bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving access to the physical health clinic in a community first-episode psychosis service
Authors: Tansley-Ahmed Zena , Lim Wei Han 
Published: June 2021

AimsPhysical health outcomes are poor for patients with severe mental illness as demonstrated by the significant mortality gap present globally.[1] Access to and engagement with care is a key factor underpinning this disparity.[2] The Early Intervention in Psychosis service works with young people from 14-35 experiencing a first episode of psychosis in the community. Within the service, difficulties in engagement have been reflected in the high ‘no-show’ rates observed in the Foundation Year 2 trainee doctor-led physical health clinic. This quality improvement project aimed to reduce the ‘did not attend’ (DNA) rate in the physical health clinic by 20% in order to improve patient outcomes, particularly in the context of their physical health.MethodThe project took place between September and November 2020, over the course of 10 weeks. A driver diagram was constructed to identify key influencing factors and subsequent change ideas. In order to implement each of these changes, three cycles within the Plan, Do, Study, Act (PDSA) ramp framework were completed. These consisted of phone reminders within 48 hours of appointments, a teaching session for staff alongside the distribution of an accompanying information leaflet and increased flexibility in clinic times with opportunistic appointments. The change ideas were cumulative with each cycle lasting a duration of seventeen days.ResultThe baseline DNA rate was calculated based on the preceding month and found to be 55%. Following cycle one of the project, there was a significant reduction in DNA rates to 30% although this remained relatively stable at 33% after cycle two. By the end of cycle three when all interventions had been introduced, the DNA rate had dropped to 22%. As such, a total drop in DNA rate of over 30% was achieved which surpassed the initial aim of the project.ConclusionThe outcomes of this project demonstrate that the introduction of even simple measures can lead to positive change. Successful implementation of these changes requires teamwork and a culture of openness and flexibility. Feedback from team members, particularly care coordinators, also indicated better resulting engagement of clients with the service overall, suggesting potential for both improved mental and physical health outcomes. Next steps for this project may involve not only continued implementation of established changes but also service user input and scope for virtual consultations particularly in light of current COVID-19 restrictions.
Improving patient access to medication information: a quality improvement project on patient-centred prescribing
Authors: Todd Anna , Blunstone Rosy 
Published: June 2021

AimsWard rounds are sometimes the only opportunity for patients to discuss medication. Patient and professional feedback on an acute male inpatient ward in South London highlighted a demand for more medication information outside the formal ward round setting. We aimed to have 100% of patients meet our criteria for “Patient-Centred Prescribing” on the ward by March 2021. To fulfil criteria, all patients are offered: (1) ward round discussion, (2) written patient information leaflets (PILs), (3) informal discussion groups, all regarding medication.The principles of this quality improvement project (QIP) were drawn from definitions of patient-centred care and standards of good practice; patients should have access to a variety of information formats, relevant to the individual, and the knowledge gained empowers patients.Patient experience data revealed that 30% of clients answered passively to the question, “Do you feel involved in your care?” We hypothesized that medication discussion groups positively impact patients’ wellbeing, by providing a safe space that facilitates conversation surrounding medication issues.MethodWe conducted weekly audits on patients whose admission duration was >7 days, and recorded fulfilment of the above criteria. At week 1, we introduced a program of weekly medication discussion groups led by members of the wider multi-disciplinary team covering a broad topic range. At week 6, we developed a rolling rota of the discussion groups and posters were displayed in advance. At week 14, all patients were offered PILs through a 1:1 interaction and this continued as routine practice. Medication discussion group feedback was obtained via questionnaires and “The Blob Tree”, a psycho-emotional assessment tool commonly used in healthcare settings.ResultIn 19 weeks, the median percentage of patients who fulfilled our criteria for Patient-Centred Prescribing was 92.86%. After 11 medication discussion groups, 79.3% of questionnaire responders wanted further sessions. 88% of “The Blob Tree” responses collected inferred a positive emotional response after the group discussions and half of those noticed an improvement in their emotional state.ConclusionThis QIP was overall a success; it fulfilled a requirement to meet good standards in information sharing and became embedded in the fabric of the ward, continuing to run as part of the activities program. It demonstrated the impact of education on patients’ mental wellbeing through empowerment and peer support. As a by-product it established multidisciplinary connections and improved therapeutic relationships. Challenges included patient engagement secondary to acute mental illness or negative symptoms and maintaining project momentum following a COVID-19 outbreak.
Professional training and case-load mix within a community mental health team
Authors: Walsh Richard , Fahy Rebecca , Abdelgadir Ala , Walsh Elizabeth , Patel Sonn 
Published: June 2021

