bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using electronic clinical records to investigate service use and in-patient care of adults with intellectual disability and/or autism spectrum disorder
Authors: Mutch Jennifer , Sheehan Rory , Marston Louise , Werbeloff Nomi , Osborn David , Hassiotis Angela 
Published: June 2021

AimsTo describe characteristics of adults with intellectual disability (ID) and/or autism spectrum disorder (ASD) accessing care in one mental health Trust.To explore factors associated with in-patient admission/risk of re-admission within 12 months of discharge.BackgroundThere is concern that adults with intellectual disability and those with autism spectrum disorder are frequently admitted to mental health hospitals. The evidence from NHS datasets suggests that this remains a significant issue and is associated with personal, social and economic costs.MethodAdults (≥ 18 years) with ICD-10 diagnosis of “mental retardation” and/or autism who had accessed care in the Camden and Islington Foundation Trust were identified using the Clinical Record Interactive Search (CRIS). The identification process was validated through cross checking of free text in the electronic clinical notes. We compared demographic and clinical characteristics and service use, including length of admission, of 315 individuals with ASD and 339 with ID (with or without ASD). Logistic regression was used to explore factors associated with in-patient admission and re-admission within 12 months of discharge.ResultA greater proportion of adults with ID (with or without ASD) had a diagnosis of psychosis, substance misuse, or dementia whereas diagnosis of anxiety disorder was greater in those with ASD. Antipsychotics and other psychotropics were twice as likely to be prescribed for the ID ± group. Admission to psychiatric in-patient care was greater in those with ID ± ASD (adjusted OR 4.00, 95% confidence interval (CI) 2.41-6.63), men (aOR 2.28, 95%CI 1.39-3.75), younger adults (aOR 0.98, 95%CI 0.97-1.00), and in those with a diagnosis of schizophrenia spectrum disorder (aOR 5.08, 95%CI 3.00-8.61), affective disorder (aOR 2.23, 95%CI 1.29-3.83), personality disorder (aOR 1.94, 95%CI 1.02-3.68), and record of previous inpatient admission (aOR 2.18, 95%CI 1.17-4.05). Having ASD alone was associated with a greater risk of re-admission within one year of discharge, although this difference was not statistically significant (aOR 0.70, 95% CI 0.32-1.52). Comorbid diagnoses of affective disorder or personality disorder were the only significant associations with re-admission (aOR 3.11, 95%CI 1.34-7.23 and aOR 8.28, 95%CI 2.85-24.04, respectively).ConclusionThese findings provide the first longitudinal investigation into the acute care pathway for adults with ID and/or ASD in the NHS. Replication in other trusts is now needed to inform “at risk of admission” registers and guide targeted interventions to prevent admission.
Length of hospital stays in patients with psychosis before and after starting on lurasidone
Authors: Nguyen Uyen , Das Debasis 
Published: June 2021

AimsThis study looked at the differences in the length of hospital stays in number of days, 12 months before and after starting on Lurasidone, in patients with psychosis.MethodA retrospective review of medical records between 2016 and 2019 of patients with psychosis due to all causes at a First Episode Psychosis service in the United Kingdom was performed. Most common side effects, duration of Lurasidone treatment and reasons for stopping Lurasidone were recorded. The length of hospital stays (in number of days) before and after being started on Lurasidone of those had taken Lurasidone for at least 12 months were compared using a paired t-test.Result43 (n = 43) patients had taken Lurasidone at some point during the study period with a mean age of 30.48 years and a male: female ratio of 1.4:1. The average duration of treatment was 327 days. The most common reported side effects were sedation (16%), nausea (7%) and tardive dyskinesia (7%). Among these 43 patients, 19 patients (44%) tolerated and were on Lurasidone for at least 12 months with a mean age of 30.42 and a male: female ratio of 0.42:1. Of these 19 patients, the total number of days of hospital stays within 12 months before and after Lurasidone initiation was 1179 days (mean = 62.05) and 242 days (mean = 16.47) respectively. The paired t-test showed a significant reduction in the average length of hospital stays in these patients within 12 months after Lurasidone initiation (p = 0.0466).ConclusionPatients with psychosis who were on Lurasidone had a statically significantly reduction in the length of hospital stays within 12 months of medication initiation; up to 44% tolerance rate, with better tolerance in female patients and the most common side effects being sedation, nausea, tardive dyskinesia.
Using qualitative methods, what factors do child & adolescent higher trainees and new consultants (within 1 year of appointment), report in choosing their higher training subspecialty?
Authors: Parker Mary , Boylan Jim , Wolstenholme Nicholas 
Published: June 2021

