bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does attending psychiatry teaching lectures change attitude of medical students towards people with mental illness? A longitudinal survey from nepal
Authors: Thapaliya Suresh , Singh Shizu , Goit Bharat , Sawant Sandesh , Gupta Anoop Krishna 
Published: June 2021

AimsThe study aims to compare the attitude of early clinical year medical students towards people with mental illness at the beginning and the end of their psychiatry teaching schedule. It hypothesizes that long exposure to psychiatry lectures can help to reduce the negative attitude.BackgroundHealth professionals are also known to harbour negative attitude towards people with mental illness. Reducing stigma among medical students is crucial to shape the attitude of future health professionals towards people with mental illness. However, the effect of Psychiatry training on the attitude of the medical students shows mixed results.MethodIt was a prospective longitudinal study conducted among fourth year medical students affiliated with a teaching hospital in Southern Nepal as an initiative to improve quality of Psychiatry training for medical students. The students who gave their consent for participation were assessed for their attitude at the beginning, after the first two introductory lectures and at the end of the Psychiatry lecture-based teaching schedule (36 two weekly lectures in 5 month period), using self-administered 16-item Mental Illness Clinician's Attitudes Scale (MICA-2) ‘medical students version’ questionnaire in English language. Permission was taken from the author of the study to use the scale. IRB approval was taken prior to the study.ResultA total of 95 (approx. 67%) students participated in the study. At the first follow-up i.e. second week, (n = 85), there was no significant difference in negative attitude as assessed by MICA score (p = 0.47). However, at six months follow-up (n = 82), the negative attitude significantly differed compared to the baseline (p < 0.001).ConclusionWhile brief lectures about mental illness can provide some knowledge about mental illness, long term exposure to psychiatry lectures can reduce attitude of medical students on people with mental illness. Hence, it is also crucial to incorporate academic contents that reduce negative attitude about people with mental illness.Financial declaration: The study was self-funded by the department of Psychiatry at National Medical College and Teaching Hospital, Parsa, Nepal.
Attitude and knowledge about electroconvulsive therapy (ECT) among medical students in Nepal: a pilot survey
Authors: Thapaliya Suresh , Singh Shizu , Shrestha Shuva , Gupta Anoop Krishna 
Published: June 2021

AimsElectroconvulsive Therapy (ECT) is an important modality of treatment for treatment resistant psychiatric disorders. Young medical students like general public might harbor several misconceptions about ECT. In this pilot survey, we explored the knowledge and attitude about ECT amongst young medical students training in a medical college affiliated to a teaching hospital in Southern Nepal.MethodA 23-item questionnaire in English language with either ‘True’ or ‘False’ response as outcome was developed by reviewing findings from previous studies. Brief information was also taken to record familiarity of medical students with ECT as a treatment procedure. The study was conducted as a departmental pilot survey for quality improvement of Psychiatry Undergraduate Training. A total of 128 medical students in early clinical year enrolled in MBBS curriculum at a teaching hospital in Southern Nepal participated in the survey. The students were not exposed to any specific teaching regarding ECT while participating in the study.ResultThe students were aged between 21 and 28 years with almost equal gender distribution. Among them, 89.1% had heard about ECT before whereas 15.6% knew someone who has received ECT. Although 90.6 % of students believed ECT can be lifesaving many times, a substantial number of students had misconception about ECT such as assuming it as a painful procedure (71.9%). Almost half of them believed ECT can have severe consequences like death or permanent brain damage. Around one fourth to one third believed ECT is inhumane, without scientific proof or a form of punishment for violent angry patients. Surprisingly, a significant higher percentage of male students believed that ‘ECT leads to permanent loss of memory’ (11/34 vs. 3/30, p = 0.04) and ‘ECT is given as a punishment to violent/angry patients’ (15/34 vs. 4/30, p = 0.01).ConclusionSeveral misconceptions about ECT are prevalent in medical students that need to be adequately addressed during their training to develop a positive attitude and basic knowledge about the treatment.
Research into psychiatry trainees views around the impact COVID-19 has had on the provision of electroconvulsive therapy training
Authors: Webb Cara 
Published: June 2021

