bluuebunny/crossref_metadata_2025_split huggingface dataset:
The blues, and an almost shocking surprise – Unexpected PE in a catatonic patient, that almost had ECT
Authors: Cheah Michael , Mohamed Ashma , Mathilakath Anand 
Published: June 2021

AimsTo present a case of a near-miss, where an unexpected Pulmonary Embolism (PE) was identified in a patient with psychotic depression and catatonia, who almost had Electroconvulsive Therapy (ECT). Our aim is to highlight the importance of Venous-Thrombo Embolism (VTE) risk assessment in all psychiatric inpatients, particularly those with catatonia, and those about to undergo ECT.MethodA 53-year-old female admitted with her first presentation of psychotic depression, catatonia, poor oral intake, and significant weight loss in the community for months prior to admission. She was recommended for emergency ECT as the severity of her self-neglect was becoming life threatening. Her first ECT session was cancelled due to low potassium levels prior to ECT, which proved to be a fortunate event. She developed sudden onset chest pain the next day, and following further medical investigations; was diagnosed to have a bilateral PE, and subsequently treated with Apixaban. Due to the potential risk of ECT dislodging the clots, treatment was done by optimising medication alone; Venlafaxine 300 mg, Mirtazapine 45 mg, Haloperidol 6 mg. She made a slow but successful recovery, and was discharged home, with ongoing support from Early Intervention in Psychosis services.ResultWe conducted a literature search, and it is well known that there is an increased risk of VTE in catatonic patients, as well as other psychiatric inpatients; due to anti-psychotic medication. Furthermore, cases have been reported where ECT was associated with increased risk of death in patients with known VTE/PE.On retrospective review of the patient's risks of developing VTE in the community, it was clear, that she was at very high risk of developing VTE. It was also noted that she should have had a VTE risk assessment on admission, in accordance with NICE guidelines; where all acute psychiatric inpatients should have this assessed as soon as possible.ConclusionThrough a process of assessment and treatment, VTE is often preventable. Identification of high-risk patients on admission to hospital is therefore crucial. It is thus, imperative that a comprehensive VTE risk assessment is completed on admission and regularly reviewed.This case highlights the risk of missing VTE assessments in WAA Inpatients, particularly those with catatonia, about to undergo ECT, which could have been fatal. As such, VTE/PE risk assessment in such patients, about to undergo ECT, is particularly crucial.Clinicians need to have a high index of suspicion of VTE/PE, particularly in patients with catatonia.
SW Neuronet – neuroscience for psychiatrists update day
Authors: Churchhouse Gabrielle , Sinclair Lindsey , Morris Simon George 
Published: June 2021

AimsThe Royal College of Psychiatrists Neuroscience Project was established to promote greater integration of modern neuroscience into psychiatric training and practice. Regional “Neuronets” are being established to develop local learning opportunities. As the Southwest Neuronet, we sought to establish a high quality and sustainable regional educational event promoting modern neuroscience in psychiatry.MethodWe developed and ran two events in collaboration with the Neuroscience Project, a whole day in-person event in September 2019 and a half day online event in January 2021. Attendees were invited from the Southwest with the latter event being shared more widely through other “Neuronets”. Both featured talks by leading experts in the neuroscience of psychiatry. The first was themed around “Neuroscience from the lab to the clinic”, building on basic research methodologies to their applications in clinical psychiatry. Our pandemic era online event, “Neuroscience of psychosis”, was structured around an evolving clinical case. Both featured interactive elements using audience polling technology to gather views and collate questions. Feedback was gathered through an online survey with individual session ratings and event ratings.Result154 people attended the in-person event from across the South West Division. This included psychiatry trainees, consultants and a small number of other mental health professionals. 382 people signed up to our online event with 262 attending live and others watching recorded sessions. Feedback response rates were 42% and 33% respectively. Feedback on the practical arrangements was highly positive, particularly highlighting pre-event communication. Attendees valued the high calibre of speakers and particularly rated topics of psychiatric genetics, novel antidepressants, and autoimmune psychosis. Environmental sustainability was a prominent theme in our first event with support for our paperless approach but highlighted further potential to reduce waste associated with catering. Overall, attendees valued the opportunity to build on knowledge of basic research techniques but also wished to see greater focus on clinical applications of neuroscience, which we had responded to with the inclusion of a clinical case to frame our online event.ConclusionThese events provide a prototype for low-cost regional neuroscience in psychiatry education events, in-person or online. Sustainability in terms of cost, human resources for organisation, and environmental impact are all important considerations for such events. We plan to continue to run these annually, forming part of the legacy of the Neuroscience Project. In line with feedback received, we seek to maximise the clinical relevance but also share novel research techniques encountered in the literature.
Evaluating adult forensic staff knowledge of olanzapine long-acting injection post injection syndrome: a service improvement project
Authors: Clark Annalie , Boyle Onagh , Farrell Suhanthini , Evans Catrin 
Published: June 2021