AimsThis Research aims to identify factors reported by recent and current trainees in choosing Child & Adolescent (C&A) Psychiatry for their higher training/career path. The hypothesis is that via thematic analysis prominent factors will emerge to inform future recruitment and retention.BackgroundThe need to attract more doctors into Psychiatry has been identified by NHS, Royal College of Psychiatrists and the Media; Health Education England figures show core psychiatry had lowest fill rates of any specialty in 2016,17 &18.Some subspecialties experience particular difficulties e.g. C&A. Royal College of Psychiatry analysis of workforce in March 2018 showed the numbers of C&A psychiatrists of all grades have fallen by 6.3% in four years and for consultants alone the decrease was 6.9% over the same period.However, very little research has been completed investigating why trainees might choose C&A Psychiatry with a literature search revealing only one report of C&A trainees views in the UK in 2006.MethodA qualitative design was chosen to provide insight into the factors affecting participants in choosing their career.The theoretical framework supporting the study relates to capturing experience via a case study approach, aiming to explore reported issues in a real life context and considering similarities in the cases to inform future recruitment.The Research was approved by The Health Research Authority and local Research & Development departments.Purposeful sampling was used with voluntary participation following informed consent and non-identifiable demographic data were collected and analysed quantatively.Semi-structured interviews to saturation were conducted with fourteen (N = 14) participants asked questions exploring their subspecialty choice. Responses were recorded and transcribed verbatim prior to thematic analysis, including triangulation via a co-coding process to check areas were not over-represented and/or subject to researcher thoughts and possible unconscious biases.ResultSemi-structured interviews included all North-East C&A trainees and 3 recently qualified Consultants.Demographics results included 5 male and 6 female participants and 6 non-UK graduates.Emergent themes were analysed into key findings including:
–interest in children/specialty–specialty experience–supportive supervisors/team–work-life balance–opportunity to impact/intervene early.Limitations include study of a single geographical area and possible researcher bias.ConclusionThis Research provides novel findings re factors influencing career choice of C&A Psychiatry to inform future recruitment and retention. Clear themes have emerged re important recruitment/retention factors and the study highlights need for more research to investigate reasons why C&A is not chosen.
Comparison of hospitalizations in patients on first generation versus second generation long acting injectable (LAI) antipsychotics
Authors: Rasool Seemab , Venan Paster 
Published: June 2021

AimsThere is limited data on the comparison of efficacy between first and second antipsychotic LAIs. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics, significantly reduce hospitalizations as compared to conventional depots.Our aim was to compare hospitalizations in patients on first and second generation LAI antipsychotics.MethodA retrospective observational study was done by reviewing the records of all the depot clinics in South Essex, United Kingdom. A list of patients enrolled and receiving LAI antipsychotics was obtained from the 6 depot clinics. Data were collected by going through the electronic records of the patients on the depot clinic lists and taking down the demographics, diagnosis and the hospital admissions. Other variables like comorbid drug abuse were also recorded.ResultAmongst a total of 346 patients 223 (64 %) were males and 123 (36%) were females. Average age was 50.3 (range 21 to 88 years) and 290 (83%) patients were single. An overwhelming majority of patients 299 (87 %) were not in employment. Regarding the diagnosis, the majority, 237 patients were diagnosed with Paranoid Schizophrenia, 49 patients were diagnosed with Schizoaffective disorder, 38 patients were diagnosed with Bipolar affective disorder, 20 patients had a diagnosis of Delusional disorder and only 2 patients had a primary diagnosis of Mental and Behavioral disorders due to substance abuse. Of the total 346 only 17 patients were on a Community treatment Order.Risperidone was the most commonly used second generation LAI at 26%,Aripiprazole in 10% and Paliperidone was used in 5% patients. Olanzapine LAI was only used in 2 patients. Amongst first generation LAIs Zuclopenthixol, Fluclopentixol were both used in 24%, and Haloperidol in 10% patients. 21 % of patients were reported to be actively abusing drugs.65 (32.6%) of the total 200 patients on Ist Generation LAIs had hospital admissions55 (39.8%) of the total 138 patients on 2nd Generation LAIs had hospital admissionsThis difference was not statistically significant (Z test)- P value of 0.082427ConclusionThe results in our observational study are equivocal, both LAIs providing equitable decrease in the hospital admissions albeit with a slightly favourable outcome (not statistically significant though) attributable to the first generation LAIs. There was a high incidence of unemployment and drug abuse in our cohort of patients, thus targeted interventions can be established in rehabilitation of such individuals.
A randomised controlled trial to investigate the effectiveness of sustained photoprotective behaviour in xeroderma pigmentosum after intervention
Authors: Searle Tamara , Walburn Jessica , Norton Sam 
Published: June 2021

