bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a co-produced tool for monitoring and supporting the mental health of young people
Authors: MacKeith Joy , Good Anna , Burns Sara 
Published: June 2021

AimsThe aims were to develop and validate a tool for monitoring and supporting the mental health of young people. Based on extensive experience of developing similar tools, the hypothesis was that a user-friendly tool could be produced with sound psychometric properties.BackgroundThe Outcomes Star is a suite of collaboratively completed, strengths-based tools with the dual roles of both supporting and monitoring change. Service users are empowered through their active involvement in identifying their strengths and creating their care plan. Triangle, the creators of the Outcomes Star was approached by a number of organisations to develop a version of the Star for young people with mental health issues in early intervention services and also to support young people in managing a diagnosed mental illness.MethodUsing a series of focus groups and an iterative process of refinement we gathered data from practitioners and service users on the domains in which they wish to create change, and the steps of the change process. A draft version of the new tool was piloted in two organisations by 67 workers and 177 young people over six months. The pilot data were analysed to assess the psychometric properties of My Mind Star (acceptability, skew, factor structure, internal consistency, item redundancy and responsiveness).ResultThe resulting tool, My Mind Star consisted of seven domains: Feelings and emotions, Healthy lifestyle, Where you live, Friends and relationships, School, training and work, How you use your time and Self-esteem. Almost all young people and practitioners (94%) agreed that their completed Star was ‘a good summary of my life right now’ and that it gave a better idea of service users’ support needs. Psychometric analyses indicated a unidimensional structure with good internal consistency (α = .76) and no item redundancy. My Mind Star was responsive to change between the first and second readings, with medium and small-medium effect sizes.ConclusionInitial findings suggest that My Mind Star has good psychometric properties and is perceived as acceptable and useful by young people and practitioners, Further research is planned to conduct a full validation of the psychometric properties of this Star including inter-rater reliability and predictive validity.Financial sponsorship of the study: Action for Children
Exploring the mental health impact on private flat owners in residential buildings with external combustible cladding
Authors: Martin William 
Published: June 2021

AimsTo explore the mental health of private flat owners in residential buildings with external combustible cladding, which require remediation following the 2017 Grenfell tower fire.The speed at which the fire at Grenfell spread, killing 72 people, is largely attributed to external combustible cladding. It is increasingly suspected that there are ongoing profound effects on the mental health of people living in flats with external combustible cladding like Grenfell both in the UK and abroad. The issue has left flat owners facing severe financial hardship, the threat of bankruptcy and concerns about safety in their own homes.MethodAn exploratory ‘Google Forms’ online mental health survey comprising multiple choice and free text questions over 47 sections was distributed to flat owners in affected buildings. The survey remained open for 6 weeks to allow response. 550 individual responses were studied.Result550 individuals completed the survey, from 143 buildings across 45 UK councils.As a direct result of external combustible cladding:
89.5% said their mental health had deteriorated,22.5% reported having suicidal feelings or a desire to self-harm,71.1% reported having difficulty sleeping,93.8% said they were suffering from worry and anxiety,59.6% used coping strategies to deal with their situation,35.1% said that existing physical and mental health conditions had been exacerbated,84.1% said they cannot move on with their lives and57.9% of people had concerns about seeking help or treatment for mental/physical health problems caused by their situation during the pandemic.In addition, free text responses reflected feelings of anxiety and low mood attributed to the constant fear of fire, and an inability to plan families and future homes. One person said, “I have been left utterly broken by this. My mental and physical health has worsened, I have severe anxiety, depression and PTSD. I struggle each day to keep myself alive.”ConclusionSafe housing is a basic human right. The results show the current situation is having a detrimental impact on flat owners’ mental health and makes a strong case for the provision of specific services offering support - particularly given it is 3.5 years since Grenfell and a viable solution for all is yet to be found.
A systematic review to evaluate the effectiveness of mental health literacy interventions implemented in schools and communities in low- and middle- income countries
Authors: McGuckin Niamh , Leavey Gerard 
Published: June 2021

