bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the predictive factors for depression among hemodialysis patients: a case-control study
Authors: Muhammad Jawad Zaidi Syed , Kaneez Mehwish , Bhatti Hamza Waqar , Khan Shanzeh , Fatima Shafaq , Hamza Muhammad , Fatima Mishal 
Published: June 2021

AimsDepression remains an exceedingly ubiquitous entity that significantly depreciates the quality of life and disease prognosis among end-stage renal disease (ESRD) patients. Even though the deleterious effects of depression on ESRD patients are well-established in the literature, the predictive factors that predispose such patients to depression need to be explored. Our study thus aims to gauge these factors and create a predictive model for optimal psychiatric and medical management of such patients.MethodAll ESRD patients with a disease duration of at least one year underwent a complete psychiatric evaluation based on DSM-V guidelines preceded by a cognitive evaluation by Mini-Mental State Examination (MMSE). A total of 73 patients diagnosed with moderate to severe major depressive disorder were selected as cases. Patients suffering from recurrent psychotic episodes, having a past or family history of psychiatric illness, being already treated for depression, having any substance abuse (current or past), were excluded from the study. Following the similar guidelines, and exclusion criteria, 146 patients (two controls for each case) having no depression were selected as controls. The cases and controls were studied and matched for a myriad of sociodemographic factors. The various risk factors for depression were evaluated using univariate and multivariate binary logistics analysis.ResultThe significant risk factors for depression among hemodialysis patients were age (OR = 1.79, CI = 0.47–3.81), comorbidities (OR = 2.13, CI = 0.51–3.96), duration of renal disease (OR = 2.54, CI 0.63–4.28), duration of hemodialysis (OR = 2.36, CI = 0.89–4.11), unemployment (OR = 2.33, CI = 0.79–3.88), and being unmarried (OR = 1.93, CI = 0.44–3.53). Prospect of survival, financial instability, social stigmatization, and effect of comorbidities on ESRD were major concerns for the cases that attributed to their depressive symptoms.ConclusionThe factors that herald the onset of depression among hemodialysis patients include increasing age, presence of comorbidities, unemployment being unmarried, and increasing duration of hemodialysis. These factors will aid the clinicians to identify high-risk patients that require psychiatric consultation. We recommend prompt psychiatric intervention (pharmacologic or non-pharmacologic) and appropriate patient counseling so that the depressive symptoms can be alleviated and dismal disease prognosis can be prevented among such high-risk patients.
Psychiatric presentations in acute illness with COVID-19: a retrospective analysis
Authors: Nelmes Elizabeth , Ng Audrey 
Published: June 2021

AimsTo assess the psychiatric presentations in patients with a diagnosis of COVID-19 referred to a liaison psychiatry department during a one month period in the peak of the global pandemic.MethodA retrospective analysis of the patients referred to liaison psychiatry during January 2021 who also had a diagnosis of COVID-19. Confirmed cases of COVID-19 were defined as those confirmed by COVID-19 PCR in respiratory samples or clinically suspected cases from chest radiograph or CT. Severe COVID-19 was defined as those requiring supplementary oxygen due to saturations of 93% or less.ResultDuring January 2021, a total of 24 patients were referred to liaison psychiatry with concurrent COVID-19 infection. Out of these patients, 63% had a previous mental health diagnosis. The most common reason for referral was low mood (37.5%), followed by agitation (25%) and psychosis (25%). When considering first psychiatric presentations with concurrent COVID-19 infection, the most common presentation was psychosis (44%). The time course of psychosis was most frequently seen in the seven days prior to a positive swab. In one case a patient was sectioned under the Mental Health Act for psychosis two days prior to developing symptoms. Two of these patients were worked up for possible encephalitis including radiological imaging and lumbar puncture. For patients defined as having severe COVID-19, the most common referral was low mood. In those referred for low mood, 66% had a history of an affective disorder. In two cases low mood was complicated by an acute stress reaction to recent bereavement. For one patient this included the bereavement of two relatives to COVID-19. For patients admitted to intensive care and intubated for respiratory support the most common referrals were low mood and agitation. These factors we found a barrier to successful rehabilitation following periods of significant illness.ConclusionThe impact of COVID-19 on psychiatric presentations extends beyond the socio-economic factors precipitating crises across the nation. Our findings of acute psychiatric illness in the prodromal phase of the viral illness suggest a neuropsychiatric pathogenesis to COVID-19.
Longterm cognitive dysfunction in paediatric brain tumour survivors - the need for multifactorial risk screening
Authors: Rengit Ashy 
Published: June 2021

