bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facilitated early discharge in Wandsworth
Authors: Firdosi Mudasir , Hubbeling Allerdiena , Kapoor Twaisha 
Published: June 2021

ObjectiveThere is limited research surrounding facilitated early discharge (FD) and Home Treatment Teams (HTTs). This study aimed to compare patients who received FD with patients who were discharged without FD to identify whether there were significant differences in terms of social demographics, illness characteristics, health outcome and treatment duration. Using this data we furthermore aimed to provide proposals to help advance the effectiveness of FD, as well as suggesting concepts of where future research should lie.Case reportA randomised sample of patients who received FD and patients who were discharged without FD was obtained from a South London Hospital. This was manually narrowed down to patients specifically treated by the Wandsworth Home Treatment Team (WHTT). Socio-demographic and clinical data were then attained from the patients’ electronic records to compare and statistically analyse between the two groups.DiscussionPatients who received FD from the WHTT were found to have significantly less previous psychiatric admissions compared to those who were discharged without FD (p = 0.032). All other variables were found to have no association with FD.ConclusionHaving a high number of previous psychiatric admissions seems to be an aspect that decreases the chance of being allocated FD. This variable can be seen as an indicator of severity of illness and a challenging social environment; it could therefore be valuable to take this variable into consideration when allocating FD. Furthermore, total treatment duration was found to not be significantly different for FD and non-FD patients, thus supporting the use of CRHTTs as an equivalent alternative for inpatient admission, however, national scale research should be conducted to strengthen and expand on these findings.
Prolong psychosis preceding cognitive and motor symptoms; an unusual presentation in Huntington's disease
Authors: Khan Nida , Mansoor Marium 
Published: June 2021

ObjectiveTo describe an unusual clinical presentation of Huntington's disease.Case reportA 39-years-old married female, a homemaker, presented to the psychiatry clinic with her husband, with over a nine-year history of decreased sleep, suspiciousness, self-talking, agitation, anger outbursts, aggression, and social isolation. The patient was diagnosed with schizophrenia. Previously, she received various antipsychotics and Electroconvulsive therapy (ECT). The patient showed a partial response to treatment. Over the last 2-3 years, the patient had a progressive decline and later required supervision in her Activities of Daily Living (ADLs). She developed slurred speech limited to 1-2 worded answers, gait disturbance, falls, involuntary movements of the trunk and distal extremities, bowel and bladder incontinence, and severe weight loss. The patient's mother and older brother had a history of death in their early 40s due to an unknown cause.At presentation, the patient was restless, irritable, self-talking incoherently, neither made nor maintained eye contact and tried hitting and biting upon approaching closely. She did not respond to any queries or followed commands. The patient showed poor personal hygiene. On examination, the patient was hemodynamically stable, had a loss of muscle bulk, broad-based gait, and choreiform movements of the trunk and distal extremities. We admitted the patient to the psychiatry ward and also consulted the neurology team. Her blood investigations showed ASMA antibodies positive, MRI brain was suggestive of Huntington's disease (HD), and her genetic test for Huntington gene confirmed the diagnosis of HD. We started the patient on Fluoxetine, Clonazepam, and Olanzapine. The patient showed a decrease in agitation, and her self-talking stopped.DiscussionHD is a rare genetic disease that has well-characterized symptoms. However, as seen in our patient, these symptoms can evolve and progress unusually in the early and middle stages. Psychosis in HD patients is rare but known. Psychosis is rare in HD and usually presents after a clear clinical picture of HD is apparent. Our case discussed psychotic symptoms in the pre-choreic stage of HD which adds to the existing evidence on challenging presentations and management of HD. Further research can help increase confidence in these outcomes and treatment guidelines.ConclusionOur case highlights an unusual clinical presentation of HD, which can be challenging and lead to diagnostic delays. We recommend a thorough approach to history and revision of diagnosis in case of atypical presentations.
A rare case of a patient with resistant schizophrenia who hears a voice reading the texts instead of being read in her mind
Authors: Nanayakkara Thilini , Wijesiri Vipula 
Published: June 2021

