bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Psychiatric Disorders in Adolescents With Epilepsy Attending a Tertiary Care Centre in South India
Authors: Omanakuttan Geethu Parvathy , Devasia Mithun Pulichumakal , Williams Laura Jayne , Anil Kumar Thekkethayil Viswanathan 
Published: July 2023

AimsEpilepsy is one of the most common neurological disorders characterized by an enduring predisposition to generate seizures, which can affect all age groups. Prevalence of overall psychiatric disorders among persons with epilepsy is significantly higher, and children and adolescents with epilepsy were found to have even higher rate of disorders ranging from 35% to 50%. Along with anxiety and depressive disorders, attention deficit hyperactivity disorder (ADHD) is also a common psychiatric disorder in children and adolescents. This study was primarily aimed to estimate the prevalence of psychiatric disorders among adolescents diagnosed with epilepsy. It also looked for any association between such disorders with various sociodemographic and epilepsy related factors.MethodsA cross sectional study was conducted among 117 adolescents aged 11 to 18 years diagnosed with epilepsy. Patients with intellectual disability were excluded. After taking written informed consent and assent from parents and participants, relevant sociodemographic and clinical data were recorded. Prediction of having a psychiatric disorder was made using multi-informant type of Strength and Difficulties Questionnaire (SDQ), with a total score in borderline range suggestive of possible and score in abnormal range suggestive of probable psychiatric disorder. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 22. Chi-square test was used to find association between categorical variables. For all statistical interpretations, p < 0.05 was considered the threshold for statistical significanceResultsAssessment with multi-informant type of SDQ has predicted that 64.1% of adolescents with epilepsy has possible (23.9%) or probable (40.2%) psychiatric disorder.Prevalence of abnormal scores for hyperactivity subscale was 29.9%, conduct subscale was 29.1%, emotional symptoms subscale was 40.2% and peer-problem subscale was 27.4%.88 % had high pro-social score suggestive of good social behaviors.An abnormal or borderline total difficulty score on SDQ was significantly associated with inadequate seizure control (p = 0.029). No significant association was noted between a higher total difficulty score on SDQ with age, sex, sociodemographic status or disease related variables like age of onset, duration and type of epilepsy, monotherapy or polytherapy or family history of psychiatric illness.ConclusionA higher proportion of adolescents with epilepsy were identified to risk of having a psychiatric morbidity, which can possibly impair the quality of life and treatment outcome, particularly in Indian context.Early identification of such disorders using screening tools and a multidisciplinary approach for managing them at the earliest can possibly improve the outcome, for which further research is recommended.
Caring for Women Going Through Care Proceedings in the Perinatal Period While in Prison
Authors: Streets Lulu , Pontvert Caroline , Pitfield Christy 
Published: July 2023

AimsThis literature review aims to identify and understand the mental health needs of women in prison going through care proceedings in the perinatal period, in order for professionals to effectively care and support these women. Mental health difficulties in the perinatal period has been found to effect up to 27% of new and expectant mothers. The likelihood of experiencing these specific mental health issues is increased when there is past psychiatric and/or trauma history. Women in prison are more likely to have experienced childhood adversity and have psychiatric illnesses than the general population, which make them more susceptible to developing perinatal mental ill health. It has also been acknowledged that going through care proceedings can impact maternal mental health, which in prison brings specific and unique challenges. Therefore, the perinatal women in prison who are going through these proceedings have specific needs that have previously been overlooked, which this literature review aims to identify.MethodsThe databases searched for literature written since 2008 were: PubMed, PsychNet, Web of Science, Springer Link. Search strategy key words were: prison, perinatal, care proceedings and maternal mental health. Data were then collected and summarised thematically. 16 studies met the inclusion criteria.ResultsThe negative effects of going through care proceedings during the perinatal period include: earlier rates of maternal mortality, increased trauma symptoms, lack of support and increase in shame and issues with self-esteem and identity. Additionally, literature that focused specifically on women in prison going through care proceedings, found additional effects such as increased self-harming behaviours and depressive mood symptoms.In order to address these difficulties, the following interventions have been recommended: more trauma informed training for professionals, oppositional identity work, a focus on building Epistemic Trust and ensuring interventions are delivered within 18 months of removal as this has been identified as a window of opportunity to make meaningful impact.ConclusionGoing through care proceedings in the perinatal period has been identified as a significant challenge for mothers, which has increased complexity for women in prison. This literature review highlights the need for specific trauma-informed support and specialist perinatal mental health interventions for this population. Future research should focus on identifying the needs of women in prison going through care proceedings further, as it has previously been overlooked.
Assessment of Knowledge Regarding Alcohol Unit Conversion in Psychiatry Practitioners
Authors: Saima  , Williams Laura Jayne 
Published: July 2023