AimsIdentify common risk factors for longterm cognitive dysfunction in PBTS (paediatric brain tumour survivors) Examine how various paediatric cancer treatment modalities affect cognitive outcomes Consider baseline features which may increase the risk of cognitive dysfunction in PBTSMethodCurrent research into the neuropsychiatric sequelae of childhood brain tumours is limited, therefore review of the literature was conducted to identify research within this field.DatabasesGoogle Scholar - papers accessed via the University of Brighton or Sussex online libraryNICE HDAS - HMIC, AMED, MEDLINE, BNI, PsycINFO, CINAHL, Pubmed, EMBASE & EMCAREMendeley reference manager - papers for background readingSearch termsPICO(T) method - Population (Cancer Survivors), Intervention (Cancer Treatment), Comparison (Brain tumour), Outcome (Cognitive dysfunction) & Time (Childhood & adolescence) Boolean operators (AND/OR), truncation and wildcard search functions were also utilised.Inclusion criteria; no limits on date, study type or gender, however, study results were limited by age - as the research focus was restricted to children and adolescents.Excluded results; papers which did not meet inclusion criteria, duplicate studies, studies measuring non-cognitive cancer outcomes or investigating non-cortical tumours, non-English language studies with no available English translations.ResultCommon risk factors - certain tumour types (glioneuronal tumours or gliomas) or inner cortical tumour sites e.g. were more vulnerable to epileptogenesis. In particular, seizures which were prolonged and treatment-resistant were associated with a greater degree of cognitive dysfunction.Impact of various cancer treatment modalities - overall results understandably suggested that patients are more likely to develop cognitive deficits following brain tumour treatment. In particular, partial tumour resection (especially if epileptogenic), whole-brain irradiation, cranial radiotherapy and chemotherapy were more likely to impact cognitive function.Baseline features that may increase likelihood of cognitive dysfunction e.g. intellectual disability or education level were not noted in the reviewed literature.ConclusionCancer is one of the leading causes of global child mortality, and younger populations often present to paediatric oncology services with brain tumour involvement. Current childhood brain tumour research has begun to recognise that many young survivors develop into adulthood with cognitive sequelae impacting quality of life measures. However, existing evidence is also limited and requires further research to produce a standardised clinical tool for screening various risk factors which may increase longterm risk of cognitive dysfunction and subsequent difficulties with daily life.
Depression, perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya
Authors: Hussein Shah Sayed Shah Nur , Laving Ahmed , Okech-Helu Violet , Kumar Manasi 
Published: June 2021

AimsLittle is known about mental health risk factors in medical residents and doctors in Sub-Saharan Africa. Residents are at a greater risk of developing depression, stress and substance abuse than the general public owing to the stressful nature of their medical training. Poor mental health in residents leads to decreased clinical efficiency and training satisfaction; it can also lead to substance dependence, self-harm and suicide.Our primary aim was to ascertain depression prevalence among medical residents in Kenya's largest national teaching and referral hospital. Secondary aims were to analyze how depression was associated with perceived stress, perceived social support, substance use, and educational environment.MethodSelf report questionnaires were administered in this cross-sectional survey to 338 residents covering eight specialties (Medicine, Psychiatry, Paediatrics, Obstetrics/Gynaecology, Anaesthesia, General Surgery, Cardiothoracic Surgery, and Ear Nose Throat Surgery). In addition to key sociodemographics, the Centres for Epidemiology Depression Scale - Revised, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Alcohol, Smoking and Substance Involvement Screening Test, and Postgraduate Hospital Educational Environment Measure were used.ResultThe mean participant age was 31.8 years and 53.4% were males. Most residents (70.4%) reported mild/no depressive symptoms 12.7% had moderate, and 16.9% had severe symptoms.High social support (71.8%) and moderate stress (61.6%) were reported by most residents. Almost half (46.3%) rated their educational environment as being more positive than negative. Out of 238 respondents 11.3% were at moderate risk of health and other problems due to cocaine use, while 13.3% (out of 240 respondents) were at risk due to alcohol. On bivariate analyses, we found significant correlations between depression, perceived stress, substance use, perceived social support, and educational environment. Multivariate analysis revealed that depression was strongly associated with: fewer hours of sleep (β = -0.683, p = 0.002), high perceived stress (β = 0.709, p < 0.001) and low perceived social support (β = -2.19, p < 0.001).ConclusionHigh perceived social support, low perceived stress, and less sleep were significantly associated with lower depression scores. A large proportion of residents were at risk of developing depression (29.6%). There were high levels of perceived social support (71.8%). A concerning proportion of residents used substances like alcohol and cocaine. This work is one of few that describe the mental health of an important and understudied population group in an LMIC. Priority must be given to protect and promote the mental health of such a vulnerable group.Data collection and analysis were funded by Kenyatta National Hospital.
Treatment resistant depression in the UK: sub-analysis of a European real-world evidence study
Authors: Talbot Jordan , MacIntyre Donald J , Rathod Shanaya , Morrens Joachim , Young Allan H 
Published: June 2021

