bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parent Experiences of a Pilot Functional Neurological Disorders Clinic at Great Ormond Street Hospital (GOSH)
Authors: Eilon Talia , Evans Sacha , Pujar Suresh , Orme Lily , Smith Abbie 
Published: August 2024

AimsThere are a shortage of specialist services available for Functional Neurological Disorders, especially within the paediatric population. Patients and families often find themselves falling within the borderland between medical and psychiatric services. Functional symptoms can cause significant morbidity and disruption to the lives of children and young people, impacting their access to education and social lives. Early diagnosis and explanation of FND is a mainstay of treatment, and is associated with positive outcomes. A Functional Neurological Disorder pilot MDT clinic was set up within Great Ormond Street Hospital, with the aim to provide a one-off therapeutic assessment and psychoeducation. We surveyed families who attended the clinic to assess their experiences and outcomes.MethodsA pilot clinic was set up for patients referred within GOSH with a confirmed diagnosis of FND. The Multidisciplinary team consisted of a CAMHS psychiatrist, paediatric neurologist, physiotherapist and occupational therapist. Patients received a one-off outpatient consultation to discuss FND symptoms and background history. Clinicians provided psychoeducation for patients and families about the diagnosis and devised treatment plans including follow-up assessments, onward referral to local services and a consultation with teams where appropriate. A follow-up survey was conducted using semi-structured telephone interviews and patient satisfaction questionnaires. Questionnaires were scored using a Likert rating scale (1: very dissatisfied – 5: very satisfied). Parents were asked about their understanding of the FND diagnosis and about their experiences of support from local teams.Results25 patients diagnosed with FND were referred to the clinic. Of those, 20 patients took up the consultation. Patients presented with range of functional syndromes. 15 families consented to follow-up interviews. Parents rated their experience at the FND clinic highly (median score 5 – very satisfied). They were very dissatisfied with follow up care (median score 1). Only one patient remained under CAMHS at the time of follow up. 3 families had sought support privately. Parents subjectively rated their children's symptoms at follow up as: much worse (3); a bit worse (1); the same (7); a bit better (2) and much better (2).ConclusionPatients and parents demonstrated high levels of satisfaction with the one-off therapeutic assessment. The majority of parents reported that the GOSH consultation helped them to understand the diagnosis of FND. All families felt they had received inadequate support from primary care, local CAMHS services and schools. Patients who struggled to access support from CAMHS/ school were less likely to experience any improvement in FND symptoms and had poorer levels of functioning.
A Cross-Sectional View on the Comprehensive Multi-Disciplinary Model of Care for a Peri-Natal Mental Health Service Within a Tertiary Women's Hospital in Western Australia
Authors: Goel Chinar , Goel Prisha 
Published: August 2024

AimsKing Edward Memorial Hospital (KEMH) is the largest tertiary women's hospital in Western Australia and a tertiary referral center for complex pregnancies, for example, adolescent pregnancies (12–19 yr olds), pregnancies with obstetric complications or fetal anomalies, statewide drug and alcohol antenatal service and preterm births. With 6000 births annually, this women's hospital does not only provide obstetric care, but also looks after gynecology, oncology and chronic pain patients. We would like to share the model of care for our women's mental health service which provides statewide Childbirth and Mental illness (CAMI) service looking after women with chronic enduring mental illness, statewide drug and alcohol antenatal service (WANDAS), adolescent model of care and our service for all other women attending this tertiary hospital within a unique consultation liaison model.MethodsOur team comprises 3.0 full time consultant psychiatrists, 2 Psychiatry trainee registrars, 5 clinical psychologists, 2 triage nurses and administrative staff. In total, we had 1959 referrals to our service in 2022–23 financial year. These women had varying amount of input from our service during their treatment in hospital: one assessment with advice and signposting to brief therapy, up to a fully comprehensive Multidisciplinary Team (MDT) care as provided by an adult community mental health service. In addition to comprehensive assessment, MDT interventions include risk assessment, pharmacological interventions, psychological interventions, working alongside child protection services, infant mental health and attachment work.ResultsOur most common diagnostic categories included post-traumatic stress disorder (10%), adjustment disorders (10%) followed by Generalized anxiety disorder and recurrent depressive disorder (6% each). Our key performance indicators include: number of consumers (541 in 2022–23) that received comprehensive intervention from us in last 12 mths, consumer and carers’ feedback and rate of completion of outcome scale at point of admission and discharge from service. These figures have remained consistent for the last 5 yrs.ConclusionOur hybrid model of care is unique as it incorporates a consultation liaison and a community mental health care model for women attending our hospital. This allows us to provide a safe, specialized, timely service to women in their most vulnerable period of life.
The Evaluation, Review, and Recommendations, Regarding Referrals to a West Yorkshire Specialist Forensic Community Team
Authors: Gow Laura 
Published: August 2024

