bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatry Trainee Burnout in the United Kingdom: The BoSS Study
Authors: Beezhold J.N. , Beezhold K. , Malik A. , Lydall G. , Podlesek A. , Jovanovic N. 
Published: June 2017

IntroductionBurnout syndrome is defined by three domains: emotional exhaustion, cynicism and reduced professional efficacy. Junior doctors have a high susceptibility to burnout reflected in the high prevalence identified in previous work. This is a significant issue as burnout has measurable effects on work performance. There has been limited research conducted on burnout in psychiatry trainees in the United Kingdom.AimThis paper takes a step towards addressing this gap by extracting the data concerning UK psychiatric trainees collected in the international burnout syndrome study (BoSS), which aimed to assess the prevalence and contributing factors of burnout among psychiatric trainees from over 20 countries, and presenting the findings concerning UK trainees.MethodData collected included demographic data and information related to working hours, bullying, harassment and stalking, supervision, suicidal ideation, depression (PHQ−9), and a personality trait assessment. Burnout syndrome was measured using the Maslach burnout inventory (MBI-GS). A total of 3964 psychiatry trainees in the UK were invited, of which 1187 (30%) responded including 811 (20%) providing complete responses for MBI-GS.ResultsThe mean age was 33 years, and 49.1% of respondents were male. Gender distribution of participants was the same as non-participants. Mean scores were 2.6 for exhaustion, 2.1 for cynicism and 4.5 for professional efficacy; and severe burnout was found in 309 (38%).ConclusionThree factors were positively associated with severe burnout: long working hours, lack of clinical supervision and not having regular time to rest.Disclosure of interestThe authors have not supplied their declaration of competing interest.
The Psychiatric Morbidity and Mortality Teaching Conference to Improve Patient Safety: Lessons Learned at the Massachusetts General Hospital
Authors: Freudenreich O. , Smith F. , Wozniak J. , Fava M. , Rosenbaum J. 
Published: June 2017

IntroductionA morbidity and mortality (M&M) conference is a time-honored educational format in surgery and medicine to review bad patient outcomes and learn from mistakes made. However, despite the value of learning together as peers from difficult cases with unexpected outcomes, most psychiatric departments in the United States do not have an M&M conference. Several years ago, the department of psychiatry at Massachusetts's general hospital in Boston began a monthly M&M conference.ObjectivesDescribe our department's experience with the M&M format as an educational vehicle to teach patient safety and improve care in an increasingly complex care environment.AimsIntroduce the M&M format that we have developed at our department and obstacles encountered.MethodsWe reviewed the content of our four years of M&M conferences; the feedback received from participants after each conference; and changes introduced to improve the conference.ResultsOur department has successfully implemented and sustained a monthly psychiatric M&M conference that is well attended and valued. A critical decision was mandatory involvement of residents to prepare cases in conjunction with a dedicated faculty member. A structured presentation using a root cause analysis framework to guide the discussion in order to harness the wisdom of the group allows for a more comprehensive understanding of factors leading to bad outcomes, including systems-based problems.ConclusionsA psychiatric M&M conference can teach individual clinicians about patient safety. Developing a departmental mechanism to apply lessons learned in the conference to improve hospital systems is the next task.Disclosure of interestThe authors have not supplied their declaration of competing interest.
How Satisfied are Undergraduate Students with Interprofessional Training? Meta-analysis of a Pilot Study
Authors: Lazzari C. , Masiello I. 
Published: June 2017

