bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of rTMS on patients with dual diagnosis of depressive disorder and substance use disorders
Authors: Foad Wael , Alhawi Rami , Altamimi Samer , Hussain Zahid , Moselhy Hamdy , Fayek Mohamed 
Published: June 2021

AimsWe aim to investigate the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) in reducing consumption and craving among patients with Substance Use Disorder (SUD) and comorbid depressive disorder.BackgroundDorsolateral prefrontal cortex (DLPFC) is greatly involved in SUD evolution (1). Research has turned to targeting this brain area with rTMS; a non-invasive brain stimulation technique that modulates cortical excitability by sending pulsatile electromagnetic fields through the skull and into the brain (2). rTMS is an FDA approved and safe treatment option for treatment-resistant depression (TRD) (3).MethodFifty-four patients were admitted over six-month period of time (June 2019- December 2019) to the inpatient unit of Erada center for treatment and rehabilitation of SUD in Dubai. All patients who fulfilled ICD-10 diagnoses of Depressive disorder and SUD were screened for further assessment.Positive drug screen was confirmed through urine analysis. Hospital Anxiety and Depression Scale (HADS) and Brief Substance Craving Scale (BSCS) were applied to all participants. Patients were contracted for 5-times weekly High frequency (10 Hz) rTMS for 4 weeks (total of 20 treatments). Those who managed to complete their contracted TMS sessions were matched for age and sex with similar number of patients who received standard treatment as usual (TAU). Stimulation was as per FDA clearance for rTMS application in TRD.ResultEight patients were excluded (previous head trauma). A total of 46 patients had TMS mapping; nine of whom completed 20 sessions.Opioids was the most commonly used drug in almost 52% of patients (n = 14), followed by amphetamines in almost 30% (n = 8) and Cannabis in 18.5% (n = 5).Among those who completed 20 rTMS sessions; HADS scores on anxiety and depression fell by 85% and 78% respectively. BSCS score fell by 98%. Relapse rate (defined by positive drug screen) at 3 months was 33%.For those who completed 10 sessions; there was only 50% reduction on BSCS scores and 66% relapse rate. There were no data available on their HADS scores (only collected at baseline and at completion of 20 sessions).Those who only had TAU; there were no reduction in their BSCS (average score of 7 at both baseline and after 2 weeks).ConclusionOur findings suggest that rTMS may be an effective and safe treatment for both depressive disorder and craving for SUD which is supported by other studies (3,4).Our study is probably the first of its kind within Middle East population with addiction problems.
Person centred approaches to learning hold a potential for a mature depth of understanding and engagement as opposed to the traditional 'transmission of knowledge' approach to learning
Authors: Hayes Catherine , Heald Adrian 
Published: June 2021

AimsDo students experience a person-centred experiential (PCE) approach to learning in a university context differently to transmitted knowledge learning from prior education, and if so, how?BackgroundThe person-centred approach, as defined and developed by Carl Ransom Rogers, remains on the margins of practice in the UK. The approach sustains a non-medical stance. All of the Improving Access to Psychological Therapies Person Centred Experiential Counselling (APT PCEC) workforce require a qualification in person-centred experiential counselling. In order to attune to Roger's hypothesis regarding the conditions required in order to facilitate psychological growth, person-centred learning is a principle stance.Researching experiences of PCE learning through anonymous feedback from students attending different levels of training (BA, MA and post qualification PCE-Counselling for Depress (CfD) License) is an initial test of the hypothesis .Counselling education in the UK is increasingly highly standardised and driven by competency frameworks. This work begins to uncover person-centred students’ evaluation of undertaking person-centred qualifications. Modules and continuing professional practice were constructed to facilitate a person-centred learning environment wherein the curriculum was designed by students or the experiential aspect of the learning drove the agendaMethodThe sample was made up of (N = 30) students. 8 students were studying for a Master's degree in person-centred experiential psychotherapy, 10 students were studying a BA in humanistic psychotherapy, 12 students were attending a mandatory IAPT Continuous Professional Development (CPD) training in PCE therapy. The evaluation responses were subject to a thematic analysis.ResultThe emerging themes parallel each other and indicate that degree students were very aware of the difference from their previous learning experience in education.68% of MA Students experienced psychological maturation through the process of training.83% of BA students became more agentic in their approach to learning.83% IAPT therapists noticed the nurturing, compassion and humane approach to the learning, despite the mandatory nature of the offer and empowered them in regards to their non-medical stance within an NHS context.ConclusionOur findings point to the significance and impact of person-centred learning for person-centred psychotherapists’ development during and post-qualification. Implications can be drawn in regards to engaging with person-centred learning in public sector and health contexts.Person centred approaches to learning hold a potential for a mature depth of understanding and engagement as opposed to the traditional ‘transmission of knowledge’ approach to learning.
Reduced motivation to work for financial reward associated with harmful alcohol use in a community sample of young adults
Authors: Henry Jessica , Ersche Karen , Lim Tsen Vei 
Published: June 2021