AimsMental health literacy campaigns have received increasing attention as a useful method of reducing the burden of mental disorders, by promoting public awareness and improving attitudes surrounding mental disorders. However, despite the wealth of research into the effectiveness of mental health literacy interventions in high-income countries, there is an absence of evaluations of these interventions in low-middle-income countries (LMICs). This systematic review aims to pool the evidence on effectiveness of these interventions in LMICs.MethodMEDLINE(OVID), PyschInfo, Scopus and reference lists of included studies were searched. Studies that quantitively measured the effectiveness of mental health literacy interventions amongst schools and communities in LMICs were included, regardless of study design. The included papers were not limited to a particular population demographic, ethnicity or educational level. Studies were included if conducted in LMICs according to the World Bank Classification. Each study was critically assessed according to CASP critical appraisal checklists.ResultTen studies met the inclusion and exclusion criteria, including 6 case series, 3 controlled before and after studies and 1 cross sectional study. Most of the studies claimed significant improvement of knowledge, attitudes and coping skills following the intervention. However, the overall the methodological quality of the studies was rated as fair to poor.ConclusionThe review found that mental health literacy interventions may have promising effects, however the pooled evidence of the effectiveness in LMICs was inconclusive. Further research into the effectiveness of these interventions would benefit from using a RCT design, or controlled-before and after studies, with careful control of confounding variables in order to further establish effect. This study provided insights into the barriers to effective implementation of these programs and examined the contextual appropriateness of such interventions. The review provides recommendations for policy makers for the development of future interventions.
Management of medically unexplained symptoms (MUS): a stepwise integrated model between primary and secondary caremanagement of medically unexplained symptoms (MUS): a stepwise integrated model between primary and secondary care
Authors: Al-Dahash Zaineb S Y , Loveday William , Law Naomi , Qureshi Mutahira , Gallagher Paul , Turton Daniel , Polledri Luca 
Published: June 2021

AimsDescription of a model to improve care for patients with Medically Unexplained Symptoms (MUS) by small targeted investment and maximisation of existing resources.BackgroundTreatment of MUS presents several challenges including a lack of clarity on the best models of care and limited service provision. Patients typically present with a physical complaint to physical health outlets: here limited confidence in professionals around how to address these often leads to poor patient/doctor experience, inappropriate use of resources and repeated attendance. Evidence shows that integration of care, psychological interventions and upskilling physicians in interventions such as positive communication, can significantly improve outcomes. Psychiatric Liaison Teams (PLT) are positioned at the interface of mental and physical health services and can play a crucial role for these patients, when provided with the right skill-mix.Method1FTE Clinical Psychologist specialising in MUS was integrated into the PLT. Pathways to triage between primary, secondary psychology and the new service were agreed, alongside channels of communication and supervision. The job plan included integrated sessions in Gastroenterology, Rheumatology and PLT. The activities included: assessments, formulations and discharges; brief psychological interventions; group sessions for patients; one-day long courses to GP trainees and physicians, and input in specialities MDTs. Clinical outcomes, numbers of patients seen and signposted, teaching sessions and simulation training delivered were collected.ResultOver 20 months the service was able to process 237 referrals, 35 were managed over the phone. Referral sources: Gastroenterology 32%, Rheumatology 37%, Psychiatric liaison 28%.116 patients attended 315 face to face appointments and 21 phone contacts were made. Core-10 data show reduction from moderately severe to mild psychological distress in a sample of patients. 58% of patients were referred on for continuing care. The service ran 8 patient groups including sessions on pain management and joint sessions with Rheumatology. It ran 9 one-day long courses for GP and physician trainees, training a total of 120 doctors: feedback showed increased confidence in managing and recognising MUS. Attendances to Emergency Departments covered by Barking Havering and Redbridge and Bart's Health Trusts combined (5 sites) reduced by 22%, saving an estimated £19,200, while ambulance usage in the cohort dropped by 29%, saving an estimated £9072.ConclusionThe integration of a specialist psychologist with a mix of educational, advisory and clinical role to a PLT can provide an effective and efficient stepped-up model to increase the provision of care for patients with MUS
Use and understanding of functional cognitive disorder terminology in United Kingdom clinical practice - a survey
Authors: Nash Alexandra , Stone Jon , Carson Alan , Ritchie Craig , McWhirter Laura 
Published: June 2021