IntroductionLearning to work in an interprofessional team entails satisfaction in working with others.ObjectiveContextual assessment of the degree of satisfaction of undergraduate healthcare students (doctors, nurses, occupational therapists and physiotherapists) during interprofessional education (IPE).AimsMeta-analysis of degree of satisfaction contextually assessed during major interprofessional learning moments.MethodsThirty-six undergraduate health care students (medical students, nursing students, occupational therapy students) answered questions on a 5-point Likert scale (from “Very satisfied” to “Very dissatisfied”). A meta-analysis with Tau2 (t2), Cochrane's Q, and I2 analyzed IPE activities: self-reflection after daily training, interactions with teachers, discussion of clinical cases during ward rounds and patient care as a team.ResultsMeta-analysis reported significant heterogeneity in the degrees of satisfaction (Fig. 1): 47.2% being “satisfied” with reflection after IPE, {t2 = .011; Q (5df) = 30.03; I2 = 83%, P < .0001}; 45% being “satisfied” during interactions with their teachers {t2 = .01; Q (5df) = 25.74; I2 = 80%, P < .001}; 31.4% being “satisfied” about the discussion of a clinical case during ward rounds {t2 = .009; Q (5df) = 22.61; I2 = 77.89%, P < .001}; and 44.4% being “satisfied” about patient care with the interprofessional team {t2 = .009; Q (5df) = 22.99; I2 = 78.25%, P < .001}.ConclusionsUndergraduate students show satisfaction with IPE activities. This helps improve the quality of care and teamwork in the busiest wards.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Parental Causal Explanations and Treatment Seeking in Attention Deficit Hyperactivity Disorder: Perspectives From a Developing Nation Based on Process Theory
Authors: Shah R. , Sharma A. , Grover S. , Chauhan N. , Jhanda S. 
Published: June 2017

IntroductionCultural factors have an important role in causal model of symptoms, threshold for treatment seeking and acceptability of professional help in ADHD.Objectives and aimsTo explore causal explanations and treatment seeking amongst parents of children with ADHD and understand these in context of a largely collectivistic culture as in India.MethodsIn-depth semi-structured interviews were conducted with 27 consenting parents; data interpreted using process theory.ResultsInitial reaction to psychiatric referral revealed themes of disbelief/surprise, feeling confused/offended and lag of 6–36 months to consultation. Parents most commonly attributed causality to psychosocial reasons (lack of motivation/volitional, inadequate disciplining), while few gave one or more biomedical explanations (epilepsy, brain damage, low birth weight, nutritional deficiency, maternal ill health, low intelligence) alone or with a psychosocial reason. Despite the initial reaction, all but 1 parent was relieved with medical explanation, accepted diagnosis, and perceived need for treatment. Most parents were willing to start/continue medication if doctor suggested so as “he/she would know the best”. All parents expressed that counseling was needed.ConclusionsInitial reactions and delay in treatment seeking is understood in light of cultural attitudes towards mental illnesses and psychiatric consultation in developing nations. More importantly, despite initial reluctance, most parents accepted biomedical explanation and treatment. The doctor patient relationship modeled on a guru-chela relation of complete trust in authority can explain this process change. We conclude that cultural attitudes not only influence causal models and initial treatment seeking, but also modify process of help seeking.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Trajectories of depression and anxiety symptoms in coronary heart disease strongly predict health care costs
Authors: Palacios J. , Khondoker M. , Mann A. , Tylee A. , Hotopf M. 
Published: June 2017

IntroductionThere is little information describing the trajectories of depression and anxiety symptomatology in the context of coronary heart disease (CHD), and their comparison according to sociodemographic and disability measures, cardiac risk factors, and health care costs.MethodsUsing a primary care cohort of 803 patients with a diagnosis of CHD, a latent class growth curve model was developed to study the distinct trajectories of depression and anxiety symptoms (using the hospital anxiety and depression scale) over a 3-year period comprised of 7 distinct follow-up points. Multinomial regression analysis was then conducted to study the association between latent classes, baseline risk factors, and total health care costs across time.ResultsThe 5-class model yielded the best combination of statistical best-fit analysis and clinical correlation. These classes were as follows: “stable asymptomatic” (n = 558), “worsening” (n = 64), “improving” (n = 15), “chronic high” (n = 55), and “fluctuating symptomatology” (n = 111). The comparison group was the “stable asymptomatic” class. The symptomatic classes were younger and had higher proportion of women, and were also associated with non-white ethnicity, being a current smoker, and having chest pain. Other measures of disease severity, such as a history of myocardial infarction and comorbidities, were not associated with class membership. The highest mean total health care costs across the 3 years were the “chronic high” and “worsening” class, with the lowest being the “improving” and “stable low” classes. The total societal costs for patients in the “chronic high” and “worsening” class were significantly higher, as compared to the “stable low” class.Disclosure of interestThe authors have not supplied their declaration of competing interest.
The effects of brain stimulation with direct electrical current in the treatment of resistant obsessive-compulsive disorders
Authors: Najafi K. , Fakour Y. , Zarrabi H. , Khalkhali S.M.R. , Ramezanghorbani N. , Najafi T. , Shabafrouz S. 
Published: June 2017