ObjectiveThis case is presented to describe a rare psychopathology in which the patient hears her own voice speaking out loud all the texts that she sees in books or papers and she cannot read them inside her mind. This psychopathological phenomena has some features of reflex hallucinations, thought echo as well as of inner reading voices yet it cannot be categorized into either one.Case reportThis is a 26-year-old female with Schizophrenia for 3 years. While on medication 8 months before presentation she started hearing her own voice reading any text that she sees. When she sees a text she cannot read it in her mind and understand, but she hears it in her own voice to her ears. With this she also hears other voices talking about her and to her. She also believes that her father is the one who controls all her actions and the things that happen to her. In her mental state examination her mood was euthymic and she had delusions of control, thought broadcasting and in her perceptions she had visual perceptual abnormality where she saw the same object she would look at in another direction but they are under her control. She also had second and third person auditory hallucinations. She was admitted to start on clozapine because her voices did not respond to any medication.DiscussionAuditory hallucinations are the most commonly encountered type in schizophrenia with a prevalance of 70–80%. This patient hears the words that she sees which has some features of reflex hallucinations, however in the latter the hallucination is not a transformation of the perception. This also has some qualities of thought echo, where just as the patient thinks she can hear them. However in this patient she cannot read the texts in her mind. Inner reading voices are where a person talks to oneself while reading, however in the subjective mind. In our patient this phenomenon also proved to be the most difficult to treat as all her other auditory hallucinations responded to Clozapine, while still this phenomenon remained.ConclusionThis case is presented to describe the rare psychopathology in this patient in the form of auditory hallucinations
Treatment with the direct oral anticoagulants (DOACs) Apixaban and Rivaroxaban associated with significant worsening of behavioural and psychological symptoms of dementia (BPSD)
Authors: Porter Kim , Souza Stephen De , Hargreaves Iain , Goddard Rebecca 
Published: June 2021

ObjectiveTo demonstrate the increasing evidence for an aetiological role of cerebral mitochondrial dysfunction in neuropsychiatric disorders.To raise awareness of the importance of frontline staff partaking in post marketing surveillance of medications.Case reportWe report the cases of two patients who developed worsening BPSD, coinciding with starting the factor Xa inhibitor DOAC medications Apixaban and Rivaroxaban respectively. Both patients required detaining under the Mental Health Act (MHA). Their symptoms improved significantly, within two weeks, on switching to alternative anticoagulant therapies and they were both discharged from the acute psychiatric ward.DiscussionFrontline healthcare staff in acute settings and the community manage a heavy workload. It is all too easy to overlook potential neuropsychiatric drug side effects, especially if they are not clearly listed. They may be easily missed amongst older patients and wrongly attributed to dementia.Rivaroxaban is structurally related to the antibiotic Linezolid which has been reported to cause mitochondrial toxicity. Pre marketing In vitro studies concluded the risk of mitochondrial toxicity associated with this anticoagulant to be low. However a more recent in vitro study, using rat kidney mitochondria, reported evidence of mitochondrial swelling and a collapse of the membrane potential following exposure to low doses of Rivaroxaban. The effect of Apixaban, which is structurally related to Rivaroxaban, has yet to be investigated on mitochondrial function.Recent research supports not only an association between reduced cerebral mitochondrial function and neuropsychiatric symptoms and disorders, but also the aetiological role it may play.There is a need for a far greater awareness and understanding of the potential cerebral mitochondrial toxicity of drugs commonly prescribed to our older populations.ConclusionCerebral mitochondrial toxicity can have a significant impact on the health and well-being of patients.Older patients are particularly prone to experiencing neuropsychiatric side effects that may not have been apparent during preclinical trials.Development of a rating scale of drugs that are potentially less toxic to cerebral mitochondria could inform national prescribing guidelines and enable safer treatments to be offered to older people, reducing the likelihood of them experiencing apparent behavioural and psychological symptoms of dementia.
The impact of the COVID-19 pandemic on obsessive compulsive disorder: a single case study
Authors: Sibanda-Mbanga Josephine , Govender Anusha 
Published: June 2021

