bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Health in Mentally Ill Patients Attending the Outpatient Clinic of Taha Baasher Psychiatric Hospital, Khartoum
Authors: Serebel Areej , Mussab Ahmed 
Published: July 2023

AimsMental illness has been very common lately and the mentally ill are a special population with their own particular set of needs and challenges. In general physical health of the mentally ill is poorer than that of the general population and oral health is especially neglected hence the desire to quantify this.MethodsThis study was a cross-sectional hospital based study conducted in the outpatient clinic of Taha Basher Psychiatric teaching hospital. The sample (90) was selected randomly from among the adult patient attendants who agreed to participate in the study.ResultsThe mean DMF was 4.91 +/-4.46 . It was positively correlated to age and duration of illness. It was higher in females and the greatest proportion was due to missing teeth and the smallest proportion was the filled teeth. There were no dentures used by any of the patients.ConclusionThose involved in the study reflect the poor level of oral health among the mentally ill population and this deficiency is unfortunately not receiving enough attention of care givers or mental health professionals. The dental community ought to establish a professional referral system with such facilities to facilitate patient care.
Experience of Differential Attainment in Psychiatry Trainees at Surrey and Borders Partnership NHS Foundation Trust (SABP)
Authors: Shaheed Sidra , Mudunkotuwe Jeremy , Jenkinson Josie 
Published: July 2023

AimsDifferential attainment is a term used to describe variation in the achievement of groups of doctors based on certain characteristics. Evidence suggests that international medical graduates (IMGs) in the UK struggle at different stages of training in many specialties including psychiatry. This project aims to explore the experience of psychiatry trainee doctors and their trainers at SABP to understand this issue and identify areas for quality improvement.MethodsThis was an exploratory study using a mixed methods approach. Qualitative data were collected via semi-structured interviews and focus groups conducted with trainees and trainers. Interviews and focus groups were recorded and transcribed, then analysed for themes. Quantitative data were collected via an online survey sent to trainees and trainers and were analysed using descriptive statistics. Informed consent was obtained from all participants. This project received approval from the Health Education England research governance committee and was conducted in accordance with British Educational Research Association (BERA) guidelines.ResultsThe online survey had a good response rate of 60.4% for trainees (26 out of total 43 trainees) and 64.7% for trainers (22 out of total 34 trainers). Challenges identified by the participants both in qualitative and quantitative data mirrored the national picture. Five main themes that were identified from semi-structured interviews and focus groups were: 1) the impact of professional and informal support, 2) challenges faced by IMGs in adjusting to the new system, 3) communication barriers, 4) Stress and burnout impacting trainees’ performance and 5) unconscious bias during recruitment, exams, and ARCP on the training experience of IMGs.ConclusionThis project was used to generate ideas for quality improvement with regard to the experience of trainees and the reduction of differential attainment within the trust. Findings from this research have guided SABP in the development of interventions to support IMGs and trainers, particularly regarding professional and non-professional support. These interventions include an induction booklet for doctors joining the trust, an IMG support network, and a mentorship scheme for all the trainees. We aim to explore the experience of IMGs trainees and trainers using a similar method in the future to evaluate the success of these interventions. Our findings will have an impact on other organisations providing postgraduate training in psychiatry and other specialties.
The Effect of Clozapine on Violence / Aggression in Adults With Mental Illness and Personality Disorders: A Systematic Literature Review
Authors: Shaheen Manar 
Published: July 2023