IntroductionDirect brain stimulation with electrical currents is an effective treatment for depression and considering is an effective supplementary treatment of resistant obsessive-compulsive disorder.AimAssess the effects of brain stimulation with direct electrical current in the treatment of resistant obsessive-compulsive disorders.MethodsThe present study is a paired clinical trial conducted in a group of 42 patients diagnosed with treatment resistant obsessive-compulsive disorder in the province of Rasht. Direct brain stimulation with electrical current was performed according to the protocol throughout the 15 treatment sessions. The effectiveness of the first, fifth, tenth and fifteenth session(s) of treatment were evaluated based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and results were analyzed using Repeated Measure ANOVA, Spearman Correlation and Pearson Correlation software SPSS version 22.ResultsAll 42 participants stayed throughout the study. Mean age of patients was 10.14 ± 29.10. Mean test scores of Yale-Brown Obsessive Compulsive Scale in the first, fifth, tenth and fifteenth session of treatment was 6.78 ± 28.4, 4.58 ± 22.8, 6.3 ± 16.4 and 5.37 ± 10.8,respectively which is significantly lower (P-value = 0.00, F = 80.12). No significant correlation was observed between the participant's age, sex, education level, marital status and employment status and in any of the test scores of Yale-Brown Obsessive Compulsive Scale in the first, fifth, tenth and fifteenth session of treatment (P-value > 0.05).ConclusionIn order to attain a sustainable long term effects of the proposed treatment, it is recommended that patients be reminded on their next schedule of treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Paroxetine concentrations in obsessive-compulsive disorder: Support for a therapeutic interval
Authors: Humble M.B. , Reis M. 
Published: June 2017

IntroductionPrevious studies of concentrations of serotonin reuptake inhibitors (SRIs) versus therapeutic efficacy have yielded inconsistent results. Even if the relationships between the individual's serotonergic system and the clinical symptoms of obsessive-compulsive disorder (OCD) are poorly understood, the SRIs are consistently effective in OCD. However, studies on SRI concentrations in OCD treatment are rare.Objectives/aimsTo identify possible links between paroxetine concentrations and anti-obsessive response.MethodsIn a randomised, double-blind trial, comparing clomipramine, paroxetine and placebo in OCD treatment, serum paroxetine levels were measured after 1 week and after 4 weeks of treatment in 18 patients. Anti-obsessive response was assessed with Yale-Brown obsessive compulsive scale (Y-BOCS) and patients’ global evaluation (PGE), after 12 weeks of treatment.ResultsSerum paroxetine concentrations after 4 weeks suggested a therapeutic interval between 50 and 240 nmol/L (13–63 ng/mL). The mean Y-BOCS decrease was 54% inside versus 7% outside this interval (t = 3.96; P = 0.0011).ConclusionsParoxetine levels seemingly predicted clinical outcome. Studies with a greater number of patients are necessary in order to confirm this finding and to discern whether it is useful in clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Predictors of functioning in major depression
Authors: Serra-Blasco M. , Aguilar E. , Vicent M. , Navarra G. , Portella M.J. , Sánchez A. , Ros L. , Acebillo S. , Lahera G. , Palao D. , Cardoner N. 
Published: June 2017

