bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-dose olanzapine in treatment resistant schizophrenia. A case report and literature review
Authors: Clarke Ciara , Rushe Clodagh , Byrne Fintan 
Published: June 2021

ObjectiveWe report a case of a 58-year-old gentleman who was hospitalised intermittently for one year due to treatment resistant schizophrenia. Prior to hospitalisation he had been prescribed standard antipsychotics for decades without full resolution of positive psychotic symptoms. During his final admission lasting six months he was guarded, suspicious, irritable, constantly paced the corridor and displayed thought block and paranoid persecutory delusions. He would not enter the assessment room or allow any blood or ECG monitoring, however, he was compliant with oral medication. He was successfully treated with high dose olanzapine (40mg/day) and was discharged to the community. The aim of this study is to bring awareness and add to the body of evidence for the use of high-dose olanzapine in patients with treatment resistant schizophrenia in whom a trial of clozapine is not possible.Case reportThe patient gave written consent for this case report to be written and presented. An extensive literature review was performed and key papers were identified. Discussion focuses on the key areas in the literature.DiscussionThis case demonstrates that high-dose olanzapine can be used effectively as an alternative to clozapine in treatment resistant schizophrenia.ConclusionThis case highlights the need for further evaluation of high-dose olanzapine as an alternative to clozapine in patients with treatment-resistant schizophrenia.
Management of inappropriate sexual behaviour in frontotemporal dementia: a case study
Authors: McKenzie Stefan , Kwan Zoe , Sivakumar Velusamy 
Published: June 2021

ObjectiveTo present a case of a 79-year-old male with frontal lobe dementia (following a cerebral abscess) who was referred due to inappropriate sexualised behaviour (ISB) in a care home setting.To discuss the evidence base for the management of ISB in frontotemporal dementia.Case report79-year-old male patient who was diagnosed with frontal lobe dementia, following a craniotomy to aspirate and evacuate a cerebral abscess which affected the left frontal, parietal and temporal lobes. He then started to exhibit sexualised behaviour; he was using sexualised language towards female residents and care workers in the residential home, and was inviting residents to his room and asking them to touch him. This behaviour was felt to be due to inappropriate sexual behaviour which forms part of the spectrum of behavioural and psychological symptoms of dementia. Non-pharmacological interventions were tried but failed to manage his symptoms. He was started on Paroxetine which treated the symptoms for approximately 12 months. The symptoms reocurred and he was switched to Amisulpride which had a positive effect on his symptoms.DiscussionISB is a behavioural and psychological symptom of dementia and may be seen in 7% to 25% of patients with dementia. ISB is distressing for the caregivers and also presents considerable challenges for the treating clinician. ISB presents with behaviour such as sexual language, implied sexual acts, and overt sexual acts. A differentiation should be made between whether the act was one of intimacy-seeking or disinhibition. However, there is a need to intervene when there are risks to the wellbeing and safeguards of the patient and also caregivers and residents. ISB can be difficult to treat, and there is limited evidence on the subject. It is often better managed by non-pharmacological interventions if possible, due to patients often being less responsive to psychoactive therapies and the risks involved with using medication. Non-pharmacological interventions include environmental, behavioural and educational approaches, and examples of these are discussed. Pharmacological interventions are also discussed, but there is a lack of evidence in this area; currently the evidence is from case series and case reports. The variety of drug classes illustrate the non specific nature of drug therapy.ConclusionManaging and treating ISB is difficult and complex.The evidence suggests using non-pharmacological approaches as first line before considering pharmacological interventions.However, there is a need for further research to develop robust non-pharmacological and pharmacological interventions in the treatment of ISB.
Dyeing to live – a case of clozapine in disguise, and physicians' courage
Authors: Rae Alma , Kinghorn Thomas 
Published: June 2021