AimsCommunity Mental Health Teams (CMHTS) are now the cornerstone of modern mental health care and play a central role in assessment, diagnosis and care coordination. CMHTs vary widely in their service provision and composition. Within teams there is latitude for variation of professional roles but the extent to which different disciplines undertake generic and profession-specific work is poorly defined. This cross-sectional study aims to establish how professional training influences the distribution of case-load mix within a general adult CMHTMethodThe GR1 CMHT provides care to a mixed urban/rural population of 25,000 in Galway city and Connemara. A review was conducted of multi-disciplinary case notes for all patients actively registered with the team for a period of one year. Name, age, gender, whether referred or admitted in the past year, medication and day hospital attendance were recorded. Clinical diagnoses were recorded but, where missing, verified with a relevant team member. The team consultant reviewed and verified the 1CD-10 primary clinical diagnosis for all patients. Evidence of clinical input by multidisciplinary team members was recorded from clinical files with the final electronic database being checked by each professional for accuracy. We examined any input over the past year rather thanfrequency of input. Patient characteristics and diagnosis by professional discipline were examined using descriptive statistics.ResultOf a total of 246 patients registered to the team, 37.8% (N = 93) saw one, 34.6% (N = 85) saw two and 24.4% (N = 60) saw 3 or more team members. Of those who saw three or more team members, psychotic disorders represented the majority diagnoses (40%, N = 24) followed by personality disorders (25%, N = 15) and affective disorders (15%, N = 9). Patients were most commonly seen by a doctor (91.5%, N = 225) followed by community mental health nurses (CMHNs) (52.8%, N = 130). Doctors saw 85% or more of all patients grouped by ICD-10 diagnoses. The majority of social work and occupational therapy case-mix comprised psychotic disorders (SW = 44.2%, OT = 34.2%) followed by personality disorders (SW = 25.6%, OT = 23.7%). Of psychology case-mix, the highest was personalitydisorders at 41.6% (N = 13) followed by anxiety and related disorders at 25% (N = 8). CMHN case-mix was highest for psychotic disorders at 44.6% (N = 58) followed by 21.5% mood disorders (N = 28).ConclusionThis cross sectional survey informs how we currently target our specialist resources. We will now develop this to include frequency of contact to inform resource allocation and skill mix.
GP Trainees' perceptions and experiences of the training placement in Psychiatry - A qualitative study
Authors: Ahmed Raja Adnan , Saeed Rugiyya , Tombs Michal 
Published: June 2021

AimsThis qualitative study aims to explore the leaning needs of the GP trainees for their psychiatry placements.MethodIn this qualitative study, semi-structured interviews of eight former GP trainees were conducted. Data were transcribed and analysed using thematic analysis. Triangulation through multiple analysts” was used to improve the validity of the studyResultThis study identified six key areas of learning needs for GP trainees during their psychiatry placement. i) the on-call experience which enabled the participants to learn how to manage acutely unwell patients in psychiatry, ii) learning the self-harm and suicidal risk assessment which is an important skill for a GP practising in primary care, iii) training in relation to psychiatric medication which enabled GPs to prescribe more confidently in the community, iv) exposure to the community psychiatry which was helpful in getting exposure to community-based clinical practice, v) learning from formal teaching activities which can be tailored to cover the relevant primary care related clinical topics and finally, vi) getting the opportunity to improve the communications skills during the psychiatry placement which is useful for all doctor in training.ConclusionWe recommend that detailed induction of the service setup is required before GP trainees start on-calls and a well-defined support network should be provided and explained to the training doctors. Risk assessment teaching should be delivered by formal training, regular supervision and discussions. Training on psychiatric medication especially in the context of GP prescribing should be considered as part of formal teaching experience. Opportunities to work with community mental health teams and outpatient clinics should be generated and offered to the trainees. Formal teaching sessions should be set up with an understanding of the GP training curriculum and their learning needs. Improvement of communications skills with exposure to difficult communication scenarios under supervision during psychiatric placement should be identified as an important area of learning for the GP trainees.
Psychological impact of COVID-19 pandemic on frontline health care workers in Bangladesh: A cross-sectional study
Authors: Ahmed Suman , Ahsan Mohammad Shamsul , Khan Rubaiya , Hasan Mahbubul , Ferdous Fahmida , Shahjahan Humayra , Hossain Murin , Kar Ananya , Hossain Kamrul 
Published: June 2021