AimsViolence is not uncommonly seen in patients with mental illness and personality disorders. Various medications have been used to control aggression including antipsychotic medications. Clozapine has proven effectiveness in the treatment of resistant schizophrenia. Recently studies tried to explore its effectiveness as anti-aggression medication. The aim of the review is to explore the efficacy of Clozapine in controlling violence in adults with mental illness and personality disorders.Methodscomprehensive psychiatric literature review was conducted. Screening of the relevant articles in the national and international databases covering the period between 1973 and 2012. Multiple data sources searched. The author used the Cochrane Library, Ovid on line and NHS Evidence journals and databases to access health care databases advanced search to find articles on EMBASE, MEDLINE, AMED , CINAHL ,PsycINFO, Health Business Elite and HMIC. The studies narrowed down following a flowchart, based on the PRISMA statement. Studies including patients with brain injury, moderated/ severe learning disabilities were excluded. Quality assessment of literature completed.Results52 robust studies were retrieved showing consistent evidence to support the use of Clozapine as anti-aggressive medications in patients with schizophrenia and schizoaffective disorders. Studies has shown that a dose of 500 mg daily has a superior effect on controlling aggression, A serum Clozapine level of 0.35 mcg/l can exert anti aggression effect. Some studies noted that its anti-aggression effect could be observed from 5 weeks onwards after treatment is initiated.The evidence supporting its use in individual with personality disorders has been little. Neither randomized controlled trial nor prospective case controlled trials were conducted to support its anti-aggressive effect in this group. However, few studies reported some reduction in the aggressive behaviour when small dose of 100 mg daily was used in patients with emotionally unstable personality disorder.ConclusionThere is sufficient evidence to support the use of Clozapine in controlling aggression and violence in patients with schizophrenia and schizoaffective disorders. Its use in personality disorders needs further exploration and support by robust studies. Studies has found anxiety disorders very common in borderline personality disorders, 88% of personality disorder patients involved in a study had co morbid Anxiety disorder. It is possible that the sedative effect of clozapine; may have lowered anxiety levels and subsequently contributed to the reduction in impulsivity and aggression.
Exploration Heuristics During Anxiety – an Online Study
Authors: Tertikas Georgios , Dubois Magda , Hauser Tobias U. , Campbell-Meiklejohn Daniel K. , Critchley Hugo D. 
Published: July 2023

AimsEvery day, we may choose something new randomly (random exploration) or select something new with no prior information (de-novo exploration). The link between exploration and anxiety has only been studied using trait-like anxiety questionnaires, but an experimental manipulation of anxiety could have different results. Individual differences (e.g., sex or novelty-seeking (NS) trait) also impact specific exploration strategies. Thus, we examined if anxiety manipulation in a task would influence different exploration strategies while also looking at sex, NS bias and trait anxiety.Methods117 healthy subjects (58 female) completed online questionnaires (novelty-seeking dimension of the Cloninger's Tridimentional Personality Questionnaire (TPQ-NS), trait anxiety questionnaire (STAI)) and performed the Maggie's farm task. This task allows to review different exploration strategies, promoting exploration via the number of available choices (horizon). The threat of aversive stimuli (loud noises appearing at random times) was used to emulate anxiety, in a between-subject design. Comparing computational models of exploration, the best-fitting model (evaluated by Bayesian Information Criterion) in our data was a Thompson model with an ε-greedy element (random exploration) and a novelty bonus η (de-novo exploration). We used repeated-measures ANOVA, comparing the effect of horizon on the ε and η parameters with the anxiety category as a between-subject factor. We used partial Pearson's correlations of ε and η derivatives (mean and standardised-difference (SD) across horizon) with STAI and TPQ-NS measures correcting for participant's reported stress levels and anxiety category. Partial correlations analyses were repeated after splitting the data by sex.ResultsThere was no between-subject effect of anxiety category on the horizon of either ε (F(1,1) = 0.253, p = 0.6) or η (F(1,1) = 0.305, p = 0.58). SD of ε was negatively correlated with TPQ-NS (r = −0.184, p = 0.050) but no other partial correlation was significant. When splitting by sex, SD of ε was negatively correlated with the STAI score (r = −0.341, p = 0.01) in females and the TPQ-NS score in males (r = −0.275, p = 0.038). The mean η positively correlated with the STAI score (r = 0.318, p = 0.016) in males.ConclusionWhile the experimentally modulated anxiety did not affect the exploration parameters, individual differences in NS and trait anxiety are suggested to affect random and de-novo exploration in a sex-dependent manner. Imaging research, or research into anxiety population could help further solidify these results in the future.
Patterns of Insomnia and Its Treatment in North Central London: Using Primary Care Data to Establish Unmet Needs and Health Inequalities
Authors: Waterman Lauren , Harrison Fleur , Osuagwu Uche , Dougan Sarah 
Published: July 2023