Objective… in which clozapine tablets were dyed pink, to work around a delusion preventing treatment, and physicians tolerated and monitored an alarming early response to the drug.Patient56-year-old female with severe enduring Bipolar I Disorder, current episode manic with psychosis, already an inpatient for six months. When first seen by us, polypharmacy was evident including haloperidol 25 mg daily. Thorough trials of mood stablisers and second generation antipsychotics in various combinations had all failed. She had never had a clozapine trial.MSEDishevelled middle-aged woman of European descent. Restless; shuffling gait; speech pressured, rapid and whispering, often to the point of unintelligibility. Affect labile: anxious and distressed, suspicious, angry, elevated and demanding. Thought form tangential+++ content paranoid persecutory themes, preoccupied with sexual trauma and delusional belief that yellow medication whether solid or liquid was poisonous. Risks of vulnerability, falls, aggression, neuroleptic malignant syndrome (NMS) and protracted psychotic mania requiring long term hospitalisation.PlanChange to clozapine.ProblemAll formulations are yellow.SolutionTeam discussion, ethical analysis, clozapine tablets dyed with red vegetable dye.Ethical analysisPotential benefit to patient great; current medications not effective and NMS possibly developing; she was fully informed about clozapine with no attempt made to hide the identity of the now crimson tablets.OutcomePatient accepted the clozapine. Temperature, C reactive protein (CRP) and troponin were all normal at baseline but all rose above normal in week 1 of initiation. They peaked in week 3 and by week 4 were dropping, normalising completely within a few weeks. She was transferred to a medical ward for monitoring during weeks 2 and 3 of titration. There were no electrocardiogram changes, no chest pain, no signs of bowel obstruction and no evidence of agranulocytosis. Clinically, she remained well throughout except for the rise in temperature. Once the yellow medicine delusion receded she accepted undyed yellow tablets; the result was discharge home with her best mental state and level of functioning in 15 years.Significance of this caseThere are no cases in the literature that we could find where tablets had been dyed, or where clozapine had been persisted with when such rises in temperature, CRP and troponin occurred. This case illustrates both. The risks in our view were outweighed by the simple fact that clozapine was her only hope of a life worth living.
The introduction of balint groups for core medical trainees – a pilot
Authors: Ayeni Itunuayo , Patterson Anne 
Published: June 2021

AimsTo introduce and assess the impact of balint groups on core medical trainee (CMT) doctors working within an acute medical trust.BackgroundA high rate (80%) of dissatisfaction and burnout has been reported amongst trainee doctors. This has had a significant impact on recruitment with a large proportion of foundation doctors delaying their application into core specialist training. Of those already in training, up to 50% have reported taking time, out citing burnout as a cause. Balint groups are a form of reflective practice groups looking at the doctor-patient interaction. For core psychiatric trainees these groups are a mandatory part of their training.MethodWe piloted a total of three balint groups over a period of three months amongst CMT doctors based at an acute medical trust in London. A specialty registrar (ST6) in psychiatry facilitated the balint groups. Balint facilitators received supervision from a consultant psychiatrist in psychotherapy. CMT doctors were given questionnaires at the beginning of session one and emerging themes later explored. The questionnaires used were taken from the ‘Bristol Trainee-led Balint Group Scheme’.ResultThe pre-questionnaires showed that all CMT doctors surveyed believed psychological factors play an important role on patient presentation and recovery. 14/19 (74%) agreed or strongly agreed that a doctor's reaction to a patient directly influenced care. All doctors agreed or strongly agreed that it was important to reflect on a patient's emotional experience, as it was crucial to their development as a doctor.CMT doctors found balint groups useful as it provided them a space, which was not routinely offered to discuss challenging cases. Themes that emerged included a lack of support and difficulties maintaining boundaries when treating complex patients. Litigation was a recurring theme with many trainees reporting anxieties and a lack of support. Trainees reported guilt and worries that they were not doing enough for their patients. These themes appeared to have a direct impact on training experience and burnout.ConclusionWith increasing burnout and dissatisfaction amongst junior doctors, balint groups provide a unique approach to supporting junior doctors within medical specialties. The current pilot has demonstrated that CMT doctors can make use of balint groups in an effective way. We recommend that balint groups should become an integral part of specialist medical training. Psychiatrists can play a central role in supporting the health and well being of medical trainees through balint group facilitation.
Virtual balint group experience due to the COVID-19 pandemic
Authors: Brown Rebecca , Philips Nicola 
Published: June 2021

