bluuebunny/crossref_metadata_2025_split huggingface dataset:
A framework for nurturing doctors: systematic review of wellbeing interventions in medical students
Authors: Bradley Rhian , Yousofi Tahmina , Faruqui Rafey , Hamilton-West Kate 
Published: June 2021

AimsUK medical students report high levels of stress, in particular within the coronavirus pandemic: 46% have a probable psychiatric disorder; almost 15% consider suicide; 80% describe support as poor or moderately adequate. Our aim was to propose a novel conceptual framework for the implementation of effective interventions to reduce their stress and support wellbeing.MethodA systematic review of MEDLINE, PsycINFO and CINAHL databases was undertaken with appropriate search terms, supplemented by reference searching. Published quantitative and qualitative primary research was included. Findings were reported in line with Preferred Reporting Items for Systematic Reviews and MetaAnalyses.ResultRecords identified through database searching 2,347; additional records 139; records following removal of duplicates 1,324. Full text studies included 41: ‘Curriculum and Grading’ (n = 4); ‘Mindfulness and Yoga’ (n = 11); ‘Stress Management/Relaxation’ (n = 13); ‘Behavioural Interventions’ (n = 3); ‘Cognitive & Self-awareness Interventions’ (n = 2); Mentorship (n = 3); ‘Education, Screening and Access to care’ (n = 3); ‘Multifaceted Interventions’ (n = 2).Effective interventions include those that reduce academic stress through grading changes and supporting transition to clinical training; resilience enhancing interventions such as mindfulness, yoga, CBT, group based exercise and relaxation; peer mentorship; faculty mentorship when actively engaged by the mentor; reducing stigma; improving detection; and improving access to treatment.Outcomes for clinical year students were less promising, suggesting interventions may be insufficient to combat clinical stressors.ConclusionWe propose a framework for implementing these effective interventions through ‘Ecological and Preventative’ paradigms. The former highlights an individual's interaction with their sociocultural environment, recognising multiple levels of influence on health: individual, interpersonal, institutional, community, and national. At each level the framework of primary, secondary and tertiary prevention can be applied.Primary Prevention (intervening before health is impacted): reducing academic stress; resilience interventions; mentorship; peer support; brief interventions to avoid progress to established disorders.Secondary Prevention (reducing prevalence of disorder): early detection through staff training and screening; treatment referral pathways; reciprocal arrangements if peers are placed within local settings.Tertiary Prevention (reducing impairment): reasonable adjustments, communicated between placementsThis recognises that medical students require a range of interventions at multiple levels to reduce stress, promote wellbeing and manage the spectrum of mental health difficulties they may encounter. The ecological framework also acknowledges the reciprocity of individuals being influenced by and influencing their environment, which aligns with the concept of co-production.
The impact of the March 2020 lockdown on the cardiometabolic risk factors of male forensic and rehabilitation patients
Authors: Dodough Nicholas , Phull Jaspreet , Singh Jaswant , Sendell Jackie 
Published: June 2021

AimsTo explore the impact of the March 2020 lockdown restrictions on the cardiometabolic risk factors of male forensic and rehabilitation inpatients in one NHS trust in the United Kingdom.MethodRetrospective data from September 2019 to September 2020 (six months before and after the 23 March 2020 lockdown) was collected by evaluating the health records of male patients in a low secure forensic ward and two rehabilitation units.ResultThe number of patients with BMI values within the study period was 34 while the number of patients with blood results was 26. This study showed that the average BMI six months before the start of the March lockdown was 29.8 kg/m2 while the average BMI at the end of six months after the lockdown was 31.8 kg/m2.The results from the 6-month interval before the March 2020 lockdown (M = 0, SD = 0) and the 6- month interval after the March 2020 lockdown (M = 0.9, SD = 4.16) indicate that the March 2020 lockdown resulted in an increase of BMI, t (5) = 2.42, P = 0.036. The result is significant at p < 0.058.8% of patients had an increase in their doses of antihypertensive agents after the lockdown whereas no patients had an increase of dose before the lockdown. 7.7% of patients had an HBA1c of more than 48 mmol/L after the lockdown compared to 3.8% before the lockdown. The serum triglycerides and total cholesterol levels also increased after the lockdown with an average increase of 0.17 mmol/L and 0.25 mmol/L respectively. The average serum HDL levels decreased after the lockdown with an average decrease of 0.06 mmol/L.ConclusionThere appears to be a positive correlation between the onset of the March 2020 lockdown and an increase of BMI, worsening of blood pressure, glycemic control and lipid metabolism.Limitations
(1)Waist circumference was not measured during the study period preventing us from examining all of the features of metabolic syndrome.(2)This study did not look at the levels of physical activity (such as access to section 17 leave) and dietary habits before and after the March 2020 lockdown which may explain the results found.RecommendationsTo raise metabolic awareness of the impact of the lockdown restrictions on cardiometabolic risk in people with SMI and the general public.
Impact of COVID-19 on the mental health of healthcare workers in different regions of the world
Authors: Islam Mahfuja , George Philip , Sankaran Sindhu , Su Hui Janet Leu , Kit Tzun 
Published: June 2021