AimsThis study aimed to investigate whether an intervention designed to improve photoprotective behaviours is effective at changing behaviour and whether any change could be maintained.BackgroundXeroderma Pigmentosum (XP) is a rare condition in which patients are at risk of malignancies when exposed to ultra-violet radiation (UVR). Sufferers must take extra precautions to protect themselves from UVR. They must apply sunscreen to exposed skin, wear thick clothing, gloves, and a UVR-protective visor. Treatments include preventative photoprotective measures; the use of sunscreen and protective clothing. Additionally, frequent eye and skin examinations are required and swift removal of any premalignant lesions.MethodIn this randomised controlled trial, 16 participants with XP were given questionnaires at 4 time points; baseline, post-intervention, 5 months and 9 months post-intervention. The intervention involved 7 one-on-one counselling sessions, as well as telephone consultations. Counselling sessions encouraged photoprotection adherence, self-efficacy and discussions of any barriers to improving photoprotective behaviour. This study focused on psychosocial variables, attitudes and photoprotection. Questionnaires included the photoprotection self-efficacy questionnaire, Self-Reported Behavioural Automaticity Index, Short Warwick-Edinburgh Mental Wellbeing Scale, Quality of Life and Brief Photoprotection Adherence Questionnaire.ResultThe intervention was shown to have no significant effect on participants’ questionnaires scores. Univariate ANCOVA revealed a group effect between follow-up 1 (FU1) and follow-up 2 (FU2); η2 = 0.422 for self-efficacy in wearing photoprotective clothing. A group effect was identified from BL to FU1 and FU1 to FU2; η2 = 0.343 and η2 = 0.378 respectively in how often participants reapplied sunscreen to their face when outside for longer periods. Univariate ANCOVA revealed no group or time effect for the other outcome variables; for example, sunscreen self-efficacy.ConclusionThe intervention had no significant effect on photoprotective behaviour questionnaire scores. Future research could focus on recruiting more participants globally to generate more statistically powered results. Research should focus on producing a maintainable intervention so that any positive change would produce better long-term health outcomes. This study lays the foundations for future XP research, which will be vital to improve understanding and enhance photo protective behaviour.
How does self-report of anxiety symptoms compare with observer assessments after acquired brain injury?
Authors: Seelochan Alex , Paramlall Mark , Tyagi Himanshu , Kandasamy Rohan , Bakar Ida , Holloway Cameron , Harding Samantha , Gadhvi Anna 
Published: June 2021