AimsPost injection syndrome (PIS) is a serious complication that can occur after Olanzapine Long Acting Injection (LAI). It can occur without any derangement in physical observations. It is important that patients are monitored appropriately following administration of Olanzapine LAI to ensure that symptoms of PIS are appropriately identified and managed. This project aimed to evaluate the current level of knowledge about PIS in two staff groups within an Adult Forensic Service – in-patient nursing staff and junior doctors and advanced practitioners (APs) providing medical cover to inpatient wards.MethodElectronic surveys evaluating knowledge about the symptoms of PIS, monitoring requirements and management of possible PIS were circulated to inpatient nursing staff, junior doctors and APs working within an Adult Forensic Service in the North West of England.Result1) Nursing staff knowledge – 26 nursing staff completed the survey. 4.5% of nurses correctly identified all symptoms of PIS and 72.7% believed that tachycardia or hypotension occur in PIS. 22.7% of nurses identified the correct management plan if a patient feels unwell following Olanzapine LAI. 40.9% would only request a medical review if physical observations were abnormal. 2) Junior doctor and AP knowledge – 6 doctors and 6 advanced practitioners completed the survey. 17% of doctors and APs correctly identified all symptoms of PIS. 50% believed hypotension or tachycardia were symptoms of PIS. 25% of doctors and APs identified correct management of PIS and 16.7% believed that the patient should be managed on the psychiatric ward unless physical observations became abnormal.ConclusionLevels of knowledge about the symptoms and management of PIS are low within this Adult Forensic Service. Knowledge of PIS and management of suspected PIS needs to be improved in nursing staff, junior doctors and advanced practitioners to ensure correct identification and safe management. In response to these findings, a care plan for monitoring of patients after Olanzapine LAI was developed. This included a structured monitoring proforma for completion post depot administration and instructions for managing suspected PIS. This care plan is kept in the front of the drug chart of all patients prescribed Olanzapine LAI. One-page educational summaries on PIS were written and circulated to nursing staff, junior doctors and APs. Information on Olanzapine LAI use and PIS were included in junior doctor induction materials and on-call handbook, to improve trainee awareness and knowledge.
Bridging the gap – MTI experience to an excellent MTI experience – An experiential, theme driven, concordance verifying study
Authors: Enara Arun , Garg Kabir , Kanchana Ramachandran 
Published: June 2021