ObjectiveA growing body of research evidence shows that individuals with Obsessive Compulsive Disorder (OCD) have been negatively affected by the COVID-19 pandemic including deterioration of OCD symptoms plus relapse from previously well-controlled OCD. The impact of the COVID-19 pandemic is discussed in a single case study of a patient with OCD consisting of contamination concerns. In addition, the effectiveness of providing Exposure and Response Prevention (ERP) virtually is evaluated with regards to the treatment outcome in COVID-19 related OCD.Case reportThis study describes a 41-year-old, single, employed female with OCD consisting of concerns of contamination and infecting others thereby causing harm. The total duration of the disorder is 32 years with the most recent presentation being of three years duration. Relapse during the pandemic resulted in OCD symptoms being solely concerned with COVID-related contamination. The questionnaires routinely completed at the time of assessment and treatment were the Obsessive Compulsive Inventory (OCI); Yale Brown Obsessive Compulsive Scale (YBOCS); Beck Depression Inventory (BDI). Clinical data were collated and analysed prior to and during the pandemic. Treatment consisted of ERP and was adapted for provision via a virtual platform. ERP involved exposure to a graded hierarchy of COVID-specific anxiety-provoking situations modified to take government guidelines into consideration.DiscussionPrior to the COVID-19 pandemic the patient's response to treatment with cognitive behavioural therapy (CBT) including ERP indicated a 79% improvement in OCD symptoms on self -rated measures. The impact of the pandemic led to a significant 65% deterioration in OCD symptoms, regarding COVID-19 contamination concerns. Intervention with ERP resulted in 73% improvement over a three-month period. Measures of depression symptoms indicated an 80% improvement pre-COVID, with a 78% deterioration at relapse. Following treatment, the patient also showed a 65% improvement in depression symptoms. Improvements have been maintained at one month follow-up.ConclusionThe case study supports literature indicating the exacerbation of OCD symptoms due to the COVID-19 pandemic for patients with contamination fears and washing compulsions. The promising results support the use of ERP as an effective treatment for COVID-related OCD symptoms. It also validates the provision of CBT interventions virtually to ensure accessibility of treatment to OCD sufferers.
The catatonia syndrome: forgotten but not gone – a case report
Authors: Cenko Blerta , Milic Spiro 
Published: June 2021

AimsTo highlight the presentation and treatment of catatonia in a patient with Schizophrenia.BackgroundCatatonia is a syndrome of altered motor behaviour accompanying many general and neurological disorders. It frequently goes unrecognized, leading to the erroneous conclusion that it is rare. Signs and symptoms of catatonia are commonly relieved by the intravenous (IV) administration of a barbiturate or benzodiazepine. If the patient does not fully respond to the sedative drug, ECT becomes the default.ResultA 61-year Caucasian male with a diagnosis of Paranoid Schizophrenia had been stable for 17 years on Clozapine. He was monitored by his GP. He resided in supported accommodation for 19 years and he was rehoused in a new borough. He was unable to obtain new prescription for Clozapine from his new GP and suffered a psychotic relapse following a period with no Clozapine and admitted under section 2 of the MHA. Clozapine was not restarted due to concerns of prolonged QTc and ectopics. Aripiprazol 15 mg and promethazine were prescribed. He was transferred to a medical ward three weeks later presenting as rigid with abnormal posturing on his bed, febrile, tachycardic and mute. He was confused, withdrawn and not responding to questions. In the medical ward he was bedbound, had high spiking temperatures, raised CK, ongoing fever.He was agitated , restless and confused with dystonic movements of arms and legs and echolalia. He developed an oral thrush, fecal impaction and was catheterised, had mittens put on due to pulling his iv cannulas. Clonazepam 2 mg QDS was prescribed, antipsychotic stopped and rehydrated. After two weeks in hospital clozapine was reintroduced and titrated accordingly. After 8 weeks Lorazepam was introduced as 1 mg QDS and he discharged to psychiatry unit on Lorazepam 1.5 mg QDS after 82 days in medical ward. He continued to be rigid and psychotic. Treatment continued with lorazepam increased up to 16 mg daily and 8 session of ECT were prescribed. Following ECT his mental state improved significantly and there was no rigidity or abnormal movements.ConclusionCatatonia is better regarded as a movement and behavioral syndrome with particular attributes and diverse antecedents. First line of treatment is high dose of Lorazepam and second line ECT. Catatonia is a diagnosable and treatable entity.More education is needed to reinforce this message for physicians, especially in emergency departments and psychiatric facilities.
A literature review for the introduction of psychiatric simulation to University of Liverpool Medical School
Authors: Challinor Alexander , Hyland Declan 
Published: June 2021