AimsThere is robust research evidence that insomnia is highly prevalent in the general population, with a significant adverse impact on physical and mental health and quality of life. There is also strong evidence of the cost-effectiveness of cognitive-behavioural therapy for insomnia (CBT-I), the first-line treatment for insomnia recommended by the UK's National Institute for Health and Care Excellence. However, data from primary care records has not been used in the UK to establish real-world impact, including local prevalence, treatment rates and inequalities. This study's aim was to establish these in North London.MethodsPseudonymised data were extracted from primary care records across three North London boroughs for 765,035 patients (aged 15+ years). Insomnia prevalence was determined by identifying patients with a code for insomnia in previous five years, sleeping tablet prescription in previous three months, or code for insomnia treatment. Data were aggregated upon extraction and analysed using descriptive statistics.ResultsInsomnia prevalence was 4.3%. Prevalence increased steadily with age, being highest in those aged 85–90 years (10.8%). There was significant variation by ethnic group and deprivation quintile, with highest prevalence in the most deprived quintile (5.2%) and those of Bangladeshi ethnicity (7.3%). Variation in insomnia prevalence, diagnosis and treatment occurred between GP practices. Prevalence was significantly higher in patients with comorbidities, including those with chronic obstructive pulmonary disease (17.5%), diabetes mellitus (11.8%), severe mental illness (16.6%), and depression (14.1%). 0.3% of people with an insomnia code had been referred for CBT-I.ConclusionInsomnia was found to be as common as other illnesses that receive high levels of focus and resourcing in the UK. Prevalence estimates were likely underestimates since patients were only counted as having insomnia if this could be identified from coded data or prescription information. Significant variation in prevalence and treatment rates by factors such as ethnicity and deprivation quintile may represent health inequalities. Additionally, insomnia was particularly common among patients with certain comorbid illnesses and of advancing age, meaning that those groups should be actively screened for insomnia. Concerningly, referral rates for CBT-I were extremely low. It is vital that clinicians receive training in diagnosing insomnia and local treatment pathways, and that culturally appropriate services are commissioned to address this unmet need and ensure equitable access. Although this study included data from only one locality, it is consistent with international research findings. Therefore, prevalence and unmet need is likely to be high in many other areas and should be investigated locally.
Esketamine Nasal Spray Improves Rate and Time to Remission Versus Quetiapine Extended Release in Subgroups of Patients With Treatment Resistant Depression and Two or Three Plus Prior Treatment Failures: Results From ESCAPE-TRD, a Randomised Phase IIIb Trial
Authors: Young A.H. , Cubała W.J. , Nielsen R.E. , Popova A. , Ito T. , Mulhern-Haughey S. , Pirotte N. , Rive B. , Thilakarathne P. , Usankova I. , Godinov Y. 
Published: July 2023