AimsIn the changes brought about by remote working, the local psychotherapy case discussion group (Balint Group) has developed as a remote service via video consultation. It is important to consider the effect that this change in method of delivery has had on experience.MethodAn anonymous survey was distributed to determine the benefits and challenges from participants and facilitators with at least a month of virtual Balint Group experience. The open-ended survey questions captured extended answer responses from 16 students and trainees, and 5 (co-)facilitators, within Nottinghamshire Healthcare NHS Foundation Trust. The qualitative feedback was analysed by thematic analysis, identifying three main themes.ResultThe first theme of practicalities was centred around access to the group. The virtual format had benefits in terms of reducing travel and time commitment and so improving attendance. However, disadvantages were in technological issues and finding a private and safe environment, individuals often not leaving the work environment on which they were reflecting.The second theme of communication identified how virtual methods are a less natural way of interacting (for example sequential point making), losing both immediacy of reactions and non-verbal communication. There was a loss of essential communication cues, with disjointed conversation affecting contribution.The third theme of group dynamics had some advantages, feeling less intimidating virtually. Yet disadvantages included loss of group cohesion, with participants not building the same relationships (on arriving and leaving a group space), and trust. The more subtle emotions in the group might be missed and opinions given less openly. The facilitators needed to be more directive and experienced difficulties maintaining group engagement and managing the frame.ConclusionThe advantages of virtual format are more based on accessibility and the disadvantages more experiential. There are elements of being physically remote that lead to a disembodied experience, that might impact on capacity to reflect emotionally. This might make it more difficult to identify unconscious processes and the experience might be more cognitive. There is a risk that virtually participants will feel more alone with difficult feelings and unsupported by the group.When mental health is being affected by social isolation due to the pandemic, having groups virtually can mimic this isolation in working life. Overall the preference remained for an in-person group.However, it was clear that access to some form of a group was important, to contain anxiety during these unprecedented times.
Education for corrections officers to better meet the mental health needs of inmates
Authors: Darani Shaheen , Patel Kiran , Hayos Laura , Connors Tanya , Islam Faisal , Saiva Anika , Simpson Sandy 
Published: June 2021

AimsIn Canada, there has been an increase in the rate of incarceration of individuals with mental health diagnoses. Overrepresentation of individuals with psychiatric diagnoses in correctional settings is well-established. Front-line officers play a central role in dealing with mental health struggles of inmates. Nonetheless, the training that officers receive is often considered inadequate. To address this gap, the goal of this study was to design, implement, and evaluate a mental health training for correctional officers at the Toronto South Detention Centre (TSDC) and Vanier Centre for Women (VCW) in Ontario, Canada.MethodA needs assessment was undertaken among officers at the TSDC. In response to needs identified, a one-day course was delivered to officers (n = 57) at the TSDC and VCW (n = 41). The curriculum included mental health awareness; assessment of risk; communicating with inmates in distress; and self-care. Live simulations provided the opportunity for participants to identify signs of mental illness, assess risk, and respond strategically to de-escalate situations. Participants’ knowledge and confidence in their ability to identify and assist individuals with these problems was established using pre and post measures. Participant satisfaction was also measured via a survey. A three-month follow-up administration was used to determine maintenance of gains. Focus groups at nine months were conducted to understand participants’ needs, learning, and impact of training.ResultThe results were promising, with 92% and 88% of participants at TSDC and Vanier Centre for Women respectively expressing satisfaction and 62% and 68% at TSDC and Vanier Centre for Women respectively stating they intended to change practices. Analyses of change in knowledge and confidence scores pre to post-training showed statistically significant improvement in all areas measured. Three-month follow-up at TSDC showed 75% of respondents have applied what they learned from the training to a “moderate or great extent”. Focus group themes showed improved attitudes and ability to identify behaviours related to inmate mental health struggles and interest in further training to support officers’ mental health.ConclusionThis study shows that training informed by officer learning needs can help them better meet the mental health needs of inmates. Training can improve attitudes toward inmates presenting with mental health issues. Training that is interactive and provides skills practice can have sustained impact on practice. Further training should integrate self-care to support officers' mental health.
The Safety Conversation: developing a trustwide safety conference at CNWL during a pandemic
Authors: Duncan Emily , Edwards Simon , Butler Alison , Kelly Cornelius 
Published: June 2021

AimsThe COVID pandemic has had both a massive impact on clinical service delivery and the way that training and education is provided. CNWL is a large NHS provider and has approximately 7000 staff working across 150 locations, providing mental health and community health services. In response to the need to share learning across the organisation, a trustwide “Safety Conversation Day” took place to spotlight the work being done to promote safety and to act as a platform to share ideas and learning across the trust. This was the first ever virtual conference organised by the trust.MethodThe one-day conference included virtual posters and an all-day open access virtual conversation delivered via zoom. The day was divided into 6 safety themes: Safety tools; Safer Environments; Supporting and Involving Staff; Safer use of Medicines; See Think Act and Relational Security; and Prevention is Better than Cure. Frontline staff delivered 5-6 short presentations each hour highlighting new ways of working, quality improvement, local research etc.Staff were also encouraged to submit posters for the event, with webinars held on how to write a poster held prior to the safety conversation to promote engagement. Prizes were awarded for best posters in the different categories.A mentimeter survey was running throughout the day to get feedback from participants.ResultThis was the largest event of this kind held by the trust. 430 unique viewers logged in during the day to watch the presentations.Feedback was very positive on the mentimeter survey. 3 questions were asked on a likert scale of: Strongly Disagree – Strongly Agree (rated out of 5):
–‘I found the posters really useful': 4.5/5–‘I found the presentations very useful': 4.6/5–‘I will share what I've learnt about safety': 4.6/5Open space questions and word cloud responses also highlighted qualitative feedback with most frequent responses including ‘inspiring', ‘interesting and ‘stimulating’.174 posters were presented with good representation from all services and staff groups across the trust (18 on safer use of medicines, 15 on co-production, 52 on quality improvement, 50 on COVID and non-COVID safety, 16 on use of technology, 23 on supporting and involving staff). These posters have since been downloaded 4062 times.ConclusionThe first CNWL safety conference proved an excellent opportunity to celebrate achievements in patient safety in a very difficult year. It was very well-received and well-attended by staff, promoting maximal learning across the organisation.
Recruiting medical students from underrepresented backgrounds to a project to identify support challenges amongst their peers whilst encouraging early career engagement in psychiatry
Authors: McAdam Heather Gail , Aitken Debbie 
Published: June 2021