AimsNational health services are facing an increased burden of alcohol-related problems. Between 2019–2020, 280,000 hospital admissions were attributable to alcohol use (1). This was 2% higher than 2018–2019, and 8% higher than 2016–2017. The UK Government has taken some action by recommending a maximum weekly alcohol consumption limit in units; however it is unclear whether psychiatrists are aware of these recommendations. It can often be difficult to calculate accurately the units of alcohol consumed, due to differences in the alcohol concentration of apparently similar drinks (3). The aim of this online survey was to assess junior doctors’ knowledge and their understanding of alcohol unit conversions.MethodsThis was a cross-sectional study, administered via an online questionnaire. We invited junior and middle grade doctors working in Psychiatric Inpatient Units and CMHTs in the North Wales region via e-mail. We have used the same questionnaire that was used in previous studies. The questionnaire captured respondents’ training level, their current alcohol consumption and perception about their knowledge of alcohol unit conversions, as well as assessing their knowledge about alcohol unit conversions using four test scenarios. The data were gathered using the Microsoft office forms (online) and analysed descriptively (i.e., frequency and percentage) using Microsoft Excel.ResultsTwenty-three medical doctors working in Psychiatry completed the online questionnaire, of which the majority were junior doctors (n = 15; 65%). Almost three-quarters of the respondents (n = 17; 74%) reported regular consumption of alcohol. The majority of respondents (n = 20; 86%) reported that they had knowledge of alcohol units.Nearly half of the respondents were able to calculate correct daily allowance of alcohol in units for males (n = 13; 56%) and for female (n = 12; 52%). Twelve respondents were able to calculate the correct allowance in units for both genders. About one quarter of the respondents (n = 5; 22%) mentioned weekly limits instead of daily limits of alcohol in units.In response to test scenarios, seven respondents (30%) were able to correctly calculate 9 units of alcohol in a 750ml bottle of 12% wine. Ten respondents (43%) were able to correctly calculate 30 units in the bottle of whiskey. For the lager scenario, the volume was given in pints, and only one respondent was able to calculate 47.6 units correctly. For a wine (36.4 units) and sherry (12 units), only 6 (26%) and 4 (17%) respondents answered correctly, respectively.ConclusionWe found that medical doctors working in psychiatry do not have adequate knowledge of alcohol unit conversions. To tackle the increasing burden of alcohol-related problems, learning about alcohol unit conversions should be incorporated into teaching programmes for psychiatry practitioners.
Quality Improvement Project: Referral Process for Adults With Suspected ADHD
Authors: Streeter Cassandra , Dankyi Stephanie , Akin-Ojo Isabelle 
Published: July 2023

AimsTwelve GP surgeries refer adults with suspected ADHD to Horsham Assessment and Treatment Service (ATS). Patients are referred by GPs via letter and an adult ADHD self-report scale (ASRS). Letter contents are variable and some referrals are rejected. There is no gold standard or national guideline for what referral information is required. We used a combination of guidelines and advice from The Royal College of Psychiatrists, The National Institute for Health and Care Excellence, and ADHD UK. Aims: to evaluate the current quality of the referrals, to obtain GP’' views on the referral process, to make the process more efficient and clearer, and with that improve patient experience.MethodsA retrospective data collection method was used. 57 patients were referred between 31st August 2021 and 1st April 2022. We reviewed 54 referral letters (3 were excluded). Main information looked for: presenting difficulties, resultant impairments, confirmation some symptoms present in childhood, past medical history, family history and if an ASRS was attached. We sent a questionnaire to obtain GPs’ opinions on the referral process and how to improve this.ResultsResults of reviewing referral letters:
•89% of referrals explained the current difficulties•52% described the resultant impairments•61% of referrals mentioned if symptoms had been present in childhood•91% of referrals contained past medical history and current medication•No referrals mentioned family history•6% of referrals contained some physical health data•85% of referrals to ATS were accepted; 13% rejected as ASRS not attached.Results from GP questionnaires: 11 surveys were returned. Most GPs were not confident in making a referral or what information is required, and did not understand the referral process. GPs would like a referral form, a flowchart outlining the referral process and information for patients about ADHD assessment.Conclusion89% of referrals explained current difficulties. Just over half described the resultant impairments, and confirmed if there were symptoms in childhood. Most referrals contained past medical history. 6% contained some physical health data. Only 85% of referrals were accepted. GPs would like a referral form, a flowchart and information for patients.Results were distributed to staff in ATS and we will distribute results to GPs. We have created a referral form and flowchart to make the referral process more efficient and clearer, and to improve patient experience. We will re-evaluate this after a few weeks, so we can compare with previous data collected.
Reducing the Use of Rapid Tranquilisation in Over 65s in a General Hospital
Authors: Chircop Omar , Manning Jane , Heslop Joshua , Dadar-mann Vinita , Jenkinson Josie 
Published: July 2023