AimsThe current COVID-19 outbreak has changed the way electroconvulsive therapy (ECT) is provided. In many areas it has been moved from the more traditional ECT suites to general surgical theatres for a number of reasons, most notably being the need to ensure adequate ventilation. The introduction of the need for PPE to be worn throughout ECT and for general hospital operating procedures to be adhered to has also been a big change. The change in the required infection control procedures has had an impact on treatment capacity and has led many areas to reduce, relocate or centralise their ECT provisions which has had a knock on effect on training.This study assesses the perceived impact COVID-19 has had on the provision of training and learning in ECT for core and higher psychiatry trainees in the North West as well as their perceived competence levels.MethodViews were sought through surveys and focus groups from September to December 2020, participants were core and higher psychiatry trainees in the North West. Participants were recruited via email, the total population size was 87, 21 Core trainees responded and 14 higher trainees. From the survey respondents, 5 participants agreed to attend a focus group.ResultResults show that the provision of ECT training has been poor during the COVID-19 outbreak. Almost 81% of core trainees surveyed and 92.86% of higher trainees had participated in no ECT sessions from the start of the COVID-19 outbreak to the time of data collection eight to ten months later.81% of core trainees and 85.71% of higher trainees had received no teaching in any form about ECT over the period studied.When considering the competencies required in ECT for a core trainee, one (4.76%) felt they were fully competent, 3 (14.29%) nearly competent, 7(33.33%) needs some improvement, 10 (47.62%) not yet competent. Only one higher trainee felt they met the RCPsych competencies, 5 (35.71%) were nearly competent, 6 (42.86%) need some improvement and 2 (14.29%) were not yet competent.ConclusionThis study indicates a clear lack of provision of training which is very concerning ,and possibly pre dates the COVID outbreak, particularly in the case of specialty trainees who may well be consultants in a number of months and will not have the time to make up for the lost training. In order for ECT provision to continue it is crucial that we are able to adequately train the future workforce.
Peripheral cortisol administration blunts reward arousal but heightens anxiety-like arousal in marmosets
Authors: Alexander Laith , Gaskin Philip , McIver Lauren , Roberts Angela 
Published: June 2021

AimsExcess hypothalamic-pituitary-adrenal (HPA) axis activation is common in people with major depression and generalised anxiety disorder. We sought to determine whether higher circulating levels of the glucocorticoid cortisol are causally related to the expression of anhedonia-like and anxiety-like behaviours in marmosets.MethodFour marmosets (two male, two female) took part in the study. Cortisol and saline control injections were administered intramuscularly and salivary cortisol samples were taken before and after injections to determine if circulating cortisol levels changed from pre- to post-injection. To measure anhedonia-like behaviours, we trained marmosets on an appetitive Pavlovian conditioning paradigm, where animals learn to associate two anticipatory auditory cues (conditioned stimulus + or conditioned sitmulus -, CS+ or CS-) with the presence or absence of food reward (unconditioned stimulus + or unconditioned stimulus -, US+ or US-). Using cardiovascular telemetry probes and video cameras, we recorded animals' cardiovascular and behavioural arousal in freely moving conditions, comparing the injection of saline control versus 5mg/kg, 10mg/kg or 20mg/kg intramuscular cortisol. To measure anxiety-like behaviours, we used a human intruder (HI) paradigm, where marmosets are confronted with an unfamiliar human in their home cage. We recorded their behaviour on video cameras after saline control or 20mg/kg intramuscular cortisol. We used an exploratory-factor analysis (EFA) to determine how marmosets' behaviours towards the intruder loaded onto an 'anxiety-like' score. We then compared these scores under saline control versus cortisol conditions. Significance was set at p < 0.05.ResultUnlike saline control, we found that subcutaneous injections of 20 mg/kg cortisol successfully elevated peripheral cortisol concentrations to levels equivalent to peak circadian concentrations (p = 0.023). In the appetitive setting, 5 mg/kg, 10 mg/kg and 20 mg/kg cortisol injections blunted anticipatory (CS+ induced) increases in behavioural arousal (p = 0.004) but did not alter anticipatory cardiovascular arousal. Consummatory behavioural and cardiovascular arousal also remained intact. In the HI test, 20 mg/kg cortisol injections moderately increased anxiety towards the intruder as measured by an increase in marmosets' EFA-derived anxiety-like scores (p = 0.035).ConclusionIn marmosets, elevated peripheral cortisol levels are causally related to the behavioural features of blunted reward anticipation together with elevated anxiety-like behaviours characteristic of mood and anxiety disorders. Future work will characterise the neuroimaging changes induced by elevated peripheral cortisol levels and identify the regions of the prefrontal cortex contributing to HPA axis regulation and dysregulation.
Multicentre evaluation of the pharmacological management of women with bipolar disorder in the perinatal period
Authors: Dias Marisa Casanova , Jones Ian , Wieck Angelika 
Published: June 2021

