bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social cognition and major depressive disorder: impact on psychosocial function and therapeutic opportunities
Authors: Weightman Michael , Baune Bernhard 
Published: June 2021

AimsThis poster aims to examine the impact of social cognitive deficits on psychosocial functioning in depressed patients, as well as summarise the utility of various evidence-based therapeutic interventions employed to target these deficits. The stated hypotheses were twofold: (1) that social cognitive impairment in major depressive disorder will correlate with poorer psychosocial functioning; and (2) that these deficits will respond to existing anti-depressant therapies.BackgroundSocial cognition is an important adaptive trait that incorporates the identification, perception and interpretation of socially relevant information from the external world. It is frequently affected in major depressive disorder such that depressed patienMethodA review of the existing literature was performed in order to test the stated hypotheses. Pertinent sources were identified via the MEDLINE, EMBASE, PsycINFO, PubMed, Scopus and Google Scholar databases. A total of 107 studies met inclusion criteria for review.ResultImpaired social cognitive performance in depressed patients correlated with poorer psychosocial functioning across the key domains of general cognitive functioning and quality of life. Many current anti-depressant therapies were found to have a normalising effect on the social cognitive abilities of depressed subjects, both at a neural and functional level. Anti-depressant medications, in particular citalopram and reboxetine, appeared to correct facial affect recognition deficits, while a psychotherapeutic approach demonstrated improvements in theory of mind and negative interpretive bias. Data relating to other common treatments, such as electroconvulsive therapy, are limited.ConclusionThe impact and treatment of social cognitive deficits in major depressive disorder is an important emerging field. The social cognitive deficits evident in depressed patients are sometimes subtle, but afford a significant functional impact. Additionally, it appears these impairments are at least partially reversible using anti-depressants or psychotherapy.
Are we meeting local and national guidelines for physical health assessment following admission to the meadows?
Authors: Abbasi Yasmin , Morgan Ruairidh , O'Docherty Alice 
Published: June 2021

AimsWe audited practice at the Meadows Inpatient Unit regarding physical health assessment, against standards set by Surrey and Borders Partnership and NICE.BackgroundSABP policy states that within 24 hours of admission to inpatient services, physical health assessment should be offered. It should be completed within 72 hours. Refusal should be documented.These guidelines state that within 2 weeks of admission blood tests should be completed, and for specific individuals an ECG should be performed.NICE guidelines state that “physical healthcare needs” should be discussed with newly admitted patients. NICE guidelines regarding physical health monitoring for individuals with psychosis or schizophrenia recommend that assessment includes “full physical examination to identify physical illness”.NICE suggests use of antipsychotics for individuals with dementia who have severe distress, or are at risk of harming themselves or others. Those with behavioural and psychological symptoms of dementia (BPSD) should therefore be physically assessed to ensure safe use of antipsychotics may be implemented.MethodAll admissions to The Meadows over seven months were audited retrospectively. The clinical notes were accessed from Systm1.Consensus medical opinion was reached that full examination should include: GCS/level of consciousness, cardiorespiratory, abdominal and neurological examinations.Age, gender, diagnosis and prescriptions of psychotropic medication at time of admission were recorded.The sample included 35 patients.Result55% of patients had a diagnosis of dementia.63.8% of patients were prescribed antipsychotics on admission, more than other psychotropic medication. This may reflect that the most common diagnosis was dementia, commonly with associated BPSD.97% of patients had a physical examination completed within 24 hours; most excluded neurological examination. 91% of patients had blood tests completed in two weeks, with the most commonly excluded tests being lipids and glucose. 86% of patients had an ECG in two weeks. In general, documentation of reason for not completing an examination was completed.ConclusionWe found good compliance with recommendations for physical health assessment. Areas for improvement include better assessment of neurology and more thorough blood tests.Recommended physical health examination for new admissions is not outlined in SABP policy. We recommend the following:GCS/level of consciousness, cardiovascular, respiratory, abdominal, and neurological examinations, and baseline observations.ECG should be a requirement of admission. In order to facilitate this, staff need to be trained to perform ECGs.NICE guidelines refer to HBA1c rather than glucose, which should be reflected in SABP policy.
Audit cycle - VTE risk assessment in inpatient wards in mid Essex
Authors: Abdelkhalek Hesham , Elagawany Adel , McDowall Fiona , Leahy Matthew , Baker Emily , Penberton Nkechi 
Published: June 2021