AimsThe aim of this review is to systematically investigate simulation in psychiatry to enable the evidence based introduction of psychiatry simulation into the undergraduate curriculum at the University of Liverpool.BackgroundTransformations in the structure of psychiatric delivery and reductions in funding to mental health care have limited the availability of direct patient clinical experiences for medical students. Experiential learning through simulation can be utilised as a powerful pedagogical tool and provide exposure to a broad range of psychopathology.Although psychiatric skills and knowledge are gained from the current University of Liverpool undergraduate curriculum, there is no specific well-designed psychiatry simulation.MethodThe author searched MEDLINE, EMBASE and PsycINFO databases for studies that met the inclusion criteria. Search terms included ‘simulation (psychiatry or ‘mental health’). Studies were also searched using snowballing via citation tracking within the databases.Inclusion criteria comprised studies of an educational intervention that involved simulation. The intervention had to be utilised within the field of psychiatric teaching.ResultThe literature review illustrated the dearth of studies analysing role-playing (RP) and/or simulated patients (SP) in psychiatry with it typically encountered as part of the more general communication skills curriculum. Studies analysing SP and RPs demonstrate how they build on the social context of learning alongside drawing on a range of educational theories, including experiential learning. However, studies show that well-designed simulation training should encompass more facets of learning to be transformative, specifically reflecting upon ones experiences alongside understanding and interpreting this new knowledge, allowing it to guide future actions and change practice.Studies analysing virtual-reality in psychiatry are limited but demonstrate significant improvements in students’ acquisition of key psychiatric skills and exposure to psychopathology. More studies are needed to evaluate the efficiency and cost-effectiveness of virtual-reality over more traditional methods.Despite the increase in simulation teaching within psychiatry, and the expansion of innovative simulation approaches in other specialties, there was limited use of novel approaches found within the studies analysing psychiatric simulation. There were studies evaluating novel approaches to psychiatry simulation outside of the undergraduate curriculum.ConclusionWhilst there are barriers to overcome in simulation training, these are primarily logistical and are clearly outweighed by the educational gain demonstrated throughout this review. Simulation training in psychiatry has often remained limited to traditional communication-oriented scenarios using RP or SP. A greater emphasis on furthering the advancement and integration of more innovative approaches into psychiatric undergraduate teaching is needed.
Exploring student thoughts and perception of videos as a learning resource
Authors: Pasqua Gianluca Di , Mahajan Pranav 
Published: June 2021

AimsAs medical education becomes increasingly digital, there is a plethora of readily available video resources available to medical students, aimed at teaching a wide range of topics. Despite this abundance, students report a myriad of issues. These range from videos containing outdated material, being of a poor production quality, and not being entirely relevant to their learning objectives. The aim of this study is to explore student thoughts and perceptions of videos as a teaching and learning resource. As the Mental State Examination is a component of the Psychiatry curriculum that students often find difficult, we have written, filmed and produced a video series explaining and demonstrating it.MethodFollowing the production of the Mental State Examination videos at the University of Sheffield – which contained multiple doctor-patient consultations, interspersed with narration outlining the key learning points – three focus groups were undertaken. These were aimed at understanding student thoughts and perception on the new videos, and the use of videos in medical education in general. Taking a qualitative approach, thematic analysis was performed on the content of the focus groups.ResultThere was universal positive feedback about the structure and content of the videos we had produced; students enjoyed observing the various doctor-patient consultations and felt the separate elements of the Mental State Examination was explained logically and concisely. Furthermore, students appreciated that the videos were produced at their own University, believing this added to their validity. With regards to videos as a teaching resource in general, focus groups revealed that students appreciated specific, relevant and novel video material. Most students felt that videos can play an important role in medical education. There was a unanimous belief however that videos used in medical education should be produced well and be factually correct.ConclusionUnderstanding how students feel about videos as a teaching and learning resource is crucial in the development of more in the future. This study suggests more video resources for many areas, both within Psychiatry, and within the greater sphere of medical education, would be welcomed. This ought to be accompanied with student evaluation.
Whistle while you work: improving psychiatry training in a London NHS Trust and what we learned along the way
Authors: Duncan Emily , Bailey Alex , Edwards Simon , Butler Alison , Humsi Layth 
Published: June 2021

AimsThe aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.MethodCollected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.Reassessed and fedback to the trainees throughout.ResultOur baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.Conclusion•Trainees must be central to the work in improving their training•Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan•Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses•Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes•Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central roleWe hope that developing a structured approach to a large task like improving training will help make changes sustainable, and enables us to share our learning with others.