AimsTo collate experiences of international medical graduates (trained psychiatrists) on the Medical Training Initiative (MTI) and equivalent programs (International Medical Fellowship (IMF)/CESR Fellowships) in the United Kingdom and to understand shared themes.MethodThree psychiatrists with the experience of being part of MTI/IMF program, for a minimum of 1 year, participated in theme guided, focussed discussions to understand common experiences. These discussion where limited to 3 broad headings. Opportunities to grow, what we wish the college knew and what we wished the trusts and supervisors knew. The experiential accounts were captured and circulated among a group of 20 MTI/IMF/CESR fellowship doctors and rated on a 5 point Likert scale varying between strongly agree to strongly disagree.ResultThe findings suggest that the expectations and experiences of the psychiatrists on such programs share some common themes. Most of them had varied experiences under the theme ‘opportunities to grow’. The suggestions for what these doctors ‘wished the trusts, college and supervisors knew’ had a good concordance among the 20 doctors who reviewed the themes and suggestions. The details of the themes and commonalities will be discussed at the conference.ConclusionThe expectations and experiences of the doctors on MTI/equivalent program share common themes. Bridging the gap between MTI experience to an excellent MTI experience would involve identifying such shared experiences, that could potentially guide development of processes, thereby making these training fellowships better tailored to each trainee.
Regional survey into trainee experience of core psychotherapy training
Authors: Evans Lauren , Belam Georgia 
Published: June 2021

AimsThis project aims to assess the experience of psychiatry core trainees who have undertaken core psychotherapy training (CPT), to identify what is experienced positively and potential areas of improvement.BackgroundPsychotherapy is an necessary part of core psychiatry training, requiring one short and one long case to complete core training.MethodAn anonymous online survey was drafted, containing both qualitative and quantitative questions, to assess trainees experiences of CPT. It was circulated via Trust email (locally) and Twitter (nationally).ResultA total of 35 responses were received: 21 core trainees, 12 higher trainees, 1 consultant, and 1 staff grade doctor. 6 respondents had completed a short case only; 2 a long case only; 25 both; and 2 neither.Confidence in psychotherapy knowledge was rated on a 1–5 scale (1: significantly below average to 5: significantly above average). Theoretical knowledge improved from a 2.57 average before CPT to 3.63 following, and clinical application improved from 2.43 before to 3.66 following.Knowledge prior to delivering CPT was most commonly obtained from Balint group (71.4% of respondents) and MRCPsych courses (65.7%).The main barriers to obtaining psychotherapy experience were: accessing supervision (60.0% of respondents); not enough patients (53.3%); and a lack of guidelines on accessing supervision and patients (43.3%). Additionally, getting time away from day jobs was identified as a concern, particularly among LTFT trainees.Important learning points from CPT identified by trainees were: knowledge of psychoanalytic concepts, such as transference and counter-transference; differences between the theoretical models; an alternative approach to formulation; and how these skills can be useful in all clinical encounters, such as maintaining rapport, boundaries, and time-keeping. The useful role of supervision was also highlighted.ConclusionThis project serves as an introductory look into how trainees view their experience of CPT, and potential areas for improvement.Themes for improvement, arising from qualitative responses, are: clear reading list, including introductory materials; clear guidelines at induction, including supervisor contact details; improved access to supervision; patients to be allocated; protected time for psychotherapy, with extra support for LTFTs; shadowing; increased choice of modality; and more formal teaching on psychotherapy. These are key areas to be targeted to improve the trainee experience, particularly for those who risk delays in their training.
Evaluating virtual role play based learning to improve the confidence and competence of Junior Doctors undertaking on call shifts in inpatient Psychiatry
Authors: Gardner Katherine 
Published: June 2021