AimsFrontline health care workers exposed to COVID-19 patients could be at increased risk of developing psychological issues. The study aimed to estimate the prevalence of mental health-related problems, specifically depression, anxiety, post-traumatic stress disorder (PTSD), and insomnia among health care professionals during the COVID-19 pandemic in Bangladesh and to compare these between medical and allied health care professionals.MethodThis cross-sectional survey was conducted using Google Form then subsequent telephone interview between June and August 2020. Using random sampling, a total of 479 health care professionals participated in the study. We collected data on demographics. Anxiety and depression were measured using 4 items Patient Health Questionnaire-4 (PHQ-4), PTSD was measured using 4 items Primary Care (PC)-PTSD-Screen, and insomnia was measured by using a 7-item Insomnia Severity Index (ISI). A multivariable logistic regression analysis was performed to assess risk factors associated with mental health symptoms.ResultOverall, 17.6% of frontline health workers had symptoms of anxiety, 15.5% had depression symptoms, 7.6% had PTSD symptoms and 5.9% had symptoms of insomnia. Compared to allied health professionals (n = 113, 24%), doctors (n = 366, 76%) had significantly higher prevalence of anxiety: 21.1% vs 06%, (OR = 4.19; 95% CI = 1.88–9.35; p-value <0.001); depression: 18% vs 6.8%, (OR = 2.99; 95% CI = 1.40–6.42; p-value 0.005); PTSD: 9.4% vs 1.7%, (OR = 5.96; 95% CI = 1.41–25.11; p-value 0.015) and insomnia: 7.4% vs 0.9%, (OR = 9.22; 95% CI = 1.24–68.4; p-value 0.03). Logistic regression analysis showed that pre-existing medical illness has significantly more risks of developing symptoms of anxiety (adjusted OR = 2.85; 95% CI = 1.71–4.76; p-value <0.001) and depression (OR = 2.29; 95% CI = 1.39–3.77; p-value 0.001). Having a postgraduate degree (adjusted OR = 6.13; 95% CI = 1.28–29.28; p-value 0.023) and working in secondary care setting (adjusted OR = 3.08; 95% CI = 1.18–8.02; p value 0.021) have significant predictors of developing anxiety symptoms among health workers. Those who had worked more than 6 weeks in COVID-19 dedicated hospitals had risk of developing symptoms of PSTD (OR = 2.83; 95% CI = 1.35–5.93; p value 0.006) and insomnia (OR = 2.63; 95% CI = 1.15–6.02; p value 0.022).ConclusionOur study demonstrated a high prevalence of symptoms of depression, anxiety, PTSD, and insomnia among Bangladeshi frontline health workers (particularly among doctors) during the COVID-19 pandemic. There is an urgent need to address the mental health needs of frontline health workers.Funding: Medical Research Council, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Preconception interventions and resources for women with serious mental illness: a rapid evidence review
Authors: Atmore Katie , Howard Louise , Easter Abigail 
Published: June 2021

AimsThere is little research into evidence-based preconception interventions for women with serious mental illness (SMI). Women with SMI will have specific needs around preconception due to the complexities of the teratogenicity of medications, risk of mental illness relapse and higher levels of stigma around motherhood. If effectively delivered preconception care could mitigate these difficulties and improve outcomes for mother and baby. The aim of this research was therefore to determine to identify and describe studies evaluating preconception interventions for women of child-bearing age who have an existing SMI through searches of the peer-reviewed literature.MethodA rapid review was conducted to search MEDLINE and PsychINFO databases from the year 2000 onwards for peer-reviewed articles describing preconception interventions/resources delivered prior to a pregnancy to women of child-bearing age with a pre-existing existing serious mental illness (including schizophrenia, bipolar and eating disorders).ResultA total of 592 results were returned from the searches and 576 of these remained after the removal of duplicates. 11 studies were included in the final narrative synthesis describing the following intervention types: Health warning (1), Health screening (1), Teratogen phone service (2), Psychiatric consultation (5), Family planning information (1) and Peripartum management plan (1). Interventions were delivered in Australia, UK, Italy, Germany, Netherlands, USA and Nigeria.ConclusionThough the included studies indicated that some efforts have been made globally to meet the preconception needs of women with SMI the numbers included in the studies tended to be low and reflective of small-scale service provision. Future studies utilising a randomised controlled trial design would lower the risk of bias and provide more generalisable evidence of effectiveness for these interventions. The results of this review were used to inform the development of a number of resources to aid the planning of healthy pregnancies in both women with SMI and the health professionals working with them.
Taking leadership over psychopathogenic environments
Authors: Cockburn Alastair , Morris Jane 
Published: June 2021