AimsIn the United Kingdom Specialist Community Forensic Teams (SCFT) are a new national development, aiming to enable and support earlier discharge from secure hospitals, and provide treatment to patients on a forensic pathway, in a community setting.This project's ambition was to yield data to support future development of the service. The following research question was developed, as a focus for the project:
‘In order for patients to be cared for as close to home as possible and for forensic services to reduce the length of inpatient stay, when should a patient be referred to a Specialist Forensic Community Team?’MethodsThe project was accepted by Cardiff University and South West Yorkshire Foundation Trust as a service evaluation.The project methodology considered the impact of trauma throughout, given the forensic setting and high prevalence of trauma in individuals accessing forensic services.A questionnaire was developed, which covered several relevant themes regarding the service, including the research question, and was distributed to patients, professionals, and referrers, either using, or associated with the team.The total number of participants recruited was n = 45. These were made up of service users (n = 17), referrers to the service (n = 10), and other professionals (n = 18).ResultsParticipants felt they understood the purpose of the SCFT, placed importance on being involved in service evaluation, and were confident their responses would influence service development.Reasons to refer to the SCFT were the perceived helpfulness of the team, supporting transitions, risk management, teamwork, therapeutic alliance, quality, and clinical knowledge.Results favoured multi-disciplinary team agreement as being an important factor in the timing of SCFT referral. Upon admission, or granting of unescorted leave, were also cited as appropriate times to refer to the service. Clinically appropriate timing, individual needs, and service user motivation were additional indicators for SCFT referral.ConclusionThe West Yorkshire SCFT offers previously unavailable pathways from secure services into the community. The clinical model uses a trauma-informed, formulation-driven, collaborative approach to care, treatment, and risk management, which participants found favourable. Improved community pathways and connections offer a sense of improved hope, and a feeling of being helped, which is supportive of personal recovery.There are recommendations which suggest that a community pathway agenda, embedded into services from admission, will support clinically appropriate timing of SCFT referral, and should be a decision which is made collaboratively, with patients, carers, and the multidisciplinary services around them.
Mind Over Menopause: Bridging the Gap in Mental Health Care
Authors: Thatcher Alexandra , Graham Catherine , Denton Grace , Kearly-Shiers Katherine , Manley Kristyn 
Published: August 2024

AimsThe effect of menopause on mental health is increasingly well recognised. Studies assessing peri- and post-menopausal women report higher incidences of depression and anxiety. Without recognition and treatment, the negative impact on mental health during menopause can lead to long-lasting effects on quality of life. NICE and the British Menopause Society (BMS) guidelines recommend cognitive behavioural therapy (CBT) and an individualised approach, for women experiencing depression and anxiety as a result of menopause. The aim of this project was to collect data relating to the provision of mental health interventions (and how they are accessed) for women seeing menopause specialists across the UK. This data can then be used to inform and promote improvements in the delivery of care for menopause mood symptoms.MethodsAn expert panel of psychiatry, gynaecology and general practice clinicians designed an online survey which considered NICE/BMS guidance, the current evidence base and local referral/funding pathways. This was piloted on health care professionals in primary and secondary care before review by BMS Council Members. A link to the survey was distributed via email to members of the BMS on one occasion.Results139 responses were received from menopause specialists across the 15 UK Deaneries. 71% worked in primary care and 29% in secondary care. 65% of clinicians offer CBT for mood symptoms but 99% reported suboptimal provision of this intervention. 43% of respondents reported over half of their patients with mood symptoms would benefit from psychological support, however 80% do not have a designated mental health wellbeing practitioner. 35% of specialists have referred complex patients to secondary mental health services. When asked what mental health resources would be most beneficial for their patients, 83% desired improved access to CBT, 65% psychological support attached to all menopause clinics, 53% guidance on managing mood symptoms in menopause and 39% an MDT clinic.ConclusionThe data suggests that complex mood disorders are common in women presenting to menopause services and require non-hormonal interventions to support benefits seen with HRT. The results suggest poor provision of psychological interventions, particularly talking therapies, for women experiencing mood disorders as part of their menopause. Improved cross-specialty working and training, and improved access to CBT were identified as methods of addressing this. Locally, these results have formed the basis of a service funding bid for CBT and development of a pilot cross-speciality gynaecology/psychiatry MDT Hub.
An Evaluation of the Prevalence of Use of High Dose Antipsychotic Therapy Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust
Authors: Hyland Declan , Singh Roopa , Dainton Kerry 
Published: August 2024