AimsA previous audit of use of rapid tranquillisation in older adults conducted in 2019 identified high rates of use of sedation, and poor adherence to local guidelines. Following this audit, a number of quality improvement (QI) initiatives were undertaken in order to try to improve practice, including multiple teaching sessions to a variety of staff. This re-audit was conducted to study whether initiatives had been effective in line with the Plan Do Study Act cycle of Quality Improvement.MethodsUsing the same audit tool developed in 2019, six wards (2 geriatric, 3 medical and 1 surgical) were audited. Patients over 65 given oral or intramuscular sedating medications had their drug charts and notes reviewed. Data were collected on type of sedation, route prescribed, whether it was prescribed regularly or PRN, whether an indication was documented, underlying diagnosis and what monitoring took place post sedation.Results297 drug charts were reviewed, and 13 patients were prescribed rapid tranquilisation (RT). The maximum daily dose was included in 63% of prescriptions similar to that of the first audit (58%). The most common route of administration was intramuscular, unlike the previous audit which was oral/intramuscular.50% of prescriptions documented an indication, of which 25% were illegible. Whilst in the first audit the figure was 33%.Of all the patients prescribed RT, 77% had a diagnosis of delirium, 77% had a diagnosis of dementia and about 53.8% had both. In both audits 100% of patients had a diagnosis of dementia or delirium. Most prescriptions were for lorazepam (75%). There was no evidence of observations being taken in line with post RT monitoring in the trust policy in both auditsConclusionFurther work needs to be done to improve practice. Interventions to date have not been effective. Further plans for QI work include updating the RT policy to be more specific and useful for the acute trust, to fit in with a recently introduced electronic records system (ERS) and to include a clear section on older adults with signposting to the delirium and dementia policies. As well as adding prompts and protocols to the ERS to support safe prescribing and dispensing of RT. Teaching will be repeated and a poster has been developed and promoted on all the wards. The project group are planning to join the trust's ‘medication safety huddle’ regularly to include pharmacists in teaching and work. The audit will be repeated in three months time.
WHO AM I? Transcultural Psychiatry in Practice
Authors: Elisha-Aboh Christiana , Tangen Wendy , Dodough Nicholos , Romeu Daniel , Adwok Nyakomi , Nightingale Sharon , Hashmi Nazish 
Published: July 2023

AimsCulture refers to the way of life of a group of people and influences their value system. It affects virtually every area of life, unconsciously shaping one's outlook, behaviours and responses. As the world becomes more multicultural, it is essential that mental health professionals possess the much-needed awareness into the constructs of cultural variation and their impact on the expression of psychopathology and treatment. Black, Asian and Minority groups are a diverse group and make up 16% of the population in England & Wales. They are reported to have a less positive experience of mental health systems compared to white people. The common barriers ethnic minority groups face in accessing mental health care include: cultural barriers, stigma, language barriers, lack of cultural sensitivity from professionals, stereotyping, unconscious bias and so on. The aim of this quality improvement project is to improve the delivery of patient care and professional support to ethnically diverse groups.MethodsA pre-workshop survey was set up to aid planning. The virtual workshop had over 80 people in attendance and included panel discussions, anchored by four professionals and three patients, all with lived experience. It lasted for 1-hour 15minutes, followed by a debrief. Feedback was obtained through survey monkey and the results were analysed with Microsoft Excel.ResultsThe pre-workshop planning survey identified that 91 % of respondents within the Trust (57 individuals) worry about being misunderstood when working with culturally diverse patients. 93 % feel more education on cultural diversity is needed and only 20 % felt they had sufficient knowledge and resources for day-to-day practice with a diverse patient group.The feedback survey results on the day explored five questions which included: awareness of barriers minority groups experience, awareness of available transcultural resources, awareness of transcultural issues, awareness of local protocols and resources, and likelihood to intervene against discrimination showed an improvement of 41.2%; with average pre-workshop scores of 55% and average post-workshop scores of 96.2%. Using thematic analysis, other areas of interest relating to transcultural psychiatry, at future workshops were considered as; greater awareness, practical approaches, culture/intersectionality, social justice, greater time allocation, spirituality, resources, gender/sexuality and ageConclusionOverall, majority of the feedback received was positive. Attendees valued the interactive nature of the panel discussions and choice of topics. Suggested areas of improvement were having more time for discussion and including other relevant topics. Recommendations include repeating workshops and raising local/national awareness.
RANZCP Commitment to People With Intellectual and Developmental Disability
Authors: Moore Elizabeth 
Published: July 2023

