bluuebunny/crossref_metadata_2025_split huggingface dataset:
A closed audit reviewing the electrocardiograms of patients presenting to the memory assessment team
Authors: Heath Joseph , Anderson Maroulla , Miles-Stokes Jonathan 
Published: June 2021

AimsTo review the ECGs of all patients referred to MAT services over the preceding 5 year period.BackgroundNeurodegenerative conditions such as Alzheimer's Disease can be treated with Acetylcholinesterase Inhibitors (AChEI) to slow down cognitive decline. Side effects of AChEIs include bradycardia, syncope and cardiac conduction disorders. An electrocardiograms (ECG) is completed prior to memory assessment team (MAT) medical assessments to screen for those who may be at risk of the cardiac side effects of AChEIs. ECGs may be included in the initial referral to the service or completed by the MAT. Given the predominantly elderly population referred to the MATs service, other incidental abnormalities are to be expected. Not all MAT referrals that are screened by memory nurses reach the threshold to be reviewed by the medical team and therefore not all ECGs are routinely reviewed, potentially missing clinically significant abnormalities.ResultA total of 1795 patients were identified as being referred to a single mental health unit in the North West on England over a five-year period. 781 (44%) of the patients had an ECG completed by the MAT, of which 452 (58%) showed an abnormality. Significant abnormalities that were previously unknown to the patients’ primary care provider include eight cases of Atrial Fibrillation (AF), four cases of Trifasciular Block, and 19 cases of Left Ventricular Hypertrophy (LVH). 64 (8%) of patients who had an ECG by the MAT had a bradycardia.ConclusionIn addition to identifying abnormalities that could interfere with memory medication, this audit showed that over half of the ECGs completed by the MAT had an atypical trace. Cardiology was consulted to identify which abnormalities were considered clinically significant and if not already known, the general practitioner (GP) was informed. A change in the local service means that all ECGs completed by the MAT are now screened at point of filling into the notes, so any future abnormalities are identified and followed up immediately.
Obsessive compulsive disorder in treatment seeking children & adolescents during the COVID-19 pandemic
Authors: Henein Anthony , Pascual-Sanchez Ana , Corciova Suzana , Hodes Matthew 
Published: June 2021

AimsFew studies have investigated the COVID-19 pandemic's effect on children and adolescents with obsessive compulsive disorder (OCD), who are thought to be particularly vulnerable. This study aims to investigate whether the COVID-19 pandemic is associated with increased referral of young people with OCD in one area of London and determine if COVID-19 has been associated with change in symptom severity and treatment offered in recent years.MethodA retrospective study was conducted using clinical service data investigating 58 young people (8–17 years) referred and assessed in CNWL NHS Foundation Trust CAMHS, before and during the COVID-19 pandemic in 2020 (months March–October 2018–2020). Changes in symptom severity were measured using the health of the nation outcome scale for children and adolescents (HoNOSCA). Total HoNOSCA and three HoNOSCA items were used; emotional symptoms, family relationships and school attendance. Patient clinical records were reviewed to assess if COVID-19 had exacerbated OCD symptoms. The type of treatment offered (cognitive behavioural therapy -CBT- only vs combined CBT and medication) was also compared. Analysis was carried out using Chi-square, Kruskal–Wallis and Mann–Whitney U tests.Result26 (5.62%) initial assessments to CAMHS were related to OCD in 2020, compared to 12 (1.30%) and 20 (2.27%) assessments pre-pandemic (2018 and 2019), showing a significant increase in the proportion of OCD cases (X2 (1, N = 58) = 20.3, p < .001). There was no significant difference in total HoNOSCA, emotional, family relationships, or school attendance scores on initial assessment. However, 69.2% of clinical records in 2020 showed symptom worsening over the COVID-period, compared to 30.8% of cases assessed pre-pandemic.There was a significant difference between the type of treatment offered before and during COVID-19 (X2 (2, N = 58) = 12.7, p = .002), with a higher proportion of patients who were referred to CAMHS for OCD but discharged without treatment before the pandemic (37.5% vs 0%). While CBT only remains the most frequent treatment offered, combined treatment was more frequent during the pandemic, although this difference was not significant.ConclusionThe proportion of OCD-related initial assessments in CAMHS increased during the pandemic despite the overall number of referrals falling. Furthermore, fewer cases were discharged without treatment in CAMHS during this period. Given this, and that many were reported to have deteriorated during the pandemic, services will likely need to address the increased burden of more severe cases. Further research is warranted to assess the generalisability of our findings.
A national cross-sectional survey and interviews exploring the relationship between well-being and burnout in doctors
Authors: Jenkins John , Boxley Emma , Simons Gemma 
Published: June 2021

