bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do core psychiatry trainee cognitive behaviour therapy cases meet training needs? An evaluation of core psychiatry trainee delivered CBT cases in Sheffield: implications for training and services
Authors: Abayaratne Dasal , Birkett Russell , Davies John 
Published: June 2021

AimsThis evaluation aims to understand if Cognitive Behaviour Therapy (CBT) cases for Core Psychiatry Trainees (CPTs) in Sheffield provide good training in therapy skills and if these can be integrated into general psychiatric practice.BackgroundCompletion of psychotherapy cases part of the curriculum for CPTs, with cognitive behavior therapy being one of the common modalities used. Whilst there is evidence that trainees often provide competent therapy it is unclear what cases are appropriate and how these contribute to wider CPT learning objectives.MethodCPTs who had completed a clinical case in CBT at a tertiary psychotherapy service were identified. All were surveyed and patient demographics and outcomes also collated.ResultThe results showed a significant impact on trainees understanding of CBT, applying theory to clinical context, and changed future practice. Despite being complex, 64% of patients needed no further therapy and 42% were discharged from mental health services.ConclusionThe evaluation demonstrates the positive outcomes for patients, trainees, future clinical practice, and a move towards collaboration as laid out in the Five-year forward view for mental health. This suggests that medical trainees have a valuable contribution, and role despite minimal experience in CBT.
‘Comfortable, safe and valued’: an analysis of the impact of COVID-19 on Hertfordshire's Community Perinatal Team
Authors: Adeyemi Stephanie , Cohen Sarah 
Published: June 2021

AimsThis study aimed to assess the impact that the COVID-19 pandemic has had on the Hertfordshire Community Perinatal Team (CPT) group interventions and the innovations made.BackgroundThe CPT is a multidisciplinary mental health service that runs three groups: Circle of Security (CoS), Emotional Coping Skills (ECS) and a peer support group - Wellbeing and Lifestyle. The service has received an increase in referrals during the COVID-19 pandemic.MethodMethods: Team member and client semi structured interviews were conducted with answers transcribed in real time and analysed. Patient clinical records were accessed via PARIS and analysed in order to identify patient demographics within each group and whether these had changed during the pandemic. Clinical outcome measures and client feedback were evaluated to see whether the change in groups is impacting their clinical effectiveness.ResultResults: Innovations made by the CPT include: groups becoming virtual, launching of the new Circle of Security Group which helps women tackle the ‘Ghosts in the Nursery’ and strengthen maternal bonds, restructuring existing groups, breakout room forums and incorporating communication platform apps such as Whatsapp. The Wellbeing and Lifestyle Group increased in size and reach (7 women from 7 areas in 2019 vs 12 women from 12 areas in 2021) with an increased retention rate (71% in 2019 vs 100% in 2021) and a decreased attrition rate (29% in 2019 to 0% in 2021). The Emotional Coping Skills group experienced similar changes (10 areas represented in 2019 vs 15 different areas in 2021) with an increased retention rate (58% in 2019 vs 100% in 2021) and decreased attrition rate (42% in 2019 vs 0% in 2021).ConclusionThe Hertfordshire Community Perinatal Team has responded to the pandemic by innovating existing groups and creating new forums; many of which will continue on even after the pandemic ceases. The groups have acted as a lifeline for women breaking up the monotony and isolation of lockdown life and providing an invaluable space for women to be heard.
Reviewing suitability of Essex Partnership University Foundation NHS Trust out of area locked rehab placements
Authors: Ali Shereen , Karale Miland , Aboelenin Shaimaa , Ahmed Ayesha , Adulesi Dolly , Adebayo Emmanuel 
Published: June 2021