AimsFor patients with depression, the likelihood of remission decreases with each subsequent treatment failure. Per European Medicines Agency guidance, treatment resistant depression (TRD) is defined as nonresponse to ≥2 consecutive treatments at adequate dosage and duration in the current depressive episode. In ESCAPE-TRD (NCT04338321), esketamine nasal spray (NS) increased the probability of achieving remission and remaining relapsefree, compared with quetiapine extended release (QXR) in patients with TRD. Here, we report the efficacy of esketamine NS vs QXR in patient subgroups with 2 or ≥3 consecutive prior treatment failures (PTFs).MethodsESCAPETRD was a phase IIIb trial comparing the efficacy of esketamine NS with QXR in patients with TRD. Patients (N = 676) were randomised 1:1 to esketamine NS (n = 336; 56/84 mg; twice weekly, weekly, or every 2 weeks [wks]) or QXR (n = 340; 150–300 mg daily, both in combination with an ongoing selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor. Randomisation was stratified by age (18-64 years; 65–74 years) and PTFs (2; ≥3).The primary endpoint of remission (Montgomery-Åsberg Depression Rating Scale total score ≤10) at Wk8 and the secondary endpoint of remaining relapse-free through Wk32 after remission at Wk8, were analysed in PTF patient subgroups and compared between study arms, with treatment discontinuation considered as a negative outcome. The effect on time to remission was assessed using hazard ratios (HR) from a Cox regression model.ResultsOf the randomised patients, 415 (61.4%; esketamine NS: 204, QXR: 211) had experienced 2 PTFs and 261 (38.6%; esketamine NS: 132, QXR: 129) had experienced ≥3.Of patients with 2 PTFs, 54/204 (26.5%) esketamine NS-treated patients and 46/211 (21.8%) Q-XR-treated patients achieved remission at Wk8 (p = 0.267). Of patients with ≥3 PTFs, 37/132 (28.0%) and 14/129 (10.9%) patients achieved remission at Wk8 in esketamine NS and Q-XR arms, respectively (p < 0.001). Of patients with 2 and ≥3 PTFs, 49/204 (24.0%) and 24/132 (18.2%) of esketamine NS-treated patients and 38/211 (18.0%) and 10/129 (7.8%) of Q-XR-treated patients achieved remission at Wk8 without relapse to Wk32 (p = 0.133 and p = 0.013), respectively.Esketamine NS significantly improved time to remission, with a greater effect in the ≥3 PTF subgroup (2 PTFs: HR = 1.547 [95% confidence interval (CI) 1.210–1.976]; p < 0.001 vs ≥3 PTFs: HR = 2.066 [95% CI 1.469–2.907]; p < 0.001).ConclusionEsketamine NS demonstrated a significantly superior remission rate versus QXR at Wk8 in patients with ≥3 PTFs, and significantly shorter time to remission versus Q-XR in both subgroups.
Review of Consent to Treatment Documentation in University Hospital Wishaw Inpatient Psychiatry
Authors: Ansari Saba , Reid Kyle , Ahmad Fayyaz 
Published: July 2023

AimsTo establish if the Mental Health Act Code of Practice was being followed in the mental health inpatient ward population in Wishaw General Hospital. Specifically, those who were subject to detention with a Compulsory Treatment Order (CTO) under the Mental Health Act and whether or not documentation of consent to treatment was being kept.MethodsOver the course of one week beginning on 1st December 2022, we reviewed the inpatient population within acute psychiatric wards (Wards 1-3) at Wishaw General Hospital to determine the nature of patient admissions, informal or under detention, specifically Short Term Detention Certificate (STDC) or Compulsory Treatment Order(CTO). A total of 57 inpatient notes were evaluated, including those of 10 patients with STDC and 14 with CTO. From these 14 patients, we determined whether T2b(240) or T3b(240) forms were clearly documented in both paper and electronic records (MORSE).ResultsOne of the three patients on Ward 1 who were subject to CTO had both electronic and physical documentation of the T3B form. In the physical notes of two patients, the T2B or T3B form, as well as the reason and specific treatment, were adequately described.Seven of the eight patients subject to CTO in Ward 2 had adequate documentation of the cause and particular treatment, as well as clear documentation of the T2B or T3B form in their physical notes. None of these patient’' electronic notes contained any documentation. As the last patient was less than two months into CTO, they did not fit the criteria for the T2B or T3B consent forms.All three patients subject to CTO from Ward 3 had clear documentation of T3B forms in their physical notes, as well as appropriate documentation of their cause and treatment. There was no documentation on these patient’' electronic notes.ConclusionOverall, the clinical documentation was accurate with strict adherence to mental health act code of practice. 100% of patients requiring consent to treatment documentation either via T2B or T3B form were completed and available for review in the paper notes. Of note however, only 1 patient had CTO documentation and consent to treatment documentation available on electronic records (MORSE) which would allow remote viewing.We propose the practice to upload detention certificates and consent to treatment forms to Electronic data (MORSE within the “files” tab). This information will be shared with ward staff to encourage copy and filing of documentation within this section on MORSE (electronic records).
Evaluating a Pilot ‘Hearing Voices Group’ for People With Learning Disabilities
Authors: Bates Kirsty 
Published: July 2023