AimsDoctors’ mental health is a national concern – the General Medical Council, British Medical Association and Health Education England pledge to improve their well-being. Well-being has no common definition, instead pathogenic measures such as burnout are published as a demonstration of doctors’ wellbeing. Yet, the relationship between burnout and wel-being has not been explored.Aimto investigate the relationship between burnout and well-being.Hypothesisthey are negatively associated, but not opposites.MethodAn online cross-sectional national survey was distributed to doctors of all grades and specialties via the Royal Colleges and doctor organisations. The Oldenburg Burnout Inventory (OLBI) measured burnout, and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) measured well-being. Correlation coefficients between total scores of these measures estimated the relationship. Additionally, semi-structured interviews explored personal definitions of wellbeing and its relationship with burnout. Thematic analysis was carried out.Result64 doctors completed the OLBI and WEMWBS. Comparing the total scores for the questionnaires with Spearman's rho indicates a moderate negative correlation (rs= –0.658, p = 0.00, n = 64). Total scores were made into binary variables, a Chi-square test showed that a low WEMWBS score (<40) and a very high risk OLBI score (≥2.85 exhaustion and ≥2.6 disengagement) were statistically significantly associated (X 2 (1, N = 64) = 4.232, p = 0.04). Three themes emerged from the 10 interviews conducted: the importance of networks/relationships outside work; scepticism towards the proposal of an NHS wellbeing check-in; and how participants do not strive to improve their wellbeing until its decline.ConclusionThis research demonstrates that wellbeing and burnout have only a moderate negative correlation when using commonly employed measurement tools. Therefore, measures of burnout are not a surrogate for wellbeing. Further research could adopt a salutogenic approach by using the WEMWBS to monitor doctors’ wellbeing and could explore interventions to increase well-being, rather than waiting for its decline.
Profile of sleep pattern, psychiatric comorbidity and problematic electronic gadget use in children and adolescents with autism and ADHD
Authors: Kaur Darpan , Patani Sanay , Verma Rishab , Ghildiyal Rakesh 
Published: June 2021

AimsTo assess the profile of Sleep pattern, Psychiatric comorbidity and problematic electronic gadget use and explore demographic factors and correlations in children and adolescents with ADHD and Autism.Hypothesis: There are statistically significant problems and associations across sleep pattern, psychiatric comorbidity and gadget use in children and adolescents with autism and ADHD.BackgroundLiterature highlights increasing global trends and emerging concerns over the problematic use of electronic gadgets and sleep related problems in children and adolescents with autism and ADHD. There is sparse literature on the profile of sleep patterns, psychiatry comorbidity and problematic gadget use in children and adolescents with autism and ADHD from developing countries.MethodThis was an observational study conducted at the Child and Adolescent Psychiatry Clinic, Department of Psychiatry at a tertiary care Institution under the STS ICMR Project 2019 with Institutional Ethics Clearance. Apriori Sample size calculated was 70. Children and adolescents diagnosed with autism or ADHD as per ICD 10 criteria, fulfilling the inclusion criteria and willing to participate in the study were included. Informed consent was obtained from caregivers. Sleep Disturbance Scale for Children, Self Designed Parent based Problematic Electronic Gadget Use Scale, Vanderbilt ADHD scale, Indian scale for Assessment of Autism and the Child and Adolescent Psychiatry Clinic structured Performa were the tools for data collection. The results were analyzed with descriptive tests, chi square test and multiple logistic regressions using SPSS.ResultMean age of the sample was 9.1 years and majority (57%) were boys. Forty nine patients had ADHD and 21 patients had Autism. Problematic gadget use was higher in children ranging from 6 to 15 years of age and 12.8% had severe levels of problematic gadget use. 34.3% patients experienced severe problems in initiating and maintaining sleep. Oppositional-Defiant disorder was the most common comorbidity, predominantly inattentive type (76.4%) was the most common subtype of ADHD and mild autism (54.3%) was the most common type of autism in the sample. There were statistically significant associations (p < 0.05) between age and gadget use; hyperactive subtype of ADHD and problems with initiating and maintaining sleep and ADHD subtype, sex profile and problematic gadget use.ConclusionWe conclude that sleep problems, psychiatric comorbidity and problematic gadget use are prevalent with statistically significant associations in children and adolescents with autism and ADHD as per our study findings. Our study has relevant clinical, research and policy implications.
Factors in psychiatric admissions: before and during the COVID-19 pandemic
Authors: McCarron Robyn , Swann Peter , Thompson Fiona , Murray Graham 
Published: June 2021