AimsHigh Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.This evaluation aimed to determine prevalence of HDAT across the 16 general adult inpatient wards and the Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust.MethodsA list of all inpatients admitted to the 16 general adult inpatient wards and to the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was subject to HDAT and, if so, whether this was due to antipsychotic monotherapy, combination of two or more antipsychotics, or due to regular and as required (PRN) antipsychotic medication.ResultsOf the 215 inpatients on the 16 general adult wards and the PICU, a total of 29 (13.5%) patients were prescribed HDAT. Four wards had no patients on HDAT; one ward had 5 patients on HDAT. Two of the 12 patients on the PICU were on HDAT. Of the 29 HDAT patients, none were on just one regular antipsychotic, 11 were on one regular antipsychotic and one PRN, 11 on two regular antipsychotics only, 4 were on two regular antipsychotics and one PRN antipsychotic, 1 patient was on three regular antipsychotics and 2 patients on three regular antipsychotics and one PRN antipsychotic. Of the 29 HDAT patients, 14 (48%) had schizoaffective disorder, 9 (31%) had schizophrenia, 5 (17%) had bipolar disorder and 1 (4%) had emotionally unstable personality disorder.ConclusionOnly a minority of inpatients on the general adult wards and the PICU are prescribed HDAT. There was variation in HDAT prescribing across the wards and this may reflect the degree of diagnostic variability of each ward's inpatients. In those patients that are subject to HDAT, there is a need for appropriate baseline physical investigations to be completed and for appropriate monitoring of ECG and relevant blood tests. There is a need to consider whether each HDAT patient has been considered for treatment with clozapine, if appropriate.
Patients' Experience of Using Virtual Consultations in Their Care During Their Inpatient Stay on Acute Mental Health Admission
Authors: Elshafei Ahmed , Junaid Elizabeth , Ekwere Umoh , Maheen Fatima 
Published: August 2024

AimsTo obtain the views of patients regarding their experience of meetings where virtual media (video conferencing) has been used during their inpatient stay in the acute female admission ward.MethodsData was collected via a questionnaire. Service users who met the inclusion criteria were past and current inpatients in the acute female psychiatric ward during the last six months. The sample of the service users included in the project was selected from all applicable cases via convenience sampling – those on the ward who consented and were able to engage, as well as past inpatients whom we contacted via telephone after their discharge who met these same criteria.Verbal consent was obtained from all the patients who agreed to participate. Data was collected and analysed using Microsoft Excel.Results13 patients in total completed the facilitated questionnaire which used 11 questions rated by Likert Scale as well as an open space area for further comments. Age ranges varied among participants with 39% age range 18–30, 38% aged 31–50 and 23% aged 51–65. 61% were of white British descent. Majority (38%) were admitted for schizophrenia, schizotypal and delusional disorders, 31% for disorders of adult personality, 23% for mood (affective) disorder and 8% for anxiety, dissociative, stress related, somatoform and nonpsychotic mental disorders.Most patients rated the use of virtual consultations positively, with over ¾ of patients answering strongly agree or agree (positive response) to most questions. This included feeling able to express themselves effectively as in an in-person consultation, feeling that they received adequate care, feeling that the audio-visual quality was satisfactory and that their privacy was respected. One suggestion for improvement from the patients was to clarify the number of people in the room and how many students are present during the consultation.ConclusionVirtual consultations were overall well received among the patients interviewed. Interventions that facilitate timeliness and privacy in consultations as well as training for staff in verbal and nonverbal communication skills for virtual consultations would be beneficial. Further surveys in groups underrepresented in the survey such as men, older people, ethnic minority groups, people with visual or hearing impairment and other mental disorders not present in the sample would help to give further insight into how virtual consultations are received and barriers by different groups.
Developing a CAMHS Hub Crisis Management Service – the First Six Months
Authors: McDonald James , Columb David , Moriarty Laura , Verdon Clare , Murphy Katie 
Published: August 2024

