bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment
Authors: Kaur Darpan , Verma Rishab , Ghildiyal Rakesh 
Published: June 2021

AimsThe aim of the study was to assess the attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.The hypothesis of the study was there are significant problems in the domains of attitude and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.BackgroundParents are an important stake holder in child and adolescent psychiatry and mental health care service models. There is scarce literature from developing countries regarding attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.MethodThis study was conducted at the Child and Adolescent Psychiatry Clinic, Department of Psychiatry at a Tertiary Care Institution. Eligibility criteria comprised of parents of children and adolescents who had come for consultation. The parents were provided information of the study and those willing to participate were included in the study. A convenience sample of 100 parents was considered for the study. The parents were interviewed using a specially designed survey comprising 30 questions with Yes/No response developed by the authors for the purpose of the study. Informed consent and Institutional Ethics Committee Clearance was obtained. Data were analysed using SPSS.ResultWe found that the majority of parents were from urban area (72%) and mothers comprised 68%. We found that 46% of parents did not want a psychiatric diagnosis and 35 % parents felt stigmatized for seeing a psychiatrist for their child. Sixty nine percentage of parents preferred counseling as the first line of treatment and 31% preferred medicines as the first line of treatment. We found that 33 % felt additional psychological tests could be useful and 54% of parents felt brain imaging and blood tests could be useful for their child. Majority of parents expected basic improvement for their child within 1 week(32%) and expected full improvement by 1 month(82%). Fifty three percent of parents had searched online information prior to consulting and found useful information. However, 38% of the parents felt confused after reading online information and 69 % of parents were more worried about giving medications after referring online information.ConclusionOur study provides useful key insights from parent's perspective in child and adolescent psychiatric services. Implications exist for future research as well as policy perspectives on the role, attitudes and expectations of parents as vital stake holders in child and adolescent psychiatry.
Transient musical hallucinations in a young adult male associated with alcohol withdrawal
Authors: Lim Mao , Blackman Graham , David Anthony , Mannan Fahmida 
Published: June 2021

AimsWe present the case of a 25-year-old male who presented to A&E with isolated musical hallucinations, in the absence of audiological or neurological disease.BackgroundMusical hallucinations (MH) are a form of complex auditory hallucinations whereby an individual experiences an instrumental and/or vocal melody in the absence of auditory stimuli.ResultThe patient had a history of recreational drug use and a family history of psychosis. Hallucinations, which were preceded by discontinuation of alcohol and re-initiation of citalopram for depression, resolved spontaneously after three days.ConclusionAetiological factors are discussed alongside the existing literature. Whilst the underlying mechanisms underpinning musical hallucinations remains elusive, the case illustrates the potential role of alcohol withdrawal, serotonin toxicity, recreational drug use and genetic vulnerability.
Autism in girls and the pre-referral environment
Authors: Nussbaum Peter 
Published: June 2021

AimsThis literature review sought to identify and highlight any sex specific factors in the diagnosis of autism spectrum conditions during the pre-referral period which might affect diagnosis rates in ASD in girls. The null hypothesis was that there are no sex specific factors that affect referral and diagnosis of ASD in girls.BackgroundHistorically, boys are diagnosed with ASD more than girls but rates vary depending on clinical population characteristics. Diagnosis trends continue to demonstrate a large male excess. The concept of autism as a predominantly male condition has been challenged and there is increased focus on females with high functioning autism who are not being detected as easily.Various theories exist as to why this is the case.There are high rates of suicidality in ASD and risk of death by suicide is higher in ASD women (the reciprocal of the suicide rates in general population where more men complete suicide). Women with high functioning autism represent an at risk group. Undetected autism in females may be complicated by ‘camouflaging’ or masking of symptoms which puts a large strain on individuals functioning and mental health. Costs to society and the individual are large.However, early identification and intervention improves outcomes such as activities of daily living and social behaviours.MethodAn electronic literature search was completed using MEDLINE, PsycINFO and EMBASE in November 2018. Key terms were: (‘child*’ OR ‘adolescent’ OR ‘young pe*’) AND (‘ASD’ OR ‘autism’ OR ‘asperger*’ OR ‘high functioning*’ OR ‘PDD’ OR ‘Pervasive developmental*’) AND (‘girl*’ OR ‘sex’ OR ‘gender’). Papers were excluded on a number of grounds.Result11 papers were included in the review from an initial 2823 abstracts.ConclusionA number of papers highlighted important learning points. Some of the more original conclusions included that we require more studies comparing populations of girls with ASD to high risk, high functioning girls and female controls to clarify features particular to the ‘female phenotype’. Delays in diagnosis in girls appears to pre-date assessment so further thought on how to educate and support referral sources (caregivers and schools) on how to identify girls with autism is recommended and would be informed by further research focus on the previous point. Active case ascertainment should be considered in future research and follow-up of girls who do not receive a diagnosis at initial assessment were additional learning points that came from the review.
Towards peak experience - exploring the influence of wilderness on conscious awareness
Authors: Purnell Oli 
Published: June 2021