AimsThe COVID-19 pandemic has impacted community mental health, but the effect on psychiatric admissions is unknown. We investigated factors contributing to acute psychiatric admissions, and whether this changed during the first UK lockdown.MethodA retrospective case-note review study with an exploratory mixed-methods design was used to examine factors in psychiatric admissions following the first UK 2020 lockdown compared to the same time periods in 2019 and 2018.ResultThemes of psychopathology, risk, social stressors, community treatment issues, and physical health concerns were generated. The mean number of codes per case was 6⋅19 (s.d. = 2⋅43), with a mean number of categories per case of 3⋅73, (s.d. = 0⋅98). Changes in routines and isolation were common factors in the study year; accommodation and substance abuse were more prominent in the control year. Relationship stressors featured strongly in both groups. There were significantly more women (χ2(1, N = 98) = 20⋅80, p < 0⋅00001) and older adults (χ2(1, N = 98) = 8⋅61, p = 0⋅0033) in the study group than the control. Single people, compared to those in a relationship (χ2(1, N = 45) = 4.46, p = 0⋅035), and people with affective disorders compared to psychotic disorders ((χ2(1, N = 28) = 5.19, p = 0⋅023), were more likely to have a COVID-19 related admission factor.ConclusionThe COVID-19 pandemic amplified pre-existing psychosocial vulnerabilities with a disproportionate psychiatric admissions impact on the mental health of women, the elderly and those with affective disorders.
Vive la difference! Celebrating and supporting autistic psychiatrists with autistic doctors international
Authors: McCowan Sue , Shaw Sebastian C K , Doherty Mary , Grosjean Bernadette , Blank Paula , Kinnear Malcolm 
Published: June 2021

AimsWe aim to raise awareness of the existence and value of autistic doctors in psychiatry and to also signpost psychiatrists who are or suspect they might be autistic towards peer support.MethodAutism refers to a lifelong difference in how people communicate and interact with the world. These differences lead to strengths and challenges with individual profiles which include special interests, hyper-focus, and often sensory differences and anxiety. Autism has an estimated prevalence of 1-2%, which is likely an underestimate. It was noted that there was little in the way of advocacy for autistic doctors around the world. Anecdotal evidence also suggested possible issues of misunderstanding and stigmatisation of autistic doctors. As such, there was a need to tackle this to promote positive change. MD founded the group Autistic Doctors International (ADI) in 2019 to foster camaraderie, advocacy and support. ADI has flourished with 250+ members currently. In a recent member poll, 24 of 180 respondents identified themselves as psychiatrists – second only to general practice (n = 54). Several other consultant psychiatrists are known to self-identify as autistic but have not formally joined due to the fear of disclosure. The group has additionally supported multiple doctors to tackle prejudice and discrimination in the workplace / training environment. It has also brought together autistic doctors with academic interests and has generated multiple academic outputs in the form of publications, research grants and conference posters/papers regarding autism.ResultPsychiatrists, and doctors in general, are a self-selecting group for many autistic strengths such as hyper-focus, curiosity, self-motivation, a desire to study social communication, attention to detail, pattern recognition, problem solving and empathy, which, contrary to prevailing stereotypes, can be marked in autism. The increasing numbers of doctors joining ADI supports the assumption that autistic individuals are safe and effective clinicians. It is worth noting that many members are not ‘doctors in difficulty’. Those who have been able to achieve suitable accommodations, often without realising why they were needed, have flourished. Such accommodations and outcomes are in line with the neurodiversity movement, which promotes a view of autism as difference, rather than pure disability or disorder. This aims to challenge stereotypes and the tragedy narrative surrounding autism.ConclusionAutism awareness is increasing amongst doctors but more open discussion is still needed in order to facilitate appropriate peer and workplace support. This is likely to improve mental wellbeing and resilience for autistic psychiatrists.
Clinical audit of prescribing for attention deficit hyperactivity disorder (ADHD) in children and young people services (CYPS)
Authors: Parker Mary , Martin Elaine 
Published: June 2021