AimsTo look at 14 EPUT out of area patient profiles, map their journey to the current locked rehab placements -To review the appropriateness of placement of 14 patients through reviewing whether the care provided is achieving the rehabilitation goals.To look at patients’ needs and whether the local alternatives can provide the careBackgroundRehabilitation services aim to help complex General Adult Mental health patients reintegrate in the community by promoting independent living skills. Some complex mental health patient's care needs mandate a specialist rehabilitation services. Currently there has been a nationwide shortage of local rehabilitation services. This resulted in placing complex needs patients out of area in locked rehabilitation hospitals and miles away from their local community connections. Families and local community team providers travel miles to keep in contact with their complex need persons. The NHS five year plan includes minimizing the current out of area placements and for local services to work together as per CQC recommendations to work together and bring those individuals closer to home.MethodWe designed a tool and examined the electronic records for all 14 out of area placed patient profiles, mapping their clinical journey and reviewing whether the care provided is achieving the rehabilitation goals.Result(N = 14), Patient profiles: 78.5% had residual symptoms (Psychotic symptoms 85%). Patient's Illness profile; treatment resistant with residual symptoms in 71.4% and 7% had comorbid illicit substance misuse, other illness profiles 21.4%. History of alcohol and illicit drug misuse was present in 78.5% and 45% of them were using illicit substances more than 5 years. .patients’ risk profile revealed 86.7% had history of non-compliance. Attempted suicide 21.4% has attempted suicide at list once in which 1/3 of them had more than one attempt. 64.3% Had positive history of offending behavior. All patients in the sample had history of violence 85.7% had risk of vulnerability and self-neglect, 28.5% has history of carrying weapons, 35.7 had a previous Custodial sentence. Average Duration of illness average 16.7 years, average distance from home was 149 miles though clozapine was considered in 92.8% only 35.7% of sample was on clozapine, and the other 64.3% were on combinations. Only 35.7% were on depot.ConclusionThere is a need for expert input for advice regarding complex Management of residual symptoms and rehabilitation needs in the community. Health and social care joint working is needed.
Elderly offenders at Wathwood Hospital: perspectives and practicalities
Authors: Chaudhry Sidra , Hayes Gwilym 
Published: June 2021

AimsThe following project explores where Wathwood Hospital stands in provision of services to its elderly patients.BackgroundThe only dedicated forensic medium secure unit for elderly offenders in England is the St. Andrews medium secure unit in Northampton with only 17 beds. Due to the limited beds, other units must accommodate elderly patients, which raises the question whether these units can provide the appropriate services for this very vulnerable population.MethodInclusion Criteria:Male>55 years of ageAdmitted from 2012 onwards (from when database was maintained)Data were gathered using patient electronic records including index offence, mental disorder, physical health comorbidities and discharge destinations. Patient identifiable data were anonymized to protect their identities.A staff survey was also conducted to find their perspective on managing elderly patients and whether Wathwood Hospital had the appropriate resources for elderly offenders in their area of work.ResultA total of 220 referrals were searched with only 9 patients >55 years. Index offenses, mental disorder diagnoses, physical comorbidities including cognitive assessments in the form of memory tests and brain imaging were also collated for identified patients from electronic patient records.Index offences included violence against person, arson, homicide, robbery, threatening behaviour and dangerous driving and affray. Diagnoses included learning disability, delusional disorder, paranoid schizophrenia, bipolar affective disorder, alcohol dependence, personality disorder and depressive disorder.Patients had multiple comorbidities such as diabetes, COPD, hypertension, coronary artery disease and musculoskeletal problems. Out of the nine admitted patients, only six had an ACE with an average score of 70.83. Five patients had brain imaging, with two normal results and the others showing some degree of atrophy and ischemic changes.Discharge destinations included medium secure units, low secure unit and prison. One patient unfortunately died during admission and four are still inpatients.A staff survey conducted showed their perspective on the challenges in managing elderly patients and whether Wathwood Hospital had the appropriate resources for them to work with elderly offenders in their area of work. All results will be explained through tables and graphs.ConclusionIt's evident that there are challenges in managing elderly patients in units not specifically designed to manage them. This is also due to the lack of geriatric training and resources available to allied health care professionals to carry out their respective work. It's therefore crucial we formulate more inclusive strategies to address these challenges.
A retrospective analysis comparing clinical outcome measures pre- and post- the introduction of telehealth in a community-based psychiatry clinic in a tertiary medical centre
Authors: Dhar Arup , Edwards Liam , Waerea Moana 
Published: June 2021