AimsThis study examines what effect wilderness has on our conscious awareness, and by extension of that meta-cognition; our physical, mental and spiritual health. It reviews available scientific and artistic literature and integrates this with interviews in order to generate original grounded theory. It was found that intensity of wilderness experience varied proportionally with four mediators; Challenge, Immersion, Beauty and Time. With these maximised, experiences broadly within four themes occurred; Increased Awareness, Confidence, Perspective and Connectedness. When sufficiently intense, these four experiences amalgamated to elicit what Maslow described as 'Peak Experience'. As such, this thesis unexpectedly provides a pragmatic recipie towards peak experience, and a map of one's potential psychological journey, in the context of wilderness.
Junior doctors rate online simulation as ‘good enough’ but not as good as face to face sessions
Authors: Bachra Josh , Ludvigsen Anna , Junaid Kehinde 
Published: June 2021

AimsTo compare the feasibility and acceptability of delivering a simulation-based learning (SBL) programme for Junior Doctors virtually versus face to face.MethodThe Nottinghamshire Healthcare Simulation Centre has been delivering a SBL programme for Foundation Year 2 doctors on behalf of Health Education East Midlands for the past three years. Since face to face teaching was not possible during the COVID-19 pandemic the programme was delivered online using the same content and format as for prior cohorts. Feedback questionnaires from 128 face to face participants (F2F) and 133 virtual participants (V) were compared.ResultThere was a decrease in Likert scale ratings across all domains in the virtual group. This was most apparent when examining the ‘strongly agreed’ responses: the venue/remote format was suitable for the session 34% decrease, the course length was appropriate 24% decrease, the pace of the course was appropriate 20% decrease, the simulation was helpful and relevant 15% decrease, the content of the course was organised and easy to follow 13% decrease, the learning objectives were met 10% decrease, the presenters were engaging 6% decrease, the trainers were well prepared 3% decrease. The virtual group included responses in the ‘strongly disagree’ and ‘disagree’ categories relating to the virtual format, length and pace, which did not occur in any domain for the F2F group.Combining the ‘strongly agree’ and ‘agree’ statements also showed a decrease in satisfaction with 72.5% of responses falling into this category for the V group and 88.3% for the F2F group. Fewer participants in the V group would recommend the course to a colleague (98% V vs 99% F2F).ConclusionProviding the SBL programme using an online format was feasible while also being acceptable to most participants. However, participants did not rate this experience as highly as face to face teaching. The largest decreases in satisfaction were in areas related to the virtual format. An interesting finding is that participants rated the pace and length of the online course as less agreeable, despite the content and scheduling being the same as for the face to face group.Based on these findings face to face teaching should resume when practicable. In the meantime, the virtual delivery may be improved if the course length was reduced. Analysis of qualitative feedback may provide insights into why participants did not rate the virtual simulation as highly as the face to face equivalent.
Can probiotics benefit young people with autism spectrum disorders?
Authors: Ramani Pooja , Sala Regina 
Published: June 2021

