bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Helpful Is the Label of ‘Emerging Personality Disorder’?: A Service Evaluation Exploring CAMHS Clinicians’ Experiences of Young People Being Labelled With a Diagnosis of ‘Emerging Personality Disorder’
Authors: Drozdova Zuzana , Bentham Charlotte , Collin Thea , Youakim Sherif 
Published: July 2023

AimsUse of the ‘emerging personality disorder’ label in young people has been a controversial topic amongst CAMHS clinicians. Following discussions in a CAMHS focus group, we formally explored the views and experience of CAMHS clinicians across teams in Humber Teaching NHS Foundation Trust with the view to gain more understanding of the different stances of the clinicians, the reasons behind them and to inform future care pathways.MethodsThe service evaluation was approved by Humber NHS FT CAMHS Clinical Network and Clinical Audit Team and conducted across the Humber CAMHS service, made up of multi-disciplinary professionals including medical, psychological, therapy, nursing and social work clinicians. Data were collected prospectively, using an anonymous online survey design, with Likert scale and open-ended questions, with the option of additional comments. Consent was gained form all participants. Qualitative data collected from the open-ended survey questions were analysed using thematic analysis as described by Braun and Clarke (2006). Researchers were blind to the demographic variables of respondents, in order to promote anonymity. Authentic anonymous citations were used to illustrate the findings.ResultsA total of 50 survey responses were received from CAMHS clinicians from 9 teams. Clinicians’ views of the helpfulness of the label of ‘emerging personality disorder’ within CAMHS (n = 49): 22.4% found it helpful (very or somewhat) to staff; 21.3% helpful to families; 65.4% found it unhelpful (somewhat or actively) to staff and 63.8% unhelpful to families. 47 responded to the optional open-ended questions eliciting experiences and views of the use of the label. Qualitative analysis revealed evidence of polarity of opinion, particularly in perceived consequences for the young people and families, and identified three major themes: a shared developmental and trauma-informed understanding; the perceived impacts associated with the label of ‘emerging personality disorder’ (9 subthemes); and clinicians’ proposed next steps. There was a shared understanding of the role of interpersonal trauma and invalidation, resulting impacts on the development of skills in emotion regulation and interpersonal relationships.ConclusionOur findings highlighted the polarity of the views, the lack of consensus in the use of this label amongst CAMHS clinicians and the importance of discussions around future pathways. There is a need to consider the view of experts by experience (young people and families who have been through this process) to consider the short and, more importantly, the long term impacts of living with a label of ‘emerging personality disorder’.
Suicidality in the Absence of Self-Harm: Trends in Presentation to a General Hospital's Liaison Psychiatry Service
Authors: Newton Nick , Lee William 
Published: July 2023

AimsFollowing the initial phase of the COVID-19 pandemic, and with the introduction of an off-site Crisis Hub, has there been a change in presentation to the Emergency Department (ED) with suicidality in the absence of self-harm?MethodsPatients referred to the Liaison Psychiatry Service (LPS) from the ED at the Royal Cornwall Hospital with suicidal threat over a two-month period were identified in 2019 (pre-pandemic and the creation of the Crisis Hub), 2021 and 2022 (post pandemic and Crisis Hub implementation).Demographic data for each attendance were recorded: age and gender, mode of arrival/route of referral and outcome of assessment.ResultsThe number of attendances has decreased since 2019 (87 in 2019, 71 in 2021 and 53 in 2022). This is on the backdrop of decreasing total departmental attendances and a fall in the proportion referred to LPS: 541 in 2019, 3.84% of the total ED attendances, 510 in 2021, 4.32% of the total ED attendances and 400, 3.7% of the total ED attendances in 2022.The proportion arriving under Section 136 of the Mental Health Act (MHA), is also increasing: 0% in 2019, but 15.5% in 2021, and 13.8% in 2022. This corresponds to an increasing proportion taken from the ED by the police to another Place of Safety.A small proportion of those attending were considered suitable to be assessed at the Crisis Hub and were subsequently taken there (5% in 2021 and 3% in 2022). The most common reason to reject referral to the Crisis Hub was recent alcohol consumption.The proportion requiring admission varied: 3.4% in 2019, 5.6% in 2021 and 1.7% in 2022.ConclusionThe number of patients arriving with the police under s136 has increased. The numbers were too small to see a trend in transfers to the crisis hub and psychiatric admissions.Future work might evaluate the vanguard street triage service, or be a repeat of this evaluation once there is medical cover in the hub, or look at the fraction of patients seen in the hub who are referred on to ED, or be qualitative studies of staff and patients’ views of the hub.
A Service Evaluation and Improvement Project: Outcomes of Referrals From Prison to the Male Psychiatric Intensive Care Unit (PICU) in Kent
Authors: Satisha Shantala , Dunn Jenny , Felix Francis , Delaffon Vijay 
Published: July 2023