AimsThe aim of this retrospective analysis was to look at the effect that telehealth had on patient outcomes and the therapeutic alliance.MethodClinical outcomes measures were collected prospectively as part of routine clinical care. Outcome measures were administered at patients’ initial and final appointment. Information was merged into a single database and imported into IBM SPSS for retrospective analysis. The following measures were administered at the beginning and end of treatment and were used to evaluate patient progress; Health of the Nation Outcome Scale (HoNOS), Life Skills Profile (LSP), Session Rating Scale (SRS), Outcome Rating Scale (ORS).ResultTwo cohorts were derived from the clinic; the first cohort (n = 90; 53 females; 37 males; M = 35.72 years; SD = 12.12 years) comprised of those patients whose care occurred between 23/09/2019 and 22/03/2020 and did not receive telehealth appointments. The second cohort (n = 122; 68 females; 54 males; M = 36.2 years; SD = 12.78 years) were those patients who presented to the clinic and were discharged between 23/03/2020 and 21/09/2020 and received at least one telehealth appointment. In the pre-telehealth cohort, mean HoNOS scores at baseline were 17.87 compared to 13.53 at discharge, mean LSP scores at baseline were 10.76 compared to 9.01 at discharge, mean SRS scores at baseline were 34.17 compared to 36.04 at discharge, and mean ORS scores at baseline were 12.97 compared to 21.28 at discharge. In the post-telehealth cohort, mean HoNOS scores at baseline were 14.45 compared to 10.50 at discharge, mean LSP scores at baseline were 7.85 compared to 7.19 at discharge, mean SRS scores at baseline were 36.04 compared to 35.36 at discharge, and mean ORS scores at baseline were 18.83 compared to 15.85 at discharge.ConclusionResults show that telehealth did not impact negatively on the therapeutic effect of clinical sessions, highlighted by similar reductions in HoNOS and LSP scores. It was seen in the post-telehealth cohort that there was worsening in the subject-rated scales (SRS and ORS) which was not seen in the pre-telehealth face-to-face cohort. Thus, there seems to be a discernible negative difference from the patient's perspective in the clinical sessions. This may be due to the difficulties in therapeutic alliance using the telehealth platform. We appreciate that there are a number of confounding factors, especially the effect of COVID-19 isolation. Telehealth is a useful addition to our assessment and treatment paradigms and its use should continue; however, we should be aware of the potential negative effect on therapeutic alliance.
What happens to people admitted to a specialist dementia unit in the west of Scotland?
Authors: Donaldson Andrew , Patrick Craig , Short Lindsay , Maginnis Helen 
Published: June 2021

AimsRecent local research examined mortality rates following admission to a dementia ward. We wanted to expand on this work and include other important health outcomes for patients admitted to our specialist in-patient dementia unit in the west of Scotland. This would provide a comprehensive overview of our in-patient population, aid service review and improve care. We hypothesised that patients admitted would be physically frail, have a significant mortality rate and would likely require long-term care post discharge.MethodThe clinical notes for each admission to the unit for one year were examined (total 62). We extracted data from a number of different areas such as demographics, mortality rates, discharge destination, readmission rates and prescribed medications.Result60% had an Alzheimer's/mixed dementia diagnosis. Average length of stay was 64 days. 62% were discharged to a care home (50% of this total had lived at home prior to admission), 18% to complex care and 20% to the community. 66% were prescribed an antipsychotic and the average number of medications was 8.4. 35% had a readmission under general medicine within a year of discharge. 19% died whilst an inpatient and a further 30% had died one year post-discharge (total one-year mortality of 44%).ConclusionPeople admitted to our dementia unit are physically frail, with only 20% returning to live in the community, 35% being readmitted to a general medical ward within a year of discharge and 44% dying during the admission or within a year of discharge. We need to bear these results in mind when considering if hospital admission is appropriate and ultimately further develop our skills in palliative and end of life care in order to provide those people admitted to our dementia unit (and those who remain at home) with the highest standard of care.
Evaluation of a specialist service model for treating body dysmorphic disorder (BDD): application of National Institute for Health and Clinical Excellence Guidelines for BDD (NICE, 2006)
Authors: Govender Anusha 
Published: June 2021

AimsBody dysmorphic disorder (BDD) is still poorly recognised with a dearth of research into treatment. The OCD/BDD Service (South West London St. George's Mental Health NHS Trust) is a specialist service offering treatment for BDD using the National Institute for Health and Clinical Excellence (NICE) stepped care model for BDD as a basis for service provision.This is the only known study to date to evaluate the implementation of the NICE guidelines recommended treatment for BDD in clinical practice. Furthermore, a sample of patients and clinicians were interviewed to elicit their evaluation of treatment.MethodA total of 48 patients with a primary diagnosis of BDD who were offered treatment between 2006 and 2018 were identified. Questionnaires routinely completed at time of assessment were Yale Brown Obsessive Compulsive Scale for BDD (YBOCS-BDD); Montgomery-Asberg Depression Rating Scale (MADRS); Beck Depression Inventory (BDI) and Sheehan Disability Scale (SDS). Assessments were conducted by clinicians with expertise in BDD. Clinical data including risks and sociodemographic information were collated and analysed. Data were examined with intention to treat analysis. Thematic Analysis (TA) was used to analyse data from semi-structured interviews conducted with ten clinical staff and seven patients regarding their experiences of treatment. Qualitative data were coded and themes identified.ResultClinical data at assessment indicated impaired functioning plus high risks and substance misuse. There was a higher percentage of females (58%); average duration of BDD was 19.23 years. Clinical outcomes indicated significant improvements in the total sample from baseline on measures of BDD, depression and functioning (p = 0.001). Patients described their progress in terms of living skills, social interactions and quality of life. The main themes identified included the significance of the therapeutic relationship expressed by both patients and clinicians; the lack of early intervention and knowledge of BDD in healthcare.ConclusionCurrent recommendations for treating BDD were found to be beneficial overall. However, there are patients who are non-responders and including experiences of patients’ and clinicians’ perspectives provided valuable insights into other options for treatment which are lacking and could enhance current recommendations where CBT and medication have not enabled progress. The young onset age with long duration, highlights the need for developing awareness of BDD so that it is not a hidden disorder.
A review of patients discharged from Shannon Clinic- are shorter stays in secure hospitals associated with poorer patient outcomes?
Authors: Grimason Amy , East Adrian 
Published: June 2021