BackgroundThe audit aimed to assess, when 3rd and 4th line medications were prescribed for ADHD, if practice was compliant with Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) prescribing guidelines and the updated NICE Guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management 2018.MethodThe audit was conducted in the four Teesside Child & Adolescent community teams during April/May 2018. Each team identified all patients prescribed 3rd and 4th line ADHD medications leading to 30 responses (n = 30).Information was collected from electronic and paper medical records using a designated audit tool compiled from the above evidence based guidelines. The data were analysed for compliance against standards using an excel spreadsheet and reviewed by the audit lead.ResultThere were many areas of good practice demonstrated in the audit including diagnostic recording, pre-treatment non-medical interventions where ADHD was not severe, and use of Methylphenidate as first line medication in accordance with BNF limits. In the majority of records reviewed, there was good evidence of a variety of NICE recommended non-medication interventions which were often continued post medication initiation.There was also very good evidence of comprehensive verbal and written information and psychoeducation including benefits and potential side effects of medication (92% verbal and 58% written).A pre-treatment assessment was completed in all but 3 cases, 1 of which had no assessment documented and 2 cases were transferred from out of area.Issues identified by the audit, where there was deviation from guidelines, included 4 cases where Methylphenidate was not prescribed as first line, of these, 3 were prescribed Atomoxetine due to parental choice and one was due to contraindications, suggesting patient choice was an important factor in selection of 2nd line medication.The audit demonstrates that clinical practice had moved away from the previous guidance in NICE CG72 (to prescribe atomoxetine 2nd line) towards the prescription of Lisdexamfetamine 2nd line (75%) as reflected in the new NICE guidelines: NG87, 2018 (updated 2019).ConclusionThis audit cycle has demonstrated that use of an evidence based approach has been instrumental in improving patient care. The Audit evidenced good practice in areas such as pre-assessment, information and psychological education, initial use of Methylphenidate, use of Lisdexamfetamine 2nd line, as well as consideration of patient choice. Importantly the audit highlighted that implementation of updated NICE compliant trust guidance, followed by a planned trust-wide audit will promote continuous improvement in patient care.
A natural language processing approach to modelling treatment alliance in psychotherapy transcripts
Authors: Ryu Jihan , Heisig Stephen , McLaughlin Caroline , Bortz Rebeccah , Katz Michael , Gu Xiaosi 
Published: June 2021