AimsComorbid anxiety and mood disorders occur in 30% and 60% of individuals post-ABI (acquired brain injury), respectively (Juengst et al, 2014). The presence of psychiatric symptoms correlate to poorer outcomes in post-stroke rehabilitation, worsened quality of life (QoL), and deficits in memory, attention, and processing speed that persists years following the index event. Despite this, it is unclear whether to what degree anxiety impacts cognition. Furthermore, the literature on this topic is inconsistent when comparing subjective and clinician measurements. This study seeks to ameliorate this gap in literature by analyzing how clinicians’ measures of anxiety and cognitive performance correlate with subjective assessments of patient's own anxiety symptoms.MethodIndividuals with an ABI who were seen in a clinical neuropsychiatry outpatient clinic between 2019 and 2020 completed a GAD-7 (Generalized Anxiety Disorder-7) questionnaire (patient's self-report of the severity of anxiety symptoms) and an observer completed a Neuropsychiatric Inventory Questionnaire (NPIQ) including a subscale for anxiety (NPIQ-A). Participants also underwent a formal cognitive examination with the Montreal Cognitive Assessment (MoCA). A total of 24 ABI patients (depressed ABI and non-depressed ABI) were analyzed for variation, statistical agreement and correlation. Here, total anxiety scores (using GAD-7 scores), anxiety severity (correlating category based on total GAD-7 score) were compared against the objective measures for anxiety (NPI-QA) and cognition (MoCA). In order to standardize MoCA scores, z scores were used in the statistical analysis.ResultThe patient's subjective raw scores of anxiety were statistically significantly different from the corresponding scores from objective observers on Wilcoxon-Rank Sum tests (p < 0.01), however, there was a statistical correlation between GAD (categorized by severity level) and NPI-QA (p = 0.75). Spearman Rank Correlation did show positive, but, statistically insignificant correlation between dyads of these independent variables (including GAD7/NPIQ-A, GAD 7 categorised/NPIQ-A, GAD7/MoCA, GAD 7 categorised/MoCA).ConclusionThese findings indicate (1) self-reported measures of anxiety (GAD7) in ABI were inconsistent with objective measures of anxiety in this cohort, (2) anxiety measures did not demonstrate significant correlation when compared to objective measures for cognitive function, and (3) ABI patients did not display good insight into the severity of their anxiety symptoms as measured by the GAD7. Further research should focus on utilizing other subjective measurement tools for anxiety and/or clinician evaluation tools with NPIQ-A.
Before the light fades, who blows the whistle? : a narrative review on sports dementia
Authors: Sodiya Olusegun , Edafegwotu Ovwigho , Jeje Jide 
Published: June 2021

AimsTraumatic brain injury is a leading risk factor for degenerative conditions. Although in the past this was believed to affect mostly boxers, recent studies have expanded the at-risk population to include American football players, rugby players, hockey players and other athletes involved in contact sports. Hence, there has been growing interest in the media and the public at large on the short and long term impacts of head trauma in sportspersons. The aim of this study is provide an overview of the impact of traumatic brain injury in contact sports and the link to early onset dementia.MethodFor the purpose of this study we conducted a literature search using PubMed electronic base and Google scholar. The search was made in February 2021 and using the following keywords ‘early onset dementia’, ‘presenile dementia’, ‘traumatic brain injury’, ‘contact sports’, ‘sportsmen’, and ‘athletes’. The search words were used individually and in combination to gather relevant articles. Types of studies included were case reports, case series, cohorts, cross-sectional, editorial and newspaper articles.ResultMost of the published studies have shown significant associations between repeated head trauma and brain morphological changes evidenced by the presence of myelinated axons, astrocytosis, perivascular neuroinflammation and formation of phosphorylated Tau proteinopathy. These contribute significantly to alterations in axonal functioning and synaptic transmissions which sets the stage for neuronal degeneration. These changes affect both the macroscopic and microscopic structures with consequent neurochemical disturbances and functional deficits which, manifest primarily as executive dysfunction.ConclusionCurrent evidence supports an association between participation in contact sports and neurodegenerative disease, despite the protective aspects of sporting activities. Overall the studies reviewed have shown that brain injury remains a potent risk factor for the early onset dementia seen in sportspersons. Consequently, it is prudent for more proactive and precautionary measures to be put in place to reduce impacts of head injury and to better identify and manage brain injury in sports.
Establishing prevalence of diagnosis of personality disorder across high secure forensic services using the ICD 10 and ICD 11 classification
Authors: Soni Anju , Sengupta Samrat , Treasaden Ian 
Published: June 2021