IntroductionLife functioning difficulties are a relevant but undervalued consequence of major depression. Mood symptoms and cognitive deficits have a significant, and somehow independent, impact on them. Therefore, cognitive difficulties should be considered a potential target to improve patients’ functioning.AimsTo examine the degree in which objective and subjective cognition explain functional outcome.ObjectivesTo assess objective cognitive function (CF) with a neuropsychological battery and to measure subjective CF using measures of cognitive perception.MethodsNinety-nine patients with depression were assessed by age, sex and level of schooling. Depressive symptoms severity was measured by Hamilton Depression Rating Scale (HDRS-17). Objective CF consisted in the following cognitive domains: memory, attention, executive functioning and processing speed. Subjective CF was assessed with Perceived Deficit Questionnaire-Depression (PDQ-D). Functioning Assessment Short Test (FAST) was used to evaluate life functioning, excluding the cognitive domain. All the listed measures were included in a multiple regression analysis with FAST scores as dependent variable.ResultsThe regression model was significant (F1,98 = 67.484, P < 0.001) with an R of 0.825. The variables showing statistical power included (from higher to lower β-coefficient) HDRS-17 (β = 0.545, t = 8.453, P < 0.001), PDQ-D (β = 0.383, t = 6.047, P < 0.001) and DSST (β = −0.123, t = −1.998, P = 0.049).ConclusionsThe severity of depressive symptoms is the variable that best explains life functioning. Surprisingly, the second factor hindering it is the patients’ perception of their cognition. Current findings highlight the importance of correcting cognitive bias in order to improve functionality. However, results have to be taken cautiously as mood symptoms could partly explain the bias.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Aggression and violence towards healthcare workers in a psychiatric service in Italy. A retrospective questionnaire-based survey
Authors: Piacentino D. , Moser S. , Tosato S. , Bonetto C. , Conca A. , Bizzarri J.V. 
Published: June 2017

IntroductionViolence at work is a major concern in healthcare services. Prevention programs have been implemented, albeit being scarce in Italy.Objectives or AimsThe Bolzano psychiatric department adopted a de-escalation model developed by the Institut-für-Professionelles-Deeskalations-Management (ProDeMa®). It includes evaluation, prevention, and practical training aimed at preventing/reducing patients’ aggressive behavior toward healthcare workers.MethodsIn 2015, health professionals were interviewed by using a ProDeMa® 11-item questionnaire that assessed the type and frequency of endured patients’ aggressive behavior, as well as the conditions capable of producing or preventing it. One-way ANOVA with Tukey post-hoc test was used for comparisons.ResultsA total of 165/211 (78%) surveyed workers (mean age ± DE = 44.9 ± 7.7; females = 64.6%) completed the questionnaire, of whom 21% employed at the inpatients unit (INP), 37% at the outpatients unit (OUTP), 42% at the rehabilitation facility (REHAB). The one-year number of verbal aggressions (VA) was 9766, with INP (mean ± SD = 15.2 ± 29.6) vs. OUTP (mean ± SD = 6.2 ± 30.6) vs. REHAB (mean ± SD = 8.4 ± 26.1). The one-year number of physical aggressions (PA) was 1502, with INP (mean ± SD = 3.3 ± 12.2) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.7). The one-year number of injuries (IN) was 200, with INP (mean ± SD = 0.5 ± 1.9) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.2). ANOVA showed significant differences in terms of mean verbal/physical aggression and injuries among the three workplaces (P-values = 0.000), with post-hoc Tukey test showing a significant difference of INP vs. REHAB and OUTP. The most frequent risk factors identified by the staff for precipitating aggression included rigid rules (15.1%) and inadequate communication (9.1%).ConclusionsThe three types of violence are common in all facilities of our Department.Disclosure of interestThe authors have not supplied their declaration of competing interest.
The Chinese version of the brief assessment of cognition in schizophrenia: Data of a large-scale Mandarin-speaking population
Authors: Wang L.J. , Hsu S.T. 
Published: June 2017