AimsPatient-therapist alliance is a critical factor in psychotherapy treatment outcomes. This pilot will identify language concepts in psychotherapy transcripts correlating with the valence of treatment alliance using natural language processing tools. Specifically, high-order linguistic features will be extracted through exploratory analysis of texts and interpreted for their power to discriminate alliance rated by patients.MethodAdult patients and therapists in outpatient clinic at various stages of relationship building and treatment goals consented to participate in the cross-sectional study approved by the Institutional Board Review. Psychotherapy sessions were recorded using wireless microphones and transcribed by two research assistants. After the recording, each patient completed Working Alliance Inventory– Short Form, to generate clinical scores of alliance. We used the Linguistic Inquiry Word Count (LIWC) tool to map words to psycholinguistic categories, and generated novel linguistic parameters describing the individual language for each speaker role. Canonical-correlational analysis and descriptive statistics were used to analyze the two datasets.ResultPatients (N = 12, 83% female, mean age = 40) were primarily diagnosed with personality disorders (67%) working on real-life interpersonal issues (median treatment duration 18.5 weeks, 50% psychodynamic, 32% cognitive-behavioral, 16% supportive modality). In this heterogenous sample, patients who used the “achieve” (e.g. trying, better, success, failure) and “swear” psycholinguistic categories of words rated the treatment alliance lower (r=−0.70, p = 0.01; r=−0.65, p = 0.02). Patients rated alliance lower with therapists, who used more “I” pronoun (r=−0.58, p < 0.05) and higher with therapists using more “risk” (difficult, safe, crisis) and “power” (important, strong, inferior, passive) categories (r = 0.66, p = 0.02, r = 0.58, p < 0.05), which commonly appeared in psychoeducation and conceptual framing of problems. Interestingly, there was no correlation with “affiliation” category (p = 0.9). Linear regression modeling from “achieve,” “swear” variables and “I,” “risk” variables with duration of treatment as covariate predicted the patient's rating of alliance (Adjusted R2 = 0.66, p = 0.03).ConclusionOur data collection and sub-sample analysis are ongoing. Preliminary results are showing speaker-specific language patterns in cognitive-emotional domain, e.g. self-expressivity, and in clinician's therapy style, covarying with the patient's perceived closeness in the heterogenous treatment dyads. Novel application of natural language processing to characterize alliance using the data-driven approach is an unbiased method that can provide feedback to clinicians and patients. This characterization can also potentially provide insights into the mechanisms underlying the therapeutic process and help develop psycholinguistic markers for this critical clinical phenomena.
Working in the woodlands: a mixed methods evaluation of Green Care in first episode psychosis
Authors: Sharp Harriet , Cuthbert Sharon , Berry Clio 
Published: June 2021

AimsRecognition of the essential role of nature-based activities for general wellbeing is expanding. Previous evaluation of nature-based activities has shown that those with greater mental health needs may benefit proportionally more compared to the general population. Currently, there is limited evidence of the benefits of green care for those with severe and enduring mental illness, including psychosis.We aim to establish benefits and difficulties encountered during a 10-session green care programme for 18-30 year olds who have experienced first episode of psychosis (FEP) using a mixed methods approach.MethodThis was a service evaluation of the Woodland Group, run by Circle of Life Rediscovery (CLR) and commissioned by Sussex Partnership NHS Foundation Trust in Autumn 2019 for 10 half-day sessions. All participants were aged 18–30 years, referred from Early Intervention in Psychosis service and had experienced FEP. Patients were supported by EIS staff with a ratio of at least 3:1. Sessions consisted of a welcome and agenda setting, ice-breaking activity, core nature-based activity (such as roasting chestnuts, maintaining the woodland area) and a ‘sense meditation’.Quantitative data for this evaluation were collected through routinely collected 15-item Questionnaire on the Process of Recovery (QPR), and a semi-structured intervention experience questionnaire. Qualitative data were collected via a focus group within the final session of the Woodlands Group. Thematic analysis was performed by the three co-authors.ResultSession attendance ranged between 3-15. 4/8 patients showed reliable improvement on QPR outcome measures, 1 showed deterioration and 3 showed no change. Mean QPR scores showed modest increase from average 3.4 (week 1) to 3.8 (week 10). 100% of respondents would recommend this group to others. Thematic analysis identified themes of connection with nature and others, development of a sense of wellbeing and ‘peacefulness’ and new perspectives on psychotic experience.ConclusionThis small, retrospective evaluation is the first to investigate green care interventions for young people experiencing FEP. Our results reflect the positive informal feedback from participants and supporting staff following attendance at the Woodlands Group. Limitations include small sample size, incomplete data, and reliance on patient-reported outcomes. These findings show promise for green care activities within EIS and represents a sustainable intervention in mental health care.