AimsTo engage lived experience individuals to run a project identifying the mental health challenges unique to medical students who self identify as belonging to marginalised groups;To use the project findings to inform mental health support and education during medical training and beyond;To encourage the individuals to engaged mental health policy and education whilst also using the process to inform their future medical careers, including in the field of psychiatry.MethodLived experience individuals were recruited to the project following open applications from medical students. The role was to design a project to create an evidence base for tailored support methods needed to reduce marginalised medical students’ increased risk of poor mental health. This formed the basis of guidance on how medical schools and healthcare systems can improve wellbeing support for their students and staff. With support from a trained staff and student member, the recruited officers were encouraged to follow their preferred method for fulfilling the project aims, using their own and peers’ experiences to inform what was most useful.ResultRepresentatives were selected from BAME, LGBT+, international, disabled and widening participation backgrounds. The students decided to conduct a survey open to all medical student colleagues across the United Kingdom. The survey questions were split into four sections based on the challenges faced by their own lived experience: General Information; University and Community Experiences; Medical School Experiences and Teaching and Clinical Experiences. There were 58 questions in total including 26 multiple choice; 24 open answers; and 8 Likert scale.Following data collection, the information taken from the survey and focus groups, supported by background reading, was thematically analysed to identify the key challenges. This will then be used to create a report to share with the medical school containing areas for improvement in mental health support, education and engagement. The officers themselves would also reflect on their experiences throughout the process, including their ability to engage in mental health policy, education and further career options such as psychiatry.ConclusionFrom creating an appropriate and supportive structure, it can be possible to encourage students with lived experience to share their challenges whilst becoming engaged in mental health policy and support. Furthermore, from creating a culture of reflection in the area of mental health, they are helping raise awareness of the subject early on in medical careers and promote engagement into specialties such as psychiatry.
Resilience-culture of support
Authors: Hashmi Nazish , Muniyappl Sunitha 
Published: June 2021

AimsBetter-informed trainees will have increased confidence and improved resilience which will have a positive impact on the workforce. To promote and celebrate diversity in psychiatric workforce it is imperative to acknowledge the above and provide adequate support to IMGs across UK.BackgroundNearly two fifth of licensed doctors in NHS are from black and ethnic minorities. Studies have shown that International Medical Graduates (IMGs) are particularly prone to certain difficulties compared to UK graduates. IMGs are more likely to be subject to investigations by General Medical Council for concerns over clinical skills and knowledge, communication skills, lack of awareness of the laws and code of practice. This has been highlighted by GMC as well as Royal College of Psychiatrists. To promote and celebrate diversity in psychiatric workforce it is imperative to acknowledge this and provide adequate support to IMGs across UK.MethodAn additional rotation wide induction programme was started for IMGs in August 2018 in West Yorkshire. This has continued on a 6 monthly basis for all new starters and last one was held on 21st of August 2019. Teaching included information about Good Medical Practice, confidentiality issues, principles of consent, information about living skills and practical teaching on phlebotomy and requesting investigations.ResultThe doctors who attended these sessions found it to be very helpful and some suggested it to be a full day programme. According to the feedback collected there was a definite improvement in understanding noted by IMGs in most areas covered. This induction was also acknowledged in the School of Psychiatry conference in October 2019.ConclusionConsidering the increasing numbers of International medical graduates it will be beneficial to arrange similar events at local level for easier accessibility. In line with RCPsych and GMC guidelines all trusts should be encouraged to offer IMG induction sessions locally.