AimsTreatment resistant depression (TRD) affects ≤20% of patients with major depressive disorder and is defined as failure to respond to ≥2 different antidepressants in the same major depressive episode (MDE). TRD patients’ outcomes are poor and real-world data from the UK are limited. The Treatment Resistant Depression in Europe Cohort was established to study patients being treated in local, routine clinical practice. The analysis presented here aimed to compare UK-specific data with data from other European countries included in the study.MethodA prospective, multicentre, observational cohort study of TRD patients in Italy, Germany, Spain, Portugal, the Netherlands, the UK and Belgium was conducted. Patients aged 18–74 years with current TRD, Montgomery-Åsberg Depression Rating Scale (MADRS) score ≥20, and initiating a new treatment for depression, were eligible. Data from medical records, clinician assessments and patient-reported questionnaires were collected over time, with follow-up of ≥6 months.ResultData from 411 patients were analysed. At baseline, UK patients (n = 49) had similar depression severity to the whole European cohort (34.7% vs 32.6% of patients categorised as severe based on MADRS score, respectively). Patients had experienced the current MDE for a mean (standard deviation [SD]) of 6.1 (7.9) years vs 2.6 (3.9) years and 14.3% vs 4.9% had experienced ≥5 treatment failures during this time in the UK and whole cohort, respectively. Total mean (SD) Sheehan Disability Scale (SDS) scores of 24.5 (5.1) and 22.4 (5.5) were reported for the UK and whole cohort, respectively. Unemployment and long-term sick leave rates were 38.8% and 20.4% in the UK and 30.2% and 19.0% in the whole cohort, respectively. At 6 months, 8.9% of UK patients were in remission, and 82.2% had not responded to treatment, representing the lowest remission and highest non-response rates across all countries.ConclusionUK patients had been ill for longer and had more prior treatment failures than other countries in the study. They had high work and functional impairment, and the worst treatment outcomes of all the countries studied. UK TRD patients experience high disease burden; there is an unmet need for treatment strategies with better response rates.AcknowledgementsWe thank all participating patients. Study, and medical writing (Costello Medical, UK), funded by Janssen. AHY's independent research is funded by the National Institute for Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
CAMHS Emergency Assessment Service (EAS): development & implementation during the COVID-19 crisis
Authors: Saour Tania , Tolmac Jovanka , Girelas Braulio , Turton William , Branney Lauren 
Published: June 2021

Aims•To provide emergency psychiatric assessment throughout the COVID-19 pandemic.•To maintain patient and staff safety by minimising exposure to infection risk by reducing A&E contact.•To alleviate pressures on the A&E department by enabling CAMHS patients be seen in an alternative setting.•To provide a more appropriate environment for the assessment of young people in acute distress.Method•Service live 8th April 2020 to 8th June 2020.•Exclusion criteria: 1) confirmed/suspected overdose; 2) self-harm with injuries requiring medical attention; 3) acute psychotic episode; 4) drug/alcohol intoxication; 5) high risk of absconding (ASD/LD/LAC), 6) severe agitation/aggression; 7) eating disorders requiring medical intervention; 8) section 136 of the MHA; 9) break down of a social care placement; 10)medically unexplained symptoms.Data reviewed of all young people who were referred to A&E during March–April 2020. Each case was assessed as to whether they were then seen within the EAS Service.These cases were reviewed demographically looking at ethnicity, gender, while also reviewing the reason for referral.Result•A total of 90 cases referred to Urgent Care Team•Nineteen (21%) met criteria for assessment at EAS•80% of presentations between 12am and 9am.•Commonest reasons for referral : low mood with suicidal ideation (42%), anxiety (26%)
→50% service users not previously known to CAMHS•Majority of service users were female•Mean age 15 years•All but one of the young people assessed at the EAS, were discharged home with community follow-upConclusion•Average total no. monthly referrals to CAMHS Urgent Care Team (UCT) fell from approx. 90 to 45.•Only a small proportion of referrals (21%) could be safely seen by the EAS, suggesting that the majority of young people required a joint assessment by A&E and CAMHS Urgent Care Team.•When need arises, very rapid reconfiguration and implementation of CAMHS emergency services is achievable.•EAS diverted a small number of young people from exposure to COVID-19 in A & E.•The service was set up speedily without evaluation of parent/carer/young people views or evaluation of cost-effectiveness.•If similar services are to be set up permanently, the balance between safety and the risk of division between mental & physical health services and potential to increase stigmatisation of mental illness should be considered.•Adaptation to future outbreaks should be informed by this initiative.
Triple chronotherapy for the rapid treatment and maintenance of response in depressed outpatients: a feasibility and pilot randomised controlled trial
Authors: Veale David , Serfaty Marc , Humpston Clara , Papageorgiou Andriani , Markham Sarah , Hodsoll John , Young Allan H 
Published: June 2021