AimsAims: The project aims to evaluate the referrals from prison services for admission to our PICU from June 2020 to October 2021. Hypothesis: We expect referrals to come from multiple sources with variable timeframes for assessment. For those admitted to PICU, we expect delays in transfer out of PICU with increased PICU length of stay. We believe this to be secondary to lack of an established protocol for this pathway. Background: Our single 12 bedded male PICU in the trust has seen increased demands on its beds for prisoners requiring admission to mental health services. While PICU beds can meet the low secure requirements for prison transfers, they cannot function as forensic low secure beds due to their role within Acute services. With the increased number of referrals and the lack of a clearly defined pathway for these prison transfers, there was a risk of erosion of PICU philosophy aiming for discharge at the point when intensive care was not required, i.e increased length of stay.MethodsData were collected for all referrals from prison services to the male PICU between June 2020 and October 2021, recording the demographics, clinical information and timeframes for assessment. For those admitted to the PICU, percentage meeting the PICU criteria, admission-discharge pathways, serious untoward incidents and delays in transfer were recorded.ResultsThere were 22 referrals from prisons, of which 11 (50%) were admitted to the male PICU. The referrals came from multiple sources with poor coordination between the PICU, forensic and prison services with delays in assessment. 100% of the admissions met criteria for PICU. There were 2 serious incidents related to security levels of the environment. The pathway out of PICU included prison, forensic services and acute wards. Over half the patients were downgraded to non-restricted detentions and stepped down to acute beds. There was a delay in transferring out of PICU in 36% of the patients leading to increased length of stay.ConclusionIn conclusion, the data support our initial concerns that there is a need for a protocol guiding the transfer of prisoners to our PICU for treatment. This has led to discussions to develop such a protocol with close collaboration between prisons, forensic services and PICU. We hope this will lead to a much smoother process from having a single point of referral, timely assessments and decisions making, better defined exit pathways with less delays in transfer from PICU.
A Qualitative Evaluation of the Quality of Assessments for the Psychological Medicine in Primary Care Service: A Patient Perspective
Authors: Patel Zahra , Shaw Fiona , Aliu Oluwatoyin , Moffat Claire , Alachkar Mustafa 
Published: July 2023

