest in sleep as a potentially modifiable risk factor for dementia. Future evidence is required from intervention studies that attempt to improve sleep parameters.
Mechanisms of transcranial magnetic stimulation in the treatment of anorexia nervosa
Authors: Shackshaft Lydia 
Published: June 2021

AimsSevere and Enduring Anorexia Nervosa (SE-AN) is a challenging condition to treat, with limited therapeutic options, high morbidity, and the highest mortality rates of any psychiatric illness. Repetitive Transcranial Magnetic Stimulation (rTMS) is an emerging treatment option, as evidence demonstrates promising efficacy in improving mood and reducing core Anorexia Nervosa symptoms, as well as safety and tolerability to patients. We aimed to investigate the neurophysiological mechanisms of rTMS use in SE-AN patients by assessing changes in resting state functional connectivity, in the first functional neuroimaging analysis investigating rTMS effects in Anorexia Nervosa patients.Method26 females with a current diagnosis of SE-AN received 20 sessions of sham or real high frequency rTMS (10 hertz) to the left dorsolateral prefrontal cortex in a randomised double-blind trial. Resting-state functional magnetic resonance imaging was performed before and after rTMS. Neural correlates of rTMS treatment were identified using a seed-based functional connectivity analysis with the left dorsolateral prefrontal cortex and bilateral amygdalae as regions of interest. Functional connectivity differences were analysed using t-contrasts in a mixed ANOVA (flexible factorial analysis) to assess interactions between treatment group (real rTMS vs sham) and time-point (pre or post TMS).ResultNo statistically significant changes in resting-state functional connectivity were observed post-rTMS compared to baseline in participants receiving active rTMS compared to sham. Increased functional connectivity between the left amygdala and left pre-supplementary motor area was observed to reach cluster-wise significance (PFWE < 0.05). However, after Bonferroni correction for multiple comparisons (3 seed regions), this did not reach the significance threshold PFWE <0.017.ConclusionThis study highlights the need for further investigation of neurophysiological mechanisms, including resting-state functional connectivity modulation, resulting from rTMS to the dorsolateral prefrontal cortex in SE-AN patients. This requires higher powered studies to account for heterogeneity in treatment response. We have provided some indication that high frequency rTMS may have therapeutic benefit in SE-AN by modification of functional connectivity between prefrontal and limbic brain regions, resulting in improved top-down cognitive control over emotional processing and ability to enact goal-directed behaviours, enabling secondary reductions in eating disorder behaviours.