AimsThe global health system is facing a serious challenge after the recent outbreak of COVID-19 coronavirus infection which was first identified in Wuhan, China in November 2019 and declared as a pandemic in March 2020 by WHO. There is a wide consensus that this pandemic has negative psychosocial consequences as well as unforeseeable provision of mental health care services and just not on physical health alone. The aim of this research study is to determine the prevalence of psychological distress and to identify the sociodemographic variables with the main attributable factors associated with the psychological distress among healthcare workers and suggestions on how to reduce the impact on the mental health of healthcare workers during the COVID-19 pandemic in different regions of the world.MethodWe performed a cross-sectional study from September-November 2020. We used a self-administered survey tool which was distributed electronically to healthcare workers across the globe. The data were stored on an online database with password protected devices where survey responses were restricted to investigators exclusively.Data collected were: 1) Socio-demographic data (age, gender, marital status, ethnicity, religion, role in the healthcare, region of practice); 2) Psychological General Well-Being Index (PGWBI) questionnaire which contains 22 standardized items. This is a subjective assessment to score the degree of psychological well-being by focusing on 6 domains: depression; anxiety; positive-well-being; self-control; vitality and general health; 3) Subjective assessment from respondents of the main attributable factors causing psychological distress and suggested methods to help reduce the impact on mental health on health care workers.ResultMajority out of the 217 respondents were from a younger age group; females and married/domestic partnership, mainly from Western Pacific Region, South East Asian and the African Region. More than half the respondents were moderate-severely psychologically distressed and the three main attributable factors causing psychological distress were: fear of family/friends contracting COVID-19 followed by lack of PPE and discomfort caused by wearing PPE for long hours. Respondents suggested that the distress would be reduced if: more resources were provided in hospital; protocols and guidelines were implemented and counselling facilities with recreational activities were available to frontline workers.ConclusionThis study showed that the COVID-19 pandemic has affected the mental health of healthcare workers and more support or strategies need to come in place to protect frontline workers at the time of crises.
Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study
Authors: Jomaa Sami , Kakaje Ameer , Zohbi Ragheed Al , Alyousbashi Ayham , Abdelwahed Rawan N K , Aldeen Osama Hosam , Alhalabi Mohammad Marwan , Ghareeb Ayham , Latifeh Youssef 
Published: June 2021

AimsThe Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria.MethodThis is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters.ResultThis study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lower PTSD scores but was associated with a worse physical component of HRQL.ConclusionThis is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.
Reducing aggression and improving offending outcomes in youth with conduct disorder, results of a systematic review
Authors: McEwan Craig , Dunn Lauren , Harvey Jake 
Published: June 2021

AimsThe aim of this literature review was to determine what interventions are effective in reducing aggression and offending behaviour in under 18's with conduct disorder.Null hypothesis: There is no difference in aggression or offending behaviour in under 18's with conduct problems in spite of interventions offeredBackgroundMental health services for children and adolescents who are aggressive or who have come into contact with the Youth Justice System are sparse and often under resourced. Conduct disorder (CD) is one of the most frequently diagnosed conditions in adolescents, particularly in young offenders (Kenny et al 2007). The most effective prevention programs for youth at risk of persistent delinquency has previously been found to be a multi model program focussing on the family context. However, this has not taken in to consideration the extent and prevalence of mental disorder, including conduct disorder, within the target population.MethodA systematic literature search was undertaken on medline and psychoinfo between January and December 2018. Identified papers were then screened by two independent researchers against pre-agreed inclusion and exclusion criteria. Relevant papers were assessed for bias and results summarised.ResultFrom an initial data set of 526 papers, 9 were included for review. 4 focussed on psychopharmacology (1 aripiprazole, 1 risperidone, 1 risperidone vs clozapine, 1 clozapine), 1 family centred feedback, 1 Mode Deactivation Therapy and 3 were multi modal (combinations of Mode Deactivation Therapy, Stop Now and Act Programme, CBT, Didactic sessions, 1:1 counselling). None of the multi-modal interventions were standardised or comparable to each other. End points varied from 8 weeks (aripiprazole) to 15 months (multimodal SNAP programme). Settings varied from community programmes to secure inpatient settings. Whilst one risperidone study reported it to be effective in reducing aggression, it was not significant. One SNAP (multimodal) programme failed to show significant effect. All other 7 interventions, across various methods, demonstrated significant reductions in aggression, violence or other antisocial behaviour.ConclusionFew papers were identified that assessed interventions for youth with conduct disorder. The papers that were identified were significantly heterogeneous in their intervention, sample selection, methodology and outcome measures. Unfortunately, this leads to an inability to compare any interventions for this demographic. Despite the rise in Forensic Child and Adolescent Mental Health Services, there is a weak and poorly understood evidence base for supporting and managing young people with conduct disorder.
Prevalence and correlates of depression and quality of life among primary caregivers of patients with schizophrenia attending a Nigerian Tertiary Hospital
Authors: Akinfala Akinloye , Sowunmi Oladipo , Sakeeb Imam 
Published: June 2021