AimsNeuroimaging research suggests that alcohol dependency is associated with impairments in anticipating monetary rewards, but not aversive or alcohol-related cues.We sought to investigate if reinforcement sensitivity is altered in young adults, who regularly consume harmful levels of alcohol, using a monetary incentive reinforcement (MIR) task. In light of previous research suggesting reduced motivation to obtain reward, we hypothesized that young alcohol users would show reduced motivation for monetary gain, but unimpaired loss avoidance behaviour.MethodWe recruited 46 volunteers from the local community in Cambridge (UK), half of whom reported consuming alcohol at harmful levels, as reflected by the Alcohol Use Disorder Test. Participants completed a number of personality questionnaires, including the Barratt Impulsivity Scale (BIS-11) and Sensation-Seeking-Scale (SSS-V) and performed the MIR task, which measures participants’ efforts in avoiding punishment and gaining rewards. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25 (IBM, Chicago IL). Analysis of co-variance (ANOVA) were used to explore group differences in demographics, personality traits and task performance; age and gender were included as co-variates.ResultThe groups were well-matched in terms of socioeconomic status and education levels. As the alcohol group was significantly younger than the control group and dominated by females, age and gender were statistically controlled for. Alcohol users reported significantly higher levels of impulsivity (F1,41 = 6.0, p = 0.019) and sensation-seeking traits (F1,42 = 36.7, p < 0.001) and demonstrated normal sensitivity to monetary value (F1,41 = 1.07,p = 0.307). However, when challenged to on the MIR task to gain reward or avoid punishment, alcohol users were as equally motivated as control volunteers to take action to avoid financial loss (F1,41 = 2.6,p = 0.112) but showed less motivation to work towards financial reward (F1,41 = 4.7,p = 0.036). Especially for small rewards, alcohol users exerted significantly less efforts, as reflected by a reduced accuracy rate (F1,41 = 6.6,p = 0.014) and a significant increase in late responses (F1,41 = 7.7,p = 0.008). The lack of motivation to work for reward was negatively associated with the severity of alcohol use, as reflected by the AUDIT score (r=−.48,p < 0-05).ConclusionWe observed reduced motivation to obtain financial reward, but not avoid loss in a community sample of heavy drinkers. As the observed effect was directly related to alcohol use severity, it may suggest changes in reinforcement sensitivity occur at an early stage of chronic alcohol use. Future research may want to monitor reward motivation in alcohol users longitudinally to evaluate whether it would be a suitable target for early intervention.
Inflammatory mechanisms of mental illness: brain inflammatory response to interferon stimulation
Authors: Herron James , Cavanagh Jonathan 
Published: June 2021

AimsWe hypothesise that peripheral IFN stimulation results in a brain inflammatory response via pathways of neuroimmune communication which in turn results in sickness-behaviour and depressive phenotype. We aim to determine if peripheral IFN stimulation results in brain inflammatory response including upregulation of inflammatory cytokines and chemokines.BackgroundThere is increasing interest in the role of dysregulated immune function and inflammation in the pathogenesis of psychiatric disorders including mood disorders and dementias. Immune mechanisms offer a new approach to investigating mechanism in addition to offering hope for new avenues of treatment.Interferon (IFN) therapy in humans is known to be associated with a significant risk of developing depression, both during therapy and increasing risk of relapse in the years following exposure, yet the mechanism remains unclear. IFN stimulation in animal models may offer insights into this phenomenon, in addition to furthering our understanding the role of immune mechanisms in the development of psychiatric phenotypes.MethodMice (n. 42) were exposed to either IFN-alpha, IFN-gamma or vehicle control using either osmotic pump or intraperitoneal injection over the course of 7 days. Mice were scarificed, brains were dissected and RNA extracted. Inflammatory gene transcription within the brain was determined using real time quantitative polymerase chain reaction (RTqPCR). Absolute quantification was achieved using standard curves and reference gene. Statistical significance was determined using Mann-Whitney or ANOVA/Kruskal-Wallis depending on normality of data and number of groups.ResultIFNγ stimulation is associated with a significant brain upregulation of a number of inflammatory cytokines and chemokines including Il1β, Tnfα, Il10, Ifnγ, Ccl2, Ccl5, Ccl19, Cxcl10 and Ccr5. However, unexpectedly we did not find IFNα stimulation to associate with brain inflammatory transcriptional changes.ConclusionThis work demonstrates a brain inflammatory response to peripheral IFNγ stimulation. The inflammatory profile, including upregulated chemokines, suggests that recruitment of leukocytes across the blood brain barrier may be part of the immune response. Further experiments using existing tissues will explore if there are structural/cellular changes within the brain parenchyma. Further experiments within the group will seek to demonstrate if IFN treatment associates with sickness behaviour in order to determine if this is a clinically meaningful model. Suprisingly, we did not see similar changes in the IFNα treated group, which requires further investigation.Funding: University of Glasgow, The Sackler Trust
Stealth-vaping: a new era of illicit substance misuse? a systematic review and meta-analysis of the prevalence of electronic nicotine delivery systems for the consumption of illicit substances
Authors: Hicks Tim , Arrowsmith Rebecca , Keill Susannah , Papadakou Eleni 
Published: June 2021