Aims. Background: Psychological Medicine in Primary Care, Stockport works with people with persistent physical symptoms and personality difficulties whose psychological needs cannot be met by existing services due to complexity. The service views the assessment process as a therapeutic intervention in its own right and utilises a relational, formulation-based approach over 2 to 5 sessions. A letter including this formulation is sent following assessment to both the patient and their GP.Aims:
1.To evaluate the quality of the assessments from a patient perspective.2.To improve the quality of the assessments in order to improve patient care and the support offered to patients.MethodsA short questionnaire with open questions was created. Thirty-two patients assessed by the service took part in semi-structured interviews by means of a short telephone discussion after consent was taken. Three independent investigators reviewed their responses and performed thematic analysis, using an inductive and recursive approach.ResultsTheme 1: The understanding of the service and awareness of the referral affects the perception of the assessment.Theme 2: There can be therapeutic gain in the assessment process, which appears to be mediated by the relationship with the assessors including:
•Emotional catharsis•Having a wider perspective of personal issues•Developing new coping mechanisms•Regaining a sense of agency•Gaining a sense of hope•Developing a better understanding of emotions•Having a different experience to past encounters with mental health servicesTheme 3: The relationship with the assessor plays an important role in the experience of the assessment process, and is mediated by skills of the assessor, including:
•Active listening•A sense of thoroghness; not feeling rushed•Sensitive use of verbal and non-verbal communication•An empathic, non-judgmental approach•A warm, professional approach•Open, clear, collaborative communication•A consistent approach•Validation•Psychological containmentPatient perception of the degree of attunement in these areas appears to lend itself to a sense of psychological trust and safety in the process.Theme 4: The outcome of the assessment can lead to various emotional responses which can play a role in how people perceive the assessment processTheme 5: The assessment letter is considered an important part of the assessment by many, but not all, participantsConclusionPsychiatric assessment can be a therapeutic intervention in its own right and a collaborative, relational approach can help to facilitate this.
A Comparison of the Number of Referrals for Psychiatric Assessment and Prescribing Rates of Psychotropic Medication in the Year Leading Up to the COVID-19 Pandemic and the First Year of the Pandemic in a Child and Adolescent Mental Health Service (CAMHS) in South Edinburgh
Authors: Voy Steven , Robinson Clare , Blue Sarah 
Published: July 2023

AimsTo establish if there were any significant changes in the number of referrals for psychiatric assessment or prescribing rates of psychotropic medication in the South Edinburgh tier 3 CAMHS team during the first year of the COVID-19 pandemic compared to the previous year. To explore factors that might be responsible for these changes.MethodsReferrals to the Psychiatric Assessment Clinic were analysed between the periods of 23rd March 2019 and 22nd March 2020 and 23rd March 2020 to 22nd March 2021. Using the unique numeric patient identifier, data from these referrals was gathered retrospectively by looking at clinical documentation on the healthcare information system used across NHS Lothian. Data were gathered for 243 patients.Data were collected on psychiatric diagnosis and, if medication was prescribed, what class of medication this was. Information on potential confounding factors was also gathered including sex, age, co-morbid psychiatric diagnoses, history of self-harming behaviours and suicide attempts, family set-up, schooling and other support services involved. Information was stored anonymously.Data were coded. Statistical analysis was undertaken using SPSS (statistical package for the social sciences).ResultsReferrals for psychiatric assessment almost doubled from 83 pre-pandemic to 160 during the first year of the pandemic. Referral rates for most psychiatric disorders increased. The proportion of patients prescribed psychotropic medication increased significantly during the first year of the COVID-19 pandemic compared to the year preceding (P=0.031).Analysis of possible confounding factors was completed. Anti-depressant prescribing rates for those from non-nuclear families increased significantly in the year during the pandemic (P=0.012). Other differences were observed but these were not statistically significant. The numbers of patients who self-harmed, attempted suicide or carried out both increased from 42 to 79.ConclusionFindings add to the existing body of literature highlighting an increase in referrals to mental health services and prescribing of psychotropic medications in the first year of the pandemic in comparison to those pre-pandemic. No clear conclusions could be drawn about factors responsible for change. Continuing to monitor referrals and confounding factors over time would be useful from a public health perspective. It would allow trends to be drawn so that planning can be carried out for future pandemics.
Audit of Clinic Letters Sent to GP Following CAMHS Outpatient Clinic Appointments at Black Country Partnership NHS Foundation Trust
Authors: Afinni-Adewunmi Nofisat , Eneka-Akhator Nwaife , Manuwa Olufikunayo 
Published: July 2023