AimsThis study aimed to explore the terms used by old-age psychiatrists and psychologists to describe subjective and mild cognitive impairment and functional cognitive disorders (FCD) in clinical practice.MethodParticipants were selected from across the United Kingdom based on their clinical involvement in the assessment of cognitive complaints. 9 old-age psychiatrists and 4 psychologists were interviewed about their use of terminology in clinical practice and their awareness and understanding of FCD terminology via semi-structured interview questions and case vignettes. Interviews were conducted between December 2020 and February 2021 using online platforms Zoom and Microsoft Teams. Participants were recruited by email and Twitter. All questions were asked verbally; however, the four case vignettes were displayed via screen-share. All discussions and answers were transcribed and transcripts were coded manually using the exploratory case study methodology in order to identify themes in participants’ responses.ResultThis study has highlighted the variable use of terms used to describe and diagnose patients presenting with symptoms of cognitive disorders. The terms ‘mild cognitive impairment’, ‘subjective cognitive decline’ and ‘functional cognitive disorder’ were used most commonly amongst participants, though the terms ‘subjective cognitive impairment’ and ‘pseudodementia’ were also presented. This theme of language discontinuity is underscored by participants’ varying use of terminology when describing or presenting their diagnoses for the case vignettes. The data also reveals a sub-theme of variability in application of the term FCD. Whilst all participants gave similar definitions for this term, the application of FCD as a diagnosis in practice was inconsistent. Six participants described FCD as associated with or secondary to other functional or psychiatric conditions, four participants viewed FCD as an isolated diagnosis, and one participant considered FCD to be either part of another illness or a separate diagnosis. Two participants neither used nor recognised the term FCD.ConclusionIt is evident that there is varied use of terms describing or diagnosing forms of cognitive symptoms. The findings of this study highlight the need for a clear, adoptable definition of FCD in practice as well as implementable management plans for FCD patients. This is critical in order to avoid misdiagnosis and mismanagement, which may have harmful effects on patients living with debilitating cognitive symptoms.
A survey into the influence of dopaminergic drug exposure on ‘sense of presence’ symptoms in patients with parkinson's disease
Authors: Padfield Emma , Potticary Hannah , Segal Tim 
Published: June 2021

AimsThe first objective was to estimate prevalence of sense of presence (SoP) experiences in patients with Parkinson's Disease (PD), including whether onset was prior to or after commencing dopaminergic medication. The second objective was to explore the relationship between frequency of SoP experiences and dopaminergic drug, drug dosage and length of drug exposure. The experimental hypothesis was that SoP symptoms in PD would present more frequently in patients treated longer and with higher dopaminergic drug doses.BackgroundPD is a debilitating neurodegenerative disorder. Psychiatric symptoms are common and associated with impaired quality of life and higher treatment costs. PD psychosis often starts with ‘minor hallucinations’, the most common being a false ‘sense of presence’ (SoP), the vivid sensation that someone else is nearby when nobody is there. SoP symptoms typically do not cause significant distress but may act as a prognostic marker for future severe psychosis and may prompt alteration of treatment or reduction in dopaminergic drug dosage. This study aimed to extend prior research by characterizing SoP further and investigating the link with dopaminergic medication.MethodThis was a retrospective, cross-sectional study. Twenty-one patients diagnosed with PD completed a questionnaire to identify presence of SoP symptoms, duration of symptoms, timing of onset related to dopaminergic treatment and the frequency of symptoms in relation to current levodopa equivalent dose (LED). Descriptive frequencies were compared using a two-tailed t-test. Multiple regression analysis was conducted to assess the relationship between frequency of SP experiences, levodopa equivalent dose and length of drug exposure.ResultSixteen of twenty-one patients reported experiencing SoP symptoms. Patients who had not experienced SoP symptoms had a significantly lower LED than those who had experienced these symptoms. There were no other significant differences between the groups. No statistical significance was shown on regression analysis; however our study was not adequately powered for the regression analysis as the number of participants was too low.ConclusionThis study confirms that SoP symptoms are common among patients with PD and supports a correlation between the total daily equivalent dose of levodopa and SoP symptoms. It does not provide evidence for a temporal relationship between onset of SoP symptoms and duration of dopaminergic treatment. The study was insufficiently powered and a larger study is required to investigate further.
A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants
Authors: Soni Anju , Walters Pamela 
Published: June 2021