AimsTo determine the prevalence and correlates of depression and quality of life and their relationship among primary caregivers of patients with schizophrenia in a psychiatry specialist hospital.MethodA total of 138 caregivers of patients diagnosed with schizophrenia attending the outpatient clinic of the Neuropsychiatric Hospital Aro, Abeokuta were recruited. Sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI-PLUS) (depressive module) and World Health Organization Quality of Life-Bref (WHOQOL-Bref) were administered on the caregivers while Brief Psychiatric Rating Scale (BPRS) was used to measure symptoms severity in the patients.ResultThe mean (±SD) age of respondents was 48.3 years (±14.7), 53.6% were females and 33.3% were without partners. The prevalence of depression among the caregivers who participated in the study was 13.8%. Female gender (χ2 = 5.68, df = 1, p = 0.02), hailing from a minority tribe (χ2 = 9.78 df = 1, p < 0.01), and Previous treatment for mental illness (χ2 = 8.24 df = 1, p < 0.01) were associated with depression. Female gender (ß = 1.35, OR = 3.86, p = 0.03), minority tribe (ß = 1.95, OR = 7.03, p < 0.01), and previous treatment for mental illness (ß = 3.19, OR = 24.21, p = 0.01) were independently predictive of depression in the caregivers.Independent predictors of lower quality of life (QOL) were: Parents/siblings relationship for social relationship domain (ß = −7.076, p = 0.037) and spending more than 35 hours per week for Environmental domain (ß = −5.622, p = 0.028).Finally, a significant correlation was also found between Depression and Psychological Domain of QOL (t = 3.048, p < 0.01) and Social Domain of QOL (t = 2.154, p = 0.03).ConclusionThis study shows that primary caregivers of patients with schizophrenia have high prevalence of depression and poor quality of life. There is need to pay attention to the psychological wellbeing and quality of life of caregivers who come in contact with psychiatric services, and not just the patients they accompany.
Diversion and liaison services in England and Wales for mentally disorder offenders – a narrative review
Authors: McLaughlin Patrick 
Published: June 2021

AimsTo critically examine the development of L&D services in England and Wales and critically appraise their evidence base.BackgroundHigh levels of morbidity across the criminal justice pathway are well established. Although the strongest evidence has emerged from prison studies, the court literature also confirms these high levels. In acknowledgment of this, there have been a range of initiatives to improve access to services for mentally ill individuals involved with the criminal justice system. Once such initiative has been the development of court liaison and diversion services (L&D).MethodRelevant literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the development of L&D services and their evidence base.ResultThe provision of L&D services has increased substantially since their first introduction in England and Wales in 1989. Early L&D services were largely small-scale, unfunded local schemes, and were dependent upon the energy and interest of clinicians who chose to lead in this area. This led to geographical variations in provision and variations in L&D model delivery. The Bradley Report (2009) recommended that a national L&D model be created. The roll-out of a national L&D model meant that half the population of England was covered by 2015, with funding assured for a final wave of L&D services to provide for total population coverage.Where implemented, L&D services have been shown to lead to increased numbers of local team referrals. They may reduce court adjournments and the overall amount of time spent attending court. There is also some evidence of an association with improved mental health among both adults and young people, with reductions in re-conviction rates amongst the later. There remain deficiencies in the evidence base with regards to the economic impact of L&D services. The majority of economic assessments of L&D services have been performed in the United States with fewer studies in the UK.ConclusionAlthough there is evidence that liaison and diversion can produce benefits, there is a general recognition that a higher standard of evidence is required, including experimental work and assessment of economic impact. L&D services carry a financial burden, but this may be offset by incorporating the value of the health improvements that may be brought in those who might otherwise not have received treatment.
Do reality distortions contribute to an increased risk of violent offending in schizophrenia? – a narrative review
Authors: McLaughlin Patrick 
Published: June 2021