AimsTriple chronotherapy (defined as sleep deprivation for 36 hours, followed by 4 days of advancing the time of sleep, together with daily morning bright light therapy for 6 months) has demonstrated benefits for the rapid treatment of depressive symptoms in 4 small, controlled trials of in-patients. Our aims were to test the feasibility of recruitment and delivery of triple chronotherapy for out-patients with depression.MethodIn a single blind trial, 82 participants were randomised to either triple chronotherapy or a control intervention. The primary outcome was Hamilton Depression Rating Scale 6 item (HAM-D6) at 1 week. Timings of observer ratings were baseline; 1 week; 2 weeks; 4 weeks; 8 weeks and 26 weeks after randomisation. Triple chronotherapy consisted of (a) Total sleep deprivation for 36 hours. On Day 1 patients were supported in a small group to stay awake at night with an occupational therapist, (b) Phase Advance of Sleep over 4 days. Phase Advance began after the first night of sleep deprivation, when they left the hospital at about 8am and were asked to go to bed earlier at about 5pm and rise at about 1am. Their sleep and wake up times were then shifted 2 hours later on each of the following three days until they attained their usual bedtime again at about 11pm.As a control for the triple chronotherapy, participants were given psychoeducation and written information on sleep hygiene. They were also given SomniLight amber light daily for 1 week in the morning.ResultParticipants in the triple chronotherapy group were able to stay awake for the planned thirty-six hours and 89.9% adhered to the plan of phase advance of their sleep over the following 4 days. We achieved our recruitment target with 60 participants having completed the trial within 13 months. There were no reported adverse side effects. We explored outcomes and found a significant difference between the groups for the HAM-D6 at week 1, 8 and 26. Response (> 50% reduction in symptoms) was achieved by 52% in the triple chronotherapy group compared to 18% in the control group at week 1. This gradually increased to 70% achieving response in the triple chronotherapy group at week 26 compared to 22% in the control group.ConclusionTriple chronotherapy produced a significant and rapid benefit after 1 week in out-patients with depression that was sustained at 26 weeks. Further cost-effective trials with a larger clinical sample size are required.
A retrospective case-control service evaluation of CAARMS scores of patients with autism in York EIP, compared to age matched controls
Authors: Whitney Daniel , Wright Stephen 
Published: June 2021

AimsStudies show the prevalence of Autism Spectrum Conditions in Early Intervention in Psychosis (EIP) populations is 3.6-3.7%, compared to approximately 1-1.5% in the general population. The CAARMS (Comprehensive Assessment of At Risk Mental States) is a national tool used by EIP services as a screening tool to bring patients into services and stratify their symptoms to determine what pathway may be most appropriate (First Episode Psychosis pathway (FEP) or At Risk Mental State pathway (ARMS)). As far as we are aware the CAARMS has not been validated in an autistic population. It is our view that several of the questions in the CAARMS may be interpreted differently by people with autism, thus affecting the scores. The aim of this evaluation was to identify whether CAARMS scores differ between patients diagnosed with autism and matched controls in York EIP.MethodFrom their mental health records, we identified all patients in the service with a diagnosis of autism. We then compared the CAARMS scores, at the time of referral, to those of age matched controls (matched by being in the age range 16-30) without an autism diagnosis, using continuous sampling by date of referral.Result14 patients in the service had a diagnosis of autism and had completed a CAARMS. CAARMS domains are all scored between 0 and 6 (indicating increasing severity or frequency). Compared to the age matched controls, autistic patients had a higher mean difference in their scores for ‘Non-Bizarre Ideas’ (mean difference of 0.86 for severity and 0.57 for frequency) and ‘Disorganised Speech’ (mean difference of 0.28 for severity and 0.57 for frequency). These results did not reach statistical significance which was unsurprising given the sample size. The gender split between groups was similar.ConclusionOur evaluation suggests a difference in CAARMS scores between patients in our service with a diagnosis of autism and those without. A larger study would be needed to confirm a statistically significant difference and multicentre results would be needed as evidence of generalisability. However, if such a difference were confirmed it might question the validity of CAARMS in autistic patients or suggest that modifications, perhaps in the form of reasonable adjustments to the questions or scoring, were needed to increase the validity in this population. We would suggest that spending extra time checking the patient has understood the intended meaning of the questions in the CAARMS may increase validity, particularly in the ‘Non-Bizarre Ideas’ domain.