AimsThe pharmacological management of women with bipolar disorder in the perinatal period is challenging. This population has a high recurrence rate, but some medications can be a concern in pregnancy and breastfeeding. Little is known about prescribing practices in perinatal services, and the impact of medication on recurrence rates.The aims of this study are: 1) to describe the use of medication in women with bipolar disorder in the perinatal period and 2) to evaluate the impact of medication on the rate of postpartum recurrence.MethodClinical data were collected from pregnant women with a diagnosis of bipolar disorder in the nine participating centres in the UK and who were not experiencing an episode of illness entering the postpartum period. Using a proforma, data were collected for the period between conception and three months postpartum: sociodemographic, reproductive, the severity of illness, medication and recurrence.Data were analysed for association using χ2 tests and logistic regression.ResultIn this sample of 167 women, 91 (55%) were taking medication at delivery: 62 (37%) antipsychotics, 41 (25%) antidepressants, and 25 (15%) mood stabilisers. In 12 cases medication was reduced before delivery. Of those who were taking medication at delivery six decreased of stopped after delivery and one increased the dose. 42% of women in this sample experienced a recurrence, with 30% of the sample experiencing a manic/psychotic episode. There was no significant association between taking medication and recurrence χ 2(1) = 0.07, p = 0.79. There continued to be no association in a multivariable analysis when adjusted for parity, severity (previous admissions, age at first treatment, bipolar subtype), type of medication during pregnancy and immediate postpartum changes aOR 0.33 95%CI [0.03; 3.40], p = 0.35.ConclusionA high number of women with bipolar disorder are taking medication before delivery and in the majority, antipsychotics are prescribed. The postnatal recurrence rate in both medicated and unmedicated women is high. These results are in line with existing literature. Further work is needed in larger samples to provide clinical guidance for women and their clinicians.
Buspirone in obsessive-compulsive disorder: a potential dark horse?
Authors: Garg Kabir , Tyagi Himanshu 
Published: June 2021

AimsPharmacological management of Obsessive-Compulsive Disorder (OCD) presents a challenge in modern psychiatry. While most patients respond preferably to serotonin re-uptake inhibitors (SRI), the response is usually delayed by several weeks leading to an insufficient short term management of anxiety. It is also frequently inadequate and needs higher doses and augmentation in many instances. Investigating newer pharmacological strategies to address such treatment gaps has always been of interest. Buspirone is a novel anxiolytic medication with additional weak antidepressant and poor anti-psychotic effects. It is the only medication in its category, i.e. azapriones. It has comparable anti-anxiety efficacy to that of benzodiazepines without their sedating or habit forming effects, and has been demonstrated to moderate serotonin and other monoamine neurotransmission with a favourable safety profile.MethodWe reviewed the literature pertaining to the use of Buspirone in OCD for both as a primary anti-obsessive agent and for a potential secondary role in management of chronic anxiety and/or anxiety disorders comorbid to OCD.ResultThe results of a number of case reports and open trials have been positive while controlled trials have shown contradictory results. In a double blind RCT comparing clomipramine and buspirone, significant improvement was found in both groups with no differences between the two. Further two trials observing buspirone augmentation of clomipramine and fluoxetine treatment respectively, in a double-blind placebo controlled design reported significant improvement in the treatment as opposed to the placebo arm. Another double-blind placebo controlled study of buspirone augmentation of fluvoxamine resistant patients did not show significant benefits as an anti-obsessional agent, but notable anxiolytic effects were reported. In all the trials buspirone was largely well tolerated and did not pose any significant interactions with other psychotropic agents or dependence potential.ConclusionBuspirone is a pharmacologically unique agent with a good safety profile. Given the robust anxiolytic effects of this Peron along with complex neurotransmission modulatory effects coupled with a favourable tolerance and dependents profile might make buspirone an attractive novel pharmacological agent for augmentation in OCD . Further controlled studies to better establish effectiveness and deciphering if certain patients may respond to its use over others, are warranted
Different onset patterns of monthly paliperidone palmitate in hospitalised patient diagnosed with schizophrenia
Authors: Herrera-Sánchez Javier , Aznar Julia , Izaguirre Leire , Ovejero Santiago 
Published: June 2021