ObjectiveThe brief assessment of cognition in schizophrenia (BACS) is a cognitive assessment tool used to measure the broad aspects of cognition that are most frequently impaired in patients with schizophrenia. This study aims to develop the normative data of the Chinese version of the BACS among the Mandarin-speaking population.MethodsThis cross-sectional study included 382 healthy participants (age range: 19–79 years; mean age: 48.0 ± 16.7 years, 47.6% male) in Taiwan, who were evaluated with the BACS. Means and standard deviations of subtests and composite scores were arranged by age group and gender. The Z-scores calculated based on the U.S. norms were compared to our scores based on the norms established in the present study.ResultsThe raw scores of all the BACS tests (verbal memory, digit sequencing, token motor test, verbal fluency, symbol coding, and Tower of London) were negatively correlated with participants’ age. Females were superior to males in verbal memory, but inferior to them in executive function. Furthermore, applying the U.S. norms of the BACS to determine the performance of the Chinese BACS results in bias with regard to verbal memory, token motor test, verbal fluency, symbol coding, Tower of London, and composite score.ConclusionsThese findings demonstrate that directly applying Western cognitive norms to a Mandarin-speaking population can cause biased interpretations. The results of the current study can be an important reference for clinical settings and research related to cognitive assessments in Mandarin-speaking Chinese populations.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Burnout as a form of mental health problem among nurses in the Philippines
Authors: Lu J.L. 
Published: June 2017

IntroductionNurses are among the health professionals that are confronted with burnout due to workload demands. The dominance of females in the profession reinforce the prevailing notion that the caring professions such as nursing are relegated to women. This gives the study its gender perspective.ObjectivesTo determine the interaction between situational, factors, role stressors, hazard exposure and personal factors in the largest tertiary hospital in the Philippines.MethodsThis was a cross-sectional study, which aimed to determine the interaction between situational, factors, role stressors, hazard exposure and personal factors among 246 nurses consisting most of females (78.5%) from the different wards and units in the Philippines General Hospital (PGH).ResultsAlmost half (49.6%) of the respondents reported being ill due to work in the past year, and 56.1% missed work because of an illness. Correlation statistics using the Spearman's rho showed organizational role stressors was most significant in burnout among nurses in the Philippine's largest tertiary hospital. Organizational role stressors consisted of ten dimensions, namely:– inter-role distance (IRD);– role stagnation (RS);– role expectation conflict (REC);– role erosion (RE);– role overload (RO);– role isolation (RI);– personal inadequacy (PI);– self-role distance (SRD);– role ambiguity;– resource inadequacy (RIn).ConclusionThe contribution of the study is in advancing new concepts in the already existing framework of burnout, and thus, can assist nurses and hospital administration on how to control this problem.Disclosure of interestThe author has not supplied his declaration of competing interest.
A case of neurosyphilis in a patient presenting with bipolar mixed episode suggestive symptoms
Authors: Martins M. , Fernandes R. 
Published: June 2017

IntroductionSyphilis is a sexually transmitted disease caused by Treponema pallidum. Early invasion of the central nervous system might occur early in the course of the disease. Clinical manifestations may include acute meningeal syphilis, meningovascular syphilis, paretic neurosyphilis and tabetic neurosyphilis. Psychiatric symptoms are often the presenting symptoms of this illness and the correct diagnosis involves both a high degree of suspicion and adequate diagnostic tests.ObjectivesThe authors report a case of a patient, with no previous history of mental illness, initially admitted in a psychiatric unit with a clinical picture suggestive of a mixed bipolar disorder episode who has been diagnosed with neurosyphilis a year after.MethodsReview of clinical records and complementary exams.ResultsBy the first admission, the patient presented with depressed and irritable mood, emotional lability, aggressiveness, grandiose and racing thoughts. Upon discharge, he was diagnosed with bipolar disorder and referred to ambulatory unit. The following year he starts presenting cognitive deficits and a progressive loss of autonomy in daily living activities, being referred to neurology evaluation. A year after the first admission, he is admitted in a neurology unit and diagnosed with neurosyphilis.ConclusionsCurrent prevalence of symptomatic neurosyphilis in Western Europe is unknown. Atypical cases presenting with heterogeneous psychiatric and neurologic symptoms, with no previous history of mental illness, should raise a high index of clinical suspicion, since consequences for the patient's health might be severe if not properly diagnosed and treated.Disclosure of interestThe authors have not supplied their declaration of competing interest.