AimsIt is trust policy that the VTE risk assessment should be completed for every patient admitted to wards. The standard for this audit is therefore 100% completion. We completed the audit in October 2018 and closed the loop in September 2019.MethodThis was a cross-sectional study of all patients on all the wards according to patients’ list on the electronic system (Paris) on certain date. In the first audit we used an audit tool from a similar audit performed in another area in the trust. For the purpose of re- audit we designed an audit tool to reflect the changes made in the electronic form.ResultIn the re-audit, there was noticeable improvement in the completion rate compared to initial audit (95% vs. 82%); however, there was still under-performance. An interesting observation of the re-audit is that 74% percent of admissions had VTE risk assessments forms completed on same day of admission or next day compared to only 45% in previous audit.ConclusionWhen looking at the completion of individual components on the VTE forms there are still some room for improvement as well. For example, in 26% of the patients there was no documentation about the use of prophylactic anticoagulants before admission compared to 34% in our previous audit. Also in 7% of the patients there was no documentation about the outcome of the assessment compared to only 3% in previous audit.This is an audit to assess the completion of electronic VTE forms as per trust policy. Following the initial audit we made recommendations to improve completion rate. In the re-audit there was an improvement in total completion rate but we have not met the goal of 100% yet.
Root causes of deaths by suicide amongst patients under the care of a mental health trust: a thematic analysis
Authors: Bagchi Dhruba , Webb Kerry , Odejimi Opeyemi 
Published: June 2021

AimsThis study explores common themes emerging from root causes of Serious Incident (SI) reports of mental health service users who died by suicide under the care of a mental health trust.BackgroundSuicide is a global health problem. It is estimated every year about 800,000 people die by suicide worldwide. Previously, the United Kingdom (UK) reported a significant reduction. However, the latest report in 2018 indicated a marked increase. Furthermore, 28% of people who died by suicide in the UK were under the care of mental health service 12 months prior to their death. The causes of suicide are not usually straightforward, but sometimes could be preventable. Thus exploring the root causes is a step in the right direction to preventing this global problem.MethodThematic analysis was carried to identify themes emerging from the Root Causes (RCs) within the Serious Incident (SI) reports of patients who died by suicide while under the care of the Trust between January 1st, 2017 and July 31st, 2018. Over the 18 month period, there were 71 deaths, of which 36 were ruled as suicide by the coroner. A further 16 were considered by the review team as possible suicide and were therefore included to increase the scope of learning. This review is therefore based on 48 cases.ResultThree main themes emerged from this study. They are patient, professional and organisational factors. Majority of the death were patient related factors, particularly exacerbation of patient's mental health condition. Furthermore, the most frequently occurring professional and organisational factor were issues around patient risk assessment and management and inadequate psychiatric bed respectively.ConclusionThe findings of this study have helped gained an understanding of the perceived causes of death of patient who died by suicide. It is hoped that this will in turn influence the manner in which, decisions, policies and resource allocation are carried out to further prevent and reduce the incidence of suicide, particularly amongst mental health patients.
Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65
Authors: Bradbury Sarah , Crowther George , Chinnasamy Manimegalai , Shaw Laura , Ormerod Sara , Wilkinson Alison , Chubb Rebecca , Daher Mazen , Kumar Pramod , Gaskin Andrew , Williams Karen , Brown Angus , Stebbings Eleanor , Sahu Sunita , Smyth Roger , Kinsler Hilary , O'Connor Stephen , Wells Andrew , Overshott Ross , Junaid Kehinde , Mordekar Aparna , Humphries Jenny , James Karen , Mittal Shweta , Dasari Sarita , Grant-Peterkin Hugh , Campbell Niall , West Robert , Tadros Professor George , Sampson Elizabeth 
Published: June 2021