AimsDo psychiatrists believe children are growing up in psychopathogenic environments that significantly contribute to mental ill- health? If so, do they feel empowered to change those environments? If not, how can psychiatrists be given a role where they can create meaningful change? Finally, how much responsibility can psychiatry usefully take for changing psychopathogenic environments?BackgroundWe define psychopathogenic environments as environments that predispose to mental ill-health. It is the psychological environment we live in - including income, the way we interact with others (e.g. social media, bullying), what we do with our free time, pressures at school and expectations of our peers. It is not discrete events (e.g. trauma) and stretches beyond life at home (where many ACE's occur).Self-harm presentations to medical professionals amongst teenagers are on the rise, Universities report a fivefold increase in disclosure of mental health conditions in the last decade. Here we consider if psychopathogenic environments are part of the cause of these changes.MethodA 10-item questionnaire distributed to Child and Adolescent Psychiatrists in NHS Lothian, NHS Grampian and Manchester University NHS Trust via a consultant in each Trust.ResultAll 14 respondents said psychopathogenic environments are “very important” contributors to mental ill-health. 13/14 say the environments have got worse in the last 10 years. 13/14 responded negatively about whether psychiatrists could change them. When given white space to tackle the problem they suggested changes were needed from Government including against poverty / inequality, education, public health nudges, more resources, MDT working and better access to leisure facilities. Given specific choices, 11/14 identified influencing Government as a major way forward.ConclusionThis group of psychiatrists believe psychopathogenic environments are; 1) a very important contributor to mental ill-health 2) getting worse but 3) feel largely powerless to tackle it. It is a problem they think is important and want to engage in, but lack time, resources and struggle with the complexity of the problem. How therefore, can psychiatrist show leadership in this area? The two perspectives to consider how to empower psychiatrists to help create change are 1) how they can influence the environment for individual patients, 2) how they can influence public policy and government to make wider changes.Is this the job of psychiatrists? Not alone, but as agents they have a unique insight and authority as both a lens for and director of these environments.
Prevalence and correlates of substance use among transgender adults: a systematic narrative review
Authors: Connolly Dean , Gilchrist Gail 
Published: June 2021

AimsTo understand the prevalence, patterns and correlates of substance use among transgender adults.BackgroundMinority stress theories suggest that the increasing rates of discrimination experienced by transgender people are precipitants of substance use. This is likely exacerbated by an inadequate provision of trans-inclusive substance misuse services. However, the exclusion of transgender people from the general substance misuse literature makes it difficult to determine the extent to which gender minority status influences substance use. A systematic review was undertaken to better understand the prevalence, patterns and correlates of substance use among this group.MethodIn accordance with the PRISMA guidance, a literature search was conducted to 29th May 2019 on PubMed, PsycINFO, EMBASE and Global Health databases. Primary quantitative studies, published in the English language, that reported the prevalence, patterns or correlates/risk factors of substance use by trans people were included, with no restriction on methodological design.Result651 unique records were identified by the search and 40 studies were included in the synthesis. While there was some suggestion of excess risk of substance use among trans people, there was insufficient evidence to estimate prevalence or quantify the risk of substance use among transgender people, relative to a cisgender population. However, this review identified several gender minority related correlates of substance use which are of relevance to clinicians working with transgender patients, including transphobic discrimination or violence, unemployment and sex work, gender dysphoria, high visual gender non-conformity and intersectional sexual minority status.ConclusionThere are currently significant gaps in the trans substance use literature, relating to the disproportionate investigation of transgender women with multiple intersectional disadvantages, who are not representative of the wider trans community. However, there is sufficient evidence to recommend screening for substance use when individuals report high levels of gender minority stress and to consider the use of integrated trauma-informed psychosocial interventions when managing problematic substance use in the transgender adult.
A clinical inventory of moderators of tic severity in Tourette's Syndrome
Authors: Conti Francesca , Tyagi Himanshu 
Published: June 2021

AimsChanges in the severity of tics in Tourette's syndrome (TS), as seen with variations in the intensity or frequency of tics, can be moderated by a variety of independent factors such as external or internal stimuli. Identifying such moderators has important clinical implications as it can aid clinicians in adjusting interventions. Hence, based on our previous review of tic-severity moderators, we developed a clinical inventory of moderating variables for motor and vocal tics for inclusion in the new version of the Queen Square Proforma for Tourette's Syndrome to aid initial assessments in the National Tourette Syndrome Service's Outpatient Clinic for Adults.MethodA review of tic-severity moderators was previously carried out by the authors to investigate the kinds of moderators and their worsening, improving or neutral effects on tic severity. Based on this a semantic thematic analysis of the identified moderators was carried out and themes were developed based on appropriate and relevant MeSH terms in order to create the categories and items of the clinical inventory.ResultSeventy-three different tic severity moderators were identified, the most common being exercise, sleep, peer victimisation, psychosocial stress, watching TV, academic activities and distraction. Twenty-nine themes emerged from the thematic analysis which were then used to update the clinical inventory of tic severity moderators. The review also highlighted the subjectivity of these moderators’ effects on tic severity as some moderators were tic-worsening in some individuals and tic-improving or neutral in others, which is contrary to the current dichotomous understanding.ConclusionThe updated clinical inventory of tic severity moderators invites researchers and clinicians to be more aware of the existence, variability and subjective effects of these tic severity moderators in individuals with TS, as these have been previously looked in a dichotomous way. By better identifying tic-severity moderators and their worsening, improving or neutral effects on tic severity this clinician rated inventory will have potentially important, direct implications for the management and treatment of tics.