AimsThe aims are to evaluate the effectiveness of Probiotics on young people with Autism Spectrum Disorder.We hypothesized that there will be an improvement of the comorbid gastrointestinal symptoms that can accompany Autism Spectrum Disorder.We believe that the use of probiotics can exert bidirectional effects on the gut-brain axis which may result in improvements in core Autism symptoms.MethodA literature search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used databases including OVID MEDLINE, Pubmed, EMBASE, AMED and the Cochrane register of controlled trials. Studies using Probiotics as a treatment for children with ASD were identified by key search terms; Child*, young person*, adoles*, teenagers, ASD, Autism Spectrum Disorder, Autism, Pervasive developmental disorder, PDD, Probiotics, Supplements, Lactobacillus, and Bifidobacterium. Inclusion criteria: Children of age range 2-18 with a diagnosis of ASD and having at least one gastrointestinal symptom were included. Exclusion criteria: The following were excluded: studies looking at Autism with interventions aside from Probiotics; studies where Probiotics were tested in conjunction with other interventions; studies where there were additional neurodevelopmental disorders.ResultTwelve studies identified all utilized probiotics. This included 7 Randomised Control Trials, 2 Open-Label studies, 1 pre and post-intervention design and 1 Case study. All RCTs gave probiotics or placebo to children.Ten studies showed an improvement in gastrointestinal symptoms. Six studies showed improvements in various behavioral measures. Four studies showed improvements in core autism symptoms. However, the sample sizes in these studies were not large enough to prove statistical significance.ConclusionNo studies showed an adverse reaction which indicates probiotics can be considered a safe treatment.The improvements in a variety of parameters imply probiotics a suitable adjunctive intervention that may help improve ASD core symptoms in young people as well as improving physical and behavioural comorbidities which in some cases was noted by parents.However, due to high dropout rates and generally small sample sizes, larger-scale trials are needed to critically confirm the efficacy of probiotics for children with ASD.
A review of serious untoward incidents (SUIS) of patients with personality disorder (PD)
Authors: Reid Harry , Lee Tennyson , James Charlotte , Hancox William , Stoikos Stefanos 
Published: June 2021

AimsThe aim of this paper is to describe key findings and recommendations of SUI reports regarding patients with a diagnosis of PD in East London NHS Foundation Trust (ELFT). Patients with a diagnosis of PD are often involved in SUIs with regards to risk to themselves or others. Contributing factors might be the nature of their disorder in terms of mood instability and impulsivity, self-harming or antisocial behaviour, and the difficulties posed to assessing clinicians in predicting risk.BackgroundPatients with PD present severe challenges to services. SUI findings thus serve as a lightning rod for issues in their management. With the emergence of NICE guidelines for borderline PD [2009] and antisocial PD [2009] regarding risk assessments, there has been greater optimism for management of PDs.MethodA case series of 50 SUI reports of patients with a diagnosis of PD were identified from the governance and risk management team of ELFT. Themes were categorized as positive practice, contributory factors, and recommendations. Findings are related to guidelines in NICE and RCPsychiatry. Any patient with a diagnosis of PD (of any sub-type) that was involved in a SUI in ELFT met the inclusion criteria. There were no exclusion criteria.ResultThe most frequent themes in positive practice were ‘continuity of care’ and ‘clinical practice’. The most frequent subthemes in clinical practice were ‘assessments’ and ‘follow-up’. ‘Continuity of care’ included examples of collaborative working between various teams, as in joint assessments, good communication, and timely referrals. In contributory factors ‘poor documentation’ was the most frequent theme. 14 reports found no contributory factors. In recommendations the most frequent theme was the need for development and implementation of PD policies and for improved risk management.ConclusionNICE guidelines stress the importance of continuity of care and good clinical care and it is commendable that these were findings in positive practice. The importance of documentation being accurate and timely needs underlining in hard pressed time poor clinicians. Services would do well to review PD policies specifically regarding risk management at a wider Trust and local service level. Our findings point to the ongoing need for workforce development as recommended in the RCPSych position statement on PD published in January 2020.
Long admission waiting list at the Orchard clinic-why?
Authors: Sayeed Hannah , Brown Johanna , Lenihan Fionnbar 
Published: June 2021