AimsThe number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.MethodWe performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.ResultReferral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.ConclusionTo plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
Reducing admission time to Broadmoor High Secure Hospital – a case review
Authors: Capanna Maria Vittoria , Ali Saima , Bates Robert 
Published: June 2021

AimsProlonged waiting times for admission to psychiatric hospital settings are a common and widespread issue. Delayed admissions may result in poorer outcomes due to prolonged mental suffering and delays in initiating treatment. Long waiting times also have a negative impact at a service level, impeding patient flow.National guidance has been recently updated, recommending that patient transfers to secure services take no longer than 28 days from referral. These transfers are frequently affected by delays in admission, possibly resulting in increased risk to patients, staff and the public.The aim of this project was to audit all referrals to Broadmoor High Secure Hospital in England within a one year period with special focus taken on calculating the time taken from referral to admission. We aimed to assess if there were any rate limiting steps which could be targeted to reduce time from referral to admission.MethodWe collected data and conducted a retrospective cohort review for all admissions from September 2019-September 2020. Where available, information was obtained for each step of the referrals process. Individual patient records were reviewed where required.Exclusion criteria: data withdrawn, transfers from other high secure services (HSS), incomplete data, “MOJ instruction” or urgent admission bypassing the process.Result18 cases were excluded as per exclusion criteria. 46 patients were included in the study. 16 referrals originated from medium secure psychiatric hospitals, and 30 from prison.The average time from referral to admission was 44.3 days. Admission of patients from MSUs was quicker, taking an average of 40.3 days when compared to prison referrals, which took 45.9 days.The breakdown of timings for each step in the referrals process was calculated to determine if a rate limiting step could be identified.On average it took 2.1 working days to allocate a case to a clinician, 7.6 days for an assessment, 9.2 days to complete a report and 3.5 days to submit this to the admissions panel. The mean time from referral to the date of the panel hearing was 22.5 working days, and admission took a further 21.8 days on average.ConclusionThe current average time to admission exceeds the new 28 day recommendation. This could both be due to the COVID-19 pandemic, and miscommunication about time targets. We will review the process and aim to reduce the time from referral to admission in line with new guidance.
An audit on consent to treatment within forensic inpatient units at the Newsam Centre
Authors: Bond Elisabeth , Tial Stephanie Vel En , Stephenson Clare 
Published: June 2021

AimsWe aimed to investigate the adherence to the Mental Health Act Code of Practice and the adequate documentation of consent to treatment across three forensic low secure inpatient units.MethodOur sample included all inpatients detained on three forensic wards at The Newsam Centre. This included a total of 31 patients with an age range of 25 to 59 years. The Mental Health Act Code of Practice was used as criteria for audit standards. Data were collected using Microsoft Excel and analysed using descriptive methods.ResultWe found that 28 patients out of 31 had been admitted for over three months and of these patients 12 were subject to a T2 and 16 subject to a T3. A total of 24 patients had their CTT medication list documented on the online drug chart; with a remaining seven patients who did not. As per guidelines, 27 patients had the appropriate medications prescribed as per their CTT, however one patient did not. The audit revealed a total of two patients currently on a Section 62. Of the qualifying T3 forms, four patients had this reviewed every two years whilst there was one patient who had not.ConclusionWe found that the adherence to Mental Health Act Code of Practice was overall positive with the majority of service users being reviewed appropriately and documented as per guidance. However, areas identified for improvement included the recording of CTT on online drug charts as well as reviewing T3 every two years. This audit highlights the need for easy access to guidance, appropriate documentation as well as frequent checking of adherence. A leaflet has been created outlining the guidelines and will be distributed to all staff working within the forensic settings and placed in easily accessible locations. As further recommendations from this audit we advise all wards to plan weekly checks during team meetings to ensure information is up to date and that all staff are aware of any discrepencies. A re-audit is planned in the coming months to re-assess adherance after implementation of the interventions.
The impact of COVID-19 on an inpatient mother and baby unit: a service evaluation
Authors: Cranshaw Joanna , Seneviratne Gertrude , Rao Ranga , Ogunmuyiwa Julia , McMillin Rebecca , Ntephe Chukwuma , Dain Victoria 
Published: June 2021