AimsElectronic medical case files of male prisoners in a category B prison in London was studied to establish a prevalence during an 8-month period of the use of and the reasons for prescribing gabapentinoids in prison.In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination.MethodA retrospective, SystmOne electronic case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1500 prisoners; Average turnover of prisoners up to 6000 per year), including to establish practice standards related to the prescription of Gabapentinoids in the prison and determine the compliance with these.ResultIn total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. Half of the cases were co-prescribed gabapentinoids with an opioid substitute and 17% with antidepressants. Only in 22% of the cases there was documentation of discussion with the prisoner about the potential risks of co-prescribing with these medications. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners.ConclusionFor those prescribed gabapentinoids in prison, the indications for such use especially if off label should be reviewed and their use minimised where relevant.The initiation of gabapentinoids in prison should be avoided.For patients who are also receiving antidepressants and opioid substitutes or are abusing opiates, consideration should be given as to whether it is safe to continue on gabapentinoids, given the risks of misuse and death.Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well.From 1 April 2019, gabapentinoids have been classed as Class C controlled drugs in the UK.
Psychiatric liaison referrals: a thematic analysis during peak COVID-19
Authors: Svedberg Kaj , Hancox William , Grant-Peterkin Hugh 
Published: June 2021

AimsWith the advent of the COVID-19 Pandemic the NHS long term Plan commitments of January 2019 to improve crisis care nationwide became all the more pressing. The aim of this study was to thematically investigate what mental health crisis presentations might be diverted from the Emergency department to external crisis hubs in order to reduce the COVID-19 contamination risks.MethodAll referrals made to the Homerton University Hospital (HUH) mental health liaison service were looked at between 1/3/20-11/6/20 (n = 846), coinciding with the first peak of the COVID-19 Pandemic.Referral data was anonymised and sorted independently into naturally emerging thematic classes by two junior liaison doctors.Cases that did not clearly fit any of the 14 themes generated were further looked into to determine outcome of referral and discussed to try and match to an appropriate class.Result14 frequent themes for mental health crisis referrals were identified. The distribution of these ranged from most common (suicidality) to neurocognitive presentation and identified shifts in themes over the course of the pandemic peak such as increases of low mood, anxiety and intoxication requiring medical attention over the three month period.ConclusionAlthough themes for presentations may be identified in acute referrals to mental health liaison services it is problematic determining how these may be parsed safely to crisis hubs without risking overlooking cases that may require medical attention. The most common theme that was identified and remained throughout the first wave of the COVID-19 Pandemic was acute suicidal presentation. The remaining themes would require careful consideration around risk thresholds for what a service may wish to accept in devolving the emergency department liaison and balance these against future risks of repeat COVID-19 waves.
Medical comorbidities of patients presenting to an adult neurodevelopmental new case clinic in Singapore
Authors: Tan Ho Teck , Moon James Patrick , Tan Giles Ming Yee 
Published: June 2021

AimsTo describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.BackgroundMedical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.MethodA retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.Result319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.ConclusionPatients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.