AimsPaliperidone palmitate long-acting injectable (PPLAI) initially requires two loading doses of 150 and 100 mg on days 1 and 8 (± 4 days) intramuscularly. In clinical practice, different PPLAI initiation patterns have been observed. The aim of this study is to describe different PPLAI onset patterns in hospitalised patients diagnosed with schizophrenia.MethodA naturalistic, transversal, retrospective, descriptive study was carried out. Patients were recruited in the adult inpatient unit of Hospital Universitario Jiménez Díaz (Madrid, Spain) from November 2012 to February 2021. During this period, a total of 357 patients were treated with PPLAI, 172 of them were diagnosed with schizophrenia and, among these, 24 received an atypical onset pattern during hospitalization. Different PPLAI onset patterns, PPLAI dose at discharge and number of days hospitalised were analysed. This study followed the Declaration of Helsinki principles and was approved by the Local Ethics Committee. All participants gave written informed consent.ResultThe sample presents 24 patients (17 men, 7 women) that represents 6.72% of a global sample, with an average age of 40.21 years (men 35.59 years vs. women 51.43 years). In this study, different PPLAI onset patterns were described: those receiving 150-150 mg represent 25% of the sample (n = 6), as do those receiving 100-75 mg, also representing 25% of the sample (n = 6). The rest of the onset patterns were: 150-75 mg (20.83%, n = 5), 100-100 mg (12.5%, n = 3), 150-75 mg (4.16%, n = 1), 100-50 mg (4.16%, n = 1), 75-100 mg (4.16%, n = 1), and 75-75 mg (4.16%, n = 1). The average hospital stay is 17.88 days. The PPLAI maintenance dose at discharge was 104.17 mg/month. The group of patients who received two doses of 150 mg (150-150 mg) had an average length of stay of 27.67 days compared to the rest of the patients who had an average length of stay of 15.12 days, this difference being statistically significant (p = 0.010). The 150-150 mg group was discharged with a mean maintenance dose of 141.67 mg versus the other patients who needed a mean maintenance dose of 91.18 mg, which was also statistically significant (p = 0.001).ConclusionThe most used pattern of atypical onset of PPLAI in this sample is 150-150 mg and 100-75 mg. Patients treated with 150-150 mg loading pattern are hospitalized for a longer period and needed higher maintenance dose at discharge. Further studies are needed.
Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines update
Authors: Allan John 
Published: June 2021

AimsTo provide guidance for the management of mood disorders, both depressive and bipolar disorders, based on scientific evidence supplemented by expert clinical consensus.BackgroundIt is the EIT responsibility to monitor a patient's physical health and the effects of anti-psychotic medication for at least the first 12 months.MethodThe update has been developed in a consistent manner to the 2015 guideline. The composition of the working group has remained largely the same as has the process to evaluate the evidence and synthesise the findings. To approach the update, the working group identified areas within the 2015 guideline where significant changes had occurred, for example the development of new therapies or where thinking and practice have changed and new ideas have emerged. Recommendations were reviewed in light of any new findings and evidence. As only some sections of the 2015 guideline have been updated/revised, the time taken to develop the update has been considerably shorter. Public consultation and peer review informed the final version.ResultThis led us to review the mechanism in the team for arranging and reviewing these investigations.ConclusionThe mood disorders clinical practice guideline update addresses both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework supplemented by expert clinical consensus.
Standards for lithium monitoring. “Are we good at adhering to these standards in Lanarkshire”?
Authors: Ansari Saba , Nawab Khalid , Killeen Niall , Spence Elizabeth , Fotedar Monika 
Published: June 2021

AimsThe National Institute for Health and Clinical Excellence (NICE) recommend that renal and thyroid function must be checked before lithium is prescribed and for all patients who are prescribed lithium should have their renal and thyroid function checked every six months, and their serum lithium checked every three months. The aim of this audit is to ascertain whether or not routine blood monitoring for bipolar disorder patients, taking lithium is in keeping with the guidelines.BackgroundLithium has been a mainstay in the management of bipolar disorder since the 1970's; indeed, lithium carbonate was first used in the early 1880's for the treatment of mania. Despite its usefulness however, the drawback of lithium treatment remains its very narrow therapeutic index, toxic side effects and as such its need for close therapeutic monitoring.MethodA list of patients with a diagnosis of bipolar disorder being treated with lithium was collated from an electronic database of psychiatry patients in Cumbernauld Community and inpatients at Glencairn unit Coathill Hospital and Cleland Hospital. A retrospective analysis using Clinical Portal was conducted looking at blood results; Lithium levels checked 3 times a year and Kidney functions and Thyroid function checked twice a year, over the previous year. Our results were then compared to the NICE Guidelines for lithium monitoring to see if they complied with the expected routine monitoring schedule. We may have missed patients open to Community Psychiatric Nurses (CPN) but not open to Consultant psychiatrists. Other group that might have been missed could be open to General Practitioners but not to secondary care. We attempted to contact them but this was unsuccessful.ResultTotal of 690 patients were studied. Of 690 patients 51 patients had the diagnosis of Bipolar Affective Disorder. 49 percent of them were prescribed Lithium. 48percent had their Lithium bloods checked and 60 percent had their Kidney function and thyroid functions checked according to the guidelines. There were no data available for around 7 percent of patients but their Lithium levels were indicated only in Clinical notes.ConclusionThis audit has demonstrated that Lithium monitoring falls short of conforming to accepted standards. Data obtained by this audit have prompted an electronic alert system for patients on Lithium endorsing primary care, mental health and laboratory staff to work together to ensure supporting recommended Lithium monitoring.