AimsTo critically examine the factors that drive an increased risk of violence in the schizophrenic population, with emphasis on the role played by reality distorted symptoms.BackgroundA multitude of studies have reported a positive association between schizophrenia and violence. Many of the risk factors for violence among the non-mentally disordered population, such as substance use, childhood conduct problems and victimisation, are the same as for persons with schizophrenia. There remains controversy however as to whether reality distorted symptoms themselves contribute to the increased risk of violence.MethodRelevant literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the current evidence base for the role of reality distorted symptoms in violence in schizophrenia.ResultStudies ascertaining the contribution of reality distorted symptoms in violent behaviour have produced contradictory results. At a population level, several epidemiological surveys have found little or no contribution for reality distorted symptoms. Such studies frequently show that violence can be accounted for almost entirely by other factors such as substance use and victimisation. However studies investigating relationships between clinical diagnoses and population-wide violence may be unable to detect association at the symptom level. A number of studies have found strong associations between schizophrenia and violence which was not explained by comorbid substance use and have shown strong associations between specific reality distorted symptoms (in particular persecutory delusions accompanied by anger) and violent behaviour.ConclusionThere is heterogeneity in the relationship between schizophrenia and violence. Factors that are associated with increased risk of violence among the schizophrenic population are also pertinent to those without mental disorders. With regards to the pathways to violence in schizophrenia the following conclusions may be drawn: there is an well-established increased risk of violence associated with schizophrenia which has been replicated in many studies; this risk is driven largely by substance use but other factors such as victimisation are also important; there is evidence that reality distorted symptoms, particularly persecutory symptoms, play a role in violent behaviour in some patients, particularly when co-occurring with anger; finally, there may be shared aetiological links between schizophrenia and antisocial behaviour.
The haematological side effects of clozapine: literature review and meta-analysis
Authors: Munshi Tariq , Naeem Farooq , Ayub Mohammed , Farooq Saeed , Khachatryan Davit , Asmer Selim , Wang Peter , Premji Shahista , Winssen Christine Van , Lau Felix , Fairbairn Jonathan 
Published: June 2021

AimsThis review and meta-analysis aim to estimate the cumulative incidence of clozapine induced agranulocytosis and leukopenia the impact of the associated factors such as dose of clozapine, duration of follow-up, gender and race on the cumulative incidence.BackgroundClozapine is the only medication licensed for treatment-resistant schizophrenia. There has been a renewed interest in the role of Clozapine in the treatment of Schizophrenia based on strong evidence that favours its efficacy and safety. Despite the evidence that Clozapine has superior efficacy and has been recommended for treatment-resistant cases by the national guidelines, the drug is underutilised.MethodWe included all studies in which clozapine was used for a psychotic illness. We included studies which provided data on two primary indices; Leucopenia or agranulocytosis and neutropenia; defined according to the cut off used by CPMS for total WBC and neutrophil count. Additionally we included studies reporting another blood dyscrasia or death due to agranulocytosis. Studies were identified by searching AMED, BIOSIS, CINAHL, EMBASE, MEDLINE, PsycINFO, PubMed, and registries of Clinical Trials and their monthly updates, hand searches, gray literature, and conference proceedings from the first available date until 2nd February, 2015. The search was updated on 15th March, 2017. The Protocol was initiated and then registered with PROSPERO International prospective register of systematic reviews University of York, Centre for Reviews and Dissemination.ResultThe cumulative incidence of the agranulocytosis in all studies was 00.32 % (CI 00.1-0.63). The cumulative incidence in all studies for different types of blood dyscrasia were following: leucopenia 00.96 % (CI 0.39-1.70), neutropenia 2.93 % (CI 1.49-4.72), other blood dyscrasias 4.64% (CI 2.34-7.52) and any blood dyscrasia was 2.23 (CI 1.46-3.12).ConclusionThe limitations of this review are mainly due to the nature of evidence from the included studies. We adopted a broad inclusion criteria to include all the available evidence. Number of patients started on Clozapine may be withdrawn from the Clozapine on the earliest signs of blood dyscrasias since the introduction of Clozapine monitoring services. This means that the true incidence of agranulocytosis and neutropenia may be higher and this may be a major bias in finding the true incidence of Clozapine induced neutropenia.