AimsUnique challenges have been faced by women in the perinatal period during the COVID-19 pandemic and the impact of this is compounded for women suffering from mental illness. This service evaluation looked at different aspects of the treatment pathway on a specialist inpatient psychiatric Mother and Baby Unit during the pandemic to identify what changes occurred.MethodData were collected for all admissions to the unit between January 2019 and October 2020, with the beginning of the pandemic being defined as on or after 1st March 2020. Information was collected retrospectively from electronic clinical notes on ethnicity, length of stay, diagnosis, mental health act use and restrictive practice, medication, psychology, occupational therapy and social services involvement.ResultThere were 114 admissions to the MBU during the study period. 4 were parenting assessments rather than acute psychiatric admissions and were excluded from the analysis, giving a sample of 110 women. 58% (62/110) were classed as “pre-pandemic” and 43.6% (48/110) were “during pandemic”. 95.45% (105/110) of women were postpartum 4.55% (5/110) were pregnant. Mean length of stay was shorter during the pandemic at 44 days, compared to 61 pre-pandemic. There was greater use of the mental health act during the pandemic: only 43.75% of patients were informal throughout admission, compared to 70.97% pre-pandemic. Mean duration of detention was shorter at 25 days (32 pre-pandemic). Psychotic illness made up a greater proportion of diagnoses during the pandemic: 56% (27/48) compared to 44% (27/62) pre-pandemic. The next most common diagnostic group was mood and anxiety disorders, which made up 29% (14/48) of diagnoses during the pandemic, but 43% (27/62) pre-pandemic. Outcomes as measured using the Health of the Nation Outcome Scale showed a mean improvement between admission and discharge of 6.65, compared to 5.15 pre-pandemic. HONOS scores were higher on admission during the pandemic (12.83, vs 10.88), suggesting a higher level of acuity.ConclusionDuring the COVID-19 pandemic on this Mother and Baby Unit, length of stay was shorter, a greater proportion of patients were detained under the mental health act (although length of detention was shorter) and psychotic illness was more prevalent. This study demonstrates that there were differences in this perinatal inpatient population during the pandemic and this may be a reflection on the wider impact of COVID-19 on perinatal mental health.
Audit of shared-care lithium monitoring in a large rural GP practice
Authors: Cranshaw Thomas 
Published: June 2021

AimsTo compare monitoring of lithium treatment with shared care lithium monitoring agreements in a large rural GP practice.BackgroundA ‘near miss’ event with a patient with drug induced long QT syndrome highlighted a need for an audit of lithium monitoring at a large rural GP practice.The practice had entered into shared-care monitoring agreements with the local mental health care trust. Under these agreements, responsibility for physical monitoring of lithium treatment was assumed by the practice.MethodUsing audit functions built into the IT system, all patients at the practice who were currently prescribed lithium-containing medications were identified (n = 28). Individual monitoring standards were determined for each patient based on the shared care agreement. These varied depending on age and comorbidity. Monitoring data obtained from medical records was compared against the individualised monitoring requirement.ResultThe key finding was that 26% of patients for whom annual ECGs were indicated according to the shared care agreement had received an ECG in the past year. 78% of patients had a lithium level recorded in the previous 3 months. 81% of patients had a renal function test within their monitoring requirements. 52% of patients had lipid measurement in the previous year.ConclusionThere is a great degree of heterogeneity in the extent to which shared care monitoring agreements are achieved. It is noted that those standards to which a Quality Outcome Framework incentive applied had a greater chance of being met. Worryingly, the QOF statements relating to lithium treatment have now been retired as of April 2019. It is suggested that psychiatrists are aware of the challenges primary care faces when monitoring lithium treatment.