AimsAdults with learning disabilities have traditionally been excluded from psychosis research studies and intervention trials because of their learning disabilities. There is a distinct lack of knowledge about adults with learning disabilities and their lived experience of psychosis including specific symptoms such as voice hearing. Interventions such as Hearing Voices Groups (HVG) have been developed without thorough understanding of what these experiences mean for this population, I found one pilot study ran by South London and Maudsley (SLAM) in 2018 (1)
•Understand more about voice hearing experiences in people with a learning disability•Evaluate whether an adapted HVG is acceptable and affective in this patient group•To obtain feedback in order to improve the group for future practiceMethodsWe set up a hearing voices group for people under the Bristol Community Learning Disability Team (CLDT) who experience hearing voices which causes them distress. The sessions for the group were inspired by ideas from the book “People with Intellectual Disabilities Hear Voices too” published by Psychologist Dr John Cheetham, which we adapted into accessible session plans. The group consisted of 6 service users and was facilitated by me and 3 mental health nurses and ran for 8 weeks on a weekly basis for 1 hour 30 mins. Each participant worked through an accessible handout which we then collated at the end to create a take home workbook of all the material covered throughout the group, as well as individual feedback from the group facilitators.We used CORE-LD 30 and World Health Organisation Quality of Life (WHOQOL-8) tool pre-group and post-group which are both validated tools for use in people with a learning disability. We also conducted an adapted Maastricht's interview with each service user to understand more about their voice hearing experiences and a post group feedback questionnaire.ResultsAll participants had a reduction in their CORE-LD score with lower scores indicating fewer distressing symptoms and lower risk to self, with an average reduction in score of 39%. Themes of why they thought they heard voices included: bereavement, bad neighbours, doing something bad in the past. When asked what the voices say, they were mostly negative insults towards the service user or telling them to harm themselves. Feedback post group included: more sessions/more time, learnt ways of coping with voices, helped to speak about the voices, felt safe and less alone, enjoyed sharing experiences, understand voices.ConclusionThe NICE Guidelines 2017 Quality statement 4 states that we should be tailoring psychological interventions for people with learning disabilities. Previously there were specific interventions for people with a learning disability within the LD service. The evaluation of this group helps to support the effectiveness in adapting a well-established intervention and the value of offering this on a continued basis in the Bristol CLDT.
Use of an Information Pack to Improve Relative’', Friend’' and Carer’' Satisfaction With the Admission Process in an Older Adult Inpatient Service: A Quality Improvement Project
Authors: Baxter Luke , Zacharia Tharun 
Published: July 2023

AimsWe performed a Quality Improvement Project in an inpatient Old Age Adult ward to increase patients’ relatives, friends and carers’ (RFCs’) knowledge about important aspects of hospital admission, through the provision of an information pack. By increasing this knowledge, we aimed to improve RFC satisfaction surrounding the admission process. Previously published evidence has shown that increasing the perception of involvement of RFCs in a patient's admission promotes greater satisfaction within this group. Adequate information provision is regarded as an important part of promoting perceived involvement; conversely, a lack of information provision and communication has been associated with dissatisfaction with hospital admissions among RFCs.MethodsUsing a survey directed towards members (n=9) of the ward MDT, we identified several topics relating to hospital admission that were regarded as high priority for inclusion in an information pack. MDT members were also asked about their perception of RFC satisfaction in the admission process. RFCs (n=8) were asked how well-informed they felt about these topics with a separate survey, and their level of satisfaction with the admission process. An information pack was created based on the results of these surveys and distributed to RFCs. The RFC survey was then repeated to assess improvements in RFC knowledge and satisfaction.ResultsPerceived RFC satisfaction among staff members prior to the publication of the information pack was lower than actual RFC satisfaction. RFC satisfaction with and knowledge about the admission process increased following the distribution of the care pack.ConclusionAdmission information packs can be used on inpatient old age wards to improve patient family, friend and carer knowledge and satisfaction.