AimsThis poster will:
1.Describe the establishment of an acute crisis management service within a Child and Adolescent Mental Health Service (CAMHS) in the Republic of Ireland.2.Summarise clinical activity during the first six months of the service and qualitative feedback from service users and clinicians on their experience of the service.MethodsIn December 2021 the Republic of Ireland Health Service Executive approved the roll out of acute crisis management services for CAMHS – known as Hubs, with a remit to provide intensive brief interventions to support young people experiencing acute Psychiatric crises. Multiple weekly appointments are provided in clinic, at home or via telehealth.The Lucena Clinic CAMHS – based in Counties Dublin and Wicklow, was chosen as a pilot site. Staff were recruited in January 2023 consisting of:
1FTE Consultant Child and Adolescent Psychiatrist1Candidate Advance Nurse Practitioner1Senior Social Worker1Senior Occupation Therapist1AdministratorA multi-disciplinary Steering Group was established with a view to planning clinical programs, ensuring safety and governance, procuring resources and embedding service evaluation.The service went live in May 2023. Clinical data was gained from data entry to the service Electronic Patient Record.Qualitative feedback was gained from service users using post-discharge questionnaires and from clinicians using semi-structured interview.Results1.Between May and December 2023 the Hub received 61 referrals and accepted 35.2.27 of those accepted were new referrals to the service.3.Patients received an average of 27.1 hours of clinical intervention during their admission.4.Shortest admission was 10 hrs, the longest 66.5 hrs.5.6 young people were seen at home, totalling 41 visits.6.24 young people were discharged to CAMHS, 2 to GP, 2 to the clinic's Day Program, 3 required in-patient admission.Service user feedback was positive with families highlighting ease of access to the service, intensity of intervention and a friendly environment as positives.One parent remarked that they did not feel the Hub was the right setting for their child's care.Clinician feedback highlighted the Hub as a positive support for community CAMHS with rapid access to intervention and communication from the Hub team mentioned as positives. One drawback identified was the intensity of intervention setting an unrealistic expectation for ongoing care.ConclusionThe Hub appears a welcome addition to CAMHS with positive feedback from service users and clinicians. Ongoing development phase and evaluation is required.
Significant Global Improvements for Opioid Dependent Patients Receiving 8 Sessions of Flexible Trauma Informed Psychological Therapies Whilst on Long Acting Injectable Buprenorphine: 9 Month Findings
Authors: Melichar Jan , James Lucie , Tucker James , Jones Lewis , Dennie Emma 
Published: August 2024

AimsOpioid dependence is associated with adverse physical health, mental health and social consequences. Daily oral opiate substitutes offer some treatment gains but several negative associations including daily dosage fluctuations, long-term reliance on services and negative impact on ability to work.Long-acting injectable buprenorphine (LAIB) is a new treatment option, extensively used in Wales since 2020. We have shown the many gains, including increased treatment retention, reduced service reliance, improved patient satisfaction and increased capacity for people to move on in their recoveries, are likely to be due to LAIBs unique combination of allostatic μ-opioid receptor agonism (craving reduction) and sustained κ-receptor antagonism (anxiolysis). However, ~50% experience resurfacing of mental health and/or trauma symptoms on LAIB that impedes recovery. The Buvidal Psychological Support Service, commissioned by Welsh Government, seeks to develop the evidence base for provision of rapidly accessible, tiered psychological support alongside LAIB to address this. Here we present initial 9-month findings.MethodsTier 1 of the service offers 8 weekly individual therapy sessions, delivered flexibly over 2–6 months, with an experienced trained therapist focused on psychoeducation, co-production of a trauma and compassioned based formulation, and the development of skills to manage current mental health or trauma symptoms.Pre- and post-evaluation programme assessed efficacy including: EQ5D-5L, Work and Social Adjustment Scale (WSAS), Clinical Global Impressions (CGI), PRO Severity and Clinical Outcomes in Routine Evaluation –10 (CORE-10).ResultsThe service launched in March 2023 with 100 referrals in the first 9 months.35 patients have completed Tier 1, taking between 2 and 6 months to complete.Patients who completed Tier 1 showed clinically significant reductions in psychological distress and improvements in global functioning, quality of life and perceived mental health difficulties.These were statistically significant at p < 0.001 for all measures (EQ5D, ICECAPS, WSAS, CGI, PRO, CORE-10) (28< = n <=34).ConclusionRates of retention in treatment are greater than expected amongst this complex client group and the significant global improvements support the notion that those on LAIB present with increased stability and ability to engage in therapy, and that a tiered flexible approach to therapy can promote psychological safety and engagement and sustained recovery.We propose that a tiered trauma-focused psychology service is well placed to meet the needs of people on LAIB and should be a core component of LAIB treatment in the UK.