AimsThere has been an increasing recognition of the lack of clinical validity of different types of ICD10 personality disorder.The prevalence was established among patients in a high secure hospital in England of those with either a primary or secondary diagnosis of personality disorder and its recorded type according to ICD10 and then ICD11.The new ICD11 classification increased the validity of diagnosis of personality disorder as well as its severity.BackgroundICD 11 has proposed the dropping of the classification of personality disorder based on particular types of personality disorder and instead adopting a diathesis model based on 2 dimensions: presence of personality disorder and three levels of severity (Mild, Moderate and Severe) and the option of specifying one or more prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality, and Anankastia) and also specify a Borderline Pattern qualifier.MethodThe electronic medical records were used to establish the presence and type of personality disorder using the criteria of ICD10 and ICD11.The researchers assured reliability by rating some vignettes using the Schedule for Personality Assessment from Notes and Documents (SPAN-DOC) before rating actual cases.ResultFrom a total population of 208 patients, 64(30.8%) were classified as having either a primary or secondary diagnosis of personality disorder according to the ICD 10.30 (47%) had dissocial personality disorder (DSPD), 19(30%) emotionally unstable personality disorder (EUPD) and 8(13%) paranoid personality disorder. 20 (31%) had a comorbid diagnosis of mental illness and about a tenth had diagnoses of multiple personality disorders. These types of personality disorder diagnosed by the researchers using ICD 10 did not always match the types of personality disorder diagnosed by clinicians at the hospital.All patients met the criteria of personality disorder under ICD 11 but the number with a borderline specifier was greater than those with an ICD10 diagnosis of EUPD. Using the trait domain qualifiers in ICD 11, patients with ICD 10 diagnoses of EUPD or DSPD showed dissociation and disinhibition, with those with a DSPD showing low and those with EUPD high negative affectivity.ConclusionThe results confirm that while psychiatrists in a high secure hospital reliably diagnose the presence of a personality disorder, they are much less able to make an accurate diagnosis as to the actual type of personality disorder. The new ICD 11 classification will increase the clinical validity of the diagnosis of personality disorder and its severity.
How can automated linguistic analysis help to discern functional cognitive disorder from healthy controls and mild cognitive impairment?
Authors: Beavis Lizzie , O'Malley Ronan , Mirheidari Bahman , Christensen Heidi , Blackburn Daniel 
Published: June 2021

AimsThe disease burden of cognitive impairment is significant and increasing. The aetiology of cognitive impairment can be structural, such as in mild cognitive impairment (MCI) due to early Alzheimer's disease (AD), or in functional cognitive disorder (FCD), where there is no structural pathology. Many people with FCD receive a delayed diagnosis following invasive or costly investigations. Accurate, timely diagnosis improves outcomes across all patients with cognitive impairment. Research suggests that analysis of linguistic features of speech may provide a non-invasive diagnostic tool. This study aimed to investigate the linguistic differences in conversations between people with early signs of cognitive impairment with and without structural pathology, with a view to developing a screening tool using linguistic analysis of conversations.MethodIn this explorative, cross-sectional study, we recruited 25 people with MCI considered likely due to AD, (diagnosed according to Petersen's criteria and referred to as PwMCI), 25 healthy controls (HCs) and 15 people with FCD (PwFCD). Participants’ responses to a standard questionnaire asked by an interactional virtual agent (Digital Doctor) were quantified using previously identified parameters. This paper presents statistical analyses of the responses and a discussion of the results.ResultPwMCI produced fewer words than PwFCD and HCs. The ratio of pauses to speech was generally lower for PwMCI and PwFCD than for HCs. PwMCI showed a greater pause to speech ratio for recent questions (such as ‘what did you do at the weekend?’) compared with the HCs. Those with FCD showed the greatest pause to speech ratio in remote memory questions (such as ‘what was your first job?’). The average age of acquisition of answers for verbal fluency questions was lower in the MCI group than HCs.ConclusionThe results and qualitative observations support the relative preservation of remote memory compared to recent memory in MCI due to AD and decreased spontaneous elaboration in MCI compared with healthy controls and patients with FCD. Word count, age of acquisition and pause to speech ratio could form part of a diagnostic toolkit in identifying those with structural and functional causes of cognitive impairment. Further investigation is required using a large sample.