AimsTo estimate the prevalence of using Electronic Nicotine Delivery Systems (ENDS) for the consumption of illicit Substances (illegal under UK Law). We hypothesised that this is an increasingly common mode of delivery.BackgroundUsing ENDS to consume nicotine is increasing in popularity worldwide with a prevalence in the UK of 6% and in the USA 4%-6%. Existing studies have reported that people are switching to vaping because it is felt to be safer than smoking.However there is also emerging evidence that this mode of consumption is increasingly being used as it is discreet and much less easy to detect, hence sometimes referred to as stealth-vaping. This appears to be driving a switch to vaping to administer substances other than nicotine, notably, but not exclusively cannabis, including concentrated forms of Tetrahydrocannabinol (THC) and synthetic cannabinoids. Anecdotally this practice is known to be occurring in psychiatric inpatient settings.This is against a backdrop of the uncertain long-term effects of vaping and the emergence of case reports of the death of otherwise healthy young persons after using ENDS to consume cannabis.MethodSearch strategy: MEDLINE , EMBASE, Cochrane Database of Systematic Reviews, Grey Literature using Medical Subject Headings (MeSH), text words relating to vaping of drugs and hand searching journals.Statistical methods: Synthesis of data was performed using inverse variance with double arcsine transformation in MetaXL. Heterogeneity was assessed with the Cochran's Q and I2.ResultFrom 970 abstracts, 61 papers were selected for full text review, 18 met the inclusion criteria. The total study population for the outcome of ENDS nicotine users who also use ENDS for the consumption of illicit substances was 9098. There was significant heterogeneity with a random effects model prevalence of 17% (95%CI 7%-32%). The total study population for the outcome of cannabis users who use ENDS to consume cannabis was 52708. There was significant heterogeneity with a random effects model prevalence of 23% (95%CI 12%-37%).ConclusionThe use of ENDS to consume illicit substances is concerning as it appears to be relatively common practice. This was most notable in studies of existing cannabis users, younger people and medical marijuana users.Given the uncertainty of long term health consequences and poor understanding of sudden death in some users, this study highlights an emerging and substantial public health concern.Currently there is a paucity of primary studies to elucidate the impact on health.
Post traumatic growth during COVID-19: unity in diversity
Authors: Lakha Meena Afzal , Bhowmik Anindya , Bisht Sneha , Shrestha Suzani , Gajanan Kantappa , Shah Samir 
Published: June 2021

AimsThis poster reflects how the experience of staying with people of diverse nations and cultural background helped the stranded IMGs cope with this agony in a foreign land during an unprecedented tumultuous situation. The aim is to show that despite diversity among people, the hard times made them unite and overcome countless difficulties.BackgroundThe COVID 19 pandemic has been a period of global health crisis and has exponentially affected mental health issues in the world population. In these difficult times, several International Medical Graduates (IMGs), who had come to the UK to attend their PLAB exams, were left stranded as the exams were postponed, flights cancelled and borders sealed. Faced with huge uncertainty their mental health was of great concern.At this time the British Association of Physicians of Indian Origin (BAPIO) came forward to help this cohort of stranded doctors in terms of accommodation, finances, mental health support, preparation for exams to the extent of liaising with General Medical Council (GMC) and Home Office. The virtual support group provided a platform for IMGs from different nations and cultures to get in touch with each other helping overcome mental burden and stress.The stories presented in the poster show how unity in diversity helped these young doctors deal with mental trauma amidst the Pandemic.Method276 doctors from 27 countries were looked after by BAPIO. From those excerpts taken from 26 IMGs, personal narratives was used as a method for qualitative assessment.The percentage of IMGs clearing their exams and getting jobs in the NHS has been used for quantitative assessment.ResultQualitative: The personal narratives of the IMGs show how they were positively impacted by staying together albeit different nationalities and cultural background.Quantitative: A total of 21 IMGs out of the 26 cleared their PLAB 2 exams and got registration under General Medical Council giving a percentage of 81.7%. 20 IMGs have successfully joined the NHS in various posts giving a job success rate of 95.2%.ConclusionThe experience of living and sharing housings with people from different nationalities, has increased appreciation and also prepared them to work in the NHS which has a diverse work force. This learning experience has been integral for all of us in shaping our life in the UK making everyone more compassionate.
Treatment of anorexia nervosa in young people with autism: a literature review
Authors: Karim Aneesa 
Published: June 2021