AimsThe Orchard clinic is one of the three medium secure units in Scotland. This project was completed:
To gain an understanding of the causes of the Orchard clinic's long admission waiting list.To use this information to improve current clinical pathways, service development and further research and development.MethodTo study the longitudinal traffic flow through the clinic from January 2017 to December 2019, data were collected for this time retrospectively from electronic minutes of fortnightly bed management meetings at the Orchard clinic.This was cross checked with the Orchard clinic's record of admissions and discharges during this time and approved by the Forensic Research and Audit Group, NHS Lothian.ResultNovember 2018 onwards, a surge of 90% was observed in the admission waiting list.Looking at the trends of traffic flow through the clinic during this time, the following observations were made:1. More admissions than discharges, especially November 2018 onwards.2. New referrals for medium secure care at the Orchard clinic peaked twice during this time.3. Delayed discharges peaked in July 2018 and further in January 2019 running parallel to the surge in admission waiting list thereafter.4. 42% patients on the delayed discharge list belonged to other health boards awaiting local low secure/community placements.ConclusionDelayed discharges were identified as a constant parallel to the long waiting list and hence identified as the main factor contributing to it. Out of area (non-NHS Lothian) admissions were noted to be linked to these delayed discharges.Regular peaks in new referrals was also noted to be contributory.
Tolerability of a single IV administration of a methylene blue challenge in patients with bipolar disorder: preliminary data from a pharmaco-MRI study
Authors: Sharp Harriet , Russo Alfonso , Colasanti Alessandro , Pinna Antonello , Nwaubani Prince , Marco Riccardo De 
Published: June 2021

AimsTo summarise the tolerability profile following an infusion of methylene blue (MB), including subjective effects on mood and energy levels and haemodynamic changes, in patients with Bipolar Affective Disorder (BPAD).BackgroundBPAD is associated with mitochondrial dysfunction and impaired cellular energy production. MB is proposed to enhance mitochondria function via rerouting electrons and intracellular reduction of oxidative stress, and is therefore a candidate compound for use as a probe to reveal alterations in brain oxygen metabolism in vivo in patients with BPAD. Although there are reports of MB used as treatment for BPAD, the tolerability and subjective effects of a single IV dose in this population has not yet been defined.MethodUsing a single-blind, randomised, within-subject design, 7 patients with BPAD on stable pharmacological treatment and 6 healthy controls (HCs) received an infusion of 0.5mg/kg MB and a placebo glucose solution one week apart. Visual Analogue Scales (VAS) assessing ‘Mood’ and ‘Energy’ levels were completed by 11 participants, and blood pressure (BP), heart rate (HR) and any subsequent side effects were recorded before and after infusions.ResultA significant, albeit very small, effect of MB on ‘Mood’ levels relative to placebo was demonstrated, independent of groups (change relative to baseline: 5.5% ± 11 increase (placebo) vs -1.6 % ± 9.5 reduction (MB); p = 0.027). Although there was no effect of MB on energy levels in either group, there appeared to be a trend for a general group difference in ‘Energy’ levels across all trials, with lower ratings in BPAD patients (p = 0.058).There was a trend for significantly lower post-infusion HR relative to pre-infusion (-6.4 ± 8.8 bpm, p = 0.07. Diastolic BP was higher (3.0 ± 7.8mmHg, p = 0.039). These effects were independent of groups and drug. The most common side effect with MB was mild/moderate pain at infusion site (n = 10/13), resolving within median 32.5 minutes (IQR 6-102), and discoloured urine in 7/13 subjects lasting median 44.5 hours (IQR 36-59). No difference in frequency of side effects reported between groups.ConclusionAlthough limited by small sample size, this tolerability analysis demonstrates a acceptable profile of effects of MB on subjective ratings and blood pressure, in both BPAD and HCs. Common side effects of discoloured urine and pain at infusion site are in line with previous reports in the literature. We observed a small effect of MB on mood ratings which could be related to the discomfort experienced during infusion.
Dramatic portrayal of suicide: a critical analysis of Netflix's 13 Reasons Why
Authors: Sutton Anna , Overshott Ross 
Published: June 2021