AimsThe aim was to evaluate the quality of clinic letters sent to GP following outpatient appointments by CAMHS Consultants. The audit was based on the guidance of the Royal College of psychiatrist on writing clinic letters .MethodsInitial Audit was a retrospective audit of 40 randomly selected clinic letters sent to the GP following outpatient appointments in the previous 1 year between June 2021 and Janauary 2022. The Re-AUDIT was with 60 clinic letters sent to the GP following outpatient appointments between June 2022 and December 2022.Information was then collected about whether the following were included in the letters;inclusion of diagnosis with ICD code, current medication, indications for medications, allergies, physical measurements, mental state examination, risk assessment, care plan and useful links where relevant.ResultsOverall changes were seen in quality of the GP letter in some specific areas, while some areas showed a decline or no significant changesIn including ICD 10 diagnosis to the GP letters, 100% of letters as compared to 80% in initial auditIndications for medications were discussed/noted in 56.6% of letters when compared to 32.5% initial audit. Physical measurements were also well documented in 80% of letters. This increased from the previous 55%. Mental state examination and risk assessment also increased from 88.3% from 60%, and 86.6% from 70% respectively.There was a drop in figures in including Current medication in letters.(100% to 90%) and also in copying patients /carers into letters(from 100% in previous audit to 86.6% in re-audit)Little of no changes were seen in the quality of letters when observing useful links and allergies. The numbers were very low: allergy status infact dropped from 27.5% to 3.3%. Including useful links and resources in the GP letters only showed a growth from 7.5% to 13.3%.Conclusion•Significance of allergy status and continuous reminder that allergy can start at any age in any service user. Drug interaction also important•Clearly stating all treatment including pharmacotherapy and psychological therapies•Continuous emphasis of indications for medications and psychoeducation including about commencing, stopping medications and side effects•QI project to bring together all useful links and make accessible to clinicians and patients
Completing the Cycle: Re-Audit of Rotherham Specific Inpatient Physical Health Management and Documentation Following a 2021 Trust-Wide Audit
Authors: Bell Lydia , Jenkinson Joe , Allan Lewis 
Published: July 2023

AimsRotherham Doncaster and South Humber (RDaSH) NHS Trust completed a Trust-wide audit in August 2021 to look at aspects of physical health management in their inpatient units. Good results were achieved in relation to new admissions having completed initial medical examination within 24 hours and consideration being given as to whether the patient had the capacity to make the decision to agree or refuse such an examination. However, inadequate results were achieved in relation to anything more than an examination of appearance, pulse or blood pressure being conducted with a chaperone, and the patient being given the opportunity to state their preferences in relation to the sex of the chaperone. This audit completed the audit cycle by re-auditing the above criteria in Rotherham inpatient units in order to assess ongoing progress against targets following recommendations.MethodsA dip sample of five patients per ward (two Acute Adult, one Rehabilitation, one PICU and two Older Adult wards) was used. Patients who were admitted between 1st July and 30th September 2022 were picked randomly and their electronic records were studied.ResultsNearly 90% of patients received a physical examination by a doctor within 24 hours of admission. But, whilst these patients undertook an examination that was more than just general observation, blood pressure or pulse, in only 14% of these was it documented that they had a chaperone present. In addition, not a single person was offered the choice to choose the gender of their chaperone.Just one third of patients had their capacity to agree or decline examination documented. Perhaps unsurprisingly, the Older Adult wards performed better against this criteria.ConclusionRotherham inpatient wards continue to perform well in terms of conducting timely initial physical health examinations. However, we identified there is a clear lack of documentation around documenting whether someone has capacity to consent to their physical examination or not and what gender someone would prefer to chaperone them. Unfortunately, this is a continuing issue.We have identified an opportunity at the RDaSH Junior Doctor's induction, where the clerking is explained, to intervene and educate around what the Trust expects as standard.We plan to implement this change and re-audit the above criteria again to see if we can make an improvement.
Physical Health Monitoring of Patients on Antipsychotic Medication at a Medium Secure Unit
Authors: Deol Harlene , Gibbon Simon , Fullerton Christine , Wokekoro Oronne 
Published: July 2023