AimsTo enable junior doctors to practice their clinical skills in managing psychiatric emergencies via virtual role plays, and to gain confidence and competence in their skills in acute psychiatry. Lecture based learning about psychiatric emergencies is a part of the induction programme for all junior doctors starting their placements however practical learning and practice of skills in this area is not. The COVID-19 pandemic has further exacerbated this issue by providing an additional challenge to the delivery of face to face teaching for junior doctors both in clinical and educational settings.MethodThe author offered a virtual role play based teaching session to two cohorts of Junior Doctors (GP trainees and foundation trainees) who were starting their psychiatric hospital placements at Surrey and Borders Partnership. The virtual sessions were conducted over Microsoft teams. This session had been run once before as face to face teaching (F2F) in January 2019 (N = 9) prior to the COVID-19 pandemic. Data from this session were compared to data obtained from the virtual sessions in November 2020 and January 2021 (N = 16).Pre and post study questionnaires were administered via Microsoft Forms. Each session lasted 1 hour and consisted of 3 different role play scenarios based around acute psychiatric emergencies. One junior doctor volunteer acted as the ‘patient’ in each scenario and another volunteer as the ‘doctor’. The other participants all acted as observers. Each scenario lasted 10 minutes with ten minutes for feedback from the researcher afterwards using the ALOBA framework.Categorical, ordinal data were collected using a Likert scale and general qualitative feedback was also gathered.ResultThe questionnaire return rate was 100% for F2F teaching and 57% for virtual teaching. 100% of participants felt that F2F role play was an acceptable way to practice skills in acute psychiatry vs 75% of participants who felt this about virtual role play. 100% of participants found that F2F role play was ‘quite’ or ‘very’ effective in improving their confidence and perceived competence in acute psychiatry vs 88% of participants who felt this about virtual role play.ConclusionVirtual role play based learning is an acceptable and effective method in improving the confidence and perceived competence of junior doctors undertaking on call shifts in inpatient psychiatry but it appears to be less effective than face to face role play based learning. The researcher will act upon the qualitative feedback obtained which suggested ways in which the virtual session could be improved.
Motivators and deterrents in choosing a career in psychiatry; making the most of psychiatry school events
Authors: Kazmi Nosheen , Lewis Emily , Rodrigues dos Santos Catarina Cardoso , Olety Sahana 
Published: June 2021

AimsIn response to the Royal College of Psychiatrists’ recruitment strategy, a bi-annual Psychiatry School event was set up in the North West of England. The Psychiatry School aims to inspire medical students and foundation doctors to choose a career in Psychiatry with two days of workshops on different sub-specialties and various aspects of the career pathway. A previous service evaluation has shown attending the event improves attitudes towards psychiatry.The aim is to assess whether improving attitudes to psychiatry has been sustained and gain a clearer understanding of the motivators and deterrents in choosing a career in Psychiatry to better inform future events.MethodAn online questionnaire about positive and negative aspects of psychiatry was sent to attendees of the Autumn North West Psychiatry School 2020 before and after the event.ResultThe total number of completed questionnaires was 62.53.6% people were considering applying for core psychiatry training prior to the event and this rose to 85.3% in the post event questionnaire.Motivators for a career in psychiatry prior to the event included having a better holistic understanding of patients and wide range of sub-specialities. There was a common theme of interest in research opportunities. Dynamic patient-doctor relationship, exploring issues in depth and treating diverse populations were key motivators.It is encouraging to note that 100% responders felt their positive views on psychiatry were validated.The majority of deterrents were disregarded and attendees felt positive about choosing a career in psychiatry.ConclusionFollowing the event, the only negative view on a career in Psychiatry was the concern about the potential impact on one's own mental health. This is an important issue (highlighted in the Royal College of Psychiatrists Position Statement) that deserves consideration at future events to highlight potential effects on Psychiatrists wellbeing and how these can be avoided or mitigated.The wide variety of sub-specialities and opportunities for research were key areas that motivated attendees and we will continue to deliver engaging workshops around these themes.
An innovative method of expanding the support for doctors returning to training in psychiatry after a period of extended leave: the Sheffield Mindful Support Programme
Authors: Linnington Helen , Alhaj Hamid 
Published: June 2021