AimsThe aims of this project were to assess how well the Netflix drama 13 Reasons Why portrayed suicide, in terms of both accuracy and safety, and to discuss the potential effect this could have on viewers.BackgroundPsychiatric content within dramatic media can have measurable effects on the population, such as reinforcing stigma around mental illness. Given the show's focus on a character's suicide, the most serious effect here would be suicide contagion.Guidelines and regulations for the portrayal of suicide in media are in place to protect those who might be vulnerable to suicide contagion.MethodWe formed our own pro-forma of 42 criteria using existing guidelines written for both news and dramatic media. These criteria were formatted into positive and negative pairs; positive being instances of guidelines being followed, negative as guidelines being broken. These were further organised into 7 categories.Each episode of seasons 1-2 was then assessed against the criteria. Cumulative instances of guidelines being followed or broken were compared within and between seasons. Context of each instance was taken into account by the primary researcher, and we also highlighted instances of exceptional breach of these guidelines.ResultThe results showed an over-all breach of the guidelines, with no significant improvement between the seasons. Some categories of criteria, such as “asking for help” and “mental health”, were portrayed well overall. Other categories, such as “blame”, performed extremely badly.The most significant breach was the graphic suicide scene at the end of the first season, which completely disregarded Samaritans’ guidelines.ConclusionThe breaching of guidelines in this show was overwhelming. In terms of severity, although there were some positive themes running through the seasons, there were also worrying instances of guidelines being completely disregarded. This led to the conclusion that the producers of the show did not take their responsibility to young, vulnerable viewers seriously regarding the dangers around portraying suicide.Suggestions from this study are that more guidelines around suicide are needed specifically for dramatic media, and that existing guidelines should be conflated and have stronger implementation by regulators. This implementation should potentially include overseas providers such as Netflix. Ethically, a significant challenge here is maintaining balance between safety and allowing artistic licence.
Basic clinical equipment for physical health assessment in mid Essex inpatient units
Authors: Abdelkhalek Hesham , Griffiths Tamsin , Motley Kim , Ramjan Raisa , Harrop Sophia 
Published: June 2021

AimsIt is trust policy that the Basic Clinical Equipment for Physical Health Assessment should be available on each unit. The standard for this audit is therefore 100% completion.BackgroundThis was a cross-sectional study of six mental health units across Mid Essex. We audited equipment and consumables in comparison to trust policies. For the purpose of the audit we designed an audit tool.MethodOverall compliance across all wards for all audited items was 77.5% (64.9% – 87.5%). Average compliance for equipment provision 83.3% (73.9 %– 91.3%) was greater than that for consumables 72.1% (58.8% – 82.4%).ResultWhen looking at the compliance on each unit separately, our data show that no unit has met the standard of 100% for equipment or consumables. From all units, one of the two older adults’ inpatient units had the highest overall compliance and highest compliance for consumables at 87.5% and 82.4% respectively while the perinatal unit had the lowest overall compliance and lowest compliance for consumables at 64.9% and 58.8 respectively. For the equipment compliance, intensive care unit and one of the older adults tied for the highest compliance at 91.3% while male inpatient unit and perinatal inpatient unit were tied the lowest compliance at 73.9%.ConclusionThis is an audit to assess the availability of Basic Clinical Equipment for Physical Health Assessment on inpatient units in Mid Essex. With an audit standard of 100% completion, it shows that overall compliance on all units was 77.5% which is not meeting our standard.