AimsPeople who have a serious mental illness have a higher prevalence of physical health problems as compared to the general population; with a 2–3 times greater risk of cardiovascular morbidity and mortality, double the risk of obesity and diabetes, three times the risk of hypertension and metabolic syndrome and five times the risk of dyslipidaemia than the general population. There is a concern that some antipsychotic drugs have metabolic consequences that contribute to the risk. As such, it is imperative that patients treated with antipsychotics receive appropriate health monitoring. Physical health monitoring of antipsychotic medications is an essential aspect of our practice, and despite assurance in previous audits, we agreed to monitor biannually to ensure we were maintaining standards. Additionally, this audit aimed to look more closely at special monitoring requirements for drugs such as Olanzapine, Chlorpromazine, Clozapine and Quetiapine which had not been measured in previous audits and would likely highlight some areas for improvement.MethodsAudit standards were drawn from the Maudsley Prescribing Guidelines in Psychiatry 14th edition, in addition to NICE Guidance CG178 - Psychosis and schizophrenia in adults: prevention and management.A random number generator was used to select patients from each of the 7 wards, giving a sample size of 21 patients. Data were collected on Weight, BP, ECG and various blood tests conducted from February 2021 – February 2022. Data was collected from a combination of patient electronic record, CPA reports, and online blood results system. Data were inputted to MS Excel which created percentage compliance in each domain.Results1.Blood Pressure: General compliance in the taking of BP met our standard of 100%2.Weight: Annual monitoring compliance was 93% however compliance fell short for special recommendations for Clozapine, Olanzapine and Chlorpromazine.3.ECG: Our compliance fell short in the recording of an ECG on admission, or at reaching target medication dose. Annual monitoring compliance was 93%.4.Bloods: Annual compliance for FBC, LFT, U&Es, Lipids, Prolactin and5.Glucose were 100%, however our compliance fell short for baseline recording and interim 3-6 monthly monitoring for various blood tests.ConclusionOverall results demonstrate good, safe practice, particularly during a challenging period for clinical teams. Shortfalls particularly at baseline were related to risk issues making investigations impractical. It was agreed that there should be an increased frequency of regular glucose monitoring and that HbA1c monitoring was a reasonable measure for this.
An Audit of Clinicians Completing Independent Seclusion Reviews (Trust-Wide Audit Within Cumbria, Northumberland, Tyne and Wear, NHS Foundation Trust)
Authors: Edwards Nicole , Fearnley Edward 
Published: July 2023

AimsThe Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) seclusion policy states that if a patient has been nursed in seclusion for 8 consecutive hours (or 12 hours intermittently over a 48 hour period), then an independent seclusion review (ISR) is mandated. One member of this ISR team must include an Approved Clinician (AC). Our aim was to establish whether an AC (including non-medical) was present at ISRs. If the doctor was not an AC, we established whether a discussion with an AC was documented.MethodsThe method included reviewing all episodes of seclusion that took place in CNTW between the 01.10.2021 and the 31.12.2021 (i.e. Q4 for 2021). All electronic (RiO) seclusion records and progress notes were examined to determine who was present at each ISR occurring within each episode of seclusion.Results260 episodes of seclusion occurred in Q4 2021 within CNTW. 96 episodes continued long enough to trigger an ISR.Of the 96 episodes, a total of 221 ISRs were examined.Of those senior clinicians present at ISR, 83% were medical members of staff, 11% were non-medical ACs and 6% were neither.Of the medical clinicians present at ISR, 68% were not AC grade.Of the different grades of non-AC doctors present at ISRs, 72% were "SHO grade".The overall breakdown of non AC medical staff included 6% F2 Doctors, 16% Higher Trainees, 19% Speciality Doctors, 4% Associate Specialists, 5% were International Fellows and 1% Senior Trust Fellows.29% of ISRs occurred outside of normal working hours.71% occurred 9:00-17:00 Monday to Friday (excluding Bank Holidays).0% of non-AC medical ISRs had a documented discussion with the AC.ConclusionNearly a third of IRSs occurred outside of standard (contracted) working hours for doctors.In addition, the majority of ISRs were completed by non AC doctors. The majority of these doctors were "SHO" level Doctors (including Core Trainees, GP Trainees and Foundation Trainees).The audit was presented at the CNTW Seclusion Steering Group, with actions including a change to the seclusion policy. This now explicitly states that ISRs must be conducted by an AC “unless in the case of extreme circumstances, and in such cases the review should be discussed with an AC”.There are additional plans to develop consistent approaches for organising ISRs (to ensure the vast majority happen within normal working hours and with an AC present).