AimsShannon Clinic was established as the regional secure unit in Northern Ireland in 2005 and provides medium secure care to Northern Ireland's population of 1.8 million. Previous research has shown that inpatient admissions are shorter when compared to other secure units. Northern Ireland has less secure beds per population than the other UK nations, which can be a driver for shorter hospital stays. This review was undertaken to examine if shorter inpatient stays were associated with poorer outcomes.MethodAll the discharges from Shannon Clinic to the Southern Health and Social Care Trust were reviewed over a period of 10 years (2009-2019). The outcome measures examined were mortality, readmission rate and reoffending rate. Crude rates for these were calculated. To allow for comparison, these rates were compared to the systematic review findings of Fazel et al (2016), which was an international review examining patient outcomes following discharge from secure hospitals.DUNDRUM 1 Triage Security scores for the patient group were also reviewed, to ensure a sample representative of patients needing medium secure care.Result41 patients had been discharged during this period. DUNDRUM 1 Triage Security scores ranged from 2.44 to 3.2.The average length of admission was 415.5 days. This is shorter than the average reported by Fazel et al (2016).The crude rates for all of the variables calculated (mortality, readmission to hospital and reoffending) for patients discharged from Shannon to the trust were less of those reported in the systematic review by Fazel et al (2016).ConclusionThis review suggests that patient outcomes are not negatively impacted by shorter inpatient stays in secure hospitals. A possible reason for this is the regional model of care approach, which helps ensure continuity and safe management of the transition between secure care and the community. In addition, there is close multidisciplinary working with supported living providers in the trust area to ensure patients' needs are met.Following this initial review, there are now plans to review discharge outcomes for all patients discharged during this period. There are five trust areas in total in Northern Ireland so this will allow for comparison across the region.The review has also been used within the unit to develop information leaflets for patients at admission and posters for display in the unit. We hope this will provide clarity to patients about secure care and a sense of optimism from the start of their admission.
Characterising a cohort of patients referred to a liaison psychiatry service from the Intensive Care Unit
Authors: Hanks Jennifer , Fai Lam Chun Chiang Sin , McMullen Isabel , Parsons Martin 
Published: June 2021

AimsThis is descriptive study of a cohort of patients referred to a liaison psychiatry service from the intensive care department of a major London teaching hospital and trauma centre. The objective was to characterise key patterns in reasons for referral, nature of input, and gain a general sense of the workload. The rationale for collating this information was the consideration to developing a specific intensive care liaison service given the increasing evidence about the cognitive and mental health impacts of post-intensive care syndrome and the need for a coordinated management approach between stakeholders.MethodA cohort of 80 patients referred to liaison psychiatry service over a 6-month period from May to October 2020 was used. Descriptive statistics were used to characterise the patient's age, referring ward, reason for admission and referral, nature of input, number of reviews, previous engagement with mental health services, whether substance abuse or self-harm were related to the admission, and the destination upon discharge.ResultThe age range of patients at point of referral was 25-80 years. For 25% of patients, this admission marked their first engagement with secondary mental health services and for around 50%, not only was a new diagnosis given during the admission, but there was no recorded history of any psychiatric diagnoses. Around 10% of patients were referred for management of delirium. Anxiety disorder accounted for the greatest proportion of diagnoses upon discharge, at 22%. There was much variability in the number of intensive care ward reviews carried out, ranging from one to over 10.In 24%, self-harm led to presentation and 18% had comorbid substance misuse. Medication review was the single most common reason for referral in 13%, whereas requests for talking therapy and capacity assessments were 5% and 2% respectively. The vast majority of patients required a level of ongoing psychiatric input warranting community involvement or admission.ConclusionThis cohort often required detailed work-ups, new diagnoses and a high level of subsequent psychiatric management following discharge from hospital. The wide age range of patients meant that both working age and older adult liaison teams were involved in assessing referrals. Consideration could be given to a specific intensive-care liaison service due to the workload and complexity of needs, as well as the increasing awareness of the need for family support and early inclusion both for their benefit and that of the patient, particularly when the proportion of new diagnoses in this cohort is considered.