AimsTo provide an overview of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) work to improve support for those with an intellectual or developmental disability.MethodsPeople with intellectual disability experience significantly higher rates of physical and mental health conditions in comparison to the general population. However, there can be multiple barriers to effective health care including, but not limited to, stigma and discrimination, the training of health professionals and a failure to consider the specific needs of people with intellectual disability in health and disability policy leading to deficits in funding to support generic services or develop specialist service models.In Australia, a Disability Royal Commission was established in 2019 in response to community concern about reports of violence against, and the neglect, abuse and exploitation of, people with disability. The RANZCP has provided information to the Royal Commission and appeared at a public hearing focused on the education and training of health professionals in relation to people with cognitive disability. In 2022, the RANZCP published new position statements on autism and intellectual disability to address the unmet needs faced by people with autism and intellectual disability and provide a foundation for future College advocacy for improving resourcing and mental health support for these groups.ResultsThe new RANZCP position statements on autism and intellectual disability make a number of systemic recommendations to address the mental health needs of autistic people and intellectual disability including:
•providing adequate funding to ensure appropriate policy implementation•educating and training health providers in the mental health needs of autistic people and people with intellectual disability•including the voices of autistic people to support a more inclusive approach to policy development and service design•collecting data on the needs of people with intellectual disability who are living with mental health conditions to support better service planning and better health outcomes.•In response to recommendations from the Disability Royal Commission, the RANZCP is also revising its training syllabus to include additional requirements for cognitive disability and has reviewed its CPD program to determine whether CPD for the provision of health care to people with intellectual disability should be enhanced.ConclusionThe RANZCP is committed to addressing the unmet mental health needs and significant challenges of people with autism and intellectual disability and advocating for improving resourcing and mental health support for these groups.
An Unusual Case of Neuroleptic Malignant Syndrome on a Stable Dose of Antipsychotic
Authors: Sanger Emily , Rutt Benjamin , Hall David , Foster Harry , Obasohan Owen 
Published: July 2023

AimsNeuroleptic Malignant Syndrome (NMS) is a rare, life-threatening complication of antipsychotic medication. There are no gold standard tests to diagnose NMS, however various diagnostic criteria have been suggested. NMS is typically reported in patients who have recently commenced an antipsychotic or had a change in dose. This case report describes an elderly female who developed NMS after being treated with the same dose of antipsychotic for 7 years. We aimed to establish whether similar cases are commonly reported, and what the key learning outcomes are.MethodsThis case presents an 82-year-old female taking the same dose of zuclopenthixol for 7 years. She was admitted with increased confusion and was initially prescribed antibiotics for a possible infection. She later became pyrexial and developed hypertonia, at which point NMS was suspected. Her creatinine kinase titre was significantly elevated, and her antipsychotic was discontinued. A potential trigger was a significant rectal bleed occurring a few weeks prior with no other obvious triggers noted. She was switched to quetiapine but developed NMS again when this dose was increased.ResultsThere are few reports of NMS occurring in patients taking a long-term and stable antipsychotic dose. One case describes NMS developing after 30 years on Clozapine with no clear trigger. Another reports NMS after 7 years on Olanzapine, however this was triggered by dehydration. This case is an example of NMS in an elderly patient with a complex medical history who was initially misdiagnosed with sepsis before NMS was suspected. This shows the importance of considering NMS not only in those who have recently commenced antipsychotics or recently changed dose, but also those who have been stable on medication for a number of years. In suspected NMS, we should aim to stop relevant medication immediately and commence conservative management. It is important to highlight these atypical presentations so that NMS can be recognised without delaying treatment, thereby reducing mortality and improving patient outcomesConclusionThis report highlights the importance of considering NMS in patients who have been prescribed the same dose of antipsychotic for an extended period. Awareness of potential risk factors such as medical comorbidity that may trigger an episode of NMS even in those on established antipsychotic treatment is vital. Symptoms may mimic infection and it is important to raise awareness of atypical presentations to effectively identify, and treat, NMS earlier to improve outcomes.