AimsTo offer regular continuous professional development opportunities covering both clinical and non-clinical skills to trainees and trainers and enhance their experience and skills to increase their wellbeing and resilience.BackgroundThere are approximately 50,000 doctors undertaking postgraduate training in England. Of these, 10% (5000) are taking approved time out of training at any time. A 2017 HEE survey revealed that doctors returning to work reported numerous concerns. Based on these and with the backdrop of the Bawa-Gaba case HEE's Supported return to Training programme (SuppoRTT) was developed.We at Sheffield Health and Social Care NHS Foundation Trust devised a unique “Mindful SuppoRTT” initiative and were successful in securing funding from HEE. Part of which was the organisation of a conference aimed at various groups of doctors including those who have previously had time out of training, are currently out of training and those considering time out.The Sheffield Mindful SuppoRTT Programme not only aimed to provide a structured and systematic process for planning and returning from absence, but also focussed on enhancing performance through promoting the wellbeing of participants and supporting them with important clinical and non-clinical skills.Method2-day twice yearly conferences, which covered training on speciality specific as well as non-technical skills were organised. The clinical workshops covered interactive sessions of common and emergency clinical scenarios. A wide range of non-technical skills such as an introduction to mindfulness, tai chi, resilience, team-working and leadership, “Thinking Environment” and meditation were introduced and developed using bespoke training. Feedback was collected at the end of each conference day. The attendees were asked to use a 5-point Likert scale (5 being the highest) to rate their satisfaction with the day and to highlight which sessions they found most and least useful.ResultThe attendee satisfaction rate was high. The first conference had ratings of 56% of attendees scoring 5 (excellent) and the remainder scoring 4 (very good). The second conference achieved even higher satisfaction ratings with 94% of attendees scoring 5 and the remainder scoring 4.ConclusionThe conference had high attendee satisfaction. The hope is to expand on its success and open it up to delegates from all specialities within HEE South Yorkshire and the Humber. Evaluation of the long-term impact of this programme is also warranted.
A cross-sectional study exploring attitudes of first year medical students towards psychiatry and factors they identified that would help stimulate their interest
Authors: Mark Isabel , De Las Heras Victoria Fernandez Garcia 
Published: June 2021

AimsPsychiatry has had long standing recruitment difficulties. Many efforts have been made to explore strategies that encourage interest in the specialty, with early university experience being an important factor in ultimate career choice. The Royal College of Psychiatrists ‘Choose Psychiatry’ guidance for medical schools outlines four key areas of focus: teaching excellence, placement quality, leadership and enrichment activities, with other research reporting similar conclusions. The aim of this study was to assess attitudes towards psychiatry amongst first year medical students, examine what input they would welcome from psychiatrists at this stage of their career and consider if their wishes are in keeping with the ‘Choose Psychiatry’ guidance.MethodAll first-year medical students at St George's University of London were approached in October 2019 and offered the opportunity for early psychiatry exposure. 60 students were recruited. Data were collected in November 2019 via an online questionnaire comprising of baseline demographics, the 30-item Attitudes Towards Psychiatry questionnaire (ATP-30) and a free-text question asking what students would like from psychiatry at this stage of their education. Quantitative data were analysed using Excel, whilst qualitative data were analysed thematically.ResultThe mean ATP-30 score was 113.83 (SD 12.57, range 70-135). Gender, ethnicity and religious background were not associated with a change in ATP score. Undergraduates’ attitudes were more positive than those of postgraduates (independent t-test revealed a p-value of 0.087). Seven themes were identified outlining what students wanted from psychiatry, the most prominent being: (a) learning about the lifestyle of a psychiatrist and finding a role model, (b) exploring the patient perspective, (c) exploring the interaction between psychiatry and specialities and (d) having an opportunity to develop communication skills.ConclusionThe findings demonstrate higher ATP-30 results than previous literature has reported, potentially due to mental health awareness campaigns in recent years. As undergraduates were found to have a higher mean score, targeting them for additional psychiatry contact may be beneficial. Themes identified by students in this study support ‘Choose Psychiatry’ guidance, whilst also highlighting the potential for combining some psychiatry with other specialties in the curriculum. Integration with communication skills teaching might help engage those not initially psychiatry-inclined. Further study will be required to establish whether implementing the suggested strategies can lead to improvement in student ATP-30 scores and ultimately increased recruitment rates.