AimsThe purpose of this review was to review existing literature relating to treatment of anorexia nervosa in young people with a diagnosis of autism. Hypothesis was that there would be a limited amount of literature in this age group.Previous research has suggested that there is over-representation of autistic traits in anorexia nervosa. There are implications for treatment outcomes for young people with anorexia nervosa and autism. Young people with autism may find it more difficult to engage in psychological treatments for anorexia nervosa, due to cognitive and behavioural inflexibility, or communication difficulties. Researchers are therefore looking at other options for treatment.MethodThis is a narrative review. Search was conducted in January 2020. Keywords used were “anorexia nervosa” combined with “autism” combined with “treatment”. Only published, peer-reviewed, full articles in English were included. Search of OVID (for MEDLINE, PsycINFO, EMBASE and ERIC databases) gave a result of 222 articles. 9 articles met the inclusion criteria. Search of CINAHL gave a result of 12 articles; 3 articles met the inclusion criteria but had been reviewed following OVID search.ResultThemes identified for discussion were: cognitive remediation therapy; improving emotional identification; adaptations to communication; dietary, sensory and environmental considerations; recognising the role of autism; and pharmacological therapies.ConclusionLiterature suggests that treatment targeting cognitive features, common to anorexia nervosa and autism, can be effective. There has been interest in the use of cognitive remediation therapy (CRT) and cognitive remediation and emotion skills training (CREST). However, more research is required in younger patient groups. Use of medication is in experimental stages, with studies considering a role for oxytocin from age 16. Qualitative studies provide information on modifications to treatment which could be helpful. The review highlights the need for a standardised, evidence-based treatment pathway for this patient group.
Attitudes of medical students towards choosing psychiatry as a career
Authors: Ahmad Mohammad , Dabbagh Marwan , Dabaliz Alawwab , Obeidat Akef 
Published: June 2021

AimsOur aim is to study factors influencing attitudes of medical students towards pursuing Psychiatry as a career. We hypothesise that the minimal exposure and/or importance given to Psychiatry during medical school is insufficient to let a student truly experience and appreciate the specialty.BackgroundStudies report an annual decline in Psychiatry Trainees in many parts of the world. This deficiency is projected to create gaps between mental health service needs and providers. Studies have also explored the crisis in recruitment and the positive impact a short course can have in promoting engagement in Psychiatry by students.MethodAn anonymous questionnaire was distributed amongst medical students, from years 1 to 5, in the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Factors assessed in the survey included demographics, specialty ranking, acceptance ratios, role models and personal experiences, among others. Those who didn't express interest were asked about the lack of exposure to Psychiatry during medical school along with other influential factors that have been studied elsewhere, including those that we hypothesise to be of significance in our study population.ResultA total of 153 students responded. Positive views towards Psychiatry increased linearly by year (50% in Year 1 to 90% in Year 5). 33% of students selected psychiatry as a top 3 choice with the most significant factors being a unique patient-doctor relationship (P < 0.05), and the challenges faced in the specialty (95%).Of the 67% of students who did not prefer Psychiatry, insufficient exposure to ward experiences and the specialty as a whole were unanimously agreed upon factors. Other deterring factors included lack of instant gratification when treating a psychiatric patient (72%), and an underestimation by the non-medical community of a Psychiatrists role (26%).ConclusionOur findings give an optimistic view towards the future of Psychiatry in the region, given the large number of students (33%) who consider it in their top 3 choices for a career. However, a larger number of students continue to have a negative view towards Psychiatry, especially due to the lack of exposure to the specialty during medical school. The factors identified in our study should be tackled by medical schools or curriculum provision authorities, as this has shown to be of benefit in studies in other parts of the world.